Wednesday, January 30, 2019

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What role do antioxidants play in the body and how do they act?

The main role of antioxidants is to prevent, retard and / or reverse reactions leading to the oxidation of biological substrates (proteins, lipids and nucleic acids). Although antioxidants can act through various mechanisms, mostly by stabilizing a free radical through the donation of an electron, or a hydrogen atom. As a result of such interaction, free radicals lose their reactivity and antioxidants are oxidized.



Cooper Complete - CoQ10 100 mg - CoEnzyme10 Ubiquinol Supplement - 30 Day Supply
Cooper Complete - CoQ10 100 mg - CoEnzyme10 Ubiquinol Supplement - 30 Day Supply




On the other hand, certain antioxidants can also act by inhibiting the formation of
pro-oxidant species , favoring the removal of such species, or facilitating the reduction of those biological substrates that have already been targeted for oxidation.


ANTIOXIDANTS IN FOOD: MAIN SOURCES AND THEIR CONTENTS

The presence of natural antioxidants in food is important, not only because these compounds help to define the organoleptic characteristics and preserve the nutritional quality of the products that contain them, but also because, when ingested, they help to preserve -in a considerable way- the health of the individuals who consume them. Indeed, the recommendation to increase the intake of foods rich in natural antioxidants is currently considered one of the most effective ways to reduce the risk of developing those chronic noncommunicable diseases that most limit the quality and life expectancy of The world population.

In this section, the following questions are addressed, among others: What are the main dietary sources of antioxidants? What is the chemical nature of the antioxidants that are most abundant in foods? and How to access information about the content and antioxidant activity of foods?

Faced with the question " Which food would bring more antioxidants to the body ?", The following considerations should be kept in mind: (i) the greater the antioxidant content (mg / 100 g of weight) of a given food, the greater the contribution of antioxidants that the ingestion of said food supposes to the organism; (ii) for a food with a given antioxidant content, we will have that the greater the amount of food eaten, the greater the total amount of antioxidants that could enter the body. Then, to define what food could suppose a greater contribution of antioxidants to the organism, it will be necessary to consider both the content of antioxidants present in it, as well as the size of the portion (g) of the food that regularly characterizes its intake.

In attention to both considerations, ideally, to ensure a greater contribution of antioxidants to the body , we should choose to consume those foods that along with being "rich in antioxidants" are, in addition, regularly consumed in larger portions. The truth, however, is that along with the above, other considerations should also be kept in mind. For example, the one that not necessarily all the antioxidants present in a food will be absorbed in equal magnitude after its arrival in the gastro-intestinal tract (from where they are absorbed, to be transported through the blood to the various organs and tissues where they would act) . Indeed, for a given individual, the bioavailability of a given antioxidant (fraction of the amount initially ingested that eventually reaches the blood), will depend, among other factors, on:

  • (1) the chemical structure of each antioxidant in question (eg absorption efficiency of tocopherols relative to carotenoids or flavonoids),
  • (2) of the matrix in which each antioxidant is part of the food (eg whole fruit with respect to juice, lyophilized or microencapsulated thereof) and
  • (3) of the state in which the food to be ingested is found (eg, raw with respect to cooked, natural with respect to processed).

Clearly, for the consumer of a given food it is not possible to directly affect these last three factors. However, in the perspective of ensuring a greater contribution of antioxidants to the body, the consumer -when duly informed- will have the possibility of leaning towards those foods that contain more antioxidants. For this, the following two questions are addressed below:

What are the antioxidants that are most abundant in food ?
What are the main dietary sources of said antioxidants ?

Regarding the first question, in short, among the antioxidants that abound most in the diet include: ascorbic acid, vitamin E, carotenoids, and polyphenols. For each of these antioxidants are described below, aspects related to its chemistry, with some of its functions, with the recommended daily doses, and with the main foods that contain them:


Ascorbic acid . Ascorbic acid or Vitamin C (Figure I) is a water-soluble compound that fulfills important functions as an antioxidant in the body. As such, it has the potential to protect proteins, lipids, carbohydrates and acids nucleic acids (DNA and RNA) against oxidative damage caused by various free radicals and reactive species. To access information related to the antioxidant properties of ascorbic acid, its main biological actions and health benefits, please go to the section "Antioxidants and health: Scientific evidence". From a nutritional point of view, ascorbic acid is an essential nutrient. However, unlike most mammals and other animals, humans do not have the ability to synthesize vitamin C, so they must obtain it through the diet. Vitamin C is necessary for the synthesis of collagen (a structural component of blood vessels, tendons), ligaments, and bones. It also plays an important role in the synthesis of noradrenaline, carnitine (necessary to obtain energy from the metabolism of lipids), and possibly in the metabolic conversion of cholesterol into bile acids. Severe vitamin C deficiency can lead to scurvy. Although it is now known that such a condition can be prevented and / or reversed with a minimum dose of 10 mg of vitamin C per day, the recommended daily doses
(RDA, Recommended Daily Allowance) in the US are markedly superior.

Table I shows the RDA values ​​according to age and gender. The calculation of the RDA continues to be based mainly on the prevention of the disease associated with vitamin C deficiency, rather than the prevention of chronic diseases and the promotion of optimal health. It should be noted that the recommended intake of vitamin C for smokers is 125 mg / day, that is, 35 mg / day higher than that of non-smokers. This is due to the fact that smokers are under greater oxidative stress, as a result of tobacco consumption (cigarette smoke), and that they generally have lower blood levels of vitamin C.

Learn the opinion of experts from the Linus Pauling Institute , (Oregon, USA) about the population's requirements for vitamin C.

Vitamin C and its food sources. Fruits and vegetables are, in general, a good source of vitamin C. Although the content of ascorbic acid in such foods can vary greatly depending on the species and variety of the fruit or vegetable (Table II), with a daily intake of five servings of fruits + vegetables (2 ½ cups, equivalent to 400 g) it is possible to ensure an approximate intake of 200 mg of this vitamin. While it is always more desirable to consume ascorbic acid in the form of the foods that contain it (as they provide not only vitamin C but also numerous other nutrients, fibers and microminerals), it should be noted that there is no chemical difference between ascorbic acid present in natural form in foods (whose isomer is L) and synthetic L-ascorbic acid.
If you would like to know the ascorbic acid content in more detail, and for a larger number of foods, please refer to the USDA Food Compound Vitamin C Database



Vitamin E The term vitamin E comprises two chemically closely related types of molecules: tocopherols and tocotrienols. From a structural point of view, both molecules include a hydroxyl group attached to a C-6 of a ring aromatic which is, in turn, attached to an oxygenated heterocycle. From said heterocycle (C-2) a long hydrocarbon side chain is born which, in the case of tocopherols, is totally saturated (phytyl chain), while in the tocotrienols it exhibits three instaurations. Both tocopherols and tocotrienols occur in the form of alpha, beta, gamma and delta isomers. Figure II shows the chemical structure of tocopherols.

In food, the concentration of tocopherols is substantially higher than that of tocotrienols. Within the tocopherols, the gamma isomer is more abundant than alpha, at least in the Western diet (especially in the North American). However, the levels of alpha-tocopherol in the blood are approximately ten times higher than those of gamma-tocopherol. The latter is due to the fact that the human liver has a tocopherol transfer protein that does not respond to gamma but only to the alpha isomer, which allows storage, incorporation into lipoproteins and subsequent transport and distribution of it to other tissues. In addition, relative to the alpha isomer, the other tocopherols are actively bio-transformed (degraded) in the organism, which does not allow their accumulation.

Until now, scientific evidence indicates that the main biological function of alpha-tocopherol in humans would be to act as an antioxidant. The fat-soluble nature of alpha-tocopherol (mainly given by the phytyl side chain) allows it to reach higher concentrations in lipid environments. The latter leads to its antioxidant properties manifesting mainly at the level of cell membranes (eg plasma, mitochondrial), preventing and / or retarding the oxidation of the lipids of such structures, and lipoproteins such as LDL (low density lipoprotein, Low Density Lipoprotein). The oxidation of LDL by reactive species (free radicals and other oxidants) is a key event in the process of atherogenesis since it is conducive to the formation of atheromas or plaques in the vascular sub-endothelium.

The ability of alpha-tocopherol to efficiently intercept the propagation of lipoperoxidation is not limited to its action only in biological systems. In fact, alpha-tocopherol is also very effective when it is used as an antioxidant to prevent or retard the oxidative rancidity that affects lipids and fats in food.

When a molecule of alpha-tocopherol "neutralizes" a free radical (especially of the lipoperoxy type), whether in a biological or abiotic system, it does so by donating its phenolic hydrogen atom (HAT) to said radical. As a result, the alpha-tocopherol molecule becomes a free radical called tocopheryl, which, as expected, lacks antioxidant activity. However, when such a reaction takes place in the body, other antioxidants, such as vitamin C, would be able to react with the tocopheryl radical, regenerating the original antioxidant capacity of alpha-tocopherol. Aspects related to the above and with the role of alpha-tocopherol in the oxidation of LDL and in the reduction of the risk of development of cardiovascular diseases are included in the section
"Antioxidants and health: Scientific evidence".

The most commonly found form of alpha-tocopherol in foods is RRR-alpha-tocopherol (also known as "natural tocopherol" or d-alpha-tocopherol or ddd-alpha-tocopherol). Synthetic alpha-tocopherol, which is labeled all-rac- or dl-alpha-tocopherol, has only half the biological activity (as a vitamin) of the RRR-alpha-tocopherol isomer.

Table III shows the recommended daily doses of vitamin E (RDA applied in the USA), according to age and gender. It is important to note that the values ​​of RDA indicated in said table are based on the prevention of symptoms of vitamin E deficiency and not on the doses that would be required to promote health and prevent chronic diseases. The reason for the latter is that the available scientific evidence is still insufficient to support the recommendation to increase such intake of tocopherol beyond the RDA.
The main sources of alpha-tocopherol in the Western diet They include vegetable oils (marigold, safflower, olive), nuts, almonds, and green leafy vegetables. The eight forms of vitamin E (alpha, beta, gamma and delta of tocopherols and tocotrienols) are found in varying amounts in foods (Table IV).
For more information on the content of tocopherols in foods, please refer to the USDA Food Vitamin Composition Database



Carotenoids Carotenoids are pigments synthesized by plants, where they act as "quencheadores" (deactivators) of singlet oxygen. The latter is a ROS formed during the process of photosynthesis. Although singlet oxygen has a very minor importance in the development of oxidative stress generated by the human organism, as indicated below, the antioxidant activity of carotenoids is not limited to the removal of said ROS.

In our diet, carotenoids concentrate mostly (in the form of all-trans isomers) in fruits, vegetables and cereals, giving them yellow, orange or red colors. From a structural point of view, carotenoids are classified into: carotenoids, represented by alpha-carotene, beta-carotene and lycopene, and in xanthophylls, represented by beta-cryptoxanthin, lutein and zeaxanthin. Xanthophylls are carotenoids that include one or more oxygen atoms in their structures.

Figure III shows the chemical structure of the carotenoids most commonly present in food.
Alpha-carotene, beta-carotene and beta-cryptoxanthin are pro-vitamin A type carotenoids, which means that they can be converted into retinol or vitamin A in the body (essential to ensure normal tissue growth, and for a proper functioning of the immune system and vision). The pro-vitamin A function of said carotenoids is the only function currently recognized as essential. Lutein, lycopene and zeaxanthin do not act as pro-vitamin A.

In general, carotenoids exhibit low bioavailability. The latter is partly due to the fact that these compounds are mostly bound to proteins in their phyto-alimentary matrices. The processes of cutting, homogenization and cooking of foods rich in carotenoids generally increases their bioavailability. In order for the carotenoids of the diet to be absorbed at the intestinal level, they must first be released from the food matrix and incorporated into mixed miscelas (mixture of bile salts and various types of lipids). Therefore, a minimum amount of fat (3-5 g) in a meal is required to ensure efficient intestinal absorption. For example, in the case of lycopene, its bioavailability from the tomato is substantially increased when subjected to a cooking process in oil.

Carotenoids and their food sources . Yellow or orange vegetables, such as carrots and squash, are a very good source of alpha and beta-carotene. For its part, spinach is also a good source of beta-carotene, although chlorophyll masks the yellow-orange pigment present in its leaves.

Some foods that are a good source of alpha-carotene and beta-carotene are the following (Table V):

  • Some foods that are a good source of beta-cryptoxanthin are the following (Table VI):
  • Some foods that are a good source of lycopene are the following (Table VII):
  • Some foods that are a good source of lutein + zeaxanthin (given the complexity of their analysis separately, the determinations often express the sum of the content of these two xanthophylls) are (Table VIII):

For more information about the content of carotenoids in these and other foods, go to: http://www.nal.usda.gov/fnic/foodcomp/search/



The polyphenols . Polyphenols are compounds that are bio-synthesized by plants (their fruits, leaves, stems, roots, seeds or other parts). All polyphenols exhibit antioxidant properties. These compounds account for most of the antioxidant activity exhibited by fruits, vegetables and certain infusions and natural beverages habitually consumed by the population. From a chemical point of view, all the polyphenols exhibit in their structure, at least, one or more hydroxyl groups (HO-) linked to an aromatic ring, that is, they present some phenolic group. In turn, among the polyphenols it is possible to distinguish two subtypes of compounds:

  • I) The flavonoids , whose structure (diphenylpropane, C6-C3-C6, Figure IV) comprises two aromatic rings (A and B) which are they are linked together by a heterocycle formed by three carbon atoms and one oxygen atom (C), and for which more than five thousand compounds have been described in the vegetable kingdom. As described below, in turn, the flavonoids are subdivided into the following six groups of compounds: anthocyanidins, flavanols, flavanones, flavonols, flavones and isoflavones.
  • II) The so - called non-flavonoids (a few hundred), which mainly comprise mono-phenolic alcohols (eg hydroxytyrosol), simple phenolic acids and stilbenes (eg resveratrol). In the case of simple phenolic acids, which make up the majority of the non-flavonoid polyphenols, there are benzoic acid derivatives (eg protocatécuico, gallic, vanillic, p-hydroxy-benzoic) and those of cinnamic acid (chlorogenic) , coffee, ferulic, p-cumárico).

While all polyphenols exhibit antioxidant properties, it has been established that some of these compounds also exhibit, among others, anti-inflammatory, antiplatelet, anti-bacterial, estrogenic activity and activity-modulating properties of numerous enzymes, including that of certain digestive enzymes. Some of these aspects are addressed in the section "Antioxidants and health: Scientific evidence".

The ability of polyphenols to act as antioxidants, both flavonoids and non-flavonoids, depends primarily on the presence of HO- groups in their structure. Being linked to a benzene ring, the groups hydroxyl confer to polyphenol the ability to act, either as a donor of a hydrogen atom (HAT) or as an electron donor (SET) to a free radical (or other reactive species). In the case of flavonoids, in particular, some can also act as antioxidants through a mechanism that involves their ability to react with (chelating) certain transition metals (such as copper and iron). Such a reaction prevents the formation of hydroxyl free radicals (from hydrogen peroxide in the Fenton reaction) and superoxide (from molecular oxygen) that would otherwise catalyze both metals to be in their free and reduced state (that is, redox-active). Therefore, the flavonoids that exhibit catecholic hydroxyls in ring B of their structure also promote an antioxidant effect through the aforementioned mechanism (eg quercetin, Figure V).

Flavonoids are usually found in nature as conjugated compounds, that is, linked to different sugars (such as glucose, fructose), or in the form of free compounds (called aglycones). The proportions of free flavonoid and conjugate will depend on the type of food in which they are found. In turn, the gastrointestinal tract will be exposed to a different ratio of free / conjugated, depending on the state of cooking of the food, and the action they have had throughout the process of digestion, various enzymes capable of hydrolyzing the sugars. The latter is not less, therefore, the physicochemical properties (which define solubility and potential to be absorbed) of the polyphenols can be markedly affected by the presence of said sugars. It should be noted, however, that absorption is not a fundamental process when the action of these compounds is exerted directly on the lumen of the gastrointestinal tract; for example, modulating the activity of some digestive enzyme, or acting as an antioxidant in a direct way on ROS present in the lumen. It is, however, when the action of the flavonoids is exerted in a systemic way, that is, in organs, tissues or cells which can only be accessed after gastrointestinal absorption and distribution from the blood to such tissues. In general terms, the conjugated form of polyphenols is more polar (water-soluble) and therefore less absorbable (and bioavailable). At the level of the large intestine, the bacteria that normally colonize the colon also play an important role in the metabolism of flavonoids, favoring their absorption by promoting the hydrolysis of glycosidic bonds. Indeed, different individuals may differ in their ability to hydrolyze a particular flavonoid (and then to absorb it) depending on the differences they have in their colonic microflora.

Is the intake of polyphenols "essential" for the conservation of health? There is still no evidence that the consumption of polyphenols is "essential" for the conservation of health, and therefore there are no recommended daily dose (RDA) values ​​of these compounds. However, abundant scientific literature reports several health benefits associated with a higher consumption of foods rich in polyphenols, such as certain fruits, vegetables, legumes and cereals. In addition, increasingly, the evidence shows that the consumption of products rich in polyphenols, such as cocoa (in the form of dark / bitter chocolate), green tea (in beverages / juices that contain it) or red wine (in the form of moderate) has effects that would be potentially favorable for the conservation and / or normalization of relevant physiological parameters or indicative of cardiovascular health.

To access information related to some of the health benefits associated with the consumption of foods rich in polyphenols, please go to the section " Antioxidants and health: Scientific evidence "

Although the proportion of flavonoids with respect to polyphenols that are not flavonoids can vary significantly between one food and another, in the case of fruits and vegetables, flavonoids are, in general, the polyphenols that are most abundant in these foods. Along with the latter, it is worth mentioning that the scientific literature that implicates polyphenols as health protection factors mainly comprises polyphenols of the flavonoid type. Table IX describes, for each of the six groups of flavonoids mentioned above (anthocyanidins, flavanols, flavanones, flavonols, flavones and isoflavones), the main compounds that constitute each group of flavonoids, and gives examples of those foods that concentrate most such flavonoids

What drinks could be a good source of antioxidants? For the flavonoids described in the table, along with fruits and vegetables, certain beverages can also be a source of antioxidants. Examples of beverages that concentrate antioxidants, and also because of their frequency of consumption could suppose a very good contribution of some of these compounds, are green tea (and to a lesser extent black tea), coffee (especially grain) and Red wine. It should be noted, however, that the consumption of these beverages as a form of ingesting antioxidants should be limited to adults, and if they are abundant and sustained, they should consider the potential inconvenience that the obligatory co-ingestion of caffeine can suppose in the case of tea and regular coffee, compounds capable of affecting the bioavailability of dietary iron in the case of tea, and the consumption of alcohol and the corresponding calories in the case of red wine. In this last case, it is necessary to clarify that although red wine can be a good source of certain polyphenols, many fruits and vegetables also contain the same antioxidant compounds, being fruits and vegetables, in addition, an excellent source of other polyphenols and , above all, of numerous nutrients (proteins, lipids, fatty acids, vitamins, micro- and macrominerals, fibers, etc.) that are not present in such a beverage. Clearly, unlike red wine, the consumption of fruits and vegetables can be promoted on the basis of their nutritional wealth and without the ethical and public health reserves that merit the real risks that would imply the promotion of a greater consumption of red wine as a important way to "gain health".

In spite of these last considerations, the consumption of tea, coffee and also of red wine constitutes a practice deeply rooted and transversal in our society. For example, in the case of tea (in its various types), its consumption accounts worldwide for the second most consumed beverage, after water. Without excluding certain Latin American populations, in the case of Chile, it is necessary, together with the aforementioned beverages, certain infusions of herbs or "digestive water", prepared from plants regularly used by the population, such as boldo, bailahuén and rosa mosqueta (among others), could also be an interesting source of antioxidants for the population. It should be clarified, however, that unlike tea, coffee and red wine, the real impact that the consumption of such herbal infusions can have on the antioxidant status of the organism or other relevant biological parameters has not yet been evaluated. the preservation of human health.

More information about what antioxidant compounds characterize and what is the antioxidant level of beverages such as green tea, coffee, red wine, and certain "digestive water"? will be presented promptly on this site. We already appreciate your eventual interest in this topic.

Antioxidants as preservatives of processed foods.

What are the main antioxidants used in the preservation of food? The antioxidants used in the preservation of food can be classified, according to their origin, into two types: natural and synthetic. Among the natural antioxidants that are most commonly used as preservatives are: ascorbic acid, alpha-tocopherol and various derivatives of rosmarinic acid. Such compounds can be obtained: by direct extraction from their natural sources (where they exist in abundance), or by chemical synthesis. Among the non-natural or synthetic antioxidants most used by the food industry are: butyl-hydroxytoluene (BHT; E 321), butyl-hydroxyanisole (BHA; E 320), tert-butyl-hydroquinone (TBHQ), ethoxyquin (EQ) , propyl gallate (E 310) and metal chelators such as EDTA and citric acid.

If you would like to access more information regarding the following antioxidants, we invite you to click as appropriate: BHT , BHA , TBHQ and EQ .

Are there risks associated with the chronic consumption of synthetic antioxidants? The safety of most synthetic antioxidants (such as BHA, BHT, EQ, TBHQ and certain gallates) has been increasingly questioned, especially in the last 2 decades, as a result of studies that show that, when administered in a prolonged manner and in high doses, some of these compounds can be mutagenic and / or carcinogenic in experimental animals. However, currently, given the effectiveness, low cost and still controversial evidence of real risk in humans, synthetic antioxidants are still used by natural antioxidants as main preservatives in the food industry. Although more research is still required, the evidence existing today indicates that, when used in doses lower than the ADI (Acceptable Daily Intake), the prolonged use of those synthetic antioxidants that are considered GRAS (Generally Recognized As Safe) are not it should pose an appreciable risk to the health of the population ( for more information ).

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ANTIOXIDANTS: DEFINITION, CLASSIFICATION AND GENERAL CONCEPTS

The scientific evidence accumulated during the last two decades indicates that, beyond the initial promises of delaying aging, antioxidants when consumed in the form of food have an important potential to reduce the development of those diseases that currently affect the most world population (cardiovascular, tumor and neurodegenerative diseases). As a result of this recognition, antioxidants have increasingly been considered by the population as " Molecules whose consumption is synonymous with health ".



Ovoenergen - CoQ10 for Women, 999 mg per day
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In this section, fundamental aspects related to the definition, classification, mechanisms of action and main biological actions promoted by antioxidants are addressed. In addition, concepts related to the role of free radicals and oxidative stress in health and human pathology are reviewed. These last aspects are treated additionally, in extenso , in the section " Antioxidants and health: scientific evidence ".

What is an antioxidant?
An antioxidant can be defined, in the broadest sense of the word, as any molecule capable of preventing or slowing the oxidation (loss of one or more electrons) of other molecules, usually biological substrates such as lipids, proteins or nucleic acids. The oxidation of such substrates can be initiated by two types of reactive species: free radicals, and those species which, without being free radicals, are sufficiently reactive to induce the oxidation of substrates such as those mentioned.

But what is a free radical?
From a chemical point of view, a free radical is any species (atom, molecule or ion) that contains at least one unpaired electron in its outermost orbital, and that is in turn capable of existing independently (hence the free term).


The atoms order their electrons (ê) in regions called "atomic orbitals", in the form of pairs of electrons. The latter gives the atom stability, or low chemical reactivity towards its environment.

However, under certain circumstances, said orbital may lose its parity, either by yielding or capturing an electron (ê). When this occurs, the resulting orbital exhibits an unpaired ê, converting the atom in a free radical.

The presence of an "unpaired" electron in the outermost orbital of an atom gives the latter an increased ability to react with other atoms and / or molecules present in its environment, normally, lipids, proteins and nucleic acids. The interaction between free radicals and said substrates gives rise to alterations in the structural, and eventually functional, properties of the latter.

The reactive species derived from oxygen ( ROS ) is a collective term, widely used, which includes all those reactive species that, whether or not free radicals, focus their reactivity on an oxygen atom. However, often under the name ROS, other chemical species whose reactivity is centered or derived in atoms other than oxygen are included. Strictly speaking, however, species whose reactivity derives or focuses on atoms such as nitrogen or chlorine should be referred to as RNS (Reactive Nitrogen Species) and RCS (Reactive Chlorine species), respectively.

See table that describes the main free radicals and reactive species derived from oxygen and nitrogen.

Main free radicals and reactive species derived from oxygen and nitrogen normally generated in our body.


Is the generation of reactive oxygen species in the body a normal process? The endogenous generation of ROS (free radicals and other reactive pro-oxidant species) is a normal part of the metabolism of all aerobic living beings. Indeed, under physiological conditions, most of the tissues of the human body generate significant amounts of ROS. Among the most generated ROS, the free radical superoxide anion ( O2 • - ) stands out. The generation of said radical takes place, at cellular level, mainly through the electron transport chain in the mitochondria (specifically, during the interaction between oxygen molecules and complexes I and III).

Although the chain of electron transport constitutes a series of biochemical reactions designed to generate, between the matrix and in the inter-membrane space of the mitochondria, a gradient (of protons) necessary for the re-synthesis of ATP from ADP , during the course of its operation, between 1% and up to 3% of the oxygen that regularly enters the mitochondria is converted into superoxide radicals (that is, oxygen gains an electron). Fortunately, the high presence of SOD in the mitochondria allows the dismutation of the superoxide radicals, oxygen and hydrogen peroxide. Since the accumulation of peroxide, either in the mitochondria or outside it, would be toxic to the cell, a greater part of the peroxide formed is rapidly reduced to water inside the mitochondria, by the action of the enzyme glutathione peroxidase. The hydrogen peroxide that does not reach to be reduced, leaves the mitochondria to be subsequently reduced by other peroxidases in the cytoplasm, and inside the peroxisomes by the action of the catalase.

The physiological formation of O2 • - is not limited to its mitochondrial production. Indeed, this species can also be generated in the cytosol of many cells through the action of enzymes such as xanthine oxidase (XO), glucose oxidase and amino-oxidases; at the level of endoplasmic reticulum O2 radicals - are also generated through the action of certain cytochromes P-450, and at the level of the plasma membrane by the action of the enzyme NADPH-oxidase (NOX). Although this last enzyme is present in abundance in neutrophils, such cells need to be activated as a condition to initiate the massive production of O2 • - .

Besides superoxide, what other reactive species is normally generated in the organism?
Another reactive species normally generated by the organism is nitric oxide ( NO • ). This free radical, which results from the action of the cytosolic enzyme nitric oxide synthase (NOS), is generated continuously, though not exclusively, by vascular-endothelial cells (those that "cover the inside of a blood vessel). Together with O2 • - , NO • constitutes an example of reactive species whose generation and action is not only physiological, but absolutely fundamental for the proper functioning of the organism. As discussed in the section "Antioxidants and health: scientific evidence", the controlled production of O2 • - and NO • is not only physiological, but is also fundamental to ensure the health of the human organism.

How can antioxidants be classified? The protection of the biological substrates promoted by most of the antioxidants involves their direct interaction with reactive species such as those referred to in Table I. However, it is also possible to distinguish other mechanisms through which antioxidants actively contribute to preventing or preventing retard the oxidation of a biological substrate. In order to review these mechanisms, it is necessary to previously classify those antioxidants that are normally present in the human body.

While there are different ways to classify antioxidants, from a perspective of their origin and presence in the body, it is possible to distinguish between those antioxidants that are normally bio-synthesized by the body, and those that enter it through the diet . Among the first are:

  • i) enzymatic antioxidants, such as superoxide dismutase, catalase, glutathione peroxidase, glutathione S-transferases, thioredoxin-reductases and sulfoxy-methionine reductases, and
  • ii) non-enzymatic antioxidants, such as glutathione, uric acid, dihydro-lipoic acid, metallothionein, ubiquinol (or Co-enzyme Q) and melatonin. Although i) and ii) are primarily bio-synthesized by the human body, the diet can also contain said antioxidants. However, it should be clarified that the contribution that could be made to the organism ingestion of (foods with) said antioxidants is not very significant because they undergo significant degradation / biotransformation throughout the gastro-intestinal tract.

Regarding the antioxidants that enter the body only through the diet, these are classified, essentially, in:

  • i) vitamins-antioxidants, such as ascorbic acid, alpha-tocopherol and beta-carotene (or pro-vitamin A),
  • ii) carotenoids (such as lutein, zeaxanthin and lycopene),
  • iii) polyphenols, in their categories of flavonoids and non-flavonoids, and
  • iv) compounds that do not fall into the three previous categories, such as some glucosinolates (eg isothiocyanates) and certain organo-sulfur compounds (eg, diallyl-disulfide).

What are the main mechanisms of action of antioxidants?

Antioxidants can prevent or slow the oxidation of a biological substrate, and in some cases reverse the oxidative damage of the affected molecules.

Direct interaction with reactive species : The most known mechanism, although not necessarily the most relevant to action, refers to the ability of many antioxidants to act as "stabilizers or quenchers of various reactive species." This last supposes the known activity "scavenger" of free radicals that have many antioxidant molecules. In the case of free radicals, such action implies their stabilization through the transfer of an electron to said reactive species. Such a mechanism, defined as "SET" (single electron transfer), allows the free radical to lose its condition by "matching" its unpaired electron. One consequence for the antioxidant is that, as a result of yielding an electron, it becomes a free radical and ends up oxidizing under a form that is low or zero reactivity towards its surroundings (Figure II). Along with the SET mechanism, many antioxidants can stabilize free radicals through a mechanism that involves the direct transfer of a hydrogen atom (this is an electron with its proton). Such mechanism is defined as "HAT" (hydrogen atom transfer). In the latter case, the free radical is also electronically stabilized.

Antioxidants whose action is promoted through SET and / or HAT mechanisms are mostly non-enzymatic antioxidants, whether these are normally bio-synthesized by the human organism or enter the body through the diet. Most of the antioxidants that act through these mechanisms present in their chemical structure, as functional groups, phenolic hydroxyl (for example, all polyphenols and tocopherols). However, other antioxidants, non-phenolic, such as glutathione, melatonin, and ascorbic, dihydro-lipoic and uric acids, are also examples of molecules whose action is promoted by SET and / or HAT mechanisms.

Together with the SET and HAT mechanisms, certain antioxidants can also act by stabilizing reactive species through a mechanism that implies "the direct addition of the radical to its structure". An example of this type of antioxidant action is that promoted by carotenes such as beta-carotene. As a result of such reaction, the free radical (eg peroxyl) loses its condition, and the carotene is covalently modified, becoming a free radical that through successive reactions is oxidized and converted into epoxide and carbonyls derivatives of markedly lower reactivity.

As expected, the direct interaction between an antioxidant and a reactive species will prevent either the initiation and / or the propagation of oxidative processes that affect the biological substrates.

Prevention of enzymatic formation of reactive species : Some antioxidants can act by preventing the formation of ROS and RNS. They do this by inhibiting the expression, synthesis or activity of pro-oxidant enzymes involved in the generation of reactive species, such as NADPH-oxidase (NOX), xanthine oxidase (XO), myeloperoxidase (MPO) and Nitric oxide synthase (NOS). This type of antioxidant action does not demand that an antioxidant exhibit in its structure characteristics that are typically associated with the mechanisms of action ET or HAT. Examples of inhibitors of the activity of these enzymes are, for compounds coming from the diet, certain polyphenols capable of inhibiting NOX, MPO and XO, and some agents used in the therapy of gout, such as allopurinol, and febuxostat that inhibit the xanthine oxidase.

Prevention of the formation of reactive species dependent on metals : A second mechanism that also involves the inhibition of the formation of reactive species is related to counterpose the capacity of certain transition metals, such as iron and copper (both in their reduced state), to catalyze (redox activity) the formation of superoxide radicals from the reduction of oxygen and hydroxyl radicals, from hydrogen peroxide (Fenton reaction). Those molecules that have the ability to bind such metals, forming complexes or chelates, manage to inhibit the redox activity of these, preventing the formation of the aforementioned reactive species. Included in this group of antioxidants are: i) certain peptides and proteins normally bio-synthesized by the body and whose physiological function involves transporting, storing and / or excreting iron (such as ferritin) or copper (such as metallothionein and ceruloplasmin), ii) certain polyphenols that access the organism through the diet and whose distinctive feature is to present in its flavonoid structure a catechol group in the B ring, and iii) some agents that are used in metal removal therapy such as desferroxamina that traps iron, and penicillamine or tetrathiomolybdate that trap copper.

Activation or induction of the activity of antioxidant enzymes : As part of the antioxidant defense, the human organism bio-synthesizes certain enzymes whose function is to remove reactive species, mainly ROS. Among these are the following: superoxide dismutase (SOD, in its Cu / Zn and Mn-dependent isoforms) that reduces superoxide radicals to hydrogen peroxide, catalase (CAT, iron-dependent) that reduces hydrogen peroxide to water, glutathione peroxidase (GSpx; dependent) that reduces lipo-hydroperoxides to their corresponding alcohols, glutathione-S-transferase (GST) in its peroxidase type that acts by reducing organic peroxides, glutathione reductase that reduces oxidized glutathione (GSSG) to reduced (GSH), and sulfoxy-methionine- reductase that regenerates methionine from its sulfoxy-oxidized metabolite (Table II).

The antioxidant action of all these enzymes results in a decrease in the cellular redox state. Among the enzymes mentioned, two cases merit an additional comment. The first, the SOD is distinguished because although its action removes a free radical (superoxide), as a product of its action forms a species that is also reactive, hydrogen peroxide. The latter highlights the importance of other enzymes capable of removing hydrogen peroxide, such as CAT and GSpx. The second enzyme that warrants comment is glutathione reductase because its antioxidant action is double because it catalyzes not only the removal of a ROS but also, as a result, results in the formation of GSH, an important cellular antioxidant.
There is evidence that certain compounds present in the human diet could induce the expression of genes that code for the synthesis of some of the antioxidant enzymes such as those described in Table II. Examples of such compounds are some polyphenols present in fruits and vegetables, various isothiocyanates (such as sulforaphane) present in cruciferous (broccoli, cauliflower) and some curcuminoids (such as curcumin) of turmeric. These compounds are, more often, known as inducers of bio-transforming enzymes of the phase II type, ie those enzymes that conjugate electrophilic xenobiotics.

Can food be a good source of antioxidant enzymes? Although food does not constitute an effective contribution of antioxidant enzymes, since after ingestion these are degraded during the digestion process, some if they can contribute to their optimal functioning by providing those microminerals that are required for the biosynthesis of such enzymes. It is necessary to clarify, however, that a greater dietary contribution of microminerals such as Cu, Zn, Mn, Fe, or Se, could suppose an increase in the activity of antioxidant enzymes when the organism exhibits a deficit condition in such microminerals. In the absence of such a deficiency or lack, it is not expected that their higher intake (or supplementation) will be translated per se in an increase in their activity.

Oxidative stress : Under certain conditions, the speed with which reactive species (ROS and RNS) are generated in the organism exceeds the speed with which these species are removed by the antioxidant defense mechanisms (that is, those that are proper to them, plus those that they are contributed by the diet). To the imbalance or redox imbalance that takes place we call it oxidative stress. The latter may arise as a result of; i) an exacerbated production of reactive species, even in the presence of a balanced dietary supply of antioxidants, ii) a decreased intake of foods rich in antioxidants, even in the absence of an increased production of reactive species, iii) a reduced biosynthesis of some of the endogenous antioxidant mechanisms (whether enzymatic or non-enzymatic), even in the presence of a balanced dietary supply of antioxidants and in the absence of an increased production of reactive species.

What is the consequence of oxidative stress for the organism?

When oxidative stress affects biological substrates, the redox imbalance that characterizes such stress translates into a oxidative damage to various macromolecules. When oxidative damage is intense, sustained over time, and can not be reversed or repaired, it will lead to the appearance of those pathologies that are currently associated with oxidative stress. Figure III shows some of the main pathologies in which oxidative stress is involved, either as a determining factor or as an aggravating condition of the damage and loss of functions that characterize such diseases.

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What are antioxidants and what are they?

Old age is a process of cellular oxidation, natural and progressive, a process that must be understood by those who want to preserve physical youth as much as possible through supplements, creams and various beverages, rich in antioxidants, which slow cellular oxidation and, With this, they mitigate the ravages of old age and prolong life expectancy.

Antioxidants are chemical compounds that the human body uses to eliminate free radicals, which are very reactive chemical substances that introduce oxygen into cells and produce oxidation of its different parts, alterations in DNA and various changes that accelerate the aging of the body. This is because oxygen, although essential for life, is also a very reactive chemical element. The body generates free radicals for its own use (control of muscles, elimination of bacteria, regulation of the activity of organs, etc.), but at the same time it generates antioxidants to eliminate excess free radicals, since these substances are very aggressive .



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To understand what an antioxidant is, we must first know what cellular oxidation is. In a very general way, this occurs when an unstable atom loses an electron (particle with a negative charge), which allows it to form a new compound with another element, causing an imbalance between the production of reactive oxygen species and the capacity of a system biological to clean the body of harmful substances. The oxygen we use to breathe is one of the main responsible for cellular oxidation and serves to produce energy throughout the body, but small portions of this element produce free radicals, which are formed normally in the body to metabolize.

In the organism there is a balance between reactive oxygen species and antioxidant defense systems. When this balance is altered or decompensated in favor of those, the so-called oxidative stress occurs, which means that stress can be triggered by solar radiation, inflammatory and immune responses, alcoholism, smoking, vitamin deficiency and other factors.

Natural antioxidant defense system

As mentioned before, the body has antioxidant systems that counteract the effect of free radicals. This first line of defense has been divided into non-enzymatic antioxidants - such as vitamins A, C and E, which are acquired through diet - and enzymatic antioxidants

Non-enzymatic antioxidants

Non-enzymatic antioxidants refer mainly to vitamins A, C and E. In general, vitamins and some other molecules are found in lycopene (tomato, watermelon and some fruits) and flavonoids (Ginkgo biloba).
This vitamin is used for the repair of body tissues and the maintenance of the skin; It serves to take care of the condition of the bones, the hair, the nails and the teeth and helps to improve the vision. We can find it in dairy products.

Vitamin C. Involved in the formation of collagen, which strengthens and holds together the tissues of the body; For this reason, it also helps our bones, teeth and tissues to be strong and healthy. We can find it in citrus fruits such as orange and lemon.

Vitamin E. Also called tocopherol, protects the body from toxic agents, prevents the abnormal destruction of red blood cells and eye disorders, anemia and heart attacks. We can find it in egg yolks, vegetable oils and cereals

Ginkgo biloba From the leaves of ginkgo an extract is obtained that has flavonoids that, when ingested, increase the central and peripheral blood circulation, which makes the irrigation of the organic tissues more efficient. This benefits people of mature and senile age, since their bodies lose the capacity to carry out that function (especially in the brain, which causes loss of memory, fatigue, confusion, depression and anxiety). The consumption of ginkgo reduces these symptoms and also makes the irrigation of the heart and extremities more efficient.

Enzymatic antioxidants

Enzymatic antioxidants are those that the same organism produces and that counteract the effects of free radicals to a certain degree. A clear example of them is glutathione, which is found inside the cell (cytosol).

Therefore, the use of antioxidants is an excellent option for all people, from young to old, because they protect our body in an integral way.

Thanks to the beneficial characteristics that have been found in them, nowadays there is a great variety of products that contain them; such as food supplements, cosmetics and beverages, among many others. That is why it is recommended that people eat daily foods containing antioxidants to avoid a large number of diseases and to maintain a healthy and healthy physical appearance.

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We tell you ALL you need to know about antioxidants

They help us to delay aging and prevent diseases. From the hand of our expert, Meritxell Marti, you will discover what they are, what their function is and where you can find them.

Surely, you've heard about antioxidants on countless occasions, especially because they have always been associated with their anti-aging action. However, beyond this characteristic, the fact is that researchers have also associated their consumption with an important source of health. To know more about them, our expert, Meritxell Marti Pharmaceuticals , tells us, in detail, everything we need to know about these important substances. Take note!



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What are antioxidants? What do they do ?


Antioxidants are substances that help prevent the oxidation of cells and can come from natural extracts, foods with high composition in active or chemical products.
Cellular oxidation destroys cells, and this occurs as a result of the action of so-called free radicals. The most powerful and aggressive is the reactive oxygen radical.

Free radicals are atoms that have an unpaired electron in their composition, which makes them enormously unstable and reactive. And is that to try to get stability, steal electrons to other atoms that happen to become free radicals. This chain reaction causes the destruction of the cells, so that they are the cause of aging and the appearance of degenerative diseases.

Those responsible for neutralizing free radicals are antioxidants, basically, some assets among which enzymes, vitamins, active substances of food and natural products can be found. They are responsible for trapping free radicals so that they do not circulate through our body and prevent their harmful effect on our health.

Certain substances, life habits, and even some drugs promote the formation of free radicals and, as a consequence, the premature deterioration of our organism; Among the best known are: tobacco, excessive alcohol consumption, little sleep, pollution, stress, excessive sun or an unbalanced diet ... For this reason, it is advisable to incorporate antioxidants into our diet because, in reality, the Most of us can not escape the action of free radicals.

Which are the best known? Which one is the best?

It is not about knowing which is the best or the worst, but to know which is the most appropriate and if it is taken in the appropriate dose. Among the best known, we could highlight: vitamin C and all foods that contain it, resveratrol, omega 3, super oxide dismutase, vitamin E, selenium, pycnogenol, cocoa, astaxanthin.

Which is the most appropriate for each person?

To smokers , my advice is undoubtedly vitamin C , at least one gram daily. However, resveratrol is also a great scavenger of free radicals, but at a dose of from 150 mg / day, to much higher concentrations, which can reach up to 500 mg / day.

The omega 3 I advise to all the people who have tendency to high levels of cholesterol, and from about 40 years to prevent inflammation and protect the joints. Of course, it should not be consumed by people who are taking anticoagulants or have a scheduled operation, the appropriate dose should not be less than 1 gram / day

The SOD: is an extract of the Cantaloup melon, of great antioxidant power, which is also ideal in people with joint and stress problems, the most common is to find it in the pharmacy as Glisodin, whose most appropriate dose is 250 mg.

Vitamin E : is an important antioxidant, in fact it is one of the antioxidants that is also used as a preservative in many foods and cosmetics, especially oils; I advise women who especially have dry skin and during menopause, as it is also a precursor of estrogen. Like omega 3, it should not be taken by people who are taking anticoagulants or who are waiting for a surgical operation.

Selenium: this mineral is present in almost all metabolic cycles, and I advise it as a supplement to other antioxidants or nutrients. We usually find it in supplements with vitamin E and a dose of 200 mcg / day is recommended

Picnogenol: this complex is an extract of pine, perhaps the most expensive of all. It is a powerful antioxidant. The recommended dose is 100 mg / day.

Cocoa: I mean the seeds or berries of the cacao plant, and not the chocolate. These seeds are very rich in flavonoids and exert an important action against free radicals. They protect cardiovascular health very especially. The doses of the whole plant in capsules is usually about 800 mg / day.

Astaxanthin: is another flavonoid that, in addition to antioxidant action, will provide energy. The doses are very varied because they can go from 4 mg a day to 12 mg / day, depending on the supplement.

Which ones should not be mixed and which ones should?

It is very common to buy complexes containing several antioxidants, however, if we are going to take several, my advice is to combine those that protect from the oxidation of fats, specifically omega 3 or vitamin E with others such as resveratrol. Although it is not harmful to health, it is preferable not to combine two similar products, such as resveratrol and pycnogenol.

If we want a perfect combination, this would be one of the group of omega or vitamin E and another such as resveratrol or cocoa. Of course, you have to take into account the doses; For example, if the doses are low for each of the products, you can combine several that act in a similar way.

From what age?

There really is not a specific age from which we should start taking antioxidants. It depends on the degree of aging and the amount of oxidants to which we are exposed. For example, if you are a smoker, you can start once you are 20 years old. Although, in general, almost everyone from 35 should take a supplement.

Older people or those who are medicated should not take antioxidants without prior knowledge of the doctor, as they may be incompatible with any of the drugs.

How long should we take them and when should we change?

There is no time limit to take antioxidants, if they are part of the diet, in fact, it is as if we want to take an orange juice every morning or eat an apple every day and we do not consider a break of these foods.

However, as can happen with food, we can get tired, for this reason I prefer to advise the change of products, especially if they are buying commercial brands that carry different combinations. For example, if you are taking resveratrol, after six months you can opt for cocoa and, after six months, switch to another. Or, if it's Omega 3, it can be exchanged for vitamin E or Krill.

But, in general, it is not necessary to make a stop of antioxidant supplements unless, for some special circumstance, it is required. For example, to make an analytical, an operation, for pregnancy or for a disease in which the doctor expressly indicates.

Do foods high in antioxidants do the same action as pharmaceutical extracts in capsules or other forms?

Some foods also have antioxidant capacity and, following a healthy and high diet in these foods, we could replace the supplements; However, food does not usually provide enough nutrients to be effective. For example, to get a good amount of antioxidant cocoa we should drink up to 4 glasses of cocoa powder.

The so-called superfoods contain the highest levels of antioxidants. Some of them are red berries, turmeric, nuts or green leafy vegetables.

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What are antioxidants and how do they work?

Do you know what they are and why do they recommend them so much? Here we tell you

There is a nutritional trend that began several years ago and is based on the increased consumption of antioxidants. Since then we heard antioxidants here and there, we began to eat more blueberries, apples, cherries and everything we hear that contains many of these substances, because they can do us good, but we do not really know what they are or what they do.

But that's not going to be any problem because we're going to explain it as clearly as possible.



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What are they

Antioxidants are chemicals that can prevent or slow down cell damage . An antioxidant is not a substance, it is rather a cellular behavior. Any compound that can donate electrons and counteract the damage of free radicals has antioxidant properties.

The natives find them mainly in fruits and vegetables, marine plants and some fish and seafood that eat marine plants. There are thousands of compounds with these characteristics, but the most common are vitamin A, C, E, beta-carotene and lycopene. Antioxidants can also be produced artificially and consumed as supplements.

What are free radicals and why do they harm us?

Exposure to oxygen, or oxidation, can "break" the atoms, so they are left with unpaired electrons. This makes them a loose chemical hazard. These bad guys, called free radicals, are always looking for loose electrons to stabilize their atoms. Free radicals cling to the electrons of other cells, causing a chain reaction of more free radicals. Stealing nearby electrons means that the joint cell loses some electrons and becomes a free radical. Something very tired.

It is not a good idea to damage the structure of a cell, especially if cells containing DNA are damaged in this oxidative stress. This process is related to serious diseases such as cancer, heart problems, diabetes, arthritis, fibromyalgia, Parkinson's, Alzheimer's, autoimmune diseases, cognitive decline, and eye problems such as macular degeneration.

What antioxidants do

They are found in the first line of defense that the body uses to keep free radicals from doing too much damage. That is, they prevent damage to the cells, since they can donate electrons so that they do not steal them from the cells around them. Likewise, antioxidants can help repair the cell damage caused by these bad guys.

The bad news

There is little scientific evidence that antioxidants will protect us from heart problems or cancer. For example, some studies suggest that consuming additional beta carotene may increase the risk of lung cancer in smokers. And some tests in cancer patients who take antioxidant supplements during their treatments had worse results. In a randomized trial, women who consumed antioxidants in supplements had higher rates of skin cancer than those who did not.

Some investigations have concluded that they only have a placebo effect. It has also been proven that not all free radicals are bad for health. The body needs a certain amount of these to get rid of cancer cells and bacteria, among other things. Taking too many antioxidants can prevent these beneficial free radicals, causing diseases anyway.

Although we do not know exactly how the antioxidants that come from nature affect diseases, a diet with lots of fruits rich in antioxidants, vegetables and grains will always be beneficial.

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Antioxidants: What are they? and how do they work?

We have heard many times the expression "is an antioxidant " with healthy foods but do we know what is and why should be included in our diet?

We are in the midst of "media war" between the food industries to win the trust of consumers, so from Vitonica we will review some basic features about antioxidants and other posts about more "functional supplements" such as omega 3.



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  •     An antioxidant is a molecule capable of retarding or preventing the oxidation of other molecules . Oxidation reactions can produce free radicals that start chain reactions that damage cells. Antioxidants end these reactions by removing free radical intermediates and inhibit other oxidation reactions by oxidizing themselves.
  •     Antioxidants block the damaging effect of free radicals . Respiration in the presence of oxygen is essential in the cellular life of our organism, but as a consequence of it these free radicals are produced, which cause negative health effects throughout life through their ability to alter DNA (genes), proteins and lipids or fats.
  •     There are situations that increase the production of free radicals such as intense physical exercise, environmental pollution, smoking, infections, stress, diets rich in fat and overexposure to the sun.
  •     Antioxidants are found in foods such as vegetables, fruits, grain cereals, legumes, nuts and tea .

Tuesday, January 29, 2019

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Hip arthrosis: what it is, symptoms, diagnosis and treatment

What is it

The osteoarthritis of the hip joint consists in the deterioration of the cartilage of this joint. It is relatively frequent, although not as much as osteoarthritis of knees or hands. In general, it is typical of older people, although it can appear before the age of 50, being exceptional in young people.



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symptom

The main symptom is pain, although rigidity and impairment of functionality (mobility) also appear. In hip osteoarthritis pain is localized in the groin area. Occasionally, the pain goes down the front of the thigh and can also hurt the knee, which may make the patient think that the problem is in the knee. Therefore, it is very important to know that hip pain is not located in the area of ​​the body popularly known as "the hips."

Origin

It is not known. The cause of osteoarthritis is thought to be the consequence of a sum of genetic and environmental factors.

Diagnosis

The diagnosis is based on the symptoms that the patient has along with the exploration of the hip, which presents a loss of mobility. To confirm the diagnosis, an X-ray can be done that shows the typical findings that arthritis produces in the joint, and allows to establish a prognosis according to the hip is more or less worn.

Treatment

Currently there is no treatment that can cure osteoarthritis, but it can relieve symptoms, slow their evolution and improve quality of life. For this, several alternatives are available: physical measurements, drugs and surgery.

The rheumatologist is the most experienced doctor to establish the diagnosis of hip osteoarthritis and differentiate it from other joint diseases, as well as to establish the optimal treatment according to the degree of the disease. The rheumatologist will refer you to other specialists when necessary and will advise you at the time about the convenience of the surgery.

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Osteoarthritis and heels: do they have any relation?

Given that the heels cause a greater load and, therefore, a greater pressure on the joints of the middle and forefoot, "it can produce greater wear on these joints, favoring the onset of osteoarthritis ", explains Alfredo Martínez, president of the College Official Podiatrists of the Valencian Community (ICOPCV). "Specifically," he continues, "it affects the metatarsophalangeal joints and the toes."



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Whenever heels are used, this overload occurs in this area, therefore, the impact on the joints will depend on the height of the heel and the time of use . Martínez indicates that from this it can be deduced that, at a shorter time of use, the risk of osteoarthritis is lower.
Heel height

As for the height of the heel, the expert points out that from two or three centimeters the weight of the body moves forward . "The higher the heel, the greater the incidence of that weight on the forefoot and, thus, the higher the heel, the more likely that the disease will occur."

In addition, an increase of this risk could be added when the footwear does not have any fastening in the back part of the foot, that is to say, in the heel. This would be the case of sandals.

Can you prevent the problem?


All these problems can not be prevented more than using a flat shoe. Martinez believes that "when you use a heel you can not walk in any other way than in the position that the footwear prints on the foot, so there is no way to prevent osteoarthritis when wearing that footwear ".

To minimize this, the podiatrist suggests wearing spare shoes and changing them whenever possible to minimize the time of use of the heel and perform exercises with the feet, such as shrugging and stretching the fingers.

Other problems of heels

Apart from the risk of osteoarthritis, usually walking with this type of shoes can lead to other problems. "They give important problems of metatarsal overloads and dislocations or upheavals of the metatarsal or phalangeal joints," says Josep Manel Ogalla Rodriguez, president of the Official College of Podiatrists of Catalonia and full professor at the University of Barcelona .

In addition, they provoke hardness in the sole of the foot and fingers in claw, with the consequent calluses in the fingers.

According to Ogalla, the areas most affected by the use of heels are:

  •     The bones of the foot
  •     The joints of the foot.
  •     Ankle.
  •     The knees.
  •     The position of the spine.
  •     All the musculature of these regions.

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Arthrosis: tips to improve the quality of life

Arthrosis is the most frequent joint disease in Spain. In fact, between 2 and 4 million people suffer from it and according to experts more than 70 percent of people over 50 have signs of osteoarthritis on radiographs, but only 25 percent will have symptoms .



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"The main symptoms of arthrosis are pain, joint stiffness, deformity and the decrease or loss of mobility," explains Montserrat Romera-Baurés, coordinator of the Arthrosis Working Group of the Spanish Society of Rheumatology (Artroser ), who indicates that all this affects the quality of life of the people who suffer from it. "In a survey conducted in Barcelona, ​​20 percent of those interviewed reported disability or dependence to perform activities of daily living. In the EPISER study, 67 percent of respondents with knee osteoarthritis reported that their health status was bad or regular, "he adds.

So, do these figures show that nothing can be done to improve the quality of life of those affected by an illness that affects more women than men and in which obesity is a determining risk factor? On the contrary, Romera-Baurés points out that there is a whole series of non-pharmacological measures that can help improve pain , reduce functional disability and try to slow the progression of the disease .

Know the disease, the most important

Information is power. And this also moves to osteoarthritis. Knowing the disease, the different treatments and the basic measures that can be implemented in your day to day will make a difference.

The expert recommends, for example, incorporate aerobic exercise on a day-to-day basis. "Exercise maintains neuromuscular coordination, prevents muscle atrophy and retains the strength of tendons and ligaments."

Another important aspect that influences are the postural habits: we must avoid sunken sofas and chairs, use chairs with flat backrest and adequate beds . "It is not advisable to carry pesos and it is better to use cars to go shopping", he adds.

Regarding the advice to cope with the disease, the coordinator of Artroser highlights:

  •     Control weight and / or lose weight in those cases where there is overweight .
  •     It is necessary to exercise to strengthen the muscles and to preserve mobility.
  •     Physical therapies in the form of heat and cold can be beneficial. "In general, heat is better, which relieves pain and relaxes the muscles. The cold will be used only in cases of inflammation of a joint, "he explains.
  •     The use of canes and / or crutches also serve to relieve pain and provide stability and safety, avoiding possible falls.
  •     The footwear must be suitable, with little heel (4-5 cm) and that holds the foot well. The orthopedic insoles also help to cushion the impact.
  •     In some cases it is necessary to unload the joint using discharge splints.

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Advice from the pharmacy to relieve pain in osteoarthritis

Many patients with osteoarthritis are used to living with pain, they are resigned", says Eloi Merencio Naudín, coordinator of the Pain Group of the Spanish Society of Family and Community Pharmacy (Sefac). "We have to explain to them that surely we can not take away the pain, but we can reduce it ".

And in this role, in helping the patient to improve their quality of life, the pharmacist plays a crucial role since many of the doubts about their treatment and how they can adapt to day to day can be resolved in the pharmacy that they have closer to home.



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Merencio states that their work is important because they can explain what medications are prescribed by the specialist, they can give them detailed information that will help the patient follow it and therefore improve before, as well as explain possible adverse reactions to medications or what other drugs or foods your treatment can interact with.

What can I do to improve?

This is one of the most frequent questions patients ask their pharmacist. The experts, in addition to helping them in aspects that include how to take the medication, how long they should follow it or whether or not they can combine it with other medications can give them other non-pharmacological recommendations that will alleviate their day to day.

These are:
Most convenient type of physical exercise

The spokesman stresses that it is convenient to perform exercises with little impact: soft bicycle without standing up, swimming, walking in the water or performing isometric exercises where the joint does not suffer impact, among others.

Adequate diet and diet habits

This point is very important. "If you are overweight you should follow a diet to lose weight since excess weight is always an aggravating factor of osteoarthritis, " he adds.
Correct the posture and use templates to reduce the impact with the ground

At this point, Merencio highlights two aspects:

  •     Standing: the top of the head should be aligned with the roof, the chest upright, the scapulas aligned, the knees straight, and the arches of the feet well supported to the ground and with good support.
  •     Sitting: the back straight, the buttocks well supported to the chair, the knees at a right angle and at the same height as the hip. The feet on the floor and the table at the height of the elbows. Try to avoid the use of chairs that are too small and that do not rotate.

Finally, the specialist emphasizes that the patient can carry out some changes that may favor the disappearance of pain, such as having a muscle mass developed to minimize the weight that the joints carry.

"They can also apply cold after a physical activity to reduce inflammation, use optimal and comfortable shoes, take a good posture and especially pay attention to health professionals .

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Arthrosis treatments, symptoms and information in CuidatePlus

What is it

Osteoarthritis is a chronic disease that affects the joints. Normally, it is located in the hands, knees, hips or spine. Arthrosis causes pain, inflammation and prevents normal movements such as closing one's hand, climbing stairs or walking.

The joints are the components of the skeleton that allow the connection between two bones (such as the elbow, knee, hip, etc.) and, therefore, movement. The cartilage is the tissue responsible for covering the ends of these bones and is essential for the proper functioning of the joint since it acts as a shock absorber.



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Arthrosis causes the deterioration of the articular cartilage, causing the bones to wear out and the pain to appear. As the cartilage is disappearing, the bone reacts and grows on the sides (osteophytes) producing deformation of the joint.
Incidence

Arthrosis is the most frequent articular disease in Spain , according to data from the Spanish Society of Rheumatology , which estimates that more than 7 million Spaniards over 20 years of age have osteoarthritis of the knee, hand or spine. In addition, this disease is more frequent in women , 52 percent, compared to 29 percent in men.

"From the radiological point of view, the population segment between 50 and 64 years old presents 70 percent of osteoarthritis in the hands, 40 percent in the feet, 10 percent in the knees and 3 percent in the hips ", they point out.

In addition, according to the World Health Organization , about 28 percent of the world population over 60 years of age has osteoarthritis and 80 percent of it has limitations in their movements . The increase in life expectancy and the aging of the population will make osteoarthritis the fourth cause of disability in the year 2020.
Causes

To date, the causes of osteoarthritis are not known exactly , but there are some risk factors associated with its appearance:

  •     Age : increases exponentially after 50 years.
  •     Sex : affects mostly women over 50-55 years old.
  •     Genetics : it can also be a hereditary disease. In particular, the genetic inheritance in the development of osteoarthritis can reach up to 65 percent.
  •     Work activity : the repetition of joint movements can lead, in the long term, to joint overload. Therefore, certain work activities (hairdressers, masons, etc.), can cause the appearance of arthrosis.
  •     High physical activity : elite athletes have a higher risk of developing the disease.
  •     Menopause : the decrease in estrogen levels that occurs with the arrival of menopause is one of the risk factors for its development.
  •     Obesity : it does not seem to participate in the development of osteoarthritis, but it can aggravate it in certain joints such as the knees.
  •     Injuries : fractures and injuries can be a triggering factor.


symptom

The manifestations of osteoarthritis are very varied, progressive and appear dilated over time.

The most frequent symptoms are joint pain , limitation of movements , crunches and, in some cases, joint effusion . In addition, some people may present joint stiffness and deformity .

The pain that most worries people with osteoarthritis is pain. In a first stage, it is triggered when it moves or an effort is made with the joint. This pain usually ceases with rest. Subsequently, the worsening of osteoarthritis will cause pain to appear both with movement and with rest.

One of the good points of arthritic pain is that it is not always constant, so that patients can be for long periods of time without suffering pain, which does not mean that osteoarthritis does not follow its evolution.

Prevention

The main measure that risk groups have to take into account to prevent the development of the disease is to eat a healthy and balanced diet , such as the Mediterranean diet , exercise moderately , activities that are appropriate to age and condition. current physical person and avoid obesity .

It is also convenient to limit the intense physical effort, such as carrying heavy objects or work activities that involve overexertion.

On the other hand, experts recommend that people be careful when playing contact sports, such as football or rugby, as they are not recommended for patients with osteoarthritis. The reason is that these sports are one of the factors that can trigger the disease. In fact, many players suffer from osteoarthritis of the knee due to injuries suffered in the meniscus .

In case of having the disease they should avoid the movements that produce pain, without getting to immobilize the area.

Types

Currently osteoarthritis manifests itself mainly in four areas:

Knee osteoarthritis

Knee osteoarthritis is the most common type of osteoarthritis. In fact, in Spain, 10 percent of Spaniards suffer from it. It is possible to distinguish between two types of osteoarthritis of the knee:

  •     Primary knee osteoarthritis : it is closely related to aging and genetics, and is linked to the wear and tear of the different parts of the knee (bones, the synovial membrane and cartilage).
  •     Secondary knee arthrosis : it usually occurs due to a previous injury, such as a fracture or a ligament injury. It usually affects athletes and obese people, since the overexertion they demand from their knees is high.

In this case the disease affects the internal and / or frontal parts of the knee causing pain when an effort is made. As a consequence of this pain and the degenerative evolution of the disease, the patient may have lameness if the disease progresses to an advanced stage. In this type of osteoarthritis the movement of the joint usually causes clicks.

Arthrosis of hands

Arthrosis of the hands is the second most common type of osteoarthritis. In Spain, 6 percent of citizens suffer. It is usually closely linked to the female sex and the genetic inheritance of the patient . Arthrosis of the hands originates in a joint and, later, can extend to the rest of the hand.

It is very visible, as it tends to deform the fingers and affects the daily life of patients in everyday tasks such as writing. During the process, the pain accompanies the evolution of the disease being stronger at the beginning and mitigating as the nodules appear. The discomfort usually decreases when the deformation is complete. The functionality of the hand may be affected and the joint may be slightly bent or deflected.

Hip arthrosis

Osteoarthritis of the hip is one that affects the upper part of the leg. This type of osteoarthritis is quite common, although not as much as osteoarthritis of the knee or hand. In general, it is typical of older people, but it can appear before the age of 50, being exceptional in young people.

The main symptom is pain, which is located in the groin area and in the inner thigh area . However, sometimes the pain can be reflected in the knee.

At the beginning of the illness, the pain only appears when walking and going up or down stairs. Pain is also felt after a period of rest, until the joint becomes warm, and then reappears after a long walk or prolonged exercise, because the joint is overloaded. Progressively, difficult actions such as crossing or flexing the legs, or walking, become difficult. In advanced stages, pain may appear during the night, due to the resting position and, with the passage of time, it is normal for lameness to appear when walking.

Column osteoarthritis

The spine is made up of many joints. This causes osteoarthritis to develop in this area, often in the lumbar and cervical area .

This type of osteoarthritis can be asymptomatic, so it is often not diagnosed and is located by chance when performing an X-ray for another reason.

The pain can appear when performing mechanical activities, such as movements and overloads in the affected area. In addition, changes in time and pressure often aggravate the pain.

Diagnosis

As explained by the Spanish Society of Rheumatology (SER), the diagnosis of the pathology is made through a clinical interview.

There are some tests that help the specialist complete the study. Through an x-ray the doctor can distinguish the osteophytes, the clamping of the cartilage, the subchondral geodes and the asymmetric decrease of the joint space, clear symptoms of osteoarthritis.

Other tests that can be used in exceptional cases are CT and magnetic resonance when the doctor has doubts about the origin of the process or is studying other problems in a complementary way, such as a disc extrusion in a spondyloarthrosis or meniscus rupture in a gonarthrosis.

Finally, high resolution ultrasound has been incorporated as a very effective diagnostic tool because it reveals the soft parts that surround the joint, as well as if there is inflammation or injury in any of them and distinguish if the bone profile is altering.

Treatments

The main objective of treatment in osteoarthritis is to improve pain and functional disability without causing side effects.

To achieve this, the SER insists that the first step that specialists must take is to teach patients to avoid everything that contributes to injuring joints such as overweight, repetitive movements, inappropriate attitudes at work, footwear, kitchen utensils, furniture, etc.

Secondly, it is advised that each patient has a personalized and adapted table of exercises that must be done under the supervision of the physiotherapist to improve the course of the disease.

Finally, from the SER point out that the rheumatologist will decide the appropriate pharmacological treatment for each case:

Anti-inflammatories and / or analgesics

In the most acute phase, the pain increases a lot because of the inflammation of the affected area. At this point, it may be necessary to prescribe medical anti - inflammatories and / or analgesics to reduce the swelling of the area and thus relieve pain.

Chondroprotective drugs

They are the only specific drugs to treat osteoarthritis in the long term because they act directly on the affected joint. Not only do they relieve pain and improve mobility, but they are demonstrating that they have the capacity to attack the root disease, slowing down the deterioration of the joint. Among them are drugs such as chondroitin sulfate , glucosamine sulfate and hyaluronic acid .

In 2015, The Cochrane Library published a review on chondroitin sulfate that confirms the efficacy and safety of this drug in the treatment of osteoarthritis. The conclusions show that the patients treated with chondroitin sulfate presented an improvement of the pain and of the functional capacity statistically significant and clinically relevant against placebo, demonstrating in addition advantages of security.

Surgery

If the patient is in a final stage of the disease, specialists recommend prosthetic surgery as a therapeutic option.

Forecast

Although this disease is not very serious, it does significantly decrease the quality of life of patients. In fact, its prognosis differs greatly depending on the joint that is affected and the evolution of the pathology.

In addition, factors such as early diagnosis and joint prevention measures can contribute to slowing the development of osteoarthritis .

In general terms, the SER explains that the evolution of the pathology is slow and progressive.

How does it affect the patient's life?

Pain and lack of mobility are the main factors that affect and diminish the quality of life of patients.

Given that the disease affects mainly patients over 60 years of age, the functional limitation may increase the sedentary lifestyle in these population groups. This can promote obesity, and with it the risk of increased cholesterol levels , the presence of diabetes , hypertension , or other risk factors for cardiovascular diseases .