While Millennials are zeroing in on functional foods for anti-inflammatory benefits; Boomers–and now aging Gen-Xers—seek the perfect diet to keep their hearts young. In its August 2016 Data Brief, the Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics (NCHS) reported that heart disease remains the No. 1 killer in America.
After three decades of decline, the number of deaths from cardiovascular disease (CVD) rose by 3% from 2011 to 2014. This rise is “something to be concerned about,” says Robert Anderson, PhD, chief of NCHS and coauthor of the brief. Anderson says health professionals must continue to promote healthy eating and activity, and to encourage patients to reduce risk factors such as obesity, diabetes, and high blood pressure.
These data are not lost on Americans. Six out of 10 say they are “very” or “somewhat” concerned about preventing heart disease and managing unhealthy cholesterol and high blood pressure, according to Natural Marketing Institute’s (NMI) 2015 Trends in Healthy Living report. More than 75% of the 3,000 Americans NMI surveyed reported eating heart healthy foods or beverages. As many as 40% of respondents admitted they had changed their diets to address cholesterol levels, and 28% said they had “upped their intake of heart healthy foods.”
Of those surveyed by NMI, a significant number noted that they believe their diets are deficient in key heart healthy ingredients. These include the following: fiber (33%), omega-3s/fatty acids (31%), and whole grains (27%). Half of consumers want to see [more] health claims on food packages, such as “oatmeal may lower the risk of heart disease.”
In the Genes
The cause of heart disease is generally considered as secondary to two overall categorical factors: lifestyle and genetics. The lifestyle factors—smoking and other directly harmful habits, poor diet, and lack of exercise—are within our control. Until recently, the genetic factors were believed to be beyond our control. But science has been amassing evidence that genetic patterns can actually change for individuals who were dealt a bad genetic hand for heart disease risk, according to researchers at the Center for Human Genetic Research at Massachusetts General Hospital.
The Center’s analysis of data from studies of 55,000 people revealed that the genetic contribution to heart disease risk can be cut in half by eating a diet of fruits, vegetables, and grains, along with not smoking and moderately exercising. “The basic message of our study is that DNA is not destiny,” says Sekar Kathiresan, MD, director of preventive cardiology at Massachusetts General Hospital.
The researchers mapped out 50 different gene regions that contribute to an increased risk of heart attack. For the unfortunate individuals who possess those genetic factors, the risk is twice as high, explains Kathiresan. A healthier lifestyle, including a healthy diet, counterbalances the genetic risk and cuts the overall risk of heart attack by half, he says.
Certainly, more research is needed into the impact of nutraceutical or highly bioactive ingredients on genes and disease prevention. But the door to potential for ingredients and their role in nutrigenomics—the interaction of nutrition and genes—is one that swings both ways. The knowledge of CVD risk levels and factors for specific ethnic groups and subgroups makes it possible for product developers and manufacturers to appeal to both the culinary preferences and the health needs of particular demographic segments.
One exciting trend in product development is the increasing rate of discovery—and rediscovery—of beneficial plant-derived ingredients. (See, “Botanical Growth,” PF January, 2017.) Botanicals are not only becoming more common in mainstream foods and beverages, but they also are being marketed in ways that deliberately demonstrate their co-existence with flavor and satisfaction in a food or beverage. Amla, the Indian gooseberry (Phyllanthus emblica), is an example of this revival.
Amla is an ingredient of increasing interest regarding heart health. A pilot study of 20 male smokers (aged 20 to 60) with cardiovascular abnormalities examined intake outcomes of 250mg of gooseberry fruit extract (containing not less than 60% w/w hydrolyzable tannoids). The researchers measured key parameters, such as lipids, fasting glucose, platelet aggregation, antioxidant activity, and blood pressure.
The most significant differences from baseline scores among the intervention group included an increase in HDL cholesterol from 37.4 mg/dL vs 47.0 mg/dL; a decline in lipoprotein values from 31.20 mg/dL to 23.13 mg/dL; lowered platelet aggregation (from 54.75% vs 37.68%); and a total cholesterol reduction from 192.2 mg/dL to 180.5 mg/dL. The researchers further noted that there were “measurable and significant changes in many cardiovascular risk parameters in just two months.”
A review study published in November, 2016 in the journal BioMed Research International analyzed the effect of traditional dietary ingredients from both the Mediterranean regions and Asia. The study authors coined the phrase “MediterrAsian” and concluded that consumption of these regions’ culturally acceptable ingredients could well improve HDL cholesterol levels. “The results of this systematic review indicate that dietary supplementation with four typical components of the MediterrAsian diet, that is, red yeast rice, bergamot, artichoke, and virgin olive oil, have promising effects on the increase of HDL-cholesterol serum levels,” researchers remarked.
Food as Thy Medicine
For many Americans who have both high serum cholesterol and a family history of heart disease, statin drugs have traditionally been the first line of defense. However, comparative data from leading medical journals show that certain foods alone, or combined with non-statin drugs, can be as effective as statins at reducing cholesterol and the risk of heart disease.
A case in point is the Harvard study, “Association Between Lowering LDL-C and Cardiovascular Risk Reduction Among Different Therapeutic Interventions: A Systematic Review and Meta-analysis,” released last September in the Journal of the American Medical Assn. (JAMA). Researchers found that both statin users and those who maintained a heart healthy diet (alone or in combination with non-statin drugs) experienced similar reductions in low-density lipoprotein (LDL-C) and relative risk for major vascular events. Considering the side effects from statin drugs, the ability to achieve the same effects with diet or a combination of diet and less aggressive drugs is significant.
Taking the concept of food as medicine to the next level is the Step One Foods line by TruHealth LLC. The products were developed with a “food first” philosophy by company founder Elizabeth Klodas, MD. Klodas is a cardiologist who created Step One products for patients and consumers interested in using foods in place of statins. She emphasizes that no matter how a person achieves reduced cholesterol levels, the resulting cardiovascular risk reduction is the same.
Klodas explains that she reviewed more than 300 studies to perfect a precise formula of “clinically impactful levels of fiber, omega-3 fatty acids, antioxidants and plant sterols in just two servings per day.”
“At a fundamental level, statins treat the symptom—high serum cholesterol—while Step One Foods treat [a contributing] cause: poor diet,” continues Klodas. “It’s a very different focus and approach, but the results are comparable. Our food-based approach is achieving cholesterol reductions comparable to medium-dose statin medications: specifically, an average 39-point LDL cholesterol reduction in 30 days.”
The Mediterranean diet has become well known as the diet with the most proven platform for heart health. An October 2016 study in the Annals of Internal Medicine that reviewed 90 controlled studies, each with 100 subjects or more, and who were followed for a least one year. Researchers looked at mortality and incidence of cardiovascular disease, hypertension, and diabetes. The study also looked at adherence outcomes, and investigated cohort studies for cancer outcomes.
The results of this review indicated that the participants who followed a Mediterranean Diet with no restrictions on total fat intake had a lower incidence of cardiovascular events, specifically myocardial infarction, stroke, or heart-related deaths.
A JAMA Internal Medicine study of 131,342 participants showed that mortality from heart disease was significantly reduced for those who consumed a plant protein-centered diet, especially for those with [at least] one risk factor for cardiovascular disease.
One of the benefits of a plant-based diet is an increase in magnesium intake. A meta-analysis of 1 million European consumers across nine countries found that an extra 100mg of magnesium could reduce stroke risk by 7% and type 2 diabetes by 19%. Primary sources of magnesium include whole grains, nuts, beans, leafy greens, and cocoa.
Innova Market Insights reports that there is no end to the growth for consumers upping their intake of plant proteins and cutting back on meat intake. Globally, there is a 24% growth rate in the number of consumers claiming to eat meatless at least once a week. In the US, the growth rate is 38%, with an additional 120,000 Americans who already adopted meatless eating. Innova reports a 60% increase in global food launches using a vegetarian claim in the five years from 2011-2015.
Millennials and Functional Foods
An emerging consumer trend is a desire for foods that are inherently healthy. For example, according to research by the NPD Group, “Eating Habits in America,” consumer preferences have evolved from avoidance labels in the 1980s and fortification claims in the 1990s to foods and ingredients that are innately healthy. In 2016, consumers entered a third phase, the “healthy food revolution,” says Harry Balzer, author of the report and senior vice president of the NPD Group.
This new era puts less emphasis on terms like “low fat” and more weight on anti-inflammatory foods and ingredients. One example is grapes, prized for their polyphenolic benefits. Welch’s recently introduced Concord grape concentrate in bite-size nib called FruitWorx. A 100g serving has the equivalent amount of polyphenols contained in about 72 grapes.
FruitWorx can be used in cereals, snacks, bakery, and confectionery applications. “Research demonstrates that Concord grapes and their juice can help support a healthy heart by contributing to vascular health and promoting healthy circulation,” says Casey Lewis, RD, Welch’s health and nutrition lead.
Turmeric is another ingredient gaining widespread popularity for its innate health benefits. A 2016 Google food trends study, “Food Trends 2016,” gives the bright orange spice top billing for foods with function. From November 2015 to January 2016, internet interest in turmeric grew 56%. Curcumin, the active ingredient extracted from turmeric’s rhizomes, has held up to scrutiny in hundreds of animal and human studies. Each study has uncovered superior antioxidant properties that reduce inflammation and thus protect the heart.
Human clinical trials using both curcumin and curcuminoids have shown reduced lipid profiles, reduced cholesterol and blood pressure lowering benefits and cardioprotective effects. Each health attribute stems from curcumin’s ability to reduce oxidative stress and lower inflammatory responses by inhibiting pro-inflammatory proteins and enzymes.
In October 2016, FDA nailed the coffin shut on artificially derived partially hydrogenated oils (PHOs) by ruling they are “not Generally Recognized as Safe.” The FDA ruling noted, “Removing PHOs from processed foods could prevent thousands of heart attacks and deaths each year.” Companies that have not already done so have three years to comply with the ruling to remove PHOs from food and beverage formulations, unless they have an exemption from FDA.
Palm oil shortening is perfectly poised to replace PHOs. “Palm oil shortening gives baked products the soft, layered texture and mouthfeel that consumers expect in cookies, pie crusts, crackers, and similar products,” says Percival Andrade, PhD, Ecuadorian-based palm oil expert and advisor to Natural Habitats/Palm Done Right. Just how the various forms of palm oil fats affect heart health is still being determined.
The form of an oil, such as refined or unrefined, greatly affects its properties. For example, both refined and unrefined forms of red palm oil contain high levels of monounsaturated fatty acids, the same type of fat that gives the Mediterranean diet its heart healthy benefits. Both forms are also high in coenzyme Q10, a vital nutrient for heart health. But only unrefined red palm oil still contains plant sterols, known for reducing inflammation to maintain heart health.
As consumers seek ways to maintain and improve heart health, food is increasingly becoming the first choice. “The pendulum is swinging towards a more comprehensive, inclusive approach to health and healing. Patients are demanding it, and physicians are recognizing the limitations of a pharmaceutical-only approach,” says Klodas. “Therapeutic foods help fill this gap.”
Better science means food producers can strive to include real food ingredients in quantities that make a significant difference to health. “This opens up our ability to use food as a formal, structured intervention instead of, or in addition to, pharmaceuticals,” Klodas adds. “It is completely novel, and has the potential to fundamentally change health and health care.”
Originally appeared in the February, 2017 issue of Prepared Foods as Food First for Heart Health.
Berries Take Heart
GenXers, now segueing into middle age, are focusing increasingly on health concerns. This includes a growing demand for “health-identified” ingredients. According to the US Highbush Blueberry Council, the phytochemicals found in fruits such as blueberries, fit the bill perfectly. Fruits, especially those that are concentrated sources of antioxidant compounds such as the anthocyanins in dark red, blue and purple berries, have long been linked by research to cardiovascular health benefits.
Fruits like blueberries can act as a versatile and low-calorie source of antioxidant compounds as well as vitamin C, potassium, and fiber. The Blueberry Council has noted that “health and convenience factors have boosted consumer demand for processed and frozen blueberries.” Helping, too, is the fact that blueberries have a familiarity and sense of comfort that appeal to consumers, while being readily associated with health-promoting foods and snacks associated with antioxidants.
The Blueberry Council points out that blueberries are an easy-to-formulate ingredient for product development in all categories, from snack and bakery items to beverages, cereals and dairy. There are already blueberries as an ingredient in the realm of products that make the claim for antioxidants.