In my last post I wrote about cinnamon and how it seems to be useful for blood sugar balance, a factor that is important for overall health.  I also wrote about how the glycaemic index and glycaemic load of food and meals can have an effect on the blood sugar (glucose) levels. 

A very recent study (1) has found a link between the glycaemic index of the foods and the glycaemic load of the meals we eat and the risk of developing breast cancer. As previously mentioned, the links between diet and cancer are widely researched.  The World Cancer Research Fund UK (WCRF UK), a charity dedicated to cancer prevention, estimate that lifestyle factors such as being overweight, eating an unhealthy diet and being inactive are responsible for about a third of all cancers in developed countries (2). 

Gycaemic index and glycaemic load are terms used to characterise foods and diets based on their effects on blood glucose levels.  Foods that release sugar quickly into the bloodstream have what is known as a high Glycaemic Index (GI), meals that favour a spike in blood sugar levels are said to have a high Glycaemic Load (GL).  White bread, potatoes, processed/refined carbohydrates have a high glycemic index i.e. they tend to cause a rapid surge in blood sugar.  Vegetables, whole-grain high-fibre carbohydrates, create a more gradual change in blood sugar levels and are considered to have a low glycemic index.  For the classification of more food examples please visit the website 'The Glycemic Index', there you will find a database where you can search for specific foods and find out more about GI and health. 

This recent study (1) took place in Sweeden and looked at data from 61,433 women who completed special food frequency questionnaires in the late 1980s.  After around 17 years there were 2952 women who had developed breast cancer.  Analysis of the date found that eating a diet with high glycaemic load was significantly associated with an increased risk of developing breast cancer.
 
When the data was further analysed: total carbohydrate intake, glycaemic index and glycaemic load were all positively associated with the risk of developing a certain type of breast tumour known as oestrogen receptor (ER+) positive/progesterone receptor (PR-) negative breast cancer (ER+/PR-).  Women with the highest glycaemic index diet had a 44% increased risk of developing ER+/PR- breast cancer compared to women with the lowest glycaemic index diet.  Women in the highest category of glyceamic load had an 81% increased risk of ER+/PR- tumours, and those with the highest carbohydrate intake had a 34% increased risk, compared to those in the lowest groups.  (No associations were observed for ER+/PR+ or ER-/PR- breast tumours)

The investigators speculate that high-glycemic load diets may boost breast cancer risk by increasing concentrations of insulin and sex hormones in the body, which may contribute to the development and spread of breast cancer cells.  The WCRF UK say that the relevance of GI and GL to cancer “might lie in the fact that the rise in blood glucose after a meal is closely linked to that of insulin, which apart from its crucial role in carbohydrate and lipid metabolism, is also one of a family of important growth factors (2)”.  High blood sugar levels after a meal are also related to an increase in inflammation in the body.

A healthy, nutritious diet which is low in processed/refined foods and rich in vegetables, nuts/seeds, beans, pulses, unprocessed meats and fish (especially oily fish such as salmon, mackerel and trout), healthy fats, unrefined wholegrains will generally keep blood sugar levels stable.  Including a source of protein with every meal is also important for blood sugar balance e.g. beans/pulses, unprocessed meat and fish, eggs, nuts/seeds.  For more information on blood sugar balance please read my post on cinnamon which contains relevant links. 

(1)Larsson SC et al.  2009.  Glycemic load, glycemic index and breast cancer risk in a prospective cohort of Swedish women.  International Journal of Cancer.  125: 153-157
(2)WCRF/AICR.  2009.  Policy and action for cancer prevention.  Food, nutrition and physical activity: a global perspective.  Washington DC: AICR, 2009
Written by Ani Kowal

Cinnamon has been a popular spice for both culinary and medicinal purposes for many hundreds of years (thousands in fact).  Over the last 20 years scientific studies with the spice have been increasing and there has been particular interest in the way that cinnamon appears to be useful in helping blood sugar control (especially in type 2, non insulin dependent, diabetes) via its effects on insulin and other cellular mechanisms.

Laboratory studies have suggested that cinnamon has effects on the way that insulin (a key hormone involved with blood sugar balance) is used by cells and also on the amount of insulin produced by the body after a meal, and animal studies have found that cinnamon seems to lower blood sugar levels, lower triglyceride levels (blood fats linked to heart disease), lower total cholesterol levels while increasing the levels of HDL (‘good’) cholesterol (1)

In 2003 a clinical trial(2) took place in Pakistan which looked at the effect of cinnamon supplementation in individuals with type 2 diabetes.  The results showed that cinnamon powder taken over 40 days lowered blood glucose (sugar) levels, triglyceride levels, LDL cholesterol (a type of cholesterol considered to be a risk for heart disease) and total cholesterol levels.  The dose of cinnamon used ranged from 1-6g per day and all doses seemed effective.

This year a very small published trial (3) found that 3g of cinnamon eaten with rice pudding significantly reduced the insulin response in the body compared to no cinnamon in healthy individuals.  The results indicate a relation between the amount of cinnamon consumed and the decrease in insulin concentration.   Another small trial published this year (4) in healthy individuals found that 3g of cinnamon each day for 14 days reduced blood glucose response to oral glucose tolerance tests as well as improving insulin sensitivity.  However, when cinnamon supplementation was stopped the effects were quickly lost.  The authors conclude that cinnamon may improve blood sugar control and insulin sensitivity, but the effects are quickly reversed.

Why is it important that we are aware of blood sugar (glucose levels)?  You may be thinking “I am not a diabetic so why should I be concerned about my blood sugar?”

In September last year I explained how sugar and carbohydrates (which the body breaks down into sugars that are absorbed into the blood) can have a significant effect on raising the risk of heart disease in non-diabetic individuals.  I have also previously written about the effect that balancing blood sugar levels in the body can have including fatigue and craving prevention and keeping energy levels stable during the day (see posts dated 8th and 10th September 27th April)

Unfortunately over the years ultra low fat diets and increased consumption of processed and refined foods has led many people to eat diets that are high in sugar and/or high in (non-vegetable and fruit) carbohydrates.  Foods that release sugar quickly into the bloodstream have what is known as a high Glycaemic Index (GI), meals that favour a spike in blood sugar levels are said to have a high Glycaemic Load (GL).  To identify foods with a high glycaemic index that will contribute to increasing the GL of a meal please view the website: The Glycemic Index, there you will find a database where you can search for specific foods and find out more about GI and health.  

Unbalanced blood sugar levels following a meal (post-prandial dysmetabolism) can cause havoc in the body.  A high post-meal blood sugar level can lead to damaging free radicals (reactive oxygen molecules) being released which are a risk for atherosclerosis (damage to blood vessels) and metabolic syndrome (a big risk factor for heart disease) as well as many other conditions ranging from cancer to arthritis.  The high blood sugar can lead to internal inflammation, dysfunction in the lining of the blood vessels and may also lead to an increase in triglycerides (blood fats) - all risk factors for heart disease.  On a more immediate unbalanced blood sugar levels can sometimes lead to feelings of fatigue, lack of energy and cravings. 

Cinnamon appears to work by helping the body with the way it deals with sugar in the blood via various mechanisms– the effects of cinnamon appear to be important in type 2 diabetics but also healthy individuals.  Cinnamon supplements are available and you can use cinnamon as a sweetener on morning oats/porridge and in baking and cooking.  However, the best way to balance blood sugar levels is to eat a healthy, nutritious diet with a low glycaemic load (see the posts mentioned previously).  Eating a healthy, balanced diet will help to prevent blood glucose imbalance in the body.  A diet that is high in minimally process foods, vegetables, fruits, unrefined whole grains, beans/pulses, nuts/seeds, lean protein, oily fish (such as salmon, mackerel, sardines and trout) will go far in reducing the post-meal increases in glucose, triglycerides (blood fats) and other markers of disease compared to a typical western diet that is processed and full of high GI carbohydrates.

(1)Kim SH, Hyun SH, Choung SY: Anti-diabetic effect of cinnamon extract on blood glucose in db/db mice. J Ethnopharmacol 104:119–123, 2006
(2)Khan A, Safdar M, Khan MMA, Khattak KN, Anderson RA: Cinnamon improves glucose and lipids of people with type 2 diabetes. Diabetes Care 26:3215–3218, 2003
(3)Hlebowicz J et al.  2009.  Effects of 1 and 3 g cinnamon on gastric emptying, satiety, and postprandial blood glucose, insulin, glucose-dependent insulinotropic polypeptide, glucagon-like peptide 1, and ghrelin concentrations in healthy subjects.  Am J Clin Nutr.  89:815-821
(4) Solomon TP & Blannin AK.  2009.  Changes in glucose tolerance and insulin sensitivity following 2 weeks of daily cinnamon ingestion in healthy humans. Eur J Appl Physiol. 2009 Apr;105(6):969-76.
Written by Ani Kowal

"Trichotillomania is an impulse control disorder or form of self-injury characterized by the repeated urge to pull out scalp hair, eyelashes, facial hair, nose hair, pubic hair, eyebrows or other body hair, sometimes resulting in noticeable bald patches. Trichotillomania is classified in the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders) as an impulse control disorder. It may seem, at times, to resemble a habit, an addiction, a tic disorder or an obsessive-compulsive disorder. Trichotillomania often begins during the individual's teenage years. Depression or stress can trigger the condition. Due to social implications the disorder is often unreported and it is difficult to predict accurately prevalence (1)" but it is estimated to affect 2-4% of the population and seems to be more common in women than men.

Usually trichotillomania is treated with SSRI (Selective Serotonin Reuptake Inhibitor) anti-depressant drugs which many people prefer not to take due to the potential side-effects.  Researchers at the University of Minnesota Medical School have just published a study (2) which suggests that NAC (N-Acetylcysteine) a commonly available health food supplement may help to stop the urges of those suffering with trichotillomania.  NAC is an amino acid that acts as an antioxidant in the body.

The study(2) was small but well designed involving 50 trichotillomania sufferers, with an average age of around 34, for 12 weeks.  Half were given 1,200mg of NAC each day for 6 weeks.  For the following 6 weeks they were given 2,400mg NAC per day.  The other half were given placebo (inactive) supplements.  After 9 weeks, those taking NAC had a significant reduction in the incidence of hair-pulling.  After 12 weeks 56% of those on the NAC supplement reported feeling much, or very much improved (compared to only 16% of those on the placebo).  No side-effects were found when taking the NAC supplement.
 

The study offers significant hope to sufferers of this distressing self-harming condition and is also an important study as it is one of the first studies of compulsive behaviours to look at lowering levels of glutamate, a chemical that triggers excitement, in the brain to curb harmful behaviours.  NAC seems to affect levels of glutamate in a very specific area of the brain which may be why it seems to help patients curb their self-harmful behaviour.

Dysfunction of glutamate-mediated brain nerve functions has also been implicated in obsessive-compulsive disorder (OCD).  The study authors believe that NAC and other glutamate modulators may be applicable to other disorders, addictions and compulsive behaviours.  Prior to this study a case was documented (3) where NAC was shown to be clinically helpful for a sufferer of OCD (obsessive compulsive disorder).  Further studies are certainly warranted in this area, especially since many individuals are looking for natural alternatives to psychiatric drugs.  It may be that NAC will be useful in conjunction with other known nutritional mood influencing aids, I certainly look forward to further studies being published in this area.

If you are suffering with trichotillomania (or other compulsive behaviours) you may wish to contact the following online support networks and may wish to speak to your doctor or health professional about trying NAC to see if it is useful for you:
UK and Ireland Trichotillomania Support Group  and the Trichotillomania Support Online

(1)http://wapedia.mobi/en/Trichotillomania
(2) Grant JE et al.  2009.  N-Acetylcysteine, a Glutamate Modulator, in the Treatment of Trichotillomania: A Double-blind, Placebo-Controlled Study. Arch Gen Psychiatry. 66(7):756-763
(3) Lafleur DL et al.  2006.  N-acetylcysteine augmentation in serotonin reuptake inhibitor refractory obsessive-compulsive disorder.  Psychopharmacology.  184(2):254-256.

(Written by Ani Kowal)

On Thursday I went to the Nutrition Society Summer meeting at the University of Surrey.  The five day conference had concentrated on various aspects of over- and undernutrition.  The symposia that I attended were exceptionally interesting and thought provoking.  One of the presentations(1) was given by Dr Paul Kelly of Barts and London School of Medicine and Dentistry.  He was speaking about the microorganisms in the digestive system and links to diarrhoea in individuals in developing countries.  However, he briefly mentioned an animal study that linked the makeup of the bacteria in the digestive system and a propensity to obesity.  This got me thinking about whether that link was present in humans.  Upon returning home I had a search through the medical databases to see if there was any literature to support these thoughts.

Can bacteria in the gut have anything to do with developing excess body weight or obesity?

There seems to be a fair amount of recently published interest in the topic of digestive bacterial balance and the links to obesity and overweight (e.g. 2,3,4,5,6).  For many years the large intestine was thought only to be important for water absorption and storage of waste.  However, the adult human gut contains up to 100 trillion microbial organisms (including bacteria and yeasts) collectively known as the microbiota or microbiome.  These gut bacteria seem to have an effect on the entire body and not just the health of the digestive system.

Obesity is a complex disease involving many factors with no miracle cure and no easy solutions - I am not about to disillusion anyone by inferring that bacterial balance is a major factor and probiotics (supplemental good gut bacteria) are the cure.  However, gut bacteria may well be having some kind of impact on the development of excess body weight in some people.  What we eat does affect the composition of the microorganisms that are present in our digestive systems and in turn these microorganisms can have an effect on the health of our body.  A review published in French this year (2) looked at the evidence which suggests that the gut microorganisms are linked with metabolism and inflammation, and could be involved in type 2 diabetes, metabolic syndrome and obesity.

An extensive review published in America last year (3) looked at a wide range of evidence in order to investigate the potential role of the gut bacteria in the development of obesity. The authors of the paper found that interactions among the microorganisms in the gut appear to have complex effects in the human body and that the gut organisms may have an important role in regulating weight and may also be partly responsible for the development of obesity in some people.  Evidence suggests that our gut microorganism environment is established within the first year of life and then remains fairly constant through adulthood.  However dietary factors, infections and antibiotic use may lead to long-term changes.

The gut bacteria may be acting on weight via effects on: calorie utilisation from food, metabolism, inflammatory responses, hormone regulation or other means and evidence does suggest that obese and lean individuals seem to have different composition of gut bacteria (3).  A study published last year (4) followed children from birth to age 7 years.  Children of normal weight and those who were overweight had significant differences in their gut bacterial composition suggesting that an important link between bacterial balance and obesity development possibly via inflammatory pathways.  The authors conclude that their findings may offer “new possibilities for preventive and therapeutic applications in weight management”.

Can modifying the gut bacteria through diet and/or probiotic or prebiotic (such as FOS, fructooligoosaccharides) supplements have an impact on body weight?

The review paper (3) emphasises that the best, nonsurgical, strategy for reversing obesity in the population seems to be to promote small but long-term changes in diet and physical activity.  The authors go on to say that further evidence with regards bacterial gut balance is needed but that microorganisms may well be influencing obesity.  They suggest that probiotic and prebiotic supplements may be useful in order to positively change the gut bacterial balance and help prevent and treat overweight but that these manipulations should clearly not be viewed as a substitute for a healthy diet and exercise.

Prebiotics act as food for the good ‘friendly’ bacteria in the digestive system and studies (3) suggest that prebiotics in the diet may reduce our energy and food intake, increase satiety, reduce hunger and appetite and reduce total daily calorie intakes.  FOS may also have effects on blood sugar balance in the body.

Probiotics, live ‘friendly’ bacterial supplements, may also change the bacterial balance of the digestive system and have an effect on overall health in the body, but studies in humans and the links to weight control are lacking.  An interesting study presented at a conference this year (6,7) found that probiotics during and after pregnancy may help prevent the development of obesity after birth.  The study found that at 1 year after giving birth, 25% of women given probiotics along with dietary counseling had central obesity based on that definition, compared with 43% of women given diet advice alone. In a press release the author stated that "This is the first study showing that probiotics-supplemented diet during pregnancy and breastfeeding influences the adiposity [fat mass]of women over the 12-month postpartum period," Further evidence is needed but the author said that modification of bacterial balance in the intestines with probiotic supplements "together with a balanced diet may offer a reasonably economic, practical, safe and potentially successful method to be used with other lifestyle-related factors in controlling obesity" (7).

Further conclusive evidence needed, however prebiotics (such as FOS) and probiotics do seem to positively change the composition of bacteria in our digestive systems and affect overall health.  Supplements are readily available but should not be seem as a quick-weight loss fix.  A healthy diet and lifestyle is of paramount importance for weight control and overweight prevention and treatment.

(1)Dr Paul Kelly.  2009.  Symposium 4: Gut function: effects on over and under-nutrition.  Nutrition, intestinal defence and the microbiome.  The Nutrition Society Summer Meeting.  University of Surrey.  Thursday 2nd July 2009.
(2) Pataky Z et al.  2009.  Gut microbiota, responsible for our body weight?  Rev Med Suisse.  5:662-664 [Article in French]
(3) DoBaise JK et al.  2008.  Gut microbiota and its possible relationship with obesity.  Mayo Clinical Processings.  83:460-469
(4) Kalliomaki M et al.  2008.  Early differences in fecal microbiota composition in children may predict overweight.  Am J Clin Nutr.  87:534-538
(5) Tennyson CA &Friedman G.  2008.  Microecology, obesity and probiotics.  Curr Opin Endocrinol Diabetes Obes.  15:442-447
(6) Kirsi Laitinen, nutritionist and senior lecturer at the University of Turku in Finland.  Study findings presented at 17th European Congress on Obesity http://www.easo.org/eco2009/index.htm 6-9 May 2009 held in Amsterdam
(7)  Anthony J. Brown, MD.  2009.  Probiotics may help ward off postpartum obesity.  2009-05-08 15:24:34 -0400 (Reuters Health).  http://www.reuters.com/article/healthNews/idUSTRE5475QP20090508

Written by Ani Kowal

The links between diet and cancer are widely researched.  The World Cancer Research Fund UK (WCRF UK) estimate that lifestyle factors such as being overweight, eating an unhealthy diet and being inactive are responsible for about a third of all cancers in developed countries (1).  The WCRF UK are a charity committed to cancer prevention.

A recently published study (2) has found a significant link between eating a diet high in carotenoid rich fruits and vegetables and a reduction in the risk of breast cancer in premenopausal women.

Carotenoids such as alpha and beta carotene, lutein and zeaxanthin 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.

The study (2) involved 5,707 women with invasive breast cancer (2,363 premenopausal women and 3,516 postmenopausal women) and 6,389 individuals with no breast cancer, control subjects (2,594 premenopausal women and 3,516 postmenopausal women).  In an interview, these women were asked about their intake of carotenoid rich fruits and vegetables.  The researchers found that pre-menopausal women eating high intakes of vitamin A, beta-carotene, alpha-carotene, lutein and zeaxanthin appeared to have a reduced risk of breast cancer.  Eating at least two servings of carotenoid-rich vegetables each day was associated with around a 17% reduced risk of breast cancer.  As an association study the results are positive but further studies would be necessary before any firm conclusions could be drawn about the effect of dietary carotenoids on cancer risk. 

Carotenoids may be acting to prevent cancer via different means.  Carotenoids have been shown to interfere with oestrogen (hormone) signalling which may explain why their cancer-preventing effects would be limited to premenopausal women.  In addition to this, carotenoids act as antioxidants in the body and antioxidants have been linked to cancer prevention.  Antioxidants prevent damage to the body cells by naturally occurring unstable oxygen molecules, known as free radicals.  Antioxidants may help to ‘quench’ or mop-up the destructive free radical molecules and therefore protect against cell-damage (which could lead to cancer formation).

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.  This is not a suggestion to 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. 

(1)WCRF/AICR.  2009.  Policy and action for cancer prevention.  Food, nutrition and physical activity: a global perspective.  Washington DC: AICR, 2009.
(2) Mignone LI et al.  2009.  Dietary carotenoids and the risk of invasive breast cancer.  International Journal of Cancer.  124:2929-2937
Written by Ani Kowal

Over the years there has been debate as to whether oral contraceptive use in women leads to depletion of certain nutrients in the body.  There is some evidence that oral contraceptives may reduce levels of Vitamin B1, B2, B6, folate, vitamin C, vitamin E, zinc, magnesium and calcium.  However, many of these studies were small and carried out over 20 years ago with very little follow up since.  During this time the contraceptive pill has changed dramatically and now contains lower doses of hormones.  Women who are eating a healthy, nutrient-rich diet probably gain enough vitamins and minerals to counteract any deficit but many women in the UK are not reaching the minimum 5 portions per day of vegetables and fruits and many also do not gain enough magnesium and other minerals through their diets. 
 

The early studies do warrant attention and I was interested to find two more recent papers (1,2) which point to the importance of being nutrient-aware when taking oral contraceptives.  These two studies look at how oral contraceptives may have an effect on the antioxidant levels in the body.  

I have written about dietary antioxidants in many previous blog posts.  Antioxidant intakes and bodily status has 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 carotenoids, vitamins C and E and various antioxidant bioflavonoids (bioactive plant chemicals). 

Anitoxidants help to prevent damage to cells in our body 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.

It has been thought for some time that oral contraceptive use may lead to increased oxidative stress in women.  One study (1) which took place in 2007 included 209 healthy women aged 40-48 years.  The oxidative stress status of the women was studied, this included an analysis of antioxidant levels, trace minerals and three markers of oxidative damage to fats (lipids).  Among the 209 women 23% used oral contraception, 57% did not use contraception and 20% used hormonal and copper intrauterine devices (IUD). 

Results showed(1) that women using oral contraception had significantly higher oxidative damage to lipids (lipid peroxidation) compared to the other 2 groups of women.  Lipid peroxidation has been linked to heart disease.  Oral contraceptive users also had significantly lower blood plasma levels of several antioxidants such as beta-carotene and gamma-tocopherol (a form of vitamin E).  The study scientists checked their data and confirm that modifications in plasma beta-carotene levels could not be attributed to dietary differences between the three groups.  The beta-carotene levels were 39-50% lower in the oral contraceptive users compared to the other groups of women.  The authors conclude that these lowered levels of antioxidants and increased signs of bodily oxidative stress could represent a potential cardiovascular risk factor for these women.

Another study (2) looked to examine the influence of oral contraceptive use on blood serum levels of antioxidants.  The study was a very small, preliminary trial in pre-menopausal women.  The researchers found that oral contraceptive use significantly decreased coenzyme Q10 (an antioxidant) and alpha-tocopherol (vitamin E) levels.  The authors conclude that further studies are needed to investigate the potential role of oral contraceptives on oxidative stress in women.

Coenzyme Q10 is naturally produced by the body and was first isolated in 1957, it is essential for energy production in all bodily cells and also acts as an antioxidant in the body.  Coenzyme Q10 itself is found in many foods but is particularly concentrated in nuts and oils.  The body does produce this nutrient naturally and does not rely on external sources.  In order to produce CoQ10 we require various essential cofactors.  These include a variety of vitamins especially of the B group (Folic Acid, Vitamin B2, The Niacinamide form of Vitamin B3, Vitamin B5,Vitamin B6, Vitamin B12) and Vitamin C .  Hence a healthy diet rich in fruits, vegetables, wholegrain cereals and lean proteins will aid the natural production of this coenzyme and help to keep our circulating levels high.

The results of these studies need backing up by further larger clinical trials but could indicate the consideration of antioxidant supplementation for women taking oral contraceptives. 

Eating a healthy diet low in processed and refined foods and rich in vegetables, fruits, nuts/seeds, beans and pulses, lean meats, fish (especially oily varieties), wholegrains and healthy fats is the best way to ensure that your body gets plenty of vitamins, minerals and antioxidants.  If you feel that your diet is regularly falling short then you could consider taking a broad spectrum multivitamin and mineral supplement – but remember that a supplement cannot be considered as an alternative for a healthy diet.

1.Chapelle JP et al.  2007.  Effect of different contraceptive methods on the oxidative stress status in women aged 40 48 years from the ELAN study in the province of Liege, Belgium.  Hum Reprod.  22:2335-2343
2. Palan PR et al.  2006.  Effects of menstrual cycle and oral contraceptive use on serum levels of lipid-soluble antioxidants.  Am J Obstet Gynecol.  194:e35-38

Written by Ani Kowal

A recently published small study (1) has found that men with prostate cancer who consumed an active green tea supplement had significant reductions in biological-markers predictive of prostate cancer progression.

Green tea has become an incredibly popular drink and supplement and an increasing number of studies are being published with regards its health benefits.  The number of current human studies investigating the relationship between green tea and prostate cancer is small.  This study (1) was preliminary but informative.  It involved just 26 men aged 41-72 years old who were diagnosed with prostate cancer and due to undergo radical prostatectomy.  The trial looked to determine the effects of short-term supplementation with the active compounds found in green tea on biological-markers in patients diagnosed with prostate cancer.  These biomarkers [technically looking at hepatocyte growth factor (HGF), vascular endothelial growth factor (VEGF) and prostate specific antigen (PSA)] are good prognostic indicators of prostate cancer progression.

The men involved in the study were given 4 green tea capsules for an average of 34 days prior to surgery.  The 4 capsules provided the equivalent of around 12 cups of normally brewed green tea.  Results showed that there was a significant reduction in blood serum levels of the biological-markers of prostate cancer after treatment with the green tea capsules.  Some of the patients had reductions in the biomarker levels of more than 30%.  The supplements had no effect on liver function, which was used as a measure of toxicity.

The supplement used contained 1.3g tea polyphenols, bioactive plant nutrients, that are found naturally in green tea: 800 mg of epigallocatechin-3-gallate (EGCG) and lesser amounts of epicatechin, epigallocatechin, and epicatechin-3-gallate.  Green tea supplements often have these polyphenols listed as active 'ingredients'.

In a press release(2) one of the authors commented: "These studies are just the beginning and a lot of work remains to be done, however, we think that the use of tea polyphenols alone or in combination with other compounds currently used for cancer therapy should be explored as an approach to prevent cancer progression and recurrence". 

In the same press release(2) William G. Nelson, V., M.D., Ph.D., professor of oncology, urology and pharmacology at the Johns Hopkins Kimmel Cancer Center, said that he believed the reduced blood serum biomarkers of prostate cancer may be attributable to some sort of benefit relating to green tea components "Unfortunately, this trial was not a randomized trial, which would have been needed to be more sure that the observed changes were truly attributable to the green tea components and not to some other lifestyle change (better diet, taking vitamins, etc.) men undertook in preparation for surgery,". However, "this trial is provocative enough to consider a more substantial randomized trial."

The researchers of this study are currently conducting a comparable trial among patients with breast cancer.

For general information about nutrition and prostate health please read my previous blog posts on the subject (Prostate health Part I and II).  For more information on prostate cancer please visit the Prostate Cancer Care website.

The World Cancer Research Fund (WCRF) estimate that lifestyle factors such as being overweight, eating an unhealthy diet and being inactive are responsible for about a third of all cancers in developed countries (3).  Please visit the WCRF website for information related to diet and cancer prevention.

1. McLarty J et al.  2009.  Tea Polyphenols Decrease Serum Levels of Prostate-Specific Antigen, Hepatocyte Growth Factor, and Vascular Endothelial Growth Factor in Prostate Cancer Patients and Inhibit Production of Hepatocyte Growth Factor and Vascular Endothelial Growth Factor In vitro.  Cancer Prevention Research, 10.1158/1940-6207.CAPR-08-0167.  Published online June 19
2.Sciencedaily.com press release.  American Association for Cancer Research (2009, June 22). Green Tea May Slow Prostate Cancer Progression. ScienceDaily. Retrieved June 23, 2009, from http://www.sciencedaily.com¬ /releases/2009/06/090619112329.htm
(3) WCRF/AICR.  2009.  Policy and action for cancer prevention.  Food, nutrition and physical activity: a global perspective.  Washington DC: AICR, 2009.

Written by Ani Kowal

Regular readers of my blog will have realised by now that I have a great interest in Omega 3 fatty acids.  Research suggests that these essential fats play a role in the prevention of several diseases ranging from heart disease to cancer, stroke, diabetes, arthritis, asthma, osteoporosis, mood disorders (including depression), eye diseases and many more (including most conditions with a link to inflammation).  A major voice for the importance of these fats is Artemis Simopoulos MD.  Dr Simopoulos is president of The Centre for Genetics, Nutrition and Health and a member of the board of directors of the American Association for World Health.  Since 1984 her research has been largely dedicated to the evolutionary aspects of diet, the omega-6:omega-3 ratio of the diet and the importance of omega-3 fatty acids for health.

In an interview (1) Dr Simopoulos said that one of the biggest food myths today is that you have to give up fat to lose weight and enjoy health.  A statement I wholeheartedly agree with.  Of course, not all fats are the same and today I want to discuss the virtues of omega 3 fatty acids.  These can be found in fish, especially oily fish such as salmon, trout, mackerel and sardines, seafood, as well as flaxseeds, walnuts and green leafy vegetables.  Meat and eggs in the UK do not contain large amounts of omega 3 fatty acids anymore since our farming methods have drastically changed over the years, this has contributed to the huge decline in our intakes of this vital fat.  Grass reared animals will have better omega 3 fatty acid levels, but nowhere near as high as in the past when animals were less intensively reared.

Dr Simopoulous has written many research and review papers about the importance of omega 3 fatty acids, and I am going to use some information from a fairy recent one (2) to provide the basis for this post.  She has also written many books including ‘The Omega Plan’.

It is thought that humans evolved on a diet that was very rich in essential omega-3 fatty acids, and a ratio of omega-6:omega-3 fatty acids of about 1:1 (or at most 2:1).  Currently the western diet has an imbalanced ratio of about 15:1 !!  This represents a huge shift and a relative ‘deficiency’ in omega-3 fats.  The excessive amounts of omega-6 fats and the very high omega-6:omega-3 ratio today is thought to be a major contributor to many of the diseases listed above.  A diet rich in omega-3 fatty acids and with a lower omega-6:omega-3 ratio is highly desirable for reducing the risk of many of the chronic diseases in the Western world.  Low intakes of omega-3 fats and higher intakes of omega-6 fats can lead to an increase in inflammation in the body since omega-3 fats are used by the body to make potent anti-inflammatory chemicals whereas too much omega-6 can lead to the production of pro-inflammatory chemicals by the body.

Nutrition can affect our genes and hence have an influence on disease.  Over the last 10,000 years our diet has drastically changed, especially over the last 150 years, to almost unrecognisable degrees in most people.  However, genetically we have not changed much (our DNA is much the same).  Our genes today are incredibly similar to those of our ancestors who lived around 40,000 years ago.  Our diet now is so very different, particularly in the type of fats we eat, and in the antioxidant nutrient content of our foods (antioxidants are found abundantly in vegetables and fruits) and this is surely affecting our health.

The review paper(2) details the ways in which our diet differs from that of our pre-industrial ancestors:
1. We have an increase in energy intake and a decrease in energy expenditure
2. Our diets are richer in saturated fat, omega-6 fats and trans fats and lower in omega-3 fats
3. We do not eat as much complex carbohydrates and fibre
4. We eat a huge amount more cereal grains and a reduced amount of fruits and vegetables
5. We eat less protein, antioxidants and calcium

Omega-6 fatty acids are found abundantly in our diets – most seeds, nuts, vegetable fats (vegetable seed oils) are omega 6 rich.  By contrast our diets are generally low in omega-3 fats: short chain omega-3 fats (alpha linolenic acid) are found in flaxseeds and walnuts (as well as chia and perilla seeds) and in their longer chain forms (EPA eicosapentaenoic acid and DHA docosahexaenoic acid) are found in oily fish.  The long chain omega-3 fats seem particularly important for our health and are found in concentrated amounts in the human brain.  The body can use the short chain omega-3 fats from the diet to form the longer-chain EPA and DHA forms but the process is far from efficient.  EPA and DHA are used by the body to produce the biological chemicals which have potent anti-inflammatory effects.  As a nutritionist I feel that it is essential we work toward increasing the intake of omega-3 and decreasing the intake of omega-6 fats in our diets in order to redress the omega-6:omega-3 balance (2).

If you feel that you do not eat oily fish regularly (you may be vegetarian or vegan or example), at least twice per week, then you may wish to consider taking an omega-3 fish oil supplement that provides around 250-300mg EPA and 250-350mg DHA per day.  Choose supplements that also contain vitamin E or another antioxidant since these protect the oil from degradation.  For vegans and vegetarian flaxseeds and walnuts represent good sources of the short chain omega-3 fatty acid – however, a flaxseed oil supplement that provides around 500-1000mg alpha-linolenic acid daily is worth considering.  Again, choose a supplement that contains a protective antioxidant.  There are now some vegan EPA and DHA supplements being produced from algae.  They are obtainable from only a few sources and can be expensive but their popularity and availability are rising and they are worth considering.

Dr Simopoulos offers 7 general dietary guidelines(1):
1.Enrich your diet with omega-3 fatty acids with cold-water fish, flax and walnut oil
2.Use canola, olive and flax oils as your primary oils
3.Eat seven or more servings of fruits and vegetables each day
4.Eat more peas, beans and nuts
5.Eat less saturated fat
6.Avoid oils high in omega-6 fatty acids such as corn, safflower, peanut, soyabean, sunflower and cottonseed oils – avoid products made from these oils
7.Avoid trans-fatty acids (found in many processed foods.  Trans fatty acids are used in the prepared food industry to prolong the shelf life of baked goods like biscuits).

In addition to this I would add that a healthy diet is one that contains minimal amounts of processed and refined foods.  Think natural! 

(1)http://www.1stvitality.co.uk/pdfs/Barleans_GB_dr_Simopoulos.pdf
(2)Simopoulos AP.  2008.  The importance of the omega-6/omega-3 fatty acid ratio in cardiovascular and other chronic diseases.  Exp Biol Med (Maywood).  233:674-688

Written by Ani Kowal