Leading an active, healthy lifestyle is something that we are all aware is very important for our general health.  It was very interested to read a study recently published in the British Journal of Sports Medicine (1) that found many young women, of menstruating age, refrain from taking part in recreational sports because of worry about having a weak bladder.  It was found that many women abandoned, or limited, their favourite sport due to urinary incontinence.

Most women are aware of the benefits of pelvic floor muscle exercises to help prevent urinary leakage but I wanted to investigate if there were any dietary/nutritional links to this distressing condition.  For more info on pelvic floor muscles and exercises please click the link to the following NHS website or downloadable leaflet.  Various types of pelvic floor toning systems are also available to buy, they may help to make pelvic floor exercises easier to perform effectively.

A weak bladder or urinary stress incontinence can disrupt life, lead to feelings of depression and stress as well as sleep deprivation.  Urinary stress incontinence is a term used to describe small urine leaks when the bladder is under pressure, such as from exercise, coughing, or laughing, and can also be used to describe more frequent urinary urges during the day or night.  Urinary frequency becomes more common with advancing age, with  nearly half of people over 60 reporting to suffer from nocturia, two or more episodes of urination during the night.  In women, stress incontinence is usually caused by a weakening of the bladder sphincter muscles and pelvic floor muscles so strengthening these can often help.

Drugs commonly used for urinary incontinence are usually not very effective and are associated with certain side-effects. Only a small proportion of the affected population of women seeks treatment because most people consider their urinary symptoms a consequence of normal aging.  However, there do seem to be a few remedies that may help.

Pumpkin seed extract:
Pumpkin seeds (Curcubita pepo) were traditionally used to treat urinary problems and in Germany pumpkin seed is often recommended for irritable bladder issues.  In the past available supplements contained both the oil and water-soluble parts of the seed.  More recently it has been shown, in test tube and laboratory studies, that it is the water soluble components of pumpkin seed that have a greater effect due to being more efficiently absorbed into the bloodstream (2,3,4)

Supplements are now available that use the extract 'EFLA® 940' a kind of pumpkin seed extract that is free from the normal fats and fatty acids present in the seeds.  This extract has been used in studies with women suffering from urinary problems, especially frequent urination and stress incontinence and positive results have been registered.  Studies in Japan suggest that incontinent episodes may be reduced by up to 79%,(5) daytime urination by up to 39%,(6) and nighttime urination by up to 68%.(7)

Magnesium:
The mineral magnesium is known to prevent muscle spasms.  Two small, preliminary studies (8,9) suggest that a magnesium supplement may be useful in reducing incontinence episodes.  Many women in the UK do not get enough magnesium in their daily diet and could well do with boosting their intakes.  Good dietary sources include nuts, seeds, whole grains and green leafy vegetables.  Most of the magnesium is lost when whole grains are refined to make white flour and processed foods.  If you do not regularly eat nuts and wholegrains you may wish to consider taking a magnesium supplement to provide around 200-300mg of elemental magnesium daily.

Other factors:
There is evidence(10) to suggest that overweight/obesity, smoking, and consumption of carbonated (fizzy) drinks are risk factors for over active bladder and associated urinary incontinence as is the consumption of caffeinated drinks (11).  Many women may try to cope with urinary incontinence by drinking less but this can lead to other health problems, headaches and urinary tract infections.  Drinking water, or herbal and uncaffeinated drinks, instead of caffeinated teas, coffees, cokes and fizzy drinks is advisable and may lead to some improvement in the condition.

(1) Salvatore S et al.  2008.  The impact of urinary stress incontinence in young and middle-age women practicing recreational sport activity: an epidemiological study.Br. J. Sports Med., Sep 2008; doi:10.1136/bjsm.2008.049072
(2)Willian Faloon.  November 2008.  A breakthrough in the relief of overactive bladder and urinary incontinence.  LE Magazine
(3) EFLA® Pumpkin Seed Special Extract: New in vitro studies on the efficacy and mode of action in incontinence disorders. Frutarom Switzerland Ltd.; 2006. 
(4) Hata K. Effects of pumpkin seed extract on urinary bladder function in anesthetized rats. Medical Science and Pharmaceutical Science. 2005;54(3): 339-45.
(5) Hitoshi S & Takashi T.  2001.  Clinical study of mixed processed food containing pumpkin seed extract and soybean germ extract on pollakiuria in elder women.  Japanese Journal of Medicine and Pharmaceutical Science. 
(6)Karlsson A & Lundeberg E.  A pilot study of Uretin 45+ in women with urge incontinence and/or a mixture of urge and stress incontinence.
(7)Yanagisawa E. Study of effectiveness of mixed processed food containing Cucurbita pepo seed extract and soybean seed extract on stress urinary incontinence in women. Jpn J Med Pharm Sci. 2003; 14(3):313-22.
(8)Gordon D et al.  1998.  Double-blind, placebo controlled study of magnesium hydroxide for treatment of sensory urgency and detrusor instability: preliminary results.  Br J Obstet Gynaecol.  105:667-669
(9)Boschert S.  2003.  Milk of magnesia may help ease urinary urge incontinence.  Family Practice News.  33:46
(10)Milne JL.  2008.  Behavioral therapies for overactive bladder: making sense of the evidence.J Wound Ostomy Continence Nurs. 2008 Jan-Feb;35(1):93-101;
(11)Arya LA et al.  2000.  Dietary caffeine intake and the risk for detrusor instability: a case-control study. Obstet Gynecol. 96(1):85-9.

Written by Ani Kowal

World Osteoporosis Day occurs on Monday October 20th and the National Osteoporosis Society (NOS) is running a UK-wide campaign ‘Love Your Bones’ which is intended to raise awareness about the importance of healthy bones.  The goal of the National Osteoporosis Society is to improve understanding of osteoporosis, what causes it and to promote the steps people can take to keep their bones healthy and reduce their risk.

“Osteoporosis literally means ‘porous bones’. Our bones are made up of a thick outer shell and a strong inner mesh which looks like a honeycomb made up of tiny struts of bone. Osteoporosis means some of these struts become thin or break, making bones more fragile and prone to fracture. It often remains undetected until a bone is first broken, which commonly occurs in the wrists, hips and spinal bones. It is these broken bones or fractures which can lead to the pain associated with osteoporosis. Spinal fractures can also cause loss of height and curvature of the spine.”(1)

Please visit the NOS for loads more information on bone health.  They have many online and downloadable resources, including a booklet ‘Healthy Eating For Strong Bones’ and a page dedicated to the ‘Sunlight Campaign’ which highlights the fact that sunlight is one of the very best natural sources of vitamin D, a vitamin that is essential for the building of healthy bones and the prevention of osteoporosis.  The NOS point out that up to 15 % of people in the UK are estimated to have low levels of vitamin D, while 80% have levels which are considered unhealthy.  There have now been many calls for a revised vitamin D intake recommendation in the UK(2) due to extensive evidence of low levels. The NOS website provides simple tips for boosting your vitamin D levels.

Calcium and Vitamin D
A recent review paper(2) looked at the evidence surrounding the importance of calcium and vitamin D for bone health and the prevention and treatment of osteoporosis.  The paper points out that an estimated one in three women and one in twelve men aged over 55 years will suffer from osteoporosis in their lifetime.  This represents a huge cost in the UK (many millions of pounds per year).  Calcium supplements appear to be effective in reducing bone loss in women in late post menopause (after five years), particularly in those with a low daily calcium intake (less than 400 mg/d).  Supplementation with vitamin D and calcium has also been shown to reduce fracture rates in some elderly populations. Low vitamin D status is associated with an increased risk of falling and a variety of other health outcomes and is an area that requires urgent attention.

It is very important to consider bone health at an early age, this is because peak bone mass (peak bone strength) is reached before the age of 30, after this age bone gradually grows weaker.  Building up great bone strength early on in life will help reduce the risk of osteoporosis later in life.  Most studies show that calcium, supplemental or high dietary intake, is important in at a young age in order to reach a good peak bone mass (3), 600mg-1,000mg calcium daily before the age of 25 may be beneficial to reaching a good bone mass.  As mentioned above evidence regarding supplementation later in life is mixed.  However, a supplement containing vitamin D and calcium could be useful in maintaining bone mass (providing around 800mg calcium daily and 20mcg/800IU vitamin D).

Other nutrients
The role of other nutrients on bone remains to be fully defined(2), although there are promising data in the literature for links between various nutrients including: magnesium, zinc, copper, potassium, silicon, manganese, vitamin K, vitamin C, vitamin B and phytonutrients (biochemical plant compounds).  A varied, healthy diet, especially on rich in fruits and vegetables, will provide a huge array of nutrients that may positively impact bone health.  If you feel your diet is lacking you may wish to consider a high quality food-state multi-vitamin and mineral supplement.  This is NOT a substitute for good dietary habits!! 

Omega 3 fatty acids
Yes, it is the fish oils making an appearance again!  Eating a diet rich in the omega 3 fatty acids EPA and DHA, found in oily fish such as mackerel, salmon and sardines, may contribute to a reduced risk of osteoporosis by inhibiting the production of pro-inflammatory chemicals (eicosanoids) that are known to be involved in the process of bone loss.  This is a relatively new field of interest in osteoporosis.  Two recent reviews (4,5) looked at the evidence so far which does indicate a benefit, though the authors point out that further evidence is needed before firm conclusions can be drawn.  However, due to the numerous health benefits of omega 3 fatty acids (see previous blog posts) I would suggest the regular inclusion of oily fish in the diet (at least twice weekly), or taking a supplement providing around 250mg EPA and 250mg DHA a day.  For vegetarians I would suggest a daily flaxseed oil supplement to provide around 500mg alpha-linolenic acid (a shorter chain omega 3 fatty acid).

Fruits and Vegetables
A number of studies over the last decade have suggested a clear, positive link between fruit and vegetable consumption and bone health(6).  These foods provide a huge range of nutrients that are important for bone health.  In addition to the nutrients fruit and vegetables positively affect the pH balance (a measure of acid-alkali balance) in the body, by increasing the alkalinity in the body (making the body less acidic), which plays a major role in the prevention of calcium loss from bones.  Foods which are acid forming in the body include foods such as most meat and animal protein, cheddar cheese and many grain products e.g. white bread, pasta, cornflakes.  If the body is too acidic, not in pH balance, then bones can release their calcium (which increases alkalinity) into the blood to try and maintain the balance.  Obviously calcium loss is not what we want!!  Providing the body with abundant supplies of vegetables and fruits may well help to keep our bones strong as well as protecting us from many other diseases.

If you drink a lot of caffeinated tea, coffee or regularly consume fizzy drinks you may wish to reduce the amount you consume in order to protect your bones.  High intakes of these drinks can have a negative effect on bones.  The phosphoric acid they contain may cause calcium loss from bones.

Visit the National Osteoporosis Society website for more information

(1)The National Osteoporosis Society
(2) New-Lanham SA.  2008.  Importance of calcium, vitamin D and vitamin K for osteoporosis prevention and treatment.  Proc Nutr Soc.  67(2):163-76.
(3) Eastell R & Lambert H.  2002.  Strategies for skeletal health in the elderly.  Proc Nutr Soc.  61:173-180
(4)Salari P et al.  2008.  A systematic review of the impact of the impact of n-3 fatty acids in bone health and osteoporosis.  Med Sci Monit.  14:RA37-44
(5)Fernandes G et al.  2008.  Effects of n-3 fatty acids on autoimmunity and osteoporosis.  Front Biosci.  13:4015-4020
(6) New SA.  2003.  Intake of fruit and vegetables:implications for bone health.  Proc Nutr Soc.  62:889-899

Written by Ani Kowal

Period pain (menstrual pain or dysmenorrhoea) is thought to affect around 75% of women at some time in their lives with around 15% having pain sever enough for it to disrupt their normal daily lives.  Doctors have categorised women who suffer with period pain into two groups, primary and secondary. 

Primary – period pain which has no identifiable cause.

Secondary – period pain with an identifiable cause such as endometriosis, fibroids and pelvic inflammatory disease. 

In this post I am going to concentrate on primary dysmenorrhoea (to give it the full name).