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

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

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

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

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

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

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

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

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

Written by Ani Kowal

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

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

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

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

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

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

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

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

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

Check back later in the week for information regarding osteoarthritis.

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

Written by Ani Kowal

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

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

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

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

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

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

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

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

Written by Ani Kowal

Period pain (menstrual pain or dysmenorrhoea) is thought to affect around 75% of women at some time in their lives with around 15% having pain sever enough for it to disrupt their normal daily lives.  Doctors have categorised women who suffer with period pain into two groups, primary and secondary. 

Primary – period pain which has no identifiable cause.

Secondary – period pain with an identifiable cause such as endometriosis, fibroids and pelvic inflammatory disease. 

In this post I am going to concentrate on primary dysmenorrhoea (to give it the full name).

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

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

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

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

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

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

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

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

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

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

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

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

Written by Ani Kowal

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

Autumn is here and the rain and wind may have you retreating to the sofa to snuggle with hot drinks rather than get out and about walking or exercising.  However, the benefits of braving the cold may actually warm the heart!  A new study (1) has found that any amount of physical activity appears to lower the risk of death among women and men with already diagnosed coronary heart disease.  On the 31st July I wrote about physical activity and the prevention of cancer and with World Heart Day fast approaching (28th September) I thought it apt to mention this newly published study.

Individuals with heart disease frequently limit the amount of physical activity they partake in due to symptoms such as shortness of breath, chronic fatigue and circulatory problems.  The researchers of this study wanted to investigate the long-term effects of exercise in individuals with existing heart disease.  The study involved 14,021 people followed for an average of 14.7 years.  The researchers categorised their physical activity into four levels – sedentary, mild, moderate and strenuous.

The results showed that the risk of death from cardiovascular problems increased significantly with less physical activity.  The more active an individual was, the lower the risk of death from cardiovascular problems.  This trend was similar in men and women.  Over the course of the study, the death rate was lowest among men and women involved in strenuous recreation such as endurance activities or competitive team sports.  The death rate was highest among men and women reporting sedentary leisure activities that primarily involved sitting.  Sedentary individuals were 1.6 times more likely to die from cardiovascular disease or other causes over the long term compared to those more physically active.

The study concluded that “leisure-time physical activity independently predicted long-term survival in men and women with chronic stable CHD[coronary heart disease]”

If you suffer from heart problems ALWAYS make sure that you check with your GP or specialist before embarking on a new exercise regimen and seek advice on the best form of exercise for you to try.  Walking and swimming are often recommended as good, gentle, ways to get started. 

(1) Apullan MD et al.  2008.  Usefulness of Self-Reported Leisure-Time Physical Activity to Predict Long-Term Survival in Patients With Coronary Heart Disease.  Am J Cardiol. 102:375-379

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