Andrew Lazootin, Naturopath

Declining folate levels linked with dementia.

Researchers from Chonnam National University Medical School in Kwanju, Korea report that older individuals who were deficient in folate had triple the risk of developing dementia compared to those with higher levels of the vitamin.

The study included 625 men and women aged 65 and older who were free of dementia in 2001. Upon enrollment, blood samples were collected and analyzed for serum folate and vitamin B12, as well as plasma homocysteine, and assessments for dementia were conducted. These tests were repeated at follow-up examinations which took place an average of 2.4 years later.

Folate deficiency was present in 3.5 of the participants at the beginning of the study, and B12 deficiency in 17.4 percent. Twenty percent had elevated homocysteine levels, which were associated with having lower folate and B12. Five hundred eighteen participants completed the study, of which 34 went on to develop Alzheimer’s disease, seven acquired vascular dementia, and four developed dementia of other origin.

Over the course of the study, folate levels decreased and vitamin B12 levels rose. Dementia was significantly associated with having lower folate levels upon enrollment as well as with showing a decline in the vitamin at follow-up . Those whose folate levels were deficient at the beginning of the study experienced 3.43 times the risk of dementia than those who whose folate levels were considered adequate. Having comparatively lower levels of B12 and increased homocysteine concentrations were also associated with dementia.

The drop in folate, but not B12 levels may reflect vitamin supplementation, since most Korean supplements provide B12 but not folic acid. The authors note the possibility that the differences associated with dementia in this study may reflect supplement use; however they do not believe that this is the only explanation for the finding.

The researchers suggest that alterations in nutrient levels may be associated with other indicators of impending dementia, including weight loss, which can indicate changes in dietary quality. “Attention needs to be paid to the nutritional status of people with dementia from the time of diagnosis onwards, regardless of whether this is a cause or effect of their condition,” the authors observe. “In addition, there may be good arguments for focusing interventions for the prevention of dementia on nutritionally deficient frail populations,” they conclude.

Fighting Father Time by Outrunning Him Training Hard Can Help Stave Off Aging

 You know what is expected to happen when you grow old. You will probably slow down, grow weak, your steps will become short and mincing, and you will lose your sense of balance. That is what researchers of aging consistently find, and it is no surprise to most of us.

But it is worth remembering that the people in those studies were sedentary, said Dr. Vonda Wright, a professor of orthopedics at the University of Pittsburgh.

Wright, a 40-year-old runner, decided to study people who kept training as they got older or began competing in middle age. She wanted to know what would happen to them and at what age performance starts to decline.

The results were surprising, even to many researchers. The investigators found that while people slow down as they age, they may be able to stave off more of the deterioration than previously thought. They also found that people could successfully start exercising later in life; one man took up running at age 62 and ran his first marathon, a year later, in 3 hours and 25 minutes.

It is a testament to how adaptable the human body is, researchers said, that people can start serious training at an older age and become highly competitive. It also shows that some physiological factors needed for good performance are not much affected by age.

Researchers say that one should be able to maintain muscles as one ages, including the muscle enzymes needed for good athletic performance, and should be able to maintain an ability to exercise for long periods near so-called lactic threshold, meaning near maximum effort.

But it requires knowing how to train, doing the right sort of exercise and keeping it up. “Train hard and train often,” said Hirofumi Tanaka, a 41-year-old soccer player and exercise physiologist at the University of Texas.

Tanaka said that meant doing things like regular interval training - repeatedly going all out, easing up, then going all out again. These workouts train the body to increase its oxygen consumption by allowing it to maintain an intense effort.

“One of the major determinants of endurance performance is oxygen consumption,” Tanaka said. “You have to make training as intense as you can.”

Steven Hawkins, an exercise physiologist at the University of Southern California, recommends exercising hard over exercising often. “High performance is really determined more by intensity than volume,” Hawkins said. “Sometimes, when you’re older, something has to give. You can’t have both so you have to cut back on the volume. You need more rest days.”

Hawkins said that he had been amazed by some people who seemed to defy the rules of aging, people he described as “those rare birds who get faster.” Some subjects in his study, which followed runners for nearly two decades, actually had better running times when they were 60 than when they were 50.

“We really don’t know why,” Hawkins said. “Maybe they were training harder.”

Then there are people like the 62-year-old man who suddenly took up running and people like Imme Dyson, a 71-year-old runner who lives in Princeton, New Jersey. Dyson said that she took up running when she was 48 and loved it from the start. Her daughter, who had been a college triathlete, told her how to train.

“She said, ‘Mom, if your workout didn’t hurt, you didn’t work hard enough,’ ” Dyson said.

“Working consistently really is the recipe,” Dyson said. And it has made a difference for her, allowing her to run races ranging from 5 kilometers, or 3.1 miles, to marathons. She is consistently among the best in the United States in her age group. She has run a 15-kilometer cross-country race in 1:19:08 and she ran a 10- kilometer race in 51:50.

Not every aging athlete does so well. But research by James Hagberg, an exercise physiologist at the University of Maryland, found that studies of aging athletes sometimes were distorted because they included people who had reduced or stopped training. That is understandable; there is no reason, researchers say, to exhort everyone to maintain an intense effort decade after decade.

Athletes told Hagberg that they had just lost their motivation. “Some of them would say: ‘Competition just doesn’t motivate me as much at 75. I’ve been doing it for 50 years,’ ” Hagbert said. “Others would say, ‘I just can’t keep it up any more.’ ”

But for those who still have the drive, the news that muscle mass and lactic threshold can be maintained is encouraging. The reason people become slower is that oxygen consumption declines with age. In large part that is because, as has long been known, the maximum heart rate steadily falls with each decade by about seven to eight beats a minute. It happens with or without training, in sedentary and in active people, Tanaka said, and no one knows why. But as a result, the heart cannot pump as much blood at maximum effort.

Aspirin reduces heart attacks. Yes, but…

 In 1982, 22,071 male doctors said they’d be happy to be part of a study to see whether a single tablet of aspirin would reduce their risk of heart attack. They were the right age between 40 and 84. They were healthy, with no history of heart disease. Not much else was noted not how much they smoked or what they weighed or whether they liked a good thick steak every night.

One group took 325 milligrams of aspirin and another took 325 milligrams of sugar. The study was called the Physicians’ Health Study, and it was supposed to last through 1990.

By March 1988, an independent board looking at the data had seen enough. The aspirin regimen produced a 47 percent reduction in the total incidence of heart attacks.

And that medical finding became a cultural given in no time. There was a new reason to take aspirin, and companies that made it were happy to market it to a new and massive audience. An estimated 50 million Americans now take the over-the-counter pain reliever to protect their hearts from clots, the leading cause of attacks and strokes.

Take an aspirin, save your life. Better than apples.

It’s been 20 years since the first news. And science continues to refine the initial finding. Every year but one since 1900, the leading cause of death in the United States has been cardiovascular disease. (The exception was 1918.) Even with all the advancements since, more than 2,500 Americans die every day from heart disease. That’s one every 34 seconds.

Last spring, researchers at the University of Kentucky published findings that might have changed some thinking in the medical profession. In short, they said that not everyone needs an aspirin a day. And if you do, they said, you don’t need 325 milligrams.

Two of those researchers cardiologists Charles Campbell and Susan Smyth at the university’s Gill Heart Institute recently explained their work and the most current findings about aspirin and heart health.

Q. What was the crux of your findings?

In a review of numerous trials employing aspirin as a preventative and as subsequent regimen after an initial heart attack, we could not find a benefit from taking the higher [1 adult tablet, 325 milligrams] dose over taking a quarter of that [one baby aspirin, 81 milligrams] dose.

Q. So taking a baby aspirin a day is now what should be recommended?

If it’s warranted. No one should begin an aspirin regimen without first speaking to a doctor or health care provider. Things like your blood pressure and cholesterol count and family history are what’s important in determining your risk of heart attack, and those should be analyzed before any regimen is begun.

In general, if it’s been determined that you have a 10 percent chance of having a heart attack in the next 10 years, the aspirin regimen is advisable. Obviously, the higher the risk, the more benefit you accrue.

Q. If it’s warranted and I am diligent in taking it daily, am I absolutely reducing my risk of heart attack?

It’s hard to prove the negative. And it may matter if you are male or female. In studies with men, there is reasonable data to suggest that taking an aspirin will reduce heart attack risk but not stroke. (It should be noted that men suffer heart attacks about 10 years earlier in life i.e., in their 50s than women do.) And in studies with women, the effect of the regimen seems to be reducing stroke but not heart attack.

Q. But what about if I’m having a heart attack?

Get an aspirin into you as quickly as you can. In an emergency room setting, that’s 162 milligrams or two baby aspirins but 325 milligrams is fine. Chew it so that it dissolves and gets into your bloodstream with haste. Some 250,000 people die of heart attacks each year before they reach a hospital. That number could be reduced if more would recognize the symptoms of a heart attack and act accordingly.

Q. Do Tylenol, Motrin or Aleve work the same way?

No. Those are acetaminophen products and do not have the same mechanism. However, do not take these drugs and aspirin together, as they compete for the same binding sites and may blind each other’s positive effects.

Q. Does coated aspirin work?

That’s not really clear, but absolutely do not use it in the acute setting where you’re in the midst of a heart attack. It would take too long to get into your system.

Q. Who should not take a daily dose of aspirin to prevent heart attack?

Anyone at low risk of having a heart attack. If there is not much benefit of using the drug or any drug, all that you’re left with is the side effects and, in the case of aspirin, that can be bleeding into the stomach or intestines or an allergic reaction.

Q. Is there any evidence that an aspirin regimen is valuable in treatment of other diseases?

Yes. In a study following 90,000 American nurses for 20 years, those who reported taking a regular dose of aspirin experienced half the colon cancer as those who did not take aspirin. This is called observational evidence, and it [also] suggests that those women who regularly take aspirin have a slightly lower risk of having breast cancer. The question is if taking the aspirin is what causes the slight variation in incidence. Much more work is needed. The results of a randomized controlled study by researchers at Harvard Medical School are expected this year.

Q. If I am not advised to take an aspirin regimen, what should I be doing to protect my heart against attack?

Exercise regularly. Eat lots of fruits and vegetables. Don’t smoke. Drink only in moderation. Know what your blood pressure, blood sugar and cholesterol readings are. Have regular checkups to monitor your overall heart health.

New screening tests can detect heart problems before they are life-threatening

New screening tests that were largely unavailable five years ago, can quickly and painlessly detect potential heart problems well before they become life-threatening, according to Legacy Heart Center managing partner Marc S. Shalek, M.D.”And with this month being Heart Month, it’s a good time for forty-something men and women to call their doctors and schedule a heart health check-up,” he noted.

According to statistics from the American Heart Association, although heart disease continues to be the leading cause of death for Americans (with stroke coming in third), the trend lines for both diseases are heading down.

Dr. Shalek attributes the decline to early detection and treatment and notes that two new tests are particularly effective in catching cardiovascular problems early, before damage is done.

One is called the CIMT or carotid intima media thickness test. A CIMT uses an ultrasound scan of the carotid arteries in the neck that carry blood to the brain to measure the thickness of the various layers in the blood vessel and the build up of plaque.

“It actually provides an analysis of the ‘age’ of your arteries and reliably correlates with the risk of future strokes and heart attacks. By measuring the thickness of the first two layers of the carotid artery, we can get a good idea of a patient’s risk for cardiovascular disease,” he noted.

The other test is a coronary calcium scoring test, which uses the new super-fast CT scanners to measure the calcium build-up in your coronary arteries.

“Studies have shown that coronary calcium scores directly correlate with the risk of heart attack, even if your other risk factors–family history, age, cholesterol levels, diabetes, smoking and obesity–are low,” said Dr. Shalek.

“Although calcium doesn’t cause a heart attack, even in otherwise healthy people a higher coronary calcium score signals that plaque is present and atherosclerosis or hardening of the arteries has begun. Left untreated, the arteries will gradually narrow, restricting the flow of blood and increasing your risk of heart attack and stroke.”

Cardiologists recommend that men over 40 and women over 45 who have two or more risk factors undergo the tests. Risk factors include high cholesterol, high triglycerides, smoking, hypertension, diabetes, being overweight or a having a history of heart disease in the family.

“People should keep in mind that nearly half of all heart attacks occur before the age of 65 and more than a third of all Americans who have a heart attack show no symptoms beforehand,” Dr. Shalek said. “On the other hand, the American Heart Association says that some 85 percent of sudden heart attacks could be prevented if the conditions that led to the attack are diagnosed early enough to prescribe treatment.”

A new look at fasting: Studies find health benefits

If your pants mysteriously shrank during the holiday season, you may want to consider a weight-loss method with a bad reputation: skipping or drastically restricting meals.You’ve heard the reason not to: You’ll only eat more later on. But people don’t automatically replace all the missed calories at their next meal, says David Levitsky, a professor of nutrition and psychology at Cornell University. His research team assigned one group of people small lunches of about 200 calories, while a second group dined on about 600 calories. Both ate as they wished during the rest of the day. After two weeks, the small-lunch bunch lost weight; they were eating about 400 calories fewer than the all-you- can-eaters.

A variation that might not even feel like self-denial is to restrict calories every other day. In a small study published in March 2007, researchers followed a group of 10 overweight people who were fed just 20 percent of their normal calorie intake on alternate days. The other days, they could eat what they wanted. After eight weeks, they’d lost an average of 8 percent of their body weight, says study co-author James Johnson, a clinical instructor in the department of surgery at Louisiana State University School of Medicine and author of a forthcoming book on alternate-day calorie restriction.

“I like the psychology of it,” says Kenneth Webb, 37, a hedge fund trader from Walnut Creek, Calif., who’s followed Johnson’s program. “On the down days, you’ve got hope for tomorrow who can’t diet for one day? And on an up day, you’ve got no guilt about it.” Webb calculated his basic calorie needs based on his level of activity and eats just 30 percent of that one day; the next, he eats 130 percent. He’s lost 30 pounds since July.

Besides shrinking the waistline, skipping meals on a regular basis might protect against disease. A study presented in November 2007 at an American Heart Association conference compared the rates of heart disease among Mormons, who are supposed to fast on the first Sunday of every month, with the habits and disease rates among a smaller number of non-Mormons.

Controlling for other behaviors that make a difference in the risk of heart disease, the researchers found that fasting seemed to be significant: If you fasted, you had a smaller chance of having heart disease.

“The thought from a biological perspective is that fasting rests the metabolism for a day and resensitizes the body’s cells to glucose and insulin,” says study author Benjamin Horne, who researches heart disease at Intermountain Medical Center and the University of Utah in Salt Lake City. That’s only a theory, he notes, since most studies on calorie restriction have been done on rodents, roundworms and slugs.

Still, there’s plenty of evidence from the animal studies to suggest that some sort of calorie-restricted eating plan might be good for humans, too, says Mark Mattson, a neuroscientist at the National Institute on Aging in Bethesda, Md., who was also an author of the alternate-day study. (That study focused on asthma sufferers, whose symptoms improved more when they reduced their intake than seemed attributable to just losing weight.)

Eating less cuts down on the production of free radicals, which damage cells and can lead to disease, says Mattson. And there’s a cellular response similar to what happens when we exercise. Like working out, going without calories is mildly stressful to the cells at the time but beneficial over the long run.

“Dietary restriction is about the best dietary advice I can give you,” says Levitsky. “We don’t know about living a longer life, but all the markers are in a favorable direction.”

You may have noticed, though, that the bottom line of any of these techniques is cutting the overall number of calories you eat. Webb, for example,

has effectively reduced his average daily calorie intake to 80 percent of what it used to be.

Like Webb, many people may find that skipping a meal or two a week, or taking a day every month entirely away from food, or eating a lot less during a given meal or every other day, is far more appealing than making the sacrifice all the time.

Reduced choline and betaine levels correlate with higher levels of inflammation

The February, 2008 issue of the American Journal of Clinical Nutrition published the finding of Greek researchers that having reduced levels of the B vitamin choline, as well as betaine (trimethylglycine, a derivative of choline), is linked with a higher blood concentration of markers of inflammation. Inflammation is involved in the pathogenesis of atherosclerosis among other conditions, and inflammatory markers, including C-reactive protein, interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-a), have been associated with cardiovascular event risk.

The current research evaluated data from 3,042 participants in the ATTICA epidemiologic study which included men and women in the Attica province of Greece who were free of cardiovascular disease, infections, dental problems or recent surgical history upon enrollment. Dietary questionnaire responses were analyzed for choline and betaine intake levels, and fasting blood samples were tested for levels of interleukin-6, C-reactive protein, TNF-a, homocysteine, glucose and total cholesterol.

Compared with subjects whose choline levels were in the lowest one-third of participants, those whose intake fell in the top third at over 310 milligrams per day had an average level of C-reactive protein that was 22 percent lower, an interleukin-6 level that was 26 percent lower, and a TNF-a level that was 6 percent lower. For those whose betaine levels were in the top third at over 360 milligrams per day, homocysteine levels were 10 percent lower, C-reactive protein concentrations were 19 percent lower, and TNF-a levels were 12 percent lower than participants whose levels were in the bottom third.

To the author’s knowledge, the study is the first to show that a choline and betaine rich diet can influence inflammation. The various interrelations examined in the study suggest that although an effect on homocysteine may be involved in the findings, it may not be the only mechanism by which betaine and choline help reduce inflammation. (Homocysteine, a metabolic byproduct, has been shown to be related to inflammation when elevated.)

The authors remark that the reduction in inflammatory indexes observed in this study is similar to that which occurs among people who follow a Mediterranean diet or who consume increased amounts of omega-3 fatty acids. In an accompanying editorial, Steven H. Ziesel of the University of North Carolina at Chapel Hill suggests that the relatively higher betaine content of the Greek diet studied in the current investigation may be a newly revealed anti-inflammatory component of the Mediterranean diet. “There are multiple potential mechanisms whereby diets lower in choline and betaine might result in increases in biomarkers of inflammation in healthy humans,” he writes. “If the association between choline and betaine and inflammation can be confirmed in studies of other populations, an interesting new dietary approach may be available for reducing chronic diseases associated with inflammation.“

What to avoid if you want to make it to 90

An article published in the February 11, 2008 issue of the American Medical Association journal Archives of Internal Medicine reveals that avoiding five modifiable factors can significantly increase the odds of living to the age of 90.

Laurel B. Yates, MD, MPH, of Brigham & Women’s Hospital in Boston and associates evaluated data from 2,357 older participants in the Physician’s Health Study, a trial of aspirin and beta-carotene as cardiovascular disease and cancer preventives in 22,071 male physicians. Demographic information, blood pressure, cholesterol levels, diabetes and angina history, exercise frequency, smoking status, body mass index, and other data were obtained upon enrollment between 1981 and 1984. Follow-up questionnaires were completed annually to ascertain changes in health or lifestyle habits, or the occurrence of chronic diseases or risks through March, 2006.

Nine hundred-seventy men in the current investigation survived to age 90 and beyond. The research team identified five controllable factors associated with failure to reach 90: smoking, diabetes, obesity, hypertension, and a sedentary lifestyle.

Not surprisingly, smoking more than doubled the risk of dying before the age of 90. Diabetes, obesity, and hypertension also significantly elevated mortality risk, while regular exercise lowered it by 30 percent compared to those who rarely or never exercised. Men who survived to 90 had a healthier lifestyle, less chronic disease, and were older when disease was diagnosed. They also experienced improved late-life function and well-being.

From the results of this study, the researchers estimated that a 70 year old nondiabetic nonsmoker with normal weight and blood pressure who exercised two to four times per week had a 54 percent probability of living to age 90. The presence of three of the identified risk factors conferred a 14 percent probability, while having all five resulted in only a 4 percent chance.

“Although the impact of certain midlife mortality risks in elderly years is controversial, our study suggests that many remain important, at least among men,” the authors write. “Thus, our results suggest that healthy lifestyle and risk management should be continued in elderly years to reduce mortality and disability.”

In an accompanying editorial, William J. Hall, MD notes that the fastest-growing group of older Americans is aged 85 years and older. “This unprecedented increase of the oldest old is occurring in an era of extraordinary rapid development of new knowledge of the human genome, holding tantalizing promise for novel solutions to human disease and even increased life extension,” he writes. “This study suggests that adherence to sound medical management and lifestyle modification pays enormous dividends in life extension and probably substantial reductions of aggregate medical care costs.”

Antioxidants reduce cataract risk in women

 The antioxidants vitamin E and lutein, from both food and supplements, may reduce women’s risk for cataracts, researchers report.A study in the January issue of The Archives of Ophthalmology enrolled more than 35,000 women who were followed for an average of 10 years.

After statistically adjusting for smoking, alcohol use, body mass index and other variables, the researchers found that the more vitamin E and lutein the women used, the less likely they were to have cataracts. Compared with the one-fifth of women who consumed the least antioxidants, the one-fifth who consumed the most reduced their risk for cataracts by 14 percent with vitamin E and 18 percent with lutein.

Vegetable oils, nuts, leafy green vegetables and whole grains are sources of vitamin E, and lutein is found in various fruits, corn, kale, spinach and other vegetables.

William Christen, the lead author and an associate professor of medicine at Brigham and Women’s Hospital, said this study was observational only and that “there is no solid randomized trial for any specific nutrient to prevent eye disease.”

Still, Christen said, the findings suggest that there is a benefit to antioxidants and that people should eat plenty of fruits and vegetables. “This is advice you may have heard before,” he said. The research was supported in part by a grant from DSM Nutritional Products.

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THE TANGO MAY HELP PARKINSON’S PATIENTS When the band strikes up a tango, people with Parkinson’s disease may want to head for the dance floor. That is the lesson from a new study reporting that when Parkinson’s patients took tango classes, their balance improved.

Problems with walking and balance are common among people with the disease, and often lead to falls. Among the difficulties, the researchers said, are shuffling and trouble turning while walking. Patients may experience a sudden “freezing” that can either slow them down or stop them entirely. They also have trouble walking while performing another activity at the same time.

The study appears in the December issue of The Journal of Neurologic Physical Therapy. The lead author is Madeleine Hackney of the Washington University School of Medicine in St. Louis, Missouri.

The researchers described what happened when 19 Parkinson’s patients were given either 20 tango classes or 20 exercise classes.

The exercise class consisted of one hour of movement, much of it in chairs or using chairs for support. The tango class was more vigorous, and focused on stretching, balance, footwork and timing.

Both groups demonstrated general improvement, but only the tango students appeared to do better when it came to balance. The improvement was fairly limited, and the researchers said more study was needed.

Obesity boosts cancer risk, says health review.

 Being obese boosts the risk of half a dozen types of cancer, and the odds strengthen as one’s waistline thickens, according to a major review published on Saturday by The Lancet.

Doctors at the University of Manchester, northwestern England, trawled through 141 studies that monitored the health of 282,000 people who gained weight.

Their benchmark of fat was the body mass index (BMI), in which the individual’s weight in kilos is divided by the square of the person’s height in metres. Individuals with a BMI of 25-29.9 are considered overweight, while those with a BMI of 30 or more are obese.

The investigators found that every gain of five points in BMI among men raised the risk of gullet cancer by 52 percent, of thyroid cancer by 33 percent and of colon and kidney cancers by 24 percent.

Among women, a BMI increase of five points hiked the risk of cancer of the uterus lining by 59 percent, of the gallbladder by 59 percent, of the gullet by 51 percent and of the kidney by nine percent.

Smaller but still significant associations were seen between BMI increase and cancer of the rectum, colon and skin among men, and of the breast, pancreas, thyroid and colon among women. In both sexes, there was an increased risk of leukaemia, non-Hodgkin lymphoma and multiple myeloma.

Obesity has long been linked to deaths from cardiovascular disease and to diabetes in industrialised countries, a phenomenon that is now extending to cities in developing economies.

According to some estimates, deaths from obesity in the United States outstripped those from smoking in 2005.

But only recently has strong evidence emerged of an association between excess body fat and cancer.

A ground-breaking report issued last year by the World Cancer Research Fund and the American Institute for Cancer Research found a link with cancers of the throat, colon, rectum, kidney and, among post-menopausal women, the breast.

In a commentary, also published by The Lancet, Swedish nutritionists Susanna Larsson and Alicja Wolk of the Karolinska Institute in Stockholm speculated that excess body fat may cause changes in levels of insulin, sex steroids and other hormones.

This could have an impact on apoptosis, the mechanism by which a flawed cell commits suicide.

Cancerous cells are able to bypass apoptosis and proliferate unchecked.

Localised accumulation of fat cells could also contribute significantly to specific tumours, such as cancers of the liver and throat, suggested Larsson and Wolk.

Christmas without the extra pounds

CHRISTMAS dinner might taste great, but it can also be a real minefield if you are watching your weight, with a typical meal containing as many as 3,000 calories.

So how can you transform your festive feast into a balanced meal without losing any of that Christmas sparkle?

Turkey: The traditional Christmas meat can be an excellent source of protein. It is important to remove the skin, which is high in fat, making sure a portion does not take up more than a third of your plate.

Vegetables: Christmas dinner is a great chance to get some healthy vegetables into your diet, with carrots and parsnips both containing the antioxidant beta-carotene. Peas are another traditional choice and are a good source of fibre, which is important for keeping your digestive system healthy.Brussels sprouts, a Christmas favourite, contain fibre and vitamin C, and glucosinolates, which are all great for your health.

Gravy: This is often high in fat so try using a gravy skimmer, which will save you lots of calories. Gravy made from vegetable cooking water adds extra flavour, as well as vitamins and minerals.

Roast potatoes: Christmas dinner would not be the same without roast spuds, but they tend to be high in fat so it’s a good idea to limit how many you eat. You can cut calories by roasting potatoes in larger chunks, as this reduces the amount of fat each potato absorbs. Try using olive oil instead of lard or butter, as this will replace saturated fat with unsaturated fats, which are better for you and can help keep your heart healthy.

Stuffing: If you buy stuffing from the shops, it is often high in salt, and those made with sausage meat can be high in saturated fat, too. You can make your own stuffing by mixing some chopped fresh herbs with wholemeal breadcrumbs, a cooked chopped onion, a few dried apricots, a little sunflower oil and some beaten egg. This will give you vitamins and minerals. But remember to increase the turkey’s cooking time if you are cooking the stuffing in the bird, or else cook it separately on a baking tray.

Wine: While wine is a favourite at Christmas dinner, if you are going to drink then try to do so in moderation.Rather shockingly, the World Cancer Research Fund recommends limiting intake to a meagre one drink a day for women and fewer than two drinks for men.

Cheese and biscuits: While cheese is a good source of calcium, it can also be high in saturated fat and salt. Reduced fat cheese makes a good substitute.Stick to small slices. Why not serve it with celery sticks and sliced apples or pears?

Dessert: Mince pies and Christmas pudding might taste good, but they are high in fat, sugar and calories, so should be eaten in moderation. A mince pie alone contains 250 calories. Why not try a lighter option, such as pears poached in grape juice with ginger and cloves? There are plenty of traditional yet healthy ways to round off your Christmas dinner. Satsumas are a great source of vitamin C, while dates are high in fibre and rich in potassium. Unsalted nuts are a good source of unsaturated fat and contain cancer-protective anti-oxidants.