A common problem for women going though the menopause is the experience of psychological symptoms such as anxiety, mood swings and depression.  Hormone replacement therapy (HRT) and/or antidepressant medication is often offered to women going through the menopause in order to address such features.  These medications are linked with a variety of side effects and often women prefer to seek more natural alternatives in order to deal with their symptoms. 

A very recent study (1) has indicated the usefulness of the long chain omega 3 fatty acids EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid), naturally found in oily fish such as salmon, mackerel, trout and sardines, in the protection against depressive and mood related symptoms in menopausal women.  The study involved 120 women with moderate-to-severe psychological distress.  These individuals were randomly assigned to receive either an omega 3 supplement (containing EPA and DHA) or a placebo supplement (containing sunflower oil) for 8 weeks.  Changes in psychological wellbeing and depressive symptoms was assessed in these women via the use of specific medical scales and questionnaires.

Previous studies have shown the usefulness of using omega 3 fatty acids in the treatment of depression and mood disorders but this was the first trial using omega 3 fats in the treatment of psychological distress and depressive symptoms in menopausal women.  The results were useful and positive.  In a press release (2) the lead study scientist, Dr Lucas, said that the test results before and after the eight-week period indicate that omega-3s significantly improved the condition of women suffering symptoms of psychological distress and mild depression.  (No positive effect was observed among a small sub-group of women with more severe depressive symptoms). These results suggest that omega-3 supplementation may be beneficial for improving the psychological wellbeing of some menopausal women.

Women with hot flashes also noted that their condition improved after consuming omega-3 fatty acids.  The change that could be attributed to the use of omega-3 fats was equivalent to results obtained with hormone therapy and antidepressants (1,2).

The results do not surprise me.  There is now mounting evidence to support the use of omega 3 fatty acids in the treatment and prevention of anxiety and depression/depressive symptoms in a range of individuals (including children with ADHD).  Omega 3 fatty acids are absolutely essential for healthy brain structure and function.  Our bodies cannot make these essential omega 3 fatty acids (that is why they are known as essential fats), they must be taken in through the diet and are vital to numerous aspects of health.  We really do need to feed our brains!

If you do not regularly eat oily fish you may wish to consider a fish oil supplement providing around 350mg EPA and 350mg DHA daily.  Vegetarians may wish to think about taking a flaxseed oil supplement providing 500-1000mg alpha linolenic acid daily.  In the UK, and western world as a whole, most of us do not get enough omega 3 fats from our diets.  A supplement could be very useful to provide widespread health benefits.  As you will notice from my previous blog posts I mention omega 3 fatty acids regularly and am incredibly interested in the ongoing medical research surrounding these fats.

(1)Lucas M et al.  2009.  Ethyl-eicosapentaenoic acid for the treatment of psychological distress and depressive symptoms in middle-aged women: a double-blind, placebo-controlled, randomized clinical trial. Am J Clin Nutr 89: 641-651.
(2)Université Laval (2009, February 1). Omega-3 Fatty Acids Ease Depressive Symptoms Related To Menopause. ScienceDaily. Retrieved February 2, 2009,

Written by Ani Kowal

In October of last year I wrote about eating for bone health and mentioned the clear and positive associations between fruit and vegetable consumption and strong bones (1).  The post concentrated mainly on the way these foods act to effect the pH balance within the body.  Fruits and vegetables contain a huge array of vitamins, minerals and phytonutrients/flavonoids (chemically active plant compounds) that may also act to strengthen bone.

Last month a paper was published in the American Journal of Clinical Nutrition (2) which points toward the bone protective effects of carotenoids.  Previous evidence suggests that carotenoids may be acting to prevent bone loss and also to stimulate bone cell growth. Carotenoids, found abundantly in fruit and vegetables, act as antioxidants in the body and it is this mechanism that may be protecting the bones from damage by naturally occurring unstable oxygen molecules in the body, known as free radicals.  Antioxidants may help to ‘quench’ the destructive free radical molecules and therefore protect against damage.  As nutrients, antioxidants are ingested in the diet and are then distributed via the blood into various parts of the body tissues, including the bones.  

The researchers involved in this latest study (2) looked at the potential effects on bone mineral density of overall and individual intake of several carotenoid compounds, including alpha-carotene, beta-carotene, beta-cryptoxanthin, lycopene, lutein and zeaxanthin.  The study scientists tracked the bone mineral density in the hip and spine of 213 men and 390 women over the course of four years.  They found that carotenoid intake was associated with some levels of protection against bone mineral density losses at the hip in men and at the spine in women.  The results suggest that carotenoids, especially lycopene, may be protective against bone loss in older adults.  Further studies are certainly needed but the evidence adds further weight to the mounting data which shows just how important fruits and vegetables are to the whole body, including our bones.

A diet rich in colourful fruits, vegetables will provide plentiful amounts of antioxidants.  Carotenoids are a family of over 700 naturally occurring yellow, red, orange and dark green pigments found in vegetables and fruits.  Good sources include carrots, sweet potatoes, tomatoes, squash, peppers, cantaloupe melons, nectarines, papaya, mango and dark green vegetables such as spinach, kale, watercress and asparagus.  Introducing a good mix of these fruits and vegetables on a regular basis in the diet will help keep carotenoid levels in the body high.

Absorption of carotenoids from foods into the body is greatly affected by fat.  Without a fat source carotenoids are not easily absorbed.  Fat acts as a carrier for these nutrients to allow them passage from the gut into our blood and bodily cells.  I am certainly not suggesting that you drown your vegetables or salads in gallons of oil, however, I am a firm believer in using small amounts of olive oil in dressings and cooking.  Including some nuts, seeds or olives in salads may also be helpful in order to gain maximum absorption of these important nutrients. 

If you are looking at carotenoid supplements, especially lycopene, look for those that contain an oil carrier, these will aid maximum absorption.  Of course fruits and vegetables contain far more than just carotenoids and a supplement cannot be seen as a substitute for good dietary habits, but if you feel that you do not get a good variety of vegetables and fruits in your daily diet you may wish to consider a supplement to help make up for any short-fall.

It is particularly important that young people look after their bone health, a balanced diet as well as exercise is vital in this respect.  Recently the National Osteoporosis Society (NOS) produced a press release and report regarding their findings that young people in the UK are endangering their health by not looking after their bones.  Prevention is the key to osteoporosis which affects up to three million people in the UK.

The NOS found that (3) that less than a quarter of people knew they should start looking after their bones before the age of 30, despite the fact that bone strength actually peaks during our 20s. Younger people need to ‘bank’ plenty of bone by the age of 30 as bones tend not to regenerate as quickly after that.  
• Almost half (49%) of young people (18-24 yrs) did not know there were any steps they could take to keep their bones healthy;
• More than half were unaware that exercise can help reduce the risk of osteoporosis;
• One in three did not know about the positive role diet can play.

Professor Roger Francis, Chair of the charity’s Medical Board, states(3):
 
“Our bones are living tissue, much like our skin. New bone replaces old throughout our lives. But the most crucial years are when we’re young as this is when the cells building new bone are most active. Until our mid 20s our bones are gaining density and strength. From our 30s onwards our bones gradually lose their density. The more we can build up our bones when we are young the better we can help to protect ourselves against osteoporosis and fragility fractures in later life.” (3)

Women are more at risk of developing osteoporosis since their bones are smaller and also more vulnerable to hormonal changes.  Being underweight, and having a low BMI (body mass index) is also a big risk factor.  Currently many girls and women are striving to reach a low bodyweight and achieve the size zero that is touted by so many celebrities.  The report found that only 21% of people knew that being underweight was a significant risk factor for osteoporosis development (3).

Encouraging young people to eat fruit and vegetables, as well as foods rich in calcium, magnesium and other minerals is very important for bone strength and development.  Please visit the National Osteoporosis Society website for more information about bone health. A very informative document about osteoporosis can be downloaded from the site and my post about eating for strong bones may also be of interest.

(1) New SA.  2003.  Intake of fruit and vegetables:implications for bone health.  Proc Nutr Soc.  62:889-899
(2) Sahni S et al.  2009.  Inverse association of carotenoid intakes with 4-y change in bone mineral density in elderly men and women: the Framingham Osteoporosis Study. Am J Clin Nutr 89: 416-424
(3) NOS press release

Written by Ani Kowal

Milk thistle (Silybum marianum), sometimes thought of as the detox herb, is a tall herbal plant with prickly leaves and a ‘milky’ looking sap.  The herb was being used medicinally in ancient Greece and continues to be used by many individuals today, especially to treat liver ailments.  Often the supplement is known as silymarin, which is the name of the major bioflavonoid, or active plant compound, found in the herb.

Many hundreds of studies have documented the usefulness of this herb.  Often people associate milk thistle with ‘detox’ regimens.  This is probably because there is some evidence to suggest that the herb can fortify or strengthen the liver.  The liver is the major detoxification organ of the body, it ‘cleans’ our blood and neutralises any toxins from the air, diet, metabolic processes or drugs/medicines.  The bioflavonoids in milk thistle appear to protect and strengthen the liver cells, possibly through antioxidant and anti-inflammatory processes and actions.  The herb also appears to help promote the regeneration of new liver cells in order to replace older damaged ones.  There also seems to be some indications that the herb helps in the prevention of cancer, possibly via its antioxidant capabilities.

A recent Hungarian research paper (1) reviewed the available evidence for milk thistle in the treatment of chronic liver diseases.  The most common serious liver problems are viral infections (hepatitis) and liver scarring (cirrhosis) often caused by alcoholism and fatty liver.  Many of the liver diseases are linked to damage by free-radicals, which are destructive oxygen molecules naturally present in the body, and the antioxidant capacity of milk thistle is probably why it is so useful.  The bioflavonoids found in milk thistle act as antioxidants and can ‘mop-up’ these free radicals.  (I have written about antioxidants numerous times in my blog posts). 

Antioxidants are linked to the reduction in the risk of many conditions raging from cancer, to heart disease, dementia and arthritis.  One of the reasons why fruit and vegetables are so important in our diets is because they provide many antioxidant nutrients, such as vitamins C and E and various antioxidant bioflavonoids.  The research paper discusses the findings that milk thistle benefits the liver through mechanisms such as strengthening cell membranes, acting as an antioxidant, helping liver cells to regenerate, reducing liver inflammation and helping to prevent liver scarring.  The paper(1) also discusses the significant antiviral activities of the herb which could account for its potential usefulness in helping patients with hepatitis. 

A recent laboratory cell study (2) looked at how the antioxidant bioflavonoids in milk thistle protect the cholesterol in our blood from becoming damaged or oxidised.  Oxidised cholesterol is far more dangerous to our bodies and poses an increased risk for heart disease.  Milk thistle appeared to be very potent in protecting against oxidation.  Similarly the antioxidants appear to be potentially important in the prevention of cancer (3,4).  It appears that milk thistle acts through a variety of cellular mechanisms in our body and not just through antioxidant capacity.  Further larger trials with this herbal supplement are certainly warranted to clarify its health benefits.

The antioxidant power of this herb may mean that it could be very useful as a dietary supplement in the prevention of all kinds of free-radical related diseases(6) such as liver problems, cancers, heart disease, dementia, arthritis and a whole host of others.  However, supplements are definitely not the whole story.  It is important to remember that supplements are not a substitute for a healthy diet.  Vegetables and fruits will provide an array of various antioxidant and other nutrients which are vital for our health.  A milk thistle supplement could be viewed as an extra boost for the body.  If you think you may have over-done the alcohol and pain-relief medicines recently and fancy strengthening your liver you could consider a short course (1-3 months) of milk-thistle supplementation in addition to a liver strengthening healthy antioxidant diet. 

(1)Fehér J & Lengyel G.  2008.  [Silymarin in the treatment of chronic liver diseases: past and future.] [Article in Hungarian]. Orv Hetil. 149(51):2413-8.
(2) Ferenci P et al.  2008.  Silibinin is a potent antiviral agent in patients with chronic hepatitis C not responding to pegylated interferon/ribavirin therapy.  Gastroenterology.  135:1561-1567
(3) Wallace S et al.  2008.  Milk thistle extracts inhibit the oxidation of low-density lipoprotein (LDL) and subsequent scavenger receptor-dependent monocyte adhesion.  J Agric Food Chem.  56:3966-3972
(4) Hogan FS et al.  2007.  Flavonoid, silibinin, inhibits proliferation and promotes cell-cycle arrest of human colon cancer.  J Surg Res.  143:58-65
(5) Ramasamy K & Agarwal R.  2008.  Multitargeted therapy of cancer by silymarin.  Cancer Letter.  269:352-362
(6) Asghar Z & Masood Z.  2008.  Evaluation of antioxidant properties of silymarin and its potential to inhibit peroxyl radicals in vitro.  Pak J Pharm Sci.  21:249-254

Written by Ani Kowal

Veins are vessels that carry blood to the heart and within them are valves that allow blood to travel in only one direction.  Sometimes these valves become weakened and do not close completely, this allows some blood to flow backward where it can end up collecting.  A condition known as chronic venous insufficiency occurs when veins in the legs cannot pump enough blood back to the heart.  The blood pools, legs may feel heavy and painful and the ankles may swell.  The condition often leads to the occurrence of varicose veins, a swelling and bulging of the veins. 

Varicose veins are most commonly seen in the legs and are not usually a serious causes for concern.  Sometimes blood and other fluid can leak out of the veins into the surrounding tissue, this is uncommon but severe and can cause scaly, itchy skin or fluid pooling and swelling in the legs.  Without attention varicose veins do tend to worsen and may need to be removed via surgery.  However, veins can be strengthened through a variety of means in order to prevent any chronic venous insufficiency and subsequent varicose veins.

Individuals who spend a lot of time standing in one position may be at a greater risk of developing varicose veins.  Genetic and hormonal factors may also be involved in the development of chronic venous insufficiency and varicose veins and obesity, lack of exercise, pregnancy and heavy lifting can aggravate the condition.

Fibre

There is some evidence to suggest that one of the causative factors of varicose veins is constipation.  It seems that straining in constipation can cause raised abdominal pressures which are transmitted to the veins of the legs, putting pressure on the valves (1,2).  Individuals who are susceptible to varicose veins may well benefit from looking to increase the amount of fibre in their diets.  Most of us in the UK tend not to include enough daily fibre in our diets and could well do with a boost!  Ensuring a good daily supply of vegetables, fruits, beans, pulses, oats, nuts and seeds will go some way to boosting daily fibre intakes.  Taking a prebiotic and/or probiotic supplement may also help prevent constipation and keep the digestive system functioning optimally.

Flavonoids

Flavonoids, or bioflavonoids, are bioactive plant compounds found in large quantities in vegetables and fruits.  Readers of my blog will be used to me mentioning them.  They have antioxidant, amongst other, actions within the body.  Procyanidins (or proanthocyanidins) are a subclass of flavonoids and studies have shown that they are useful in the treatment of symptoms associated with varicose veins (3,4,5,6).  One paper (3) analysed the data from several trials testing a herbal remedy in individuals with chronic venous insufficiency.  The supplement tested contained 150mgButchers broom (Ruscus aculeatus), 150mg hesperidin and 100mg vitamin C.  Butcher’s broom is an evergreen shrub native to the Mediterranean, it contains the flavonoids ruscogenin and neoruscogenin.  Herperidin is another type of bioflavonoid found mainly in citrus fruits.  The paper pulled together data from many trials, in total there was information from over 10,000 participants.  The supplement appeared to alleviate pain severity, feelings of heaviness in the legs and water retention.   

A study (7) examining the procyanidin content of some foods including; red wine, dark chocolate, cranberry juice and four varieties of apples found that, on average, dark chocolate and apples, especially Red Delicious and Granny Smith, contain the largest procyanidin content per serving.  Other good sources of these flavonoids include blueberries, grapes (especially the skins), peanuts and bilberries.  Incorporating procyanidin rich foods into the diet may prove beneficial to those suffering with, or wanting to prevent, varicose veins.  In general a diet rich in a wide variety of vegetables and fruits will provide a whole host of flavonoids to the body.   

Specific supplements for vein health are available and these tend to contain various classes of flavonoids.  You may wish to consider taking a supplement, in addition to a healthy balanced diet, in order to boost your dietary intake levels.

Horse Chestnut

Supplements are now available which contain extracts from the seed of the horse chestnut (Aesculus hippocastanum L.).  Horse chestnut has been traditionally used for many years to treat individuals with weak veins and varicose veins.  The benefit seems to come from a compound called escin, another type of flavonoid.  It appears to strengthen veins thereby preventing fluid loss and subsequent leg swelling.  Supplements and leg gels containing horse chestnut are readily available for treatment of the symptoms of varicose veins.  A study (8) reviewing the available evidence indicates that products containing horse chestnuts are helpful, especially in alleviating leg pain, feelings of leg heaviness and itching in patients suffering with varicose veins and other issues associated with venous insufficiency.

Other helpful advice
*Try to incorporate some form of exercise, such as walking, into your day
*Avoid crossing your legs whilst seated
*Avoid standing in one position for prolonged periods of time
*Elevate your legs when possible to prevent the blood from pooling in the veins
*Avoid tight clothes that constrict circulation
*Wear compression stockings, especially if you regularly sit or stand for prolonged periods of time

(1)Burkitt DP.  1976.  Varicose veins: facts and fantasy.  Arch Surg.  111(12):1327-32.
Fine AM.  2000.  Oligomeric proanthocyanidin complexes: history, structure, and phytopharmaceutical applications.  Alternative Medicine Review.  5(2):144-151.
(2)Lee AJ et al.  2001.  Fiber intake, constipation, and risk of varicose veins in the general population: Edinburgh Vein Study.  J Clin Epidemiol.  54(4):423-9.
(3) Boyle P, Diehm C, Robertson C. 2003.  Meta-analysis of clinical trials of Cyclo 3 Fort in the treatment of chronic venous insufficiency. Int Angiol.  22(3):250-62.
(4) Fine AM.  2000.  Oligomeric proanthocyanidin complexes: history, structure, and phytopharmaceutical applications.  Alternative Medicine Review.  5(2):144-151.
(5)Gomez Trillo JT.  1973.  Varicose veins of the lower extremities:  Symptomatic treatment with a new vasculotrophic agent.  Prensa Med Mex.  38:293-296
(6)Royer RJ et al.  1981.  [Evaluation of venotropic drugs by venous gas plethysmography. A study of procyanidolic oligomers.]  Sem Hop.  57:2009-2013
(7)Hammerstone JF et al.  2000.  Procyanidin content and variation in some commonly consumed foods.  Journal of Nutrition.  130(8):2086-2092S.
(8) Suter A, Bommer S, Rechner J.  2006.  Treatment of patients with venous insufficiency with fresh plant horse chestnut seed extract: a review of 5 clinical studies. Adv Ther.  23(1):179-90

Written by Ani Kowal

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