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

Both of the review studies(1,2) that I mentioned yesterday discuss the growing evidence that probiotics, supplemental beneficial bacteria, seem helpful in managing IBS.  Probiotics may help by reducing the level of inflammatory chemicals (cytokines), implicated in IBS.  Imbalances in gut bacteria can lead to chronic low-level inflammation in the intestines and the measurable presence of inflammatory markers in the bloodstream.   There are complications with the scientific studies that have taken place to date as it seems that the type of bacterial probiotic supplement used may be responsible for the degree of improvement noted in IBS sufferers.  Supplements containing Bifidobacteria seem to be especially effective.

(For definitions of probiotic, prebiotic and symbiotic please read Part I)

The problem with probiotic only supplements is the survival of the bacteria through our digestive system before they arrive at the large intestine.  It is often impossible to know how many, and which, live organisms are present in the supplements.  It is important to look for brands that are enteric-coated, so that the bacteria are not destroyed/digested by the stomach.  It is thought that probiotics work only as long as they are being taken, i.e. as the probiotic is no longer consumed, the added bacteria are rapidly washed out of the colon.  Hence prebiotic or a symbiotic supplements are probably the most beneficial in the long-term.  Another useful point to remember is that the bacteria are killed by heat so try not to take your probiotic supplement whilst drinking your morning cup of tea! 

Recently there have been some trials using symbiotics(3,4,5), supplements containing both probiotics and prebiotics, in the treatment of IBS and they have shown encouragingly positive results.  Two studies(3,4) found that the prebiotic-probiotic treatment significantly reduced feelings of general ill health, nausea, indigestion and flatulence.  Another study (5) found that a prebiotic-probiotic preparation was particularly helpful for sufferers of constipation-type IBS.  The supplement reduced general IBS symptoms, bloating and abdominal pain and increased stool frequency.

Larger trials are needed but a symbiotic supplement containing both probiotics and prebiotics may well be worth a try if you are suffering with the discomfort of IBS.  Look for supplements containing bifidobacteria and lactobacilli as these seem to be most beneficial.  After an initial period of a month or so you may wish to switch to a prebiotic (FOS) only supplement to maintain consistently high levels of gut friendly bacteria.  As I mentioned in an earlier post, I take a daily FOS supplement out of habit now and feel good on it!  Bacterial balance has been implicated in many conditions (not just those related to the digestive system) and may be important for keeping our immune system healthy.

Tomorrow I will be continuing the IBS theme so please check back for some more helpful ideas

(1)Wald A & Rakel D.  2008.  Behavioural and complementary approaches for the treatment of irritable bowel syndrome.  Nutrition in Clinical Practice.  23:284-292
(2)Heitkemper MM & Jarrett ME.  2008.  Update on irritable bowel syndrome and gender differences.  Nutrition in Clinical Practice.  23:275-283
(3)Bittner AC et al.  2005.  Prescript-Assist probiotic-prebiotic treatment for irritable bowel syndrome:a methodologically orientated, 2-week, randomized, placebo-controlled, double-blind clinical study.  Clin Ther.  27:755-761
(4)Bittner AC et al.  2007.  Prescript-Assist probiotic-prebiotic treatment for irritable bowel syndrome:an open-label, partially controlled, 1 year extension of a previously published controlled clinical trial.  Clin Ther.  29:1153-1160
(5)Colecchia A et al.  2006.  Effect of a symbiotic preparation on the clinical manifestations of irritable bowel syndrome, constipation-variant.  Results of an open, uncontrolled multicentre study.  Minerva Gastroenterol Dietol.  52:349-358

Written by Ani Kowal

Two review papers(1,2) have recently been published in the journal ‘Nutrition in Clinical Practice’ which look at the therapeutic approaches to dealing with irritable bowel syndrome (IBS).  They cover everything from cognitive behaviour therapy and hypnosis to diet and nutrition.  The papers are timely, this is a topic I am often asked about and have decided to spend the next few posts covering various nutritional aspects of IBS. 

IBS describes a combination of symptoms including constipation, diarrhoea, abdominal pain/discomfort, nausea and vomiting, feelings of fullness, gas and bloating.  Sufferers are often embarrassed by the condition which generally develops in individuals between the ages of 20 and 30 and affects around 20% of the population.  IBS also appears to be more common in women than men.

The causes of this uncomfortable condition are unclear.  However, an imbalance in intestinal bacteria is frequently implicated.  Often IBS develops after a bout of gasteroenteritis or repeat courses of antibiotics (which kill off the vast majority of intestinal bacteria).  The bacteria in the digestive system of individuals suffering from IBS seems to be different to healthy people with fewer ‘beneficial/friendly’ bacteria such as Bifidobacteria and Lactobacilli being present in those with IBS. 

Up to about 30 years ago it was a common misperception that the major functions of the large intestine (colon) was simply water re-absorption and storage of waste matter.  The colon is now recognised as an important organ due to the number of bacteria present (well over 10million bacteria are present in the colon per g of contents!).  These bacteria produce compounds, which can have beneficial/positive, neutral or damaging influences on the body.  Age, stress, antibiotics, the environment and diet can all affect the type of bacteria present in our digestive system.  A healthy diet may help boost the number of the friendly bacteria and hence decrease the incidence of infective disorders of the gastrointestinal tract and boost natural resistance against them.

The knowledge that specific species of bacteria may be of benefit to our health, especially Lactobacilli and Bifidobacteria, led to the development of probiotics, prebiotics and synbiotics which are designed to beneficially alter the bacteria present in our gut.  Most people will have a predominance of Bacteriodes bacteria in their digestive systems, these have both pathological and neutral effects.  For optimal health it would be better for us to have a gut dominated by Bifidobacteria and Lactobacilli.  The health promoting effects of these bacteria include prevention of the growth of harmful bacteria, improvement of immune functions, reducing gas/bloating problems, improved digestion and better absorption of essential nutrients and vitamin synthesis.  A probiotic, prebiotic or symbiotic supplement may be a way of beneficially altering the bacterial status of our colon. 

A probiotic is a supplement containing live friendly bacteria which aim to improve intestinal bacteria balance.  Probiotics are available as yoghurts, fermented milks, fortified fruit juices and freeze dried capsules/powders.   

A prebiotic is a food that stimulates the growth of the beneficial bacteria already present in the colon.  Fructooligosaccharides (FOS) which can be bought as powders are the most common prebiotics available.  Natural prebiotics can be found in asparagus, onion, chicory and garlic. 

Synbiotics are a mixture of probiotics and prebiotics. 

Tomorrow I will look further into these supplements and their use in the alleviation of IBS specific symptoms.

(1)Wald A & Rakel D.  2008.  Behavioural and complementary approaches for the treatment of irritable bowel syndrome.  Nutrition in Clinical Practice.  23:284-292
(2)Heitkemper MM & Jarrett ME.  2008.  Update on irritable bowel syndrome and gender differences.  Nutrition in Clinical Practice.  23:275-283

Written by Ani Kowal

Almonds are my one of my favourite snacks, I love the way their crunch turns to creaminess after a bit of chewing!  I learned something new this weekend, Almonds (botanical name Prunus amygdalus dulcis) are actually fruits.  They are not botanically classified as Nuts but are considered so for commercial and culinary purposes. 

A recent study(1) has found that almonds may act as prebiotics, a food source that promotes the growth of ‘friendly’ gut bacteria in our digestive systems.  The research was carried out by the Institute of Food Research which found that ground almonds stimulated the growth of beneficial bacteria in a model gut system.  The fat portion of the almonds seemed to be the most important component for the growth of the good bacteria.  Studies in human volunteers will, no doubt, take place in the future.  Prebiotics may be important not only for the optimal health of the digestive system but also for the health of the immune system and hence our ability to ward off infections (I have mentioned this in previous posts).

Reading this research reminded me of all the other benefits of almond-eating!  Almonds have been shown to have cholesterol lowering effects and may also protect against type 2 diabetes and heart disease.  In addition to this they have antioxidant potential and are a good source of vitamin E, fibre, calcium, magnesium and monounsaturated fatty acids.

A study published in 2004(2) found that adding almonds to our usual daily diets can produce favourable nutrient changes without any additional dietary advice or modification.  The study evaluated the impact of long-term almond supplementation on the nutritional intake and diet quality in 43 healthy men and 38 women aged 25-70 years. The participants were followed for 1 year. During the first 6 months, individuals were simply asked to follow their usual diets; in the second 6 months, they were asked to add almonds to their diets (about 50g per day, an average of 42 almonds). Their nutrient intakes were assessed seven times during each 6 month diet period.

When the study participants changed from their usual diet to the almond-supplemented diet, their intakes of healthy, mono- and poly- unsaturated, fats significantly increased by 42% and 24% respectively, fibre by 12%, vegetable protein by 19%, vitamin E by 66% and Magnesium by 23%; their intakes of trans fatty acids (not very healthy for the body), salt, cholesterol and sugars significantly decreased by 14, 21, 17 and 13% respectively. These were spontaneous nutrient changes (not caused by nutritional/dietary advice or literature) that closely match the dietary recommendations given to prevent cardiovascular and other chronic diseases.  The study highlights that something as simple as adding a handful of almonds for a healthy daily snack to an individual’s routine diet can induce favourable nutrient modifications for chronic disease prevention.

Before you throw your hands up in horror and say “but Ani, I can’t possibly eat nuts on a daily basis because of the calorie content and the impact on my weight” I ask you to please read on!  Nuts have a stabilising effect on blood sugar levels and may therefore help prevent sugar cravings, hunger-pangs and mid-afternoon energy slumps.  The fibre content may also help to keep you feeling fuller for longer.  Almonds can replace other common snacks such as crisps or ‘cereal bars’ which are refined foods and certainly not as nutritious.  In addition to this, studies have shown that including nuts in your daily diet will not cause you to pile on the pounds.  A study published in 2003(3) found that almonds may also be useful in weight-reduction programmes:

The study scientists wanted to evaluate the effect of an almond-enriched, or complex carbohydrate-enriched, low-calorie diet in a weight reduction program.  The study ran for 24-weeks and included a total of 65 overweight and obese adults age 27-79.  The almond group ate 84g of almonds per day as part of their diet.  Overall their daily nutrient intake was 39% total fat (25% monounsaturated fatty acids), and 32% carbohydrate (as percent of dietary energy).  The other group ate a complex carbohydrate, low fat diet comprising 18% total fat (5% monounsaturated fatty acids), and 53% carbohydrate.  Both diets had the same calorie and protein content.

Those on the almond supplemented diet, in contrast to complex carbohydrates, had greater sustained, reductions in weight, waist circumference, body fat mass and blood pressure.  Both groups saw a reduction in symptoms characteristic of type 2 diabetes and metabolic syndrome (e.g. glucose levels, blood pressure, cholesterol, triglycerides, and insulin resistance), however among subjects with diagnosed type 2 diabetes, diabetes medication reductions were sustained or further reduced in a greater proportion of the almond group as compared to the carbohydrate group. 

As my final offering I would like to cite a study that took place in 2002(4).  In this study 81 individuals (male and female) ate around 50g almonds (about 320 calories) a day for six months following a period of six months of eating their normal daily diets.  The participants received no additional dietary advice.  During the year the body weight and normal exercise habits of the individuals was evaluated.  During the almond feeding period, average body weight was not statistically or biologically increased.  There was a positive increase in the unsaturated:saturated dietary fat ratio (a good ratio change!).  The authors estimate that there was a natural energy compensation ie the extra energy from almonds was naturally displaced by an unconscious reduction in consumption of other foods (perhaps snacking stopped or consumption of sugary or refined foods declined).

Go ahead, try snacking on something different and health-full today, eat a few almonds (be sure that they are unsalted, un-blanched and with their skins still on)!

(1) Mandalari, C. Nueno-Palop, G. Bisignano, M. S.J. Wickham, and A. Narbad.  2008.  Investigation of the potential prebiotic properties of almond (Amygdalus communis L.) seeds  Appl. Envir. Microbiol. 2008 : [E-pub ahead of print 00739-08v1] 
(2) Jaceldo-Siegl K, Sabaté J, Rajaram S, Fraser GE. 2004.  Long-term almond supplementation without advice on food replacement induces favourable nutrient modifications to the habitual diets of free-living individuals. Br J Nutr.  92(3):533-40.
(3) Wien MA, Sabaté JM, Iklé DN, Cole SE, Kandeel FR. 2003.  Almonds vs complex carbohydrates in a weight reduction program. Int J Obes Relat Metab Disord. 27(11):1365-72.
(4) Fraser GE.  2002.  Effect on body weight of a free 76 Kilojoule (320 calorie) daily supplement of almonds for six months.  J Am Coll Nutr.  21(3):275-83
(5) Institute of Food Research press release

Written by Ani Kowal

At the beginning of the week I examined how a Mediterranean diet may be useful in the prevention and easing of asthma symptoms.  Today I wanted to add a little more information on the link between diet and asthma.

Salt consumption has been linked to asthma.  A review(1) of studies found that reducing salt intake may be helpful in reducing the severity of asthma attacks in affected individuals.  One study found that giving salt, an additional 6.1g per day, worsened symptoms in asthmatic patients and increased their use of inhaled steroids.  The authors of this study suggest that a low salt diet (around 5g per day) may have favourable effects in patients with asthma and can reduce the need for anti-asthma drugs(2).  Salt appears to heighten the airways’ response to histamine causing increased airway constriction(3).  Avoiding the addition of salt to food and limiting consumption of processed foods might help to reduce asthma symptoms and is also a good idea for all of us.  Excess salt has been linked to various conditions including high blood pressure, heart disease, cancer, kidney problems, osteoporosis and fluid retention (for more information on salt and health visit Consensus Action on Salt and Health CASH).

Interesting evidence shows that the gut bacteria of healthy infants appears different to those who suffer from allergies, eczema and asthma (known as ‘atopic’ infants).  Atopic infants seem to have a disturbed balance between beneficial and potentially harmful bacteria in their large intestine(4,5,6).  A healthy balance of microorganisms in the digestive system is thought to be essential for the normal development and maturation of the immune system.  In one study, the probiotic Lactobacillus GG was give to pregnant women who had at least one first-degree relative (or partner) with an allergic condition such as atopic eczema, allergic rhinitis, or asthma.  After the birth, the probiotic was also given to the child for 6 months.  Probiotic supplementation significantly reduced risk of early allergic disease in children at high risk (7). 

Research in this area is still in the early stages, clinical studies of children and supplement studies in animals do suggest that the exposure to microbes through the digestive system powerfully shapes immune function.  Taking a probiotic or prebiotic supplement during pregnancy, breastfeeding and early childhood could be considered in order to prevent against asthma/allergy development in children.  Some infant milks are already including pre probiotics in their formulation (Always check with a doctor before undergoing any supplementation programme, especially during pregnancy).

Finally I would like to mention food allergies.  If your child suffers from asthma it may be worth taking them to the doctor for a skin-prick test in order to determine whether they suffer from a true food allergy.

Food sensitivity may be an underlying factor in asthma, especially in childhood asthma.  In one study, 91% of children with respiratory allergy improved on a six-week diet that excluded common problem foods including grains and dairy products(8).  And a review(9) found that approximately 5% to 8% of asthma patients have a food allergy that can be confirmed via a food challenge. Identification and elimination of problem foods is often a useful strategy in the management of asthma.  This should always be done under the supervision of a doctor. 

(1)Mickleborough TD & Fogarty A. 2006. Dietary sodium intake and asthma: an epidemiological and clinical review.  International Journal of Clinical Practice.  60:1616-1624.
(2)Medici TC et al.  1993.  Are asthmatics salt-sensitive? A preliminary controlled study. Chest.  Oct;104(4):1138-43
(3)Burney PG et al.  1981.  The effect of changing dietary sodium on the bronchial response to histamine.  Thorax.  44(1):36-41
(4)Kirjavainen PV et al.  2001.  characterizing the composition of intestinal microflora as a prospective treatment target in infant allergic disease.  FEMS Immunol Med Microbiol.  32:1-7. 
(5)Kirjvainen PV et al.  2002.  Aberrant composition of gut microbiota of allergic infants: a target of bifidobcterial therapy at weaning.  Gut.  51:51-55. 
(6)Murch, SH.  2001.  Toll of allergy reduced by probiotics.  Lancet.  357:1057-1059
(7)Kalliomaki M et al.  2001.  Probiotics in primary prevention of atopic disease: a randomised placebo-controlled trial.  Lancet.  357:1076-1079
(8)Ogle KA & Bullock JD.  1980.  Children with allergic rhinitis and/or bronchial asthma treated with elimination diet: a five-year follow-up.  Ann Allergy.  May;44(5):273
(9)Miller A.  2001.  The etiologies, pathophysiology, and alternative/complementary treatment of asthma.  Alternative Medicine Review.  6(1):20-47.

Written by Ani Kowal

Whilst writing my last post about zinc and the common cold I came across some interesting research and evidence about probiotics and how they may be useful in enhancing the function of our immune system.  Probiotics are supplements containing ‘beneficial’ or friendly bacteria which inhabit the intestines.  These friendly bacteria produce various substances in our bodies, such as acetic acid, lactic acid and hydrogen peroxide, which  may help to counteract detrimental bacterial and viral infections in all parts of the body (not just in our digestive systems). 

Two studies (1,2) have looked specifically at how taking probiotics daily can prevent us from catching colds and how they may affect the duration and severity of cold symptoms if we do succumb.  Results suggest that taking probiotic supplements for at least three months had a positive effect on the cells of the immune system, shortened common cold episodes by almost 2 days and reduced the severity of symptoms!

Evidence for the various health benefits of taking daily probiotic and/or prebiotic supplements is growing each year.  Probiotics work by supplying 'beneficial/friendly' bacteria to the digestive system and Prebiotics, often called FOS or fructooligosaccharides, work by promoting the continued growth of friendly bacteria present in the intestines.  FOS act as a food source that only the beneficial bacteria can use to grow.  Personally I have taken prebiotics for many years now.  One of my professors at university, Prof Glen Gibson, has published several scientific papers and studies concerning the benefits of prebiotics and probiotics to health and he spurred me into taking a daily supplement. 

Many products are available that combine Probiotics and Prebiotics together.  After a month of taking the combined supplement you may wish to switch and use a prebiotic/FOS supplement only.  This will help to maintain high levels of the beneficial bacteria in the digestive system.
 
References
(1) de Vrese M et al.  2005.  Effect of Lactobacillus gasseri PA 16/8, Bifidobacterium longum SP 07/3, B. bifidum MF 20/5 on common cold episodes:  a double blind, randomized, controlled trial.  Clinical Nutrition.  24(4):481-491
(2) Tubelius, P et al.  2005.  Increasing work-place healthiness with the probiotic Lactobacillus reuteri:  a randomised, double-blind placebo-controlled study.  Environ Health.  4(1):25

Written by Ani Kowal