Many people are currently heading back to work after an extended Christmas and New Year break.  It can be tough to get back into the swing of things after having time off and often people feel lacking in energy.  There are a few natural ways that can be useful to help provide a mood boost and prevent feelings of lethargy.

Back in September I wrote about the link between anxioxidant nutrients and symptoms such as stress, anxiety and fatigue.  It is important to keep your dietary antioxidant levels high, this will boost your immune system but may also help to combat fatigue.  The best way of providing the body with ample antioxidants is to eat a variety of colourful vegetables and fruits daily.  Get a minimum of 5 portions a day.  A good way to make sure you are always supplied is to take easy to eat fruits and vegetable stick to work with you.  Keep them at your desk and snack away guilt-free.  Blueberries, any berries in fact, are packed with antioxidants and also very tasty.  Clementines are easy to peel and readily available at the moment and most supermarkets stock carrot and celery sticks if you don’t have time to prepare your own in the morning.  You can dip these into a tomato-based salsa for an extra antioxidant hit. Any fruits and vegetables will work to boost antioxidant levels in the body – remember to eat a variety to provide an array of different antioxidants to the body.  Antioxidant supplements made from natural berries and herbs are now also available to buy but should not be viewed or used as an alternative to a healthy diet.

Magnesium is also considered a great lethargy buster.  Fatigue is thought by some in the medical field to be one of the typical early symptoms of magnesium deficiency (1).  Stress hormones can promote a reduction in tissue magnesium levels and mild magnesium deficiency may promote the feelings of fatigue.  Magnesium is an incredibly important mineral and acts as a multi-functional nutrient in the body where it is present in all cells!  It takes part in around 300 processes in the body and is vital to many bodily functions such as energy production, nerve function, muscle relaxation, bone and tooth formation, heart rhythm and aids in the production and use of insulin. 

The National Diet and Nutrition Survey (NDNS) of adults aged 19-64 (2) found that quite a shocking number of women in the UK are not achieving adequate daily magnesium intakes with 74% of women age 19-64 not reaching the RNI (reference nutrient intake) for magnesium and 85% of 19-24 year old women not beaching the RNI for this vital nutrient.  Many men (about 42%) too appear not to be reaching recommended levels.  Modern society does not eat as many whole grains, seeds, beans and nuts as in previous times and it is these sources that are rich in magnesium.  Processed foods contain little of this vital mineral.  Good dietary sources of magnesium include dried figs, almonds, hazelnuts, walnuts, cashew nuts, sunflower seeds and dark chocolate (minimum 70% cocoa solids!).  Wholegrains such as brown rice and oatmeal also contain good amounts.

Omega 3 fatty acids from oily fish such as salmon are vital for the brain and may help lift the mood.  Good dietary sources of omega 3 fatty acids include oily fish such as mackerel, salmon, sardines, trout and some nuts, especially walnuts, and flax seeds.  For people who don’t regularly eat fish considering a daily omega 3 supplement could be very helpful.  In fact I would suggest that the majority of individuals in the UK do not achieve good dietary Omega 3 intakes.  For vegetarians and vegans a flaxseed oil supplement can be useful and there are now supplements containing the longer chain omega 3 fatty acids, EPA and DHA, available which are made from algae. 

Ginseng is often taken as an energy boosting supplement.  Korean Ginseng, also known as Panax ginseng, appears to be helpful in treating and reducing stress-related fatigue (3,4,5).  A short term, one month, supplement with this herb could be worth a try.  Remember to read the label and stick to the recommended dosages.

Keeping blood sugar levels stable during the day will help prevent energy and mood slumps – a key here is to ensure you include a source of protein with each meal, this could include eggs, unprocessed meats and fish, beans, lentils or other pulses and nuts or seeds.  It is also important to avoid refined carbohydrates and minimise caffeine intake since this can disrupt hormones involved in blood sugar balance.  Eating a healthy balanced diet rich in a variety of vegetables and fruits and minimal processed and refined foods will help to keep levels of all nutrients and antioxidants high.  If you feel that you are in need of a boost or are consistently finding it hard to eat a diet rich in a variety of vegetables and fruits you could consider taking a good quality multi-vitamin and mineral supplement to cover any dietary shortfalls.  Personally I like the food-state supplements which are easily absorbed by the body and derived from natural sources.  Multi-nutrient supplements that also contain probiotics (‘good’ bacteria) are also available.  A study (6) found that such a supplement could help to reduce stress and exhaustion as well as improving the immune system.  Remember that a nutrient supplement can never be considered as an alternative to a healthy diet. 

(1)Saris N-E L et al.  2000.  Magnesium:  an update on physiological, clinical and analytical aspects.  Clinica Chimica Acta.  294:1-26, 2000.
(2)Henderson L et al.  2003.  The National Diet and Nutrition Survey: Adults aged 19-64 years.  HMSO London.
(3)Bannerjee U et al.  1982.  Antistress and antifatigue properties of panax ginseng:  comparison with piracetam.  Acta Physiol Lat Am.  32(4):277-285.
(4)Reay J L et al.  2005.  Single doses of Panax ginseng (G115) reduce blood glucose levels and improve cognitive performance during sustained mental activity.  J Psychopharmacol.  19(4):357-365, 2005.
(5)Reay J L et al.  2006.  Effects of Panax ginseng, consumed with and without glucose, on blood glucose levels and cognitive performance during sustained 'mentally demanding' tasks.  J Psychopharmacol.
(6)Grunenwald J et al.  2002.  Effect of a probiotic multivitamin compound on stress and exhaustion.  Adv Ther.  19:141-150
Written by Ani Kowal

Last week I wrote about premenstrual syndrome (PMS) and how calcium can be helpful to some women suffering from the condition.  I mentioned in the post that calcium and magnesium work well together and a combined supplement is preferable to a single nutrient supplement.  Magnesium and calcium work together in the body and magnesium is necessary for the efficient absorption and use of calcium but magnesium has benefits in PMS that go beyond simply acting in conjunction with calcium.

Back in 1973 some French scientists first reported that supplementing women with 400mg a day of magnesium seemed to help their PMS symptoms (1).  Studies followed which reported that the red blood cell levels of magnesium were significantly lower in patients who suffered with PMS than in those who did not suffer from the condition (2,3,4).  Subsequently supplementation trials in women with PMS have found that supplemental magnesium can reduce PMS symptoms (5,6,7,8).  Specifically magnesium supplements seemed to have a positive effect on symptoms related to mood (5), migraines (6) and fluid retention (7).

A small preliminary study (5) found that women who were being given a magnesium supplement had significant reductions in their total PMS symptoms in the second month of treatment compared to women taking the placebo.  It was also noted that a significant reduction in ‘negative mood’ occurred in women who were taking the magnesium compared to those taking the placebo.  Another study (7) found that, compared to placebo, magnesium supplementation at 200mg per day over two months significantly improved PMS symptoms, especially symptoms related to fluid retention such as breast tenderness, abdominal bloating, swelling of extremities and weight gain.

A more recent study (8) found that PMS symptoms improved during magnesium treatment.  The women were given 250mg magnesium for 3 months.  After three months the PMS score, as assessed by a specific research questionnaire called the Moos' Modified Menstrual Distress Questionnaire, was significantly lower than before therapy. During the same period, the mean PMS scores, as recorded in patients' diaries, also showed significant improvements . The authors conclude that magnesium supplementation was effective in reducing premenstrual symptoms in women with PMS in this preliminary study.

Magnesium is an incredibly important mineral and acts as a multi-functional nutrient in the body where it is present in all cells!  It takes part in around 300 processes in the body and is vital to many bodily functions such as energy production, nerve function, muscle relaxation, bone and tooth formation, heart rhythm and aids in the production and use of insulin (it is involved in blood sugar regulation which is thought to be an important factor in PMS)

Specific functions of magnesium relevant to PMS:
* Magnesium acts as a muscle relaxant (as it is needed for nerve to muscle signal transmission) and hence may be useful for fatigue symptoms.
* Many of the body’s energy pathways need magnesium – in this way it may be important to help restore vitality and prevent lethargy/tiredness.
* Inflammation is implicated in some forms of PMS (especially when breast tenderness is experienced).  Magnesium is needed for the metabolism of essential fatty acids, a good balance of fatty acids is needed in order to prevent inflammation.
* Low magnesium status may be responsible for promoting hormonal imbalance in women.  A low magnesium status may affect the aldosterone to oestrogen ration.  Enhanced levels of aldosterone can promote potassium and magnesium loss in the urine and may also promote sodium retention – this could induce fluid retention.
* As briefly mentioned above, magnesium is involved in blood sugar control.  Low magnesium levels can be implicated in two ways – by decreasing the ability of the liver to handle glucose and by increasing insulin secretion in response to glucose.  This may affect changes in appetite and cravings.
* The reduced dopamine (mood chemical in the brain) levels which are thought to be partly responsible for anxiety and irritability in PMS may be worsened by low magnesium levels.
* Low magnesium levels may enhance stress reactions and emotional stress such as anxiety can further increase our bodily need for magnesium.

In the UK it is currently recommended that women aim to include 270mg of magnesium per day into their daily diet.  However The National Diet and Nutrition Survey (NDNS) of adults aged 19-64 (9) found that quite a shocking number of women in the UK are not achieving adequate daily magnesium intakes with 74% of women age 19-64 not reaching the RNI (reference nutrient intake) for magnesium and 85% of 19-24 year old women not beaching the RNI for this vital nutrient.  Modern society does not eat as many whole grains, seeds, beans and nuts as in previous times and it is these sources that are rich in magnesium.  Processed foods contain little of this vital mineral.  Good dietary sources of magnesium include dried figs, almonds, hazelnuts, walnuts, cashew nuts, sunflower seeds and dark chocolate (minimum 70% cocoa solids!).  Wholegrains such as brown rice and oatmeal also contain good amounts.

The ideal amount of magnesium has yet to be determined for PMS improvement but practitioners often recommend a supplement of 200-400mg daily.  Symptoms seem to show improvement after 2-4 months.  It may well be worth supplementing with magnesium if you don’t routinely eat magnesium rich foods to see if it helps your symptoms – especially if you suffer from anxiety, low mood, stress, food cravings or water retention.  As mentioned in the post relating calcium and PMS – consider taking the two minerals together. 

1.Nicholas, A.  1973.  Traitement du syndrome  pre-menstrel et de la dysmenorrhee par l’ion magnesium.  First International Symposium on Magnesium Deficit in Human Pathology.  261-263.
2.Abraham, GE.  Lubran MM.  1981.  Serum and red cell magnesium levels in patients with premenstrual tension.  Am J Clin Nutr.  34:2364-2366.
3.Sherwood, RA et al.  1986.  Magnesium and the premenstrual syndrome.  Ann Clin Biochem.  23:667-670.
4.Rosenstein, DL et al.  1994.  Magnesium measures across the menstrual cycle in premenstrual syndrome.  Biol Psychiatry.  35:557-561
5.Fracchinetti, F. et al.  1991.  Oral magnesium successfully relieves premenstrual mood changes.  Obstet Gynecol.  78:177-181.
6 Fracchinetti, F.  et al.  1991.  Magnesium prophylaxis of menstrual migraine: effects on intracellular magnesium.  Headache.  31:298-301.
7.Walker, AF et al.  1998.  Magnesium supplementation alleviates premenstrual symptoms of fluid retention.  J Womens Health.  7:1157-1165.
8.Quaranta S et al.  2007.  Pilot study of the efficacy and safety of a modified-release magnesium 250 mg tablet (Sincromag) for the treatment of premenstrual syndrome.  Clin Drug Investig. 27(1):51-8.
9. Henderson L et al.  2003.  The National Diet and Nutrition Survey: Adults aged 19-64 years.  HMSO London.

Written by Ani Kowal

Those of you who suffer from migraine headaches will know how traumatic these attacks can be.  A migraine is more than just a severe headache.  Migraine is characterised by acute pain often in conjunction with visual disturbance, nausea and vomiting.  Bright lights, noise, smells and movement can often aggravate a migraine with many sufferers opting to take refuge in silent, dark rooms until the attack has passed, which can be anything up to a couple of days.

Migraine is a multi-factorial condition, thought to occur due to the sudden widening of blood vessels supporting the brain.  Genetics and pre-menstrual hormones appear to play a part and there also seem to be many triggers associated with migraine attacks such as:
*Specific foods
*Food additives, especially monosodium glutamate (MSG)
*Stress, emotional and physical
*Low blood sugar levels
*Strenuous exercise
*The environment – bright lights, flashing lights, strong smells, loud noise, the weather, smoking, stuffy atmosphere
*Certain medications

For many people there is not just one trigger but a combination of factors which, individually can be tolerated but when several occur together a threshold is passed causing an attack. Around 3-5% of the population are affected by migraine, in children the incidence is equal in boys and girls but after puberty more women than men will suffer from the condition, probably due to pre-menstrual hormone actions. 

There are two main types of migraine:
1.Classical migraine – this is when the migraine headache and nausea are preceded or accompanied by what is known as an ‘aura’.  The aura, which can last for up to an hour before the headache starts, can involve a host of phenomenon such as visual problems, tingling in various body parts, depression or feelings of restlessness.  This type of migraine is less common occurring in 10-15% of sufferers
2.Common migraine – occurs in 85-90% of sufferers, there is no aura that occurs preceding the headache attack.  The headache will be intense and often throbbing, typically affecting only one side of the head.

Studies indicate food sensitivity may be a major contributing factor in migraine (1,2,3,4).  There is some evidence to suggest that certain foods are more of a trigger for migraine attack and are often referred to as ‘the five Cs’; chocolate, cheese, claret (and other red wines), caffeine and citrus fruits.  Uncovering a food sensitivity may be a useful way to treat migraines, this should always be done under medical supervision.  Food sensitivity is unlikely to be a sole trigger for migraine, often a food will only trigger an attack if other factors are at play e.g. emotional stress or premenstrual hormonal factors.

Magnesium
Migraine has been related to low magnesium levels and magnesium deficiency (5). During a migraine attack the blood vessels around the brain tend to constrict (shut down) and then dilate (open out). The second phase of dilation is believed to cause the pain characteristic of migraine. Magnesium deficiency tends to increase the risk of spasm in the lining of the arteries, increasing the risk of subsequent dilation and pain.  Magnesium may be particularly helpful for women who suffer from premenstrual migraines.  Research has found that 360mg of magnesium a day decreases menstrual migraine (6).  A recent small study (7) investigated the effects of magnesium supplementation in the prevention of common migraine (migraine without aura).  In the study 600mg of magnesium citrate was used per day and it was found to be significantly helpful, when compared to placebo, in the prevention of migraine.

Many individuals in the UK do not get enough magnesium in the diet, this is particularly true in women.  Foods that are rich in magnesium include nuts, seeds, pulses (such as beans and lentils) and wholegrains.  Migraine sufferers may wish to consider taking take 200mg magnesium 1-2 times a day as a preventative measure.

Omega 3 fatty acids
Certain essential fatty acids, particularly omega 3 fatty acids (found abundantly in oily fish and flaxseeds), have been found to be helpful to migraine sufferers.  These fatty acids probably act by preventing or reducing the release of inflammatory chemicals in the body, known as eicosanoids, which have been implicated in the causation of headaches.  One study (8) found that supplementation with alpha-linolenic acid, an essential omega 3 fatty acid found in flaxseeds, reduced the frequency, severity and total duration of migraine attacks by 86%.  During the sixth month of the study, 22% of the patients became free of migraine and more than 90% experienced less nausea and vomiting.  Studies (9,10) also show that fish oils (which contain the long chain fatty acids EPA and DHA) may be beneficial in the treatment of recurrent migraines. 

Migraine sufferers may benefit from consuming a diet rich in omega 3 fatty acids, found in oily fish such as salmon, mackerel, sardines and trout and certain nuts and seeds e.g. flaxseeds and walnuts.  If you suffer from migraine you may also want to consider a daily fish oil supplement to provide around 300mg EPA and 300mg DHA per day.  Vegetarians could consider a flaxseed oil supplement providing 500-1000mg alpha linolenic acid daily.  Most fatty acid supplements also contain vitamin E which acts to protect the oil from degradation or rancidity, this may have other benefits too: a recent study(11) found that vitamin E supplements may be helpful for women who suffer from premenstrual migraines.  These fatty acids are incredibly important for many aspects of health.

For more information about migraines, symptoms and helpful resources please visit the charity Migraine Action.  If you are taking prescribed migraine medication please check with your doctor before starting any supplement regimen.

(1)Egger J, et al.  1983.  Is migraine food allergy? A double-blind trial of oligoantigenic diet treatment. Lancet.  ii:865-869
(2)Grant EC.  1979.  Food allergies and migraine. Lancet.  I:966-969
(3)Hughs EC, et al.  1985.  Migraine: a diagnostic test for etiology of food sensitivity by a nutritionally supported fast and confirmed by long-term report. Ann Allergy.  55:28-32
(4)Monro J, et al.  1980.  Food allergy in migraine. Lancet.  ii:1-4
(5)Gallai V, et al.  1992.  Serum and salivary magnesium levels in migraine.  Results in a group of juvenile patients.  Headache.  32:132-135.
(6)Facchinetti F, et al.  1991.  Magnesium prophylaxis of menstrual migraine: effects on intracellular magnesium.  Headache.  31:298-301.
(7) Köseoglu E et al. 2008.  The effects of magnesium prophylaxis in migraine without aura. Magnes Res.  21(2):101-8.
(8) Wagner, W., et al.  1997.  Prophylactic treatment of migraine with gamma-linolenic and alpha-linolenic acids.  Cephalagia.  17(2):127-130.
(9) Glueck, C. J., et al.  Amelioration of severe migraine with omega-3 fatty acids:  a double-blind placebo controlled clinical trial.  American Journal of Clinical Nutrition.  43(4):710, 1986
(10)Harel, Z., et al.  2002.  Supplementation with omega-3 polyunsaturated fatty acids in the management of recurrent migraines in adolescents.   J Adolesc Health.  31(2):154-61
(11)Ziaei S et al.  2009.  The effect of vitamin E on the treatment of menstrual migraine.  Med Sci Monit.  15(1):CR16-9.
Written by Ani Kowal

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).