Almonds are my one of my favourite snacks, I love the way their crunch turns to creaminess after a bit of chewing!  I learned something new this weekend, Almonds (botanical name Prunus amygdalus dulcis) are actually fruits.  They are not botanically classified as Nuts but are considered so for commercial and culinary purposes. 

A recent study(1) has found that almonds may act as prebiotics, a food source that promotes the growth of ‘friendly’ gut bacteria in our digestive systems.  The research was carried out by the Institute of Food Research which found that ground almonds stimulated the growth of beneficial bacteria in a model gut system.  The fat portion of the almonds seemed to be the most important component for the growth of the good bacteria.  Studies in human volunteers will, no doubt, take place in the future.  Prebiotics may be important not only for the optimal health of the digestive system but also for the health of the immune system and hence our ability to ward off infections (I have mentioned this in previous posts).

Reading this research reminded me of all the other benefits of almond-eating!  Almonds have been shown to have cholesterol lowering effects and may also protect against type 2 diabetes and heart disease.  In addition to this they have antioxidant potential and are a good source of vitamin E, fibre, calcium, magnesium and monounsaturated fatty acids.

A study published in 2004(2) found that adding almonds to our usual daily diets can produce favourable nutrient changes without any additional dietary advice or modification.  The study evaluated the impact of long-term almond supplementation on the nutritional intake and diet quality in 43 healthy men and 38 women aged 25-70 years. The participants were followed for 1 year. During the first 6 months, individuals were simply asked to follow their usual diets; in the second 6 months, they were asked to add almonds to their diets (about 50g per day, an average of 42 almonds). Their nutrient intakes were assessed seven times during each 6 month diet period.

When the study participants changed from their usual diet to the almond-supplemented diet, their intakes of healthy, mono- and poly- unsaturated, fats significantly increased by 42% and 24% respectively, fibre by 12%, vegetable protein by 19%, vitamin E by 66% and Magnesium by 23%; their intakes of trans fatty acids (not very healthy for the body), salt, cholesterol and sugars significantly decreased by 14, 21, 17 and 13% respectively. These were spontaneous nutrient changes (not caused by nutritional/dietary advice or literature) that closely match the dietary recommendations given to prevent cardiovascular and other chronic diseases.  The study highlights that something as simple as adding a handful of almonds for a healthy daily snack to an individual’s routine diet can induce favourable nutrient modifications for chronic disease prevention.

Before you throw your hands up in horror and say “but Ani, I can’t possibly eat nuts on a daily basis because of the calorie content and the impact on my weight” I ask you to please read on!  Nuts have a stabilising effect on blood sugar levels and may therefore help prevent sugar cravings, hunger-pangs and mid-afternoon energy slumps.  The fibre content may also help to keep you feeling fuller for longer.  Almonds can replace other common snacks such as crisps or ‘cereal bars’ which are refined foods and certainly not as nutritious.  In addition to this, studies have shown that including nuts in your daily diet will not cause you to pile on the pounds.  A study published in 2003(3) found that almonds may also be useful in weight-reduction programmes:

The study scientists wanted to evaluate the effect of an almond-enriched, or complex carbohydrate-enriched, low-calorie diet in a weight reduction program.  The study ran for 24-weeks and included a total of 65 overweight and obese adults age 27-79.  The almond group ate 84g of almonds per day as part of their diet.  Overall their daily nutrient intake was 39% total fat (25% monounsaturated fatty acids), and 32% carbohydrate (as percent of dietary energy).  The other group ate a complex carbohydrate, low fat diet comprising 18% total fat (5% monounsaturated fatty acids), and 53% carbohydrate.  Both diets had the same calorie and protein content.

Those on the almond supplemented diet, in contrast to complex carbohydrates, had greater sustained, reductions in weight, waist circumference, body fat mass and blood pressure.  Both groups saw a reduction in symptoms characteristic of type 2 diabetes and metabolic syndrome (e.g. glucose levels, blood pressure, cholesterol, triglycerides, and insulin resistance), however among subjects with diagnosed type 2 diabetes, diabetes medication reductions were sustained or further reduced in a greater proportion of the almond group as compared to the carbohydrate group. 

As my final offering I would like to cite a study that took place in 2002(4).  In this study 81 individuals (male and female) ate around 50g almonds (about 320 calories) a day for six months following a period of six months of eating their normal daily diets.  The participants received no additional dietary advice.  During the year the body weight and normal exercise habits of the individuals was evaluated.  During the almond feeding period, average body weight was not statistically or biologically increased.  There was a positive increase in the unsaturated:saturated dietary fat ratio (a good ratio change!).  The authors estimate that there was a natural energy compensation ie the extra energy from almonds was naturally displaced by an unconscious reduction in consumption of other foods (perhaps snacking stopped or consumption of sugary or refined foods declined).

Go ahead, try snacking on something different and health-full today, eat a few almonds (be sure that they are unsalted, un-blanched and with their skins still on)!

(1) Mandalari, C. Nueno-Palop, G. Bisignano, M. S.J. Wickham, and A. Narbad.  2008.  Investigation of the potential prebiotic properties of almond (Amygdalus communis L.) seeds  Appl. Envir. Microbiol. 2008 : [E-pub ahead of print 00739-08v1] 
(2) Jaceldo-Siegl K, Sabaté J, Rajaram S, Fraser GE. 2004.  Long-term almond supplementation without advice on food replacement induces favourable nutrient modifications to the habitual diets of free-living individuals. Br J Nutr.  92(3):533-40.
(3) Wien MA, Sabaté JM, Iklé DN, Cole SE, Kandeel FR. 2003.  Almonds vs complex carbohydrates in a weight reduction program. Int J Obes Relat Metab Disord. 27(11):1365-72.
(4) Fraser GE.  2002.  Effect on body weight of a free 76 Kilojoule (320 calorie) daily supplement of almonds for six months.  J Am Coll Nutr.  21(3):275-83
(5) Institute of Food Research press release

Written by Ani Kowal

New research(1) has just emerged from Baycrest which shows that adults with type 2 diabetes who eat unhealthy, high-fat, meals may experience memory declines immediately afterward, but this may be offset by taking antioxidant vitamin supplements together with the meal.

Baycrest is an academic health sciences centre, affiliated with the University of Toronto, which is internationally-renowned for its research on aging and the conditions associated with ageing such as memory loss, depression and stroke.

The study authors make reference to the fact that there is already a growing body of evidence that links diabetes to cognitive (mental) complications in humans.  Adults with type 2 diabetes seem especially vulnerable to acute memory deficits after eating unhealthy foods.  This latest study suggests that taking high doses of antioxidant vitamins C and E with such meals may help minimize those memory slumps.

One of the study authors, Michael Herman Chui, said “Our bottom line is that consuming unhealthy meals for those with diabetes can temporarily further worsen already underlying memory problems associated with the disease”.

The study was a very small preliminary trial that involved only 16 adults (with an average age of 63) with type 2 diabetes who were not regularly taking antioxidant supplements.  They attended three weekly sessions that involved consuming a different test meal on each visit. One meal consisted of high fat foods (a Danish pastry, cheddar cheese and yogurt with added whipped cream); the second meal consisted of only water; and the third test meal was the same high-fat meal plus vitamin C (1000 mg) and E (800 IU) supplements.

After eating the meal, participants completed a series of tests that measured their recall abilities for words they had heard and paragraph information they had read.  It was found that vitamin supplementation consistently improved recall scores.  Compared to those who consumed only water or the meal with antioxidant vitamins, participants who ate the high fat meal showed significantly more forgetfulness (of words and paragraph information) in immediate and time delay recall tests. 

The study authors emphasize that their findings obviously require further replication in much larger trials. Future studies will also need to look at how the antioxidant vitamins may be working.  Personally, I would also like to see further trials using antioxidant foods, such as fruits and vegetables, in conjunction with meals to test if the same benefits are seen as with supplementation (I have a feeling results would be very positive)!

Type 2 diabetes is associated with persistent, long term oxidative stress, a known major contributor to cognitive (mental) decline and Alzheimer disease. Consuming unhealthy foods can induce this type of stress which is triggered by elevations of free radicals: unstable molecules that can damage body tissue, including brain tissue. These destructive reactions tend to occur over a 1-3 hour period after the ingestion of food.  Fruits and vegetables contain numerous antioxidant nutrients and can minimise oxidative stress, it is important to include such foods as an integral part of all meals.  This study showed that antioxidants could reduce immediate memory deficits caused by unhealthy eating.

Dr. Carol Greenwood, senior author of the study, cautioned that relying on antioxidant vitamins at meal time is not a quick fix. “While our study looked at the pill form of antioxidants, we would ultimately want individuals to consume healthier foods high in antioxidants, like fruits and vegetables” (well said!).

An overall healthy lifestyle is important in maintaining optimal mental health at all ages.  This includes regular exercise, staying mentally active, being socially engaged in a variety of activities as well as adopting a healthy diet rich in fruits, vegetables and healthy fats found in oily fish, nuts and seeds.

(1) Chui MH & Greenwood CE.  2008.  Antioxidant vitamins reduce acute meal-induced memory deficits in adults with type 2 diabetes.  Nutrition Research.  28 (7): 423-494
(2) Baycrest press release

Written by Ani Kowal

A fabulous study was published online yesterday (Monday 23rd June) in Circulation(1), a journal written by the American Heart Association.  The study is particularly interesting as it looks at overall dietary patterns, rather than specific dietary elements, and the association to death from cardiovascular disease (heart disease and stroke) and other chronic diseases.

The scientists used information from 72,113 women who were free of heart attack, angina, coronary artery surgery, stroke, diabetes and cancer at the start of the study.  The women were followed for 18 years from 1984-2002 and their dietary habits were tracked via validated food frequency questionnaires that were administered every 2-4 years throughout the 18 years.

Two very distinct eating patterns emerged and were noted by the scientists:
1. A ‘prudent’ diet – this was characterised by high intakes of fruit, vegetables, legumes (beans and pulses), fish, poultry and wholegrains.
2. A ‘western’ diet – this diet was characterised by high intakes of processed meat, red meat, refined grains, French fries and sweets/desserts.

During the 18 years 6011 women died.  1154 were cardiovascular deaths and 3139 were deaths from cancer.  Analysis, which took into account lifestyle variables, found that following the healthy ‘prudent’ diet was associated with a 28% lower risk of cardiovascular death and a 17% lower risk of mortality from all causes.  The women following the traditional western style diet were 22% more likely to die from cardiovascular disease, had a 16% increased risk of death from cancer and were 21% more likely to die from any cause.

A point to remember is that all of these women were initially healthy.  At the start of the 18 year follow up they were free from all major diseases.  Over the years, following a healthy diet reduced the risk of death from all causes.  I love this study as it does not focus on one particular dietary element.  It highlights the importance of adopting an overall healthy diet.  A diet abundant in healthy foods provides our bodies with a huge host of different vitamins, minerals, healthy essential fats, fibre, flavonoids and more!  All of these nutrients interact together in a complex way and are all important for our health. 

One of the study authors, Dr Christin Heidemann, is quoted on Reuters as saying “These results highlight the importance of intensifying efforts to promote the adoption of a healthy diet including high intakes of vegetables, fruit, legumes, whole grains, fish and poultry and low intakes of red and processed meat, refined grains, French fries and sweets”.  I wholeheartedly agree!!

Healthy eating for life may indeed give us more life!

(1)Heidemann C et al.  2008.  Dietary patterns and risk of mortality from cardiovascular disease, cancer, and all causes in prospective cohort of women.  Circulation.  [E-pub ahead of print June 23]

Written by Ani Kowal

On Thursday (19th June) the American Medical Association (AMA), the largest doctors organisation in the USA, voted at their Annual Meeting to urge the Food and Drug Administration to re-examine the recommendations for vitamin D intake in light of new scientific evidence.

Those of you who have been reading my posts will know that I have mentioned vitamin D a couple of times already with respect to prevention of many diseases including cancer and heart disease.  This year alone there have been over 100 papers, articles or studies released which show how important this ‘sunshine vitamin’ is for our optimal health and wellbeing.  There is an almost constant stream of new scientific findings showing benefit.

The AMA are concerned because the American Reference Intake Values for Vitamin D were established back in 1997.  I hope that here in the UK we follow suit soon and re-examine our recommended intake too.  Ours was set back in the early 1990s!  Current research strongly suggests that we need more of this important vitamin than previously thought.

On Friday (20th June) a study(1) was published in the Journal of Clinical Oncology, I wanted to mention it here because it did not look at vitamin D with regards disease prevention.  The study looked at vitamin D and survival after cancer.  It has been previously shown that individuals with higher levels of vitamin D in their blood are less at risk of contracting colorectal cancer.  This present study found that among patients affected by colorectal cancer a higher pre-diagnosis vitamin D level was associated with a significant improvement in overall survival.  The authors of the study say that a trial is being planned in which colon cancer patients will take vitamin D along with post-surgery chemotherapy to assess whether there are any benefits with supplementation.

Just as I was about to finish this post a very interesting piece of peer-reviewed clinical research came to light(2) that was published in Pain Treatment Topics a few days ago.  The paper looked at vitamin D in relation to ‘pain’ and found that:

“Inadequacies of vitamin D have been linked to chronic musculoskeletal pain of various types, muscle weakness or fatigue, fibromyalgia syndrome, rheumatic disorders, osteoarthritis, hyperesthesia, migraine headaches, and other complaints. It also has been implicated in the mood disturbances of chronic fatigue syndrome and seasonal affective disorder.  Current best evidence demonstrates that supplemental vitamin D can help to resolve or alleviate chronic pain and fatigue syndromes in many patients who have been unresponsive to other therapies.”

There are downloadable documents on the Pain Treatment Topics website which provide detailed background information and recommendations.  There is a Full report and a Patient brochure available.  If you are suffering from any of the mentioned conditions you may wish to discuss this evidence with your doctor to see if Vitamin D supplementation could be useful to you.

Many of us find that spending some time in the sunshine is very healing for the mind and helps to reduce perceived stress-levels too.  It really does seem like the sun is important for the health of the body too!

(1)Ng K et al.  2008.  Circulating 25-Hydroxyvitamin D Levels and Survival in Patients With Colorectal Cancer.  Journal of Clinical Oncology.  26(18):2984-2991
(2) Stewart B. Leavitt, MA, PhD, Pain Treatment Topics, June 2008.  Vitamin D – A Neglected 'Analgesic' for Chronic Musculoskeletal Pain.  An Evidence-Based Review & Clinical Practice Guidance

Written by Ani Kowal

At the beginning of the week I examined how a Mediterranean diet may be useful in the prevention and easing of asthma symptoms.  Today I wanted to add a little more information on the link between diet and asthma.

Salt consumption has been linked to asthma.  A review(1) of studies found that reducing salt intake may be helpful in reducing the severity of asthma attacks in affected individuals.  One study found that giving salt, an additional 6.1g per day, worsened symptoms in asthmatic patients and increased their use of inhaled steroids.  The authors of this study suggest that a low salt diet (around 5g per day) may have favourable effects in patients with asthma and can reduce the need for anti-asthma drugs(2).  Salt appears to heighten the airways’ response to histamine causing increased airway constriction(3).  Avoiding the addition of salt to food and limiting consumption of processed foods might help to reduce asthma symptoms and is also a good idea for all of us.  Excess salt has been linked to various conditions including high blood pressure, heart disease, cancer, kidney problems, osteoporosis and fluid retention (for more information on salt and health visit Consensus Action on Salt and Health CASH).

Interesting evidence shows that the gut bacteria of healthy infants appears different to those who suffer from allergies, eczema and asthma (known as ‘atopic’ infants).  Atopic infants seem to have a disturbed balance between beneficial and potentially harmful bacteria in their large intestine(4,5,6).  A healthy balance of microorganisms in the digestive system is thought to be essential for the normal development and maturation of the immune system.  In one study, the probiotic Lactobacillus GG was give to pregnant women who had at least one first-degree relative (or partner) with an allergic condition such as atopic eczema, allergic rhinitis, or asthma.  After the birth, the probiotic was also given to the child for 6 months.  Probiotic supplementation significantly reduced risk of early allergic disease in children at high risk (7). 

Research in this area is still in the early stages, clinical studies of children and supplement studies in animals do suggest that the exposure to microbes through the digestive system powerfully shapes immune function.  Taking a probiotic or prebiotic supplement during pregnancy, breastfeeding and early childhood could be considered in order to prevent against asthma/allergy development in children.  Some infant milks are already including pre probiotics in their formulation (Always check with a doctor before undergoing any supplementation programme, especially during pregnancy).

Finally I would like to mention food allergies.  If your child suffers from asthma it may be worth taking them to the doctor for a skin-prick test in order to determine whether they suffer from a true food allergy.

Food sensitivity may be an underlying factor in asthma, especially in childhood asthma.  In one study, 91% of children with respiratory allergy improved on a six-week diet that excluded common problem foods including grains and dairy products(8).  And a review(9) found that approximately 5% to 8% of asthma patients have a food allergy that can be confirmed via a food challenge. Identification and elimination of problem foods is often a useful strategy in the management of asthma.  This should always be done under the supervision of a doctor. 

(1)Mickleborough TD & Fogarty A. 2006. Dietary sodium intake and asthma: an epidemiological and clinical review.  International Journal of Clinical Practice.  60:1616-1624.
(2)Medici TC et al.  1993.  Are asthmatics salt-sensitive? A preliminary controlled study. Chest.  Oct;104(4):1138-43
(3)Burney PG et al.  1981.  The effect of changing dietary sodium on the bronchial response to histamine.  Thorax.  44(1):36-41
(4)Kirjavainen PV et al.  2001.  characterizing the composition of intestinal microflora as a prospective treatment target in infant allergic disease.  FEMS Immunol Med Microbiol.  32:1-7. 
(5)Kirjvainen PV et al.  2002.  Aberrant composition of gut microbiota of allergic infants: a target of bifidobcterial therapy at weaning.  Gut.  51:51-55. 
(6)Murch, SH.  2001.  Toll of allergy reduced by probiotics.  Lancet.  357:1057-1059
(7)Kalliomaki M et al.  2001.  Probiotics in primary prevention of atopic disease: a randomised placebo-controlled trial.  Lancet.  357:1076-1079
(8)Ogle KA & Bullock JD.  1980.  Children with allergic rhinitis and/or bronchial asthma treated with elimination diet: a five-year follow-up.  Ann Allergy.  May;44(5):273
(9)Miller A.  2001.  The etiologies, pathophysiology, and alternative/complementary treatment of asthma.  Alternative Medicine Review.  6(1):20-47.

Written by Ani Kowal

Generally I am a very calm and relaxed individual.  However, this morning I woke up with an underlying feeling of anxiety for no specific reason.  This may be affecting many of you at the moment with all the news headlines regarding the ‘credit crunch’ and various other negative stories.  Within an hour I was feeling great again so I thought I might share some of my tips with you here today.

For me it was the following that helped me to get my happy feeling back: 10 minutes of deep breathing followed by a 40 minute walk and then ten minutes of hula-hooping in the sun!  Hula-hooping has now become my exercise of choice as it causes me much laughter.

Any exercise will produce feel good chemicals in the brain.  There are all sorts of studies that have shown the positive effects of exercise on mood.  Going out for a walk has always helped me to feel very calm.  It takes me out into a different environment and allows my mind to drift free of thought.  Both low intensity exercise, such as a gentle walk, or higher intensity exercise, such as running, may help to reduce feelings of anxiety(1).  Yoga and deep breathing can also help to reduce worry(2).  Concentrating on the breath during deep breathing is also used during meditation and yoga relaxation.  It allows us to be focussed on the now, the present moment, minimising any fraught thinking about the past or the future.  A recent study(3) found that this sort of meditation was related to reduced feelings of anxiety and improved well-being.

A small preliminary study published last year(4) gives us a few clues as to why yoga and associated conscious breathing exercises may be useful in reducing anxiety levels.  The study found that brain GABA levels (gamma amino butyric acid) increase after an hour yoga session compared to an hour of reading.  GABA has calming and anti-anxiety effects in the brain.

So, if you feel a little anxious I suggest ten minutes of conscious breathing and a walk around the block (or some yoga or even hula-hooping), it may well help to calm and centre your thoughts.

Having a good nutritional status is important for the efficient functioning of the brain and body.  A well-balanced diet packed with vegetables, fruits, nuts, seeds and wholegrains will boost your body with all kinds of nutrients and may help to keep anxious thoughts at bay.  Calcium, magnesium, many B vitamins are important for the proper functioning of the nervous system.  Many people in the UK do not achieve good intakes of magnesium from the diet (found abundantly in nuts, seed and wholegrains).  Studies have shown that magnesium deficiency can enhance stress reactions in the body and anxiety can also increase our bodily need for magnesium(5).  You may wish to consider taking a high quality multivitamin and mineral supplement during periods of anxiety, a study(6) found that a multi supplement taken for 28 days was associated with a consistent reduction in anxiety and perceived stress (when compared to placebo).  

(1) Broman-Fulks JJ et al.  2004.  Effects of aerobic exercise on anxiety sensitivity.  Behav Res Ther.  42(2):125-136
(2) Kjellgren A et al.  2007.  Wellness through a comprehensive yogic breathing program – a controlled pilot trial.  BMC Complement Altern Med.  19:7-43
(3) Carmody J, Baer RA.  2008.  Relationships between mindfulness practice and levels of mindfulness, medical and psychological symptoms and well-being in a mindfulness-based stress reduction program. J Behav Med. 2008 Feb;31(1):23-33
(4) Streeter CC et al.  2007.  Yoga Asana sessions increase brain GABA levels: a pilot study. J Altern Complement Med. 13(4):419-26.
(5) Seelig MS.  1994.  Consequences of magnesium deficiency on the enhancement of stress reactions; preventative and therapeutic implications, a review.  J AM Coll Nutr.  13:429-446
(6) Carroll D et al.  2000.  The effects of an oral multivitamin combination with calcium, magnesium and zinc on psychological well-being in healthy young male volunteers: a double blind placebo controlled trial.  Psychopharmacology.  150:220-225

Written by Ani Kowal

It seems like an odd link, diet and breathing, but actually it makes enormous amounts of sense.  Our bodies need nutrients to function effectively.  Nutrition affects every cell from those that make up our bones to those of the skin.  The lungs and the cells of the immune system, both of which are involved in asthma, are no exception.  During an asthma attack the immune system produces certain antibodies (immunoglobulin E) and these stimulate the release of a chemical called histamine in the lining of the airways in the lungs.  The airways consequently become inflamed and swollen, excess mucous is also released and this can block the smaller airways and affect breathing.

The asthma statistics(1) for the UK are shocking.  5.2 million of us are currently receiving treatment for the condition.  1.1 million sufferers are children, that represents 1 in 10 kids, and 4.1 million are adults, that is 1 in 12.  On average there will be 3 children in every classroom who have asthma in the UK.  We also have the highest prevalence of severe wheeze in children aged 13-14 years WORLDWIDE!  Not a position to be proud of.  Every 19minutes a child is admitted to hospital due to their asthma and asthma costs the NHS over £996million per year.  Employers ought to care too as over 12.7million working days are lost to asthma each year.

I am an optimist, so this post is not all doom and gloom!  Dietary change can make a terrific difference!

The decision to write about asthma was prompted by two reasons.  The first was watching a child come out of a fast-food outlet and immediately using his “puffer” medication and the second was that two very interesting studies(2,3) have been published this month which link the adherence to a Mediterranean diet to a reduction in asthma symptoms.

In the first study(2) the scientists looked at the diet of 1784 children who were aged around 4 years, they found that adhering to a traditional Mediterranean diet was a protective factor for wheezing.  The second study(3) looked at diet during pregnancy and what affect that had on children when they were 6 years old.  The results indicate a protective effect of adherence to a Mediterranean diet during pregnancy against asthma-like symptoms (including wheezing and allergy) in childhood.  The lead scientist of the second study, Dr Chatzi, has previously published studies which indicate the protective effects of a Mediterranean diet against asthma symptoms.

So what constitutes a traditional Mediterranean diet?  Basically, this is healthy diet rich in a variety of different fruits and vegetables, legumes (peas and beans), oily fish, nuts and seeds, olive oil and unrefined wholegrains.  The diet is also high in fibre and relatively low in red meat, saturated fats and trans fatty acids (which are abundant in some processed foods).  The total fat content in general is relatively high but the type of fat is monounsaturated and also high in omega 3 fatty acids.  There are many reasons why this kind of healthy balanced diet could reduce the prevalence of asthma symptoms:

Fruits and vegetables are abundantly rich in all sorts of vitamins and flavonoids (a group of over 4000 plant compounds).  Studies (7,8) have shown that the flavonoid quercetin (found abundantly in onions and apples) appears to reduce the risk and severity of asthma symptoms.  This is probably due to the anti-inflammatory properties that quercetin exhibits in the body.  Vitamin C may be particularly important to asthmatics (9) as it seems to reduce the degree of constriction in the airways.  Studies (10) have found that asthma sufferers tend to have lower plasma vitamin C levels than non-asthmatics and supplementation of 1000mg Vitamin C a day may help improve lung function and reduce the frequency and severity of asthma attacks.  As mentioned in the post on hayfever, Vitamin C and Quercetin both act as natural anti-histamines in the body.  Asthmatics tend to have high histamine levels.  Histamine is produced by cells of the immune system and stimulates an inflammatory reaction in the body which may be responsible for the wheezing and shortness of breath in asthma sufferers.

Other vitamins and nutrients found in fruits and vegetables, such as carotenes, have also been implicated as important for prevention of symptoms in asthma sufferers.

Nuts, Seeds and Wholegrains are rich in the mineral magnesium.  A diet high in magnesium may well be useful for asthmatics since this important mineral appears to alleviate the bronchoconstriction (tightening of the airways in the lungs) associated with asthma.  There are many studies (far too many for me to list) which indicate the importance of magnesium in those suffering with asthma.  A study in children showed that low magnesium intakes are associated with poorer lung function(4) another found that asthma patients supplemented with 400 mg magnesium a day showed an improvement in asthma symptom scores(5).  Many studies have also found that asthmatics commonly have lower levels of magnesium in their blood(e.g. 6).  The National Diet and Nutrition Surveys (NDNS) for the UK have found that dietary intakes of magnesium are generally low in most children and women in the UK.  We would all do well to try and include more nuts, seeds and wholegrains into our daily diets. 

Fat:  There is some evidence that asthma may be related to an imbalance in fatty acids in the diet.  An Australian study(11) found that a diet high in omega 6 fatty acids and low in omega 3 fatty acids increased the risk of asthma symptoms in a large group of children.  Excessive amounts of omega-6 fatty acids, found in vegetable oils, and a relative lack of omega-3 fats, found in oily fish such as salmon and mackerel and some nuts and seeds, seems to promote inflammation and aggravate asthma. Inflammatory chemicals produced from omega 6 fats by the immune system can trigger constriction of the airways and mucous production.  Omega 3 fatty acids are involved in the production of anti-inflammatory chemicals by the cells of the immune system. 

One study(12) in asthmatic patients found that supplementation with corn oil (rich in omega-6 fats) tended to increase the production of inflammatory white blood cells, whereas supplementation with perilla seed oil (rich in omega-3 fats) had the opposite effect.  Patients treated with perilla seed oil also had significant increases in their lung function.  In another study(13), supplementation with fish oil (rich in the omega 3-fats) for 10 months reduced asthma symptom scores in a group of children.  Avoidance of excessive amounts of margarine and vegetable oils, and the inclusion of oily fish such as salmon, trout, mackerel and herring (or flaxseed oil for vegetarians) in the diet may, therefore, possibly help to control asthma symptoms.  Using olive oil in place of vegetable oils will probably prove useful as it is a monounsaturated fat and does not contribute to inflammation in the body, indeed it may even play a role in reducing inflammation(14).

In part II I will be covering other important dietary measures that affect asthmatics

(1) Asthma UK www.asthma.org.uk
(2) Castro-Rodriguez JA et al.  2008.  Mediterranean diet as a protective factor for wheezing in preschool children.  J Pediatr.  152(6):823-8, 828
(3) Chatzi L et al.  2008Mediterranean diet in pregnancy is protective for wheeze and atopy in childhood. Thorax.  63(6):507-13
(4) Gilliland FD et al.  2002.  Dietary magnesium, potassium, sodium and children’s lung function.  Am J Epidemiol.  155(2):125-131
(5) Hill J et al.  1997.  Investigation of the effect of short-term change in dietary magnesium intake in asthma.  Eur Respir J.  Oct;10(10):2225-9.
(6) Alamoudi OS.  2000.  Hypomagnesemia in chronic, stable asthmatics: prevalence, correlation with severity and hospitalization.  Eur Resoir J.  16:427-431
(7) Knekt P et al.  2002.  Flavonoid intake and risk of chronic diseases.  Am J Clin Nutr.  76:560-568.
(8) Saheen SO et al.  2001.  Dietary antioxidants and asthma in adults: population-based case-control study.  Am J Respir Crit Care Med.  164:1823-1828
(9) Bielory L et al.  1994.  Asthma and Vitamin C.  Annals Allergy.  73(2):89-96.
(10) Harik-Khan RI et al.  2004.  Serum vitamin levels and the risk of asthma in children.  Am J Epidemiol.  159:351-357.
(11) Oddy WH et al. 2004. Ratio of omega-6 to omega-3 fatty acids and childhood asthma.  Journal of Asthma.  41:319-326.
(12) Okamoto, M et al.  2000.  Effects of dietary supplementation with n-3 fatty acids compared with n-6 fatty acids on bronchial asthma.  Intern Med.  39(2):107-111
(13) Nagakura et al.  2000.  Dietary supplementation with fish oil rich in omega-3 polyunsaturated fatty acids in children with bronchial asthma.  Eur Resp J.  16(5):861-865.
(14) Beauchamp GK et al.  2005.  Phytochemistry: ibuprofen-like activity in extra-virgin olive oil.  Nature.  437:45-46.

Written by Ani Kowal

As I was tucking into my lunch yesterday I was taken by just how tasty the chickpeas were!  Munching on the little gems got me thinking about their nutritional value and their potential benefits to our health.

These ‘legumes’ go by many names: Chickpea, Ceci Bean, Indian Pea, Egyptian Pea, Garbanzo Bean and Gram and are mainly grown in the Mediterranean, Indian subcontinent and western Asia where they form a major part of the diet.  I was interested to learn that they are thought to be one of the earliest vegetables cultivated by humans.

Chickpeas are a useful source of fibre, zinc, folate and protein.  Being ever curious I hit the medical journals to see if there were any chickpea-specific studies.  I was in luck, one small study(1) has been published this month.  The authors wanted to assess the impact that incorporating chickpeas into the diet of 45 adults would have on their health.  The individuals taking part consumed about 728g of canned, drained chickpeas per week, (if you break this down to 100g per day it doesn’t sound like such a huge amount!), for 12 weeks.  After this time the participants went back to eating their normal diet for 4 weeks. 

In the ‘chickpea phase’ they ate around 7g more fibre a day (this is significant, as the UK population generally do not consume enough fibre) than they did during the ‘normal phase’.  They also had a lower saturated fat: polyunsaturated fat ratio.  Interestingly during the ‘chickpea phase the participants had significantly lowered total cholesterol and LDL cholesterol levels, low density lipoprotein cholesterol, thought to be the ‘bad guy’ cholesterol linked to heart disease, and also had better markers for blood sugar control (they showed lower fasting insulin levels and lower insulin resistance).  Analysis by the scientists revealed that it was the dietary fibre content of the chickpeas that was having the greatest effect on these health indicators.  The authors comment that their results warrant larger studies in groups who have problems with high cholesterol levels and/or poor blood sugar control (such as individuals with type II diabetes or insulin-resistance syndrome).

Another small study that was published in 2006(2) showed similar benefits of including chickpeas in the diet.  The study compared the effects of a chickpea-supplemented diet to those of a wheat-supplemented diet on cholesterol levels.  The 47 participants ate a chickpea-supplemented diet for at least 5 weeks and then a wheat-supplemented diet for at least 5 weeks.  The serum total cholesterol and LDL cholesterol levels were significantly lower after the chickpea-supplemented diet as compared with the wheat-supplemented diet.

A diet that is high in fibre has been linked to numerous health benefits in most areas of the body from the: heart, where it seems to have positive effects on blood pressure and risk of heart disease; digestive system where it seems to be useful to sufferers of irritable bowel syndrome (IBS), constipation and diverticulitis and the immune system where there seems to be a link with reduced risk of cancer.  A high fibre diet also appears to be very useful in blood sugar control and also appetite control as it gives us the feeling of fullness and helps to control satiety.  The recommended daily intake for fibre in the UK is currently set at 18g/d, however for optimal health many experts regard at least 25g per day as necessary.  In the UK our average intake is low at only 12g/d.

Chickpeas can be easily incorporated into salads, curries, dips (e.g. hummus), veggie-burgers, casseroles and stews....the list is endless.  If you are using canned chickpeas (which are very convenient and still nutritious) go for those in water with no added salt or sugar.

(1)Pittaway JK, Robertson IK, Ball MJ.  2008.  Chickpeas may influence Fatty Acid and fiber intake in an ad libitum diet, leading to small improvements in serum lipid profile and glycemic control.  J Am Diet Assoc. 108:1009-13.
(2) Pittaway JK, Ahuja KD, Cehun M, Chronopoulos A, Robertson IK, Nestel PJ, Ball MJ.  2006.  Dietary supplementation with chickpeas for at least 5 weeks results in small but significant reductions in serum total and low-density lipoprotein cholesterols in adult women and men.  Ann Nutr Metab.  50(6):512-8.

Written by Ani Kowal

On the 30th May  I wrote about the importance of Vitamin D for health and concentrated mainly on the link to cancer prevention.

Yesterday a study was published in the Archives of Internal Medicine(1) which adds to the growing body of research that links low vitamin D levels to poorer heart health.

This particular study involved a group of 18225 middle aged and older men (aged 40-75 years).  The men were free of diagnosed heart disease at the initial blood collection.  They were then followed for 10 years and in this time 454 developed heart attacks (which were either fatal or non fatal).  The study scientists then compared the blood levels of vitamin D in those men who had suffered a heart attack to a group of 900 similar men (matched for certain factors such as age and smoking status) who had not.  The results showed that men with low blood levels of vitamin D were at increased risk of heart attack compared to men with sufficient levels.  Even men with intermediate blood levels of vitamin D were at increased risk of heart attack.

The findings are significant as the scientists adjusted the results to exclude a whole host of other possible confounding factors such as family history of heart attack, weight (Body Mass Index), alcohol consumption, physical activity levels, history of diabetes, blood pressure, ethnicity, omega 3 fatty acid intake and cholesterol levels.  Even when these factors were taken into account the men with low vitamin D levels were twice as likely to experience a heart attack than those with high vitamin D levels.

The authors of the study conclude that “Low levels of 25(OHD) [vitamin D] are associated with a higher risk of myocardial infarction [heart attack] in a graded manner, even after controlling for factors known to be associated with coronary artery disease”

Previous studies have linked low vitamin D levels to atherosclerosis (hardening of the arteries), congestive heart failure and high blood pressure.  As I mentioned in my previous post on vitamin D many of us in the UK may not have adequate levels of vitamin D in our blood.  A supplement of 12mcg/d (around 500iu) could be useful to those who rarely get out in the sunlight or during the autumn and winter months.

It is not entirely understood why vitamin D is so important for the health of the heart.  There are indications that vitamin D acts to reduce the production of pro-inflammatory chemicals (cytokines) which are linked to heart disease and may even increase the production of anti-inflammatory chemicals which are protective.  Vitamin D may also have an effect on certain hormones which play an important role in the regulation of blood pressure. 

(1)Giovannucci E et al.  2008.  25-Hydroxyvitamin D and risk of myocardial infarction in men: a prospective study.  Arch Intern Med.  168:1181-1187

Written by Ani Kowal

Now that it is getting warmer (I was in London this weekend and it was a real scorcher!) it is essential that we consume adequate fluids throughout the day in order to keep properly hydrated.  Dehydration occurs, technically, when the loss of water from the body equates to 1% of the body’s weight.  It is important to drink before feeling thirsty as the sensation of thirst usually occurs after the body is already more than 1% dehydrated.

Keeping hydrated is important in order for us to function at our best.  Dehydration actually impairs short-term memory and can make us feel fatigued and irritable and is linked to the occurrence of headaches.  However, what we chose to quench our thirst can have a real impact on our health and waistlines!  I would highly recommend sticking to water as a thirst preventer and quencher.

A single can of regular soft drink may contain 40-50g of sugar.  If you were to drink one can a day in addition to your daily regular food intake you could gain 5kg of weight in one year!  The International Association for the Study of Obesity recognise that energy dense drinks represent a significant contributing factor in the rise in childhood obesity.  Soft drinks represent liquid calories and last year an analysis of 88 medical studies(1) concluded that there are clear associations between soft drink intake and increased energy intake and body weight. Soft drink intake was also associated with lower intakes of important nutrients (such as calcium and vitamins) and with an increased risk of several medical problems such as diabetes.

What about ‘diet’ soft drinks?  Artificial sweeteners are not something I can get excited about and I personally do not think they have any part to play in achieving a healthy balanced diet.  With respect to weight loss and/or weight maintenance there is evidence to suggest that artificial sweeteners may actually stimulate the appetite(2,3,4) and lead to increased calorie intake.  It is thought that the sweetness without the calories does not satiate the body and hence appetite is increased and subsequent calorie intake may be greater than if a regular drink had been consumed in the first place.

Pure fruit juices and fruit smoothies are often seen as the ‘healthy’ option.  Of course, these juices are more nutritious than a sugar-filled soft drinks but they do represent added calories if drunk in addition to normal daily intakes.  They are also high in natural fruit sugar (fructose) which has been linked to obesity and diabetes.  I would suggest limiting juice consumption to one glass per day with breakfast or as part of a meal but not for use as a regular thirst quencher or hydrator.

At the end of the day plain old water wins hands down in my opinion!

(1) Vartainian LR et al.  2007.  Effects of soft drink consumption on nutrition and health: a systematic review and meta-analysis.  Am J Public Health.  97:667-675
(2) Rogers PJ & Blundell JE.  1989.  Separating the actions of sweetness and calories: effects of saccharin and carbohydrates on hunger and food intake in human subjects.  Physiol Behav.  45:1093-1099
(3)Tordoff MG & Alleva AM.  1990.  Oral stimulation with aspartame increases hunger.  Physiol Behav.  47:555-559
(4) Lavin JH et al.  1997.  The effect of sucrose and aspartame sweetened sweetened drinks on energy intake, hunger and food choice of female moderately restrained eaters.  International Journal of Obesity.  21:37-42

Written by Ani Kowal

In Part I I mentioned that UV light can cause damage to the skin and contribute to photo-ageing through the initiation of inflammation.  The long chain omega 3 fatty acids EPA (Eicosapentaenoic acid) and DHA (docosahexaenoic acid) found in oily fish such as salmon, trout, sardines and mackerel as well as the shorter chain alpha-linolenic acid found abundantly in flax seeds acids are used by the body for the production of potent anti-inflammatory chemicals.  Including these omega 3 fatty acids in the diet may help to reduce sun induced inflammation, UVB skin sensitivity and may also help in the prevention of sunburn(1,2,3).

As mentioned in previous posts, omega 3 fatty acids are essential for optimal health for numerous reasons and many of us do not get adequate amounts from our daily diet.  If you are not a regular fish eater, or are vegetarian you may wish to consider taking a fish oil supplement to provide EPA (around 300mg per day) and DHA (around 200mg per day) or a vegetarian flaxseed oil (around 1000mg per day) supplement.  This could be useful to give the skin added natural sun protection and provide the body with a regular source of these essential fats.

Finally I would like to bring your attention to two studies(4,5).  They are of particular interest to me since they looked at cocoa consumption in relation to protection against sunburn.  Really dark chocolate (minimum 85% cocoa solids) is a passion of mine and I tend to indulge in a few squares at least a couple of times a week!  These studies have shown that consumption of flavanol (naturally occurring plant compounds) rich cocoa daily for 12 weeks reduced the risk of sunburn when skin was exposed to UV rays.  The major flavonols to be found in cocoa are called epicatechin and catechin, and it seems as though they are the components within cocoa that are important for boosting sun protection.  The ingestion of high flavanol cocoa led to increases in blood flow to the skin and layers below the skin, and to increases in skin thickness and hydration.

This is not a plug to justify regular chocolate binges (although it does help me to feel better about my dark chocolate habit)!  The cocoa used in these studies, and other studies that link cocoa to health benefits such as lowered risk of heart disease, was high flavanol cocoa and only a very small amount was used daily (around 350mg).  I am fond of drinking black cocoa but it is an acquired taste, as is the bitter high % cocoa chocolate that I so adore.  Sugary, sweet milk chocolate won’t provide the health benefits discussed (sorry to be the bearer of sad news!).  Flavonoids in general are found abundantly in fruits and vegetables, which, as mentioned in part I are important in sun protection through their provision of antioxidants.  Vegetables and fruit should form the core of a healthy diet and getting a good variety will give the body many of the nutrients that are needed for optimal health.

Obviously avoiding sun burn is exceptionally important, however, a slowly-acquired sun-tan may prevent against adverse effects of sun exposure in those who naturally tan easily.  Sun-sensitive individuals (those with fair skin and who burn easily) need to be careful as they have a higher risk for skin cancers.  Seeking shade, wearing a hat, adequate clothing and avoiding prolonged sunbathing is always advisable.  Sunscreens may also help but the ability of sunscreen to delay sunburn encourages many people to stay out in the sun for long periods of time and their skin (and health) may be negatively affected by this prolonged exposure. 

Please be sensible in the sun! 

(1) Rhodes LE et al.  1995.  Dietary fish oil reduces basal and ultraviolet B-generated PGE2 levels in skin and increases the threshold to provocation of polymorphic light eruption.  Journal of Investigative Dermatology.  105(4):532-535.
(2) Rhodes LE et al.  2003.  Effect of eicosapentaenoic acid, an omega-3 polyunsaturated fatty acid, on UVR-related cancer risk in humans. An assessment of early genotoxic markers.  Carcinogenesis.  24(5):919-925.
 (3) Takemura N et al.  2002.  Dietary, but not topical, alpha-linolenic acid suppresses UVB-induced skin injury in hairless mice when compared with linoleic acids.  Photochem Photobiol.  76(6):657-663.
(4) Heinrich U et al.  2006.  Long-term ingestion of high flavanol cocoa provides photoprotection against UV-induced erythema and improves skin condition in women.  Journal of Nutrition.  136(6):1565-1569.
(5) Neukam K et al.  2007.  Consumption of flavanol-rich cocoa acutely increases microcirculation in human skin.  Eur J Nutr.  46: 53-56

Written by Ani Kowal

Researchers at the Institute of Food Research in Norwich, have just published a study(1) indicating that probiotics (‘good’ bacteria) may help to keep hay fever symptoms at bay.

The researchers of this small study wanted to investigate whether the ‘good bacteria’ Lactobacillus casei Shirota (found in many probiotic supplements, yoghurts and drinks) played a role in modulating the symptoms of hay fever (seasonal allergic rhinitis).  Hay fever sufferers were given a milky drink, with or without the good bacteria, each day for five months.  The scientists kept track of, and compared the changes in, the immune system of the participants by collecting blood samples before, during and after grass pollen season.  

It was found that the probiotic being tested changed the way the body's immune cells responded to grass pollen.  The hay fever sufferers that had been drinking the probiotic containing drink had lower levels of the chemicals (interleukin 5 and 6 and interferon-gamma) partly responsible for the production of hay fever symptoms in the body.  They also had higher levels of specific antibodies (immunoglobulin G and E) which are associated with playing a protective role in allergy reactions.

The authors of the study conclude that “These data show that probiotic supplementation modulates immune responses in allergic rhinitis and may have the potential to alleviate the severity of symptoms.”

This was only a small study and the authors plan to do further work to further elucidate the role that probiotic ‘good’ bacteria may play in changing the immune status of hay fever sufferers.  As I mentioned in my post dated 19th May the good/friendly bacteria in our digestive system have been linked to positively enhancing the action of our immune system through their production of a variety of substances.  This study adds to the growing body of evidence which suggests that the bacteria in our digestive systems may be very important in affecting our overall health.

(1) Ivory K et al.  2008.  Oral delivery of Lactobacillus casei Shirota modifies allergen-induced immune responses in allergic rhinitis. Clin Exp Allergy. 2008 May 28. [Epub ahead of print]

Written by Ani Kowal

In my last post I wrote about the importance of vitamin D and sensible sunlight exposure.  This led me to start investigating natural ways to prevent skin damage from the sun (photo-damage) and sunburn.  The concept of photo-protection by dietary means is gaining increasing amounts of attention from the scientific community. 

Sun exposure leads to photo-ageing, with chronic sun exposure being a major contributor to ageing skin which is characterised by wrinkling, loss of elasticity, increased skin fragility and slower wound healing.  This photo-ageing probably occurs for a number of different reasons:

1. UV light can damage skin cell DNA via production of destructive ‘free-radical’ molecules .
2. UVB rays seem to induce the synthesis of enzymes which cause collagen, (and other skin tissue components), in the skin to degrade, this contributes to wrinkling, loss of elasticity and fragility.
3. UV light can also induce inflammation in the skin which contributes to photo-ageing.

Luckily there are some natural ways that can help us to protect our skin from sun damage. 

Antioxidants may help to ‘quench’ the destructive free radical molecules and therefore protect against photo-damage.  Specifically; beta-carotene, lycopene, lutein, vitamin C and vitamin E seem to be most helpful.  These plant constituents are involved in the light-protecting system in plants and may contribute to the prevention of UV damage in humans.  As nutrients they are ingested in the diet and are then distributed into the skin tissues where they provide the body with photo-protection.  

A diet rich in colourful fruits, vegetables, nuts and seeds will provide plentiful amounts of these antioxidants.  Beta carotene, lutein and lycopene are all carotenoids.  Carotenoids are a family of over 700 naturally occurring yellow, red and orange 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, watercress and asparagus.  Introducing a good mix of these fruits and vegetables in the diet will help keep carotenoid levels in the body high.

Absorption of these carotenoids from foods into the body is greatly affected by fat.  Without a fat source almost no carotenoids will be absorbed.  Fat acts as a carrier for the nutrients.  Now, I am not suggesting that you drown your vegetables or salads in ‘any old lard’, however I am a firm believer in using small amounts of olive oil in dressings and cooking.  Or including some nuts, seeds or olives in salads will also be helpful in order to gain maximum absorption of these important nutrients.

Two human studies have looked at tomato consumption and blood serum lycopene levels with regards the risk of sunburn(1,2).  The study groups were given lycopene or tomato-derived products rich in lycopene (mixed with olive oil) for 10-12 weeks.  Their blood serum lycopene levels increased with supplementation and they experienced a decrease in their sensitivity toward sunburn.  Sunburn damage was up to 48% lower in the groups receiving lycopene/tomato paste compared to the control groups.

Supplements containing antioxidants such as the carotenoids, vitamin C and vitamin E may also be useful in slowing down the time of development and grade of UVB induced sun damage(3).  If you feel that you are not getting a good supply of a variety of different fruit and vegetables daily in your diet, you may wish to consider taking a supplement to boost your levels of sun-protective antioxidants, especially in the sunny months or prior to a sunny holiday. 

Check back soon for Part II where I will be looking at how nutrition can help protect the skin from the inflammatory damage that the sun can cause.

(1) Stahl W et al.  2001.  Dietary tomato paste protects against ultraviolet light–induced erythema in humans.  Journal of Nutrition.  131(5):1449-1451.
(2) Aust O et al.  2005. Supplementation with tomato-based products increases lycopene, phytofluene, and phytoene levels in human serum and protects against UV-light-induced erythema.  Int J Vitam Nutr Res.  75(1):54-60. 
(3) Greul AK et al.  2002.  Photoprotection of UV-irradiated human skin: an antioxidative combination of vitamins E and C, carotenoids, selenium and proanthocyanidins.  Skin Pharmacol Appl Skin Physiol.  15(5):307-315

Written by Ani Kowal