Iodine;an overlooked micronutrient

Iodine, one of the most important micronutrient required at all stages of life. Iodine is essential for the synthesis of Thyroid hormone, triidothyronine (T3 )and thyroxine (T4) which regulates body metabolism. Thyroid hormones receptors are presents in almost every cell of the body, so they are important regulators of many physiological processes includes brain development, growth, metabolism and cardiac function. Iodine plays a vital role in brain development during early pregnacy till childhood. Many brain structures and systems appear to be affected with iodine deficiency, including areas such as the hippocampus, microstructures such as myelin, and neurotransmitters.

25 -30mg of iodine present in a healthy body, 80% of which is stored in the thyroid gland. The non hormonal iodine is found in a variety of body tissues including mammary glands, eye, gastric mucosa, cervix and salivary glands.

How much Iodine Do we Need

In the UK, the recommended daily intake of iodine for a healthy adult (male and female) is140 microgram and there is no specific recommendation for pregnant and breastfeeding women. As during pregnancy, iodine requirement increases so the British Dietetic Association (BDA) suggested 200 microgramm of iodine per day for pregnant and breastfeeding women.

dietary sources of iodine

Milk and dairy products fish and eggs are a major source of iodine. In the UK, milk and dairy products provide as much as 34% of iodine intake. Fortified milk is recommended for those who are using non dairy milk alternative. however, a study conducted by the University of surry revealed that only a few plant based milk brands in UK are fortified with iodine.

Fruits and vegetables also contain iodine but the amount varies depending on the iodine content of the soil, fertilizers use up and irrigation practice. The table below produced by BDA shows the iodine content of food in the UK.

Some vegetables impair absorption of iodine like cruciferous vegetables (broccoli, cauliflower, cabbage and soya) and cause swelling of the thyroid gland (goitre) due to low levels of thyroid hormones. However, normal consumption of cruciferous vegetable does not appear to increase the risk of hypothyroidism unless accompanied by iodine deficiency. 

iodine deficiency

  • Pregnant and lactating women; The iodine requirement in pregnant women is 50% higher as compared to non preganant women as; maternal iodine production increases by 50% in eraly pregnancy.At this stage fetal thyroid is not fully active so, additional iodine is rquired for fetus toproduce its own thyroid hormones.
  • vegetarian /vegans
  • People with food allergies; milk or fish allergies
  • Lactose intolerance

Globally, iodine deficiency is a serious public health issue and it is estimated that around 2 billion people all over the world are iodine deficient. iodine deficiency leads to hypothyroidism which causes impair neurodevelopment in early childhood.

It is claimed by WHO that iodine deficiency is the most significant preventable cause of brain damage and mental retardation. Severe iodine deficiency during pregnancy causes Endemic cretenism( congenital hypothyroidism) in the newborn which is marked by gross mental retardation, deaf mutism, short stature.

iodine deficiency causes a spectrum of disorders in different age groups collectively known as iodine deficiency disorders ( DIDs). The effects of IDD in humans at different stages of life are presented in the following pyramid.

Iodine deficiency can be corrected by adding iodine to dietary media like salt, oil, water, sauces etc. The methods of proven value for mass use are iodized salt and iodized oil. To this end, fortification of salt with iodine has been identified and considered to be the most suitable method of fortification.

universal iodized salt is recommended intervention by WHO for iodine deficiency however, in the UK there is no iodized fortification program and most sale salts are not fortified. it is better to meet iodine requirement through diet.

TAKE HOME MESSAGE;

Iodine is essential for thyroid hormone production and its deficiency may impair body metabolism and brain development.

The best way to meet your daily iodine requirement is eating a healthy well balanced diet. People with different dietary choices like vegan and vegetraian are increased risk of developing iodine deficiency.

vegans should check their iodine levels and in case of iodine deficiency, consume iodine supplements but always consult GP, dietitian or nutritionist before using iodine supplements.

Strong evidence is still needed to conclude the efficacy of iodine supplementation in mild to moderate iodine deficient women on the cognitive function of their children.

Avoid seaweed based supplements as they may cause iodine intoxication.

iron; what you need to know

Iron is one of the most important micronutrient required for normal functioning of the body. About 70% of stored iron found in red blood cells and muscles cells. Red blood cells contain a protein called haemoglobin which is composed of four subunits and each subunit contain hemegroup (iron in the centre), oxygen bind to this heme group, while myoglobin in muscles cells stored, transport and release oxygen whenever body needed.

  • oxygen transportation
  • red cell production(erythropoiesis)
  • DNA synthesis
  • metabolism and immune function.

how much do we need;

According to British dietetic association, daily recommendations for iron varies. People have different requirements, acoording to heir age, sex, physiological state like pregnancy, and sometimes their state of health. Routine iron supplementation is not recommended for pregnant women in UK.

infants 0-3 months 1.7mg
4-6 months 4.3 mg
7-12 months 7.8mg
childrens 1-3 years 6.9mg
4-6 years 6.1mg
7-10 years 8.7 mg
Adolescents 11- 18 years 14.8 mg(girls)
11.3 mg(boys)
Adults 19-55 years 14.8 mg(females)
19-55 years 8.7 mg(males)
55+years 8.7mg

dietary sources of iron ;

Iron is found in two forms; heme and non heme. heme is animal derived iron and absorbed rapidly as compared to non heme iron which ismostly derived from plant. Heme iron absorb at the rate of 35% while non heme absorb at the rate of 25% and its absorption affected by several factors in food like ; Phytate (present in fibre containing food), Tannins (present in tea and coffee) and calcium. Certain medicines like H2 receptors blockers (used for the treatment of acidity and stomach ulcers), Cholesterol-lowering medications inhibit the absorption of iron.

Vitamin C reduces the inhibitory effect of phytates, polyphenols, calcium and egg proteins and enhances the absorption of iron.

Spinach; spinach is a rich source of iron, about 3.5 ounces of raw spinach contain 2.7mg of iron

Broccoli; Broccoli is a good source of iron,1 cup of cooked broccoli contains 1 mg of iron. Moreover, it is packed with vitamin C, which helps in iron absorption.

Dates; they are an excellent source of iron, carry 0.90 mg/100 g of fruits.

Dried apricots contain 2.6 milligrams of iron per 100 grams. 

Red meat; 3.5 ounces of ground beef contain 6.5 mg of iron.

Turkey; 3.5 ounces (100gramm) of turkey meat has 1.43 mg of iron.

Legumes; beans lentils chickpeas peas and soybean are all good sources of iron, one cup of cooked lentils contain 6.6mg of iron.

Quinoa; 185 gm of cooked quinoa contains 2.8mg of iron.

Pumpkin seeds; 1 ounce of pumpkin seeds contains 2.5 mg of iron.

iron deficiency;

  • Blood loss; Blood loss is the most common cause of iron deficiency. In men and postmenopauseal women, low iron status is almost results from gastrointestinal bleeding.
  • Increased iron requirement: pregnancy, lactation
  • Diminished iron absorption: celiac disease and atropic gastritis.

signs and symptoms of iron deficiency;

  • Lethargy, fatigue
  • pale coloured skin and lower eyelid
  • clubbing of nails
  • increased sensitivity to cold
  • imapaired concentration
  • poor immune system

Low iron status may result in iron deficiency anaemia, more than 2 billion people all over the world suffering from iron defiecency anaemia, making it the most common nutritional deficiency condition.

iron deficency anaemia in pregnant women increases the risk of prinatal infections, pre eclampsia and bleeding. Mternal anaemia also associated with poor fetal wellbieng and is linked to the low birth weight, prematurity and fetal death.

excess iron intake can be harmful;

Excess iron intake can also harmful. certain epidemiological studies indicate a link between high iron intake and increased incidence of cardio vascular disease, type2 diabetes and some cancer of digestive tracrt.

take-home message;

  • Eat balanced diet consist of all food groups, if you are vegan or vegetarian always eat combination of food so iron absorption is not compromised
  • Do not drink tea or coffee with food as they impair absorption of iron.
  • seek your GP advice if; feel tried, women with heavy periods, people with renal diseases or on medication which impair iron absorption.

MIGRAINES

Migraine is common all over the world, it has been estimated that it affects around 1 in every 5 women and around 1 in every 15 men.Migraine is not a just common headache, it is a chronic condition affecting all aspect of life. 90% of people who suffer from migraines are unable to function or work properly during their migraines. According to a report published by Work Foundation UK “Migraine costs the UK economy £8.8 billion per year in lost productivity.

SYMPTOMS;

Migraine symptoms vary from person to person, however the majority of patients presented with three main symptoms;

  • Headache which is usually onesided.people with migraine describe it as throbbing, crushing or pounding.
  • Sensitivity to light and sound
  • Nausea and vomiting

There are different phases of migraine like; prodrome phase, aura phase and resolution phase.

Many migraineurs experience vague vegetative or affective symptoms
as much as 24 hours prior to the onset of a migraine attack. This phase is called the prodrome and should not be confused with the aura phase. Aura phase is consist of neurological symptoms like sensitivity to light or sound.

Within an hour of resolution of the aura symptoms, the typical migraine headache usually appears with its unilateral throbbing pain and associated nausea, vomiting, sensitivity to light(photophobia), or sound (phonophobia). This headache may persist for up to 72 hours if untreated and ended with resolution phase which is characterized by deep sleep.

causes;

The exact cause of migraine remains unclear, but there is often family history of migraine, suggestive of genetic predisposition. Additionally, research suggests that variations within the dopamine D2 receptor gene also may have some effect on susceptibility to migraine. Thus, genetic studies are providing important information about the molecular basis
of migraine. Migraine is also considered as a neurovascular disease because of throbbing nature of headache. According to Dr. John Detre, a professor of neurology and radiology:

Abnormalities in both the circle of Willis and blood flow were most prominent in the back of the brain, where the visual cortex is located. This may help explain why the most common migraine auras consist of visual symptoms such as seeing distortions, spots or wavy lines.”

Every one has different migrain trigger but there are few common triggers which may initiate the attack of migraine like;

  • Hormonal changes; The great female preponderance and the tendency for some women to have migraine attack at certain points in their menstrual cycle hint at hormonal influence.
  • Emotional stress; According to the American Headache Society, about 4 to 5 people with migraine report stress as a trigger.
  • DIET; certain food like alcohol, chocolates, curried meat, smoked fish, yeast extract, food preservatives that contain nitrities and nitrates, artificial sweetener and monosodium glutamate(MSG) may trigger a migraine.
  • Sleep; poor sleep reduces the levels of dopamine and serotonin, neurotransmitters, essential for and trigger migraine headache. one study shows that good sleep reduces both the number and frequency of mgraine in the participants.

Treatment and management

There is no specific treatment for migraine but certiain medicine can be effective for acute attack like

  • Painkillers like paracetamole, Aspirin with an antiemetic for vomitting like Metoclopramide
  • Antinflammatory like ibubrophin
  • Triptans like sumatriptan

if attacks are frequents, prevention of migraine can be treated by propranolol or tricyclic such as amitriptilyin

If you suspect a specific trigger is causing your migraines, such as stress or a certain type of food, avoiding this trigger may help reduce your risk of experiencing migraines.

It may also help to maintain a generally healthy lifestyle, including regular exercise, sleep and meals, as well as ensuring you stay well hydrated and limiting your intake of caffeine and alcohol.

Keeping track of your migraine headach bu using migraine journal can help you identify the triggers and potentially reduces the frequency of your attack

If your migraines are severe or you have tried avoiding possible triggers and are still experiencing symptoms, a GP may prescribe medicines to help prevent further attacks.

Do not allow your life to be controlled by migraine.

seasonal affective disorder

if dark and cold weather makes you depressed and tired, learn about Seasonal affective disorder and what are the best ways to treat it.
Seasonal affective disorder or winter blue is a mood disorder in which people may experience depression/anxiety mostly in winters although they have normal mental health. Around 6%of UK population and between 2-8%of people in other high latitude countries such as Denmark, Canada and Sweden these symptoms may interfere with the normal routine of people and they are unable to perform their work or function properly due to the severity of these symptoms. women are 40% more likely than men to experience symptoms of SAD.

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Advanced Glycation End products and their link to chronic diseases.

Advanced glycation end products are pro-inflammatory molecules found in various foods (animal derived proteins and processed food). They also formed inside the body by a chemical reaction called Glycation. AGEs from diet absorbed partially in the intestine (only 30% ) and about two third of absorbed AGEs remain in the body for 3 day resulting in increased oxidative stress and inflammation.

Factors which may increase the formation of AGEs in food.

Urbarri and his colleagues formed a database of 560 different food and their AGEs content based on standard serving size. This database revealed that AGEs content of food depends on several factors like type of food, cooking temperature and cooking time.Food with higher content of proteins and fats are rich sources of exogenous AGEs as compared to carbohydrates.

  • Animal derived proteins have higher levels of AGEs, On the other hand, fresh fruits vegetables, low-fat milk and legumes have the lowest AGEs (Goldberg et al .,2004). The reason must be sought in the higher quantity of water and in a richer presence of vitamins and antioxidant molecules, which may be able to prevent AGE formation.
  • Cooking techniques; Different cooking techniques are linked to the formation of AGES like grilling, frying, roasting. Foods items processed by dry heat like chips cracker contains the highest level of AGEs per gram of food (Uribarri J, 2010) this processing method also increases AGEs content of lean red meat and poultry. As this pyramid shows formation of AGEs by different cooking techniques frying>grilled>boiled>raw.

   The AGES Pyramid                                                                      

AGEs and their link with chronic diseases;

Advanced glycation end products are believed to play a critical role in the pathogenesis of different diseases like polycystic ovarian syndrome (PCOS), diabetes, liver diseases, heart diseases, arthritis and kidney failure. our body can eliminate AGEs by enzymatic mechanisms and through the kidney. however, when we consume too much AGEs, they begin to accumulate in our body and promote oxidative stress and inflammation.There is also evidence that people with Diabetes and PCOS have higher levels of AGEs in their body as compared to healthy population.

How much do we need;

limited data is available regarding the exact amount of AGEs intake however, according to Uribarri, the average total daily adult consumption of AGEs in our diet is around 16,000 AGE kU/day. Therefore, a high-AGE diet is often referred to as anything significantly above 16,000 kilo units daily and anything well below this is considered as low AGEs diet.

How we generate low AGEs diet;

studies has shown that by restricting the dietary intake of AGEs in patients with diabetes and kidney diseases as well as in healthy people, reduces the markers of oxidative stress and inflammation.one study reported that consumption of low AGEs diet over 4 weeks improve insulin resistance in overweight women .Some studies reported that reduced level of serum AGEs are associated with reduction in body fat mass and adipose tissues in women with PCOS.

Reduced intake of AGEs can be achieved by ;

  • Increasing the consumption of fish, legumes, low-fat milk products, vegetables, fruits, and whole grains.one study reported that phytonutrients like iridoids found in deep red coloured berries can reduces AGEs formation in our body.
  • By reducing the intake of solid fats, fatty meats, full-fat dairy products, and highly processed foods.
  • By switching cooking techniques; boiling, steaming and stewing reduces the production of AGEs in food. For example, the high AGE content of broiled chicken (5,828 kU/100 g) and broiled beef (5,963 kU/100 g) can be significantly reduced (1,124 kU/100 g and 2,230 kU/100 g, respectively) when the same piece of meat is either boiled or stewed.
  • The use of acidic marinades, such as lemon juice and vinegar, before cooking, can also be encouraged to limit dAGE generation.
  • Get active; regular physical activity may reduces the formation of AGEs inside the body.

Finally, more research is needed to fully understand the role of dietary AGEs in chronic diseases and a complete database on AGE content in different foods may helpful for future studies. however, low AGEs diet guidelines are consistent with the existing healthy eating recommendation. As with most dietary issues, the key is moderation: “Just diminish your exposure.


Polycystic ovarian syndrome and lifestyle interventions

Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder among women in their childbearing age around 18 -25% of women all over the world suffering from this syndrome.

PCOS SYMPTOMS

Women with this PCOS can represent different symptoms, most common are following;

  • Irregular periods
  • Excess facial hair growth (HIRSUTISM)
  • Infertility or difficulty getting pregnant ( because of irregular ovulation or failure to ovulate)
  • Obesity
  • Acne and skin problems like Dermatitis.
  • Depression, anxiety, bipolar disorders and eating disorders.
  • Metabolic syndrome; hypertension, diabetes and coronary artery diseases

How to diagnose PCOS??

This condition should invite early diagnosis and intervention because there is considerable evidence that women with PCOS are at increased risk of
infertility, dysfunctional uterine bleeding, metabolic syndrome, type II diabetes, and cardiovascular disease. A Rotterdam criterion is widely used as a diagnostic assessment for PCOS. It requires two of the following three features;

  • Irregular or skipped periods
  • Anovulation
  • Multiple cysts in ovaries on ultrasound
  • Higher levels of Androgens; either manifested by symptoms like Hirsuitism, Acne or balding or biological evidence like raised levels of Testosterone in their blood tests.

Causes and risk factors;

The exact cause of this syndrome remains elusive however excess androgens production and insulin resistance may cause this syndrome. A Genetic factor is also important as several studies reported an increase incidence among first degree relatives. It is reported by studies that around 50-70% of women with PCOS have insulin resistance meaning their cells are not able to use insulin effectively. To keep body glucose normal, the body tries to pump out the high level of insulin. This hyperinsulinemia is associated with weight gain and increase production of androgen hormone testosterone. Insulin resistance makes it harder to lose weight, that’s why women with PCOS experience this issue.

lifestyle interventions for PCOS management;

According to international PCOS guideline 2018, lifestyle interventions like diet, exercise, behaviour or combined are recommended as first line management for PCOS. Several studies reported the higher prevalence of obesity and overweight in women with PCOS as compared to the general population so these prevention opportunities are particularly relevant for the management of PCOS symptoms.

How the intervention might work

Lifestyle intervention is therefore anticipated to work because a reduction in the Body Mass Index (BMI) will be associated with a reduction in insulin resistance, which will, in turn, lead to an improvement in the reproductive and metabolic features of PCOS. Weight loss of as little as 5-10% has been demonstrated to correct oligo anovulation and improve the ability of women with PCOS to conceive.

PCOS nutrition ;

its is frequently asked by women with PCOS that which diet is best for curing their symptoms but unfortunately there is no such miracle diet. Research shows that diet which reduces insulin resistance like some carbs, proteins and healthy fats may help in improving menstrual irregularities and obesity.

➡️choose your carbs wisely as all carbs are not bad… carbohydrates with high fibre content like whole grains, lentils, legume and beans are helpful in reducing weight and risk of type 2 diabetes in women with PCOS.

➡️ Food with a low glycemic index (a ranking system indicate how rapidly blood sugar level rises after eating carbohydrates) may reduce insulin resistance as reported by several studies.

➡️ Protein may helps in cravings, balance hormones levels and aid in weight reduction, examples are lean meat, egg, seafood and plant based proteins. some evidence has suggested the beneficial effect of a diet with higher ratio of protein to carbohydrates.

➡️ Food that reduces inflammation as; tomato, spinach, olive oil, walnuts, almonds, blueberries and strawberries.

Food to avoid;

  • Food high in refined carbs like white bread, Muffins, white pasta
  • sugary drinks like soda and juices as they increase blood sugar levels, which can lead to weight gain and worsen the symptoms of PCOS.
  • Processed food and red meat.

Review the stress in your life;

stress increases cortisol level and this high level is linked with insulin resistance and weight gain. yoga and meditation can reduce stress as reported by studies.

Make sure you are getting enough sleep:

Several studies observed that short sleep duration is significantly associated with metabolic abnormalities, including higher BMI, raised fasting insulin levels, and increased risk of insulin resistance. Make sure you are getting enough and good quality sleep.

Get active;

Regular physical activity may help in reducing insulin resistance. studies have shown that low intensity exercise like walking or cycling reduces levels of cortisol and helps in reducing insulin resistance.

Consider supplements;

certain supplements like vitamin D, Myo inositol may help manage weight and other symptoms of PCOS though there is very little research is available to recommend these supplements for PCOS.

Take-home message;

PCOS is distressing for most of the women due to its symptoms and it is suggested by clinicians and dietitians that life style modification is the first line treatment for overweight and obese women.However due to diversity of symptoms one size does no fit for all. Make healthy food choices and create workout plan that suits your body and your PCOS….

BEAT THE BLOAT

Bloating is swelling or distention of the abdomen (belly area) after eating.it is very frequent and normal for the majority of people. About 16-30% of people report that they regularly experience bloating after eating. But for some, it is quite painful and makes them sluggish and uncomfortable.

Causes of bloating;

➡️ Some medical conditions like; celiac disease, irritable bowel syndrome, eating disorders, hormone flux and food intolerance.

➡️ Serious causes like; ovarian cancer, pancreatic cancer, stomach cancer liver diseases and kidney diseases but remember, bloating in these conditions is associated with other specific symptoms.

➡️Large meals: eating large potion means our body produces more gas during digestion and that process can lead to our tummy being larger.

➡️Food sensitivity: some food like beans, pulses, lactose, wheat, veggies high in FODMAP may cause bloating in some people.

➡️ fizzy drinks, drinking through a straw and talking during eating may increase the amount of swallowed air.

➡️Stress and anxiety may also cause bloating, poor sleeping habits can have an impact.

➡️Drinking too much caffeine or alcohol

How to reduce bloating;

👉Small meal and proper chewing: proper chewing may reduce the amount of swallowed air and makes you eat slower.

👉Check your fibre: fibre intake should be adequate. too little or too much fibre can make bloating worse.

👉Food records: food diaries may help to identify the patterns of symptoms and food you eat.

👉 Fermented food; eating fermented food like kimchi, tempeh, pickles and kefir may reduce bloating as they are full of probiotics and natural way to boost good bacteria in our gut.

👉 Stay well hydrated: As constipation is one of the main cause of bloating and could be triggered by not drinking enough fluid. Aim to drink 1.5 litres of water a day and cut down on hydration robbers like caffeine, alcohol, fizzy drinks.

👉Avoid chewing gums and carbonated drinks.

👉Regular exercise: A short walk after a meal can alleviate bloating. Aim for 30 minutes mild exercise. gentle exercise and stretching can help diffuse trapped gas like yoga

👉 Check your hormonal cycle; many women experienced bloating and constipation when their period is due, because of higher levels of progesterone. Overcome any hormonal hurdle by staying active, drinking plenty of water and eating a healthy diet.

👉Herbal tea can also helpful; peppermint tea or peppermint oil has been shown to relax our gut muscles and help relieve bloating triggered by trapped gas. several studies suggest that peppermint oil in IBS is helpful as it has an antispasmodic effect which means it relax our gut and reduce tummy pain and bloating associated with IBS.

▶️Take-home Message: it is important to remember that occasional bloating is normal but If bloating is associated with diarrhoea and other medical conditions you should consult with the doctor.