According to the Centers for Disease Control, nearly one million Americans per year die of CVD. That’s more than 40 percent of all deaths, at a rate of nearly two per minute.
By Mark Anthony, Ph.D. | 12/05/2005
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The core of CVD is the buildup of plaque in arteries, the thick-walled vessels that carry oxygenated blood. Accounting for much of the thickness is a layer of smooth muscle that helps to propel the blood along. The interior vessel wall is lined with endothelial cells, a sort of inside skin. According to the most popular theory, the “response to injury hypothesis,” plaque begins with damage to the endothelial layer.
The injured artery lining undergoes a complex series of changes that can narrow the passageways and reduce the flow of blood. Defensive cells attach to the injured walls, secreting growth factors, which attract wound-healing proteins. The smooth muscle layer then expands into the artery and this highly inflammatory process invites the attachment of cholesterol. This is because the injured wall has more cholesterol receptors.
|Because the risk factors for CVD are complex, the effective heart-health diet must be anti-inflammatory, anti-oxidant, anti-obesity and anti-hypertensive all at the same time. Image courtesy of NutriBody.com.|
The growing mass becomes vulnerable to rupture and the formation of a deadly clot, which if lodged in a narrowed artery that feeds the heart, can halt blood flow and starve a portion of the heart muscle. That is a heart attack.
The risk factors for CVD are complex. What causes the original injury is uncertain, but risk factors such as smoking, elevated blood pressure and high blood cholesterol are the usual suspects. Risk factors are perceived as individual contributors, but frequently risk factors are clustered.
For example, the metabolic syndrome that is a precursor to type II diabetes is characterized by a variety of symptoms, like elevated blood sugar and high LDL cholesterol, insulin resistance, obesity and hypertension. Obesity is a heart disease risk, and generally carries with it hypertension, increased markers of inflammation and elevated cholesterol.The Diet Connection
The complex nature of CVD means that for diet to be protective, it must address many factors and do so consistently. It’s not enough to call a diet “heart-healthy” simply because it’s low in fat or results in lower cholesterol. Half of all heart attacks happen in people who do not have elevated cholesterol levels.
The effective heart-health diet must be anti-inflammatory, anti-oxidant, anti-obesity and anti-hypertensive all at the same time. Anti-diabetic also comes in. And of course, it has to taste good and be convenient, otherwise nobody will stick with it long enough for it to be effective.
Sound impossible? Actually, it’s not difficult at all, just a matter of balance. A balanced, heart-healthy diet begins with a generous supply of fruits and vegetables. Numerous studies have revealed that a diet rich in fruits and vegetables tends to reduce blood pressure, lower cholesterol and dial down markers of inflammation. It’s associated with lower body weight and less incidence of type II diabetes. In other words, all the biggies.
The effectiveness of a diet rich in fruits and vegetables was confirmed by the DASH studies (Dietary Approaches to Stop Hypertension) sponsored by the NHLBI (National Heart Lung Blood Institute). A diet that included 10 servings per day of fruits and vegetables, whole grains, beans, nuts and low-fat dairy products significantly reduced hypertension. In fact, simply adding more fruits and vegetables to a standard American diet lowered hypertension, though not quite as dramatically as the full-blown DASH diet.
Many fruits and vegetables are rich in potassium and magnesium. And although the DASH diet was also high in calcium and low in sodium, the significant change in the balance of electrolytes is considered by many researchers to be more effective at lowering hypertension than simply reducing salt intake.
While fruits and vegetables are naturally low in sodium, their ability to reduce hypertension exceeds that which can be accomplished by simply altering electrolyte balance with supplements. Also, a diet rich in fruits and vegetables initiates many positive changes all at once that can go beyond lowering hypertension.
The Phytochemical Factor
|Grapes provide a wealth of phytochemicals, especially resveratrol. Photo courtesy of USDA's Agricultural Research Service.|
Fresh fruits and vegetables teem with heart-protective chemicals called phytochemicals. Phytochemicals can act as antioxidants, accompanying cholesterol during transport and protecting it from oxidation. It’s believed oxidized cholesterol is more likely to bind to injured artery walls.
These compounds work alone and in concert and number in the thousands, ranging from antioxidant vitamins, such as C and E, to carotenoids, such as beta-carotene, and lycopene. There are also polyphenols, which include phenolic acids (cinnamic acids, benzoic acids).
Resveratrol, the polyphenol from grapes, also appears to protect the artery walls from oxidation, inflammation, platelet aggregation and clot formation. Other phytochemical classes include flavonoids (of which there are over 6,000); stilbenes and lignans; organosulfur compounds and phytosterols.
The total cost to the nation in health care and lost productivity from heart disease is projected to be over $350 billion in 2005. Nearly 61 million people have been diagnosed with some form of cardiovascular disease (CVD), and not just seniors. Coronary heart disease (CHD), the main type of CVD and the number one cause of death in the U.S., is a major cause of disability among men and women in the prime of life.
A recent study showing that daily consumption of pomegranate juice may improve stress-induced myocardial ischemia in patients with CHD demonstrates there is still much untapped potential in these compounds, something processors have duly noted. A few years ago, you could only find pomegranate juice on the back shelf of an odd health-food store. Today, it’s in virtually every beverage case.Fiber for the Heart
Fiber, associated with cancer protection, also plays a heart-healthy role. However, in spite of a decades-long awareness and education campaign by health and nutrition experts, Americans still meet only half their minimum recommended fiber intake.
Apples, pears, oranges, plums and bananas are good sources of soluble fiber (mostly pectin), along with vegetables like spinach, broccoli, okra, potatoes and squash. Soluble fiber can trap cholesterol and prevent its recycling.
Bob Green, executive director of the Michigan Bean Council, notes that the humble bean is an unrefined food that’s one of our richest sources of soluble fiber. Beans have been staples in virtually every civilization for thousands of years. Green points to a study in which subjects who ate four servings of beans per week showed a 22 percent lower chance of heart disease than a control group that enjoyed beans less than one time per week.
Dry beans are more than merely a source of soluble fiber. They’re a good source of B vitamins, including folate. Their unique blend of protein and fiber makes them the slowest digesting of all carbohydrates and thus perfect for dieters and diabetics. Beans are creeping into processed foods, both whole and as bean “flour” in reformulations, but they could and should be a bigger part of the American diet.
Guar gum, added as a fiber supplement to traditional breads, improves texture and has been shown to lower cholesterol in study subjects by 10 percent. The viscous nature of guar gum tends to slow the entrance of sugar into the blood, which can make traditional breads more satisfying. Partially hydrolyzed gums can provide completely water-soluble fiber that is perfect for smoothing drinks without adding extra sugar and fat.
TIC Gums (www.ticgums.com
), Belcamp, Md., produces a comprehensive line of hydrocolloids (gums). Gums, once used for primarily for texture and stability of products, have found new life as an added source of dietary fiber.
Going with the Grain
|For a fiber bonanza, whole grains and food gums can be combined in products like these energy bars. Photo courtesy of TIC Gums.|
Whole grains are another fiber-rich food. It’s hard to imagine a time when oats weren’t associated with breakfast. Quaker began providing the nation with oats for breakfast as early as 1877. And just when we replaced oatmeal with heavily sugared cereals, we “discovered” soluble fiber. The big processing news last year was the shift, pioneered by General Mills, to whole-grain formulas by many cereal manufacturers.
Oats represent the richest sources of soluble fiber among all grains. The addition of oats to a heart-healthy diet can significantly lower cholesterol. Other grains have soluble fiber; barley may reduce cholesterol, but it’s not widely used in the U.S.
The benefits of whole grains are not restricted to soluble fiber. The majority of studies show that higher total intake of whole grains is associated with lower risk of CHD. Most nutrients are significantly reduced during the processing of grains, several of which have the potential to offer protection from CHD.
For example, folate, necessary to metabolize homocysteine, is decreased by over 60 percent. An elevated blood level of homocysteine is now a known risk factor for CHD in certain individuals. Various antioxidant phytochemicals, such as lignans, are lost in processing, along with the beneficial fats found in the germ of the grain.Reformulating for Health
In the U.S. we eat about seven times more refined grains than whole grains. Only a small percentage of us meet the five-a-day recommendation for fruits and vegetables, let alone the 10 per day of the DASH study.
Lately, much emphasis has been placed on reformulating grain staples because they have become the weak spot of the modern diet. Replacing portions of white flour and sugar in modern food formulas is becoming a popular strategy for manufacturers juggling the modern desire for convenient foods with the necessity to meet high demand for acceptable heart-healthy alternatives.
“I think the future is now. Already, from all sides there is a demand for healthier foods,” says Bill Driessen, technical sales manager for Taiyo International Inc. Taiyo provides a number of natural ingredients and products that include heart healthy soluble fibers and antioxidant-rich green teas. “Government health agencies see the need for improving the eating habits of the general population as a means to reducing obesity and heart disease.
“Schools are implementing programs to improve nutritional content, and consumers are demanding products that offer proven health benefits,” Driessen continues. “The food and beverage industry is responding by developing delicious products that are healthier than their predecessors. Ultimately, food and beverage manufacturers search for ingredient suppliers that have a strong focus on research and development.”
Targeting the Healthy Heart
|Fortitech is bullish on taurine; the firm includes the amino acid in some of its heart-healthy nutrient mixes.|
Manufacturers are in high gear to provide reformulations for heart health. At DSM Nutritional Products (www.nutraaccess.com
), Parsippany, N.J., epigallocatechin gallate (EGCG), one of the most active components of green tea, is the basis of a product called Teavigo. Teavigo is used to add a highly effective antioxidant punch to reformulated foods.
Davisco Foods Intl. (www.daviscofoods.com
), Eden Prairie, Minn., produces a type of hydrolyzed whey protein shown in clinical trials to significantly reduce hypertension. Fortitech Inc. (www.fortitech.com
), Schenectady, N.Y., provides a variety of nutrient mixes designed to enhance the health potential of traditional foods. These include taurine, a potentially heart-healthy amino acid, and antioxidant mixes that include coenzyme Q10.
According to Ram Chaudhari, Ph.D., executive vice president and chief scientific officer for Fortitech, “Taurine comprises over 50 percent of the total free amino acid pool of the heart. It has a positive action on cardiac tissue and has been shown in some studies to lower blood pressure.”
Coenzyme Q (CoQ-10) is of particular interest to heart health, because it has been shown specifically to strengthen the heart muscle. Few foods are rich in CoQ-10. We synthesize our own in a complex process that requires a nutrient-dense diet. Vigorous exercise also increases CoQ-10.
In addition, CoQ-10 is a powerful antioxidant that can both enhance vitamin E, and travel in lipoproteins to protect cholesterol from oxidation, thus reducing its potential to stick to artery walls.Soy Sterol-ization
Soybeans have been a boon to producers of heart-healthy products. A recent Shanghai Women’s Health Study of 75,000 Chinese women added to the mountain of positive studies connecting soy consumption to health by demonstrating a dose-dependant reduction in CVD risk with soybeans.
Soy flour is used to replace portions of white flour and increase the vegetable protein of a variety of healthful dishes, and soy is the basis of numerous drinks that have become wildly popular due to reported benefits of soy phytochemicals called isoflavones.
Lesser known healthful ingredients produced from soybeans are cholesterol look-alikes that can lower cholesterol in blood. Cholesterol is only found in animal products, but it has a counterpart in the plant world called phytosterols. Their structural similarity to cholesterol allows them to compete for absorption with dietary cholesterol in the small intestines.
A daily intake of 2 g of phytosterols can reduce plasma cholesterol by as much as 10 percent, without significant inhibition of the absorption of fat-soluble vitamins. According to Mark Empie, Ph.D., vice president of regulatory affairs for Archer Daniels Midland Co. (www.admworld.com
), Decatur, Ill., “Sterols are most widely used in margarine-type spreads, but there are increasing uses in other products like yogurts, beverages, cooking oil, and baked goods. We anticipate that the additional usage of sterols in a variety of products will continue to increase.”Nuts About Fats
The fat contribution to a heart-healthy diet can be nearly as controversial as carbohydrates. But there is no reason to exclude healthy fats from a heart-health diet, and plenty of evidence that certain fats are protective.
|The Coromega Co. found a way to remove the fishy odor and flavor from Omega-3-rich fish oil. They then add orange or orange-chocolate flavoring and voila! — an ingredient suitable for food processing applications.|
The International Tree Nut Council’s Nutrition Research and Education Foundation petitioned the FDA to include nuts as heart-healthy foods. In 2003 the FDA agreed, issuing a qualified health claim, saying that eating 1.5 oz. of most nuts, including almonds, may reduce the risk of heart disease when they’re part of a diet low in saturated fat and cholesterol. Multiple studies have shown nuts can lower cholesterol levels. Nuts are also nutrient dense and contain antioxidant vitamins and phytochemicals, along with plant sterols.
Olive oil has been shown to lower cholesterol without decreasing HDL, and is an integral part of the cuisine throughout the Mediterranean region — a region with much lower incidence of heart disease than the rest of the world. Foods of the Mediterranean, especially olives and olive oil, are highly touted as heart healthy by health promotion groups such as Oldways Preservation and Exchange Trust, the developers of the Mediterranean Diet Pyramid.
Omega-3 fatty acids have been strongly associated with diminished risk of CVD ever since studies on the Greenland Inuit population revealed low levels of heart disease in spite of their high animal-fat diet.
Omega-3 fatty acids act by influencing the type of ecosanoids that are produced, tipping the balance to favor the anti-inflammatory classes. They also reduce the stickiness of platelets. Higher levels of omega-3 are associated with lower levels of blood triglycerides.
The most bioavailable omega-3s are those in fish — something Americans don’t eat a lot of. Although the beneficial fat is available from some plant sources such as cranberries, flax and walnuts, one ingredient company, the Coromega Co. (www.coromega.com
), Vista, Calif., developed a unique process that removes the fish odor and flavor from pharmaceutical-grade fish oil. Orange or orange-chocolate flavoring is then added to yield an ingredient suitable for use as a flavorful supplement or in food processing applications.
For a diet to effectively reduce the multifaceted risk factors for coronary heart disease, it must be balanced and consistently applied. If your objective is to improve your diet at home, you fill the pantry and refrigerator with healthy foods, so they’ll always at your fingertips in competition with the less healthy choices. The same is true of a nation fighting for its health. Success depends on how much you have to go out of your way to gather heart-healthy food.
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