Nutrition and the Toxic Patient

cropped-IMG_7188-1.jpgThe general population is increasingly being exposed to a variety of “toxic” substances and, as a result, our environmentally polluted world is causing a myriad of health problems.   Whilst we generally understand the concept of toxins that come from external sources- for example, car fumes, tobacco smoke, drugs, dental fillings, environmental pollution, etc., we are less aware of the endogenous toxins that we encounter daily.  These toxins include those generated from viral and bacterial sources within the body, or toxins that are created by the body itself due to its own metabolism.

Long-term exposure to toxins, a decreased ability to metabolise toxins and therefore neutralise them within the liver, or simply an inability to clear toxins from the body can result in toxic overload that can contribute to the many symptoms associated with ME/CFS/fibromyalgia.

The symptoms of toxic overload, such as fatigue, dizziness and nausea, headaches, brain fog, and so on, are frequently misdiagnosed and pharmaceuticals prescribed, which may exacerbate symptoms and the patient enters a vicious cycle of treatment that has little or no benefit in alleviating symptoms.

So what does the toxic patient do?  It is not possible to remove ourselves from all exposures to toxins, but what we can do is to provide the best possible protection from the effect these toxins have on our health.  We have a complex internal system, involving multiple enzyme families that act, within the liver, to modify and detoxify agents from external sources, as well as those created internally – as a product of digestion, for example.

These enzymes depend on many dietary nutrients including essential vitamins, essential minerals, proteins and essential fats.   Deficiencies of any of these nutrients can contribute not only to the disruption of this important detoxification system, but to all physiological and biochemical pathways that contribute to normal functioning of the cells, tissues and organs that make up the human body.  It is no wonder that diet is so important to our overall health.

By modifying our diet we can therefore protect the organs and systems involved in detoxifying and eliminating toxins and manipulate the endogenous systems that protect the body from the effects of toxins.

Broadly, the ME/CFS/fibromyalgia diet should comprise simple, healthy and unadulterated foods that nourish the body and provide the raw nutrients needed to ensure detoxification pathways are provided with the key co-factors to perform optimally.  ‘Junk’ foods, and foods that are processed and highly refined (such as white sugar and flour) should all be eliminated, as they offer little nutritional value and are most likely to trigger symptoms, as well as being high in artificial additives and chemicals.  Eating a good variety of foods that incorporate organic products will help to eliminate pesticides and other toxins, whilst increasing essential vitamins, minerals, proteins and important fats such as omega-3s.  It is also important to eat small portions at regular intervals to ensure that the body’s nutritional requirements are continuously met.

A very important element of the diet relates to the types of fat that we eat, which can have a significant effect on how we feel. Saturated fats and trans fats, found in animal products and processed foods, have a negative effect on our health. In contrast, polyunsaturated fats (omega-6 and omega-3) have a major positive effect on our health because they are converted in the body to powerful hormone-like substances called ‘eicosanoids’. It is these eicosanoids that regulate physiological functions, with major roles in cardiovascular health, inflammation, immunity and mood.

Consuming a diet that is balanced in these types of fat can help to ensure that our bodies work most efficiently, right down to the cellular level. Consuming too much omega-6 fatty acids, however, can have negative effects. Omega-6s are found in plant oils such as vegetable oil and corn oil, or non-organic meat (these animals are fed on grains rich in omega-6), and while omega-6 fats are essential for good health, too much can result in the over-production of eicosanoids, triggering pain-processing pathways and increasing production of inflammatory products, as well as over-stimulating the immune system.

In contrast, omega-3 fatty acids (specifically those found in oily fish) have the opposite effect.  Generally, Western diets are high in omega-6 and low in omega-3.  Increasing omega-3 fatty acids, especially one known as EPA (eicosapentaenoic acid) and found in oily fish, can help reduce the production of specific proteins which trigger pain and inflammation, at the same time stimulating the production of neurotransmitters – brain chemicals involved in electrical signalling, mood and sleep.

Unfortunately, however, it’s not as simple as merely increasing fish intake. The polluted state of our oceans means that the benefits of consuming fish, as a rich source of omega-3, may be offset by the presence of contaminants, such as methylmercury (MeHg), dioxins, polychlorinated biphenyls (PCBs), and should be limited to twice weekly.   Highly purified omega-3 oils such as Vegepa – a product of choice for many practitioners – offer a safe and convenient method of increasing EPA levels without the risk of consuming hazardous contaminants – a consequence which can be associated with eating too much fish.

Incorporating organic fruit and vegetable produce into the diet, where possible, will also help to ensure that contaminants such as pesticides, herbicides and fertilizers are avoided.  Organic produce is also much higher in important vitamins and minerals – micronutrients that are essential in every biochemical pathway in the body.  Organic meat is also lower in omega-6, higher in omega-3 and, importantly, is free of the steroids and hormones associated with intensive farming methods.

Sugar is also an important element in the ME/CFS/fibromyalgia diet, since the brain and body need energy supplied at an even rate in order to function optimally. Sudden peaks, followed by troughs, in blood sugar can result in low energy and fatigue. The glycaemic index (GI) ranks carbohydrates according to their effect on blood glucose levels and is a good guide to informing us which foods to include as part of a healthy diet, and indeed which foods to limit. White sugar and other refined (simple) carbohydrates have a high GI value, and can be found in processed white bread and white pasta, white rice and most convenience foods. Avoiding these simple carbohydrates and consuming foods with a low GI value, will help to keep blood sugar levels even, and help to stabilise mood too. Good low GI foods include high fibre cereals, whole grain products, beans, pulses, brown rice, whole wheat pasta, fruit and vegetables. Not only are these foods far better for stabilising our blood sugar levels, but these foods also tend to be high in fibre, as well as vitamins and minerals which are needed for good immune function and maintaining energy levels.

Choice of protein is also key when considering the FM diet, since it is needed by the body for growth and repair, and our requirements increase when our body is in a hypercatabolic state (such as fighting infection, during illness, inflammation etc). Ensuring that we get the right amount and type of protein is extremely important for people with M.E./CFS/fibromyalgia.  Amino acids, which are the building blocks of protein, are essential for our health; animal produce is actually the best source of protein as it contains all eight essential amino acids. But we shouldn’t forget that organic meat far outweighs non-organic for nutritional value.  It’s sensible to avoid eating too much red meat, and fish is an excellent source of protein, as well as omega-3 good fats. Fish is low in saturated fat and particularly rich in arginine and glutamine – amino acids known to have a regulatory role in both cardiovascular health and immunity. Remember, though – due to contamination issues, fish should be limited to twice weekly, and smaller, short-lived species tend to be safer to eat than larger, long-lived fish such as tuna.  Vegetarians, on the other hand, need to eat a good combination of cereals and pulses to ensure that all the essential amino acids are included in the diet.  A great plant source of all 8 essential amino acids is quinoa, which can be sprouted or treated in the same way as couscous or rice.

To summarise, these simple guidelines will help people with M.E./CFS/ fibromyalgia to gradually modify their diet towards greater well-being, and a body that is stronger and more resilient to the obstacles it faces with M.E./CFS/fibromyalgia:

Eat small meals and try to eat regularly throughout the day

Include:

  • Complex carbohydrates (whole grain/wholemeal)
  • Organic ‘5-a day’
  • Fibre
  • Healthy plant fats – replace vegetable oil/corn oil with olive oil
  • Fish up to twice weekly – a good source of omega-3 fatty acids
  • Omega-3 EPA purified Vegepa capsules
  • Lean animal protein and vegetable protein
  • 8 glasses of purified water/day

Avoid

  • Junk food and fast food
  • Trans fats
  • Too much saturated fat
  • Processed and refined food (white sugar, white flour, white pasta, white rice)
  • Too much alcohol and caffeine
  • Artificial ingredients, additives, and chemicals

As well as the above plan for eating well, avoiding stress is also important in managing symptoms.  Try to take regular exercise, outdoor walks, perhaps join a support group and spend time with close friends or family – sharing experiences and advice can all help.

Man’s best friend and more?

Last week saw a rather unusual story in the headlines in which a jack Russell took it upon itself to remove an infected toe from his sleeping owner. Jerry Douthett, a 48-year-old musician from Rockford, USA, had been out drinking, and on returning home had fallen into a deeper than usual sleep. He awoke, some hours later, to find the sheets of his bed blood soaked, and on further investigation, found the big toe that had been infected for several weeks, but for which he had not sought medical attention, had disappeared. It turned out that Kiko, the family dog, had detected the infection and chewed the toe to the point that is was completely removed. Whilst the story had a an edge of humour to it, it came to light that Mr Douthett had in fact been suffering from type II diabetes, a condition he was unaware of, but for which he is now is being treated. Some of the long term damaging effects of diabetes are to the blood vessels and nerves that supply the limbs. Neuropathy is the direct damage of nerves and results in gradual loss of sensation and, if the skin is damaged, can result in infection, as experienced first hand by Mr Douthett. Unfortunately, many people have type II diabetes for years without knowing it, simply because any early symptoms can be vague and may not cause undue concern, or seem important at the time. Symptoms, amongst others include feeling thirsty all the time, frequent urination, unexplained tiredness and unexplained weight loss, muscle wasting and frequent infections, or slow-healing sores. It is important, therefore, to be aware of these symptoms and visit your GP if you have any concerns. Catching diabetes early is a key factor to managing the condition successfully. In Mr Douthett’s case he had his dog’s ability to smell his infection to thank, as it has enabled him to now regulate his glucose levels and hopefully avoid any further losses!

A dogs’ ability to detect infection is not surprising, given their acute sense of smell, believed to be around 100,000 times more acute than that of humans. The distinct olfactory gift that is associated with the canine species has, in fact, led scientists to conduct small-scale studies of dogs’ ability to detect the chemical markers of cancer, specifically melanoma, with extremely promising results. Much of the research in this area is based on the theory that a disease causes subtle chemical changes in the body, or alterations in metabolism, which in turn releases a different smell or chemical marker to which dogs can be trained to recognise. Whilst the concept that dogs may be used as a cancer diagnostic tool is doubtful, their use in heath care is certainly of significance. Indeed, their use as guide dogs and hearing dogs is now advancing to their use to warn their owners of epileptic seizures, low blood sugar and heart attacks to name but a few. So they really are man’s best friend!

Why being depressed can make your brain shrink!

For many sufferers, depression brings on many kinds of emotions and feelings including anxiety, guilt and shame, so it’s not surprising that many people fail to seek help. Often, many of the feelings that are associated with depression are, in part, caused by a general lack of understanding of the condition, not only by the sufferer, but by family members, friends, employers and colleagues. And yet the majority of people will experience some psychological problems during their lives. In fact very few people will go through life without experiencing some form of mental trauma of some description. But what is it that goes on in your head when you are feeling depressed?

There is increasing scientific focus on the mechanisms that occur within the body and brain of depressed patients. Indeed, it is becoming much clearer that inflammation significantly contributes to the cause and progress of depression, and that this triggers a myriad of processes that all contribute to the symptoms associated with the condition. It is difficult to comprehend that inflammation can trigger depression, because it is generally thought of as a response to injury or irritation that is characterised by physical processes such as pain and swelling.

However, inflammation need not be physical or obvious, and inflammatory processes and brain-immune interactions are now known to be involved in the development of major depression. Inflammation is certainly suggested to contribute to the dysfunction of biological systems involved in the production of important neurotransmitters (brain hormones) such as serotonin and noradrenalin. Indeed, increased levels of inflammatory products called cytokines (produced by immune cells, and involved in relaying messages between cells) have consistently been reported in patients with depression. Pro-inflammatory cytokines have many physiological functions but, significantly, have been reported to modulate central nervous system functions including a process called neurogenesis, which is simply the method by which nerve cells are generated. Excessive inflammation, and the production of cytokines amongst other things, causes a series of processes that ultimately damage neurones leading to their death. When cells within the brain die, this causes atrophy, or shrinking, by which there is loss of brain gray matter. Structural brain changes detected by a process called MRI scanning in depressed patients have been reported in several brain regions.

However, there appears to be hope offered through supplementing with fish oil. EPA is an omega-3 fatty acid known to help the symptoms of depression and reduce levels of inflammatory cytokines, whilst producing beneficial anti-inflammatory products. There is increasing scientific interest in the ability of EPA to prevent neuronal cell death and therefore reduce or prevent gray matter loss. Much of the pioneering work has focused on the role of EPA in Huntington’s disease with extremely promising results. Given the evidence that omega-3 fatty acids are beneficial for conditions in which there is reduced gray matter atrophy, such as Huntington’s disease, supplementing with ethyl-EPA may have further positive benefits on gray matter volume in individuals with depression, and further studies to support this hypothesis are certainly warranted.

Puri BK, Bydder GM, Manku MS, Clarke A, Waldman AD, Beckmann CF. (2008)
Reduction in cerebral atrophy associated with ethyl-eicosapentaenoic acid treatment in patients with Huntington’s disease. J Int Med Res. 36: 896-905.

Song C, Wang H. Cytokines mediated inflammation and decreased neurogenesis in animal models of depression.Prog Neuropsychopharmacol Biol Psychiatry. 2010 [Epub ahead of print]

Omega 3 and depression

IMG_0650There is growing evidence for the role of omega3 fish oil, not only in the etiology of major depression, but also as a treatment method. Given the numerous and undesirable side effects associated with conventional pharmaceutical treatments it is no wonder that many individuals actively seek natural alternatives, and the pure EPA fish oil (eicosapentaenoic acid – EPA) may just be what the doctor ordered.

Indeed, several studies have highlighted that abnormal cell membrane fatty acid composition is related to risk and incidence of major depression, and that supplementation with omega-3, and specifically with EPA, appears to normalize fatty acid levels and reduce the symptoms associated with this condition. However different studies can report different findings, and whilst several studies may appear to give varied and often conflicting results, performing a meta-analysis gives an indication of general findings by ‘pooling’ the data from several studies to give an overall picture and therefore adding clarity to a concept.

A recent meta-analysis of 14 studies comparing the levels of polyunsaturated fatty acids between depressive patients and control subjects found that omega-3 polyunsaturated fatty acid levels were significantly lower in those individuals suffering from depression (Lin et al, 2010). Because the primary sources of these long-chain omega-3 fats are fish and shellfish, it is not surprising that those individuals with the highest consumption are the least likely to suffer from depression (Suominen-Taipale et al, 2010). Treating people who suffer with depression using fish oils is therefore a viable method for alleviating symptoms whilst restoring omega-3 levels. Given that low levels of omega-3 are also associated with increased risk of cardiovascular disease, as well as several other chronic disorders and conditions, the overall health benefits of raising omega-3 levels reach out much further as a nutritional approach to improving health.

Encouragingly, improvements in depressive symptoms can be seen as quickly as 8 weeks after commencing treatment. Indeed, a group of Montreal researchers have recently confirmed that taking omega 3 fish oil supplements, at doses higher than that normally consumed in an average diet, is superior to placebo in treating symptoms and that results can be observed within a two month time period (Lespérance et al, 2010). The results of this particular study also confirm EPA to be the predominant active ingredient responsible for the benefits of omega-3.

A meta-analysis of 28 trials investigating as to whether either EPA or docosahexanoeic acid (DHA) or both are responsible for the reported benefits showed that those trials in which EPA was the predominant or only fatty acid used, gave the most significant findings. Furthermore, it was suggested that the effects of 1g daily of EPA could be enhanced and prolonged by the addition of gamma-linolenic acid (GLA), an omega-6 fatty acid found in evening primrose oil (Martins 2009). Given that 1 in 4 individuals will suffer from depression at some point in their life, it is encouraging to know that there is a safe and natural way not only to treat depression but also as a method that could reduce the possibility of developing the condition in the first place.

 

Lespérance F, Frasure-Smith N, St-André E, Turecki G, Lespérance P, Wisniewski SR. The Efficacy of Omega-3 Supplementation for Major Depression: A Randomized Controlled Trial. J Clin Psychiatry 10.4088/JCP.10m05966blu

Lin PY, Huang SY, Su KP. A Meta-Analytic Review of Polyunsaturated Fatty Acid Compositions in Patients with Depression. Biol Psychiatry. 2010 May 7. [Epub ahead of print]

Martins JG EPA but not DHA appears to be responsible for the efficacy of omega-3 long chain polyunsaturated fatty acid supplementation in depression: evidence from a meta-analysis of randomized controlled trials. J Am Coll Nutr. 2009 28:525-42.

Suominen-Taipale AL, Partonen T, Turunen AW, Männistö S, Jula A, Verkasalo PK.Fish consumption and omega-3 polyunsaturated Fatty acids in relation to depressive episodes: a cross-sectional analysis. PLoS One. 2010 May 7;5:e10530.

Irritable bowel syndrome, serotonin levels and the role of diet

Irritable bowel syndrome (IBS) is becoming an increasingly common gut disorder in which the sufferer typically experiences: abdominal pain, cramping, bloating, excess wind, diarrhoea, and/or constipation, or an alternating combination of the two. Whilst the severities of these symptoms vary considerably between individuals, IBS has a profound effect on the sufferer’s quality of life. Many of the day to day activities that the majority of us take for granted can pose much more of challenge when you have IBS. You no longer simple take your body for granted, with careful forward planning essential in order to cope with the unpleasant, and often, embarrassing symptoms. Understanding IBS and what triggers the variety of symptoms is paramount to developing coping strategies.

It is thought that people with IBS have an abnormal gastrocolic response. This is the physiological reflex that controls the movements of the gastrointestinal tract (GI tract). Simply put, this mechanism controls the movement (peristalsis) that pushes food through and out of the gut. In IBS, simply eating or drinking can cause an over reaction of this process resulting in painful cramps, often resulting in diarrhoea.

Whilst the action of eating causes an increase in gut mobility, eating large meals seems to cause excessive cramping and bouts of diarrhoea, so a key tip is to try to eat small amounts and to try to eat regularly. Many people with IBS also find there are specific dietary triggers that can result in discomfort and bowel dysfunction. Knowing what foods to include, and what foods to avoid, can make a dramatic impact on regulating or avoiding specific symptoms.

Several gut peptides (types of protein), and neuropeptides are involved in the control of the gastrocolic reflex, of which serotonin is one such example. Serotonin, a neurotransmitter peptide, is generally known for its role in the regulation of mood, appetite, sleep, and some cognitive functions including memory and learning. However approximately 80% of the serotonin is actually produced in the body by the enterochromaffin cells found in the gut lining. The function of serotonin within the gut is to control muscle contractions, thereby functioning to maintain the movement of the intestines. Importantly however, many IBS sufferers can directly link stress to the onset of symptoms and it appears that there may, in some cases, be a link between serotonin, stress and IBS.

During a stressful experience there is a complex set of interactions between the hypothalamus (a part of the brain), the pituitary gland (also part of the brain) and the adrenal glands (at the top of each kidney). Several types of neurotransmitters are involved in this system, collectively known as the HPA-axis, which is thought to be dysfunctional in individuals with several conditions including fibromyalgia, chronic fatigue syndrome and depression to which IBS is often linked. Sufferers of these conditions can have numerous abnormalities in their hormonal, metabolic and brain-chemical activity including levels of serotonin. Dysregulation of the serotonin system has been found in individuals with IBS, with low levels associated with constipation, and high levels with diarrhoea (Sikander et al, 2009).

The link between stress, diet and IBS means that suffers can help reduce symptoms not only by modifying their diet, but also from reducing tension and stress through simple relaxation techniques such as: meditation, yoga and the Alexander Technique. Certainly living with IBS is far from pleasant, but with the right diet and learning how to manage stress, there is no reason why IBS should not be controllable. Let you control your IBS and not your IBS control you!

FOODS TO INCREASE FOODS TO AVOID
Carbohydrates
Complex carbohydrates, also known as starchy foods, are broken down slowly in the body to produce energy and are much kinder to the GI tract. This includes foods such as rice, oats and barley as well cooked vegetables.
Carbohydrates
Avoid foods high in fast releasing sugars such as unrefined grains, confectionary, cakes and biscuits. Avoid raw vegetables, salads and raw fruit.
Fats
Increasing omega-3 from oily fish (mackerel, sardines, pilchards, salmon) or through supplements can help alleviate inflammation and calm the guts. Try including evening primrose oil as a source of GLA, an anti-inflammatory omega-6 fatty acid
Fats
Avoid saturated fats from red meat and dairy food and fried food as these are classic triggers that exacerbate the symptoms of IBS
Protein
Lean chicken, pork, turkey and fish can supply good animal protein.
Protein
Avoid protein from red meat.
Fibre
Soluble fibre absorbs excess fluids forming a gel which bulks out faeces and can therefore help to reduce diarrhoea. By bulking out faeces, soluble fibre keeps the muscles of the GI tract gently stretched thus giving them something to grip on during a peristaltic motion and helps to avoid painful spasms. This in turn can help relieve constipation by softening and pushing through any impacted faecal matter.
Fibre
Insoluble fibre (bran, raw fibrous vegetables, salad greens, unpeeled fruits) can trigger painful gastrointestinal spasms
Fluids
Drink plenty of fluid to avoid constipation. The following teas can help eliminate gas and bloating but also can relax the intestine smooth muscle: peppermint, fennel, ginger and chamomile.
Fluids
Coffee, tea (even decaffeinated) and alcohol are powerful GI tract irritants, and can have the same effects as fats and insoluble fibres. Also avoid sugary carbonated drinks or drinks containing the sweeteners sorbitol or xylitol.
Probiotics
Available as dietary supplements and foods such as yogurt, with most products containing one of two types of bacteria – Lactobacillus or Bifidobacterium. Probiotics are often combined with prebiotics to form synbiotics. Prebiotics are simply non-digestible food ingredients that selectively stimulate the growth and activity of beneficial microorganisms already in the colon.

Sikander A, Rana SV, Prasad KK. (2009) Role of serotonin in gastrointestinal motility and irritable bowel syndrome. Clin Chim Acta. 403:47-55.

Middle age and hot sweats, oh joy!

I was invited out to a dinner party a few weeks ago, joining a group of friends that I had known for many years but some of whom I had not seen for some time. By the time we had finished desert and were sipping our coffees the conversation turned from general catch up to a subject that seems to involve some degree of doom and gloom.

The subject was the ugly word ‘menopause’ (to which I still shudder slightly) and seemed to be on the minds of many of my dinner comrades. Whilst we all still proclaimed to be of healthy ‘child-bearing’ age it seemed that the menopause was in fact the next major event to look forward to in most of our lives (bar the daughter of my friend Shelly who, at the age of 24, found the whole conversation quite amusing).

So why the long faces? Well simply put, the menopause can be a rather unpleasant experience for many women. When the ovaries cease to produce eggs, oestrogen levels drop, the normal menstrual cycle is disrupted and the whole package results in a number of generally unpleasant symptoms. I have only one friend that I know of who is currently at this stage of her life, and as we were chatting her face lit up like a cartoon creation that had eaten chillies unwittingly. You could almost see the smoke leaving her ears as she panted like a small dog that had been left out in the sun without any water. After a few minutes her ruddy cheeks returned to normal and she muttered the words “sorry, hot flush”. Oh, what a joy to look forward to! Thereafter the subject was focused on who would and who wouldn’t turn to HRT (hormone replacement therapy). Whilst HRT is by far the most effective therapy, it seems that many people are turning to natural methods to alleviate the symptoms of menopause, for fear of side effects. So, what is out there exactly?

First let us consider the phytoestrogens (isoflavones: genistein and daidzein) found in red clover and products such as soya flour, soya milk, and tofu, which have a wide range of heath positive benefits. The interest in phytoestrogens has developed because of the epidemiological evidence that women whose diets are rich in these compounds, such as women in Japan and Asia, appear to have a much lower incidence of “Western diseases” such as heart disease, osteoporosis, and cancers of the breast, colon, and womb. Women in these countries also do not appear to suffer the same way with hot flushes and sweats as we do in the western world. Another beneficial plant is black cohosh from the buttercup family, which grows in eastern and central areas of the United States. Black cohosh was used by Native Americans as a traditional folk remedy for womens’ health conditions, such as menstrual cramps and hot flashes, arthritis and muscle pain. Whilst some people may not be familiar with the benefits associated with black cohosh, they are likely to be aware of the general association between menopausal as well as premenstrual syndrome (PMS) and evening primrose oil.

Evening Primrose oil is a plant oil that contains gamma-linolenic acid (GLA), an omega-6 fatty acid. GLA is involved in the metabolism of hormone-like substances called prostaglandins that regulate pain and inflammation in the body and can help with both the hot flushes and mood swings associated with menopause. Whilst all of the above are relatively well known alternatives to HRT, ethyl-eicosapentaenoic acid (E-EPA), an omega-3 fatty acid found in fish oil, has recently been shown to be an effective method for reducing hot flushes.

Results from the first double-blind, placebo-controlled randomized clinical trial of E-EPA published last year found that E-EPA was more effective than the placebo in reducing hot flushes, with a 55% average reduction in symptoms in these women (Lucas et al, 2009). EPA, like GLA, is the precursor to a family of anti-inflammatory prostaglandins and works, therefore, in a similar way to that of GLA. Combining these two anti-inflammatory products in one product such as Vegepa certainly offersa unique method of managing menopausal symptoms, either on its own or in combination with other approaches.

Lucas M, Asselin G, Mérette C, Poulin MJ, Dodin S. (2009) Effects of ethyl-eicosapentaenoic acid omega-3 fatty acid supplementation on hot flashes and quality of life among middle-aged women: a double-blind, placebo-controlled, randomized clinical trial. Menopause 16:357-66.

The mood food connection

Each year on 10th October, the Mental Health Foundation marks the day by raising awareness about mental health and well-being. Whilst we would probably all consider ourselves as reasonably tolerant and open minded, there is still quite a significant stigma about depression. If we haven’t experienced depression directly, it’s highly probable that we know someone, perhaps a friend, relative or workmate, who suffers. Mental Health Statistics report that 1 in 4 British adults experience at least one diagnosable mental health problem in any one year and 1 in 6 of us experiences this at any given time. In 2001 the World Health Organisation (WHO) estimated that approximately 450 million people worldwide have a mental health problem, of which 154 million are affected by depression.One of the major side effects of depression is that the way we think about food changes and this can influence how we eat – both the types of food and how often. Because food can directly influence our mood, our diet is even more fundamental when we’re feeling low.

The Glycemic Index

The brain needs energy supplied at an even rate in order to function optimally. Sudden peaks in blood sugar will adversely affect behaviour, anxiety, depression, and fatigue, so it is particularly important for people with depression to keep their blood glucose levels even. Although commonly known for its diabetes and weight loss benefits, the glycemic index (most commonly referred to as GI index), which ranks carbohydrates according to their effect on blood glucose levels, is a good guide to informing us which foods to include as part of a healthy diet, and indeed which foods to limit.

While all carbohydrate foods are eventually broken down into glucose, quick-release simple carbohydrates (such as high sugar foods, glucose and fructose) are broken down more quickly into glucose than complex carbohydrates (such as wholemeal grains), releasing glucose rapidly into the bloodstream. Repeated ‘spikes’ of glucose can decrease insulin sensitivity, increasing the risk of type 2 diabetes, as well as promoting oxidative stress in the veins and arteries – a cause of coronary heart disease. After the highs come the energy-sapping blood sugar lows and, frequently, strong urges to reach for another sugary carbohydrate snack to perk us up. Indeed individuals who suffer from atypical depression (a subtype of depression) often overeat and report an almost irresistible craving for carbohydrates.

White sugar and other refined carbohydrates, such as those found in processed white bread and white pasta, white rice and most convenience foods, supply few nutrients to the body but use up important B vitamins, which are essential for our nervous and immune systems, as well as healthy digestion. Avoiding refined foods and sugar, as well as consuming foods with a low GI value, will help to keep blood sugar levels even. Perhaps a more accurate reference guide to prevent blood sugar spikes is the Glycemic Load(GL) ranking system, which is based on a food’s GI value and average portion size. For example, whilst an apple is not low GI, it has a low GL and will barely influence blood sugar levels.

Micronutrient deficiencies

It is extemely common for depression sufferers to have low levels of B vitamins and essential minerals such as zinc, selenium and magnesium. These water-soluble vitamins and minerals must be consumed daily to avoid depletion. Deficiency can, in turn, hinder the body’s ability to utilise specific omega-3 fatty acids, which are known to lift our mood by elevating serotonin and regulating levels of this important neurotransmitter.

EPA, a long-chain omega-3 fatty acid found in fish oil, not only influences serotonin and dopamine in the brain, but is also converted to powerful anti-inlammatories via a series of enzyme-mediated steps. It is these enzymes that rely on the presence of B vitamins and essential minerals in order to function, without which the body’s production of natural anti-inflammatories is minimal, and can even result in the production of inflammatory substances. Combining a good nutritional vitamin and mineral supplement with 1 gram EPA daily (or 4 capsules Vegepa) can help to balance serotonin levels and alleviate the symptoms of depression.

Carbohydrate cravings are also linked with low levels of chromium, which helps to regulate blood sugar levels and reduce cravings. This is because for blood sugar to provide energy, it must be escorted into each of our cells where the energy conversion takes place. Insulin then ‘unlocks’ the cell, allowing glucose to pass in. But there is a missing link. Insulin doesn’t work properly unless biologically active chromium is present as a cofactor (much like a catalyst).

With many modern food processing methods, up to 80% of chromium is lost – particularly with whole wheat and raw sugar when they are processed to white flour and refined sugar. If we regularly opt for these refined foods over their healthy wholegrain relatives, chromium levels within the body can easily become depleted.

Whilst it is likely a low priority during episodes of low mood to concentrate on our eating habits, following a few general guidelines can help to restore healthy brain chemistry and minimise sugar-induced mood swings.

– Avoid processed foods.

– Keep red meat to a minimum or eat organic (red meat is high in inflammatory omega-6 unless animals are fed on natural grass).

– Drink plenty of water, as the brain needs to be hydrated to function at its best.

– Don’t forget your ‘five a day’. Make sure you get plenty of vitamins and minerals by eating a wide variety of fresh fruit and vegetables. If you eat them raw they’ll supply even more nutrients.

– Eat two portions of oily fish weekly to top up on omega-3, containing the natural antidepressant EPA, or take 2 capsules of Vegepa morning and night.

If you found this article interesting, you might like to read more about anti depression foods.

Coffee Controversy: is it good or is it bad for you?

I seem to have witnessed recently several identical conversations regarding coffee drinking. Is it good or bad for you? It’s not the coffee debate per say that intrigues me but this need for something to be so black or white, good or bad. I think it depends in part on where or from whom we get our information and the message that source wants to portray. It is true that coffee has well-documented side effects including anxiety, insomnia, tremor and palpitations. But on the plus side drinking coffee appears to improve alertness and some reports suggest that drinking 3 cups a day may even, reduce the risk of type 2 diabetes, protect against cancer and offer protections against dementia including reducing the risk of developing Alzheimer’s and Parkinson’s disease. So we have the good and the bad.

Coffee, however, like the majority of food stuffs we consume, is a complex composition. The side effects often associated with a steaming cup of java are actually the result of caffeine, which belongs to a group of stimulants called xanthenes. In moderation, caffeine can have very positive effects. It gives us more energy, heightens our ability to concentrate and makes us think more clearly and can even elevate our mood. That doesn’t sound so bad. But as with most things it merely boils down to moderation. If we drink caffeinated coffee in moderation it can increase alertness and mental stamina. If we drink too much too quickly, however, we are faced with the unpleasant side effects: nausea, confusion and excitability, which can be wholly unpleasant.

As with most things in life it’s not as simple as black or white. We need to look at the diet as a whole. Most foods we eat will have positive and negative factors, of which we are constantly being reminded by the tabloid headlines. Often telling just one side of the story, these messages can be somewhat confusing and frequently leave people rather bewildered as to what to consume and what to avoid. It’s a case of being sensible, taking everything in moderation and listening to the messages your body tells you. If you get the shakes after your morning espresso then that’s your body saying stop now, that’s enough.

Statins – Should all over 50s get anti-cholesterol drugs?

Today’s Daily Mail headline announced the question “should all over 50s get anti-cholesterol drugs?” Normally statins are only prescribed to people who are considered to be at significant risk of a heart attack or stroke. In fact, it seems that these drugs can cut the risk of heart attack by 30% even in healthy people. So what are statins exactly? These are drugs that are known as HMG-CoA reductase inhibitors. HMG-CoA is an enzyme that is involved in the production of cholesterol in the liver. Ruducing or inhibiting the function of this enzyme therefore prevents cholesterol production. Statins (usually synthetic) are similar to HMG-CoA and mimic the actions of this enzyme but prevent the pathway progressing to the production of cholesterol and more than six million adults in the UK use them.

So far so good, until I open up the paper to page two where I am met with the words “although side effects are rare, they can include muscle pain and damage to the liver and kidneys.” I guess this is what infuriates me. With the majority of pharmaceuticals there will be the downside list of side effects or contraindications that steal some of the glamour from a treatment programme. Take NSAIDs, for example; these are common over-the-counter anti-inflammatory drugs, like Ibubrofen.

Whilst one of the most common over-the-counter drugs and used by millions, NSAIDs are associated with several side effects, of which many are probably not known by the common user. Whilst the frequency of side effects varies among NSAIDs, the most common side effects are nausea, vomiting, diarrhoea, constipation, rash, dizziness and headache (interesting that we often take them when we have a headache!). NSAIDs may also cause fluid retention, leading to oedema. The most serious side effects are kidney failure, liver failure, ulcers, an increased risk of heart attack and prolonged bleeding after an injury or surgery.

So why is it that if there is a natural alternative which we can take for both of these drugs and without the associated side effects, that we are not advised? Let me speak firstly about cholesterol. In the 1970s Danish researchers discovered that in spite of their high-cholesterol, high-fat, diet Greenland Eskimos had an astonishingly low incidence of cardiovascular disease (as well as arthritis and other chronic inflammatory diseases). When analysing blood samples it was discovered that they had low levels of LDL (bad cholesterol) and low levels of VLDL (triglyceride), but high levels of HDL (good cholesterol). It appeared that their high intake of omega-3 was responsible for this low risk of heart disease. Since this research emerged, much focus has been centred on the role of omega-3 fatty acids and, more recently, specifically the role of EPA in lowering cholesterol levels. EPA reduces cholesterol production by inhibiting the activity of another enzyme called acyl-CoA but without the side effects associated with statins. EPA also acts as an anti-inflammatory in a similar mechanism to that of NSAIDs, but again without the side effects. So my message today is to boost your EPA levels on a long-term basis and you may well lower the possibilities of having to resort to pharmaceuticals with all sorts of side effects.

Increase your fish intake and adopt a more Eskimo-like diet! For those who don’t like fish, you can opt for a high-EPA supplement. Purified fish oils actually are a useful alternative to oily fish consumption and, unlike most oily fish, are contamination-free.

Peripheral Neuropathy in Diabetics; what steps can we take to avoid it?

You might already be aware that of the many deteriorative conditions related to diabetes; ‘peripheral neuropathy’ is perhaps the most common, with an estimated 60-70% of diabetics reportedly experiencing symptoms. ‘Neuropathy’ describes damage, whether moderate or severe, to the peripheral nervous system (the ‘external’ portion of the nervous system, situated beyond the brain and spinal cord), which transmits information directly from the brain and spinal cord to the rest of the body.

Our nervous system acts very similarly to an electrical cable; with the nerve’s ‘impulse’ adopting the role of the electrical wire itself, and the ‘myelin sheath’ (the ‘skin’ of the nerve), mimicking the insulation surrounding the wire. If the wire becomes damaged, then the nerve signal will not travel efficiently along the wire, nor will it transmit the intended messages as instantaneously. This delay results inevitably in the ‘classic’ symptoms of neuropathy; namely; tingling, numbness, ‘burning’ and pain.

A causative link has been drawn between neuropathy and deficiencies of long-chain polyunsaturated fatty acids within the body. Indeed, insulin itself plays a pivotal role in the metabolism of EFAs (essential fatty acids), by alerting the genes necessary for enzyme-conversion to begin the process of converting short-chain fatty acids into a bio-available (i.e. usable by the body) long-chain fatty acid.

Where insulin is absent, or enzyme-activity impeded, the enzymes needed to create specific fatty acids cannot be produced and a deficiency results. Of the myelin layer which protects our vulnerable nerves, an estimated 75 % is composed exclusively of EFA’s (these are termed ‘essential’ because the body cannot generate them independently, but must instead source them externally from the diet). Depletion of this fatty, insulatory layer, leads to severe nerve damage (Neuropathy).

Nutrition, as all Diabetics are painfully aware, is central to the manufacture of insulin and for creating the right ‘biological environment’ to encourage enzyme conversions to take place. By boosting or supplementing our dietary levels of long-chain fatty acids we can essentially sidestep the risk that the enzyme-mediated conversions will fail to progress past the initial hurdle.

Fatty acid supplementation nourishes the myelin sheath, and prevents further degeneration of inter-cellular communication; it reduces the risk of developing Neuropathy, and actually reinvigorates nerve endings to overcome numbness and the likelihood of eventual tissue loss. However, EPA, a specific omega-3 fatty acid found in fish oil that appears to have significant beneficial effects on diabetic neuropathy and serum lipids as well as other diabetic complications such as nephropathy (kidney damage) and macroangiopathy (damage to the blood vessels). EPA plays a role in the compaction, stabilization, and maintenance of myelin sheaths by regulating the production of proteolipid protein or PLP. PLP is literally the ‘glue’ that hold in place the sheets of protective fats that cover the nerve axon. Loss of PLP is associated with many conditions that have nerve damage including Multiple sclerosis, Alzheimer’s disease and Huntington chorea.

OmegaForce is a patented formulation of omega-3 and 6 long-chain fatty acids with a multitude of health-enhancing properties, including anti-inflammatory and pain-relieving actions. For more information on the relationship between EPA deficiency and the pathogenesis of Diabetic Neuropathy, please go to www.igennus.com

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