So called ‘super-foods’ are constantly being given press attention.  One moment it is broccoli, the next it is blueberries.  Recently there has been a lot of enthusiasm for a Brazilian berry called the Acai Berry, pronounced ah-sigh-ee.  These berries are available as drinks, supplements and dried snacks and commonly used in mixed juices, smoothies, frozen treats and dietary supplements.

Acai palms grow in the Brazilian rainforest and can reach great heights, in excess of 60 feet!  The acai fruit, or berry, is about the size of a large blueberry and only the outermost layers of the fruit (the pulp), which surround the large seed inside, are edible.

The berry has gained interest in the health arena since it is packed with antioxidant bioflavonoids, chemically active plant compounds, that may protect against many ills (please see my numerous posts discussing antioxidants for more information).  Until now there has been very little scientific research to support the health claims surrounding the acai berry.  However, in a recent issue of the Journal of Agricultural and Food Chemistry three papers were published which investigate the antioxidant properties of the Acai Berry (1,2,3).  The findings are important since they show that the antioxidants from the berry are easily absorbed for utilisation in humans and the berries were also found to have anti-inflammatory as well as antioxidant properties. 

In laboratory cell studies it also appears that the berry shows activity against cancer cells.  However, like vitamin C, the body can only absorb a certain amount of the antioxidants from the berry in one go.  The researchers of the papers say that their results are preliminary but interesting and lots of further research studies will be needed before any specific health claims for the berry can be made.

Acai berries are naturally low in sugar and the flavour has been described as a tasty mixture of red wine and chocolate!  Again, it is a matter of dietary balance.  Eating an abundant variety of different vegetables and fruits will provide the body with a whole host of different vitamins, minerals and bioflavoids and therefore provide us with the best defence against illness.  Variety is very important, acai berries can certainly be a very delicious and nutritious part of that variety but cannot be seen as a stand-alone superfood cure all.  Acai containing foods and supplements cannot act as an overall substitute for a healthy diet, but can rather be seen as an added antioxidant boost for the body.

Making the berry a part of your well-balanced and healthy diet and lifestyle could certainly prove to be a scrumptious option!

(1)Jensen GS et al.  2008.  In Vitro and in Vivo Antioxidant and Anti-inflammatory Capacities of an Antioxidant-Rich Fruit and Berry Juice Blend. Results of a Pilot and Randomized, Double-Blinded, Placebo-Controlled, Crossover Study.  J Agric Food Chem.  56:8326-8333
(2)Mertens-Talcott SU et al.  2008.  Pharmacokinetics of anthocyanins and antioxidant effects after the consumption of anthocyanin-rich acai juice and pulp (Euterpe oleracea Mart.) in human healthy volunteers.  J Agric Food Chem.  56:7796-7802
(3)Pacheco-Palencia LA et al.  2008.  Absorption and biological activity of phytochemical-rich extracts from Açai (Euterpe oleracea Mart.) pulp and oil in vitro.  J Agric Food Chem.  56:3593-3600

Written by Ani Kowal

Back pain is exceptionally common in the UK.  Causes can be varied and may include muscle and ligament injury or strain, tissue inflammation and habitually poor posture.  Typically it is the lower back that is affected since this is the area which supports the body’s weight.  Our backs and spine are made up of a number of bones, nerves, muscles, tendons, ligaments, cartilage and other tissues.  Any sort of damage or inflammation can cause chronic pain.  Persistent and intense pain should always be checked with a doctor.

The pain medication usually used for the treatment of back pain is non-steroidal anti-inflammatory drugs, known as NSAIDs.  Many individuals would rather not take pain medication regularly, you will be pleased to hear that there are many natural alternatives.  It may also be helpful to see a physiotherapist or someone to help you with posture, such as a practitioner of the Alexander technique.

Alexander technique

The Society of Teachers of The Alexander Technique (STAT) the Alexander Technique as a “subtle and thoughtful discipline, but essentially practical and problem-solving. The Alexander Technique works through re-establishing the natural relationship between the head, the neck and the back - the "core" of the body that supports the strength of the limbs and which provides the structural environment for breathing and for the internal organs” 

A well designed scientific study (1) was published in the British Journal of Medicine last year which evaluated the usefulness of Alexander technique lessons for chronic and recurrent back pain.  One-to-one taught lessons in the Alexander technique from registered teachers was found to have long term benefits for patients suffering with chronic back pain.  The study found that only six lessons were needed before a benefit was seen.  To find a teacher of the Alexander technique visit the STAT website

Vitamin D

The sunshine vitamin was the hot topic last year and studies highlighting the importance of vitamin D for health continue to appear.  Evidence is now building to suggest that vitamin D plays an important role in controlling back pain.

Already this year a paper has been published (2) by a family doctor which reviews 6 cases of chronic back pain.  Vitamin D depletion and insufficiency was found in all patients.  Pain improved, and in some cases completely resolved, after vitamin D supplementation/repletion.  Vitamin D insufficiency is common here in the UK, we don’t tend to get enough sunlight exposure (especially in the autumn and winter months) to manufacture adequate levels of this nutrient.  Doctors all over the world have started to recognise that supplementation is probably very important for a number, if not most, individuals in order to maintain healthy vitamin D levels throughout the year.

One study (3) involved 360 patients who had experienced low back pain that had no obvious cause for more than 6 months.  83% of the study patients were found to have an abnormally low level of vitamin D before treatment with vitamin D supplements. After treatment, clinical improvement in symptoms was seen in 100% of those that had a low level of vitamin D, and in 95% of all the patients. 

A study published in the British Medical Journal (4) in 2005 called for the testing of vitamin D levels in patients seeking medical help for chronic back pain.  The authors of the study “highlight the need for attending surgeons and physicians to be aware of the potential for vitamin D deficiency in their patients since failure to recognise this easily reversible problem may result in complications of treatment, including failure of spinal fusion surgery, additional morbidity, and the substantial costs of further surgery and hospitalisation.   All patients with persistent, musculoskeletal pain are at high risk of the consequences of unrecognised and untreated vitamin D deficiency.  Current clinical guidelines for managing chronic low back pain should include assessment of vitamin D status (by measuring serum 25-hydroxyvitamin D concentrations), together with advice on appropriate vitamin D supplementation in those found to be deficient”.

If you are suffering with back pain you and under the care of a doctor you may wish to discuss vitamin D supplementation with them.  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. 

Omega 3 fatty acids

The omega 3 essential fatty acids are used in the body for the production of anti-inflammatory chemicals.  These fats are found most abundantly in oily fish such as salmon, mackerel, sardines and trout.  Vegetarian sources include flaxseeds and walnuts.  Most people in the UK do not consume enough of these essential fats which are linked to a reduced risk of all kinds of conditions from heart disease, cancer, asthma, brain disorders and arthritic problems  (to name but a few).  As I mentioned at the start of this post NSAIDs are a commonly used anti-inflammatory medication for the reduction of back pain.  However, these drugs are associated with risks such as gastric ulcers and many people prefer not to take this pain medication.  The long chain omega 3 fatty acids found in oily fish could be beneficial due to their anti-inflammatory action. 

There is one preliminary study (5) that took place in 2004 which involved patients who were suffering with neck or back pain.  They were asked to take 1200mg of omega 3 fish oils per day for 4 months.  Taking the fish oil supplement was associated with a reduction in overall pain.  Larger, controlled studies are needed but there is certainly a lot of logic behind supplementation with omega 3 fatty acids in back pain associated with inflammation.  A daily fish oil supplement containing 250-350mg EPA and 250-350mg DHA could prove useful.  Vegetarians may want to consider a flaxseed oil supplement to provide 500-1000mg alpha linolenic acid daily.

Devil’s Claw

Devil’s Claw (Harpagophytum procumbens) is a herb that tends to grow naturally in South West Africa.  The root of the herb has been traditionally used in Europe for hundreds of years and contains important plant chemicals such a harpagoside, harpagide and procumbide.  Many studies have investigated the usefulness of this herb in the treatment of back pain.

A review paper (6) highlights two high-quality trials using Devil's claw which found strong evidence for improvements in lower back pain.  The daily dose of the herb was standardised to contain 50 mg - 100 mg harpagoside.  Another high-quality trial found that the herb was as useful as rofecoxib (brand name Vioxx and Ceoxx), a prescribed NSAID, in the relief of lower back pain.

(1)Little P et al.  2008.  Randomised controlled trial of Alexander technique lessons, exercise, and massage (ATEAM) for chronic and recurrent back pain.  BMJ.  337:a884, doi: 10.1136/bmj.a884
(2) Schwalfenberg G.  2009.  Improvement of chronic back pain or failed back surgery with vitamin d repletion: a case series. J Am Board Fam Med.  22(1):69-74.
(3) Al Faraj S et al.  2003.  Vitamin D deficiency and chronic low back pain in Saudi Arabia.  Spine.  28(2):177-179.
(4) Lewis P J.  2005.  Vitamin D deficiency may have role in chronic low back pain.  British Medical Journal.  331(7508):109.
(5) Maroon JC & Bost JW. 2006.  Omega-3 fatty acids (fish oil) as an anti-inflammatory: an alternative to nonsteroidal anti-inflammatory drugs for discogenic pain.  Surg Neurol.  65(4):326-31.
(6) Gagnier JJ et al.  2007.  Herbal medicine for low back pain: a Cochrane review. Spine.  32(1):82-92.

Written by Ani Kowal

On Monday I briefly mentioned the usefulness of probiotics (‘friendly bacteria’) in restoring the bacteria of the digestive system for women who have taken repeated courses of antibiotics for their cystitis or other urinary tract infections (UTI’s).  However, probiotics may do more than just help positively rebalance gut bacteria after antibiotic use.  Studies indicate that oral probiotic supplements and vaginal probiotic creams and suppositories may actually help prevent and treat the occurrence of UTIs.

You may be wondering how probiotics (taken orally or used vaginally) could be helpful in treating or preventing infections in the urinary system?  As I mentioned on Monday, in women the bacteria responsible for urinary tract infections almost always come from the vagina or the rectum/anus and travel up through the urinary tract into the bladder where they can cause problems.  In a healthy vagina the predominant bacteria present are ‘friendly’ non-harmful strains such as Lactobacilli (1), a healthy digestive system will also be dominated by a variety of different non-pathogenic bacteria.  If the vagina and digestive system are mainly colonised with good bacteria these provide a barrier to the entry of pathogenic/harmful bacteria into the urinary tract and bladder (1).  Studies now show that probiotic supplements or foods may be helpful in order to boost the number of good bacteria in the vagina and digestive system and therefore help to prevent urinary tract infections.  Evidence also suggests that probiotics may also actively prevent the pathogenic bacteria from clinging or adhering to the urinary tract and multiplying (2).

One study (3) analysed the diet of over a hundred women, with an average age of 30, who suffered from recurrent UTI’s compared to over a hundred women who had not suffered from a UTI in over 5 years.  Frequent consumption, more than three times a week, of milk products containing probiotics was associated with a significantly reduced risk of recurrent UTI’s.  Studies (4,5) also indicate that vaginal suppositories of probiotic bacteria may be useful for the prevention of recurrent urinary tract infections.

Urine normally flows in one direction, down from the kidneys, through tubes called ureters, to the bladder.  However there is a condition known as vesicoureteral reflux (VUR) where there is an abnormal flow of urine from the bladder back into the ureters.  It is a condition most commonly diagnosed in childhood after a urinary tract infection has occurred. About one-third of children with a UTI are found to have VUR. VUR can lead to infection because urine that remains in the urinary tract provides a place for bacteria to grow.  A study(6) in children with VUR compared the preventative effect of oral probiotics with antibiotics.  The probiotic was shown to be as effective as the antibiotic in the prevention of recurrent UTIs.

The evidence for the use of probiotic supplements and vaginal suppositories in the treatment and prevention of UTI in women is still preliminary but ever growing.  There is a lot of logic behind the rationale and in practice many women, especially those who have undergone repeat antibiotic treatment, find probiotics to be really helpful in preventing and treating cystitis and other urinary tract infections.  Vaginal probiotic creams, suppositories and tablets are readily available, they usually contain lactobacillus acidophilus.  Oral probiotics (and prebiotics) may be useful in order to help keep an overall balance of good bacteria in the vagina and digestive and system.

(1) Reid G & Bruce AW.  2006.  Probiotics to prevent urinary tract infections: the rationale and evidence.  World J Urol.  24:28-32
(2) Reid G.  2000.  Probiotic Therapy and Functional Foods for Prevention of Urinary Tract Infections: State of the Art and Science.  Curr Infect Dis Rep.  2:518-522
(3)Kontiokari T et al.  2003.  Dietary factors protecting women from urinary tract infection.  Am J Clin Nutr.  77:600-604
(4) Uehara S et al.  2006.  A pilot study evaluating the safety and effectiveness of Lactobacillus vaginal suppositories in patients with recurrent urinary tract infection.  Int J Antimicrob Agents.  28 Suppl 1:S30-S34
(5) Czaja CA et al.  2007.  Phase I trial of a Lactobacillus crispatus vaginal suppository for prevention of recurrent urinary tract infection in women.  Infect Dis Obstet Gynecol.  2007:35387
(6) Lee SJ et al.  2007.  Probiotics prophylaxis in children with persistent primary vesicoureteral reflux.  Pediatr Nephrol.  22:1315-1320

Written by Ani Kowal

Many women seem to suffer with recurrent urinary tract infections (UTI), usually cystitis.  This is a painful condition that occurs when the lining of the bladder becomes inflamed, making urination painful.  I was shocked to learn that one in five women suffers from a UTI at least once per year.  Some women suffer from recurrent attacks.  If cystitis occurs treatment needs to be prompt and antibiotics may well be necessary, this is because recurring UTI's may lead to kidney infections which can be serious.  The key to UTI's seems to be prevention.

Cystitis tends to occur as a result of a bacterial infection.  Urine is normally free of bacteria when stored in the bladder but sometimes bacteria in the urinary tract can overwhelm the immune system and multiply, causing infection.  Ignoring the urge to urinate can increase the likelihood of UTI since urine remains in the bladder for increased periods allowing bacteria to multiply.  Personal hygiene is important since bacteria from the anal area may enter the urinary tract during sex or when wiping after a bowel movement (this is why women are always taught to wipe from front to back).

The problem with treating recurrent bouts of UTI with antibiotics is that, over time, it can exacerbate the issue.  The bacteria may become resistant to the antibiotics.  Antibiotic use is also associated with increased risk of recurrent thrush infections, which can also lead to UTI.  Trying to prevent an infection in the first instance seems to be the answer. 

Today I want to look at cranberry juice and cranberry supplements as a way of preventing UTI in women.  Traditionally cranberry has been used by women to treat and prevent cystitis.  It was thought that cranberry worked by making the urine acidic and therefore causing the bladder not to be an environment where bacteria can colonise and multiply.  Cranberry does acidify the urine and this is certainly one of its benefits.  However, it has been shown more recently that cranberry actually provides major benefit through other means.  It appears to prevent bacteria from adhering, or clinging, to the lining of the bladder and urinary tract.  The specific agent within cranberries that seems to be useful here are pro-anthocyanidins, natural biologically active plant compounds.  If bacteria cannot cling to the urinary tract they will be washed out of the body with the urine.

Scientific research is beginning to accumulate for the usefulness of cranberry juice, supplements and other products in the treatment and prevention of UTI. 

Recently a study tested the effectiveness of cranberry against an antibiotic called trimethoprin in the prevention of UTIs in women who suffered from recurrent attacks (1).  137 women were involved and they were given the antibiotic or 500mg cranberry extract per day for six months.  It was found that the cranberry extract was as good as the antibiotic in preventing UTI.  The antibiotic produced more side effects.  The authors of the study note that cranberry extract is a cheap and useful alternative to antibiotics and as a natural product does not carry the risk of causing antibiotic resistance or further infections with thrush causing bacteria and yeasts.

Another very recent and well designed study(2) looked at the effectiveness of cranberry supplements for the prevention of UTIs in a particularly susceptible group of individuals (those with spinal cord injuries affecting the bladder).  The study lasted six months and the participants received a cranberry extract supplement or a placebo (non active tablet).  There was a reduction in the likelihood of UTI and UTI symptoms when taking the cranberry supplement and the frequency of UTI was reduced in the cranberry group compared to placebo.  The authors of the study suggest that cranberry extract supplements should be seriously considered for the prevention of UTI.

In 2007(4) a study was conducted in women who were between the ages of 25 and 70 years old.  These women had a history of suffering with a MINIMUM of 6 UTI in the proceeding year.   The participants took one high-dose cranberry capsule twice daily for 12 weeks containing 200 mg of a concentrated cranberry extract standardized to 30% pro-anthocianidins.  The participants were then followed up once per month for 4 months and then after 2 years.  During the study none of the women suffered a UTI and two years later those who continued with a supplement continued to be free of UTI.  The study was small and preliminary and needs further follow up with placebo-controlled trial but the results are very encouraging indeed.

Cranberry juice has also been widely tested and a review of the available evidence (3) suggests that cranberry juice may decrease the number of symptomatic UTIs over a 12-month period, particularly in women who suffer with recurrent UTIs.

Most women would probably prefer not to take continued and repeat doses of antibiotics in order to prevent the occurrence of cystitis or other urinary tract infections.  Cranberry really does seem like a viable alternative.  If you want to try drinking cranberry juice for prevention then 2-3 250ml glasses a day are recommended, but be wary and check the label of the juice – many varieties are loaded with sugar and/or artificial sweetners and only contain 5% pure fruit!!  Look for juices providing 100% pure fruit juice, these tend to be cranberry mixed with another juice (pure cranberry would be very bitter).  Taking a cranberry supplement is another option, these are usually standardised to contain 10% pro-anthocyanidins and 800-1000mg a day is usually recommended. 

If you have received intensive antibiotic treatment in the past you may wish to take probiotic and/or a prebiotic supplement to help the body re-colonise with 'friendly' beneficial bacteria.

(1)McMurdo ME et al.  2008. Cranberry or trimethoprim for the prevention of recurrent urinary tract infections? A randomized controlled trial in older women.  J Antimicron Chemother.  28 November [Epub ahead of print]
(2) Hess MJ et al.  2008.  Evaluation of cranberry tablets for the prevention of urinary tract infections in spinal cord injured patients with neurogenic bladder.  Spinal Cord.  46(9):622-6.
(3) Jepson RG & Craig JC.  2007.  A systematic review of the evidence for cranberries and blueberries in UTI prevention.  Mol Nutr Food Res.  51(6):738-45.
(4) Bailey DT et al.  2007.  Can a concentrated cranberry extract prevent recurrent urinary tract infections in women? A pilot study.  Phytomedicine.  14(4):237-41

Written by Ani Kowal

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