Flavonoids in citrus fruits ‘cut stroke risk’

Grapefruit and oranges “appear to protect against having a ‘brain attack’”, the Daily Mail has reported. The Mail says that these and other citrus fruits can protect the brain from stroke due to their antioxidant content.

The research behind this story involved almost 70,000 women taking part in the Nurses’ Health Study. They were asked to complete food frequency questionnaires (which asked them to recall how frequently certain foods were consumed during a specified period of time) every four years and over around 14 years of follow-up the researchers documented the numbers of strokes that occurred, overall and by type.

The researchers found that women who had the highest intake of flavanone (a crystalline compound found in citrus fruit) had a reduced risk of ischaemic stroke. However, they found no association between consuming actual citrus fruits and juices and being at risk of ischaemic stroke, and no association between consumption of flavonoids overall and risk of stroke.

This makes these findings far from conclusive. Whether citrus fruits and the chemicals they contain have any association with stroke risk needs more investigation. But on the basis of this study alone, there is no evidence that women who eat citrus fruits will reduce their risk of stroke. However, a balanced diet high in fruit and vegetables is known to be beneficial to health and can reduce the risk of several diseases, including cardiovascular disease.

Where did the story come from?

The study was carried out by researchers from the University of East Anglia and other institutions in the US and Italy, and was funded by the National Institutes of Health, Department of Health and Human Services. It was published in the peer-reviewed medical journal Stroke.

The Daily Mail does not accurately represent the findings of the study. Its headline, “How eating oranges and grapefruit can cut the risk of a stroke”, contradicts the finding that there was no significant association between intake of citrus fruits and juices and risk of stroke.

What kind of research was this?

This was an analysis of women enrolled in the ongoing Nurses’ Health Study in the US. The researchers aimed to use data from this cohort study to examine associations between subclasses of flavonoids and risk of stroke. Flavonoids are plant chemicals believed to have antioxidant properties, and are found in several food groups, including citrus fruits, berries, onions, certain pulses, tea and wine.

Cohort studies such as this are not great at showing cause and effect. In this study, researchers circulated regular food frequency questionnaires at the same time as looking at clinical outcomes. It is difficult to guarantee that food intake patterns preceded the development of cardiovascular disease. Furthermore, because food frequency questionnaires are self-completed, they are also likely to contain inaccuracies and may not represent the pattern food intake over a lifetime. Finally, it may be difficult to ensure that other things that could be associated with both diet and risk of stroke (confounding factors) have been taken into account.

What did the research involve?

The Nurses’ Health Study started in 1976 and enrolled 121,700 female nurses aged 30 to 55. Participants completed follow-up questionnaires on diseases and lifestyle factors every two years, as well as food frequency questionnaires every four years. In this study, researchers looked at food questionnaires completed from 1990 onwards (the time when the questionnaires covered sufficient fruit and vegetables to assess flavonoid intake). This study included the 69,622 women who had sufficient information on food intake and who did not report a stroke before 1990.

The researchers constructed a database to assess intake of the different flavonoid subclasses. Intake of individual subclasses was calculated as the total consumption frequency of each food, multiplied by the content of the specific flavonoid for the specified portion size. The six flavonoid subclasses were reported to be those commonly consumed in the US diet:
■flavanones (eriodictyol, hesperetin, naringenin)
■anthocyanins (cyanidin, delphinidin, malvidin, pelargonidin, petunidin, peonidin)
■flavan-3-ols (catechins, epicatachins)
■flavonols (quercetin, kaempferol, myricetin, isohamnetin)
■flavones (luteolin, apigenin)
■polymers (including proanthocyanidins, theaflavins, and thearubigins)

The outcome of stroke was self-reported, with reports verified by review of medical records.

What were the basic results?

Over 14 years of follow-up there were 1,803 strokes among the 69,622 participants (52% ischaemic strokes – caused by a blood clot, 14% haemorrhagic – caused by a bleed in the brain, and the rest – of unknown type).

The average intake of total flavonoids was 232mg per day. Tea was reported to be the main contributor to total flavonoid intake, followed by apples and oranges or orange juice. Women who ate more flavonoids tended to:
■exercise more
■have a greater intake of fibre, folate, fruits and vegetables
■have a lower intake of caffeine and alcohol
■be less likely to smoke

The researchers found that women who consumed the highest quantity of the flavanone subclass had reduced risk of ischaemic stroke compared with those who consumed the lowest quantity of flavanone (relative risk 0.81, 95% confidence interval 0.66 to 0.99). The relationship between flavanones and stroke overall was not reported.

As 95% of flavanones are reported to be derived from citrus (in this study, oranges and orange juice were the highest contributors), they looked for a relationship between intake of citrus fruit/juice and risk of ischaemic stroke but found no significant association (relative risk 0.90, 95% confidence interval 0.77 to 1.05).

How did the researchers interpret the results?

The researchers conclude that flavonoid intake was not associated with risk of stroke, but that increased intake of the flavanone subclass reduced the risk of ischaemic stroke. They say that because experimental data suggests that the flavanone content of citrus fruits may protect the heart, there may be an association between citrus fruit consumption and stroke risk.

Conclusion

Despite the news headlines, this study provides no evidence that women who eat citrus will reduce their risk of stroke.

The researchers found a link between higher intake of flavanones and reduced risk of ischaemic stroke, but:
■no association between the actual consumption of citrus fruits and juices and risk of ischaemic stroke
■no association between total flavonoid intake and risk of stroke

The researchers didn’t report on any association between flavanone, flavonoid, or citrus consumption and risk of stroke overall. There was no association with haemorrhagic stroke and presumably there was none found for stroke overall.

Further problems with making the conclusions stated in the headlines include:
■The design of this cohort study and therefore cannot easily imply cause and effect. The researchers excluded women who had experienced a stroke prior to 1990, but assessed both food consumption and stroke outcomes over the following 14 years. This makes it difficult to ensure that food intake patterns preceded the development of cardiovascular disease.
■Food frequency questionnaires are self-completed and often contain inherent inaccuracies, and may not represent a lifelong food intake pattern.
■The researchers used the most recent US Department of Agriculture databases categorise individual foods according to their content of flavonoid chemicals. However, they do not further describe how they did this in their report. As the researchers acknowledge, there is potential for the misclassification of flavonoids using this method as there is wide variation in flavonoid content of foods. Flavonoid content of fruit depends on their geographical origin, growing season, different cultivars, agricultural methods and processing. It is also difficult to say how flavonoids are processed in the body.
■The researchers did adjust their analyses for multiple potential dietary, lifestyle and medical factors, but it is possible that some confounding factors that could be associated with both diet and risk of stroke have not been taken into account.

Whether or not citrus fruits and the chemicals they contains have any association with stroke risk may be a topic for further research. However, on the basis of this study alone, there is no evidence that women who eat grapefruit, oranges, or any other citrus fruit will reduce their risk of stroke.

10 ways to stop leaks

For many people with incontinence, the following self-help tips and lifestyle changes are enough to relieve symptoms.


1. Daily pelvic floor exercises

These can be really effective at reducing leakage, but it’s important to do the exercises properly. Find out how to do pelvic floor exercises.

You may have to do these exercises for three months before you see any benefits.

2. Quit smoking

If you smoke, you put yourself at risk of incontinence because coughing puts strain on your pelvic floor muscles. Advice to help you stop smoking is available from your GP or pharmacist. You can also call the NHS smoking helpline on 0800 022 4 322.

Read more about how to stop smoking.

3. The right exercise

High-impact exercise puts pressure on your pelvic floor muscles and can increase leakage. Sit-ups can also make you leak by straining your pelvic floor muscles. If you want to strengthen your pelvic floor to relieve symptoms, replace jogging and aerobics classes with Pilates. This gentle method of stretching and strengthening core muscles is becoming more popular as a treatment for stress incontinence.

4. Avoid lifting

Lifting puts strain on your pelvic floor muscles so avoid it wherever you can. When you do need to lift something, such as when picking up children or shopping bags, tighten your pelvic floor muscles before and during the lift.

5. Lose weight

Being overweight can weaken your pelvic floor muscles and can cause incontinence because of the pressure of fatty tissue on the bladder. Your symptoms may improve, and could clear up completely, if you lose the excess weight.

To check whether you're a healthy weight, use our Healthy weight calculator. Your body mass index (BMI) is a measure of whether you're a healthy weight for your height.

Read more about how to lose weight.

6. Deal with constipation

Straining to empty your bowels weakens your pelvic floor muscles and makes leakage worse. Never delay the urge to empty your bowels. If you have constipation, it may help to change your diet and lifestyle. Eating more fibre and taking more exercise can help. It may also help if you change the way you sit and use your muscles to empty your bowels. A specialist physiotherapist can advise you on this.

Read more about food and diet.

7. Cut down on caffeine

Caffeine irritates the bladder and can make incontinence worse. Coffee has the biggest effect, so stop drinking it or switch to decaffeinated. Fizzy drinks, tea and cocoa also contain caffeine, so cut down on these too and replace them with water and herbal or fruit teas.

8. Cut down on alcohol

Alcohol is a diuretic, a substance that makes you urinate more often. Cutting down may help your incontinence symptoms.

Read more about how to cut down on your drinking.

9. Drink enough water

Drink six to eight glasses of water a day (but not more) unless your doctor advises you otherwise. Many people with urinary incontinence avoid drinking fluids as they feel it causes more problems. However, limiting your fluid intake makes incontinence worse because it reduces your bladder's capacity.

10. Food for thought

Avoid spicy and acidic foods, such as curries and citrus fruits, as they can irritate the bladder and make symptoms worse.

Eight tips for healthy eating

Eating a healthy, balanced diet is an important part of maintaining good health, and can help you feel your best. It can be simple, too. Just follow these eight tips to get started.

The two keys to a healthy diet are:

• Eat the right number of calories for how active you are, so that you balance the energy you consume with the energy you use. If you eat or drink too much, you’ll put on weight. If you eat too little you’ll lose weight. The average man needs around 2,500 calories a day. The average woman needs 2,000 calories. Most adults are eating more calories than they need, and should eat fewer calories.
• Eat a wide range of foods to ensure that you’re getting a balanced diet and that your body is receiving all the nutrients it needs.

These practical tips cover the basics of healthy eating, and can help you make healthier choices:

1. Base your meals on starchy foods
   Starchy foods include potatoes, cereals, pasta, rice and bread. Choose wholegrain varieties when you can: they contain more fibre, and can make you feel full for longer. Starchy foods should make up around one third of the foods you eat.
   Most of us should eat more starchy foods: try to include at least one starchy food with each main meal. Some people think starchy foods are fattening, but gram for gram they contain fewer than half the calories of fat. Learn more in Starchy foods.
2. Eat lots of fruit and vegIt’s recommended that we eat at least five portions of different types of fruit and veg a day. It’s easier than it sounds. A glass of 100% unsweetened fruit juice can count as one portion, and vegetables cooked into dishes also count. Why not chop a banana over your breakfast cereal, or swap your usual mid-morning snack for some dried fruit? 
3. Eat more fishFish is a good source of protein and contains many vitamins and minerals. Aim for at least two portions a week, including at least one portion of oily fish. Oily fish is high in omega-3 fats, which may help to prevent heart disease. You can choose from fresh, frozen and canned; but remember that canned and smoked fish can be high in salt. Oily fish include salmon, mackerel, trout, herring, fresh tuna, sardines and pilchards. Non-oily fish include haddock, plaice, coley, cod, tinned tuna, skate and hake. Anyone who regularly eats a lot of fish should try to choose as wide a variety as possible.
4. Cut down on saturated fat and sugarWe all need some fat in our diet. But it’s important to pay attention to the amount and type of fat we’re eating. There are two main types of fat: saturated and unsaturated. Too much saturated fat can increase the amount of cholesterol in the blood, which increases your risk of developing heart disease. Saturated fat is found in many foods, such as hard cheese, cakes, biscuits, sausages, cream, butter, lard and pies. Try to cut down, and choose foods that contain unsaturated rather than saturated fats, such as vegetable oils, oily fish and avocados. For a healthier choice, use a just a small amount of vegetable oil or reduced fat spread instead of butter, lard or ghee. When you're having meat, choose lean cuts and cut off any visible fat. Learn more, and get tips on cutting down, in Eat less saturated fat.
   
   Most people in the UK eat and drink too much sugar. Sugary foods and drinks, including alcoholic drinks, are often high in calories, and could contribute to weight gain. They can also cause tooth decay, especially if eaten between meals. Cut down on sugary fizzy drinks, alcoholic drinks, cakes, biscuits and pastries, which contain added sugars: this is the kind of sugar we should be cutting down on rather than sugars that are found naturally in foods such as fruit and milk. Food labels can help: use them to check how much sugar foods contain. More than 15g of sugar per 100g means that the food is high in sugar. Learn more in Sugars.
5. Eat less salt
   Even if you don’t add salt to your food, you may still be eating too much. About three-quarters of the salt we eat is already in the food we buy, such as breakfast cereals, soups, breads and sauces. Eating too much salt can raise your blood pressure. People with high blood pressure are more likely to develop heart disease or have a stroke. Use food labels to help you cut down. More than 1.5g of salt per 100g means the food is high in salt. Adults and children over 11 should eat no more than 6g of salt a day. Younger children should have even less. Learn more in Salt: the facts.
6. Get active and be a healthy weightEating a healthy, balanced diet plays an important part in maintaining a healthy weight, which is an important part of overall good health. Being overweight or obese can led to health conditions such as type 2 diabetes, certain cancers, heart disease and stroke. Being underweight could also affect your health. Check whether you’re a healthy weight by using the Healthy weight calculator. Most adults need to lose weight, and need to eat fewer calories in order to do this. If you're trying to lose weight, aim to eat less and be more active. Eating a healthy, balanced diet will help: aim to cut down on foods that are high in fat and sugar, and eat plenty of fruit and vegetables. Don't forget that alcohol is also high in calories, so cutting down can help you to control your weight. If you're worried about your weight, ask your GP or a dietitian for advice.
   
   Physical activity can help you to maintain weight loss or be a healthy weight. Being active doesn’t have to mean hours at the gym: you can find ways to fit more activity into your daily life. For example, try getting off the bus one stop early on the way home from work, and walking. Being physically active may help reduce the risk of heart disease, stroke and type 2 diabetes. For more ideas, see Get active your way. After getting active, remember not to reward yourself with a treat that is high in calories. If you feel hungry after activity choose foods or drinks that are lower in calories but still filling.
7. Don't get thirstyWe need to drink about 1.2 litres of fluid every day to stop us getting dehydrated. This is in addition to the fluid we get from the food we eat. All non-alcoholic drinks count, but water, milk and fruit juices are the most healthy. Try to avoid sugary soft and fizzy drinks that are high in added sugars and can be high in calories and bad for teeth. When the weather is warm, or when we get active, we may need more.  
8. Don’t skip breakfast
   Some people skip breakfast because they think it will help them lose weight. In fact, research shows that eating breakfast can help people control their weight. A healthy breakfast is an important part of a balanced diet, and provides some of the vitamins and minerals we need for good health. Wholemeal cereal, with fruit sliced over the top is a tasty and nutritious breakfast.

For more information please visit:
http://www.nhs.uk/Livewell/Goodfood/Pages/eight-tips-healthy-eating.aspx

Spirulina: the latest and greatest superfood yet?

Spirulina: the latest and greatest superfood yet? spirulina tablets: the most nutritious natural wholefood gram per gram in the world.

Spirulina is a microalga native to alkaline lakes in hot climates. Spirulina is the most nutritious wholefood rich in natural vitamins (not synthetic), minerals and antioxidants and contains no sugars, and is low in fat, saturates and calories. 

Spirulina has large amounts of pro-Vitamin A necessary for good skin, eyes and the immune system. Spirulina contains Vitamin B12 necessary for the normal structure and function of the brain and neurological system.

Spiralyne spirulina has many phytonutrients; it is 31 times more powerful than blueberries and 60 times more powerful than spinach.

If you compare the nutrients in Spiralyne spirulina tablets to other foods you will find it has;

·         290% more calcium than whole milk

·         830% more protein than tofu

·         4500% more beta carotene than carrots

·         8000% more iron than spinach [1]

(Based on a typical analysis of Spiralyne spirulina and the above foods).

Furthermore, there is more antioxidant and anti-inflammatory activity in 3 grams of spirulina than in five servings of fruits and vegetables [2]. It is for these reasons and others that spirulina is called a superfood and is said to be ‘the most nutritious natural wholefood known to man’.

Spirulina can prevent malnutrition; an issue that doesn’t only affects poorer countries. Healthy eating is an issue that affects many of people in the U.K. The British Association for Parenteral and Enteral Nutrition estimate that at least 3 million people in the UK alone are suffering or at risk of malnutrition. Spirulina can help many people by ensuring their intake of many of the nutrients required.

In fact, spirulina’s remarkable nutritional properties have attracted interest from space agencies like NASA and the European Space Agency that have been researching spirulina to feed to their astronauts in space.

Spirulina has other properties that are even more special; it contains a variety of antioxidants such as beta-carotene and C-Phycocyanin that inhibit the damage caused to the body (DNA, RNA and cell structures) by free radicals. A Japanese study on spirulina isolated a ‘new’ compound named ‘calcium spirulan’ that is highly effective fighting infectious diseases supporting the immune system.

To find out more about the remarkable properties of spirulina, please visit: http://www.spiralyne.co.uk

[1] www.nal.usda.gov/fnic/foodcomp/search/

[2] Moorhead K, Capelli B, Cysewski G (2005), Nature's Superfood: Spirulina ISBN #0-9637511-3-1

[3]

[4]

[5]

[6]

Spirulina: what is it?

A brief guide on what is spirulina.

What is spirulina?

Arthrospira platensis (spirulina), is a pure, natural superfood; due to the diversity and concentration of nutrients it contains.

It is a nutritious uni-cellular blue-green microalga that contains many vitamins, minerals, all the essential amino acids and powerful antioxidants. Spirulina can help your body achieve and maintain optimum health and wellbeing.

Spirulina is extremely nutritious and is the most nutritious, concentrated natural wholefood (gram per gram).

Most spirulina has a constitution of over 50% protein, containing all essential amino acids.

Spirulina has no hard cell wall (no cellulose), which means it can be digested easily - it can nourish individual cells and is highly assimilated.

Spirulina 'superfood' has a very high phytonutrient content; it is 31 times more potent than blueberries in comparison and 60 times more potent than spinach.

Nutrient profile of Spiralyne spirulina tablets (known to have one the highest nutrients content) compared to other foods:

290% more calcium than whole milk

830% more protein than tofu

4500% more beta carotene than carrots

8000% more iron than spinach¹

(Based on a typical analysis of Spiralyne arthrospira platensis and the above foods).

There is more antioxidant and anti-inflammatory activity in 3 g of spirulina than in five servings of fruits and vegetables²

Spirulina is the best whole food source of Gamma linolenic acid (GLA) – an important fatty acid; it is rich in vitamins, minerals, trace elements, chlorophyll and enzymes; and it is abundant in other nutrients such as; carotenoids, sulfolipids, glycolipids, phycocyanin, superoxide dismutase, RNA and DNA.

--------------------------------------------------------------------------------

1 www.nal.usda.gov/fnic/foodcomp/search/
2 Moorhead K, Capelli B, Cysewski G (2005), Nature's Superfood: Spirulina ISBN #0-9637511-3-1

3 http://www.spiralyne.co.uk/what-is-spirulina.html