Exercise, tai chi and meditation all seem to be helpful for the treatment of insomnia and sleep problems.

On Monday I wrote about some of the natural ways that insomnia may be treated.  Continuing on the same theme I wanted to look at some new evidence which links different types of physical activity to sleep promotion.

There is recent evidence to suggest that regular daytime exercise can work very well for the treatment of insomnia, especially in women (1,2).  Being physically active seems to be linked to  sleep improvement, totality of sleep time and decreased time to sleep onset.  The same kind of benefit also seems to be gained for simple stretching and strengthening exercises as well as massage and relaxation techniques (2). 

Walking has been investigated as a technique to help individuals suffering from anxiety and mild depression with great results.  I would also suggest that it is a simple and effective way to integrate physical activity into any day.  Walking for 20-40minutes a day (not necessarily all in one bout) may well help to reduce anxiety and therefore help alleviate sleep problems and insomnia.  Personally I find walking to be an essential part of my daily routine, it brings me clarity of mind and reduces any tension.  If you wish to try exercise in an attempt to ease sleep difficulties it is usually best to exercise during the day, at least three hours before sleep.  Exercising just before bed tends to wake the body up and may exacerbate sleep problems. 

For a long time individuals practicing relaxation techniques, meditation, Tai Chi and yoga have said that their sleep greatly benefits.  Until recently evidence has been anecdotal but studies are now being carried out on these ancient practices and scientists are finding that these techniques really are usful in aiding calmness and improving sleep quality.

A very recent study (3) assessed the usefulness of Tai Chi exercise for individuals suffering with insomnia.  The study involved 112 healthy adults aged 59-86 years old.  The individuals were either assigned to a health education class for 25 weeks or they undertook Tai Chi classes.  The Tai Chi group received 16 weeks of taught Tai Chi followed by home-practice and an assessment 9 weeks later.  Sleep quality was assessed using a special medically tested sleep quality index.  Tai Chi was found to help improve sleep quality score and participants also reported a greater sleep efficiency, sleep duration and less sleep disturbance.  The authors conclude that Tai Chi is a useful non-pharmacological approach to improving sleep quality.  Tai Chi has also been found to be useful in previous studies (4).  I tried Tai Chi last year and really enjoyed the gentle form of movement.  There was a big focus on correct breathing which was very relaxing in itself, it certainly helped me to sleep more deeply and I would highly recommend trying it out if there are classes in your area.

Many people suffering with insomnia and sleep problems often find that they are going through a period of anxiety or emotional upset.  In such cases talking-therapies or counselling can be helpful to deal with the underlying anxiety and are therefore helpful for sleep.  Meditation techniques are also useful for calming the mind and reducing anxiety.  Simple techniques such as focussing on the breath, bringing yourself back to the moment or repeating a calming word or phrase (a mantra) can be very useful.

Two recent studies (5,6) have found that combining mindfulness meditation with cognitive-behaviour therapy (a form of counselling) is useful in the treatment of insomnia.  These were preliminary studies but the data strongly suggests that this combined form of treatment really does improve sleep quality.  The authors of these studies call for larger trial and additional testing.  This form of combined therapy appears to be particularly useful in relieving insomnia symptoms in individuals suffer from worry and anxiety (6).  CBT is a form of counselling and mindfulness meditation helps individuals to stay in the moment and calm their thoughts.  The Counselling Directory is an online resource that can help you find qualified CBT practitioners in your area, some of these counsellors are also trained in mindfulness meditation techniques.

I do hope that these last two posts have provided some ideas that may help you to sleep more easily this year.

(1)Llanas AC et al.  2008.  Physical therapy reduces insomnia symptoms in postmenopausal women.  Maturitas.  61:281-284
(2)Tworoger SS et al.  2003.   Effects of a Yarlong moderate-intensity exercise and stretching intervention on sleep quality in postmenopausal women. Sleep.  26:830-836
(3)Irwin MR et al.  2008.  Improving sleep quality in older adults with moderate sleep complaints:A randomised controlled trial of Tai Chi Chih.  Sleep.  31:1001-1008
(4)Li F et al.  2004.  Tai Chi and self-rated quality of sleep and daytime sleepiness in older adults: a randomised controlled trial.  J Am Geriatr Soc.  52:892-900
(5)Ong JC et al.  2008.  Combining mindfulness meditation with cognitive-behaviour therapy for insomnia:a treatment-development study.  Behav Ther.  39:171-182
(6) (6)Yook K et al.  2008.  Usefulness of mindfulness-based cognitive therapy for treating insomnia in patients with anxiety disorders:a pilot study.  J Nerv Ment Dis.  196:501-503

Written by Ani Kowal

Sleep is something we all need in order to function effectively!  Not getting enough sleep can leave us feeling irritable, unable to perform tasks properly and generally unwell.  Aiming to get between 7 and 8 hours of sleep a night is usually recommended by health professionals.  December saw the publication of two studies (1,2) linking adequate sleep to heart health.  The relationship has been previously explored and it really does seem that sleep is vital for our health and wellbeing, not just in order to prevent tiredness.  The second study (2) found that either too little sleep, 5 hours or less, or too much sleep, 9 hours or more, was associated with an increased risk of heart disease.

Many individuals find that they suffer from the odd bout of insomnia, others find that their insomnia may go on for many months, especially if they are going through an emotionally difficult period.  Pharmaceutical sleeping-pills are an option, however they often leave the user feeling heavy-headed in the morning or as if they are suffering from a ‘hang-over’.  Many people don’t want to take prescribed sleep medication and worry becoming dependent on such pills.  Since sleep is so important for our health and wellbeing I thought I would take some time to look at the many natural ways that can aid good sleep.

Insomnia is the term used to describe problems with quality, quantity and timing of sleep (3).  Sleep problems can include trouble falling asleep, problems staying asleep (frequent night waking) and waking early in the morning with difficulty resuming sleep.  A typically described feature of insomnia is feeling tired and fatigued the next day to a degree that can disrupt normal daily activities.  There are three main categories of insomnia (3):

1.Transient insomnia – which typically lasts for about a week, usually caused by jet lag, stress, environmental factors, exams etc. 
2.Short term or sub-acute insomnia – lasting 1-4 weeks, usually related to emotional problems or serious illness.
3.Chronic insomnia – usually lasts for more than a month and is sometimes related to psychiatric disorders or drug abuse.

Reduced amount of sleep can have considerable impact on the life of the patient, their family, friends and work colleagues.  It can reduce physical and mental energy, cause irritability, an inability to concentrate and is linked to a deterioration of general health.  For someone feeling very tired and fatigued it becomes dangerous to drive or operate machinery.  Insomnia can also lead to feelings of low self-esteem and confidence.  Worrying about insomnia can make the situation worse so I hope that the following information provides a little helpful advice on how the problem can be approached naturally.

Caffeine
Caffeine has a stimulant effect in the body, it triggers the release of certain stimulating hormones such as adrenaline.  Studies have shown that individuals drinking caffeinated drinks such as tea, coffee and cola are more likely to suffer from sleep disruption (4,5).  Caffeine tends to arouse us and in some people the effects can last for many hours.  If you are going through a period of sleeplessness, especially associated with anxiety it may well be very helpful to eliminate caffeine for a few weeks, or at least try to only consume one cup early in the day until sleep patterns are normalised.  Also check the labels of any painkillers you may be taking as they often contain caffeine.  Alcohol and nicotine also act as stimulants so be wary of these.

Blood sugar levels
Some individuals find that they can get to sleep very easily but then tend to wake in the middle of the night, often finding it difficult to get back to sleep again. This problem may be related to a drop in the level of sugar in the blood during the night (6). Normally, the body manages to keep a stable blood sugar level during the night.  However, if the level drops, the body attempts to normalise it by producing stimulating hormones such as adrenaline and cortisol (known as stress hormones) which can cause night waking.  Adrenaline levels often peak at around 3-4am, a time when many individuals wake.  The key to resolving such cases of insomnia is to eat a diet during the day that helps the body to maintain stable blood sugar levels.  I have written about eating to normalise blood sugar levels previously (8th and 10th September).  Blood sugar problems may also be the reason why some individuals wake up hungry during the night or early morning (6)

Balancing blood sugar levels through eating a healthy diet that provides a slow and steady supply of energy throughout the day may also help to prevent cravings and daytime 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.  Vegetables and fruits are great sources of unrefined carbohydrates as are wholegrains with a low glycaemic index (GI) these will help to ensure a steady supply of energy to the body.  Please read my previous posts for more detail on glycaemic index and eating to minimise blood sugar swings. 

Food sensitivities/allergy
Food sensitivity or allergy may also be an underlying problem in some cases of insomnia.  Foods causing allergic reactions are known to provoke many responses in the body such as an increase heart rate which may cause or aggravate insomnia (6).  If you think you may be suffering with a food allergy/intolerance it is important that you seek the advice of a health professional who will carry out proper allergy tests, undergoing your own elimination diet is not recommended.

Calcium and Magnesium
Anecdotal evidence suggests that taking calcium and magnesium in the evening, prior to sleep may help to ease trouble falling asleep.  These minerals may work by aiding relaxation and reducing anxiety.  Women in particular may find these nutrients useful, in the UK many women do not achieve desirable intakes of these minerals, especially magnesium (which is naturally found in high levels in nuts, seeds, pulses and wholegrains).  A supplement containing up to 1000mg calcium and 500mg magnesium taken prior to sleep may be helpful. 

Herbs
There are many herbal sleep aids sold online and in supermarkets, pharmacies and health-food stores.  Of the most popular are chamomile tea, lavender oil fo use in the bath and on the pillow, valerian supplements, hops supplements and supplements containing a mixture of herbs.  The scientific evidence for the use of these herbs is not well documented, however research is beginning to mount.  In practice many individuals do tend to find herbal remedies helpful and they may well be worth a try, especially if you suffer from insomnia linked to anxiety and not being able to fall asleep.  Most of the herbal remedies available are thought to be calming.

5-HTP
Sleep is induced by the production of certain feel-good brain chemicals including a substance called ‘serotonin’. In the body, serotonin is manufactured from the amino acid tryptophan and tryptophan depletion can lead to insomnia(7).  Although tryptophan cannot be bought as a supplement an intermediary in the production of serotonin, 5 hydroxytryptophan (5HT), can be purchased.  Supplementing with this substance may help induce and maintain sleep (8).  I have used this supplement in the past and found it to be very helpful.  The normal recommended dose is 50 mg, taken an hour before bedtime.  Often 5-HTP supplements also contain a variety of B vitamins that are naturally part of the serotonin pathways in brain.

Some additional advice to insomniacs (6)
*Avoid napping during the day
*Go to bed and get up at regular times
*Take regular exercise but avoid this 3 hours before bed
*Try to do something relaxing before going to bed e.g. reading, listening to music, taking a warm bath or shower
*If possible avoid emotional upsets before bed
*Avoid working in bed or in the bedroom
*Ensure that the environment is suitable for sleeping e.g. not too cold/hot, not too noisy, comfortable mattress

If insomnia persists for more than a couple of weeks please go to see your doctor.  Insomnia can be linked to medical conditions such as pain, bladder problems, gastrointestinal upsets, coughs, upper airway obstruction and depression.

(1)King RC et al.  2008.  Short Sleep Duration and Incident Coronary Artery Calcification
JAMA. 300(24):2859-2866
(2)Shankar A et al.  2008.  Sleep Duration and Coronary Heart Disease Mortality Among Chinese Adults in Singapore: A Population-based Cohort Study. American Journal of Epidemiology.  168(12):1367-1373
(3) Lader M.  2000.   Insomnia. Family Medicine Jan/Feb: 8¬12
(4)Shirlow MJ & Mathers CD.  1985.  A study of caffeine consumption and symptoms; indigestion, palpitations, tremor, headache and insomnia.  In J Epidemiol.  14:239- 248
(5) Bonnet MH & Arand DL.  1992.  Caffeine use as a model of acute and chronic insomnia.  Sleep.  15:526-536.
(6) Holbrook AM et al.  2000.  The diagnosis and management of insomnia in clinical practice: a practical evidence based approach.  JAMA.  162:21620
(7)Riemann D et al.  2002.  The tryptophan depletion test: impact on sleep in primary insomnia – a pilot study.  Psychiatry Res.  109:129-135
(8)Sourlairac A et al.  1977.  Action of 5-hydroxytryptophan, serotonin precursor, on insomniacs.  Annals Medico-Psychologiques.  135:792-798.

Written by Ani Kowal

2009 is fast approaching and many people will be deciding to make resolutions, often with a certain amount of apprehension.  The problem with New Year resolutions, in my opinion, is that often we set targets that are unobtainable or very difficult and easily broken.  Consequent feelings of failure can be destructive and upsetting.  Perhaps it is time to make some resolutions to uplift us, rather than burden us?

Making a decision to become healthy need not be something to dread.  Indeed we can relish the experience of positive change and look forward to more energy and better health.  Personally I believe that a lot of health resolutions are broken because the focus is deprivation.  We decide we are going to give up x,y and z and spend at least an hour in the gym every day!  If we can shift the focus onto what we can positively add to our lifestyle I believe that we will have a better chance of making some worthwhile health changes.  Negative behaviours seem to dissipate and diminish naturally when positive changes are added.

The path toward health need not be arduous.  Of course, I am not suggesting it is easy, some conscious effort is required but most of all an eager readiness to make small, constant, changes is what is necessary – after a while we can look back at these small steps and see that we have, indeed, come a long way.

Here are just some of the thoughts and ideas that I have had over the last few days.  It is by no means an extensive list.  What I feel is important is simply to get a feel for all the small steps that we can implement into our lives.

*Focus on aiming to build a sustainable healthy lifestyle in 2009 – try not to aim to go on a ‘diet’, lose weight or become thin.

*Concentrate on adding foods such as fruits, vegetables and salads to your day.  Take the focus off depriving yourself of foods you view as ‘bad’.  Really aim for at least 5 portions of fruit and vegetables a day.  Dried and frozen varieties all count.  If you really don’t like the taste of vegetables and salads make interesting dressings for them, olive oil with fresh herbs and garlic instantly transforms any vegetable dish.  The simple act of adding healthier options probably means you will automatically eat fewer other foods.  Banning a specific food will only make you want it more.  A healthy eating lifestyle will accommodate pleasure!! Concentrating on health and healthy food will mean that you generally reduce the amount of processed food, salt and sugar that you consume.

*Snack!!  Eating small amounts between meals helps to stave off hunger and keeps blood sugar levels stable.  Healthy snacks can be prepared in advance and kept in office draws and handbags.  Fresh fruit, dried fruit, nuts and vegetable sticks are all great options.  A few squares of good dark chocolate, 70% cocoa solids or greater, may help to curb cravings and satisfy a chocolate urge (for more information on chocolate and appetite read my recent post). 

*Eat breakfast.  Studies show that individuals who eat a healthy breakfast tend to be slimmer and healthier than those who skip this essential meal.  Even a piece of fruit on the run is better than nothing.  A breakfast that is low in sugar and contains some protein will help to keep you going for longer.  Muesli that contains plenty of nuts and seeds with a banana sliced on the top works well, scrambled eggs with tomato or mushrooms, fruit salad with nuts and seeds, aim for anything that is minimally processed.  Think natural.  Sugary cereals may leave you feeling hungry or tired within an hour and won’t provide the nutrient boost that other options provide.

*Drink plenty to keep hydrated.  Water really is the best option.  Caffeine may wake you up but can play havoc with blood sugar levels leaving you feeling tired, irritable and hungry.  If you really love a coffee or tea in the morning try and have it with a breakfast that is unrefined and contains protein, this will minimise the effects on hunger.  Perhaps try to limit your caffeinated drink option to 1-2 cups per day and really indulge in that drink, take time to taste it and savour the flavours.  Gulping down constant cups of tea, coffee or cola doesn’t allow any time for enjoyment of the drink you may swear that you need or relish.

*Don’t be Fat-Phobic!  Foods such as nuts, seeds, avocados, olives, mackerel, salmon, sardines and all oily fish are superb for our health.  The essential omega 3 fatty acids found in oily fish are particularly beneficial for so many reasons (just search through my blog posts for evidence!!).  Fat is found naturally in these foods, it is not added but concentrated there by nature.  I am not suggesting eating crisps, cakes and other refined and processed foods that have fat added to them or spreading lard over your food!  Choose naturally and you won’t go far wrong.

*Plan ahead.  Making a shopping list with lots of fresh and healthy ingredients will help with choice.  Buying vegetables and fruits in season keeps the cost down and frozen vegetables are a great way to ensure you always have options available at your fingertips.

*Eat without the TV on.  Research suggests that if you eat in front of the TV you will consume more than if you don’t.  If you live with someone use meal times to communicate, catch up, chat.  If you live on your own perhaps try the radio for company.  Take time to enjoy your meal, to taste what you are eating, to chew and digest. 

*Aim to add a walk (this does not need to be a hike!) to your day, I think this is more achievable in the long-term, than aiming for long hard sessions in the gym.  Just 30 minutes extra a day will benefit health and it need not be done in one go.  Two fifteen minute sessions can be just as beneficial.  Get off the bus a stop early, walk instead of taking the lift, walk at lunchtime with a colleague, walk with a friend in the evening or at weekends.  Or if you have old exercise DVDs get a friend over and do them together – this is cheaper than a gym membership and you can motivate one another.  Or try something different like joining a local dance class.

*Have fun.  Research shows that happiness and joy are good for health.

*Journal.  Writing things down can help in many ways.  If you have been having trouble with food and comfort eating then write down what you are eating, it helps to see what you consume and can make you more conscious of choices.  Also write down how you are feeling when you reach for the sugary comfort foods – seeing the link can be a great step in helping to break the pattern.  See if there is something else you could do for comfort – read a good book, have bath, do something creative, call a friend.  Be honest when you write your private thoughts and try to remember to write about the good things you have achieved in the day too – it can be all too easy to concentrate on negativity.  Acknowledging the positive can help you feel good.  If you feel you want to explore your eating behaviour further then CBT (cognitive behaviour therapy), or other forms of counselling such as psychosynthesis or integrative counselling are good options to explore.  Practitioners of these therapies are not there to judge, they listen openly and help you to find solutions.  The simple act of unburdening can be a pleasure in itself. 

*If you eat something that you perceive to be unhealthy then don’t beat yourself up, if you are on a generally healthy path the odd slip doesn’t mean you have to give up or crash and burn.  Enjoy the odd treat, whatever your idea of food heaven is.  See it as a wonderful indulgence not as a bad and terrible mistake.  Luxuriate in it knowing ithat it is a once in a while indulgence.

Wishing you all a health-filled, gloriously happy 2009!!

Please feel free to add your own health-resolution ideas in the comments section below.

  
Written by Ani Kowal

I do hope you all had a fabulous Christmas?  Plenty of food has been consumed in my household and, with New Years Eve fast approaching, there may be plenty more tasty treats in the planning.  Indigestion is possibly on the menu in many homes, however there are natural ways to prevent and overcome this uncomfortable problem.

Indigestion, sometimes referred to as dyspepsia, is a general term for impaired stomach/digestive functioning occurring 1-2 hours after eating.  Symptoms may include:
Abdominal Pain centred in the upper abdomen
Rumbling noises
Excessive wind
A feeling of fullness or bloating

Indigestion commonly occurs after eating a large meal, or rich, fried or spicy food.  Alcohol, coffee, cigarette smoking and some pharmaceutical drugs such as aspirin and ibuprofen can also irritate the digestive system and cause indigestion.  During stressful situations or stressful periods of time we are also more susceptible to this complaint.

Our bodies are far more adept at digesting small, regular quantities of food rather than single huge meals.  However, if you are going to be consuming a large meal there are a few things you can do to minimise discomfort.  Chewing is a simple, yet highly effective, strategy for indigestion avoidance.  Our saliva contains enzymes that start digesting food within the mouth, even before it hits the stomach.  Chewing food properly enables these enzymes to mix thoroughly with our food.  Chewing also physically breaks food up into smaller pieces which make it easier to be further broken down by our stomach acid.  Taking the time to chew food until it becomes almost creamy in consistency before swallowing is an effective method of preventing indigestion and also allows us to enjoy what we are eating, really taste the flavours and savour them.  Taking time over a meal increases the enjoyment value, usually helps us not to overeat (as it is easier to know when we are full) and can help prevent indigestion.

Whilst eating try not to drink a lot of fluid.  Excess liquid with a meal can dilute stomach acid and enzymes which digest food making the process a little less efficient.  Carbonated, fizzy, drinks seem to be the worst culprits. 

Prebiotics and Probiotics
Studies (1,2) are beginning to show that probiotics and prebiotics can aid healthy digestion and prevent indigestion.  Taking a supplement containing prebiotics and probiotics regularly can prevent symptoms such as pain, bloating and flatulence within as little as 2 weeks

A probiotic is a supplement containing live friendly bacteria which aim to improve intestinal bacteria balance.  Probiotics are available as yoghurts, fermented milks, fortified fruit juices and freeze dried capsules/powders.   

A prebiotic is a food that stimulates the growth of the beneficial bacteria already present in the colon.  Fructooligosaccharides (FOS) which can be bought as powders are the most common prebiotics available.  Natural prebiotics can be found in asparagus, onion, chicory
and garlic. 

Digestive enzymes
Many people will reach for antacids in the hope that they will aid their indigestion.  However, antacids are used to damp-down the stomach’s acid (hydrochloric acid) production and in many instances indigestion is actually linked to insufficient acid production in the stomach.  Taking an antacid could exacerbate the underlying cause of indigestion.  If, after a large meal, you feel uncomfortable with indigestion it may be helpful to take a supplement containing a mixture of natural digestive enzymes such as amylases, which digest carbohydrates, lipases, which digest fats, and proteolytic enzymes which digest proteins.  This will help your body to digest the food within your system.  I don’t suggest these supplements need to be used long term but they may well be helpful after a large meal if indigestion starts to make you feel uncomfortable.

Digestive enzyme use should be avoided in cases of gastritis, inflammation of the stomach lining, and/or ulceration as they will exacerbate the condition. 

Artichoke leaf extract
Studies (3,4) show that artichoke leaf extract supplements are useful for individuals who commonly suffer with indigestion.  It appears that after taking the supplement for six weeks individuals report their symptoms are improved and they feel more comfortable in general.  

Finish off the meal with some peppermint or ginger tea
A review published of studies and papers was published this year (5) which indicates that peppermint oil can be effective in reducing abdominal pain, flatulence and diarrhoea.  It seems to work by reducing spasms in the digestive system.  Peppermint tea contains peppermint essential oil and it may be worth sipping on some peppermint tea after a meal – it could aid in minimizing indigestion problems. 

Another recent review paper (6) indicates that ginger may well be helpful in easing indigestion.  Ginger does contain many compounds that seem to have various effects in the body and is particularly useful in relieving feelings of nausea.  Drinking some ginger tea after a meal could be worth a try!

Please see a doctor if your indigestion persists over several days, is experienced after every meal, becomes worse over time, if you vomit, you lose your appetite, or if you start to lose weight. These symptoms may indicate an underlying gastric disorder.  Apart from poor digestion or a large meal, another common cause of indigestion is an ulcer in the stomach or upper intestines and I hope to write about digestive ulcers in 2009.

Take the time to really enjoy your New Year celebrations!

(1)Kocian J.  1994.  [Lactobacilli in the treatment of dyspepsia due to dysmicrobia of various causes][Article in Czech].  Vnitr Lek.  40(2):79-83
(2)Bittner AC et al.  2007.  Prescript-assist probiotic-prebiotic treatment for irritable bowel syndrome: an open-label, partially controlled, 1-year extension of a previously published controlled clinical trial.  Clin Ther.  29:1153-1160
(3) Marakis G et al.2002.  Artichoke leaf extract reduces mild dyspepsia in an open study.  Phytomedicine.  9(8):694-699.
(4)Holtmann G et al.  2003.  Efficacy of artichoke leaf extract in the treatment of patients with functional dyspepsia: a six-week placebo-controlled, double-blind, multicentre trial.  Aliment Pharmacol Ther.  18(11-12):1099-1105.
(5) Herbal remedies for dyspepsia: peppermint seems effective.  2008.  Prescrire Int.  17:121-123
(6)Ali BH et al.  2008.  Some phytochemical, pharmacological and toxicological properties of giner (Zingiber officinal Roscoe): a review of recent research.  Food Chem Toxicol.  46:409-420

Written by Ani Kowal

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

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

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

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

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

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

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

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

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

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

Written by Ani Kowal

As Christmas is only a few days a way I thought I would mention a few common Christmas foods that have the benefit of being great for our health (rather than concentrate on the less nutritious fare!).  Brussels sprouts and dried dates are Christmas staples in many households and both of these foods have fabulous health giving properties.

Many of us remember being told to “eat your greens, they’re good for you”.  The bitter taste of broccoli, cabbage and Brussels sprouts is not one that many children crave.  However, if we can acquire a taste for that bitterness and mature our palates to accept these flavours our health could benefit greatly.  ‘Cruciferous’ vegetables of the Brassica family e.g. cabbage, broccoli, Brussels sprouts and cauliflower seem to represent an important weapon in the fight against cancer.  

Time and time again research has shown that a high consumption of fruits and vegetables is consistently associated with a reduced risk of cancer at most sites, as well as heart disease and many other health conditions.  The World Cancer Research Fund is a charity dedicated to cancer prevention.   They fund around one million pounds of research per year into the link between cancer, diet, physical activity and weight management.  The WCRF state that scientists estimate that about a third of cancers could be prevented by eating a healthy diet, being physically active and maintaining a healthy weight (1)

The conclusion drawn from many studies (too many to detail) and observations is that a high consumption of Brassica vegetables is associated with a decreased risk of many cancers and that consuming Brassica vegetables may be especially important in preventing cancer of the breast, prostate, lung and digestive tract. 

The bitter taste of these Brassica vegetables is down to a set of chemical compounds, called glucosinolates, which they contain.  More than 90 different glucosinolates are known to exist and it is the biological activity of these compounds that seems to be so important in cancer protection.  The breakdown products of glucosinolates seem to have anticancer properties, they stimulate enzyme systems in the body that detoxify foreign, potentially cancer causing, compounds.

Brussels sprouts are a sort of ‘vegetable flower’ which are picked and eaten before they progress into a “real” flowers.  They are related to the cabbage and were developed in Belgium many hundreds of years ago and given the name of the Capital city, Brussels. In addition to containing cancer preventative glucosinolate compounds they are also low in calories and high in nutrients, fibre, vitamin C, B vitamins and potassium as well as numerous phytochemicals (bioactive plant nutrients).

Perhaps it’s time we all acquired a taste for these bitter vegetables?  Tuck into a few Brussels sprouts this Christmas day and it might be a sweet ending for health!   
 

Thinking about sweets brings me seamlessly onto the humble dried date.  There are always dried dates in my household over Christmas.  My sister particularly enjoys these sweet treats and refers to them  as ‘natures toffee’.  However, there is more to this humble fruit than sweetness alone.

In 2003 a paper (2) was published in the international Journal of Food Science and Nutrition which was dedicated to the health benefits of dates.  Dates are the fruits of the date palm tree (Phoenix dactylifera L). They are packed with vitamins, minerals and fibre.  The research paper found that there are at least 15 minerals present in dates including potassium, calcium, magnesium, selenium and zinc.  Vitamin C and many of the B vitamins are also present. 

Although dates are intensely sugary, with much of the natural carbohydrate provided within dates being fruit sugar, it appears that they actually release their sugar in a slow and sustained way into the body, this is probably down to their very high fibre content.  Up to 12% of the date is dietary fibre and a large proportion of that fibre is pectin, a type of soluble fibre which holds water and forms a gel-substance in the stomach and intestines.  Subsequently, food is more slowly released from the stomach and sugar more slowly released into the blood which helps us to feel fuller for longer.  A few sweet dates as a snack will probably curb appetite, keep energy levels up and prevent us over-snacking while we wait for the Christmas dinner to be ready.

So go on, have a few sweet dates this Christmas!

(1)World Cancer Research Fund

(2) Al-Shahib W et al.  2003.  The fruit of the date palm: its possible use as the best food for the future?  Int J Food Sci Nutr.  54:247-259.

Written by Ani Kowal

My last few blog posts have had a Mediterranean theme so I decided to continue it through to this post.....last week I mentioned the Mediterranean diet in relation to prevention of heart disease, cholesterol lowering and the reduction of triglyceride levels, a risk factor for heart disease.  I also mentioned that low fat, high carbohydrate diets were not necessarily successful in reducing the overall risk of heart disease and could often contribute to an increase in triglyceride levels.  A study published in the December issue of the Archives of Internal Medicine (1) found that a Mediterranean diet supplemented with nuts could potentially play a significant role in reducing in the risks of heart disease.

The researchers were investigating the effects of a Mediterranean diet on the metabolic syndrome.  Metabolic syndrome is a term used to describe a cluster of risk factors for heart disease, diabetes and stroke which includes: high blood pressure, abdominal obesity (excess weight around the waist), high triglyceride levels, high blood sugar levels and high levels of SD-LDL cholesterol (a particularly damaging form of cholesterol) as well as other factors.

The study (1) lasted for a year and included a total of 1224 participants aged 55-80 which were split into 3 groups.  The aim was to determine the efficacy of diet on the prevention of cardiovascular/heart disease.  One group was given information about the Mediterranean diet including the use of 1L of virgin olive oil per week, the second group was advised to consume a Mediterranean diet including 30g of mixed nuts per day and the third group acted as a control group and advised to eat a low-fat diet.

After a year the prevalence of metabolic syndrome among the participants was reduced by almost 7% in the Mediterranean + olive oil group, almost 14% in the Mediterranean + nuts group and only 2% in the low fat group.  In the nut group there was also a significant drop in the number of participants with abdominal obesity, high blood triglyceride levels or high blood pressure when compared to the low fat diet (control group).  The authors conclude that “A traditional Mediterranean diet enriched with nuts could be a useful tool in the management of the metabolic syndrome”

The benefits of a Mediterranean diet may be greater when nuts are included as a fat source since nuts also provide nutrients, in addition to healthy fats, such as fibre, potassium, calcium and magnesium – which are linked to a reduction in blood pressure and may also help to regulate blood sugar levels through an effect on the hormone insulin.  Walnuts are also fairly rich in omega 3 fatty acids, not provided by olive oil, which are known to help reduce the risk of heart disease. 

Typically a Mediterranean diet is rich in olive oil, vegetables, fruits, oily fish (a great source of omega 3 fatty acids) and low in refined carbohydrates, sugar and processed foods.  I have written extensively about the Mediterranean diet previously so please search through my blog posts for further information.

The study did not assess the dietary potential for weight loss nor did the scientists look at advising an increase in physical activity.  The results were achieved with diet alone.  In combination with education on increasing physical activity I expect that the results could have been further improved.  Just 30 minutes of walking a day seems to be highly beneficial to health, even if this is broken down into two fifteen minute sessions. 

From this study and from my previous posts I think it is important to note that dietary fat is not necessarily the ‘bad guy’ that many people assume.  Perhaps refined carbohydrates, foods with a low GI (glycaemic index) which release sugar quickly into the blood stream and sugar represent huge problems to health.  Naturally high-fat foods such as nuts and seeds, avocados, olives and oily fish are great for our health and, I would suggest, far more nutritious than many of the low fat refined cereal foods that are on offer in our supermarkets.

(1)Salas-Salvado J et al.  2008.  Effect of a Mediterranean diet supplemented with nuts on metabolic syndrome status one-year results of the PREDIMED randomized trial.  Arch Intern Med.  168:2449-2458

Written by Ani Kowal

Thinking and writing about the Mediterranean diet last week got me thinking about the Mediterranean in general and the extra sunlight that many Mediterranean inhabitants are exposed to....oh it would be nice to be in the sun right now....anyway, back to the point in hand!  Vitamin D, the sunshine vitamin, has numerous health benefits and I am sure that the Mediterranean peoples gain from exposure in addition to their traditional healthy diet.

This month the American Journal of Clinical Nutrition is full of papers discussing Vitamin D (1,2,3,4).  Readers of my blog will know that this year seems to have been the year for Vitamin D research!  Many scientists are stepping up and extolling the virtues of the ‘sunlight vitamin’, for health.  Here in the UK we are well into winter and the days are short giving us very little opportunity to step into the light for any length of time.  Even if we can get out while the sun is bright we are wrapped up because of the cold so our skin isn’t exposed to the light and vitamin D cannot be manufactured.  A supplement could be the answer?

Vitamin D seems to be important in relation not only to bone health but also in the prevention of heart disease and cancer.  It also seems to be important for our immune system, muscles and brain and low levels have been linked to SAD, chronic fatigue syndrome, migraine headache and depression.

As I was writing and thinking about this post I came across a very recent and interesting study (5).  Most evidence with regards vitamin D has been carried out in adults, this study was different as it involved 90 young women aged 16-22.  The researchers measured vitamin D levels in the participants via a simple blood test and found that around 59% had insufficient levels, a huge proportion.  The result is particularly surprising since the women in this study live in Southern California, which receives abundant supplies of sunlight. 

The scientists also found that the young women with vitamin D insufficiency were significantly heavier, had a higher body mass index (BMI) and had a greater level of abdominal fat, a well recognised risk factor for heart disease and diabetes.  They were also shorter in height compared to the women with sufficient vitamin D levels.  Whether or not the low vitamin D levels are causal in weight gain cannot be known from this study, but it is worrying that so many young individuals do not have good levels of this essential nutrient, even though they live in a sunny environment.

The authors of the study indicate that health professionals could easily check for vitamin D insufficiency via a simple blood test.  Vitamin D is so important for health and so many of us in the UK are not getting enough.

There have been calls for a raising of the recommended intakes of vitamin D and some scientists are even stating that vitamin D insufficiency has now reached epidemic proportions(5).  In light of all the recent and advancing evidence it seems wise that we consider a vitamin D supplement, providing around 500-800 IU per day, especially over the autumn/winter months when sunlight exposure on our skin is minimal. 
 

Some individuals may prefer to try and gain extra vitamin D from their diet.  Unfortunately only small amounts of vitamin D are found in food sources such as oily fish e.g. mackerel, salmon and sardines (especially in canned varieties where the bones are soft and can be eaten) and eggs. 

(1)Norman AW.  2008.  A vitamin D nutritional cornucopia: new insights concerning the serum 25-hydroxyvitamin D status of the US population.  Am J Clin Nutr.  88:1455
(2)Looker AC et al.  2008.  Serum 25-hydroxyvitamin D status of the US population: 1988–1994 compared with 2000–2004.  Am J Clin Nutr.  88:1519-1527
(3)Cashman KD et al.  2008.  Estimation of the dietary requirement for vitamin D in healthy adults.  Am J Clin Nutr.  88:1535-1542
(4)Ishihara J et al.  2008.  Dietary calcium, vitamin D, and the risk of colorectal cancer.  Am J Clin Nutr.  88:1576-1583
(5)Kremer R et al.  2008.  Vitamin D Status and its Relationship to Body Fat, Final Height, and Peak Bone Mass in Young Women.  Journal of Clinical Endocrinology & Metabolism.  E Pub November 4  2008 doi:10.1210/jc.2008-1575

Written by Ani Kowal