Christmas parties and festivities are ongoing at this time of year and this often means large meals and plenty of rich food.  Indigestion is a common side-effect of over-indulgence for many people.  Indigestion will typically occur 1-2 hours after eating and symptoms may include:
* Abdominal Pain centred in the upper abdomen
* Rumbling noises
* Excessive wind/flatulence
*A feeling of fullness, distension of the stomach or bloating 

Alcohol, coffee, cigarette smoking and some pharmaceutical drugs such as aspirin and ibuprofen can also irritate the digestive system and cause indigestion.  During stressful situations or stressful periods of time we are also more susceptible to this complaint.

It may sound simple but chewing is really important when eating a large meal.  Chewing food properly before swallowing it really does help prevent indigestion.  Our saliva contains enzymes that start digesting food within the mouth, even before it hits the stomach.  Chewing food properly enables these enzymes to mix thoroughly with our food.  Chewing also physically breaks food up into smaller pieces which make it easier to be further broken down by our stomach acid. 

Another good way to prevent indigestion is to avoid drinking a lot of fluid during a meal.  Excess liquid with a meal seems to dilute stomach acid and enzymes which digest food, making the digestive process a little less efficient. 

A recent study (1) has found that taking a probiotic supplement is also a good way of reducing indigestion related symptoms.  The study was well designed and involved 61 adults who were given a supplement containing probiotic bacteria or a placebo (‘dummy’) pill for four weeks.  The researchers wanted to look at the effects on indigestion symptoms such as abdominal pain, distention, flatulence.  None of the participants had any diagnosed gastrointestinal diseases. 

Individuals who got the probiotic supplement(1) had significant improvements in their abdominal pain scores and some improvement in their feelings of abdominal distension.  The authors of the research study conclude that the probiotic product “was effective in improving the quality of life and reducing gastrointestinal symptoms in adults with post prandial [after eating] intestinal gas-related symptoms and no GI [gastrointestinal] diagnoses”.

Taking a supplement containing prebiotics and probiotics regularly may be useful in preventing symptoms such as pain, bloating and flatulence.  These supplements are safe to take long term and have also been linked to improving many digestive complaints as well as benefiting health in other ways.

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.  Often supplements will contain both prebiotics and probiotics together and these may well be worth trying for a few weeks to see if indigestion symptoms are helped. 

Take time to really enjoy your meals this Christmas.  Not rushing when eating not only adds to the enjoyment but can actually help prevent overeating since the stomach has time to send signals to the brain to indicate feelings of fullness. 

(1)Kalman DS et al.  2009.  A prospective, randomized, double-blind, placebo-controlled parallel-group dual site trial to evaluate the effects of a Bacillus coagulans-based product on functional intestinal gas symptoms.  BMC Gastroenterol.  18;9:85.
Written by Ani Kowal

Earlier this year I wrote a couple of posts concentrating on the accumulating evidence which suggests that probiotic (‘friendly’ gut bacteria) supplements may be useful to boost the immune system.  In children, studies have shown that probiotic and prebiotic (food supplement that feeds the good bacteria in the digestive system) supplements may be useful in preventing recurrent ear infections and also the common cold.

A recently published study (1) has found that prebiotic and probiotic supplements, which improve the intestinal bacterial balance, may be particularly important in preventing eczema in susceptible infants.  It has been thought for a while now that modification of the intestinal bacterial balance could be an important approach to preventing allergic disease.  This particular study aimed to look at the prevention of allergic disease in high-risk children (children with parents and/or siblings with allergic conditions).  The probiotic bacteria was given to pregnant mothers of high-risk children, ie where there was a positive family history of allergic disease, and then to the infant children for the first 12months of life.  This was a controlled trial so there were some mothers/children who were given a placebo, they did not receive a probiotic supplement. 

Parental-reported eczema during the first 3 months of life was significantly lower in the intervention group compared with placebo (1).  The authors conclude their study by reporting “This particular combination of probiotic bacteria shows a preventive effect on the incidence of eczema in high-risk children, which seems to be sustained during the first 2 years of life. In addition to previous studies, the preventive effect appears to be established within the first 3 months of life”

If there are allergies in your family and you think that your child may be at risk of developing eczema or asthma then you may consider taking a probiotic and probiotic supplement during pregnancy and also giving an infant probiotic supplement (there are many available) to your baby during the first year to two years of life.  Please talk to your doctor or health professional before beginning a supplement regimen during pregnancy or with an infant child. 

A fairly recent study (2) assessed the safety of feeding probiotic supplements to newborn infants and found that such supplements were safe and seemed to increase resistance to infections during the first 2 years of life.  The study was well designed and began with pregnant mothers who were given either a mixture of probiotics or placebo for 4 weeks before they were due to give birth.  Their babies were given the same probiotics in conjunction with a prebiotic or placebo for 6 months after birth.  925 infants were involved and followed up for 2 years.  During the 6-month supplement intervention, antibiotics were prescribed less often in the prebiotic/probiotic group than in the placebo group and throughout the 2 year follow-up period, infections occurred less frequently in the group receiving these supplements.

Eczema is an inflammatory skin condition thought to be related to other allergies, such as asthma.  Due to the inflammatory nature of the condition it is thought that long chain omega 3 fatty acids may also be particularly useful in treating the condition, I have previously written about this here, as well as in the post relating to asthma.

(1) Niers L et al.  2009.  The effects of selected probiotic strains on the development of eczema (the PandA study).  Allergy.  64(9):1349-58.
(2) Kukkonen K et al.  2008.  Long-term safety and impact on infection rates of postnatal probiotic and prebiotic (synbiotic) treatment: randomized, double-blind, placebo-controlled trial. Pediatrics. 122(1):8-12.
Written by Ani Kowal

Children everywhere are starting to get ready to go back to school after their long summer holidays.  Nutrition and diet can impact the body and health in many ways, the most apparent concerns for parents of school aged children are immune health and brain function/behaviour.

In July I wrote about probiotics and prevention/treatment of childhood colds and last year I wrote about boosting immune health in children going back to school.  Today I wanted to have another look at behaviour and the brain.  Previously I have written about ADHD, particularly with regards the importance of omega 3 fatty acids for brain function.  The brain is a highly complex organ.  In infancy and childhood the brain is growing rapidly and it requires a lot of energy.  There is a mounting body of evidence to suggest that diet can influence the development and functioning of the brain (1).  This influence may well start with the diet of the mother during pregnancy and then in the infant in early life, however later in childhood nutritional intervention may well make a difference to brain function and cannot be discounted.

There is increasing evidence that the missing of breakfast has negative behavioural and attention consequences later in the morning and it is also thought that meals of a low rather than high glycaemic load are beneficial with regards child behaviour.  There are also findings of an association between a tendency to develop low blood sugar (glucose) and aggression in children(2). 

Glycaemic index and glycaemic load are terms used to characterise foods and diets based on their effects on blood glucose levels.  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).  White bread, potatoes, processed/refined carbohydrates have a high glycaemic index i.e. they tend to cause a rapid surge in blood sugar.  Vegetables, whole-grain high-fibre carbohydrates, create a more gradual change in blood sugar levels and are considered to have a low glycaemic index.  For the classification of more food examples please visit 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.

Certain nutrients have greater effects on brain development than do others and hence may have more of an impact on childhood behaviour and brain function. The important nutrients include protein (which is so important for proper growth in childhood), certain fats (especially omega 3 fats), iron, zinc, copper, iodine, selenium, vitamin A, choline, and folate (3).  There is evidence that sub-clinical deficiencies of vitamins and minerals may influence anti-social behaviour and intelligence but the evidence is still controversial(4).The B vitamins, Folate and B12 (cobalamin), are vital for the brain.  Deficiencies have negative consequences on the developing brain, and behaviour, during infancy; and deficits of both vitamins are associated with a greater risk of depression during adulthood (5).  Recently vitamin D has also received attention with regards brain functioning.  As you can see a myriad of nutrients are important for the brain and they probably work and act synergistically, this makes clinical trials difficult to carry out.  However, there have been three well-designed studies which have reported that vitamin/mineral supplementation in children can reduce anti-social behaviour (2).

It is difficult to conclusively say which vitamins/minerals are most important and whether or not supplementation can help children – this is because behaviour is difficult to standardise and measure in a trial-setting.  Also psychological and environmental influences will be having an effect.  Needless to say our bodies are complex, we require various nutrients in correct proportions in order to stay optimally healthy.  Many children in the UK fall short of achieving recommended 5 portions of fruit and vegetable daily which is worrying for health and many children do not eat oily fish (the best source of omega 3 fatty acids) at all.  If you are concerned that your child is not eating a consistently healthy diet you may wish to consider a food-state multivitamin and mineral supplement that has been formulated specifically for children together with an omega 3 fatty acid supplement – easy to take liquid fish oils are now available for children which are naturally flavoured (usually lemon or orange).  Flaxseed oil and omega 3 supplements produced from algae are available for vegetarian/vegan children.

A UK based study concludes: “Whilst the importance of diet in educational attainment remains under investigation, the evidence for promotion of lower-fat, -salt and -sugar diets, high in fruits, vegetables and complex carbohydrates, as well as promotion of physical activity remains unequivocal in terms of health outcomes for all schoolchildren”(6)

(1)Benton D.  2008.  Eur J Nutr.  The influence of children's diet on their cognition and behavior. Eur J Nutr.  47 Suppl 3:25-37.
(2) Benton D.  2007.  The impact of diet on anti-social, violent and criminal behaviour. Neurosci Biobehav Rev. 31(5):752-74.
(3)Georgieff MK.  2007.  Nutrition and the developing brain: nutrient priorities and measurement.  Am J Clin Nutr.  85(2):614S-620S.
(4)Benton D.  2008.  Micronutrient status, cognition and behavioral problems in childhood.  Eur J Nutr. 47 Suppl 3:38-50.
(5)Black MM.  2008.  Effects of vitamin B12 and folate deficiency on brain development in children.  Food Nutr Bull.  29(2 Suppl):S126-31.
(6)Ells LJ et al.  2008.  A systematic review of the effect of dietary exposure that could be achieved through normal dietary intake on learning and performance of school-aged children of relevance to UK schools. Br J Nutr.  100(5):927-36.

Written by Ani Kowal

In April this year I wrote a detailed blog post about probiotics and their usefulness in the treatment and prevention of vaginal yeast infections, commonly known as thrush.  This topic seems to be of continuing concern to women and deserves to be revisited.

Vaginal thrush usually occurs due to over proliferation of yeast in the vagina, most commonly Candida yeast, for this reason vaginal thrush is often known as Candidiasis.  Illness, stress, lack of sleep, diet and hormonal changes can all cause the normal balance of yeast and bacteria in the vagina to be altered allowing for an overgrowth of yeast leading to thrush infection. 

To recap:  Normally a healthy vagina contains mainly lactobacilli bacteria, ‘friendly’ or beneficial bacteria, which protect it from invading pathogens (detrimental bacteria and yeasts) such as those which cause urinary tract infections, thrush and vaginitis.  A healthy digestive system will also be dominated by a variety of different non-pathogenic bacteria.  If the vagina and digestive system are mainly colonised with 'good' bacteria these provide a barrier to the entry of pathogenic/harmful bacteria into the vagina.  Women diagnosed with thrush, are normally prescribed oral or vaginal anti-yeast agents.  However, these kinds of treatments are associated with frequent recurrences of the condition.  The antibiotics and antifungals may clear up the original infection but they also tend to disrupt the future bacterial/fungal balance in the reproductive and digestive systems, this can exacerbate the condition in the long term and may lead to quick recurrence.

Studies are beginning to show that probiotic supplements or foods may be helpful in order to boost the number of good bacteria in the vagina and digestive system.  In practice many women, especially those who have undergone repeat antibiotic treatment, find probiotics to be really helpful in preventing recurrence and treating these conditions.  Probiotic creams, vaginal suppositories and tablets are readily available, they usually contain the bacteria lactobacillus acidophilus.  Oral probiotics (and prebiotics) may also be useful in order to help keep an overall balance of good bacteria in the vagina and digestive and system. 

Essential Oils

Recently I have become aware that many supplements containing oregano oil, clove oil, cinnamon and garlic are being marketed for the prevention and treatment of vaginal thrush and that oregano based creams and oils are available for topical application to the vagina for thrush treatment.  Looking at the research I can see that clinical evidence is beginning to grow in this area.  A number of laboratory/test tube studies (1,2,3,4,5,6) have been performed to show the usefulness of these agents but human trials are still necessary before firm conclusions can be drawn.

The anti-bacterial and anti-fungal properties of plant oils has been known for thousands of years.  Oregano oil and clove oil contain bioactive chemical compounds called phenols.  These plant compounds have potent anti-microbial effects.  Carvacrol is the major phenolic component of oregano oil and Eugenol is the major phenolic component of clove oil (as well as being present in cinnamon).  These phenolic compounds are often listed on the packaging of anti-candida supplements

Last year a laboratory (in vitro) study (1) took place to look at the anti-fungal activity of selected plant and spice essential oils against various species of Candida yeasts (including  Candida albicans, Candida dubliniensis, Candida tropicalis, Candida glabrata, and Candida krusei).  The results found that oregano and cinnamon essential oils were efficient anti-fungal agents.  The oregano oil was the most efficient anti-fungal oil and worked against yeast that were fluconazole resistant.  Fluconazole is a anti-fungal pharmaceutical agent, commonly used for the treatment and prevention of fungal infections including thrush, it is a common ingredient in creams and oral treatments.

Oregano and clove oil have shown good results in laboratory tests, the authors of one study (2) conclude that “Carvacrol and eugenol could be considered as promising products in the treatment of vaginal candidiasis. This work is a preliminary contribution to the development of a new generation of efficient and natural antifungal agents for curative treatment and prophylaxis [prevention]”. 

If you regularly suffer from thrush and want to try an alternative to the anti-fungal agents commonly prescribed or available over the counter you may want to try taking oral probiotic and prebiotic treatments in conjunction with vaginal probiotic creams and suppositories.  The herbal supplements containing oregano, clove and cinnamon oil as well as garlic may be useful and oils/creams containing oregano oil may be helpful when applied topically to the vagina.  In addition to this it is helpful to eat a balanced healthy diet to provide all the nutrients necessary to keep the body functioning well and keep the immune system working properly.  This kind of diet is based on natural, unprocessed ‘real food’, e.g. low in refined carbohydrate and rich in vegetables, nuts/seeds, beans/pulses, lean unprocessed meats and oily fish (such as salmon, mackerel, trout).

(1)Pozzatti P et al.  2008.  In vitro activity of essential oils extracted from plants used as spices against fluconazole-resistant and fluconazole-susceptible Candida spp. Can J Microbiol.  54(11):950-6.
(2)Chami F et al.  2004.  Evaluation of carvacrol and eugenol as prophylaxis and treatment of vaginal candidiasis in an immunosuppressed rat model.  J Antimicrob Chemother.  54(5):909-14.
(3) Chammi N et al.  2005.  Study of anticandidal activity of carvacrol and eugenol in vitro and in vivo.  Oral Microbiol Immunol.  20(2):106-111.
(4) Manohar, V., et al.  Antifungal activities of origanum oil against Candida albicans.  Mol Cell Biochem.  228(1-2):111-117, 2001.
(5) He M et al.  2007.  In vitro activity of eugenol against Candida albicans biofilms. Mycopathologia. 63(3):137-43.
(6) Low CF et al.  2008.  Inhibition of hyphae formation and SIR2 expression in Candida albicans treated with fresh Allium sativum (garlic) extract. J Appl Microbiol.  105(6):2169-77.
Written by Ani Kowal

Earlier this year I wrote about some studies which suggest that probiotic supplementation in infants and children can help to prevent recurrent ear infections.  Very recent evidence (1) suggests that probiotic supplements may also be useful in children in order to prevent common colds.

The study (1) looked to evaluate the effects of probiotic consumption on cold and influenza-like symptom incidence and duration in otherwise healthy children.  The study was well designed and included 326 children aged between 3 and 5 years old.  104 children received an inactive placebo (plain milk), 110 received a probiotic supplement containing the bacteria Lactobacillus acidophilus (mixed into milk) and 112 children received a probiotic supplement containing Lactobacillus  acidophilus in combination with another bacteria Bifidobacterium animalis (also mixed into milk). The children received two doses daily for 6 months

• Compared to the placebo group, children who received the single probiotic had a 53% reduced incidence of fever, 41.4% reduced coughing incidence and 28.2% reduction in rhinorrhea (commonly known as a runny nose!).  The children receiving the probiotic supplement containing two species of bacteria had 72.7% reduced incidence of fever, 62.1% reduction in coughing incidence and 58.8% reducion in runny nose compared to the placebo group 

• Duration of symptoms (fever, coughing and rhinorrhea) was decreased significantly in children taking the single (by 32%) and combined (by 48%) probiotic supplements.

• Antibiotic use was reduced in children taking probiotics, relative to placebo, by 68.4% for the single and 84.2% for the combined probiotic supplement groups!  Many parents do not wish their children to undergo multiple antibiotic treatments in early life for fear of antibiotic resistance occurring later.  Antibiotics also destroy good bacteria in the digestive system which are now recognised as being very important for overall health.

• Subjects receiving both of the probiotic products had significant reductions in days absent from group child care, by around 30% compared with subjects receiving placebo treatment.

The authors conclude (1) that “Daily dietary probiotic supplementation for 6 months was a safe effective way to reduce fever, rhinorrhea, and cough incidence and duration and antibiotic prescription incidence, as well as the number of missed school days attributable to illness, for children 3 to 5 years of age”.

There have been studies (e.g. 2) which have shown that feeding supplements containing probiotics and/or prebiotics are safe in newborn infants and children and seem to increase resistance to infections during the first 2 years of life.  It may well be useful to speak to your GP or practice nurse about probiotic supplements if your child has already had frequent colds and/or antibiotic use or if you just want to give a regular probiotic supplement as a preventative measure.  Antibiotics are really effective at clearing infections but do also kill the good bacteria in the digestive system.  There is evidence to suggest that good bacteria in the digestive system are important for overall immune health and may prevent subsequent infection.  Taking a prebiotic and probiotic supplement after antibiotic therapy is probably a very wise way of re-establishing balance in the digestive system. 

Prebiotic and probiotic supplements specifically designed for children and infants are readily available to buy and can be taken daily.

(1) Leyer GJ et al.  2009.  Probiotic Effects on Cold and Influenza-Like Symptom Incidence and Duration in Children.  Pediatrics: 124: e172-e179.
(2) Kukkonen K et al.  2008.  Long-term safety and impact on infection rates of postnatal probiotic and prebiotic (synbiotic) treatment: randomized, double-blind, placebo-controlled trial. Pediatrics. 122(1):8-12.

Written by Ani Kowal

On Thursday I went to the Nutrition Society Summer meeting at the University of Surrey.  The five day conference had concentrated on various aspects of over- and undernutrition.  The symposia that I attended were exceptionally interesting and thought provoking.  One of the presentations(1) was given by Dr Paul Kelly of Barts and London School of Medicine and Dentistry.  He was speaking about the microorganisms in the digestive system and links to diarrhoea in individuals in developing countries.  However, he briefly mentioned an animal study that linked the makeup of the bacteria in the digestive system and a propensity to obesity.  This got me thinking about whether that link was present in humans.  Upon returning home I had a search through the medical databases to see if there was any literature to support these thoughts.

Can bacteria in the gut have anything to do with developing excess body weight or obesity?

There seems to be a fair amount of recently published interest in the topic of digestive bacterial balance and the links to obesity and overweight (e.g. 2,3,4,5,6).  For many years the large intestine was thought only to be important for water absorption and storage of waste.  However, the adult human gut contains up to 100 trillion microbial organisms (including bacteria and yeasts) collectively known as the microbiota or microbiome.  These gut bacteria seem to have an effect on the entire body and not just the health of the digestive system.

Obesity is a complex disease involving many factors with no miracle cure and no easy solutions - I am not about to disillusion anyone by inferring that bacterial balance is a major factor and probiotics (supplemental good gut bacteria) are the cure.  However, gut bacteria may well be having some kind of impact on the development of excess body weight in some people.  What we eat does affect the composition of the microorganisms that are present in our digestive systems and in turn these microorganisms can have an effect on the health of our body.  A review published in French this year (2) looked at the evidence which suggests that the gut microorganisms are linked with metabolism and inflammation, and could be involved in type 2 diabetes, metabolic syndrome and obesity.

An extensive review published in America last year (3) looked at a wide range of evidence in order to investigate the potential role of the gut bacteria in the development of obesity. The authors of the paper found that interactions among the microorganisms in the gut appear to have complex effects in the human body and that the gut organisms may have an important role in regulating weight and may also be partly responsible for the development of obesity in some people.  Evidence suggests that our gut microorganism environment is established within the first year of life and then remains fairly constant through adulthood.  However dietary factors, infections and antibiotic use may lead to long-term changes.

The gut bacteria may be acting on weight via effects on: calorie utilisation from food, metabolism, inflammatory responses, hormone regulation or other means and evidence does suggest that obese and lean individuals seem to have different composition of gut bacteria (3).  A study published last year (4) followed children from birth to age 7 years.  Children of normal weight and those who were overweight had significant differences in their gut bacterial composition suggesting that an important link between bacterial balance and obesity development possibly via inflammatory pathways.  The authors conclude that their findings may offer “new possibilities for preventive and therapeutic applications in weight management”.

Can modifying the gut bacteria through diet and/or probiotic or prebiotic (such as FOS, fructooligoosaccharides) supplements have an impact on body weight?

The review paper (3) emphasises that the best, nonsurgical, strategy for reversing obesity in the population seems to be to promote small but long-term changes in diet and physical activity.  The authors go on to say that further evidence with regards bacterial gut balance is needed but that microorganisms may well be influencing obesity.  They suggest that probiotic and prebiotic supplements may be useful in order to positively change the gut bacterial balance and help prevent and treat overweight but that these manipulations should clearly not be viewed as a substitute for a healthy diet and exercise.

Prebiotics act as food for the good ‘friendly’ bacteria in the digestive system and studies (3) suggest that prebiotics in the diet may reduce our energy and food intake, increase satiety, reduce hunger and appetite and reduce total daily calorie intakes.  FOS may also have effects on blood sugar balance in the body.

Probiotics, live ‘friendly’ bacterial supplements, may also change the bacterial balance of the digestive system and have an effect on overall health in the body, but studies in humans and the links to weight control are lacking.  An interesting study presented at a conference this year (6,7) found that probiotics during and after pregnancy may help prevent the development of obesity after birth.  The study found that at 1 year after giving birth, 25% of women given probiotics along with dietary counseling had central obesity based on that definition, compared with 43% of women given diet advice alone. In a press release the author stated that "This is the first study showing that probiotics-supplemented diet during pregnancy and breastfeeding influences the adiposity [fat mass]of women over the 12-month postpartum period," Further evidence is needed but the author said that modification of bacterial balance in the intestines with probiotic supplements "together with a balanced diet may offer a reasonably economic, practical, safe and potentially successful method to be used with other lifestyle-related factors in controlling obesity" (7).

Further conclusive evidence needed, however prebiotics (such as FOS) and probiotics do seem to positively change the composition of bacteria in our digestive systems and affect overall health.  Supplements are readily available but should not be seem as a quick-weight loss fix.  A healthy diet and lifestyle is of paramount importance for weight control and overweight prevention and treatment.

(1)Dr Paul Kelly.  2009.  Symposium 4: Gut function: effects on over and under-nutrition.  Nutrition, intestinal defence and the microbiome.  The Nutrition Society Summer Meeting.  University of Surrey.  Thursday 2nd July 2009.
(2) Pataky Z et al.  2009.  Gut microbiota, responsible for our body weight?  Rev Med Suisse.  5:662-664 [Article in French]
(3) DoBaise JK et al.  2008.  Gut microbiota and its possible relationship with obesity.  Mayo Clinical Processings.  83:460-469
(4) Kalliomaki M et al.  2008.  Early differences in fecal microbiota composition in children may predict overweight.  Am J Clin Nutr.  87:534-538
(5) Tennyson CA &Friedman G.  2008.  Microecology, obesity and probiotics.  Curr Opin Endocrinol Diabetes Obes.  15:442-447
(6) Kirsi Laitinen, nutritionist and senior lecturer at the University of Turku in Finland.  Study findings presented at 17th European Congress on Obesity http://www.easo.org/eco2009/index.htm 6-9 May 2009 held in Amsterdam
(7)  Anthony J. Brown, MD.  2009.  Probiotics may help ward off postpartum obesity.  2009-05-08 15:24:34 -0400 (Reuters Health).  http://www.reuters.com/article/healthNews/idUSTRE5475QP20090508

Written by Ani Kowal

In January this year I wrote about cystitis and other urinary tract infections and how probiotics and cranberry could be useful for prevention and treatment of such conditions.

Three other common genitourinary complains in women are vaginal thrush, vaginitis and vaginosis. 
* Vaginal thrush usually occurs due to over proliferation of yeast in the vagina, most commonly Candida yeast, for this reason vaginal thrush is often known as Candidiasis.
* Vaginitis involves inflammation of the Vagina.  It is usually caused by a disruption in the normal chemical balance of the vagina or from infection by detrimental microorganisms (bacteria, virus and yeast).  However, the chemicals found in perfumed soaps, laundry detergents and fabric softeners can also cause or aggravate the condition. Vaginitis is usually characterized by a vaginal discharge and may be accompanied by itching and irritation.
* Vaginosis usually involves a disruption in the normal bacterial and yeast balance in the vagina and is characterized by increased vaginal discharge (which is often odorous) without inflammation, sometimes there is itching.

Normally a healthy vagina contains mainly lactobacilli bacteria, ‘friendly’ or beneficial bacteria, which protect it from invading pathogens (detrimental bacteria) such as those which cause urinary tract infections, thrush and vaginitis.  A healthy digestive system will also be dominated by a variety of different non-pathogenic bacteria.  If the vagina and digestive system are mainly colonised with 'good' bacteria these provide a barrier to the entry of pathogenic/harmful bacteria into the vagina.  Personal hygiene is important to protect against vaginal infections since bacteria from the anal area may enter the vagina during sex or when wiping after a bowel movement (this is why women are always taught to wipe from front to back).

Women diagnosed with thrush, vaginitis or vaginosis are normally prescribed oral or vaginal antibiotics or anti-yeast agents.  However, these kinds of treatments are associated with frequent recurrences of the condition and there is growing concern over antibiotic resistance.  The antibiotics may clear up the original infection but they also tend to destroy all the good bacteria in the vagina and/or digestive system and therefore disrupt the bacterial balance in the reproductive and digestive systems, this often exacerbates the issue or leads to quick recurrence of the condition.

Studies now show that probiotic supplements or foods may be helpful in order to boost the number of good bacteria in the vagina and digestive system.  The evidence for the use of probiotic supplements and vaginal suppositories in the treatment and prevention of vaginal thrush and vaginitis in women is still preliminary but ever growing.  There is a lot of logic behind the rationale and in practice many women, especially those who have undergone repeat antibiotic treatment, find probiotics to be really helpful in preventing recurrence and treating these conditions.  

Probiotic creams, vaginal suppositories and tablets are readily available, they usually contain the bacteria lactobacillus acidophilus.  Oral probiotics (and prebiotics) may also be useful in order to help keep an overall balance of good bacteria in the vagina and digestive and system.

Even over ten years ago the benefits of eating unsweetened ‘live’ natural yoghurt was known to help prevent and treat vaginal infections.  Yoghurt was also used by women vaginally to help clear up thrush.  In 1992 a study (1) assessed whether daily ingestion of yogurt containing Lactobacillus acidophilus (a probiotic yoghurt) could prevent vaginal yeast/candida infection (thrush).  Women with recurrent vaginal candidiasis received a yogurt-free diet for 6 months and a yogurt-containing diet for 6 months.  A threefold decrease in vaginal candida infections was seen when patients consumed yogurt containing Lactobacillus acidophilus.  Eating a daily yogurt containing Lactobacillus acidophilus decreased candidal yeast colonization and infection.

Research has continued to show the benefits of probiotics in the prevention and treatment of vaginal infections.  A recent laboratory study (2) found that a probiotic (lactobacillus) bacteria could attach well to vaginal and cervical cells and could also prevent the growth and multiplication of vaginosis associated bacteria and yeast.  The authors of the study suggest that probiotic vaginal suppositories or oral supplements containing lactobacilli could be really useful in maintaining the normal composition of vaginal bacteria or re-colonising the vagina with these friendly bacteria after infection.

Another recent study (3) looked at the use of probiotic lactobacilli in conjunction with a commonly prescribed anti-fungal treatment (fluconazole) for the treatment of vaginal candidiasis (yeast infection).  The study involved 55 women diagnosed with vaginal candidiasis who exhibited vaginal discharge and at least one further symptoms e.g. itching and burning vaginal feeling, dyspareunia (pain during sex) and dysuria (painful urination).  The women were treated with a single dose of fluconazole and then supplemented every morning for the following 4 weeks with either two placebo capsules or two probiotic capsules.  After 4 weeks the group who were taking the probiotic showed significantly less vaginal discharge associated with any of the other symptoms as well as a lower presence of yeast.  The authors of the study conclude that probiotic supplements can increase the effectiveness of an anti-fungal pharmaceutical agent in treating vaginal disease.

There are many other recent studies (e.g. 4,5,6,7) which indicate that oral probiotic supplements and vaginal probiotic suppositories are very helpful in the treatment and subsequent prevention of vaginitis, vaginosis and vaginal thrush.  As mentioned previously, such probiotic supplements, vaginal creams and suppositories are widely available to buy.  These may be particularly useful after receiving antibiotic or anti-fungal treatment.  Women who frequently suffer from thrush or other vaginal infections may wish to take a daily probiotic and prebiotic supplement in order to prevent further problems.

The Mooncup!

Women who are suffering with vaginal thrush, vaginosis or vaginitis are usually recommended not to use tampons since they can often aggravate symptoms.  Also, some women are affected by the bleach and other chemicals that are frequently found in tampons.  These chemicals can affect the normal bacterial/yeast balance in the vagina and make some women more susceptible to vaginal infection.

Recently I came across a nifty alternative to regular tampons and sanitary towels, called the Mooncup.  Makers of the Mooncup say that it will not cause irritation and is suitable for women with sensitive skin, thrush, eczema or allergy. 

The Mooncup is a reusable menstrual cup around two inches long and is made from a special medical grade non-allergic silicone.  It is worn internally like a tampon but collects menstrual fluid rather than absorbing it. Unlike tampons the Mooncup is not a disposable product, so you only need to buy one.  The Mooncup contains no bleaches, deodorisers or absorbency gels and does not interfere with your healthy vaginal environment, nor has it been associated with toxic shock syndrome.  For more information take a look to see if the Mooncup is something you might like to try.

(1)Hilton E et al.  1992.  Ingestion of yogurt containing Lactobacillus acidophilus as prophylaxis for candidal vaginitis.  Annals of Internal Medicine.  116(5):353-357.
(2)Coudeyras S, Jugie G, Vermerie M, Forestier C.  2009.  Adhesion of human probiotic Lactobacillus rhamnosus to cervical and vaginal cells and interaction with vaginosis-associated pathogens. Infect Dis Obstet Gynecol. 2008:549640. Epub 2009 Jan 27
(3)Martinez RC et al.  2009. Improved treatment of vulvovaginal candidiasis with fluconazole plus probiotic Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14. Lett Appl Microbiol.  48(3):269-74.
(4)Cianci A et al.  2008. Efficacy of Lactobacillus Rhamnosus GR-1 and of Lactobacillus Reuteri RC-14 in the treatment and prevention of vaginoses and bacterial vaginitis relapses.   Minerva Ginecol.  60(5):369-76.
(5)Marcone V et al.  2008.  Effectiveness of vaginal administration of Lactobacillus rhamnosus following conventional metronidazole therapy: how to lower the rate of bacterial vaginosis recurrences. New Microbiol.  31(3):429-33.
(6)Petricevic L et al. 2008.  Randomized, double-blind, placebo-controlled study of oral lactobacilli to improve the vaginal flora of postmenopausal women. Eur J Obstet Gynecol Reprod Biol. 141(1):54-7.
(7)Drago L et al.  2007.  Activity of a Lactobacillus acidophilus-based douche for the treatment of bacterial vaginosis. J Altern Complement Med. 13(4):435-8.

Written by Ani Kowal

Earache is most commonly seen in young children under the age of 4.  Usually the problem is infection in the middle ear, known as otitis media.  Colds and throat infections can lead to earache as the bacteria (and/or virus) can spread up through the nasal passages and along the Eustachian tubes, passages which connect the middle ear to the back of the nose and throat.  The bacterial infection can produce pressure, inflammation and swelling and hence cause pain in the middle ear.

The Eustachian tube will usually allow any excess secretions from the middle ear to drain away into the nose and throat.  If the tubes get blocked the secretions can build up and become infected.  In children middle ear infections are more common because the Eustachian tubes are often lying more horizontally which makes drainage tricky, fluids can build up producing a perfect environment for bacterial growth and infection.  As children grow the tubes tend to naturally bend downwards into a more vertical position allowing for better drainage making ear infections less likely.

Most bacterial middle ear infections will be quickly treated with antibiotics.  Many parents do not wish their children to undergo multiple antibiotic treatments in early life for fear of antibiotic resistance occurring later.  Antibiotics also destroy good bacteria in the digestive system which are now recognised as being very important for overall health.

‘Glue ear’ is a middle ear infection where the ear is ‘leaky’, medically this is called otitis media with effusion.  Glue ear is caused by fluid build up in the ear.  Often children with glue ear will be fitted with grommets, which are small plastic tubes inserted into the eardrum.  Grommets allow air to flow into the ear and help drainage.  Many parents, however, are not keen on grommets as there have been links to slight hearing loss later in life.

A recent study (1) interested me, it assessed a nasal spray for the treatment of chronic leaky middle ear infection in children.  The spray contained probiotics, naturally occurring ‘good’ bacteria.  The study is preliminary but the results were very promising and the study authors say that it could prevent the need for grommets and protect against hearing problems.  The spray was very efficient at dramatically reducing ear fluid and complete or significant recovery in in many cases. 

Probiotic nasal sprays are not yet commercially available for the use of middle ear infection in children.  However, there is evidence is mounting to suggest that oral probiotic  and prebiotic supplements may be helpful in strengthening the general immune system and preventing childhood nasal and respiratory tract infections. (For more inforation and definitions of prebiotics and probiotics see my blog posts on IBS)

Recently a paper(2) published in the British Journal of Nutrition found that oral probiotic supplements may offer a safe means of reducing the risk of early acute middle ear infections, antibiotic use and the risk of recurrent respiratory infections during the first year of life.  The study was small but well designed and involved 72 formula fed infants age 2 months or younger.  32 of the infants received daily formula supplemented with probiotics 12 months.  40 infants acted as controls and were given formula without probiotics.  Incidence of infection and recurrent infection was recorded.  During the first 7 months of life, 22 % infants receiving probiotics and 50 % infants receiving placebo experienced acute middle ear infection.   Antibiotics were prescribed for infections in 31 % infants receiving probiotics compared to 60 % infants receiving placebo. During the first year of life 28 % infants receiving probiotics and 55 % infants receiving placebo suffered with recurrent respiratory infections.  The study suggests that probiotics may offer a safe means of reducing the risk of early acute ear infection and reducing antibiotic use and the risk of recurrent respiratory infections during the first year of life.

Another recent study (3) found that feeding supplements containing prebiotics and probiotics to newborn infants was safe and seemed to increase resistance to infections during the first 2 years of life.  The study was well designed and began with pregnant mothers who were given either a mixture of probiotics or placebo for 4 weeks before they were due to give birth.  Their babies were given the same probiotics in conjunction with a prebiotic or placebo for 6 months after birth.  925 infants were involved and followed up for 2 years.  During the 6-month supplement intervention, antibiotics were prescribed less often in the prebiotic/probiotic group than in the placebo group and throughout the 2 year follow-up period, infections occurred less frequently in the group receiving these supplements.

It may well be useful to speak to your GP or practice nurse about probiotic supplements if your child has already had frequent ear infections and/or antibiotic use.  Antibiotics are really effective at clearing painful infections but do also kill the good bacteria in the digestive system.  There is evidence to suggest that good bacteria in the digestive system are important for overall immune health and may prevent subsequent infection.  Taking a prebiotic and probiotic supplement after antibiotic therapy is probably a very wise way of re-establishing balance in the digestive system.  Prebiotic and probiotic supplements specifically designed for children are readily available to buy.

(1)Skovbjerg S et al.  2009.  Spray bacteriotherapy decreases middle ear fluid in children with secretory otitis media. Arch Dis Child. 94(2):92-8.
(2) Rautava S, Salminen S, Isolauri E.  2008.  Specific probiotics in reducing the risk of acute infections in infancy - a randomised, double-blind, placebo-controlled study.   Br J Nutr. 6:1-5. [Epub ahead of print]
(3) Kukkonen K et al.  2008.  Long-term safety and impact on infection rates of postnatal probiotic and prebiotic (synbiotic) treatment: randomized, double-blind, placebo-controlled trial. Pediatrics. 122(1):8-12.

Writen by Ani Kowal

On Monday I briefly mentioned the usefulness of probiotics (‘friendly bacteria’) in restoring the bacteria of the digestive system for women who have taken repeated courses of antibiotics for their cystitis or other urinary tract infections (UTI’s).  However, probiotics may do more than just help positively rebalance gut bacteria after antibiotic use.  Studies indicate that oral probiotic supplements and vaginal probiotic creams and suppositories may actually help prevent and treat the occurrence of UTIs.

You may be wondering how probiotics (taken orally or used vaginally) could be helpful in treating or preventing infections in the urinary system?  As I mentioned on Monday, in women the bacteria responsible for urinary tract infections almost always come from the vagina or the rectum/anus and travel up through the urinary tract into the bladder where they can cause problems.  In a healthy vagina the predominant bacteria present are ‘friendly’ non-harmful strains such as Lactobacilli (1), a healthy digestive system will also be dominated by a variety of different non-pathogenic bacteria.  If the vagina and digestive system are mainly colonised with good bacteria these provide a barrier to the entry of pathogenic/harmful bacteria into the urinary tract and bladder (1).  Studies now show that probiotic supplements or foods may be helpful in order to boost the number of good bacteria in the vagina and digestive system and therefore help to prevent urinary tract infections.  Evidence also suggests that probiotics may also actively prevent the pathogenic bacteria from clinging or adhering to the urinary tract and multiplying (2).

One study (3) analysed the diet of over a hundred women, with an average age of 30, who suffered from recurrent UTI’s compared to over a hundred women who had not suffered from a UTI in over 5 years.  Frequent consumption, more than three times a week, of milk products containing probiotics was associated with a significantly reduced risk of recurrent UTI’s.  Studies (4,5) also indicate that vaginal suppositories of probiotic bacteria may be useful for the prevention of recurrent urinary tract infections.

Urine normally flows in one direction, down from the kidneys, through tubes called ureters, to the bladder.  However there is a condition known as vesicoureteral reflux (VUR) where there is an abnormal flow of urine from the bladder back into the ureters.  It is a condition most commonly diagnosed in childhood after a urinary tract infection has occurred. About one-third of children with a UTI are found to have VUR. VUR can lead to infection because urine that remains in the urinary tract provides a place for bacteria to grow.  A study(6) in children with VUR compared the preventative effect of oral probiotics with antibiotics.  The probiotic was shown to be as effective as the antibiotic in the prevention of recurrent UTIs.

The evidence for the use of probiotic supplements and vaginal suppositories in the treatment and prevention of UTI in women is still preliminary but ever growing.  There is a lot of logic behind the rationale and in practice many women, especially those who have undergone repeat antibiotic treatment, find probiotics to be really helpful in preventing and treating cystitis and other urinary tract infections.  Vaginal probiotic creams, suppositories and tablets are readily available, they usually contain lactobacillus acidophilus.  Oral probiotics (and prebiotics) may be useful in order to help keep an overall balance of good bacteria in the vagina and digestive and system.

(1) Reid G & Bruce AW.  2006.  Probiotics to prevent urinary tract infections: the rationale and evidence.  World J Urol.  24:28-32
(2) Reid G.  2000.  Probiotic Therapy and Functional Foods for Prevention of Urinary Tract Infections: State of the Art and Science.  Curr Infect Dis Rep.  2:518-522
(3)Kontiokari T et al.  2003.  Dietary factors protecting women from urinary tract infection.  Am J Clin Nutr.  77:600-604
(4) Uehara S et al.  2006.  A pilot study evaluating the safety and effectiveness of Lactobacillus vaginal suppositories in patients with recurrent urinary tract infection.  Int J Antimicrob Agents.  28 Suppl 1:S30-S34
(5) Czaja CA et al.  2007.  Phase I trial of a Lactobacillus crispatus vaginal suppository for prevention of recurrent urinary tract infection in women.  Infect Dis Obstet Gynecol.  2007:35387
(6) Lee SJ et al.  2007.  Probiotics prophylaxis in children with persistent primary vesicoureteral reflux.  Pediatr Nephrol.  22:1315-1320

Written by Ani Kowal

I do hope you all had a fabulous Christmas?  Plenty of food has been consumed in my household and, with New Years Eve fast approaching, there may be plenty more tasty treats in the planning.  Indigestion is possibly on the menu in many homes, however there are natural ways to prevent and overcome this uncomfortable problem.

Indigestion, sometimes referred to as dyspepsia, is a general term for impaired stomach/digestive functioning occurring 1-2 hours after eating.  Symptoms may include:
Abdominal Pain centred in the upper abdomen
Rumbling noises
Excessive wind
A feeling of fullness or bloating

Indigestion commonly occurs after eating a large meal, or rich, fried or spicy food.  Alcohol, coffee, cigarette smoking and some pharmaceutical drugs such as aspirin and ibuprofen can also irritate the digestive system and cause indigestion.  During stressful situations or stressful periods of time we are also more susceptible to this complaint.

Our bodies are far more adept at digesting small, regular quantities of food rather than single huge meals.  However, if you are going to be consuming a large meal there are a few things you can do to minimise discomfort.  Chewing is a simple, yet highly effective, strategy for indigestion avoidance.  Our saliva contains enzymes that start digesting food within the mouth, even before it hits the stomach.  Chewing food properly enables these enzymes to mix thoroughly with our food.  Chewing also physically breaks food up into smaller pieces which make it easier to be further broken down by our stomach acid.  Taking the time to chew food until it becomes almost creamy in consistency before swallowing is an effective method of preventing indigestion and also allows us to enjoy what we are eating, really taste the flavours and savour them.  Taking time over a meal increases the enjoyment value, usually helps us not to overeat (as it is easier to know when we are full) and can help prevent indigestion.

Whilst eating try not to drink a lot of fluid.  Excess liquid with a meal can dilute stomach acid and enzymes which digest food making the process a little less efficient.  Carbonated, fizzy, drinks seem to be the worst culprits. 

Prebiotics and Probiotics
Studies (1,2) are beginning to show that probiotics and prebiotics can aid healthy digestion and prevent indigestion.  Taking a supplement containing prebiotics and probiotics regularly can prevent symptoms such as pain, bloating and flatulence within as little as 2 weeks

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. 

Digestive enzymes
Many people will reach for antacids in the hope that they will aid their indigestion.  However, antacids are used to damp-down the stomach’s acid (hydrochloric acid) production and in many instances indigestion is actually linked to insufficient acid production in the stomach.  Taking an antacid could exacerbate the underlying cause of indigestion.  If, after a large meal, you feel uncomfortable with indigestion it may be helpful to take a supplement containing a mixture of natural digestive enzymes such as amylases, which digest carbohydrates, lipases, which digest fats, and proteolytic enzymes which digest proteins.  This will help your body to digest the food within your system.  I don’t suggest these supplements need to be used long term but they may well be helpful after a large meal if indigestion starts to make you feel uncomfortable.

Digestive enzyme use should be avoided in cases of gastritis, inflammation of the stomach lining, and/or ulceration as they will exacerbate the condition. 

Artichoke leaf extract
Studies (3,4) show that artichoke leaf extract supplements are useful for individuals who commonly suffer with indigestion.  It appears that after taking the supplement for six weeks individuals report their symptoms are improved and they feel more comfortable in general.  

Finish off the meal with some peppermint or ginger tea
A review published of studies and papers was published this year (5) which indicates that peppermint oil can be effective in reducing abdominal pain, flatulence and diarrhoea.  It seems to work by reducing spasms in the digestive system.  Peppermint tea contains peppermint essential oil and it may be worth sipping on some peppermint tea after a meal – it could aid in minimizing indigestion problems. 

Another recent review paper (6) indicates that ginger may well be helpful in easing indigestion.  Ginger does contain many compounds that seem to have various effects in the body and is particularly useful in relieving feelings of nausea.  Drinking some ginger tea after a meal could be worth a try!

Please see a doctor if your indigestion persists over several days, is experienced after every meal, becomes worse over time, if you vomit, you lose your appetite, or if you start to lose weight. These symptoms may indicate an underlying gastric disorder.  Apart from poor digestion or a large meal, another common cause of indigestion is an ulcer in the stomach or upper intestines and I hope to write about digestive ulcers in 2009.

Take the time to really enjoy your New Year celebrations!

(1)Kocian J.  1994.  [Lactobacilli in the treatment of dyspepsia due to dysmicrobia of various causes][Article in Czech].  Vnitr Lek.  40(2):79-83
(2)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
(3) Marakis G et al.2002.  Artichoke leaf extract reduces mild dyspepsia in an open study.  Phytomedicine.  9(8):694-699.
(4)Holtmann G et al.  2003.  Efficacy of artichoke leaf extract in the treatment of patients with functional dyspepsia: a six-week placebo-controlled, double-blind, multicentre trial.  Aliment Pharmacol Ther.  18(11-12):1099-1105.
(5) Herbal remedies for dyspepsia: peppermint seems effective.  2008.  Prescrire Int.  17:121-123
(6)Ali BH et al.  2008.  Some phytochemical, pharmacological and toxicological properties of giner (Zingiber officinal Roscoe): a review of recent research.  Food Chem Toxicol.  46:409-420

Written by Ani Kowal

Talking about bowel habits is not something we often do but if constipation is affecting your life it can be quite uncomfortable and even upsetting.  Thankfully there are plenty of ways to ease the problem without resorting to pharmaceutical laxatives.  Constipation is usually defined as a change in daily bowel patterns, particularly a decrease in the number or consistency of bowel movements, or pain or difficulty passing stools

Prebiotics and probiotics
Previously (in August) I wrote extensively about prebiotics, probiotics and synbiotics with regards IBS (irritable bowel syndrome).  Unsurprisingly these same agents work very well in the prevention and treatment of constipation.  By positively changing the bacterial makeup of the gut they help to keep the digestive system functioning efficiently.  Prebiotics also act as a source of fibre, which adds bulk to stools and absorbs water to help eliminate waste efficiently and painlessly. 

As you will probably be aware, there are many yoghurts now available on the market which contain both pre-biotics and pro-biotics.  There is evidence from recent trials (1,2) to suggest they are effective in treating constipation.  A recent study (1), published in march, found that consumption of the yoghurt was associated with increased frequency of bowel movements, a reduced perception of straining effort and a reduced perception of pain associated with defecation.

Inulin, a type of prebiotic powder supplement, has been shown to increase the number of good bacteria in the gut as well as reducing constipation better than a traditionally used lactose laxative (3).  A supplement containing both prebiotics and probiotics has also shown good results in the treatment of constipation (4).   Taking a daily symbiotic supplements, those containing prebiotics and probiotics, may well be useful for the treatment and prevention of constipation and the efficient functioning of the digestive system.  There is also emerging evidence, that I have discussed previously, which indicates that a good bacterial balance in the gut may affect the immune system of the whole body, so a daily supplement may help to keep you feeling great!

Artichoke leaf extract
As well as its usefulness in treating IBS, artichoke leaf extract seems to be helpful in alleviating constipation.  One study(5) found that 71% of constipation patients experienced improvement using artichoke leaf extract for 6 weeks.  If you are suffering from this uncomfortable condition you may wish to try an ALE supplement for a few weeks to see if it brings relief and normalises daily bowel habits.

Fibre
Previously I have mentioned how, in the UK, we tend to fall short of the daily recommendations for fibre provision.  Many of us reach only 12g/day, the recommendation is for at least 18g/day with many health professionals recommending around 25g/day.  Fruit and vegetables provide lots of fibre, as well as all the other nutrients packed within them.  We would all do well to reach a minimum of five portions daily.  Fibre provides bulk in the digestive system, this then absorbs water making stools easy to pass and preventing constipation.  A recent study(6) in children found that constipated children had significantly lower intakes of dietary fibre than non-constipated counterparts which was attributable to under-consumption of plant foods.

Regularly eating the recommended portions of a variety of fruit and vegetables may prevent the occurrence of constipation.  Increasing intakes if constipation is already present may also help to ease and clear the problem.  Two studies (7,8) have found that eating a couple of kiwi fruit a day is helpful in the treatment of constipation.

You may wish to consider a supplemental source of fibre as a short term measure for treating constipation.  One source of fibre which seems to be helpful is flaxseeds (9,10).  If you want to try this form of fibre I would recommend buying a ground flaxseed, sometimes called linseed, supplement (or grinding the seeds yourself at home), these are easier on the digestive system and the grinding will also help to release essential omega 3 fatty acids within the seeds which adds to the nutritional benefits.  A table-spoonful of ground flax (about 15-25g) a day will probably help to ease constipation within a couple of days.  A teaspoon a day (around 5g) could be useful in prevention or re-occurrence of constipation and may be particularly useful if you feel your daily fibre intake is habitually low.

Water
Drinking enough (around 1.5L) water daily is important in the prevention and treatment of constipation.  Water is absorbed by fibre in the digestive system and adds bulk to the waste making it easier to pass.  One study (11) found that including 25g of fibre from food in the daily diet was very helpful in treating constipation and that the effect was significantly enhanced by increasing fluid intake to 1.5-2.0 litres/day.  Another study (12) concluded that fluid loss (via diarrhoea and laxative use), fluid restriction, poor hydration and dehydration increased constipation. It is very important to maintain hydration to prevent constipation.

Cow’s milk
Finally I would like to suggest that if your child (up to age 10) is suffering from regular bouts of constipation it may be a good idea to ask your GP to do a test for allergy to cow’s milk.  There are studies (13,14,15) to suggest that chronic constipation occurs as a result of cows milk allergy in some children.  There is also a lot of anecdotal evidence to back this up.  It is very important that you see your GP for the allergy test, never try elimination diets at home without the involvement of a health professional.

(1)De Paula JA et al.  2008.  Effect of the ingestion of a symbiotic yoghurt on the bowel health of women with functional constipation.  Acta Gastroenterol Latinoam.  38:16-25
(2)Sairanen U et al.  2007.  Yoghurt containing galacto-oligosaccharides, prunes and linseed reduces the severity of mild constipation in elderly subjects.  Eur J Clin Nutr.  61:1423-1428
(3) Kleessen B et al.  1997.  Effects of inulin and lactose on fecal microflora, microbial activity, and bowel habit in elderly constipated persons.  Am J Clin Nutr.  65(5):1397-1402.
(4)Amenta M et al.  2006.  Diet and chronic constipation. Benefits of oral supplementation with symbiotic zir fos (Bifidobacterium longum W11 + FOS Actilight).  Acta Biomed.  77:157-162
(5) Gebhardt R.  1996.   Antidyspeptic and lipid-lowering effects of artichoke leaf extract.  Journal for General Medicine.  2
(6)Lee WT et al.  2008.  Increased prevalence of constipation in pre-school children is attributable to under-consumption of plant foods: A community-based study.  J Paediatr Child Health.  44:170-175
(7)Chan AO et al.  2007.  Increasing dietary fiber intake in terms of kiwifruit improves constipation in Chinese patients. World J Gastroenterol.  13(35):4771-5.
(8)Rish EC et al.  2002.  Kiwifruit promotes laxation in the elderly.  Asia Pacific Journal of Clinical Nutrition.  11(2):164.
(9)Cunnane, S. C., et al.  Nutritional attributes of traditional flaxseed in healthy young adults.  American Journal of Clinical Nutrition.  61(1):62-68, 1995.
(10)Dahl, W. J., et al.  Effects of flax fiber on laxation and glycemic response in healthy volunteers.  Journal of Medicinal Food.  8(4):508-511, 2005.
(11) Anti M et al.  1998.   Water supplementation enhances the effect of high-fiber diet on stool frequency and laxative consumption in adult patients with functional constipation.  Hepatogastroenterology.  45(21):727-32
(12) Arnauld MJ.  2003.  Mild dehydration: a risk factor of constipation?  Eur J Clin Nutr.  57(Supplement 2):S88-S95.
(13)Daher S et al.  2001.  Cow's milk protein intolerance and chronic constipation in children.  Pediatr Allergy Immunol.  12(6):339-42
(14)Iacono G et al.  Intolerance of cow’s milk and chronic constipation in children.  New England Journal of Medicine.  339(16):1100-1104, 1998.
(15)Heine RG et al.  2002.  Cow's milk allergy in infancy.  Curr Opin Allergy Clin Immunol.  2(3):217-25

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

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

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

Researchers at the Institute of Food Research in Norwich, have just published a study(1) indicating that probiotics (‘good’ bacteria) may help to keep hay fever symptoms at bay.

The researchers of this small study wanted to investigate whether the ‘good bacteria’ Lactobacillus casei Shirota (found in many probiotic supplements, yoghurts and drinks) played a role in modulating the symptoms of hay fever (seasonal allergic rhinitis).  Hay fever sufferers were given a milky drink, with or without the good bacteria, each day for five months.  The scientists kept track of, and compared the changes in, the immune system of the participants by collecting blood samples before, during and after grass pollen season.  

It was found that the probiotic being tested changed the way the body's immune cells responded to grass pollen.  The hay fever sufferers that had been drinking the probiotic containing drink had lower levels of the chemicals (interleukin 5 and 6 and interferon-gamma) partly responsible for the production of hay fever symptoms in the body.  They also had higher levels of specific antibodies (immunoglobulin G and E) which are associated with playing a protective role in allergy reactions.

The authors of the study conclude that “These data show that probiotic supplementation modulates immune responses in allergic rhinitis and may have the potential to alleviate the severity of symptoms.”

This was only a small study and the authors plan to do further work to further elucidate the role that probiotic ‘good’ bacteria may play in changing the immune status of hay fever sufferers.  As I mentioned in my post dated 19th May the good/friendly bacteria in our digestive system have been linked to positively enhancing the action of our immune system through their production of a variety of substances.  This study adds to the growing body of evidence which suggests that the bacteria in our digestive systems may be very important in affecting our overall health.

(1) Ivory K et al.  2008.  Oral delivery of Lactobacillus casei Shirota modifies allergen-induced immune responses in allergic rhinitis. Clin Exp Allergy. 2008 May 28. [Epub ahead of print]

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