The heart never rests. At 65-75 beats per minute, the average ticker pumps about 300 liters of blood every hour. The energy expenditure over a lifetime is enormous and requires constant replenishing. But, unlike skeletal muscle that stores glycogen for bursts of energy, the muscle tissue of the heart depends almost entirely on aerobic metabolism, using fatty acids as the main source of fuel.
By its nature, the heart muscle is rich in mitochondria, the dynamos of the cell that do the work of converting fuel to Adenosine Tri-Phosphate (ATP). ATP is the energy currency of all living systems. This calls for many nutrients -- in particular, the B vitamins, specifically thiamine (B1), riboflavin (B2), niacin (B3) and pridoxal phosphate (B6). All of these participate in the energy-producing pathways deep within the mitochondria, and all are critical to the synthesis of the vast amount of ATP necessary for continuous movement.
Meeting the ingredient challenges of creating heart-healthy foods and beverages -- and compete with the American junk food diet -- is not as difficult as one might imagine. There are multiple potential strategies for creating heart-healthy foods and beverages, each of which can make a powerful impact on heart health.
Many foods are fortified or enriched with thiamine, riboflavin and niacin, either to prevent deficiencies or to make up for nutrients lost during processing. Some sports drinks contain B vitamins, along with electrolytes, and most energy drinks are fortified with large amounts of B6 and B12, as well as taurine, a free amino acid (not bound to protein) that has many physiological functions, among which is to help maintain healthy blood pressure. Also, emerging science on heart health and dairy intake indicates vitamin D also could have a positive impact on the cardiovascular system, via its regulation of parathyroid hormone and, less directly, of serum calcium and inflammation.
Often, vitamin B-packed energy formulations are loaded with caffeine. In high doses, this alkaloid increases both heart rate and blood pressure. On the other hand, moderate amounts of caffeine are found in some foods that have a healthy effect on blood pressure.
For example, a study published last April in the American Journal of Clinical Nutrition showed products in black tea solids might lower blood pressure over a long period of time. The effect of these compounds was independent of caffeine. Most of the milk analogs use soy; grains like rice, oats and barley; and seeds, such as almonds and hemp, as a base and are fortified with vitamin D and calcium, as well as B vitamins. These beverage products only rarely contain caffeine.
Other potentially heart-healthy ingredients appear promising, but are unfamiliar to most Americans. Ribose and coenzyme Q10 are top examples. Ribose is a 5-carbon sugar that the body makes as part of riboflavin, RNA, DNA and ATP. Although it is a sugar and brings some sweetness to formulations (about half that of sucrose), it provides no calories, since the body doesn’t recognize it as fuel -- but it can increase the rate of ATP replenishment. Ribose is water-soluble, simple to use and has earned both a GRAS rating and an FDA letter of non-objection. Look for increased usage of ribose in sports drinks and other beverages, in addition to its supplemental powder form.
Coenzyme Q10 (CoQ10) is a vitamin-like molecule embedded in the inner mitochondrial membrane. Its job is to shuttle electrons back and forth between the enzyme complexes that make up the electron transport chain -- the final stage of converting food into ATP. Supplemental CoQ10 has been shown to increase the ejection fraction -- or pumping power -- of each heartbeat in subjects with cardiomyopathy. The normal healthy individual makes about 10 times the amount of CoQ10 necessary to run the electron transport chain.
CoQ10 also is a powerful antioxidant that can regenerate vitamin E, the primary fat-soluble antioxidant in the body, as well as vitamin C, the major water-soluble antioxidant. As people age, they tend to make less CoQ10, possibly due to the cumulative effects of stress, diseases and environmental generators of oxidative stress. These insults force CoQ10 into a multi-tasking situation.
With the popularity of statin drugs to reduce plasma cholesterol levels, CoQ10 has gained more attention. Statin drugs work by interrupting the synthesis of cholesterol at a critical step, a step that is also critical to synthesis of CoQ10.
This has been a matter of some controversy, as many cardiologists either approve of, or recommend taking CoQ10 along with statin drugs. (Karl Folkers, Ph.D., the scientist who worked out the structure of CoQ10 in the 50s, had been recommending this tactic for decades. It seems he was more on target than he knew.)
A study published this spring in Metabolic Syndrome and Related Disorders suggested that CoQ10 might be important for a distinct set of patients. Statins result in a small but significantly increased risk of type 2 diabetes.
The mechanism of this risk is not known precisely; however, statins are believed to reduce the synthesis of a protein called GLUT4, which aids insulin in allowing muscle and fat cells to pull glucose from the blood. In this study, fat cells incubated with Simvastatin showed reduced GLUT4 synthesis. However, there was no significant difference in GLUT4 protein levels in the cells co-treated with CoQ10.
It’s a big step from these types of studies to the demonstration of the mechanism for type 2 diabetes risk in patients taking statins. And, it’s another step to demonstrate that CoQ10 is the remedy in humans. But, this does appear to deliver more evidence of the cardioprotective effects of CoQ10. Fortunately, new methods of micro-encapsulation allow CoQ10 -- a large fat-soluble molecule -- to be added to a variety of applications that were impractical before. Already present in some sports bars, CoQ10 offers potential as a supplement added to dairy-based sports beverages and other formulations.
Grape News for Hearts
Another strategy for maintaining heart health is to reduce the oxidative stress. The top antioxidant-containing foods include fruits, such as grapes, berries and apples; vegetables, legumes (black, red and pinto beans); along with nuts and seeds, and various spices.
These typically are classed as superfruits, with the category growing as research uncovers more good news about their overall health benefits and specific cardiovascular health-enhancing properties. A study published early this year and conducted by researchers at the University of East Anglia in the UK showed that women eating three or more servings of blueberries and strawberries per week could help reduce the risk of a heart attack by one third.
The East Anglia scientists, together with the U.S.’s Harvard School of Public Health, conducted more than 18 years of research involving 93,600 women aged between 25-42, who were registered with the Nurses’ Health Study II. Women who ate the most blueberries and strawberries had a 32% reduction in their risk of having a heart attack compared to women who ate the berries once a month or less–even in women who otherwise ate a diet rich in other fruits and vegetables.
One lead researcher, Aedín Cassidy, Ph.D., says results show, “even at an early age, eating more of these fruits may reduce risk of a heart attack later in life...
This is the first study to look at the impact of diet in younger and middle-aged women.”
What was especially noteworthy regarding these fruits was that the findings were “independent of other risk factors, such as age, high blood pressure, family history of heart attack, body mass, exercise, smoking, caffeine or alcohol intake.”
The superfruit-derived nutraceutical class also includes resveratrol, quercetin, anthocyanins and polyphenolic compounds -- powerful water-soluble antioxidants usually derived from grapes. A study published in April in the American Journal of Medicine profiled 33,713 women aged 49-83 years from the Swedish Mammography Cohort. Researchers followed the women from September 1997 through December 2009 and estimated total dietary antioxidant intake and capacity (based on the Oxygen Radical Absorbance Capacity [ORAC] assay measurements of foods). Total antioxidant capacity of diet
was associated with lower risk of heart failure (defined as hospitalization or mortality of heart failure as the primary cause).
One of the most concentrated sources of anthocyanins is purple corn. Botanically the same species as sweet corn, the purple variety is a natural, deep violet, one of the deepest shades of purple in the botanical realm. The anthocyanins that give it the color also are among the most concentrated of any fruit or vegetable -- several times higher than blueberries -- and, in studies, have shown strong anti-inflammatory ability. The ORAC value of purple corn is one of the highest of any edible plant, as well.
Resveratrol, known as the key ingredient in the “French paradox” that helped ignite the antioxidant craze, was the subject of a study published last summer in the American Journal of Cardiology. In this new study, a grape extract containing resveratrol was tested in 75 patients being treated for cardiovascular disease over the course of a year. Two control groups were given a grape extract with no resveratrol and placebo (maltodextrin), respectively. Resveratrol always had performed well in laboratory studies and studies on animals. But, this study was the first to show an improvement in the inflammatory and fibrinolytic status (tendency to form clots) of human subjects.
Another randomized, placebo-controlled 2012 study, published in the Journal of Pharmacy and Nutrition Sciences, was undertaken to determine whether a grape seed extract (GSE) -- a nutraceutical containing vasodilator phenolic compounds -- lowered blood pressure in subjects with pre-hypertension. The subjects in the experimental groups received GSE at a dose of 300mg/day for eight weeks. Blood pressure, serum lipids and blood glucose were measured at the beginning of the study and at the end.
Results showed that both the systolic and diastolic blood pressures were significantly lower after treatment with GSE. Treatment with the placebo had no effect on blood pressure. There were no significant changes in serum lipids or blood glucose values. These findings suggest that GSE could be used as a nutraceutical in a lifestyle modification program for patients with pre-hypertension.
Omega-3 fatty acids, now one of the most studied nutraceutical ingredients, are essential and have shown many positive attributes for health across a wide spectrum of conditions, especially concerning heart health. There is evidence they have a positive effect on blood pressure, and they tend to lower triglyceride levels.
These effects are greater with the longer-chain omega-3s, EPA and DHA, found mostly in fish oils, although DHA derived from algae is equally effective. A diet high in fatty fish tends to reduce the risk of stroke; however, the overall affect on heart health is less clear.
Microencapsulation allows omega-3s to appear in many beverage applications, and DHA derived from algae allows it to be used in vegan applications. Another vegetarian/vegan form of omega-3 fatty acid rapidly growing in popularity is alpha-linolenic acid (ALA), the common omega fatty acid found in many nuts and seeds. Flax seed is a popular and rich source of ALA; chia (salba) and hempseed, too, are increasingly trendy sources of plant-based omegas. All are now making regular appearances in snack foods, such as crackers, chips and cereals, as well as beverages.
Soluble fibers continue to be a favorite heart-smart ingredient of food and beverage manufacturers, due to their ability to lower cholesterol and provide added texture to food and beverages. Soluble fibers have the ability to trap cholesterol, in the form of bile acids that are secreted into the small intestines to help digest fats. Now there’s a new twist that adds to their attraction: Increased attention to healthy gut bacteria, or probiotics, has led to much speculation about and research into the role of the “gut microbiome” in heart disease.
The key to heart-healthy ingredients continues to be nutrient density, with an emphasis on nutrients that provide energy, antioxidant protection, reduction in cholesterol and probably greater attention to intestinal health. This is a move away from the time when heart-healthy appeared to be a reflection of what was not contained in the food or beverage, i.e., low-fat, low-sodium, low-cholesterol, etc. Heart-healthy can be proactive, rather than merely reactive to the latest bad news.