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

On the 22 October I mentioned the potential use of Vitamin D supplements for helping individuals suffering from the mood disorder SAD (seasonal affective disorder).  This year a number of papers have been published (1,2,3,4) which suggest that vitamin D could potentially be useful for the treatment of other mood disturbances and depressive episodes.

In 2007 a review paper was published (5) which suggested that vitamin D deficiency may play a role in depression and other mood and mental health disturbances, especially in the elderly where low vitamin D levels are commonly found.  The paper highlighted a number of trials that which showed that vitamin D supplementation appeared to be useful in the treatment of depression but expressed a need for further studies.

Vitamin D seems to be a hot topic this year and I have written about it a number of times in my blog posts.  Low vitamin D levels seem to be linked to cancer, heart disease, SAD, chronic fatigue syndrome, migraine headaches and various other diseases, not only bone conditions such as osteoporosis and osteoarthritis.  It is becoming glaringly obvious that this ‘sunshine vitamin’ is more important than we once thought. 

Two studies this year have linked low vitamin D status, as measured by low circulating blood levels of vitamin D, with depressive symptoms.  One study (1) was carried out in overweight and obese individuals and the other (3) in older adults (aged 65 – 95 years).  Both studies found that there was an association between depression status and severity with decreased serum (blood) vitamin D levels.  In the study with overweight/obese participants high-dose vitamin D supplementation led to significant improvements in depressive symptoms, compared to placebo, during the study.  The studies so not prove a causal relationship between low vitamin D and depression but they do add to the mounting evidence which suggests a very real link.  Further, larger studies will be needed to verify the information and investigate this exciting association further.

It is not currently known why vitamin D may be useful in treating mood disorders or why low levels may have a part to play in causing mood problems.  It may be that vitamin D has an effect on hormones linked to mood.  Studies are bound to unravel the mystery over the next few years!

A recent analysis(6) found that there is a global widespread insufficiency of vitamin D and there is evidence from the National Diet and Nutrition Surveys (NDNS) which suggests that in the UK deficiency of this vital nutrient is a real problem (7,8,9,10).  The problem is made worse in the older generations, as we age our bodies find it increasingly difficult to manufacture vitamin D.  In the UK many of us do not get enough sunlight exposure to generate decent levels of vitamin D in our bodies, especially in the autumn and winter months when we cover our bodies up and don’t get out during the daylight hours very often. 

Walking and exercise have also been linked to improved mood, so a lunchtime walk, in daylight, may bring added mood lifting benefits.  Only small amounts of vitamin D are found in food sources such as oily fish (mackerel, salmon and sardines) and eggs.  As many of us in the UK are falling short of recommended vitamin D levels, 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.

You may also want to think about getting a daylight lamp for your work desk to help improve mood.  Some of these lamps produce light that the body can use for vitamin D production (check with the manufacturer of the lamp).

For more interesting information about the benefits of vitamin D and sunlight for health please visit the Sunlight Nutrition And Health Research Centre, the information there is well presented and backed up by significant amounts of good evidence.

(1)Jorde R et al.  2008.  Effects of vitamin D supplementation on symptoms of depression in overweight and obese subjects: randomized double blind trial.  J Intern Med. Sep 10. [Epub ahead of print]
(2)Murphy PK & Wagner CL.  2008.  Vitamin D and mood disorders among women: an integrative review.  J Midwifery Womens Health.  53:440-446
(3)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.
(4)Johnson MA et al.  2008.  Vitamin D deficiency and insufficiency in the Georgia Older Americans Nutrition Program.  J Nutr Elder.  27:29-46
(5)Berk M et al.  2007.  Vitamin D deficiency may play a role in depression.  Med Hypotheses.  69:1316-1319
(6)Hagenau T et al.  2008.  Global vitamin D levels in relation to age, gender, skin pigmentation and latitude: an ecologic meta-regression analysis.  Osteoporosis International May [E publication ahead of print]
(7) Finch S et at.  1998.  National Diet and Nutrition Survey of People aged 65 Years and Over.  London: H. M. Sationery Office.
(8) Gregory L et al.  2000.  National Diet and Nutrition Survey of People aged 4-18 years. Vol 1.  Report of the Diet and Nutrition Survey.  London:  The Stationery Office
(9) Henderson L et al.  2002.  National Diet and Nutrition Survey: Adults Aged 19-64 years.  Vol 1: Types and Quantities of Foods Consumed.  London: The Stationery Office
(10) Hypponen E & Power C.  2007.  Hypovitaminosis D in British adults age 45y: nationwide cohort study of dietary and lifestyle predictors.  Am J Clin Nutr.  85:860-888.

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

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

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

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

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

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

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

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

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

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

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

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

Written by Ani Kowal

Last week I wrote about light box therapy, and other ideas, for improving mood in SAD (seasonal affective disorder).  A more conventional approach to SAD is pharmaceutical antidepressant therapy with, for example, SSRI (selective serotonin reuptake inhibitors) type antidepressants which include fluoxetine (Prozac) and paroxetine (Paxil, Seroxat).  However, these drugs come with certain side effects (including an increased risk of suicide attempts) and their effectiveness has also been questioned.  For these reasons, many individuals seek alternative ways of dealing with low mood.  One well recognised natural agent is the herb St John’s wort (Hypericum perforatum).  Historically this plant has been used as a remedy for the treatment of depression and there is now quite a bank of medical and scientific evidence(1) confirming the effectiveness of this herb for aiding various mood disturbances.

St John’s wort is a shrubby perennial plant with bright yellow flowers, named after St John the Baptist.  Ancient Greeks and Romans believed that the herb could deter evil spirits but today it is mainly used as a natural, alternative to antidepressants.  The herbal supplements are made from the dried flowers of the plant.  The herb has been routinely used in Germany for many years where doctors and health practitioners frequently prescribe supplements for depression.

Very recently a paper was published (1) reviewing the available evidence for the use of St John’s wort in the treatment of depression.  The review included 29 high quality studies (randomised and double-blind) from a variety of countries, the studies included a total of 5489 patients and ranged from 4 weeks to 12 weeks in length.  The researchers found that, for people suffering from mild to moderate depression, St John’s wort can provide effective relief, similar to that of standard antidepressants but with fewer side effects. 

The authors note, and it is important to state, that people suffering from depressive symptoms (including a low mood, loss of interest or pleasure in life and activities) who wish to use a St John’s wort product should ALWAYS consult a doctor.  The quality of products available on the market varies widely and the herb can interact with other medications so it is always best to check with a medical practitioner before embarking on a treatment plan.

The antidepressant properties of St John’s wort are thought to be ascribed to the compounds hypericin and hyperforin that are contained within the herb.  It is not entirely known how the herb works to lift the mood but it seems to act on certain ‘feel-good’ brain chemicals (known as neurotransmitters) such as dopamine, serotonin and noradrenaline.

The typical recommended dose is 300mg of St John’s wort extract three times a day for supplements standardised to contain 0.3% hypericin.  One a day supplements containing 900mcg hypericin are also available.  ALWAYS check with a doctor before taking the herb.  It may take 4 weeks before you see any benefit.  Side effects are uncommon, however in people with fair skin it is advisable to avoid prolonged exposure to sunlight whilst taking the herb.

The herbal supplement also seems useful for the treatment of other mood disturbances such as anxiety, apathy, insomnia, stress and SAD, if you think you could benefit from taking St Johns wort I would suggest chatting with a health professional prior to undertaking a supplementation regimen.
 

(1)Linde K et al.  2008.  St John’s wort for major depression.  Cochrane Database of Systematic Reviews Issue 3. Art. No.: CD000448. DOI: 10.1002/14651858.CD000448.pub3

Written by Ani Kowal

Continuing on from from Part I here are some more ideas for SAD (seasonal affective disorder) sufferers, or for anyone wishing to lift their mood in the autumn and winter months.

Exercise
Numerous studies point toward the general mood enhancing effects of exercise.  A 30 minute walk during the day may help to lift the mood.  Studies specifically investigating SAD have found that light therapy in conjunction with daily exercise seems highly beneficial in reducing SAD symptoms (1,2,3).  There seems to be an apparent additive effect of exercise and light on mood and health-related quality of life in individuals suffering with SAD.  Trying to get out for a lunchtime walk, when the light is at its best in the winter, may really help to lift mood.  Walking with a friend can help motivation and provide time for talking which can help clear the mind.

Vitamin D
A review was published earlier this year (4) which looked at the association between vitamin D and mood disorders in women.  The researchers reviewed published study data and found that there was an association between low vitamin D levels and higher incidences of seasonal affective disorder (as well as major depressive disorder).  The authors conclude that further studies are warranted in order to asses the association in more detail.

I have previously mentioned that in the UK many of us do not get enough vitamin D.  Supplementation with vitamin D may be useful to improve mood in SAD sufferers (5,6).  It has been suggested that the seasonal symptoms of SAD may be due to changing levels of vitamin D3, the hormone of sunlight, and that supplementation with vitamin D may lead to positive changes in brain serotonin levels (a ‘feel-good’ brain chemical).  In one study subjects were given 400 IU, 800 IU, or no vitamin D3 for 5 days during late winter.  Results showed that vitamin D3 significantly enhanced positive feeling and there was some evidence of a reduction in negativity (5).  In another study, 30 days of treatment with vitamin D proved highly effective in resolving depression in a group of SAD sufferers (6).  Taking 400-800IU daily may be helpful to SAD sufferers during the winter months when sunlight is scarce.

Good diet, food cravings and blood sugar balance
Carbohydrate cravings are often reported by individuals suffering with SAD.  This could be due to the fact that carbohydrate increases the uptake of an amino acid (building blocks of protein) called tryptophan.  Tryptophan is used in the synthesis of serotonin, the good mood brain chemical.  If serotonin levels are good then appetite is often normalised and cravings are less likely occur. 

Regulating blood sugar levels with diet may also be helpful to SAD sufferers with disordered eating and cravings.  I wrote about this in more depth on the 8th and 10th of September.  Balancing blood sugar levels through eating a healthy diet that provides a slow and steady supply of energy throughout the day may help to prevent cravings and fatigue.  A diet rich in vegetables and fruits, healthy fats (especially omega 3 fatty acids from oily fish, fish oil or flax seed oil supplements) and proteins (from nuts/seeds, eggs, lean unprocessed meats, fish and pulses/beans) may help to minimise blood sugar imbalances and cravings.  Vegetables and fruits are great sources of unrefined carbohydrates as are wholegrains with a low glycaemic index (GI).  Please read my previous posts for more detail on glycaemic index and eating to minimise cravings.  If you feel that your diet is inadequate you may wish to consider taking an omega 3 fatty acid supplement (a fish oil or flaxseed oil supplement) and a good quality multivitamin-mineral supplement (I prefer ‘food state’ supplements).

Women suffering from the eating disorders bulimia or binge eating disorder may find that their conditions are more difficult to control in the winter time.  There is some indication (7) that light therapy can help minimise these symptoms in autumn/winter and aid mood and carbohydrate craving.  Investing in a light box or daylight alarm clock may prove useful.  For help and information on eating disorders please visit the BEAT website.  BEAT is a charity (the working name for the Eating Disorders Association) for people with eating disorders and their families.

Cognitive behaviour therapy / counselling
Finally, if you feel distressed and unable to cope with the depressive/mood symptoms associated with SAD you may well want to look at a form of counselling called Cognitive Behaviour Therapy to help.  There is indication (8) that this form of therapy is very useful in individuals dealing with SAD and low mood in winter.  For more information and useful links please visit the Royal College of Psychiatrists. 

Wishing you all a happy winter!

(1)Leppamaki S et al.  2004.  Drop-out and mood improvement: a randomised controlled trial with light exposure and physical exercise.  BMC Psychiatry.  4:22
(2)Partonen T et al.  1998.  Randomized trial of physical exercise alone or combined with bright light on mood and health related quality of life.  Psychol Med.  28:1359-1364
(3)Leppamaki SJ et al.  2002.  Bright light exposure combined with physical activity elevates mood.  J Affect Disord.  72:139
(4) Murphy PK&Wagner CL.  2008.  Vitamin D and mood disorders among women: an integrative review.  J Midwifery Womens Health. 53(5):440-6.
(5) Lansdowne AT et al.  1998.  Vitamin D3 enhances mood in helathy subjects during winter.  Psychopharmacology.  135(4):319-323.
(6)Gloth FM et al.  1999.  Vitamin D vs broad spectrum phototherapy in the treatment of seasonal affective disorder.  J Nutr Health Aging.  3:5-7
(7) Lam RW et al.  2001.  An open trial of light therapy for women with seasonal affective disorder and comorbid bulimia nervosa. J Clin Psychiatry.  62(3):164-8
(8)Rohan KJ et al.  2007.  A randomised controlled trial of cognitive behaviour therapy, light therapy and their combination for seasonal affective disorder.  J Consult Clin Psychol.  75:489-500

Written by Ani Kowal

Dwindling sunlight and wintry weather may leave some of us feeling a little less positive and uplifted than we would like.  This shift in mood is common, but for some individuals a real sense of depression can occur in the autumn and winter months.  In such cases Seasonal Affective Disorder, or SAD as it is commonly known, may be diagnosed. 

People with SAD frequently suffer sleep disruption, carbohydrate cravings and weight gain, depression, irritability, loss of libido, lethargy, joint pain, stomach problems and often find that their ability to cope seems to be lowered.  Treatment aims to lift mood and relieve depression.  You will be pleased to hear that there are some simple steps that can be taken to help.

Last week I mentioned The Sunlight Campaign being run by the National Osteoporosis Society which aims to highlight the importance of getting out in the sunlight in order for the body to manufacture vitamin D which is crucial for bone health (and many other health parameters!).  Today I wanted to look at the link between sunlight and mood.

The changing seasons can affect our mood and behaviour, this is a natural process that can clearly been seen in animals – and we are no exception.  Many of us will find that we want to eat a little more and sleep a little more in the winter and that the dark mornings and short days are not to our liking.  For some people these kinds of symptoms are severe enough to disrupt normal daily life and cause real distress.  These individuals are said to suffer from SAD.  SAD is characterised by episodes of depression in autumn/winter and is thought to be caused because of lack of daylight.  Our bodies have an internal 24hour clock or cycle, known as the circadian rhythm.  This cycle of day-night is affected when the daylight hours shorten in autumn/winter.  Sunlight is known to affect certain mood chemicals in the brain such as serotonin and melatonin, if there is less light then less serotonin is produced and this may lead to low mood.

Light therapy
Bright light appears to immediately have an effect on mood via the brain chemical serotonin and the pathways involved in its production (1,2,3).  There have been many studies (too many to list), which show the beneficial effects of light therapy for those suffering with SAD.  Light boxes are available to buy online and in stores and do make a real difference.  Make sure that you follow the manufacturers instructions and if you are also seeing a doctor work with them in order to gain maximum benefit.  Most people find that morning use of the light box, for between 30 minutes to an hour, is most helpful.  The light emitted from these units has a similar spectrum to daylight (it is thought hat the light needs to be at least 2,500 lux in order to be beneficial).  Daylight bulbs are also available to buy.

Bright light may actually help us all in the winter.  A study carried out in the year 2000 (4) found that bright light improved vitality and mood among people with SAD but also in healthy subjects with no SAD but who worked indoors during the winter.  This does not surprise me, if you work indoors during the winter months you are more than likely to arrive at work while it is dark, sit in the office in false light and leave when it is dark outside thus never seeing natural daylight.  Getting out for a lunchtime walk or buying a small daylight lamp unit to sit on your desk at work may make a real impact on your mood.

Dawn simulation
Some studies (5,6,7)  have now been carried out with dawn simulators for SAD.  These simulators (daylight alarm clock) are now widely available to buy and usually consist of a unit with a light that gradually increases in intensity over a 30 minute period until it is at it’s brightest when an alarm usually sounds.  The thinking behind the sunrise alarm clock is that in the winter we often wake up with a start when the alarm goes off, but it is still very dark outside.  Our bodies awake with a shock and then we turn on a bright light, we miss the normal cues to the body that occur with dawn and increasing light.  If we wake up with gradual, dawn light our circadian rhythm / natural body clock, is less disrupted.  The studies have proved very positive with some indication that the dawn simulation sunrise alarm clocks, are as good as light boxes at helping mood in SAD sufferers.

Check back later in the week for more information on SAD.

You may also wish to contact the the 'Seasonal Affective Disorder Association' a registered charity which informs the public and health professions about SAD and supports and advises sufferers of the illness.

(1)Grass F & Kasper S.  2008.  Humoral phototransduction: light transportation in the blood, and possible biological effects.  Med Hypotheses.  71:314-317
(2)Aan het Rot M et al.  2008.  Bright light exposure during acute tryptophan depletion prevents a lowering of mood in midly seasonal women.  Eur Neuropsychopharmacol.  18:14-23
(3)Hoekstra R et al.  Effect of light therapy on biopterin, neopterin and tryptophan in patients with seasonal affective disorder.  Psychiatry Res.  120:37-42
(4)Partonen T & Lonnqvist J.  2000.  Bright light improves vitality and alleviates distress in healthy people.  J Affect Disord.  57:55-61
(5)Terman M & Terman JS.  2006.  Controlled trial of naturalistic dawn simulation and negative air ionization for seasonal affective disorder.  Am J Psychiatry.  163:2126-2133
(6) Avery DH et al.  2001.  Dawn simulation and bright light in the treatment of SAD: a controlled study.  Biol Psychiatry.  50:205-216
(7)Avery DH et al.  1993.  Dawn simulation treatment of winter depression: a controlled studyAm J Psychiatry.  150:113-117

Written by Ani Kowal