The herb thyme has recently (1) been found to suppress a specific enzyme (promotes specific biochemical reactions in the body), called Cyclooxygenase-2 (COX-2), which plays a key role in inflammation.  The researchers involved in this laboratory-based cell study found that a specific chemical found in thyme, called carvacrol, seemed primarily responsible for the inflammation suppressing activity.  Other botanical essential oils were also studied – clove, rose,e ucalyptus, fennel and bergamot – these also exhibited inflammation suppressing properties but to a lesser degree when compared to thyme, which reduced COX-2 levels by almost 75%.

Plant essential oils have been used for many years in various remedies but the way they work has not been clearly understood.  The authors of this study suggest that further understanding of the anti-inflammatory properties of various plant essential oils, or their specific components like carvacrol could be very important for future formulation of anti-inflammatory medications and remedies.

There have been a few small studies (2,3,4) using extracts of the herb thyme which have found that it may be helpful for treating the symptoms of bronchitis and coughs.  This could be due to the anti-inflammatory properties as mentioned above and also the antioxidant properties of thyme which have been demonstrated recently in cell studies (e.g.5,6).

Thyme, as well as a variety of other herbs, is now added to herbal antioxidant supplement preparations and can also be purchased as a ‘tea’ and an oil.  Further studies with the herb need to take place before any firm conclusions can be drawn and recommendations made for its use.  However, if you have a cough you may want to look out for herbal cough remedies that contain thyme or perhaps try burning a little of the oil in an oil burner, or sipping on some thyme tea to see if it brings relief to your symptoms. 

In the future I expect that more herbal preparations will be investigated and incorporated into medicines for various uses.  The antioxidant and anti-inflammatory properties of thyme and other herbs is interesting and exciting since many common health complaints are linked to inflammation and ‘oxidative stress’.

(1)Hotta M et al.  2010.  Carvacrol, a component of thyme oil, activates PPAR  and  and suppresses COX-2 expression.  Journal of Lipid Research.   51: 132-139
(2) Kemmerich B.  2007. Evaluation of efficacy and tolerability of a fixed combination of dry extracts of thyme herb and primrose root in adults suffering from acute bronchitis with productive cough. A prospective, double-blind, placebo-controlled multicentre clinical trial. Arzneimittelforschung.  57(9):607-15
(3) Kemmerich B et al.  2006.   Efficacy and tolerability of a fluid extract combination of thyme herb and ivy leaves and matched placebo in adults suffering from acute bronchitis with productive cough. A prospective, double-blind, placebo-controlled clinical trial. Arzneimittelforschung.  56(9):652-60
(4) Büechi S et al.  2005.  Open trial to assess aspects of safety and efficacy of a combined herbal cough syrup with ivy and thyme. Forsch Komplementarmed Klass Naturheilkd.  12(6):328-32.
(5) Rana P & Soni G.  2008.  Antioxidant potential of thyme extract: alleviation of N-nitrosodiethylamine-induced oxidative stress.  Hum Exp Toxicol. 27(3):215-21.
(6) Wang HF et al.  2008.  DPPH free-radical scavenging ability, total phenolic content, and chemical composition analysis of forty-five kinds of essential oils.  J Cosmet Sci.  59(6):509-22.
Written by Ani Kowal

Selenium isn’t a mineral that receives a lot of press attention, however it is an essential trace element that is incredibly vital to our health.  I first became aware of the importance of selenium for optimal health when I was studying for my MSc in Nutritional Medicine at the University of Surrey.  My professor at that time, Margaret Rayman, was (and is) a leading scientific researcher in the field of selenium.  At the time I was studying (2000-2002) there was a lot of research linking low selenium intakes to increased prostate cancer risk in men.  A very recently published paper (1) has now found that low selenium intakes seem to be tied to throat and stomach cancers too.  This is a preliminary study and further research is certainly required before any firm conclusions can be drawn.

Selenium acts as an important antioxidant in the body and this may account for part of the role it plays in cancer prevention.  As an antioxidant selenium may also be useful in preventing conditions related to inflammation such as pancreatitis, rheumatoid arthritis, systemic inflammatory response syndrome, asthma and cardiovascular disease, to name but a few.  It is also vital for a healthy immune system and plays a role in fertility in men and women.  In men it is vital for good sperm motility and in women selenium appears to be vital in very early pregnancy (2)

With regards the potential cancer protective role of selenium the antioxidant role may not be the only way that selenium acts.  Selenium also seems to act at the DNA level on specific genes in a variety of complicated ways (2)

As well as the requirement of selenium for antioxidant defence there is evidence that selenium:
* Is needed for thyroid function
* Is required by the immune system
* Has important antiviral effects
* Is needed for reproduction
* Enhances mood
* Reduces the risk of cancer
* Protects against mercury toxicity

The effect of selenium and its importance is most observable in populations where selenium status is low. The amount of selenium in the soil where food is grown determines its selenium content.  This is important here in the UK since our soils are very low in selenium.  The UK RNI (reference nutrient intake) for selenium is 75mcg/d for adult men and 60mcg/d for adult women.  However in the UK selenium intakes are estimated to be 39mcg/d which is very low and probably inadequate for most individuals (3).  Selenium intakes in the UK have fallen over the last 25 years largely due to the decrease in imports of high selenium wheat from the USA and Canada.  Plant foods are generally low in selenium in the UK/Europe where soil selenium levels are low (2).

Care is needed with supplementation since high doses of selenium can build up in the body and are toxic to health.  I would suggest not taking more that 100mcg/d.  I also do not recommend taking selenium as a single nutrient supplement since nutrients interact in complex and synergistic ways.  If you are taking a multi-vitamin and mineral supplement check to see that it contains selenium, if not then consider switching to a multi-formulation that does contain selenium.  Unfortunately dietary sources of selenium are few in the UK.  Brazil nuts (just 4-6 a day) and fish contain the highest concentrations in the diet of the UK population.  Some selenium rich flours are available to buy for cooking with

(1)Steevens J et al.  2009.  Selenium status and the risk of esophageal and gastric cancer subtypes: the Netherlands cohort study.  Accepted Manuscript, 14 December 2009.  Gastroenterology.  DOI: 10.1053/j.gastro.2009.12.004
(2) Rayman, M.P. 2000.  The importance of selenium to human health.  The Lancet 356: 233-241.
(3) BNF (British Nutrition Foundation).  2001.  Briefing Paper: Selenium and Health.

Written by Ani Kowal

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

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

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

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

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

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

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

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

Vitamin D has been a major topic of research over the last 2 years.  It seems as though this vitamin is essential to many aspects for health from bone to brain.  Low blood serum levels of vitamin D have been associated with increased risk for several diseases e.g. cardiovascular diseases, diabetes, depression, dental caries, osteoporosis, and periodontal disease.  Today I wanted to look further into the role that vitamin D may play in helping individuals who suffer from low mood or depression.  Previously I mentioned that vitamin D may be helpful to individuals suffering with Seasonal Affective Disorder (SAD) and have also written about vitamin D for healthy brain function and possible prevention of dementia/Alzheimer’s Disease.

There are ‘receptors’ for vitamin D within the brain and this may be the reason why recent research is discovering a link between vitamin D and mood.  In 2006(1) a study found that low levels of vitamin D (serum 25-hydroxyvitamin D) was significantly associated with a high depression score.  Other studies (e.g. 2,3,4) have found similar associations between low vitamin D levels and poor mood.

Vitamin D, acts as a multipurpose steroid hormone within the body and is vital to health.  A lack of vitamin D, or low vitamin D levels, particularly among older adults, have been linked to cognitive (brain) function, depression, bipolar disorder, and schizophrenia.  As mentioned above vitamin D activates receptors on neurons in regions of the brain which are implicated in the regulation of behaviour.  Vitamin D also acts to protect the brain by balancing antioxidant and anti-inflammatory defences (5).

The association studies mentioned above are interesting but don’t prove that vitamin D can help treat depression.  Interestingly, a study took place last year (6) which looked at vitamin D supplementation and depression in overweight and obese individuals.  The study involved over 400 individuals who were given high dose vitamin D supplementation: 20,000iu per week, 40,000iu per week or a placebo for one year.  Depression was rated using a special scale called the Beck Depression Inventory (BDI).  The first observation that was made by the research scientists was that individuals with the lowest vitamin D levels scored significantly higher in the depression scale than those with better vitamin D levels.  After one year of supplementation the two groups given vitamin D had significant improvements in BDI scores, this did not occur in the placebo group.  Vitamin D supplementation seemed to be positively affecting mood.  The authors conclude that “It appears to be a relation between serum levels of [vitamin D] 25(OH)D and symptoms of depression. Supplementation with high doses of vitamin D seems to ameliorate these symptoms indicating a possible causal relationship”. The research was carried out in overweight and obese individuals and further trials are necessary in normal-weight individuals. 

These results suggest that vitamin D deficiency could have the ability to cause depression and that ensuring good vitamin D levels in the body could help to prevent/treat depression.  Here in the UK that would seem particularly vital in the autumn and winter months when there is less sunlight and vitamin D levels tend to drop to their lowest.

Evidence for the use of vitamin D in depression and mood disorders is preliminary and not yet conclusive.  Further evidence is needed to see whether vitamin D is as useful in cases of moderate-to severe depression as it is in mild cases.  However, as I have previously written many of us in the UK have very low vitamin D levels.  If you rarely get out into the sunlight you may wish to consider taking a vitamin D supplement which provides around 12mcg of the nutrient per day (around 500iu).  Only small amounts of vitamin D are found in food sources such as oily fish (mackerel, salmon and sardines) and egg yolks.  Vitamin D supplements may be particularly useful during the autumn and winter months and for individuals who have darker skins or who don’t go outside regularly.  If you think you want to supplement much higher levels (more than 1000iu daily) then please visit your doctor since vitamin D is a fat soluble vitamin and it is possible to take too much.  When looking for vitamin D supplements two forms are generally available.  Cholecalciferol, known as vitamin D3, and ergocalciferol or vitamin D2. Cholecalciferol is generally taken to be the more potent, easily absorbed and preferred form of vitamin D

(1)Jorde R et al.  2006.  Neuropsychological function in relation to serum parathyroid hormone and serum 25-hydroxyvitamin D levels:  The Tromso study.  Journal of Neurology.  253(4):464-70
(2)Wilkins CH et al.  2006.   Vitamin D deficiency is associated with low mood and worse cognitive performance in older adults. Am J Geriatr Psychiatry. 14(12):1032-40.
(3)Murphy PK et al.  2008.  Vitamin D and mood disorders among women: an integrative review. J Midwifery Womens Health.  53(5):440-6.
(4) Hoogendijk WJ et al.  2008.  Depression is associated with decreased 25-hydroxyvitamin D and increased parathyroid hormone levels in older adults. Arch Gen Psychiatry.  65(5):508-12.
(5)Cherniack EP et al.  2009.  Some new food for thought: the role of vitamin D in the mental health of older adults.  Curr Psychiatry Rep. 11(1):12-9.
(6)Jorde R et al.  2008.  Effects of vitamin D supplementation on symptoms of depression in overweight and obese subjects: randomised double blind trial.  J Intern Med.  264:599-609
Written by Ani Kowal

Age related macular degeneration (AMD) is the most common cause of blindness in people over the age of 50 in the UK.  I have previously written about this condition but to re-cap:  

The macular is the light sensitive area in the centre of the retina that controls visual field and the ability to see colours.  AMD is caused by the deterioration of the macular.  As this happens the peripheral, outer, vision remains intact as the centre field of vision becomes slowly blurry, grey or filled with a large black spot.  Two forms of AMD exists: the dry form which develops slowly, accounting for 90% of all cases; and the wet form which causes rapid deterioration of central vision. 

The exact causes of AMD are unknown although free radical damage, where unstable oxygen molecules damage the eye cells, is strongly implicated.  Tobacco smoke and sun exposure can increase the level of free radicals in the body and both are a risk for AMD.  High blood pressure and diabetes are also risk factors as these conditions can limit blood flow to the eyes.  For more information please visit Macular Disease Society website.  The Macular Disease Society aims to build confidence and independence for those with central vision impairment.  They are the only UK charity dedicated to helping people with macular degeneration and offer information, a helpline, counselling and emotional support among other resources.

Previously I have gone into detail as to why long chain omega 3 fatty acids may be important for eye health and written about various published studies.  A new paper (1) has just been published in the American Journal of Clinical Nutrition which adds further weight to the evidence.  The researchers of this study(1) wanted to investigate whether long chain omega 3 fatty acids, EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid), which are found in oily fish such as mackerel, trout, sardines and salmon, are associated with a reduced likelihood of developing AMD.  The study involved over 1800 people who were are risk of developing AMD,.  The individuals were followed from 1992 to 2005 and their diets were assessed vial a special validated questionnaire.  The results show that participants who reported the highest long chain omega 3 intakes were 30% less likely than their peers to develop AMD.  This study showed a strong association between omega 3 fatty acids and protection against AMD but further trials would be needed to prove cause and effect.  The authors conclude that “If these results are generalizable, they may guide the development of low-cost and easily implemented preventive interventions for progression to advanced AMD”

Long chain omega 3 fats certainly seems to be part of the story.  Antioxidants and other nutrients have also been implicated in the protection against eye disease.  Please read my previous posts on AMD and cataract for more information on how certain nutrients may be important for good eye health.  It is not yet recommended that omega 3 supplements be taken specifically for protection against AMD, however these fats are vital for health for a number of reasons, if you do not regularly (at least twice a week) eat oily fish you may wish to consider a fish oil supplement.  Vegetarians and vegans can take a flaxseed oil supplement (which provides short chain omega 3 fatty acids) or look into buying EPA/DHA supplements produced from algae, these supplements are becoming increasingly available.

(1)SanGiovanni JP et al.  2009.  omega–3 Long-chain polyunsaturated fatty acid intake and 12-y incidence of neovascular age-related macular degeneration and central geographic atrophy: AREDS report 30, a prospective cohort study from the Age-Related Eye Disease Study.  Am J Clin Nutr 2009;90 1601-1607
Written by Ani Kowal

On Monday I wrote about phytochemicals in relation to obesity.  Bioflavonoids are phytochemicals, or plant nutrient, that I have written about often.  Fruit and vegetables and other plant-based foods such as nuts, seeds, pulses, beans are the richest sources of flavonoids.  A favoured source of flavonoids for me is cocoa.  Cocoa and dark chocolate made from a minimum of 70% cocoa solids are a great source of flavonoids that have high antioxidant potential and have been linked to a reduced risk of all sorts of health problems such as heart disease and certain cancers.  In addition to antioxidant bioflavonoids cocoa contains a number of minerals such as magnesium. Dark chocolate also contains fibre and is much lower in sugar than milk chocolate, so most people find that they need far less to satisfy their chocolate cravings.

A recent study (1) has found that a high intake of cocoa bioflavonoids may be related to a reduced inflammatory response in the body in patients at high risk of cardiovascular disease (heart disease and stroke).  Cardiovascular disease is considered an inflammatory condition.  The authors note that “These antiinflammatory effects may contribute to the overall benefits of cocoa consumption against atherosclerosis”.

The study involved forty two individuals at high risk of cardiovascular disease.  The individuals received 40g cocoa powder with 500mL skimmed milk or only 500ml skimmed milk for 4 weeks.  The regimen was then switched.   Before and after each intervention period, inflammatory markers in the cells and in blood serum were evaluated.  The results indicate that intake of cocoa polyphenols may positively change inflammatory chemicals in individuals at high risk of cardiovascular disease (1)

Flavonoids act as antioxidants in the body, helping to prevent cell damage and protection against disease by mopping-up destructive unstable oxygen molecules known as 'free radicals'.  Polypheonols also seem to have other protective effects on the heart and blood vessels.  They seem to prevent blood clotting, abnormal heart beat and blood vessel narrowing.  As yet scientists are not exactly sure of how these plant compounds act, however they do seem to positively change the way our genes function.

A recent review of published evidence(2) also suggests that there could be a link between cocoa consumption and protection against cancer.  The high concentration of bioflavonoids - catechins and procyanidins, found in cocoa and dark chocolate products is thought to be the important factor.  As mentioned the anti-inflammatory and antioxidant properties of these bioflavonoids probably also accounts for the cancer protective properties.  Studies into cocoa and cancer prevention have been small and are preliminary.  Larger trials would be necessary for any definitive evidence.

The major flavonols to be found in cocoa are called epicatechin and catechin.  The important message is that dark chocolate (minimum 70% cocoa solids) and cocoa rich products can be enjoyed in moderation and as part of a healthy balanced diet rich in bioflavonoids from other sources, especially vegetables and fruits.  Vegetables and fruit should form the core of a healthy diet and getting a good variety will give the body many of the nutrients that are needed for optimal health.  Flavonoid supplements are now available, though the evidence for their use is still in the early stages.  If you feel your diet is lacking in vegetables and fruits you may want to consider a supplement to top-up and cover the shortfall, but remember supplements are not a replacement for a healthy diet.

(1)Mongas M et al.  2009.  Effect of cocoa powder on the modulation of inflammatory biomarkers in patients at high risk of cardiovascular disease.  Am J Clin Nutr.  90:1144-1150
(2)Maskarinec G.  2009.  Cancer protective properties of cocoa: a review of the epidemiologic evidence. Nutr Cancer. 61(5):573-9.
Written by Ani Kowal

Vegetables and fruits contain abundant amounts of phytochemicals (bioflavonoids), bioactive plant nutrients, which are thought to be vital to the body for many reasons and linked to a reduced risk of all kinds of conditions from heart disease and cancer to dementia and bone loss.  The recommendations to eat plenty of these plant-based foods are certainly valid and very important.  A high intake of phytochemical compounds has been shown to be important for optimal health and prevention of disease.

A recent study (1) has linked high intakes of phytochemicals with reduced adiposity,fat tissue, as well as reduced oxidative stress, a kind of stress that occurs in the cells of our bodies when they are under attack by molecules known as ‘free radicals’.  In the body antioxidant defences are important to prevent damage by these free radical molecules which can cause inflammation and are linked to many diseases.  Many phytochemicals act as antioxidants in the body.

The authors of this study(1) used a simple 'phytochemical index' to determine the levels of these plant chemicals consumed by 54 people aged between 18-30 years.  Participants were ordered into normal weight and overweight groups.  Dietary records and blood samples were collected. The phytochemical index was a way of comparing the number of calories consumed from plant-based foods with the overall number of daily calories. 

The adults in the two groups consumed about the same amount of calories.  However overweight-obese adults consumed fewer plant-based foods and subsequently fewer protective trace minerals and phytochemicals and more saturated fats. They also had higher levels of oxidative stress and inflammation than their normal-weight peers, these processes are related to the onset of obesity, heart disease, diabetes and joint disease.  The authors conclude that having more phytochemicals in the diet is related to a lower fat mass and lower levels of oxidative stress.  Phytochemicals may be having an effect on the metabolic processes associated with obesity but further research would be necessary to elucidate this (1). 

As mentioned earlier, phytochemicals are found in large amounts in vegetables and fruits, they are also present in nuts, beans, pulses and lentils.  These are foods that we are always being reminded to include in high levels in the diet.  In a press release (2) the author of the study stated  “We need to find a way to encourage people to pull back on fat and eat more foods rich in micronutrients and trace minerals from fruits, vegetables, whole grains and soy,".  The author goes on to recommend (2) "Fill your plate with colorful, low-calorie, varied-texture foods derived from plants first. By slowly eating phytochemical-rich foods such as salads with olive oil or fresh-cut fruits before the actual meal, you will likely reduce the overall portion size, fat content and energy intake. In this way, you're ensuring that you get the variety of protective, disease-fighting phytochemicals you need and controlling caloric intake."

Plant based foods are generally lower in calories but more filling than processed foods since they contain plentiful amounts of fibre that can help us to feel fuller for longer, these foods really should represent the cornerstone of a healthy diet.  Supplements can never replace a healthy diet, however if you feel you are frequently falling short of eating enough vegetables and fruits you may want to consider taking a bioflavonoid supplement or a food-state multivitamin and mineral supplement to cover any short-term shortfalls.

There are many simple ways to include more vegetables and fruits in the diet e.g.
*Replace processed snack bars with a piece of fruit or a handful of mixed unsalted nuts
*Vegetable sticks with some hummus make a great snack
*Grate an apple into your morning oats/porridge or added a chopped banana – avoid sweet, processed breakfast cereals
*Include plenty of salad in your lunchtime sandwich, 
*Have 2-3 portions of vegetables with your evening meal
*Eat fruit with natural yoghurt as a dessert
*Replace pre-packaged, processed foods as often as possible with fresh produce – the authors of the study state (2) "We always want to encourage people to go back to the whole sources of food, the non-processed foods if we can help it," "That would be the bottom line for anyone, regardless of age and body size, keep going back to the purer plant-based foods. Remember to eat the good quality food first."

(1)Vincent HK et al.  2009.  Relationship of the dietary phytochemical index to weight gain, oxidative stress and inflammation in overweight young adults. Journal of Human Nutrition and Dietetics.  Sep 4. [Epub ahead of print]
(2)University of Florida (2009, October 22). Phytochemicals In Plant-based Foods Could Help Battle Obesity, Disease. ScienceDaily. Retrieved October 23, 2009, from http://www.sciencedaily.com¬ /releases/2009/10/091021144251.htm

Written by Ani Kowal

I have mentioned folate a lot in my blog posts but mainly in relation to women, especially pregnant women.  However, recent research presented at the at the 2009 American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) Annual Meeting & OTO EXPO, in San Diego, CA(1) has found that high folate intakes in men may be associated with a 20% decreased risk of hearing loss.

The study(1) involved 3,559 cases of men with hearing loss.  The study authors found that men over the age of 60 who have a high intake of foods and supplement high in folate had a 20% decrease in risk of developing hearing loss.  The authors believe this is the largest study to delve into the relation between dietary intake and hearing loss. They also believe their findings could allow for greater education, prevention, and screening efforts in a bid to prevent hearing loss.  Further studies would certainly be necessary as this study only shows an association and not cause and effect. 

Ten years ago a small study in women (2) found that poor folate levels were associated with age-related decline in hearing.  The study was conducted in 55 healthy women aged 60-71.  The women were tested for hearing function and categorised into two groups – those with normal hearing and those with impaired hearing.  Women with impaired hearing had a 31% lower blood level of folate than women with normal hearing.  In addition to this study a couple of years ago a research team (3) found that folic acid supplementation seemed to slow the decline of low-frequency hearing in folate-deficient, older adults.  The objective of this study was to determine whether folic acid supplementation slows age-related hearing loss.  728 men and women were involved.  Subjects received daily oral folic acid (800 micro-grams) or placebo supplementation for 3 years.  Folic acid supplementation slowed the decline in hearing of the speech frequencies associated with aging in a population (but did not affect the decline in hearing high frequencies).  The authors note that the results need to be replicated in further larger studies but that folic acid supplementation seemed to slow the decline of low-frequency hearing in folate-deficient, older adults.

Folic acid may be playing a role in the prevention of age-related hearing loss by improving blood circulation to the artery that supplies blood to the cochlea of the ear.  In addition, folic acid is also related to lowering elevated homocysteine levels.  Elevated homocysteine could be related to age-related hearing loss.  Most people are aware that high levels of homocysteine in the blood have been linked to an increased risk of heart problems.  Recently high homocysteine levels have also been linked to poor bone health, poor eye health (such as age-related macular degeneration) and other health problems.  To recap from my past blog posts: Homocysteine is produced when the amino acid (the building blocks of protein) methionine is broken down in the body.  Normal levels of homocysteine are important to help build and maintain body tissues, however elevated concentrations in the blood can be harmful and have been associated with an increased risk of many disorders.  At normal levels homocystein can be converted in the body into a harmless substance called cystanthionine.  The conversion of homocysteine into this harmless substance depends upon various B vitamins  (B6, B12 and folic acid).  Having good levels of these B vitamins appears to be a very good way of preventing high homocysteine levels and low levels of B vitamins have been associated with raised homocysteine levels.

Foods particularly rich in folate include leafy vegetables such as spinach, asparagus, turnip greens, lettuces, dried or fresh beans and peas, fortified cereal products, sunflower seeds, yeast extract, liver and liver products.  Vitamin B6 is mainly found in meat, fish and eggs.  Vitamin B12 is found in liver, meats, eggs, milk and yeast extract. 

Vegetarians and vegans and those who feel they are not eating a varied, balanced diet may wish to consider taking a multiple B vitamin supplement to ensure good levels of these important B vitamins

(1)American Academy of Otolaryngology -- Head and Neck Surgery (2009, October 6). Higher Folates, Not Antioxidants, Can Reduce Hearing Loss Risk In Men. ScienceDaily. Retrieved October 6, 2009, from http://www.sciencedaily.com/releases/2009/10/091005161116.htm
(2)Houston DK et al.  1999.  Age-related hearing loss, vitamin B-12, and folate in elderly women.  American Journal of Clinical Nutrition.  69(3):564-571.
(3) Durga J et al.  2007.  Effects of folic acid supplementation on hearing in older adults: a randomized, controlled trial.  Ann Intern Med.  146(1):1-9.
Written by Ani Kowal

Back in May I reported the results of a study which found that taking folic acid before pregnancy and during early pregnancy was associated with a reduced risk of premature birth.  A recent study (1) has found that women with high antioxidant levels in their blood seem less likely to give birth prematurely.

The study(1) was a case control study.  It included over 5000 women.  All the women involved in the study had an interview, examination and blood test at week 24-26 of their pregnancy.  Some of the placentas from term and preterm births were also analysed.  There were 207 preterm births in total.  Women with high (above the average) blood plasma concentrations of carotene (both alpha and beta carotene), cryptoxanthin (a type of carotenoid), and lycopene seemed to have a reduced risk of preterm birth.  (I have written about carotenoids a number of times). 

Carotenoids such as alpha and beta carotene, lutein and zeaxanthin are a family of over 700 naturally occurring yellow, red, orange and dark green pigments found in vegetables and fruits.  Good sources include carrots, sweet potatoes, tomatoes, squash, peppers, cantaloupe melons, nectarines, papaya, mango and dark green vegetables such as spinach, kale, watercress and asparagus.  Introducing a good mix of these fruits and vegetables on a regular basis in the diet will help keep carotenoid levels in the body high.  Carotenoids act as antioxidants in the body.  Antioxidants are important to prevent damage to the body cells by naturally occurring unstable oxygen molecules, known as free radicals.  Antioxidants may help to ‘quench’ or mop-up the destructive free radical molecules and therefore protect against cell-damage.

This study found that women with higher blood levels of certain carotenoids were less likely to deliver their babies preterm.  In the study, the one-half of mothers-to-be with the highest blood levels of certain carotenoids were 30 percent to 50 percent less likely to deliver prematurely than women with lower levels. The findings do not prove cause-and-effect. There may be other things about women with high carotenoid levels that explain the association with lower preterm-birth risk but the authors conclude that further studies are certainly warranted to investigate the apparent link found in this study.

If carotenoids, or other antioxidants, do help prevent premature delivery, the reasons are not yet entirely clear.  The authors speculate that it could be related to protection from any ill effects of environmental toxins, like air pollution, or exposure to bacteria or other infectious agents.

Eating a healthy diet during pregnancy, and indeed at any time, is crucial.  Ensuring that you achieve the minimum 5 portions of vegetables and fruits daily is a good idea.  Aiming to eat plenty of these foods will mean that antioxidant levels in the body will naturally be high.  In addition, many women may choose to take a multivitamin and mineral supplement specifically designed for use during pregnancy and this may also boost levels of important antioxidants in the body, as well as providing folic acid.

(1)Kramer MS et al.  2009.  Antioxidant Vitamins, Long-Chain Fatty Acids, and Spontaneous Preterm Birth.  Epidemiology. 20(5):707-713.
Written by Ani Kowal

Last week I wrote about a study which found that green tea may positively impact bone health.  Today I wanted to look at a newly published study (1) which found that women who drink green tea regularly seem to have a reduced risk of stomach cancer.  Past studies have linked green tea consumption to a reduced risk of cancer at various sites in the body and it is probable that this has to do with the antioxidant flavonoids/polyphenols that the tea contains such as catechins (which I also discussed last week).  There is an added benefit of green tea in terms of prevention against stomach cancer – it is thought that the tea contains compounds that may fight certain types of bacteria which have been linked to stomach cancer.

This study (1) examined the association between green tea consumption and gastric cancer.  Data for over 200,000 individuals were analysed for the research.  In women, but not men, a significantly decreased risk of stomach cancer was observed for those women who consumed 5 or more cups of green tea per day compared to those who drank one cup or less per day.  Interestingly the reduced risk of stomach cancer seemed to apply to cancers in certain parts of the stomach.  The study took place in Japan where individuals frequently drink more than 5 cups of green tea daily.

Here in the UK green tea is becoming increasingly popular as a drink and also as a nutritional supplement, with many people switching their regular milky black tea for the green variety.  This current study does not prove that green tea protects against stomach cancer – the researcher want to do further research to see whether drinking the tea actually reduces the risk of stomach cancer, or whether women with a lower risk simply happen to drink more of it.

As I have mentioned many times in the past, antioxidant nutrients and flavonoids appear to be very important in reducing the risk of various cancers and other diseases.  The best way to boost antioxidant levels is to eat a large variety of vegetables and fruits daily, a minimum of 5 portions is recommended, however some experts say this is too low and that we need to be aiming for at least 9 a day in order to prevent various illnesses.  If you feel that you consistently fall short of the recommended 5 per day you may want to consider taking an antioxidant supplement that contains a variety of flavonoids – the evidence for these supplements is currently scant but studies are presently being carried out.  Please remember that supplements should never be viewed as a replacement for a balanced diet.

(1) Inoue M et al.  2009.  Green tea consumption and gastric cancer in Japanese: a pooled analysis of six cohort studies. Gut.  58(10):1323-32.
Written by Ani Kowal

On the 8th July this year I wrote a piece entitled “Are you tearing your hair out? Study finds nutritional supplement may help reduce compulsive behaviour”, the post was looking at a study which found that N-acetylcysteine (NAC) may be useful for sufferers of trichotillomania.  NAC is an amino acid that acts as an antioxidant in the body but also affects levels of glutamate in the brain.  Glutamate triggers excitement in the brain, lowering glutamate levels may help people who suffer with obsessive compulsive disorders.  Today I thought I would have another look at obsessive compulsive disorder (OCD) in general to assess whether any other nutritional/lifestyle advice could help.

One nutrient that seems to be coming up time and time again in the medical literature is inositol.  Insolitol is classified as a member of the vitamin B complex and is sometimes referred to as vitamin B8.  Naturally inositiol (in its myo-inositol form) is found in nuts, beans and fruit, especially cantaloupe melon, oranges, grapefruit and raisins.  It has many functions in the body, structurally it is important in some lipids (fats) and cell membranes but it also functions in insulin control pathways, nerve guidance, calcium control within cells, and serotonin activity.  Serotonin is often known as a feel-good brain chemical.  Low levels have been linked to many mood disturbances.  Low levels of insolitol in the body have also been linked with depression, bulimia, panic disorder, OCD, bipolar depression and agoraphobia.

So let’s have a closer look at the available medical studies with inositol in OCD and similar disorders.

In 1996 (1) a small, but well designed, study published in the American Journal of Psychiatry found that 18g of inositol per day for six weeks was effective at significantly reducing OCD symptoms when compared to a placebo.  In 1997 (2) another small trial found that 18g of inositol for six weeks significantly reduced scores of OCD symptoms compared when compared with placebo treatment. 

A group of researchers in 2001 (3) undertook a study to compare the effect of inositol with that of fluvoxamine in individuals with panic disorder.  Fluvoxamine is a Selective Serotonin Reuptake Inhibitor (SSRI) pharmaceutical antidepressant drug often used in OCD.  The trial participants received up to 18g/day of inositol and up to 150mg/d of fluvoxamine for a month.  Improvements on Hamilton Rating Scale for Anxiety scores, agoraphobia scores, and Clinical Global Impressions Scale scores were similar for both treatments.   In the first month, inositol reduced the number of panic attacks per week by an average of 4.0 compared with a reduction of 2.4 with fluvoxamine.  Nausea and tiredness were more common with fluvoxamine.  The authors of the study conclude that “Because inositol is a natural compound with few known side effects, it is attractive to patients who are ambivalent about taking psychiatric medication. Continuing reports of inositol's efficacy in the treatment of depression, panic disorder, and OCD should stimulate replication studies”.

Also published in 2001 was a paper (4) which reported three case studies to show that inositol may help in the treatment of trichotollomania.  The paper describes the cases of two women with trichotillomania and one with compulsive skin picking.  They were treated with 6g inositol (which was in a powder form and taken dissolved in water or juice three times per day). The treatment lasted 8-16 weeks and all of them found their condition improved with inositol treatment.  The authors of the paper conclude: "The three cases described here suggest that inositol might be a treatment option in some patients with hair pulling and skin picking and could be considered in patients who tolerate SRIs [selective reuptake inhibitors] poorly or who are unwilling to take them," 
 

These studies and case-studies certainly indicate that inositol is worth investigating further and I hope that larger trials are carried out soon.  Many OCD sufferers and sufferers of depression and other mood disturbances are unwilling to take anti-depressant drugs due to the many side-effects and a general unwillingness to take pharmaceutical mood-altering medications.  Side effects of inositol treatment are few and generally mild.  Possible side effects of high dose inositol treatment are mainly gastrointestinal symptoms such as gas, diarrhoea and abdominal cramps.  Headaches may also occur. 

How might inositol be working to help in OCD, trichotillomania and similar disorders?

As mentioned earlier inositol is involved with serotonin action in the brain. In 2001 (5) and 2002 (6) a group of researchers looked specifically at OCD and how inositol may be working to help sufferers of the condition.  There is, as yet, no conclusive answer but inositol certainly seems to be having an effect in brain cells at specific ‘receptor’ sites which are important in brain chemical signalling (dopamine and serotonin appear to be brain chemicals that are affected by inositol).  Inositol from the diet is incorporated into cell membranes of neurones, brain cells, where it serves a function in brain chemical signalling.  In addition to its role in cell signalling, inositol lipids also seem to alter receptor sensitivity, can direct membrane trafficking events, and have also been found to modulate an increasing array of complex signalling proteins in the brain (6).  Further research work is needed in order to gain firmer insights.

If you are a sufferer of OCD, trichotillomania or panic disorder and are looking for an alternative treatment to conventional antidepressants, or are interested in taking a natural substance in addition to conventional treatment it may well be worth talking to your medical doctor about inositol.  They may not be aware of the evidence, in which case you could show them this blog post and they can read the full study papers to gain a fuller perspective.  Never stop taking a conventional treatment without talking to your medical doctor first and do not start a high dose inositol treatment without first consulting a medical doctor. 

If you are suffering with trichotillomania you may also wish to contact the following online support network:  Trichotillomania Support Online.  For OCD sufferers the following charity, OCD-UK, may be a helpful point of contact.

(1) Fux, M et al.  1996.  Inositol treatment of obsessive-compulsive disorder.  American Journal of Psychiatry.  153(9):1219-1221
(2) Levine J.  1997.  Controlled trials of inositol in psychiatry.  Eur Neuropsychopharmacol.  7(2):147-155.
(3) Palatnik A et al.  2001.  Double-blind, controlled, crossover trial of inositol versus fluvoxamine for the treatment of panic disorder. J Clin Psychopharmacol. 21(3):335-9
(4) Seedat S, Stein D, Harvey B (2001), Inositol in the treatment of trichotillomania and compulsive skin picking (letter). J Clin Psychiatry 62(1):60-61.
(5) Harvey BH et al.  2001.  Chronic inositol increases striatal D(2) receptors but does not modify dexamphetamine-induced motor behavior. Relevance to obsessive-compulsive disorder.  Pharmacol Biochem Behav.  68(2):245-253.
(6) Harvey BH et al.  2002.  Defining the neuromolecular action of myo-inositol: application to obsessive-compulsive disorder.  Prog Neuropsychopharmacol Biol Psychiatry.  26(1):21-32.
Written by Ani Kowal

Green tea is becoming increasingly popular as a drink in the UK and throughout the ‘West’.  More and more people are also taking green tea supplements due to the numerous reports of the health benefits attributed to this drink.  Previously I have written about green tea with respect to antioxidants, heart disease, cancer and ageing.  Today I wanted to look at some new evidence (1) that certain chemical compounds within green tea may help to improve bone health. 

The study(1) was a preliminary laboratory-based cell study and further work would be necessary before firm conclusions or recommendations can be drawn from the results, however it gives interesting evidence nonetheless.  I have mentioned before that green tea contains bioactive plant chemicals, polyphenols, known as catechins.  The common polyphenols which are often listed on green tea supplements include those that were researched in this study, namely epigallocatechin, gallocatechin, and gallocatechin gallate.  These polyphenols have antioxidant properties in the body which probably account for many of their health benefits.

The laboratory study(1) found that tea catechins had positive effects on bone metabolism – they stimulated bone cell formation and helped to slow its breakdown.  Epigallocatechin appeared to be particularly helpful in boosting bone growth and bone mineralisation (which helps to strengthen bones).  This was the first study to pinpoint which chemicals in green tea are important in the possible improvement of bone health.  Importantly the researchers also noted that the catechins did not appear to cause any toxic effects in the bone cells.

Last month I wrote about the link between onions and bone health and have also written about carotenoids and bone strength as well as the importance of fruits and vegetables for bones.  The link between all these factors, including green tea, seems to be antioxidants.  As I said on Monday the best way to get dietary antioxidants is through eating a variety of fruits and vegetables daily.  Supplements cannot be seen as an alternative to a good diet but can be used as a support if you feel that you regularly struggle to include a minimum of five portions of vegetables and fruits into your daily diet.  More evidence is continually being published regarding the importance of flavonoids and antioxidants for health.

I would like to end this post by pointing out that antioxidant flavonoids/polyphenols are also found in cocoa as I have previously discussed!  This is why good quality dark chocolate (70% cocoa solids or above) can be enjoyed in small quantities guilt-free!  There are many studies which now extol the benefits of cocoa for health.  As I finish writing this piece I am allowing a square of my favourite 85% cocoa solids dark chocolate to melt on my tongue!

(1)Ko, CH et al.  2009.  Effects of Tea Catechins, Epigallocatechin, Gallocatechin, and Gallocatechin Gallate, on Bone Metabolism.  J. Agric. Food Chem. 57 (16): 7293–7297

Written by Ani Kowal

Due to the economic events occurring over the last year many people have felt under incredible stress.  A recent study (1) has found that an antioxidant supplement may be helpful in reducing symptoms such as fatigue, stress and anxiety which are fairly prevalent in developed populations at this current time.  There have been several suggestions in the scientific literature that there is a link between individual perceived stress and ‘oxidative stress’ – a kind of stress that occurs in the cells of our bodies when they are under attack by molecules known as ‘free radicals’.  In the body antioxidant defences are important to prevent damage by these free radical molecules which can cause inflammation and are linked to many diseases.  Our bodies contain many enzymes that act as antioxidants, a main one being SOD, superoxide dismutase.  The study mentioned (1) used a melon juice supplement that was high in SOD to see if it had any effect on individual symptoms of stress.

This pilot study (1) was well planned and included seventy healthy volunteers aged between 30 and 55 years, who felt daily stress and fatigue. They took the dietary melon supplement or a placebo once daily over a 4 week period. Symptoms of stress and fatigue were measured using four specific psychometric scales.

Supplementation with the melon concentrate supplement significantly improved perceived signs and symptoms of stress and fatigue linked to e.g. pain, sleep troubles, concentration, weariness, attitude, irritability compared to the placebo. In the same way, quality of life and perceived stress were significantly improved with supplementation (1).

One of the authors of the study said in a press release (2) "Several studies have shown that there is a link between psychological stress and intracellular oxidative stress. We wanted to test whether augmenting the body's ability to deal with oxidative species might help a person's ability to resist burnout. The 35 people in our study who received capsules containing superoxide dismutase showed improvement in several signs and symptoms of perceived stress and fatigue." She added that " It will be interesting to confirm these effects and better understand the action of antioxidants on stress in further studies with a larger number of volunteers and a longer duration."

The best way of providing the body with antioxidants is to eat a diet that is rich in vegetables and fruits.  These foods provide antioxidant vitamins, minerals and bioflavonoids (bioactive plant compounds).  Antioxidant supplements made from natural berries and herbs are now also available to buy but should not be viewed or used as an alternative to a healthy diet.  If you feel that you are under particular stress/mental strain at the moment you may wish to increase the number of antioxidant containing foods in your diet.  If you are struggling to reach the daily minimum of 5 portions of vegetables and fruits then a good quality antioxidant supplement may be something you wish to consider in the short term in order to boost your antioxidant levels during periods of stress.

It will be interesting to see what further research uncovers in the realm of antioxidants and stress symptoms, with so many people feeling pressure in their lifes these kinds of studies could represent important steps toward helping to ease difficult symptoms.

(1)Milesi MA et al.  2009.  Effect of an oral supplementation with a proprietary melon juice concentrate (Extramel) on stress and fatigue in healthy people: a pilot, double-blind, placebo-controlled clinical trial.  Nutrition Journal.  8:40 (15 September 2009)
(2)Press Release: Antioxidant Ingredient Proven To Relieve Stress. ScienceDaily. Retrieved September 16, 2009, from http://www.sciencedaily.com/releases/2009/09/090914194652.htm

Written by Ani Kowal

Messages are constantly being published to encourage us to eat plenty of vegetables and fruits and I certainly write about the importance of these foods often.  Vegetables and fruits provide the body with an array of vitamins, minerals and bioflavonoids (bioactive plant chemicals) which are associated with the prevention of many diseases.  Some of the vitamins and bioflavonoids act as antioxidants in the body and this may be one way that that prevent disease.  Antioxidants are another topic that I often write about, they protect the body from attack by destructive molecules known as ‘free radicals’.

A newly published study (1) has found that eating a diet rich in vegetables and fruits may be associated with a reduced risk of ‘cognitive impairment’, mental impairment, later in life.

193 healthy people aged 45-102 years old were included in the study.  Each participant took part in cognitive testing and also gave blood which was assessed for antioxidant status.  Each person also completed a specific food frequency questionnaire which assessed their daily intake of vegetable and fruits.  The participants were scored to have either a high intake or a low intake.  94 subjects in the high-intake score group had significantly higher cognitive test scores and higher levels of antioxidant nutrients in their blood compared to 99 subjects who had low intake of vegetables and fruits.  In addition to this the cognitive scores were directly correlated with blood levels of specific antioxidant nutrients (1).

The authors of the study conclude (1) “Healthy subjects of any age with a high daily intake of fruits and vegetables have higher antioxidant levels, lower levels of biomarkers of oxidative stress, and better cognitive performance than healthy subjects of any age consuming low amounts of fruits and vegetables. Modification of nutritional habits aimed at increasing intake of fruits and vegetables should be encouraged to lower prevalence of cognitive impairment in later life”. 

This follows on well from the piece I posted on Monday which discussed recent evidence that lifestyle may impact cognition later in life.  The High Intake group in this study was consuming around 400g of vegetables and fruits daily which is a very achievable amount.  The low intake group, by contrast were eating less that 100g of these foods daily.  Integrating at least 5 portions of vegetables and fruits into the daily diet is highly recommended. 

Dr. M. Cristina Polidori, currently at the Department of Geriatrics, Marienhospital Herne, Ruhr-University of Bochum, Germany, explained in a press release (2): “It is known that there is a strong association between fruit and vegetable intake and the natural antioxidant defenses of the body against free radicals. It is also known that bad nutritional habits increase the risk of developing cognitive impairment with and without dementia. With this work we show a multiple link between fruit and vegetable intake, antioxidant defenses and cognitive performance, in the absence of disease and independent of age. Among other lifestyle habits, it is recommended to improve nutrition in general and fruit and vegetable intake in particular at any age, beginning as early as possible. This may increase our chances to remain free of dementia in advanced age.”

Further, much larger, studies are planned that will include patients with Alzheimer’s disease at different stages and patients with mild cognitive impairment without dementia.  I will be following developments with interest.  As my many previous posts have shown, a good diet and lifestyle really can impact our health, both in the present and the future.  As I mentioned last week, even small changes can add up over time to create a bigger impact. 

(1)Polidori MC et al.  High fruit and vegetable intake is positively correlated with antioxidant status and cognitive performance in healthy subjects. J Alzheimers Dis. 17:4
(2)Science daily press release.  http://www.sciencedaily.com/releases/2009/09/090909064910.htm.  IOS Press BV (2009, September 10). High Fruit And Vegetable Intake Linked To Antioxidant Status And Cognitive Performance In Healthy Subjects. ScienceDaily. Retrieved September 11, 2009, from http://www.sciencedaily.com¬ /releases/2009/09/090909064910.htm
Written by Ani Kowal

Kingston University, London UK recently published a study (1) which looked at a variety of plant extracts and their roles as antioxidants and anti-ageing agents in the body.  The scientists from Kingston University tested 21 plant and herbal extracts including: White tea, Green Tea, Burdock root, Anise, Angelica, Lavender, Rose tincture, Pomegranate.  White tea came out top of the bunch in all tests, outperforming all of the other herbs and plants that were evaluated (1).

In a press release (2) Professor Declan Naughton, a leading specialist on inflammation in the UK, from the School of Life Sciences at Kingston University in South West London, said the research showed white tea had anti-ageing potential and high levels of anti-oxidants which could prevent cancer and heart disease. “We’ve carried out tests to identify plant extracts that protected the structural proteins of the skin, specifically elastin and collagen,” he explained. “Elastin supports the body’s natural elasticity which helps lungs, arteries, ligaments and skin to function. It also helps body tissue to repair when you suffer wounds and stops skin from sagging.” “Collagen is a protein found in connective tissues in the body and is important for skin, strength and elasticity”, he added.

Results showed white tea prevented the activities of the enzymes which breakdown elastin and collagen, known as collagenase and elastinase.  The breakdown of these important skin proteins can lead to wrinkles that accompany ageing.  The enzymes are also associated with inflammatory diseases such as rheumatoid arthritis.  Free-radicals, which are normally kept in check by antioxidants, are also associated with inflammatory conditions (many of my other posts have gone into great detail about antioxidants).
 

Professor Naughton said (2): “These enzymes and oxidants are key components of normal body processes. However, in inflammatory conditions, suppressing the activities of these excess components has been the subject of decades of research. We were surprised to find such high activity for the white tea extracts in all five tests that were conducted.” “We were testing very small amounts far less than you would find in a drink,” “The early indicators are that white tea reduces the risk of inflammation which is characteristic of rheumatoid arthritis and some cancers as well as wrinkles.”

Other plants and herbs that helped to protect against the breakdown of elastin and collagen, indicating that they may have an anti-aging potential, included extracts of rose, green tea, angelica, anise and pomegranate.  These are all readily available as supplements and pomegranate and rose are often used in anti-ageing skin creams.

The plants and herbs that were tested also contained various phenolic compounds (a group of natural plant chemicalss which include the bioflavonoids) - these bioactive plant compounds have received a lot of attention over the last few years for their health giving properties and potential to protect against a variety of diseases.  In this study (1) White tea had the highest phenolic content and antioxidant potential.  Green tea and rose tincture also showed high antioxidant potential.

Last year I wrote about the effects of UV exposure and aging (Part I, Part II) and how antioxidants as well as other nutrients can help prevent free radical damage to collagen and elastin in the skin.  It is important to remember that this was just a preliminary laboratory study and it is unknown whether the plants and herbs tested would have similar effects in the body.

(1) Thring TSA et al.  2009. Anti-collagenase, anti-elastase and anti-oxidant activities of extracts from 21 plants. BMC Complementary and Alternative Medicine.  9:27 (4 August 2009)
(2)Press Release:  Kingston University.  White tea could keep you healthy and young looking http://www.kingston.ac.uk/pressoffice/latestnews/2009/august/10-White-tea-could-keep-you-healthy-and-young-looking/

Written by Ani Kowal

Previously I have written about the health benefits of following a Mediterranean diet and I was very interested to read a study (1) that has just been published in the Journal of the American Medical Association which found that eating a Mediterranean-style diet is associated with a reduced risk for Alzheimer’s disease.  The study also found that physical activity was associated with a reduced risk for Alzheimer’s disease (independent of diet).  Adhering to a Mediterranean diet and having a good level of physical activity further reduced the risk of developing this disease.

This research adds to a growing body of evidence which suggests that lifestyle can have a significant impact on health, which certainly seems very logical to me!

A traditional Mediterranean diet is abundant in vegetables, fruits, nuts, legumes/beans, fish (especially oily fish), healthy fats and wholegrains.  It is generally low in processed foods, dairy products, red meats, and saturated fats.  In the past research has been conducted on Mediterranean diet and Alzheimer’s disease as well as physical activity and risk for Alzheimer’s.  This is the first study (1) to investigate the combined effects of diet and physical activity on risk for Alzheimer’s disease.

The authors of the study(1) used data from 1880 elderly residents, who had an average age of 77, living in New York.  None of the participants had Alzheimer’s disease or dementia at the start of the study which ran from 1992 to 2006.  At the start of the study diet and level of physical activity were assessed and scored.  Physical activity was scored as vigorous (e.g. jogging), moderate (e.g. hiking or cycling) and light (e.g. golfing or gardenting).  For diet the participants were given a score from 0-9 depending on how close to a Mediterranean diet their diet was.  These scores were then grouped into low, middle or high adherence to a Mediterranean diet.  Over the course of the study, about every 18 months, participants underwent neurological and neuropsychological tests.

*  A total of 282 cases of Alzheimer’s disease were diagnosed over the course of the study.
*  The most physically active participants had a 33% reduced risk of developing Alzheimer’s disease when compared to participants who were the least physically active
*  Those who most closely followed a Meditteranean diet have a 40% reduction in the risk for Alzheimer’s compared to participants who adhered the least.
*  Those who had the highest level of physical activity and whose diet was closest to the Mediterranean diet had a 60% reduced risk of developing Alzheimer’s when compared to those who did not exercise and did not follow a Mediterranean-style diet.

It was also noted that even a low level of physical activity did seem to have a protective effect which is important since it suggests that making even small changes can be beneficial.

Dr Susanne Sorensen, head of research, at the Alzheimer’s Society said in a Press Release (2) about the study:

“ ‘Dementia is one of people's biggest fears in later life but very few people realise that there are things they can do to reduce their risk of developing this devastating condition. This study adds to the growing body of evidence that a healthy diet and regular exercise can reduce the chance of developing dementia.

'A Mediterranean diet full of green leafy vegetables, oily fish, nuts and low in saturated fats is an incredibly healthy approach to eating and may reduce your risk of developing dementia. This study suggests combining this diet with regular exercise is one of the best ways to cut your chances of developing dementia.'

'With one million people set to develop dementia in the next 10 years, it is essential that we act now to defeat it.' ”

The study was not a clinical trial, it was an observational study and cannot prove the link between following a Mediterranean diet and being physically active and the risk for Alzheimer’s disease.  However, it does point toward a strong association and provides us with indications of the importance of following a healthy eating regimen an including exercise into our lifestyles.  There are many components in the Mediterranean diet which may be protecting the brain including omega 3 fatty acids from oily fish and numerous antioxidant vitamins and flavonoids (bioactive plant chemicals) from vegetables and fruits.  As well as minerals.  No doubt all these components act together synergistically to reduce overall risk of Alzheimer’s and help to keep our brain healthy and functioning efficiently.  The key message seems to be to follow a healthy diet and lifestyle. 

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

(1)Scarmeas N et al.  2009.   Physical Activity, Diet, and Risk of Alzheimer Disease.  JAMA. 2009;302(6):627-637.
(2) Press Release: Alzheimer’s Society comment on Mediterranean-type diet reducing Alzheimer’s risk http://www.alzheimers.org.uk/site/scripts/press_article.php?articleID=386
Written by Ani Kowal

Recently I attended a seminar which concentrated on bone health in women going through the menopause.  The decrease in blood serum oestrogen after menopause is associated with bone loss and subsequent brittle bones and osteoporosis.

A study(1) was briefly mentioned at the seminar which seemed to suggest that onion consumption was linked to bone health in peri- and post-menopausal women.  I was intrigued!  The study found that individuals who consumed onions once a day or more had an overall bone density that was significantly greater than individuals who consumed onions once per month or less.  This association was apparent even after the authors took various other factors (that can affect bone health) into account such as age, body mass index (BMI), daily calcium intake, serum vitamin D, serum parathyroid hormone, oestrogen use, smoking status, and exercise status.  This suggests that onion consumption may be an independent factor in bone health. The study also found that older women who consume onions most frequently may decrease their risk of hip fracture by more than 20% versus those who never consume onions.

Why would onions be having this kind of effect? A possible explanation could be that onions contain a flavonoid (bioactive plant compound) called quercetin which has antioxidant and anti-inflammatory actions in the body and has been linked with protecting against heart disease, cancer and asthma.  Quercetin is also found in apples and grapes.  Two laboratory studies (2,3) last year found that quercetin could increase new bone formation.

Quercetin is also classes as a phytoestrogen.  Phytoestrogens are natural plant-derived compounds that bind to oestrogen receptors and have oestrogen-like activity in the body.  Recently phytoestrogens have attracted much attention among public and medical communities because of their potential beneficial role in prevention and treatment of cardiovascular diseases, osteoporosis, diabetes and obesity, menopausal symptoms, renal diseases and various cancers.

Our bone cells (osteoblasts) have two oestrogen receptors on their surface and certain phytoestrogens, including quercetin, can interact with these oestrogen receptors in bone.  It is possible that quercetin binds to the bone oestrogen receptors and stimulates and increases bone formation and bone mineralisation.  Further studies are needed to investigate these ideas. The authors of one of the studies say (3)“If quercetin, this common constituent in fruits and vegetables, can be shown to increase bone forming activities in bone cells and improve healing in bone defects, it may be the long-sought-after safe and ideal agent for stimulation of bone formation and bone defect repair”

Onions are one of my favourite vegetables and easy to integrate into meals and salads.  Apples and grapes are also easily incorporated into the daily diet.  Last year I wrote about the importance of fruit and vegetables for bone health.  A number of studies over the last decade have suggested a clear, positive link between fruit and vegetable consumption and bone health.  These foods provide a huge range of nutrients that are important for bone health.  In addition to the nutrients, fruit and vegetables positively effect the pH balance (a measure of acid-alkali balance) in the body, by increasing the alkalinity in the body (making the body less acidic), which plays a major role in the prevention of calcium loss from bones.  Foods which are acid forming in the body include foods such as most meat and animal protein, cheddar cheese and many grain products e.g. white bread, pasta, cornflakes.  If the body is too acidic, and not in pH balance, then bones can release their calcium (which increases alkalinity) into the blood to try and maintain the balance.  Obviously calcium loss is not what we want!! 

Providing the body with abundant supplies of vegetables and fruits, especially those high in quercetin, may help to keep our bones strong as well as protecting us from many other diseases.  Quercetin supplements are also readily available to buy, usually as an antioxidant boost for the body and for allergy prevention and treatment, although their impact on bone health have not yet been tested. 

Please also read my other various posts on osteoporosis for more information on how to keep bones healthy

(1) Matheson EM et al.  2009.  The association between onion consumption and bone density in perimenopausal and postmenopausal non-Hispanic white women 50 years and older. Menopause.  16(4):756-9.
(2) Wong RW & Rabie AB.  2008.  Effect of quercetin on bone formation. J Orthop Res.26(8):1061-6.
(3)Wong RW &  Rabie AB.  2008.  Effect of quercetin on preosteoblasts and bone defects. Open Orthop J. 10;2:27-32.

Written by Ani Kowal

Many people are understandably worried about swine flu.  A press release (1) was issued on Tuesday (11th August) providing information that the Vatican has tripled their order of black elderberry extract this year, compared to their order last year.  It seems as though the Pope may be trying a natural way to prevent influenza and boost his immune system.

“This year the International Pharmacy of Vatican City has ordered 600 bottles of the black elderberry extract compared to 200 bottles last year, showing that divine intervention may work miracles, but when it comes to combating flu, even the Pope needs a helping hand” (1)

Black elderberry extract (Sambucol ®) is something I have written about previously in my blog.  There is evidence suggesting that it can reduce the duration of an influenza attack by about 4 days and may  also prevent against influenza. 

Black elderberries are thought to contain a unique compound, called antivirin, which seems to coat viruses and prevents them from penetrating and infecting healthy body cells. As a result viruses, such as influenza, are unable to replicate.  This means that the body’s white blood cells can ingest the infected cells, effectively removing the virus from the body.

A press pack(2) produced about black elderberry extract details the results of a laboratory based study that took place in 2006 (3) which found black elderberry extract (Sambucol ®) effective against the H5N1 strain of bird flu (avian influenza H5N1):  “Laboratory trials were undertaken at Retroscreen Virology Ltd., a leading research institute associated with the University of London.  Sambucol ® was found to be at least 99% effective against avian influenza virus H5N1.  Sambucol ® was effective at significantly neutralizing the infectivity of the virus in cell culture.  Further studies are to be undertaken to assess the effectiveness of Sambucol ® against avian influenza (H5N1) virus infections in humans”

Black elderberries also contain high levels of natural antioxidants known as flavonoids which help strengthen the immune system against viral attack; indeed the black elderberry has twice the antioxidant capacity of blueberries and significantly higher antioxidant capability than that of cranberries.

Black elderberry extracts are widely available in the UK and sold as a liquids or lozenges.  The products can be taken as a preventative or at the first signs of cold or flu-like symptoms.  A healthy diet, rich in a variety of fruit and vegetables, is obviously the most important way to keep the immune system strong, healthy and effective.  However, if you are concerned about flu and feel that your diet tends to fall short you may consider following the Popes lead and taking an elderberry extract supplement to give your immune system an extra boost.

It is very important that if you begin to experience flu-like symptoms you consult your doctor immediately.  For more information on black elderberry visit the website http://www.blackelderberry.info/

(1) The Pope exorcises the flu with black elderberries.  Tuesday, 11 August 2009.  Press release distributed via Response Source, a service from Daryl Willcox Publishing, on behalf of Tiger White PR.  http://www.responsesource.com/releases/rel_display.php?relid=LzgXz
(2) Razei Bar.  Sambucol ®A Unique Plant Extract.  New Scientific Findings on H5N1 Bird Flu.  Press Information Kit.  http://www.mivelle.hu/sambucol/Press%20kit%20London%209.1.06.pdf
(3) Balasingam S et al.  2006.  Neutralizing activity of Sambucol ® against avian NIBRG-14 (H5N1) influenza virus.  Bird flu: the first pandemic of the 21st century.  A central role of antivirals.  London.
Written by Ani Kowal

A research team at the University of Exeter has just published results of a study which shows (1) that drinking beetroot juice may help boost stamina and help individuals to exercise for up to 16% longer than they are normally able to, this may be down to the nitrate content of the beetroot juice.  The researchers are not yet sure of the exact mechanism that causes the nitrate in the beetroot juice to boost stamina. However, they suspect it could be a result of the nitrate turning into nitric oxide in the body, which can relax blood vessels and increase blood flow.

The research team believes that the findings could be of great interest to endurance athletes. They could also be relevant to elderly people or those with cardiovascular, respiratory or metabolic diseases.

This was a very small, preliminary study which took place in men (1).  The participants were given 500ml of organic beetroot juice each day for 6 days before completing a series of tests involving cycling on an exercise bike – the exercise tests ranged from moderate-intensity to severe-intensity.  On a separate occasion the same men were given a blackcurrant cordial drink for six consecutive days before completing the same cycling tests.  After drinking beetroot juice the group was able to cycle for significantly longer than when they were given the placebo blackcurrant drink.  The men also gave blood samples throughout the trial.

The beetroot juice contained around 11.2 mM of nitrate while the placebo blackcurrant juice had a negligible nitrate content.  The study was performed ‘double blind’ which means that neither the participants nor the administrators they interacted with knew which of the two agents was being tested, the beetroot juice or the blackcurrant cordial.

On days 4-6 the blood plasma nitrite levels were significantly higher in the beetroot juice phase than in the placebo phase and the blood pressure of participants was also significantly reduced in the beetroot juice phase (other studies have shown that beetroot juice can reduce blood pressure).  The authors are not sure how the nitrate in the beetroot juice boosts stamina, but they suspect it is because the nitrate turns into nitric oxide in the body.  The research team now hopes to conduct further studies to try to understand in more detail the effects of different nitrate-rich foods on exercise physiology.  Nitric oxide in the body helps to relax blood vessels and increase blood flow, hence can be important for reducing blood pressure, in the body.

One of the study authors said in a press release (2): "Our study is the first to show that nitrate-rich food can increase exercise endurance. We were amazed by the effects of beetroot juice on oxygen uptake because these effects cannot be achieved by any other known means, including training. I am sure professional and amateur athletes will be interested in the results of this research. I am also keen to explore the relevance of the findings to those people who suffer from poor fitness and may be able to use dietary supplements to help them go about their daily lives." 

Arginine supplements are available to buy and have been shown to be useful to increase nitric oxide levels in the body.  The amino acid, Arginine, is a powerful vasodilator (blood vessel relaxer) and may help to support and maintain healthy blood flow and circulation. Arginine is also an antioxidant and helps support healthy arteries.  Beetroot drinks and supplements are also available to by but it is important to remember that supplements should not be viewed as a substitute for a healthy balanced diet and lifestyle.  Beetroot is also rich source of vitamins, minerals, antioxidant bioflavonoids (bioactive plant compounds) and fibre and would certainly be a good vegetable to include as part of a varied and balanced diet.

(1)Wilkerson DP et al.  2009.  Dietary nitrate supplementation reduces the O2 cost of low-intensity exercise and enhances tolerance to high-intensity exercise in humans.  Journal of Applied Physiology (August 6, 2009).  DOI:10.1152/japplphysiol.00722.2009
(2) University of Exeter Press release.  Beetroot juice boosts stamina, new study shows http://www.exeter.ac.uk/news/featurednews/title,37371,en.php

Written by Ani Kowal

Rhodiola is a herb that I keep hearing about, it is considered to be an adaptogen.  I thought I would write about it now since I started last week writing about another adaptogenic herb, Siberian Ginseng.

To recap - Based on clinical studies, adaptogens can be defined as a group of herbal preparations that increase tolerance to mental exhaustion and enhance attention and mental endurance in situations of decreased performance. The beneficial stress-protective effect of adaptogens appears to be complex, these herbs seems to work via several mechanisms including actions on the hormonal and immune systems (1)
 

Rhodiola is also known as Golden root, it is a herb that is native to the northern regions of Europe, Scandinavia and Alaska as well as parts of Eastern Siberia.  The species of Rhodiola that is commonly used in supplements is Rhodiola rosea (occasionally Rhodiola crenulata is used insupplements).

In a recent review paper (1) it was found that strong scientific evidence is available for Rhodiola rosea extract, for the improvement of attention, cognitive function and mental performance in fatigue and in chronic fatigue syndrome.  A well designed, but small, study took place this year (2) which concluded that repeated administration of Rhodiola rosea extract exerts an anti-fatigue effect that increases mental performance, particularly the ability to concentrate, and decreases cortisol (a stress hormone) response in burnout patients with fatigue syndrome.  No serious side effects were reported.

Another study (3) which took place in healthy young individuals (aged 19-21) who were under a background of continued fatigue and stress (since they were army cadets) found that Rhodiola showed a pronounced anti-fatigue effect.  The results are interesting but the study was small and short-term, further trials would be necessary before any firm conclusions could be made about the anti-fatigue effects of Rhodiola in healthy individuals.

Exam period has just finished and schools have broken up for the long summer break but I wanted to mention one last study (4) which aimed to investigate the effects of Rhodiola rosea in students during a stressful examination period.  The investigators found that those receiving the Rhodiola had significant improvements in physical fitness and mental fatigue.  The self-assessment and general wellbeing scores were also significantly better in the group taking Rhodiola compared to those receiving placebo.

It does seem as though this herb may be helpful to take during periods where mental stress is expected.  As with Siberian ginseng, further clinical trials are necessary before firm conclusions can be drawn and recommendations for the use of Rhodiola can be made.  However, if you are feeling a bit stressed or fatigued at the moment you might decide to try a short term (2-3 week) course of this herb to see if it aids your symptoms.  Consulting a qualified herbalist would be a good idea prior to making a long-term decision.  The general dosage of Rhodiola is 50 - 750 mg per day or 500 mg taken immediately prior to exercise or any situation that demands mental clarity or energy.  Usually supplements are standardised to contain 0.8%, to 3% Salidrosides or around 40% polyphenols (bioactive plant chemicals that have antioxidant and other properties).  Always follow the manufacturers dosage instructions.

(1)Panossian A, Wikman G.  2009.  Evidence-Based Efficacy of Adaptogens in Fatigue, and Molecular Mechanisms Related to Their Stress-Protective Activity. Curr Clin Pharmacol. 2009 Sep 1. [Epub ahead of print]
(2) Olsson EM et al.  2009.  A randomised, double-blind, placebo-controlled, parallel-group study of the standardised extract shr-5 of the roots of Rhodiola rosea in the treatment of subjects with stress-related fatigue. Planta Med. 75(2):105-12.
(3) Shevtsov VA et al.  2003.  A randomized trial of two different doses of a SHR-5 Rhodiola rosea extract versus placebo and control of capacity for mental work. Phytomedicine. 10(2-3):95-105
(4) Spasov AA et al.  2000.  A double-blind, placebo-controlled pilot study of the stimulating and adaptogenic effect of Rhodiola rosea SHR-5 extract on the fatigue of students caused by stress during an examination period with a repeated low-dose regimen.  Phytomedicine.  7(2):85-89.

Written by Ani Kowal

Recently a friend recommended that I try taking some Siberian Ginseng to boost my energy levels during a particularly busy time.  Siberian ginseng was not a herb that I knew very much about.  Korean ginseng, often known as panax ginseng or Asian ginseng is the ginseng that I have read a lot about in the past and seems to have immune and metabolism boosting properties.  So what about Siberian ginseng?

Siberian ginseng (Eleutherococcus senticosus) is also known as Eleuthero, Eleutherococco, Ciwujia, Devil’s Bush, Touch-me-not and ussurian thorny pepper bush.  It is a herb that is native to Siberia, Korea and parts of China.  Since Siberian ginseng does not belong to the Panax family it cannot be considered as a ‘true’ ginseng.  Although the beneficial actions of Siberian ginseng seem to be similar to those of Korean ginseng there is some debate as to whether it may be better to rename the herb Eleuthero so as to dissociate it from Korean ginseng.

Herbalists refer to Siberian ginseng as being an ‘adaptogen’.  The term is used to describe herbs that seem to help the body to adapt during times of stress, trauma, fatigue and anxiety.  Sometimes adaptogens are simply referred to as rejuvenating herbs and their use dates back thousands of years in China and India.  It is not entirely known how these herbs work, many of them have antioxidant properties but this does not explain all of their reported benefits.  It could be that adaptogenic herbs can balance the hormonal and immune systems in the body.  I wanted to have a look to see if there was much research evidence to back up the claims that Siberian ginseng can help during times of stress.

A review paper, released very recently (1), was carried out to assess clinical trials of different adaptogenic herbs in fatigue.  The authors who collated the research say that good scientific evidence has been recorded in trials in which Siberian ginseng increased endurance and mental performance in those with mild fatigue and weakness.  The scientists also propose that the beneficial, stress protective, effect of adaptogenic herbs is related to a variety of complex mechanisms in the body that involve hormones and brain activity.

Many of the studies done with Sibersian ginseng have been animal or laboratory studies and the results have been quite positive for the use of the herb to help during times of stress or fatigue.  However, not many studies have yet been conducted in humans.  The few trials that have taken place have been small, but certainly interesting, and further evidence is warranted before any firm conclusions can be drawn.

Two studies were published in 2004 (2,3) which look specifically at Siberian ginseng and fatigue in human subjects.  The first (2) took place in elderly individuals who were suffering from fatigue and feelings of lack of energy.  The study was small and preliminary involving only 20 individuals aged 65 or over.  The participants were given either 300mg a day of died extract of Siberian ginseng or a placebo for 8 weeks.  A health related quality of life questionnaire was taken at the study and then again at 4 and 8 weeks.  At the start of the study the two groups had similar health related quality of life scores.  The participants did not know if they were receiving the Siberian ginseng or the placebo.  After 4 weeks the individuals receiving the active herb had higher scores in the health related quality of life questionnaire (in the social functioning section) than those receiving placebo.  However after 8 weeks the differences did not seem to persist.  The authors of the study conclude that Siberian ginseng may improve some aspects of mental health and social functioning in the short term.  Further studies are necessary to investigate long term effects.

The other study (3) took place in sufferers of chronic fatigue.  Siberian ginseng seemed to be most helpful for individuals with more severe fatigue.  Overall the authors conclude that the findings for the use of Siberian ginseng in chronic fatigue are not yet strong but that “the findings of possible efficacy for patients with moderate fatigue suggests that further research may be of value”.
 

Siberian ginseng has been used for many years as a tonic for vitality and health and I believe we can learn a lot by looking at ancient herbal treatment regimens.  However, I also feel that it is important to investigate the science behind the claims and test the efficacy and safety of herbs before promoting them.  Laboratory evidence for Siberian ginseng is fairly strong and human trials are beginning to emerge to strengthen the health claims.

If your energy, vitality and stamina seem to be waning, rather than reaching for a coffee (which can further stress the body systems) you might want to investigate whether short term use of Siberian ginseng works for you.  Consulting a herbalist is a good option and always read the manufacturers dosage suggestions before use.  The most commonly recommended therapeutic dosage for Siberian Ginseng (20:1 concentration, containing at least 1% Eleutheroside E) is 300 mg - 600 mg per day.

(1) Panossian A, Wikman G.  2009.  Evidence-Based Efficacy of Adaptogens in Fatigue, and Molecular Mechanisms Related to Their Stress-Protective Activity. Curr Clin Pharmacol. 2009 Sep 1. [Epub ahead of print]
(2) Cicero AF et al.  2004. Effects of Siberian ginseng (Eleutherococcus senticosus maxim.) on elderly quality of life: a randomized clinical trial. Arch Gerontol Geriatr Suppl.  9:69-73.
(3) Hartz AJ et al.  2004.  Randomized controlled trial of Siberian ginseng for chronic fatigue. Psychol Med.  34(1):51-61.

Written by Ani Kowal

Tea has long been considered a tonic for health with both black and green teas being studied for their health-giving properties.  Tea contains many bioactive plant chemicals known as polyphenols (tea polyphenols are sometimes termed catechins) which can act as antioxidants in the body and thus potentially be important for disease prevention.

A recent study has shown (1) that green tea may have an effect on the risk factors for heart disease via improving the function of cells, called epithelial cells, which line the circulatory system.  When these cells are not functioning properly it can lead to the progression of atherosclerosis.  Atherosclerosis is commonly described as ‘hardening of the arteries’ it is a chronic inflammatory response in the walls of arteries

The study was small and preliminary but found that green tea consumption has an acute beneficial effect on endothelial function in a large artery (brachial artery) in healthy individuals (when compared to caffeine or hot water).  Green tea seems to work by improving blood flow and the ability of arteries to relax.  The effects were evident fairly rapidly, almost immediately in fact, within 30 minutes of drinking the tea dilation (relaxing) of the artery could be detected.  Measurement of the arteries was performed by high resolution ultrasound.  The researchers only looked at short-term impact (up to two hours).  It is not yet known what the long-term benefits could be.  Further studies are being carried out

Previous studies have found that black tea has also been associated with improved endothelial performance but adding milk to black tea may well reduce the health benefits associated with tea drinking.  Green tea originated in China but is now a popular drink that is consumed throughout the world.  Both green and black tea come from the same camellia sinesis bush but the different processing technique create the differences between the teas.  Green tea is not fermented whereas black tea is, the fermentation process is the reason for the brown/dark colour and the different flavour of black tea.  The flavonoids in green tea are probably more potent antioxidants than those found in black tea due to the different processing techniques.

A cup of tea isn’t going to cure or prevent illness and disease as a stand alone addition to normal daily life!  A healthy lifestyle is one that includes healthy eating, physical activity and other lifestyle factors.  Including green tea can be seen as a way to boost antioxidant defences in conjunction with a healthy lifestyle.  Green tea supplements which contain high doses of the tea polyphenols (e.g. catechins) are now widely available to buy but as yet it is unknown if the potential benefits extend to the supplemental form of the flavonoids.

(1)Alexopoulos N et al.  2008.  The acute effect of green tea consumption on endothelial function in healthy individuals. Eur J Cardiovasc Prev Rehabil. 15:300-305

Written by Ani Kowal

"Trichotillomania is an impulse control disorder or form of self-injury characterized by the repeated urge to pull out scalp hair, eyelashes, facial hair, nose hair, pubic hair, eyebrows or other body hair, sometimes resulting in noticeable bald patches. Trichotillomania is classified in the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders) as an impulse control disorder. It may seem, at times, to resemble a habit, an addiction, a tic disorder or an obsessive-compulsive disorder. Trichotillomania often begins during the individual's teenage years. Depression or stress can trigger the condition. Due to social implications the disorder is often unreported and it is difficult to predict accurately prevalence (1)" but it is estimated to affect 2-4% of the population and seems to be more common in women than men.

Usually trichotillomania is treated with SSRI (Selective Serotonin Reuptake Inhibitor) anti-depressant drugs which many people prefer not to take due to the potential side-effects.  Researchers at the University of Minnesota Medical School have just published a study (2) which suggests that NAC (N-Acetylcysteine) a commonly available health food supplement may help to stop the urges of those suffering with trichotillomania.  NAC is an amino acid that acts as an antioxidant in the body.

The study(2) was small but well designed involving 50 trichotillomania sufferers, with an average age of around 34, for 12 weeks.  Half were given 1,200mg of NAC each day for 6 weeks.  For the following 6 weeks they were given 2,400mg NAC per day.  The other half were given placebo (inactive) supplements.  After 9 weeks, those taking NAC had a significant reduction in the incidence of hair-pulling.  After 12 weeks 56% of those on the NAC supplement reported feeling much, or very much improved (compared to only 16% of those on the placebo).  No side-effects were found when taking the NAC supplement.
 

The study offers significant hope to sufferers of this distressing self-harming condition and is also an important study as it is one of the first studies of compulsive behaviours to look at lowering levels of glutamate, a chemical that triggers excitement, in the brain to curb harmful behaviours.  NAC seems to affect levels of glutamate in a very specific area of the brain which may be why it seems to help patients curb their self-harmful behaviour.

Dysfunction of glutamate-mediated brain nerve functions has also been implicated in obsessive-compulsive disorder (OCD).  The study authors believe that NAC and other glutamate modulators may be applicable to other disorders, addictions and compulsive behaviours.  Prior to this study a case was documented (3) where NAC was shown to be clinically helpful for a sufferer of OCD (obsessive compulsive disorder).  Further studies are certainly warranted in this area, especially since many individuals are looking for natural alternatives to psychiatric drugs.  It may be that NAC will be useful in conjunction with other known nutritional mood influencing aids, I certainly look forward to further studies being published in this area.

If you are suffering with trichotillomania (or other compulsive behaviours) you may wish to contact the following online support networks and may wish to speak to your doctor or health professional about trying NAC to see if it is useful for you:
UK and Ireland Trichotillomania Support Group  and the Trichotillomania Support Online

(1)http://wapedia.mobi/en/Trichotillomania
(2) Grant JE et al.  2009.  N-Acetylcysteine, a Glutamate Modulator, in the Treatment of Trichotillomania: A Double-blind, Placebo-Controlled Study. Arch Gen Psychiatry. 66(7):756-763
(3) Lafleur DL et al.  2006.  N-acetylcysteine augmentation in serotonin reuptake inhibitor refractory obsessive-compulsive disorder.  Psychopharmacology.  184(2):254-256.

(Written by Ani Kowal)

The links between diet and cancer are widely researched.  The World Cancer Research Fund UK (WCRF UK) estimate that lifestyle factors such as being overweight, eating an unhealthy diet and being inactive are responsible for about a third of all cancers in developed countries (1).  The WCRF UK are a charity committed to cancer prevention.

A recently published study (2) has found a significant link between eating a diet high in carotenoid rich fruits and vegetables and a reduction in the risk of breast cancer in premenopausal women.

Carotenoids such as alpha and beta carotene, lutein and zeaxanthin are a family of over 700 naturally occurring yellow, red, orange and dark green pigments found in vegetables and fruits.  Good sources include carrots, sweet potatoes, tomatoes, squash, peppers, cantaloupe melons, nectarines, papaya, mango and dark green vegetables such as spinach, kale, watercress and asparagus.  Introducing a good mix of these fruits and vegetables on a regular basis in the diet will help keep carotenoid levels in the body high.

The study (2) involved 5,707 women with invasive breast cancer (2,363 premenopausal women and 3,516 postmenopausal women) and 6,389 individuals with no breast cancer, control subjects (2,594 premenopausal women and 3,516 postmenopausal women).  In an interview, these women were asked about their intake of carotenoid rich fruits and vegetables.  The researchers found that pre-menopausal women eating high intakes of vitamin A, beta-carotene, alpha-carotene, lutein and zeaxanthin appeared to have a reduced risk of breast cancer.  Eating at least two servings of carotenoid-rich vegetables each day was associated with around a 17% reduced risk of breast cancer.  As an association study the results are positive but further studies would be necessary before any firm conclusions could be drawn about the effect of dietary carotenoids on cancer risk. 

Carotenoids may be acting to prevent cancer via different means.  Carotenoids have been shown to interfere with oestrogen (hormone) signalling which may explain why their cancer-preventing effects would be limited to premenopausal women.  In addition to this, carotenoids act as antioxidants in the body and antioxidants have been linked to cancer prevention.  Antioxidants prevent damage to the body cells by naturally occurring unstable oxygen molecules, known as free radicals.  Antioxidants may help to ‘quench’ or mop-up the destructive free radical molecules and therefore protect against cell-damage (which could lead to cancer formation).

Absorption of carotenoids from foods into the body is greatly affected by fat.  Without a fat source carotenoids are not easily absorbed.  Fat acts as a carrier for these nutrients to allow them passage from the gut into our blood and bodily cells.  This is not a suggestion to drown your vegetables or salads in gallons of oil, however, I am a firm believer in using small amounts of olive oil in dressings and cooking.  Including some nuts, seeds or olives in salads may also be helpful in order to gain maximum absorption of these important nutrients. 

(1)WCRF/AICR.  2009.  Policy and action for cancer prevention.  Food, nutrition and physical activity: a global perspective.  Washington DC: AICR, 2009.
(2) Mignone LI et al.  2009.  Dietary carotenoids and the risk of invasive breast cancer.  International Journal of Cancer.  124:2929-2937
Written by Ani Kowal

Over the years there has been debate as to whether oral contraceptive use in women leads to depletion of certain nutrients in the body.  There is some evidence that oral contraceptives may reduce levels of Vitamin B1, B2, B6, folate, vitamin C, vitamin E, zinc, magnesium and calcium.  However, many of these studies were small and carried out over 20 years ago with very little follow up since.  During this time the contraceptive pill has changed dramatically and now contains lower doses of hormones.  Women who are eating a healthy, nutrient-rich diet probably gain enough vitamins and minerals to counteract any deficit but many women in the UK are not reaching the minimum 5 portions per day of vegetables and fruits and many also do not gain enough magnesium and other minerals through their diets. 
 

The early studies do warrant attention and I was interested to find two more recent papers (1,2) which point to the importance of being nutrient-aware when taking oral contraceptives.  These two studies look at how oral contraceptives may have an effect on the antioxidant levels in the body.  

I have written about dietary antioxidants in many previous blog posts.  Antioxidant intakes and bodily status has been linked to a reduction in the risk of many conditions raging from cancer to heart disease, dementia and arthritis.  One of the reasons why fruit and vegetables are so important in our diets is because they provide many antioxidant nutrients, such as carotenoids, vitamins C and E and various antioxidant bioflavonoids (bioactive plant chemicals). 

Anitoxidants help to prevent damage to cells in our body by mopping-up destructive unstable oxygen molecules known as 'free radicals', these free radicals create what is known as oxidative stress in the body.  There is mounting evidence that these destructive molecules, together with lowered bodily antioxidant defences, play a significant role in the development and aggravation of many diseases and health problems.  The body does produce its own antioxidants but also relies on vitamins, mineral and phytochemicals (bioactive plant chemical) from the diet, especially from colourful vegetables and fruits, for additional valuable supplies.

It has been thought for some time that oral contraceptive use may lead to increased oxidative stress in women.  One study (1) which took place in 2007 included 209 healthy women aged 40-48 years.  The oxidative stress status of the women was studied, this included an analysis of antioxidant levels, trace minerals and three markers of oxidative damage to fats (lipids).  Among the 209 women 23% used oral contraception, 57% did not use contraception and 20% used hormonal and copper intrauterine devices (IUD). 

Results showed(1) that women using oral contraception had significantly higher oxidative damage to lipids (lipid peroxidation) compared to the other 2 groups of women.  Lipid peroxidation has been linked to heart disease.  Oral contraceptive users also had significantly lower blood plasma levels of several antioxidants such as beta-carotene and gamma-tocopherol (a form of vitamin E).  The study scientists checked their data and confirm that modifications in plasma beta-carotene levels could not be attributed to dietary differences between the three groups.  The beta-carotene levels were 39-50% lower in the oral contraceptive users compared to the other groups of women.  The authors conclude that these lowered levels of antioxidants and increased signs of bodily oxidative stress could represent a potential cardiovascular risk factor for these women.

Another study (2) looked to examine the influence of oral contraceptive use on blood serum levels of antioxidants.  The study was a very small, preliminary trial in pre-menopausal women.  The researchers found that oral contraceptive use significantly decreased coenzyme Q10 (an antioxidant) and alpha-tocopherol (vitamin E) levels.  The authors conclude that further studies are needed to investigate the potential role of oral contraceptives on oxidative stress in women.

Coenzyme Q10 is naturally produced by the body and was first isolated in 1957, it is essential for energy production in all bodily cells and also acts as an antioxidant in the body.  Coenzyme Q10 itself is found in many foods but is particularly concentrated in nuts and oils.  The body does produce this nutrient naturally and does not rely on external sources.  In order to produce CoQ10 we require various essential cofactors.  These include a variety of vitamins especially of the B group (Folic Acid, Vitamin B2, The Niacinamide form of Vitamin B3, Vitamin B5,Vitamin B6, Vitamin B12) and Vitamin C .  Hence a healthy diet rich in fruits, vegetables, wholegrain cereals and lean proteins will aid the natural production of this coenzyme and help to keep our circulating levels high.

The results of these studies need backing up by further larger clinical trials but could indicate the consideration of antioxidant supplementation for women taking oral contraceptives. 

Eating a healthy diet low in processed and refined foods and rich in vegetables, fruits, nuts/seeds, beans and pulses, lean meats, fish (especially oily varieties), wholegrains and healthy fats is the best way to ensure that your body gets plenty of vitamins, minerals and antioxidants.  If you feel that your diet is regularly falling short then you could consider taking a broad spectrum multivitamin and mineral supplement – but remember that a supplement cannot be considered as an alternative for a healthy diet.

1.Chapelle JP et al.  2007.  Effect of different contraceptive methods on the oxidative stress status in women aged 40 48 years from the ELAN study in the province of Liege, Belgium.  Hum Reprod.  22:2335-2343
2. Palan PR et al.  2006.  Effects of menstrual cycle and oral contraceptive use on serum levels of lipid-soluble antioxidants.  Am J Obstet Gynecol.  194:e35-38

Written by Ani Kowal

Regular readers of my blog will have realised by now that I have a great interest in Omega 3 fatty acids.  Research suggests that these essential fats play a role in the prevention of several diseases ranging from heart disease to cancer, stroke, diabetes, arthritis, asthma, osteoporosis, mood disorders (including depression), eye diseases and many more (including most conditions with a link to inflammation).  A major voice for the importance of these fats is Artemis Simopoulos MD.  Dr Simopoulos is president of The Centre for Genetics, Nutrition and Health and a member of the board of directors of the American Association for World Health.  Since 1984 her research has been largely dedicated to the evolutionary aspects of diet, the omega-6:omega-3 ratio of the diet and the importance of omega-3 fatty acids for health.

In an interview (1) Dr Simopoulos said that one of the biggest food myths today is that you have to give up fat to lose weight and enjoy health.  A statement I wholeheartedly agree with.  Of course, not all fats are the same and today I want to discuss the virtues of omega 3 fatty acids.  These can be found in fish, especially oily fish such as salmon, trout, mackerel and sardines, seafood, as well as flaxseeds, walnuts and green leafy vegetables.  Meat and eggs in the UK do not contain large amounts of omega 3 fatty acids anymore since our farming methods have drastically changed over the years, this has contributed to the huge decline in our intakes of this vital fat.  Grass reared animals will have better omega 3 fatty acid levels, but nowhere near as high as in the past when animals were less intensively reared.

Dr Simopoulous has written many research and review papers about the importance of omega 3 fatty acids, and I am going to use some information from a fairy recent one (2) to provide the basis for this post.  She has also written many books including ‘The Omega Plan’.

It is thought that humans evolved on a diet that was very rich in essential omega-3 fatty acids, and a ratio of omega-6:omega-3 fatty acids of about 1:1 (or at most 2:1).  Currently the western diet has an imbalanced ratio of about 15:1 !!  This represents a huge shift and a relative ‘deficiency’ in omega-3 fats.  The excessive amounts of omega-6 fats and the very high omega-6:omega-3 ratio today is thought to be a major contributor to many of the diseases listed above.  A diet rich in omega-3 fatty acids and with a lower omega-6:omega-3 ratio is highly desirable for reducing the risk of many of the chronic diseases in the Western world.  Low intakes of omega-3 fats and higher intakes of omega-6 fats can lead to an increase in inflammation in the body since omega-3 fats are used by the body to make potent anti-inflammatory chemicals whereas too much omega-6 can lead to the production of pro-inflammatory chemicals by the body.

Nutrition can affect our genes and hence have an influence on disease.  Over the last 10,000 years our diet has drastically changed, especially over the last 150 years, to almost unrecognisable degrees in most people.  However, genetically we have not changed much (our DNA is much the same).  Our genes today are incredibly similar to those of our ancestors who lived around 40,000 years ago.  Our diet now is so very different, particularly in the type of fats we eat, and in the antioxidant nutrient content of our foods (antioxidants are found abundantly in vegetables and fruits) and this is surely affecting our health.

The review paper(2) details the ways in which our diet differs from that of our pre-industrial ancestors:
1. We have an increase in energy intake and a decrease in energy expenditure
2. Our diets are richer in saturated fat, omega-6 fats and trans fats and lower in omega-3 fats
3. We do not eat as much complex carbohydrates and fibre
4. We eat a huge amount more cereal grains and a reduced amount of fruits and vegetables
5. We eat less protein, antioxidants and calcium

Omega-6 fatty acids are found abundantly in our diets – most seeds, nuts, vegetable fats (vegetable seed oils) are omega 6 rich.  By contrast our diets are generally low in omega-3 fats: short chain omega-3 fats (alpha linolenic acid) are found in flaxseeds and walnuts (as well as chia and perilla seeds) and in their longer chain forms (EPA eicosapentaenoic acid and DHA docosahexaenoic acid) are found in oily fish.  The long chain omega-3 fats seem particularly important for our health and are found in concentrated amounts in the human brain.  The body can use the short chain omega-3 fats from the diet to form the longer-chain EPA and DHA forms but the process is far from efficient.  EPA and DHA are used by the body to produce the biological chemicals which have potent anti-inflammatory effects.  As a nutritionist I feel that it is essential we work toward increasing the intake of omega-3 and decreasing the intake of omega-6 fats in our diets in order to redress the omega-6:omega-3 balance (2).

If you feel that you do not eat oily fish regularly (you may be vegetarian or vegan or example), at least twice per week, then you may wish to consider taking an omega-3 fish oil supplement that provides around 250-300mg EPA and 250-350mg DHA per day.  Choose supplements that also contain vitamin E or another antioxidant since these protect the oil from degradation.  For vegans and vegetarian flaxseeds and walnuts represent good sources of the short chain omega-3 fatty acid – however, a flaxseed oil supplement that provides around 500-1000mg alpha-linolenic acid daily is worth considering.  Again, choose a supplement that contains a protective antioxidant.  There are now some vegan EPA and DHA supplements being produced from algae.  They are obtainable from only a few sources and can be expensive but their popularity and availability are rising and they are worth considering.

Dr Simopoulos offers 7 general dietary guidelines(1):
1.Enrich your diet with omega-3 fatty acids with cold-water fish, flax and walnut oil
2.Use canola, olive and flax oils as your primary oils
3.Eat seven or more servings of fruits and vegetables each day
4.Eat more peas, beans and nuts
5.Eat less saturated fat
6.Avoid oils high in omega-6 fatty acids such as corn, safflower, peanut, soyabean, sunflower and cottonseed oils – avoid products made from these oils
7.Avoid trans-fatty acids (found in many processed foods.  Trans fatty acids are used in the prepared food industry to prolong the shelf life of baked goods like biscuits).

In addition to this I would add that a healthy diet is one that contains minimal amounts of processed and refined foods.  Think natural! 

(1)http://www.1stvitality.co.uk/pdfs/Barleans_GB_dr_Simopoulos.pdf
(2)Simopoulos AP.  2008.  The importance of the omega-6/omega-3 fatty acid ratio in cardiovascular and other chronic diseases.  Exp Biol Med (Maywood).  233:674-688

Written by Ani Kowal

Diet and its impact on male fertility has long been discussed and debated among scientific, medical and health professionals.  I first started to look at the link between what we eat and fertility, in men and women, whilst studying for my MSc.  The research has been steadily growing over the years and it seems likely that diet does impact fertility.

A group of Spanish researchers have published two (1,2) studies this year which look at the link between diet and semen quality in men.  The studies seem to suggest that dietary antioxidant nutrients play a key role in the prevention of damage to sperm. 

I have written about dietary antioxidants in many previous blog posts.  They have been linked to a reduction in the risk of many conditions raging from cancer to heart disease, dementia and arthritis.  One of the reasons why fruit and vegetables are so important in our diets is because they provide many antioxidant nutrients, such as vitamins C and E and various antioxidant bioflavonoids (bioactive plant chemicals). 

Anitoxidants help to prevent damage to cells in our body (including sperm cells) by mopping-up destructive unstable oxygen molecules known as 'free radicals', these free radicals create what is known as oxidative stress in the body.  There is mounting evidence that these destructive molecules, together with lowered bodily antioxidant defences, play a significant role in the development and aggravation of many diseases and health problems.  The body does produce its own antioxidants but also relies on vitamins, mineral and phytochemicals (bioactive plant chemical) from the diet, especially from colourful vegetables and fruits, for additional valuable supplies.
 

In the first research study (1) the authors found that men who ate large amounts of meat (especially processed meat) and full fat dairy products had poorer quality sperm than those who ate more fruit, vegetables and reduced fat dairy products.  The study was a case-control study in which 30 men with poor semen quality (cases) were compared to 31 men with normal sperm quality (controls).  The investigators recorded the dietary habits and food consumption of the men using a specialised food frequency questionnaire.  The authors conclude that “Frequent intake of [lipophilic] foods like meat products or milk may negatively affect semen quality in humans, whereas some fruits or vegetables may maintain or improve semen quality”.  This study points towards associations between diet and fertility.  It is certainly plausible that a healthy diet and lifestyle can impact upon the health of semen. 

The second study(2) published by the same group of scientists this year was set up in order to compare the specific nutrient intakes between 30 men with normal sperm quality and 31 men with poor sperm quality.  Dietary habits and nutrient consumption were recorded using a food frequency questionnaire.  The analysis found that control subjects, the men with normal sperm quality, had a significantly higher intake of carbohydrates, fibre, folate, vitamin C, and lycopene and lower intakes of proteins and total fat than men with poor sperm quality.  The authors conclude that “A low intake of antioxidant nutrients was associated with a poor semen quality in this case-control study of Spanish men attending infertility clinics”.

Vegetables and fruits are full of antioxidant nutrients and flavonoids which may well be protecting the sperm from damage.  The lead author of the paper, Jamie Mendiola, said in a press release(3): “In this study, we have found that people who consume more fruits and vegetables are ingesting more antioxidants, and this is the important point", "We saw that, among the couples with fertility problems coming to the clinic, the men with good semen quality ate more vegetables and fruit (more vitamins, folic acid and fibre and less proteins and fats) than those men with low seminal quality".  "A healthy diet is not only a good way of avoiding illness, but could also have an impact on improving seminal quality.  What we still do not understand is the difference between taking these vitamins naturally and in the form of supplements”.

The authors are going to continue researching this topic in another study and are particularly going to investigate the role that supplements may have on sperm quality.  Obviously I am a great advocate of healthy eating and the basis of any healthy diet is an abundance of vegetables, fruits, healthy fats from nuts/seeds/oily fish, protein from unprocessed lean meats, pulses, beans and unprocessed/unrefined wholegrain carbohydrates.  For individuals who feel they often lack the five or more recommended portions of vegetables and fruits daily may wish to consider taking a good quality multi-vitamin and mineral supplement in order to provide for any nutrient shortfalls, however supplements should never be seen as an alternative to healthy living

(1)Mendiola J et al.  2009. Food intake and its relationship with semen quality: a case-control study.  Fertil Steril.  91:812-818
(2)Mendiola et al. A low intake of antioxidant nutrients is associated with poor semen quality in patients attending fertility clinics. Fertility and Sterility, May 2009; DOI: 10.1016/j.fertnstert.2008.10.075
(3)Plataforma SINC (2009, June 3). Semen Quality May Depend Upon Antioxidants In Man's Diet. ScienceDaily. Retrieved June 4, 2009, from http://www.sciencedaily.com¬ /releases/2009/06/090602083727.htm

Written by Ani Kowal

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

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

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

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

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

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

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

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

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

Written by Ani Kowal

Age related macular degeneration (AMD) is the most common cause of blindness in people over the age of 50 in the UK.  In March this year I wrote about the links between B vitamins, homocysteine and AMD and in August last year I discussed the links between diet in general and eyesight preservation.

The macular is the light sensitive area in the centre of the retina that controls visual field and the ability to see colours.  AMD is caused by the deterioration of the macular.  As this happens the peripheral, outer, vision remains intact as the centre field of vision becomes slowly blurry, grey or filled with a large black spot.  Two forms of AMD exists: the dry form which develops slowly, accounting for 90% of all cases; and the wet form which causes rapid deterioration of central vision.

The exact causes of AMD are unknown although free radical damage, where unstable oxygen molecules damage the eye cells, is strongly implicated.  Tobacco smoke and sun exposure can increase the level of free radicals in the body and both are a risk for AMD.  High blood pressure and diabetes are also risk factors as these conditions can limit blood flow to the eyes.

For more information please visit Macular Disease Society website.  The Macular Disease Society aims to build confidence and independence for those with central vision impairment.  They are the only UK charity dedicated to helping people with macular degeneration and offer information, a helpline, counselling and emotional support among other resources.

Evidence for diet and nutrition in the prevention, and to a certain extent treatment, of the condition is growing yearly.  Since free radicals are implicated in the causation and progression of AMD it may be that antioxidant nutrients such as vitamins A, C and E, carotenoids like lutein and zeaxanthin and various phytonutrients and flavonoids, bioactive plant chamicals, are protective.  Omega 3 fatty acids may also play a protective role via their anti-inflammatory effects.

This month three studies (1,2,3) have been published linking diet to AMD.

The first study (1) involved 4003 participants in the Age-Related Eye Disease Study (AREDS), there were 7,934 eyes included in the study.  Dietary intakes of vitamins C and E, zinc, lutein and zeaxanthin, the long chain omega 3 fatty acids DHA (docosahexaenoic acid) and EPA (eicosapentaenoic acid), and low-dietary glycaemic index foods were analysed and the association between AMD was evaluated.  The results showed that consuming diets that had a low glycaemic index and high intakes of the nutrients listed was associated with a reduced risk of AMD.
 

A healthy diet rich in a variety of vegetables, fruits, beans/pulses, nuts/seeds, unprocessed meats and fish, especially oily fish, and unprocessed, unrefined wholegrain carbohydrates will provide these nutrients.  Lutein and zeaxanthin are plant pigments that are found in broccoli, spinach, green leafy vegetables and egg yolks.

The study(1) also found that diets containing foods with a low glycaemic index, also appeared protective against AMD.  Glycaemic index is a measure of how rapidly a food causes blood sugar levels to rise. High-GI foods, like white bread, many processed foods (especially high carbohydrate foods) and potatoes, tend to spur a quick elevation in blood sugar, while low-GI foods, such as lentils, nuts, beans and many high-fibre unrefined grains, create a more gradual increase in blood sugar.  The blood-sugar surges associated with high-GI diets may eventually damage the macula.  This is probably because consistently high blood sugar levels can damage fats and proteins and may put the body into oxidative stress, which over time damages cells and may lead to various diseases, including AMD.

The other two studies (2,3) looked at the links between dietary fat intake and AMD.  In the blog post that I wrote in August last year I discussed many studies that linked a high intake of long chain omega 3 fatty acids, found in oily fish, to a reduced risk of AMD.  The first of these two studies (2) found that regularly eating foods rich in healthy fats such as fish, nuts and olive oil is associated with a reduced risk of AMD and the second study (3) has found that avoiding trans fats (often found in baked and processed foods) is also associated with a reduced risk of the condition.

The first report (2) involved 2,454 participants in the Blue Mountains Eye Study, which began in 1992. The individuals involved completed food frequency questionnaires that were used to analyse and determine their intake of various fatty acids. Digital photographs of the retina were used to assess the development of AMD five and ten years later.

Eating one serving of fish per week was associated with a 31% lower risk of developing early AMD. Eating one to two servings of nuts per week was associated with a 35% lower risk of early AMD.  It is not known for definite why the fatty acids are protective against AMD but the fats may be protecting the eyes by reducing inflammation, blood vessel formation or oxidative damage in the retina.  Omega 3 fatty acids are known to be helpful in reducing inflammatory chemicals in the body (I have previously written a lot about this in various blog posts).

The other report (3) analysed data from 6,734 individuals aged 58-69.  During the follow-up period, 2,872 cases of early AMD and 88 cases of late AMD developed.  Individuals who consumed higher levels of trans-unsaturated fats-often found in baked goods and processed foods-were more likely to have late AMD.  This study also found that individuals  who consumed the most omega-three fatty acids were less likely to have early AMD.

Trans-unsaturated fatty acids may be causing damage through their effect on cholesterol levels as well as through their inflammation increasing effects.  Trans fats are also linked to an increased risk of heart disease as well as other conditions.

Available ‘eye health’ supplements often contain vitamins C, E, beta carotene and the mineral zinc in addition to lutein and zeaxanthin.  The rationale behind this comes from dietary association studies and some research evidence.  If you are considering supplements remember that they are not a substitute for nutritious daily meals!  A healthy diet, rich in a variety of vegetables and fruits, will provide an array of antioxidant nutrients to keep the whole body healthy, including the eyes.  Healthy omega 3 fats from oily fish and nuts/seeds (especially flaxseeds and walnuts) are also a vital part of a balanced diet.  Individuals who do not regularly eat oily fish such as salmon, mackerel, sardines or trout (at least twice per week) may consider taking a fish oil supplement to provide 250mg-350mg EPA and 250-350mg DHA per day, vegetarians may consider a flaxseed oil supplement to provide 500-1000mg alpha-linolenic acid per day.

(1) Chung-Jung C et al.  2009.  Dietary compound score and risk of age-related macular degeneration in the age-related eye disease study.  Ophthalmology.  116:939-946
(2) Tan JSL et al.  2009.  Dietary Fatty Acids and the 10-Year Incidence of Age-Related Macular Degeneration.  The Blue Mountains Eye Study.  Arch Ophthalmol. 127(5):656-665.
(3) Chong EWT et al.  2009.  Fat Consumption and Its Association With Age-Related Macular Degeneration.  Arch Ophthalmol.  127(5):674-680.

Written by Ani Kowal

My last blog post explored some of the many health benefits of honey.  There are also other bee products that seem to be good for our health.  One such substance is propolis.

Bee propolis is a sticky, resin-like mixture of gums, resins and balms that the bees collect from plants and trees.  Propolis is used by the bees in hive construction and repair.  Recently this bee product has been gaining attention for the health giving properties it can provide.  In folk medicine is has been used for centuries.  Many hundreds of studies have been carried out using bee propolis and it is known that the substance possesses anti-bacterial, anti-viral, anti-ulcer and anti-tumour activities (1). 

The chemical composition of propolis is rather complex, it contains over 300 compounds including polyphenols, flavonoids (bioactive plant chemicals) and various organic acids (such as caffeic acid).  I have discussed flavonoids previously in many of my blog posts, they are also abundantly found in fruits and vegetables and act as powerful antioxidants in our bodies.  A recently published study (2) has found that propolis seems to be the most powerful antioxidant of all the bee products (compared with pollen, honey and royal jelly).  This antioxidant capacity is due to the various flavonoids and caffeic acid that propolis contains.

Antioxidants are linked to the reduction in the risk of many conditions raging from cancer to heart disease, dementia and arthritis.  One of the reasons why fruit and vegetables are so important in our diets is because they provide many antioxidant nutrients, such as vitamins C and E and various antioxidant bioflavonoids. Flavonoids act as antioxidants in the body, helping to prevent cell damage and protection against disease by mopping-up destructive unstable oxygen molecules known as 'free radicals', these free radicals create what is known as oxidative stress in the body.  There is mounting evidence that these destructive molecules, together with lowered bodily antioxidant defences, play a significant role in the development and aggravation of many diseases, including heart disease, stroke and cancer to name but a few. 

The body does produce its own antioxidants but also relies on vitamins, mineral and phytochemicals (bioactive plant chemical) from the diet, especially from colourful vegetables and fruits, for additional valuable supplies.

The researchers involved in the study of bee products (2) used a series of laboratory tests to measure how well the bee products were able to scavenge three different types of reactive oxygen species.  They found that a water extract of Brazilian green propolis had the strongest effects, followed closely by an alcohol propolis extract.  An extract of bee pollen collected from two bee species in Spain also had antioxidant effects, but was only about one-tenth as strong as the propolis extracts.  The propolis was found to have antioxidant capacities equivalent to those of vitamin C and a vitamin E derivative.

The results of the study are interesting, however whether these laboratory studies would translate to health benefits in human studies is yet unknown and further research will need to be undertaken before any firm conclusions can be drawn.  It may well be that propolis could have beneficial effects against some oxidative-stress related diseases in human.  Propolis supplements are widely available to buy and are usually marketed toward boosting and maintaining a healthy immune system and protecting against colds and viral infection.  

(1)Khalil ML.  2006.  Biological activity of bee propolis in health and disease. Asian Pac J Cancer Prev. 7(1):22-31.
(2)Nakajima Y et al.  2009.  Comparison of bee products based on assays of antioxidant capacities BMC Complement Altern Med. 9(1):4. [Epub ahead of print]

Written by Ani Kowal

National Honey Week runs from the 4th to the 10th of May and is organised by the Honey Association.  Honeybees are the most important producers of honey. They gather nectar from flowers and plants and carry it to the hive or nest. Other worker bees then take over, preparing it for storing by adding enzymes. Water evaporates away and this, together with the action of the enzyme, turns the nectar to honey.

Honey has been used therapeutically for many thousands of years.  It contains some hydrogen peroxide (which has a lot of antibacterial activity) as well as flavonoids and polyphenols (bioactive plant nutrients) and these components contribute to the anti-inflammatory, antimicrobial and antioxidant properties of honey.  Honey can be effective against fungal infections, bacteria, viruses and worms as well as a bacteria called Helicobacter pylori which is a significant cause of stomach ulcers.

As a child my mum would always give me hot lemon and honey to ease a sore throat, cough or cold and the sweet warm liquid always felt comforting and soothing.  A couple of years ago a study (1) discovered that there was something behind the folk tales, the scientists found that honey is an effective cough suppressant.

The research(1) involved over a hundred children aged 2-18 years who were suffering with upper respiratory tract infections with night time symptoms.  The aim was to compare the effects of a night-time dose of buckwheat honey or honey flavoured dextromethorphan, an ingredient found in over the counter cough medicines, on night time cough and sleep difficulty associated with childhood upper respiratory tract infections.  Treatment with either honey or medicine were compared to no treatment at all.

On the first evening no medication was given to the children.  On the second evening the children were given either honey or the honey flavoured medicine 30 minutes prior to their normal bed time.  The parents then filled in a questionnaire to record: Cough frequency, cough severity, bothersome nature of cough, and child and parent sleep quality.  There were significant differences in symptom improvement between the different treatment groups.  Honey consistently scored best and was significantly better than no treatment for cough frequency and a combined score for all measured outcomes.  The medicine containing dextromethorphan did not score better than 'no treatment' for any outcome measured!  Parents rated the honey most favourably for symptom relief of their child’s night time cough and sleep difficulty due to their respiratory tract infection.  More studies in this area would be very interesting.  It is not clear which particular property in honey was responsible for its favourable action, indeed it could be many reasons working together.  If you decide to try a warm honey drink for a cough or cold then do not use boiling water as this kills off some of the beneficial properties in the honey (let the boiled water cool a little before mixing in the honey).

Honey for healing wounds

Honey has been used for many years in wound care e.g. on cuts, grazes, skin ulcers and burns.  A recent review (2) of many studies concluded that honey may “improve healing times in mild to moderate superficial and partial thickness burns compared with some conventional dressings”.  Another trial (3) that took place in South Africa found that honey was very useful for treating shallow wounds and grazes.  The trial compared aloe honey with a conventional healing gel and it was found that honey was equally as effective.  Healing creams and gels containing active honey ingredients are now available to buy for use on cuts and burns, for example comvita Comvita Manukacare 18+ - Natural Skin Care

Honey for cold sores
In December I wrote about natural remedies for cold sore sufferers (herpes infection).  A study(4) in 2005 investigated the effect of topical honey application on recurrent attacks of herpes lesions on the mouth/lips and also on the genitals and compared the treatment with honey to the treatment with acyclovir cream, the active pharmaceutical ingredient of cold sore creams.  The study was small involving only 16 adults with a history of herpes lesions.  The adults treated one attack with honey and a subsequent attack with conventional acyclovir cream.

For attacks of herpes on the mouth/lips treated with honey the average duration of attacks was 35% shorter than when treated with acyclovir, pain was 39% better, occurrence of crusting was 28% less and healing time was 43% better.  For genital herpes, the mean duration of attacks was 53% shorter with honey than with acyclovir cream, pain was 50% better, occurrence of crusting was 49% better and healing time was 59%  with honey treatment.  Two cases of cold sore (mouth) herpes and one case of genital herpes remitted completely with the use of honey.  With acyclovir treatment, none of the attacks remitted.  No side effects were observed with repeated applications of honey, whereas 3 patients developed local itching with acyclovir.  The authors conclude that topical honey application is safe and effective in the management of the signs and symptoms of recurrent lesions from labial and genital herpes.  The lesions were firmly pressed with gauze soaked with honey for 15 minutes, four times per day day, until complete healing.  As mentioned above natural honey creams are available to buy and may be worth a try if you are a cold sore sufferer.  'Comvita Lipclear Cream - Maintain Healthy Lips' contains honey, propolis (another bee product that I will be writing about later in the week) and various vitamins which may also be useful in the healing of cold sores. 

What kind of honey is best?

There are hundreds of varieties and brands of honey available to buy.  Some types seem to be more effective, in terms of healing properties, than others.  One of the most researched honeys is Manuka honey which is widely available from health food stores and on the internet and is being used in creams and supplements.  The Honey Association say: 

“Manuka honey is produced by honeybees which gather nectar from the flowers of wild Manuka bushes that are indigenous to New Zealand. This particular honey is distinctively flavoured, with a rich taste and dark appearance.  Although all types of honey contain hydrogen peroxide (particularly known for its antibacterial properties), Professor Peter Molan of the Honey Research Centre at Waikato University in New Zealand has undertaken extensive research into maunka honey and believes it contains unique properties which provide additional support to the body's natural healing process.  Molan's research has shown that manuka honey has a high antibacterial potency which heals a range of conditions, from external skin infections to aiding digestion. Molan has also shown that manuka honey can help to fight throat infections and reduce gum disease. When eaten regularly it can aid memory, increase energy levels, improve well-being and reduce feelings of anxiety”

So why not sweeten up your week with a little honey?!

(1)Paul IM et al.  2007.  Effect of honey, dextromethorphan, and no treatment on nocturnal cough and sleep quality for coughing children and their parents.  Arch Pediatr Adolesc Med. 161(12):1140-6.
(2) Jull AB et al.  2008.  Honey as a topical treatment for wounds. Cochrane Database Syst Rev. Oct 8;(4):CD005083.
(3) Ingle R. et al.  2006.  Wound healing with honey--a randomised controlled trial. S Afr Med J. 96(9):831-5.
(4)Al-Waili NS et al.  2005.  Topical honey application vs. acyclovir for the treatment of recurrent herpes simplex lesions.  Med Sci Monit.  10(8):MT94-98.

Written by Ani Kowal

Back in January I wrote about the health benefits of Brazilian Acai berries.  These so called ‘superfoods’ are rich in antioxidant bioflavonoids (biologically active plant chemicals) which may help protect the body against many diseases.  However, these berries are very expensive and have to be shipped in from many miles away.  I was interested to find out if there were any ‘home-grown’ foods that were just as tasty but cheaper to buy and more available.

Cherries seem to come up trumps!  These fruits are delicious and UK grown varieties are readily available to buy from supermarkets and local markets.  Cherry season will soon be starting.  Supermarkets are starting to stock cherries now but most of these will be from other parts of the world.  In June and July UK grown cherries become available, these are cheaper to buy.  Both sweet and sour varieties are available.  For recipe ideas I suggest you check out the BBC food in season website.

A recent (1) study looking into cherries and their ability to boost antioxidant levels in the body was presented in New Orleans, America just a few days ago at the Experimental Biology 2009 conference.  The study (1) was small involving only 12 adults aged 18-25.  They were given weighed amounts of cherries to eat, specifically sour/tart charries of the Montmorency variety, their blood and urine was then analysed to check for antioxidant activity.  The researchers found that eating even a small amount of cherries (about a cup full) significantly boosted the antioxidant activity in the body for up to 12 hours.  The study documents that the antioxidants found in cherries do in fact make it into the human bloodstream.  More research is certainly needed but the antioxidant flavonoids found in cherries could have many benefits for our health.  For example, bioflavonoids have been found to be protective against heart disease, stroke and inflammation.  For more information on please read my previous blog post on flavonoids.

Another recently published study (2) found that both sweet and sour cherry varieties contain many active antioxidant bioflavonoids.  The group of antioxidants flavonoids found in cherries are known as anthocyanins, these give cherries their red colour.  Many laboratory studies have found that bioactive anthocyanins seem to possess antioxidant, anti-inflammatory, anticancer, antidiabetic and antiobese properties – these studies need to be confirmed in larger human trials before any definite conclusions can be drawn but evidence is growing for their importance to health.

Many different flavonoids are found abundantly in fruits and vegetables, which are so important for our health.  Vegetables and fruit should form the core of a healthy diet and getting a good variety daily will give the body many of the nutrients that are needed for optimal health.  Flavonoid supplements are now available to buy (including cherry anthocyanin supplements), though the evidence for their use is still in the early stages.  If you feel your diet is consistently lacking in vegetables and fruits you may want to consider a supplement to cover the shortfall, but remember supplements can never be considered as a replacement for a healthy diet.

For more information on the science supporting the unique health benefits of cherries please visit the 'choose cherries' website.

(1)Uhley VE et al.  2009.   Pharmacokinetic study of the absorption and metabolism of Montmorency tart cherry anthocyanins in human subjects.  2009 Experimental Biology meeting abstracts, Abstract #565.4; Accessed April 19, 2009
(2)Mulabagal V et al.  2009.  Anthocyanin content, lipid peroxidation and cyclooxygenase enzyme inhibitory activities of sweet and sour cherries.  J Agric Food Chem.  57:1239-1246

Written by Ani Kowal

On Monday I was discussing the benefits of traditional Mediterranean diets.  Today I wanted to take a look at a study that took place a little further afield. In China and Japan green tea has long been believed to have important health benefits.  These benefits are now being increasingly researched and studies are showing that green tea may be useful for the prevention of many conditions from heart disease to cancer.  The health benefits probably come from the many bioactive plant chemicals (flavonoids) that green tea contains, these may work through various mechanisms including via antioxidant means.

A recent study (1) investigated diet and breast cancer risk in Chinese women.  The rate of breast cancer in China is lower, around four times lower, than in the UK.  However, this rate is now increasing, especially in the more affluent parts of China.  Part of this increase in cancer cases is thought to be linked to a move away from a traditional Chinese diet toward a more Western style diet.

The study (1) involved 1009 women from Southeast China aged 20-87 who had been diagnosed with breast cancer between the years 2004 and 2005.   In addition to this, 1009 age-matched healthy women, with no breast cancer, were recruited to act as ‘controls’.  Dietary interviews and questionnaires were conducted amongst the women.  The researchers found that a higher dietary intake of mushrooms, both fresh and dried, was associated with a decreased breast cancer risk in premenopausal and postmenopausal Chinese women and an additional decreased risk of breast cancer was found from the additive or joint effect of mushrooms and green tea.

Traditionally mushrooms and green tea form a large part of the Chinese diet.  The study specifically found that women who ate 10g or more fresh mushrooms daily were about 60% less likely to develop breast cancer compared to those who did not eat mushrooms.  Women eating 4g or more of dried mushrooms daily were about half as likely to suffer with breast cancer compared to those not consuming dried mushrooms.  In addition, the risk of breast cancer was lowered further in women who drank green tea daily as well as consuming fresh and dried mushrooms.

The study is a preliminary study and does not prove that mushrooms and green tea protect against breast cancer.  However, investigating associations between diet and disease is always interesting and informative.  More research is certainly warranted in this area.

Mushrooms, green tea, vegetables and fruits in general are high in a variety of vitamins, minerals and phytochemicals or flavonoids (biologically active plant chemicals).  These ‘nutrients’ could be having a positive effect via a variety of complex mechanisms in our bodily cells e.g. through acting as powerful antioxidants.  Eating a healthy diet rich in these foods and low in refined and processed foods will help to provide all kinds of essential nutrients, as well as fibre, and may help to protect us from a variety of diseases.  The messages coming out of studies such as this one and the Mediterranean diet studies discussed on Monday is that eating ‘real food’ or what might be termed a more ‘traditional’ diet and minimising processed and refined food (fast foods and junk foods) in the diet is good for our health (which is not so surprising)!  Our bodies are complex machines which need the right fuel in order to function well.  Processed and refined foods contain calories but very little in the way of nutrients.  Traditional diets rich in a variety of fruits, vegetables, pulses, nuts and seeds, healthy fats, unprocessed meats and fish will provide us with the nutrients necessary for optimal health and wellbeing.  Sometimes we may fall short with our diets, taking a good quality ‘food-state’ multivitamin and mineral supplement together with an essential omega 3 fatty acid supplement is something that can be considered in order to make up for any lack during times of dietary deficiency.  Supplements, however, cannot be viewed as a substitute for long-term healthy eating!

(1)Zhang M, Huang J, Xie X, Holman CD.  2009.  Dietary intakes of mushrooms and green tea combine to reduce the risk of breast cancer in Chinese women.  Int J Cancer. 124(6):1404-8.

Written by Ani Kowal

Previously I have written about the Mediterranean diet and the positive effects it can have with respect to asthma, arthritis, heart disease, metabolic syndrome cholesterol and triglyceride levels.  Already this years there have been numerous papers published which extol the health benefits of following a traditional Mediterranean diet - high in vegetables, fruits, nuts, legumes/beans, fish (especially oily fish), healthy fats and wholegrains.  Low in processed foods, dairy products, red meats, and saturated fats.
 

A new study published in February 2009 (1) looked at the association between Mediterranean diet and mild cognitive impairment - a transitional stage between normal cognition (brain function) and dementia or Alzheimer's disease.  Previous studies have linked the following of a Mediterranean diet and a reduced risk of Alzheimer disease.  The researchers found that following a Mediterranean style diet was associated with reduced risk for getting mild cognitive impairment.  In addition to this, individuals who already had mild cognitive impairment and had a higher adherence to the Mediterranean diet had lower risk of going on to develop Alzheimer's disease.

The study took place in New York and involved 1,393 individuals with no cognitive difficulties at the start of the research and 482 individuals who showed mild cognitive impairment at the start of the study.  275 of the participants who had normal brain function at the start of the research developed mild cognitive impairment over about four and a half years during follow-up.  The researchers assessed the diets of the participants using specialised food frequency questionnaires.  Those who followed a diet closest to a traditional Mediterranean diet had a 28% lower risk of developing mild cognitive impairment compared to those whose diets differed the most from traditional.  The subjects with intermediate Mediterranean diet adherence scores had a 17% lower risk of developing mild cognitive impairment.  Among the group of people with mild cognitive impairment at the beginning of the study, 106 progressed to Alzheimer's disease during follow-up and good adherence to the Mediterranean diet was associated with a lower risk for this transition (1). 

The study was not a clinical trial, it was an observational study and cannot prove the link between following a Mediterranean diet and reduced risk of cognitive impairment.  However, it does point toward a strong association and provides us with indications of the importance of following a healthy eating regimen.  A Mediterranean style diet is also linked to lower blood sugar levels, better blood vessel health and reduced inflammation, all of which are associated with brain function.  There are many components in the Mediterranean diet which may be protecting the brain including omega 3 fatty acids from oily fish and numerous antioxidant vitamins and flavonoids (bioactive plant chemicals) from vegetables and fruits.  No doubt all of these components act together to reduce overall risk of cognitive impairment.  The key message seems to be to follow a healthy diet!

Another study published this February 2009 has found that women following a Mediterranean style diet seem to have a reduced risk of having a baby affected by spina bifida(2).  Spina bifida is a birth defect that occurs when the spinal cord fails to close completely.  Folic acid supplementation is now recommended to all women planning to get pregnant and in the early stages of pregnancy since supplementation has been shown to prevent the condition.  However, folate is not the only protective nutrient, a healthy diet as a whole is very important, folate is simply one major factor.  Observational studies found that in Southern Europe, where the Mediterranean diet originated, rates of spina bifida are lower.  The current paper wanted to investigate the link further.

The study took place in the Netherlands (2).  The researchers used a sample of 50 mothers who had children affected by spina bifida and compared their diet with 81 mothers of children who were not affected (these acted as a control).  The scientists studied the habitual diet of the mothers and also looked at their blood folate and vitamin B12 levels (among other factors).  Mothers who followed a predominantly Mediterranean style dietary pattern (high in vegetables, fruit, healthy fats, fish, legumes and wholegrains) had higher levels of folate and vitamin B12.  Mothers who did not follow a Mediterranean style dietary pattern were at increased risk of having a child with spina bifida.  In fact, women with the least Mediterranean-like diet were about three times more likely to have a child with spina bifida.  In other words, women who ate more fruit, vegetables, healthy oils, fish and whole grains were less likely to give birth to a child with spina bifida.  Again the study does not prove anything conclusively but certainly points towards the benefits of following a healthy, nutrient rich, diet to reducing the risk of haing a child affected by spina bifida.

Any woman who is planning a pregnancy and who is concerned that she is not eating a consistently healthy diet rich in vegetables, fruits and healthy fats may wish to consider taking a broad-spectrum food-state supplement specifically designed for pregnancy in order to main good levels of all nutrients.  An omega 3 fatty acid supplement could also be considered, especially if oily fish and nuts/seeds are not regularly eaten.  Before deciding to take a supplement please discuss your thoughts with a GP, nurse or midwife.

Yet another study published thi February (3) has linked the Mediterranean diet to a reduced risk of hypertension (high blood pressure).  The researchers of this study, which took place in Spain, evaluated 9,408 men and women who were free from high blood pressure at the start of the trial. Dietary intakes and patterns were assessed using specifically designed medically validated food frequency questionnaires, and a 9-point Mediterranean diet score was constructed.  After 4 years, adherence to the Mediterranean diet was not associated with protection against hypertension.  However, after 6 years follow up there was a significant link to reduced blood pressure and protection against hypertension.  This is an important finding since age-related changes in blood pressure increase is common and the study shows that following a Meditteranean type diet could contribute to the prevention of age-related hypertension.

A very recent study (4) not yet published in print has found that following a Mediterranean style diet is linked to a significantly reduced risk of metabolic syndrome, a condition linked to heart disease and diabetes and various other problems.  The study is interesting as it involved 808 individuals who already had a high risk of cardiovascular disease.  The researchers found that participants with the highest score of adhering to the Mediterranean diet had the lowest risk of having metabolic syndrome compared to those with lowest adherence scores.  Participants with the highest Mediterranean Diet adherence had 54% lower risk of having high blood fat levels, hypertriglyceridemia, a big risk factor for heart and other problems.

The key point here is that a healthy, balanced diet is very important for good health.  The Mediterranean diet is not a low fat regimen, it contains ample amounts of healthy fats from foods such as fish, nuts, seeds and olive oil and fruits such as avocado.  It is also full of vegetables, fruits and fibre.  A traditional Mediterranean diet is low in processed food and contains around 9 portions of vegetables and fruits a day, we are barely able to reach 5 here in the uk!  What we eat is crucial for our bodies (and our mind) to stay healthy, however if you find that you are not consistently eating 5 portions of vegetables and fruits a day you may wish to consider a good food-state multivitamin/mineral supplement together with an omega 3 fatty acid supplement from fish oil (providing around 300mg EPA and 300mg DHA daily) or flaxseed oil (providing 500-1000mg alpha linolenic acid daily).  Please remember that supplements are not a substitute for a healthy diet!

(1)Scarmeas N et al.  2009.  Mediterranean Diet and Mild Cognitive Impairment. Arch Neurol.  66 (2): 216-225
(2) Vujkovic M et al.  2009.  The maternal Mediterranean dietary pattern is associated with a reduced risk of spina bifida in the offspring. BJOG.  116(3):408-15
(3) Núñez-Córdoba JM et al.  2009.  The Mediterranean diet and incidence of hypertension: the Seguimiento Universidad de Navarra (SUN) Study. Am J Epidemiol.  169(3):339-46.
(4)Babio N et al.  2009.  Adherence to the Mediterranean diet and risk of metabolic syndrome and its components.  Nutr Metab Cardiovasc Dis. Jan 26. [Epub ahead of print]

Written by Ani Kowal

Currently it is Save Your Vision Month in America, a campaign run by the American Optometric Association (1).  The role that diet plays in preserving our eyesight is highly important and certainly worth a loud mention.  In August last year I wrote about cataracts and age related macular degeneration (AMD) and mentioned how diet, particularly omega 3 fatty acids from oily fish and antioxidants from vegetables and fruits, was important in preventing these conditions and preserving good eyesight.   In the UK Age-related Macular Degeneration (AMD) is the leading cause of blindness, with 45% of those registered as blind suffering from the disease.  For more info on AMD please read my previous blog post.

Very recently a paper was published (2) suggesting that B vitamins, particularly folic acid, vitamin B6 (also known as pyridoxine hydrochloride) and vitamin B12 (cyanocobalamin) may be particularly important for good eye health.  The study was conducted since previous research had indicated the links between homocysteine concentrations in the blood and the risk of age related macular degeneration (AMD).

I have previously written about homocysteine.  Most people are aware that high levels of homocysteine in the blood have been linked to an increased risk of heart problems.  Recently high homocystein levels have also been linked to poor bone health and other health problems.  To recap from my past blog posts: Homocysteine is produced when the amino acid (the building blocks of protein) methionine is broken down in the body.  Normal levels of homocysteine are important to help build and maintain body tissues, however elevated concentrations in the blood can be harmful and have been associated with an increased risk of many disorders.  At normal levels homocystein can be converted in the body into a harmless substance called cystanthionine.  The conversion of homocysteine into this harmless substance depends upon various B vitamins  (B6, B12 and folic acid).  Having good levels of these B vitamins appears to be a very good way of preventing high homocysteine levels and low levels of B vitamins have been associated with raised homocysteine levels.

The researchers of the eye health study (2) wanted to examine the incidence of AMD in a trial of combined folic acid, vitamin B6 and vitamin B12 therapy.  The trial was well designed and involved over 5000 women aged 40 or older with no diagnosis of AMD at the start of the trial.  These women received either a daily placebo supplement or a supplement containing 2.5mg folic acid, 50 mg vitamin B6, and 1g vitamin B12.  After around 7 years of treatment and follow-up it was found that the women receiving the supplement had a significantly reduced risk of AMD.   The women taking the multi-B vitamin supplement were around 35% less likely to develop AMD than those taking the placebo.

The research seems to support the idea that taking a multiple B vitamin supplements is useful for sight preservation.  It is not entirely clear whether the B vitamins worked to protect eyesight simply via lowering homocysteine levels.  These vitamins may have also been working via exerting antioxidant effects or by improving blood vessel function.  Further studies would be necessary to evaluate these ideas and strengthen data before strong recommendation for B vitamin supplementation can occur.

In the diet the B vitamins may be found in the following sources (vegetarians and vegans may wish to consider a multiple B vitamin supplement):
Vitamin B6 – Mainly found in meat, fish and eggs
Vitamin B12 – liver, meat, eggs, milk, yeast extract
Folic acid – liver, orange juice, green vegetables, nuts

Continuing with the theme of eye health.  Scientists at the University of Liverpool (3) have recently announced that the degeneration of sight caused by AMD could be reduced by up to 20% through dietary changes alone, specifically through the increase of vegetables, fruits and nuts in the diet.  Professor Ian Grierson, Head of Ophthalmology at the University of Liverpool, has produced a comprehensive cooking guide called 'Fruit for Vision', designed to add fruit and vegetables into everyday meals.  The recipes were formulated in order to help AMD sufferers slow down the degeneration process by increasing micronutrient, vitamin and antioxidant intake in the diet. Non-sufferers can also use the book to add fruit, nuts and vegetables into each meal to protect against the disease.

Professor Grierson said (3): "Poor eating habits have a huge impact on health in general and the health of your eyes is no exception. Eye problems such as AMD, cataract and even glaucoma can all be affected by what we eat. But a relatively minor change in diet - adding a little more fruit into our meals - can make a profound difference and can keep eye diseases like AMD at bay for up to 20% longer.  There are of course other risk factors related to AMD such as age, light exposure, smoking and being overweight. But if we can improve the kind of food that we eat, we could dramatically reduce the number of people who may suffer from eye diseases in the future."

Fruit for Vision is published by Indigo Creative Marketing and the Macular Disease Society. It provides easy recipes that incorporate fruit and nuts in to the diet. The recipes suggest minor additions to what we already eat, rather than major dietary changes.

Over in America, the AOA has also released information (4) in order to highlight the importance that diet and nutrition play in eye health.  The AOA highlights six nutrients important for eyesight:
Lutein, Zeaxanthin, Essential fatty acids, Vitamins C, Vitamin E, Zinc  
 
In their press release the AOA mention the following food sources of these specific nutrients:
Lutein and zeaxanthin: Colorful fruits and vegetables such as broccoli, spinach, kale, corn, green beans, peas, oranges and tangerines
Essential fatty acids: Oily fish like trout, salmon, sardines, or herring, nuts and seeds, whole grain foods, chicken and eggs
Vitamin C: Fruits and vegetables, including oranges, grapefruit, strawberries, papaya, green peppers and tomatoes
Vitamin E: Vegetable oils, such as safflower or corn oil, almonds, pecans, sweet potatoes, and sunflower seeds
Zinc: Lean red meat, poultry, liver, shellfish, milk, baked beans, and whole grains

(1)American Optometric Association (AOA)
(2)William G. Christen, ScD et al.  2009.  Folic Acid, Pyridoxine, and Cyanocobalamin Combination Treatment and Age-Related Macular Degeneration in Women.   The Women's Antioxidant and Folic Acid Cardiovascular Study.  Arch Intern Med.169(4):335-341.
(3)University of Liverpool – press release
(4) Open Your Eyes To Healthy Eating Habits – press release by the AOA

Written by Ani Kowal

In October of last year I wrote about eating for bone health and mentioned the clear and positive associations between fruit and vegetable consumption and strong bones (1).  The post concentrated mainly on the way these foods act to effect the pH balance within the body.  Fruits and vegetables contain a huge array of vitamins, minerals and phytonutrients/flavonoids (chemically active plant compounds) that may also act to strengthen bone.

Last month a paper was published in the American Journal of Clinical Nutrition (2) which points toward the bone protective effects of carotenoids.  Previous evidence suggests that carotenoids may be acting to prevent bone loss and also to stimulate bone cell growth. Carotenoids, found abundantly in fruit and vegetables, act as antioxidants in the body and it is this mechanism that may be protecting the bones from damage by naturally occurring unstable oxygen molecules in the body, known as free radicals.  Antioxidants may help to ‘quench’ the destructive free radical molecules and therefore protect against damage.  As nutrients, antioxidants are ingested in the diet and are then distributed via the blood into various parts of the body tissues, including the bones.  

The researchers involved in this latest study (2) looked at the potential effects on bone mineral density of overall and individual intake of several carotenoid compounds, including alpha-carotene, beta-carotene, beta-cryptoxanthin, lycopene, lutein and zeaxanthin.  The study scientists tracked the bone mineral density in the hip and spine of 213 men and 390 women over the course of four years.  They found that carotenoid intake was associated with some levels of protection against bone mineral density losses at the hip in men and at the spine in women.  The results suggest that carotenoids, especially lycopene, may be protective against bone loss in older adults.  Further studies are certainly needed but the evidence adds further weight to the mounting data which shows just how important fruits and vegetables are to the whole body, including our bones.

A diet rich in colourful fruits, vegetables will provide plentiful amounts of antioxidants.  Carotenoids are a family of over 700 naturally occurring yellow, red, orange and dark green pigments found in vegetables and fruits.  Good sources include carrots, sweet potatoes, tomatoes, squash, peppers, cantaloupe melons, nectarines, papaya, mango and dark green vegetables such as spinach, kale, watercress and asparagus.  Introducing a good mix of these fruits and vegetables on a regular basis in the diet will help keep carotenoid levels in the body high.

Absorption of carotenoids from foods into the body is greatly affected by fat.  Without a fat source carotenoids are not easily absorbed.  Fat acts as a carrier for these nutrients to allow them passage from the gut into our blood and bodily cells.  I am certainly not suggesting that you drown your vegetables or salads in gallons of oil, however, I am a firm believer in using small amounts of olive oil in dressings and cooking.  Including some nuts, seeds or olives in salads may also be helpful in order to gain maximum absorption of these important nutrients. 

If you are looking at carotenoid supplements, especially lycopene, look for those that contain an oil carrier, these will aid maximum absorption.  Of course fruits and vegetables contain far more than just carotenoids and a supplement cannot be seen as a substitute for good dietary habits, but if you feel that you do not get a good variety of vegetables and fruits in your daily diet you may wish to consider a supplement to help make up for any short-fall.

It is particularly important that young people look after their bone health, a balanced diet as well as exercise is vital in this respect.  Recently the National Osteoporosis Society (NOS) produced a press release and report regarding their findings that young people in the UK are endangering their health by not looking after their bones.  Prevention is the key to osteoporosis which affects up to three million people in the UK.

The NOS found that (3) that less than a quarter of people knew they should start looking after their bones before the age of 30, despite the fact that bone strength actually peaks during our 20s. Younger people need to ‘bank’ plenty of bone by the age of 30 as bones tend not to regenerate as quickly after that.  
• Almost half (49%) of young people (18-24 yrs) did not know there were any steps they could take to keep their bones healthy;
• More than half were unaware that exercise can help reduce the risk of osteoporosis;
• One in three did not know about the positive role diet can play.

Professor Roger Francis, Chair of the charity’s Medical Board, states(3):
 
“Our bones are living tissue, much like our skin. New bone replaces old throughout our lives. But the most crucial years are when we’re young as this is when the cells building new bone are most active. Until our mid 20s our bones are gaining density and strength. From our 30s onwards our bones gradually lose their density. The more we can build up our bones when we are young the better we can help to protect ourselves against osteoporosis and fragility fractures in later life.” (3)

Women are more at risk of developing osteoporosis since their bones are smaller and also more vulnerable to hormonal changes.  Being underweight, and having a low BMI (body mass index) is also a big risk factor.  Currently many girls and women are striving to reach a low bodyweight and achieve the size zero that is touted by so many celebrities.  The report found that only 21% of people knew that being underweight was a significant risk factor for osteoporosis development (3).

Encouraging young people to eat fruit and vegetables, as well as foods rich in calcium, magnesium and other minerals is very important for bone strength and development.  Please visit the National Osteoporosis Society website for more information about bone health. A very informative document about osteoporosis can be downloaded from the site and my post about eating for strong bones may also be of interest.

(1) New SA.  2003.  Intake of fruit and vegetables:implications for bone health.  Proc Nutr Soc.  62:889-899
(2) Sahni S et al.  2009.  Inverse association of carotenoid intakes with 4-y change in bone mineral density in elderly men and women: the Framingham Osteoporosis Study. Am J Clin Nutr 89: 416-424
(3) NOS press release

Written by Ani Kowal

Milk thistle (Silybum marianum), sometimes thought of as the detox herb, is a tall herbal plant with prickly leaves and a ‘milky’ looking sap.  The herb was being used medicinally in ancient Greece and continues to be used by many individuals today, especially to treat liver ailments.  Often the supplement is known as silymarin, which is the name of the major bioflavonoid, or active plant compound, found in the herb.

Many hundreds of studies have documented the usefulness of this herb.  Often people associate milk thistle with ‘detox’ regimens.  This is probably because there is some evidence to suggest that the herb can fortify or strengthen the liver.  The liver is the major detoxification organ of the body, it ‘cleans’ our blood and neutralises any toxins from the air, diet, metabolic processes or drugs/medicines.  The bioflavonoids in milk thistle appear to protect and strengthen the liver cells, possibly through antioxidant and anti-inflammatory processes and actions.  The herb also appears to help promote the regeneration of new liver cells in order to replace older damaged ones.  There also seems to be some indications that the herb helps in the prevention of cancer, possibly via its antioxidant capabilities.

A recent Hungarian research paper (1) reviewed the available evidence for milk thistle in the treatment of chronic liver diseases.  The most common serious liver problems are viral infections (hepatitis) and liver scarring (cirrhosis) often caused by alcoholism and fatty liver.  Many of the liver diseases are linked to damage by free-radicals, which are destructive oxygen molecules naturally present in the body, and the antioxidant capacity of milk thistle is probably why it is so useful.  The bioflavonoids found in milk thistle act as antioxidants and can ‘mop-up’ these free radicals.  (I have written about antioxidants numerous times in my blog posts). 

Antioxidants are linked to the reduction in the risk of many conditions raging from cancer, to heart disease, dementia and arthritis.  One of the reasons why fruit and vegetables are so important in our diets is because they provide many antioxidant nutrients, such as vitamins C and E and various antioxidant bioflavonoids.  The research paper discusses the findings that milk thistle benefits the liver through mechanisms such as strengthening cell membranes, acting as an antioxidant, helping liver cells to regenerate, reducing liver inflammation and helping to prevent liver scarring.  The paper(1) also discusses the significant antiviral activities of the herb which could account for its potential usefulness in helping patients with hepatitis. 

A recent laboratory cell study (2) looked at how the antioxidant bioflavonoids in milk thistle protect the cholesterol in our blood from becoming damaged or oxidised.  Oxidised cholesterol is far more dangerous to our bodies and poses an increased risk for heart disease.  Milk thistle appeared to be very potent in protecting against oxidation.  Similarly the antioxidants appear to be potentially important in the prevention of cancer (3,4).  It appears that milk thistle acts through a variety of cellular mechanisms in our body and not just through antioxidant capacity.  Further larger trials with this herbal supplement are certainly warranted to clarify its health benefits.

The antioxidant power of this herb may mean that it could be very useful as a dietary supplement in the prevention of all kinds of free-radical related diseases(6) such as liver problems, cancers, heart disease, dementia, arthritis and a whole host of others.  However, supplements are definitely not the whole story.  It is important to remember that supplements are not a substitute for a healthy diet.  Vegetables and fruits will provide an array of various antioxidant and other nutrients which are vital for our health.  A milk thistle supplement could be viewed as an extra boost for the body.  If you think you may have over-done the alcohol and pain-relief medicines recently and fancy strengthening your liver you could consider a short course (1-3 months) of milk-thistle supplementation in addition to a liver strengthening healthy antioxidant diet. 

(1)Fehér J & Lengyel G.  2008.  [Silymarin in the treatment of chronic liver diseases: past and future.] [Article in Hungarian]. Orv Hetil. 149(51):2413-8.
(2) Ferenci P et al.  2008.  Silibinin is a potent antiviral agent in patients with chronic hepatitis C not responding to pegylated interferon/ribavirin therapy.  Gastroenterology.  135:1561-1567
(3) Wallace S et al.  2008.  Milk thistle extracts inhibit the oxidation of low-density lipoprotein (LDL) and subsequent scavenger receptor-dependent monocyte adhesion.  J Agric Food Chem.  56:3966-3972
(4) Hogan FS et al.  2007.  Flavonoid, silibinin, inhibits proliferation and promotes cell-cycle arrest of human colon cancer.  J Surg Res.  143:58-65
(5) Ramasamy K & Agarwal R.  2008.  Multitargeted therapy of cancer by silymarin.  Cancer Letter.  269:352-362
(6) Asghar Z & Masood Z.  2008.  Evaluation of antioxidant properties of silymarin and its potential to inhibit peroxyl radicals in vitro.  Pak J Pharm Sci.  21:249-254

Written by Ani Kowal

Veins are vessels that carry blood to the heart and within them are valves that allow blood to travel in only one direction.  Sometimes these valves become weakened and do not close completely, this allows some blood to flow backward where it can end up collecting.  A condition known as chronic venous insufficiency occurs when veins in the legs cannot pump enough blood back to the heart.  The blood pools, legs may feel heavy and painful and the ankles may swell.  The condition often leads to the occurrence of varicose veins, a swelling and bulging of the veins. 

Varicose veins are most commonly seen in the legs and are not usually a serious causes for concern.  Sometimes blood and other fluid can leak out of the veins into the surrounding tissue, this is uncommon but severe and can cause scaly, itchy skin or fluid pooling and swelling in the legs.  Without attention varicose veins do tend to worsen and may need to be removed via surgery.  However, veins can be strengthened through a variety of means in order to prevent any chronic venous insufficiency and subsequent varicose veins.

Individuals who spend a lot of time standing in one position may be at a greater risk of developing varicose veins.  Genetic and hormonal factors may also be involved in the development of chronic venous insufficiency and varicose veins and obesity, lack of exercise, pregnancy and heavy lifting can aggravate the condition.

Fibre

There is some evidence to suggest that one of the causative factors of varicose veins is constipation.  It seems that straining in constipation can cause raised abdominal pressures which are transmitted to the veins of the legs, putting pressure on the valves (1,2).  Individuals who are susceptible to varicose veins may well benefit from looking to increase the amount of fibre in their diets.  Most of us in the UK tend not to include enough daily fibre in our diets and could well do with a boost!  Ensuring a good daily supply of vegetables, fruits, beans, pulses, oats, nuts and seeds will go some way to boosting daily fibre intakes.  Taking a prebiotic and/or probiotic supplement may also help prevent constipation and keep the digestive system functioning optimally.

Flavonoids

Flavonoids, or bioflavonoids, are bioactive plant compounds found in large quantities in vegetables and fruits.  Readers of my blog will be used to me mentioning them.  They have antioxidant, amongst other, actions within the body.  Procyanidins (or proanthocyanidins) are a subclass of flavonoids and studies have shown that they are useful in the treatment of symptoms associated with varicose veins (3,4,5,6).  One paper (3) analysed the data from several trials testing a herbal remedy in individuals with chronic venous insufficiency.  The supplement tested contained 150mgButchers broom (Ruscus aculeatus), 150mg hesperidin and 100mg vitamin C.  Butcher’s broom is an evergreen shrub native to the Mediterranean, it contains the flavonoids ruscogenin and neoruscogenin.  Herperidin is another type of bioflavonoid found mainly in citrus fruits.  The paper pulled together data from many trials, in total there was information from over 10,000 participants.  The supplement appeared to alleviate pain severity, feelings of heaviness in the legs and water retention.   

A study (7) examining the procyanidin content of some foods including; red wine, dark chocolate, cranberry juice and four varieties of apples found that, on average, dark chocolate and apples, especially Red Delicious and Granny Smith, contain the largest procyanidin content per serving.  Other good sources of these flavonoids include blueberries, grapes (especially the skins), peanuts and bilberries.  Incorporating procyanidin rich foods into the diet may prove beneficial to those suffering with, or wanting to prevent, varicose veins.  In general a diet rich in a wide variety of vegetables and fruits will provide a whole host of flavonoids to the body.   

Specific supplements for vein health are available and these tend to contain various classes of flavonoids.  You may wish to consider taking a supplement, in addition to a healthy balanced diet, in order to boost your dietary intake levels.

Horse Chestnut

Supplements are now available which contain extracts from the seed of the horse chestnut (Aesculus hippocastanum L.).  Horse chestnut has been traditionally used for many years to treat individuals with weak veins and varicose veins.  The benefit seems to come from a compound called escin, another type of flavonoid.  It appears to strengthen veins thereby preventing fluid loss and subsequent leg swelling.  Supplements and leg gels containing horse chestnut are readily available for treatment of the symptoms of varicose veins.  A study (8) reviewing the available evidence indicates that products containing horse chestnuts are helpful, especially in alleviating leg pain, feelings of leg heaviness and itching in patients suffering with varicose veins and other issues associated with venous insufficiency.

Other helpful advice
*Try to incorporate some form of exercise, such as walking, into your day
*Avoid crossing your legs whilst seated
*Avoid standing in one position for prolonged periods of time
*Elevate your legs when possible to prevent the blood from pooling in the veins
*Avoid tight clothes that constrict circulation
*Wear compression stockings, especially if you regularly sit or stand for prolonged periods of time

(1)Burkitt DP.  1976.  Varicose veins: facts and fantasy.  Arch Surg.  111(12):1327-32.
Fine AM.  2000.  Oligomeric proanthocyanidin complexes: history, structure, and phytopharmaceutical applications.  Alternative Medicine Review.  5(2):144-151.
(2)Lee AJ et al.  2001.  Fiber intake, constipation, and risk of varicose veins in the general population: Edinburgh Vein Study.  J Clin Epidemiol.  54(4):423-9.
(3) Boyle P, Diehm C, Robertson C. 2003.  Meta-analysis of clinical trials of Cyclo 3 Fort in the treatment of chronic venous insufficiency. Int Angiol.  22(3):250-62.
(4) Fine AM.  2000.  Oligomeric proanthocyanidin complexes: history, structure, and phytopharmaceutical applications.  Alternative Medicine Review.  5(2):144-151.
(5)Gomez Trillo JT.  1973.  Varicose veins of the lower extremities:  Symptomatic treatment with a new vasculotrophic agent.  Prensa Med Mex.  38:293-296
(6)Royer RJ et al.  1981.  [Evaluation of venotropic drugs by venous gas plethysmography. A study of procyanidolic oligomers.]  Sem Hop.  57:2009-2013
(7)Hammerstone JF et al.  2000.  Procyanidin content and variation in some commonly consumed foods.  Journal of Nutrition.  130(8):2086-2092S.
(8) Suter A, Bommer S, Rechner J.  2006.  Treatment of patients with venous insufficiency with fresh plant horse chestnut seed extract: a review of 5 clinical studies. Adv Ther.  23(1):179-90

Written by Ani Kowal

So called ‘super-foods’ are constantly being given press attention.  One moment it is broccoli, the next it is blueberries.  Recently there has been a lot of enthusiasm for a Brazilian berry called the Acai Berry, pronounced ah-sigh-ee.  These berries are available as drinks, supplements and dried snacks and commonly used in mixed juices, smoothies, frozen treats and dietary supplements.

Acai palms grow in the Brazilian rainforest and can reach great heights, in excess of 60 feet!  The acai fruit, or berry, is about the size of a large blueberry and only the outermost layers of the fruit (the pulp), which surround the large seed inside, are edible.

The berry has gained interest in the health arena since it is packed with antioxidant bioflavonoids, chemically active plant compounds, that may protect against many ills (please see my numerous posts discussing antioxidants for more information).  Until now there has been very little scientific research to support the health claims surrounding the acai berry.  However, in a recent issue of the Journal of Agricultural and Food Chemistry three papers were published which investigate the antioxidant properties of the Acai Berry (1,2,3).  The findings are important since they show that the antioxidants from the berry are easily absorbed for utilisation in humans and the berries were also found to have anti-inflammatory as well as antioxidant properties. 

In laboratory cell studies it also appears that the berry shows activity against cancer cells.  However, like vitamin C, the body can only absorb a certain amount of the antioxidants from the berry in one go.  The researchers of the papers say that their results are preliminary but interesting and lots of further research studies will be needed before any specific health claims for the berry can be made.

Acai berries are naturally low in sugar and the flavour has been described as a tasty mixture of red wine and chocolate!  Again, it is a matter of dietary balance.  Eating an abundant variety of different vegetables and fruits will provide the body with a whole host of different vitamins, minerals and bioflavoids and therefore provide us with the best defence against illness.  Variety is very important, acai berries can certainly be a very delicious and nutritious part of that variety but cannot be seen as a stand-alone superfood cure all.  Acai containing foods and supplements cannot act as an overall substitute for a healthy diet, but can rather be seen as an added antioxidant boost for the body.

Making the berry a part of your well-balanced and healthy diet and lifestyle could certainly prove to be a scrumptious option!

(1)Jensen GS et al.  2008.  In Vitro and in Vivo Antioxidant and Anti-inflammatory Capacities of an Antioxidant-Rich Fruit and Berry Juice Blend. Results of a Pilot and Randomized, Double-Blinded, Placebo-Controlled, Crossover Study.  J Agric Food Chem.  56:8326-8333
(2)Mertens-Talcott SU et al.  2008.  Pharmacokinetics of anthocyanins and antioxidant effects after the consumption of anthocyanin-rich acai juice and pulp (Euterpe oleracea Mart.) in human healthy volunteers.  J Agric Food Chem.  56:7796-7802
(3)Pacheco-Palencia LA et al.  2008.  Absorption and biological activity of phytochemical-rich extracts from Açai (Euterpe oleracea Mart.) pulp and oil in vitro.  J Agric Food Chem.  56:3593-3600

Written by Ani Kowal

Dark chocolate, the varieties containing 85% -90% cocoa solids, is something that I really do enjoy (as regular readers of my blog will already know)!  I take comfort in knowing that this treat is also quite healthy.  Numerous studies have now linked the eating of dark chocolate to a reduced risk of heart disease and cancers, as well as other conditions.  The health benefits appear to come from the antioxidant flavonoids (bioactive plant nutrients) contained within the cocoa and also from the many minerals that cocoa contains such as magnesium.  Dark chocolate also contains fibre and is much lower in sugar than milk chocolate, so most people find that they need far less to satisfy their chocolate cravings.

As a child I remember being told not to spoil my appetite by eating too much chocolate before the Christmas meal so I was pleased to read a report produced by the Faculty of Life Sciences (LIFE) at the University of Copenhagen, the paper details some research that the scientists there have carried out on dark chocolate and appetite (1).

The scientists have found that dark chocolate is far more filling than milk chocolate and may lessen our craving for milk chocolate which is sweet, salty and provides very little in the way of nutrition.  Eating a few squares of good quality dark chocolate, 70% cocoa solids or over, may well satisfy chocolate cravings and hence prevent further binges and large Christmas weight gains.

To compare the effects of dark and milk chocolate on both appetite and subsequent calorie intake, 16 young, healthy men of normal weight who all liked both dark and milk chocolate took part in an experiment over two separate sessions.  In the first instance dark chocolate was tested and in the second stage, occurring on a different day, milk chocolate was tested.  Prior to the experiment all the participants fasted for 12 hours, so they were hungry.  They were than given 100g of chocolate to consume within 15 minutes.  The calorie content of both the dark and milk chocolate was the same.  After they had eaten the chocolate they were asked to register their appetite every half an hour for the next five hours.  Two and a half hours after having eaten the chocolate the individuals were offered pizza and instructed to eat until they felt comfortably satisfied.  The results were analysed by the scientists and were significant in that after eating dark chocolate the individuals consumed 15% fewer calories from the pizza than when they had eaten milk chocolate.  The participants also recorded that they felt less like eating after consuming the dark chocolate, it made them feel fuller for longer. 

So, in addition to providing us with nutrients and antioxidant, dark chocolate may well help to fill us up and prevent us from over-indulging on unhealthier foods this Christmas.  The appetite controlling effects of the dark chocolate could be down to the nutrients it contains or perhaps the fibre content.  Of course, I am not suggesting gorging on dark chocolate but a few pieces may not be as bad as you once thought!!

Nuts are another Christmas food that some people tend to avoid, thinking they are fatty and full of calories.  As I mentioned last week, nuts are a healthy natural food and we could all do well from eating a regular handful of unsalted, unroasted nuts.

Nuts are packed with nutrients, fibre and healthy fats.  Numerous studies suggest that people who regularly consume nuts (around 30g per day) are slimmer than those who do not.  Nuts also make a great snack as they help dampen the appetite and prevent later overeating.  The fat in nuts is mainly monounsaturated fat, the same as olive oil, which appears to reduce risk of heart disease.  Nuts are also rich in vitamin E, magnesium, potassium and fibre - all of these nutrients are great for heart health.  Brazil nuts are also very high in selenium which is linked to a reduced risk of cancer and walnuts contain omega 3 fatty acids which have many health properties.

Previously I posted a blog dedicated to the health benefits of almonds.  A recent review (2) summarised the available evidence on nuts and body weight and weight loss.  The authors write  “There are claims that energy-dense foods are especially problematic for weight loss and maintenance. Nuts are among the most energy-dense foods consumed, yet the literature consistently documents little impact of their ingestion on body weight”  Nuts seem to satisfy the appetite, they make us feel full and may therefore prevent us overeating on other, less nutritious foods.  This could be due to the fact that, as well as healthy fats, nuts also contain protein and release their energy very slowly into the bloodstream,they have a very low glycaemic index or GI. Evidence also suggests that not all of the fat in nuts is absorbed into the body, much of it being passed out in the stool. 

Cracking a few nuts this Christmas may be a great way to boost health!

(1)University of Copenhagen
(2) Mattes RD et al.  2008.  Impact of peanuts and tree nuts on body weight and healthy weight loss in adults. J Nutr 2008;138:1741S-1745S

Written by Ani Kowal

One of my friends suffers from recurrent cold sores, every time she is a little stressed or her immune system is weakened by a cold she, more often than not, gets a painful cold sore blister on her lip. 

Cold sores are caused by a virus known as Herpes simplex Type I (HSV-I), this is different form the type II herpes simplex virus responsible for genital herpes (HSV-II).  Once contracted, the cold sore virus remains dormant (inactive and causing no symptoms) in the body, usually within our nerve cells.  In a healthy, strong body the immune system tends to keep the virus under control.  However, the virus can reactivate at any time and lead to blisters forming around the mouth, but also on the gums or inner cheeks.  Recurrences typically occur when the immune system becomes stressed by a fever, cold or other viral infection.  Excessive tiredness, fatigue, stress and menstruation can also lead to a cold sore forming.  Initially the cold sore appears as a painful and/or itchy fluid-filled small blister, this then breaks to form a scab which usually remains for up to 10 days.

In previous posts I have written about how to keep the immune system strong and healthy in order to prevent against infections.  This general advice will help to keep the body generally strong and able to prevent the herpes virus becoming active.  A diet rich in vegetables and fruits, healthy fats (especially the omega 3 fatty acids found in oily fish) and within minimum inclusion of processed foods seems to be the key.  However, if you are prone to cold sores there are a few specific recommendations that may help prevent cold sore recurrences.  There are also things that can be done once a cold sore has erupted in order to minimise the pain and discomfort caused and reduce the number of days that the blister remains.  Much of the evidence was collated in a review paper(1) that I will use as a basis for this post.

The amino acids Lysine and Arginine
The HSV-I virus requires a specific amino acid (the building blocks of proteins), called arginine, in order to multiply in the body.  However, a different amino acid, lysine, appears to inhibit/prevent the replication of the virus.  Lysine seems to block or ‘antagonise’ arginine via several complex mechanisms in the body.  There are many studies(1) which show that a lysine supplement can reduce the frequency, duration and severity of cold sore attacks.  In order to keep the virus at bay it may be useful to take 500mg of lysine daily, this can increase to 500mg twice, or three times daily during a cold sore attack.

Vitamin C and bioflavonoids
In previous posts I have written about the immune boosting properties of the antioxidant vitamin C and flavonoids (bioactive plant compounds).  A diet rich in vegetables and fruits will provide abundant amounts of vitamin C and flavonoids and I would suggest eating at least five portions a day (there are so many associated health benefits!!).  Studies have shown that supplemental vitamin C and flavonoids appear helpful in reducing the duration of a cold sore attack (1) and more recent laboratory studies have shown that various flavonoids appear helpful for inactivating the virus (2,3).  You may want to think about taking extra amounts of these nutrients daily (via a supplement) as a preventative measure to help keep the immune system strong, especially if you frequently struggle to eat at least five portions of vegetables and fruits daily.  During an attack 500mg Vitamin C with 200mg bioflavonoids twice to three times daily may be helpful.  For daily prevention 200mg vitamin C and 100-200mg flavonoids daily could be useful.

Topical treatment/creams
Most people who suffer from cold sores use popular the over-the-counter creams, which contain a pharmaceutical agent called acyclovir and can sometimes cause burning and stinging, but are keen to look for a more natural cream.  There are several studies looking into different agents which can be applied to the cold sore in order to minimise the redness and the length of duration of the blister/scab.  There are studies which indicate that honey (4), Bee propolis (5,6), vitamin E (7,8) and lemon balm, Melissa officinalis, (9,10,11) may all be helpful in minimising the viral blisters, reducing pain, itchiness or duration of attack.

In the study with honey (4) the average duration of cold sore attack, pain, occurrence of crusting and average healing time were all better with the honey treatment than with the acyclovir cream.  The authors of the study remark that:  “Topical honey application is safe and effective in the management of the signs and symptoms of recurrent lesions from labial and genital herpes”

Those wishing to try a more natural cream may be interested in one that I recently came across Comvita Lipclear Cream - Maintain Healthy Lips I have not tested the cream myself but it contains all of the agents mentioned above: honey, propolis, Vitamin E and lemon balm.  It also contains lysine which may be an added bonus.

Please do read my previous posts related to boosting immune health.  Any action which keep the immune system healthy and strong is likely to minimise the chance of recurrent cold sore attacks. 

(1)Gaby AR.  2006.  Natural remedies for Herpes simplex.  Alternative Medicine Review.  11:93-101
(2) Isaacs CE et al.2008.  Epigallocatechin gallate inactivates clinical isolates of herpes simplex virus. Antimicrob Agents Chemother.  52(3):962-70.
(3) Lyu SY, Rhim JY, Park WB.  2005.  Antiherpetic activities of flavonoids against herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2) in vitro.  Arch Pharm Res.28(11):1293-301.
(4) Al-Waili NS et al.  2005.  Topical honey application vs. acyclovir for the treatment of recurrent herpes simplex lesions.  Med Sci Monit.  10(8):MT94-98.
(5) Huleihel M et al.  2002.  Anti-herpes simplex virus effect of an aqueous extract of propolis.  Isr Med Assoc J.  4(11 Supplement):923-927.
(6) Giurcaneanu F et al.  1988  [Treatment of cutaneous herpes and herpes zoster with Nivcrisol-D].  Virologie.  39(1):21-24, 1988.
(7)Fink M et al.  1980.  Treatment of herpes simplex by alpha-tocopherol (vitamin E).  Br Dent J.  148:246.
(8)Nead DE.  1976.  Effective vitamin E treatment for ulcerative herpetic lesions.  Dental Survey.  52:50-51.
(9)Dimitrova Z et al.  1993.  Antiherpes effect of Melissa officinalis L. extracts.  Acta Microbiol Bulg.  29:65-72.
(10)Wolbling RH et al.  1994.  Local therapy of herpes simplex with dried extract from Melissa officinalis." Phytomedicine.  1:25-31.
(11)Koytchev R et al.  1999.  Balm mint extract for topical treatment of recurring herpes labialis.  Phytomedicine.  6:225-230

Written by Ani Kowal

There are many hundreds of studies relating brain function to nutrition and I am never sure where to begin trying to relay these to you via this blog – the volume of available evidence always seems so daunting!  Last week I wrote about just one nutrient, vitamin B12 and cognition/mental function.  Fortunately for me one group of scientists, headed by Dr Fernando Gomez-Pinilla, have now published an extensive review paper (1) which analyzed more than 160 studies investigating various different foods and nutrients and how they affect the brain.  A concise press release was published on the UCLA newsroom website (2) and I am going to pick out some of the major findings in my post today.

Dr Fernando Gómez-Pinilla is a member of California’s largest university, UCLA, and works within the Brain Research Institute and Brain Injury Research Centre.  Together with his colleagues he decided to look into how a balanced diet and regular exercise can protect the brain and ward off mental disorders.  Dr Gomez-Pinilla looked at over 160 published studies and believes that food acts like a pharmaceutical agent in the way it can affect the brain.  He also believes that diet, exercise and sleep can, potentially, alter brain health and mental function.
 

It has long been suspected that different nutrients can affect cognitive (mental) processes and emotions.  The paper reviews new evidence exploring the nutrients and the mechanisms by which they may be responsible for the action of diet on brain health and mental function.  So many key nutrients came up as being important.  Omega 3 fatty acids, flavonoids, curcumin, B vitamins, Vitamin D, Vitamin E, Vitamin C, Calcium, zinc, selenium and carotenoids, to name but a few!  The mechanisms by which they positively affect our brain function and cognition are complex and intricate.

Omega 3 fatty acids, found most abundantly in oily fish (such as salmon, mackerel and trout), flaxseeds and walnuts came up trumps, yet again!  These fats are essential for normal brain function and the research suggests that they provide many benefits, including improving learning and memory and helping to fight against mental disorders such as depression, mood disorders, schizophrenia, and dementia.  In contrast to the healthy effects of diets that are rich in omega-3 fatty acids, the studies seem to indicate that diets high in trans fats (often found in processed foods) and saturated fats adversely affect cognition. 

The brain is highly susceptible to oxidative damage (by free radicals).  Antioxidants provided by the diet (such as vitamins A, C and E and flavonoids), found most abundantly in fruits and vegetables, seem very important in protection (many of my previous posts have discussed the importance of antioxidant nutrients).
 
 
Surprisingly what you eat may also affect future generations.  Dr Gomez-Pinilla found that recent research also supports the hypothesis that health can be passed down through generations, and a number of innovative studies point to the possibility that the effects of diet on mental health can also be transmitted across generations  "Evidence indicates that what you eat can affect your grandchildren's brain molecules".

Another interesting reference to brain structure and health was made by a group of scientists (also from UCLA) in a recently published paper (3) which was highlighted in The Times newspaper (4) this month.  The shocking headline reported that our peak age for mental health is 39 years old!!

The study was small, involving 72 men between the ages of 23-83, and the researchers evaluated brain function by testing speed of movement via finger tapping – how many times participants could tap their finger in 10 seconds.  Usually the speed of response slows as we age probably because the fatty ‘myelin’ sheath surrounding our nerves starts to deteriorate which causes responses to slow.   The researchers found that myelination of the brain neurones (nerves) was significantly correlated to finger tapping speed and reached a peak at 39 years of age, declining thereafter.  Keeping our brain myelin 'healthy' seems to be very important for this specific form of brain function (called maximum motor speed).  Although the study only involved men it is likely to be the same in women.

 In The Times newspaper the authors reveal how myelin can be damaged via excess alcohol:  “The brain is made of fat, so when you get drunk you’re basically dissolving your brain.  A glass of wine may have a beneficial effect, but if you get drunk it’s malfunctioning.  As the alcohol leaves the brain tries to repair itself but if you keep doing it, it won’t repair itself fully” (4)

The researchers also suggest that the decline in brain myelination can be diminished (GREAT NEWS!), even halted, by regular exercise, good sleep and a healthy diet including at least one gram of fish oil a day, to provide omega 3 fatty acids, and plenty of colourful vegetables and fruits which are rich in antioxidants that help to prevent free radical damage, which may damage myelin.

The newspaper article also ends on a more positive note.  Although the area of the brain tested seems to declines after the age of 39 there are other areas where the circuitry still repairs itself: wisdom, for instance, is apparently strengthened with age “ most older people have better impulse control than when they were younger because as they age, this circuit continues to myelinate and brings all their knowledge online so that they can make a decision better and faster, even though their movements may be slower”.  The researchers give the following example “It’s the Michael Jordan effect.  He retired as a basket-ball player because those neurons controlling his speed and athleticism had started breaking down, but he went on to run a multi-million-dollar empire, which he probably couldn’t have done at 25”

The take home message from these published papers is to try and live a healthy lifestyle, to exercise, get good sleep and eat an unprocessed diet rich in nutrients and omega 3 fatty acids.  Future research is bound to throw up more dietary wisdom.  As Dr Gomez-Pinilla says:  “Understanding the molecular basis of the effects of food on cognition will help us to determine how best to manipulate diet in order to increase the resistance of neurons to insults and promote mental fitness”(1).

If you are not a lover of oily fish then you may wish to take an omega 3 supplement providing around 250mg EPA and 250mg DHA per day.  For vegans and vegetarians a flaxseed oil supplement providing around 500mg alpha-linolenic acid per day may be useful.  Antioxidants are best provided by vegetables and fruits, if you worry that you are not getting at least 5 portions a day you may consider taking a low dose multi-vitamin and mineral supplement.  I personally prefer 'food-state' nutrients as they are easily absorbed by the body and not made with isolated chemicals.

(1)Gómez-Pinilla F et al. Brain foods: the effects of nutrients on brain function. Nature Reviews Neuroscience, 2008; 9 (7):568-578
(2) UCLA newsroom 09/07/08  Scientists learn how what you eat affects your brain byStuart Wolpert
(3) Bartzokis G et al.  2008.  Lifespan trajectory of myelin integrity and maximum motor speed. Neurobiol Aging. 2008 Oct 14. [Epub ahead of print]
(4)Alexandra Blair.  Thursday November 6th 2008.  If 39 is our mental peak then my brain is in big trouble. The Times 2. Page 6-7

Written by Ani Kowal

On July 28 I wrote about coenzyme Q10 and the ability it has to potentially boost exercise performance.  Today I want to look into the antioxidant capabilities of this coenzyme and how these may relate to post exercise muscle pain.  A study published recently in the British Journal of Nutrition (1) found that CoQ10 supplementation reduced exercise-induced muscular injury in athletes.

When we exercise intensively we may actually cause damage to our muscle tissue.  This damage is believed to be causal in post-exercise muscle fatigue, pain and inflammation.  Intense exercise seems to be linked to the production of free radicals (unstable oxygen molecules).  These free radicals are quite destructive and can cause all kinds of problems within the body if they are not dealt with properly by natural bodily antioxidant systems.  These destructive free-radicals are believed to be behind some of the post-exercise issues in intense exercisers.

The body does produce its own antioxidants but also relies on vitamins, mineral and phytochemicals (bioactive plant chemical) from the diet, especially from colourful vegetables and fruits, for additional valuable supplies.

The production of free radicals within the muscles seems to increase in proportion to the intensity of exercise, as you push yurself harder during exercise more free radicals will be produced, and as mentioned above these free radicals may be responsible for some of the muscle damage, inflammation and pain experienced post-exercise(2).  Normally during the day, whilst we move around and at times of gentle and moderate exercise free radicals are generated at a low rate and are taken care of by our well developed antioxidant systems.  However, during intense exercise a greatly increased rate of free radical production may exceed the capacity of our natural antioxidant defence system.  Consequently, a substantial attack of free radicals on our cell membranes may lead to cell damage and could initiate inflammation and then pain or fatigue. 

 
Coenzyme Q10 is naturally produced by the body and was first isolated in 1957, it is essential for energy production in all bodily cells and also acts as an antioxidant in the body.  The study mentioned at the start of this post (1) found that individuals who were supplemented with CoQ10 had less evidence of free radical damage after intensive exercise than those who were not supplemented.

Exercisers who have a high intensity exercise regimen (exercise for over an hour 4 or more times a week) may want to look at the possibility of taking extra antioxidant supplements (to boost the natural antioxidant systems in the body), which could include a Co Q10 supplement.  It is also important to ensure the diet includes a minimum of 5 portions of vegetables and fruits.  These foods are naturally packed with antioxidant vitamins, minerals and flavonoids which are easily absorbed by the body and are also associated with reducing the risk of a number of diseases (including heart disease and cancer).

Coenzyme Q10 itself is found in many foods but is particularly concentrated in nuts and oils.  The body does produce this nutrient naturally and does not rely on external sources.  In order to produce CoQ10 we require various essential cofactors.  These include a variety of vitamins especially of the B group (Folic Acid, Vitamin B2, The Niacinamide form of Vitamin B3, Vitamin B5,Vitamin B6, Vitamin B12) and Vitamin C .  Hence a healthy diet rich in fruits, vegetables, wholegrain cereals and lean proteins will aid the natural production of this coenzyme and help to keep our circulating levels high.

(1)Michihiro K et al.  2008.  Reducing exercise-induced muscular injury in kendo athletes with supplementation of coenzyme Q10.  BJN.  100:903-909
(2) Sjodin B et al.  1990.  Biochemical mechanisms for oxygen free radical formation during exercise.  Sports Medicine.  10(4):236-254.

Written by Ani Kowal

As you are aware from my previous posts I champion vegetable and fruit consumption.  These treasures are abundant in taste, texture, vitamins, mineral and fibre.....but they are also full of bioflavonoids, or flavanoids (members of the polyphenol family).  Flavonoids are bioactive plant compounds which have gained increasing amount of publicity over the last few years.  Scientists have been looking into the health benefits of these plant compounds and quite a lot of interesting data has been coming to light.

A yet to be published review article(1) looked at polyphenols (mainly found in grapes) and their role in health and found that these compounds may help to reduce the risk of heart disease.  The authors of the study state that “Consumption of grape and grape extracts and/or grape products such as red wine may be beneficial in preventing the development of chronic degenerative diseases such as cardiovascular disease".  Grape seeds, grape skin and grape juice contain many different polyphenols including; resveratrol, anthocyanins and flavonoids – you may be familiar with these names as they are widely available as supplements.  In conclusion to this review the authors say "supplementation with grape seed, grape skin or red wine products may be a useful adjunct to consider for a dietary approach in the prevention of cardiovascular diseases, although additional research is required to support such a strategy"

Flavonoids act as antioxidants in the body, helping to prevent cell damage and protection against disease by mopping-up destructive unstable oxygen molecules known as 'free radicals' (I have mentioned antioxidants and their role in health previously a number of times).  Polypheonols also seem to have other protective effects on the heart and blood vessels.  They seem to prevent blood clotting, abnormal heart beat and blood vessel narrowing.  As yet scientists are not exactly sure of how these plant compounds act, however they do seem to positively change the way our genes function.

Another recently published study(2) looked at the association between a variety of flavonoids and the risk of cardiovascular disease and stroke.  The scientists studied 1950 Finish men aged between 42-60 who were free from prior heart disease or stroke.  Participants were followed for an average of 15 years and during this time over 100 strokes and 150 cardiovascular disease deaths occurred.  Data analysis revealed that men who consumed the highest amounts of flavonoids had a greatly reduced risk of stroke and there was also a reduced risk of death from cardiovascular disease.  The results are unsurprising as fruit and vegetables are the major sources of flavonoids and there is plenty of data to show that these foods protect us from all kinds of diseases including stroke and heart disease.  The interesting point comes from the fact that the analysis took into account various vitamin intakes suggesting that the flavonoids themselves make a real impact on health.

Yet another study published just this month (3) highlights the health benefits of flavonoids, this time their potential role in weight maintenance and prevention of weight gain.  The researchers of this study looked at the association between flavonoids and BMI (body mass index, a measure of overweight) over a 14 year period in 4280 men and women aged between 55-69 years.  The results showed that women with the highest intake of flavonoids experienced a significantly lower increase in BMI over the study period.  Again, this is not surprising.  Individuals who eat a lot of vegetables and fruits tend not to fluctuate in weight and stay leaner.   

Now onto two pieces of research (4,5) which I am particularly fond of as they involve dark chocolate!  Readers of my blog will know my penchant for dark chocolate.  Dark chocolate containing 85%+ cocoa solids is something I truly adore and really savour the moment of one bitter square slowly melting over my tongue!  Drinking black cocoa is also something I enjoy.  The health benefits of cocoa have been publicised over the last few years and evidence that cocoa may help in the prevention of many conditions, such as cancer and heart disease, is mounting.  Cocoa is packed with great minerals such as magnesium and is also ‘choc’ full of flavonoids.

A very recent study(4) suggests that cocoa consumption may be good for the heart (great news since I would have trouble giving it up!).  The researchers investigated the short-term effects of eating either solid dark chocolate or drinking liquid cocoa on blood vessel function and blood pressure.  The small study included 45 adults who were overweight but healthy (and not obese) who were, on average, 53 years old.  In the first stage of the trial the participants consumed a bar of dark chocolate containing 22g of cocoa powder or a cocoa-free bar.  In the second stage the participants drank sugar-free cocoa containing 22g cocoa powder, cocoa containing sugar or a placebo containing no cocoa.

Eating dark chocolate and drinking sugar-free cocoa improved blood vessel function compared to placebo and blood pressure decreased in individuals who ate the dark chocolate bar or drank the sugar-free cocoa, compared to those who consumed the placebo.  The researchers conclude by saying “The acute [short term] ingestion of both solid dark chocolate and liquid cocoa improved endothelial [lining of the blood vessels] function and lowered blood pressure in overweight adults. Sugar content may attenuate [reduce] these effects, and sugar-free preparations may augment [improve] them”

The other small study(5) found that flavonoid rich cocoa was associated with a significant increase in blood flow to the brain, as measured via a special sort of ultrasound (Transcranial dopler ultrasound).  The authors suggest that their data could indicate a promising role for regular cocoa consumption in the treatment and prevention of stroke and dementia.

These studies were very small and preliminary but I found them interesting!!  I would like to add that this is not a plug to justify regular chocolate binges (although it does help me to feel better about my dark chocolate habit)!  The cocoa used in these studies, and other studies that link cocoa to health benefits such as lowered risk of heart disease, was high flavanol cocoa and only a very small amount was used daily.  Sugary, sweet milk chocolate won’t provide the health benefits discussed (sorry to be the bearer of sad news!). 

Flavonoids and polyphenols in general are found abundantly in fruits and vegetables, which are so important for our health.  Vegetables and fruit should form the core of a healthy diet and getting a good variety will give the body many of the nutrients that are needed for optimal health.  Flavonoid supplements are now available, though the evidence for their use is still in the early stages.  If you feel your diet is lacking in vegetables and fruits you may want to consider a supplement to top-up and cover the shortfall, but remember supplements are not a replacement for a healthy diet.

(1)http://www.elsevier.com/wps/find/authored_newsitem.cws_home/companynews05_01042 Mounting evidence shows health benefits of grape polyphenols.  Philadelphia October 28.  Due to be published in the November issue of Nutrition Research
(2)Mursu J et al.  2008.  Flavonoid intake and the risk of ischaemic stroke and CVD mortality in middle-aged Finnish men: the Kuopio Ischaemic Heart Disease Risk Factor Study.  BJN.  100:890-895
(3)Hughes L et al.  2008.  Higher dietary flavone, flavonol, and catechin intakes are associated with less of an increase in BMI over time in women: a longitudinal analysis from the Netherlands Cohort Study.  Am J Clin Nutr.  88:1341-1352
(4)Faridi Z et al.  2008.  Acute dark chocolate and cocoa ingestion and endothelial function:a randomised controlled crossover trial.  Am J Clin Nutr.  88:58-63
(5) Sorond FA et al.  2008. Cerebral blood flow response to flavanol-rich cocoa in healthy elderly humans. Neuropsychiatric Disease and Treatment. 4:433-440

Written by Ani Kowal

Unfortunately one of my very dear friends is seriously unwell, so I started writing this from the 9th floor of St Thomas’s hospital.  There are hand wash points all over the place in a bid to prevent the spread of infection.  Any hint of a sniffle and I would not be allowed to set foot onto the ward.  So, I am doing my very best to keep my immune system strong! 

In the past I have written about the prevention and treatment of colds and coughs and generally about the immune system and how to keep it strong.  It is the time of year when the cold and flu virus sis rife and people are very interested in how they can escape the infections that seem to be surrounding them.  Earlier this week I was made aware of the potential benefits of Black Elderberry extract (brand name Sambucol®) for the prevention and alleviation of the influenza virus.  I wanted to delve into the scientific research to discover if there is fact behind the hype.

Black Elderberry (sambucus nigra), a member of the honeysuckle family, is a tree-like shrub.  Traditionally various parts of the plant, including the leaves, bark, flowers and berries, have been used in medicine.  The health giving properties have been documented as far back as the 5th century.  Currently much of the interest and research has focussed on extract from the berries.  Research(1) suggests that elderberry has antiviral properties, especially against the influenza virus, and also seems to activate and boost the immune system as well as acting as an antioxidant.

The berries contain various bioactive plant compounds, known as flavonoids, as well as certain vitamins (C, A and various B vitamins), that appear to be responsible for the positive effects on the immune system and our health.

Sambucol® is a supplement that contains 38% standardised extract of black elderberry.  Research(2,3) suggests that elderberry extract appears to boost and activate the immune system in individuals who are healthy as well as those who are already suffering from a viral infection.

Two small well planned studies (randomised, placebo-controlled, double-blind studies 4,5) found that Sambucol® effectively inhibited the influenza A and B virus strains when given orally to patients in the first 48 hours of flu symptoms developing.  The earlier preliminary study (4) was very small, involving only 27 patients, but demonstrated the ability of elderberry (4 tablespoons of Sambucol® syrup per day) to reduce influenza symptoms in 20% of influenza patients within 24 hours and to reduce influenza symptoms in 75% of patients within 48 hours.  After three days of elderberry use, 90% of influenza patients experienced a total alleviation of symptoms. 

The most recent study (5) involved 60 patients aged 18-54 years who had just began (48 hours or less) to suffer from flu-like symptoms.  Participants received 15 ml of elderberry or placebo syrup four times a day for 5 days, and recorded their symptoms using a special scale.  In the participants receiving the elderberry syrup the symptoms were relieved, on average, 4 days earlier and use of rescue medication was significantly less compared those receiving placebo.  The study was small but very encouraging, the findings need to be confirmed in a larger study.

The underlying mechanism (1) for elderberry’s effectiveness in the treatment of influenza virus was discovered by an Isreili virologist, Dr Mumcuoglu.  The berry seems to be able to prevent and inhibit the replication of the influenza virus.  The active compounds within the elderberry seem to ‘coat’ or neutralise the spike-like projections that are found on the surface of several viruses, including the influenza viruses.  When these spikes are deactivated the virus is prevented from piercing the human cells, so the virus does not enter our cells and is prevented from replicating.  Unlike bacteria, a virus cannot replicate on its own, it must attack living cells in order to survive.  If the virus is prevented from entering our cells it will be unable to survive and cause us to suffer health problems.

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

The elderberry extract, Sambucol®, is widely available in the UK as a liquid or lozenge.  The products can be taken as a preventative or at the first signs of cold or flu-like symptoms.  A healthy diet (rich in fruit and vegetables) is obviously the most important way to keep the immune system strong, healthy and effective.  However, if you are surrounded by people with colds, or worried about the ‘flu-season’ taking an elderberry extract may well give your immune system an extra boost and help you to fight off invading infections. 

(1) Sambucus nigra - monograph.  2005.  Altern Med Rev.  10(1):51-54.
(2) Barak V et al.  2001.  The effect of Sambucol® , a black elderberry-based, natural product, on the production of human cytokines:I.  Inflammatory cytokines.  Eur Cytokine Netw.  12:290-296
(3) Barak V et al.  2002.  The effect of herbal remedies on the production of human inflammatory and anti-inflammatory cytokines.  Isr Med Assoc J.  4:S919-S922
(4) Zakay-Rones Z et al.  1995.  Inhibition of several strains of influenza virus in vitro and reduction of symptoms by an elderberry extract (Sambucus nigra) during an outbreak of influenza in Panama.  Journal of Alternative and Complementary Medicine.  1(4):361-369.
(5) Zakay-Rones, Z et al.  2004.  Randomized study of the efficacy and safety of oral elderberry extract in the treatment of influenza A and B virus infections.  J Int Med Res.  32(2):132-140.

Written Ani Kowal

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

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

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

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

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

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

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

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

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

Written by Ani Kowal

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

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

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

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

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

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

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

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

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

Check back later in the week for information regarding osteoarthritis.

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

Written by Ani Kowal

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

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

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

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

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

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

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

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

Written by Ani Kowal

Coronary heart disease (CHD) is the leading cause of death in the UK, looking after our hearts is very important!  However, at recent conference(1) it was disclosed that almost half of us (48%) do not know what CHD is, recognise the symptoms or know what increases the risk.  I hope to provide a little insight here.

CHD covers two main issues, heart attack and angina (severe chest pain).  “Coronary heart disease occurs when the coronary arteries (the arteries that supply blood and oxygen to the heart muscle) become narrowed by a gradual build-up of fatty material within their walls.  This condition is called atherosclerosis and the fatty material is called atheroma.  In time, the artery may become so narrow that it cannot deliver enough oxygen containing blood to the heart muscle, particularly at times when there is more demand -such as when you are exerting yourself. The pain or discomfort that happens as a result is called angina.  If the atheroma becomes unstable, a piece may break off and lead to a blood clot forming. If the blood clot blocks the coronary artery, the heart muscle is starved of blood and oxygen and may become permanently damaged. This is known as a heart attack.”(2)

The symptoms of CHD are varied and can include: shortness of breath, palpitations/irregular heartbeat, chest pain, jaw pain, arm pain, dizziness, fainting. 

Risk factors are also varied and include: smoking, unhealthy/unbalanced diet, overweight, obesity, lack of exercise, excessive alcohol consumption, emotional/psychological stress, social isolation, diabetes and high blood pressure.  The good news is that relatively simple dietary and lifestyle changes can protect the heart.

A fantastic resource that I highly recommend is The British Heart Foundation website.  There you can read, in detail, about risk factors, dietary advice and you can also download factsheets and information booklets.  There is a section dedicated to CHD prevention, which is key, it covers diet, weight, diabetes, cholesterol, smoking, diabetes, family history, stress and counselling.

Today I just wanted to cover a few points in relation to diet and heart health.

Fruit and Vegetables
The recommendation to consume vegetables and fruit for protection from heart disease is supported by an ever-growing body of evidence.  Much evidence is drawn from studies linking higher consumption of vegetables and fruit to a lower risk of CHD (e.g. 3,4,5).  I would like to highlight one of the most recent studies(6).  The researchers found that that the benefit of fruit or vegetable consumption in reducing the risk of CHD increased proportionally by the number of servings consumed. Those consuming the most fruit (more than five portions per day) had a 60% lower risk for coronary heart disease when compared to those eating one or fewer portions per day.  Consumption of vegetables more than three times daily was associated with a 70% lower risk of CHD compared to individuals who did not eat vegetables.  Consumption of fruits and vegetables really does seem to provide significant protection against coronary heart disease!  So Tuck in! 

Vegetables and fruit are probably acting to protect against CHD through a variety of relevant substances including numerous vitamins and carotenoids, minerals, phytonutrients (bioactive plant chemicals) and fibre.  Many plausible mechanisms can explain how these various nutrients or bioactive constituents in vegetables and fruit can prevent CHD.  Try and include a variety of different vegetables and fruits in your daily diet.  Each meal can contain a portion or two e.g. chop fresh fruit, or sprinkle a handful of unsweetened dried fruit into museli or yoghurt at breakfast time, include a side salad with lunch, snack on fruit or vegetable sticks rather than cereal bars, biscuits or other refined foods and aim to include at least two types of vegetable with your evening meal.
 

Supplemental vitamins and minerals
Taking vitamin and mineral supplements should not be seen as a substitute for a healthy diet.  Supplements are void of many other substances found within fruit and vegetables which may be useful in CHD prevention such as phytochemicals (bioactive plant chemicals) and fibre.  However, there is a lot of evidence that has looked at specific nutrients in the prevention of CHD (too much evidence to list), vitamins such as the B vitamins, vitamin E and D, antioxidant vitamins such as vitamin C and many carotenoids and minerals such as magnesium and selenium may be useful protective agents.  If you feel that your diet is not rich in a variety of vegetables and fruits (at least 5 a day) you may wish to consider taking a broad-spectrum multivitamin and mineral supplement to ensure an adequate supply.  There are so many available supplements, it can be a mind-boggling experience trying to choose a product!  If you do decide to go down the supplement route I would recommend what are known as ‘food state’ multivitamin and mineral supplements.  These are easily absorbed by the body and are produced from food sources, rather than the usual chemical-isolate form of product.

Wholegrain cereals
Incorporating wholegrain foods into the diet may help to reduce the risk of CHD.  Whole grain foods (e.g. corn, barley, rye, oats & rice) in their most un-refined and natural form are rich sources of fibre, antioxidants, vitamins, minerals and phytonutrients, all of these probably act together to help protect the body against CHD.  Many studies demonstrate that the consumption of whole grain foods may help to reduce the risk of CHD (e.g. 7,8,9).  I would like to stress the importance of UN-REFINED foods.  There are many products that now advertise the fact that they are wholegrain but they may also be loaded with added sugar and have a high GI, high glycaemic index (i.e. they release sugar quickly into the bloodstream) and I certainly wouldn’t recommend their inclusion into the daily diet.  Be label savvy and look at the ingredients to see what you are buying.

Check back later this week for more heart healthy tips in Part II 

(1)British Pharmaceutical Conference 2008 http://www.bpc2008.org/
(2)British Heart Foundation http://www.bhf.org.uk/
(3) Rissanen TH et al.  2003.  Low intake of fruits, berries and vegetables is associated with excess mortality in men: the Kuopio Ischaemic Heart Disease Risk Factor (KIHD) Study.  J Nutr.  133(1):199-204.
(4) Liu S et al.  2000.  Fruit and vegetable intake and risk of cardiovascular disease: the Women's Health Study.  Am J Clin Nutr.  72(4):922-8
(5) Joshipura KJ et al.  2001.  The effect of fruit and vegetable intake on risk for coronary heart disease.  Ann Intern Med.  134(12):1106-14
(6)Nikolic M et al.  2008.  Fruit and vegetable intake and the risk for developing coronary heart disease. Cent Eur J Public Health. 16(1):17-20.
(7)Jacobs DR et al.  1999.  Is whole grain intake associated with reduced total and cause-specific death rates in older women?  The Iowa Women’s Health Study.  Am J Public Health.  89:1-8
(8)Rimm EB et al.  1996.  Vegetable, fruit and cereal fibre intake and risk of coronary heart disease among men.  JAMA.  275:447-451
(9)Liu S et al.  1999.  Whole-grain consumption and risk of coronary heart disease: results from the Nurses’ Health Study.  Am J Clin Nutr.  70:412-419

Written by Ani Kowal

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

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

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

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

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

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

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

Written by Ani Kowal

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

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

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

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

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

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

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

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

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

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

Written by Ani Kowal

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

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

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

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

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

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

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

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

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

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

Written by Ani Kowal

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

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

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

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

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

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

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

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

Written by Ani Kowal

My eyesight is something that I value very highly.  Without my spec's or contact lenses I have very limited vision.  Looking after my eyes, in order to prevent further long-sightedness in later life, is certainly high on my agenda.  Age Related Macular Degeneration (AMD) is the most common cause of blindness in people over the age of 50 in the UK and I feel that it deserves a little attention! 

The macular is the light sensitive area in the centre of the retina that controls visual field and the ability to see colours.  AMD is caused by the deterioration of the macular.  As this happens the peripheral, outer, vision remains intact as the centre field of vision becomes slowly blurry, grey or filled with a large black spot.  Two forms of AMD exists: the dry form which develops slowly, accounting for 90% of all cases; and the wet form which causes rapid deterioration of central vision.

The exact causes of AMD are unknown although free radical damage, where unstable oxygen molecules damage the eye cells, is strongly implicated.  Tobacco smoke and sun exposure can increase the level of free radicals in the body and both are a risk for AMD.  High blood pressure and diabetes are also risk factors as these conditions can limit blood flow to the eyes.

Evidence for diet and nutrition in the prevention, and to a certain extent treatment, of the condition is growing yearly.  The latest study was published in the August volume of the American Journal of Clinical Nutrition(1) and adds to the growing body of research(2,3,4,5,6,7,8) suggesting that oily fish and the long chain omega 3 fatty acids they provide, EPA and DHA (eicosapentaenoic acid and docosahexaenoic acid), may be preventative. 

This recent study(1) assessed the dietary intake data and photographic eye evidence of 105 individuals with AMD and compared it to 2170 control individuals (without any features of AMD).  All participants were aged 65 or over.  The researchers found that eating oily fish at least once per week compared with less than that was associated with a 50% reduced likelihood of having AMD.  There was no benefit from eating non-oily, white fish.  There was also a strong significant association between intake levels of DHA and EPA and AMD.  Individuals eating around 300mg or more of these fatty acids per day were 70% less likely to have AMD.  Two (75g) servings of oily fish, such as salmon, mackerel, sardines or trout, provides around 500mg of DHA and EPA 

The scientists are not yet recommending omega 3 supplements as the study did not investigate whether supplements would have the same benefit as dietary sources.  However, evidence for the potential benefits of fish oil (long chain omega 3 fatty acid) supplements is beginning to emerge, with one very recent study(5) finding that 800mg of DHA per day over 2-4 months was associated with beneficial changes in the macular. 

Omega 3 fatty acids are incredibly important for many aspects of health (and I have mentioned them throughout my blog postings).  Including at least two portions of oily fish per week is certainly recommended, however, many individuals in the UK do not achieve these intakes for various reasons.  A daily fish oil supplement providing around 250mg of EPA and 250mg DHA may be something worth considering (for general health).  For vegetarians and vegans a flaxseed oil supplement providing around 500-800mg of alpha-linolenic acid (a short chain omega 3 fatty acid which the body can convert to the longer chain forms) daily is a good way of ensuring a daily supply of these essential fats.

The other important nutrients worth discussing in relation to AMD prevention are the antioxidant carotenoids lutein and zeaxanthin, naturally found in foods such as spinach, collard greens and kale.  Research data(9,10,11,12) suggests that individuals with high dietary intakes of lutein and zeaxanthin, and high body levels of the carotenoids, have a reduced risk of developing AMD.  Supplements of these nutrients are now widely sold and targeted at eye health.  The supportive evidence for supplementation is not yet solid.  A small study(13) has shown benefit and paves the way for larger studies.  A very recent review(14) of the currently available evidence, published last month, concluded that “A definite association between lutein and zeaxanthin supplementation and clinical benefit has yet to be hown; however, it may still be an appropriate cautionary measure for patients at high risk for developing AMD”

Available ‘eye health’ supplements often contain vitamins C, E, beta carotene and the mineral zinc in addition to lutein and zeaxanthin.  The rationale behind this comes from dietary association studies and some research evidence.  If you are considering supplements remember that they are not a substitute (more of a bonus) for nutritious daily meals!  A healthy diet, rich in a variety of vegetables and fruits, will provide an array of antioxidant nutrients to keep the whole body healthy, including the eyes.

(1)Augood C et al.  2008.  Oily fish consumption, dietary docosahexaenoic acid and eicosapentaenoid acid intakes, and associations with neovascular age related macular degeneration.  American Journal of Clinical Nutrition.  88:398-406
(2)Chong EW et al.  2008.  Dietary omega-3 fatty acid and fish intake in the primary prevention of age-related macular degeneration: a systematic review and meta-analysis.  Arch Ophthalmol.  126:826-833.
(3)SanGiovanni JP et al.  2007.  The relationship of dietary lipid intake and age-related macular degeneration in a case-control study: AREDS Report No. 20.  Arch Opthalmol.  125:671-679
(4)Seddon JM et al.  2006.  Cigarette smoking, fish consumption, omega-3 fatty acid intake, and associations with age-related macular degeneration: the US Twin Study of Age-Related Macular Degeneration.  Arch Opthalmol.  124:995-1001
(5)Johnson EJ et al.  2008.  The influence of supplemental lutein and docosahexaenoic acid on serum, lipoproteins, and macular pigmentation.  Am J Clin Nutr.  87:1521-1529
(6)Cho E et al.  2001.  Prospective study of dietary fat and the risk of age-related macular degeneration.  Am J Clin Nutr.  73:209-218
(7)Seddon JM et al.  2001.  Dietary fat and risk for advanced age related macular degeneration.  Arch Opthalmol.  119:1191-1199
(8)Smith W et al.  2000.  Dietary fat and fish intake and age related maculopathy.  Arch Opthalmol.  112:222-227
(9)Seddon JM et al.  1994.  Dietary carotenoids, vitamin A, C and E and advanced age-related macular degeneration.  JAMA.  272:1413-1420
(10)Bone RA et al.  2000.  Lutein and zeaxanthin in the eyesm serum and diet of human subjects.  Experimental Eye Research.  71:239-245
(11)Bone RA et al.  2001.  Macular pigment in donor eyes with and without AMD:A case-control study.  Invest Opthalmol Vis Sci.  42:234-240
(12)Gale CR et al.  2003.  Lutein and zeaxanthin status and risk of age-related macular degeneration.  Invest Opthalmol Vis Sci.  44:2661-2465
(13)Richer S et al.  2004.  Double-masked, placebo-controlled, randomised trial of lutein and antioxidant supplementation in the intervention of atropic age related macular degeneration: the Veterans LAST study (Lutein Antioxidant Supplementation Trial).  Optometry.  75:216-230)
(14)Zhao L & Sweet BV.  2008.  Lutein and Zeaxanthin for macular degeneration.  Am J Health Syst Pharm.  65:1232-1238

Written by Ani Kowal

One of my close friends is pregnant (I am very excited)!  We were chatting about pregnancy health and the topic of preeclampsia came up.  Recently a study(1) was published which suggests that increasing the amount of fibre eaten during early pregnancy may help to reduce the risk of preeclampsia developing later.  I thought now was as good time as any to look into this complex topic further!

Preeclampsia is a serious condition also known as: pregnancy-induced hypertension (PIH); proteinuric gestational hypertension; and toxaemia of pregnancy.  It is a form of high blood pressure (hypertension) that develops in conjunction with water retention (oedema) and/or excess protein in the urine (proteinuria).  Around 3% of all pregnant women suffer from preeclampsia each year and this condition is the principal cause of maternal death in the UK.  Around 10 mothers and 1000 babies die each year as a result of the effects of preeclampsia and the condition is also the most common reason for elective (often early) delivery.  Usually preeclampsia occurs between the 20th week of Pregnancy and the end of the first week postpartum.  The earlier it presents in pregnancy the more threatening it can become.

As I began my research last week I thought this post would be relatively short.  Going back to my 2001 MSc lecture notes there was not a whole lot of dietary/nutrition related evidence to work with.  However, as I began to search through recent medical databases I was pleased and enthralled with the emergence of new information.  The definitive causes of preeclampsia are not known and there are many theories.  Nutritional factors, however, do seem to be at play. 

Keep body weight in check:
Maternal overweight and obesity places women at risk.  A BMI (body mass index) greater than 25 is seen as a risk.  To work out your BMI divide your weight in kg / by your height in metres² (height x height) or use an online BMI calculator e.g. the NHS calculator.  A recent study(2) also shows that gaining a lot of weight during pregnancy may be a risk factor.  This study looked at 34,143 women age 18-34 who were already overweight at the start of their pregnancies.  Gaining more than 15lb during pregnancy was a significant risk factor for the development of preeclampsia and gaining more than 25lb increased the risk further.  The lowest risk of adverse outcomes was for women who gained 6-14lb.

Dietary fibre:
The study(1) mentioned in my opening paragraph was carried out because evidence already exists for the beneficial effects of fibre in reducing hypertension (high blood pressure).  1538 pregnant women were involved in the study and their dietary intake was assessed 3 months before and during early pregnancy.  Women with the highest dietary fibre intake (more than 21g/day) had a significantly reduced risk of preeclampsia when compared to women with the lowest dietary fibre intake (less than 12g/day).  These are important findings, as I have mentioned in previous blog posts the average intake of fibre in the UK is low (around only 12g/day).  The recommended daily intake is currently set at 18g/day in the UK, however for optimal health many experts regard at least 25g/day as necessary. 

This most recent study adds weight to earlier evidence(3) which also found that fibre was associated with a significantly reduced risk of preeclampsia.  The researchers also found that potassium intake was a significant protective factor (I will be discussing potassium intake a blood pressure further on Thursday).  This evidence was interesting as it mentioned specific foodstuffs, with fruits and vegetables being associated with a reduced risk of preeclampsia development (unsurprisingly since vegetables and fruits are great sources of fibre and potassium).

Fruits, Vegetables and Antioxidant Vitamins:
You may be sick of my constant mentioning of vegetables and fruits?!  Well, they really are vitally important to health and I will be writing about them as often as possible!  As indicated above these super foods provide the body with fibre and are fantastic sources of potassium.  In addition to this they are packed full of vitamins, minerals and flavonoids (bioactive plant compounds).  Many of these plant nutrients act as antioxidants in the body.

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

Dietary antioxidants and supplemental vitamin C and E(4,5), lycopene(6), selenium(7,8) and  multivitamins(9) all appear to have some protective role to play against the development of preeclampsia, although the evidence for supplements is not yet conclusive and further large trials are needed.  The evidence to date certainly seems to suggest an important role for fruit and vegetable consumption during pregnancy, a variety of colourful vegetables and fruits will provide a whole array of vital nutrients to the body.  Selenium is not as widely available in the UK diet, although Brazil nuts are a terrific source. 

In addition to diet you may wish to discuss taking a pregnancy safe multi-vitamin and mineral supplement with your GP, midwife or health professional.

Omega 3 Essential Fatty Acids:
Recent evidence suggests that women with preeclampsia have reduced levels of essential omega 3 fatty acids in their blood(9,10).  Omega 3 fatty acids are vital for the efficient functioning of the immune system.  A lack, or imbalance, of these fatty acids is associated with inflammation in the body.  Inflammatory chemicals (cytokines) have been implicated in the development of and risk for preeclampsia.  Omega 3 fatty acids are essential for optimal foetal development (and are especially important in brain and immune development) and it is important to ensure a regular supply during pregnancy.  I have spoken about these fats extensively in previous posts.  Good dietary sources are oily fish (salmon, trout, mackerel, sardines) and flaxseeds or walnuts for vegetarians/vegans.  Many people in the UK do not eat these foods regularly.  Speaking to your GP or midwife about an omega 3 supplement, a fish oil (providing about 250mg EPA and 250mg DHA per day) or flaxseed oil may be prudent to ensure adequate levels throughout pregnancy and beyond.

At the moment the evidence is preliminary and needs backing up by large, well designed trials and further research.  Personally, I feel that the take home message is that being a normal weight (BMI 19-24), being physically active and having a healthy, nourishing diet rich in fruits, vegetables and essential fats may be protective.....great advice for good health for all of us then!

(1) Qiu et al.  2008.  Dietary fibre intake in early pregnancy and risk of subsequent preeclampsia.  American Journal of Hypertension.  21:903-909 [EPub doi:10.1038/ajh.2008.209 17 July]
(2) Langford A et al.  2008.  Does Gestational Weight Gain Affect the Risk of Adverse Maternal and Infant Outcomes in Overweight Women?  Matern Child Health J.  [Epub ahead of print]
(3) Frederick, I. O., et al.  Dietary fiber, potassium, magnesium and calcium in relation to the risk of preeclampsia.  J Reprod Med.  50(5):332-344, 2005.
(4)Chappell LC et al.  1999.  Effects of antioxidants on the occurrence of preeclampsia in women at increased risk: a randomised trial.  The Lancet.  354:810-816
(5)Chappell  LC et al.  2002.  Vitamin C and E supplementation in women at risk of preeclampsia is associated with changes in indicies of oxidative stress and placental function.  Am J Obstet Gynecol.  187:777-784
(6)Sharma JB et al.  2003.  Effect of lycopene on preeclampsia and intra-uterine growth retardation in primigravids.  Int J Gynaecol Obstet.  81:257-262
(7)Han L & Zhou SM.  1994.  Selenium supplement in the prevention of pregnancy induced hypertension.  Chin Med J.  107:870-871
(8)Rayman et al.  2003.  Low selenium status is associated with the occurrence of the pregnancy disease preeclampsia in women from the United Kingdom.  Am J Obstet Gynecol.  189:1343-1349
(9) Bodnar LM et al.  2006.  Periconceptional multivitamin use reduces the risk of preeclampsia.  Am J Epidemiol.  164:470-477
(10) C et al.  2006.  Erythrocyte omega-3 and omega-6 polyunsaturated fatty acids and preeclampsia risk in Peruvian women.  Arch Gynecol Obstet.  274:97-103
(11)Mehendale S et al.  2008.  Fatty acids, antioxidants, and oxidative stress in pre-eclampsia.  Int J Gynaecol Obstet.  100:134-238

Written by Ani Kowal

As I have mentioned before, I love to walk.  I can walk for hours!  Put me in a gym however and I tire quickly.  Personally I think this has more to do with boredom than my fitness!  A recent study seems to suggest that taking coenzyme Q10 supplements may increase the amount of time an individual can exercise before they become fatigued. 

Coenzyme Q10 is a type of fat-soluble coenzyme (the Q stands for Quinone), the most important Q coenzyme for humans.  A coenzyme is a compound that is necessary for the functioning of enzymes, protein substances produced in the body that act to accelerate biochemical reactions -enzymes are vital for all cellular processes in the body. 

Coenzyme Q10 is naturally produced by the body and was first isolated in 1957, it is essential for energy production in all bodily cells and is especially abundant in the heart - heart cells use a lot of energy in order to beat over 100,000 times a day!  Around the world it has become one of the most popular dietary supplements, with individuals reporting many health benefits such as increased energy and memory improvement.  Many trials (too many to reference here) have investigated this supplement and it seems to be beneficial for the prevention and treatment of many conditions from heart disease to blood pressure, cancer, circulatory conditions, gum disease, Alzheimer’s disease, Parkinson’s disease, immune related disorders and age related conditions.

As I mentioned at the start of this post the most recent research(1) on supplemental coenzyme Q10, also called CoQ10, suggests that it may enhance athletic performance and increase the time you can exercise before tiredness sets in.  The scientists involved in this study wanted to determine whether supplementation of CoQ10 could improve exercise performance in both trained and untrained individuals.  The study was small and involved 22 trained and 19 untrained individuals (male and female).  They received either a 100mg placebo or a CoQ10 supplement twice a day for 14 days.  Blood samples and muscle biopsies were taken.  On the first day the subjects were given a single dose of 200mg of the placebo or CoQ10.  One hour after being given the supplement the individuals were given a variety of endurance tests.  Additional blood samples and a second muscle biopsy were taken after completion of the tests.  After this first day the subjects were given 100mg of placebo or CoQ10 twice a day, once in the morning and once in the evening, for 14 days.  They then returned to the lab for more tests.

The levels of Coenzyme Q10 in the blood plasma were significantly increased following 2 weeks of the supplementation (compared to placebo group).  Following the one high dose of CoQ10 on day one muscle levels of CoQ10 were significantly higher and this was related to increased time to exhaustion on the treadmill (individuals could run for longer before tiring).  After two weeks of supplementation there was also a trend towards increased time to exhaustion.  Tests also revealed that the CoQ10 seemed to be acting as an antioxidant (individuals taking the CoQ10 had lower levels of oxidative stress).

The results make sense since Coenzyme Q10 is involved in the conversion of carbohydrates into energy.  This may explain why people who regularly take the supplement report an increase in their feelings of energy.  A previous small study(2) found that coenzyme Q10 supplementation at 150mg twice a day for two months increased blood levels of the nutrient and significantly increased the subjective perceived level of vigour in middle-aged men when compared to placebo.  A small study in cross country skiers(3) demonstrated the ability of coenzyme Q10 (90 mg per day) to increase all measures of physical performance.  In the study, 94% of skiers receiving coenzyme Q considered that their treatment has been beneficial in improving their performance.  In endurance runners(4) levels of CoQ10 were found to be lower than normal at rest (probably due to the increased need for energy production in such athletes) and further depleted after exercise training.  Supplemental CoQ10 improved the blood plasma levels in the runners and also seemed to help prevent the muscle damage that often occurs as a result of intensive exercise or endurance exercise(4).

If you are a regular gym-goer or generally training to improve fitness levels you may wish to try a coenzymeQ10 supplement to see if it benefits your training schedule.  50mg-100mg of the supplement twice per day is usually recommended.  As CoQ10 is fat soluble look for supplements that contain an oil base as these are more efficiently absorbed.

Coenzyme Q10 is found in many foods but is particularly concentrated in nuts and oils.  The body does produce this nutrient naturally and does not rely on external sources.  In order to produce CoQ10 we require various essential cofactors.  These include a variety of vitamins especially of the B group (Folic Acid, Vitamin B2, The Niacinamide form of Vitamin B3, Vitamin B5,Vitamin B6, Vitamin B12) and Vitamin C .  Hence a healthy diet rich in fruits, vegetables, wholegrain cereals and lean proteins will aid the natural production of this coenzyme and keep our circulating levels high. 

Just in case you are wondering, the research has not tempted me into the gym, I am more than happy with my walking (and the occasional hula-hooping)!

(1)Cooke M et al.  2008.  Effects of acute and 14-day coenzyme Q10 supplementation on exercise performance in both trained and untrained individuals. J Int Soc Sports Nutr.  4;5:8.
(2)Porter DA et al.  1995.  The effect of oral coenzyme Q10 on the exercise tolerance of middle-aged, untrained men.  Int J Sports Med.  16(7):421-427.
(3)Yikoski T et al.  1997.  The effect of coenzyme Q10 on exercise performance of cross-country skiers.  Molecular Aspects of Medicine (United Kingdom).  18(Supplement):S283-S290.
(4) Bargossi, A M et al.  1993.  Antioxidant effects of exogenous ubiquinone (Q10) in high level endurance runners.  Free Radicals and Antioxidants in Nutrition.  1993:63-74.

Written by Ani Kowal

Usually on the train back from a trip to Devon I spend my time reading and immersing myself in the view.  Yesterday was pleasantly different as I was sat next to Adal, a charming doctor.  We got chatting about all kinds of topics including medicine, nutrition and faddy diet foods.  As I got back to London I was greeted by a juice bar advertising ‘shots’ of bright green wheat grass juice and this got me thinking – is it a hyped up fad food or is there some science behind the wheat grass phenomenon?

Wheat grass is also known as wheat sprouts and can be widely bought as a juice or a powder that is mixed into a drink.  The bright green colour comes from chlorophyll, a pigment fundamental in the conversion of sunlight into carbohydrate in plants via the process of photosynthesis.  Regular consumers of the grass juice say that it improves their feelings of wellbeing, aids digestion and gives them an instant energy boost.  Wheat grass contains fibre, vitamin B, vitamin C, beta carotene, minerals (calcium, magnesium, potassium), amino acids and more.  So it seems that this grass does pack a nutrient filled punch.  However, I wanted to know if there was any science behind the anecdotal health claims.  After some investigation I managed to unearth a few studies.

A small study last year(1) found that 500mg of wheat grass taken daily increased blood plasma antioxidant status, vitamin C, beta carotene, vitamin E and the blood activity of an antioxidant enzyme and reduced oxidative stress in individuals when compared to placebo.  In addition to this trial a cell study in 2004(2) found that wheat grass contains a powerful cocktail of antioxidant molecules and biologically active substances (such as flavonoids) that can be absorbed during the digestion process.

An antioxidant is a substance that protects our cells from the damaging effects of highly reactive molecules called free radicals (which cause oxidative stress in the body).  These destructive molecules are associated with ageing, cancer, heart disease, stroke, cataracts, arthritis and more.  The body does produce its own antioxidants but also relies on vitamins, mineral and phytochemicals (bioactive plant compounds) from the diet, especially from colourful vegetables and fruits, for additional valuable supplies.  A shot of wheat grass may be one way to give the body an antioxidant boost!

In addition to the antioxidant potential of wheat grass, which may be beneficial in the prevention against cancer via protection of our DNA from free-radical damage, studies suggest that wheat grass may additionally be cancer protective via blocking the metabolic activation of many carcinogens (cancer causing substances)(3).

There is also preliminary emerging evidence to suggest that wheat grass may have beneficial effects on the health of our blood cells and blood cell production.  So far these studies have only been carried out in individuals with serious conditions such as cancer(4) and the blood disorder thalassaemia(5).  As yet there is no definitive literature to confirm if these benefits occur in healthy individuals but these trials certainly point the way.  Scientists believe that the positive benefits to the blood may come from the antioxidants in the wheatgrass(6) or perhaps from the chlorophyll in wheat grass which has a similar structure to haem, the iron containing pigment in our red blood cells that binds oxygen in order to carry it to all of the cells in our body(7). 

Finally, the use of wheat grass juice for treatment of various gastrointestinal/digestive conditions has been suggested by its proponents for more than 30 years, but until recently had never been clinically assessed in a controlled trial.  In 2002 a small randomized, double-blind, placebo-controlled study(8) took place to assess the use of wheat grass in ulcerative colitis sufferers.  Ulcerative colitis is characterized by chronic inflammation and ulceration of the lining of the colon and rectum.  The study patients received either 100 ml of wheat grass juice, or a matching placebo, daily for 1 month.  Treatment with wheat grass juice was associated with significant reductions in the overall disease activity and in the severity of rectal bleeding.  The authors think the beneficial effects were probably due to the antioxidant capacity of the wheat grass.

The above mentioned studies have been small and mainly based on serious conditions that thankfully are not common.  However, the evidence is interesting and it seems as though there is some benefit to the green shot.  It will be interesting to see if any further evidence emerges over the next few years.  Please note that wheat grass is not a miracle food and cannot make up for a poor diet.  Including a colourful variety of vegetables and fruits in the daily diet will provide a huge host of antioxidant vitamins, minerals and phytochemicals.  If you decide to try wheat grass juice try to view it as an added nutrient bonus for your body! 

(1)Shyam R et al.  2007.  Wheat grass supplementation decreases oxidative stress in healthy subjects: a comparative study with spirulina [letter to the editor]. J Altern Complement Med.  13(8):789-791.
(2) Marsili V, Calzuola I, Gianfranceschi GL. 2004.  Nutritional relevance of wheat sprouts containing high levels of organic phosphates and antioxidant compounds. J Clin Gastroenterol. 2004 Jul;38(6 Suppl):S123-6.
(3)Peryt B et al.  1992.  Mechanism of antimutagenicity of wheat sprout extracts.  Mutat Res.  269(2):201-215.
(4) Bar-Sela G, Tsalic M, Fried G, Goldberg H.  2007.  Wheat grass juice may improve hematological toxicity related to chemotherapy in breast cancer patients: a pilot study. Nutr Cancer. 58(1):43-8.
(5) Marawaha RK et al.  2004.  Wheat grass juice reduces transfusion requirement in patients with thalassemia major: a pilot study. Indian Pediatr.41(7):716-20
(6) Fernandes CJ & O’Donovan DJ.  2005.  Natural antioxidant therapy for patients with hemolyticanemia. Indian Pediatr.  42: 618-619. Letter to the editor
(7) Pole SN.  2006.  Wheat grass juice in thalassemia. Indian Pediatr. 43(1):79-80; author reply 80.
(8) Ben-Arye E et al.  2002.  Wheat grass juice in the treatment of active distal ulcerative colitis: a randomized double-blind placebo-controlled trial.  Scand J Gastroenterol.  37(4):444-449.

Written by Ani Kowal

Last weekend I had the most delicious artichoke and broad bean salad and it spurred me into thinking about the health benefits of artichoke.  More and more people are taking a supplement of artichoke leaf extract for a variety of reasons.  Artichoke leaf extract is made from the thistle-like leaves at the base of the stem of the Globe Artichoke (botanical name Cynara scolymus) and not from the (very tasty!) artichoke heart that we use in cooking.

Quite a lot of recent research into artichoke leaf extract in the UK has come from the University of Reading and has mostly concentrated on the positive effects of the herb on the digestive system.  Studies have indicated that it may alleviate irritable bowel syndrome(1, 2) and indigestion(3,4). 

However, the latest research, published online last month, has found that artichoke leaf extract is also very effective at reducing cholesterol levels(5).  Many people are now taking statins in order to try and reduce their high cholesterol levels.  Taking steps through diet, exercise and perhaps supplements, before cholesterol levels reach a high could help to reduce the need for drugs (it is my personal opinion that prevention is always better than cure).  This piece of research is important because the study involved healthy people who had only moderately raised blood plasma cholesterol levels (not yet needing drugs) and it was found that the artichoke leaf extract was helpful in reducing their blood cholesterol concentrations.

The trial involved 75 individuals with total plasma cholesterol in the range 6.0–8.0 mmol/l and lasted 12 weeks.  The participants took 1280 mg of a standardised artichoke leaf extract (4 capsules), or a placebo each day.  Plasma total cholesterol decreased significantly in the treatment group (compared to the placebo) by an average of 4.2%.  This may seem like a modest change but it is favourable and certainly significant.

Dr Rafe Bundy, the lead study scientist, is quoted as saying “Reducing cholesterol levels can reduce the risk of developing cardiovascular disease. Our research investigated whether ALE [artichoke leaf extract] could be beneficial to otherwise healthy people who had raised levels of cholesterol but were not yet at a stage where they needed standard medical intervention. ALE may provide another option which people could try over and above a healthy diet in order to help lower plasma cholesterol.”

Artichoke leaf extract may be having an effect via antioxidant action, though the exact mechanism is not clear.  The extract contains a variety of polyphenols/flavonoids (bio-active plant chemicals) such as Caffeic Acid, Chlorogenic Acid and a group of compounds collectively called Caffeoylquiinic Acids (e.g. Cynarin), these are probably the active substances responsible for the beneficial health effects.

Artichoke leaf extract is widely available as a supplement and often supplements are standardised to contain around 15% Chlorogenic Acid and 2-5% Cynarin.  Typically around 600mg-900mg per day is recommended (check the recommended dose on the label) for improved digestion and cholesterol lowering.

(1) Walker AF et al.  2001.  Artichoke leaf extract reduces symptoms of irritable bowel syndrome in a post-marketing surveillance study.  Phytotherapy Research.  15(1):58-61.
(2)Bundy R et al.  2004.  Artichoke leaf extract reduces symptoms of irritable bowel syndrome and improves quality of life in otherwise healthy volunteers suffering from concomitant dyspepsia: a subset analysis.  J Altern Complement Med.  10(4):667-669.
(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)Bundy R et al.  2008.  Artichoke leaf extract (Cynara scolymus) reduces plasma cholesterol in otherwise healthy hypercholesterolemic adults: a randomised double-blind placebo controlled trial. Phytomedicine [Epub ahead of print DOI: 10.1016/j.phymed.2008.03.001 doi:10.1016/j.phymed.2008.03.001]    

Written by Ani Kowal

Curry is a firm favourite here in the UK and many of you may be planning on eating spicy dishes over the coming week.  Turmeric is one of the main spice ingredients of curry powder and has been used for thousands of years in Indian and Chinese medicine to relieve many different conditions.  In the last few years the spice has gained recognition here in the West as a powerful anti-inflammatory and antioxidant agent.

Curcumin, a polyphenol (plant chemical), is the key active component found within turmeric and is largely responsible for the orange/yellow colour of the spice.  In ancient times turmeric was used on the Indian subcontinent to treat various illnesses such as rheumatism, body-ache, skin diseases, intestinal worms, diarrhoea, intermittent fevers, liver disorders, nausea, urinary discharges, indigestion, inflammations, constipation, absent periods (amenorrhoea), and colic(1).

A recently published review paper(2) discusses the growing body of research suggesting that curcumin, has potential for the prevention and therapy of cancer.  Animal studies and in vitro (test tube) studies on human cells have shown that curcumin can both inhibit the formation of tumours and can act on cancer development in a variety of ways. Cell studies also demonstrate that curcumin is efficient at inducing controlled cell death (known as apoptosis) and that the spice exhibits a degree of selectivity for the destruction of cancer cells.  Studies indicate that curcumin is a safe agent, after further trials in humans take place it may well be developed for use in cancer prevention and therapy.

Another recent review paper(3) discusses the mounting evidence, from cell studies, of the anti-inflammatory and anti-oxidant potentials of turmeric and curcumin.  If further studies find that these properties extend in humans it would be hugely significant as many diseases have underlying inflammatory causes e.g. diabetes, cardiovascular diseases, arthritis, Alzheimer's disease, psoriasis and many, many more!

Although curcumin and turmeric have promising health properties it was previously thought that absorption of the polyphenol into the body was limited.  However, a recent human study(4) found that curcumin was well absorbed by humans and could be detected in their blood plasma after consumption.  This is good news in terms of the therapeutic potential of the spice.  Neither turmeric nor curcumin has yet been extensively studied in human clinical trials, though small trials have taken place and larger ones are planned. 

A small study(5) with 62 patients who had ulcerating mouth or skin cancers found that an extract of turmeric as well as an ointment of curcumin was very helpful in relieving symptoms in the patients.  The patients applied the ointment to their lesions three times a day for at least four weeks.  Reduction in smell was noted in 90% of the cases and in 70% the lesions dried up (they were no longer weeping/exuding).  50% of participants noted a reduction in pain and 10% of patients experienced a reduction in lesion size.  

Turmeric is available as a supplement and many people take the spice in capsule form for anti-inflammatory conditions such as rheumatoid arthritis and also for indigestion and digestive complaints.  If you decide to try such a supplement the recommended dose is usually 500mg-1000mg a day.  Do not exceed the recommended dose as turmeric in large amounts can cause gastrointestinal problems.  Of course, if you have any medical conditions or are currently taking any medication you should consult your doctor, curcumin can alter the effectiveness of some medications.

Using spices and herbs to flavour food is also a great way to improve taste and palatability without the use of salt and, as these studies show, may add to the overall health-potential of your meals.  Why not spice up your meals this week?!

(1)Pari L, Tewas D, Eckel J.  2008.  Role of curcumin in health and disease. Arch Physiol Biochem.  114(2):127-49.
(2)López-Lázaro M.  2008.  Anticancer and carcinogenic properties of curcumin: Considerations for its clinical development as a cancer chemopreventive and chemotherapeutic agent. Mol Nutr Food Res. May 21;52(S1):103-127. [Epub]
(3)Krishnaswamy K.  2008.  Traditional Indian spices and their health significance. Asia Pac J Clin Nutr.17 Suppl 1:265-8.
(4) Vareed SK et al.  2008.  Pharmacokinetics of curcumin conjugate metabolites in healthy human subjects. Cancer Epidemiol Biomarkers Prev.  17(6):1411-7.
(5)Kuttan R, Sudheeran PC, Joseph CD. Turmeric and curcumin as topical agents in cancer therapy. Tumori. 1987; 73:29-31.

Written by Ani Kowal

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

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

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

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

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

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

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

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

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

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

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

Written by Ani Kowal

New research(1) has just emerged from Baycrest which shows that adults with type 2 diabetes who eat unhealthy, high-fat, meals may experience memory declines immediately afterward, but this may be offset by taking antioxidant vitamin supplements together with the meal.

Baycrest is an academic health sciences centre, affiliated with the University of Toronto, which is internationally-renowned for its research on aging and the conditions associated with ageing such as memory loss, depression and stroke.

The study authors make reference to the fact that there is already a growing body of evidence that links diabetes to cognitive (mental) complications in humans.  Adults with type 2 diabetes seem especially vulnerable to acute memory deficits after eating unhealthy foods.  This latest study suggests that taking high doses of antioxidant vitamins C and E with such meals may help minimize those memory slumps.

One of the study authors, Michael Herman Chui, said “Our bottom line is that consuming unhealthy meals for those with diabetes can temporarily further worsen already underlying memory problems associated with the disease”.

The study was a very small preliminary trial that involved only 16 adults (with an average age of 63) with type 2 diabetes who were not regularly taking antioxidant supplements.  They attended three weekly sessions that involved consuming a different test meal on each visit. One meal consisted of high fat foods (a Danish pastry, cheddar cheese and yogurt with added whipped cream); the second meal consisted of only water; and the third test meal was the same high-fat meal plus vitamin C (1000 mg) and E (800 IU) supplements.

After eating the meal, participants completed a series of tests that measured their recall abilities for words they had heard and paragraph information they had read.  It was found that vitamin supplementation consistently improved recall scores.  Compared to those who consumed only water or the meal with antioxidant vitamins, participants who ate the high fat meal showed significantly more forgetfulness (of words and paragraph information) in immediate and time delay recall tests. 

The study authors emphasize that their findings obviously require further replication in much larger trials. Future studies will also need to look at how the antioxidant vitamins may be working.  Personally, I would also like to see further trials using antioxidant foods, such as fruits and vegetables, in conjunction with meals to test if the same benefits are seen as with supplementation (I have a feeling results would be very positive)!

Type 2 diabetes is associated with persistent, long term oxidative stress, a known major contributor to cognitive (mental) decline and Alzheimer disease. Consuming unhealthy foods can induce this type of stress which is triggered by elevations of free radicals: unstable molecules that can damage body tissue, including brain tissue. These destructive reactions tend to occur over a 1-3 hour period after the ingestion of food.  Fruits and vegetables contain numerous antioxidant nutrients and can minimise oxidative stress, it is important to include such foods as an integral part of all meals.  This study showed that antioxidants could reduce immediate memory deficits caused by unhealthy eating.

Dr. Carol Greenwood, senior author of the study, cautioned that relying on antioxidant vitamins at meal time is not a quick fix. “While our study looked at the pill form of antioxidants, we would ultimately want individuals to consume healthier foods high in antioxidants, like fruits and vegetables” (well said!).

An overall healthy lifestyle is important in maintaining optimal mental health at all ages.  This includes regular exercise, staying mentally active, being socially engaged in a variety of activities as well as adopting a healthy diet rich in fruits, vegetables and healthy fats found in oily fish, nuts and seeds.

(1) Chui MH & Greenwood CE.  2008.  Antioxidant vitamins reduce acute meal-induced memory deficits in adults with type 2 diabetes.  Nutrition Research.  28 (7): 423-494
(2) Baycrest press release

Written by Ani Kowal

It seems like an odd link, diet and breathing, but actually it makes enormous amounts of sense.  Our bodies need nutrients to function effectively.  Nutrition affects every cell from those that make up our bones to those of the skin.  The lungs and the cells of the immune system, both of which are involved in asthma, are no exception.  During an asthma attack the immune system produces certain antibodies (immunoglobulin E) and these stimulate the release of a chemical called histamine in the lining of the airways in the lungs.  The airways consequently become inflamed and swollen, excess mucous is also released and this can block the smaller airways and affect breathing.

The asthma statistics(1) for the UK are shocking.  5.2 million of us are currently receiving treatment for the condition.  1.1 million sufferers are children, that represents 1 in 10 kids, and 4.1 million are adults, that is 1 in 12.  On average there will be 3 children in every classroom who have asthma in the UK.  We also have the highest prevalence of severe wheeze in children aged 13-14 years WORLDWIDE!  Not a position to be proud of.  Every 19minutes a child is admitted to hospital due to their asthma and asthma costs the NHS over £996million per year.  Employers ought to care too as over 12.7million working days are lost to asthma each year.

I am an optimist, so this post is not all doom and gloom!  Dietary change can make a terrific difference!

The decision to write about asthma was prompted by two reasons.  The first was watching a child come out of a fast-food outlet and immediately using his “puffer” medication and the second was that two very interesting studies(2,3) have been published this month which link the adherence to a Mediterranean diet to a reduction in asthma symptoms.

In the first study(2) the scientists looked at the diet of 1784 children who were aged around 4 years, they found that adhering to a traditional Mediterranean diet was a protective factor for wheezing.  The second study(3) looked at diet during pregnancy and what affect that had on children when they were 6 years old.  The results indicate a protective effect of adherence to a Mediterranean diet during pregnancy against asthma-like symptoms (including wheezing and allergy) in childhood.  The lead scientist of the second study, Dr Chatzi, has previously published studies which indicate the protective effects of a Mediterranean diet against asthma symptoms.

So what constitutes a traditional Mediterranean diet?  Basically, this is healthy diet rich in a variety of different fruits and vegetables, legumes (peas and beans), oily fish, nuts and seeds, olive oil and unrefined wholegrains.  The diet is also high in fibre and relatively low in red meat, saturated fats and trans fatty acids (which are abundant in some processed foods).  The total fat content in general is relatively high but the type of fat is monounsaturated and also high in omega 3 fatty acids.  There are many reasons why this kind of healthy balanced diet could reduce the prevalence of asthma symptoms:

Fruits and vegetables are abundantly rich in all sorts of vitamins and flavonoids (a group of over 4000 plant compounds).  Studies (7,8) have shown that the flavonoid quercetin (found abundantly in onions and apples) appears to reduce the risk and severity of asthma symptoms.  This is probably due to the anti-inflammatory properties that quercetin exhibits in the body.  Vitamin C may be particularly important to asthmatics (9) as it seems to reduce the degree of constriction in the airways.  Studies (10) have found that asthma sufferers tend to have lower plasma vitamin C levels than non-asthmatics and supplementation of 1000mg Vitamin C a day may help improve lung function and reduce the frequency and severity of asthma attacks.  As mentioned in the post on hayfever, Vitamin C and Quercetin both act as natural anti-histamines in the body.  Asthmatics tend to have high histamine levels.  Histamine is produced by cells of the immune system and stimulates an inflammatory reaction in the body which may be responsible for the wheezing and shortness of breath in asthma sufferers.

Other vitamins and nutrients found in fruits and vegetables, such as carotenes, have also been implicated as important for prevention of symptoms in asthma sufferers.

Nuts, Seeds and Wholegrains are rich in the mineral magnesium.  A diet high in magnesium may well be useful for asthmatics since this important mineral appears to alleviate the bronchoconstriction (tightening of the airways in the lungs) associated with asthma.  There are many studies (far too many for me to list) which indicate the importance of magnesium in those suffering with asthma.  A study in children showed that low magnesium intakes are associated with poorer lung function(4) another found that asthma patients supplemented with 400 mg magnesium a day showed an improvement in asthma symptom scores(5).  Many studies have also found that asthmatics commonly have lower levels of magnesium in their blood(e.g. 6).  The National Diet and Nutrition Surveys (NDNS) for the UK have found that dietary intakes of magnesium are generally low in most children and women in the UK.  We would all do well to try and include more nuts, seeds and wholegrains into our daily diets. 

Fat:  There is some evidence that asthma may be related to an imbalance in fatty acids in the diet.  An Australian study(11) found that a diet high in omega 6 fatty acids and low in omega 3 fatty acids increased the risk of asthma symptoms in a large group of children.  Excessive amounts of omega-6 fatty acids, found in vegetable oils, and a relative lack of omega-3 fats, found in oily fish such as salmon and mackerel and some nuts and seeds, seems to promote inflammation and aggravate asthma. Inflammatory chemicals produced from omega 6 fats by the immune system can trigger constriction of the airways and mucous production.  Omega 3 fatty acids are involved in the production of anti-inflammatory chemicals by the cells of the immune system. 

One study(12) in asthmatic patients found that supplementation with corn oil (rich in omega-6 fats) tended to increase the production of inflammatory white blood cells, whereas supplementation with perilla seed oil (rich in omega-3 fats) had the opposite effect.  Patients treated with perilla seed oil also had significant increases in their lung function.  In another study(13), supplementation with fish oil (rich in the omega 3-fats) for 10 months reduced asthma symptom scores in a group of children.  Avoidance of excessive amounts of margarine and vegetable oils, and the inclusion of oily fish such as salmon, trout, mackerel and herring (or flaxseed oil for vegetarians) in the diet may, therefore, possibly help to control asthma symptoms.  Using olive oil in place of vegetable oils will probably prove useful as it is a monounsaturated fat and does not contribute to inflammation in the body, indeed it may even play a role in reducing inflammation(14).

In part II I will be covering other important dietary measures that affect asthmatics

(1) Asthma UK www.asthma.org.uk
(2) Castro-Rodriguez JA et al.  2008.  Mediterranean diet as a protective factor for wheezing in preschool children.  J Pediatr.  152(6):823-8, 828
(3) Chatzi L et al.  2008Mediterranean diet in pregnancy is protective for wheeze and atopy in childhood. Thorax.  63(6):507-13
(4) Gilliland FD et al.  2002.  Dietary magnesium, potassium, sodium and children’s lung function.  Am J Epidemiol.  155(2):125-131
(5) Hill J et al.  1997.  Investigation of the effect of short-term change in dietary magnesium intake in asthma.  Eur Respir J.  Oct;10(10):2225-9.
(6) Alamoudi OS.  2000.  Hypomagnesemia in chronic, stable asthmatics: prevalence, correlation with severity and hospitalization.  Eur Resoir J.  16:427-431
(7) Knekt P et al.  2002.  Flavonoid intake and risk of chronic diseases.  Am J Clin Nutr.  76:560-568.
(8) Saheen SO et al.  2001.  Dietary antioxidants and asthma in adults: population-based case-control study.  Am J Respir Crit Care Med.  164:1823-1828
(9) Bielory L et al.  1994.  Asthma and Vitamin C.  Annals Allergy.  73(2):89-96.
(10) Harik-Khan RI et al.  2004.  Serum vitamin levels and the risk of asthma in children.  Am J Epidemiol.  159:351-357.
(11) Oddy WH et al. 2004. Ratio of omega-6 to omega-3 fatty acids and childhood asthma.  Journal of Asthma.  41:319-326.
(12) Okamoto, M et al.  2000.  Effects of dietary supplementation with n-3 fatty acids compared with n-6 fatty acids on bronchial asthma.  Intern Med.  39(2):107-111
(13) Nagakura et al.  2000.  Dietary supplementation with fish oil rich in omega-3 polyunsaturated fatty acids in children with bronchial asthma.  Eur Resp J.  16(5):861-865.
(14) Beauchamp GK et al.  2005.  Phytochemistry: ibuprofen-like activity in extra-virgin olive oil.  Nature.  437:45-46.

Written by Ani Kowal

In Part I I mentioned that UV light can cause damage to the skin and contribute to photo-ageing through the initiation of inflammation.  The long chain omega 3 fatty acids EPA (Eicosapentaenoic acid) and DHA (docosahexaenoic acid) found in oily fish such as salmon, trout, sardines and mackerel as well as the shorter chain alpha-linolenic acid found abundantly in flax seeds acids are used by the body for the production of potent anti-inflammatory chemicals.  Including these omega 3 fatty acids in the diet may help to reduce sun induced inflammation, UVB skin sensitivity and may also help in the prevention of sunburn(1,2,3).

As mentioned in previous posts, omega 3 fatty acids are essential for optimal health for numerous reasons and many of us do not get adequate amounts from our daily diet.  If you are not a regular fish eater, or are vegetarian you may wish to consider taking a fish oil supplement to provide EPA (around 300mg per day) and DHA (around 200mg per day) or a vegetarian flaxseed oil (around 1000mg per day) supplement.  This could be useful to give the skin added natural sun protection and provide the body with a regular source of these essential fats.

Finally I would like to bring your attention to two studies(4,5).  They are of particular interest to me since they looked at cocoa consumption in relation to protection against sunburn.  Really dark chocolate (minimum 85% cocoa solids) is a passion of mine and I tend to indulge in a few squares at least a couple of times a week!  These studies have shown that consumption of flavanol (naturally occurring plant compounds) rich cocoa daily for 12 weeks reduced the risk of sunburn when skin was exposed to UV rays.  The major flavonols to be found in cocoa are called epicatechin and catechin, and it seems as though they are the components within cocoa that are important for boosting sun protection.  The ingestion of high flavanol cocoa led to increases in blood flow to the skin and layers below the skin, and to increases in skin thickness and hydration.

This is not a plug to justify regular chocolate binges (although it does help me to feel better about my dark chocolate habit)!  The cocoa used in these studies, and other studies that link cocoa to health benefits such as lowered risk of heart disease, was high flavanol cocoa and only a very small amount was used daily (around 350mg).  I am fond of drinking black cocoa but it is an acquired taste, as is the bitter high % cocoa chocolate that I so adore.  Sugary, sweet milk chocolate won’t provide the health benefits discussed (sorry to be the bearer of sad news!).  Flavonoids in general are found abundantly in fruits and vegetables, which, as mentioned in part I are important in sun protection through their provision of antioxidants.  Vegetables and fruit should form the core of a healthy diet and getting a good variety will give the body many of the nutrients that are needed for optimal health.

Obviously avoiding sun burn is exceptionally important, however, a slowly-acquired sun-tan may prevent against adverse effects of sun exposure in those who naturally tan easily.  Sun-sensitive individuals (those with fair skin and who burn easily) need to be careful as they have a higher risk for skin cancers.  Seeking shade, wearing a hat, adequate clothing and avoiding prolonged sunbathing is always advisable.  Sunscreens may also help but the ability of sunscreen to delay sunburn encourages many people to stay out in the sun for long periods of time and their skin (and health) may be negatively affected by this prolonged exposure. 

Please be sensible in the sun! 

(1) Rhodes LE et al.  1995.  Dietary fish oil reduces basal and ultraviolet B-generated PGE2 levels in skin and increases the threshold to provocation of polymorphic light eruption.  Journal of Investigative Dermatology.  105(4):532-535.
(2) Rhodes LE et al.  2003.  Effect of eicosapentaenoic acid, an omega-3 polyunsaturated fatty acid, on UVR-related cancer risk in humans. An assessment of early genotoxic markers.  Carcinogenesis.  24(5):919-925.
 (3) Takemura N et al.  2002.  Dietary, but not topical, alpha-linolenic acid suppresses UVB-induced skin injury in hairless mice when compared with linoleic acids.  Photochem Photobiol.  76(6):657-663.
(4) Heinrich U et al.  2006.  Long-term ingestion of high flavanol cocoa provides photoprotection against UV-induced erythema and improves skin condition in women.  Journal of Nutrition.  136(6):1565-1569.
(5) Neukam K et al.  2007.  Consumption of flavanol-rich cocoa acutely increases microcirculation in human skin.  Eur J Nutr.  46: 53-56

Written by Ani Kowal

In my last post I wrote about the importance of vitamin D and sensible sunlight exposure.  This led me to start investigating natural ways to prevent skin damage from the sun (photo-damage) and sunburn.  The concept of photo-protection by dietary means is gaining increasing amounts of attention from the scientific community. 

Sun exposure leads to photo-ageing, with chronic sun exposure being a major contributor to ageing skin which is characterised by wrinkling, loss of elasticity, increased skin fragility and slower wound healing.  This photo-ageing probably occurs for a number of different reasons:

1. UV light can damage skin cell DNA via production of destructive ‘free-radical’ molecules .
2. UVB rays seem to induce the synthesis of enzymes which cause collagen, (and other skin tissue components), in the skin to degrade, this contributes to wrinkling, loss of elasticity and fragility.
3. UV light can also induce inflammation in the skin which contributes to photo-ageing.

Luckily there are some natural ways that can help us to protect our skin from sun damage. 

Antioxidants may help to ‘quench’ the destructive free radical molecules and therefore protect against photo-damage.  Specifically; beta-carotene, lycopene, lutein, vitamin C and vitamin E seem to be most helpful.  These plant constituents are involved in the light-protecting system in plants and may contribute to the prevention of UV damage in humans.  As nutrients they are ingested in the diet and are then distributed into the skin tissues where they provide the body with photo-protection.  

A diet rich in colourful fruits, vegetables, nuts and seeds will provide plentiful amounts of these antioxidants.  Beta carotene, lutein and lycopene are all carotenoids.  Carotenoids are a family of over 700 naturally occurring yellow, red and orange pigments found in vegetables and fruits.  Good sources include carrots, sweet potatoes, tomatoes, squash, peppers, cantaloupe melons, nectarines, papaya, mango and dark green vegetables such as spinach, watercress and asparagus.  Introducing a good mix of these fruits and vegetables in the diet will help keep carotenoid levels in the body high.

Absorption of these carotenoids from foods into the body is greatly affected by fat.  Without a fat source almost no carotenoids will be absorbed.  Fat acts as a carrier for the nutrients.  Now, I am not suggesting that you drown your vegetables or salads in ‘any old lard’, however I am a firm believer in using small amounts of olive oil in dressings and cooking.  Or including some nuts, seeds or olives in salads will also be helpful in order to gain maximum absorption of these important nutrients.

Two human studies have looked at tomato consumption and blood serum lycopene levels with regards the risk of sunburn(1,2).  The study groups were given lycopene or tomato-derived products rich in lycopene (mixed with olive oil) for 10-12 weeks.  Their blood serum lycopene levels increased with supplementation and they experienced a decrease in their sensitivity toward sunburn.  Sunburn damage was up to 48% lower in the groups receiving lycopene/tomato paste compared to the control groups.

Supplements containing antioxidants such as the carotenoids, vitamin C and vitamin E may also be useful in slowing down the time of development and grade of UVB induced sun damage(3).  If you feel that you are not getting a good supply of a variety of different fruit and vegetables daily in your diet, you may wish to consider taking a supplement to boost your levels of sun-protective antioxidants, especially in the sunny months or prior to a sunny holiday. 

Check back soon for Part II where I will be looking at how nutrition can help protect the skin from the inflammatory damage that the sun can cause.

(1) Stahl W et al.  2001.  Dietary tomato paste protects against ultraviolet light–induced erythema in humans.  Journal of Nutrition.  131(5):1449-1451.
(2) Aust O et al.  2005. Supplementation with tomato-based products increases lycopene, phytofluene, and phytoene levels in human serum and protects against UV-light-induced erythema.  Int J Vitam Nutr Res.  75(1):54-60. 
(3) Greul AK et al.  2002.  Photoprotection of UV-irradiated human skin: an antioxidative combination of vitamins E and C, carotenoids, selenium and proanthocyanidins.  Skin Pharmacol Appl Skin Physiol.  15(5):307-315

Written by Ani Kowal

The symptoms of hay fever may well be irritating and even distressing at times.  As I said in Part I I do not suffer from the condition so this may well sound easy for me to say, but trying not to get too upset and stressed about your hay fever could be a great help.  This is important to mention because stress(1) has been linked to the production of inflammatory agents in the body and could hence further aggravate your symptoms thus starting up a vicious cycle.

As discussed previously hay fever is an inflammatory condition.  A natural agent that would be highly useful in mediating the inflammatory reactions in the body is the long chain omega 3 fatty acid, Eicosapentaenoic Acid or EPA.  As well as having a general anti-inflammatory role EPA may actually help to prevent hay fever.  A study in 2003(2) demonstrated that individuals with a high intake of dietary EPA had a 55% reduction in their incidence of hay fever compared with persons who consume low amounts of dietary EPA.

EPA is naturally found in oily fish such as mackerel, salmon, trout and sardines.  As well as aiding the production of potent anti-inflammatory chemicals in the body it is also beneficial to the health of the heart, brain, eyes, nerves, bones, digestive system and skin (and I am sure I will be mentioning omega 3 fatty acids in future blog postings!).  Many of us do not eat these types of fish regularly (two portions per week is usually recommended) and hence a daily fish oil supplement (providing around 300mg of EPA and 200mg DHA) may be very useful for the prevention of hay fever and even to promote optimal health and wellbeing.  For vegetarians and vegans flaxseed oil (1000mg daily) can provide omega 3 fatty acids in the form of alpha linolenic acid which the body then bio-converts to EPA (the long chain form). 

One other natural remedy which can be helpful in the treatment of hay fever is the herb Butterbur (Petasites hybridus). This herb seems to exhibit anti-inflammatory activity and anti-allergic properties.   The British Medical Journal published a study(3) which compared Butterbur supplementation with the conventional antihistamine drug cetirizine (prescribed in the UK under the name Zirtek).  Both treatments were equally effective in reducing hay fever symptoms.  However, the drug cetirizine tended to cause side effects such as fatigue and drowsiness.  The authors of the study concluded that:  “The effects of butterbur are similar to those of cetirizine in patients with seasonal allergic rhinitis.....Butterbur should be considered for treating seasonal allergic rhinitis when the sedative effects of antihistamines need to be avoided”.

As an interesting point antibiotics used in children in their first 2 years of life have been associated with a 2-3 fold increased risk of hay fever(4).  As well as destroying the bacteria that cause illness in the body antibiotics also kill the healthy bacteria that live in the digestive system.  As mentioned in a previous posting these friendly bacteria have been shown to positively affect the immune system, which is responsible for allergic and inflammatory responses in the body, so a prebiotic and probiotic supplement may be useful to anyone who has been recently exposed to antibiotics or as an immune boosting aid (see post dated 19/05/08 for more detail about pre- and probiotics for immune health).

And finally, a study last year (5) found that almost 50% of hay fever suffers seem to be highly sensitive not only to typical allergy triggers like grass, tree pollens, dust and animal hair but also to things like cold air, perfumes, cigarette smoke and household cleaning products.  So, if you find that you often suffer from symptoms like itchy eyes and stuffy or runny nose you may find it useful to take a product containing vitamin C and bioflavonoids (as discussed in Part I) all year around as a preventative, anti-allergic measure.

(1) 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.
(2) Nagel G et al.  2003.  The influence of the dietary intake of fatty acids and antioxidants on hay fever in adults.  Allergy.  58(12):1277-1284.
(3) Schapowal A.  2002.  Randomised controlled trial of butterbur and cetirizine for treating seasonal allergic rhinitis.  BMJ.  324:144-146
(4) Wickens K et al.  1999.  Antibiotic use in early childhood and the development of asthma, hay fever and eczema. Clin Exp Allergy.  29:766-771
(5)Shusterman D and Murphy MA.  2007.  Nasal hyperreactivity in allergic and non-allergic rhinitis: a potential risk factor for non-specific building-related illness.Indoor Air.  17:328-333

Written by Ani Kowal

Recently my mum came back from a trip with a heavy springtime cold, a member of her travelling party had kindly passed on the infection and poor mum was suffering with the typical symptoms of a tickly throat, headache and runny nose.  Colds are caused by viruses and our susceptibility to these infections is largely dictated by the efficiency of our immune system.  A healthy diet providing our bodies with optimal nutrition may help to keep our immune systems strong and protect us from infection.

The symptoms of a common cold tend to last from a few days to a couple of weeks but most cases are over within one week (fortunately my mum is fit and healthy and her cold only lasted a few days!).   There is mixed evidence with regards prevention and treatment of colds with complementary health methods but I am always one to try ‘beating the bug’ naturally!

One of the nutrients that is essential for the efficient functioning of our immune system is zinc and last month a study published in the Journal of Infectious Diseases (1) found that using lozenges containing zinc at the first sign of a cold (within 24 hours of developing symptoms) was associated with reduced duration and severity of cold symptoms.  This study adds weight to previous research indicating that zinc lozenges, sucked in the mouth and not swallowed whole, seem to help prevent infection from the common cold and also accelerate recovery once infected. 

This most recent study involved 50 volunteers who had suffered cold symptoms, such as a cough, runny nose and muscle aches, for less than 24 hours. Half of the participants were given zinc lozenges, containing about 13mg of zinc, and half were given inactive ‘placebo’ lozenges (the two groups were not aware of which lozenges they had been assigned).  They then took one lozenge every 2 to 3 hours while awake.  The group taking the zinc lozenges had cold symptoms for an average of 3 days less than those taking the placebo.  Every cell in our body needs zinc and the investigators believe that beneficial clinical effects seen in the zinc group were due to the antioxidant and anti-inflammatory effects that this nutrient has in the body.

Lozenges and dissolvable tablets and drinks often contain vitamin C, another nutrient which some studies suggest (2) may be useful in reducing the severity and duration of cold symptoms.  If you feel a cold coming on it may be useful to try sucking on a lozenge every three hours or so while symptoms persist.  

References:
(1) Prasad AS, Beck FW, Bao B, Snell D, Fitzgerald JT.  2008.  Duration and severity of symptoms and levels of plasma interleukin-1 receptor antagonist, soluble tumor necrosis factor receptor, and adhesion molecules in patients with common cold treated with zinc acetate.  J Infect Dis.  Mar 15;197(6):795-802
(2) Van Straten et al.  2002.  Preventing the common cold with a vitamin C supplement: a double-blind, placebo-controlled survey.   Adv Ther.  19(3):151-159

Written by Ani Kowal

The herb thyme has recently (1) been found to suppress a specific enzyme (promotes specific biochemical reactions in the body), called Cyclooxygenase-2 (COX-2), which plays a key role in inflammation.  The researchers involved in this laboratory-based cell study found that a specific chemical found in thyme, called carvacrol, seemed primarily responsible for the inflammation suppressing activity.  Other botanical essential oils were also studied – clove, rose,e ucalyptus, fennel and bergamot – these also exhibited inflammation suppressing properties but to a lesser degree when compared to thyme, which reduced COX-2 levels by almost 75%.

Plant essential oils have been used for many years in various remedies but the way they work has not been clearly understood.  The authors of this study suggest that further understanding of the anti-inflammatory properties of various plant essential oils, or their specific components like carvacrol could be very important for future formulation of anti-inflammatory medications and remedies.

There have been a few small studies (2,3,4) using extracts of the herb thyme which have found that it may be helpful for treating the symptoms of bronchitis and coughs.  This could be due to the anti-inflammatory properties as mentioned above and also the antioxidant properties of thyme which have been demonstrated recently in cell studies (e.g.5,6).

Thyme, as well as a variety of other herbs, is now added to herbal antioxidant supplement preparations and can also be purchased as a ‘tea’ and an oil.  Further studies with the herb need to take place before any firm conclusions can be drawn and recommendations made for its use.  However, if you have a cough you may want to look out for herbal cough remedies that contain thyme or perhaps try burning a little of the oil in an oil burner, or sipping on some thyme tea to see if it brings relief to your symptoms. 

In the future I expect that more herbal preparations will be investigated and incorporated into medicines for various uses.  The antioxidant and anti-inflammatory properties of thyme and other herbs is interesting and exciting since many common health complaints are linked to inflammation and ‘oxidative stress’.

(1)Hotta M et al.  2010.  Carvacrol, a component of thyme oil, activates PPAR  and  and suppresses COX-2 expression.  Journal of Lipid Research.   51: 132-139
(2) Kemmerich B.  2007. Evaluation of efficacy and tolerability of a fixed combination of dry extracts of thyme herb and primrose root in adults suffering from acute bronchitis with productive cough. A prospective, double-blind, placebo-controlled multicentre clinical trial. Arzneimittelforschung.  57(9):607-15
(3) Kemmerich B et al.  2006.   Efficacy and tolerability of a fluid extract combination of thyme herb and ivy leaves and matched placebo in adults suffering from acute bronchitis with productive cough. A prospective, double-blind, placebo-controlled clinical trial. Arzneimittelforschung.  56(9):652-60
(4) Büechi S et al.  2005.  Open trial to assess aspects of safety and efficacy of a combined herbal cough syrup with ivy and thyme. Forsch Komplementarmed Klass Naturheilkd.  12(6):328-32.
(5) Rana P & Soni G.  2008.  Antioxidant potential of thyme extract: alleviation of N-nitrosodiethylamine-induced oxidative stress.  Hum Exp Toxicol. 27(3):215-21.
(6) Wang HF et al.  2008.  DPPH free-radical scavenging ability, total phenolic content, and chemical composition analysis of forty-five kinds of essential oils.  J Cosmet Sci.  59(6):509-22.
Written by Ani Kowal

Selenium isn’t a mineral that receives a lot of press attention, however it is an essential trace element that is incredibly vital to our health.  I first became aware of the importance of selenium for optimal health when I was studying for my MSc in Nutritional Medicine at the University of Surrey.  My professor at that time, Margaret Rayman, was (and is) a leading scientific researcher in the field of selenium.  At the time I was studying (2000-2002) there was a lot of research linking low selenium intakes to increased prostate cancer risk in men.  A very recently published paper (1) has now found that low selenium intakes seem to be tied to throat and stomach cancers too.  This is a preliminary study and further research is certainly required before any firm conclusions can be drawn.

Selenium acts as an important antioxidant in the body and this may account for part of the role it plays in cancer prevention.  As an antioxidant selenium may also be useful in preventing conditions related to inflammation such as pancreatitis, rheumatoid arthritis, systemic inflammatory response syndrome, asthma and cardiovascular disease, to name but a few.  It is also vital for a healthy immune system and plays a role in fertility in men and women.  In men it is vital for good sperm motility and in women selenium appears to be vital in very early pregnancy (2)

With regards the potential cancer protective role of selenium the antioxidant role may not be the only way that selenium acts.  Selenium also seems to act at the DNA level on specific genes in a variety of complicated ways (2)

As well as the requirement of selenium for antioxidant defence there is evidence that selenium:
* Is needed for thyroid function
* Is required by the immune system
* Has important antiviral effects
* Is needed for reproduction
* Enhances mood
* Reduces the risk of cancer
* Protects against mercury toxicity

The effect of selenium and its importance is most observable in populations where selenium status is low. The amount of selenium in the soil where food is grown determines its selenium content.  This is important here in the UK since our soils are very low in selenium.  The UK RNI (reference nutrient intake) for selenium is 75mcg/d for adult men and 60mcg/d for adult women.  However in the UK selenium intakes are estimated to be 39mcg/d which is very low and probably inadequate for most individuals (3).  Selenium intakes in the UK have fallen over the last 25 years largely due to the decrease in imports of high selenium wheat from the USA and Canada.  Plant foods are generally low in selenium in the UK/Europe where soil selenium levels are low (2).

Care is needed with supplementation since high doses of selenium can build up in the body and are toxic to health.  I would suggest not taking more that 100mcg/d.  I also do not recommend taking selenium as a single nutrient supplement since nutrients interact in complex and synergistic ways.  If you are taking a multi-vitamin and mineral supplement check to see that it contains selenium, if not then consider switching to a multi-formulation that does contain selenium.  Unfortunately dietary sources of selenium are few in the UK.  Brazil nuts (just 4-6 a day) and fish contain the highest concentrations in the diet of the UK population.  Some selenium rich flours are available to buy for cooking with

(1)Steevens J et al.  2009.  Selenium status and the risk of esophageal and gastric cancer subtypes: the Netherlands cohort study.  Accepted Manuscript, 14 December 2009.  Gastroenterology.  DOI: 10.1053/j.gastro.2009.12.004
(2) Rayman, M.P. 2000.  The importance of selenium to human health.  The Lancet 356: 233-241.
(3) BNF (British Nutrition Foundation).  2001.  Briefing Paper: Selenium and Health.

Written by Ani Kowal

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

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

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

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

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

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

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

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

Vitamin D has been a major topic of research over the last 2 years.  It seems as though this vitamin is essential to many aspects for health from bone to brain.  Low blood serum levels of vitamin D have been associated with increased risk for several diseases e.g. cardiovascular diseases, diabetes, depression, dental caries, osteoporosis, and periodontal disease.  Today I wanted to look further into the role that vitamin D may play in helping individuals who suffer from low mood or depression.  Previously I mentioned that vitamin D may be helpful to individuals suffering with Seasonal Affective Disorder (SAD) and have also written about vitamin D for healthy brain function and possible prevention of dementia/Alzheimer’s Disease.

There are ‘receptors’ for vitamin D within the brain and this may be the reason why recent research is discovering a link between vitamin D and mood.  In 2006(1) a study found that low levels of vitamin D (serum 25-hydroxyvitamin D) was significantly associated with a high depression score.  Other studies (e.g. 2,3,4) have found similar associations between low vitamin D levels and poor mood.

Vitamin D, acts as a multipurpose steroid hormone within the body and is vital to health.  A lack of vitamin D, or low vitamin D levels, particularly among older adults, have been linked to cognitive (brain) function, depression, bipolar disorder, and schizophrenia.  As mentioned above vitamin D activates receptors on neurons in regions of the brain which are implicated in the regulation of behaviour.  Vitamin D also acts to protect the brain by balancing antioxidant and anti-inflammatory defences (5).

The association studies mentioned above are interesting but don’t prove that vitamin D can help treat depression.  Interestingly, a study took place last year (6) which looked at vitamin D supplementation and depression in overweight and obese individuals.  The study involved over 400 individuals who were given high dose vitamin D supplementation: 20,000iu per week, 40,000iu per week or a placebo for one year.  Depression was rated using a special scale called the Beck Depression Inventory (BDI).  The first observation that was made by the research scientists was that individuals with the lowest vitamin D levels scored significantly higher in the depression scale than those with better vitamin D levels.  After one year of supplementation the two groups given vitamin D had significant improvements in BDI scores, this did not occur in the placebo group.  Vitamin D supplementation seemed to be positively affecting mood.  The authors conclude that “It appears to be a relation between serum levels of [vitamin D] 25(OH)D and symptoms of depression. Supplementation with high doses of vitamin D seems to ameliorate these symptoms indicating a possible causal relationship”. The research was carried out in overweight and obese individuals and further trials are necessary in normal-weight individuals. 

These results suggest that vitamin D deficiency could have the ability to cause depression and that ensuring good vitamin D levels in the body could help to prevent/treat depression.  Here in the UK that would seem particularly vital in the autumn and winter months when there is less sunlight and vitamin D levels tend to drop to their lowest.

Evidence for the use of vitamin D in depression and mood disorders is preliminary and not yet conclusive.  Further evidence is needed to see whether vitamin D is as useful in cases of moderate-to severe depression as it is in mild cases.  However, as I have previously written many of us in the UK have very low vitamin D levels.  If you rarely get out into the sunlight you may wish to consider taking a vitamin D supplement which provides around 12mcg of the nutrient per day (around 500iu).  Only small amounts of vitamin D are found in food sources such as oily fish (mackerel, salmon and sardines) and egg yolks.  Vitamin D supplements may be particularly useful during the autumn and winter months and for individuals who have darker skins or who don’t go outside regularly.  If you think you want to supplement much higher levels (more than 1000iu daily) then please visit your doctor since vitamin D is a fat soluble vitamin and it is possible to take too much.  When looking for vitamin D supplements two forms are generally available.  Cholecalciferol, known as vitamin D3, and ergocalciferol or vitamin D2. Cholecalciferol is generally taken to be the more potent, easily absorbed and preferred form of vitamin D

(1)Jorde R et al.  2006.  Neuropsychological function in relation to serum parathyroid hormone and serum 25-hydroxyvitamin D levels:  The Tromso study.  Journal of Neurology.  253(4):464-70
(2)Wilkins CH et al.  2006.   Vitamin D deficiency is associated with low mood and worse cognitive performance in older adults. Am J Geriatr Psychiatry. 14(12):1032-40.
(3)Murphy PK et al.  2008.  Vitamin D and mood disorders among women: an integrative review. J Midwifery Womens Health.  53(5):440-6.
(4) Hoogendijk WJ et al.  2008.  Depression is associated with decreased 25-hydroxyvitamin D and increased parathyroid hormone levels in older adults. Arch Gen Psychiatry.  65(5):508-12.
(5)Cherniack EP et al.  2009.  Some new food for thought: the role of vitamin D in the mental health of older adults.  Curr Psychiatry Rep. 11(1):12-9.
(6)Jorde R et al.  2008.  Effects of vitamin D supplementation on symptoms of depression in overweight and obese subjects: randomised double blind trial.  J Intern Med.  264:599-609
Written by Ani Kowal

Age related macular degeneration (AMD) is the most common cause of blindness in people over the age of 50 in the UK.  I have previously written about this condition but to re-cap:  

The macular is the light sensitive area in the centre of the retina that controls visual field and the ability to see colours.  AMD is caused by the deterioration of the macular.  As this happens the peripheral, outer, vision remains intact as the centre field of vision becomes slowly blurry, grey or filled with a large black spot.  Two forms of AMD exists: the dry form which develops slowly, accounting for 90% of all cases; and the wet form which causes rapid deterioration of central vision. 

The exact causes of AMD are unknown although free radical damage, where unstable oxygen molecules damage the eye cells, is strongly implicated.  Tobacco smoke and sun exposure can increase the level of free radicals in the body and both are a risk for AMD.  High blood pressure and diabetes are also risk factors as these conditions can limit blood flow to the eyes.  For more information please visit Macular Disease Society website.  The Macular Disease Society aims to build confidence and independence for those with central vision impairment.  They are the only UK charity dedicated to helping people with macular degeneration and offer information, a helpline, counselling and emotional support among other resources.

Previously I have gone into detail as to why long chain omega 3 fatty acids may be important for eye health and written about various published studies.  A new paper (1) has just been published in the American Journal of Clinical Nutrition which adds further weight to the evidence.  The researchers of this study(1) wanted to investigate whether long chain omega 3 fatty acids, EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid), which are found in oily fish such as mackerel, trout, sardines and salmon, are associated with a reduced likelihood of developing AMD.  The study involved over 1800 people who were are risk of developing AMD,.  The individuals were followed from 1992 to 2005 and their diets were assessed vial a special validated questionnaire.  The results show that participants who reported the highest long chain omega 3 intakes were 30% less likely than their peers to develop AMD.  This study showed a strong association between omega 3 fatty acids and protection against AMD but further trials would be needed to prove cause and effect.  The authors conclude that “If these results are generalizable, they may guide the development of low-cost and easily implemented preventive interventions for progression to advanced AMD”

Long chain omega 3 fats certainly seems to be part of the story.  Antioxidants and other nutrients have also been implicated in the protection against eye disease.  Please read my previous posts on AMD and cataract for more information on how certain nutrients may be important for good eye health.  It is not yet recommended that omega 3 supplements be taken specifically for protection against AMD, however these fats are vital for health for a number of reasons, if you do not regularly (at least twice a week) eat oily fish you may wish to consider a fish oil supplement.  Vegetarians and vegans can take a flaxseed oil supplement (which provides short chain omega 3 fatty acids) or look into buying EPA/DHA supplements produced from algae, these supplements are becoming increasingly available.

(1)SanGiovanni JP et al.  2009.  omega–3 Long-chain polyunsaturated fatty acid intake and 12-y incidence of neovascular age-related macular degeneration and central geographic atrophy: AREDS report 30, a prospective cohort study from the Age-Related Eye Disease Study.  Am J Clin Nutr 2009;90 1601-1607
Written by Ani Kowal

On Monday I wrote about phytochemicals in relation to obesity.  Bioflavonoids are phytochemicals, or plant nutrient, that I have written about often.  Fruit and vegetables and other plant-based foods such as nuts, seeds, pulses, beans are the richest sources of flavonoids.  A favoured source of flavonoids for me is cocoa.  Cocoa and dark chocolate made from a minimum of 70% cocoa solids are a great source of flavonoids that have high antioxidant potential and have been linked to a reduced risk of all sorts of health problems such as heart disease and certain cancers.  In addition to antioxidant bioflavonoids cocoa contains a number of minerals such as magnesium. Dark chocolate also contains fibre and is much lower in sugar than milk chocolate, so most people find that they need far less to satisfy their chocolate cravings.

A recent study (1) has found that a high intake of cocoa bioflavonoids may be related to a reduced inflammatory response in the body in patients at high risk of cardiovascular disease (heart disease and stroke).  Cardiovascular disease is considered an inflammatory condition.  The authors note that “These antiinflammatory effects may contribute to the overall benefits of cocoa consumption against atherosclerosis”.

The study involved forty two individuals at high risk of cardiovascular disease.  The individuals received 40g cocoa powder with 500mL skimmed milk or only 500ml skimmed milk for 4 weeks.  The regimen was then switched.   Before and after each intervention period, inflammatory markers in the cells and in blood serum were evaluated.  The results indicate that intake of cocoa polyphenols may positively change inflammatory chemicals in individuals at high risk of cardiovascular disease (1)

Flavonoids act as antioxidants in the body, helping to prevent cell damage and protection against disease by mopping-up destructive unstable oxygen molecules known as 'free radicals'.  Polypheonols also seem to have other protective effects on the heart and blood vessels.  They seem to prevent blood clotting, abnormal heart beat and blood vessel narrowing.  As yet scientists are not exactly sure of how these plant compounds act, however they do seem to positively change the way our genes function.

A recent review of published evidence(2) also suggests that there could be a link between cocoa consumption and protection against cancer.  The high concentration of bioflavonoids - catechins and procyanidins, found in cocoa and dark chocolate products is thought to be the important factor.  As mentioned the anti-inflammatory and antioxidant properties of these bioflavonoids probably also accounts for the cancer protective properties.  Studies into cocoa and cancer prevention have been small and are preliminary.  Larger trials would be necessary for any definitive evidence.

The major flavonols to be found in cocoa are called epicatechin and catechin.  The important message is that dark chocolate (minimum 70% cocoa solids) and cocoa rich products can be enjoyed in moderation and as part of a healthy balanced diet rich in bioflavonoids from other sources, especially vegetables and fruits.  Vegetables and fruit should form the core of a healthy diet and getting a good variety will give the body many of the nutrients that are needed for optimal health.  Flavonoid supplements are now available, though the evidence for their use is still in the early stages.  If you feel your diet is lacking in vegetables and fruits you may want to consider a supplement to top-up and cover the shortfall, but remember supplements are not a replacement for a healthy diet.

(1)Mongas M et al.  2009.  Effect of cocoa powder on the modulation of inflammatory biomarkers in patients at high risk of cardiovascular disease.  Am J Clin Nutr.  90:1144-1150
(2)Maskarinec G.  2009.  Cancer protective properties of cocoa: a review of the epidemiologic evidence. Nutr Cancer. 61(5):573-9.
Written by Ani Kowal

Vegetables and fruits contain abundant amounts of phytochemicals (bioflavonoids), bioactive plant nutrients, which are thought to be vital to the body for many reasons and linked to a reduced risk of all kinds of conditions from heart disease and cancer to dementia and bone loss.  The recommendations to eat plenty of these plant-based foods are certainly valid and very important.  A high intake of phytochemical compounds has been shown to be important for optimal health and prevention of disease.

A recent study (1) has linked high intakes of phytochemicals with reduced adiposity,fat tissue, as well as reduced oxidative stress, a kind of stress that occurs in the cells of our bodies when they are under attack by molecules known as ‘free radicals’.  In the body antioxidant defences are important to prevent damage by these free radical molecules which can cause inflammation and are linked to many diseases.  Many phytochemicals act as antioxidants in the body.

The authors of this study(1) used a simple 'phytochemical index' to determine the levels of these plant chemicals consumed by 54 people aged between 18-30 years.  Participants were ordered into normal weight and overweight groups.  Dietary records and blood samples were collected. The phytochemical index was a way of comparing the number of calories consumed from plant-based foods with the overall number of daily calories. 

The adults in the two groups consumed about the same amount of calories.  However overweight-obese adults consumed fewer plant-based foods and subsequently fewer protective trace minerals and phytochemicals and more saturated fats. They also had higher levels of oxidative stress and inflammation than their normal-weight peers, these processes are related to the onset of obesity, heart disease, diabetes and joint disease.  The authors conclude that having more phytochemicals in the diet is related to a lower fat mass and lower levels of oxidative stress.  Phytochemicals may be having an effect on the metabolic processes associated with obesity but further research would be necessary to elucidate this (1). 

As mentioned earlier, phytochemicals are found in large amounts in vegetables and fruits, they are also present in nuts, beans, pulses and lentils.  These are foods that we are always being reminded to include in high levels in the diet.  In a press release (2) the author of the study stated  “We need to find a way to encourage people to pull back on fat and eat more foods rich in micronutrients and trace minerals from fruits, vegetables, whole grains and soy,".  The author goes on to recommend (2) "Fill your plate with colorful, low-calorie, varied-texture foods derived from plants first. By slowly eating phytochemical-rich foods such as salads with olive oil or fresh-cut fruits before the actual meal, you will likely reduce the overall portion size, fat content and energy intake. In this way, you're ensuring that you get the variety of protective, disease-fighting phytochemicals you need and controlling caloric intake."

Plant based foods are generally lower in calories but more filling than processed foods since they contain plentiful amounts of fibre that can help us to feel fuller for longer, these foods really should represent the cornerstone of a healthy diet.  Supplements can never replace a healthy diet, however if you feel you are frequently falling short of eating enough vegetables and fruits you may want to consider taking a bioflavonoid supplement or a food-state multivitamin and mineral supplement to cover any short-term shortfalls.

There are many simple ways to include more vegetables and fruits in the diet e.g.
*Replace processed snack bars with a piece of fruit or a handful of mixed unsalted nuts
*Vegetable sticks with some hummus make a great snack
*Grate an apple into your morning oats/porridge or added a chopped banana – avoid sweet, processed breakfast cereals
*Include plenty of salad in your lunchtime sandwich, 
*Have 2-3 portions of vegetables with your evening meal
*Eat fruit with natural yoghurt as a dessert
*Replace pre-packaged, processed foods as often as possible with fresh produce – the authors of the study state (2) "We always want to encourage people to go back to the whole sources of food, the non-processed foods if we can help it," "That would be the bottom line for anyone, regardless of age and body size, keep going back to the purer plant-based foods. Remember to eat the good quality food first."

(1)Vincent HK et al.  2009.  Relationship of the dietary phytochemical index to weight gain, oxidative stress and inflammation in overweight young adults. Journal of Human Nutrition and Dietetics.  Sep 4. [Epub ahead of print]
(2)University of Florida (2009, October 22). Phytochemicals In Plant-based Foods Could Help Battle Obesity, Disease. ScienceDaily. Retrieved October 23, 2009, from http://www.sciencedaily.com¬ /releases/2009/10/091021144251.htm

Written by Ani Kowal

I have mentioned folate a lot in my blog posts but mainly in relation to women, especially pregnant women.  However, recent research presented at the at the 2009 American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) Annual Meeting & OTO EXPO, in San Diego, CA(1) has found that high folate intakes in men may be associated with a 20% decreased risk of hearing loss.

The study(1) involved 3,559 cases of men with hearing loss.  The study authors found that men over the age of 60 who have a high intake of foods and supplement high in folate had a 20% decrease in risk of developing hearing loss.  The authors believe this is the largest study to delve into the relation between dietary intake and hearing loss. They also believe their findings could allow for greater education, prevention, and screening efforts in a bid to prevent hearing loss.  Further studies would certainly be necessary as this study only shows an association and not cause and effect. 

Ten years ago a small study in women (2) found that poor folate levels were associated with age-related decline in hearing.  The study was conducted in 55 healthy women aged 60-71.  The women were tested for hearing function and categorised into two groups – those with normal hearing and those with impaired hearing.  Women with impaired hearing had a 31% lower blood level of folate than women with normal hearing.  In addition to this study a couple of years ago a research team (3) found that folic acid supplementation seemed to slow the decline of low-frequency hearing in folate-deficient, older adults.  The objective of this study was to determine whether folic acid supplementation slows age-related hearing loss.  728 men and women were involved.  Subjects received daily oral folic acid (800 micro-grams) or placebo supplementation for 3 years.  Folic acid supplementation slowed the decline in hearing of the speech frequencies associated with aging in a population (but did not affect the decline in hearing high frequencies).  The authors note that the results need to be replicated in further larger studies but that folic acid supplementation seemed to slow the decline of low-frequency hearing in folate-deficient, older adults.

Folic acid may be playing a role in the prevention of age-related hearing loss by improving blood circulation to the artery that supplies blood to the cochlea of the ear.  In addition, folic acid is also related to lowering elevated homocysteine levels.  Elevated homocysteine could be related to age-related hearing loss.  Most people are aware that high levels of homocysteine in the blood have been linked to an increased risk of heart problems.  Recently high homocysteine levels have also been linked to poor bone health, poor eye health (such as age-related macular degeneration) and other health problems.  To recap from my past blog posts: Homocysteine is produced when the amino acid (the building blocks of protein) methionine is broken down in the body.  Normal levels of homocysteine are important to help build and maintain body tissues, however elevated concentrations in the blood can be harmful and have been associated with an increased risk of many disorders.  At normal levels homocystein can be converted in the body into a harmless substance called cystanthionine.  The conversion of homocysteine into this harmless substance depends upon various B vitamins  (B6, B12 and folic acid).  Having good levels of these B vitamins appears to be a very good way of preventing high homocysteine levels and low levels of B vitamins have been associated with raised homocysteine levels.

Foods particularly rich in folate include leafy vegetables such as spinach, asparagus, turnip greens, lettuces, dried or fresh beans and peas, fortified cereal products, sunflower seeds, yeast extract, liver and liver products.  Vitamin B6 is mainly found in meat, fish and eggs.  Vitamin B12 is found in liver, meats, eggs, milk and yeast extract. 

Vegetarians and vegans and those who feel they are not eating a varied, balanced diet may wish to consider taking a multiple B vitamin supplement to ensure good levels of these important B vitamins

(1)American Academy of Otolaryngology -- Head and Neck Surgery (2009, October 6). Higher Folates, Not Antioxidants, Can Reduce Hearing Loss Risk In Men. ScienceDaily. Retrieved October 6, 2009, from http://www.sciencedaily.com/releases/2009/10/091005161116.htm
(2)Houston DK et al.  1999.  Age-related hearing loss, vitamin B-12, and folate in elderly women.  American Journal of Clinical Nutrition.  69(3):564-571.
(3) Durga J et al.  2007.  Effects of folic acid supplementation on hearing in older adults: a randomized, controlled trial.  Ann Intern Med.  146(1):1-9.
Written by Ani Kowal

Back in May I reported the results of a study which found that taking folic acid before pregnancy and during early pregnancy was associated with a reduced risk of premature birth.  A recent study (1) has found that women with high antioxidant levels in their blood seem less likely to give birth prematurely.

The study(1) was a case control study.  It included over 5000 women.  All the women involved in the study had an interview, examination and blood test at week 24-26 of their pregnancy.  Some of the placentas from term and preterm births were also analysed.  There were 207 preterm births in total.  Women with high (above the average) blood plasma concentrations of carotene (both alpha and beta carotene), cryptoxanthin (a type of carotenoid), and lycopene seemed to have a reduced risk of preterm birth.  (I have written about carotenoids a number of times). 

Carotenoids such as alpha and beta carotene, lutein and zeaxanthin are a family of over 700 naturally occurring yellow, red, orange and dark green pigments found in vegetables and fruits.  Good sources include carrots, sweet potatoes, tomatoes, squash, peppers, cantaloupe melons, nectarines, papaya, mango and dark green vegetables such as spinach, kale, watercress and asparagus.  Introducing a good mix of these fruits and vegetables on a regular basis in the diet will help keep carotenoid levels in the body high.  Carotenoids act as antioxidants in the body.  Antioxidants are important to prevent damage to the body cells by naturally occurring unstable oxygen molecules, known as free radicals.  Antioxidants may help to ‘quench’ or mop-up the destructive free radical molecules and therefore protect against cell-damage.

This study found that women with higher blood levels of certain carotenoids were less likely to deliver their babies preterm.  In the study, the one-half of mothers-to-be with the highest blood levels of certain carotenoids were 30 percent to 50 percent less likely to deliver prematurely than women with lower levels. The findings do not prove cause-and-effect. There may be other things about women with high carotenoid levels that explain the association with lower preterm-birth risk but the authors conclude that further studies are certainly warranted to investigate the apparent link found in this study.

If carotenoids, or other antioxidants, do help prevent premature delivery, the reasons are not yet entirely clear.  The authors speculate that it could be related to protection from any ill effects of environmental toxins, like air pollution, or exposure to bacteria or other infectious agents.

Eating a healthy diet during pregnancy, and indeed at any time, is crucial.  Ensuring that you achieve the minimum 5 portions of vegetables and fruits daily is a good idea.  Aiming to eat plenty of these foods will mean that antioxidant levels in the body will naturally be high.  In addition, many women may choose to take a multivitamin and mineral supplement specifically designed for use during pregnancy and this may also boost levels of important antioxidants in the body, as well as providing folic acid.

(1)Kramer MS et al.  2009.  Antioxidant Vitamins, Long-Chain Fatty Acids, and Spontaneous Preterm Birth.  Epidemiology. 20(5):707-713.
Written by Ani Kowal

Last week I wrote about a study which found that green tea may positively impact bone health.  Today I wanted to look at a newly published study (1) which found that women who drink green tea regularly seem to have a reduced risk of stomach cancer.  Past studies have linked green tea consumption to a reduced risk of cancer at various sites in the body and it is probable that this has to do with the antioxidant flavonoids/polyphenols that the tea contains such as catechins (which I also discussed last week).  There is an added benefit of green tea in terms of prevention against stomach cancer – it is thought that the tea contains compounds that may fight certain types of bacteria which have been linked to stomach cancer.

This study (1) examined the association between green tea consumption and gastric cancer.  Data for over 200,000 individuals were analysed for the research.  In women, but not men, a significantly decreased risk of stomach cancer was observed for those women who consumed 5 or more cups of green tea per day compared to those who drank one cup or less per day.  Interestingly the reduced risk of stomach cancer seemed to apply to cancers in certain parts of the stomach.  The study took place in Japan where individuals frequently drink more than 5 cups of green tea daily.

Here in the UK green tea is becoming increasingly popular as a drink and also as a nutritional supplement, with many people switching their regular milky black tea for the green variety.  This current study does not prove that green tea protects against stomach cancer – the researcher want to do further research to see whether drinking the tea actually reduces the risk of stomach cancer, or whether women with a lower risk simply happen to drink more of it.

As I have mentioned many times in the past, antioxidant nutrients and flavonoids appear to be very important in reducing the risk of various cancers and other diseases.  The best way to boost antioxidant levels is to eat a large variety of vegetables and fruits daily, a minimum of 5 portions is recommended, however some experts say this is too low and that we need to be aiming for at least 9 a day in order to prevent various illnesses.  If you feel that you consistently fall short of the recommended 5 per day you may want to consider taking an antioxidant supplement that contains a variety of flavonoids – the evidence for these supplements is currently scant but studies are presently being carried out.  Please remember that supplements should never be viewed as a replacement for a balanced diet.

(1) Inoue M et al.  2009.  Green tea consumption and gastric cancer in Japanese: a pooled analysis of six cohort studies. Gut.  58(10):1323-32.
Written by Ani Kowal

On the 8th July this year I wrote a piece entitled “Are you tearing your hair out? Study finds nutritional supplement may help reduce compulsive behaviour”, the post was looking at a study which found that N-acetylcysteine (NAC) may be useful for sufferers of trichotillomania.  NAC is an amino acid that acts as an antioxidant in the body but also affects levels of glutamate in the brain.  Glutamate triggers excitement in the brain, lowering glutamate levels may help people who suffer with obsessive compulsive disorders.  Today I thought I would have another look at obsessive compulsive disorder (OCD) in general to assess whether any other nutritional/lifestyle advice could help.

One nutrient that seems to be coming up time and time again in the medical literature is inositol.  Insolitol is classified as a member of the vitamin B complex and is sometimes referred to as vitamin B8.  Naturally inositiol (in its myo-inositol form) is found in nuts, beans and fruit, especially cantaloupe melon, oranges, grapefruit and raisins.  It has many functions in the body, structurally it is important in some lipids (fats) and cell membranes but it also functions in insulin control pathways, nerve guidance, calcium control within cells, and serotonin activity.  Serotonin is often known as a feel-good brain chemical.  Low levels have been linked to many mood disturbances.  Low levels of insolitol in the body have also been linked with depression, bulimia, panic disorder, OCD, bipolar depression and agoraphobia.

So let’s have a closer look at the available medical studies with inositol in OCD and similar disorders.

In 1996 (1) a small, but well designed, study published in the American Journal of Psychiatry found that 18g of inositol per day for six weeks was effective at significantly reducing OCD symptoms when compared to a placebo.  In 1997 (2) another small trial found that 18g of inositol for six weeks significantly reduced scores of OCD symptoms compared when compared with placebo treatment. 

A group of researchers in 2001 (3) undertook a study to compare the effect of inositol with that of fluvoxamine in individuals with panic disorder.  Fluvoxamine is a Selective Serotonin Reuptake Inhibitor (SSRI) pharmaceutical antidepressant drug often used in OCD.  The trial participants received up to 18g/day of inositol and up to 150mg/d of fluvoxamine for a month.  Improvements on Hamilton Rating Scale for Anxiety scores, agoraphobia scores, and Clinical Global Impressions Scale scores were similar for both treatments.   In the first month, inositol reduced the number of panic attacks per week by an average of 4.0 compared with a reduction of 2.4 with fluvoxamine.  Nausea and tiredness were more common with fluvoxamine.  The authors of the study conclude that “Because inositol is a natural compound with few known side effects, it is attractive to patients who are ambivalent about taking psychiatric medication. Continuing reports of inositol's efficacy in the treatment of depression, panic disorder, and OCD should stimulate replication studies”.

Also published in 2001 was a paper (4) which reported three case studies to show that inositol may help in the treatment of trichotollomania.  The paper describes the cases of two women with trichotillomania and one with compulsive skin picking.  They were treated with 6g inositol (which was in a powder form and taken dissolved in water or juice three times per day). The treatment lasted 8-16 weeks and all of them found their condition improved with inositol treatment.  The authors of the paper conclude: "The three cases described here suggest that inositol might be a treatment option in some patients with hair pulling and skin picking and could be considered in patients who tolerate SRIs [selective reuptake inhibitors] poorly or who are unwilling to take them," 
 

These studies and case-studies certainly indicate that inositol is worth investigating further and I hope that larger trials are carried out soon.  Many OCD sufferers and sufferers of depression and other mood disturbances are unwilling to take anti-depressant drugs due to the many side-effects and a general unwillingness to take pharmaceutical mood-altering medications.  Side effects of inositol treatment are few and generally mild.  Possible side effects of high dose inositol treatment are mainly gastrointestinal symptoms such as gas, diarrhoea and abdominal cramps.  Headaches may also occur. 

How might inositol be working to help in OCD, trichotillomania and similar disorders?

As mentioned earlier inositol is involved with serotonin action in the brain. In 2001 (5) and 2002 (6) a group of researchers looked specifically at OCD and how inositol may be working to help sufferers of the condition.  There is, as yet, no conclusive answer but inositol certainly seems to be having an effect in brain cells at specific ‘receptor’ sites which are important in brain chemical signalling (dopamine and serotonin appear to be brain chemicals that are affected by inositol).  Inositol from the diet is incorporated into cell membranes of neurones, brain cells, where it serves a function in brain chemical signalling.  In addition to its role in cell signalling, inositol lipids also seem to alter receptor sensitivity, can direct membrane trafficking events, and have also been found to modulate an increasing array of complex signalling proteins in the brain (6).  Further research work is needed in order to gain firmer insights.

If you are a sufferer of OCD, trichotillomania or panic disorder and are looking for an alternative treatment to conventional antidepressants, or are interested in taking a natural substance in addition to conventional treatment it may well be worth talking to your medical doctor about inositol.  They may not be aware of the evidence, in which case you could show them this blog post and they can read the full study papers to gain a fuller perspective.  Never stop taking a conventional treatment without talking to your medical doctor first and do not start a high dose inositol treatment without first consulting a medical doctor. 

If you are suffering with trichotillomania you may also wish to contact the following online support network:  Trichotillomania Support Online.  For OCD sufferers the following charity, OCD-UK, may be a helpful point of contact.

(1) Fux, M et al.  1996.  Inositol treatment of obsessive-compulsive disorder.  American Journal of Psychiatry.  153(9):1219-1221
(2) Levine J.  1997.  Controlled trials of inositol in psychiatry.  Eur Neuropsychopharmacol.  7(2):147-155.
(3) Palatnik A et al.  2001.  Double-blind, controlled, crossover trial of inositol versus fluvoxamine for the treatment of panic disorder. J Clin Psychopharmacol. 21(3):335-9
(4) Seedat S, Stein D, Harvey B (2001), Inositol in the treatment of trichotillomania and compulsive skin picking (letter). J Clin Psychiatry 62(1):60-61.
(5) Harvey BH et al.  2001.  Chronic inositol increases striatal D(2) receptors but does not modify dexamphetamine-induced motor behavior. Relevance to obsessive-compulsive disorder.  Pharmacol Biochem Behav.  68(2):245-253.
(6) Harvey BH et al.  2002.  Defining the neuromolecular action of myo-inositol: application to obsessive-compulsive disorder.  Prog Neuropsychopharmacol Biol Psychiatry.  26(1):21-32.
Written by Ani Kowal

Green tea is becoming increasingly popular as a drink in the UK and throughout the ‘West’.  More and more people are also taking green tea supplements due to the numerous reports of the health benefits attributed to this drink.  Previously I have written about green tea with respect to antioxidants, heart disease, cancer and ageing.  Today I wanted to look at some new evidence (1) that certain chemical compounds within green tea may help to improve bone health. 

The study(1) was a preliminary laboratory-based cell study and further work would be necessary before firm conclusions or recommendations can be drawn from the results, however it gives interesting evidence nonetheless.  I have mentioned before that green tea contains bioactive plant chemicals, polyphenols, known as catechins.  The common polyphenols which are often listed on green tea supplements include those that were researched in this study, namely epigallocatechin, gallocatechin, and gallocatechin gallate.  These polyphenols have antioxidant properties in the body which probably account for many of their health benefits.

The laboratory study(1) found that tea catechins had positive effects on bone metabolism – they stimulated bone cell formation and helped to slow its breakdown.  Epigallocatechin appeared to be particularly helpful in boosting bone growth and bone mineralisation (which helps to strengthen bones).  This was the first study to pinpoint which chemicals in green tea are important in the possible improvement of bone health.  Importantly the researchers also noted that the catechins did not appear to cause any toxic effects in the bone cells.

Last month I wrote about the link between onions and bone health and have also written about carotenoids and bone strength as well as the importance of fruits and vegetables for bones.  The link between all these factors, including green tea, seems to be antioxidants.  As I said on Monday the best way to get dietary antioxidants is through eating a variety of fruits and vegetables daily.  Supplements cannot be seen as an alternative to a good diet but can be used as a support if you feel that you regularly struggle to include a minimum of five portions of vegetables and fruits into your daily diet.  More evidence is continually being published regarding the importance of flavonoids and antioxidants for health.

I would like to end this post by pointing out that antioxidant flavonoids/polyphenols are also found in cocoa as I have previously discussed!  This is why good quality dark chocolate (70% cocoa solids or above) can be enjoyed in small quantities guilt-free!  There are many studies which now extol the benefits of cocoa for health.  As I finish writing this piece I am allowing a square of my favourite 85% cocoa solids dark chocolate to melt on my tongue!

(1)Ko, CH et al.  2009.  Effects of Tea Catechins, Epigallocatechin, Gallocatechin, and Gallocatechin Gallate, on Bone Metabolism.  J. Agric. Food Chem. 57 (16): 7293–7297

Written by Ani Kowal

Due to the economic events occurring over the last year many people have felt under incredible stress.  A recent study (1) has found that an antioxidant supplement may be helpful in reducing symptoms such as fatigue, stress and anxiety which are fairly prevalent in developed populations at this current time.  There have been several suggestions in the scientific literature that there is a link between individual perceived stress and ‘oxidative stress’ – a kind of stress that occurs in the cells of our bodies when they are under attack by molecules known as ‘free radicals’.  In the body antioxidant defences are important to prevent damage by these free radical molecules which can cause inflammation and are linked to many diseases.  Our bodies contain many enzymes that act as antioxidants, a main one being SOD, superoxide dismutase.  The study mentioned (1) used a melon juice supplement that was high in SOD to see if it had any effect on individual symptoms of stress.

This pilot study (1) was well planned and included seventy healthy volunteers aged between 30 and 55 years, who felt daily stress and fatigue. They took the dietary melon supplement or a placebo once daily over a 4 week period. Symptoms of stress and fatigue were measured using four specific psychometric scales.

Supplementation with the melon concentrate supplement significantly improved perceived signs and symptoms of stress and fatigue linked to e.g. pain, sleep troubles, concentration, weariness, attitude, irritability compared to the placebo. In the same way, quality of life and perceived stress were significantly improved with supplementation (1).

One of the authors of the study said in a press release (2) "Several studies have shown that there is a link between psychological stress and intracellular oxidative stress. We wanted to test whether augmenting the body's ability to deal with oxidative species might help a person's ability to resist burnout. The 35 people in our study who received capsules containing superoxide dismutase showed improvement in several signs and symptoms of perceived stress and fatigue." She added that " It will be interesting to confirm these effects and better understand the action of antioxidants on stress in further studies with a larger number of volunteers and a longer duration."

The best way of providing the body with antioxidants is to eat a diet that is rich in vegetables and fruits.  These foods provide antioxidant vitamins, minerals and bioflavonoids (bioactive plant compounds).  Antioxidant supplements made from natural berries and herbs are now also available to buy but should not be viewed or used as an alternative to a healthy diet.  If you feel that you are under particular stress/mental strain at the moment you may wish to increase the number of antioxidant containing foods in your diet.  If you are struggling to reach the daily minimum of 5 portions of vegetables and fruits then a good quality antioxidant supplement may be something you wish to consider in the short term in order to boost your antioxidant levels during periods of stress.

It will be interesting to see what further research uncovers in the realm of antioxidants and stress symptoms, with so many people feeling pressure in their lifes these kinds of studies could represent important steps toward helping to ease difficult symptoms.

(1)Milesi MA et al.  2009.  Effect of an oral supplementation with a proprietary melon juice concentrate (Extramel) on stress and fatigue in healthy people: a pilot, double-blind, placebo-controlled clinical trial.  Nutrition Journal.  8:40 (15 September 2009)
(2)Press Release: Antioxidant Ingredient Proven To Relieve Stress. ScienceDaily. Retrieved September 16, 2009, from http://www.sciencedaily.com/releases/2009/09/090914194652.htm

Written by Ani Kowal

Messages are constantly being published to encourage us to eat plenty of vegetables and fruits and I certainly write about the importance of these foods often.  Vegetables and fruits provide the body with an array of vitamins, minerals and bioflavonoids (bioactive plant chemicals) which are associated with the prevention of many diseases.  Some of the vitamins and bioflavonoids act as antioxidants in the body and this may be one way that that prevent disease.  Antioxidants are another topic that I often write about, they protect the body from attack by destructive molecules known as ‘free radicals’.

A newly published study (1) has found that eating a diet rich in vegetables and fruits may be associated with a reduced risk of ‘cognitive impairment’, mental impairment, later in life.

193 healthy people aged 45-102 years old were included in the study.  Each participant took part in cognitive testing and also gave blood which was assessed for antioxidant status.  Each person also completed a specific food frequency questionnaire which assessed their daily intake of vegetable and fruits.  The participants were scored to have either a high intake or a low intake.  94 subjects in the high-intake score group had significantly higher cognitive test scores and higher levels of antioxidant nutrients in their blood compared to 99 subjects who had low intake of vegetables and fruits.  In addition to this the cognitive scores were directly correlated with blood levels of specific antioxidant nutrients (1).

The authors of the study conclude (1) “Healthy subjects of any age with a high daily intake of fruits and vegetables have higher antioxidant levels, lower levels of biomarkers of oxidative stress, and better cognitive performance than healthy subjects of any age consuming low amounts of fruits and vegetables. Modification of nutritional habits aimed at increasing intake of fruits and vegetables should be encouraged to lower prevalence of cognitive impairment in later life”. 

This follows on well from the piece I posted on Monday which discussed recent evidence that lifestyle may impact cognition later in life.  The High Intake group in this study was consuming around 400g of vegetables and fruits daily which is a very achievable amount.  The low intake group, by contrast were eating less that 100g of these foods daily.  Integrating at least 5 portions of vegetables and fruits into the daily diet is highly recommended. 

Dr. M. Cristina Polidori, currently at the Department of Geriatrics, Marienhospital Herne, Ruhr-University of Bochum, Germany, explained in a press release (2): “It is known that there is a strong association between fruit and vegetable intake and the natural antioxidant defenses of the body against free radicals. It is also known that bad nutritional habits increase the risk of developing cognitive impairment with and without dementia. With this work we show a multiple link between fruit and vegetable intake, antioxidant defenses and cognitive performance, in the absence of disease and independent of age. Among other lifestyle habits, it is recommended to improve nutrition in general and fruit and vegetable intake in particular at any age, beginning as early as possible. This may increase our chances to remain free of dementia in advanced age.”

Further, much larger, studies are planned that will include patients with Alzheimer’s disease at different stages and patients with mild cognitive impairment without dementia.  I will be following developments with interest.  As my many previous posts have shown, a good diet and lifestyle really can impact our health, both in the present and the future.  As I mentioned last week, even small changes can add up over time to create a bigger impact. 

(1)Polidori MC et al.  High fruit and vegetable intake is positively correlated with antioxidant status and cognitive performance in healthy subjects. J Alzheimers Dis. 17:4
(2)Science daily press release.  http://www.sciencedaily.com/releases/2009/09/090909064910.htm.  IOS Press BV (2009, September 10). High Fruit And Vegetable Intake Linked To Antioxidant Status And Cognitive Performance In Healthy Subjects. ScienceDaily. Retrieved September 11, 2009, from http://www.sciencedaily.com¬ /releases/2009/09/090909064910.htm
Written by Ani Kowal

Kingston University, London UK recently published a study (1) which looked at a variety of plant extracts and their roles as antioxidants and anti-ageing agents in the body.  The scientists from Kingston University tested 21 plant and herbal extracts including: White tea, Green Tea, Burdock root, Anise, Angelica, Lavender, Rose tincture, Pomegranate.  White tea came out top of the bunch in all tests, outperforming all of the other herbs and plants that were evaluated (1).

In a press release (2) Professor Declan Naughton, a leading specialist on inflammation in the UK, from the School of Life Sciences at Kingston University in South West London, said the research showed white tea had anti-ageing potential and high levels of anti-oxidants which could prevent cancer and heart disease. “We’ve carried out tests to identify plant extracts that protected the structural proteins of the skin, specifically elastin and collagen,” he explained. “Elastin supports the body’s natural elasticity which helps lungs, arteries, ligaments and skin to function. It also helps body tissue to repair when you suffer wounds and stops skin from sagging.” “Collagen is a protein found in connective tissues in the body and is important for skin, strength and elasticity”, he added.

Results showed white tea prevented the activities of the enzymes which breakdown elastin and collagen, known as collagenase and elastinase.  The breakdown of these important skin proteins can lead to wrinkles that accompany ageing.  The enzymes are also associated with inflammatory diseases such as rheumatoid arthritis.  Free-radicals, which are normally kept in check by antioxidants, are also associated with inflammatory conditions (many of my other posts have gone into great detail about antioxidants).
 

Professor Naughton said (2): “These enzymes and oxidants are key components of normal body processes. However, in inflammatory conditions, suppressing the activities of these excess components has been the subject of decades of research. We were surprised to find such high activity for the white tea extracts in all five tests that were conducted.” “We were testing very small amounts far less than you would find in a drink,” “The early indicators are that white tea reduces the risk of inflammation which is characteristic of rheumatoid arthritis and some cancers as well as wrinkles.”

Other plants and herbs that helped to protect against the breakdown of elastin and collagen, indicating that they may have an anti-aging potential, included extracts of rose, green tea, angelica, anise and pomegranate.  These are all readily available as supplements and pomegranate and rose are often used in anti-ageing skin creams.

The plants and herbs that were tested also contained various phenolic compounds (a group of natural plant chemicalss which include the bioflavonoids) - these bioactive plant compounds have received a lot of attention over the last few years for their health giving properties and potential to protect against a variety of diseases.  In this study (1) White tea had the highest phenolic content and antioxidant potential.  Green tea and rose tincture also showed high antioxidant potential.

Last year I wrote about the effects of UV exposure and aging (Part I, Part II) and how antioxidants as well as other nutrients can help prevent free radical damage to collagen and elastin in the skin.  It is important to remember that this was just a preliminary laboratory study and it is unknown whether the plants and herbs tested would have similar effects in the body.

(1) Thring TSA et al.  2009. Anti-collagenase, anti-elastase and anti-oxidant activities of extracts from 21 plants. BMC Complementary and Alternative Medicine.  9:27 (4 August 2009)
(2)Press Release:  Kingston University.  White tea could keep you healthy and young looking http://www.kingston.ac.uk/pressoffice/latestnews/2009/august/10-White-tea-could-keep-you-healthy-and-young-looking/

Written by Ani Kowal

Previously I have written about the health benefits of following a Mediterranean diet and I was very interested to read a study (1) that has just been published in the Journal of the American Medical Association which found that eating a Mediterranean-style diet is associated with a reduced risk for Alzheimer’s disease.  The study also found that physical activity was associated with a reduced risk for Alzheimer’s disease (independent of diet).  Adhering to a Mediterranean diet and having a good level of physical activity further reduced the risk of developing this disease.

This research adds to a growing body of evidence which suggests that lifestyle can have a significant impact on health, which certainly seems very logical to me!

A traditional Mediterranean diet is abundant in vegetables, fruits, nuts, legumes/beans, fish (especially oily fish), healthy fats and wholegrains.  It is generally low in processed foods, dairy products, red meats, and saturated fats.  In the past research has been conducted on Mediterranean diet and Alzheimer’s disease as well as physical activity and risk for Alzheimer’s.  This is the first study (1) to investigate the combined effects of diet and physical activity on risk for Alzheimer’s disease.

The authors of the study(1) used data from 1880 elderly residents, who had an average age of 77, living in New York.  None of the participants had Alzheimer’s disease or dementia at the start of the study which ran from 1992 to 2006.  At the start of the study diet and level of physical activity were assessed and scored.  Physical activity was scored as vigorous (e.g. jogging), moderate (e.g. hiking or cycling) and light (e.g. golfing or gardenting).  For diet the participants were given a score from 0-9 depending on how close to a Mediterranean diet their diet was.  These scores were then grouped into low, middle or high adherence to a Mediterranean diet.  Over the course of the study, about every 18 months, participants underwent neurological and neuropsychological tests.

*  A total of 282 cases of Alzheimer’s disease were diagnosed over the course of the study.
*  The most physically active participants had a 33% reduced risk of developing Alzheimer’s disease when compared to participants who were the least physically active
*  Those who most closely followed a Meditteranean diet have a 40% reduction in the risk for Alzheimer’s compared to participants who adhered the least.
*  Those who had the highest level of physical activity and whose diet was closest to the Mediterranean diet had a 60% reduced risk of developing Alzheimer’s when compared to those who did not exercise and did not follow a Mediterranean-style diet.

It was also noted that even a low level of physical activity did seem to have a protective effect which is important since it suggests that making even small changes can be beneficial.

Dr Susanne Sorensen, head of research, at the Alzheimer’s Society said in a Press Release (2) about the study:

“ ‘Dementia is one of people's biggest fears in later life but very few people realise that there are things they can do to reduce their risk of developing this devastating condition. This study adds to the growing body of evidence that a healthy diet and regular exercise can reduce the chance of developing dementia.

'A Mediterranean diet full of green leafy vegetables, oily fish, nuts and low in saturated fats is an incredibly healthy approach to eating and may reduce your risk of developing dementia. This study suggests combining this diet with regular exercise is one of the best ways to cut your chances of developing dementia.'

'With one million people set to develop dementia in the next 10 years, it is essential that we act now to defeat it.' ”

The study was not a clinical trial, it was an observational study and cannot prove the link between following a Mediterranean diet and being physically active and the risk for Alzheimer’s disease.  However, it does point toward a strong association and provides us with indications of the importance of following a healthy eating regimen an including exercise into our lifestyles.  There are many components in the Mediterranean diet which may be protecting the brain including omega 3 fatty acids from oily fish and numerous antioxidant vitamins and flavonoids (bioactive plant chemicals) from vegetables and fruits.  As well as minerals.  No doubt all these components act together synergistically to reduce overall risk of Alzheimer’s and help to keep our brain healthy and functioning efficiently.  The key message seems to be to follow a healthy diet and lifestyle. 

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

(1)Scarmeas N et al.  2009.   Physical Activity, Diet, and Risk of Alzheimer Disease.  JAMA. 2009;302(6):627-637.
(2) Press Release: Alzheimer’s Society comment on Mediterranean-type diet reducing Alzheimer’s risk http://www.alzheimers.org.uk/site/scripts/press_article.php?articleID=386
Written by Ani Kowal

Recently I attended a seminar which concentrated on bone health in women going through the menopause.  The decrease in blood serum oestrogen after menopause is associated with bone loss and subsequent brittle bones and osteoporosis.

A study(1) was briefly mentioned at the seminar which seemed to suggest that onion consumption was linked to bone health in peri- and post-menopausal women.  I was intrigued!  The study found that individuals who consumed onions once a day or more had an overall bone density that was significantly greater than individuals who consumed onions once per month or less.  This association was apparent even after the authors took various other factors (that can affect bone health) into account such as age, body mass index (BMI), daily calcium intake, serum vitamin D, serum parathyroid hormone, oestrogen use, smoking status, and exercise status.  This suggests that onion consumption may be an independent factor in bone health. The study also found that older women who consume onions most frequently may decrease their risk of hip fracture by more than 20% versus those who never consume onions.

Why would onions be having this kind of effect? A possible explanation could be that onions contain a flavonoid (bioactive plant compound) called quercetin which has antioxidant and anti-inflammatory actions in the body and has been linked with protecting against heart disease, cancer and asthma.  Quercetin is also found in apples and grapes.  Two laboratory studies (2,3) last year found that quercetin could increase new bone formation.

Quercetin is also classes as a phytoestrogen.  Phytoestrogens are natural plant-derived compounds that bind to oestrogen receptors and have oestrogen-like activity in the body.  Recently phytoestrogens have attracted much attention among public and medical communities because of their potential beneficial role in prevention and treatment of cardiovascular diseases, osteoporosis, diabetes and obesity, menopausal symptoms, renal diseases and various cancers.

Our bone cells (osteoblasts) have two oestrogen receptors on their surface and certain phytoestrogens, including quercetin, can interact with these oestrogen receptors in bone.  It is possible that quercetin binds to the bone oestrogen receptors and stimulates and increases bone formation and bone mineralisation.  Further studies are needed to investigate these ideas. The authors of one of the studies say (3)“If quercetin, this common constituent in fruits and vegetables, can be shown to increase bone forming activities in bone cells and improve healing in bone defects, it may be the long-sought-after safe and ideal agent for stimulation of bone formation and bone defect repair”

Onions are one of my favourite vegetables and easy to integrate into meals and salads.  Apples and grapes are also easily incorporated into the daily diet.  Last year I wrote about the importance of fruit and vegetables for bone health.  A number of studies over the last decade have suggested a clear, positive link between fruit and vegetable consumption and bone health.  These foods provide a huge range of nutrients that are important for bone health.  In addition to the nutrients, fruit and vegetables positively effect the pH balance (a measure of acid-alkali balance) in the body, by increasing the alkalinity in the body (making the body less acidic), which plays a major role in the prevention of calcium loss from bones.  Foods which are acid forming in the body include foods such as most meat and animal protein, cheddar cheese and many grain products e.g. white bread, pasta, cornflakes.  If the body is too acidic, and not in pH balance, then bones can release their calcium (which increases alkalinity) into the blood to try and maintain the balance.  Obviously calcium loss is not what we want!! 

Providing the body with abundant supplies of vegetables and fruits, especially those high in quercetin, may help to keep our bones strong as well as protecting us from many other diseases.  Quercetin supplements are also readily available to buy, usually as an antioxidant boost for the body and for allergy prevention and treatment, although their impact on bone health have not yet been tested. 

Please also read my other various posts on osteoporosis for more information on how to keep bones healthy

(1) Matheson EM et al.  2009.  The association between onion consumption and bone density in perimenopausal and postmenopausal non-Hispanic white women 50 years and older. Menopause.  16(4):756-9.
(2) Wong RW & Rabie AB.  2008.  Effect of quercetin on bone formation. J Orthop Res.26(8):1061-6.
(3)Wong RW &  Rabie AB.  2008.  Effect of quercetin on preosteoblasts and bone defects. Open Orthop J. 10;2:27-32.

Written by Ani Kowal

Many people are understandably worried about swine flu.  A press release (1) was issued on Tuesday (11th August) providing information that the Vatican has tripled their order of black elderberry extract this year, compared to their order last year.  It seems as though the Pope may be trying a natural way to prevent influenza and boost his immune system.

“This year the International Pharmacy of Vatican City has ordered 600 bottles of the black elderberry extract compared to 200 bottles last year, showing that divine intervention may work miracles, but when it comes to combating flu, even the Pope needs a helping hand” (1)

Black elderberry extract (Sambucol ®) is something I have written about previously in my blog.  There is evidence suggesting that it can reduce the duration of an influenza attack by about 4 days and may  also prevent against influenza. 

Black elderberries are thought to contain a unique compound, called antivirin, which seems to coat viruses and prevents them from penetrating and infecting healthy body cells. As a result viruses, such as influenza, are unable to replicate.  This means that the body’s white blood cells can ingest the infected cells, effectively removing the virus from the body.

A press pack(2) produced about black elderberry extract details the results of a laboratory based study that took place in 2006 (3) which found black elderberry extract (Sambucol ®) effective against the H5N1 strain of bird flu (avian influenza H5N1):  “Laboratory trials were undertaken at Retroscreen Virology Ltd., a leading research institute associated with the University of London.  Sambucol ® was found to be at least 99% effective against avian influenza virus H5N1.  Sambucol ® was effective at significantly neutralizing the infectivity of the virus in cell culture.  Further studies are to be undertaken to assess the effectiveness of Sambucol ® against avian influenza (H5N1) virus infections in humans”

Black elderberries also contain high levels of natural antioxidants known as flavonoids which help strengthen the immune system against viral attack; indeed the black elderberry has twice the antioxidant capacity of blueberries and significantly higher antioxidant capability than that of cranberries.

Black elderberry extracts are widely available in the UK and sold as a liquids or lozenges.  The products can be taken as a preventative or at the first signs of cold or flu-like symptoms.  A healthy diet, rich in a variety of fruit and vegetables, is obviously the most important way to keep the immune system strong, healthy and effective.  However, if you are concerned about flu and feel that your diet tends to fall short you may consider following the Popes lead and taking an elderberry extract supplement to give your immune system an extra boost.

It is very important that if you begin to experience flu-like symptoms you consult your doctor immediately.  For more information on black elderberry visit the website http://www.blackelderberry.info/

(1) The Pope exorcises the flu with black elderberries.  Tuesday, 11 August 2009.  Press release distributed via Response Source, a service from Daryl Willcox Publishing, on behalf of Tiger White PR.  http://www.responsesource.com/releases/rel_display.php?relid=LzgXz
(2) Razei Bar.  Sambucol ®A Unique Plant Extract.  New Scientific Findings on H5N1 Bird Flu.  Press Information Kit.  http://www.mivelle.hu/sambucol/Press%20kit%20London%209.1.06.pdf
(3) Balasingam S et al.  2006.  Neutralizing activity of Sambucol ® against avian NIBRG-14 (H5N1) influenza virus.  Bird flu: the first pandemic of the 21st century.  A central role of antivirals.  London.
Written by Ani Kowal

A research team at the University of Exeter has just published results of a study which shows (1) that drinking beetroot juice may help boost stamina and help individuals to exercise for up to 16% longer than they are normally able to, this may be down to the nitrate content of the beetroot juice.  The researchers are not yet sure of the exact mechanism that causes the nitrate in the beetroot juice to boost stamina. However, they suspect it could be a result of the nitrate turning into nitric oxide in the body, which can relax blood vessels and increase blood flow.

The research team believes that the findings could be of great interest to endurance athletes. They could also be relevant to elderly people or those with cardiovascular, respiratory or metabolic diseases.

This was a very small, preliminary study which took place in men (1).  The participants were given 500ml of organic beetroot juice each day for 6 days before completing a series of tests involving cycling on an exercise bike – the exercise tests ranged from moderate-intensity to severe-intensity.  On a separate occasion the same men were given a blackcurrant cordial drink for six consecutive days before completing the same cycling tests.  After drinking beetroot juice the group was able to cycle for significantly longer than when they were given the placebo blackcurrant drink.  The men also gave blood samples throughout the trial.

The beetroot juice contained around 11.2 mM of nitrate while the placebo blackcurrant juice had a negligible nitrate content.  The study was performed ‘double blind’ which means that neither the participants nor the administrators they interacted with knew which of the two agents was being tested, the beetroot juice or the blackcurrant cordial.

On days 4-6 the blood plasma nitrite levels were significantly higher in the beetroot juice phase than in the placebo phase and the blood pressure of participants was also significantly reduced in the beetroot juice phase (other studies have shown that beetroot juice can reduce blood pressure).  The authors are not sure how the nitrate in the beetroot juice boosts stamina, but they suspect it is because the nitrate turns into nitric oxide in the body.  The research team now hopes to conduct further studies to try to understand in more detail the effects of different nitrate-rich foods on exercise physiology.  Nitric oxide in the body helps to relax blood vessels and increase blood flow, hence can be important for reducing blood pressure, in the body.

One of the study authors said in a press release (2): "Our study is the first to show that nitrate-rich food can increase exercise endurance. We were amazed by the effects of beetroot juice on oxygen uptake because these effects cannot be achieved by any other known means, including training. I am sure professional and amateur athletes will be interested in the results of this research. I am also keen to explore the relevance of the findings to those people who suffer from poor fitness and may be able to use dietary supplements to help them go about their daily lives." 

Arginine supplements are available to buy and have been shown to be useful to increase nitric oxide levels in the body.  The amino acid, Arginine, is a powerful vasodilator (blood vessel relaxer) and may help to support and maintain healthy blood flow and circulation. Arginine is also an antioxidant and helps support healthy arteries.  Beetroot drinks and supplements are also available to by but it is important to remember that supplements should not be viewed as a substitute for a healthy balanced diet and lifestyle.  Beetroot is also rich source of vitamins, minerals, antioxidant bioflavonoids (bioactive plant compounds) and fibre and would certainly be a good vegetable to include as part of a varied and balanced diet.

(1)Wilkerson DP et al.  2009.  Dietary nitrate supplementation reduces the O2 cost of low-intensity exercise and enhances tolerance to high-intensity exercise in humans.  Journal of Applied Physiology (August 6, 2009).  DOI:10.1152/japplphysiol.00722.2009
(2) University of Exeter Press release.  Beetroot juice boosts stamina, new study shows http://www.exeter.ac.uk/news/featurednews/title,37371,en.php

Written by Ani Kowal

Rhodiola is a herb that I keep hearing about, it is considered to be an adaptogen.  I thought I would write about it now since I started last week writing about another adaptogenic herb, Siberian Ginseng.

To recap - Based on clinical studies, adaptogens can be defined as a group of herbal preparations that increase tolerance to mental exhaustion and enhance attention and mental endurance in situations of decreased performance. The beneficial stress-protective effect of adaptogens appears to be complex, these herbs seems to work via several mechanisms including actions on the hormonal and immune systems (1)
 

Rhodiola is also known as Golden root, it is a herb that is native to the northern regions of Europe, Scandinavia and Alaska as well as parts of Eastern Siberia.  The species of Rhodiola that is commonly used in supplements is Rhodiola rosea (occasionally Rhodiola crenulata is used insupplements).

In a recent review paper (1) it was found that strong scientific evidence is available for Rhodiola rosea extract, for the improvement of attention, cognitive function and mental performance in fatigue and in chronic fatigue syndrome.  A well designed, but small, study took place this year (2) which concluded that repeated administration of Rhodiola rosea extract exerts an anti-fatigue effect that increases mental performance, particularly the ability to concentrate, and decreases cortisol (a stress hormone) response in burnout patients with fatigue syndrome.  No serious side effects were reported.

Another study (3) which took place in healthy young individuals (aged 19-21) who were under a background of continued fatigue and stress (since they were army cadets) found that Rhodiola showed a pronounced anti-fatigue effect.  The results are interesting but the study was small and short-term, further trials would be necessary before any firm conclusions could be made about the anti-fatigue effects of Rhodiola in healthy individuals.

Exam period has just finished and schools have broken up for the long summer break but I wanted to mention one last study (4) which aimed to investigate the effects of Rhodiola rosea in students during a stressful examination period.  The investigators found that those receiving the Rhodiola had significant improvements in physical fitness and mental fatigue.  The self-assessment and general wellbeing scores were also significantly better in the group taking Rhodiola compared to those receiving placebo.

It does seem as though this herb may be helpful to take during periods where mental stress is expected.  As with Siberian ginseng, further clinical trials are necessary before firm conclusions can be drawn and recommendations for the use of Rhodiola can be made.  However, if you are feeling a bit stressed or fatigued at the moment you might decide to try a short term (2-3 week) course of this herb to see if it aids your symptoms.  Consulting a qualified herbalist would be a good idea prior to making a long-term decision.  The general dosage of Rhodiola is 50 - 750 mg per day or 500 mg taken immediately prior to exercise or any situation that demands mental clarity or energy.  Usually supplements are standardised to contain 0.8%, to 3% Salidrosides or around 40% polyphenols (bioactive plant chemicals that have antioxidant and other properties).  Always follow the manufacturers dosage instructions.

(1)Panossian A, Wikman G.  2009.  Evidence-Based Efficacy of Adaptogens in Fatigue, and Molecular Mechanisms Related to Their Stress-Protective Activity. Curr Clin Pharmacol. 2009 Sep 1. [Epub ahead of print]
(2) Olsson EM et al.  2009.  A randomised, double-blind, placebo-controlled, parallel-group study of the standardised extract shr-5 of the roots of Rhodiola rosea in the treatment of subjects with stress-related fatigue. Planta Med. 75(2):105-12.
(3) Shevtsov VA et al.  2003.  A randomized trial of two different doses of a SHR-5 Rhodiola rosea extract versus placebo and control of capacity for mental work. Phytomedicine. 10(2-3):95-105
(4) Spasov AA et al.  2000.  A double-blind, placebo-controlled pilot study of the stimulating and adaptogenic effect of Rhodiola rosea SHR-5 extract on the fatigue of students caused by stress during an examination period with a repeated low-dose regimen.  Phytomedicine.  7(2):85-89.

Written by Ani Kowal

Recently a friend recommended that I try taking some Siberian Ginseng to boost my energy levels during a particularly busy time.  Siberian ginseng was not a herb that I knew very much about.  Korean ginseng, often known as panax ginseng or Asian ginseng is the ginseng that I have read a lot about in the past and seems to have immune and metabolism boosting properties.  So what about Siberian ginseng?

Siberian ginseng (Eleutherococcus senticosus) is also known as Eleuthero, Eleutherococco, Ciwujia, Devil’s Bush, Touch-me-not and ussurian thorny pepper bush.  It is a herb that is native to Siberia, Korea and parts of China.  Since Siberian ginseng does not belong to the Panax family it cannot be considered as a ‘true’ ginseng.  Although the beneficial actions of Siberian ginseng seem to be similar to those of Korean ginseng there is some debate as to whether it may be better to rename the herb Eleuthero so as to dissociate it from Korean ginseng.

Herbalists refer to Siberian ginseng as being an ‘adaptogen’.  The term is used to describe herbs that seem to help the body to adapt during times of stress, trauma, fatigue and anxiety.  Sometimes adaptogens are simply referred to as rejuvenating herbs and their use dates back thousands of years in China and India.  It is not entirely known how these herbs work, many of them have antioxidant properties but this does not explain all of their reported benefits.  It could be that adaptogenic herbs can balance the hormonal and immune systems in the body.  I wanted to have a look to see if there was much research evidence to back up the claims that Siberian ginseng can help during times of stress.

A review paper, released very recently (1), was carried out to assess clinical trials of different adaptogenic herbs in fatigue.  The authors who collated the research say that good scientific evidence has been recorded in trials in which Siberian ginseng increased endurance and mental performance in those with mild fatigue and weakness.  The scientists also propose that the beneficial, stress protective, effect of adaptogenic herbs is related to a variety of complex mechanisms in the body that involve hormones and brain activity.

Many of the studies done with Sibersian ginseng have been animal or laboratory studies and the results have been quite positive for the use of the herb to help during times of stress or fatigue.  However, not many studies have yet been conducted in humans.  The few trials that have taken place have been small, but certainly interesting, and further evidence is warranted before any firm conclusions can be drawn.

Two studies were published in 2004 (2,3) which look specifically at Siberian ginseng and fatigue in human subjects.  The first (2) took place in elderly individuals who were suffering from fatigue and feelings of lack of energy.  The study was small and preliminary involving only 20 individuals aged 65 or over.  The participants were given either 300mg a day of died extract of Siberian ginseng or a placebo for 8 weeks.  A health related quality of life questionnaire was taken at the study and then again at 4 and 8 weeks.  At the start of the study the two groups had similar health related quality of life scores.  The participants did not know if they were receiving the Siberian ginseng or the placebo.  After 4 weeks the individuals receiving the active herb had higher scores in the health related quality of life questionnaire (in the social functioning section) than those receiving placebo.  However after 8 weeks the differences did not seem to persist.  The authors of the study conclude that Siberian ginseng may improve some aspects of mental health and social functioning in the short term.  Further studies are necessary to investigate long term effects.

The other study (3) took place in sufferers of chronic fatigue.  Siberian ginseng seemed to be most helpful for individuals with more severe fatigue.  Overall the authors conclude that the findings for the use of Siberian ginseng in chronic fatigue are not yet strong but that “the findings of possible efficacy for patients with moderate fatigue suggests that further research may be of value”.
 

Siberian ginseng has been used for many years as a tonic for vitality and health and I believe we can learn a lot by looking at ancient herbal treatment regimens.  However, I also feel that it is important to investigate the science behind the claims and test the efficacy and safety of herbs before promoting them.  Laboratory evidence for Siberian ginseng is fairly strong and human trials are beginning to emerge to strengthen the health claims.

If your energy, vitality and stamina seem to be waning, rather than reaching for a coffee (which can further stress the body systems) you might want to investigate whether short term use of Siberian ginseng works for you.  Consulting a herbalist is a good option and always read the manufacturers dosage suggestions before use.  The most commonly recommended therapeutic dosage for Siberian Ginseng (20:1 concentration, containing at least 1% Eleutheroside E) is 300 mg - 600 mg per day.

(1) Panossian A, Wikman G.  2009.  Evidence-Based Efficacy of Adaptogens in Fatigue, and Molecular Mechanisms Related to Their Stress-Protective Activity. Curr Clin Pharmacol. 2009 Sep 1. [Epub ahead of print]
(2) Cicero AF et al.  2004. Effects of Siberian ginseng (Eleutherococcus senticosus maxim.) on elderly quality of life: a randomized clinical trial. Arch Gerontol Geriatr Suppl.  9:69-73.
(3) Hartz AJ et al.  2004.  Randomized controlled trial of Siberian ginseng for chronic fatigue. Psychol Med.  34(1):51-61.

Written by Ani Kowal

Tea has long been considered a tonic for health with both black and green teas being studied for their health-giving properties.  Tea contains many bioactive plant chemicals known as polyphenols (tea polyphenols are sometimes termed catechins) which can act as antioxidants in the body and thus potentially be important for disease prevention.

A recent study has shown (1) that green tea may have an effect on the risk factors for heart disease via improving the function of cells, called epithelial cells, which line the circulatory system.  When these cells are not functioning properly it can lead to the progression of atherosclerosis.  Atherosclerosis is commonly described as ‘hardening of the arteries’ it is a chronic inflammatory response in the walls of arteries

The study was small and preliminary but found that green tea consumption has an acute beneficial effect on endothelial function in a large artery (brachial artery) in healthy individuals (when compared to caffeine or hot water).  Green tea seems to work by improving blood flow and the ability of arteries to relax.  The effects were evident fairly rapidly, almost immediately in fact, within 30 minutes of drinking the tea dilation (relaxing) of the artery could be detected.  Measurement of the arteries was performed by high resolution ultrasound.  The researchers only looked at short-term impact (up to two hours).  It is not yet known what the long-term benefits could be.  Further studies are being carried out

Previous studies have found that black tea has also been associated with improved endothelial performance but adding milk to black tea may well reduce the health benefits associated with tea drinking.  Green tea originated in China but is now a popular drink that is consumed throughout the world.  Both green and black tea come from the same camellia sinesis bush but the different processing technique create the differences between the teas.  Green tea is not fermented whereas black tea is, the fermentation process is the reason for the brown/dark colour and the different flavour of black tea.  The flavonoids in green tea are probably more potent antioxidants than those found in black tea due to the different processing techniques.

A cup of tea isn’t going to cure or prevent illness and disease as a stand alone addition to normal daily life!  A healthy lifestyle is one that includes healthy eating, physical activity and other lifestyle factors.  Including green tea can be seen as a way to boost antioxidant defences in conjunction with a healthy lifestyle.  Green tea supplements which contain high doses of the tea polyphenols (e.g. catechins) are now widely available to buy but as yet it is unknown if the potential benefits extend to the supplemental form of the flavonoids.

(1)Alexopoulos N et al.  2008.  The acute effect of green tea consumption on endothelial function in healthy individuals. Eur J Cardiovasc Prev Rehabil. 15:300-305

Written by Ani Kowal

"Trichotillomania is an impulse control disorder or form of self-injury characterized by the repeated urge to pull out scalp hair, eyelashes, facial hair, nose hair, pubic hair, eyebrows or other body hair, sometimes resulting in noticeable bald patches. Trichotillomania is classified in the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders) as an impulse control disorder. It may seem, at times, to resemble a habit, an addiction, a tic disorder or an obsessive-compulsive disorder. Trichotillomania often begins during the individual's teenage years. Depression or stress can trigger the condition. Due to social implications the disorder is often unreported and it is difficult to predict accurately prevalence (1)" but it is estimated to affect 2-4% of the population and seems to be more common in women than men.

Usually trichotillomania is treated with SSRI (Selective Serotonin Reuptake Inhibitor) anti-depressant drugs which many people prefer not to take due to the potential side-effects.  Researchers at the University of Minnesota Medical School have just published a study (2) which suggests that NAC (N-Acetylcysteine) a commonly available health food supplement may help to stop the urges of those suffering with trichotillomania.  NAC is an amino acid that acts as an antioxidant in the body.

The study(2) was small but well designed involving 50 trichotillomania sufferers, with an average age of around 34, for 12 weeks.  Half were given 1,200mg of NAC each day for 6 weeks.  For the following 6 weeks they were given 2,400mg NAC per day.  The other half were given placebo (inactive) supplements.  After 9 weeks, those taking NAC had a significant reduction in the incidence of hair-pulling.  After 12 weeks 56% of those on the NAC supplement reported feeling much, or very much improved (compared to only 16% of those on the placebo).  No side-effects were found when taking the NAC supplement.
 

The study offers significant hope to sufferers of this distressing self-harming condition and is also an important study as it is one of the first studies of compulsive behaviours to look at lowering levels of glutamate, a chemical that triggers excitement, in the brain to curb harmful behaviours.  NAC seems to affect levels of glutamate in a very specific area of the brain which may be why it seems to help patients curb their self-harmful behaviour.

Dysfunction of glutamate-mediated brain nerve functions has also been implicated in obsessive-compulsive disorder (OCD).  The study authors believe that NAC and other glutamate modulators may be applicable to other disorders, addictions and compulsive behaviours.  Prior to this study a case was documented (3) where NAC was shown to be clinically helpful for a sufferer of OCD (obsessive compulsive disorder).  Further studies are certainly warranted in this area, especially since many individuals are looking for natural alternatives to psychiatric drugs.  It may be that NAC will be useful in conjunction with other known nutritional mood influencing aids, I certainly look forward to further studies being published in this area.

If you are suffering with trichotillomania (or other compulsive behaviours) you may wish to contact the following online support networks and may wish to speak to your doctor or health professional about trying NAC to see if it is useful for you:
UK and Ireland Trichotillomania Support Group  and the Trichotillomania Support Online

(1)http://wapedia.mobi/en/Trichotillomania
(2) Grant JE et al.  2009.  N-Acetylcysteine, a Glutamate Modulator, in the Treatment of Trichotillomania: A Double-blind, Placebo-Controlled Study. Arch Gen Psychiatry. 66(7):756-763
(3) Lafleur DL et al.  2006.  N-acetylcysteine augmentation in serotonin reuptake inhibitor refractory obsessive-compulsive disorder.  Psychopharmacology.  184(2):254-256.

(Written by Ani Kowal)

The links between diet and cancer are widely researched.  The World Cancer Research Fund UK (WCRF UK) estimate that lifestyle factors such as being overweight, eating an unhealthy diet and being inactive are responsible for about a third of all cancers in developed countries (1).  The WCRF UK are a charity committed to cancer prevention.

A recently published study (2) has found a significant link between eating a diet high in carotenoid rich fruits and vegetables and a reduction in the risk of breast cancer in premenopausal women.

Carotenoids such as alpha and beta carotene, lutein and zeaxanthin are a family of over 700 naturally occurring yellow, red, orange and dark green pigments found in vegetables and fruits.  Good sources include carrots, sweet potatoes, tomatoes, squash, peppers, cantaloupe melons, nectarines, papaya, mango and dark green vegetables such as spinach, kale, watercress and asparagus.  Introducing a good mix of these fruits and vegetables on a regular basis in the diet will help keep carotenoid levels in the body high.

The study (2) involved 5,707 women with invasive breast cancer (2,363 premenopausal women and 3,516 postmenopausal women) and 6,389 individuals with no breast cancer, control subjects (2,594 premenopausal women and 3,516 postmenopausal women).  In an interview, these women were asked about their intake of carotenoid rich fruits and vegetables.  The researchers found that pre-menopausal women eating high intakes of vitamin A, beta-carotene, alpha-carotene, lutein and zeaxanthin appeared to have a reduced risk of breast cancer.  Eating at least two servings of carotenoid-rich vegetables each day was associated with around a 17% reduced risk of breast cancer.  As an association study the results are positive but further studies would be necessary before any firm conclusions could be drawn about the effect of dietary carotenoids on cancer risk. 

Carotenoids may be acting to prevent cancer via different means.  Carotenoids have been shown to interfere with oestrogen (hormone) signalling which may explain why their cancer-preventing effects would be limited to premenopausal women.  In addition to this, carotenoids act as antioxidants in the body and antioxidants have been linked to cancer prevention.  Antioxidants prevent damage to the body cells by naturally occurring unstable oxygen molecules, known as free radicals.  Antioxidants may help to ‘quench’ or mop-up the destructive free radical molecules and therefore protect against cell-damage (which could lead to cancer formation).

Absorption of carotenoids from foods into the body is greatly affected by fat.  Without a fat source carotenoids are not easily absorbed.  Fat acts as a carrier for these nutrients to allow them passage from the gut into our blood and bodily cells.  This is not a suggestion to drown your vegetables or salads in gallons of oil, however, I am a firm believer in using small amounts of olive oil in dressings and cooking.  Including some nuts, seeds or olives in salads may also be helpful in order to gain maximum absorption of these important nutrients. 

(1)WCRF/AICR.  2009.  Policy and action for cancer prevention.  Food, nutrition and physical activity: a global perspective.  Washington DC: AICR, 2009.
(2) Mignone LI et al.  2009.  Dietary carotenoids and the risk of invasive breast cancer.  International Journal of Cancer.  124:2929-2937
Written by Ani Kowal

Over the years there has been debate as to whether oral contraceptive use in women leads to depletion of certain nutrients in the body.  There is some evidence that oral contraceptives may reduce levels of Vitamin B1, B2, B6, folate, vitamin C, vitamin E, zinc, magnesium and calcium.  However, many of these studies were small and carried out over 20 years ago with very little follow up since.  During this time the contraceptive pill has changed dramatically and now contains lower doses of hormones.  Women who are eating a healthy, nutrient-rich diet probably gain enough vitamins and minerals to counteract any deficit but many women in the UK are not reaching the minimum 5 portions per day of vegetables and fruits and many also do not gain enough magnesium and other minerals through their diets. 
 

The early studies do warrant attention and I was interested to find two more recent papers (1,2) which point to the importance of being nutrient-aware when taking oral contraceptives.  These two studies look at how oral contraceptives may have an effect on the antioxidant levels in the body.  

I have written about dietary antioxidants in many previous blog posts.  Antioxidant intakes and bodily status has been linked to a reduction in the risk of many conditions raging from cancer to heart disease, dementia and arthritis.  One of the reasons why fruit and vegetables are so important in our diets is because they provide many antioxidant nutrients, such as carotenoids, vitamins C and E and various antioxidant bioflavonoids (bioactive plant chemicals). 

Anitoxidants help to prevent damage to cells in our body by mopping-up destructive unstable oxygen molecules known as 'free radicals', these free radicals create what is known as oxidative stress in the body.  There is mounting evidence that these destructive molecules, together with lowered bodily antioxidant defences, play a significant role in the development and aggravation of many diseases and health problems.  The body does produce its own antioxidants but also relies on vitamins, mineral and phytochemicals (bioactive plant chemical) from the diet, especially from colourful vegetables and fruits, for additional valuable supplies.

It has been thought for some time that oral contraceptive use may lead to increased oxidative stress in women.  One study (1) which took place in 2007 included 209 healthy women aged 40-48 years.  The oxidative stress status of the women was studied, this included an analysis of antioxidant levels, trace minerals and three markers of oxidative damage to fats (lipids).  Among the 209 women 23% used oral contraception, 57% did not use contraception and 20% used hormonal and copper intrauterine devices (IUD). 

Results showed(1) that women using oral contraception had significantly higher oxidative damage to lipids (lipid peroxidation) compared to the other 2 groups of women.  Lipid peroxidation has been linked to heart disease.  Oral contraceptive users also had significantly lower blood plasma levels of several antioxidants such as beta-carotene and gamma-tocopherol (a form of vitamin E).  The study scientists checked their data and confirm that modifications in plasma beta-carotene levels could not be attributed to dietary differences between the three groups.  The beta-carotene levels were 39-50% lower in the oral contraceptive users compared to the other groups of women.  The authors conclude that these lowered levels of antioxidants and increased signs of bodily oxidative stress could represent a potential cardiovascular risk factor for these women.

Another study (2) looked to examine the influence of oral contraceptive use on blood serum levels of antioxidants.  The study was a very small, preliminary trial in pre-menopausal women.  The researchers found that oral contraceptive use significantly decreased coenzyme Q10 (an antioxidant) and alpha-tocopherol (vitamin E) levels.  The authors conclude that further studies are needed to investigate the potential role of oral contraceptives on oxidative stress in women.

Coenzyme Q10 is naturally produced by the body and was first isolated in 1957, it is essential for energy production in all bodily cells and also acts as an antioxidant in the body.  Coenzyme Q10 itself is found in many foods but is particularly concentrated in nuts and oils.  The body does produce this nutrient naturally and does not rely on external sources.  In order to produce CoQ10 we require various essential cofactors.  These include a variety of vitamins especially of the B group (Folic Acid, Vitamin B2, The Niacinamide form of Vitamin B3, Vitamin B5,Vitamin B6, Vitamin B12) and Vitamin C .  Hence a healthy diet rich in fruits, vegetables, wholegrain cereals and lean proteins will aid the natural production of this coenzyme and help to keep our circulating levels high.

The results of these studies need backing up by further larger clinical trials but could indicate the consideration of antioxidant supplementation for women taking oral contraceptives. 

Eating a healthy diet low in processed and refined foods and rich in vegetables, fruits, nuts/seeds, beans and pulses, lean meats, fish (especially oily varieties), wholegrains and healthy fats is the best way to ensure that your body gets plenty of vitamins, minerals and antioxidants.  If you feel that your diet is regularly falling short then you could consider taking a broad spectrum multivitamin and mineral supplement – but remember that a supplement cannot be considered as an alternative for a healthy diet.

1.Chapelle JP et al.  2007.  Effect of different contraceptive methods on the oxidative stress status in women aged 40 48 years from the ELAN study in the province of Liege, Belgium.  Hum Reprod.  22:2335-2343
2. Palan PR et al.  2006.  Effects of menstrual cycle and oral contraceptive use on serum levels of lipid-soluble antioxidants.  Am J Obstet Gynecol.  194:e35-38

Written by Ani Kowal

Regular readers of my blog will have realised by now that I have a great interest in Omega 3 fatty acids.  Research suggests that these essential fats play a role in the prevention of several diseases ranging from heart disease to cancer, stroke, diabetes, arthritis, asthma, osteoporosis, mood disorders (including depression), eye diseases and many more (including most conditions with a link to inflammation).  A major voice for the importance of these fats is Artemis Simopoulos MD.  Dr Simopoulos is president of The Centre for Genetics, Nutrition and Health and a member of the board of directors of the American Association for World Health.  Since 1984 her research has been largely dedicated to the evolutionary aspects of diet, the omega-6:omega-3 ratio of the diet and the importance of omega-3 fatty acids for health.

In an interview (1) Dr Simopoulos said that one of the biggest food myths today is that you have to give up fat to lose weight and enjoy health.  A statement I wholeheartedly agree with.  Of course, not all fats are the same and today I want to discuss the virtues of omega 3 fatty acids.  These can be found in fish, especially oily fish such as salmon, trout, mackerel and sardines, seafood, as well as flaxseeds, walnuts and green leafy vegetables.  Meat and eggs in the UK do not contain large amounts of omega 3 fatty acids anymore since our farming methods have drastically changed over the years, this has contributed to the huge decline in our intakes of this vital fat.  Grass reared animals will have better omega 3 fatty acid levels, but nowhere near as high as in the past when animals were less intensively reared.

Dr Simopoulous has written many research and review papers about the importance of omega 3 fatty acids, and I am going to use some information from a fairy recent one (2) to provide the basis for this post.  She has also written many books including ‘The Omega Plan’.

It is thought that humans evolved on a diet that was very rich in essential omega-3 fatty acids, and a ratio of omega-6:omega-3 fatty acids of about 1:1 (or at most 2:1).  Currently the western diet has an imbalanced ratio of about 15:1 !!  This represents a huge shift and a relative ‘deficiency’ in omega-3 fats.  The excessive amounts of omega-6 fats and the very high omega-6:omega-3 ratio today is thought to be a major contributor to many of the diseases listed above.  A diet rich in omega-3 fatty acids and with a lower omega-6:omega-3 ratio is highly desirable for reducing the risk of many of the chronic diseases in the Western world.  Low intakes of omega-3 fats and higher intakes of omega-6 fats can lead to an increase in inflammation in the body since omega-3 fats are used by the body to make potent anti-inflammatory chemicals whereas too much omega-6 can lead to the production of pro-inflammatory chemicals by the body.

Nutrition can affect our genes and hence have an influence on disease.  Over the last 10,000 years our diet has drastically changed, especially over the last 150 years, to almost unrecognisable degrees in most people.  However, genetically we have not changed much (our DNA is much the same).  Our genes today are incredibly similar to those of our ancestors who lived around 40,000 years ago.  Our diet now is so very different, particularly in the type of fats we eat, and in the antioxidant nutrient content of our foods (antioxidants are found abundantly in vegetables and fruits) and this is surely affecting our health.

The review paper(2) details the ways in which our diet differs from that of our pre-industrial ancestors:
1. We have an increase in energy intake and a decrease in energy expenditure
2. Our diets are richer in saturated fat, omega-6 fats and trans fats and lower in omega-3 fats
3. We do not eat as much complex carbohydrates and fibre
4. We eat a huge amount more cereal grains and a reduced amount of fruits and vegetables
5. We eat less protein, antioxidants and calcium

Omega-6 fatty acids are found abundantly in our diets – most seeds, nuts, vegetable fats (vegetable seed oils) are omega 6 rich.  By contrast our diets are generally low in omega-3 fats: short chain omega-3 fats (alpha linolenic acid) are found in flaxseeds and walnuts (as well as chia and perilla seeds) and in their longer chain forms (EPA eicosapentaenoic acid and DHA docosahexaenoic acid) are found in oily fish.  The long chain omega-3 fats seem particularly important for our health and are found in concentrated amounts in the human brain.  The body can use the short chain omega-3 fats from the diet to form the longer-chain EPA and DHA forms but the process is far from efficient.  EPA and DHA are used by the body to produce the biological chemicals which have potent anti-inflammatory effects.  As a nutritionist I feel that it is essential we work toward increasing the intake of omega-3 and decreasing the intake of omega-6 fats in our diets in order to redress the omega-6:omega-3 balance (2).

If you feel that you do not eat oily fish regularly (you may be vegetarian or vegan or example), at least twice per week, then you may wish to consider taking an omega-3 fish oil supplement that provides around 250-300mg EPA and 250-350mg DHA per day.  Choose supplements that also contain vitamin E or another antioxidant since these protect the oil from degradation.  For vegans and vegetarian flaxseeds and walnuts represent good sources of the short chain omega-3 fatty acid – however, a flaxseed oil supplement that provides around 500-1000mg alpha-linolenic acid daily is worth considering.  Again, choose a supplement that contains a protective antioxidant.  There are now some vegan EPA and DHA supplements being produced from algae.  They are obtainable from only a few sources and can be expensive but their popularity and availability are rising and they are worth considering.

Dr Simopoulos offers 7 general dietary guidelines(1):
1.Enrich your diet with omega-3 fatty acids with cold-water fish, flax and walnut oil
2.Use canola, olive and flax oils as your primary oils
3.Eat seven or more servings of fruits and vegetables each day
4.Eat more peas, beans and nuts
5.Eat less saturated fat
6.Avoid oils high in omega-6 fatty acids such as corn, safflower, peanut, soyabean, sunflower and cottonseed oils – avoid products made from these oils
7.Avoid trans-fatty acids (found in many processed foods.  Trans fatty acids are used in the prepared food industry to prolong the shelf life of baked goods like biscuits).

In addition to this I would add that a healthy diet is one that contains minimal amounts of processed and refined foods.  Think natural! 

(1)http://www.1stvitality.co.uk/pdfs/Barleans_GB_dr_Simopoulos.pdf
(2)Simopoulos AP.  2008.  The importance of the omega-6/omega-3 fatty acid ratio in cardiovascular and other chronic diseases.  Exp Biol Med (Maywood).  233:674-688

Written by Ani Kowal

Diet and its impact on male fertility has long been discussed and debated among scientific, medical and health professionals.  I first started to look at the link between what we eat and fertility, in men and women, whilst studying for my MSc.  The research has been steadily growing over the years and it seems likely that diet does impact fertility.

A group of Spanish researchers have published two (1,2) studies this year which look at the link between diet and semen quality in men.  The studies seem to suggest that dietary antioxidant nutrients play a key role in the prevention of damage to sperm. 

I have written about dietary antioxidants in many previous blog posts.  They have been linked to a reduction in the risk of many conditions raging from cancer to heart disease, dementia and arthritis.  One of the reasons why fruit and vegetables are so important in our diets is because they provide many antioxidant nutrients, such as vitamins C and E and various antioxidant bioflavonoids (bioactive plant chemicals). 

Anitoxidants help to prevent damage to cells in our body (including sperm cells) by mopping-up destructive unstable oxygen molecules known as 'free radicals', these free radicals create what is known as oxidative stress in the body.  There is mounting evidence that these destructive molecules, together with lowered bodily antioxidant defences, play a significant role in the development and aggravation of many diseases and health problems.  The body does produce its own antioxidants but also relies on vitamins, mineral and phytochemicals (bioactive plant chemical) from the diet, especially from colourful vegetables and fruits, for additional valuable supplies.
 

In the first research study (1) the authors found that men who ate large amounts of meat (especially processed meat) and full fat dairy products had poorer quality sperm than those who ate more fruit, vegetables and reduced fat dairy products.  The study was a case-control study in which 30 men with poor semen quality (cases) were compared to 31 men with normal sperm quality (controls).  The investigators recorded the dietary habits and food consumption of the men using a specialised food frequency questionnaire.  The authors conclude that “Frequent intake of [lipophilic] foods like meat products or milk may negatively affect semen quality in humans, whereas some fruits or vegetables may maintain or improve semen quality”.  This study points towards associations between diet and fertility.  It is certainly plausible that a healthy diet and lifestyle can impact upon the health of semen. 

The second study(2) published by the same group of scientists this year was set up in order to compare the specific nutrient intakes between 30 men with normal sperm quality and 31 men with poor sperm quality.  Dietary habits and nutrient consumption were recorded using a food frequency questionnaire.  The analysis found that control subjects, the men with normal sperm quality, had a significantly higher intake of carbohydrates, fibre, folate, vitamin C, and lycopene and lower intakes of proteins and total fat than men with poor sperm quality.  The authors conclude that “A low intake of antioxidant nutrients was associated with a poor semen quality in this case-control study of Spanish men attending infertility clinics”.

Vegetables and fruits are full of antioxidant nutrients and flavonoids which may well be protecting the sperm from damage.  The lead author of the paper, Jamie Mendiola, said in a press release(3): “In this study, we have found that people who consume more fruits and vegetables are ingesting more antioxidants, and this is the important point", "We saw that, among the couples with fertility problems coming to the clinic, the men with good semen quality ate more vegetables and fruit (more vitamins, folic acid and fibre and less proteins and fats) than those men with low seminal quality".  "A healthy diet is not only a good way of avoiding illness, but could also have an impact on improving seminal quality.  What we still do not understand is the difference between taking these vitamins naturally and in the form of supplements”.

The authors are going to continue researching this topic in another study and are particularly going to investigate the role that supplements may have on sperm quality.  Obviously I am a great advocate of healthy eating and the basis of any healthy diet is an abundance of vegetables, fruits, healthy fats from nuts/seeds/oily fish, protein from unprocessed lean meats, pulses, beans and unprocessed/unrefined wholegrain carbohydrates.  For individuals who feel they often lack the five or more recommended portions of vegetables and fruits daily may wish to consider taking a good quality multi-vitamin and mineral supplement in order to provide for any nutrient shortfalls, however supplements should never be seen as an alternative to healthy living

(1)Mendiola J et al.  2009. Food intake and its relationship with semen quality: a case-control study.  Fertil Steril.  91:812-818
(2)Mendiola et al. A low intake of antioxidant nutrients is associated with poor semen quality in patients attending fertility clinics. Fertility and Sterility, May 2009; DOI: 10.1016/j.fertnstert.2008.10.075
(3)Plataforma SINC (2009, June 3). Semen Quality May Depend Upon Antioxidants In Man's Diet. ScienceDaily. Retrieved June 4, 2009, from http://www.sciencedaily.com¬ /releases/2009/06/090602083727.htm

Written by Ani Kowal

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

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

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

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

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

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

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

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

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

Written by Ani Kowal

Age related macular degeneration (AMD) is the most common cause of blindness in people over the age of 50 in the UK.  In March this year I wrote about the links between B vitamins, homocysteine and AMD and in August last year I discussed the links between diet in general and eyesight preservation.

The macular is the light sensitive area in the centre of the retina that controls visual field and the ability to see colours.  AMD is caused by the deterioration of the macular.  As this happens the peripheral, outer, vision remains intact as the centre field of vision becomes slowly blurry, grey or filled with a large black spot.  Two forms of AMD exists: the dry form which develops slowly, accounting for 90% of all cases; and the wet form which causes rapid deterioration of central vision.

The exact causes of AMD are unknown although free radical damage, where unstable oxygen molecules damage the eye cells, is strongly implicated.  Tobacco smoke and sun exposure can increase the level of free radicals in the body and both are a risk for AMD.  High blood pressure and diabetes are also risk factors as these conditions can limit blood flow to the eyes.

For more information please visit Macular Disease Society website.  The Macular Disease Society aims to build confidence and independence for those with central vision impairment.  They are the only UK charity dedicated to helping people with macular degeneration and offer information, a helpline, counselling and emotional support among other resources.

Evidence for diet and nutrition in the prevention, and to a certain extent treatment, of the condition is growing yearly.  Since free radicals are implicated in the causation and progression of AMD it may be that antioxidant nutrients such as vitamins A, C and E, carotenoids like lutein and zeaxanthin and various phytonutrients and flavonoids, bioactive plant chamicals, are protective.  Omega 3 fatty acids may also play a protective role via their anti-inflammatory effects.

This month three studies (1,2,3) have been published linking diet to AMD.

The first study (1) involved 4003 participants in the Age-Related Eye Disease Study (AREDS), there were 7,934 eyes included in the study.  Dietary intakes of vitamins C and E, zinc, lutein and zeaxanthin, the long chain omega 3 fatty acids DHA (docosahexaenoic acid) and EPA (eicosapentaenoic acid), and low-dietary glycaemic index foods were analysed and the association between AMD was evaluated.  The results showed that consuming diets that had a low glycaemic index and high intakes of the nutrients listed was associated with a reduced risk of AMD.
 

A healthy diet rich in a variety of vegetables, fruits, beans/pulses, nuts/seeds, unprocessed meats and fish, especially oily fish, and unprocessed, unrefined wholegrain carbohydrates will provide these nutrients.  Lutein and zeaxanthin are plant pigments that are found in broccoli, spinach, green leafy vegetables and egg yolks.

The study(1) also found that diets containing foods with a low glycaemic index, also appeared protective against AMD.  Glycaemic index is a measure of how rapidly a food causes blood sugar levels to rise. High-GI foods, like white bread, many processed foods (especially high carbohydrate foods) and potatoes, tend to spur a quick elevation in blood sugar, while low-GI foods, such as lentils, nuts, beans and many high-fibre unrefined grains, create a more gradual increase in blood sugar.  The blood-sugar surges associated with high-GI diets may eventually damage the macula.  This is probably because consistently high blood sugar levels can damage fats and proteins and may put the body into oxidative stress, which over time damages cells and may lead to various diseases, including AMD.

The other two studies (2,3) looked at the links between dietary fat intake and AMD.  In the blog post that I wrote in August last year I discussed many studies that linked a high intake of long chain omega 3 fatty acids, found in oily fish, to a reduced risk of AMD.  The first of these two studies (2) found that regularly eating foods rich in healthy fats such as fish, nuts and olive oil is associated with a reduced risk of AMD and the second study (3) has found that avoiding trans fats (often found in baked and processed foods) is also associated with a reduced risk of the condition.

The first report (2) involved 2,454 participants in the Blue Mountains Eye Study, which began in 1992. The individuals involved completed food frequency questionnaires that were used to analyse and determine their intake of various fatty acids. Digital photographs of the retina were used to assess the development of AMD five and ten years later.

Eating one serving of fish per week was associated with a 31% lower risk of developing early AMD. Eating one to two servings of nuts per week was associated with a 35% lower risk of early AMD.  It is not known for definite why the fatty acids are protective against AMD but the fats may be protecting the eyes by reducing inflammation, blood vessel formation or oxidative damage in the retina.  Omega 3 fatty acids are known to be helpful in reducing inflammatory chemicals in the body (I have previously written a lot about this in various blog posts).

The other report (3) analysed data from 6,734 individuals aged 58-69.  During the follow-up period, 2,872 cases of early AMD and 88 cases of late AMD developed.  Individuals who consumed higher levels of trans-unsaturated fats-often found in baked goods and processed foods-were more likely to have late AMD.  This study also found that individuals  who consumed the most omega-three fatty acids were less likely to have early AMD.

Trans-unsaturated fatty acids may be causing damage through their effect on cholesterol levels as well as through their inflammation increasing effects.  Trans fats are also linked to an increased risk of heart disease as well as other conditions.

Available ‘eye health’ supplements often contain vitamins C, E, beta carotene and the mineral zinc in addition to lutein and zeaxanthin.  The rationale behind this comes from dietary association studies and some research evidence.  If you are considering supplements remember that they are not a substitute for nutritious daily meals!  A healthy diet, rich in a variety of vegetables and fruits, will provide an array of antioxidant nutrients to keep the whole body healthy, including the eyes.  Healthy omega 3 fats from oily fish and nuts/seeds (especially flaxseeds and walnuts) are also a vital part of a balanced diet.  Individuals who do not regularly eat oily fish such as salmon, mackerel, sardines or trout (at least twice per week) may consider taking a fish oil supplement to provide 250mg-350mg EPA and 250-350mg DHA per day, vegetarians may consider a flaxseed oil supplement to provide 500-1000mg alpha-linolenic acid per day.

(1) Chung-Jung C et al.  2009.  Dietary compound score and risk of age-related macular degeneration in the age-related eye disease study.  Ophthalmology.  116:939-946
(2) Tan JSL et al.  2009.  Dietary Fatty Acids and the 10-Year Incidence of Age-Related Macular Degeneration.  The Blue Mountains Eye Study.  Arch Ophthalmol. 127(5):656-665.
(3) Chong EWT et al.  2009.  Fat Consumption and Its Association With Age-Related Macular Degeneration.  Arch Ophthalmol.  127(5):674-680.

Written by Ani Kowal

My last blog post explored some of the many health benefits of honey.  There are also other bee products that seem to be good for our health.  One such substance is propolis.

Bee propolis is a sticky, resin-like mixture of gums, resins and balms that the bees collect from plants and trees.  Propolis is used by the bees in hive construction and repair.  Recently this bee product has been gaining attention for the health giving properties it can provide.  In folk medicine is has been used for centuries.  Many hundreds of studies have been carried out using bee propolis and it is known that the substance possesses anti-bacterial, anti-viral, anti-ulcer and anti-tumour activities (1). 

The chemical composition of propolis is rather complex, it contains over 300 compounds including polyphenols, flavonoids (bioactive plant chemicals) and various organic acids (such as caffeic acid).  I have discussed flavonoids previously in many of my blog posts, they are also abundantly found in fruits and vegetables and act as powerful antioxidants in our bodies.  A recently published study (2) has found that propolis seems to be the most powerful antioxidant of all the bee products (compared with pollen, honey and royal jelly).  This antioxidant capacity is due to the various flavonoids and caffeic acid that propolis contains.

Antioxidants are linked to the reduction in the risk of many conditions raging from cancer to heart disease, dementia and arthritis.  One of the reasons why fruit and vegetables are so important in our diets is because they provide many antioxidant nutrients, such as vitamins C and E and various antioxidant bioflavonoids. Flavonoids act as antioxidants in the body, helping to prevent cell damage and protection against disease by mopping-up destructive unstable oxygen molecules known as 'free radicals', these free radicals create what is known as oxidative stress in the body.  There is mounting evidence that these destructive molecules, together with lowered bodily antioxidant defences, play a significant role in the development and aggravation of many diseases, including heart disease, stroke and cancer to name but a few. 

The body does produce its own antioxidants but also relies on vitamins, mineral and phytochemicals (bioactive plant chemical) from the diet, especially from colourful vegetables and fruits, for additional valuable supplies.

The researchers involved in the study of bee products (2) used a series of laboratory tests to measure how well the bee products were able to scavenge three different types of reactive oxygen species.  They found that a water extract of Brazilian green propolis had the strongest effects, followed closely by an alcohol propolis extract.  An extract of bee pollen collected from two bee species in Spain also had antioxidant effects, but was only about one-tenth as strong as the propolis extracts.  The propolis was found to have antioxidant capacities equivalent to those of vitamin C and a vitamin E derivative.

The results of the study are interesting, however whether these laboratory studies would translate to health benefits in human studies is yet unknown and further research will need to be undertaken before any firm conclusions can be drawn.  It may well be that propolis could have beneficial effects against some oxidative-stress related diseases in human.  Propolis supplements are widely available to buy and are usually marketed toward boosting and maintaining a healthy immune system and protecting against colds and viral infection.  

(1)Khalil ML.  2006.  Biological activity of bee propolis in health and disease. Asian Pac J Cancer Prev. 7(1):22-31.
(2)Nakajima Y et al.  2009.  Comparison of bee products based on assays of antioxidant capacities BMC Complement Altern Med. 9(1):4. [Epub ahead of print]

Written by Ani Kowal

National Honey Week runs from the 4th to the 10th of May and is organised by the Honey Association.  Honeybees are the most important producers of honey. They gather nectar from flowers and plants and carry it to the hive or nest. Other worker bees then take over, preparing it for storing by adding enzymes. Water evaporates away and this, together with the action of the enzyme, turns the nectar to honey.

Honey has been used therapeutically for many thousands of years.  It contains some hydrogen peroxide (which has a lot of antibacterial activity) as well as flavonoids and polyphenols (bioactive plant nutrients) and these components contribute to the anti-inflammatory, antimicrobial and antioxidant properties of honey.  Honey can be effective against fungal infections, bacteria, viruses and worms as well as a bacteria called Helicobacter pylori which is a significant cause of stomach ulcers.

As a child my mum would always give me hot lemon and honey to ease a sore throat, cough or cold and the sweet warm liquid always felt comforting and soothing.  A couple of years ago a study (1) discovered that there was something behind the folk tales, the scientists found that honey is an effective cough suppressant.

The research(1) involved over a hundred children aged 2-18 years who were suffering with upper respiratory tract infections with night time symptoms.  The aim was to compare the effects of a night-time dose of buckwheat honey or honey flavoured dextromethorphan, an ingredient found in over the counter cough medicines, on night time cough and sleep difficulty associated with childhood upper respiratory tract infections.  Treatment with either honey or medicine were compared to no treatment at all.

On the first evening no medication was given to the children.  On the second evening the children were given either honey or the honey flavoured medicine 30 minutes prior to their normal bed time.  The parents then filled in a questionnaire to record: Cough frequency, cough severity, bothersome nature of cough, and child and parent sleep quality.  There were significant differences in symptom improvement between the different treatment groups.  Honey consistently scored best and was significantly better than no treatment for cough frequency and a combined score for all measured outcomes.  The medicine containing dextromethorphan did not score better than 'no treatment' for any outcome measured!  Parents rated the honey most favourably for symptom relief of their child’s night time cough and sleep difficulty due to their respiratory tract infection.  More studies in this area would be very interesting.  It is not clear which particular property in honey was responsible for its favourable action, indeed it could be many reasons working together.  If you decide to try a warm honey drink for a cough or cold then do not use boiling water as this kills off some of the beneficial properties in the honey (let the boiled water cool a little before mixing in the honey).

Honey for healing wounds

Honey has been used for many years in wound care e.g. on cuts, grazes, skin ulcers and burns.  A recent review (2) of many studies concluded that honey may “improve healing times in mild to moderate superficial and partial thickness burns compared with some conventional dressings”.  Another trial (3) that took place in South Africa found that honey was very useful for treating shallow wounds and grazes.  The trial compared aloe honey with a conventional healing gel and it was found that honey was equally as effective.  Healing creams and gels containing active honey ingredients are now available to buy for use on cuts and burns, for example comvita Comvita Manukacare 18+ - Natural Skin Care

Honey for cold sores
In December I wrote about natural remedies for cold sore sufferers (herpes infection).  A study(4) in 2005 investigated the effect of topical honey application on recurrent attacks of herpes lesions on the mouth/lips and also on the genitals and compared the treatment with honey to the treatment with acyclovir cream, the active pharmaceutical ingredient of cold sore creams.  The study was small involving only 16 adults with a history of herpes lesions.  The adults treated one attack with honey and a subsequent attack with conventional acyclovir cream.

For attacks of herpes on the mouth/lips treated with honey the average duration of attacks was 35% shorter than when treated with acyclovir, pain was 39% better, occurrence of crusting was 28% less and healing time was 43% better.  For genital herpes, the mean duration of attacks was 53% shorter with honey than with acyclovir cream, pain was 50% better, occurrence of crusting was 49% better and healing time was 59%  with honey treatment.  Two cases of cold sore (mouth) herpes and one case of genital herpes remitted completely with the use of honey.  With acyclovir treatment, none of the attacks remitted.  No side effects were observed with repeated applications of honey, whereas 3 patients developed local itching with acyclovir.  The authors conclude that topical honey application is safe and effective in the management of the signs and symptoms of recurrent lesions from labial and genital herpes.  The lesions were firmly pressed with gauze soaked with honey for 15 minutes, four times per day day, until complete healing.  As mentioned above natural honey creams are available to buy and may be worth a try if you are a cold sore sufferer.  'Comvita Lipclear Cream - Maintain Healthy Lips' contains honey, propolis (another bee product that I will be writing about later in the week) and various vitamins which may also be useful in the healing of cold sores. 

What kind of honey is best?

There are hundreds of varieties and brands of honey available to buy.  Some types seem to be more effective, in terms of healing properties, than others.  One of the most researched honeys is Manuka honey which is widely available from health food stores and on the internet and is being used in creams and supplements.  The Honey Association say: 

“Manuka honey is produced by honeybees which gather nectar from the flowers of wild Manuka bushes that are indigenous to New Zealand. This particular honey is distinctively flavoured, with a rich taste and dark appearance.  Although all types of honey contain hydrogen peroxide (particularly known for its antibacterial properties), Professor Peter Molan of the Honey Research Centre at Waikato University in New Zealand has undertaken extensive research into maunka honey and believes it contains unique properties which provide additional support to the body's natural healing process.  Molan's research has shown that manuka honey has a high antibacterial potency which heals a range of conditions, from external skin infections to aiding digestion. Molan has also shown that manuka honey can help to fight throat infections and reduce gum disease. When eaten regularly it can aid memory, increase energy levels, improve well-being and reduce feelings of anxiety”

So why not sweeten up your week with a little honey?!

(1)Paul IM et al.  2007.  Effect of honey, dextromethorphan, and no treatment on nocturnal cough and sleep quality for coughing children and their parents.  Arch Pediatr Adolesc Med. 161(12):1140-6.
(2) Jull AB et al.  2008.  Honey as a topical treatment for wounds. Cochrane Database Syst Rev. Oct 8;(4):CD005083.
(3) Ingle R. et al.  2006.  Wound healing with honey--a randomised controlled trial. S Afr Med J. 96(9):831-5.
(4)Al-Waili NS et al.  2005.  Topical honey application vs. acyclovir for the treatment of recurrent herpes simplex lesions.  Med Sci Monit.  10(8):MT94-98.

Written by Ani Kowal

Back in January I wrote about the health benefits of Brazilian Acai berries.  These so called ‘superfoods’ are rich in antioxidant bioflavonoids (biologically active plant chemicals) which may help protect the body against many diseases.  However, these berries are very expensive and have to be shipped in from many miles away.  I was interested to find out if there were any ‘home-grown’ foods that were just as tasty but cheaper to buy and more available.

Cherries seem to come up trumps!  These fruits are delicious and UK grown varieties are readily available to buy from supermarkets and local markets.  Cherry season will soon be starting.  Supermarkets are starting to stock cherries now but most of these will be from other parts of the world.  In June and July UK grown cherries become available, these are cheaper to buy.  Both sweet and sour varieties are available.  For recipe ideas I suggest you check out the BBC food in season website.

A recent (1) study looking into cherries and their ability to boost antioxidant levels in the body was presented in New Orleans, America just a few days ago at the Experimental Biology 2009 conference.  The study (1) was small involving only 12 adults aged 18-25.  They were given weighed amounts of cherries to eat, specifically sour/tart charries of the Montmorency variety, their blood and urine was then analysed to check for antioxidant activity.  The researchers found that eating even a small amount of cherries (about a cup full) significantly boosted the antioxidant activity in the body for up to 12 hours.  The study documents that the antioxidants found in cherries do in fact make it into the human bloodstream.  More research is certainly needed but the antioxidant flavonoids found in cherries could have many benefits for our health.  For example, bioflavonoids have been found to be protective against heart disease, stroke and inflammation.  For more information on please read my previous blog post on flavonoids.

Another recently published study (2) found that both sweet and sour cherry varieties contain many active antioxidant bioflavonoids.  The group of antioxidants flavonoids found in cherries are known as anthocyanins, these give cherries their red colour.  Many laboratory studies have found that bioactive anthocyanins seem to possess antioxidant, anti-inflammatory, anticancer, antidiabetic and antiobese properties – these studies need to be confirmed in larger human trials before any definite conclusions can be drawn but evidence is growing for their importance to health.

Many different flavonoids are found abundantly in fruits and vegetables, which are so important for our health.  Vegetables and fruit should form the core of a healthy diet and getting a good variety daily will give the body many of the nutrients that are needed for optimal health.  Flavonoid supplements are now available to buy (including cherry anthocyanin supplements), though the evidence for their use is still in the early stages.  If you feel your diet is consistently lacking in vegetables and fruits you may want to consider a supplement to cover the shortfall, but remember supplements can never be considered as a replacement for a healthy diet.

For more information on the science supporting the unique health benefits of cherries please visit the 'choose cherries' website.

(1)Uhley VE et al.  2009.   Pharmacokinetic study of the absorption and metabolism of Montmorency tart cherry anthocyanins in human subjects.  2009 Experimental Biology meeting abstracts, Abstract #565.4; Accessed April 19, 2009
(2)Mulabagal V et al.  2009.  Anthocyanin content, lipid peroxidation and cyclooxygenase enzyme inhibitory activities of sweet and sour cherries.  J Agric Food Chem.  57:1239-1246

Written by Ani Kowal

On Monday I was discussing the benefits of traditional Mediterranean diets.  Today I wanted to take a look at a study that took place a little further afield. In China and Japan green tea has long been believed to have important health benefits.  These benefits are now being increasingly researched and studies are showing that green tea may be useful for the prevention of many conditions from heart disease to cancer.  The health benefits probably come from the many bioactive plant chemicals (flavonoids) that green tea contains, these may work through various mechanisms including via antioxidant means.

A recent study (1) investigated diet and breast cancer risk in Chinese women.  The rate of breast cancer in China is lower, around four times lower, than in the UK.  However, this rate is now increasing, especially in the more affluent parts of China.  Part of this increase in cancer cases is thought to be linked to a move away from a traditional Chinese diet toward a more Western style diet.

The study (1) involved 1009 women from Southeast China aged 20-87 who had been diagnosed with breast cancer between the years 2004 and 2005.   In addition to this, 1009 age-matched healthy women, with no breast cancer, were recruited to act as ‘controls’.  Dietary interviews and questionnaires were conducted amongst the women.  The researchers found that a higher dietary intake of mushrooms, both fresh and dried, was associated with a decreased breast cancer risk in premenopausal and postmenopausal Chinese women and an additional decreased risk of breast cancer was found from the additive or joint effect of mushrooms and green tea.

Traditionally mushrooms and green tea form a large part of the Chinese diet.  The study specifically found that women who ate 10g or more fresh mushrooms daily were about 60% less likely to develop breast cancer compared to those who did not eat mushrooms.  Women eating 4g or more of dried mushrooms daily were about half as likely to suffer with breast cancer compared to those not consuming dried mushrooms.  In addition, the risk of breast cancer was lowered further in women who drank green tea daily as well as consuming fresh and dried mushrooms.

The study is a preliminary study and does not prove that mushrooms and green tea protect against breast cancer.  However, investigating associations between diet and disease is always interesting and informative.  More research is certainly warranted in this area.

Mushrooms, green tea, vegetables and fruits in general are high in a variety of vitamins, minerals and phytochemicals or flavonoids (biologically active plant chemicals).  These ‘nutrients’ could be having a positive effect via a variety of complex mechanisms in our bodily cells e.g. through acting as powerful antioxidants.  Eating a healthy diet rich in these foods and low in refined and processed foods will help to provide all kinds of essential nutrients, as well as fibre, and may help to protect us from a variety of diseases.  The messages coming out of studies such as this one and the Mediterranean diet studies discussed on Monday is that eating ‘real food’ or what might be termed a more ‘traditional’ diet and minimising processed and refined food (fast foods and junk foods) in the diet is good for our health (which is not so surprising)!  Our bodies are complex machines which need the right fuel in order to function well.  Processed and refined foods contain calories but very little in the way of nutrients.  Traditional diets rich in a variety of fruits, vegetables, pulses, nuts and seeds, healthy fats, unprocessed meats and fish will provide us with the nutrients necessary for optimal health and wellbeing.  Sometimes we may fall short with our diets, taking a good quality ‘food-state’ multivitamin and mineral supplement together with an essential omega 3 fatty acid supplement is something that can be considered in order to make up for any lack during times of dietary deficiency.  Supplements, however, cannot be viewed as a substitute for long-term healthy eating!

(1)Zhang M, Huang J, Xie X, Holman CD.  2009.  Dietary intakes of mushrooms and green tea combine to reduce the risk of breast cancer in Chinese women.  Int J Cancer. 124(6):1404-8.

Written by Ani Kowal

Previously I have written about the Mediterranean diet and the positive effects it can have with respect to asthma, arthritis, heart disease, metabolic syndrome cholesterol and triglyceride levels.  Already this years there have been numerous papers published which extol the health benefits of following a traditional Mediterranean diet - high in vegetables, fruits, nuts, legumes/beans, fish (especially oily fish), healthy fats and wholegrains.  Low in processed foods, dairy products, red meats, and saturated fats.
 

A new study published in February 2009 (1) looked at the association between Mediterranean diet and mild cognitive impairment - a transitional stage between normal cognition (brain function) and dementia or Alzheimer's disease.  Previous studies have linked the following of a Mediterranean diet and a reduced risk of Alzheimer disease.  The researchers found that following a Mediterranean style diet was associated with reduced risk for getting mild cognitive impairment.  In addition to this, individuals who already had mild cognitive impairment and had a higher adherence to the Mediterranean diet had lower risk of going on to develop Alzheimer's disease.

The study took place in New York and involved 1,393 individuals with no cognitive difficulties at the start of the research and 482 individuals who showed mild cognitive impairment at the start of the study.  275 of the participants who had normal brain function at the start of the research developed mild cognitive impairment over about four and a half years during follow-up.  The researchers assessed the diets of the participants using specialised food frequency questionnaires.  Those who followed a diet closest to a traditional Mediterranean diet had a 28% lower risk of developing mild cognitive impairment compared to those whose diets differed the most from traditional.  The subjects with intermediate Mediterranean diet adherence scores had a 17% lower risk of developing mild cognitive impairment.  Among the group of people with mild cognitive impairment at the beginning of the study, 106 progressed to Alzheimer's disease during follow-up and good adherence to the Mediterranean diet was associated with a lower risk for this transition (1). 

The study was not a clinical trial, it was an observational study and cannot prove the link between following a Mediterranean diet and reduced risk of cognitive impairment.  However, it does point toward a strong association and provides us with indications of the importance of following a healthy eating regimen.  A Mediterranean style diet is also linked to lower blood sugar levels, better blood vessel health and reduced inflammation, all of which are associated with brain function.  There are many components in the Mediterranean diet which may be protecting the brain including omega 3 fatty acids from oily fish and numerous antioxidant vitamins and flavonoids (bioactive plant chemicals) from vegetables and fruits.  No doubt all of these components act together to reduce overall risk of cognitive impairment.  The key message seems to be to follow a healthy diet!

Another study published this February 2009 has found that women following a Mediterranean style diet seem to have a reduced risk of having a baby affected by spina bifida(2).  Spina bifida is a birth defect that occurs when the spinal cord fails to close completely.  Folic acid supplementation is now recommended to all women planning to get pregnant and in the early stages of pregnancy since supplementation has been shown to prevent the condition.  However, folate is not the only protective nutrient, a healthy diet as a whole is very important, folate is simply one major factor.  Observational studies found that in Southern Europe, where the Mediterranean diet originated, rates of spina bifida are lower.  The current paper wanted to investigate the link further.

The study took place in the Netherlands (2).  The researchers used a sample of 50 mothers who had children affected by spina bifida and compared their diet with 81 mothers of children who were not affected (these acted as a control).  The scientists studied the habitual diet of the mothers and also looked at their blood folate and vitamin B12 levels (among other factors).  Mothers who followed a predominantly Mediterranean style dietary pattern (high in vegetables, fruit, healthy fats, fish, legumes and wholegrains) had higher levels of folate and vitamin B12.  Mothers who did not follow a Mediterranean style dietary pattern were at increased risk of having a child with spina bifida.  In fact, women with the least Mediterranean-like diet were about three times more likely to have a child with spina bifida.  In other words, women who ate more fruit, vegetables, healthy oils, fish and whole grains were less likely to give birth to a child with spina bifida.  Again the study does not prove anything conclusively but certainly points towards the benefits of following a healthy, nutrient rich, diet to reducing the risk of haing a child affected by spina bifida.

Any woman who is planning a pregnancy and who is concerned that she is not eating a consistently healthy diet rich in vegetables, fruits and healthy fats may wish to consider taking a broad-spectrum food-state supplement specifically designed for pregnancy in order to main good levels of all nutrients.  An omega 3 fatty acid supplement could also be considered, especially if oily fish and nuts/seeds are not regularly eaten.  Before deciding to take a supplement please discuss your thoughts with a GP, nurse or midwife.

Yet another study published thi February (3) has linked the Mediterranean diet to a reduced risk of hypertension (high blood pressure).  The researchers of this study, which took place in Spain, evaluated 9,408 men and women who were free from high blood pressure at the start of the trial. Dietary intakes and patterns were assessed using specifically designed medically validated food frequency questionnaires, and a 9-point Mediterranean diet score was constructed.  After 4 years, adherence to the Mediterranean diet was not associated with protection against hypertension.  However, after 6 years follow up there was a significant link to reduced blood pressure and protection against hypertension.  This is an important finding since age-related changes in blood pressure increase is common and the study shows that following a Meditteranean type diet could contribute to the prevention of age-related hypertension.

A very recent study (4) not yet published in print has found that following a Mediterranean style diet is linked to a significantly reduced risk of metabolic syndrome, a condition linked to heart disease and diabetes and various other problems.  The study is interesting as it involved 808 individuals who already had a high risk of cardiovascular disease.  The researchers found that participants with the highest score of adhering to the Mediterranean diet had the lowest risk of having metabolic syndrome compared to those with lowest adherence scores.  Participants with the highest Mediterranean Diet adherence had 54% lower risk of having high blood fat levels, hypertriglyceridemia, a big risk factor for heart and other problems.

The key point here is that a healthy, balanced diet is very important for good health.  The Mediterranean diet is not a low fat regimen, it contains ample amounts of healthy fats from foods such as fish, nuts, seeds and olive oil and fruits such as avocado.  It is also full of vegetables, fruits and fibre.  A traditional Mediterranean diet is low in processed food and contains around 9 portions of vegetables and fruits a day, we are barely able to reach 5 here in the uk!  What we eat is crucial for our bodies (and our mind) to stay healthy, however if you find that you are not consistently eating 5 portions of vegetables and fruits a day you may wish to consider a good food-state multivitamin/mineral supplement together with an omega 3 fatty acid supplement from fish oil (providing around 300mg EPA and 300mg DHA daily) or flaxseed oil (providing 500-1000mg alpha linolenic acid daily).  Please remember that supplements are not a substitute for a healthy diet!

(1)Scarmeas N et al.  2009.  Mediterranean Diet and Mild Cognitive Impairment. Arch Neurol.  66 (2): 216-225
(2) Vujkovic M et al.  2009.  The maternal Mediterranean dietary pattern is associated with a reduced risk of spina bifida in the offspring. BJOG.  116(3):408-15
(3) Núñez-Córdoba JM et al.  2009.  The Mediterranean diet and incidence of hypertension: the Seguimiento Universidad de Navarra (SUN) Study. Am J Epidemiol.  169(3):339-46.
(4)Babio N et al.  2009.  Adherence to the Mediterranean diet and risk of metabolic syndrome and its components.  Nutr Metab Cardiovasc Dis. Jan 26. [Epub ahead of print]

Written by Ani Kowal

Currently it is Save Your Vision Month in America, a campaign run by the American Optometric Association (1).  The role that diet plays in preserving our eyesight is highly important and certainly worth a loud mention.  In August last year I wrote about cataracts and age related macular degeneration (AMD) and mentioned how diet, particularly omega 3 fatty acids from oily fish and antioxidants from vegetables and fruits, was important in preventing these conditions and preserving good eyesight.   In the UK Age-related Macular Degeneration (AMD) is the leading cause of blindness, with 45% of those registered as blind suffering from the disease.  For more info on AMD please read my previous blog post.

Very recently a paper was published (2) suggesting that B vitamins, particularly folic acid, vitamin B6 (also known as pyridoxine hydrochloride) and vitamin B12 (cyanocobalamin) may be particularly important for good eye health.  The study was conducted since previous research had indicated the links between homocysteine concentrations in the blood and the risk of age related macular degeneration (AMD).

I have previously written about homocysteine.  Most people are aware that high levels of homocysteine in the blood have been linked to an increased risk of heart problems.  Recently high homocystein levels have also been linked to poor bone health and other health problems.  To recap from my past blog posts: Homocysteine is produced when the amino acid (the building blocks of protein) methionine is broken down in the body.  Normal levels of homocysteine are important to help build and maintain body tissues, however elevated concentrations in the blood can be harmful and have been associated with an increased risk of many disorders.  At normal levels homocystein can be converted in the body into a harmless substance called cystanthionine.  The conversion of homocysteine into this harmless substance depends upon various B vitamins  (B6, B12 and folic acid).  Having good levels of these B vitamins appears to be a very good way of preventing high homocysteine levels and low levels of B vitamins have been associated with raised homocysteine levels.

The researchers of the eye health study (2) wanted to examine the incidence of AMD in a trial of combined folic acid, vitamin B6 and vitamin B12 therapy.  The trial was well designed and involved over 5000 women aged 40 or older with no diagnosis of AMD at the start of the trial.  These women received either a daily placebo supplement or a supplement containing 2.5mg folic acid, 50 mg vitamin B6, and 1g vitamin B12.  After around 7 years of treatment and follow-up it was found that the women receiving the supplement had a significantly reduced risk of AMD.   The women taking the multi-B vitamin supplement were around 35% less likely to develop AMD than those taking the placebo.

The research seems to support the idea that taking a multiple B vitamin supplements is useful for sight preservation.  It is not entirely clear whether the B vitamins worked to protect eyesight simply via lowering homocysteine levels.  These vitamins may have also been working via exerting antioxidant effects or by improving blood vessel function.  Further studies would be necessary to evaluate these ideas and strengthen data before strong recommendation for B vitamin supplementation can occur.

In the diet the B vitamins may be found in the following sources (vegetarians and vegans may wish to consider a multiple B vitamin supplement):
Vitamin B6 – Mainly found in meat, fish and eggs
Vitamin B12 – liver, meat, eggs, milk, yeast extract
Folic acid – liver, orange juice, green vegetables, nuts

Continuing with the theme of eye health.  Scientists at the University of Liverpool (3) have recently announced that the degeneration of sight caused by AMD could be reduced by up to 20% through dietary changes alone, specifically through the increase of vegetables, fruits and nuts in the diet.  Professor Ian Grierson, Head of Ophthalmology at the University of Liverpool, has produced a comprehensive cooking guide called 'Fruit for Vision', designed to add fruit and vegetables into everyday meals.  The recipes were formulated in order to help AMD sufferers slow down the degeneration process by increasing micronutrient, vitamin and antioxidant intake in the diet. Non-sufferers can also use the book to add fruit, nuts and vegetables into each meal to protect against the disease.

Professor Grierson said (3): "Poor eating habits have a huge impact on health in general and the health of your eyes is no exception. Eye problems such as AMD, cataract and even glaucoma can all be affected by what we eat. But a relatively minor change in diet - adding a little more fruit into our meals - can make a profound difference and can keep eye diseases like AMD at bay for up to 20% longer.  There are of course other risk factors related to AMD such as age, light exposure, smoking and being overweight. But if we can improve the kind of food that we eat, we could dramatically reduce the number of people who may suffer from eye diseases in the future."

Fruit for Vision is published by Indigo Creative Marketing and the Macular Disease Society. It provides easy recipes that incorporate fruit and nuts in to the diet. The recipes suggest minor additions to what we already eat, rather than major dietary changes.

Over in America, the AOA has also released information (4) in order to highlight the importance that diet and nutrition play in eye health.  The AOA highlights six nutrients important for eyesight:
Lutein, Zeaxanthin, Essential fatty acids, Vitamins C, Vitamin E, Zinc  
 
In their press release the AOA mention the following food sources of these specific nutrients:
Lutein and zeaxanthin: Colorful fruits and vegetables such as broccoli, spinach, kale, corn, green beans, peas, oranges and tangerines
Essential fatty acids: Oily fish like trout, salmon, sardines, or herring, nuts and seeds, whole grain foods, chicken and eggs
Vitamin C: Fruits and vegetables, including oranges, grapefruit, strawberries, papaya, green peppers and tomatoes
Vitamin E: Vegetable oils, such as safflower or corn oil, almonds, pecans, sweet potatoes, and sunflower seeds
Zinc: Lean red meat, poultry, liver, shellfish, milk, baked beans, and whole grains

(1)American Optometric Association (AOA)
(2)William G. Christen, ScD et al.  2009.  Folic Acid, Pyridoxine, and Cyanocobalamin Combination Treatment and Age-Related Macular Degeneration in Women.   The Women's Antioxidant and Folic Acid Cardiovascular Study.  Arch Intern Med.169(4):335-341.
(3)University of Liverpool – press release
(4) Open Your Eyes To Healthy Eating Habits – press release by the AOA

Written by Ani Kowal

In October of last year I wrote about eating for bone health and mentioned the clear and positive associations between fruit and vegetable consumption and strong bones (1).  The post concentrated mainly on the way these foods act to effect the pH balance within the body.  Fruits and vegetables contain a huge array of vitamins, minerals and phytonutrients/flavonoids (chemically active plant compounds) that may also act to strengthen bone.

Last month a paper was published in the American Journal of Clinical Nutrition (2) which points toward the bone protective effects of carotenoids.  Previous evidence suggests that carotenoids may be acting to prevent bone loss and also to stimulate bone cell growth. Carotenoids, found abundantly in fruit and vegetables, act as antioxidants in the body and it is this mechanism that may be protecting the bones from damage by naturally occurring unstable oxygen molecules in the body, known as free radicals.  Antioxidants may help to ‘quench’ the destructive free radical molecules and therefore protect against damage.  As nutrients, antioxidants are ingested in the diet and are then distributed via the blood into various parts of the body tissues, including the bones.  

The researchers involved in this latest study (2) looked at the potential effects on bone mineral density of overall and individual intake of several carotenoid compounds, including alpha-carotene, beta-carotene, beta-cryptoxanthin, lycopene, lutein and zeaxanthin.  The study scientists tracked the bone mineral density in the hip and spine of 213 men and 390 women over the course of four years.  They found that carotenoid intake was associated with some levels of protection against bone mineral density losses at the hip in men and at the spine in women.  The results suggest that carotenoids, especially lycopene, may be protective against bone loss in older adults.  Further studies are certainly needed but the evidence adds further weight to the mounting data which shows just how important fruits and vegetables are to the whole body, including our bones.

A diet rich in colourful fruits, vegetables will provide plentiful amounts of antioxidants.  Carotenoids are a family of over 700 naturally occurring yellow, red, orange and dark green pigments found in vegetables and fruits.  Good sources include carrots, sweet potatoes, tomatoes, squash, peppers, cantaloupe melons, nectarines, papaya, mango and dark green vegetables such as spinach, kale, watercress and asparagus.  Introducing a good mix of these fruits and vegetables on a regular basis in the diet will help keep carotenoid levels in the body high.

Absorption of carotenoids from foods into the body is greatly affected by fat.  Without a fat source carotenoids are not easily absorbed.  Fat acts as a carrier for these nutrients to allow them passage from the gut into our blood and bodily cells.  I am certainly not suggesting that you drown your vegetables or salads in gallons of oil, however, I am a firm believer in using small amounts of olive oil in dressings and cooking.  Including some nuts, seeds or olives in salads may also be helpful in order to gain maximum absorption of these important nutrients. 

If you are looking at carotenoid supplements, especially lycopene, look for those that contain an oil carrier, these will aid maximum absorption.  Of course fruits and vegetables contain far more than just carotenoids and a supplement cannot be seen as a substitute for good dietary habits, but if you feel that you do not get a good variety of vegetables and fruits in your daily diet you may wish to consider a supplement to help make up for any short-fall.

It is particularly important that young people look after their bone health, a balanced diet as well as exercise is vital in this respect.  Recently the National Osteoporosis Society (NOS) produced a press release and report regarding their findings that young people in the UK are endangering their health by not looking after their bones.  Prevention is the key to osteoporosis which affects up to three million people in the UK.

The NOS found that (3) that less than a quarter of people knew they should start looking after their bones before the age of 30, despite the fact that bone strength actually peaks during our 20s. Younger people need to ‘bank’ plenty of bone by the age of 30 as bones tend not to regenerate as quickly after that.  
• Almost half (49%) of young people (18-24 yrs) did not know there were any steps they could take to keep their bones healthy;
• More than half were unaware that exercise can help reduce the risk of osteoporosis;
• One in three did not know about the positive role diet can play.

Professor Roger Francis, Chair of the charity’s Medical Board, states(3):
 
“Our bones are living tissue, much like our skin. New bone replaces old throughout our lives. But the most crucial years are when we’re young as this is when the cells building new bone are most active. Until our mid 20s our bones are gaining density and strength. From our 30s onwards our bones gradually lose their density. The more we can build up our bones when we are young the better we can help to protect ourselves against osteoporosis and fragility fractures in later life.” (3)

Women are more at risk of developing osteoporosis since their bones are smaller and also more vulnerable to hormonal changes.  Being underweight, and having a low BMI (body mass index) is also a big risk factor.  Currently many girls and women are striving to reach a low bodyweight and achieve the size zero that is touted by so many celebrities.  The report found that only 21% of people knew that being underweight was a significant risk factor for osteoporosis development (3).

Encouraging young people to eat fruit and vegetables, as well as foods rich in calcium, magnesium and other minerals is very important for bone strength and development.  Please visit the National Osteoporosis Society website for more information about bone health. A very informative document about osteoporosis can be downloaded from the site and my post about eating for strong bones may also be of interest.

(1) New SA.  2003.  Intake of fruit and vegetables:implications for bone health.  Proc Nutr Soc.  62:889-899
(2) Sahni S et al.  2009.  Inverse association of carotenoid intakes with 4-y change in bone mineral density in elderly men and women: the Framingham Osteoporosis Study. Am J Clin Nutr 89: 416-424
(3) NOS press release

Written by Ani Kowal

Milk thistle (Silybum marianum), sometimes thought of as the detox herb, is a tall herbal plant with prickly leaves and a ‘milky’ looking sap.  The herb was being used medicinally in ancient Greece and continues to be used by many individuals today, especially to treat liver ailments.  Often the supplement is known as silymarin, which is the name of the major bioflavonoid, or active plant compound, found in the herb.

Many hundreds of studies have documented the usefulness of this herb.  Often people associate milk thistle with ‘detox’ regimens.  This is probably because there is some evidence to suggest that the herb can fortify or strengthen the liver.  The liver is the major detoxification organ of the body, it ‘cleans’ our blood and neutralises any toxins from the air, diet, metabolic processes or drugs/medicines.  The bioflavonoids in milk thistle appear to protect and strengthen the liver cells, possibly through antioxidant and anti-inflammatory processes and actions.  The herb also appears to help promote the regeneration of new liver cells in order to replace older damaged ones.  There also seems to be some indications that the herb helps in the prevention of cancer, possibly via its antioxidant capabilities.

A recent Hungarian research paper (1) reviewed the available evidence for milk thistle in the treatment of chronic liver diseases.  The most common serious liver problems are viral infections (hepatitis) and liver scarring (cirrhosis) often caused by alcoholism and fatty liver.  Many of the liver diseases are linked to damage by free-radicals, which are destructive oxygen molecules naturally present in the body, and the antioxidant capacity of milk thistle is probably why it is so useful.  The bioflavonoids found in milk thistle act as antioxidants and can ‘mop-up’ these free radicals.  (I have written about antioxidants numerous times in my blog posts). 

Antioxidants are linked to the reduction in the risk of many conditions raging from cancer, to heart disease, dementia and arthritis.  One of the reasons why fruit and vegetables are so important in our diets is because they provide many antioxidant nutrients, such as vitamins C and E and various antioxidant bioflavonoids.  The research paper discusses the findings that milk thistle benefits the liver through mechanisms such as strengthening cell membranes, acting as an antioxidant, helping liver cells to regenerate, reducing liver inflammation and helping to prevent liver scarring.  The paper(1) also discusses the significant antiviral activities of the herb which could account for its potential usefulness in helping patients with hepatitis. 

A recent laboratory cell study (2) looked at how the antioxidant bioflavonoids in milk thistle protect the cholesterol in our blood from becoming damaged or oxidised.  Oxidised cholesterol is far more dangerous to our bodies and poses an increased risk for heart disease.  Milk thistle appeared to be very potent in protecting against oxidation.  Similarly the antioxidants appear to be potentially important in the prevention of cancer (3,4).  It appears that milk thistle acts through a variety of cellular mechanisms in our body and not just through antioxidant capacity.  Further larger trials with this herbal supplement are certainly warranted to clarify its health benefits.

The antioxidant power of this herb may mean that it could be very useful as a dietary supplement in the prevention of all kinds of free-radical related diseases(6) such as liver problems, cancers, heart disease, dementia, arthritis and a whole host of others.  However, supplements are definitely not the whole story.  It is important to remember that supplements are not a substitute for a healthy diet.  Vegetables and fruits will provide an array of various antioxidant and other nutrients which are vital for our health.  A milk thistle supplement could be viewed as an extra boost for the body.  If you think you may have over-done the alcohol and pain-relief medicines recently and fancy strengthening your liver you could consider a short course (1-3 months) of milk-thistle supplementation in addition to a liver strengthening healthy antioxidant diet. 

(1)Fehér J & Lengyel G.  2008.  [Silymarin in the treatment of chronic liver diseases: past and future.] [Article in Hungarian]. Orv Hetil. 149(51):2413-8.
(2) Ferenci P et al.  2008.  Silibinin is a potent antiviral agent in patients with chronic hepatitis C not responding to pegylated interferon/ribavirin therapy.  Gastroenterology.  135:1561-1567
(3) Wallace S et al.  2008.  Milk thistle extracts inhibit the oxidation of low-density lipoprotein (LDL) and subsequent scavenger receptor-dependent monocyte adhesion.  J Agric Food Chem.  56:3966-3972
(4) Hogan FS et al.  2007.  Flavonoid, silibinin, inhibits proliferation and promotes cell-cycle arrest of human colon cancer.  J Surg Res.  143:58-65
(5) Ramasamy K & Agarwal R.  2008.  Multitargeted therapy of cancer by silymarin.  Cancer Letter.  269:352-362
(6) Asghar Z & Masood Z.  2008.  Evaluation of antioxidant properties of silymarin and its potential to inhibit peroxyl radicals in vitro.  Pak J Pharm Sci.  21:249-254

Written by Ani Kowal

Veins are vessels that carry blood to the heart and within them are valves that allow blood to travel in only one direction.  Sometimes these valves become weakened and do not close completely, this allows some blood to flow backward where it can end up collecting.  A condition known as chronic venous insufficiency occurs when veins in the legs cannot pump enough blood back to the heart.  The blood pools, legs may feel heavy and painful and the ankles may swell.  The condition often leads to the occurrence of varicose veins, a swelling and bulging of the veins. 

Varicose veins are most commonly seen in the legs and are not usually a serious causes for concern.  Sometimes blood and other fluid can leak out of the veins into the surrounding tissue, this is uncommon but severe and can cause scaly, itchy skin or fluid pooling and swelling in the legs.  Without attention varicose veins do tend to worsen and may need to be removed via surgery.  However, veins can be strengthened through a variety of means in order to prevent any chronic venous insufficiency and subsequent varicose veins.

Individuals who spend a lot of time standing in one position may be at a greater risk of developing varicose veins.  Genetic and hormonal factors may also be involved in the development of chronic venous insufficiency and varicose veins and obesity, lack of exercise, pregnancy and heavy lifting can aggravate the condition.

Fibre

There is some evidence to suggest that one of the causative factors of varicose veins is constipation.  It seems that straining in constipation can cause raised abdominal pressures which are transmitted to the veins of the legs, putting pressure on the valves (1,2).  Individuals who are susceptible to varicose veins may well benefit from looking to increase the amount of fibre in their diets.  Most of us in the UK tend not to include enough daily fibre in our diets and could well do with a boost!  Ensuring a good daily supply of vegetables, fruits, beans, pulses, oats, nuts and seeds will go some way to boosting daily fibre intakes.  Taking a prebiotic and/or probiotic supplement may also help prevent constipation and keep the digestive system functioning optimally.

Flavonoids

Flavonoids, or bioflavonoids, are bioactive plant compounds found in large quantities in vegetables and fruits.  Readers of my blog will be used to me mentioning them.  They have antioxidant, amongst other, actions within the body.  Procyanidins (or proanthocyanidins) are a subclass of flavonoids and studies have shown that they are useful in the treatment of symptoms associated with varicose veins (3,4,5,6).  One paper (3) analysed the data from several trials testing a herbal remedy in individuals with chronic venous insufficiency.  The supplement tested contained 150mgButchers broom (Ruscus aculeatus), 150mg hesperidin and 100mg vitamin C.  Butcher’s broom is an evergreen shrub native to the Mediterranean, it contains the flavonoids ruscogenin and neoruscogenin.  Herperidin is another type of bioflavonoid found mainly in citrus fruits.  The paper pulled together data from many trials, in total there was information from over 10,000 participants.  The supplement appeared to alleviate pain severity, feelings of heaviness in the legs and water retention.   

A study (7) examining the procyanidin content of some foods including; red wine, dark chocolate, cranberry juice and four varieties of apples found that, on average, dark chocolate and apples, especially Red Delicious and Granny Smith, contain the largest procyanidin content per serving.  Other good sources of these flavonoids include blueberries, grapes (especially the skins), peanuts and bilberries.  Incorporating procyanidin rich foods into the diet may prove beneficial to those suffering with, or wanting to prevent, varicose veins.  In general a diet rich in a wide variety of vegetables and fruits will provide a whole host of flavonoids to the body.   

Specific supplements for vein health are available and these tend to contain various classes of flavonoids.  You may wish to consider taking a supplement, in addition to a healthy balanced diet, in order to boost your dietary intake levels.

Horse Chestnut

Supplements are now available which contain extracts from the seed of the horse chestnut (Aesculus hippocastanum L.).  Horse chestnut has been traditionally used for many years to treat individuals with weak veins and varicose veins.  The benefit seems to come from a compound called escin, another type of flavonoid.  It appears to strengthen veins thereby preventing fluid loss and subsequent leg swelling.  Supplements and leg gels containing horse chestnut are readily available for treatment of the symptoms of varicose veins.  A study (8) reviewing the available evidence indicates that products containing horse chestnuts are helpful, especially in alleviating leg pain, feelings of leg heaviness and itching in patients suffering with varicose veins and other issues associated with venous insufficiency.

Other helpful advice
*Try to incorporate some form of exercise, such as walking, into your day
*Avoid crossing your legs whilst seated
*Avoid standing in one position for prolonged periods of time
*Elevate your legs when possible to prevent the blood from pooling in the veins
*Avoid tight clothes that constrict circulation
*Wear compression stockings, especially if you regularly sit or stand for prolonged periods of time

(1)Burkitt DP.  1976.  Varicose veins: facts and fantasy.  Arch Surg.  111(12):1327-32.
Fine AM.  2000.  Oligomeric proanthocyanidin complexes: history, structure, and phytopharmaceutical applications.  Alternative Medicine Review.  5(2):144-151.
(2)Lee AJ et al.  2001.  Fiber intake, constipation, and risk of varicose veins in the general population: Edinburgh Vein Study.  J Clin Epidemiol.  54(4):423-9.
(3) Boyle P, Diehm C, Robertson C. 2003.  Meta-analysis of clinical trials of Cyclo 3 Fort in the treatment of chronic venous insufficiency. Int Angiol.  22(3):250-62.
(4) Fine AM.  2000.  Oligomeric proanthocyanidin complexes: history, structure, and phytopharmaceutical applications.  Alternative Medicine Review.  5(2):144-151.
(5)Gomez Trillo JT.  1973.  Varicose veins of the lower extremities:  Symptomatic treatment with a new vasculotrophic agent.  Prensa Med Mex.  38:293-296
(6)Royer RJ et al.  1981.  [Evaluation of venotropic drugs by venous gas plethysmography. A study of procyanidolic oligomers.]  Sem Hop.  57:2009-2013
(7)Hammerstone JF et al.  2000.  Procyanidin content and variation in some commonly consumed foods.  Journal of Nutrition.  130(8):2086-2092S.
(8) Suter A, Bommer S, Rechner J.  2006.  Treatment of patients with venous insufficiency with fresh plant horse chestnut seed extract: a review of 5 clinical studies. Adv Ther.  23(1):179-90

Written by Ani Kowal

So called ‘super-foods’ are constantly being given press attention.  One moment it is broccoli, the next it is blueberries.  Recently there has been a lot of enthusiasm for a Brazilian berry called the Acai Berry, pronounced ah-sigh-ee.  These berries are available as drinks, supplements and dried snacks and commonly used in mixed juices, smoothies, frozen treats and dietary supplements.

Acai palms grow in the Brazilian rainforest and can reach great heights, in excess of 60 feet!  The acai fruit, or berry, is about the size of a large blueberry and only the outermost layers of the fruit (the pulp), which surround the large seed inside, are edible.

The berry has gained interest in the health arena since it is packed with antioxidant bioflavonoids, chemically active plant compounds, that may protect against many ills (please see my numerous posts discussing antioxidants for more information).  Until now there has been very little scientific research to support the health claims surrounding the acai berry.  However, in a recent issue of the Journal of Agricultural and Food Chemistry three papers were published which investigate the antioxidant properties of the Acai Berry (1,2,3).  The findings are important since they show that the antioxidants from the berry are easily absorbed for utilisation in humans and the berries were also found to have anti-inflammatory as well as antioxidant properties. 

In laboratory cell studies it also appears that the berry shows activity against cancer cells.  However, like vitamin C, the body can only absorb a certain amount of the antioxidants from the berry in one go.  The researchers of the papers say that their results are preliminary but interesting and lots of further research studies will be needed before any specific health claims for the berry can be made.

Acai berries are naturally low in sugar and the flavour has been described as a tasty mixture of red wine and chocolate!  Again, it is a matter of dietary balance.  Eating an abundant variety of different vegetables and fruits will provide the body with a whole host of different vitamins, minerals and bioflavoids and therefore provide us with the best defence against illness.  Variety is very important, acai berries can certainly be a very delicious and nutritious part of that variety but cannot be seen as a stand-alone superfood cure all.  Acai containing foods and supplements cannot act as an overall substitute for a healthy diet, but can rather be seen as an added antioxidant boost for the body.

Making the berry a part of your well-balanced and healthy diet and lifestyle could certainly prove to be a scrumptious option!

(1)Jensen GS et al.  2008.  In Vitro and in Vivo Antioxidant and Anti-inflammatory Capacities of an Antioxidant-Rich Fruit and Berry Juice Blend. Results of a Pilot and Randomized, Double-Blinded, Placebo-Controlled, Crossover Study.  J Agric Food Chem.  56:8326-8333
(2)Mertens-Talcott SU et al.  2008.  Pharmacokinetics of anthocyanins and antioxidant effects after the consumption of anthocyanin-rich acai juice and pulp (Euterpe oleracea Mart.) in human healthy volunteers.  J Agric Food Chem.  56:7796-7802
(3)Pacheco-Palencia LA et al.  2008.  Absorption and biological activity of phytochemical-rich extracts from Açai (Euterpe oleracea Mart.) pulp and oil in vitro.  J Agric Food Chem.  56:3593-3600

Written by Ani Kowal

Dark chocolate, the varieties containing 85% -90% cocoa solids, is something that I really do enjoy (as regular readers of my blog will already know)!  I take comfort in knowing that this treat is also quite healthy.  Numerous studies have now linked the eating of dark chocolate to a reduced risk of heart disease and cancers, as well as other conditions.  The health benefits appear to come from the antioxidant flavonoids (bioactive plant nutrients) contained within the cocoa and also from the many minerals that cocoa contains such as magnesium.  Dark chocolate also contains fibre and is much lower in sugar than milk chocolate, so most people find that they need far less to satisfy their chocolate cravings.

As a child I remember being told not to spoil my appetite by eating too much chocolate before the Christmas meal so I was pleased to read a report produced by the Faculty of Life Sciences (LIFE) at the University of Copenhagen, the paper details some research that the scientists there have carried out on dark chocolate and appetite (1).

The scientists have found that dark chocolate is far more filling than milk chocolate and may lessen our craving for milk chocolate which is sweet, salty and provides very little in the way of nutrition.  Eating a few squares of good quality dark chocolate, 70% cocoa solids or over, may well satisfy chocolate cravings and hence prevent further binges and large Christmas weight gains.

To compare the effects of dark and milk chocolate on both appetite and subsequent calorie intake, 16 young, healthy men of normal weight who all liked both dark and milk chocolate took part in an experiment over two separate sessions.  In the first instance dark chocolate was tested and in the second stage, occurring on a different day, milk chocolate was tested.  Prior to the experiment all the participants fasted for 12 hours, so they were hungry.  They were than given 100g of chocolate to consume within 15 minutes.  The calorie content of both the dark and milk chocolate was the same.  After they had eaten the chocolate they were asked to register their appetite every half an hour for the next five hours.  Two and a half hours after having eaten the chocolate the individuals were offered pizza and instructed to eat until they felt comfortably satisfied.  The results were analysed by the scientists and were significant in that after eating dark chocolate the individuals consumed 15% fewer calories from the pizza than when they had eaten milk chocolate.  The participants also recorded that they felt less like eating after consuming the dark chocolate, it made them feel fuller for longer. 

So, in addition to providing us with nutrients and antioxidant, dark chocolate may well help to fill us up and prevent us from over-indulging on unhealthier foods this Christmas.  The appetite controlling effects of the dark chocolate could be down to the nutrients it contains or perhaps the fibre content.  Of course, I am not suggesting gorging on dark chocolate but a few pieces may not be as bad as you once thought!!

Nuts are another Christmas food that some people tend to avoid, thinking they are fatty and full of calories.  As I mentioned last week, nuts are a healthy natural food and we could all do well from eating a regular handful of unsalted, unroasted nuts.

Nuts are packed with nutrients, fibre and healthy fats.  Numerous studies suggest that people who regularly consume nuts (around 30g per day) are slimmer than those who do not.  Nuts also make a great snack as they help dampen the appetite and prevent later overeating.  The fat in nuts is mainly monounsaturated fat, the same as olive oil, which appears to reduce risk of heart disease.  Nuts are also rich in vitamin E, magnesium, potassium and fibre - all of these nutrients are great for heart health.  Brazil nuts are also very high in selenium which is linked to a reduced risk of cancer and walnuts contain omega 3 fatty acids which have many health properties.

Previously I posted a blog dedicated to the health benefits of almonds.  A recent review (2) summarised the available evidence on nuts and body weight and weight loss.  The authors write  “There are claims that energy-dense foods are especially problematic for weight loss and maintenance. Nuts are among the most energy-dense foods consumed, yet the literature consistently documents little impact of their ingestion on body weight”  Nuts seem to satisfy the appetite, they make us feel full and may therefore prevent us overeating on other, less nutritious foods.  This could be due to the fact that, as well as healthy fats, nuts also contain protein and release their energy very slowly into the bloodstream,they have a very low glycaemic index or GI. Evidence also suggests that not all of the fat in nuts is absorbed into the body, much of it being passed out in the stool. 

Cracking a few nuts this Christmas may be a great way to boost health!

(1)University of Copenhagen
(2) Mattes RD et al.  2008.  Impact of peanuts and tree nuts on body weight and healthy weight loss in adults. J Nutr 2008;138:1741S-1745S

Written by Ani Kowal

One of my friends suffers from recurrent cold sores, every time she is a little stressed or her immune system is weakened by a cold she, more often than not, gets a painful cold sore blister on her lip. 

Cold sores are caused by a virus known as Herpes simplex Type I (HSV-I), this is different form the type II herpes simplex virus responsible for genital herpes (HSV-II).  Once contracted, the cold sore virus remains dormant (inactive and causing no symptoms) in the body, usually within our nerve cells.  In a healthy, strong body the immune system tends to keep the virus under control.  However, the virus can reactivate at any time and lead to blisters forming around the mouth, but also on the gums or inner cheeks.  Recurrences typically occur when the immune system becomes stressed by a fever, cold or other viral infection.  Excessive tiredness, fatigue, stress and menstruation can also lead to a cold sore forming.  Initially the cold sore appears as a painful and/or itchy fluid-filled small blister, this then breaks to form a scab which usually remains for up to 10 days.

In previous posts I have written about how to keep the immune system strong and healthy in order to prevent against infections.  This general advice will help to keep the body generally strong and able to prevent the herpes virus becoming active.  A diet rich in vegetables and fruits, healthy fats (especially the omega 3 fatty acids found in oily fish) and within minimum inclusion of processed foods seems to be the key.  However, if you are prone to cold sores there are a few specific recommendations that may help prevent cold sore recurrences.  There are also things that can be done once a cold sore has erupted in order to minimise the pain and discomfort caused and reduce the number of days that the blister remains.  Much of the evidence was collated in a review paper(1) that I will use as a basis for this post.

The amino acids Lysine and Arginine
The HSV-I virus requires a specific amino acid (the building blocks of proteins), called arginine, in order to multiply in the body.  However, a different amino acid, lysine, appears to inhibit/prevent the replication of the virus.  Lysine seems to block or ‘antagonise’ arginine via several complex mechanisms in the body.  There are many studies(1) which show that a lysine supplement can reduce the frequency, duration and severity of cold sore attacks.  In order to keep the virus at bay it may be useful to take 500mg of lysine daily, this can increase to 500mg twice, or three times daily during a cold sore attack.

Vitamin C and bioflavonoids
In previous posts I have written about the immune boosting properties of the antioxidant vitamin C and flavonoids (bioactive plant compounds).  A diet rich in vegetables and fruits will provide abundant amounts of vitamin C and flavonoids and I would suggest eating at least five portions a day (there are so many associated health benefits!!).  Studies have shown that supplemental vitamin C and flavonoids appear helpful in reducing the duration of a cold sore attack (1) and more recent laboratory studies have shown that various flavonoids appear helpful for inactivating the virus (2,3).  You may want to think about taking extra amounts of these nutrients daily (via a supplement) as a preventative measure to help keep the immune system strong, especially if you frequently struggle to eat at least five portions of vegetables and fruits daily.  During an attack 500mg Vitamin C with 200mg bioflavonoids twice to three times daily may be helpful.  For daily prevention 200mg vitamin C and 100-200mg flavonoids daily could be useful.

Topical treatment/creams
Most people who suffer from cold sores use popular the over-the-counter creams, which contain a pharmaceutical agent called acyclovir and can sometimes cause burning and stinging, but are keen to look for a more natural cream.  There are several studies looking into different agents which can be applied to the cold sore in order to minimise the redness and the length of duration of the blister/scab.  There are studies which indicate that honey (4), Bee propolis (5,6), vitamin E (7,8) and lemon balm, Melissa officinalis, (9,10,11) may all be helpful in minimising the viral blisters, reducing pain, itchiness or duration of attack.

In the study with honey (4) the average duration of cold sore attack, pain, occurrence of crusting and average healing time were all better with the honey treatment than with the acyclovir cream.  The authors of the study remark that:  “Topical honey application is safe and effective in the management of the signs and symptoms of recurrent lesions from labial and genital herpes”

Those wishing to try a more natural cream may be interested in one that I recently came across Comvita Lipclear Cream - Maintain Healthy Lips I have not tested the cream myself but it contains all of the agents mentioned above: honey, propolis, Vitamin E and lemon balm.  It also contains lysine which may be an added bonus.

Please do read my previous posts related to boosting immune health.  Any action which keep the immune system healthy and strong is likely to minimise the chance of recurrent cold sore attacks. 

(1)Gaby AR.  2006.  Natural remedies for Herpes simplex.  Alternative Medicine Review.  11:93-101
(2) Isaacs CE et al.2008.  Epigallocatechin gallate inactivates clinical isolates of herpes simplex virus. Antimicrob Agents Chemother.  52(3):962-70.
(3) Lyu SY, Rhim JY, Park WB.  2005.  Antiherpetic activities of flavonoids against herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2) in vitro.  Arch Pharm Res.28(11):1293-301.
(4) Al-Waili NS et al.  2005.  Topical honey application vs. acyclovir for the treatment of recurrent herpes simplex lesions.  Med Sci Monit.  10(8):MT94-98.
(5) Huleihel M et al.  2002.  Anti-herpes simplex virus effect of an aqueous extract of propolis.  Isr Med Assoc J.  4(11 Supplement):923-927.
(6) Giurcaneanu F et al.  1988  [Treatment of cutaneous herpes and herpes zoster with Nivcrisol-D].  Virologie.  39(1):21-24, 1988.
(7)Fink M et al.  1980.  Treatment of herpes simplex by alpha-tocopherol (vitamin E).  Br Dent J.  148:246.
(8)Nead DE.  1976.  Effective vitamin E treatment for ulcerative herpetic lesions.  Dental Survey.  52:50-51.
(9)Dimitrova Z et al.  1993.  Antiherpes effect of Melissa officinalis L. extracts.  Acta Microbiol Bulg.  29:65-72.
(10)Wolbling RH et al.  1994.  Local therapy of herpes simplex with dried extract from Melissa officinalis." Phytomedicine.  1:25-31.
(11)Koytchev R et al.  1999.  Balm mint extract for topical treatment of recurring herpes labialis.  Phytomedicine.  6:225-230

Written by Ani Kowal

There are many hundreds of studies relating brain function to nutrition and I am never sure where to begin trying to relay these to you via this blog – the volume of available evidence always seems so daunting!  Last week I wrote about just one nutrient, vitamin B12 and cognition/mental function.  Fortunately for me one group of scientists, headed by Dr Fernando Gomez-Pinilla, have now published an extensive review paper (1) which analyzed more than 160 studies investigating various different foods and nutrients and how they affect the brain.  A concise press release was published on the UCLA newsroom website (2) and I am going to pick out some of the major findings in my post today.

Dr Fernando Gómez-Pinilla is a member of California’s largest university, UCLA, and works within the Brain Research Institute and Brain Injury Research Centre.  Together with his colleagues he decided to look into how a balanced diet and regular exercise can protect the brain and ward off mental disorders.  Dr Gomez-Pinilla looked at over 160 published studies and believes that food acts like a pharmaceutical agent in the way it can affect the brain.  He also believes that diet, exercise and sleep can, potentially, alter brain health and mental function.
 

It has long been suspected that different nutrients can affect cognitive (mental) processes and emotions.  The paper reviews new evidence exploring the nutrients and the mechanisms by which they may be responsible for the action of diet on brain health and mental function.  So many key nutrients came up as being important.  Omega 3 fatty acids, flavonoids, curcumin, B vitamins, Vitamin D, Vitamin E, Vitamin C, Calcium, zinc, selenium and carotenoids, to name but a few!  The mechanisms by which they positively affect our brain function and cognition are complex and intricate.

Omega 3 fatty acids, found most abundantly in oily fish (such as salmon, mackerel and trout), flaxseeds and walnuts came up trumps, yet again!  These fats are essential for normal brain function and the research suggests that they provide many benefits, including improving learning and memory and helping to fight against mental disorders such as depression, mood disorders, schizophrenia, and dementia.  In contrast to the healthy effects of diets that are rich in omega-3 fatty acids, the studies seem to indicate that diets high in trans fats (often found in processed foods) and saturated fats adversely affect cognition. 

The brain is highly susceptible to oxidative damage (by free radicals).  Antioxidants provided by the diet (such as vitamins A, C and E and flavonoids), found most abundantly in fruits and vegetables, seem very important in protection (many of my previous posts have discussed the importance of antioxidant nutrients).
 
 
Surprisingly what you eat may also affect future generations.  Dr Gomez-Pinilla found that recent research also supports the hypothesis that health can be passed down through generations, and a number of innovative studies point to the possibility that the effects of diet on mental health can also be transmitted across generations  "Evidence indicates that what you eat can affect your grandchildren's brain molecules".

Another interesting reference to brain structure and health was made by a group of scientists (also from UCLA) in a recently published paper (3) which was highlighted in The Times newspaper (4) this month.  The shocking headline reported that our peak age for mental health is 39 years old!!

The study was small, involving 72 men between the ages of 23-83, and the researchers evaluated brain function by testing speed of movement via finger tapping – how many times participants could tap their finger in 10 seconds.  Usually the speed of response slows as we age probably because the fatty ‘myelin’ sheath surrounding our nerves starts to deteriorate which causes responses to slow.   The researchers found that myelination of the brain neurones (nerves) was significantly correlated to finger tapping speed and reached a peak at 39 years of age, declining thereafter.  Keeping our brain myelin 'healthy' seems to be very important for this specific form of brain function (called maximum motor speed).  Although the study only involved men it is likely to be the same in women.

 In The Times newspaper the authors reveal how myelin can be damaged via excess alcohol:  “The brain is made of fat, so when you get drunk you’re basically dissolving your brain.  A glass of wine may have a beneficial effect, but if you get drunk it’s malfunctioning.  As the alcohol leaves the brain tries to repair itself but if you keep doing it, it won’t repair itself fully” (4)

The researchers also suggest that the decline in brain myelination can be diminished (GREAT NEWS!), even halted, by regular exercise, good sleep and a healthy diet including at least one gram of fish oil a day, to provide omega 3 fatty acids, and plenty of colourful vegetables and fruits which are rich in antioxidants that help to prevent free radical damage, which may damage myelin.

The newspaper article also ends on a more positive note.  Although the area of the brain tested seems to declines after the age of 39 there are other areas where the circuitry still repairs itself: wisdom, for instance, is apparently strengthened with age “ most older people have better impulse control than when they were younger because as they age, this circuit continues to myelinate and brings all their knowledge online so that they can make a decision better and faster, even though their movements may be slower”.  The researchers give the following example “It’s the Michael Jordan effect.  He retired as a basket-ball player because those neurons controlling his speed and athleticism had started breaking down, but he went on to run a multi-million-dollar empire, which he probably couldn’t have done at 25”

The take home message from these published papers is to try and live a healthy lifestyle, to exercise, get good sleep and eat an unprocessed diet rich in nutrients and omega 3 fatty acids.  Future research is bound to throw up more dietary wisdom.  As Dr Gomez-Pinilla says:  “Understanding the molecular basis of the effects of food on cognition will help us to determine how best to manipulate diet in order to increase the resistance of neurons to insults and promote mental fitness”(1).

If you are not a lover of oily fish then you may wish to take an omega 3 supplement providing around 250mg EPA and 250mg DHA per day.  For vegans and vegetarians a flaxseed oil supplement providing around 500mg alpha-linolenic acid per day may be useful.  Antioxidants are best provided by vegetables and fruits, if you worry that you are not getting at least 5 portions a day you may consider taking a low dose multi-vitamin and mineral supplement.  I personally prefer 'food-state' nutrients as they are easily absorbed by the body and not made with isolated chemicals.

(1)Gómez-Pinilla F et al. Brain foods: the effects of nutrients on brain function. Nature Reviews Neuroscience, 2008; 9 (7):568-578
(2) UCLA newsroom 09/07/08  Scientists learn how what you eat affects your brain byStuart Wolpert
(3) Bartzokis G et al.  2008.  Lifespan trajectory of myelin integrity and maximum motor speed. Neurobiol Aging. 2008 Oct 14. [Epub ahead of print]
(4)Alexandra Blair.  Thursday November 6th 2008.  If 39 is our mental peak then my brain is in big trouble. The Times 2. Page 6-7

Written by Ani Kowal

On July 28 I wrote about coenzyme Q10 and the ability it has to potentially boost exercise performance.  Today I want to look into the antioxidant capabilities of this coenzyme and how these may relate to post exercise muscle pain.  A study published recently in the British Journal of Nutrition (1) found that CoQ10 supplementation reduced exercise-induced muscular injury in athletes.

When we exercise intensively we may actually cause damage to our muscle tissue.  This damage is believed to be causal in post-exercise muscle fatigue, pain and inflammation.  Intense exercise seems to be linked to the production of free radicals (unstable oxygen molecules).  These free radicals are quite destructive and can cause all kinds of problems within the body if they are not dealt with properly by natural bodily antioxidant systems.  These destructive free-radicals are believed to be behind some of the post-exercise issues in intense exercisers.

The body does produce its own antioxidants but also relies on vitamins, mineral and phytochemicals (bioactive plant chemical) from the diet, especially from colourful vegetables and fruits, for additional valuable supplies.

The production of free radicals within the muscles seems to increase in proportion to the intensity of exercise, as you push yurself harder during exercise more free radicals will be produced, and as mentioned above these free radicals may be responsible for some of the muscle damage, inflammation and pain experienced post-exercise(2).  Normally during the day, whilst we move around and at times of gentle and moderate exercise free radicals are generated at a low rate and are taken care of by our well developed antioxidant systems.  However, during intense exercise a greatly increased rate of free radical production may exceed the capacity of our natural antioxidant defence system.  Consequently, a substantial attack of free radicals on our cell membranes may lead to cell damage and could initiate inflammation and then pain or fatigue. 

 
Coenzyme Q10 is naturally produced by the body and was first isolated in 1957, it is essential for energy production in all bodily cells and also acts as an antioxidant in the body.  The study mentioned at the start of this post (1) found that individuals who were supplemented with CoQ10 had less evidence of free radical damage after intensive exercise than those who were not supplemented.

Exercisers who have a high intensity exercise regimen (exercise for over an hour 4 or more times a week) may want to look at the possibility of taking extra antioxidant supplements (to boost the natural antioxidant systems in the body), which could include a Co Q10 supplement.  It is also important to ensure the diet includes a minimum of 5 portions of vegetables and fruits.  These foods are naturally packed with antioxidant vitamins, minerals and flavonoids which are easily absorbed by the body and are also associated with reducing the risk of a number of diseases (including heart disease and cancer).

Coenzyme Q10 itself is found in many foods but is particularly concentrated in nuts and oils.  The body does produce this nutrient naturally and does not rely on external sources.  In order to produce CoQ10 we require various essential cofactors.  These include a variety of vitamins especially of the B group (Folic Acid, Vitamin B2, The Niacinamide form of Vitamin B3, Vitamin B5,Vitamin B6, Vitamin B12) and Vitamin C .  Hence a healthy diet rich in fruits, vegetables, wholegrain cereals and lean proteins will aid the natural production of this coenzyme and help to keep our circulating levels high.

(1)Michihiro K et al.  2008.  Reducing exercise-induced muscular injury in kendo athletes with supplementation of coenzyme Q10.  BJN.  100:903-909
(2) Sjodin B et al.  1990.  Biochemical mechanisms for oxygen free radical formation during exercise.  Sports Medicine.  10(4):236-254.

Written by Ani Kowal

As you are aware from my previous posts I champion vegetable and fruit consumption.  These treasures are abundant in taste, texture, vitamins, mineral and fibre.....but they are also full of bioflavonoids, or flavanoids (members of the polyphenol family).  Flavonoids are bioactive plant compounds which have gained increasing amount of publicity over the last few years.  Scientists have been looking into the health benefits of these plant compounds and quite a lot of interesting data has been coming to light.

A yet to be published review article(1) looked at polyphenols (mainly found in grapes) and their role in health and found that these compounds may help to reduce the risk of heart disease.  The authors of the study state that “Consumption of grape and grape extracts and/or grape products such as red wine may be beneficial in preventing the development of chronic degenerative diseases such as cardiovascular disease".  Grape seeds, grape skin and grape juice contain many different polyphenols including; resveratrol, anthocyanins and flavonoids – you may be familiar with these names as they are widely available as supplements.  In conclusion to this review the authors say "supplementation with grape seed, grape skin or red wine products may be a useful adjunct to consider for a dietary approach in the prevention of cardiovascular diseases, although additional research is required to support such a strategy"

Flavonoids act as antioxidants in the body, helping to prevent cell damage and protection against disease by mopping-up destructive unstable oxygen molecules known as 'free radicals' (I have mentioned antioxidants and their role in health previously a number of times).  Polypheonols also seem to have other protective effects on the heart and blood vessels.  They seem to prevent blood clotting, abnormal heart beat and blood vessel narrowing.  As yet scientists are not exactly sure of how these plant compounds act, however they do seem to positively change the way our genes function.

Another recently published study(2) looked at the association between a variety of flavonoids and the risk of cardiovascular disease and stroke.  The scientists studied 1950 Finish men aged between 42-60 who were free from prior heart disease or stroke.  Participants were followed for an average of 15 years and during this time over 100 strokes and 150 cardiovascular disease deaths occurred.  Data analysis revealed that men who consumed the highest amounts of flavonoids had a greatly reduced risk of stroke and there was also a reduced risk of death from cardiovascular disease.  The results are unsurprising as fruit and vegetables are the major sources of flavonoids and there is plenty of data to show that these foods protect us from all kinds of diseases including stroke and heart disease.  The interesting point comes from the fact that the analysis took into account various vitamin intakes suggesting that the flavonoids themselves make a real impact on health.

Yet another study published just this month (3) highlights the health benefits of flavonoids, this time their potential role in weight maintenance and prevention of weight gain.  The researchers of this study looked at the association between flavonoids and BMI (body mass index, a measure of overweight) over a 14 year period in 4280 men and women aged between 55-69 years.  The results showed that women with the highest intake of flavonoids experienced a significantly lower increase in BMI over the study period.  Again, this is not surprising.  Individuals who eat a lot of vegetables and fruits tend not to fluctuate in weight and stay leaner.   

Now onto two pieces of research (4,5) which I am particularly fond of as they involve dark chocolate!  Readers of my blog will know my penchant for dark chocolate.  Dark chocolate containing 85%+ cocoa solids is something I truly adore and really savour the moment of one bitter square slowly melting over my tongue!  Drinking black cocoa is also something I enjoy.  The health benefits of cocoa have been publicised over the last few years and evidence that cocoa may help in the prevention of many conditions, such as cancer and heart disease, is mounting.  Cocoa is packed with great minerals such as magnesium and is also ‘choc’ full of flavonoids.

A very recent study(4) suggests that cocoa consumption may be good for the heart (great news since I would have trouble giving it up!).  The researchers investigated the short-term effects of eating either solid dark chocolate or drinking liquid cocoa on blood vessel function and blood pressure.  The small study included 45 adults who were overweight but healthy (and not obese) who were, on average, 53 years old.  In the first stage of the trial the participants consumed a bar of dark chocolate containing 22g of cocoa powder or a cocoa-free bar.  In the second stage the participants drank sugar-free cocoa containing 22g cocoa powder, cocoa containing sugar or a placebo containing no cocoa.

Eating dark chocolate and drinking sugar-free cocoa improved blood vessel function compared to placebo and blood pressure decreased in individuals who ate the dark chocolate bar or drank the sugar-free cocoa, compared to those who consumed the placebo.  The researchers conclude by saying “The acute [short term] ingestion of both solid dark chocolate and liquid cocoa improved endothelial [lining of the blood vessels] function and lowered blood pressure in overweight adults. Sugar content may attenuate [reduce] these effects, and sugar-free preparations may augment [improve] them”

The other small study(5) found that flavonoid rich cocoa was associated with a significant increase in blood flow to the brain, as measured via a special sort of ultrasound (Transcranial dopler ultrasound).  The authors suggest that their data could indicate a promising role for regular cocoa consumption in the treatment and prevention of stroke and dementia.

These studies were very small and preliminary but I found them interesting!!  I would like to add that this is not a plug to justify regular chocolate binges (although it does help me to feel better about my dark chocolate habit)!  The cocoa used in these studies, and other studies that link cocoa to health benefits such as lowered risk of heart disease, was high flavanol cocoa and only a very small amount was used daily.  Sugary, sweet milk chocolate won’t provide the health benefits discussed (sorry to be the bearer of sad news!). 

Flavonoids and polyphenols in general are found abundantly in fruits and vegetables, which are so important for our health.  Vegetables and fruit should form the core of a healthy diet and getting a good variety will give the body many of the nutrients that are needed for optimal health.  Flavonoid supplements are now available, though the evidence for their use is still in the early stages.  If you feel your diet is lacking in vegetables and fruits you may want to consider a supplement to top-up and cover the shortfall, but remember supplements are not a replacement for a healthy diet.

(1)http://www.elsevier.com/wps/find/authored_newsitem.cws_home/companynews05_01042 Mounting evidence shows health benefits of grape polyphenols.  Philadelphia October 28.  Due to be published in the November issue of Nutrition Research
(2)Mursu J et al.  2008.  Flavonoid intake and the risk of ischaemic stroke and CVD mortality in middle-aged Finnish men: the Kuopio Ischaemic Heart Disease Risk Factor Study.  BJN.  100:890-895
(3)Hughes L et al.  2008.  Higher dietary flavone, flavonol, and catechin intakes are associated with less of an increase in BMI over time in women: a longitudinal analysis from the Netherlands Cohort Study.  Am J Clin Nutr.  88:1341-1352
(4)Faridi Z et al.  2008.  Acute dark chocolate and cocoa ingestion and endothelial function:a randomised controlled crossover trial.  Am J Clin Nutr.  88:58-63
(5) Sorond FA et al.  2008. Cerebral blood flow response to flavanol-rich cocoa in healthy elderly humans. Neuropsychiatric Disease and Treatment. 4:433-440

Written by Ani Kowal

Unfortunately one of my very dear friends is seriously unwell, so I started writing this from the 9th floor of St Thomas’s hospital.  There are hand wash points all over the place in a bid to prevent the spread of infection.  Any hint of a sniffle and I would not be allowed to set foot onto the ward.  So, I am doing my very best to keep my immune system strong! 

In the past I have written about the prevention and treatment of colds and coughs and generally about the immune system and how to keep it strong.  It is the time of year when the cold and flu virus sis rife and people are very interested in how they can escape the infections that seem to be surrounding them.  Earlier this week I was made aware of the potential benefits of Black Elderberry extract (brand name Sambucol®) for the prevention and alleviation of the influenza virus.  I wanted to delve into the scientific research to discover if there is fact behind the hype.

Black Elderberry (sambucus nigra), a member of the honeysuckle family, is a tree-like shrub.  Traditionally various parts of the plant, including the leaves, bark, flowers and berries, have been used in medicine.  The health giving properties have been documented as far back as the 5th century.  Currently much of the interest and research has focussed on extract from the berries.  Research(1) suggests that elderberry has antiviral properties, especially against the influenza virus, and also seems to activate and boost the immune system as well as acting as an antioxidant.

The berries contain various bioactive plant compounds, known as flavonoids, as well as certain vitamins (C, A and various B vitamins), that appear to be responsible for the positive effects on the immune system and our health.

Sambucol® is a supplement that contains 38% standardised extract of black elderberry.  Research(2,3) suggests that elderberry extract appears to boost and activate the immune system in individuals who are healthy as well as those who are already suffering from a viral infection.

Two small well planned studies (randomised, placebo-controlled, double-blind studies 4,5) found that Sambucol® effectively inhibited the influenza A and B virus strains when given orally to patients in the first 48 hours of flu symptoms developing.  The earlier preliminary study (4) was very small, involving only 27 patients, but demonstrated the ability of elderberry (4 tablespoons of Sambucol® syrup per day) to reduce influenza symptoms in 20% of influenza patients within 24 hours and to reduce influenza symptoms in 75% of patients within 48 hours.  After three days of elderberry use, 90% of influenza patients experienced a total alleviation of symptoms. 

The most recent study (5) involved 60 patients aged 18-54 years who had just began (48 hours or less) to suffer from flu-like symptoms.  Participants received 15 ml of elderberry or placebo syrup four times a day for 5 days, and recorded their symptoms using a special scale.  In the participants receiving the elderberry syrup the symptoms were relieved, on average, 4 days earlier and use of rescue medication was significantly less compared those receiving placebo.  The study was small but very encouraging, the findings need to be confirmed in a larger study.

The underlying mechanism (1) for elderberry’s effectiveness in the treatment of influenza virus was discovered by an Isreili virologist, Dr Mumcuoglu.  The berry seems to be able to prevent and inhibit the replication of the influenza virus.  The active compounds within the elderberry seem to ‘coat’ or neutralise the spike-like projections that are found on the surface of several viruses, including the influenza viruses.  When these spikes are deactivated the virus is prevented from piercing the human cells, so the virus does not enter our cells and is prevented from replicating.  Unlike bacteria, a virus cannot replicate on its own, it must attack living cells in order to survive.  If the virus is prevented from entering our cells it will be unable to survive and cause us to suffer health problems.

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

The elderberry extract, Sambucol®, is widely available in the UK as a liquid or lozenge.  The products can be taken as a preventative or at the first signs of cold or flu-like symptoms.  A healthy diet (rich in fruit and vegetables) is obviously the most important way to keep the immune system strong, healthy and effective.  However, if you are surrounded by people with colds, or worried about the ‘flu-season’ taking an elderberry extract may well give your immune system an extra boost and help you to fight off invading infections. 

(1) Sambucus nigra - monograph.  2005.  Altern Med Rev.  10(1):51-54.
(2) Barak V et al.  2001.  The effect of Sambucol® , a black elderberry-based, natural product, on the production of human cytokines:I.  Inflammatory cytokines.  Eur Cytokine Netw.  12:290-296
(3) Barak V et al.  2002.  The effect of herbal remedies on the production of human inflammatory and anti-inflammatory cytokines.  Isr Med Assoc J.  4:S919-S922
(4) Zakay-Rones Z et al.  1995.  Inhibition of several strains of influenza virus in vitro and reduction of symptoms by an elderberry extract (Sambucus nigra) during an outbreak of influenza in Panama.  Journal of Alternative and Complementary Medicine.  1(4):361-369.
(5) Zakay-Rones, Z et al.  2004.  Randomized study of the efficacy and safety of oral elderberry extract in the treatment of influenza A and B virus infections.  J Int Med Res.  32(2):132-140.

Written Ani Kowal

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

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

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

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

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

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

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

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

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

Written by Ani Kowal

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

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

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

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

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

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

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

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

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

Check back later in the week for information regarding osteoarthritis.

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

Written by Ani Kowal

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

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

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

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

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

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

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

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

Written by Ani Kowal

Coronary heart disease (CHD) is the leading cause of death in the UK, looking after our hearts is very important!  However, at recent conference(1) it was disclosed that almost half of us (48%) do not know what CHD is, recognise the symptoms or know what increases the risk.  I hope to provide a little insight here.

CHD covers two main issues, heart attack and angina (severe chest pain).  “Coronary heart disease occurs when the coronary arteries (the arteries that supply blood and oxygen to the heart muscle) become narrowed by a gradual build-up of fatty material within their walls.  This condition is called atherosclerosis and the fatty material is called atheroma.  In time, the artery may become so narrow that it cannot deliver enough oxygen containing blood to the heart muscle, particularly at times when there is more demand -such as when you are exerting yourself. The pain or discomfort that happens as a result is called angina.  If the atheroma becomes unstable, a piece may break off and lead to a blood clot forming. If the blood clot blocks the coronary artery, the heart muscle is starved of blood and oxygen and may become permanently damaged. This is known as a heart attack.”(2)

The symptoms of CHD are varied and can include: shortness of breath, palpitations/irregular heartbeat, chest pain, jaw pain, arm pain, dizziness, fainting. 

Risk factors are also varied and include: smoking, unhealthy/unbalanced diet, overweight, obesity, lack of exercise, excessive alcohol consumption, emotional/psychological stress, social isolation, diabetes and high blood pressure.  The good news is that relatively simple dietary and lifestyle changes can protect the heart.

A fantastic resource that I highly recommend is The British Heart Foundation website.  There you can read, in detail, about risk factors, dietary advice and you can also download factsheets and information booklets.  There is a section dedicated to CHD prevention, which is key, it covers diet, weight, diabetes, cholesterol, smoking, diabetes, family history, stress and counselling.

Today I just wanted to cover a few points in relation to diet and heart health.

Fruit and Vegetables
The recommendation to consume vegetables and fruit for protection from heart disease is supported by an ever-growing body of evidence.  Much evidence is drawn from studies linking higher consumption of vegetables and fruit to a lower risk of CHD (e.g. 3,4,5).  I would like to highlight one of the most recent studies(6).  The researchers found that that the benefit of fruit or vegetable consumption in reducing the risk of CHD increased proportionally by the number of servings consumed. Those consuming the most fruit (more than five portions per day) had a 60% lower risk for coronary heart disease when compared to those eating one or fewer portions per day.  Consumption of vegetables more than three times daily was associated with a 70% lower risk of CHD compared to individuals who did not eat vegetables.  Consumption of fruits and vegetables really does seem to provide significant protection against coronary heart disease!  So Tuck in! 

Vegetables and fruit are probably acting to protect against CHD through a variety of relevant substances including numerous vitamins and carotenoids, minerals, phytonutrients (bioactive plant chemicals) and fibre.  Many plausible mechanisms can explain how these various nutrients or bioactive constituents in vegetables and fruit can prevent CHD.  Try and include a variety of different vegetables and fruits in your daily diet.  Each meal can contain a portion or two e.g. chop fresh fruit, or sprinkle a handful of unsweetened dried fruit into museli or yoghurt at breakfast time, include a side salad with lunch, snack on fruit or vegetable sticks rather than cereal bars, biscuits or other refined foods and aim to include at least two types of vegetable with your evening meal.
 

Supplemental vitamins and minerals
Taking vitamin and mineral supplements should not be seen as a substitute for a healthy diet.  Supplements are void of many other substances found within fruit and vegetables which may be useful in CHD prevention such as phytochemicals (bioactive plant chemicals) and fibre.  However, there is a lot of evidence that has looked at specific nutrients in the prevention of CHD (too much evidence to list), vitamins such as the B vitamins, vitamin E and D, antioxidant vitamins such as vitamin C and many carotenoids and minerals such as magnesium and selenium may be useful protective agents.  If you feel that your diet is not rich in a variety of vegetables and fruits (at least 5 a day) you may wish to consider taking a broad-spectrum multivitamin and mineral supplement to ensure an adequate supply.  There are so many available supplements, it can be a mind-boggling experience trying to choose a product!  If you do decide to go down the supplement route I would recommend what are known as ‘food state’ multivitamin and mineral supplements.  These are easily absorbed by the body and are produced from food sources, rather than the usual chemical-isolate form of product.

Wholegrain cereals
Incorporating wholegrain foods into the diet may help to reduce the risk of CHD.  Whole grain foods (e.g. corn, barley, rye, oats & rice) in their most un-refined and natural form are rich sources of fibre, antioxidants, vitamins, minerals and phytonutrients, all of these probably act together to help protect the body against CHD.  Many studies demonstrate that the consumption of whole grain foods may help to reduce the risk of CHD (e.g. 7,8,9).  I would like to stress the importance of UN-REFINED foods.  There are many products that now advertise the fact that they are wholegrain but they may also be loaded with added sugar and have a high GI, high glycaemic index (i.e. they release sugar quickly into the bloodstream) and I certainly wouldn’t recommend their inclusion into the daily diet.  Be label savvy and look at the ingredients to see what you are buying.

Check back later this week for more heart healthy tips in Part II 

(1)British Pharmaceutical Conference 2008 http://www.bpc2008.org/
(2)British Heart Foundation http://www.bhf.org.uk/
(3) Rissanen TH et al.  2003.  Low intake of fruits, berries and vegetables is associated with excess mortality in men: the Kuopio Ischaemic Heart Disease Risk Factor (KIHD) Study.  J Nutr.  133(1):199-204.
(4) Liu S et al.  2000.  Fruit and vegetable intake and risk of cardiovascular disease: the Women's Health Study.  Am J Clin Nutr.  72(4):922-8
(5) Joshipura KJ et al.  2001.  The effect of fruit and vegetable intake on risk for coronary heart disease.  Ann Intern Med.  134(12):1106-14
(6)Nikolic M et al.  2008.  Fruit and vegetable intake and the risk for developing coronary heart disease. Cent Eur J Public Health. 16(1):17-20.
(7)Jacobs DR et al.  1999.  Is whole grain intake associated with reduced total and cause-specific death rates in older women?  The Iowa Women’s Health Study.  Am J Public Health.  89:1-8
(8)Rimm EB et al.  1996.  Vegetable, fruit and cereal fibre intake and risk of coronary heart disease among men.  JAMA.  275:447-451
(9)Liu S et al.  1999.  Whole-grain consumption and risk of coronary heart disease: results from the Nurses’ Health Study.  Am J Clin Nutr.  70:412-419

Written by Ani Kowal

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

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

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

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

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

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

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

Written by Ani Kowal

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

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

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

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

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

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

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

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

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

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

Written by Ani Kowal

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

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

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

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

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

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

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

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

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

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

Written by Ani Kowal

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

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

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

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

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

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

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

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

Written by Ani Kowal

My eyesight is something that I value very highly.  Without my spec's or contact lenses I have very limited vision.  Looking after my eyes, in order to prevent further long-sightedness in later life, is certainly high on my agenda.  Age Related Macular Degeneration (AMD) is the most common cause of blindness in people over the age of 50 in the UK and I feel that it deserves a little attention! 

The macular is the light sensitive area in the centre of the retina that controls visual field and the ability to see colours.  AMD is caused by the deterioration of the macular.  As this happens the peripheral, outer, vision remains intact as the centre field of vision becomes slowly blurry, grey or filled with a large black spot.  Two forms of AMD exists: the dry form which develops slowly, accounting for 90% of all cases; and the wet form which causes rapid deterioration of central vision.

The exact causes of AMD are unknown although free radical damage, where unstable oxygen molecules damage the eye cells, is strongly implicated.  Tobacco smoke and sun exposure can increase the level of free radicals in the body and both are a risk for AMD.  High blood pressure and diabetes are also risk factors as these conditions can limit blood flow to the eyes.

Evidence for diet and nutrition in the prevention, and to a certain extent treatment, of the condition is growing yearly.  The latest study was published in the August volume of the American Journal of Clinical Nutrition(1) and adds to the growing body of research(2,3,4,5,6,7,8) suggesting that oily fish and the long chain omega 3 fatty acids they provide, EPA and DHA (eicosapentaenoic acid and docosahexaenoic acid), may be preventative. 

This recent study(1) assessed the dietary intake data and photographic eye evidence of 105 individuals with AMD and compared it to 2170 control individuals (without any features of AMD).  All participants were aged 65 or over.  The researchers found that eating oily fish at least once per week compared with less than that was associated with a 50% reduced likelihood of having AMD.  There was no benefit from eating non-oily, white fish.  There was also a strong significant association between intake levels of DHA and EPA and AMD.  Individuals eating around 300mg or more of these fatty acids per day were 70% less likely to have AMD.  Two (75g) servings of oily fish, such as salmon, mackerel, sardines or trout, provides around 500mg of DHA and EPA 

The scientists are not yet recommending omega 3 supplements as the study did not investigate whether supplements would have the same benefit as dietary sources.  However, evidence for the potential benefits of fish oil (long chain omega 3 fatty acid) supplements is beginning to emerge, with one very recent study(5) finding that 800mg of DHA per day over 2-4 months was associated with beneficial changes in the macular. 

Omega 3 fatty acids are incredibly important for many aspects of health (and I have mentioned them throughout my blog postings).  Including at least two portions of oily fish per week is certainly recommended, however, many individuals in the UK do not achieve these intakes for various reasons.  A daily fish oil supplement providing around 250mg of EPA and 250mg DHA may be something worth considering (for general health).  For vegetarians and vegans a flaxseed oil supplement providing around 500-800mg of alpha-linolenic acid (a short chain omega 3 fatty acid which the body can convert to the longer chain forms) daily is a good way of ensuring a daily supply of these essential fats.

The other important nutrients worth discussing in relation to AMD prevention are the antioxidant carotenoids lutein and zeaxanthin, naturally found in foods such as spinach, collard greens and kale.  Research data(9,10,11,12) suggests that individuals with high dietary intakes of lutein and zeaxanthin, and high body levels of the carotenoids, have a reduced risk of developing AMD.  Supplements of these nutrients are now widely sold and targeted at eye health.  The supportive evidence for supplementation is not yet solid.  A small study(13) has shown benefit and paves the way for larger studies.  A very recent review(14) of the currently available evidence, published last month, concluded that “A definite association between lutein and zeaxanthin supplementation and clinical benefit has yet to be hown; however, it may still be an appropriate cautionary measure for patients at high risk for developing AMD”

Available ‘eye health’ supplements often contain vitamins C, E, beta carotene and the mineral zinc in addition to lutein and zeaxanthin.  The rationale behind this comes from dietary association studies and some research evidence.  If you are considering supplements remember that they are not a substitute (more of a bonus) for nutritious daily meals!  A healthy diet, rich in a variety of vegetables and fruits, will provide an array of antioxidant nutrients to keep the whole body healthy, including the eyes.

(1)Augood C et al.  2008.  Oily fish consumption, dietary docosahexaenoic acid and eicosapentaenoid acid intakes, and associations with neovascular age related macular degeneration.  American Journal of Clinical Nutrition.  88:398-406
(2)Chong EW et al.  2008.  Dietary omega-3 fatty acid and fish intake in the primary prevention of age-related macular degeneration: a systematic review and meta-analysis.  Arch Ophthalmol.  126:826-833.
(3)SanGiovanni JP et al.  2007.  The relationship of dietary lipid intake and age-related macular degeneration in a case-control study: AREDS Report No. 20.  Arch Opthalmol.  125:671-679
(4)Seddon JM et al.  2006.  Cigarette smoking, fish consumption, omega-3 fatty acid intake, and associations with age-related macular degeneration: the US Twin Study of Age-Related Macular Degeneration.  Arch Opthalmol.  124:995-1001
(5)Johnson EJ et al.  2008.  The influence of supplemental lutein and docosahexaenoic acid on serum, lipoproteins, and macular pigmentation.  Am J Clin Nutr.  87:1521-1529
(6)Cho E et al.  2001.  Prospective study of dietary fat and the risk of age-related macular degeneration.  Am J Clin Nutr.  73:209-218
(7)Seddon JM et al.  2001.  Dietary fat and risk for advanced age related macular degeneration.  Arch Opthalmol.  119:1191-1199
(8)Smith W et al.  2000.  Dietary fat and fish intake and age related maculopathy.  Arch Opthalmol.  112:222-227
(9)Seddon JM et al.  1994.  Dietary carotenoids, vitamin A, C and E and advanced age-related macular degeneration.  JAMA.  272:1413-1420
(10)Bone RA et al.  2000.  Lutein and zeaxanthin in the eyesm serum and diet of human subjects.  Experimental Eye Research.  71:239-245
(11)Bone RA et al.  2001.  Macular pigment in donor eyes with and without AMD:A case-control study.  Invest Opthalmol Vis Sci.  42:234-240
(12)Gale CR et al.  2003.  Lutein and zeaxanthin status and risk of age-related macular degeneration.  Invest Opthalmol Vis Sci.  44:2661-2465
(13)Richer S et al.  2004.  Double-masked, placebo-controlled, randomised trial of lutein and antioxidant supplementation in the intervention of atropic age related macular degeneration: the Veterans LAST study (Lutein Antioxidant Supplementation Trial).  Optometry.  75:216-230)
(14)Zhao L & Sweet BV.  2008.  Lutein and Zeaxanthin for macular degeneration.  Am J Health Syst Pharm.  65:1232-1238

Written by Ani Kowal

One of my close friends is pregnant (I am very excited)!  We were chatting about pregnancy health and the topic of preeclampsia came up.  Recently a study(1) was published which suggests that increasing the amount of fibre eaten during early pregnancy may help to reduce the risk of preeclampsia developing later.  I thought now was as good time as any to look into this complex topic further!

Preeclampsia is a serious condition also known as: pregnancy-induced hypertension (PIH); proteinuric gestational hypertension; and toxaemia of pregnancy.  It is a form of high blood pressure (hypertension) that develops in conjunction with water retention (oedema) and/or excess protein in the urine (proteinuria).  Around 3% of all pregnant women suffer from preeclampsia each year and this condition is the principal cause of maternal death in the UK.  Around 10 mothers and 1000 babies die each year as a result of the effects of preeclampsia and the condition is also the most common reason for elective (often early) delivery.  Usually preeclampsia occurs between the 20th week of Pregnancy and the end of the first week postpartum.  The earlier it presents in pregnancy the more threatening it can become.

As I began my research last week I thought this post would be relatively short.  Going back to my 2001 MSc lecture notes there was not a whole lot of dietary/nutrition related evidence to work with.  However, as I began to search through recent medical databases I was pleased and enthralled with the emergence of new information.  The definitive causes of preeclampsia are not known and there are many theories.  Nutritional factors, however, do seem to be at play. 

Keep body weight in check:
Maternal overweight and obesity places women at risk.  A BMI (body mass index) greater than 25 is seen as a risk.  To work out your BMI divide your weight in kg / by your height in metres² (height x height) or use an online BMI calculator e.g. the NHS calculator.  A recent study(2) also shows that gaining a lot of weight during pregnancy may be a risk factor.  This study looked at 34,143 women age 18-34 who were already overweight at the start of their pregnancies.  Gaining more than 15lb during pregnancy was a significant risk factor for the development of preeclampsia and gaining more than 25lb increased the risk further.  The lowest risk of adverse outcomes was for women who gained 6-14lb.

Dietary fibre:
The study(1) mentioned in my opening paragraph was carried out because evidence already exists for the beneficial effects of fibre in reducing hypertension (high blood pressure).  1538 pregnant women were involved in the study and their dietary intake was assessed 3 months before and during early pregnancy.  Women with the highest dietary fibre intake (more than 21g/day) had a significantly reduced risk of preeclampsia when compared to women with the lowest dietary fibre intake (less than 12g/day).  These are important findings, as I have mentioned in previous blog posts the average intake of fibre in the UK is low (around only 12g/day).  The recommended daily intake is currently set at 18g/day in the UK, however for optimal health many experts regard at least 25g/day as necessary. 

This most recent study adds weight to earlier evidence(3) which also found that fibre was associated with a significantly reduced risk of preeclampsia.  The researchers also found that potassium intake was a significant protective factor (I will be discussing potassium intake a blood pressure further on Thursday).  This evidence was interesting as it mentioned specific foodstuffs, with fruits and vegetables being associated with a reduced risk of preeclampsia development (unsurprisingly since vegetables and fruits are great sources of fibre and potassium).

Fruits, Vegetables and Antioxidant Vitamins:
You may be sick of my constant mentioning of vegetables and fruits?!  Well, they really are vitally important to health and I will be writing about them as often as possible!  As indicated above these super foods provide the body with fibre and are fantastic sources of potassium.  In addition to this they are packed full of vitamins, minerals and flavonoids (bioactive plant compounds).  Many of these plant nutrients act as antioxidants in the body.

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

Dietary antioxidants and supplemental vitamin C and E(4,5), lycopene(6), selenium(7,8) and  multivitamins(9) all appear to have some protective role to play against the development of preeclampsia, although the evidence for supplements is not yet conclusive and further large trials are needed.  The evidence to date certainly seems to suggest an important role for fruit and vegetable consumption during pregnancy, a variety of colourful vegetables and fruits will provide a whole array of vital nutrients to the body.  Selenium is not as widely available in the UK diet, although Brazil nuts are a terrific source. 

In addition to diet you may wish to discuss taking a pregnancy safe multi-vitamin and mineral supplement with your GP, midwife or health professional.

Omega 3 Essential Fatty Acids:
Recent evidence suggests that women with preeclampsia have reduced levels of essential omega 3 fatty acids in their blood(9,10).  Omega 3 fatty acids are vital for the efficient functioning of the immune system.  A lack, or imbalance, of these fatty acids is associated with inflammation in the body.  Inflammatory chemicals (cytokines) have been implicated in the development of and risk for preeclampsia.  Omega 3 fatty acids are essential for optimal foetal development (and are especially important in brain and immune development) and it is important to ensure a regular supply during pregnancy.  I have spoken about these fats extensively in previous posts.  Good dietary sources are oily fish (salmon, trout, mackerel, sardines) and flaxseeds or walnuts for vegetarians/vegans.  Many people in the UK do not eat these foods regularly.  Speaking to your GP or midwife about an omega 3 supplement, a fish oil (providing about 250mg EPA and 250mg DHA per day) or flaxseed oil may be prudent to ensure adequate levels throughout pregnancy and beyond.

At the moment the evidence is preliminary and needs backing up by large, well designed trials and further research.  Personally, I feel that the take home message is that being a normal weight (BMI 19-24), being physically active and having a healthy, nourishing diet rich in fruits, vegetables and essential fats may be protective.....great advice for good health for all of us then!

(1) Qiu et al.  2008.  Dietary fibre intake in early pregnancy and risk of subsequent preeclampsia.  American Journal of Hypertension.  21:903-909 [EPub doi:10.1038/ajh.2008.209 17 July]
(2) Langford A et al.  2008.  Does Gestational Weight Gain Affect the Risk of Adverse Maternal and Infant Outcomes in Overweight Women?  Matern Child Health J.  [Epub ahead of print]
(3) Frederick, I. O., et al.  Dietary fiber, potassium, magnesium and calcium in relation to the risk of preeclampsia.  J Reprod Med.  50(5):332-344, 2005.
(4)Chappell LC et al.  1999.  Effects of antioxidants on the occurrence of preeclampsia in women at increased risk: a randomised trial.  The Lancet.  354:810-816
(5)Chappell  LC et al.  2002.  Vitamin C and E supplementation in women at risk of preeclampsia is associated with changes in indicies of oxidative stress and placental function.  Am J Obstet Gynecol.  187:777-784
(6)Sharma JB et al.  2003.  Effect of lycopene on preeclampsia and intra-uterine growth retardation in primigravids.  Int J Gynaecol Obstet.  81:257-262
(7)Han L & Zhou SM.  1994.  Selenium supplement in the prevention of pregnancy induced hypertension.  Chin Med J.  107:870-871
(8)Rayman et al.  2003.  Low selenium status is associated with the occurrence of the pregnancy disease preeclampsia in women from the United Kingdom.  Am J Obstet Gynecol.  189:1343-1349
(9) Bodnar LM et al.  2006.  Periconceptional multivitamin use reduces the risk of preeclampsia.  Am J Epidemiol.  164:470-477
(10) C et al.  2006.  Erythrocyte omega-3 and omega-6 polyunsaturated fatty acids and preeclampsia risk in Peruvian women.  Arch Gynecol Obstet.  274:97-103
(11)Mehendale S et al.  2008.  Fatty acids, antioxidants, and oxidative stress in pre-eclampsia.  Int J Gynaecol Obstet.  100:134-238

Written by Ani Kowal

As I have mentioned before, I love to walk.  I can walk for hours!  Put me in a gym however and I tire quickly.  Personally I think this has more to do with boredom than my fitness!  A recent study seems to suggest that taking coenzyme Q10 supplements may increase the amount of time an individual can exercise before they become fatigued. 

Coenzyme Q10 is a type of fat-soluble coenzyme (the Q stands for Quinone), the most important Q coenzyme for humans.  A coenzyme is a compound that is necessary for the functioning of enzymes, protein substances produced in the body that act to accelerate biochemical reactions -enzymes are vital for all cellular processes in the body. 

Coenzyme Q10 is naturally produced by the body and was first isolated in 1957, it is essential for energy production in all bodily cells and is especially abundant in the heart - heart cells use a lot of energy in order to beat over 100,000 times a day!  Around the world it has become one of the most popular dietary supplements, with individuals reporting many health benefits such as increased energy and memory improvement.  Many trials (too many to reference here) have investigated this supplement and it seems to be beneficial for the prevention and treatment of many conditions from heart disease to blood pressure, cancer, circulatory conditions, gum disease, Alzheimer’s disease, Parkinson’s disease, immune related disorders and age related conditions.

As I mentioned at the start of this post the most recent research(1) on supplemental coenzyme Q10, also called CoQ10, suggests that it may enhance athletic performance and increase the time you can exercise before tiredness sets in.  The scientists involved in this study wanted to determine whether supplementation of CoQ10 could improve exercise performance in both trained and untrained individuals.  The study was small and involved 22 trained and 19 untrained individuals (male and female).  They received either a 100mg placebo or a CoQ10 supplement twice a day for 14 days.  Blood samples and muscle biopsies were taken.  On the first day the subjects were given a single dose of 200mg of the placebo or CoQ10.  One hour after being given the supplement the individuals were given a variety of endurance tests.  Additional blood samples and a second muscle biopsy were taken after completion of the tests.  After this first day the subjects were given 100mg of placebo or CoQ10 twice a day, once in the morning and once in the evening, for 14 days.  They then returned to the lab for more tests.

The levels of Coenzyme Q10 in the blood plasma were significantly increased following 2 weeks of the supplementation (compared to placebo group).  Following the one high dose of CoQ10 on day one muscle levels of CoQ10 were significantly higher and this was related to increased time to exhaustion on the treadmill (individuals could run for longer before tiring).  After two weeks of supplementation there was also a trend towards increased time to exhaustion.  Tests also revealed that the CoQ10 seemed to be acting as an antioxidant (individuals taking the CoQ10 had lower levels of oxidative stress).

The results make sense since Coenzyme Q10 is involved in the conversion of carbohydrates into energy.  This may explain why people who regularly take the supplement report an increase in their feelings of energy.  A previous small study(2) found that coenzyme Q10 supplementation at 150mg twice a day for two months increased blood levels of the nutrient and significantly increased the subjective perceived level of vigour in middle-aged men when compared to placebo.  A small study in cross country skiers(3) demonstrated the ability of coenzyme Q10 (90 mg per day) to increase all measures of physical performance.  In the study, 94% of skiers receiving coenzyme Q considered that their treatment has been beneficial in improving their performance.  In endurance runners(4) levels of CoQ10 were found to be lower than normal at rest (probably due to the increased need for energy production in such athletes) and further depleted after exercise training.  Supplemental CoQ10 improved the blood plasma levels in the runners and also seemed to help prevent the muscle damage that often occurs as a result of intensive exercise or endurance exercise(4).

If you are a regular gym-goer or generally training to improve fitness levels you may wish to try a coenzymeQ10 supplement to see if it benefits your training schedule.  50mg-100mg of the supplement twice per day is usually recommended.  As CoQ10 is fat soluble look for supplements that contain an oil base as these are more efficiently absorbed.

Coenzyme Q10 is found in many foods but is particularly concentrated in nuts and oils.  The body does produce this nutrient naturally and does not rely on external sources.  In order to produce CoQ10 we require various essential cofactors.  These include a variety of vitamins especially of the B group (Folic Acid, Vitamin B2, The Niacinamide form of Vitamin B3, Vitamin B5,Vitamin B6, Vitamin B12) and Vitamin C .  Hence a healthy diet rich in fruits, vegetables, wholegrain cereals and lean proteins will aid the natural production of this coenzyme and keep our circulating levels high. 

Just in case you are wondering, the research has not tempted me into the gym, I am more than happy with my walking (and the occasional hula-hooping)!

(1)Cooke M et al.  2008.  Effects of acute and 14-day coenzyme Q10 supplementation on exercise performance in both trained and untrained individuals. J Int Soc Sports Nutr.  4;5:8.
(2)Porter DA et al.  1995.  The effect of oral coenzyme Q10 on the exercise tolerance of middle-aged, untrained men.  Int J Sports Med.  16(7):421-427.
(3)Yikoski T et al.  1997.  The effect of coenzyme Q10 on exercise performance of cross-country skiers.  Molecular Aspects of Medicine (United Kingdom).  18(Supplement):S283-S290.
(4) Bargossi, A M et al.  1993.  Antioxidant effects of exogenous ubiquinone (Q10) in high level endurance runners.  Free Radicals and Antioxidants in Nutrition.  1993:63-74.

Written by Ani Kowal

Usually on the train back from a trip to Devon I spend my time reading and immersing myself in the view.  Yesterday was pleasantly different as I was sat next to Adal, a charming doctor.  We got chatting about all kinds of topics including medicine, nutrition and faddy diet foods.  As I got back to London I was greeted by a juice bar advertising ‘shots’ of bright green wheat grass juice and this got me thinking – is it a hyped up fad food or is there some science behind the wheat grass phenomenon?

Wheat grass is also known as wheat sprouts and can be widely bought as a juice or a powder that is mixed into a drink.  The bright green colour comes from chlorophyll, a pigment fundamental in the conversion of sunlight into carbohydrate in plants via the process of photosynthesis.  Regular consumers of the grass juice say that it improves their feelings of wellbeing, aids digestion and gives them an instant energy boost.  Wheat grass contains fibre, vitamin B, vitamin C, beta carotene, minerals (calcium, magnesium, potassium), amino acids and more.  So it seems that this grass does pack a nutrient filled punch.  However, I wanted to know if there was any science behind the anecdotal health claims.  After some investigation I managed to unearth a few studies.

A small study last year(1) found that 500mg of wheat grass taken daily increased blood plasma antioxidant status, vitamin C, beta carotene, vitamin E and the blood activity of an antioxidant enzyme and reduced oxidative stress in individuals when compared to placebo.  In addition to this trial a cell study in 2004(2) found that wheat grass contains a powerful cocktail of antioxidant molecules and biologically active substances (such as flavonoids) that can be absorbed during the digestion process.

An antioxidant is a substance that protects our cells from the damaging effects of highly reactive molecules called free radicals (which cause oxidative stress in the body).  These destructive molecules are associated with ageing, cancer, heart disease, stroke, cataracts, arthritis and more.  The body does produce its own antioxidants but also relies on vitamins, mineral and phytochemicals (bioactive plant compounds) from the diet, especially from colourful vegetables and fruits, for additional valuable supplies.  A shot of wheat grass may be one way to give the body an antioxidant boost!

In addition to the antioxidant potential of wheat grass, which may be beneficial in the prevention against cancer via protection of our DNA from free-radical damage, studies suggest that wheat grass may additionally be cancer protective via blocking the metabolic activation of many carcinogens (cancer causing substances)(3).

There is also preliminary emerging evidence to suggest that wheat grass may have beneficial effects on the health of our blood cells and blood cell production.  So far these studies have only been carried out in individuals with serious conditions such as cancer(4) and the blood disorder thalassaemia(5).  As yet there is no definitive literature to confirm if these benefits occur in healthy individuals but these trials certainly point the way.  Scientists believe that the positive benefits to the blood may come from the antioxidants in the wheatgrass(6) or perhaps from the chlorophyll in wheat grass which has a similar structure to haem, the iron containing pigment in our red blood cells that binds oxygen in order to carry it to all of the cells in our body(7). 

Finally, the use of wheat grass juice for treatment of various gastrointestinal/digestive conditions has been suggested by its proponents for more than 30 years, but until recently had never been clinically assessed in a controlled trial.  In 2002 a small randomized, double-blind, placebo-controlled study(8) took place to assess the use of wheat grass in ulcerative colitis sufferers.  Ulcerative colitis is characterized by chronic inflammation and ulceration of the lining of the colon and rectum.  The study patients received either 100 ml of wheat grass juice, or a matching placebo, daily for 1 month.  Treatment with wheat grass juice was associated with significant reductions in the overall disease activity and in the severity of rectal bleeding.  The authors think the beneficial effects were probably due to the antioxidant capacity of the wheat grass.

The above mentioned studies have been small and mainly based on serious conditions that thankfully are not common.  However, the evidence is interesting and it seems as though there is some benefit to the green shot.  It will be interesting to see if any further evidence emerges over the next few years.  Please note that wheat grass is not a miracle food and cannot make up for a poor diet.  Including a colourful variety of vegetables and fruits in the daily diet will provide a huge host of antioxidant vitamins, minerals and phytochemicals.  If you decide to try wheat grass juice try to view it as an added nutrient bonus for your body! 

(1)Shyam R et al.  2007.  Wheat grass supplementation decreases oxidative stress in healthy subjects: a comparative study with spirulina [letter to the editor]. J Altern Complement Med.  13(8):789-791.
(2) Marsili V, Calzuola I, Gianfranceschi GL. 2004.  Nutritional relevance of wheat sprouts containing high levels of organic phosphates and antioxidant compounds. J Clin Gastroenterol. 2004 Jul;38(6 Suppl):S123-6.
(3)Peryt B et al.  1992.  Mechanism of antimutagenicity of wheat sprout extracts.  Mutat Res.  269(2):201-215.
(4) Bar-Sela G, Tsalic M, Fried G, Goldberg H.  2007.  Wheat grass juice may improve hematological toxicity related to chemotherapy in breast cancer patients: a pilot study. Nutr Cancer. 58(1):43-8.
(5) Marawaha RK et al.  2004.  Wheat grass juice reduces transfusion requirement in patients with thalassemia major: a pilot study. Indian Pediatr.41(7):716-20
(6) Fernandes CJ & O’Donovan DJ.  2005.  Natural antioxidant therapy for patients with hemolyticanemia. Indian Pediatr.  42: 618-619. Letter to the editor
(7) Pole SN.  2006.  Wheat grass juice in thalassemia. Indian Pediatr. 43(1):79-80; author reply 80.
(8) Ben-Arye E et al.  2002.  Wheat grass juice in the treatment of active distal ulcerative colitis: a randomized double-blind placebo-controlled trial.  Scand J Gastroenterol.  37(4):444-449.

Written by Ani Kowal

Last weekend I had the most delicious artichoke and broad bean salad and it spurred me into thinking about the health benefits of artichoke.  More and more people are taking a supplement of artichoke leaf extract for a variety of reasons.  Artichoke leaf extract is made from the thistle-like leaves at the base of the stem of the Globe Artichoke (botanical name Cynara scolymus) and not from the (very tasty!) artichoke heart that we use in cooking.

Quite a lot of recent research into artichoke leaf extract in the UK has come from the University of Reading and has mostly concentrated on the positive effects of the herb on the digestive system.  Studies have indicated that it may alleviate irritable bowel syndrome(1, 2) and indigestion(3,4). 

However, the latest research, published online last month, has found that artichoke leaf extract is also very effective at reducing cholesterol levels(5).  Many people are now taking statins in order to try and reduce their high cholesterol levels.  Taking steps through diet, exercise and perhaps supplements, before cholesterol levels reach a high could help to reduce the need for drugs (it is my personal opinion that prevention is always better than cure).  This piece of research is important because the study involved healthy people who had only moderately raised blood plasma cholesterol levels (not yet needing drugs) and it was found that the artichoke leaf extract was helpful in reducing their blood cholesterol concentrations.

The trial involved 75 individuals with total plasma cholesterol in the range 6.0–8.0 mmol/l and lasted 12 weeks.  The participants took 1280 mg of a standardised artichoke leaf extract (4 capsules), or a placebo each day.  Plasma total cholesterol decreased significantly in the treatment group (compared to the placebo) by an average of 4.2%.  This may seem like a modest change but it is favourable and certainly significant.

Dr Rafe Bundy, the lead study scientist, is quoted as saying “Reducing cholesterol levels can reduce the risk of developing cardiovascular disease. Our research investigated whether ALE [artichoke leaf extract] could be beneficial to otherwise healthy people who had raised levels of cholesterol but were not yet at a stage where they needed standard medical intervention. ALE may provide another option which people could try over and above a healthy diet in order to help lower plasma cholesterol.”

Artichoke leaf extract may be having an effect via antioxidant action, though the exact mechanism is not clear.  The extract contains a variety of polyphenols/flavonoids (bio-active plant chemicals) such as Caffeic Acid, Chlorogenic Acid and a group of compounds collectively called Caffeoylquiinic Acids (e.g. Cynarin), these are probably the active substances responsible for the beneficial health effects.

Artichoke leaf extract is widely available as a supplement and often supplements are standardised to contain around 15% Chlorogenic Acid and 2-5% Cynarin.  Typically around 600mg-900mg per day is recommended (check the recommended dose on the label) for improved digestion and cholesterol lowering.

(1) Walker AF et al.  2001.  Artichoke leaf extract reduces symptoms of irritable bowel syndrome in a post-marketing surveillance study.  Phytotherapy Research.  15(1):58-61.
(2)Bundy R et al.  2004.  Artichoke leaf extract reduces symptoms of irritable bowel syndrome and improves quality of life in otherwise healthy volunteers suffering from concomitant dyspepsia: a subset analysis.  J Altern Complement Med.  10(4):667-669.
(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)Bundy R et al.  2008.  Artichoke leaf extract (Cynara scolymus) reduces plasma cholesterol in otherwise healthy hypercholesterolemic adults: a randomised double-blind placebo controlled trial. Phytomedicine [Epub ahead of print DOI: 10.1016/j.phymed.2008.03.001 doi:10.1016/j.phymed.2008.03.001]    

Written by Ani Kowal

Curry is a firm favourite here in the UK and many of you may be planning on eating spicy dishes over the coming week.  Turmeric is one of the main spice ingredients of curry powder and has been used for thousands of years in Indian and Chinese medicine to relieve many different conditions.  In the last few years the spice has gained recognition here in the West as a powerful anti-inflammatory and antioxidant agent.

Curcumin, a polyphenol (plant chemical), is the key active component found within turmeric and is largely responsible for the orange/yellow colour of the spice.  In ancient times turmeric was used on the Indian subcontinent to treat various illnesses such as rheumatism, body-ache, skin diseases, intestinal worms, diarrhoea, intermittent fevers, liver disorders, nausea, urinary discharges, indigestion, inflammations, constipation, absent periods (amenorrhoea), and colic(1).

A recently published review paper(2) discusses the growing body of research suggesting that curcumin, has potential for the prevention and therapy of cancer.  Animal studies and in vitro (test tube) studies on human cells have shown that curcumin can both inhibit the formation of tumours and can act on cancer development in a variety of ways. Cell studies also demonstrate that curcumin is efficient at inducing controlled cell death (known as apoptosis) and that the spice exhibits a degree of selectivity for the destruction of cancer cells.  Studies indicate that curcumin is a safe agent, after further trials in humans take place it may well be developed for use in cancer prevention and therapy.

Another recent review paper(3) discusses the mounting evidence, from cell studies, of the anti-inflammatory and anti-oxidant potentials of turmeric and curcumin.  If further studies find that these properties extend in humans it would be hugely significant as many diseases have underlying inflammatory causes e.g. diabetes, cardiovascular diseases, arthritis, Alzheimer's disease, psoriasis and many, many more!

Although curcumin and turmeric have promising health properties it was previously thought that absorption of the polyphenol into the body was limited.  However, a recent human study(4) found that curcumin was well absorbed by humans and could be detected in their blood plasma after consumption.  This is good news in terms of the therapeutic potential of the spice.  Neither turmeric nor curcumin has yet been extensively studied in human clinical trials, though small trials have taken place and larger ones are planned. 

A small study(5) with 62 patients who had ulcerating mouth or skin cancers found that an extract of turmeric as well as an ointment of curcumin was very helpful in relieving symptoms in the patients.  The patients applied the ointment to their lesions three times a day for at least four weeks.  Reduction in smell was noted in 90% of the cases and in 70% the lesions dried up (they were no longer weeping/exuding).  50% of participants noted a reduction in pain and 10% of patients experienced a reduction in lesion size.  

Turmeric is available as a supplement and many people take the spice in capsule form for anti-inflammatory conditions such as rheumatoid arthritis and also for indigestion and digestive complaints.  If you decide to try such a supplement the recommended dose is usually 500mg-1000mg a day.  Do not exceed the recommended dose as turmeric in large amounts can cause gastrointestinal problems.  Of course, if you have any medical conditions or are currently taking any medication you should consult your doctor, curcumin can alter the effectiveness of some medications.

Using spices and herbs to flavour food is also a great way to improve taste and palatability without the use of salt and, as these studies show, may add to the overall health-potential of your meals.  Why not spice up your meals this week?!

(1)Pari L, Tewas D, Eckel J.  2008.  Role of curcumin in health and disease. Arch Physiol Biochem.  114(2):127-49.
(2)López-Lázaro M.  2008.  Anticancer and carcinogenic properties of curcumin: Considerations for its clinical development as a cancer chemopreventive and chemotherapeutic agent. Mol Nutr Food Res. May 21;52(S1):103-127. [Epub]
(3)Krishnaswamy K.  2008.  Traditional Indian spices and their health significance. Asia Pac J Clin Nutr.17 Suppl 1:265-8.
(4) Vareed SK et al.  2008.  Pharmacokinetics of curcumin conjugate metabolites in healthy human subjects. Cancer Epidemiol Biomarkers Prev.  17(6):1411-7.
(5)Kuttan R, Sudheeran PC, Joseph CD. Turmeric and curcumin as topical agents in cancer therapy. Tumori. 1987; 73:29-31.

Written by Ani Kowal

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

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

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

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

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

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

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

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

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

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

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

Written by Ani Kowal

New research(1) has just emerged from Baycrest which shows that adults with type 2 diabetes who eat unhealthy, high-fat, meals may experience memory declines immediately afterward, but this may be offset by taking antioxidant vitamin supplements together with the meal.

Baycrest is an academic health sciences centre, affiliated with the University of Toronto, which is internationally-renowned for its research on aging and the conditions associated with ageing such as memory loss, depression and stroke.

The study authors make reference to the fact that there is already a growing body of evidence that links diabetes to cognitive (mental) complications in humans.  Adults with type 2 diabetes seem especially vulnerable to acute memory deficits after eating unhealthy foods.  This latest study suggests that taking high doses of antioxidant vitamins C and E with such meals may help minimize those memory slumps.

One of the study authors, Michael Herman Chui, said “Our bottom line is that consuming unhealthy meals for those with diabetes can temporarily further worsen already underlying memory problems associated with the disease”.

The study was a very small preliminary trial that involved only 16 adults (with an average age of 63) with type 2 diabetes who were not regularly taking antioxidant supplements.  They attended three weekly sessions that involved consuming a different test meal on each visit. One meal consisted of high fat foods (a Danish pastry, cheddar cheese and yogurt with added whipped cream); the second meal consisted of only water; and the third test meal was the same high-fat meal plus vitamin C (1000 mg) and E (800 IU) supplements.

After eating the meal, participants completed a series of tests that measured their recall abilities for words they had heard and paragraph information they had read.  It was found that vitamin supplementation consistently improved recall scores.  Compared to those who consumed only water or the meal with antioxidant vitamins, participants who ate the high fat meal showed significantly more forgetfulness (of words and paragraph information) in immediate and time delay recall tests. 

The study authors emphasize that their findings obviously require further replication in much larger trials. Future studies will also need to look at how the antioxidant vitamins may be working.  Personally, I would also like to see further trials using antioxidant foods, such as fruits and vegetables, in conjunction with meals to test if the same benefits are seen as with supplementation (I have a feeling results would be very positive)!

Type 2 diabetes is associated with persistent, long term oxidative stress, a known major contributor to cognitive (mental) decline and Alzheimer disease. Consuming unhealthy foods can induce this type of stress which is triggered by elevations of free radicals: unstable molecules that can damage body tissue, including brain tissue. These destructive reactions tend to occur over a 1-3 hour period after the ingestion of food.  Fruits and vegetables contain numerous antioxidant nutrients and can minimise oxidative stress, it is important to include such foods as an integral part of all meals.  This study showed that antioxidants could reduce immediate memory deficits caused by unhealthy eating.

Dr. Carol Greenwood, senior author of the study, cautioned that relying on antioxidant vitamins at meal time is not a quick fix. “While our study looked at the pill form of antioxidants, we would ultimately want individuals to consume healthier foods high in antioxidants, like fruits and vegetables” (well said!).

An overall healthy lifestyle is important in maintaining optimal mental health at all ages.  This includes regular exercise, staying mentally active, being socially engaged in a variety of activities as well as adopting a healthy diet rich in fruits, vegetables and healthy fats found in oily fish, nuts and seeds.

(1) Chui MH & Greenwood CE.  2008.  Antioxidant vitamins reduce acute meal-induced memory deficits in adults with type 2 diabetes.  Nutrition Research.  28 (7): 423-494
(2) Baycrest press release

Written by Ani Kowal

It seems like an odd link, diet and breathing, but actually it makes enormous amounts of sense.  Our bodies need nutrients to function effectively.  Nutrition affects every cell from those that make up our bones to those of the skin.  The lungs and the cells of the immune system, both of which are involved in asthma, are no exception.  During an asthma attack the immune system produces certain antibodies (immunoglobulin E) and these stimulate the release of a chemical called histamine in the lining of the airways in the lungs.  The airways consequently become inflamed and swollen, excess mucous is also released and this can block the smaller airways and affect breathing.

The asthma statistics(1) for the UK are shocking.  5.2 million of us are currently receiving treatment for the condition.  1.1 million sufferers are children, that represents 1 in 10 kids, and 4.1 million are adults, that is 1 in 12.  On average there will be 3 children in every classroom who have asthma in the UK.  We also have the highest prevalence of severe wheeze in children aged 13-14 years WORLDWIDE!  Not a position to be proud of.  Every 19minutes a child is admitted to hospital due to their asthma and asthma costs the NHS over £996million per year.  Employers ought to care too as over 12.7million working days are lost to asthma each year.

I am an optimist, so this post is not all doom and gloom!  Dietary change can make a terrific difference!

The decision to write about asthma was prompted by two reasons.  The first was watching a child come out of a fast-food outlet and immediately using his “puffer” medication and the second was that two very interesting studies(2,3) have been published this month which link the adherence to a Mediterranean diet to a reduction in asthma symptoms.

In the first study(2) the scientists looked at the diet of 1784 children who were aged around 4 years, they found that adhering to a traditional Mediterranean diet was a protective factor for wheezing.  The second study(3) looked at diet during pregnancy and what affect that had on children when they were 6 years old.  The results indicate a protective effect of adherence to a Mediterranean diet during pregnancy against asthma-like symptoms (including wheezing and allergy) in childhood.  The lead scientist of the second study, Dr Chatzi, has previously published studies which indicate the protective effects of a Mediterranean diet against asthma symptoms.

So what constitutes a traditional Mediterranean diet?  Basically, this is healthy diet rich in a variety of different fruits and vegetables, legumes (peas and beans), oily fish, nuts and seeds, olive oil and unrefined wholegrains.  The diet is also high in fibre and relatively low in red meat, saturated fats and trans fatty acids (which are abundant in some processed foods).  The total fat content in general is relatively high but the type of fat is monounsaturated and also high in omega 3 fatty acids.  There are many reasons why this kind of healthy balanced diet could reduce the prevalence of asthma symptoms:

Fruits and vegetables are abundantly rich in all sorts of vitamins and flavonoids (a group of over 4000 plant compounds).  Studies (7,8) have shown that the flavonoid quercetin (found abundantly in onions and apples) appears to reduce the risk and severity of asthma symptoms.  This is probably due to the anti-inflammatory properties that quercetin exhibits in the body.  Vitamin C may be particularly important to asthmatics (9) as it seems to reduce the degree of constriction in the airways.  Studies (10) have found that asthma sufferers tend to have lower plasma vitamin C levels than non-asthmatics and supplementation of 1000mg Vitamin C a day may help improve lung function and reduce the frequency and severity of asthma attacks.  As mentioned in the post on hayfever, Vitamin C and Quercetin both act as natural anti-histamines in the body.  Asthmatics tend to have high histamine levels.  Histamine is produced by cells of the immune system and stimulates an inflammatory reaction in the body which may be responsible for the wheezing and shortness of breath in asthma sufferers.

Other vitamins and nutrients found in fruits and vegetables, such as carotenes, have also been implicated as important for prevention of symptoms in asthma sufferers.

Nuts, Seeds and Wholegrains are rich in the mineral magnesium.  A diet high in magnesium may well be useful for asthmatics since this important mineral appears to alleviate the bronchoconstriction (tightening of the airways in the lungs) associated with asthma.  There are many studies (far too many for me to list) which indicate the importance of magnesium in those suffering with asthma.  A study in children showed that low magnesium intakes are associated with poorer lung function(4) another found that asthma patients supplemented with 400 mg magnesium a day showed an improvement in asthma symptom scores(5).  Many studies have also found that asthmatics commonly have lower levels of magnesium in their blood(e.g. 6).  The National Diet and Nutrition Surveys (NDNS) for the UK have found that dietary intakes of magnesium are generally low in most children and women in the UK.  We would all do well to try and include more nuts, seeds and wholegrains into our daily diets. 

Fat:  There is some evidence that asthma may be related to an imbalance in fatty acids in the diet.  An Australian study(11) found that a diet high in omega 6 fatty acids and low in omega 3 fatty acids increased the risk of asthma symptoms in a large group of children.  Excessive amounts of omega-6 fatty acids, found in vegetable oils, and a relative lack of omega-3 fats, found in oily fish such as salmon and mackerel and some nuts and seeds, seems to promote inflammation and aggravate asthma. Inflammatory chemicals produced from omega 6 fats by the immune system can trigger constriction of the airways and mucous production.  Omega 3 fatty acids are involved in the production of anti-inflammatory chemicals by the cells of the immune system. 

One study(12) in asthmatic patients found that supplementation with corn oil (rich in omega-6 fats) tended to increase the production of inflammatory white blood cells, whereas supplementation with perilla seed oil (rich in omega-3 fats) had the opposite effect.  Patients treated with perilla seed oil also had significant increases in their lung function.  In another study(13), supplementation with fish oil (rich in the omega 3-fats) for 10 months reduced asthma symptom scores in a group of children.  Avoidance of excessive amounts of margarine and vegetable oils, and the inclusion of oily fish such as salmon, trout, mackerel and herring (or flaxseed oil for vegetarians) in the diet may, therefore, possibly help to control asthma symptoms.  Using olive oil in place of vegetable oils will probably prove useful as it is a monounsaturated fat and does not contribute to inflammation in the body, indeed it may even play a role in reducing inflammation(14).

In part II I will be covering other important dietary measures that affect asthmatics

(1) Asthma UK www.asthma.org.uk
(2) Castro-Rodriguez JA et al.  2008.  Mediterranean diet as a protective factor for wheezing in preschool children.  J Pediatr.  152(6):823-8, 828
(3) Chatzi L et al.  2008Mediterranean diet in pregnancy is protective for wheeze and atopy in childhood. Thorax.  63(6):507-13
(4) Gilliland FD et al.  2002.  Dietary magnesium, potassium, sodium and children’s lung function.  Am J Epidemiol.  155(2):125-131
(5) Hill J et al.  1997.  Investigation of the effect of short-term change in dietary magnesium intake in asthma.  Eur Respir J.  Oct;10(10):2225-9.
(6) Alamoudi OS.  2000.  Hypomagnesemia in chronic, stable asthmatics: prevalence, correlation with severity and hospitalization.  Eur Resoir J.  16:427-431
(7) Knekt P et al.  2002.  Flavonoid intake and risk of chronic diseases.  Am J Clin Nutr.  76:560-568.
(8) Saheen SO et al.  2001.  Dietary antioxidants and asthma in adults: population-based case-control study.  Am J Respir Crit Care Med.  164:1823-1828
(9) Bielory L et al.  1994.  Asthma and Vitamin C.  Annals Allergy.  73(2):89-96.
(10) Harik-Khan RI et al.  2004.  Serum vitamin levels and the risk of asthma in children.  Am J Epidemiol.  159:351-357.
(11) Oddy WH et al. 2004. Ratio of omega-6 to omega-3 fatty acids and childhood asthma.  Journal of Asthma.  41:319-326.
(12) Okamoto, M et al.  2000.  Effects of dietary supplementation with n-3 fatty acids compared with n-6 fatty acids on bronchial asthma.  Intern Med.  39(2):107-111
(13) Nagakura et al.  2000.  Dietary supplementation with fish oil rich in omega-3 polyunsaturated fatty acids in children with bronchial asthma.  Eur Resp J.  16(5):861-865.
(14) Beauchamp GK et al.  2005.  Phytochemistry: ibuprofen-like activity in extra-virgin olive oil.  Nature.  437:45-46.

Written by Ani Kowal

In Part I I mentioned that UV light can cause damage to the skin and contribute to photo-ageing through the initiation of inflammation.  The long chain omega 3 fatty acids EPA (Eicosapentaenoic acid) and DHA (docosahexaenoic acid) found in oily fish such as salmon, trout, sardines and mackerel as well as the shorter chain alpha-linolenic acid found abundantly in flax seeds acids are used by the body for the production of potent anti-inflammatory chemicals.  Including these omega 3 fatty acids in the diet may help to reduce sun induced inflammation, UVB skin sensitivity and may also help in the prevention of sunburn(1,2,3).

As mentioned in previous posts, omega 3 fatty acids are essential for optimal health for numerous reasons and many of us do not get adequate amounts from our daily diet.  If you are not a regular fish eater, or are vegetarian you may wish to consider taking a fish oil supplement to provide EPA (around 300mg per day) and DHA (around 200mg per day) or a vegetarian flaxseed oil (around 1000mg per day) supplement.  This could be useful to give the skin added natural sun protection and provide the body with a regular source of these essential fats.

Finally I would like to bring your attention to two studies(4,5).  They are of particular interest to me since they looked at cocoa consumption in relation to protection against sunburn.  Really dark chocolate (minimum 85% cocoa solids) is a passion of mine and I tend to indulge in a few squares at least a couple of times a week!  These studies have shown that consumption of flavanol (naturally occurring plant compounds) rich cocoa daily for 12 weeks reduced the risk of sunburn when skin was exposed to UV rays.  The major flavonols to be found in cocoa are called epicatechin and catechin, and it seems as though they are the components within cocoa that are important for boosting sun protection.  The ingestion of high flavanol cocoa led to increases in blood flow to the skin and layers below the skin, and to increases in skin thickness and hydration.

This is not a plug to justify regular chocolate binges (although it does help me to feel better about my dark chocolate habit)!  The cocoa used in these studies, and other studies that link cocoa to health benefits such as lowered risk of heart disease, was high flavanol cocoa and only a very small amount was used daily (around 350mg).  I am fond of drinking black cocoa but it is an acquired taste, as is the bitter high % cocoa chocolate that I so adore.  Sugary, sweet milk chocolate won’t provide the health benefits discussed (sorry to be the bearer of sad news!).  Flavonoids in general are found abundantly in fruits and vegetables, which, as mentioned in part I are important in sun protection through their provision of antioxidants.  Vegetables and fruit should form the core of a healthy diet and getting a good variety will give the body many of the nutrients that are needed for optimal health.

Obviously avoiding sun burn is exceptionally important, however, a slowly-acquired sun-tan may prevent against adverse effects of sun exposure in those who naturally tan easily.  Sun-sensitive individuals (those with fair skin and who burn easily) need to be careful as they have a higher risk for skin cancers.  Seeking shade, wearing a hat, adequate clothing and avoiding prolonged sunbathing is always advisable.  Sunscreens may also help but the ability of sunscreen to delay sunburn encourages many people to stay out in the sun for long periods of time and their skin (and health) may be negatively affected by this prolonged exposure. 

Please be sensible in the sun! 

(1) Rhodes LE et al.  1995.  Dietary fish oil reduces basal and ultraviolet B-generated PGE2 levels in skin and increases the threshold to provocation of polymorphic light eruption.  Journal of Investigative Dermatology.  105(4):532-535.
(2) Rhodes LE et al.  2003.  Effect of eicosapentaenoic acid, an omega-3 polyunsaturated fatty acid, on UVR-related cancer risk in humans. An assessment of early genotoxic markers.  Carcinogenesis.  24(5):919-925.
 (3) Takemura N et al.  2002.  Dietary, but not topical, alpha-linolenic acid suppresses UVB-induced skin injury in hairless mice when compared with linoleic acids.  Photochem Photobiol.  76(6):657-663.
(4) Heinrich U et al.  2006.  Long-term ingestion of high flavanol cocoa provides photoprotection against UV-induced erythema and improves skin condition in women.  Journal of Nutrition.  136(6):1565-1569.
(5) Neukam K et al.  2007.  Consumption of flavanol-rich cocoa acutely increases microcirculation in human skin.  Eur J Nutr.  46: 53-56

Written by Ani Kowal

In my last post I wrote about the importance of vitamin D and sensible sunlight exposure.  This led me to start investigating natural ways to prevent skin damage from the sun (photo-damage) and sunburn.  The concept of photo-protection by dietary means is gaining increasing amounts of attention from the scientific community. 

Sun exposure leads to photo-ageing, with chronic sun exposure being a major contributor to ageing skin which is characterised by wrinkling, loss of elasticity, increased skin fragility and slower wound healing.  This photo-ageing probably occurs for a number of different reasons:

1. UV light can damage skin cell DNA via production of destructive ‘free-radical’ molecules .
2. UVB rays seem to induce the synthesis of enzymes which cause collagen, (and other skin tissue components), in the skin to degrade, this contributes to wrinkling, loss of elasticity and fragility.
3. UV light can also induce inflammation in the skin which contributes to photo-ageing.

Luckily there are some natural ways that can help us to protect our skin from sun damage. 

Antioxidants may help to ‘quench’ the destructive free radical molecules and therefore protect against photo-damage.  Specifically; beta-carotene, lycopene, lutein, vitamin C and vitamin E seem to be most helpful.  These plant constituents are involved in the light-protecting system in plants and may contribute to the prevention of UV damage in humans.  As nutrients they are ingested in the diet and are then distributed into the skin tissues where they provide the body with photo-protection.  

A diet rich in colourful fruits, vegetables, nuts and seeds will provide plentiful amounts of these antioxidants.  Beta carotene, lutein and lycopene are all carotenoids.  Carotenoids are a family of over 700 naturally occurring yellow, red and orange pigments found in vegetables and fruits.  Good sources include carrots, sweet potatoes, tomatoes, squash, peppers, cantaloupe melons, nectarines, papaya, mango and dark green vegetables such as spinach, watercress and asparagus.  Introducing a good mix of these fruits and vegetables in the diet will help keep carotenoid levels in the body high.

Absorption of these carotenoids from foods into the body is greatly affected by fat.  Without a fat source almost no carotenoids will be absorbed.  Fat acts as a carrier for the nutrients.  Now, I am not suggesting that you drown your vegetables or salads in ‘any old lard’, however I am a firm believer in using small amounts of olive oil in dressings and cooking.  Or including some nuts, seeds or olives in salads will also be helpful in order to gain maximum absorption of these important nutrients.

Two human studies have looked at tomato consumption and blood serum lycopene levels with regards the risk of sunburn(1,2).  The study groups were given lycopene or tomato-derived products rich in lycopene (mixed with olive oil) for 10-12 weeks.  Their blood serum lycopene levels increased with supplementation and they experienced a decrease in their sensitivity toward sunburn.  Sunburn damage was up to 48% lower in the groups receiving lycopene/tomato paste compared to the control groups.

Supplements containing antioxidants such as the carotenoids, vitamin C and vitamin E may also be useful in slowing down the time of development and grade of UVB induced sun damage(3).  If you feel that you are not getting a good supply of a variety of different fruit and vegetables daily in your diet, you may wish to consider taking a supplement to boost your levels of sun-protective antioxidants, especially in the sunny months or prior to a sunny holiday. 

Check back soon for Part II where I will be looking at how nutrition can help protect the skin from the inflammatory damage that the sun can cause.

(1) Stahl W et al.  2001.  Dietary tomato paste protects against ultraviolet light–induced erythema in humans.  Journal of Nutrition.  131(5):1449-1451.
(2) Aust O et al.  2005. Supplementation with tomato-based products increases lycopene, phytofluene, and phytoene levels in human serum and protects against UV-light-induced erythema.  Int J Vitam Nutr Res.  75(1):54-60. 
(3) Greul AK et al.  2002.  Photoprotection of UV-irradiated human skin: an antioxidative combination of vitamins E and C, carotenoids, selenium and proanthocyanidins.  Skin Pharmacol Appl Skin Physiol.  15(5):307-315

Written by Ani Kowal

The symptoms of hay fever may well be irritating and even distressing at times.  As I said in Part I I do not suffer from the condition so this may well sound easy for me to say, but trying not to get too upset and stressed about your hay fever could be a great help.  This is important to mention because stress(1) has been linked to the production of inflammatory agents in the body and could hence further aggravate your symptoms thus starting up a vicious cycle.

As discussed previously hay fever is an inflammatory condition.  A natural agent that would be highly useful in mediating the inflammatory reactions in the body is the long chain omega 3 fatty acid, Eicosapentaenoic Acid or EPA.  As well as having a general anti-inflammatory role EPA may actually help to prevent hay fever.  A study in 2003(2) demonstrated that individuals with a high intake of dietary EPA had a 55% reduction in their incidence of hay fever compared with persons who consume low amounts of dietary EPA.

EPA is naturally found in oily fish such as mackerel, salmon, trout and sardines.  As well as aiding the production of potent anti-inflammatory chemicals in the body it is also beneficial to the health of the heart, brain, eyes, nerves, bones, digestive system and skin (and I am sure I will be mentioning omega 3 fatty acids in future blog postings!).  Many of us do not eat these types of fish regularly (two portions per week is usually recommended) and hence a daily fish oil supplement (providing around 300mg of EPA and 200mg DHA) may be very useful for the prevention of hay fever and even to promote optimal health and wellbeing.  For vegetarians and vegans flaxseed oil (1000mg daily) can provide omega 3 fatty acids in the form of alpha linolenic acid which the body then bio-converts to EPA (the long chain form). 

One other natural remedy which can be helpful in the treatment of hay fever is the herb Butterbur (Petasites hybridus). This herb seems to exhibit anti-inflammatory activity and anti-allergic properties.   The British Medical Journal published a study(3) which compared Butterbur supplementation with the conventional antihistamine drug cetirizine (prescribed in the UK under the name Zirtek).  Both treatments were equally effective in reducing hay fever symptoms.  However, the drug cetirizine tended to cause side effects such as fatigue and drowsiness.  The authors of the study concluded that:  “The effects of butterbur are similar to those of cetirizine in patients with seasonal allergic rhinitis.....Butterbur should be considered for treating seasonal allergic rhinitis when the sedative effects of antihistamines need to be avoided”.

As an interesting point antibiotics used in children in their first 2 years of life have been associated with a 2-3 fold increased risk of hay fever(4).  As well as destroying the bacteria that cause illness in the body antibiotics also kill the healthy bacteria that live in the digestive system.  As mentioned in a previous posting these friendly bacteria have been shown to positively affect the immune system, which is responsible for allergic and inflammatory responses in the body, so a prebiotic and probiotic supplement may be useful to anyone who has been recently exposed to antibiotics or as an immune boosting aid (see post dated 19/05/08 for more detail about pre- and probiotics for immune health).

And finally, a study last year (5) found that almost 50% of hay fever suffers seem to be highly sensitive not only to typical allergy triggers like grass, tree pollens, dust and animal hair but also to things like cold air, perfumes, cigarette smoke and household cleaning products.  So, if you find that you often suffer from symptoms like itchy eyes and stuffy or runny nose you may find it useful to take a product containing vitamin C and bioflavonoids (as discussed in Part I) all year around as a preventative, anti-allergic measure.

(1) 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.
(2) Nagel G et al.  2003.  The influence of the dietary intake of fatty acids and antioxidants on hay fever in adults.  Allergy.  58(12):1277-1284.
(3) Schapowal A.  2002.  Randomised controlled trial of butterbur and cetirizine for treating seasonal allergic rhinitis.  BMJ.  324:144-146
(4) Wickens K et al.  1999.  Antibiotic use in early childhood and the development of asthma, hay fever and eczema. Clin Exp Allergy.  29:766-771
(5)Shusterman D and Murphy MA.  2007.  Nasal hyperreactivity in allergic and non-allergic rhinitis: a potential risk factor for non-specific building-related illness.Indoor Air.  17:328-333

Written by Ani Kowal

Recently my mum came back from a trip with a heavy springtime cold, a member of her travelling party had kindly passed on the infection and poor mum was suffering with the typical symptoms of a tickly throat, headache and runny nose.  Colds are caused by viruses and our susceptibility to these infections is largely dictated by the efficiency of our immune system.  A healthy diet providing our bodies with optimal nutrition may help to keep our immune systems strong and protect us from infection.

The symptoms of a common cold tend to last from a few days to a couple of weeks but most cases are over within one week (fortunately my mum is fit and healthy and her cold only lasted a few days!).   There is mixed evidence with regards prevention and treatment of colds with complementary health methods but I am always one to try ‘beating the bug’ naturally!

One of the nutrients that is essential for the efficient functioning of our immune system is zinc and last month a study published in the Journal of Infectious Diseases (1) found that using lozenges containing zinc at the first sign of a cold (within 24 hours of developing symptoms) was associated with reduced duration and severity of cold symptoms.  This study adds weight to previous research indicating that zinc lozenges, sucked in the mouth and not swallowed whole, seem to help prevent infection from the common cold and also accelerate recovery once infected. 

This most recent study involved 50 volunteers who had suffered cold symptoms, such as a cough, runny nose and muscle aches, for less than 24 hours. Half of the participants were given zinc lozenges, containing about 13mg of zinc, and half were given inactive ‘placebo’ lozenges (the two groups were not aware of which lozenges they had been assigned).  They then took one lozenge every 2 to 3 hours while awake.  The group taking the zinc lozenges had cold symptoms for an average of 3 days less than those taking the placebo.  Every cell in our body needs zinc and the investigators believe that beneficial clinical effects seen in the zinc group were due to the antioxidant and anti-inflammatory effects that this nutrient has in the body.

Lozenges and dissolvable tablets and drinks often contain vitamin C, another nutrient which some studies suggest (2) may be useful in reducing the severity and duration of cold symptoms.  If you feel a cold coming on it may be useful to try sucking on a lozenge every three hours or so while symptoms persist.  

References:
(1) Prasad AS, Beck FW, Bao B, Snell D, Fitzgerald JT.  2008.  Duration and severity of symptoms and levels of plasma interleukin-1 receptor antagonist, soluble tumor necrosis factor receptor, and adhesion molecules in patients with common cold treated with zinc acetate.  J Infect Dis.  Mar 15;197(6):795-802
(2) Van Straten et al.  2002.  Preventing the common cold with a vitamin C supplement: a double-blind, placebo-controlled survey.   Adv Ther.  19(3):151-159

Written by Ani Kowal