Friday, 23 February 2018

Supplements: can you get everything you need with a balanced diet? - by Dr Nina Bailey BSc, MSc, PhD, RNutr

This Sunday's blog is written by Dr Nina Bailey from Igennus. Nina is a leading expert in marine fatty acids and their role in health and disease. Here she discusses supplements and if they are absolutely necessary for maintaining your health and preventing disease.


Headlines like this constantly pop up on social media and can leave many of us confused and unsure about the pros and cons of supplementation.  As with many of the headlines we read, the complete ‘story’ is rarely told, the ‘facts’ often distorted or, in some cases (depending on the author/source), can be simply untrue.  As with most things in life, there are two sides to every story.  We are often told that supplements (omega-3, multivitamins, minerals and so on) are simply a waste of money, and as a nutrition scientist I both agree and disagreewith this statement.

I do agree that not all supplements are formulated for efficacy (and hence will not be effective) and that there will of course be some individuals who, because of their diet and lifestyle or current health situation (note that I don’t say ‘choices’, which I will expand on later!), don’t need to supplement. Mostly, I disagree because we cannot make sweeping statements that appear to apply to the whole of the population!  We are all unique, and the nutrient requirements of one person will differ quite significantly from the next depending on their general lifestyle, their working habits, activity levels and sleep status. Do they drink regularly? Do they smoke? Are they under stress at work or home?  The simple fact is that no two people are the same, or lead the same life, and so of course there will be individuals who require additional nutrients or micronutrients at certain points or stages in their lives.  If the products they take are expertly formulated to deliver safe, viable doses, in forms that are known to be both bioavailable and effective, then the health benefits are unquestionable.   What we often hear from so-called ‘experts’, however, is that a balanced diet allows us to obtain the nutrients we need so avoids the need for supplements!

Just eat food!

So, can we really get all the nutrients we need from our diet? Absolutely!  We should indeed be able to sustain ourselves with the nutrients we require for everyday function via the food we choose to eat!  But wait, before we actually ditch our pot of multivitamins and minerals or fish oil supplement, let’s just take a moment to look at what is considered to be a balanced diet and, importantly, some of the factors that may (or may not) influence our ability to maintain a nutrient-rich variety of foods.

A diet that promotes health and prevents disease is one that contains an abundance of natural, unprocessed, seasonal, organic, fresh whole plant foods; a broad range of wild, grass-fed or pastured organic animal proteins; plus an array of ‘good’ fats.  If this is your diet (and has been for decades), then thumbs up to you, as it’s highly likely that your vitamin and mineral levels, along with your omega-3s, are nicely optimised.  But wait: you work long hours in the city, commute an hour each way, you find time to work out twice weekly yet survive on less than 7 hours sleep at night!  Okay, so now we need to look again, as it’s highly likely that some aspects of your life may be exerting a high level of emotional and physical stress on certain metabolic pathways (not even to mention the impact of likely unavoidable factors such as pollution).  With stress there is inflammation and with inflammation we are at a higher risk of developing poor health.  You may (or may not) feel generally ‘healthy’ (so you get a bit tired at times and perhaps get the odd cold, but nothing more than that)  but the inner workings may (invisibly) disagree.

It may not be that you are nutrient deficient per se, but you may need more nutrient[s] than someone eating a similar diet but who has less of an inflammation-encouraging stress burden than you do! The key thing to take on board here is that we and our life situations are all different and so are our nutrient requirements. This way of thinking is the focus of personalised nutrition, which concentrates on the individual rather than the population as a whole, whose standard guidelines tell us that we should all be consuming ‘X’ amount of vitamins or ‘Y’ amount of calcium, regardless of age, sex, activity levels or even stress!  Eating more nutrient-rich foods may be the answer on an individual basis or, alternatively, we could move to supplementation.  But here is the crux of the matter, because taking a poorly formulated supplement may well cause your body more harm than good.   Unless your product is formulated using carefully selected, highly bioavailable, body-ready nutrients in doses that aim to support (not overload) the numerous metabolic and cellular processes that occur on a continuous basis, then you may as well not bother.

Let us look back to headlines published by the Daily Mail in 2016, where it stated that calcium supplements ‘dramatically increase risk of heart attacks’ but without clarifying that it is the type of calcium that was the issue. Given that the majority of calcium supplements contain calcium in the carbonate form (aka limestone) it is actually not surprising that this form of calcium builds up in the arteries (rock is terribly hard to digest and absorb…).   In addition, supplements are not foods, and should not [in terms of how we ‘dose’] be treated as such, yet consumption guidance on many calcium supplements means that individuals are taking  a large dose, all at once, that the body is simply unable to process.    In contrast, taking naturally-derived calcium [such as algae-sourced, pre-digested] over the day as a split-dose will lead to calcium accumulation within the bones (where you need it) and not the arteries, with significant benefits to bone mineral density, which is generally the purpose of taking a calcium supplement. (Kaats et al., 2011)

So what is the perfect diet?

This is a subject close to my heart and while the jury is out on defining a recognised, validated diet that meets the requirements of the whole population (simply because it is unlikely to exist), you can read about how to optimise your diet to give you the best possible nutrient-dense ingredients to reduce the risk of chronic disease here.    It’s also recognised by experts in nutrition that it’s not about how much of a food we eat, but more about focusing on the quality of the foods we consume. For example, it’s well established that food budgets can lower the nutritional adequacy of an individual’s diet.  Indeed, people’s food choice and diet variety of foods integral to a healthy diet (i.e. fruit, vegetables, fish) can be perceived as a luxury, with healthier alternatives (organic, grass-fed and so on) to common foods often carrying a price premium, making them essentially unachievable for some.  While many of us may wish to follow a perceived nutrient-rich, balanced diet, various economic ‘barriers’ can be influential on our dietary choices.  It is, for example, estimated that half of the weekly income is needed for a person on income support to eat a healthy diet, while the considerably higher cost of therapeutic diets places an even greater burden on older people with limited incomes. (Conklin et al., 2013) Thus I highlight the importance of my earlier comment about an individual’s diet and lifestyle situation rather than their diet and lifestyle choice as it is well established that socio-economic factors will influence how well a person will, or can, eat. (Maguire & Monsivais 2015) The assumption that we are all (or could be) consuming a balanced diet is therefore not feasible and supplementation may well be a convenient (and more affordable) option for many.  What is clear is that while we are consistently reminded of the benefits of a balanced diet, the figures for diet-related chronic diseases would suggest that the majority of us are non-compliant!

Diet related disease

In 2006-07, poor-diet-related ill health cost the NHS in the UK £5.8 billion, (Scarborough et al., 2011) and 10 years on, that figure has undoubtedly continued to grow.  Diabetes and obesity are key diseases that lead to other diet-related chronic diseases and it is well accepted that nutritional strategies that focus on the prevention of obesity and diabetes can reduce the prevalence of other major chronic diseases. In addition, cancer, cardiovascular disease, liver disease, kidney disease, digestive disease, and mental illness are consequences as well as causes of other diet-related chronic diseases.  All diseases have multifactorial causes, and most result from decreased antioxidant status, increased inflammatory status, impaired carbohydrate/lipid/one-carbon metabolism, impaired functioning of neurons and DNA transcription, hypertension, and/or modified gut flora. (Fardet & Boirie 2013)  Thus, it can be said that increasing antioxidant status, decreasing inflammation and/or supporting the complex systems that influence health via diet (and/or supplementation) can only aid in reducing disease risk.

Some studies suggest that supplements like vitamins and antioxidant can be harmful, so are supplements actually safe?

When used appropriately, yes, supplements are safe.  What is ‘appropriately’ I hear you ask?  When we read negative headlines it’s always worth looking at the source of the information behind them.  What is clear from many dietary intervention studies is that many nutrients work synergistically and that when given in very high doses, there is indeed a potential for them to cause problems by disrupting nutrient pathways.  Nutrients are not drugs, and should not be treated as such in research trials.  The antioxidant vitamin E, for example, is a popular antioxidant that has been associated with a reduced risk of cancer, yet a study published in 2011 found that the risk of prostate cancer actually increased among the men taking vitamin E compared to the men taking a placebo.  Scary stuff and you could easily think that this therefore makes vitamin E supplementation a bad idea for everyone – right?  Not so!  Let’s look more closely at some of the facts in this case.    Firstly, the trial used a synthetic vitamin E, a mixture of eight a-tocopherol stereoisomers in equal amounts (stereoisomers are molecules that have the same molecular formula but their atoms have a different arrangement).  Only one of these stereoisomers, (12.5% of the total mixture), was RRR- or d-a-tocopherol, the natural form.  A number of studies have shown significant differences between natural-source and synthetic vitamin E.  They have also shown that natural-source vitamin E is more efficiently used by the body than its synthetic counterpart and that the body has a preference for natural-source vitamin E over synthetic vitamin E.  (Burton et al., 1998) Had this trial used naturally-derived vitamin E the outcome may well have been very different.  Indeed, other trials have reported that both dietary and supplemental (as natural α-tocopherol) vitamin E are not only inversely associated with prostate cancer risk (high levels/high intake offer protection) but may also contribute to improved prostate cancer survival in those men with the disease. (Watters et al., 2009)
Secondly, when we give high doses of a single antioxidant such as vitamin E to an individual who may already be low in antioxidants, this can have the potential to cause vitamin E to become a pro-oxidant with the capacity to increase inflammation and therefore have health-negative outcomes; it is useful, therefore, to understand how antioxidants actually ‘work’ and the factors that influence their actions.  Antioxidants act to stabilise free radicals usually by donating an electron, hydrogen or other chemical group that, essentially, calms the free radical down and stops it going on the rampage.  However, depleted antioxidants have the capacity to become pro-oxidants thereby ‘switching teams’ to become free radicals themselves unless another antioxidant (such as CoQ10, lipoic acid or vitamin C) steps in to donate one of its electrons, thus converting vitamin E back from a pro-oxidant to an antioxidant.  So – numerous antioxidants act together, essentially working as a tag team to keep the body free from free radicals;  however, if someone hasn’t been eating their veggies, they may be low in antioxidants and so dumping a high-dose vitamin E into the mix may cause a rise in the pro-oxidant version.  Therefore rather than supplementing with single antioxidants, it is more effective to supplement with a mix so they have the capacity to recycle each other.  The antioxidant story is a complex subject that was recently clarified by fellow nutritionist Sophie Tully and you can read more about the pros and cons of taking antioxidant supplements and how to optimise the benefits for you rather than the population on a general level here.

Choosing the right supplement

It’s a minefield out there! For a consumer, the variety of supplements in health shops, online, or even in supermarkets can be overwhelming. I’m going to use my own experience of involvement in­­­­­ supplement formulation to illustrate the importance of awareness of the choices to be made in doing so:  the focus is to ensure the efficacy and safety of formulas. Uptake and retention of nutrients is optimised by taking measures to overcome bioavailability issues, by using only the most effective ‘body-ready’ forms, or pre-methylated forms of vitamins and minerals.  We incorporate a slow release matrix into our tablets and we actively encourage split-dosing to ensure all-day coverage. We also do not believe in overloading the body with excessive ‘mega’ doses that the body does not need or simply cannot absorb in one dose. The majority of water-soluble nutrients are simply not needed in mega-amounts for an effect and can (such as in the case of folic acid) come with undesired contraindications.  Sometimes the body will simply excrete any excess it does not need or cannot absorb in one dose. For example, with nutrients such as B12 and vitamin C, absorption is far better when the nutrient is delivered at smaller doses at a sustained rate because the transport systems responsible for their uptake quickly become saturated.  This means that as the dose increases, the absorption rate decreases and the majority of the nutrient will simply pass though the body unabsorbed – this is wasteful and financially unacceptable.  In addition, we use vitamin B12 as methylcobalamin(rather than the cheaper poorly absorbed cyanocobalamin form) for enhanced uptake. We use Quatrefolic® which is the body-ready form of folate, as [6S]-5-methyltetrahydrofolate, while most standard supplements contain synthetic folic acid. Incidentally, the article I am responding to referred to the use of folic acid as desirable during pregnancy; I would point out that folic acid is now being updated to folate by many supplement manufacturers because of issues around impaired folic acid metabolism and the role this plays in the development of neural tube defects (such as spina bifida).   We also choose the active form of riboflavin, riboflavin-5-phosphate.  Similarly, vitamin B6 is pyridoxal-5-phosphate, the only form of B6 with cofactor activity.    Taking such important considerations as bioavailability and dose frequency into account, safe supplements are formulated with the aim of delivering unprecedented yet cost-effective health benefits – otherwise what is the point?

Summary

Supplements may not be for everyone, but if we base the argument for not supplementing on the utopian notion that we can obtain all the vitamins and minerals we need from a balanced diet, then it’s highly likely that the majority of us would benefit from a micronutrient top-up!  In addition, given the growing burden that dietary-related chronic diseases are having on our NHS system, it is evident that nutrient deficiencies (= increased nutrient demands) are rife.  It is also evident that with an increasing market, not all supplements will be equal in terms of safety and efficacy and that purchasing from a reputable healthcare company with a team of experienced, and highly qualified nutrition scientists (who are also practising nutrition practitioners) behind the development of their products will ensure that you are in the safest hands possible when choosing products aimed at optimising health. If you’re interested, here is the link to The Independent’s article What vitamins should I take, which prompted this article.

References

Burton GW, Traber MG, Acuff RV, Walters DN, Kayden H, Hughes L, Ingold KU. Human plasma and tissue alpha-tocopherol concentrations in response to supplementation with deuterated natural and synthetic vitamin E.
Am J Clin Nutr. 1998 Apr;67(4):669-84.
Conklin AI, Maguire ER, Monsivais P. Economic determinants of diet in older adults: systematic review. J Epidemiol Community Health. 2013 Sep;67(9):721-7
Fardet A, Boirie Y. Associations between diet-related diseases and impaired physiological mechanisms: a holistic approach based on meta-analyses to identify targets for preventive nutrition. Nutr Rev. 2013 Oct;71(10):643-56.
Maguire ER, Monsivais P. Socio-economic dietary inequalities in UK adults: an updated picture of key food groups and nutrients from national surveillance data. Br J Nutr. 2015 Jan 14;113(1):181-9.

Scarborough P, Bhatnagar P, Wickramasinghe KK, Allender S, Foster C, Rayner M. The economic burden of ill health due to diet, physical inactivity, smoking, alcohol and obesity in the UK: an update to 2006-07 NHS costs. J Public Health (Oxf). 2011 Dec;33(4):527-35.
Watters JL, Gail MH, Weinstein SJ, Virtamo J, Albanes D. Associations between alpha-tocopherol, beta-carotene, and retinol and prostate cancer survival. Cancer Res. 2009 May 1;69(9):3833-41.

Friday, 9 February 2018

Top 5 immune-boosting foods from your kitchen - Maxine Sheils from Igennus




This week's blog post is one from Maxine Sheils, a Nutritional Therapy graduate of the College of Naturopathic Medicine who has recently joined Igennus. Here are Maxine's top 5 immune-boosting foods from your kitchen...





We were fortunate enough to have a beautifully long summer but that’s a far cry from the current cold weather, so we thought this would be the perfect time to share our favourite immune-boosting foods before those office sniffles start. It happens every time the weather changes, one person in the office has a cough and before you know it, you’re feeling run down for the next week or so. Fortunately for the Igennus office (and it may be somewhat of an occupational ‘hazard’), we rarely see a sick day, so we’re definitely doing something right. Here are the 5 foods that you can find in our cupboards that may have something to do with it…





Turmeric

You may have already noticed, but we love turmeric at Igennus, so much so, we took the most beneficial component (curcumin), used the most up-to-date technology (Longvida) and bottled it. Whilst the raw ingredient isn’t as potent, it’s definitely a staple in our herb and spice cabinet. Turmeric’s beneficial element is curcumin, which makes up around 4% – 8% of turmeric. It’s great for reducing inflammation associated with the common cold; it’s antimicrobial, meaning that it will help the body fend off any nasty bacteria from unwell co-workers; it has antioxidant activity to protect cells from the damaging effects of bacteria and virus, and has even been shown to help modulate the immune system. Finally, if you’re prone to respiratory conditions such as bronchitis, laryngitis or sinusitis, you’ll be happy to hear that turmeric also has positive effects on the respiratory tract. Need I say more? 8 grams of turmeric are found to increase blood levels to a therapeutic amount so it’s time to get cooking up a dhal, or try your hand at a turmeric latte.


Garlic


Not only does garlic keep the vampires away, it’ll also keep those other nasty bugs at bay too. Another herb with antioxidant and antibacterial activity that will have positive effects on your immune system, garlic is also an antiviral, meaning that if you get cold sores when you’re run down, garlic is going to be your saviour. It’s also proven its worth as a protector against human rhinovirus, the main culprit to blame for the common cold. So put the tissue box down, and get cooking some garlic-roasted vegetables. Yes, the house will smell of garlic, but they’ll taste utterly delicious and you’ll be reaping the benefits.

Ginger



This common kitchen spice features heavily in our meals during the cooler months. Why? Because it’s not only warming, but it also has so many health benefits that we want to benefit from. Like turmeric, it also has antibacterial, antioxidant, anti-inflammatory and respiratory benefits, but on top of that, it also has anti-emetic properties, meaning that if you’re suffering with any nausea or vomiting as a side effect of illness, you’re going to be wanting a lot of ginger. We love this in curries, homemade ginger tea with added lemon, and in homemade treats such as ginger and walnut loaf.


Manuka Honey


What’s the difference between honey and Manuka honey, that we spend an awful lot more on what sounds like the same thing – honey? All honey is produced from bees and extracted from hives; however, with Manuka honey, the bees produce it from the flower of the Manuka tree. Native to New Zealand, Manuka honey contains methylglyoxal (MGO), the active ingredient believed to contain antibacterial properties. We love this for wounds or sore throats, but it’s even an FDA-approved medical device for supporting wound healing, and has been shown to reduce wound healing time of diabetic foot ulcers when the dressing contained Manuka honey.

Tip: When Ocado sell Manuka honey with a MGO of 550+ at £99, and Tesco sell Manuka honey with NPA 15+ for £19.90, it all gets a little confusing as to what’s really worth investing money in. Fortunately, we’ve found this helpful chart on different ratings for Manuka (i.e. UMF, NPA, MGO); basically, the higher the score the better. Still, there’s a lot of choice out there so go with what suits your budget and only use it when needed.

Apple cider vinegar


Not the most obvious one perhaps, however apple cider vinegar (ACV) is great for stimulating the production of stomach acid and digestive enzymes in those with low levels, to help aid digestion of food. Stomach acid is also required to kill off any bacteria in food so if levels are low, it’s easy for a bacterial infection to hit from the ingestion of contaminated food. Whilst it’s worth investigating levels of stomach acid with a nutritionist and reasons for low levels, a quick solution in the meantime does involve the use of apple cider vinegar. Alone, it’s not particularly that palatable but it’s time to get experimenting with recipes as you can make some delicious salad dressing using ACV. It can be whisked together to make a salad dressing with added olive oil, freshly squeezed lemon juice and wholegrain mustard.

And there we have it, our top 5 immune-boosting foods straight from the kitchen cupboards. If you’re feeling really brave, you could try my own personal cold remedy. As soon as I feel a sniffle that feels like it has the potential to grow into a full blown cold, I pour some warm water into a cup, add a couple of crushed garlic cloves, grate a nub of ginger, add a good serving of turmeric, a splash of ACV and a bit of Manuka honey and throw it back quickly before I can taste it. It works for me but, as I said, you need to be feeling brave.

Friday, 2 February 2018

Rock Bottom - by Tamás Vincze

Today is world cancer day. In light of this we have another from Tamás Vincze, who was diagnosed with cancer when he was on the cusp of adulthood. Here he kindly shares with us a chapter from his recently published book...



My name is Tamás and I’m a former cancer patient. In the earlier post I spoke briefly about my experience with cancer and Eighteen and Cancer, my recently published book. In this post I’d like to share a chapter from the book about a moment, which I think we’ve all experienced during the journey with cancer: Rock Bottom. This is my experience of that period and the beginnings of moving out of that place.

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Rock Bottom
Image result for Tamás Vincze 
The treatments over the next few weeks were some of the worst I experienced. Medication arrived late to the hospital, and I sometimes waited half a day for sessions to begin. Nurses couldn’t insert the IV, or there simply wasn’t a bed available due to emergencies. I would sit in a dark corner of the hospital before treatment, far away from people, not practicing mindfulness but thinking of how and why I got there. Everything that had been going right was going horribly, horribly wrong. After some treatments I could barely stand up and had to spend the night at the hospital. The sights and sounds of the cancer ward are depressing at best during the day, but they can be terrifying at night.

I had always made sure never to stay overnight. It’s an impossible place to rest. There is something about darkness that can be very disturbing, and night-time silenced the ward and turned it into an alien place. I couldn’t see my fellow cancer patients but I could sense and hear them loudly. Raw unfiltered human emotions, begging, pleading or praying. Bargaining for a bit more time, hoping that there’ll be another and perhaps better tomorrow. Begging for more time with families and loved ones, praying that this is not yet the end. Occasionally this quiet would be interrupted by an emergency and a patient would be taken out and gone for hours.

At nights like these I could hardly find the peace to sleep and struggled to process what I saw. I was only 18, but here I was seeing people more than twice my age encounter enormous suffering. I had no idea what to say that might help them. All I could do was observe, seeing and feeling their fear of death: “Please don’t let me die just yet.” I had known from the beginning that my cancer was not terminal, but I couldn’t help wondering how different things might have been. What would or could have I done in their circumstances? What emotions would I have had to face?  The details of our lives were all different – age, name, hometown, occupation – but ultimately we all wanted the same thing: life without cancer.

The sessions became worse. One day in late March I arrived at the hospital and somehow knew that it was going to be bad. I had been becoming increasingly fearful of chemotherapy and the horrible physical side effects. At some point it got so bad that I was thinking of ways to escape, but common sense prevailed at the end. On this day, after the customary tests, I was escorted to a room with about eight other cancer patients (private rooms were hard to come by). When I looked around I saw the familiar landscape of white beds, IV poles and colourful medicine bottles, but more than that I saw misery, mine and theirs.

After about an hour of treatment I saw and felt darkness closing in on me and felt a burning pain moving through my body, gathering force with every breath I took. I started sweating, tossing and turning in the bed. The pain kept intensifying, and I felt my arms and legs go completely stiff as the throbbing pain spread from the IV needle in my right arm. As it moved further up into my body the burning turned into a strong, pulsing sickness. My mind shut down and I lay there, eyes closed, clutching onto my life. This shock was so sudden that there was no time for self-pity. Instead I begged and pleaded: “Please let me get through this.” “Please let me survive.” “Let me live and I’ll never take anything for granted, especially my health.”

After a while I felt a cold soft hand touch my forehead and then my cheeks. I looked up and saw a doctor sitting by the bed, looking down with kindness. I was in agony and searching for hope to help me through. She touched my arm where the needle was inserted and said quietly “Just breathe, it’s going to be okay”. What I went through had been so violent that having this loving, human experience of sitting with her for a few minutes was like the ray of sunshine after a storm. While the burning sensation didn’t stop yet, her presence was soothing. After a while she gave me a glass of water and a pill. It calmed me further and lulled me into quiet sleep for a few hours.

The last thing I remember before passing out was asking her for the name of the pill: Xanax. That was my rock bottom. I had never needed anything external to keep my sanity, but on this day I was in such pain that I was completely helpless. There is a danger that, once you get used to receiving outside help, your self-reliance will weaken. I had tried to avoid that as much as possible: I always thought that only people with much more serious ailments took pills such as these.

I’m not sure why I attributed so much weight to this incident, but it marked a turning point for me and another moment of grace. After I woke up and regained my senses I was grateful for this to be over but I had had enough. The last few treatments had been awful, and looking back at how well the first six had gone I was amazed to realise, through a very painful lesson, how much my emotional state influenced the outcome of the chemotherapies. After the ‘victory’ of reaching the halfway point, I had thought of little else but my own significance. I paid the price for not being present to my own health, which was a sure way of losing. The other sure path to defeat was to fall back into despair. As long as I could avoid both these extremes I was going to be okay.

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If you are a kindred spirit, have an inspiring story, have any questions or just want to chat please feel free to reach out on www.tamasvincze.com. My book is available on Amazon.