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ANONYMOUUS

DIET THERAPY OF DISEASES

NUTRITION INTERVENTIONS IN SICKLE CELL ANAEMIA

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Sickle cell disease is an inherited blood disorder where red blood cells that carry oxygen assume a totally different shape from the normal. Normally, red blood cells assume a disc shape while flowing through blood vessels, but in sickle cell anemia, red blood cells assume a crescent like shape.

Devastating as the disease might be, no cure has been found yet.

Interestingly, through research and a bid to increase knowledge, it has been found out that nutritional problems are fundamental to the severity of the disease, thereby increasing interests to promote dietary supplementation for decreasing morbidity and to help improve the quality of patient’s life.
Several methods of treatment and management have been in use for quite a while now and they include:

MANAGEMENT OPTIONS
-Hydroxycarbamide (or hydroxyurea) This substance helps to reduce the number of painful episodes in Hbss patients.
-Blood transfusion: A number of observational and randomised controlled trials have established the pivotal role of transfusion therapy in the management of SCD, most notably in primary stroke prevention.
-Allogeneic HSCT and gene therapy: Allogeneic haemopoietic stem cell transplant (HSCT) is the only curative treatment for SCD and is successful in 85%–90% of patients. Transplantation offers disease-free survival and stabilisation of neurological lesions.
Features as growth retardation, impaired immune function, and delayed menarche do suggest a relationship between sickle cell disease and undernutrition. Also, a variety of micronutrient deficiency has been suggested in sickle cell disease.
– Several reports indicate that vitamin E levels are low in sickle erythrocytes. Since these abnormal red cells both generate excessive oxidation products and are more sensitive to oxidant stress, supplementation with vitamin E is advised in people with sickle cell anaemia.
– Complications of sickle cell disease as poor ulcer healing, growth retardation, delays in sexual development, immune deficiencies have been linked to zinc deficiency. It is also pertinent that zinc be supplemented in people with sickle cell.
– Deficiency of Vitamin D is common in sickle cell disease due to dark skin pigmentation, limited sun exposure, increased catabolism and decreased nutrient and energy intake. Vitamin D in it’s entirety is crucial for calcium homeostasis and essential for bone mineralization.

Therefore, a high dose of 100,000 International units (IU) (equivalent to 3,333 IU/day) versus the standard treatment 12,000 IU (equivalent to 400 IU/day) of oral vitamin D3 supplements might just help in reducing risk of respiratory infections.
– Amino acids like arginine and glutamine also play important roles in the synthesis of nitric oxide. Nitric oxide makes it possible for easy blood flow by dilating the blood vessels properly. Increased deficiency of the duo might lead to metabolic stress, increased resting energy expenditure (REE), muscle wasting and decreased immune function. Supplementing with 600mg/kg/day of glutamine showed improved nutritional status of glutamine.

EMERGING INTERVENTIONS
Recently, derivatives from plants has been studied to show their effects in treating people with SCD. Some plants which contain peculiar antioxidants are being studied and there might just be hope to managing SCD.
Exploration of extracts from Moringa oleifera (Moringa), Cajanus cajan (pigeon pea) , Zanthoxylum zanthoxyloides (artar root), and Carica papaya (paw paw) are all being studied to see their possible effects in treating oxidative stress in SCD patients.
With these ongoing experiments, it has been noticed that extracts from these plants could aid in the resistance of hemolysis and reduce the number of sickled red blood cells.

Also, it has been noticed that exercise might play an important role in SCD patients. Exercise helps in reducing oxidative stress and also in the release of nitric oxide which helps in the proper flow of blood through vessels.

CONCLUSION
The nutritional risks faced by SCD patients are usually high and mostly unnoticed. Its imperative to include nutrition as an adjuvant therapy for addressing chronic diseases related with SCD in order to aid effective management.

SOURCES: https://pubmed.ncbi.nlm.nih.gov/3551592/
https://www.dovepress.com/nutrition-in-sickle-cell-disease-recent-insights-peer-reviewed-fulltext-article-NDS
https://www.health.harvard.edu/a_to_z/sickle-cell-anemia-a-to-z
https://adc.bmj.com/content/100/1/48
https://www.todaysdietitian.com/news/042412_news.shtml

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DIET THERAPY OF DISEASES

Cholelithiasis: treatment options

on by ANONYMOUUS add comment

Stones form in different organs in the body due the retention of excess types of minerals in the body that can easily crystallise if there is insufficient fluid around to dissolve them.
Cholelithiasis is one condition that affects the bile duct and gall bladder. In cholelithiasis, hard stones composed of cholesterol or bile pigments form in the gall bladder (choleccystolithiasis) or in the bile duct (choledocholithiasis). In the US alone, about 9% of women and 6% of men have gallstones, and most are asymptomatic. While in the south western region of Nigeria, Ibadan, the prevalence of cholelithiasis is 2.1%.
When the concentration of cholesterol rises to the point of supersaturation, crystallization occurs. In other parts where stones form, stones could be composed of calcium, oxalate, uric acid, struvite. But in this case, stones are composed of cholesterol. A sludge containing cholesterol, mucin, calcium salts, and bilirubin forms, and, ultimately, stones develop. This occur when the concentration of cholesterol rises so high to the point of supersaturation. Normally, in bile, cholesterol leves are at equilibrium with bile salts and phosphatidylcholine.
Although gallstones are typically asymptomatic (they show no symptoms), some cause biliary colic, in which stones intermittently obstruct the neck of the gallbladder and cause episodes of abdominal pain. Chronic obstruction may result in cholecystitis (infection and inflammation of the gallbladder) or cholangitis (infection and inflammation of the common bile duct). Both of which are very serious and, if untreated, may result in sepsis, shock, and death.

Presenting symptoms include episodic right-upper-quadrant or epigastric pain, which often occurs in the middle of the night after eating a large meal and may radiate to the back, right scapula, or right shoulder. Diaphoresis, nausea, vomiting, dyspepsia, burping, and food intolerance (especially to fatty, greasy, or fried foods; meats; and cheeses) are common. More severe symptoms, including fever and jaundice, may signify cholecystitis or cholangitis.

What Are the Possible Risk Factors?
1. Family history: there is every tendency to develop gallstones if there is a family history. In short, it is twice as more in rates.

2. Increasing age: Gallstones are mostly very common in individuals above the age of 40.

3. Female sex: with the presence of the hormone estrogens in female, they are more likely to develop gall stones at all age groups. This increased risk is most notable in young women, who are affected 3-4 times more often than men of the same age.

4. Elevated estrogen and progesterone: During pregnancy, oral contraceptive use, or hormone replacement therapy, estrogen and progesterone induce changes in the bile duct that predispose one to gallstones.

5. Obesity: Due to the elevated secretion and production of cholesterol in obese individual, they are at high risk of developing gall stones.

6. Rapid weight loss: Bariatric surgery and very-low-calorie diets adopted for weight loss regimes can increase risk of gallstone formation, possibly due to increased concentrations of bile constituents.

7. Diabetes mellitus: Hepatic insulin resistance and high triglycerides may increase risk of gallstones.

8. Gallbladder stasis: When bile remains in the gallbladder for an extended period, supersaturation can occur. Gallbladder stasis is associated with diabetes mellitus, total parenteral nutrition (probably due to lack of enteral stimulation), vagotomy, rapid weight loss, celiac sprue, and spinal cord injury.

9. Cirrhosis: Cirrhosis i.e scarring of the liver tissues, increases the risk of developing gall stones 10 times more.

10. Medications: Drugs implicated in the development of cholelithiasis include clofibrate, octreotide, and ceftriaxone.

11. Physical inactivity: Exercise may reduce gallstone risk. Findings from the Health Professionals Follow-Up Study suggested that the risk of symptomatic cholelithiasis could be reduced by 30 minutes of daily aerobic exercise. Young or middle-aged men (65 years or younger) who were the most physically active had half the risk for developing gallstones, compared with those who were least active. In older men, physical activity cut risk by 25%. Physical activity is also associated with reduced gallstone risk in women.

How can it be Diagnosed?
Laboratory tests include complete blood count (CBC), liver function tests, amylase, and lipase.

– Right-upper-quadrant (trans-abdominal) ultrasound will reveal the presence of gallstones and show evidence of cholecystitis, if present.

– Hydroxy iminodiacetic acid (HIDA) scan is sometimes indicated to rule out cystic duct obstruction and acute cholecystitis.

– Endoscopic retrograde cholangiopancreatography (ERCP) or magnetic resonance cholangiopancreatography (MRCP) assesses the presence of gallstones within the bile ducts. ERCP can also be used to extract stones when they are found, preventing the need for surgery.

Are there Treatment options?
Asymptomatic gallstones are generally not treated. Cholecystectomy (surgical removal of the gall bladder) is the treatment of choice for symptomatic disease.

Oral bile acids (e.g., ursodeoxycholic acid) can be used to dissolve small stones and stone fragments. However, they are not really efficient as the stones typically reoccur.

It is helpful to avoid large, fatty meals, as a large caloric load is the most likely trigger for biliary colic symptoms.

Long-term statin use has been associated with a reduced risk of gallstone development.

Nutritional Considerations
Gallstones are strongly related to high-fat, low-fibre diets. In areas like Asia and Africa populations which have plant-based diets as traditional diets. An abundance of high protein and high saturated fatty diets are risk factors to developing gallstones. Diets low in dietary fibre, especially the westernized diets play a major role in the development of gall stones. The following factors are associated with reduced risk of gallstones:

– Plant-based diets: Both animal fat and animal protein may contribute to the formation of gallstones. According to research, up to 90% of gallstones are cholesterol. This totally suggests that a change diet (e.g., reducing dietary saturated fat and cholesterol and increasing soluble fibre) may reduce the risk of gallstones.
“Vitamin C, which is found in plants and is absent from meat, affects the rate-limiting step in the catabolism of cholesterol to bile acids and is inversely related to the risk of gallstones in women”
In a 12-year prospective cohort study among US men, individuals consuming the most refined carbohydrates have a 60% greater risk for developing gallstones, compared with those who consumed the least. Conversely, in a 1998 cross-sectional study of men and women in Italy, individuals eating the most fiber (particularly insoluble fiber) have a 15% lower risk for gallstones compared with those eating the least.

– Avoidance of excess weight: staying within a healthy BMI results in reduced risks of developing gall stones as obesity is a huge factor to increased risk. Those with BMI above 30 kg/m2 should endeavour to shed some few extra pounds to reduce their risk.

– Weight cycling: simply meaning repeatedly intentionally losing and unintentionally regaining weight. This cycle increases the likelihood of cholelithiasis.

– Moderate alcohol intake: alcohol consumption, especially when it is too much, has always been linked to different types of ailments; gallstone formation isn’t left out.

SUMMARY
Adopting western diets totally puts you at risk of developing gall stones. A diet rich in antioxidants, fibre, anti-inflammatory substances keeps you at reduced risk rate.
Stones make life very unbearable, you should be very conscious about your diet and lifestyle.

SOURCES
Biddinger SB, Haas JT, Yu BB, et al. Hepatic insulin resistance directly promotes formation of cholesterol gallstones. Nat Med. 2008;14(7):778-82. [PMID:18587407]
Leitzmann MF, Giovannucci EL, Rimm EB, et al. The relation of physical activity to risk for symptomatic gallstone disease in men. Ann Intern Med. 1998;128(6):417-25. [PMID:9499324]
Leitzmann MF, Rimm EB, Willett WC, et al. Recreational physical activity and the risk of cholecystectomy in women. N Engl J Med. 1999;341(11):777-84. [PMID:10477775]
Erichsen R, Frøslev T, Lash TL, et al. Long-term statin use and the risk of gallstone disease: A population-based case-control study. Am J Epidemiol. 2011;173(2):162-70. [PMID:21084557]
Bodmer M, Brauchli YB, Krähenbühl S, et al. Statin use and risk of gallstone disease followed by cholecystectomy. JAMA. 2009;302(18):2001-7. [PMID:19903921]
Stinton LM, Shaffer EA. Epidemiology of gallbladder disease: cholelithiasis and cancer. Gut Liver. 2012;6(2):172-87. [PMID:22570746]
Ahmed A, Cheung RC, Keeffe EB. Management of gallstones and their complications. Am Fam Physician. 2000;61(6):1673-80, 1687-8. [PMID:10750875]
Pixley F, Wilson D, McPherson K, Mann J. Effect of vegetarianism on development of gall stones in women. Br Med J (Clin Res Ed) . 1985;291:11-12.
Tsai CJ, Leitzmann MF, Willett WC, et al. Fruit and vegetable consumption and risk of cholecystectomy in women. Am J Med. 2006;119(9):760-7. [PMID:16945611]
Simon JA, Hudes ES. Serum ascorbic acid and gallbladder disease prevalence among US adults: the Third National Health and Nutrition Examination Survey (NHANES III). Arch Intern Med. 2000;160(7):931-6. [PMID:10761957]

read more
DIET THERAPY OF DISEASES

Cholelithiasis: Treatment Options

on by ANONYMOUUS add comment

Stones form in different organs in the body due the retention of excess types of minerals in the body that can easily crystallise if there is insufficient fluid around to dissolve them.
Cholelithiasis is one condition that affects the bile duct and gall bladder. In cholelithiasis, hard stones composed of cholesterol or bile pigments form in the gall bladder (choleccystolithiasis) or in the bile duct (choledocholithiasis). In the US alone, about 9% of women and 6% of men have gallstones, and most are asymptomatic. While in the south western region of Nigeria, Ibadan, the prevalence of cholelithiasis is 2.1%.
When the concentration of cholesterol rises to the point of supersaturation, crystallization occurs. In other parts where stones form, stones could be composed of calcium, oxalate, uric acid, struvite. But in this case, stones are composed of cholesterol. A sludge containing cholesterol, mucin, calcium salts, and bilirubin forms, and, ultimately, stones develop. This occur when the concentration of cholesterol rises so high to the point of supersaturation. Normally, in bile, cholesterol leves are at equilibrium with bile salts and phosphatidylcholine.
Although gallstones are typically asymptomatic (they show no symptoms), some cause biliary colic, in which stones intermittently obstruct the neck of the gallbladder and cause episodes of abdominal pain. Chronic obstruction may result in cholecystitis (infection and inflammation of the gallbladder) or cholangitis (infection and inflammation of the common bile duct). Both of which are very serious and, if untreated, may result in sepsis, shock, and death.

Presenting symptoms include episodic right-upper-quadrant or epigastric pain, which often occurs in the middle of the night after eating a large meal and may radiate to the back, right scapula, or right shoulder. Diaphoresis, nausea, vomiting, dyspepsia, burping, and food intolerance (especially to fatty, greasy, or fried foods; meats; and cheeses) are common. More severe symptoms, including fever and jaundice, may signify cholecystitis or cholangitis.

What Are the Possible Risk Factors?
1. Family history: there is every tendency to develop gallstones if there is a family history. In short, it is twice as more in rates.

2. Increasing age: Gallstones are mostly very common in individuals above the age of 40.

3. Female sex: with the presence of the hormone estrogens in female, they are more likely to develop gall stones at all age groups. This increased risk is most notable in young women, who are affected 3-4 times more often than men of the same age.

4. Elevated estrogen and progesterone: During pregnancy, oral contraceptive use, or hormone replacement therapy, estrogen and progesterone induce changes in the bile duct that predispose one to gallstones.

5. Obesity: Due to the elevated secretion and production of cholesterol in obese individual, they are at high risk of developing gall stones.

6. Rapid weight loss: Bariatric surgery and very-low-calorie diets adopted for weight loss regimes can increase risk of gallstone formation, possibly due to increased concentrations of bile constituents.

7. Diabetes mellitus: Hepatic insulin resistance and high triglycerides may increase risk of gallstones.

8. Gallbladder stasis: When bile remains in the gallbladder for an extended period, supersaturation can occur. Gallbladder stasis is associated with diabetes mellitus, total parenteral nutrition (probably due to lack of enteral stimulation), vagotomy, rapid weight loss, celiac sprue, and spinal cord injury.

9. Cirrhosis: Cirrhosis i.e scarring of the liver tissues, increases the risk of developing gall stones 10 times more.

10. Medications: Drugs implicated in the development of cholelithiasis include clofibrate, octreotide, and ceftriaxone.

11. Physical inactivity: Exercise may reduce gallstone risk. Findings from the Health Professionals Follow-Up Study suggested that the risk of symptomatic cholelithiasis could be reduced by 30 minutes of daily aerobic exercise. Young or middle-aged men (65 years or younger) who were the most physically active had half the risk for developing gallstones, compared with those who were least active. In older men, physical activity cut risk by 25%. Physical activity is also associated with reduced gallstone risk in women.

How can it be Diagnosed?
Laboratory tests include complete blood count (CBC), liver function tests, amylase, and lipase.

– Right-upper-quadrant (trans-abdominal) ultrasound will reveal the presence of gallstones and show evidence of cholecystitis, if present.

– Hydroxy iminodiacetic acid (HIDA) scan is sometimes indicated to rule out cystic duct obstruction and acute cholecystitis.

– Endoscopic retrograde cholangiopancreatography (ERCP) or magnetic resonance cholangiopancreatography (MRCP) assesses the presence of gallstones within the bile ducts. ERCP can also be used to extract stones when they are found, preventing the need for surgery.

Are there Treatment options?
Asymptomatic gallstones are generally not treated. Cholecystectomy (surgical removal of the gall bladder) is the treatment of choice for symptomatic disease.

Oral bile acids (e.g., ursodeoxycholic acid) can be used to dissolve small stones and stone fragments. However, they are not really efficient as the stones typically reoccur.

It is helpful to avoid large, fatty meals, as a large caloric load is the most likely trigger for biliary colic symptoms.

Long-term statin use has been associated with a reduced risk of gallstone development.

Nutritional Considerations
Gallstones are strongly related to high-fat, low-fibre diets. In areas like Asia and Africa populations which have plant-based diets as traditional diets. An abundance of high protein and high saturated fatty diets are risk factors to developing gallstones. Diets low in dietary fibre, especially the westernized diets play a major role in the development of gall stones. The following factors are associated with reduced risk of gallstones:

– Plant-based diets: Both animal fat and animal protein may contribute to the formation of gallstones. According to research, up to 90% of gallstones are cholesterol. This totally suggests that a change diet (e.g., reducing dietary saturated fat and cholesterol and increasing soluble fibre) may reduce the risk of gallstones.
“Vitamin C, which is found in plants and is absent from meat, affects the rate-limiting step in the catabolism of cholesterol to bile acids and is inversely related to the risk of gallstones in women”
In a 12-year prospective cohort study among US men, individuals consuming the most refined carbohydrates have a 60% greater risk for developing gallstones, compared with those who consumed the least. Conversely, in a 1998 cross-sectional study of men and women in Italy, individuals eating the most fiber (particularly insoluble fiber) have a 15% lower risk for gallstones compared with those eating the least.

– Avoidance of excess weight: staying within a healthy BMI results in reduced risks of developing gall stones as obesity is a huge factor to increased risk. Those with BMI above 30 kg/m2 should endeavour to shed some few extra pounds to reduce their risk.

– Weight cycling: simply meaning repeatedly intentionally losing and unintentionally regaining weight. This cycle increases the likelihood of cholelithiasis.

– Moderate alcohol intake: alcohol consumption, especially when it is too much, has always been linked to different types of ailments; gallstone formation isn’t left out.

SUMMARY
Adopting western diets totally puts you at risk of developing gall stones. A diet rich in antioxidants, fibre, anti-inflammatory substances keeps you at reduced risk rate.
Stones make life very unbearable, you should be very conscious about your diet and lifestyle.

SOURCES
Biddinger SB, Haas JT, Yu BB, et al. Hepatic insulin resistance directly promotes formation of cholesterol gallstones. Nat Med. 2008;14(7):778-82. [PMID:18587407]
Leitzmann MF, Giovannucci EL, Rimm EB, et al. The relation of physical activity to risk for symptomatic gallstone disease in men. Ann Intern Med. 1998;128(6):417-25. [PMID:9499324]
Leitzmann MF, Rimm EB, Willett WC, et al. Recreational physical activity and the risk of cholecystectomy in women. N Engl J Med. 1999;341(11):777-84. [PMID:10477775]
Erichsen R, Frøslev T, Lash TL, et al. Long-term statin use and the risk of gallstone disease: A population-based case-control study. Am J Epidemiol. 2011;173(2):162-70. [PMID:21084557]
Bodmer M, Brauchli YB, Krähenbühl S, et al. Statin use and risk of gallstone disease followed by cholecystectomy. JAMA. 2009;302(18):2001-7. [PMID:19903921]
Stinton LM, Shaffer EA. Epidemiology of gallbladder disease: cholelithiasis and cancer. Gut Liver. 2012;6(2):172-87. [PMID:22570746]
Ahmed A, Cheung RC, Keeffe EB. Management of gallstones and their complications. Am Fam Physician. 2000;61(6):1673-80, 1687-8. [PMID:10750875]
Pixley F, Wilson D, McPherson K, Mann J. Effect of vegetarianism on development of gall stones in women. Br Med J (Clin Res Ed) . 1985;291:11-12.
Tsai CJ, Leitzmann MF, Willett WC, et al. Fruit and vegetable consumption and risk of cholecystectomy in women. Am J Med. 2006;119(9):760-7. [PMID:16945611]
Simon JA, Hudes ES. Serum ascorbic acid and gallbladder disease prevalence among US adults: the Third National Health and Nutrition Examination Survey (NHANES III). Arch Intern Med. 2000;160(7):931-6. [PMID:10761957]

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LIFESTYLE

FERTILITY : DOES DIET PLAY A ROLE?

on by ANONYMOUUS add comment

Generally, one major factor considered to affect fertility is age. As you grow older, your organs, hormones and system seem to deteriorate.

But apart from this, there are other external and non-modifiable lifestyle factors that also affects the fertility of a woman and they include smoking, elevated consumption of caffeine and alcohol, stress, agonist sports, chronic exposure to environmental pollutants and other nutritional related issues.

In addition to the aforementioned, other metabolic disorders like diabetes, obesity, and hyperlipidaemia which are associated to an intake of high caloric diet could also interfere with a woman’s fertility.

Infertility is defined as the inability to conceive after one year of unprotected intercourse.
Infertility has really become a thing of concern in the modern society and its recurrence affects about 20-30% of the female population globally.

In Nigeria, about 10-30% of couples are saddled with the burden of infertility
The World Health Organization (WHO) reporting up to 80 million women world-wide having been affected by this disease to date, with a prevalence of ~50% of all women in developing countries.

There are possible gynaecological issues or systemic diseases that poses a threat female fertility, but asides these, unbalanced nutrition and unhealthy diet also interfere with reproduction processes in women.
Gradually, inadequate weight gain due abnormal energy supply, extreme restrictions, and inadequate intake of nutrients (both macro and micro), have a detrimental impact on the normal functioning of the ovaries.
Taking a proactive approach could help curb emotional stress and even cut financial costs attached to infertility problems.
Your odds at getting pregnant might just be improved by being intentional about your diet, effectively dealing with stress and being more active.

POSSIBLE LIFESTYLE FACTORS THAT AFFECTS FERTILITY
1. SMOKING: Smoking, be it first or second-hand smoke, can have a negative impact on the reproductive process for women. Cadmium and cotinine are two specific toxins found in tobacco smoke which can reduce egg production.
2. ALCOHOL: there are no safe levels for alcohol if you’re planning to conceive
3. BMI: for females wanting to conceive, body weight is of the essence and should not be overlooked. A BMI higher than 30 could impact hormonal imbalances and affect fertility processes.
4. RECREATIONAL DRUGS: use of some illicit drugs could have a great impact on fertility for women. Women who are expectant shouldn’t use heroin, ecstasy, marijuana and other illicit drugs.

WHAT ARE SOME POSSIBLE CAUSES OF INFERTILITY?
– Unexplained Infertility: reason of infertility is unknown and can’t be linked to any external or internal factors. Most times, more than a year of trying to conceive.
– Endocrine Disorders (PCOS (Polycystic Ovary Syndrome): these sort of disorders leads to an alteration of sex hormones in the female body thereby leading to elevated insulin levels and overproduction of testosterone (male hormone).
– Anatomical Abnormalities & Anomalies (Endometriosis, Uterine Irregularities): conditions where similar tissues to the ones inside your uterus, grows outside of the uterus. These conditions subject the uterus to be shaped in abnormal ways; heart shaped, unicorn shaped etc. (fibroids and polyps also included)

HOW DOES DIET AFFECT FERTILIY?
A number of dietary considerations should be considered in order to curtail hormonal fluctuations in females. The adequacy of a diet totally influences the functionality of hormones in the female body, especially fertility related hormones,
Let’s see some dietary considerations that directly affects hormonal response in the female body.
1. WHOLE GRAINS: whole grains are lower in glycemic index (their ability to increase blood glucose per time), and help increase chances of reduced insulin resistance in females. Insulin resistance poses a huge threat of inflammatory disorders and weight gain which directly affects hormonal balances in the female body. Whole grains include oatmeal, millet, bulgur, corn etc.
2. PROTEINS: getting most of your proteins from plant sources could help women with ovulatory issues. Isoflavones contained in soy products have been shown to positively affect ovulation and also helps women undergoing ART (assisted reproductive technology). Also, a higher intake of dairy products has been linked to decreased risk of endometriosis. Successful incorporation of dairy products into the diet of females, would have a great impact on fertility.
3. HEALTY FATS: trans-fat negatively affects fertility, enhance inflammation, and also play a role in egg quality and implantation. It’s very important to know the types of fats which are healthy and take out the unhealthy ones. Fats from nuts, avocado, seeds and fatty fish are healthy fats.
Also, supplementation with omega-3 fatty (500-1000mg) acid may help reduce the amount of male hormones circulating in the system (testosterone), thereby reducing risks of developing PCOS and regulating menstrual cycle.
4. SUPPLEMENTATION: supplementing with vitamins like folate, vitamin D, and vitamin B12 has been shown to improve better embryo quality and reduce risks of ovulatory infertility. Antioxidants also has shown to support and provide the eggs with adequate nutrition. Other supplements of importance include glutathione and CoQ10.

SUMMARY
A correct balance of proteins, fats, carbohydrates and vitamins in the daily diet helps provide optimum female reproductive health and reduce risk of infertility possibly caused by inflammation and hormonal imbalances.

SOURCES:

Does diet really affect fertility? – A few useful tips from Fertifa’s nutrition expert

https://web.archive.org/web/20240526160252if_/https://www.fertifa.com/does-diet-really-affect-fertility-a-few-useful-tips-from-fertifa-nutrition-expert/embed/#?secret=gQtj2ZEpTC
https://www.todaysdietitian.com/marketing/webinars/fertility/TDFinalRecorded.pdf
https://www.insider.com/how-healthy-and-unhealthy-diets-can-impact-fertility-2018-4

Nutrition and Fertility: 5 Things to Know

https://web.archive.org/web/20240526160252if_/https://uncfertility.com/fertility-blog/nutrition-and-fertility-5-things-to-know/embed/#?secret=Yv24HznkCQ
https://www.todaysdietitian.com/newarchives/050113p38.shtml

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LIFESTYLE

IS INTERMITTENT FASTING THE NEW GO-TO DIET TRICK?

on by ANONYMOUUS add comment

It seems like the trend now is fasting, we’ve come a long way in the nutrition space and there has been so many takes on how to lose weight or help with some chronic diseases.
So the question is: will fasting help me lose weight, manage diabetes and other chronic diseases?

Absolutely! It would, but is it sustainable and convenient?
Is it suitable for everyone? What are the merits and demerits of fasting?
These are the questions we’ll love to use this article to answer, but before then;

WHAT IS INTERMITTENT FASTING?
Intermittent fasting, also known as intermittent energy restriction is any schedule for meals that involves a cycle between voluntary fasting and non-fasting periods. It can include an alternate day fasting, periodic fasting or daily time restricted fasting.

Apart from the religious type of fasting, there are 3 main types of intermittent fast:
– 5:2 Diet: this type of fasting involves that you fast for 2 days per week and you’ll be allowed to take 25% of your daily caloric needs, while you eat normally for 5 days.
– Alternate day fasting: you have to skip a day and eat the other day. So, you eat on Monday and skip Tuesday, eat Wednesday and skip Thursday, and it goes om like that. You’re still allowed to just 25% of your normal daily calories per day In this type of regimen.
– Time restricted fasting: this type involves fasting for 8-12 hours of the day and eating during the remaining time frame. For this, you are not restricted to having just 25% of your daily calories. Apart from the above mentioned, there is the warrior diet also.

IS INTERMITTENT FASTING REALLY EFFECTIVE?
A study found that participants consumed 35% fewer calories and lost an average of 7.7 pounds (3.5kg) after alternating between 36 hours of fasting and 12 hours of unlimited eating over 4 weeks. For some studies, there was not any significant weight loss between the fasting group and moderate calorie group
There are quite a number of side effects of intermittent fasting especially when it is abused and they include: extreme hunger pangs, lightheadedness, reduced concentration, fatigue and nausea. All these put together might just make the regimen to be effective only for a short time.
Furthermore, people might tend to eat more than required on days that they are free to eat would result to no weight loss.

CAN I TRY GOING ON AN INTERMITTENT FAST?
For some groups, intermittent fasting is advised at all, you can still achieve your health goal without having to do marathon fasts
If you have diabetes, on routine medication, pregnant or breastfeeding, you should not do intermittent fasting.
You really should not go on a long fast, or skip meals so you would lose weight or manage your blood sugar levels. The caveat is that when your body doesn’t take in any food, obviously calories would be depleted and other nutrients, thereby leading to a decrease in blood sugar, so it is not magical

You can stick to healthy and mindful eating and still achieve perfect glucose levels and still lose weight without any type of side effects, so why go on a regimen with side effects?

SOURCES

https://www.healthline.com/nutrition/intermittent-fasting-guide
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5959807
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DIET THERAPY OF DISEASES

NUTRITION IN HEPATITIS

on by ANONYMOUUS add comment

OVERVIEW
Everything you eat and drink has to go through your liver in order to change food substances into stored energy and chemicals which are necessary for life. Your liver makes nutrients available so your body can use them to build cells, give you energy, and maintain normal body functions.

The liver is responsible for:
– removing toxins from drugs and alcohol from the body
– metabolizing fat
– excretion of bilirubin (a product of broken-down red blood cells), cholesterol, hormones, and drugs
– breakdown of carbohydrates, fats, and proteins
– activation of enzymes, which are specialized proteins essential to body functions
– storage of glycogen (a form of sugar), minerals, and vitamins (A, D, E, and K)
– synthesis of blood proteins, such as albumin
– synthesis of clotting factors

HOW DIET AFFECTS THE LIVER
An unhealthy choice in diet can sometimes give the liver to much work to do thereby leading to a liver failure. If your diet provides too many calories, you will gain weight. Being overweight is linked to the buildup of fat in the liver, called “fatty liver.” Toxins, such as alcohol, damage the liver over time.
One very common liver disease (failure) is hepatitis.
Hepatitis refers to a common inflammation of the kidneys caused mostly by viral infections and other factors as toxins, auto immune diseases and alcohol.
There are different types of hepatitis and are all differentiated by Alphabets A-G.
According to the Centers for Disease Control and Prevention (CDC)Trusted Source, approximately 4.4 million Americans are currently living with chronic hepatitis B and C. Many more people don’t even know that they have hepatitis.
There are 5 types of viral infections with 5 distinct types of viruses:

Hepatitis A
Hepatitis A is caused by an infection with the hepatitis A virus (HAV). This type of hepatitis is most commonly transmitted by consuming food or water contaminated by feces from a person infected with hepatitis A.

Hepatitis B
Hepatitis B is transmitted through contact with infectious body fluids, such as blood, vaginal secretions, or semen, containing the hepatitis B virus (HBV). Injection drug use, having sex with an infected partner, or sharing razors with an infected person increase your risk of getting hepatitis B.
It’s estimated by the CDC that 1.2 million people in the United States and 350 million people worldwide live with this chronic disease.

Hepatitis C
Hepatitis C comes from the hepatitis C virus (HCV). Hepatitis C is transmitted through direct contact with infected body fluids, typically through injection drug use and sexual contact. HCV is among the most common bloodborne viral infections in the United States. Approximately 2.7-3.9 million people currently living with a chronic form of this infection.

Hepatitis D
Also called delta hepatitis, hepatitis D is a serious liver disease caused by the hepatitis D virus (HDV). HDV is contracted through direct contact with infected blood. Hepatitis D is a rare form of hepatitis that only occurs in conjunction with hepatitis B infection. The hepatitis D virus can’t multiply without the presence of hepatitis B. It’s very uncommon in the United States.

Hepatitis E
Hepatitis E is a waterborne disease caused by the hepatitis E virus (HEV). Hepatitis E is mainly found in areas with poor sanitation and typically results from ingesting fecal matter that contaminates the water supply. This disease is uncommon in the United States. However, cases of hepatitis E have been reported in the Middle East, Asia, Central America, and Africa, according to the CDC .

COMMON SYMPTOMS OF HEPATITIS
• fatigue
• flu-like symptoms
• dark urine
• pale stool
• abdominal pain
• loss of appetite
• unexplained weight loss
• yellow skin and eyes, which may be signs of jaundice

DIAGNOSIS OF HEPATITIS
Hepatitis can be diagnosed by liver function test, blood test, ultra sound, liver biopsy. The doctor always checks for risk before deciding what method to adopt in diagnosis.

TREATMENT OPTIONS FOR HEPATITIS
All types of hepatitis require either anti-viral vaccination, hydration if there is diarrhea (especially in type A), and nutrition.
Currently, there is no vaccination for Hepatitis C. Those that develop cirrhosis during the course of this would require a liver transplant.
Acute cases like Hepatitis E usually don’t require vaccination or treatment as they go on their own if the individual heeds to lifestyle modification by a professional.

RISK FACTORS
These include contact with an infected person (either living in close contact or sexual contact), poor hygiene, traveling to areas with inadequate sanitation, contaminated food (especially shellfish), and illicit drug use. Also, Patients with underlying liver disease (e.g., autoimmune hepatitis, hemochromatosis, Wilson’s disease, alpha-1 antitrypsin deficiency) are at increased risk of developing symptomatic hepatitis.
Alcohol use, smoking, HIV infection, and fatty liver are risk factors for progression of hepatitis.

NUTRITION AND HEPATITIS
Dietary management in hepatitis involves more of a lifestyle modification and hygienic approach.
Hygiene and sanitation: you should be careful of what you eat as a travller as you can pick up the virus from under cooked and contaminated foods. Make sure you heat food appropriately.

Avoiding contaminated shellfish and game meats.

Avoiding high-iron foods and iron supplements. Hepatitis C progression occurs in patients as a result of accelerated hepatic iron uptake and the oxidative stress caused by iron-catalyzed free radical production. Along with phlebotomy, a low-iron diet helps lower the risk for hepatocellular carcinoma (HCC) in these patients.

Nutritional supplementation may be required. Treatment with interferon (IFN) has shown to be very effective especially in Hep C patients. Research has it that it could help in weight reduction as it reduces appetite.

A low-fat, low-cholesterol diet may be helpful. Chronic hepatitis C (CHC) infection increases the risk for hepatic steatosis. A higher intake of dietary cholesterol contributes to this problem and is associated with the progression of hepatitis C-related liver disease. A dietary regimen that is reduced in fat (23% of calories) and cholesterol (185 mg/d) is adviced to help in the management of this Hepatitis.

Adequate vitamin D status. Vitamin D deficiency is common in patients with chronic liver disease, and these patients may have a reduced ability to convert vitamin D to its active form. An inverse relationship seems to exist between vitamin D concentrations and viral load in patients with CHC. Deficiency significantly lowers the chance for a sustained virological response to pegylated interferon and ribavirin, and vitamin D supplementation improves the probability of response to treatment.

Avoidance of extremes in B12 status. Adequate B12 status helps with clearance of hepatitis C from the circulation of infected patients. However, overly high serum B12 levels may also foster viral replication and are associated with concentrations of hepatitis C RNA levels.

Coffee consumption and chronic hepatitis C. Coffee consumption may be helpful, reducing oxidative DNA damage, increasing death of virus-infected cells, stabilizing chromosomes, and reducing fibrosis.

HOW HEPATITIS C AFFECTS DIET
If you have hepatitis, you usually don’t need a special diet. Just trying to eat healthy, maintain a healthy weight, and avoid alcohol is all that is needed. Its mostly lifestyle modification. Though, in severe cases, there might be nutrient restrictions especially fat restriction.
There are special cases, however, when hepatitis C can affect the diet:
• Patients with cirrhosis
As liver disease progresses, patients may lose their appetite and become so tired they have a hard time eating. They may become very thin and poorly nourished and be less able to fight off disease. They may need to limit salt in their diet to prevent their body from putting fluid into their legs and abdomen.
• Other medical conditions and diet
People who have other medical conditions may need other specific changes in their diet. Conditions that warrant specific dietary restrictions include high blood pressure, heart disease, diabetes mellitus, high cholesterol, celiac sprue or chronic kidney disease.

EATING TIPS
People with hepatitis C don’t need to follow a special “hepatitis C diet.” The advice that an average, healthy person gets will work just as well for people with hepatitis C, unless those people also have cirrhosis or another condition, such as diabetes, HIV, or kidney disease.
General dietary advice:
• Eat regular, balanced meals
• Maintain healthy calorie intake
• Eat whole-grain cereals, breads, and grains
• Eat lots of fruits and vegetables
• Get adequate protein
• Go easy on fatty, salty, and sugary foods
• Drink enough fluids
• Reach and maintain a healthy weight
Cautions:
• Avoid alcohol
• Be careful with dietary supplements
Herbal products
Just because something is “natural” doesn’t mean it is harmless. Certain herbs, including Kava-Kava and pennyroyal, can cause liver damage.
Endeavour to always talk to your doctor before taking megavitamin therapy, herbal products, or any other dietary supplement. Remember, your first concern should be safety.
SOURCE: https://nutritionguide.pcrm.org/nutritionguide/view/Nutrition_Guide_for_Clinicians/1342052/all/Viral_Hepatitis
https://www.hepatitis.va.gov/hcv/patient/diet/single-page.asp#:~:text=If%20you%20have%20hepatitis%2C%20you,is%20all%20that%20is%20needed.&text=As%20liver%20disease%20progresses%2C%20patients,have%20a%20hard%20time%20eating.

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DIET THERAPY OF DISEASES

Non Alcoholic Fatty Liver Disease: What You Need To Know

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Your liver  is your largest internal organ which is responsible for digestion, detoxification, and storage of energy. 

A very little infection could lead to its damage if not treated properly. 

The term ‘liver disease’ is a compendium of many different conditions including hepatitis, liver cancer, fatty liver disease and genetic conditions like hemochromatosis. Let’s delve a little bit into a disease that could be curbed nutritionally, especially one that affects about 25% of the world’s population (Non alcoholic fatty liver disease (NAFLD)

What is NAFLD & NASH?

Non-alcoholic fatty liver disease (NAFLD) is a condition in which fat is inappropriately stored in the cells of the liver. As the name implies, this particular type of fatty liver disease occurs in people who drink little/no alcohol – while there is also fatty liver that can result from excessive alcohol consumption. Often times, it’s not stereotypical, you may drink moderately, as well as have nutrition and lifestyle habits which can still  contribute to fatty liver disease. Regardless of the cause, lifestyle changes are typically the first intervention.

If left undiagnosed or untreated, having NAFLD could also increase a person’s risk of developing a more advanced form of liver disease, called non-alcoholic steatohepatitis (NASH). 30% of those with NAFLD progress to developing NASH. So, what’s the difference? In NAFLD, there are fatty deposits throughout the liver, but little to no inflammation or liver cell damage. 

NASH on the other hand, is a form of NAFLD and is characterized by fatty deposits in the liver PLUS inflammation and liver cell damage, fibrosis (hardening of the liver) and can even lead to permanent scarring in the liver, called cirrhosis. In other words, it is more permanent and irreversible than normal NAFLD – but can still be managed with lifestyle, diet, and/or medications.

Why would someone who doesn’t consume excess alcohol still have fat deposits around their liver? There are a few risk factors that are associated with developing NAFLD and NASH including:

  • Having characteristics of metabolic syndrome – this includes factors such as high blood pressure, high cholesterol, diabetes mellitus or insulin resistance, and large waist circumference
  • Rapid weight loss may be due to a previous illness or stringent eating patterns 
  • Obesity
  • Excessive intake of energy, in particular fat and sugar, and overall lack of balance in the diet
  • Genetic risk factors

SYMPTOMS OF NAFLD?

One of the most challenging aspects of NAFLD and NASH is that they could be asymptomatic, particularly in the early stages in which many people get little to no symptoms at all. If individuals do present with symptoms, they generally experience one or more of the following things:

  • Pain/discomfort in the upper right abdomen (where the liver is located)
  • Fatigue
  • Unexplained weight loss
  • General feeling of unwell

“In the more extreme cases, where liver cirrhosis and scar tissue develop, people may experience fluid buildup called edema or ascites, and yellowing of the skin and eyes called jaundice”. However, this is unlikely to occur in the beginning stages of NAFLD and NASH.

“Because this condition is difficult to detect with physical symptoms, it is key to manage your health by seeing your doctor regularly and having routine blood work – usually annually or every couple of years unless you are at higher risk. This is especially important for anyone with a personal history or family history of liver issues, diabetes mellitus (particularly type 2), or any of the other risk factors listed above”.

How is NAFLD diagnosed?

Doctors use routine medical check-ups in detecting liver disease, which can involve physical examination, blood work, and imaging tests. In many cases, the first signs of NAFLD pop up in blood tests. Doctors will commonly include a check for liver enzyme levels including alanine aminotransferase (ALT) and aspartate aminotransferase (AST). If these are elevated, your doctor may want to investigate fatty liver disease.

Other tests for diagnosing NAFLD & NASH include imaging tests such as abdominal ultrasounds, fibro scans, and CT scans to view the liver and detect fatty tissue. 

A combination of blood tests and imaging is typically enough to determine if someone has NAFLD, but your healthcare team may decide to do additional testing to identify the severity of your condition such as a liver biopsy or additional blood testing.

ARE THERE TREATMENT OPTIONS?

You have realized that drinking alcohol In moderation doesn’t stop you from developing NAFLD, so it’s wise to watch your lifestyle patterns to avoid developing this disease. Poorly managed fatty liver disease can ultimately lead to cirrhosis and increased risk of liver cancer. 

Treatment of NAFLD involves a combination of lifestyle and medication management, although some people might not require pharmacotherapy to improve their liver function.

IS THERE NEED TO LOSE WEIGHT IF I HAVE NAFLD?

A vast majority of the recommendations that exist regarding nutrition for NAFLD are focused on reducing overall weight as a means for improving liver biomarkers. However, a systematic review from 2003 revealed that a vast majority of the studies that analyzed the connection between weight reduction and NAFLD had flawed methods, making it difficult to truly connect the dots between weight loss and NAFLD, predominantly because weight loss if often not permanent, and weight cycling appears to be a possible risk factor for worsening NAFLD and progression to NASH or cirrhosis.

As earlier stated, weight loss especially if rapidly chased, could lead to development and worsening of NAFLD . Pursuing weight loss does not always mean someone is healthy! If weight loss must be involved, it should be realistic and sustainable and not some type of “crash diet” lose 30kg in 3 weeks” type of diet. 

DIETARY MANAGEMENT 

There is no standard “NAFLD diet”, but there are some key dietary concepts that are linked to better outcomes in those with non-alcoholic fatty liver which includes :

  • Reducing saturated fat intake – saturated fat is primarily found in animal products, particularly beef, pork, creamy sauces, cheese, and other high fat dairy. It is also in coconut and palm oil.
  • Reducing intake of simple carbohydrates, especially fructose – high consumption of simple sugars such as those found in pop, juice, baked goods, candy and highly processed grains can contribute to excess fat being deposited in the liver. Avoiding these foods is recommended. Enjoy these foods occasionally and continue to eat natural sugars from fruits, vegetables, and dairy.
  • Increasing consumption of unsaturated fats such as omega-3s – Omega-3 fatty acids have been shown to help with reducing inflammation and fat synthesis in the liver. Foods high in omega-3 fatty acids include fish (particularly salmon, trout, tuna, mackerel & sardines), nut, seeds, plant oils and fortified foods like omega-3 eggs.
  • Increasing fibre consumption – getting enough fibre in the diet can actually help to reduce the amount of fat we uptake into our bloodstream and carry to the liver. Fibre, particularly soluble fibre, binds to fat in the digestive track and helps us to do away with it naturally.  Yes sure- we poop it right out! Fibre also plays a key role in regulating blood sugars and gut health, both factors implicated in the development of NAFLD.
  • Reducing or eliminating alcohol intake – like mentioned earlier, we often see those with moderate alcohol intake diagnosed with NAFLD. Alcohol is very hard on the liver, so reducing intake or entirely cutting it out  is helpful.
  • Exercise – staying active always is a key component of reducing fat deposits in the liver. If you think the gym is a scary place, then you can try dancing.

THINK MEDITERRANEAN! 

To be on a safer path, following a Mediterranean-style eating plan with an emphasis on lots of plant-based foods (veggies, fruit, and whole grains) ,leaner cuts of meat like chicken, turkey, and fish. Alongside this, consuming 1-2 meatless meals that include pulses like beans, chickpeas, and lentils is a great way of displacing intake of foods higher in saturated fat, plus an excellent source of fibre which might range from fleshy fruits with pulps or leafy vegetables.

Working with a dietitian is also highly recommended if you have NAFLD, as each case is very unique and should be individualized.

Medications

“There are numerous drugs that have been studied for NAFLD – almost too many to count! Generally speaking, medications used for the treatment of NAFLD mainly target the underlying cause (or suspected cause) of NAFLD”. In particular, medications that aid in cholesterol reduction and blood sugar management are a mainstay of care for NAFLD. 

SUMMARY

If you have been recently  diagnosed with NAFLD, working with a dietitian to incorporate a balanced diet that will help to reduce fatty deposits in your liver is highly recommended!

Many health professionals would  encourage weight loss to treat NAFLD. While this might sound appropriate, please remember that weight loss without a focus on sustainable behaviours and long-term health can actually worsen NAFLD, particularly rapid weight loss. 

Sources: https://ignitenutrition.ca/blog/non-alcoholic-fatty-liver-disease-what-you-should-know/?utm_source=dlvr.it&utm_medium=twitter

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GENERAL RESEARCHMEN’S HEALTH

NITRIC OXIDE AND PERFORMANCE

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You may have heard of nitric oxide supplements, which claim to increase workout performance and boost your productivity in general and even enhance endurance in za oza room. You might even find some inside your pre-workout formulas too.

SO WHAT IS, OR WHAT DOES NITRIC OXIDE DO?

“Nitric oxide (NO) is a gas that the body produces, and it helps with blood flow (vasodilator) and could also act as a neurotransmitter. Nitric oxide supplements are formulated in order to try to increase the amount of nitric oxide in your blood, which might in turn help increase blood flow to working muscles and help reduce time to fatigue during a workout..

(To be clear, nitric oxide is very different from nitrous oxide, a.k.a. the stuff that gets you high.)

Theoretically, NO supplements could do wonders for your fitness routine. But in terms of scientific evidence, well, let’s just keep our fingers crossed…

So many questions might be running through your mind now like: Are nitrous oxide supplements safe? Do they work? First off, some of those supplements might not actually be nitric oxide—so be careful with which ones you’re buying. “While companies may label them as ‘nitric oxide’ supplements and boosters, they really don’t contain any nitric oxide. For example, Some ‘boosters’ could  contain compounds such as L-arginine

While the L-arginine in your body is involved in nitric oxide production, research is mixed as to whether taking it in supplement form will increase nitric oxide production, and if it could, whether that would actually enhance exercise performance and improve health.

“It’s also important to note that many booster supplements may contain additional ingredients that are not well researched or well regulated, so it’s wise to read labels carefully and seek professional advice before popping them pills.

If you’re looking to still give nitric oxide a try, here’s what you should know.

FUNCTIONALITY.

In the body, nitric oxide is secreted by the endothelial cells, which line the inner walls of the blood vessels, and it communicates with the smooth muscle cells, triggering them to relax. This blood flow regulation plays a role in multiple body functions, including maintaining erections and controlling blood pressure.

NO supplements, however, don’t actually contain nitric oxide. Instead, they contain ingredients (or substrates) that are thought to give your body a nudge to produce more nitric oxide, such as L-arginine and L-citrulline.

“If you’re ingesting nitrate or L-arginine, the idea is that it’s supposed to stimulate the synthesis of nitric oxide in the endothelial cell. So the more substrates there are, the more NO can be produced,”

Because blood is responsible for the transportation of oxygen to working muscles, the reasoning is that the increased blood flow caused by taking NO supplements might help you work out for a longer period of time and speed up recovery time. Proponents also claim that increased blood flow might make your muscles bigger and more pronounced.

EFFICACY OF NO SUPPLEMENTS

Honestly, me self nor know. There’s simply not enough evidence to suggest that they do.

Seemingly, the idea is that these supplements will increase NO, and then because of that, it’ll support the process of vasodilation, and obviously, the downstream  effect of vasodilation would be this massive increase in blood flow, which leads to increased exercise performance and enhanced recovery. “But most, if not all, of [these purported benefits] have not been supported by available evidence.”

In studies that have shown a link between improvements in performance and nitrate levels in the blood, such positive results could simply be a result of extensive training, as exercise itself enhances NO activity. Plus, dietary nitrate comes from other sources, like vegetables, and most studies don’t control for this.

Even if there are benefits to NO supplementation, it’s unclear whether they would apply to everyone. A review of 42 studies related to the effects of dietary ingredients linked with NO and exercise performance found mixed results: the review concluded that while NO supplements may “improve tolerance” to aerobic and anaerobic exercise in people who either aren’t in shape or are moderately trained, there seems to be no benefit in highly trained people.

BEETS AND IMPROVED WORKOUT?

 A few studies have shown that nitrate supplementation through beetroot juice can be effective at increasing endurance and overall power. One study found a link between 15 days of beetroot juice supplementation and an increase in power max during moderate–intensity cycling tests. While more research is required, it might interest you to note that of the ingredients that may have an impact on NO levels and exercise performance, beetroot juice is the most promising.

“Beets are the highest dietary source of nitrates, which are converted into nitric oxide in the body. Because of their natural nitrate content and it’s ability to convert to nitric oxide so well, beets have been shown through many studies to support the heart, especially by improving blood pressure,”.

Beets are also linked to other nitric oxide benefits, including improvements in both increasing strength and endurance performance as well as improvements in cognition during exercise, lower inflammation levels, greater antioxidant function, improved cognition.

Plus, beets are also good for your heart and muscle recovery, and are a good source of fiber. 

It’s important to note that blood nitrate levels peak within 2–3 hours. Therefore, to maximize their potential, it’s best to consume beets 2–3 hours before training or competing

SIDE EFFECTS OF NITRIC OXIDE SUPPLEMENTS

Even though the jury’s out on whether NO supplements really do improve performance, Bloomer says if you want to try them at a low dosage, go ahead. That said, if you’re prone to hypotension (or low blood pressure), you might want to skip them, as they could leave you feeling lightheaded or dizzy.

You should note that high dosages of NO supplements could put your kidney function at risk, particularly if you already have a nitrate-heavy diet. In such cases, “it might actually cause a reduction in performance, because your kidneys are too stressed out trying to process all this extra nitrate. To be on the safe side, just stick to the dosage stated on the package.

DOES NITRIC OXIDE HELP SEXUALLY OR BOOST LIBIDO

Since Nitric oxide itself plays a  substantial role in initiating and sustaining erections in males, and since it also increases blood flow to the penis, which can help a man maintain his erection, it could increase performance in bed and help you go longer. But there are other intrinsic factors to this.

A recent study did show that L-arginine supplements might enhance the effects of a common erectile dysfunction drug, but studies on people without dysfunction is limited, so general benefits aren’t totally known.

IS NITRIC OXIDE DANGEROUS FOR YOUR LIVER?

“While research isn’t conclusive, the answer to this may depend on whether you’re ingesting high amounts of synthetic nitrates and nitrites from processed meats or eating nitrates naturally from vegetables,”.

The World Health Organization and American institute for cancer research advise against any intake of processed and cured meats, and most contain sodium nitrates and nitrites. “Some research has linked sodium nitrates to free radical damage to cells including those in the liver, however much of this research has been conducted on animals with human studies being based on correlation rather than causation,” she says.

FOODS THAT ARE HIGH IN NITRIC OXIDE

Beetroot juice contains a notable amount of nitric oxide, and there is research to show that drinking it before competition can help with performance. One study found cyclists who drank beetroot juice two to three hours before exercise increased peak power and pedaling velocity. Another review also shows that beetroot juice can increase overall endurance and power for athletes.

It could also be found in leafy greens and other vegetables, but in smaller amounts. Vegetables are rich in nitrates, and high nitrate intake is associated with higher nitric oxide levels in the body, reason why incorporating veggies to your diet is important; so long as you have a healthy oral microbiome. Regular use of antibacterial mouthwash actually kills the bacteria that aid in production of nitric oxide from nitrates (and may impact the bacterial balance in your lower digestive tract),”.

There are a few vegetables with nitric oxide, but the ones with the highest nitrite content are beets which tops the list, as well as celery, chard, watercress, lettuce, spinach, and arugula. The next group with the greatest amount includes cucumber, celeriac, Chinese cabbage, endive, fennel, kohlrabi, leeks, and parsley.

IS DAILY INTAKE OF NITRIC OXIDE ADVISED?

Consuming nitrates through food is totally encouraged. The research on beet juice and beet powder shows the best success in improving exercise performance and heart health with daily consumption of at least 2 weeks. “Nitrate content may be an additional reason high vegetable intake is associated with better heart health, too,”

When it comes to supplements containing ingredients other than pure beet or vegetable powder, you want to be careful. Supplements are not well regulated for safety, purity, potency or effectiveness of claims, so if you do choose another “nitric oxide booster” pick one that is third party tested, preferably by NSF for Sport or Informed Choice for Sport.

To be candid, from a professional view, I don’t think you should supplement daily. No dietitian would recommend it. There isn’t much research on these supplements, so it’s difficult to assess what the long term side effects might be. Instead, just eat your darn veggies  or beets to get your nitric oxides you must. 

SOURCES: https://www.healthline.com/nutrition/benefits-of-beets#section3

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DIET THERAPY OF DISEASES

GASTROPARESIS

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GASTROPARESIS

As a saying goes thus : “ to eat is human, to digest is divine; a number of people find it difficult to utilize their digestive tracts after enjoying a sumptuous meal. Really, it’s saddening to be afraid to eat that very delicious meal because you know you would probably be bloated or even constipated. So, what to do? 

Let’s take a look at this exciting digestive disorder called gastroparesis, shall we?

Gastroparesis (abbreviated as GP) represents a clinical syndrome characterized by sluggish emptying of solid food (and more rarely, liquid nutrients) from the stomach, which causes persistent digestive symptoms especially nausea and primarily affects young to middle-aged women, but is also known to affect younger children and males.

It’s thought to be the result of a problem with the nerves (vagus) and muscles that control how the stomach empties.

Sadly, If these nerves are damaged, the muscles of your stomach might become dysfunctional and the motility of food can slow down.

“While delayed emptying of the stomach is the clinical feature of gastroparesis, the relationship between the degree of delay in emptying and the intensity of digestive symptoms does not always match”. For instance, some diabetics may exhibit pronounced gastric stasis yet suffer very little from the classical gastroparetic symptoms of: nausea, vomiting, reflux, abdominal pain, bloating, fullness, and loss of appetite. “Rather, erratic blood-glucose control and life-threatening hypoglycemic episodes may be the only indication of diabetic gastroparesis. In another subset of patients (diabetic and non-diabetic) who suffer from disabling nausea that is to the degree that their ability to eat, sleep or carry out activities of daily living is disrupted gastric emptying may be normal, near normal, or intermittently delayed”. In such cases, a gastric neuro-electrical dysfunction, or gastric dysrhythmia (commonly found associated with gastroparesis syndrome), may be at fault.

DIABETES AND GASTROPARESIS 

Over time, diabetes can affect many parts of your body (especially nerves). One of those is the vagus nerve, which controls how quickly your stomach empties. “When it’s damaged, your digestion slows down and food stays in your body longer than it should”.

Although it’s more common in people with type 1 diabetes, people with type 2 can also get it.

From a study carried out by Phillips LK et al., 2015 : 

Glucose and gastric emptying: bidirectional relationship. The rate of gastric emptying is a critical determinant of postprandial glycemia. Glucose entry into the small intestine induces a feedback loop via CCK, peptide YY (PYY) and glucagon-like peptide 1 (GLP-1), which are secreted from the intestine in response to nutrient exposure. GLP-1 and gastric inhibitory polypeptide (GIP) induce the release of insulin, and GLP-1 inhibits glucagon secretion, which attenuates postprandial glycemic excursions. Amylin, which is co-secreted with insulin, also slows gastric emptying. At the same time, the blood glucose concentration modulates gastric emptying, such that acute elevations of blood glucose levels slow gastric emptying (effects are evident even within the physiological range) and emptying is accelerated during hypoglycemia.

DIAGNOSIS

Diagnosis of gastroparesis begins with a doctor asking about symptoms and past medical and health experiences (history), and then performing a physical exam. Any medications that are being taken need to be disclosed.

Tests will likely be performed as part of the examination. These help to identify or rule out other conditions that might be causing symptoms. Tests also check for anything that may be blocking or obstructing stomach emptying. Examples of these tests include:

  • a blood test,
  • an upper endoscopy, which uses a flexible scope to look into the stomach,
  • an upper GI series that looks at the stomach on an x-ray, or
  • an ultrasound, which uses sound waves that create images to look for disease in the pancreas or gallbladder that may be causing symptoms.

SYMPTOMS 

The digestive symptom profile of nausea, vomiting, abdominal pain, reflux, bloating, early satiety, and anorexia can vary in patients both in combination and severity.

Others may include weight loss/weight gain, constipation and/or diarrhea, wide glycemic fluctuations in diabetics, belching and bloating-again, developing soon after meal ingestion and lasting for hours-along with visible abdominal distention. The distention and bloating may push up against the diaphragm making breathing uncomfortable.

“A poorly emptying stomach additionally predisposes patients to regurgitation of solid food, as well as gastroesophageal reflux disease (GERD)”. The reflux may range from mild through to severe. GERD complications can create esophageal spasm (also called non-cardiac chest pain) and can add to the burden of chronic pain. In severe cases, reflux aspiration pneumonitis compounds the clinical picture.

CAUSES

Reports from one tertiary referral center found that out of their 146 patients with gastroparesis: 36% were idiopathic (unknown causes), 29% were diabetic, 13% were post-surgical, 7.5% had Parkinson’s disease and 4.8% had collagen diseases. Any disease of metabolic, neurological (psychiatric, brainstem, autonomic including sympathetic and parasympathetic or enteric), or connective tissue (autoimmune) origin has the potential to disrupt gastric neural circuitry.

Apparently, diabetes is the most common known cause of gastroparesis. It can damage nerves — including the vagus nerve, which regulates your digestive system — and certain cells in your stomach.

Other causes of gastroparesis include:

Related Disorders

A stomach motor disturbance known as “dumping syndrome” whereby food or liquids empty too quickly from the stomach can present with similar symptoms as are found in gastroparesis. Other disorders that may clinically present as gastroparesis (gastritis, gastric ulcers, pyloric stenosis, celiac disease, and GI obstructions) need to be ruled out.

TREATMENT 

You may find these tips helpful:

  • instead of 3 meals a day, try smaller, more frequent meals – this means there’s less food in your stomach and it will be easier to pass through your system
  • try soft and liquid foods, or even semi solid foods which are easier to digest. In severe cases, broths might be advisable. 
  • Masticate well before swallowing ( i tried to check how long it’ll take to carefully grind a spoon of rice and i got 21seconds; you should try eating slowly. winks).
  • drink non-fizzy liquids with each meal

It may also help to avoid certain foods that are hard to digest, such as apples with their skin on or high-fibre foods like oranges and broccoli, plus foods that are high in fat, which can also slow down digestion.

MEDICATIONS 

Use of drugs like domperidone, erythromycin, anti-emetics. Also note that these drugs might have side effects so it’s important to discuss with your doctor before using them. 

Domperidone should only be taken at the lowest effective dose for the shortest possible time because of the small risk of potentially serious heart-related side effects.

Other options like electric stimulation, botulinum toxin injections, a feeding tube, surgery

FOOTNOTE FOR DIABETICS

The nerves to the stomach can be damaged by high levels of blood glucose, so it’s important to keep your blood glucose levels under control if you have diabetes.

Your doctor alongside a dietitian can advise you about any changes you may need to make to your diet or medicine. For example, if you’re taking insulin, you may need to divide your dose before and after meals and inject insulin into areas where absorption is typically slower, such as into your thigh.

SOURCES: https://www.nhs.uk/conditions/gastroparesis/

https://rarediseases.org/rare-diseases/gastroparesis
https://aboutgastroparesis.org/signs-symptoms.html/diagnosis-tests.html
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6028327
https://www.webmd.com/diabetes/type-1-diabetes-guide/diabetes-and-gastroparesis#1
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DIET THERAPY OF DISEASES

ACHALASIA: CAUSES, SYMPTOMS AND TREATMENTS

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Achalasia is a rare disorder of the food pipe (oesophagus), which can make it difficult to swallow food and drink.

Normally, the muscles of the oesophagus contract to squeeze food along towards the stomach. A ring of muscle at the end of the food pipe then relaxes to let food into the stomach.

The upper esophageal sphincter is a muscular valve that is located at the upper portion of the esophagus, which is typically about 8 inches long.

Unlike the lower esophageal sphincter (LES), which opens and closes without our conscious effort, the upper esophageal sphincter is under our conscious control. We can control when it opens. For example, we can open the upper esophageal sphincter by swallowing foods or liquids.​

In achalasia however, there is a failure of organized esophageal peristalsis causing impaired relaxation of the lower esophageal sphincter, and resulting in food stasis and often marked dilatation of the esophagus. 

Obstruction of the distal esophagus from other non-functional etiologies, notably malignancy, may have a similar presentation and have been termed “secondary achalasia” or “pseudoachalasia“.

SYMPTOMS 

Patients may present with: 

  • dysphagia for both solids and liquids: this is in contradistinction to dysphagia for solids only in cases of esophageal carcinoma 
  • chest pain/discomfort
  • eventual regurgitation
  • drooling of vomit or saliva
  • gradual but significant weight loss

CAUSES

Almost thought to be familial, but is also thought to happen when the nerves in the oesophagus become damaged and stop working properly, which is why the muscles and ring of muscle don’t work. It could also be as a result of the body’s immune system attacking healthy cells (autoimmune condition).

PATHOLOGY

“Peristalsis in the distal smooth muscle segment of the esophagus may be lost due to an abnormality of the” Auerbach plexus” (responsible for smooth muscle relaxation), resulting in weak, uncoordinated contractions that are non-propulsive”. The abnormality may also occur in the vagus nerve or its dorsal motor nucleus.

The lower esophageal sphincter eventually fails to relax, either partially or completely, with elevated pressures demonstrated manometrically . Early in the course of achalasia, the lower esophageal sphincter tone may be normal or changes may be subtle.

TREATMENT OPTIONS 

MEDICATION: Medicines like nitrates or nifedipine can help relax the muscles in your oesophagus and make swallowing less painful and difficult.

Botox injection and balloon dilation could also be useful.

DIETARY MANAGEMENT 

The management of the patient with achalasia and nutritional problems is very similar to that of patients with dysphagia due to neurologic disease or esophagogastric cancer. Oral feeding has relevant psychosocial significance to patients and their families, and should be continued whenever possible. In some patients, oral intake is often not adequate even in the absence of significant swallowing difficulties. In mild to moderate achalasia, nutrition is generally mildly affected and, if the family encourages the patient to follow dietary modifications, loss of weight and malnutrition rarely occurs.

Dysphagia diets should be highly individualized, including modification of food texture or fluid viscosity. Food may be chopped, minced, or puréed, and fluids may be thickened.

If a patient is unable to eat or drink or to consume sufficient quantities of food, or the risk of pulmonary aspiration is high, tube feeding should be provided. If there is a possibility for surgical myotomy, enteral nutrition via a nasal feeding tube will be adequate as a provisional measure, considering that a malnourished patient is always at major risk for postoperative complications.

SOURCES : https://www.nhs.uk/conditions/achalasia/

https://radiopaedia.org/articles/achalasia
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3108680
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