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

As I mentioned on Monday, the 12th October marks World Arthritis Day 2008.  Today I am going to cover osteoarthritis which is the most common type of arthritis.  The disease occurs due to the gradual degeneration of the cartilage which lines the joints.  This causes pain, swelling and restricted movement.  The condition most commonly affects weight bearing joints such as the hips and knees but may also attack the joints in the hands and feet.  Women are twice as likely as men to be affected and the most common form of treatment are NSAIDs, non-steroidal anti-inflammatory drugs, to relieve pain and reduce swelling/inflammation. 

For more info on osteoarthritis please visit Arthritis Care, a UK based charity for those suffering with the condition.

My intention had been to start off by reviewing some of the evidence surrounding glucosamine sulphate and chondroitin sulphate in relieving symptoms of osteoarthritis.  However the press pounced on a story earlier this week and you may have read headlines saying that dietary supplements of glucosamine and/or chondroitin fare no better than placebo in slowing the progression of knee osteoarthritis. (Oh the media do love a negative story!).  The study(1) being referred to did indeed find that neither glucosamine sulphate nor chondroitin sulphate worked to slow the loss of knee cartilage in osteoarthritis.  However, the researchers have said that some of their findings were confusing and that more study was needed before any definite conclusions could be drawn.  In addition to this it was quite a small study which can affect the statistical analysis of results, and a small sub-set group of patients (with grade 2 osteoarthritis) did appear to show a trend toward benefit from the supplements (but the benefit was not statistically/mathmatically significant) compared to placebo.  The study did not measure the effects of supplementation on pain levels, or other symptoms, in the osteoarthritis sufferers.

I am going to continue along my planned lines of mentioning glucosamine and chondroitin sulphate supplementation for osteoarthritis as there are a number of studies that do indicate that these agents may well be beneficial to sufferers of the condition.

Glucosamine sulphate is an essential building block in the manufacture of cartilage and, taken as a supplement, may reduce the pain and inflammation associated with osteoarthritis.  Several studies exist which show glucosamine to be an effective treatment for osteoarthritis(2,3,4,5). Glucosamine sulphate has also been shown to control the symptoms of osteoarthritis as well as the NSAID ibuprofen (6,7). The normal recommended dose of glucosamine sulphate is 500 mg, three times daily. Once therapeutic benefit is achieved, it is usually possible to taper down to a once or twice a day dose.

Another agent which is often used in conjunction with glucosamine sulphate is chondroitin sulphate.  Chondroitin sulphate seems to work by attracting fluid into the joint cartilage tissue. This may improve the spongy, shock-absorbing qualities of the cartilage, and may also help bring essential nutrients to the area.  Many trials have shown that supplementation with chondroitin sulphate can reduce pain, increase joint mobility and/or cause healing within the joints of osteoarthritis sufferers (8,9,10,11). The normal recommended dose of chondroitin sulphate is 400 mg, three times a day.

Glucosamine and chondroitin are very often combined together in nutritional supplements designed to enhance joint health, although it is yet uncertain whether a combination works more effectively than either agent alone.  A review(12) published this year concluded that “although the evidence is not entirely consistent, most research suggests that glucosamine sulphate can improve symptoms of pain related to osteoarthritis, as well as slow disease progression in patients with osteoarthritis of the knee. Chondroitin sulphate also appears to reduce osteoarthritis symptoms and is often combined with glucosamine, but there is no reliable evidence that the combination is more effective than either agent alone”

The evidence for other supplements aiding osteoarthritis is not strong(13) and further trials are needed however, there is indication that antioxidant vitamins such as vitamin C, E and Beta carotene, vitamins D and various B vitamins as well as omega 3 fatty acids may be involved with reducing symptoms.  To me this highlights the importance of a healthy diet rich in a variety of fruits and vegetables, to provide the body with vitamins and minerals, together with regular inclusion of oily fish to provide omega 3 fatty acids (which can act as anti-inflammatory agents in the body).

1.Sawitzke AD et al.  2008.  The Effect of Glucosamine and/or Chondroitin Sulfate on the Progression of Knee Osteoarthritis: A Report from the Glucosamine/Chondroitin Arthritis Intervention Trial. Arthritis & Rheumatism.  58:3183-3191.
2.Reginster JY et al.  2001.  Long-term effects of glucosamine sulphate on osteoarthritis progression: a randomised, placebo-controlled clinical trial.  Lancet.  357:251-256.
3.Noack W et al.  1994. Glucosamine sulphate in osteoarthritis of the knee. Osteo and Cart.  2:51-59
4.Pujalte JM et al.  1980.  Double blind clinical evaluation of oral glucosamine sulphate in the basic treatment of osteoarthrosis. Curr Med Res Opin.  2:110-114
5.Dovanti A et al.  1980.  Therapeutic activity of oral glucosamine sulphate in osteoarthritis: a placebo-controlled double-blind investigation. Clinical Therapeutics.  3(4):266-272
6.Qiu GX et al.  1998.  Efficacy and safety of glucosamine sulfate versus ibuprofen in patients with knee osteoarthritis.  Arzneimittelforschung.  48:469-474
7.Muller-Fabbender H et al.  1994.  Glucosamine sulphate compared to ibuprofen in osteoarthritis of the knee.  Osteo and Cart.  2:61-69
8.Uebelhart D et al.  1998.  Effects of oral chondroitin sulfate on the progression of knee osteoarthritis: a pilot study.  Osteoarthritis Cartilage.  6(Suppl A):39-46
9.Verbruggen G et al.  1998.  Chondroitin sulfate: S/DMOAD (structure/disease modifying anti-osteoarthritis drug) in the treatment of finger joint OA.  Osteoarthritis Cartilage.  6(Supplement A):37-38
10.Bucsi L et al.  1998.  Efficacy and tolerability of oral chondroitin sulfate as a symptomatic slow-acting drug for osteoarthritis (SYSADOA) in the treatment of knee osteoarthritis.  Osteoarthritis Cartilage.  May 6, (Supplement A):31-36.
11.Leeb BF et al.  2000.  A metaanalysis of chondroitin sulfate in the treatment of osteoarthritis.  J Rheumatol.  27(1):205-11
12. Gregory PJ et al.  2008.   Dietary supplements for osteoarthritis. Am Fam Physician. 77(2):177-84.
13.  Wang Y et al.2004.  The effect of nutritional supplements on osteoarthritis.  Altern Med Rev. 9(3):275-96.

Written by Ani Kowal

Sunday 12th October marks World Arthritis Day 2008.  The theme for the day this year is ‘Think Positive’, this acknowledges the fact that many arthritis sufferers are often emotionally affected.  The World Arthritis Day website and the UK site Arthritis Care, both provide fantastic resources which include positive and helpful information to those suffering from arthritis.  This campaign this year focuses on improvement of access to psychological forms of support and self-management courses.
 

Rheumatoid arthritis is an autoimmune disease; a disease when, for unknown reasons, the body starts to attack itself.  In Rheumatoid arthritis the attack occurs on the membranes (synovial membranes) of a joint which becomes chronically inflamed which can cause pain, swelling, morning stiffness, muscle wasting and osteoporosis.  Eventually bone and cartilage is damaged.  Rheumatoid arthritis can affect several joints and commonly occurs in people aged between 30 and 50.  The condition is three times more common in women than men and seems to run in families. Conventional treatment centres around pain relief and reduction of inflammation, most commonly with drugs called NSAIDs, Non steroidal anti-inflammatory drugs.

Healthy eating is important in order to support the body so that it may function optimally.  A balanced diet will provide all the important vitamins, minerals, amino-acids (proteins), essential fatty acids and energy necessary for health.  There is some indication that a healthy diet rich in fruits, vegetables and healthy fats , such as the omega 3 fatty acids found in oily fish and olive oil, is protective against the development of rheumatoid arthritis (e.g.1,2,3).  A study last year(4) found that this kind of Mediterranean-type diet, rich in vegetables, fruits and fish, also seems helpful in relieving some of the symptoms of rheumatoid arthritis, such as pain and early morning stiffness, in those already suffering from the disease.

If you suffer from rheumatoid arthritis you may want to consider talking to your GP/health professional about being allergy tested.  There are medical studies to show that in some individuals who suffer from rheumatoid arthritis, it is made worse when they eat foods they are allergic or sensitive to and made better when they avoid those specific foods (5,6,7,8,9,10).   Please do not attempt an elimination diet without the support of a health professional. 

With regards specific foods and/or supplements that may be helpful to rheumatoid arthritis sufferers the evidence centres mainly around the long chain omega 3 fatty acids, found in oily fish such as mackerel, salmon, trout and sardines.  (Regular readers of my blog will, no doubt, have guessed these fats would have come up somewhere in this post).  These long chain omega 3 fatty acids (EPA and DHA) decrease the production of inflammatory chemicals (such as eicosanoids, cytokines and reactive oxygen species) in the body and also give rise to a family of anti-inflammatory mediators (called resolvins).  Omega 3 fatty acids are therefore potentially very potent natural anti-inflammatory agents.  There have been many studies (11 provides a review) which report anti-inflammatory effects of supplemental fish oil in patients with rheumatoid arthritis. 

The benefits of fish oil in these trials included reduced duration of morning stiffness, reduced number of tender or swollen joints, reduced joint pain, reduced time to fatigue, increased grip strength and decreased use of NSAIDs.  The totality of current evidence really suggests that long chain omega 3 fatty acids so have clinical benefit in rheumatoid arthritis.  One paper(12) concluded that "the findings of benefit from fish oil in rheumatoid arthritis are robust," "dietary fish oil supplements in rheumatoid arthritis have treatment efficacy," and "dietary fish oil supplements should now be regarded as part of the standard therapy for rheumatoid arthritis".

If you are not a regular eater of oily fish (at least twice a week) then you may wish to consider taking a fish oil supplement.  The doses used in trials with rheumatoid arthritis sufferers have varied, you may wish to start by taking 2g of fish oil a day to provide around 500-700mg of EPA and 500-700mg DHA per day (try splitting this dose throughout the day as this will minimise any potential adverse effects on the digestive system).  

In addition to increasing oily fish intake, or taking a supplement, it may be advantageous to simultaneously reduce your consumption of a specific type of fatty acid called ‘arachidonic acid’ this is a specific omega 6 fatty acid found preformed in egg yolk, beef, liver and kidneys (it can also be manufactured in the body from precursor fatty acids found in vegetable oils).  Arachidonic acid can be used by the body to produce chemicals that have potent inflammatory activity.  One study (13) found that fish oils were more efficacious when taken simultaneously with a diet low in arachidonic acid.  In this study fish oil or placebo was given to patients who ate either their typical diet or an ‘anti-inflammatory diet’ that restricted the intake of arachidonic acid-rich foods.  Patients consuming the anti-inflammatory diet in addition to taking the fish oil supplement had significantly lowered inflammatory chemicals in their blood plasma.  The reductions in the number of swollen joints, number of tender joints and pain scores seen with fish oil supplementation were all also greater for patients consuming the anti-inflammatory diet.

For more information on rheumatoid arthritis please visit the Arthritis Care website.

Check back later in the week for information regarding osteoarthritis.

1.Cerhan JR et al.  2003.  Antioxidant micronutrients and risk of rheumatoid arthritis in a cohort of older women.  Am J Epidemiol.  157:345-354
2.Pattison DJ et al.  2004.  Does diet have a role in the aetiology of rheumatoid arthritis?  Proc Nutr Soc.  63:137-143
3. Linos A et al.  1999.  Dietary factors in relation to rheumatoid arthritis: a role for olive oil and cooked vegetables?  Am J Clinical Nutr.  70:1077-1082.
4.McKellar G et al.  2007.  A pilot study of a Mediterranean-type diet intervention in female patients with rheumatoid arthritis living in areas of social deprivation in Glasgow.  Ann Rheum Dis.  66:1239-1243
5.Darlington LG et al.  1986.  Placebo-controlled, blind study of dietary manipulation therapy in rheumatoid arthritis.  Lancet.  i:236-238
6.Darlington LG.  1991.  Dietary therapy for arthritis.  Rheum Dis Clin North Am.  17:273-285.
7.Beri, D., et al.  1988.  Effect of dietary restrictions on disease activity in rheumatoid arthritis.  Ann Rheum Dis.  47:69-72
8.Hicklin JA et al.  1980.  The effect of diet in rheumatoid arthritis. Clin Allergy.  10:463
9.Panush RS et al.  1988.  Diet therapy for rheumatoid arthritis.  Arthritis Rheum.  26:462-471
10.Taylor, M. R.  1983.  Food allergy as an etiological factor in arthropathies:  a survey.  J Internat Acad Prev Med  8:28-38
11.Calder PC.  2006.  N-3 polyunsaturated fatty acids, inflammation and inflammatory diseases.  Am J Clin Nutr.  83:1505S-1519S
12.Cleland LG & James MJ.  2000.  Fish oil and rheumatoid arthritis:anti-inflammatory and collateral health benefits.  J Rheumatol.  27:2305-2307
13.Adam O et al.  2003.  Anti-inflammatory effects of a low arachidonic acid diet and fish oil in patients with rheumatoid arthritis.  Rheumatol Int.  23:27-36

Written by Ani Kowal

Earlier this year a study was published(1) highlighting the fact that local removal of endometriosis, via key-hole surgery, was associated with good short-term outcomes but, on long-term follow-up, such procedures were often unsuccessful and there was a need for further surgeries later on.  The study authors concluded that better treatment is needed for those suffering from endometriosis.  Reading the paper led me to have a look and see if there were any natural remedies associated with an improvement in the condition.

Endometriosis is a painful disease that affects women during their reproductive years and is caused when the tissue lining the uterus starts to grow in other parts of the abdomen, outside of the uterus, such as the ovaries.  The precise mechanism for the development of endometriosis in the pelvis and abdominal cavity has not been elucidated. 

Evidence is accumulating to suggest a role for fish oils (long chain omega 3 fatty acids) in the management of endometriosis (2,3,4). Fish oils appear to reduce the inflammation associated with endometriosis.  Inflammation is mediated by a group of chemical substances in the body known as eicosanoids.  Synthesis of these inflammatory mediators can be influenced by the dietary ratio of omega-3 and omega-6 polyunsaturated fatty acids.  The eicosanoids derived from omega-3 fatty acids are far less potent inflammatory agents, hence it would seem sensible for women who suffer from endometriosis to increase their consumption of omega 3 fatty acids, found in oily fish e.g. mackerel, salmon, trout and sardines or consider taking a supplemet to provide around 250mg of EPA and 250mg DHA daily.  Studies do suggest that women afflicted with endometriosis generally have elevated levels of Leukotriene B4, a potent inflammatory chemical (5).

Very recent preliminary evidence(6) suggests that endometriosis is linked to excessive oxidative stress, and a lower level of vitamin E, an antioxidant.  This was just a small pilot study which needs follow up with larger trials.  However, another small study(7) published in March this year which found that supplementation with the antioxidant vitamins C and E was associated with a decrease in the concentration of oxidative stress markers in women with endometriosis.  The women involved were given 343mg vitamin C and 84mg vitamin E daily or a placebo.  After 4 months the supplemental group had lower levels of oxidative stress markers.

Antioxidants protect our cells from the damaging effects of highly reactive molecules called free radicals, which cause oxidative stress in the body.  There is mounting evidence that these destructive molecules, together with lowered antioxidant defences, play a significant role in the development and aggravation of many diseases.  The body does produce its own antioxidants but also relies on vitamins, mineral and phytochemicals (bioactive plant chemical) from the diet, especially from colourful vegetables and fruits, for additional valuable supplies.

Antioxidants are important for many health reasons (which I have written about in previous posts) and eating plenty of colourful fruits and vegetables daily will provide the body with many antioxidant nutrients.  A healthy diet may well be particularly important to those suffering with endometriosis.  In 2004 a study (8) was carried out in order to investigate the relationship between diet and endometriosis.  The investigation involved 504 women with confirmed endometriosis and 504 women without endometriosis.  Dietary analysis suggested that a high intake of green vegetables and fresh fruit was associated with a significantly reduced risk of endometriosis whereas a high intake of red meat and ham (processed meat) was associated with a significantly increased risk.  Such associations do not show cause but studies like this do help to highlight the importance of a healthy diet, especially the real benefits of fruits and vegetables for disease prevention.  Taking a broad-spectrum antioxidant (or multi nutrient) supplement, in addition to a healthy diet, is also an option in order to ensure good intake levels are constantly achieved. 

For more information on endometriosis please contact Endometriosis UK, a charity dedicated to supporting women with the condition, or endometriosis.org a global forum for information about endometriosis.

(1) Shakiba K et al.  2008.  Surgical Treatment of Endometriosis: A 7-Year Follow-up on the Requirement for Further Surgery. Obstet. Gynecol.  111:1285 -1292.
(2)Covens AL et al.  1988.  The effect of dietary supplementation with fish oil fatty acids on surgically induced endometriosis in the rabbit.  Fertil Steril.  49(4):698-703.
(3)Gazvani MR et al.  2001.  High omega-3:omega-6 fatty acids in culture medium reduce endometrial gland and stromal cell cultures from women with and without endometriosis.  Fertil Steril.  76:717-722
(4)Yano, Y.  1992.  Effect of dietary supplementation with eicosapentaenoic acid on surgically induced endometriosis in the rabbit.  Nippon Sanka Fujinka Gakkai Zasshi.  44(3):282-288.
(5)Pungetti D et al.  1987.  Prostanoids in peritoneal fluid of infertile women with pelvic endometriosis and PID.  Acta Eur Fertil.  18(3):189-192.
(6)Campos Petean C et al.  2008.  Lipid peroxidation and vitamin E in serum and follicular fluid of infertile women with peritoneal endometriosis submitted to controlled ovarian hyperstimulation: a pilot study.  Fertil Steril. 2008 Feb 2. [Epub ahead of print]
(7) Mier-Cabrera J et al.  2008 Effect of vitamins C and E supplementation on peripheral oxidative stress markers and pregnancy rate in women with endometriosis. Int J Gynaecol Obstet. 100:252-256
(8) Parazzini F et al.  2004.  Selected food intake and risk of endometriosis. Hum Reprod.  19:1755-1759.

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).

Sugar, carbohydrates and balancing blood sugar levels
You may well be wondering what sugar and blood sugar levels have to do with heart disease.  A lot!  Unfortunately over the years ultra low fat diets have been touted as being the major players in the protection against heart disease, this led many people to eat diets that were high in sugar and/or high in (non-vegetable and fruit) carbohydrates.  Many low-fat foods contain ample amounts of added sugar and are often highly refined/processed.  Previously (see posts dated 8th September and 9th September) I mentioned the importance of providing the body with a steady supply of energy and preventing blood sugar imbalances in order to prevent fatigue.  Well, balanced blood sugar levels also seem to be incredibly important in preventing heart disease (and don’t just affect diabetics as you may well have thought).  Simply lowering the total amount of fat in the diet is unlikely to improve fat (lipid and cholesterol) profiles or reduce coronary heart disease (CHD) risk (1). 

Foods that release sugar quickly into the bloodstream have what is known as a high Glycaemic Index (GI), meals that favour a spike in blood sugar levels are said to have a high Glycaemic Load (GL).  To identify foods with a high glycaemic index that will contribute to increasing the GL of a meal please view the website The Glycemic Index, there you will find a database where you can search for specific foods and find out more about GI and health. 

Unbalanced blood sugar levels following a meal (post-prandial dysmetabolism) can cause havoc in the body.  A high post-meal blood sugar level can lead to damaging free radicals (reactive oxygen molecules) being released which are a risk for atherosclerosis (damage to blood vessels) and metabolic syndrome (a big risk factor for heart disease).  The high blood sugar can lead to internal inflammation, dysfunction in the lining of the blood vessels and may also lead to an increase in triglycerides (blood fats) - all risk factors for heart disease (2,3).  A recent review paper(3) looked at how the current western diet, which favours meals that cause spikes in blood glucose, can be improved in order to exert immediate favourable changes in post-meal glucose dysregulation.  The authors found that: 

“Specifically, a diet high in minimally processed, high-fiber, plant-based foods such as vegetables and fruits, whole grains, legumes, and nuts will markedly blunt the post-meal increase in glucose, triglycerides (blood fats), and inflammation”.  Additionally they found that lean protein, fish oil, weight loss and exercise also prevent post-meal glucose spikes.

Eat healthy fats to protect the heart.
You guessed it, I am going to talk about omega 3 fatty acids and fish oils again!  Omega 3 fatty acids are essential to the body and so following a fat-free diet really isn’t clever for health reasons.

Raised triglyceride (fat) levels in the blood are a risk for CHD, they often occur in conjunction with accumulation of central body fat, blood sugar and insulin problems and raised levels of what is known as SDLDL cholesterol (small dense low density lipoprotein cholesterol) a very destructive type of cholesterol.  Together these risk factors for CHD are known as the metabolic syndrome (or syndrome X).  Metabolic syndrome is present in about 25% of the UK middle aged population and its' importance as a risk for CHD development is now well established (4).  Raised blood fat levels can be lowered by losing weight and eating a diet that prevents blood sugar fluctuations, as mentioned above. 

Another way of reducing blood fat levels is by including oily fish (e.g. salmon, mackerel and sardines), a rich source the healthy omega 3 fats (EPA and DHA), in the diet or taking fish oil supplements.  Trials have confirmed the blood fat (triglyceride) lowering effects of fish oils.  In one study(5) supplementation with 3g/d reduced post-meal triglyceride rises by 26% and reduced fasting triglyceride levels by 35%.  Fish oils and consumption of oily fish also seem to provide many other benefits for CHD, there is evidence that they can, reduce blood pressure, prevent blood clotting, prevent abnormal heart beats (arrhythmias), reduce inflammation and reduce constriction in blood vessels – all factors that may reduce CHD risk (6,7). 

Very recently a study(8) found that the low risk of heart disease in the Japanese population may well be due to their high intakes of omega 3 fatty acids from fish oils.  Another large study (9), released only a few weeks ago, has found that an omega 3 fatty acid supplement reduced death and admission to hospital for all cardiovascular reasons in people with existing heart problems.  If you are vegetarian/vegan another recently published study paper (10) has found that flaxseed oil, a vegetarian oil rich in the omega 3 fatty acid alpha-linolenic acid, could be protective against heart problems and heart attacks.

If you do not regularly consume oily fish (at least twice per week) you may wish to consider a fish oil supplement providing around 250mg of EPA and 250mg of DHA daily.  For vegetarians a flaxseed oil supplement providing around 500-700mg of alpha linolenic acid could be considered.

While a lot of emphasis has been placed on the need to avoid saturated fat in the diet (red meat, diary, eggs), there is mounting evidence (e.g. 11,12,13) to suggest that the fats known as ‘partially hydrogenated’ and ‘trans fatty acids’ are more of a risk factor for CHD. These fats, found in many fast foods, baked goods, processed foods and margarine are associated with an increased risk of heart disease, it makes sense to avoid such ‘trans’ fatty acids.

Please look after your heart.  Eat healthy foods which are minimally processed and include plenty of fruits and vegetables into your daily meals, try to incorporate some form of exercise (walking counts) into your day, try and quit the cigarettes if you are a smoker and don’t let stress rule your life.  If you have any concerns regarding symptoms then speak to your GP.  Take some time to look at the British Heart Foundation website and become heart health aware!

(1)Hu FB & Willett WC.  2002.  Optimal diets for prevention of coronary heart disease.  JAMA.  288(20):2569-78.
(2)Livesey G et al.  Glycemic response and health--a systematic review and meta-analysis: relations between dietary glycemic properties and health outcomes.  Am J Clin Nutr.  87:258s-268s
(3)O’Keef JH et al.  2008.  Dietary strategies for improving post-prandial glucose, lipids, inflammation, and cardiovascular health.  J Am Coll Cardiol. 51(3):249-55.
(4) Griffin BA & Fielding BA.  2001.  Postprandial lipid handling.  Curr Opin Clin Nutr Metab Care.  4:93-98.
(5) Minihane, AM. et al.  2000.  ApoE polymorphism and fish oil supplementation in subjects with an atherogenic lipoprotein phenotype.  Arterioscler Thromb Vasc Biol.  20:1990-1997.
(6) Kris-Etherton PM et al.  2003.  Fish consumption, fish oil, omega 3 fatty acids, and cardiovascular disease.  Circulation.  106:2747-2759
(7) Nordoy A et al.  2001.  n-3 Polyunsaturated Fatty Acids and Cardiovascular  Diseases.  Lipids.  (Suppl)36:S127-S129
(8)Sekikawa A et al.  2008.  Marine-Derived n-3 Fatty Acids and Atherosclerosis in Japanese, Japanese-American, and White Men: A Cross-Sectional Study.  J Am Coll Cardiol.  52:417-424
(9)GISSI-HF 2008.  Effect of n-3 polyunsaturated fatty acids in patients with chronic heart failure (the GISSI-HF trial): a randomised, double-blind, placebo-controlled trial.  The Lancet.  E-Pub ahead of print August 2008  DOI:10.1016/S0140-6736(08)61239-8
(10)Campos H et al.  2008.   -Linolenic Acid and Risk of Nonfatal Acute Myocardial Infarction.  Circulation.  E-Pub before print July 2008.   doi: 10.1161/CIRCULATIONAHA.107.762419
(11) Ascherio A.  2002.  Epidemiologic studies on dietary fats and coronary heart disease.  Am J Med.  30;113 Suppl 9B:9-12.
(12)Ascherio A & Willett WC.  1997.  Health effects of trans fatty acids.  Am J Clin Nutr.  66:1006s-1010s
(13) Oomen CM et al.  2001.  Association between trans fatty acid intake and 10-year risk of coronary heart disease in the Zutphen Elderly Study: a prospective population-based study.  Lancet.  357(9258):746-51.

Written by Ani Kowal

Following on from Monday, here are some more important dietary and lifestyle factors that may help to prevent prostate problems:

Lycopene is an antioxidant carotenoid that I have mentioned a few times in my blog posts.  It can be found within red/orange coloured fruits and vegetables such as tomatoes, watermelon, pink and red grapefruits, guava and papaya .  A review of multiple studies was published this year(1), it discusses the role of lycopene in the prevention of prostate cancer.  The paper states “Based on the evidence from epidemiologic [association/observational studies], animal, in vitro [test tube] and human clinical trials, it is evident that lycopene, a non-provitamin A carotenoid, is a promising agent for prostate cancer prevention”, the authors go on to suggest that larger trials should be implemented in order to assess whether this nutrient could be used as a medical agent for prostate cancer prevention.  If you do not regularly consume lycopene containing foods you may wish to consider a lycopene supplement.  Absorption of lycopene from foods, or indeed supplements, is affected greatly by fat.  Without a fat source lycopene will not be efficiently absorbed into the body so you would do well to find supplements that contain an oil base (there are many available) and dress any salads or vegetables with a little olive oil.  Studies (2,3) also suggest that lycopene may be useful in reducing the risk and progression of BPH.

Again I am going to mention oily fish and the essential omega 3 fatty acids which they contain!  It seems that I mention these essential fats consistently through my blog posts – they are certainly not labelled ‘essential’ for no reason!  Back in 1999 a study(4) in men found that patients with prostate cancer and BPH had significantly lower levels of omega 3 fatty acids in their blood serum compared to healthy men with no signs of either disease.  A study published in 2004(5) involved a cohort of 47,866 men aged 40-75 with no history of cancer at the start of the study (in 1986).  They were followed for 14 years during which time 2965 new cases of prostate cancer were diagnosed, 448 cases being advanced.  A higher intake of the omega 3 fatty acids EPA and DHA (found in oily fish such as salmon, mackerel, sardines and trout) was related to a lower risk of prostate cancer and advanced prostate cancer.  Frequent oily fish consumption has also been strongly associated with a decreased risk of prostate cancer in other studies(6,7). 

Trying to eat at least two portions of oily fish per week would probably benefit multiple health factors, it is yet unknown whether there is a benefit from taking supplemental omega 3 fatty acids for reducing the risk of prostate cancer.  However, if you are not a regular eater of oily fish I would suggest a daily supplement providing around 250g of EPA and 250g of DHA daily.  Since these fatty acids are known to reduce inflammatory markers in the body they may well be helpful in preventing BPH.

Eating well is important for every cell in our body!  A healthy diet could certainly help protect your prostate! 

It is also important for me to mention exercise.  Studies show that men who regularly take some form of physical activity have reduced incidence of BPH and other urinary tract symptoms(8,9).  I am not suggesting a daily pounding of the treadmill in the gym or excessive iron-man measures.  Walking could be enough to help!  One study(9) found that walking for 2-3 hours per week was associated with a 25% reduced risk of having BPH compared to those not walking.  Choose an activity you enjoy, something that gets you moving a few times per week.

(1)Dahan M et al.  2008.  Lycopene in the prevention of prostate cancer.  J Soc Integr Oncol.  6:29-36
(2)Kristal AR et al.  2008.  Dietary patterns, supplement use, and the risk of symptomatic benign prostatic hyperplasia: results from the prostate cancer prevention trial.  Am J Epidemiol.  167:925-934
(3)Schwarz S et al.  2008.  Lycopene inhibits disease progression in patients with benign prostate hyperplasia.  J Nutr.  138:49-53
(4)Yang YJ et al.  1999.  Comparison of fatty acid profiles in the serum of patents with prostate cancer and benign prostatic hyperplasia.  Clin Biochem.  32:405-409.
(5)Leitzmann MF et al.  2004.  Dietary intake of n-3 and n-6 fatty acids and the risk of prostate cancer.  Am J Clin Nutr.  80:204-216
(6)Hedelin M et al.  2007.  Association of frequent consumption of fatty fish with prostate cancer risk if modified by COX-2 polymorphism.  Int J Cancer.  120:398-405
(7)Augustsson K et al.  A prospective study of intake of fish and marine fatty acids and prostate cancer.  Cancer Epidemiol Biomarkers Prev.  12:64-67
(8)Orsini N et al.  2006.  Long-term physical activity and lower urinary tract symptoms in men. J Urol.  176:2546-50
(9) Platz EA et al.  1998.  Physical activity and benign prostatic hyperplasia.  Arch Intern Med.  158:2349-56.

Written by Ani Kowal

My last posting concentrated on new evidence suggesting that desk work could be contributing to overeating.  Staying on the work theme I wanted to briefly mention a recent(1) study published by ComPsych Corporation that reveals how healthy eating seems to improve our energy levels at work.

ComPsych Corporation is the world’s largest provider of employee assistance programs, operating in 92 countries.  They also provide services to address employee behavioural health, wellness and work-life balance.  Their 2008 workplace wellness study, which surveyed over 1000 employees in the US, revealed that 50% of workers with balanced diets have high energy compared to only 5% with those with unbalanced diets.  In addition to the aforementioned results the study also found that of the employees with healthy diets 73% reported having high levels of productivity compared to 24% of employees with poor dietary habits.  51% of employees who were not overweight had high morale compared to 25% who were overweight.

It seems obvious to me that continual feelings of high energy will help keep us motivated and hence productive at work.  Healthy eating can impact us in many ways.  Providing the body with optimal nutrition will keep us functioning well both mentally and physically.  Not rocket science really!

In the last post I mentioned the stress hormone cortisol and the possible effects of work on our blood sugar balance.  ‘Stress’ within the workplace is really a ‘fight or flight’ response to a mental challenge but it can become a problem when it is too much for an individual to handle.  Hormones such as cortisol and adrenaline flood the body during stressful times and cause digestion to slow, muscles to tense, heart rate to rise and blood sugar levels to fluctuate.  In a situation such as a tiger about to attack us this is a beneficial response as we use all our energy to flee the scene!  If we are at our desks in a work situation and this energy and tension is not discharged it starts to have an effect all of our organs and cells which can lead to health problems ranging from high blood pressure to digestive problems, sleep problems and even cancers.  Each of us responds differently under pressured situations so stress is a very personal issue.  There are many ways that we can attenuate the negative effects of too much work and mental pressure.  Exercise, relaxation, avoiding caffeine, reducing alcohol levels, making room for fun and eating a balanced and healthy diet can all help.

In addition to ensuring a diet that is as healthy as possible there are a few specific nutrients which may help support the body during times of stress.

Stress seems to promote the release of inflammatory chemicals in the body.  Omega 3 fatty acids may inhibit the ability of excess stress to initiate inflammation.  Excessive amounts of omega 6 fatty acids (found in vegetable oils), and a relative lack of omega 3 fatty acids (found in oily fish and some nuts and seeds) also seems to promote inflammation in the body. Maintaining a balance of omega 6 and omega 3 fatty acids i.e. avoidance of excessive amounts of margarine and vegetable oils and the regular inclusion of oily fish (e.g. salmon and mackerel), walnuts and flaxseeds in the diet may therefore benefit individuals during times of stress.  In one(2) study twenty-seven university students had their blood serum sampled a few weeks before and after, as well as one day before, a difficult oral examination (a time of considerable stress).  This stress was associated with a significant increase in the production inflammatory chemicals in the body (cytokines).  Subjects with high omega-6 fatty acid levels had a greater production of these inflammatory cytokines compared with subjects with high omega-3 fatty acid levels. Another study (3) found that supplementation with fish oils inhibited the release of the stress hormones adrenaline and cortisol in response to mental stress.  If you are not a regular eater of oily fish you may wish to consider a supplement that provides around 250mg of EPA and 250mg of DHA (long chain omega 3 fatty acids) daily.  Or, if you are vegetarian/vegan, a daily flaxseed oil supplement providing around 500mg alpha-linoleic acid.

Another useful nutrient during times of stress is the mineral magnesium.  Studies have shown that excessive stress may cause the depletion of magnesium within the body (4,5).  Many people in the UK do not get enough magnesium in their diets.  Rich sources include nuts, seeds, pulses (beans, chickpeas) and wholegrain cereals.  If you feel you are not regularly eating these foods you may wish to consider a supplement providing around 300mg of magnesium a day.  

Finally I would like to mention gut bacteria (for more information see IBS post part I). Studies have shown that excessive stress can cause the depletion of beneficial ‘good’ bacteria (such as species of lactobacilli and bifidobacteria) in the intestinal tract (6) Individuals may therefore benefit from taking a probiotic and prebiotic in times of stress.  One study(7) evaluated the use of a probiotic multivitamin supplement in 42 adults suffering from stress or exhaustion.  The supplement was taken daily for 6 months.  At the end of the study, an overall 40.7% improvement in stress was noted.  In addition, decreases of 29% in the frequency of infections and of 91% in gastrointestinal discomforts, both established indicators of stress, were recorded.  This was probably due to a combination of both the vitamins and the probiotics.  It is also known that stress can cause depletion of certain antioxidant vitamins in the body.

A balanced diet that prevents fluctuations in blood sugar levels (see post dated Monday 8th September) that includes a variety of vegetables and fruits together with healthy fats from nuts, seeds and oily fish and minimal amounts of processed and refined foods will really help to support the body during times of stress (well at all times really!)

(1)ComPsych 2008 Health and Productivity Index.
(2)Maes M  et al.  2000.  In humans, serum polyunsaturated fatty acid levels predict the response of proinflammatory cytokines to psychologic stress.  Biol Psychiatry.  47(10):910-920.
(3)Delarue, J., et al.  Fish oil prevents the adrenal activation elicited by mental stress in healthy men.  Diabetes Metab.  29(3):289-295, 2003.
(4) Johnson S et al.  2001.  The multifaceted and widespread pathology of magnesium deficiency.  Medical Hypotheses.  56(2):163-170.
(5) Cernak I et al.  2000.  Alterations in magnesium and oxidative status during chronic emotional stress.  Magnes Res.  13:29-36
(6)Lizko NN et al.  1984.  [Events in the development of dysbacteriosis of the intestines in man under extreme conditions.]  Nahrung.  28:599-605.
(7)Gruenwald J et al.  2002.  Effect of a probiotic multivitamin compound on stress and exhaustion.  Adv Ther.  19(3):141-50

Written by Ani Kowal

Continuing with the theme of child health I have decided to look at the prevention of common infections such as those of the ear, nose and throat, and tummy upsets.  Children returning to school after the long holiday break will be exposed to others who they may not have seen in weeks and also to the various ‘bugs’ that they may be carrying.  Fear not, it is not inevitable that your children will end up feeling poorly and catching every illness around them! 

A healthy, strong immune system will help to prevent various infections, or keep them short and less intense if they do occur.  Ensuring that your child is eating healthily will mean that they are getting all the vitamins, minerals and essential fatty acids they need in order to keep their immune system fighting fit.  However, I am aware that many children are not regularly getting the recommended daily 5 portions of fruit and vegetables.  This may mean that they are lacking in essential nutrients and their immune system may not be running at optimum.  Certain supplements, specially formulated for children, may be helpful in supporting a healthy diet in order to keep the immune system healthy.  However, a supplement cannot be seen as a replacement for the foundations provided by a healthy lifestyle.

Here I will be looking at some of the evidence which suggests that a multivitamin and mineral supplement taken together with a fish oil supplement (to provide essential omega 3 fatty acids) and a pre/pro-biotic supplement could be useful in helping to prevent childhood infections. 

Two papers have been published by a group of researchers who used a fish oil and multivitamin-mineral supplement in children who regularly suffered from recurrent ear(1) and sinus(2) infections.  The studies were very small and preliminary but both suggested benefit in the prevention of these common childhood conditions.  The researchers suggest that such preventative treatments could reduce the need for prescribed antibiotics.  Evidence also exists to suggest that individuals who suffer from recurrent tonsillitis infections may have a disturbed balance of various vitamins(3,4) and minerals(5), especially lowered zinc levels.

Previously I have written about zinc and vitamin C in relation to the prevention and shortening of the common cold and I would recommend you visit this post for more information. 

A few months ago I wrote about the importance of maintaining a good balance of ‘friendly’ bacteria in the digestive system in order to boost immune function and how evidence suggests that taking a daily probiotic supplement may prevent the occurrence of the common cold.  Children who have suffered from recurrent infections will normally have been exposed to frequent courses of antibiotics.  Antibiotics may indeed have been useful for fighting the bacterial infection, however they also kill many of the beneficial bacteria that would normally live in a healthy gut.  This imbalance could lead to a less efficient immune system and an increased likelihood of further infections.  One study(6) revealed that; in children with acute infections of the upper and lower respiratory tract, such as bronchitis and pneumonia, a probiotic supplement seemed helpful in regulating the immune system.  A recent review paper(7) indicated that probiotics also have immune enhancing effects in children and may prevent infections and diarrhoea. 

A daily supplement containing probiotics and prebiotics (such as FOS fructooligosaccharides) may be worth considering.  For more information on prebiotics and probiotics I would suggest visiting the post on irritable bowel syndrome which defines and explains these supplements.

When considering multi-nutrient supplements I would suggest a child-specific ‘food-state’ supplement as these will be easily absorbed by the body.  Again I would like to stress that supplements should not be seen as a substitute for a healthy, balanced diet plentiful in a variety of colourful fruits, vegetables and healthy fats. 

Best wishes to all children for an enjoyable first term back at school!

(1)Linday LA, Dolitsky JN, Shindledecker RD, Pippenger CE. 2002.  Lemon-flavored cod liver oil and a multivitamin-mineral supplement for the secondary prevention of otitis media in young children: pilot research. Ann Otol Rhinol Laryngol.  111(7 Pt 1):642-52.
(2)Linday LA, Dolitsky JN, Shindledecker RD.  2004.  Nutritional supplements as adjunctive therapy for children with chronic/recurrent sinusitis: pilot research. Int J Pediatr Otorhinolaryngol.  68(6):785-93.
(3)Aleszczyk J et al.  2001.  [Evaluation of vitamin and immune status of patients with chronic palatal tonsillitis][Polish Article].  Otolaryngol Pol.  55:65-67
(4)Shukla GK et al.  1998.  Comparative status of oxidative damage and antioxidant enzymes in chronic tonsillitis patients.  Boll Chim Farm.  137:206-209
(5)Onerci M et al.  1997.  Trace elements in children whith chronic and recurrent tonsillitis.  Int J Pediatr Otorhinolaryngol.  41:47-51
(6)Lykova EA, Vorob'ev AA, Bokovoi AG, Murashova AO.  2001.  [Impaired interferon status in children with acute respiratory infection and its correction with bifidumbacterin-forte] [Article in Russian].  Zh Mikrobiol Epidemiol Immunobiol.   Mar-Apr;(2):65-7 
(7)Nova E, Wärnberg J, Gómez-Martínez S, Díaz LE, Romeo J, Marcos A. Immunomodulatory effects of probiotics in different stages of life. Br J Nutr. 2007 Oct;98 Suppl 1:S90-5.

Written by Ani Kowal

The long summer holidays have ended and children are heading back into their classrooms.  Over the last few years the press have been giving increasing coverage to a condition known as ADHD (attention deficit hyperactivity disorder).  Today I would like to write about essential fatty acids, one of the many nutritional aspects associated with the condition. 

The following facts were provided by a fantastic charity – Food for the Brain(1) – a non-profit educational charity, created by a group of nutritionists, doctors, psychiatrists, psychologists, teachers and scientists to promote the link between nutrition and mental health.

 
-Children with ADHD often have three basic problems, they can't pay attention, they are hyperactive and they act on impulse.
-It is estimated that up to 5% of school-age children in England and Wales have ADHD – representing around 67,000 children.
-In a class of 30 children there will be one or two children with ADHD.
-Boys seem more likely to have ADHD than girls.
-In the UK, between three and nine boys are diagnosed with ADHD for every girl diagnosed, this may be because boys and girls tend to have different symptoms of ADHD.
-Inattention is more common among girls while hyperactivity is more common among boys.  A boy who is hyperactive (shouting, running about and getting into trouble) may be more noticeable than a girl who is inattentive (daydreaming, forgetful and easily distracted).
-It is estimated that between 30% and 70% of children with ADHD continue to exhibit symptoms in the adult years.

In this blog post I am going to concentrate on the potential usefulness of long chain omega 3 fatty acids (EPA and DHA found in oily fish such as salmon, mackerel, sardines) in the management of ADHD.  These essential fatty acids are crucial to brain development and brain function and increasing evidence indicates that deficiencies or metabolic imbalances of these fatty acids might be associated with childhood developmental and psychiatric disorders including ADHD. Omega-3 are often lacking in modern diets and as I will discuss here, preliminary evidence suggests that supplementation may well be helpful in the management of ADHD and linked behavioural and learning difficulties (such as dyslexia and dysphraxia).

Children with ADHD are often found to have nutrient deficiencies, especially in essential fatty acids(2,3,4). Common symptoms of deficiency may include dry, flaky skin, frequent urination and excessive thirst.  However, symptoms vary or may be absent altogether.

Clinical trials with nutrients and behaviour problems are not easy to conduct as the diagnosis and tracking relies on behavioural criteria and trials do not allow for individual tailoring of treatments.  The data for nutritional management of ADHD is still preliminary but growing rapidly.  Personally I see the links as being exceptionally strong and I know that many other health professionals feel the same way as I do.  The brain needs optimal nutrition to function effectively.  If we are not getting enough vitamins, minerals and essential fatty acids from our diets then we are bound not to be at our best!

One of the leading researchers into learning/behavioural difficulties and nutritional supplementation in the UK is Dr Alexandra Richardson.  Dr Richardson is an inspiration and I have been privileged enough to hear her speak on a number of occasions.  In 2002 she published a paper(5) which detailed a small trial conducted with 41 children, aged 8-12, who had specific learning difficulties (mainly dyslexia) who also showed ADHD features.  The children were given essential fatty acid supplements or a placebo for 12 weeks.  After 12 weeks cognitive (learning/mental) problems and behaviour problems were significantly lower for the group treated with fatty acids.  This small pilot study paved the way for further small studies which all indicate the importance of essential fatty acids in the management of behavioural problems(6,7,8,9).  Unfortunately large scale trials are still needed but funding is notoriously difficult to find for nutritional intervention trials (compared with drug trials). 

Dr Richardson wrote a review paper(10) detailing current thinking around essential fatty acids in childhood developmental and psychiatric disorders.  In it she details the fact that long chain omega-3 fatty acids (EPA and DHA) are often lacking in our diets and that evidence has built up to suggest that deficiencies and/or imbalances are associated with childhood developmental and psychiatric disorders including ADHD, dyslexia, dyspraxia, and autistic spectrum disorders.  The current evidence seems very supportive of dietary supplementation with these fatty acids, particularly EPA (eicosapentaenoic acid).  Dr Richardson stresses the need for large-scale studies to determine optimal treatment formulations and doses and the need to develop ways of identifying individuals most likely to benefit.  She points out “Childhood developmental and psychiatric disorders clearly reflect multifactorial influences, but the study of LC-PUFA [long chain polyunsaturated fatty acids] and their metabolism could offer important new approaches to their early identification and management”

Omega 3 fatty acid supplementation will not help all children affected by ADHD.  However, omega 3 fatty acids are beneficial to health for a number of reasons (which I frequently mention in my blog posts) and, as many of us do not consume oily fish regularly (at least twice per week as a minimum), supplementation seems prudent to make up for the dietary lack. 

A daily supplement providing around 300-500mg of EPA and 250mg of DHA may be worth trying.  The appropriate dose for the improvement of mood and cognition varies.  Some of the trials with ADHD used up to 1000mg EPA.  The quality of the supplement also needs consideration as fish oils may be contaminated with heavy metal residues e.g. mercury.  Supplements containing Vitamin E or C are worthwhile as these vitamins prevent the oil from oxidation (going rancid).  High dose fish liver oils are not recommended as these contain large amounts of vitamin D and A which can be toxic if taken in excess.   

There are many other nutritional factors (vitamins and minerals) associated with ADHD and related conditions and I hope to cover these important topics in time.  Any dietary interventions with children needs to be closely monitored and I would suggest speaking with your GP or health professional before embarking on a regimen.  Dietary interventions are to be viewed as complementary to any other management approaches.  Individual cases need individually tailored treatment. 

Please visit the Food For The Brain website for more ideas and information. 

(1)www.foodforthebrain.org
(2)Burgess JR et al.  2000.  Long-chain polyunsaturated fatty acids in children with attention deficit hyperactivity disorder.  American Journal of Clinical Nutrition.  71(1):327-330.
(3)Mitchell EA, et al.  1987.  Clinical characteristics and serum essential fatty acid levels in hyperactive children. Clin Pediatr.  26:406-411
(4)Stevens LJ et al.  1995.  Essential fatty acid metabolism in boys with attention-deficit hyperactivity disorder. Am J Clin Nutr.  62:761-768
(5)A. Richardson and B. Puri.  2002.  A randomized double-blind, placebo-controlled study of the effects of supplementation with highly unsaturated fatty acids on ADHD-related symptoms in children with specific learning difficulties.  Prog Neuropsychopharmacol Biol Psychiatry, Vol 26(2):233-9
(6)Colter AL et al.  2008.  Fatty acid status and behavioural symptoms of attention deficit hyperactivity disorder in adolescents: a case-control study. Nutr J.14;7:8.
(7)Johnson M et al.  2008.  Omega-3/Omega-6 Fatty Acids for Attention Deficit Hyperactivity Disorder: A Randomized Placebo-Controlled Trial in Children and Adolescents.  J Atten Disord.  Apr 30. [Epub ahead of print]
(8)Sinn N, Bryan J.  2007.  Effect of supplementation with polyunsaturated fatty acids and micronutrients on learning and behavior problems associated with child ADHD. J Dev Behav Pediatr.28(2):82-91.
(9)Effects of an open-label pilot study with high-dose EPA/DHA concentrates on plasma phospholipids and behavior in children with attention deficit hyperactivity disorder.
Sorgi PJ et al.  2007.  Nutr J. 13;6:16.
(10)Richardson AJ.  2004. Long-chain polyunsaturated fatty acids in childhood developmental and psychiatric disorders.  Lipids. 39(12):1215-22.

Written by Ani Kowal

Sticking to the theme of eye health I wanted to briefly write about cataracts today.  Cataracts are cloudy areas that develop in the lens of the eye, the cloudiness reduces the amount of light transmitted to the retina and this causes poor vision.  In the UK about 1 in 3 people over the age of 65 develop a cataract, which gradually forms over many years.  Initially vision may only be very mildly affected and this may not progress, however, in some individuals the vision will get worse over time. 

Treatment is an option when a cataract becomes bad enough to interfere with normal life e.g. if vision starts to interfere with reading, driving, watching TV etc or stops an individual from doing anything that they would normally do.  Before making a decision about treatment it is recommended to make sure your glasses are giving you maximum benefit.  Treatment involves the removal of the cloudy lens and replacement with an artificial plastic lens (an intraocular implant).

Cataracts seem to occur due to the breakdown and subsequent clumping of proteins in the lens.  Obviously, prevention is always better than cure!  Lifestyle factors that may increase the risk of cataract development include a poor diet low in antioxidant nutrients (found in fruits and vegetables), smoking and prolonged sunlight exposure.  Again, as with AMD, free radicals appear to play a causal role and hence dietary antioxidants may be protective.

I would like to highlight three (1,2,3) very recent research studies.  The first study(1) looked at the association between cataracts and dietary lutein and zeaxanthin, caroteinoids found in spinach, collard greens and kale.  The study involved 1802 women aged 50 to 79 years.  Women with high dietary levels of lutein and zeaxanthin had a 23% lower prevalence of cataract compared to those with low levels.  Women with the highest dietary intakes or highest blood serum levels of lutein and zeaxanthin as compared with those with the lowest were 32% less likely to have cataract.  For more information on these carotenoids and potential supplements please refer to Monday's post which looked at AMD.

The researchers involved in the second study(2) wanted to investigate the relationship between antioxidant nutrient intakes and incidence of age-related cataract over a 10 year period.  The study involved 2464 individuals (aged 49 or over at the start of the study) for 5-10 years.  Eye health was observed using lens photography and dietary intakes of various antioxidants, including zinc, beta carotene, vitamins A, C and E, was assessed.  Individuals with the highest total intake, from diet and supplements, of vitamin C had a 45% reduced risk of cataract.  An above average intake of combined antioxidants -vitamins C and E, beta-carotene, and zinc - was associated with a 49% reduced risk of cataract.  The authors of the study conclude that “Higher intakes of vitamin C or the combined intake of antioxidants had long-term protective associations against development of nuclear cataract in this older population”.

Both of these studies, as in the studies I highlighted in relation to eye health on Monday, re-iterate the importance of a diet rich in vegetables and fruits, which are fabulous sources of antioxidants.  As yet the role for supplementation in the prevention of cataract is unclear (and cannot, of course, substitute diet) but many individuals are taking multivitamin and mineral supplements to help keep their eyes, and bodies, healthy.  Future large supplementation trials are planned and I look forward to seeing the results.

The third study(3) involved around 2000 individuals aged 49 or over (at the start of a 5 year investigatory period).  The researchers found that higher dietary intakes of omega-3 polyunsaturated fatty acids were associated with a significantly reduced risk (42% compared to those with the lowest intakes) of developing cataract over 5 years.   For more information regarding omega 3 fatty acids and eye health please refer to the piece that I posted on Monday which looked at AMD.

(1)Moeller SM et al.  2008.  Associations between age-related nuclear cataract and lutein and zeaxanthin in the diet and serum in the carotenoids in the age related eye disease study, an ancillary study of the women’s health initiative.  Arch Opthalmol.  126:354-364
(2)Tan AG et al.  2008.  Antioxidant intake and the long-term incidence of age-related cataract: the blue mountains eye study.  Am J Clin Nutr.  87:1899-1905
(3)Townend BS et al.  2007.  Dietary macronutrient intake and five year incident cataract: the blue mountains eye study.  Am J Opthalmol.  143:932-939.

Written by Ani Kowal