Osteoporosis; the silent disease

20th October is the world osteoporosis, around 3 million people in the UK are affected by osteoporosis and 500,000 people receive hospital treatment for fragility fracture every year. In Europe, the disability due to osteoporosis is greater than that caused by cancer (except lung cancer). BUT what is osteoporosis

Osteoporosis means Porous bone. Bone is a living tissue that is constantly being broken down and replaced, we all have some degree of bone loss as we get older but osteoporosis occurs when this balance is disturbed and either body loses too much bone or makes too little new bones. Bones lost their density and become porous and fragile. Osteoporosis develops slowly over several years

osteoporosis affects women and men of all races but white and Asian women, especially older women who are past menopausal are at high risk.

Symptoms

osteoporosis is silent diseases as symptoms appear very late, often only diagnosed when a fall or sudden impact causes a bone to break.

  • Chronic back pain
  • Loss of height over time
  • Stooped or hunched posture
  • Limited mobility

what are risks

  • GENDER
  • ETHNICITY
  • FAMILY HISTORY
  • AGE
  • MENOPAUSE
  • LOW BODY WEIGHT
  • PREVIOUS FRACTURES
  • MEDICAL CONDITION; Early menopause, thyroid disorders
  • MEDICATIONS; Glucocorticoids, Antacids

HOW TO PREVENT OSTEOPOROSIS

Osteoporosis is preventable by adopting healthy lifestyle guidelines. Nutrition, physical activity, weight, smoking cessation, avoiding heavy alcohol drinking can improve bone health.

Eat well for bone health

  • Well balanced diet consist of all food groups play a critical role in building and maintaining good bone health at every stage of life. There are certain vitamins like vitamin D and K play an important role in preventing osteoporosis. similarly, minerals like calcium, magnesium, phosphorous and copper are important for bone health.
  • Building strong bones begin in childhood and are essential to the prevention of osteoporosis. Good nutrition with plenty of calcium rich food like milk and dairy products or other calcium rich sources helps children to achieve their highest possible peak bone mass.

Recent research has found that olive oil, soybeans, blueberries, and food rich in omega 3 fatty acids are like fish oil, and flax seeds may have bone boosting benefits.

EXERCISE

Regular physical activity like aerobic exercises aimed at 30-45 minutes per day or 150 minutes every week helps in preventing osteoporosis.

Studies show that weight bearing exercises such as weight training, walking, hiking, jogging, climbing stairs and playing tennis over a period of time can improve bone density even build a new bone.

WHAT TO AVOID FOR GOOD BONE HEALTH

There are certain foods that should be consumed in moderation like soda, caffeine, saturated fats, salt and alcohol. They have no direct effect on bone health but they impair calcium absorption and reduce bone density.

smoking and bone health;

several studies found smoking as risk factor for osteoporosis and bone fracture.How smoking affects bone health, still unclear that decrease in bone density is due to smokng itself or to other risk factors common among smokers. For example women who smoke also tend to have early menopause than nono smokers and in many cases people who smoke are less physical active, drink more alcohol and poor diet as compared to non smoker.

Osteoporosis is not an invietable part of ageing; it is preventable.So it is vital that all of us, of all ages, start taking care of our bones now , before it is too late. love your bones protect your fracture

FODMAPs and their link with IBS

FODMAP is not a single entity, but a group of an acronym that stands for fermented, oligo, di, monosaccharides and polyols. FODMAPs are found in a variety of fruits, vegetables, milk and wheat.

HOW FODMAP WORKS;

FODMAP may exacerbate IBS symptoms through a various mechanism such as ;

OSMOTIC OVERLOAD; Poor absorption of FODMAP causes osmotic overload and distention of small intestine and abdominal symptoms.

BACTERIAL FERMENTATION; FODMAPs are rapidly absorbed by colonic bacteria and produce colonic distention due to gas production associated with abdominal pain and bloating.

FODMAPs are not bad for everyone, in normal healthy individuals they have important physiological effects like; they increase stool bulk, enhance calcium absorption and modulate immune function. They selectively stimulate the growth of Bifidobacterium a species of good bacteria.

FODMAPs and the irritable bowel syndrome (IBS)

IBS is a chronic functional disorder of the intestine, the most common symptoms are abdominal pain, bloating and altered bowel movements.The global prevalence of IBS is around 12% and is more common in women.

Treatment of IBS consist of pharmacological and non pharmacological measures. Among the non pharmacological options; stress reduction, dietary modifications ( restriction of certain food (FODMAP) and cognitive behaviour therapy are the most important.

LOW FODMAP DIET

In recent years, there is a growing body of research which support low FODMAP diet for the management of IBS, studies have shown that it can help up to 70-85% of patients with IBS achieve relief of their symptoms. it is now included in NICE guidelines as a second line intervention for IBS.

Following a low fodmap diet may helpful in alleviating symptoms of IBS like

  • Abdominal pain
  • Bloating
  • Altered bowel movement
  • Gas

There is no evidence that low FODMAP diet works for non digestive symptoms that are associated with IBS, such as headache and skin or joint problems.

Phases of low FODMAP diet

It is three phased elimination diet, first phase is the restriction phase in which high FODMAP food should be completely avoided. This phase lasts for 2-6 weeks. Second phase is reintroduction in which food with high FODMAP reintroduced but one at a time. This will enable you to identify which FODMAP you are sensitive too. This stage can take several months to complete and ideally should be completed under the guidance of a dietitian. Personalized stage the third phase is a combination of phase 1 and phase 2 and involves the long term, modified FODMAP diet. For more information regarding a high FODMAP food list https://www.monashfodmap.com/about-fodmap-and-ibs/high-and-low-fodmap-foods/

WHAT IS DOWNSIDES OF LOW FODMAP.

There is short term risk associated with insufficient protein, dietary fibre, B group vitamins and calcium intake.

Low levels of prebiotics;

Prebiotics are indigestible carbohydrates that are resistant to gastric acid and fermented by bacteria present in the large intestine. Prebiotics predominately found in food containing Fructans and Galacto-oligosaccharides.The low FODMAP diet restricts the intake of many high prebiotic (high FODMAP) foods and prolong restriction of high FODMAP can alter gut microbiome diversity. Studies have shown low levels of total bacterial abundance and reduced level of bifidobacterium following a low FODMAP diet. This is why re-introduction phase is very important as it allows you to have more variety in your diet but also maintain a healthy gut.

Calcium in low FODMAP diet;

The restriction of lactose containing dairy products may enhance the tendency to poor calcium availability since these items are primary source of calcium and promoting effect of lactose on calcium absorption is lost.

Lactose or dairy free calcium sources are; Kale, lactose free plant based milk fortified with calcium, hard cheese, firm tofu.

TAKE HOME MESSAGE

Low fodmap diet is considered as a second line treatment option for patients with IBS as recommended by NICE guidelines. This diet should not be used without specialized dietary advice from a registered professional. Vegan or vegetarian are at increased risk of protein deficiency due to limited plant protein sources however well constructed meal plans by registered dietitians may reduce possible nutritional deficiencies.

Non Alcoholic fatty liver disease (NAFLD) and lifestyle interventions

We know that obesity is a risk factor for several non communicable diseases, it can lead to diabetes and other metabolic conditions, but there is less awareness that obesity can lead to serious liver disease.It is estimated up to 1 in every 3 people in the UK has early stages of NAFLD, where there are small amounts of fat in their liver.

Non-alcoholic fatty liver disease is the accumulation of triglycerides in the liver cell and this buildup is independent of alcohol consumption. It is a spectrum of disorder ranging from less severe steatosis (fatty liver) to more severe non-alcoholic steatohepatitis (NASH), where the liver has become inflamed; this is estimated to affect up to 5% of the UK population. Fibrosis and cirrhosis develop at later stages and lead to liver failure and sometimes liver carcinoma.

what causes NAFLD

  • The exact cause of NAFLD remains unclear, however, it is linked with genetic and environmental factors like
  • 1.Obesity
  • 2.Diabetes
  • 3.Hyperlipidemia
  • 4.Women with PCOS5.
  • 5.Sedentary lifestyle

Treatment and prevention

There is no specific pharmacological treatment for NFALD. However, various medicines can be useful in managing the problems associated with the condition like;medications for high cholesterol, high blood pressure and Insulin sanitizers.

Life style modifications;

There is a strong consensus that lifestyle interventions such as diet, physical activity and weight reduction can help in preventing and reduces the progression of the disease. A metanalysis of 23 trials shows that lifestyle modification including weight loss and physically activity consistently reduced liver fat and improved histopathology.

WELL BALANCED DIET; Diet consists of vegetables and fruits with less processed carbohydrates. Low Glycemic index carbohydrates with more fibre content also reduce insulin resistance which is directly linked with NAFLD. Low caloric diet intake ( 3-6 months) either low carbohydrates or low fat diet results in weight loss and improved lipid profile.

Intake of polyunsaturated fats especially omega 3 fatty acids reduces the risk of NAFLD. Mediterianean diet is a best source of mono unsaturated fatty acids( MUFA) like n– oleic acid (olives, nuts, avocado), which play an important role in the metabolic profile of human metabolism. MUFA has been demonstrated a beneficial effect on lipid profile bt decreasing  plasma triacylglycerol and very low density lipoprotein (VLDL) cholesterol concentrations and modestly increasing high density lipoprotein (HDL) cholesterol without adversely affecting low density lipoprotein (LDL) cholesterol concentrations. 

Soft drinks are leading cause of added sugars in the world and different observational studies report a positive association between soft drink consumption and NAFLD. Soft drinks like cola drinks contain caramel coloring, which is rich in advanced glycation end products (AGEs) that may increase insulin resistance and inflammation.

Observational studies have demonstrated a favourable impact of coffee intake on health and in particular a protective effect from the metabolic syndrome. Coffee contain polyphenols chlorogenic acid which acts as antoxidants, anti inflammatory and reduces the risks of developing NAFLD and cardiovascular diseases.

Regular physical activity: There is a dose-response relationship between NAFLD and physical activity (both prevalence and disease severity,  therefore, the more physical activity performed throughout the day, the better! Aim to do at least 150 minutes/week of physical activity like walking or cycling. Increasing daily walking has also been shown to improve fat oxidation and is a way of increasing physical activity levels at no cost and without additional equipment. Aerobic and resistance exercises both improves NAFLD. A systematic review (24 exercise-only studies) revealed that exercise produced a 20–30% relative reduction in hepatic steatosis, independent of weight loss in NAFLD patients.

weight reduction: Based on available data, patients should optimally achieve a 5%-10% weight reduction. A prospective study with 7 years of follow up emphasized that even a modest weight change of 3–5 kg is an independent predictor for the development and remission of NAFLD, regardless of baseline body mass index (BMI).

TAKE-HOME MESSAGE

Lifestyle interventions can be highly effective in treating NAFLD across the disease spectrum and offer a holistic way of managing not only liver health, but also cardiovascular and metabolic health. Patients often feel difficult to achieve and implement these modifications, however with proper and individualized support suffient long term changes can be possible.

always set Smart, Meaurable, Achievable, Relevant, Timely goals

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.

Carbohydrates; friend or foe

Carbohydrates one of the important macronutrient found in food along with fats and protein, but the most misunderstood nutrient. People often say carbs as fattening and linked to various diseases, but this is not a real story. Let’s examine their role and bust this myth surrounding this hotly debated topic.

Types of carbohydrates:

Simple carbohydrates; simple carbohydrates consist of molecule called glucose. They rapidly degraded inside the body and raises blood glucose level. examples are honey, maple syrup, fruits and vegetables. Added sugar in cakes,candies and fruit juices is also simple carbs.

Complex carbohydrates; complex carbohydrates are starch and fibre. These are consist of long chain of glucose molecules. Examples are potatos, corn. Refined carbohydrates like white bread and pastries are also strach. Fibre is a plant derived indigestible carbohydrate.

Why we need carbohydrates:

  • Primary source of energy; The main function of carbohydrates is to provide energy. carbs are quicker to process and provide fuel to our body.our brain consume more than 20% of total energy intake and glucose is the main fuel for brain cells.unused glucose is stored in muscles and liver in the form of glycogen.
  • Important for Gut health; Fibre is helpful in digestion and improves our gut health. Our gut is the host of around 1 trillion microorganisms. several studies show that these microorganisms are crucial for various aspects of our health. Dietary fibers are indigestable and feed our gut microbiota and promote growth of GOOD bacteria.
  • Carbohydrates helps preserve muscles mass; carbohydrates prevent the breakdown of protein for energy and preserve muscles mass.
  • They influence heart diseases and Diabetes; carbohydrates enrich with fibre, reduces the risk of heart diseases, diabetes and some form of cancer. One study shows that people eating cereal based fibre have a decreased risk of colon cancer. Oats and barely contain a special chemical called Beta glucan which may helps to reduce blood cholesterol levels.

How much carb do we need

Daily recommended intake for carbohydrates is 45-65% of total caloric intake and 130gm of glucose is needed for adequate supply of energy to the brain.

Why people think carbs are bad for our health;

Carbohydrates have a bad reputation as people think eating carb means they are eating an unhealthy diet and may gain weight, but all carbohydrates are created not equally. What makes a carb good choice for our health. complex carbohydrates are good for our health as they are

  • lower in calories
  • nutrient dense like minerals vitamins and fibre
  • lower in salt and fats

while simple carbohydrates like sugar, processed food, candies, fizzy drinks fruit juices and pastries.They ae not good for our health as they are

  • lower in nutrients
  • higher in calories
  • higher in salt and fat

These carbohydrates are linked to obesity and other chronic dieaeses as reported by studies. These carbs increase blood glucose levels rapidly and to combat this hyperglycemia, our body releases insulin. insulin promotes glucose storage in muscles and liver and allows the entry of glucose into fat cells by converting glucose into fatty acids. long term intake of a diet high in refined carbs may cause insulin resistance and increase the risk of obesity and type 2 diabetes. Moreover, sugary drinks are a leading cause of tooth decay in children and adults.

what’s the answer to carbohydtrates;Eating the right type of carbs with moderation.

  • Look for carbohydrates which makes you fuller for longer with minium calories like wholegrains, fruits and vegetables.
  • Avoid refined or procesed carbohydters.limit the intake of added sugars.
  • Take note of your body; whats makes you happy and energize and what food makes you lethargic and bloated. Notice pattern of your body, adjuct accordingly and choose your carb wisely.

Do not eat less, eat right ”.