As Baby Boomers age, and the seeming indestructability of youth gives way to the frailties that accumulate with time, there arises a sober realization: Heart health is an actual thing, and it clamors for attention. A fact sheet by the American Heart Assn. paints a startling picture of what can happen with time: For the 40-59-year-old group, 40.0% of men and 34.4% of women have some level or form of cardiovascular disease (CVD). By the time it reaches the 60-79-year-old age group, it rises to 70.2% of men and 70.9% of women.
While most of the heart-health advice centers on what not to eat—reduce saturated fat, limit cholesterol, minimize added sugars and fats, cut down on salt, and don’t overeat—concerned consumers are looking for products that can help shift the odds in their favor. A mere three-in-10 chance of escaping CVD entirely isn’t very comforting.
Two of the fundamental paradigms of heart-health advice—cut down on salt and cut down on fat—have been called into question. Modern research that better controls for misreading of cause and effect; the synergy and complications of multiple variables; and preconceived conclusions is informing concerned health experts with a more honest approach to diet’s role in maintaining a healthy cardiovascular system. This, in turn, prompts consumers to look for more proactive strategies, some of which lead to fewer dead ends.
A study published last year in the Journal of the American Medical Association: Internal Medicine assessed the association between dietary sodium intake and mortality; incidents of CVD; and incidents of heart failure in older adults. The researchers followed 2,642 older adults over a 10-year period. Subjects filled out dietary questionnaires, and researchers compared different levels of sodium intake with cardiovascular events.
The results were unexpected: Sodium intake was not associated with 10-year mortality, incidents of cardiovascular disease, or incidents of heart failure. Tellingly, consuming greater than 2,300mg per day of sodium was not associated with significantly higher mortality. Of added concern was the fact that severe restriction of sodium in certain elderly patients (who were fighting other health problems, on several medications, and/or had inadequate caloric intake) could actually lead to negative complications.
The study’s authors concluded there is, at minimum, a need for stronger evidence from rigorous controlled trials before applying a policy of further sodium restriction to older adults beyond the current recommendation for the general adult population (2,300mg/d). This supported previous studies indicating increased risks of health complications following blanket application of salt reduction in the diet of seniors living in assisted-care facilities.
An even more recent study, published earlier this year in the American Journal of Hypertension, concluded “there is no scientific basis for a public health recommendation to alter sodium intake,” noting that global sodium consumption is already within 2,645-4,945mg (appx. 6-12g salt), anyway.
Tried and True
While total dietary fat and the individual’s ability to metabolize it has scientists recognizing the complicated role of fat in heart disease risk, some risk factors from fat intake are better established. Most notable are elevated levels of low-density lipoproteins (LDL), the particles that transport cholesterol from the liver, where cholesterol is moved to tissues where it is used.
Accumulation of oxidized LDL into atherosclerotic plaque is part of a cascade of local events that can diminish or close off circulation to the heart, leading to ischemia (reduction of blood flow to the heart) or potentially fatal clots that halt the blood supply. The cascade of events leading to the accumulation of plaque includes the attraction of macrophages and the production of foam cells. This increases inflammation, leading to attraction of monocytes and proteins that can lead to rupture of the plaque. This has made lowering of circulating LDL a prime target for prevention of CVD.
Soluble fibers (a.k.a., prebiotics) are known to reduce circulating LDL by a relatively simple and straightforward mechanism—they create a sink. These indigestible, complex carbohydrates bind water to slow movement of food through the small intestines and, as a result, reduce the rate of glucose absorption. Among the most powerful of these include substances like -glucan from sources such as mushrooms, yeast, barley, and oats.
These fibers also bind bile, the fat emulsifier released into the small intestine during digestion via the gall bladder. This prevents the re-absorption of bile and forces the liver to sequester more cholesterol from blood to replace the lost bile. The liver converts cholesterol into bile and stores it in the gall bladder, completing the cycle. When the soluble fiber reaches the colon, it serves as a prebiotic food source for healthful probiotic bacteria.
All soluble fibers are not equal, and their role in the prevention of atherosclerotic plaque can be complex. Specific soluble fibers are under investigation for their ability to alter the gut microbiota—the community of microorganisms that make up the healthy gut bacteria.
Another potent prebiotic is inulin, a polysaccharide that acts as storage of energy for plants. It is sourced particularly from chicory and other members of the dandelion family, such as sunchokes (Jerusalem artichokes). It also is a major polysaccharide in globe artichokes, bananas, agave, jicama, and other starchy plants and tubers.
Inulin is known to stimulate the production of short-chain fatty acids, which may affect cholesterol metabolism. Inulin is just one of a number of becoming available to manufacturers. Others include natural compounds such as fructo-oligosaccharides (FOS) and mannan-oligosaccharides (MOS). Galacto-oligosaccharides (GOS) are a group of enzymatically derived ingredients that also show prebiotic action. Prebiotic ingredients can be incorporated into a variety of foods, certain beverages, and dietary supplements.
Enter the Microbiota
Probiotics, the healthy bacteria that populate the digestive tract, are defined by the Food and Agriculture Organization (FAO) and World Health Organization (WHO) as “living microorganisms that, when administered in adequate amounts, confer upon the host a health benefit.”
According to a review published in the Royal Society of Chemistry, “Targeting the gut microbiota as a strategy to prevent and/or treat a disease is currently one of the most exciting topics of research. Emerging evidence proposes that the modulation of gut microbiota with probiotics might offer new possibilities of prophylaxis and/or disease treatment.” Recent research suggests that this includes heart disease.
Much about the makeup of a healthy gut microbiota remains unknown and is the subject of significant interpretation. Still, evidence continues to mount suggesting a variety of mechanisms by which probiotics can provide protection from cardiovascular disease. For example, some of the cardio-health benefits of probiotics could derive from the ability of certain strains to reduce LDL by altering the structure of bile acids. So-called “bile salt hydrolase” (BSH) expressing probiotics increasingly are being studied for this purpose.
In a complex process, the enzymes released by BSH probiotics cleave away part of the bile acids, rendering them more susceptible to degradation. Believed to be a defense mechanism by bacteria exposed to a harsh, bile-rich environment, this mechanism results in the net result of a reduction of circulating LDLs. BSH probiotics added to yogurt have been shown reduce LDL by 9-12% and reduce the ratio of proteins imbedded in LDL particles (markers for CVD). Lipid-lowering effects of probiotics are inconsistent, however, so further research is needed to elucidate other mechanisms.
There also is evidence that certain strains of probiotics can help lower blood pressure. While this is possibly a secondary effect of lowering blood lipids, other studies have looked at interactions with the renin-angiotensin system. Angiotensin-converting enzyme (ACE) helps regulate blood pressure by aiding the conversion of angiotensin I to angiotensin II, a vasoconstrictor. Inhibiting ACE can thus aid in blood-pressure control.
Research is ongoing into the effect of probiotics in obesity, one of the most common lead-ins to heart disease. The gut microbiota are believed to play a role in regulating the absorption of carbohydrates and lipids by fermenting certain carbohydrates into short chain-fatty acids (SCFA). It’s known that the gut microbiome in obese individuals vs. lean persons differs significantly.
The reason for this is the subject of great debate. Some researchers suggest the reduction of certain strains of healthy bacteria that produce SCFAs leads to elevated levels of lipopolysaccharides in plasma that can trigger the production of various pro-inflammatory products released by the immune system. What is known is that certain prebiotics, such as resistant starch, directly support the strains of healthy probiotics that produce SCFA.
In order to be effective, probiotics added to or inherent in foods must be able to survive first the harsh treatments of processing heat, pressure, low-pH environments, etc.—and then human digestion, including gastric hydrochloric acid, protein digestive enzymes, and bile. Then, once in the g.i. tract, they must be able to multiply.
Ingredient makers have developed strains of bacteria, for example Bacillus coagulans GBI-30, 6086, that can survive just such conditions. These probiotic ingredients are suitable for use across a spectrum of foods and beverages and are readily available to processors.
Plants in Play
The phytochemical contribution to healthy hearts came of age a generation ago, with attention paid to the so-called French Paradox in the 1980s and 90s, and especially to the phenolic compound found in red wine, resveratrol. The notion that red wine could protect the heart even for those consuming a diet high in saturated fat—the French—was exciting to consumers, to say the least.
Of course, the French in the 1970s actually did not consume a diet rich in total fat or calories and engaged in walking and other physical activities considerably more than most Americans. It also is worth pointing out the dearth of fast food in the diet of the average French person back then. The lower CVD deaths rate in France vs. the US might truly be paradoxical; or they are the product of the French diet’s lower-calorie count; more nuts, whole grains, fruits and vegetables; and more fiber. It is certainly debatable.
Nonetheless, resveratrol is a powerful antioxidant, naturally abundant in not only wine and other grape products, but in a variety of plant species. These include blueberries, raspberries, peanuts, blackberries, and mulberries, among many others.
Studies have shown resveratrol to be beneficial and even protective against several cardiovascular diseases, including ischemia, atherosclerosis, hypertension, and heart failure. Laboratory studies, including several studies in animal models, suggested a reduction LDL oxidation and inhibition of platelet aggregation (the tendency of blood platelets to stick together). Resveratrol also appears to have anti-inflammatory activity. However, the benefits of resveratrol might best be appreciated in the context of other elements in the plant.
While grapes are one of the richest natural sources or resveratrol, isolating this potent compound might not be the best method of application. A recent article published in the Annals of the New York Academy of Sciences, “Resveratrol, in its natural combination in whole grape, for health promotion and disease management,” makes the case that resveratrol performs its beneficial functions most effectively when contained in its natural matrix. Whole grapes contain an endemic combination of resveratrol and essential nutrients, along with other phytochemicals, such as catechins (also abundant in tea), anthocyanins, polyphenols, and flavonols.
If it turns out that these substances act synergistically, then the whole may be greater than the sum of the parts. Certainly there are many phytochemicals that show promise when experiments are conducted in vitro (test tube studies), but fail to show the same promise in real-life situations. Fortunately, a number of botanical ingredient makers have focused on whole-fruit/-vegetable powders and extracts, including grape and grape seed powders, as food and beverage ingredients.
Fruits and vegetables, in general, long have been associated with reduction of cardiovascular diseases. It is reasonable to attribute this potential protection to the variety of antioxidant nutrients like vitamins A, C, and E, along with selenium, critical to metabolic function and the only dietary mineral that is an antioxidant. Numerous laboratory studies suggest potential cardioprotective benefits of these antioxidant vitamins and minerals. Interestingly, these also present cases where laboratory results were not duplicated by supplementation, suggesting again that the whole is greater than the sum of its parts.
Other minerals, specifically calcium and potassium, as well as magnesium and iron, are important for heart health, as well. These, too, are not only found in good supply in plant foods but in dairy foods and grains. Dairy is a key provider of vitamin D in the diet, too. Vitamin D, already recognized as being more critical to health than just the “bone builder,” has received attention for its role in cardiovascular health, specifically in helping protect against atherosclerosis.
That the rich combination of vitamins, minerals, and phytochemicals in fruits and vegetables provide a synergistic effect fortunately falls into the trend path of consumer demand for more simple and whole ingredients in their foods and beverages. Suppliers have continued to increase offerings of whole-fruit and -vegetable ingredients in the forms of dried, dehydrated, and powdered products that retain all the inherent nutrients that can be lost when these same substances are heavily processed or isolated.
There is a complicating factor when it comes to supplements. As an example, a deficiency of selenium results in a compromised cardiovascular system and even heart failure. Luckily, sources of selenium in the diet already are adequate enough. In addition to fruits and vegetables, whole grains and nuts are abundant in the mineral.
Good Fats Better
A group of compounds that have potential synergistic effects with resveratrol are the omega-3 fatty acids (of the class called linolenic acid). These already have been recognized for decades for their contribution to healthy tickers. Most plant-derived omega-3 fatty acids available come from flax, walnuts, chia, and other seeds and nuts. They also are abundant in algae. Cold-water fish eat the algae and modify these fatty acids to suit their needs in order to adapt to bitterly-cold environments.
The most well-known and commonly used fish oil-derived omega-3 fatty acids are eicosapentanoic acid (EPA) and docosahexanoic acid (DHA). EPA and DHA perform multiple other health functions, such as aiding in retinal growth and nerve and brain development. Humans have the ability to modify linolenic acid to EPA and DHA in a limited manner. Also, few foods are good sources of EPA and DHA.
Most of our animal foods are grain-fed. Pasture-fed animals modify the linolenic acid naturally occurring in grass and other green plants to EPA and DHA—similar to the way fish alter the fatty acids in algae. In addition to providing omegas from plant sources, ingredient technology has allowed manufacturers to get them straight from the source: algae. These highly bioavailable algal omegas are increasingly popular not only for their purity, but for their high sustainability and low carbon footprint.
EPA and DHA are precursors to a variety of compounds in the body that control processes, such as platelet aggregation and inflammation. Because they tend to act as blood thinners similar to aspirin, the American Heart Assn. recommends 130mg/day of DHA/EPA (combined), for people suffering from coronary heart disease.
In addition to the role of blood thinner, there are a variety of mechanisms by which the EPA/DHA combination could benefit the heart that have yet to be elucidated. For example, there is evidence that omega-3 fatty acids relieve the oxidative stress that can damage proteins and membranes. EPA and DHA help to protect cells from the cold by maintaining the flexibility of membranes, allowing them to transmit signals normally. This same mechanism could help control inflammation by regulating components that control that process.
Because resveratrol and omega-3 fatty acids affect oxidative stress and inflammation by different pathways, there is evidence they work synergistically. This explains some of the benefits the Mediterranean diet is famous for vis. protecting against heart disease.
Spice is Nice
There are many working parts to the Mediterranean diet that have potential cardio-protective effects, from olive oil to whole grains to nuts to an abundance of phytochemical-rich plants. But the South Asian diet, too, merits attention for its use of powerful plants, especially spices and herbs.
Saffron, a spice traditional to both cuisine cultures (Mediterranean and Asian), is under investigation for having specific benefits to heart health. Saffron is the dried stigma of the Crocus sativus blossom, a centuries-old spice that traveled from India and Iran to Spain, bringing with it a strong tradition of therapeutic application.
Recent bench experiments have suggested that two major active ingredients in saffron—crocin and safranal—can exert antioxidant, anti-tumor, and anti-inflammatory properties. In experiments conducted in vitro, the isolated components demonstrated an ability to quench free radicals and reduce inflammatory markers.
In addition, crocetin (the major metabolite of crocin) has been shown to inhibit some of the degenerative effects of what are termed “advance glycated end products” (AGE) in isolated endothelial cells. In general, saffron is a powerhouse of potentially bioactive compounds. It even contains concentrations of -carotene and its carotenoid cousin, zeaxanthin, powerful antioxidants known more commonly for their action in supporting the retina and protecting against macular degeneration.
Turmeric, one of the most concentrated sources of curcumin, has been benefiting from a great deal of attention in recent years. This is due to the multiple health benefits associated with all the curcuminoid compounds, natural phenols found in not only turmeric but its cousins ginger and galangal, as well as the cruciferous vegetables. Curcumin has shown strong anti-inflammatory action, as well as serum cholesterol-lowering abilities.
The quest for heart-healthy ingredients is focusing attention on a vast spectrum of components in common foods, herbs, and spices. The slim chance of avoiding any CVD event is a powerful motivating factor, especially for Boomers.
Originally appeared in the April, 2016 issue of Prepared Foods as Here's to Heart Health.
The Humble, Heart-healthy Mushroom
The traditional class of whole foods related to vegetables is under investigation for potential health benefits, including benefits to heart health. Many varieties of mushrooms contain a number of active components that could help lower the risk of cardiovascular diseases. It is noteworthy to mention that certain mushrooms (at least 26 species) contain natural statins, inhibitors of the enzyme HMG CoA reductase, a key enzyme necessary for cholesterol synthesis. Mushrooms are known to carry a number of antioxidant compounds that include various polysaccharides, phenolics, triterpenes, nicotinate, the plant sterol ergosterol, and vitamin E. They also are the only vegan source rich in vitamin D. Studies suggest the effectiveness of natural anti-inflammatory compounds in mushrooms in preventing the buildup of arterial plaque.
Coenzyme Q10 Goes to 11
Coenzyme Q10 (CoQ-10), a key component in heart function, is gaining increased interest from processors. Most important, however, is that it appears to duplicate the effect of the manufactured statin drugs, without their considerable risks. CoQ-10 is a critical component in every cell of the body. Its many features that benefit the cardiovascular system are owed to its dual role as both a key member of the electron transport chain in the mitochondria, responsible for converting food into usable energy, and as a powerful antioxidant that helps to regenerate other antioxidants, like vitamin E.