Close to a million Americans are dying each year from heart-related complications, according to the Centers for Disease Control and Prevention, Atlanta. This leading cause of death results from lifestyle choices and diet, is largely preventable, and most importantly, is reversible to a great extent.
And while medical and pharmaceutical treatments have proliferated, adverse side effects of cholesterol- and blood pressure-lowering prescription drugs are prompting consumers to actively seek more natural solutions from food. Indeed, prospects are particularly bright for food and ingredient businesses in the heart-health category. Companies are responding with an incredible range of new foods and ingredients to help improve heart health, extend longevity and enhance the quality of life.
Few health issues can match the importance of cardiovascular care. Cost-effective means to live longer and live well are motivating individual efforts like never before. Cardiovascular health is no longer a fashionable fad, but the way to be.
A Clear and Present Danger
In January 2004, the American Heart Association projected cardiovascular disease as the fastest-growing health condition over the next ten years. Their survey confirmed that approximately one-fifth of the population is dealing with some type of cardiovascular disease including high blood pressure and elevated levels of cholesterol.
According to Elizabeth Sloan of Sloan Trends, Escondido, Calif., Americans are seeking ways to reduce weight, cholesterol and fat for a variety of cardiac conditions. Thirty percent of respondents to a recent survey are striving to reduce salt intake; 28% are managing hypertension; and 17% are battling heart disease for themselves or for a member of the household. Several new cardiovascular segments have emerged in the marketplace. “Pre-hypertension” was flagged as a new at-risk category early this year by the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. This category includes individuals with blood pressures of 120-139mm Hg systolic and 80-89mm Hg diastolic and is a precursor to chronic high blood pressure.
Women and especially “peri-menopausal women,” a critical at-risk demographic according to the AHA, is a growing segment and expected to require more preventive measures in the future. Twice as many women succumbed to cardiovascular disease as from all forms of cancer, and this number is disproportionately higher and growing compared to corresponding male deaths, which declined during the recent decade.
Children have surfaced as a new concern. More than 10% of all U.S. children have cholesterol levels greater than 170mg/dL—the traditional risk level for this age group.
The aging population and the magnified incidence of obesity--both of which are associated with increased cardiovascular disease--are significant and growing segments of the cardiovascular health category. In fact, growth in the cardiovascular health category is being driven primarily by these two segments, according to AHA.
Inflammation Emerges as Risk Indicator
Cardiovascular disease is not the result of an isolated risk factor. Rather, it culminates from a complex process that generally starts early in life and involves one of more factors including behavioral, environmental, genetic and socioeconomic status, according to Patricia Crawford, Ph.D., R.D,, co-director of the Center for Weight and Health at the University of California, Berkeley. “Prevention of cardiovascular disease entails concurrent control of the various risk factors and their determinants. Elevated blood cholesterol, obesity, hypertension and diabetes are all major risk factors.”
Cardiovascular health is being viewed differently in recent years because it has been discovered that factors other than cholesterol levels and hypertension are key indicators of cardiovascular health. Medical evidence points to inflammation related markers such as C-reactive protein to be highly associated with cardiovascular disease. Inflammation, previously associated with pains in joints, can also occur in the bloodstream when blood platelets adhere to clog up arteries and consequently, inflame them.
Food choice has a critical role in maintaining the integrity and smooth functioning of the vascular system. “Research outcomes emphasize that comprehensive management of cardiovascular disease entails controlling the associated risk factors such as obesity, elevated blood sugar, hypertension, elevated cholesterol and smoking,” according to Naomi Trostler, Ph.D., R.D., of the Hebrew University, Jerusalem. “Prescribed medications tend to focus on controlling serum insulin. For healthy cardiovascular function, one must also control blood sugar and the best way is really through watching what one eats.”
The role of diet in cardiovascular disease creates numerous opportunities for the food industry to impact heart health positively. There is a growing realization that the wisdom of the age-old adage continues to hold true--prevention is indeed better than cure. Of the virtually never ending list of foods and ingredients that have been demonstrated to benefit heart health, lutein, calcium and antioxidants ranked in the top 10 list of ingredients that U.S. food industry research executives think are most likely to grow their businesses in the next few years.
Diet’s Role Acknowledged
The U.S. Department of Health and Human Services recently acknowledged the pivotal role of diet in cardiovascular disease, the number one killer in the U.S. This motivated the U.S. Department of Agriculture to get involved in nutritional modalities to help reduce and prevent the onset of cardiovascular disease in America. Collaborative work by the National Institutes of Health centers in complementary and alternative medicine has enhanced understanding and helped raise awareness of the physiological mechanisms and the role of genetics and lifestyle choices.
Americans are demanding healthful foods in unprecedented numbers. Vending machines now dispense yogurt in schools, and more than a hundred legislative actions related to preventing or reducing obesity were passed successfully in 2003.
“Heart-healthy” and “cholesterol-lowering” claims--once perceived as offering unique competitive advantage--are now common features of supermarket shelves. Sales and offerings of heart-healthy bars, cereals and beverages has grown significantly over the past several years—a clear indication of the proactive efforts of consumers to manage their cardiovascular conditions in a variety of ways.
Marketplace evidence includes successful new food products such as Rice Dream Heartwise rice milk from Imagine Foods, Garden City, N.Y. This heart-healthy non-dairy beverage is enriched with vitamins A, D and B12 and the same amount of calcium as dairy milk. It also contains Minneapolis-based Cargill’s CoroWise, a plant-based extract containing phytosterol esters, which are believed to help reduce the risk of heart disease.
Three Marketing Strategies
The marketing of wellness foods for cardiovascular health is defined by three primary strategies. One strategy focuses on leveraging hidden nutritional assets and involves identifying the intrinsic benefits of existing components of the food and employing excellent nutrition marketing to get the word out. General Mills, Minneapolis, used this approach to apply a permitted claim for the heart health benefits of whole grains to its popular breakfast cereal brands Cheerios and garnered double-digit volume growth.
Another strategy focuses on employing nutrition science to identify and demonstrate the effectiveness of specific ingredients with heart health or cholesterol-lowering potential, and then developing foods with these ingredients. Almost always these ingredients are added to foods that do not naturally contain these ingredients in any significant quantities. Innovative extraction and processing technologies and the growing awareness of the ingredients’ health benefits have made this approach particularly successful in garnering consumers who seek more from their favorite foods.
For example, Bioriginal (Saskatchewan, Canada) successfully marketed FibrOmega, its shelf stable dietary fiber derived from flax seed, to food processors aiming to enhance their “heart healthy” status with healthy fats and soluble-to-insoluble fiber ratio. Unique, patent-protected ingredients manufacturers like Bioriginal are able to help create brands which can command premium prices from consumers anxious about their cardiovascular health.
Federal regulations have spawned a new approach, which involves replacing foods ingredients that have been flagged as being high-risk for heart disease. An example is the current market focus on replacing trans fats in bakery products and snacks. “Trans fat free” labels allow food products such as cookies and sweet baked products otherwise forbidden in the diets of those at high risk of cardiovascular disease.
Antioxidants Lead the Charge
Numerous studies conducted over the past several decades have determined antioxidants to have significant cardio protective effects—both individually and synergistically when used in combination with other antioxidants. (See "Oxidation Reduced to Its Radical Essentials," for more details on how antioxidants work.)
Antioxidant vitamins and minerals and phytochemicals, such as flavonoids and carotenoids, have been shown to help reduce oxidative stress. Indeed, consumers are driving the popularity of foods and beverages with antioxidants: antioxidants were the third most popular supplement in 2003 and one of the top five marketing aids for processed foods and beverages, according to the Natural Marketing Institute (NMI), Harleysville, Pa.
|Heart Helpful Ingredients |
The heart is a busy organ, requiring proper nutrition and care to ensure performance and prevent age and lifestyle-induced deterioration. Research, specifically in the realm of cures and treatments, point to antioxidant vitamins and minerals and several specialty ingredients, including lutein as having the ability to improve lipid levels, lower blood pressure and generally enhance overall cardiovascular wellness. Particularly effective are:
Vitamin E, a term that embraces a group of essential fat-soluble vitamins including four tocopherols and four tocotrienols, occurs naturally and in alpha, beta, gamma, and delta forms. Being fat-soluble, vitamin E works particularly well in the lipophilic environment of the heart to help protect cells and LDL from free radical oxidation. The natural d-alpha form is most efficient according to Ram Chaudhuri, senior executive vice president, research and development, Fortitech, Schenectady, N.Y.
Ester ETM, from Zila Nutraceuticals, Prescott, Ariz., is a vitamin E phosphate complex made by joining natural d-alpha tocopherol with a phosphate molecule to protect the antioxidant function of vitamin E during absorption, transport and storage in the body. The natural form is claimed to be better retained than synthetic forms, which are reportedly selected and secreted faster by the human body.
CSPHP or C-fraction soy protein hydrolysate from Kyowa Hakko (U.S. headquarters in New York) promotes healthy cholesterol levels by interfering and thereby, blocking cholesterol absorption in the intestine. CSPHP may be used as an ingredient in a number of food products and has already been approved as Foshu in Japan.
Vitamin C popularity is second only to that of its fat-soluble counterpart, vitamin E, according to the Natural Marketing Institute.
Leucoselect Phytosome is a complex containing a standardized of procyanidins from grape seeds and phospholipids from soy beans produced by Indena USA, Seattle, Wash. The compound protects LDL cholesterol under oxidative stress and has been effectively demonstrated in clinical studies with heavy smokers.
Coenzyme Q10 (CoQ10) is naturally produced in the body and is popularly known for its role in creating cellular energy from the body’s power-producing cells, the mitochondria.
Oxyphyte Heart Blend is a blend of tea catechins, particularly (-) -epigalocatechin gallate (EGCG) and (-) -epicatechin gallate (ECG), both of which inhibit LDL cholesterol. Available from RFI Ingredients, Blauvelt, N.Y., the blend is intended to help beverage and candy makers enhance the potency of heart healthy formulas.These are just the tip of a massive iceberg of ingredients promising cholesterol-lowering ability/improved heart health and which are debuting in the market or on the verge of being launched.
Rival PepsiCo, Purchase, N.Y., expanded its Tropicana Essentials line with Pure Premium Essential Healthy Heart. Touting potassium, vitamins B6, B12, C and E, and folate, the line also features Tropicana Light ’n’ Healthy with one-third less sugar and calories than orange juice, a full day’s supply of vitamin C and a supply of calcium.
The category of dietary antioxidants includes several different classes of compounds, including 5,000 or so naturally occurring phenolics. These include some 2,000 flavonoids, which are made up of flavonols, flavones, flavanols, procyanidins and anthocyanins. About 600 natural anthocyanin pigments have been identified, many of which are particularly effective at scavenging free radicals and have high antioxidant properties.
Vitamin E is undeniably the superhero among antioxidants and has been demonstrated to effectively protect the heart. Vitamin C is one of the more mainstream antioxidants and has been effectively used by food formulators to enhance the heart-healthy status of their foods. According to NMI, vitamin C is one of the more popular supplements among athletes, more than half of whom take vitamin C for its antioxidant properties, to alleviate muscle soreness and help repair cell damage.
Grapes are a gold mine of antioxidants associated with cardiovascular health. Grape skin and seeds contain anthocyanins and stilbenes (resveratrol and piceid), two classes of phenolics and flavonoid compounds quercetin, rutin, catechin and kaempferol. The antioxidant effects of grapes carry through when individuals with coronary artery disease consume Concord grape juice, prompting companies like Polyphenolics (Granger, Ind.) to extract bioactives from grape seed and grape pomace and show their effectiveness in preventing hypertension and lowering cholesterol. According to Ron Martin, Polyphenolics vice president of sales, the company is a couple of years away from getting a qualified health claim for applications in other food products.
The literature is replete with the use of berries to treat various ailments and includes grape polyphenolics to inhibit platelet aggregation and anthocyanin pigments with anti-inflammatory activity. “Total phenolics tend to have a higher correlation with antioxidant properties than total anthocyanins and in anthocyanin-rich fruits such as saskatoons, blackberry, black raspberry, blueberry and black currants,” according to Kelley Fitzpatrick, marketing and research development manager at the Richardson Center for Functional Foods & Nutraceuticals, Winnipeg, Canada. Anthocyanins and polyphenolics are found in highest concentrations in the peel and skin.
Tea is generally categorized in the realm of foods and ingredients with cardiovascular benefits. At the Harvard School of Public Health (Boston, Mass.), studies linked higher tea intake with healthy blood pressure levels, reduction in LDL oxidation, and inhibition of atherosclerosis and heart disease risk. The bioactive components of importance are catechins particularly (-) -epigalocatechin gallate (EGCG) and (-) -epicatechin gallate (ECG), both of which inhibit LDL cholesterol oxidation, slow the development of atherosclerosis.
Antioxidant specialty ingredients, like their vitamin and mineral counterparts, also are believed to reduce the damage caused by oxidative stress and even to prevent chronic disease by restoring the balance between antioxidants and free radicals. A notable specialty ingredient in cardiovascular health is coenzyme Q10 (CoQ10). Occurring naturally in the human body, CoQ10 has gained importance in recent years primarily as dietary supplements, chalking up a 12.7% increase in sales in mainstream markets in 2003 and 26.8% in the natural markets (SPINS/AC Nielsen). CoQ10 is recognized for improving peroxidation levels and contributing to a reduced risk for cardiac diseases. Efforts are under way in several Fortune 1000 food companies to incorporate CoQ10 in foods and beverages for mainstream markets.
Lutein as Food Additive
Despite the growing awareness of the dangers of unhealthy diets to avoid, many consumers find it difficult to adopt the necessary steps to prevent their cardiovascular system from becoming sick. Beyond just offering taste and basic nutrition, many fruits, vegetables and botanicals offer an array of antioxidant compounds including carotenoids that help bolster innate defenses and supply nutrients that target damaging free radicals.
Carotenoids have been shown to be significantly beneficial in heart health, specifically, lutein can scavenge free radicals to prevent or terminate oxidative chain reactions and protect against atherosclerotic development. Although fresh fruits and vegetables in addition to regular exercise are the simplest paths means to improve cardiovascular health, vegetables continue to have relatively low appeal among the U.S. population. Lutein is a boon to food formulators, constantly on the lookout for plant-based cardioprotective agents that can be used in various food products and help bolster cardiovascular wellness.
Lutein is an oxygenated carotenoid pigment found in dark green leafy vegetables, egg yolks, and other foods. “Epidemiological in vitro and in vivo investigations suggest that lutein is a potent protective factor against the progression of atherosclerosis in humans and animals,” says Zoraida DeFreitas, director of research & development, Kemin Foods, Des Moines, Iowa,
“Furthermore,” she adds, “the findings indicate that lutein’s effect is achieved with lowering of VLDL and IDL, rather than LDL, and via pathways that involve reduced inflammation and oxidative stress in the artery wall.”
Extensive education of food formulators and consumers-at-large by Kemin Foods on the benefits of lutein has resulted in its appearance on the labels of products like Ensure and Glucerna from Ross Products, Sunsweet Prune Juice and Hain Pure Foods’ Veggie and Carrot juices. Consumers associate the nutrient as having superior and almost magical effects on heart and eye health and tend to select these brands over their lutein-free competitors.
Physterols Block Cholesterol
“Several epidemiological studies associate the regular consumption of phyosterols and flavonoid-rich foods with decreased risk of cardiovascular disease,” says Anthony Almada, Chief Scientific Officer at Imaginutrition, Laguna Niguel, Calif. Phytosterols are believed to function by interfering with the body's absorption of dietary cholesterol during digestion, and by promoting the release of cholesterol, thus helping to maintain healthy cholesterol levels.
Masterfoods USA, makers of Dove Chocolate, Snickers and M&M's brands, innovatively leveraged this information to create CocoaVia, a high-flavanol chocolate snack with the health benefits of phytosterols. The FDA’s message--that foods containing at least 0.65 grams per serving of plant sterol esters, eaten twice a day with meals for a daily total intake of at least 1.3 grams, as part of a diet low in saturated fat and cholesterol, may reduce the risk of heart disease--is indeed good news for CocoaVia.
Calcium Builds Stronger Hearts, Too
The addition of calcium to just about everything from fruit juices to cereal is motivated by the consumer awareness and the marketplace demand from those who cannot get enough of it--especially children and peri-menopausal women.
CaffÃ© Botanica, Eugene, Ore., employed science and clever marketing to launch its Strength line of calcium-infused gourmet coffee beans. Calcium-enhanced water from mineral deposits in the Grotte Verdi (Green Caves) of Naples, Italy, are used to infuse coffee beans and create a smoother tasting brew with health-giving properties.
Calcium is known to improve heart health through different mechanisms than antioxidant effects. In combination with magnesium, calcium has been demonstrated to effectively lower blood pressure, with calcium specifically beneficial to serum lipid levels. Aside from aiding in the absorption of calcium, magnesium helps the body to utilize protein and is responsible for activating the multitude of essential enzymes in the body.
Studies link potassium strongly to reduced risks of stroke and high blood pressure prompting food companies to consider potassium and/or magnesium when exploring heart-healthy beverages. “Savvy consumers know about bioavailability,” asserts Ellis Hogetoorn, research & development manager at Purac, Lincolnshire, Ill., commenting on the most recent advances in the realm of commercially prepared mineral-rich foods for cardiovascular health. “We are trying to work with our customers to develop new calcium sources--to enhance calcium content or to develop new sources of calcium for real and perceived benefits,” she adds.
Amaranth is showing up on the labels of grain-based foods as a new source of calcium. Cultivated for centuries by the Aztecs, amaranth is garnering newfound respect from food formulators and consumers. Amaranth ranks as a super grain due to its superior nutrient content and rich reserves of minerals â calcium, potassium, magnesium, iron, and zinc to help support healthy blood pressure, and strong bones. When paired up with a vitamin C rich food such as a vegetable or fruit, the calcium and iron in amaranth are even more bioavailable.
“Amaranth is also rich in phytosterols and healthy fats to beat heart disease, stroke, and high blood pressure,” according to Larry Walters, President of Nu World Amaranth, Naperville, Ill. The company is focused on helping food formulators create good tasting heart-healthy foods with natural sources of fiber, calcium and phytosterols.
Cardio Goes Mainstream
Cardiovascular health is becoming an increasingly common-place proposition. Application of this proposition to more and more foods has helped level the pricing comparable to everyday foods, welcome news for those seeking affordable goodness.
But consumers don’t buy or eat science. They rely on brands and buy into hope. Ultimately, taste and convenience really influence the selection of one food over another. Companies with established food brands stand to win considerably in this race for consumer dollars and loyalty by creating good foods that say what they do and do what they say. Provided that the science is sound most companies will find their heart health products starting to perform much like any other kind of food.
About the Author
Kantha Shelke is a principal at Corvus Blue LLC, a Chicago-based firm that specializes in competitive intelligence and expert witness services. The firm helps businesses and professional organizations in the health and wellness sector to focus on what matters most. Contact her at firstname.lastname@example.org or (312) 951-5810.
Amaranth, an ancient Aztec “super” grain, is gaining new respect for its high levels of heart-healthy calcium, potassium, magnesium, iron and zinc as well as phytosterols and healthy fats. Image courtesy of Nu World Co.
Coffee joins the list with heart- and bone-healthy beverages with CafÃ© Botanica’s introduction of Strength calcium-infused coffee beans.