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

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

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

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

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

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

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

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

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

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

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

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

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

Written by Ani Kowal

Peppermint tea is one of my favourite refreshers, so I was interested to read a paper(1) published in the latest issue of the British Medical Journal linking peppermint in the treatment of IBS (irritable bowel syndrome).  Back in August I wrote three lengthy pieces investigating IBS and this paper provides a nice update. 

The key to IBS is to try and find a cause to treat, this is very individual and may be linked to stress, emotions, food intolerances and more.  Any sort of diagnosis needs to be done in conjunction with a health professional.  However, it is always good to have some idea of the natural remedies that can help reduce symptoms.  The research in the British Medical Journal was a review of randomised controlled trials looking into the effect of fibre, antispasmodics (prescribed medication) and peppermint oil in the treatment of IBS.

Fibre
Traditionally, people with irritable bowel syndrome were instructed to increase their daily intake of dietary fibre, because of its potentially beneficial effects on bulking stools and moving them through the intestine more quickly (speeding up intestinal transit time).  However, many individuals with IBS found this advice unhelpful and some people reported that it made the condition worse.  The study looked at types of fibre and their usefulness in IBS treatment.  The investigators found that bran fibre (usually from wheat) had no effect on IBS symptoms.  However, ispaghula fibre, a soluble fibre derived from plaintain, did have a beneficial effect and reduced persistent symptoms of IBS.  The authors of the study indicate that ispaghula may be particularly beneficial to individuals who suffer constipation as one of their major IBS characteristics.

Ispaghula husk is readily available to buy from health-food stores and pharmacies as well as online. 

Antispasmodics
Antispasmodic medications attempt to reduce spasms in the digestive system.  Doctors frequently prescribe these types of medication for IBS symptoms, particularly when an individual is suffering from bloating and pain.  In the study 12 drugs were assessed.  Only 5 of these were shown to bring about a relief for IBS symptoms.  Some of the drugs, which are specifically licensed for use in IBS e.g. mebeverine, dicycloverine and alverine actually seemed to have very little evidence behind them.  The best evidence seemed to be for a drug called hyoscine.  The most common side effects for this type of medication are dry mouth, dizziness, and blurred vision, but none of the trials reported any serious adverse events.

It is not really known why antispasmodics are helpful for IBS sufferers.  The authors of this study note that “The biological rationale for the efficacy of antispasmodics is unclear.....antispasmodics may act by reducing colonic contraction and transit time and therefore pain and stool frequency”.  In light of the evidence discussed in this medical journal I would think that further studies are necessary to investigate the use of these drugs in patients with IBS to see if they really are helpful.

Peppermint oil
There were fewer available studies to analyse for the use of peppermint oil.  However, the studies that have taken place with this remedy show consistently positive results for use in IBS patients.  In fact peppermint oil appeared to be the most effective treatment for IBS when assessed via a measure called NNT, or number needed to treat, a measure of the number of individuals that need to be treated for one to get significant benefit.  Peppermint appears to have natural antispasmodic properties and is widely available over the counter in capsule form.  Larger trials of this traditional remedy would be welcome.

The authors conclude their paper by talking about the current guidelines for the management of IBS, they discuss the fact that these guidelines have been set around previous studies that have potential methodological flaws.  In the UK “Antispasmodics are recommended as first line treatment, particularly when pain and bloating are the predominant symptoms, although which of these drugs should be preferred is not stated”(1).  They also suggest that the current clinical guidelines be updated to take into account their findings.

(1) Ford AC et al.  2008.  Effect of fibre, antispasmodics, and peppermint oil in the treatment of irritable bowel syndrome: systematic review and meta-analysis. BMJ.  337:a2313

Written by Ani Kowal

On 15th October I wrote about the connection between B vitamins and healthy bones and I also mentioned how elevated homocysteine levels may be implicated in bone deterioration and heart disease.  Today I want to look at the link between elevated homocysteine levels, low vitamin B12 levels and cognitive (mental) decline.

To recap: Homocysteine is produced when the amino acid (the building blocks of protein) methionine is broken down in the body.  Normal levels of homocysteine are important to help build and maintain body tissues, however elevated concentrations in the blood can be harmful and have been associated with an increased risk of many disorders.  At normal levels homocystein can be converted in the body into a harmless substance called cystanthionine.  The conversion of homocysteine into this harmless substance depends upon various B vitamins  (B6, B12 and folic acid).  Having good levels of these B vitamins appears to be a very good way of preventing high homocysteine levels and low levels of B vitamins have been associated with raised homocysteine levels.

A new study (1) was recently published which showed that older adults who have vitamin B12 levels that are low, but still within the normal range, may exhibit a quicker rate of brain shrinkage (brain volume loss) as they age compared to those who have good levels.  The authors wanted to investigate the association between vitamin B12 status and brain volume loss in a population of adults aged 61-87 over a 5 year period.  The participants were free of cognitive impairment (they were free of dementia) at the start of the study.  Those with lower vitamin B12 levels at the start of the study experienced the greatest decrease in brain volume over the 5 year period.  This was only a small preliminary study involving 107 individuals, the authors suggest that low vitamin B12 status should be further investigated and that trials with vitamin B supplements would be useful.

A loss in brain volume has been linked to a faster rate of mental decline and progression to diseases such as Alzheimer’s disease and dementia.  Vitamin B12 is extremely important in order to keep nerve cells healthy.  The study mentioned above (1) suggests, but does not prove, that modifying vitamin B12 status could be important in protecting the brain and preventing cognitive decline.  The results of the study do suggest that it is important to keep our vitamin B12 levels higher than just the minimum.

A study last year (2) looked at the association between cognitive decline and vitamin B12.  The study included 1684 individuals who were followed for 10 years.  Mental state (cognition) was examined a minimum of 3 times over the 10 years as were serum vitamin B12 concentrations.  Analysis of the results found that reduced vitamin B12 status was associated to cognitive decline.  The investigators also found that a high homocysteine level was associated with a greater rate of cognitive decline.  Again the authors indicate the need for further studies and supplementation trials for the prevention of dementia.

A review (3) paper published this year discussed the importance of vitamin B12 for brain health throughout life from infancy to adulthood.  In childhood low vitamin B12 levels may be related to behavioural problems and in adults it seems to be related to social development, depression and cognitive problems.  It seems as though this nutrient really is vital throughout our lifespan. 

Many older adults in the UK have lowered vitamin B12 levels.  In the diet, B12 comes from meat, fish, dairy, other animal products, and fortified breakfast cereals. Strict vegetarians, who avoid meat, and vegans, who avoid all animal products, are also at risk of B12 deficiency.  Studies seem to suggest that anything in the stomach that affects the normal acidity and digestive processes, ranging from infections to acid reflux medications to aging, may also interfere with the absorption of vitamin B12. 

The vitamin B group work very well as a team and interact in many processess, if you decide to take a supplement it may well be worth considering a multi-B vitamin supplement rather than single B vitamin supplement, or a broad spectrum multi-nutrient supplement (I prefer food state supplements which appear to be more easily absorbed by the body).

(1) Vogiatzoglou A et al.  2008.  Vitamin B12 status and rate of brain volume loss in community-dwelling elderly.  Neurology.  71:826-832
(2)Clarke R et al.  2007.  Low vitamin B-12 status and risk of cognitive decline in older adults.  Am J Clin Nutr.  86:1384-1391
(3)Black MM.  2008.  Effects of vitamin B12 and folate deficiency on brain development in children.  Food Nutr Bull.  29:S126-131

Written by Ani Kowal

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

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

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

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

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

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

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

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

Written by Ani Kowal

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

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

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

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

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

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

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

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

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

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

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

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

Written by Ani Kowal

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