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

It makes food taste great and brings any dish to life with flavour.  I love garlic!  Garlic is a type of vegetable, there are two species: Allium sativum  (cultivated garlic) and Allium ursinum  (wild bear's garlic), both of which belong to the Amaryllis (Amaryllidaceae) family.

A plethora of health benefits are attributed to garlic with studies showing that it seems to have positive effects for the heart and circulatory system, immune system and digestive system.  It also seems to be anti-parasitic, anti-viral, anti-fungal and anti-bacterial.  The lists go on and on!

Today I wanted to look at garlic supplementation in relation to lowering blood pressure.  Until very recently research on garlic supplementation and blood pressure had been inconclusive.  However, the latest, most comprehensive review(1) of scientific evidence “suggests that garlic preparations are superior to placebo in reducing blood pressure in individuals with hypertension [high blood pressure]”.  The review of scientific literature was undertaken by researchers at The University of Adelaide, South Australia.  The scientists looked at studies that were published between 1955 and 2007, and only included ‘high quality’ research (randomised controlled trials with true placebo groups).  A significant association was found between blood pressure at the start of intervention with garlic supplements and the levels of blood pressure reduction.

The garlic was effective at lowering both the systolic and diastolic blood pressure.  Systolic blood pressure, represented by the top number in a blood pressure reading, is the measure of the phase of the heartbeat when the heart contracts and pumps blood into the arteries.  Diastolic blood pressure, represented by the bottom number in a blood pressure reading, is the measure of the phase of the heartbeat when the heart muscle relaxes and allows the chambers to fill with blood. 

The review found that, on average, garlic reduced systolic blood pressure by 4.6 mmHg.  The scientists also looked at studies that were conducted with people with a high blood pressure (hypertension), in these studies the garlic had a more pronounced effect with a reduction of systolic blood pressure by an average of 8.4 mmHg and diastolic blood pressure by 7.3 mmHg. The higher a person's blood pressure was at the beginning of the study, the more it was reduced by taking garlic supplements.

These results are very similar to those of widely used hypertension drugs such as beta blockers, which reduce systolic blood pressure by around 5 mmHg, and ACE (angiotensin converting enzyme) inhibitors, which produce around an 8 mmHg drop in systolic blood pressure.

In the population as a whole, the authors of the study note that a reduction of systolic blood pressure by around 4-5 points and diastolic blood pressure by 2-3 points could cut the risk of heart disease and heart disease-related death by up to 20 percent.  The scientists also note that more research is needed to determine whether garlic supplementation might have long-term effects on heart disease risk. 

In most of the studies reviewed in this paper the participants given garlic took it in powdered form as a standardized supplement at a dose of 600 mg - 900 mg daily for 12-23 weeks. The garlic supplements provided around 3.6 mg - 5.4 mg of allicilin which is the active ingredient in garlic.  A fresh clove of garlic contains around 5 mg - 9 mg of allicin (and tastes wonderful!), so whether you eat garlic regularly or choose to take a supplement it may well be helpful for your blood pressure or for your health in general!

As high blood pressure is a (silent but) major risk factor for heart attack I wanted to mention the British Heart Foundation campaign which aims to alert us to the more visible symptoms of a heart attack.  As part of the campaign there will be a two minute TV  promotion at 9.17pm on ITV1 this Sunday (10th August) during a break in the  ‘Midsomer Murders’ programme.  The charity is calling the event ‘Watch Your Own Heart Attack’.  More information can be found on their website or by clicking on this link.

(1)Ried K et al.  2008.  Effect of garlic on blood pressure: A systematic review and meta-analysis.  BMC Cardiovascular Disorder.  8:13(16 June), [E-pub doi:10.1186/1471-2261-8-13]

Written by Ani Kowal

After completing my MSc I shared a house with a friend who seemed to be constantly suffering with mouth ulcers.  Looking into the literature I discovered that there were a number of natural ways that could help to prevent and treat this painful occurrence.  Since then he has been ulcer free! 

Mouth ulcers, medically known as Aphthous Stomatitis, are small, white or yellow-white, painful ulcers that usually affect the tongue or the lining of the inner cheeks or lips.  The ulcers involve the inflammation or destruction of the mucous membranes that line the mouth.  Usually they will be painful for three to four days with symptoms generally diminishing in seven to ten days.  An ulcer begins as a small red dot on the lip or the inside of the mouth, which then develops into a small blister with a white head, eventually the head will rupture, leaving an open ulcer that, without care, can become secondarily infected by yeast or bacteria.

I was reminded of my friend as I read two recent studies that have linked the herb liquorice to effectively treating mouth ulcers(1,2).  One of the studies(1) was a review that looked at over-the-counter (OTC) treatment available for mouth ulcers, the scientists found that there was no reliable evidence to suggest that OTC preparations could do more than simply manage symptoms – the exception were two treatments which contained the herbal extract liquorice.  The liquorice containing treatments reduced the pain associated with mouth ulcers and also increased the healing time.  In addition, the liquorice containing OTC treatments were as effective as a prescription only medication (amlexanox).  The second study(2) found that liquorice treatments were effective at reducing the size of ulcers, the pain and the duration which they remained.

Liquorice has been traditionally used to treat mouth ulcers for a long time due to its apparent soothing properties.  A small study(3) found that liquid liquorice extract (which is widely available) diluted in warm water and used as a mouth rinse was very helpful at accelerating the healing of mouth ulcers. 

It is unsurprising that liquorice may be helpful in reducing the swelling and pain associated with mouth ulcers as it does seem to poses anti-inflammatory properties.  If you have a mouth ulcer you may well find it helpful to drink liquorice teas (powdered liquorice root is widely available and can be used to make a tea or mouth rinse), make a mouth rinse using herbal extract or chew on a liquorice tablet twenty minutes before eating in order to help reduce pain.

Liquorice may well be helpful in treating a mouth ulcer once it has already taken painful residence in the mouth however, more importantly for those of you who may suffer from recurrent mouth ulcers, there are a number of ways to prevent their occurrence in the first place.

Toothpaste seems an unlikely place to start, however, a number of studies(4,5,6) have linked recurrent mouth ulcers to Sodium Lauryl Sulfate (SLS), a common foaming ingredient in most toothpastes.  SLS may dry out and irritate the lining membranes of the mouth and tongue and increase the risk of mouth ulcers from reoccurring.  The studies have shown that using SLS-free toothpaste is helpful to individuals susceptible to mouth ulcers.  Natural SLS-free toothpaste is now widely available and it may well be worth switching to such a paste for three months to see if it is helpful in minimising the frequency of your attacks.

Another common factor(7,8,9,10) in individuals who suffer from regular mouth ulcers is insufficiency in a variety of B vitamins (including B12, B1, B2, B6 and folic acid).  Supplementation with a multi-B vitamin complex is often very helpful to those who frequently suffer from mouth ulcers.

As a final note I would like to mention stress.  For as long as I can remember people have said that mouth ulcers are caused by stress and some resources suggest this to be an ‘old wives tale’.  Being ever curious, I started to dig around in the medical literature.  Stress is linked to inflammation in the body and so it would be feasible for a link to mouth ulcers to exist.  I did find a supportive study that looked specifically at stress and anxiety(11) in the causation of mouth ulcers and one(12) that found a relaxation therapy was very effective in reducing the recurrence of ulcers in susceptible individuals.  Stress may be linked to the depletion of many nutrients in the body.  A healthy balanced diet will help keep your nutrient levels high – important for a well functioning immune system!  In addition to this, if you regularly find yourself feeling stressed or pressured you may wish to consider supplementing with a broad-spectrum, high quality, multi vitamin and mineral product to prevent any dietary shortfalls.

(1)  Burgess JA et al.  2008.  Review of over-the-counter treatments for apthous ulceration and results from use of a dissolving oral patch containing glycyrrhiza complex herbal extract.  J Comp Dent Pract.  9:88-89
(2) Martin MD et al.  2008.  A controlled trial of a dissolving oral patch containing glycyrrhiza (licorice) herbal extract for the treatment of aphthous ulcers.  Gen Dent.  56:206-210
(3) Das SK, Das V, Gulati AK, Singh VP.  1989.  Deglycyrrhizinated liquorice in aphthous ulcers.  J Assoc Physicians India.  37(10):647
(4) Herlosfson BB et al.  1994.  Sodium lauryl sulfate and recurrent aphthous ulcers.  A preliminary trial.  Acta Odontol Scand.  52:257–59.
(5) Herlosfson BB et al.  1996.  The effect of two toothpaste detergents on the frequency of recurrent aphthous ulcers.  Acta Odontol Scand.  54:150-153.
(6) Chanine L et al.  1997.  The effect of sodium lauryl sulfate on recurrent aphthous ulcers:  a clinical study.  Compend Contin Educ Dent.  18:1238-1240.
(7) Piskin S et al.  2002.  Serum iron, ferritin, folic acid, and vitamin B12 levels in recurrent aphthous stomatitis.  J Eur Acad Dermatol Venereol.  16(1):66-7
(8) Haisraeli-Shalish M, Livneh A, Katz J, Doolman R, Sela BA.  1996.  Recurrent aphthous stomatitis and thiamine deficiency.  Oral Surg Oral Med Oral Pathol Oral Radiol Endod.  82(6):634-6
(9)Barnadas MA et al.  1997.  [Hematologic deficiencies in patients with recurrent oral aphthae].  Med Clin (Barc).  109(3):85-87
(10)Nolan A et al.  1991.  Recurrent aphthous ulceration.  J Oral Pathol Med.  20:389-391.
(11)Andrews V H et al.  1990.  The Effects of Relaxation/Imagery Training on Recurrent Aphthous Stomatitis:  A Preliminary Study.  Psychosomatic Medicine, September/October 1990; 52(5):526-535.
(12)McCartan BE et al.  1996.  Salivary cortisol and anxiety in recurrent aphthous stomatitis.  J Oral Pathol Med.  25(7):357

Written by Ani Kowal

As I began the week writing about exercise I thought I would continue along similar lines and mention some newly published research(1) which adds to the ever growing evidence suggesting that physical activity is important in preventing cancer.

This most recent research was carried out as part of the Japan Public Health Centre Study.  The trial involved a total of 79,771 Japanese men and women aged 45-74 years who were followed for around 9 years.  During this time 4334 cases of cancer occurred in the individuals taking part.  The researchers looked at overall daily physical activity levels. The surveyed population was divided into four groups according to individual working metabolic rate which was determined by the amount of time respondents spent sitting, walking, standing, sleeping and exercising. 

Increased daily physical activity was associated with a significantly decreased risk of cancer in both men and women (compared to individuals with the lowest daily physical activity rates).  The decreased risk was more clearly observed in women than in men (men in the most active group had a 13% reduced risk of developing cancer compared with the least active group, and women in the most active group had a 16% lower risk), especially among the elderly and those who were regular exercisers.  In men cancer of the colon, liver and pancreas were protected against by physical activity and in women decreased risk was specifically associated with cancer of the stomach.  The research is particularly interesting since it focused on a relatively lean and already healthy population.  Previous research on physical activity and cancer prevention has mainly focused on the western populations who are less lean.  This indicates that physical activity seems to act as an added preventative measure in its own right.

A lot of evidence already exists for the importance of physical activity in the prevention of cancer.  For more information and tips on how to increase your physical activity levels I would suggest visiting the World Cancer Research Fund (WCRF) website.  This is a fantastic charity focussing solely on the prevention of cancer through dietary and lifestyle changes.  Scientists estimate that about a third of cancers could be prevented by eating a healthy diet, being physically active and maintaining a healthy weight!  WCRF were the first cancer charity: to create awareness of the relationship between diet and cancer risk; to focus funding on research into diet and cancer prevention and; to consolidate and interpret global research to create a practical message on cancer prevention.

My daily walk is definitely here to stay!

(1) Inoue M et al.  2008.  Daily Total Physical Activity Level and Total Cancer Risk in Men and Women: Results from a Large-scale Population-based Cohort Study in Japan. Am J Epidemiol. 2008 Jul 2. [Epub ahead of print]

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

On June 16th and June 20th I wrote about asthma treatment and prevention and mentioned the apparent benefits of long chain omega 3 fatty acids (from fish oils). 

Recently published research(1) adds weight to the evidence for the benefits of fish oil supplementation in asthma prevention.  The study suggests that pregnant women who take fish oil supplements in the final trimester of their pregnancy could well be helping to reduce the risk of asthma development in their children.  The trial involved 533 women in their 30th week of pregnancy.  266 were given fish oil capsules (providing 2.7g omega 3 fatty acids) daily, 133 were given olive oil capsules and 131 were given capsules containing no oil.  The women took the capsules until delivery.  The scientists then assessed the children at age 16.  

The children of women who took the fish oil had a hugely reduced risk of developing asthma.  The risk (hazard rate) of asthma development in these children was reduced by 63% and the risk of allergic asthma was reduced by 87%. 

The authors conclude: “our results support that increasing n–3 PUFAs [fish oils] in late pregnancy may carry an important prophylactic [preventative] potential in relation to offspring asthma”.  Professor Sjurdur F Olsen, lead study author also notes "These are results from a relatively small trial and therefore it is most important that our results are confirmed by other trials before we change any dietary recommendations for pregnant women."

As mentioned in the previous asthma posts, omega 3 fatty acids seem to have their positive effects for asthma prevention via their action on the immune system.  In the final trimester of pregnancy the developing foetus has a greater need for omega 3 fatty acids for brain development.  It may be that this is a critical time for the overall health effects of omega 3 fatty acids.

The study was carried out as part of a much larger ongoing research project, called the Early Nutrition Programming Project (EARNEST), funded by the European Commission to investigate the effects of early nutrition on later health outcomes.   It is a 5 year research programme (due to end in 2010) bringing together a multi-disciplinary team of scientists from 38 institutions in 16 European countries.  The project hopes to gain a better understanding of how nutritional conditions in early life, either pre- or postnatally can affect life-long health.  As part of the EARNEST project is the establishment of an Early Nutrition programming Academy (ENA).  The aims of the academy, among others, are to foster nutrition research and its standards, in particular as it relates to nutrition in women of childbearing age, infants and children.  It is a great step on the path to understanding the importance of early nutrition better!

If you are pregnant, or planning a pregnancy, and do not regularly eat oily fish you may wish to discuss the idea of taking a fish oil (long chain omega 3 fatty acid) supplement with your doctor or midwife.  Vegetarians and vegans have the option of taking a flaxseed (sometimes called linseed) oil supplement, this is a shorter chain omega 3 fatty acid which, if taken in large enough doses, can be converted by the body into the longer chain form.

(1)Olsen SF et al.  2008.  Fish oil intake compared with olive oil intake in late pregnancy and asthma in the offspring: 16 y of registry-based follow-up from a randomized controlled trial.  Am J Clin Nutr.  88: 167-175.

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