On the 16th July I wrote about artichoke leaf extract (ALE) supplements for cholesterol lowering.  Evidence is also mounting for the usefulness of this plant supplement in the reduction of IBS symptoms (1,2).  In one study (2) 208 adults with IBS were given ALE for a two month period.  The individuals had a significant improvement whilst taking the supplement with a normalising of bowel pattern away from alternating constipation/diarrhoea toward normal.  The IBS sufferers also had a significant improvement in their total health-related quality of life scores.  The trials were small and provide preliminary evidence but it certainly seems that artichoke leaf extract is useful for an array of digestive complaints.  If you decide to try ALE supplements for the management of your IBS symptoms please follow the manufacturers dosage advice, taken in excess it may cause digestive upset.

When discussing IBS it is difficult not to mention the issue of food sensitivities or intolerances.  Some studies indicate that a large proportion of people afflicted with IBS have food sensitivities, very few have true food allergies, and that gas production and other IBS symptoms diminish when the sensitivities are discovered and the offending food(s) eliminated (3,4,5,6).  Assessing sensitivities can be quite subjective and therefore difficult to assess properly in a clinical-trial setting. 

Research suggests that some people with IBS may malabsorb the sugars lactose (found in milk), fructose (found in high concentrations in fruit juice and dried fruit) and sorbitol (found in diabetic and sugar-free products) (7).   Research shows that in a large majority of IBS patients with lactose malabsorption, a lactose-restricted diet can improve symptoms markedly both in the short term and the long term (8).  Fructose- and sorbitol-reduced diets in subjects with fructose malabsorption reduce gastrointestinal symptoms such as bloating, cramps, osmotic diarrhoea and other IBS symptoms (9).  Hence, individuals with IBS attempting to uncover food sensitivities should consider the possibility that milk, fruit juice, dried fruit and products containing sorbitol might cause worsening of their symptoms.

A note of caution – please do not attempt elimination diets without supervision from your GP or a fully qualified professional.  Many ‘food sensitivity tests’ are advertised at very high cost and, in my opinion, can often be unhelpful.  Working with a professional and keeping food diaries and symptom scores may uncover specific triggers for your personal symptoms.  Stress, emotions and psychology may also be playing a major role in your IBS symptoms so assessing how you feel could also prove helpful.  Foods may be triggering symptoms in conjunction with stressful/emotional periods but less-so at other times.

Finally I would like to briefly mention aloe vera juice.  Many individuals with digestive complaints report that their symptoms diminish greatly with the regular ingestion of an aloe vera juice drink or supplemental aloe capsules.  Most of the evidence so far is anecdotal (but that does not lessen personal experiences).  A few animal studies have started to provide weight to the evidence but very few human studies have occurred to date.  A test tube study(10) using human colon cells has shown that aloe vera did appear to work as a potent anti-inflammatory.  You may find it useful to try the juice yourself to see if it is helpful in reducing your personal symptoms.  Remember to follow the dosage guidance and try and keep note of your symptoms for about a week.  If the juice works for you then it is worth continuing with. 

That ends my posts on IBS, I do hope that the information presented over the last few days has been of help?!

(1)Walker AF et al.  2001.  Artichoke leaf extract reduces symptoms of irritable bowel syndrome in post-marketing surveillance study.  Phytotherapy Research.  15:58-61
(2)Bundy R et al.  Artichoke leaf extract reduces symptoms of irritable bowel syndrome and improves quality of life in otherwise healthy volunteers suffering from concomitant dyspepsia: a subset analysis.  J Altern Complement Med.  10:667-669
(3) King TS et al.  1998.  Abnormal colonic fermentation in irritable bowel syndrome.  Lancet.  352:1187-1189
(4) Jones AV et al.  1982.  Food intolerance: a major factor in the pathogenesis of irritable bowel syndrome.  Lancet.  ii:1115-1117
(5) Smith MA et al.  1985.  Food intolerance, atopy, and irritable bowel syndrome.  Lancet.  ii:1064
(6) Parker TJ et al.  1995.  Management of patients with food intolerance in irritable bowel syndrome: the development and use of an exclusion diet.  J Human Nutr Diet.  8:159-166
(7) Fernandez-Banares F et al.  1993.  Sugar malabsorption in functional bowel disease: clinical implications.  Am J Gastroenterol.  88:2044-2050.
(8) Bohmer CJ, Tuynman HA.  2001.  The effect of a lactose-restricted diet in patients with a positive lactose tolerance test, earlier diagnosed as irritable bowel syndrome: a 5-year follow-up study.  Eur J Gastroenterol Hepatol.  13(8):941-944
(9)Ledochowski M et al.  2000.  Fructose- and sorbitol-reduced diet improves mood and gastrointestinal disturbances in fructose malabsorbers.  Scand J Gastroenterol.  35(10):1048-52
(10)Langmead L et al.  2004.  Anti-inflammatory effects of aloe vera gel in human colorectal mucosa in vitro.  Aliment Pharmacol Ther.  19:521-527

Written by Ani Kowal

Both of the review studies(1,2) that I mentioned yesterday discuss the growing evidence that probiotics, supplemental beneficial bacteria, seem helpful in managing IBS.  Probiotics may help by reducing the level of inflammatory chemicals (cytokines), implicated in IBS.  Imbalances in gut bacteria can lead to chronic low-level inflammation in the intestines and the measurable presence of inflammatory markers in the bloodstream.   There are complications with the scientific studies that have taken place to date as it seems that the type of bacterial probiotic supplement used may be responsible for the degree of improvement noted in IBS sufferers.  Supplements containing Bifidobacteria seem to be especially effective.

(For definitions of probiotic, prebiotic and symbiotic please read Part I)

The problem with probiotic only supplements is the survival of the bacteria through our digestive system before they arrive at the large intestine.  It is often impossible to know how many, and which, live organisms are present in the supplements.  It is important to look for brands that are enteric-coated, so that the bacteria are not destroyed/digested by the stomach.  It is thought that probiotics work only as long as they are being taken, i.e. as the probiotic is no longer consumed, the added bacteria are rapidly washed out of the colon.  Hence prebiotic or a symbiotic supplements are probably the most beneficial in the long-term.  Another useful point to remember is that the bacteria are killed by heat so try not to take your probiotic supplement whilst drinking your morning cup of tea! 

Recently there have been some trials using symbiotics(3,4,5), supplements containing both probiotics and prebiotics, in the treatment of IBS and they have shown encouragingly positive results.  Two studies(3,4) found that the prebiotic-probiotic treatment significantly reduced feelings of general ill health, nausea, indigestion and flatulence.  Another study (5) found that a prebiotic-probiotic preparation was particularly helpful for sufferers of constipation-type IBS.  The supplement reduced general IBS symptoms, bloating and abdominal pain and increased stool frequency.

Larger trials are needed but a symbiotic supplement containing both probiotics and prebiotics may well be worth a try if you are suffering with the discomfort of IBS.  Look for supplements containing bifidobacteria and lactobacilli as these seem to be most beneficial.  After an initial period of a month or so you may wish to switch to a prebiotic (FOS) only supplement to maintain consistently high levels of gut friendly bacteria.  As I mentioned in an earlier post, I take a daily FOS supplement out of habit now and feel good on it!  Bacterial balance has been implicated in many conditions (not just those related to the digestive system) and may be important for keeping our immune system healthy.

Tomorrow I will be continuing the IBS theme so please check back for some more helpful ideas

(1)Wald A & Rakel D.  2008.  Behavioural and complementary approaches for the treatment of irritable bowel syndrome.  Nutrition in Clinical Practice.  23:284-292
(2)Heitkemper MM & Jarrett ME.  2008.  Update on irritable bowel syndrome and gender differences.  Nutrition in Clinical Practice.  23:275-283
(3)Bittner AC et al.  2005.  Prescript-Assist probiotic-prebiotic treatment for irritable bowel syndrome:a methodologically orientated, 2-week, randomized, placebo-controlled, double-blind clinical study.  Clin Ther.  27:755-761
(4)Bittner AC et al.  2007.  Prescript-Assist probiotic-prebiotic treatment for irritable bowel syndrome:an open-label, partially controlled, 1 year extension of a previously published controlled clinical trial.  Clin Ther.  29:1153-1160
(5)Colecchia A et al.  2006.  Effect of a symbiotic preparation on the clinical manifestations of irritable bowel syndrome, constipation-variant.  Results of an open, uncontrolled multicentre study.  Minerva Gastroenterol Dietol.  52:349-358

Written by Ani Kowal

Two review papers(1,2) have recently been published in the journal ‘Nutrition in Clinical Practice’ which look at the therapeutic approaches to dealing with irritable bowel syndrome (IBS).  They cover everything from cognitive behaviour therapy and hypnosis to diet and nutrition.  The papers are timely, this is a topic I am often asked about and have decided to spend the next few posts covering various nutritional aspects of IBS. 

IBS describes a combination of symptoms including constipation, diarrhoea, abdominal pain/discomfort, nausea and vomiting, feelings of fullness, gas and bloating.  Sufferers are often embarrassed by the condition which generally develops in individuals between the ages of 20 and 30 and affects around 20% of the population.  IBS also appears to be more common in women than men.

The causes of this uncomfortable condition are unclear.  However, an imbalance in intestinal bacteria is frequently implicated.  Often IBS develops after a bout of gasteroenteritis or repeat courses of antibiotics (which kill off the vast majority of intestinal bacteria).  The bacteria in the digestive system of individuals suffering from IBS seems to be different to healthy people with fewer ‘beneficial/friendly’ bacteria such as Bifidobacteria and Lactobacilli being present in those with IBS. 

Up to about 30 years ago it was a common misperception that the major functions of the large intestine (colon) was simply water re-absorption and storage of waste matter.  The colon is now recognised as an important organ due to the number of bacteria present (well over 10million bacteria are present in the colon per g of contents!).  These bacteria produce compounds, which can have beneficial/positive, neutral or damaging influences on the body.  Age, stress, antibiotics, the environment and diet can all affect the type of bacteria present in our digestive system.  A healthy diet may help boost the number of the friendly bacteria and hence decrease the incidence of infective disorders of the gastrointestinal tract and boost natural resistance against them.

The knowledge that specific species of bacteria may be of benefit to our health, especially Lactobacilli and Bifidobacteria, led to the development of probiotics, prebiotics and synbiotics which are designed to beneficially alter the bacteria present in our gut.  Most people will have a predominance of Bacteriodes bacteria in their digestive systems, these have both pathological and neutral effects.  For optimal health it would be better for us to have a gut dominated by Bifidobacteria and Lactobacilli.  The health promoting effects of these bacteria include prevention of the growth of harmful bacteria, improvement of immune functions, reducing gas/bloating problems, improved digestion and better absorption of essential nutrients and vitamin synthesis.  A probiotic, prebiotic or symbiotic supplement may be a way of beneficially altering the bacterial status of our colon. 

A probiotic is a supplement containing live friendly bacteria which aim to improve intestinal bacteria balance.  Probiotics are available as yoghurts, fermented milks, fortified fruit juices and freeze dried capsules/powders.   

A prebiotic is a food that stimulates the growth of the beneficial bacteria already present in the colon.  Fructooligosaccharides (FOS) which can be bought as powders are the most common prebiotics available.  Natural prebiotics can be found in asparagus, onion, chicory and garlic. 

Synbiotics are a mixture of probiotics and prebiotics. 

Tomorrow I will look further into these supplements and their use in the alleviation of IBS specific symptoms.

(1)Wald A & Rakel D.  2008.  Behavioural and complementary approaches for the treatment of irritable bowel syndrome.  Nutrition in Clinical Practice.  23:284-292
(2)Heitkemper MM & Jarrett ME.  2008.  Update on irritable bowel syndrome and gender differences.  Nutrition in Clinical Practice.  23:275-283

Written by Ani Kowal

Sticking to the theme of eye health I wanted to briefly write about cataracts today.  Cataracts are cloudy areas that develop in the lens of the eye, the cloudiness reduces the amount of light transmitted to the retina and this causes poor vision.  In the UK about 1 in 3 people over the age of 65 develop a cataract, which gradually forms over many years.  Initially vision may only be very mildly affected and this may not progress, however, in some individuals the vision will get worse over time. 

Treatment is an option when a cataract becomes bad enough to interfere with normal life e.g. if vision starts to interfere with reading, driving, watching TV etc or stops an individual from doing anything that they would normally do.  Before making a decision about treatment it is recommended to make sure your glasses are giving you maximum benefit.  Treatment involves the removal of the cloudy lens and replacement with an artificial plastic lens (an intraocular implant).

Cataracts seem to occur due to the breakdown and subsequent clumping of proteins in the lens.  Obviously, prevention is always better than cure!  Lifestyle factors that may increase the risk of cataract development include a poor diet low in antioxidant nutrients (found in fruits and vegetables), smoking and prolonged sunlight exposure.  Again, as with AMD, free radicals appear to play a causal role and hence dietary antioxidants may be protective.

I would like to highlight three (1,2,3) very recent research studies.  The first study(1) looked at the association between cataracts and dietary lutein and zeaxanthin, caroteinoids found in spinach, collard greens and kale.  The study involved 1802 women aged 50 to 79 years.  Women with high dietary levels of lutein and zeaxanthin had a 23% lower prevalence of cataract compared to those with low levels.  Women with the highest dietary intakes or highest blood serum levels of lutein and zeaxanthin as compared with those with the lowest were 32% less likely to have cataract.  For more information on these carotenoids and potential supplements please refer to Monday's post which looked at AMD.

The researchers involved in the second study(2) wanted to investigate the relationship between antioxidant nutrient intakes and incidence of age-related cataract over a 10 year period.  The study involved 2464 individuals (aged 49 or over at the start of the study) for 5-10 years.  Eye health was observed using lens photography and dietary intakes of various antioxidants, including zinc, beta carotene, vitamins A, C and E, was assessed.  Individuals with the highest total intake, from diet and supplements, of vitamin C had a 45% reduced risk of cataract.  An above average intake of combined antioxidants -vitamins C and E, beta-carotene, and zinc - was associated with a 49% reduced risk of cataract.  The authors of the study conclude that “Higher intakes of vitamin C or the combined intake of antioxidants had long-term protective associations against development of nuclear cataract in this older population”.

Both of these studies, as in the studies I highlighted in relation to eye health on Monday, re-iterate the importance of a diet rich in vegetables and fruits, which are fabulous sources of antioxidants.  As yet the role for supplementation in the prevention of cataract is unclear (and cannot, of course, substitute diet) but many individuals are taking multivitamin and mineral supplements to help keep their eyes, and bodies, healthy.  Future large supplementation trials are planned and I look forward to seeing the results.

The third study(3) involved around 2000 individuals aged 49 or over (at the start of a 5 year investigatory period).  The researchers found that higher dietary intakes of omega-3 polyunsaturated fatty acids were associated with a significantly reduced risk (42% compared to those with the lowest intakes) of developing cataract over 5 years.   For more information regarding omega 3 fatty acids and eye health please refer to the piece that I posted on Monday which looked at AMD.

(1)Moeller SM et al.  2008.  Associations between age-related nuclear cataract and lutein and zeaxanthin in the diet and serum in the carotenoids in the age related eye disease study, an ancillary study of the women’s health initiative.  Arch Opthalmol.  126:354-364
(2)Tan AG et al.  2008.  Antioxidant intake and the long-term incidence of age-related cataract: the blue mountains eye study.  Am J Clin Nutr.  87:1899-1905
(3)Townend BS et al.  2007.  Dietary macronutrient intake and five year incident cataract: the blue mountains eye study.  Am J Opthalmol.  143:932-939.

Written by Ani Kowal

My eyesight is something that I value very highly.  Without my spec's or contact lenses I have very limited vision.  Looking after my eyes, in order to prevent further long-sightedness in later life, is certainly high on my agenda.  Age Related Macular Degeneration (AMD) is the most common cause of blindness in people over the age of 50 in the UK and I feel that it deserves a little attention! 

The macular is the light sensitive area in the centre of the retina that controls visual field and the ability to see colours.  AMD is caused by the deterioration of the macular.  As this happens the peripheral, outer, vision remains intact as the centre field of vision becomes slowly blurry, grey or filled with a large black spot.  Two forms of AMD exists: the dry form which develops slowly, accounting for 90% of all cases; and the wet form which causes rapid deterioration of central vision.

The exact causes of AMD are unknown although free radical damage, where unstable oxygen molecules damage the eye cells, is strongly implicated.  Tobacco smoke and sun exposure can increase the level of free radicals in the body and both are a risk for AMD.  High blood pressure and diabetes are also risk factors as these conditions can limit blood flow to the eyes.

Evidence for diet and nutrition in the prevention, and to a certain extent treatment, of the condition is growing yearly.  The latest study was published in the August volume of the American Journal of Clinical Nutrition(1) and adds to the growing body of research(2,3,4,5,6,7,8) suggesting that oily fish and the long chain omega 3 fatty acids they provide, EPA and DHA (eicosapentaenoic acid and docosahexaenoic acid), may be preventative. 

This recent study(1) assessed the dietary intake data and photographic eye evidence of 105 individuals with AMD and compared it to 2170 control individuals (without any features of AMD).  All participants were aged 65 or over.  The researchers found that eating oily fish at least once per week compared with less than that was associated with a 50% reduced likelihood of having AMD.  There was no benefit from eating non-oily, white fish.  There was also a strong significant association between intake levels of DHA and EPA and AMD.  Individuals eating around 300mg or more of these fatty acids per day were 70% less likely to have AMD.  Two (75g) servings of oily fish, such as salmon, mackerel, sardines or trout, provides around 500mg of DHA and EPA 

The scientists are not yet recommending omega 3 supplements as the study did not investigate whether supplements would have the same benefit as dietary sources.  However, evidence for the potential benefits of fish oil (long chain omega 3 fatty acid) supplements is beginning to emerge, with one very recent study(5) finding that 800mg of DHA per day over 2-4 months was associated with beneficial changes in the macular. 

Omega 3 fatty acids are incredibly important for many aspects of health (and I have mentioned them throughout my blog postings).  Including at least two portions of oily fish per week is certainly recommended, however, many individuals in the UK do not achieve these intakes for various reasons.  A daily fish oil supplement providing around 250mg of EPA and 250mg DHA may be something worth considering (for general health).  For vegetarians and vegans a flaxseed oil supplement providing around 500-800mg of alpha-linolenic acid (a short chain omega 3 fatty acid which the body can convert to the longer chain forms) daily is a good way of ensuring a daily supply of these essential fats.

The other important nutrients worth discussing in relation to AMD prevention are the antioxidant carotenoids lutein and zeaxanthin, naturally found in foods such as spinach, collard greens and kale.  Research data(9,10,11,12) suggests that individuals with high dietary intakes of lutein and zeaxanthin, and high body levels of the carotenoids, have a reduced risk of developing AMD.  Supplements of these nutrients are now widely sold and targeted at eye health.  The supportive evidence for supplementation is not yet solid.  A small study(13) has shown benefit and paves the way for larger studies.  A very recent review(14) of the currently available evidence, published last month, concluded that “A definite association between lutein and zeaxanthin supplementation and clinical benefit has yet to be hown; however, it may still be an appropriate cautionary measure for patients at high risk for developing AMD”

Available ‘eye health’ supplements often contain vitamins C, E, beta carotene and the mineral zinc in addition to lutein and zeaxanthin.  The rationale behind this comes from dietary association studies and some research evidence.  If you are considering supplements remember that they are not a substitute (more of a bonus) for nutritious daily meals!  A healthy diet, rich in a variety of vegetables and fruits, will provide an array of antioxidant nutrients to keep the whole body healthy, including the eyes.

(1)Augood C et al.  2008.  Oily fish consumption, dietary docosahexaenoic acid and eicosapentaenoid acid intakes, and associations with neovascular age related macular degeneration.  American Journal of Clinical Nutrition.  88:398-406
(2)Chong EW et al.  2008.  Dietary omega-3 fatty acid and fish intake in the primary prevention of age-related macular degeneration: a systematic review and meta-analysis.  Arch Ophthalmol.  126:826-833.
(3)SanGiovanni JP et al.  2007.  The relationship of dietary lipid intake and age-related macular degeneration in a case-control study: AREDS Report No. 20.  Arch Opthalmol.  125:671-679
(4)Seddon JM et al.  2006.  Cigarette smoking, fish consumption, omega-3 fatty acid intake, and associations with age-related macular degeneration: the US Twin Study of Age-Related Macular Degeneration.  Arch Opthalmol.  124:995-1001
(5)Johnson EJ et al.  2008.  The influence of supplemental lutein and docosahexaenoic acid on serum, lipoproteins, and macular pigmentation.  Am J Clin Nutr.  87:1521-1529
(6)Cho E et al.  2001.  Prospective study of dietary fat and the risk of age-related macular degeneration.  Am J Clin Nutr.  73:209-218
(7)Seddon JM et al.  2001.  Dietary fat and risk for advanced age related macular degeneration.  Arch Opthalmol.  119:1191-1199
(8)Smith W et al.  2000.  Dietary fat and fish intake and age related maculopathy.  Arch Opthalmol.  112:222-227
(9)Seddon JM et al.  1994.  Dietary carotenoids, vitamin A, C and E and advanced age-related macular degeneration.  JAMA.  272:1413-1420
(10)Bone RA et al.  2000.  Lutein and zeaxanthin in the eyesm serum and diet of human subjects.  Experimental Eye Research.  71:239-245
(11)Bone RA et al.  2001.  Macular pigment in donor eyes with and without AMD:A case-control study.  Invest Opthalmol Vis Sci.  42:234-240
(12)Gale CR et al.  2003.  Lutein and zeaxanthin status and risk of age-related macular degeneration.  Invest Opthalmol Vis Sci.  44:2661-2465
(13)Richer S et al.  2004.  Double-masked, placebo-controlled, randomised trial of lutein and antioxidant supplementation in the intervention of atropic age related macular degeneration: the Veterans LAST study (Lutein Antioxidant Supplementation Trial).  Optometry.  75:216-230)
(14)Zhao L & Sweet BV.  2008.  Lutein and Zeaxanthin for macular degeneration.  Am J Health Syst Pharm.  65:1232-1238

Written by Ani Kowal

Last week I wrote about garlic in relation to lowering blood pressure.  Today I wanted to mention potassium and blood pressure.

Firstly I wanted to write a little more about the problem of high blood pressure (hypertension) in the Western world.  For purposes of illustration I am using statistics(1) for England derived from the 2005 Health Survey for England.  However, the trend is general for the UK and beyond.  High blood pressure is not great news!  It increases the risk of heart disease and stroke and is also linked to dementia and eye problems such as age related macular degeneration.

Hypertension is defined as a systolic blood pressure of 140mmHg or over, or a diastolic blood pressure of 90mmHg or over (see last week for definitions and explanations of diastolic and systolic).  The target for the general population is to have a blood pressure below 140 (systolic)/85 (diastolic).

In England 2005:
*The average systolic blood pressure was 134mmHG for men and 128mmHG for women
*35% of men and 28% of women had hypertension or were being treated for hypertension
*59% of men and 44% of women with hypertension were not receiving treatment
*Of the individuals who were being treated for high blood pressure over 50% remained hypertensive (with a high blood pressure)
 

Blood pressure levels increased with age.
*In men aged 16-24 the average systolic blood pressure was 128mmHg compared to 141mmHg in men aged 75 and over
*In women aged 16-24 the average systolic blood pressure was 117mm Hg compared to 144mmHg in those aged 75 and over. 
*Only 1% of women aged 16 to 24 are hypertensive, compared to 42% aged 55 to 64 and around 67% aged 65 to 74.

As the statistics show, high blood pressure is a very real problem, especially as we get over the age of 40.  Thankfully there is plenty we can do to keep our blood pressure in check and lower it if necessary.  Last week I discussed garlic supplementation and today I am looking at potassium.  The British Heart Foundation(1) have a booklet on blood pressure with more detailed information on why blood pressure maintenance is important, the causes of high blood pressure and detailed advice on how to reduce it.  The booklet can be downloaded from their website.

Back to potassium.  A recent review(2) has found that boosting dietary intake levels of potassium may help to lower the risk of developing high blood pressure and may also decrease blood pressure in individuals already suffering from hypertension. 

Vegetables and fruits are great sources of potassium.  The authors of the study point out that a healthy intake of potassium is thought to be one reason why vegetarians and isolated populations have a very low incidence of heart disease.  In areas were diets are low in sodium and high in vegetables and fruits (representing high potassium levels), hypertension affects only 1% of the population. In contrast, the authors note that in industrialized societies, where people consume diets high in processed foods and large amounts of dietary sodium 1 in 3 persons have hypertension.

In addition to potassium the review study looked at calcium and magnesium, minerals which are also important in controlling blood pressure.  The authors conclude that “A high intake of these minerals [potassium, calcium and magnesium] through increased consumption of fruits and vegetables may improve blood pressure levels and reduce coronary heart disease and stroke”

An increase in vegetables and fruits is fantastic general dietary advice.  These super foods are full of essential vitamins, minerals and other phytonutrients (bioactive plant chemicals) as well as fibre and are vital to our health, not just blood pressure.  Getting a minimum of five portions a day is recommended (recently the National Cancer Institute has recommended 5-9 portions a day and the Danish campaign aims at a minimum of 6 a day!).  Potassium supplements are available and limited trial data exists to support their usefulness in lowering blood pressure, however, potassium supplements should not be used as a replacement for fruit, vegetables and a healthy diet.

(1)British Heart Foundation http://www.heartstats.org/homepage.asp, http://www.bhf.org.uk/

(2)Houston MC & Harper KJ.  2008.  Potassium, magnesium and calcium:their role in both the cause and treatment of hypertension.  10:3-11

Written by Ani Kowal

One of my close friends is pregnant (I am very excited)!  We were chatting about pregnancy health and the topic of preeclampsia came up.  Recently a study(1) was published which suggests that increasing the amount of fibre eaten during early pregnancy may help to reduce the risk of preeclampsia developing later.  I thought now was as good time as any to look into this complex topic further!

Preeclampsia is a serious condition also known as: pregnancy-induced hypertension (PIH); proteinuric gestational hypertension; and toxaemia of pregnancy.  It is a form of high blood pressure (hypertension) that develops in conjunction with water retention (oedema) and/or excess protein in the urine (proteinuria).  Around 3% of all pregnant women suffer from preeclampsia each year and this condition is the principal cause of maternal death in the UK.  Around 10 mothers and 1000 babies die each year as a result of the effects of preeclampsia and the condition is also the most common reason for elective (often early) delivery.  Usually preeclampsia occurs between the 20th week of Pregnancy and the end of the first week postpartum.  The earlier it presents in pregnancy the more threatening it can become.

As I began my research last week I thought this post would be relatively short.  Going back to my 2001 MSc lecture notes there was not a whole lot of dietary/nutrition related evidence to work with.  However, as I began to search through recent medical databases I was pleased and enthralled with the emergence of new information.  The definitive causes of preeclampsia are not known and there are many theories.  Nutritional factors, however, do seem to be at play. 

Keep body weight in check:
Maternal overweight and obesity places women at risk.  A BMI (body mass index) greater than 25 is seen as a risk.  To work out your BMI divide your weight in kg / by your height in metres² (height x height) or use an online BMI calculator e.g. the NHS calculator.  A recent study(2) also shows that gaining a lot of weight during pregnancy may be a risk factor.  This study looked at 34,143 women age 18-34 who were already overweight at the start of their pregnancies.  Gaining more than 15lb during pregnancy was a significant risk factor for the development of preeclampsia and gaining more than 25lb increased the risk further.  The lowest risk of adverse outcomes was for women who gained 6-14lb.

Dietary fibre:
The study(1) mentioned in my opening paragraph was carried out because evidence already exists for the beneficial effects of fibre in reducing hypertension (high blood pressure).  1538 pregnant women were involved in the study and their dietary intake was assessed 3 months before and during early pregnancy.  Women with the highest dietary fibre intake (more than 21g/day) had a significantly reduced risk of preeclampsia when compared to women with the lowest dietary fibre intake (less than 12g/day).  These are important findings, as I have mentioned in previous blog posts the average intake of fibre in the UK is low (around only 12g/day).  The recommended daily intake is currently set at 18g/day in the UK, however for optimal health many experts regard at least 25g/day as necessary. 

This most recent study adds weight to earlier evidence(3) which also found that fibre was associated with a significantly reduced risk of preeclampsia.  The researchers also found that potassium intake was a significant protective factor (I will be discussing potassium intake a blood pressure further on Thursday).  This evidence was interesting as it mentioned specific foodstuffs, with fruits and vegetables being associated with a reduced risk of preeclampsia development (unsurprisingly since vegetables and fruits are great sources of fibre and potassium).

Fruits, Vegetables and Antioxidant Vitamins:
You may be sick of my constant mentioning of vegetables and fruits?!  Well, they really are vitally important to health and I will be writing about them as often as possible!  As indicated above these super foods provide the body with fibre and are fantastic sources of potassium.  In addition to this they are packed full of vitamins, minerals and flavonoids (bioactive plant compounds).  Many of these plant nutrients act as antioxidants in the body.

Antioxidants protect our cells from the damaging effects of highly reactive molecules called free radicals (which cause oxidative stress in the body).  There is mounting evidence that these destructive molecules, together with lowered antioxidant defences, play a significant role in the development of preeclampsia.  The body does produce its own antioxidants but also relies on vitamins, mineral and phytochemicals (including flavonoids) from the diet, especially from colourful vegetables and fruits, for additional valuable supplies.

Dietary antioxidants and supplemental vitamin C and E(4,5), lycopene(6), selenium(7,8) and  multivitamins(9) all appear to have some protective role to play against the development of preeclampsia, although the evidence for supplements is not yet conclusive and further large trials are needed.  The evidence to date certainly seems to suggest an important role for fruit and vegetable consumption during pregnancy, a variety of colourful vegetables and fruits will provide a whole array of vital nutrients to the body.  Selenium is not as widely available in the UK diet, although Brazil nuts are a terrific source. 

In addition to diet you may wish to discuss taking a pregnancy safe multi-vitamin and mineral supplement with your GP, midwife or health professional.

Omega 3 Essential Fatty Acids:
Recent evidence suggests that women with preeclampsia have reduced levels of essential omega 3 fatty acids in their blood(9,10).  Omega 3 fatty acids are vital for the efficient functioning of the immune system.  A lack, or imbalance, of these fatty acids is associated with inflammation in the body.  Inflammatory chemicals (cytokines) have been implicated in the development of and risk for preeclampsia.  Omega 3 fatty acids are essential for optimal foetal development (and are especially important in brain and immune development) and it is important to ensure a regular supply during pregnancy.  I have spoken about these fats extensively in previous posts.  Good dietary sources are oily fish (salmon, trout, mackerel, sardines) and flaxseeds or walnuts for vegetarians/vegans.  Many people in the UK do not eat these foods regularly.  Speaking to your GP or midwife about an omega 3 supplement, a fish oil (providing about 250mg EPA and 250mg DHA per day) or flaxseed oil may be prudent to ensure adequate levels throughout pregnancy and beyond.

At the moment the evidence is preliminary and needs backing up by large, well designed trials and further research.  Personally, I feel that the take home message is that being a normal weight (BMI 19-24), being physically active and having a healthy, nourishing diet rich in fruits, vegetables and essential fats may be protective.....great advice for good health for all of us then!

(1) Qiu et al.  2008.  Dietary fibre intake in early pregnancy and risk of subsequent preeclampsia.  American Journal of Hypertension.  21:903-909 [EPub doi:10.1038/ajh.2008.209 17 July]
(2) Langford A et al.  2008.  Does Gestational Weight Gain Affect the Risk of Adverse Maternal and Infant Outcomes in Overweight Women?  Matern Child Health J.  [Epub ahead of print]
(3) Frederick, I. O., et al.  Dietary fiber, potassium, magnesium and calcium in relation to the risk of preeclampsia.  J Reprod Med.  50(5):332-344, 2005.
(4)Chappell LC et al.  1999.  Effects of antioxidants on the occurrence of preeclampsia in women at increased risk: a randomised trial.  The Lancet.  354:810-816
(5)Chappell  LC et al.  2002.  Vitamin C and E supplementation in women at risk of preeclampsia is associated with changes in indicies of oxidative stress and placental function.  Am J Obstet Gynecol.  187:777-784
(6)Sharma JB et al.  2003.  Effect of lycopene on preeclampsia and intra-uterine growth retardation in primigravids.  Int J Gynaecol Obstet.  81:257-262
(7)Han L & Zhou SM.  1994.  Selenium supplement in the prevention of pregnancy induced hypertension.  Chin Med J.  107:870-871
(8)Rayman et al.  2003.  Low selenium status is associated with the occurrence of the pregnancy disease preeclampsia in women from the United Kingdom.  Am J Obstet Gynecol.  189:1343-1349
(9) Bodnar LM et al.  2006.  Periconceptional multivitamin use reduces the risk of preeclampsia.  Am J Epidemiol.  164:470-477
(10) C et al.  2006.  Erythrocyte omega-3 and omega-6 polyunsaturated fatty acids and preeclampsia risk in Peruvian women.  Arch Gynecol Obstet.  274:97-103
(11)Mehendale S et al.  2008.  Fatty acids, antioxidants, and oxidative stress in pre-eclampsia.  Int J Gynaecol Obstet.  100:134-238

Written by Ani Kowal

It makes food taste great and brings any dish to life with flavour.  I love garlic!  Garlic is a type of vegetable, there are two species: Allium sativum  (cultivated garlic) and Allium ursinum  (wild bear's garlic), both of which belong to the Amaryllis (Amaryllidaceae) family.

A plethora of health benefits are attributed to garlic with studies showing that it seems to have positive effects for the heart and circulatory system, immune system and digestive system.  It also seems to be anti-parasitic, anti-viral, anti-fungal and anti-bacterial.  The lists go on and on!

Today I wanted to look at garlic supplementation in relation to lowering blood pressure.  Until very recently research on garlic supplementation and blood pressure had been inconclusive.  However, the latest, most comprehensive review(1) of scientific evidence “suggests that garlic preparations are superior to placebo in reducing blood pressure in individuals with hypertension [high blood pressure]”.  The review of scientific literature was undertaken by researchers at The University of Adelaide, South Australia.  The scientists looked at studies that were published between 1955 and 2007, and only included ‘high quality’ research (randomised controlled trials with true placebo groups).  A significant association was found between blood pressure at the start of intervention with garlic supplements and the levels of blood pressure reduction.

The garlic was effective at lowering both the systolic and diastolic blood pressure.  Systolic blood pressure, represented by the top number in a blood pressure reading, is the measure of the phase of the heartbeat when the heart contracts and pumps blood into the arteries.  Diastolic blood pressure, represented by the bottom number in a blood pressure reading, is the measure of the phase of the heartbeat when the heart muscle relaxes and allows the chambers to fill with blood. 

The review found that, on average, garlic reduced systolic blood pressure by 4.6 mmHg.  The scientists also looked at studies that were conducted with people with a high blood pressure (hypertension), in these studies the garlic had a more pronounced effect with a reduction of systolic blood pressure by an average of 8.4 mmHg and diastolic blood pressure by 7.3 mmHg. The higher a person's blood pressure was at the beginning of the study, the more it was reduced by taking garlic supplements.

These results are very similar to those of widely used hypertension drugs such as beta blockers, which reduce systolic blood pressure by around 5 mmHg, and ACE (angiotensin converting enzyme) inhibitors, which produce around an 8 mmHg drop in systolic blood pressure.

In the population as a whole, the authors of the study note that a reduction of systolic blood pressure by around 4-5 points and diastolic blood pressure by 2-3 points could cut the risk of heart disease and heart disease-related death by up to 20 percent.  The scientists also note that more research is needed to determine whether garlic supplementation might have long-term effects on heart disease risk. 

In most of the studies reviewed in this paper the participants given garlic took it in powdered form as a standardized supplement at a dose of 600 mg - 900 mg daily for 12-23 weeks. The garlic supplements provided around 3.6 mg - 5.4 mg of allicilin which is the active ingredient in garlic.  A fresh clove of garlic contains around 5 mg - 9 mg of allicin (and tastes wonderful!), so whether you eat garlic regularly or choose to take a supplement it may well be helpful for your blood pressure or for your health in general!

As high blood pressure is a (silent but) major risk factor for heart attack I wanted to mention the British Heart Foundation campaign which aims to alert us to the more visible symptoms of a heart attack.  As part of the campaign there will be a two minute TV  promotion at 9.17pm on ITV1 this Sunday (10th August) during a break in the  ‘Midsomer Murders’ programme.  The charity is calling the event ‘Watch Your Own Heart Attack’.  More information can be found on their website or by clicking on this link.

(1)Ried K et al.  2008.  Effect of garlic on blood pressure: A systematic review and meta-analysis.  BMC Cardiovascular Disorder.  8:13(16 June), [E-pub doi:10.1186/1471-2261-8-13]

Written by Ani Kowal

After completing my MSc I shared a house with a friend who seemed to be constantly suffering with mouth ulcers.  Looking into the literature I discovered that there were a number of natural ways that could help to prevent and treat this painful occurrence.  Since then he has been ulcer free! 

Mouth ulcers, medically known as Aphthous Stomatitis, are small, white or yellow-white, painful ulcers that usually affect the tongue or the lining of the inner cheeks or lips.  The ulcers involve the inflammation or destruction of the mucous membranes that line the mouth.  Usually they will be painful for three to four days with symptoms generally diminishing in seven to ten days.  An ulcer begins as a small red dot on the lip or the inside of the mouth, which then develops into a small blister with a white head, eventually the head will rupture, leaving an open ulcer that, without care, can become secondarily infected by yeast or bacteria.

I was reminded of my friend as I read two recent studies that have linked the herb liquorice to effectively treating mouth ulcers(1,2).  One of the studies(1) was a review that looked at over-the-counter (OTC) treatment available for mouth ulcers, the scientists found that there was no reliable evidence to suggest that OTC preparations could do more than simply manage symptoms – the exception were two treatments which contained the herbal extract liquorice.  The liquorice containing treatments reduced the pain associated with mouth ulcers and also increased the healing time.  In addition, the liquorice containing OTC treatments were as effective as a prescription only medication (amlexanox).  The second study(2) found that liquorice treatments were effective at reducing the size of ulcers, the pain and the duration which they remained.

Liquorice has been traditionally used to treat mouth ulcers for a long time due to its apparent soothing properties.  A small study(3) found that liquid liquorice extract (which is widely available) diluted in warm water and used as a mouth rinse was very helpful at accelerating the healing of mouth ulcers. 

It is unsurprising that liquorice may be helpful in reducing the swelling and pain associated with mouth ulcers as it does seem to poses anti-inflammatory properties.  If you have a mouth ulcer you may well find it helpful to drink liquorice teas (powdered liquorice root is widely available and can be used to make a tea or mouth rinse), make a mouth rinse using herbal extract or chew on a liquorice tablet twenty minutes before eating in order to help reduce pain.

Liquorice may well be helpful in treating a mouth ulcer once it has already taken painful residence in the mouth however, more importantly for those of you who may suffer from recurrent mouth ulcers, there are a number of ways to prevent their occurrence in the first place.

Toothpaste seems an unlikely place to start, however, a number of studies(4,5,6) have linked recurrent mouth ulcers to Sodium Lauryl Sulfate (SLS), a common foaming ingredient in most toothpastes.  SLS may dry out and irritate the lining membranes of the mouth and tongue and increase the risk of mouth ulcers from reoccurring.  The studies have shown that using SLS-free toothpaste is helpful to individuals susceptible to mouth ulcers.  Natural SLS-free toothpaste is now widely available and it may well be worth switching to such a paste for three months to see if it is helpful in minimising the frequency of your attacks.

Another common factor(7,8,9,10) in individuals who suffer from regular mouth ulcers is insufficiency in a variety of B vitamins (including B12, B1, B2, B6 and folic acid).  Supplementation with a multi-B vitamin complex is often very helpful to those who frequently suffer from mouth ulcers.

As a final note I would like to mention stress.  For as long as I can remember people have said that mouth ulcers are caused by stress and some resources suggest this to be an ‘old wives tale’.  Being ever curious, I started to dig around in the medical literature.  Stress is linked to inflammation in the body and so it would be feasible for a link to mouth ulcers to exist.  I did find a supportive study that looked specifically at stress and anxiety(11) in the causation of mouth ulcers and one(12) that found a relaxation therapy was very effective in reducing the recurrence of ulcers in susceptible individuals.  Stress may be linked to the depletion of many nutrients in the body.  A healthy balanced diet will help keep your nutrient levels high – important for a well functioning immune system!  In addition to this, if you regularly find yourself feeling stressed or pressured you may wish to consider supplementing with a broad-spectrum, high quality, multi vitamin and mineral product to prevent any dietary shortfalls.

(1)  Burgess JA et al.  2008.  Review of over-the-counter treatments for apthous ulceration and results from use of a dissolving oral patch containing glycyrrhiza complex herbal extract.  J Comp Dent Pract.  9:88-89
(2) Martin MD et al.  2008.  A controlled trial of a dissolving oral patch containing glycyrrhiza (licorice) herbal extract for the treatment of aphthous ulcers.  Gen Dent.  56:206-210
(3) Das SK, Das V, Gulati AK, Singh VP.  1989.  Deglycyrrhizinated liquorice in aphthous ulcers.  J Assoc Physicians India.  37(10):647
(4) Herlosfson BB et al.  1994.  Sodium lauryl sulfate and recurrent aphthous ulcers.  A preliminary trial.  Acta Odontol Scand.  52:257–59.
(5) Herlosfson BB et al.  1996.  The effect of two toothpaste detergents on the frequency of recurrent aphthous ulcers.  Acta Odontol Scand.  54:150-153.
(6) Chanine L et al.  1997.  The effect of sodium lauryl sulfate on recurrent aphthous ulcers:  a clinical study.  Compend Contin Educ Dent.  18:1238-1240.
(7) Piskin S et al.  2002.  Serum iron, ferritin, folic acid, and vitamin B12 levels in recurrent aphthous stomatitis.  J Eur Acad Dermatol Venereol.  16(1):66-7
(8) Haisraeli-Shalish M, Livneh A, Katz J, Doolman R, Sela BA.  1996.  Recurrent aphthous stomatitis and thiamine deficiency.  Oral Surg Oral Med Oral Pathol Oral Radiol Endod.  82(6):634-6
(9)Barnadas MA et al.  1997.  [Hematologic deficiencies in patients with recurrent oral aphthae].  Med Clin (Barc).  109(3):85-87
(10)Nolan A et al.  1991.  Recurrent aphthous ulceration.  J Oral Pathol Med.  20:389-391.
(11)Andrews V H et al.  1990.  The Effects of Relaxation/Imagery Training on Recurrent Aphthous Stomatitis:  A Preliminary Study.  Psychosomatic Medicine, September/October 1990; 52(5):526-535.
(12)McCartan BE et al.  1996.  Salivary cortisol and anxiety in recurrent aphthous stomatitis.  J Oral Pathol Med.  25(7):357

Written by Ani Kowal