Back in August I wrote about how diet can impact the brain and behaviour in children.  Nutrition for the brain is something I am very interested in and those of you who follow this blog will see that there is a lot of scientific evidence to show that what we eat can make a difference to mood and feelings as well as brain structure and function.

A very recent review study (1) has concluded that multi-nutrient supplementation may be associated with a small but significant increase in a measure of intelligence and academic performance in healthy schoolchildren.  The authors of the study do state however that “more research is required, however, before public health recommendations can be given” (1).

The researchers undertook the study because “Although multiple micronutrient interventions have been shown to benefit children's intellectual development, a thorough evaluation of the totality of evidence is currently lacking to direct public health policy” (1).  The aim of the research was to review the present literature on the effects of multiple-nutrient supplements on cognitive (mental/intellectual) performance in school aged children (children aged up to 18).  The researchers looked at data from trials published between 1970 and 2008 – quite a huge body of work!  As stated above, they found that multi-nutrient supplements seemed to have a small but significant positive effect on academic performance. 

The important aspect of these kinds of research studies, in my opinion, is that they show that nutrition does impact the brain, thinking, mood and therefore perhaps academic performance.  Limitations of such studies include the quality of the supplement, the quantity and also the actual diet of the child.  If you read the post from August you will see that overall diet quality is very important to the brain.  A good supply of daily vegetables, fruits, unrefined and unprocessed foods and healthy omega 3 fats as well as a protein supply with each meal is a great way to look after body and mind.  Regular exercise is also crucial for mood. 

In terms of supplements, they can never replace a healthy diet.  If you are considering supplements I would suggest a good quality multivitamin-mineral supplement, I like food-state supplements as they are made from ‘food’ and not chemicals and are easily absorbed into the body.  In addition to this I think that a daily omega 3 fatty acid supplement is definitely worth considering – these fats really are essential for the brain.  The most effective of the omega 3 fatty acids for brain function seem to be the long chain omega 3 fats EPA and DHA which are found in oily fish such as salmon, trout, mackerel and sardines.  These can be purchased as an oil or in capsule form.  Many of the oils are made easy for children to take as they are flavoured and have no fishy taste or smell.  For vegetarians and vegans flaxseed oil can be taken – this is a shorter chain omega 3 fat and not as effective, since the body has to work hard to convert it into the longer chain structure – however, it is certainly worth taking.  This kind of fat can be found in good amounts in walnuts and flaxseeds.  Vegan EPA and DHA is now being produced from algae, it is expensive but available to buy from some retailers and online.

(1)Eilander A et al.  2010.  Multiple micronutrient supplementation for improving cognitive performance in children: systematic review of randomized controlled trials.  American Journal of Clinical Nutrition.  91: 115-130
Written by Ani Kowal

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

I began last week by writing about diet and lifestyle and the risk of Alzheimer’s disease.  Today I wanted to discuss a research piece(1) with a fabulous title: “Healthy Living Is The Best Revenge”.

The study took place in Germany, the authors wanted to look at the risks of developing major chronic diseases such as cardiovascular disease (heart disease and stroke), type II diabetes and cancer.  Data from 23,153 participants aged between 35 and 65 years old was used.  Four healthy lifestyle factors were looked at: never having smoked, having a body mass index (BMI) of less than 30, performing at least three and a half hours of physical activity a week and adhering to a healthy diet.  A healthy diet was considered one with high intake of fruits, vegetables, and whole-grains and low meat consumption.

BMI (Body Mass Index) is a measure often used for healthy weight, it is worked out as weight divided by height squared.  To check your own BMI you may find it useful to visit the Food Standards Agency website where an online BMI calculator can be found. (generally a BMI of 19-25 is viewed as a healthy weight).

The 4 factors were scored (healthy, 1 point; unhealthy, 0 points) to form an index that
ranged from 0 to 4.  The participants were followed for an average of 7.8 years.  3.7% of participants developed diabetes, 0.9% had a heart attack (myocardial infarction), 0.8% suffered a stroke and 3.8% developed cancer.  Fewer than 4% of participants had a 0 healthy factor score, most had 1 to 3 healthy factors, and approximately 9% had 4 factors. 

The risk for developing a chronic disease decreased progressively as the number of healthy factors increased. Participants with all 4 factors at the start of the study had a 78% lower risk of developing any of the chronic diseases compared to participants with no healthy factors (a score of 0).  The four factors were associated with a 93% reduced risk of diabetes, and 81% reduced risk of heart attack, 50% reduced risk of stroke and a 36% reduced risk of cancer.  The largest reduction in risk was associated with having a BMI less than 30, followed by never smoking, then taking at least 3.5 hours of physical activity a week and then adhering to good dietary principles.  The authors conclude that “Adhering to 4 simple healthy lifestyle factors can have a strong impact on the prevention of chronic diseases” (1)

In a press release (2) the authors say  "Our results reinforce current public health recommendations to avoid smoking, to maintain a healthy weight, to engage in physical activity appropriately and to eat adequate amounts of fruits and vegetables and foods containing whole grains and to partake of red meat prudently," "Because the roots of these factors often originate during the formative stages of life, it is especially important to start early in teaching the important lessons concerning healthy living."

It is important to note that is was an observational study which shows that lifestyle factors may be associated with a reduced risk of chronic diseases, it does not however prove cause and effect.  These kinds of studies are important indicators and we can learn a lot from them.  Evidence is continually mounting for the importance of living a healthy lifestyle – in the end living healthily is about increasing our likelihood of living a long, active and HEALTHY life. 

As I wrote last week if you feel your diet consistently falls short of vegetables and fruits you may wish to consider taking a food-state multi-vitamin and mineral supplement which tends to provide bioflavonoids in addition to the nutrients and is easy for the body to absorb.  For those of you who do not eat oil fish regularly (at least twice per week) you may want to consider taking a daily fish oil supplement in order to provide omega 3 fatty acids to the body (a supplement to provide around 250-350mg of EPA and 250-350mg DHA), for vegetarians and vegans flaxseed oil can provide the shorter chain omega 3 fatty acid, alpha linolenic acid, (a supplement providing 1000mg alpha-linolenic acid daily can be considered).  Vegetarian EPA and DHA supplements produced from algae are also becoming increasingly available. 

Getting out for a walk every day, even for 15-30minutes is a good way of adding physical activity into life.

(1) Earl Ford ES et al.  2009.  Healthy Living Is the Best Revenge: Findings From the European Prospective Investigation Into Cancer and Nutrition-Potsdam Study. Arch Intern Med.  169 (15): 1355-1362
Written by Ani Kowal
(2)Press release.  JAMA and Archives Journals (2009, August 10). Healthy Lifestyle Habits May Be Associated With Reduced Risk Of Chronic Disease. ScienceDaily. Retrieved August 12, 2009, from http://www.sciencedaily.com/releases/2009/08/090810161906.htm
Written by Ani Kowal

There seems to be a run of research being released at the moment looking at pregnancy and fertility related issues, as you can see from my recent blog posts.  In a recent review paper (1) researchers have estimated that 1.5million fewer babies would be born at low birth weights every year if all pregnant women, worldwide, took vitamin and mineral supplements. 

The lead researcher of the study, Dr Prakesh Shah, stated in a press release (2) that women should start taking vitamin and mineral supplements “as soon as they know they are pregnant”.  Compared with women who took a placebo, women who took multi-nutrient supplements were 19% less likely to have a low birth weight baby.

Low birth weight infants, those born weighing less than 2.5 kilograms (about 5.5 pounds), face a greater risk of health problems that may extend into adulthood. They tend to be more vulnerable to infections during infancy and childhood and may be more likely to have developmental problems in childhood.  As adults they may be at greater risk of diabetes and high blood pressure.  This study (1) found that “Prenatal multimicronutrient supplementation was associated with a significantly reduced risk of low birth weight and with improved birth weight when compared with iron–folic acid supplementation”.

Currently, the World Health Organization (WHO) recommends supplementation with folic acid and iron during pregnancy.  However there have been numerous studies showing that a number of different vitamins/minerals may be necessary in early pregnancy for the best outcomes for mother and baby.  In this current study (1) when compared with women taking iron and folic acid only, the researchers found the multi-supplement users had a 17% risk of having a low birth weight baby.  Babies born to women taking multimicronutrient supplements weighed 54 grams more, on average, than babies born to women taking iron and folic acid alone.  The authors of the study suggest that the WHO could consider revisiting their guidelines to recommend multi-nutrient supplements, not just iron and folic acid, for all pregnant women.

The research is limited by the fact that it is a review study of already published data, not an intervention trial.  In addition to this the studies included in the review varied with regards timing, duration, composition of micronutrients, and characteristics of the study populations.  In populations where under-nutrition is common the multi-nutrient supplement may be more helpful than in populations where nutrient rich diets are eaten.  However there is a growing increase in teenage pregnancy here in the UK and often these children are not following a healthy diet and may well be lacking in a number of vitamins and minerals.  In addition to this my previous posts have shown that many nutrients in early and pre pregnancy are associated with better health in mothers and children in Western populations, so it does seem that multi-nutrient supplements could be important for all pregnant women.

Supplements designed especially for pregnant women are widely available, however it is always a good idea to check with your doctor or midwife before taking any supplements during pregnancy.  As mentioned last week – a healthy balanced diet also very important at all times, but especially during pregnancy.

(1)Prakesh S. Shah et al.  2009.   Effects of prenatal multimicronutrient supplementation on pregnancy outcomes: a meta-analysis.  CMAJ.  June 9, 180 (12). doi:10.1503/cmaj.081777.
(2)Anne Harding.  Multivitamins best for preventing low birth weight.  08/06/2009.  Reuters Health.  http://www.reutershealth.com/archive/2009/06/08/eline/links/20090608elin005.html
(3) Canadian Medical Association Journal (2009, June 8). Multivitamins In Pregnancy Reduce Risk Of Low Birth Weights. ScienceDaily. Retrieved June 9, 2009, from http://www.sciencedaily.com/releases/2009/06/090608182549.htm

(4)Bhutta ZA & Haider BA.  2009.  Prenatal micronutrient supplementation: Are we there yet?  Commentary.  CMAJ • June 9, 2009; 180 (12). doi:10.1503/cmaj.090652

Written by Ani Kowal

Since I started the week with a focus on the pregnancy related condition preeclampsia I thought it was a good time to mention a recent study (1) that looked at vitamin supplement use in pregnancy to see if there was any association with the risk of having a miscarriage.  

In this study(1), the authors wanted to look at the relationship between use of prenatal vitamins in early pregnancy and the risk of miscarriage.  4,752 women in the US were involved and individual data about vitamin use was collected at a first-trimester interview.  Approximately 95% of participants reported use of vitamins during early pregnancy and a total of 524 women had a miscarriage.  Any use of vitamins during pregnancy was associated with a reduced risk of miscarriage when compared to women who did not take any vitamins.  The researchers found that the risk for miscarriage was 57% lower among women who took vitamins, compared to those who did not.

These results suggest that taking vitamins before pregnancy and during early pregnancy is associated with a reduced risk for miscarriage.  However the study is far from conclusive.  It may well be that women who take vitamins also tend to be more aware of the factors considered important for health and may tend to lead generally healthier lifestyles when compared to women who do not take vitamins, other confounding factors may also be involved.  Further studies are necessary before firm conclusions can be drawn regarding the effects of supplements on miscarriage risk.   

In a press release (2) the lead study author said  "Because miscarriage occurs very early in pregnancy, it is important for women of reproductive age, who may become pregnant, to eat a balanced diet and use vitamins."  Recently I have written a lot about the links between various nutrients such as folic acid, vitamin B12, vitamin D and multivitamins in early pregnancy and pre pregnancy and an apparent reduced risk of various pregnancy related issues in the mother and baby.  Pre-pregnancy and pregnancy is a very important time for healthy living and healthy eating. 

If you are planning a pregnancy eating plenty of vegetables, fruits, nuts/seeds, beans/pulses, fish (especially oily fish such as salmon, trout and mackerel), unprocessed meats and unprocessed/unrefined wholegrains will help to provide an abundance of vitamins, minerals, flavonoids (bioactive plant chemicals),fibre, protein, healthy fats and energy for you and your baby.  If you feel concerned that you may not be eating a consistently nutritious diet then you may wish to consider taking a food-state multi-nutrient supplement specifically designed for use during pregnancy.  An omega 3 supplement could also be helpful, especially if you do not regularly eat oily fish (at least twice a week) or nuts/seeds.  Before deciding to take any supplement during pregnancy please discuss your thoughts with a GP, nurse or midwife.  For information about miscarriage and support please visit the Miscarriage Association charity website. 

(1)Hasan R et al.  2009.  Self-reported vitamin supplementation in early pregnancy and risk of miscarriage.  Am J Epidemiol. 169(11):1312-8.
(2)Reuters Health press release .  Vitamin Sypplements may lessen miscarriage risk.  Joene Hendry.  Health eLine 05/06/2009.  http://www.reutershealth.com/archive/2009/06/05/eline/links/20090605elin006.html

Written by Ani Kowal

In August last year I wrote about the possible role of a diet in the prevention of preeclampsia with specific reference to maintaining a healthy body weight, dietary fibre, fruits, vegetables, antioxidant vitamins and omega 3 fatty acids.  I was very interested to read a recently published study (1) which has found that regular multivitamin use in the very early period of pregnancy is associated with a reduced risk of preeclampsia in normal weight, but not overweight, women.

Preeclampsia is a very serious condition.  Around 3% of all pregnant women suffer from preeclampsia each year and it is the principal cause of maternal death in the UK.  Preeclampsia is a form of high blood pressure that develops in conjunction with water retention and/or excess protein in the urine.  Around 10 mothers and 1000 babies die each year as a result of the effects of preeclampsia and the condition is also the most common reason for elective, often early, delivery.  Usually preeclampsia occurs between the 20th week of Pregnancy and the end of the first week postpartum.  The earlier it presents in pregnancy the more threatening it can become.  For more information please visit the Action On Pre-eclampsia charity website.

The study (1) looked at a large group of Danish women, over 28,000 women, between the years 1997-2003 who reported multivitamin supplement use during a 12 week periconceptional period, the very earliest weeks of pregnancy, measured as 4 weeks prior to and 8 weeks after the last menstrual period.  The researchers then looked to see whether the frequency and timing of multivitamin use was associated with preeclampsia risk - regular use of multivitamins in the periconceptual period was related to a reduced risk of preeclampsia among normal-weight women.  Compared with women who did not use multivitamins, regular multivitamin users with the same body mass index (of 22) had a 20% reduced risk of preeclampisa.  In addition, regular use of multivitamins in the post-conception period only seemed to be associated with a reduced risk of preeclampsia in women with a BMI less than 25 (a healthy BMI is usually measured at 18.5-20).  This is only an association study, it does not show cause and effect and further controlled supplement trials are certainly necessary before any firm conclusions can be drawn.  However, the data does indicate that multivitamins in early pregnancy may be useful in preventing preeclampsia in some women. 

BMI (Body Mass Index) is a measure often used for healthy weight, it is worked out as weight divided by height squared.  To check your own BMI you may find it useful to visit the Food Standards Agency website where an online BMI calculator can be found.

In previous weeks I have talked about early use of folic acid and vitamin B12 being important for a number of pregnancy related conditions so a multi-nutrient supplement could be a way of ensuring a good intake of a variety of nutrients linked to improved health of both the mother and child during pregnancy.  Many multi-nutrient preparations are available specifically for use by pregnant women but please always check with a doctor or health professional before starting supplementation if you are planning a pregnancy.  It is also important for me to mention that supplements cannot be seen as an alternative to a healthy diet and lifestyle.  Pregnant women really do need to ensure that they are eating well in order to give their baby the best start in life.  A healthy diet, low in processed and refined foods and  rich in vegetables, fruits, oily fish, lean unprocessed meats and fish, nuts/seeds, beans, pulses and unrefined/unprocessed wholegrains will go far in providing the body with an abundance of vitamins, minerals, flavonoids (bioactive plant chemicals) and essential fats.

Since I seem to be mentioning Vitamin D quite regularly I thought I would briefly include a study(2) that I came across very recently.  The researchers wanted to see if intake of vitamin D during pregnancy was associated with preeclampsia risk.  The study involved 23,423 Norwegian pregnant women who had not previously had children.

Participating women filled in questionnaires at week 15, 22, and 30 of pregnancy.  From these questionnaires nutrient intakes were calculated from food and dietary supplements.  Data showed that women with the lowest levels of vitamin D were more at risk of developing preeclampsia than women with the highest levels.  When the data was analysed to considering only the intake of vitamin D from supplements, the scientists found a 27% reduction in risk of preeclampsia for women taking 10-15 micrograms per day compared with women taking no supplements. No association was found between intake of vitamin D from the diet alone and the occurrence of preeclampsia.   The report concludes (2) that “These findings are consistent with other reports of a protective effect of vitamin D on preeclampsia development”.  However, the authors make an interesting point: Vitamin D intake is highly correlated with the intake of long chain omega 3 fatty acids in the Norwegian diet and further research is needed to disentangle the separate effects of these nutrients.  Oily fish are a great source of omega 3 fatty acids and one of the few good dietary sources of vitamin D.

As mentioned in many blog posts on Vitamin D many of us in the UK do not achieve good levels from the diet or from sunlight exposure. If you rarely get out into the sun, you may wish to consider a vitamin D supplement which provides around 12mcg/day (around 500iu a day).  Such a supplement may be particularly useful during the autumn and winter months.  Before considering any supplementation during pregnancy please check with your doctor and be aware that multi-vitamin and mineral supplement may already contain ample amounts of vitamin D. 

(1)Catov JM et al.  2009.  Association of Periconceptional Multivitamin Use With Reduced Risk of Preeclampsia Among Normal-Weight Women in the Danish National Birth Cohort.  American Journal of Epidemiology 2009 169(11):1304-1311; doi:10.1093/aje/kwp052
(2) Haugen M et al.  2009.  Vitamin D supplementation and reduced risk of preeclampsia in nulliparous women.  Epidemiology.  [Epub ahead of print]

Written by Ani Kowal