There seems to be a run of research being released at the moment looking at pregnancy and fertility related issues, as you can see from my recent blog posts.  In a recent review paper (1) researchers have estimated that 1.5million fewer babies would be born at low birth weights every year if all pregnant women, worldwide, took vitamin and mineral supplements. 

The lead researcher of the study, Dr Prakesh Shah, stated in a press release (2) that women should start taking vitamin and mineral supplements “as soon as they know they are pregnant”.  Compared with women who took a placebo, women who took multi-nutrient supplements were 19% less likely to have a low birth weight baby.

Low birth weight infants, those born weighing less than 2.5 kilograms (about 5.5 pounds), face a greater risk of health problems that may extend into adulthood. They tend to be more vulnerable to infections during infancy and childhood and may be more likely to have developmental problems in childhood.  As adults they may be at greater risk of diabetes and high blood pressure.  This study (1) found that “Prenatal multimicronutrient supplementation was associated with a significantly reduced risk of low birth weight and with improved birth weight when compared with iron–folic acid supplementation”.

Currently, the World Health Organization (WHO) recommends supplementation with folic acid and iron during pregnancy.  However there have been numerous studies showing that a number of different vitamins/minerals may be necessary in early pregnancy for the best outcomes for mother and baby.  In this current study (1) when compared with women taking iron and folic acid only, the researchers found the multi-supplement users had a 17% risk of having a low birth weight baby.  Babies born to women taking multimicronutrient supplements weighed 54 grams more, on average, than babies born to women taking iron and folic acid alone.  The authors of the study suggest that the WHO could consider revisiting their guidelines to recommend multi-nutrient supplements, not just iron and folic acid, for all pregnant women.

The research is limited by the fact that it is a review study of already published data, not an intervention trial.  In addition to this the studies included in the review varied with regards timing, duration, composition of micronutrients, and characteristics of the study populations.  In populations where under-nutrition is common the multi-nutrient supplement may be more helpful than in populations where nutrient rich diets are eaten.  However there is a growing increase in teenage pregnancy here in the UK and often these children are not following a healthy diet and may well be lacking in a number of vitamins and minerals.  In addition to this my previous posts have shown that many nutrients in early and pre pregnancy are associated with better health in mothers and children in Western populations, so it does seem that multi-nutrient supplements could be important for all pregnant women.

Supplements designed especially for pregnant women are widely available, however it is always a good idea to check with your doctor or midwife before taking any supplements during pregnancy.  As mentioned last week – a healthy balanced diet also very important at all times, but especially during pregnancy.

(1)Prakesh S. Shah et al.  2009.   Effects of prenatal multimicronutrient supplementation on pregnancy outcomes: a meta-analysis.  CMAJ.  June 9, 180 (12). doi:10.1503/cmaj.081777.
(2)Anne Harding.  Multivitamins best for preventing low birth weight.  08/06/2009.  Reuters Health.  http://www.reutershealth.com/archive/2009/06/08/eline/links/20090608elin005.html
(3) Canadian Medical Association Journal (2009, June 8). Multivitamins In Pregnancy Reduce Risk Of Low Birth Weights. ScienceDaily. Retrieved June 9, 2009, from http://www.sciencedaily.com/releases/2009/06/090608182549.htm

(4)Bhutta ZA & Haider BA.  2009.  Prenatal micronutrient supplementation: Are we there yet?  Commentary.  CMAJ • June 9, 2009; 180 (12). doi:10.1503/cmaj.090652

Written by Ani Kowal

Diet and its impact on male fertility has long been discussed and debated among scientific, medical and health professionals.  I first started to look at the link between what we eat and fertility, in men and women, whilst studying for my MSc.  The research has been steadily growing over the years and it seems likely that diet does impact fertility.

A group of Spanish researchers have published two (1,2) studies this year which look at the link between diet and semen quality in men.  The studies seem to suggest that dietary antioxidant nutrients play a key role in the prevention of damage to sperm. 

I have written about dietary antioxidants in many previous blog posts.  They have been linked to a 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 (bioactive plant chemicals). 

Anitoxidants help to prevent damage to cells in our body (including sperm cells) by mopping-up destructive unstable oxygen molecules known as 'free radicals', these free radicals create what is known as oxidative stress in the body.  There is mounting evidence that these destructive molecules, together with lowered bodily antioxidant defences, play a significant role in the development and aggravation of many diseases and health problems.  The body does produce its own antioxidants but also relies on vitamins, mineral and phytochemicals (bioactive plant chemical) from the diet, especially from colourful vegetables and fruits, for additional valuable supplies.
 

In the first research study (1) the authors found that men who ate large amounts of meat (especially processed meat) and full fat dairy products had poorer quality sperm than those who ate more fruit, vegetables and reduced fat dairy products.  The study was a case-control study in which 30 men with poor semen quality (cases) were compared to 31 men with normal sperm quality (controls).  The investigators recorded the dietary habits and food consumption of the men using a specialised food frequency questionnaire.  The authors conclude that “Frequent intake of [lipophilic] foods like meat products or milk may negatively affect semen quality in humans, whereas some fruits or vegetables may maintain or improve semen quality”.  This study points towards associations between diet and fertility.  It is certainly plausible that a healthy diet and lifestyle can impact upon the health of semen. 

The second study(2) published by the same group of scientists this year was set up in order to compare the specific nutrient intakes between 30 men with normal sperm quality and 31 men with poor sperm quality.  Dietary habits and nutrient consumption were recorded using a food frequency questionnaire.  The analysis found that control subjects, the men with normal sperm quality, had a significantly higher intake of carbohydrates, fibre, folate, vitamin C, and lycopene and lower intakes of proteins and total fat than men with poor sperm quality.  The authors conclude that “A low intake of antioxidant nutrients was associated with a poor semen quality in this case-control study of Spanish men attending infertility clinics”.

Vegetables and fruits are full of antioxidant nutrients and flavonoids which may well be protecting the sperm from damage.  The lead author of the paper, Jamie Mendiola, said in a press release(3): “In this study, we have found that people who consume more fruits and vegetables are ingesting more antioxidants, and this is the important point", "We saw that, among the couples with fertility problems coming to the clinic, the men with good semen quality ate more vegetables and fruit (more vitamins, folic acid and fibre and less proteins and fats) than those men with low seminal quality".  "A healthy diet is not only a good way of avoiding illness, but could also have an impact on improving seminal quality.  What we still do not understand is the difference between taking these vitamins naturally and in the form of supplements”.

The authors are going to continue researching this topic in another study and are particularly going to investigate the role that supplements may have on sperm quality.  Obviously I am a great advocate of healthy eating and the basis of any healthy diet is an abundance of vegetables, fruits, healthy fats from nuts/seeds/oily fish, protein from unprocessed lean meats, pulses, beans and unprocessed/unrefined wholegrain carbohydrates.  For individuals who feel they often lack the five or more recommended portions of vegetables and fruits daily may wish to consider taking a good quality multi-vitamin and mineral supplement in order to provide for any nutrient shortfalls, however supplements should never be seen as an alternative to healthy living

(1)Mendiola J et al.  2009. Food intake and its relationship with semen quality: a case-control study.  Fertil Steril.  91:812-818
(2)Mendiola et al. A low intake of antioxidant nutrients is associated with poor semen quality in patients attending fertility clinics. Fertility and Sterility, May 2009; DOI: 10.1016/j.fertnstert.2008.10.075
(3)Plataforma SINC (2009, June 3). Semen Quality May Depend Upon Antioxidants In Man's Diet. ScienceDaily. Retrieved June 4, 2009, from http://www.sciencedaily.com¬ /releases/2009/06/090602083727.htm

Written by Ani Kowal

Since I started the week with a focus on the pregnancy related condition preeclampsia I thought it was a good time to mention a recent study (1) that looked at vitamin supplement use in pregnancy to see if there was any association with the risk of having a miscarriage.  

In this study(1), the authors wanted to look at the relationship between use of prenatal vitamins in early pregnancy and the risk of miscarriage.  4,752 women in the US were involved and individual data about vitamin use was collected at a first-trimester interview.  Approximately 95% of participants reported use of vitamins during early pregnancy and a total of 524 women had a miscarriage.  Any use of vitamins during pregnancy was associated with a reduced risk of miscarriage when compared to women who did not take any vitamins.  The researchers found that the risk for miscarriage was 57% lower among women who took vitamins, compared to those who did not.

These results suggest that taking vitamins before pregnancy and during early pregnancy is associated with a reduced risk for miscarriage.  However the study is far from conclusive.  It may well be that women who take vitamins also tend to be more aware of the factors considered important for health and may tend to lead generally healthier lifestyles when compared to women who do not take vitamins, other confounding factors may also be involved.  Further studies are necessary before firm conclusions can be drawn regarding the effects of supplements on miscarriage risk.   

In a press release (2) the lead study author said  "Because miscarriage occurs very early in pregnancy, it is important for women of reproductive age, who may become pregnant, to eat a balanced diet and use vitamins."  Recently I have written a lot about the links between various nutrients such as folic acid, vitamin B12, vitamin D and multivitamins in early pregnancy and pre pregnancy and an apparent reduced risk of various pregnancy related issues in the mother and baby.  Pre-pregnancy and pregnancy is a very important time for healthy living and healthy eating. 

If you are planning a pregnancy eating plenty of vegetables, fruits, nuts/seeds, beans/pulses, fish (especially oily fish such as salmon, trout and mackerel), unprocessed meats and unprocessed/unrefined wholegrains will help to provide an abundance of vitamins, minerals, flavonoids (bioactive plant chemicals),fibre, protein, healthy fats and energy for you and your baby.  If you feel concerned that you may not be eating a consistently nutritious diet then you may wish to consider taking a food-state multi-nutrient supplement specifically designed for use during pregnancy.  An omega 3 supplement could also be helpful, especially if you do not regularly eat oily fish (at least twice a week) or nuts/seeds.  Before deciding to take any supplement during pregnancy please discuss your thoughts with a GP, nurse or midwife.  For information about miscarriage and support please visit the Miscarriage Association charity website. 

(1)Hasan R et al.  2009.  Self-reported vitamin supplementation in early pregnancy and risk of miscarriage.  Am J Epidemiol. 169(11):1312-8.
(2)Reuters Health press release .  Vitamin Sypplements may lessen miscarriage risk.  Joene Hendry.  Health eLine 05/06/2009.  http://www.reutershealth.com/archive/2009/06/05/eline/links/20090605elin006.html

Written by Ani Kowal

In August last year I wrote about the possible role of a diet in the prevention of preeclampsia with specific reference to maintaining a healthy body weight, dietary fibre, fruits, vegetables, antioxidant vitamins and omega 3 fatty acids.  I was very interested to read a recently published study (1) which has found that regular multivitamin use in the very early period of pregnancy is associated with a reduced risk of preeclampsia in normal weight, but not overweight, women.

Preeclampsia is a very serious condition.  Around 3% of all pregnant women suffer from preeclampsia each year and it is the principal cause of maternal death in the UK.  Preeclampsia is a form of high blood pressure that develops in conjunction with water retention and/or excess protein in the urine.  Around 10 mothers and 1000 babies die each year as a result of the effects of preeclampsia and the condition is also the most common reason for elective, often early, delivery.  Usually preeclampsia occurs between the 20th week of Pregnancy and the end of the first week postpartum.  The earlier it presents in pregnancy the more threatening it can become.  For more information please visit the Action On Pre-eclampsia charity website.

The study (1) looked at a large group of Danish women, over 28,000 women, between the years 1997-2003 who reported multivitamin supplement use during a 12 week periconceptional period, the very earliest weeks of pregnancy, measured as 4 weeks prior to and 8 weeks after the last menstrual period.  The researchers then looked to see whether the frequency and timing of multivitamin use was associated with preeclampsia risk - regular use of multivitamins in the periconceptual period was related to a reduced risk of preeclampsia among normal-weight women.  Compared with women who did not use multivitamins, regular multivitamin users with the same body mass index (of 22) had a 20% reduced risk of preeclampisa.  In addition, regular use of multivitamins in the post-conception period only seemed to be associated with a reduced risk of preeclampsia in women with a BMI less than 25 (a healthy BMI is usually measured at 18.5-20).  This is only an association study, it does not show cause and effect and further controlled supplement trials are certainly necessary before any firm conclusions can be drawn.  However, the data does indicate that multivitamins in early pregnancy may be useful in preventing preeclampsia in some women. 

BMI (Body Mass Index) is a measure often used for healthy weight, it is worked out as weight divided by height squared.  To check your own BMI you may find it useful to visit the Food Standards Agency website where an online BMI calculator can be found.

In previous weeks I have talked about early use of folic acid and vitamin B12 being important for a number of pregnancy related conditions so a multi-nutrient supplement could be a way of ensuring a good intake of a variety of nutrients linked to improved health of both the mother and child during pregnancy.  Many multi-nutrient preparations are available specifically for use by pregnant women but please always check with a doctor or health professional before starting supplementation if you are planning a pregnancy.  It is also important for me to mention that supplements cannot be seen as an alternative to a healthy diet and lifestyle.  Pregnant women really do need to ensure that they are eating well in order to give their baby the best start in life.  A healthy diet, low in processed and refined foods and  rich in vegetables, fruits, oily fish, lean unprocessed meats and fish, nuts/seeds, beans, pulses and unrefined/unprocessed wholegrains will go far in providing the body with an abundance of vitamins, minerals, flavonoids (bioactive plant chemicals) and essential fats.

Since I seem to be mentioning Vitamin D quite regularly I thought I would briefly include a study(2) that I came across very recently.  The researchers wanted to see if intake of vitamin D during pregnancy was associated with preeclampsia risk.  The study involved 23,423 Norwegian pregnant women who had not previously had children.

Participating women filled in questionnaires at week 15, 22, and 30 of pregnancy.  From these questionnaires nutrient intakes were calculated from food and dietary supplements.  Data showed that women with the lowest levels of vitamin D were more at risk of developing preeclampsia than women with the highest levels.  When the data was analysed to considering only the intake of vitamin D from supplements, the scientists found a 27% reduction in risk of preeclampsia for women taking 10-15 micrograms per day compared with women taking no supplements. No association was found between intake of vitamin D from the diet alone and the occurrence of preeclampsia.   The report concludes (2) that “These findings are consistent with other reports of a protective effect of vitamin D on preeclampsia development”.  However, the authors make an interesting point: Vitamin D intake is highly correlated with the intake of long chain omega 3 fatty acids in the Norwegian diet and further research is needed to disentangle the separate effects of these nutrients.  Oily fish are a great source of omega 3 fatty acids and one of the few good dietary sources of vitamin D.

As mentioned in many blog posts on Vitamin D many of us in the UK do not achieve good levels from the diet or from sunlight exposure. If you rarely get out into the sun, you may wish to consider a vitamin D supplement which provides around 12mcg/day (around 500iu a day).  Such a supplement may be particularly useful during the autumn and winter months.  Before considering any supplementation during pregnancy please check with your doctor and be aware that multi-vitamin and mineral supplement may already contain ample amounts of vitamin D. 

(1)Catov JM et al.  2009.  Association of Periconceptional Multivitamin Use With Reduced Risk of Preeclampsia Among Normal-Weight Women in the Danish National Birth Cohort.  American Journal of Epidemiology 2009 169(11):1304-1311; doi:10.1093/aje/kwp052
(2) Haugen M et al.  2009.  Vitamin D supplementation and reduced risk of preeclampsia in nulliparous women.  Epidemiology.  [Epub ahead of print]

Written by Ani Kowal

Following my last post I was interested to read a well researched review paper (1) that looks into the link between vitamin D deficiency and the development of dementia.  The report is published in the May issue of the Journal of Alzheimer’s disease and is written my William B Grant PhD of the Sunlight, Nutrition and Health Research Centre (SUNARC).  SUNARC is an organization devoted to research and education relating to the prevention of chronic disease through changes in diet and lifestyle.  I have previously mentioned SUNARC when reporting on the importance of Vitamin D for health.

Previously I highlighted the link between vitamin D and the brain when I wrote about the potential use of the sunlight vitamin for helping sufferers of SAD (seasonal affective disorder) and also possible link between low vitamin D levels in those suffering from depression and mood disorders.

William Grant, the author of the paper, begins by highlighting the rise in individuals who are suffering with dementia in the Western world.  The condition deserves attention since the number of people living into old age is increasing and it is a worthwhile aim to help individuals achieve lasting health as they age so they may live life to the full.  There are several risk factors for the development of Alzheimer's disease and vascular dementia. Based on an increasing number of studies linking these risk factors with Vitamin D deficiency, the article(1) suggests that further investigation of possible direct or indirect linkages between Vitamin D and these dementias is certainly needed.  Diet and lifestyle are being increasingly researched in relation to their links with dementia prevention and vitamin D is gaining attention for its role in many condition from heart disease, diabetes, bone health, cancer, infections, chronic fatigue and more.

Low blood serum levels of vitamin D have been associated(1) with increased risk for several diseases which are also considered risk factors for the development of dementia  or are often reported to precede the incidence of dementia e.g. cardiovascular diseases, diabetes mellitus, depression, dental caries, osteoporosis, and periodontal disease.  These studies are only observational studies,nproviding medical researchers with links between vitamin D and dementia.  As yet there no randomised controlled trials to draw evidence from.

The way that vitamin D may be working to protect the brain is via several mechanisms.  It seems to be able to act by protecting the neurones in the brain (brain nerve cells), it may also be protecting the blood vessels in the brain and having an effect by protecting against excess calcium entry into the brain.  Vitamin D also seems to act as an anti-inflammatory – an important factor since dementia is often linked to inflammation in the brain and body (1).  There is also plenty of evidence to suggest an important role for vitamin D in brain development and function.

Writing in the article, Dr. Grant states, "To date, the evidence includes observational studies supporting a beneficial role of vitamin D in reducing the risk of diseases linked to dementia such as vascular and metabolic diseases, as well as an understanding of the role of vitamin D in reducing the risk of several mechanisms that lead to dementia." “However, until RCTs are performed, the hypothesis cannot be considered a fact”

A recent analysis(2) found that there is a global widespread insufficiency of vitamin D and there is evidence from the National Diet and Nutrition Surveys (NDNS) which suggests that in the UK deficiency of this vital nutrient is a real problem (3,4,5,6).  The problem is made worse in the older generations, as we age our bodies find it increasingly difficult to manufacture vitamin D.  In the UK many of us do not get enough sunlight exposure to generate decent levels of vitamin D in our bodies, especially in the autumn and winter months when we cover our bodies up and don’t get out during the daylight hours very often. 

Only small amounts of vitamin D are found in food sources such as oily fish (mackerel, salmon and sardines) and egg yolks.  As many of us in the UK are falling short of recommended vitamin D levels, if you rarely get out into the sun, you may wish to consider a vitamin D supplement which provides around 12mcg/day (around 500iu a day).  Such a supplement may be particularly useful during the autumn and winter months.

For more interesting information about the benefits of vitamin D and sunlight for health please visit the SUNARC website, the information there is well presented and backed up by significant amounts of good evidence.

(1)Grant, WB.  2009. Does Vitamin D Reduce the Risk of Dementia?  Journal of Alzheimer's Disease 17:151-159.
(2)Hagenau T et al.  2008.  Global vitamin D levels in relation to age, gender, skin pigmentation and latitude: an ecologic meta-regression analysis.  Osteoporosis International May [E publication ahead of print]
(3) Finch S et at.  1998.  National Diet and Nutrition Survey of People aged 65 Years and Over.  London: H. M. Sationery Office.
(4) Gregory L et al.  2000.  National Diet and Nutrition Survey of People aged 4-18 years. Vol 1.  Report of the Diet and Nutrition Survey.  London:  The Stationery Office
(5) Henderson L et al.  2002.  National Diet and Nutrition Survey: Adults Aged 19-64 years.  Vol 1: Types and Quantities of Foods Consumed.  London: The Stationery Office
(6) Hypponen E & Power C.  2007.  Hypovitaminosis D in British adults age 45y: nationwide cohort study of dietary and lifestyle predictors.  Am J Clin Nutr.  85:860-888.

Written by Ani Kowal

What we eat can certainly have an impact on the way our brains function.  Previously I have written about the importance of a healthy diet for brain function and also the links between the Mediterranean style diet and the brain. 

In both of these posts I write about how important oily fish seem to be for the efficient functioning of the brain (mental function is often referred to as cognition).  Previously I have concentrated on the fact that oily fish provide omega 3 fatty acids which are vital for the structure and function of the brain.  However, oily fish also provides a dietary source of Vitamin D.  This is important, since food sources of vitamin D are limited.  Oily fish such as mackerel, salmon, sardines and trout are the primary food source.  Egg yolks contain some vitamin D and some foods are fortified with this ‘sunshine’ vitamin.  Our main source of vitamin D is the manufacture in the body via the exposure of our skin to sunlight.  Recently, however, there has been a lot of concern that UV exposure in the UK may be insufficient to keep vitamin D levels high enough for optimal for health with many individuals in the UK are falling short of recommended levels.  More can be read on the importance of vitamin D in previous blog posts.

A very recently published study (1) has found a link between vitamin D levels in the body and brain function (cognitive performance).  Previous studies have found that an inadequacy in vitamin D could be linked to problems with brain function but so far results have been inconsistent.  This study (1), which was conducted by University of Manchester scientists, was set up in order to examine the association between blood serum vitamin D levels and cognitive performance in middle-aged and older men.  3,133 Eurpoean men aged 40-79 years were included in the research.  Cognitive (brain) function was tested via a number of different validated tests.  Blood serum vitamin D levels were measured as was physical activity, functional performance and mood/depression.

Higher levels of vitamin D were significantly associated with better cognitive function as measured by one of the tests, the Digit Symbol Substitution test (DSST).  This test is an internationally-recognised test that assesses an individual's memory, recognition capabilities and speed of information processing.  Reduced cognitive function was most pronounced in individuals with the lowest vitamin D levels.  This research provides valuable information, however further research is warranted to determine whether health vitamin D levels, or vitamin D supplementation, can play a role in preserving cognitive function in older adults (1).

Although the study is only an association study it has some key strengths: it was based on a large population sample and took into account potential confounding influences, such as depression and levels of physical activity.   Interestingly the association between increased vitamin D and faster information processing was more significant in men aged over 60 years, although the biological reasons for this remain unclear and requires further investigation.

The positive effects vitamin D appears to have on the brain need to be explored further but certainly raise questions about its potential benefit for those with or susceptible to dementia.  Dr Susanna Sorensen, Head of Research at The Alzheimer’s Society made a comment (2) on the research via the charity website:

“One in three people over 65 will die with dementia making research into this area vital. This study, including over 3,000 men from a number of European locations, shows that maintaining vitamin D levels could play a role in reducing the decline of brain function. 

However, further research is needed to determine whether or not vitamin D can help preserve brain function in older people or reduce risk of dementia. As vitamin D is readily available to most people, through exposure to sunshine or eating oily fish, it will be interesting to see the results of future studies.

In the meantime, current evidence tells us that a healthy lifestyle, including a balanced diet and exercise, is the best way of reducing your risk of dementia.”

Alzheimer's Society is the UK's leading care and research charity for people with dementia and those who care for them.  There are 700,000 people with dementia in the UK with numbers set to rise to one million by 2025.  Alzheimer's Society is a membership organisation, which works to improve the quality of life of people affected by dementia in England, Wales and Northern Ireland.  Please visit their website for more information.  You may also like to read the two posts I mentioned at the start of this piece which are about brain function.

If you rarely get out into the sunlight you may wish to consider taking a vitamin D supplement which provides around 12mcg of the nutrient per day (around 500iu).  Vitamin D supplements may be particularly useful during the autumn and winter months and for individuals who have darker skins or who don’t go outside regularly.

(1) Lee DM et al.  2009.  Association between 25-hydroxyvitamin D levels and cognitive performance in middle-aged and older European men.  J Neurol Neurosurg Psychiatry. Published Online First: 21 May 2009. doi:10.1136/jnnp.2008.165720
(2)Alzheimer's Society comment on research into impact of vitamin D on brain performance
Published Wednesday 20th May 2009 in Research news http://www.alzheimers.org.uk/site/scripts/news_article.php?newsID=469

Written by Ani Kowal

Last week I wrote about folic acid and how it may be associated with a reduced risk of premature birth.  A recently published study (1) has found that folic acid may also reduce the risk of a baby being born with severe congenital heart defects (heart defects present from birth).

The study took place in Quebec, Canada(1).  The researchers wanted to see whether the fortification of food programme, that has been in place since 1998 and has already proved to be effective in preventing neural tube defects, had impacted the incidence of severe congenital heart defects.  The 1998 government policy requires the mandatory fortification of flour in Canada with folate.

The study(1) looked at infants who were born between 1990 – 2005 who had severe congenital heart defects.  The scientists then analysed the data to compare rates of heart defects before and after the food policy was in place.  Among the 1 324 440 births in Quebec between 1990-2005 there were 2083 infants born with severe congenital heart defects.  Analysis of the results showed no change in the birth prevalence of severe birth defects in the nine years before fortification, while in the seven years after fortification there was a significant 6% decrease per year.  The authors of the study conclude that the public health measures to increase folic acid intake in Canada were followed by a decrease in the birth prevalence of severe congenital heart defects. The findings support the hypothesis that folic acid has a preventive effect on heart defects.

According to Raluca Ionescu-Ittu, a PhD candidate on the team, "this decrease is very significant and probably underestimated. During the study period, there was an increase in other factors associated with a higher prevalence of congenital heart defects, so without the fortification we would probably have seen an increase in these defects." (2)

Despite the positive findings the authors of the study stress the need for women of childbearing age, especially those planning a pregnancy, to take folic acid supplements and not rely on food as a source.  The fortification programme was aimed at the general population, women planning a pregnancy need extra folic acid, it is a good idea for pregnant women to take a folate supplement at least three months before becoming pregnant.  Data that I mentioned last week indicates that there are benefits to taking a folate supplement a year prior to conception.  Folic acid seems to have effects on various aspects of embryonic and infant development.  Natural sources of the vitamin, such as green vegetables, might not provide sufficient doses for pregnant women.  Most medical doctors therefore recommend supplements in addition to a healthy diet rich in folic acid. 

As I have previously stressed: it is important for any woman who is planning a pregnancy to aim to eat a consistently healthy diet rich in vegetables, fruits, healthy fats and unprocessed meats, fish and wholegrain unrefined carbohydrates.  A healthy diet really does affect the unborn child, probably in more ways than we currently know through scientific investigation.  It may also be worth to consider taking a broad spectrum multivitamin and mineral food-state supplement specifically designed for pregnancy in order to maintain good levels of all essential nutrients.  An omega 3 fatty acid supplement could also be considered, especially if oily fish and nuts/seeds are not regularly eaten.  Before deciding to take any supplement during pregnancy please discuss your thoughts with a GP, nurse or midwife.

(1)Ionescu-Ittu R et al.  2009.  Prevalence of severe congenital heart disease after folic acid fortification of grain products: time trend analysis in Quebec, Canada. BMJ 2009;338:b1673
(2) McGill University Health Centre (2009, May 14). Folic Acid Effecive In Preventing Congenital Heart Defects, Canadian Research Shows. ScienceDaily. Retrieved May 19, 2009, from http://www.sciencedaily.com¬ /releases/2009/05/090514111404.htm
Written by Ani Kowal

In April this year I discussed the evidence that probiotics may be helpful in the treatment and prevention of bacterial vaginosis.  Vaginosis usually involves a disruption in the normal bacterial and yeast balance in the vagina and is characterized by increased vaginal discharge (which is often odorous) without inflammation, sometimes there will also be itching present.

Normally a healthy vagina contains ‘friendly’ or beneficial bacteria, which protect it from invading pathogens (detrimental bacteria) such as those which cause urinary tract infections, thrush and vaginosis.  A healthy digestive system will also be dominated by a variety of different friendly 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 vagina.  Having a strong and healthy immune system protects the body from many bacterial infections and personal hygiene is also important to protect against vaginal infections (bacteria from the anal area may enter the vagina during sex or when wiping after a bowel movement).

Bacterial vaginosis is common in pregnant women and can put a woman at increased risk for a variety of complications, such as premature delivery.  There is great interest in understanding how vaginosis can be prevented.  Prebiotic and probiotic oral supplements or probiotic vaginal creams and suppositories may be helpful and are generally safe during pregnancy (but always check with your doctor, heath professional or midwife before deciding to try any treatment during pregnancy).  Recently (1) a study has found that vitamin D may also be playing a role.

Readers of my blog will know that Vitamin D has been very widely researched over the last few years and the importance of this sunshine vitamin for various aspects of health is vast. Many people in the UK often do not achieve good levels of vitamin D and this may be putting them at increased risk of various health problems.  A lack of this crucial nutrient has now been linked to heart problems, cancer, brain disorders, sleep problems, headaches, weight problems and immune problems to name but a few.  Vitamin D may play a protective role against vaginosis since it has quite an influence on the immune system.

The current study(1) looked to assess whether poor vitamin D status played a role in predisposing pregnant women to bacterial vaginosis.  469 pregnant women were included in the research.  The study investigated the relationship between vitamin D status and bacterial vaginosis in 209 white and 260 black women at less than 16 weeks of pregnancy with singleton gestations. Blood samples were taken, and blood serum was analysed to ascertain the levels of vitamin D.   Pelvic examinations were performed, and vaginal smears were used to assessed and diagnose rates of bacterial vaginosis.  The reason why skin colour may be an issue is that individuals with darker skin tones find it more difficult to manufacture vitamin D since less UV light can pass (3-36% in darker skins).  Pale skins allow more UV light to pass (53-72%) and make vitamin D manufacture easier.

The data indicate that overall, women with bacterial vaginosis had lower serum vitamin D levels than those without bacterial vaginosis. The prevalence of bacterial vaginosis decreased as vitamin D concentration in the blood increased.  The findings suggest that vitamin D insufficiency is associated with bacterial vaginosis in the first 4 months of pregnancy. Further, poor vitamin D status also seemed to contribute to the strong racial disparity in the prevalence of bacterial vaginosis.  This study only provides an idea, or hypothesis, for a link between vitamin D levels and rates of bacterial vaginosis.  Further controlled intervention trials will be needed to provide confirmation.

Foods rich in vitamin D are limited, with oily fish such as mackerel, salmon and sardines being the primary natural source.  Egg yolks also contain limited amounts of the vitamin and some breakfast cereals are fortified with the vitamin.  The exposure of our skin to sunlight is definitely the main source of vitamin D.  Recently, however, there has been mass debate about whether UV exposure in the UK is sufficient to keep vitamin D levels optimal for health.  Most individuals in the UK are falling short of recommended levels. 

If you rarely get out into the sunlight you may wish to consider a vitamin D supplement which provides around 12mcg of the nutrient per day (around 500iu).  Pregnant women are advised to check with their doctor, health professional or midwife before starting any supplement regimen.  Vitamin D supplements may be particularly useful during the autumn and winter months and for individuals who have darker skins or who don’t go outside regularly.

(1)Bodnar L et al.  2009.  Maternal vitamin D deficiency is associated with bacterial vaginosis in the first trimester of pregnancy.  J Nutr.  (April 8, 2009). doi:10.3945/jn.108.103168
Written by Ani Kowal