First Eat Right - Dietitian Nutritionist Dr. Nafeesa's Diet & Nutrition Clinic

“Let food be thy medicine” these are golden words which reward you in the best of ways possible. Crops and harvests are covered by pesticides and produce quality is diminishing every day. Even if we consume the same portion of fruits and vegetables like our ancestors we are not assured of a healthier body and a stronger mind. Real agony is that we have all have forgotten to eat more of produce and have shown a greater inclination towards eating processed foods thereby stooping to even lower energy and health levels comparatively. Even toddlers and infants know what’s a burger or a French Fries, they choose their own favorite pasta or roll at restaurants and don’t prefer anything mild! It has become a difficult affair to please kids with their lunch nor it is easy to make adults eat a well-balanced meal that’s high in nutrients and energy. Apart from all this, the fast-paced world does not have time for preparing nutritious meals, going for a walk daily or reducing intake of outside foods-Isn’t food our way of celebrating team efforts, target achievements or a way of meeting and greeting friends/colleagues? Such intake of poor diet exists as the leading case of premature death and disability in many countries of the world. This is also the culprit behind metabolic syndrome and other diseases such as heart disease and diabetes which are ruling the world affecting as many people as possible.

Chronic diseases ruin the quality of life of individuals and raise the health care cost of treating patients. We do have research and trials comforting us with the good news that consuming fruits and vegetables (FV) or whole grains (WG) have potential effects on the markers of metabolic syndrome. Metabolic syndrome is the cluster of conditions such as dyslipidemia, high blood pressure, impaired glucose tolerance and abdominal fat accumulation that’s linked to increased risk of cardiovascular diseases. Of late, rather than relying on medicines the trend has changed and people have accepted that treatment for BP, obesity and hypertension should focus on diets for weight loss and exercise programs that help in increasing physical activity. In the recent decades we have numerous proofs justifying the fact that consumption of fruits, vegetables, nuts, whole grains, legumes, fish and low-fat dairy products are protective and good for health. Physicians and health experts recommend consuming at least five portions of fruits and vegetables every day for our health. But what we do is to avoid every fruit/veggie that comes our way and also use every opportunity to get lost of these nutritious foods. There are some of us who don’t even eat a single portion of veggie on many days of the week or go without munching on a slice of pineapple or kiwi.

Metabolic Benefits of Foods
Diseases such as diabetes and cardiovascular disease have robbed people of their health and the underlying mechanism for such diseases is chronic low-grade inflammation. The gut microbiota has been in the limelight for quite sometime now as we do have numerous researches showing that the quality of the gut microbiota can prevent or lead to various diseases. The immune system and the gut microbiota interact with each other and any changes in the gut microbiota can contribute to chronic inflammation. The composition of the gut changes through the lifetime of an individual affected by the diet we eat, stress and other environmental factors. One way in which the gut microbiota induces an anti-inflammatory effect is by the production of short chain fatty acids (SCFA) that also decrease the risk of cancer and obesity.

Inflammation in the body is both good and bad depending on the extent. You cut your finger or get hurt and the area around the affected part swells immediately. This means that your immune system is pretty good and the immune cells are doing their job releasing inflammatory compounds that kill bacteria and prevent the spread of infection. But sometimes, low-grade inflammation that persists over time are the root cause behind chronic diseases. The immune cells are the ones fighting here too but rather than attacking the enemy they attack the body including blood vessels and organs. This might be the work of stress, obesity or diet and if diet is the culprit we can make commendable improvements here by making strategic alterations to the diet. A diet rich in white flour, fried foods and sugar while being low in fruits and vegetables is said to be bad for health. Controlling all aspects of the diet is great but cannot be termed as a practical approach here. We know that intake of whole grains and fruits and vegetables is appreciated for gut health and anti-inflammatory effect but what is effect the of each on inflammatory markers and gut microbiota composition?
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Study Comparing WG and FV
Participants for the study were selected via flyers advertised at grocery stores based on numerous criteria that included BMI >25, no diagnosed gastrointestinal disease, no antibiotic use, <60 min/week of physical activity and low intake of fruits and vegetables. Food intake was measured using a questionnaire that included questions on serving size. A total of 49 individuals were finally selected for the study. All the participants were enrolled into one of the three groups randomly- control, WG and FV. Participants in the control group were given 3 servings/d of refined grains, those in the FV group were given 3 servings per day of fruits and vegetables that’s still below recommended levels and those in the WG group were given 3 servings/d of whole grains that was within recommended limits. All the participants visited the research lab every week during the study period and in this time they ordered their required foods from the list of foods available within each treatment group. While each of the participants were allowed to choose any combination of foods all of them had to order at least 21 and no more than 30 servings for the week
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Every week when the participants visited the research lab they brought two diaries-one contained a list of all the test foods eaten during the week and another one recorded all the gastrointestinal symptoms experienced during the week. The test foods diary listed down all the foods consumed and their individual serving sizes too. The participants were given a weekly GI symptoms questionnaire that consisted of the frequency and severity of symptoms such as stomach pain, heart burn, acid reflux, hunger pains, nausea, bloating, constipation, burping, diarrhea, abnormal stools and feelings of incomplete bowel emptying. Stool and blood samples were collected at the beginning and end of the study. Results revealed that:
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1. There was no significant difference among treatment groups at baseline except for age where there were more subjects over the age of 40 in the WC group compared to the control group
2. No significant changes in GI symptoms were recorded through the study showing that the treatment was tolerated
3. No changes in BMI was between baseline and end of the study
4. Significant decrease in lipopolysaccharide binding protein (LBP) from baseline values was seen in participants consuming WG and FV diets while the control group saw no changes. LBP is an inflammation marker measured and so are others such as interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) and high sensitivity C-reactive protein (hs-CRP).
5. WC diet resulted in decrease in TNF-α levels during intervention
6. While there was no significant difference seen in IL-6 for those participants following a control or WG diet there was a significant decrease of this inflammation marker seen in those following the FV diet plan
7. FV treatment group showed a potential increase in α-diversity (helps to measure species richness) while β-diversity (measure of change in species richness) was not different across any of the groups.
   
   

This study clearly shows that WG and FV diets had a positive impact on inflammation markers. The best thing about this study is that it compares between WG and FV. Both the treatments affected the gut microbiota in a positive way and it also shows that consuming them can have positive effects on those suffering from obesity and overweight problems.

References
Role of Whole Grains Versus Fruits and Vegetables in Reducing Subclinical Inflammation & Promoting Gastrointestinal Health in Individuals Affected by Overweight & Obesity: https://nutritionj.biomedcentral.com/articles/10.1186/s12937-018-0381-7

A simple cough makes us tired and we feel like taking the day off from school, work or even household chores. For people with asthma, they experience periods of wheezing, chest tightness, shortness of breath and coughing that might be mild or severe and might happen occasionally or even every day in life! The term ‘asthma’ is common and we all know that asthma patients carry a small tube-like device that’s called the inhaler but not many of us know what exactly causes the illness and if it can be prevented too! Asthma is a chronic, long-term condition that intermittently inflames and narrows the airways in the lungs. Its prevalence has increased tremendously in the recent decades affecting more than 300 million people worldwide and the numbers are expected to grow with yet another 100 million people affected by it by 2025. The World Health Organization (WHO) has estimated that 15 million disability-adjusted life-years (DALY) are lost and 2,50,000 deaths happen every year. It not only has social and financial burden on the affected individual but also poses a huge burden on healthcare resources. Symptoms mainly occur during the night or early in the morning disrupting sleep and above all, the quality of life of the individual is severely compromised. Anyone of any age can be a victim of this illness whose risk factors are not evident as it presents differently in both adults and children. Genes, obesity, environmental factors, allergens, infections, outdoor/indoor pollutants and tobacco smoke are some of the risk factors of asthma. The disease cannot be cured but only be managed and controlled. Treatment usually includes using controllers and relievers.
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Vitamin D
There are increasing evidences showing that vitamin D deficiency plays an integral role in chronic diseases including asthma. Also known as the sunshine vitamin, this nutrient deficiency is increasingly witnessed among the general population in individuals as young as 10-year-old to elderly people. Would you believe if I say that half of the healthy population worldwide are vitamin D-deficient? A fat-soluble vitamin, vitamin D helps in calcium absorption, for improved bone health, is vital for immune regulation and plays an important role in respiratory infections. The increase in this nutrient deficiency is mainly due to inappropriate dietary intake, lifestyle factors, behavioral changes and insufficient exposure to sun. This vitamin is also critical for inborn and adaptive immunity that might be relevant in preventing asthma, protecting against asthma, reducing its morbidity and severity. There are many examples in which vitamin D deficiency has been associated with increased airway hyperresponsiveness (AWH), lower pulmonary function, worse asthma control and steroid resistance.

The present indoor-based lifestyle and our modernized and Westernized practices keep us indoors away from the bright sun’s shining rays leading to severe vitamin D deficiency levels among any population. Though the role of vitamin D in asthma is not crystal clear we do have several cross-sectional studies that show a link between vitamin D and asthma: low levels of 25(OH)D levels in patients with mild to moderate asthma is related to poor asthma control, reduced lung function, reduced glucocorticoid response, frequent exacerbations and increased steroid use. There are also clinical trials showing the protective influence of vitamin D supplementation among asthmatic patients.

Asia is a continent that mostly faces the warmth of sunshine and in South Asia most of the days are sunny. Still, vitamin D deficiency is highly prevalent in the countries here due to various factors such as improper diet, inadequate calcium levels, culture and customs that mostly keep elderly, female population and children confined within the four walls of the house preventing them from enjoying the sun’s rays or enabling them to have sufficient vitamin D levels in their body. Indians are majorly affected with almost 69% to 82% of the Indian population suffering from vitamin D deficiency. Surprisingly, it’s not only those living in the subcontinent suffering from the deficiency but also immigrants in other countries such as Denmark, UK and Norway are highly affected.

Research on Vitamin D’s Relationship with Markers of Asthma Severity
The study was conducted in North India with 120 participants who were aged between 18 and 80 consisting of both males and females. These individuals met the asthma criteria, did not have a history of vitamin D or calcium intake in the past one month and did not have any other respiratory and systemic disorders. All the 120 participants’ sputum eosinophil count, blood eosinophil count, serum IgE level measurements, serum 25-hydroxy vitamin D levels and spirometry tests were performed. Those individuals whose vitamin D levels were on par with requirements were taken as controls in the study. The mean age of the subjects was 30.81 ±8.97, there were 72 males (60%), 48 females (40%), 57.5% were smokers and 42.5% were non-smokers. All the patients were separated into vitamin D-sufficient and vitamin D-insufficient groups and were also grouped depending on asthma severity as intermittent, mild, moderate and severe asthmatics. Vitamin D deficiency was highly witnessed in asthma patients, there was a direct relationship between serum vitamin D levels, severity of asthma, asthma control, serum IgE levels, sputum eosinophils and lung function. The table below shows different asthma severity levels in patients who are vitamin D-sufficient and insufficient.

Serum IgE levels are linked to asthma and in this study, vitamin D-sufficient participants had lower serum IgE levels compared to the other group. IgE is an excellent determinant of allergy and the study showed that severe asthma patients had higher IgE levels compared to mild asthma. Those individuals with insufficient vitamin D had a higher mean for sputum eosinophils than those with sufficient vitamin. Higher vitamin D levels are inversely associated with IgE, sputum eosinophils and peripheral blood eosinophil counts and also decreased use of anti-inflammatory meds, reduced hospital stays and less airway hyper responsiveness. This study clearly shows that vitamin D insufficiency was highly prevalent in asthma patients and the severity of asthma also depended on the insufficiency of the vitamin. Hence, supplements could be considered for those patients with asthma.
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Studies on Bronchial Asthma among Sudanese Patients
The study included 86 asthmatic patients aged 18 and above diagnosed with clinical asthma. Those >70 years of age, suffering from renal, lung and liver disease and on vitamin D, calcium and anticonvulsant drugs were excluded from the study. Their asthma levels were classified from mild to severe based on the different symptoms and blood samples were taken to measure vitamin D levels. Almost 70% patients were females and all the participants had suffered from this illness for around 10 years or so. Two-thirds of the study group had normal body mass index and only one-third were overweight/obese. Those who had well-controlled asthma were 24.4%, their mean age was 40 years, had normal BMI and 12 were males, participants with partially controlled asthma were 37.2%, mean age was 37.46 years and 26 of them were females. Those with uncontrolled asthma were 38.4%, their mean age was 45.36 years and 24 of them were females. Normal Vitamin D levels were present only in 2.3% patients while the rest had insufficient or deficient vitamin D levels. 25 (OH) level in the controlled asthma group was 25.82±17.27 ng/ml, in the partially controlled group it was 17.85±7.06ng/ml and in the uncontrolled asthma group it was 16.48±7.14ng/ml.

This study showed that only 47.7% individuals had vitamin D deficiency in comparison to few other studies which showed that almost 90% patients suffered from the deficiency. This might be because of the geographic location of Sudan that’s sunnier and hence, the people there are exposed to much more sunlight. This study also showed that vitamin D level had no role in asthma severity contradicting with previous study results. The Sudan study clearly shows that vitamin D level played a significant role in asthma control and aggravation of asthma but did not affect the severity of the illness in any way.

Vitamin D Deficiency in Asthmatic Children
The case-controlled study included 53 asthma patients and 53 controls. Children with asthma and hyperreactive airway disease were included as asthma patients. Vitamin D levels in both the groups were measured by radioimmunoassay (RIA) and was categorized as sufficient (>30 ng/ml), insufficient (20-30) and deficient (<20 ng/ml). The severity of asthma was also classified as mild, moderate and severe persistent. Both the groups had similar male gender distribution (56% vs 59%) and mean age. In the asthmatic group the mean duration of the disease was 13.1±24.6 months, 11.3% had mild asthma, 45.3% had moderate asthma and 43.4% had severe asthma. 5 of 31 kids aged below 5 years (16.1%) had high risk and 7 of 22 kids older than 5 years (31.8%) had high risk. While 73.6% asthma patients had vitamin D deficiency only 49.1% people in the control group had vitamin D deficiency, vitamin D insufficiency was 18.9% in both groups and normal vitamin D levels were 7.5% and 32.1% respectively.

Observational Studies
A study on 616 asthmatic kids showed that vitamin D deficiency/insufficiency was present in 28% kids and increased vitamin D levels led to decrease in asthma aggravations and also decreased the need for visits to the emergency department in hospitals. A cross-sectional study on 560 kids aged 6-14 years showed that kids with vitamin D insufficiency were 2.6 times at an increased risk of developing asthma exacerbations. Cohort studies show that lower dietary maternal intake of vitamin D result in increased asthma morbidity and wheezing rates in children. Studies in Finland and Japan on more than 750 mother-kid pairs show that dietary vitamin D intake during pregnancy was inversely linked to incidence of wheezing in kids.
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Clinical trials show that vitamin D offers protection against serious asthma attacks. A 6-month clinical trial showed that kids who received 500 IU/d supplementation of vitamin D had lower risk of asthma exacerbation; another trial on 100 asthmatic kids too showed the same results. But there were some other trials which did not show any association between vitamin D intake and reduction in asthma levels.

Vitamin D can definitely be a supplement therapy for managing asthma. While most studies do support the use of vitamin D for keeping asthma under control there are few studies that show that vitamin D supplements either have no effect or are responsible for increased asthma attacks.

References
Correlation between Asthma Severity & Serum Vitamin D Levels: Experience from a Tertiary Care Centre in North India: http://www.jbiomeds.com/biomedical-sciences/correlation-between-asthma-severity-and-serum-vitamin-d-levels-experience-from-a-tertiary-care-centre-in-north-india.php?aid=23236
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The Relationship between Vitamin D Level & Severity & Control of Bronchial Asthma among Adult Sudanese Patients: https://www.msjonline.org/index.php/ijrms/article/view/4784/3904

Vitamin D Deficiency and its Impact on Asthma Severity in Asthmatic Children: https://ijponline.biomedcentral.com/articles/10.1186/s13052-016-0300-5

A Review on the Role of Vitamin D in Asthma: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5491340/

Conceiving is a blessing and we don’t think beyond that when we hear the good news. Once things settle and the happiness sinks in, the couple start looking out for the best gynecologist/obstetrician to ensure a smooth pregnancy journey and to welcome their dearest bundle of joy into this world with utmost comfort and health. Parents these days are blessed in one way-they have the technology and facilities to predict a baby’s health and brain development as much as possible inside the womb but at the same time, they are also under constant pressure to take care of their health and too much of information also crumples their peace of mind. Don’t you think that ignorance is bliss sometimes in lives? Our mothers and grandmothers too delivered hale and healthy babies without much fuss and discomfort despite lacking modern hospitals and facilities to treat them as royals inside the maternity ward! While hospitals today function like five-star hotels taking care and pampering to the whims and fancies of the pregnant mum, they cannot ensure well-being and good health but only suggest practical exercise options and diet plans to help us stay healthy. Beyond that, it depends on the pregnant lady to treat her body as a holy place and work towards good health throughout her pregnancy tenure. But despite all these, there are all sorts of medical complications arising during pregnancy affecting both the mom’s and child’s health after delivery.
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Hypertensive disorders of pregnancy (HDP) that includes gestational hypertension and pre-eclampsia affect almost 5-10% pregnancies worldwide. HDP exists as a major cause of maternal and infant mortality and morbidity everywhere. The World Health Organization (WHO) estimates that almost 4 million stillbirths and 3 million deaths occur during the first week of life every year of which 98% happen in developing countries. Such deaths often reflect the mother’s health and healthcare facilities as they are the results of events that happen in utero and during birth.

Gestational Hypertension
Hypertension in pregnancy (HIP) is when diastolic blood pressure is at least 90 mmHg, systolic blood pressure is at least 140 mmHg, there is a rise in diastolic blood pressure by at least 15 mmHg and rise in systolic blood pressure by 30 mmHg in a pregnant woman on at least two different occasions at least 6 hours apart. There are various studies showing that hypertension paves ways for a number of maternal and fetal complications. High blood pressure levels lead to maternal complications, affect different organs and these women are at an increased risk of post-pregnancy cardiometabolic disease. Infants born to such mothers with HPD also have high blood pressure and body mass index (BMI) in comparison to those infants born to mothers with normal blood pressure levels. Such children grow up with vagaries through young adulthood which can even lay the foundation for type 2 diabetes and stroke in life. We have animal models suggesting that reduced uterine perfusion and exposure to anti-angiogenic factors during pregnancy can increase long-term blood pressure in the offspring. Studies indicating cardiovascular disease risk as adults has been universally proven and large offspring size at birth and risk of cardio metabolic diseases in the offspring too is positive but we don’t have human studies linking hypertension in adults to increased risk of hypertension in offspring. The study below finds an association between exposure to maternal HPD and offspring hypertension and cardiometabolic risk factor at age 40 years.

Population-based Cohort Study
Data on first-born individuals who were born between 1955 and 1972 attending the Västerbotten Health Survey was collected and this included 14,947 participants. All the residents of the county of Västerbotten were invited of which 60% of those eligible attended. All of them were provided with a self-administered questionnaire containing queries on lifestyle such as previous diagnosis of hypertension, smoking habits and family history of cardiovascular disease. Body weight and height measurements were noted down and BMI readings were calculated. Every participant was measured of his/her systolic blood pressure (SBP) and diastolic blood pressure (DBP) in supine position before August 2009 and twice again in a seated position. A 75 g 2-hour oral glucose tolerance test (OGTT) and total serum cholesterol measurements were taken.  

Of the total number of participants 383 participants (2.8%) were exposed to maternal HDP. Around the age of 40 there was not much of a difference in smoking status or education level between participants exposed and not exposed to maternal HDP. Three different models were used to investigate association between maternal HDP and offspring relative risk of hypertension at age 40 years. Poisson regression models incrementally adjusted for co-variables were used. While Model I included maternal HDP in index pregnancy, Model II (this is the main model) included infant’s sex, family history of cardiovascular disease and maternal diabetes during pregnancy. Model III included education level, smoking and BMI at age 40 years. Those participants who were affected with HDP had a higher risk of hypertension in all three models-model I, Model II and Model III. Maternal HDP was also linked to higher mean BMI, SBP, DBP and 2-hour OGTT result in Model II.

This study was the first to show that infants whose mothers suffered from HDP during pregnancy has an increased risk of hypertension. Also, maternal HDP puts the adult at an increased risk of higher blood pressure and BMI. Children born to mothers with pregnancies complicated by HDP mostly suffer from higher blood pressure, increased risk of hypertension and higher BMI compared to those kids born to mothers without any HDP risks.

Hypertensive Disorders Elevate Risk of Hypertension after Delivery
Hypertensive disorders are associated with long-term risk of cardiovascular disease but we don’t know much about the effect of it on the woman after delivery. We have study results showing that those women who develop hypertension during pregnancy are affected by elevated blood pressure in the first year after delivery. The study was on 5,960 women of whom those with pre-pregnancy high blood pressure were excluded from the analysis. Results showed that women with hypertensive disorder during pregnancy were 2.4 times likelier to develop pre-hypertension or hypertension in the ensuing year after delivery compared to those women with normal blood pressure during the pregnancy tenure. It was also seen that in comparison to women with normal blood pressure during pregnancy women with pregnancy-related hypertension were slightly younger and overweight/obese before pregnancy. This surely indicates that women who suffer from hypertension during pregnancy should keep monitoring their blood pressure with a physician after delivery to ensure that BP levels are kept under control. This helps in preventing major cardiovascular risks and complications that might arise in the future.

There are evidences suggesting that the immediate few years after delivery are crucial as there is even a fivefold increase in hypertension rate in the first five years after a pre-eclamptic pregnancy. It is possible that 25-45% women with a hypertensive disorder develop hypertension within five years of delivery. So, it is critical that women start taking care of their health even before pregnancy. Every lady in her reproductive years is advised to stay on a healthy weight and lead a healthy lifestyle to prepare herself for the pregnancy that would come her way in a few years’ time. Failing to do so not only increases the complications of pregnancy but also puts the life of both the pregnant woman and her infant at a higher risk of pregnancy-related complications.

References
Maternal Hypertensive Disorders of Pregnancy & Offspring Risk of Hypertension: https://academic.oup.com/ajh/article/32/4/331/5205123

Hypertensive Disorders during Pregnancy Increase Risk of High Blood Pressure After Delivery: https://www.sciencedaily.com/releases/2016/01/160129090124.htm

Risk of Post-pregnancy Hypertension in Women with a History of Hypertensive Disorders of Pregnancy: https://www.bmj.com/content/358/bmj.j3078

Waking up in the morning is a tough job for many and even after getting up, completing the morning chores and getting ready for work is a tiresome routine for some! Brushing teeth, having a bath and dressing up are a regular part of your morning activity but passing stool doesn’t line up as a routine in each of our lives! Though a healthy body routine includes this, not all of us are habituated to smooth bowel movements every day in our lives. Gastrointestinal issues including constipation remain a common condition in adults and children residing in every corner of the world. This not only disrupts morning routine and affects time management but also has a greater impact on the quality of life and well-being of the individual. People avoid using buses, freak out when they are travelling, eating habits change according to bowel movement and general well-being too is dramatically affected.

Constipation is pain or difficulty experienced while passing hardened stools or when there is three days in between bowel movements. Every individual faces this problem sometime in life and even healthy individuals become victims despite having no physical or physiological problems. This condition affects almost up to 25% of the population at any given time and is more common in women than men due to factors such as diet, lifestyle, old age, bowel habits and use of medications. Presently, people with constipation problems are recommended lifestyle and dietary modifications apart from other interventions such as stool softeners, osmotic laxatives and stimulant laxatives. But these laxatives sometimes can pave way for unnecessary side effects and it would be preferable to use natural methods to alleviate inappropriate bowel movement. A diet-based change is always the best approach as it is a long-term solution that has no side effects. It is suggested to eat a well-balanced meal that includes bran, whole-wheat grain, plenty of fresh fruits and vegetables, drinking fluids and staying active as a preventive as well as treatment protocol for constipation problems. Basically, it’s a food-based approach that contains aplenty water that’s prescribed as a treatment against constipation. This includes the exotic kiwifruit that has captured the attention of individuals worldwide with its sour-sweet taste and consistency. Though priced a tad higher than many regular fruits kiwis are an excellent source of vitamins and minerals, dietary fiber and polyphenols. Being used as a traditional Chinese medicine the fresh kiwis have been proclaimed to increase laxation in the elderly population due to its high fiber content. Clinical trials show that consuming the whole fruit helps enhance laxation in healthy individuals and also in those individuals with irritable bowel syndrome (IBS) and constipation. Researchers confer these benefits to the presence of soluble and insoluble fiber, polyphenols and the enzyme actinidin present in the fruit.

Effect of Kiwifruit-derived Ingredients on Bowel Movement
The kiwifruit has a strong Asian origin but are also mostly grown in New Zealand. Actazin and Gold are two powdered ingredients derived from whole New Zealand green (Actinidia deliciosa) and gold (Actinidia chinensis). In both of the varieties, the skin and seeds are removed and the flesh is cold processed for use in supplements. A group of researchers hypothesized that fleshy part in both these varieties played integral roles in improving stool frequency, stool form and gastrointestinal comfort in healthy as well as constipated individuals. The research team selected participants to prove the hypothesis right using several criteria such as age between 18 and 60 years, BMI between 19 and 30 kg/m2, had gastrointestinal symptoms, were vegans or followed a high-fiber diet, had surgery for weight loss, were pregnant or were allergic/sensitive to kiwifruit. Blood samples of the participants were collected at the beginning and end of the study.

It was a double-blind, placebo-controlled study which had two groups of participants: healthy participants with no symptoms of constipation and those with functional constipation who met the Rome III criteria for C3 functional constipation. The criteria includes 2 or more of the following: lumpy or hard stools at least 25% of the time, straining at least 25% of the time while passing stools, a sensation of anorectal obstruction or blockage at least 25% of the defecation time, 3 or less than 3 defecations per week, loose stools that rarely occur without using laxatives and insufficient criteria for irritable bowel syndrome.

There was a 14-day washout period before the study and all participants consumed 4 dietary interventions each for 28 days with a 14-day washout period between interventions. The interventions included were placebo, Actazin low (Actazin-L) dose (600 mg/day), Actazin high (Actazin-H) dose (2400 mg/day) and Gold (2400 mg/day) which were given in 4*600 mg capsules along with a glass of water. While there were no additional ingredients in Gold powder the Actazin powder contained silica and microcrystalline cellulose. Each of the participants completed a 3-day food dairy at the start and end of the trial, noted down daily bowel movements and well-being parameters. There were 19 participants in the healthy cohort group whose average age was 38 years and BMI 23. There were 9 participants in the functionally constipated cohort whose average age was 44 years and BMI was 25. Results showed that:

1. In those belonging to the healthy cohort group, Actazin-H and Gold consumption resulted in significant increase in mean daily bowel movements and Actazin-L consumption also showed a nearly significant increase compared to washout.
2. In the responder subgroup that was selected based on increase of 1 bowel movement each week, consumption of Actazin-L, Actazin-H and Gold resulted in increase in daily bowel movements compared to the washout
3. In the functionally constipated group, there was no significant difference between interventions for bowel movements and other well-being parameters.
4. Consumption of Actazin and Gold increased stool frequency but did not have an impact on stool formation
   
   

Both Actazin and Gold had a strong impact on healthy responders showing that the fruit’s bioactive components improve regularity and laxation. But in those individuals with functional constipation, dietary interventions did not increase frequency of bowel movements compared to washout. But, the consumption of Actazin and Gold showed a numerical increase in bowel movements in individuals with functional constipation but with no changes in stool consistency, laxative use and painful defecation. Hence, both Actazin and Gold increased daily bowel movement by more than 1 bowel movement per week.

Effect of Kivia Powder on Gut Health
Kiwifruit has non-digestible oligosaccharides and insoluble fiber that act as a prebiotic by being fermented to small chain fatty acids of butyrate (increases gut motility), acetate and propionate. This combination in the kiwifruit is terrific as both the oligosaccharide and the fiber pass unaltered from the small intestine to the colon acting both as a prebiotic (growth of gut microflora) and as a fiber (to bulk the stool).

Kivia powder derived from kiwis is a freeze-dried powder containing Zyactinase, the enzyme actinidin (enhances gastric protein digestion), plant polyphenols, dietary fiber, carbohydrates and oligosaccharides. The study below deals with the benefits of the Kivia powder derived from kiwifruit. Kivia powder contained extracts of kiwifruit prepared by a freeze-drying technique without any solvents or extraction. The placebo contained inactive components such as lemon powder, vital spirulina, citric acid, fructose, sucralose and tropical flavors. The Kivia powder was packed as a 5.5g dose per sachet but both, the placebo and the intervention powder were packed in identical sachets and the participants received a daily dose of one sachet dissolved in cold water along with breakfast.

The study included participants aged between 18 and 65 years with a BMI between 20 and 35. All the participants followed the following criteria to be labeled as suffering from occasional constipation: three or fewer defecations per week, straining to pass stools at least 25% of the time, lumpy or hard stools at least 25% times, a feeling of incomplete evacuation at least 25% times, having a sensation of anorectal obstruction or blockage at least 25% of the time and manual maneuvers to facilitate at least 25% of defecations. There were several other exclusion criteria and at the end there were 87 men and women consuming the study product daily for four weeks. Primary endpoint of the study was bowel movement frequency, a parameter used to assess how often an individual has his/her bowel movement; secondary endpoint was to determine the efficiency of the Kivia powder in comparison to the placebo on gut health. Endpoints included stool form (Bristol Stool Scale), bowel urgency (yes/no), abdominal bloating (0 = none, 1 = mild, 2 = moderate, 3 = intense, 4 = severe), abdominal discomfort or pain (0 = none, 1 = mild, 2 = moderate, 3 = intense, 4 = severe), satisfaction with bowel habits (0 = a great deal satisfied, 1 = a good deal satisfied, 2 = moderately satisfied, 3 = hardly satisfied, 4 = not satisfied at all), flatulence (0 = none, 1 = mild, 2 = moderate, 3 = intense, 4 = severe), and burping (0 = none, 1 = mild, 2 = moderate, 3 = intense, 4 = severe). The Bristol Stool Scale is used to classify the form of feces into categories (type 1 = separate hard lumps, like nuts, type 2 = sausage-shaped but lumpy, type 3 = like a sausage with cracks on surface, type 4 = like a sausage or snake, smooth and soft, type 5 = soft blobs with clear-cut edges and passed easily, type 6 = fluffy pieces with ragged edges, a mushy stool, type 7 = watery, no solid pieces, entirely liquid). Tertiary endpoint was to determine the efficiency of the Kivia powder compared to the placebo and quaternary endpoint included determining the safety of the Kivia powder compared to the placebo.

There were 87 participants (44 in placebo and 43 in product) but there were 4 withdrawals in the active group and 1 in the placebo group resulting in 43 participants in the placebo and 39 in the active group finally. Results showed that:

Primary Endpoint: Participants in the active group witnessed increase in number of spontaneous bowel movements (SBM) every week of the study compared to baseline. Changes in SBM from baseline to week 3 and from baseline to week 4 were significantly higher in the treatment group compared to the control group. There was a significant increase in the number of complete spontaneous bowel movements (CSBM) observed every week compared to baseline.

Secondary Endpoint: There was significant decrease in abdominal bloating at the end of every week compared to baseline, significant and nearly significant decrease in abdominal discomfort at the end of week 2 and 4 compared to baseline, abdominal pain or discomfort was lower in the treatment group compared to placebo at week 1 and 3 and significant increase in satisfaction with bowel habits at every week of the study compared to baseline. No difference was observed between the two groups in terms of abdominal bloating and satisfaction in bowel habits. Flatulence was lower for the active group compared to placebo at week 2 and 3. There was a reduction in stool forms 1 and 2 and an increase in stool forms 3, 4 and 5 in both groups. By week 2, there was a significant increase in type 4 bowel movement in the Kivia powder group compared to placebo and by week 3 (follow-up phase), there was an increase in type 5 bowel movement in the treatment group compared to placebo.
A clinical trial on Zyactinase was conducted on 58 participants with 30 of them belonging to the placebo group and 28 belonging to the experimental group. The Rome III criteria system was once again used here to measure abdominal discomfort of the participants and from 7 days (run-in period) before the study the participants were prevented from using any dietary supplement or medicine to relieve constipation. After this, there was a 7-day dosing period where each of the participants were given 6 capsules a day either of the placebo or the fruit extract. Again, during the next 7 days they were not allowed to eat anything (supplements or pills) that would facilitate easy passage of stools. Results showed that during the dosing period there was a significant difference in the number of bowel movements per week, though not quite significant there was a slight increase in the frequency of bowel movements per week in the placebo group and during the follow-up phase there still existed significant difference between the two groups.

The researchers expressed 0 as an ideal fecal score. The baseline fecal score was 1.9, during the dosing period there was a softening of the stool experienced in both the groups with the active group expressing even potent results. During the follow-up period, fecal score remained low for the active group but for the placebo group the scores increased thereby showing that the fecal stools were also becoming harder again. Abdominal discomfort scores improved drastically for the active group during the dosing and follow-up phase and consumption of 2160 mg/day of kiwi extract returned stools to near normal within the seven-day dosing period and the effect remained intact during the follow-up period. The trial thus shows that the green kiwifruit extract helped inducing normal bowel movements, relieved constipation and symptoms of IBS with no adverse effects.

References
Kiwifruit-derived supplements increase stool frequency in healthy adults: https://www.sciencedirect.com/science/article/pii/S0271531715000718

Effects of Kivia Powder on Gut Health in Patients with Occasional Constipation: https://link.springer.com/article/10.1186/1475-2891-12-78

Efficacy of Actinidin-containing Kiwifruit Extract Zyactinase on Constipation: https://www.ncbi.nlm.nih.gov/pubmed/29737803

Encapsulated Green Kiwifruit Extract: A Randomized Control Trial Investigating Alleviation of Constipation in Otherwise Healthy Adults: https://pdfs.semanticscholar.org/40a6/6d4a2f551b5835ecea9d00e79db9cec49414.pdf