Globally, heart and vascular disease, including hypertension, is expected to affect about 250 million people by the middle of the next decade. But the real tragedy is that much of it is preventable.
A healthful diet and at least moderate daily activity goes a long way to reduce risk of disease or death from cardiovascular disease (CVD). Food and beverage processors can't help much with the latter, but they've been making strides in developing products for cardiovascular health. At the heart of these heart-smart offerings are a number of ingredients known to play specific roles in cardiovascular protection.
Some of the most significant phytochemicals hitting the mainstream are plant sterols, (phytosterols). Research shows they can lower LDL cholesterol associated with heart disease risk without affecting HDL cholesterol levels. Plant sterol esters (or "stanols") are more soluble in fat and during digestion compete with cholesterol and thereby reduce their uptake.
The FDA has approved the following food health claim for phytosterols: "Foods containing at least 0.65g per serving of plant sterol esters or 0.4g of plant sterols, eaten twice a day with meals for a daily intake of at least 1.3g of plant sterols or 0.8g of sterols as part of a diet low in saturated fat and cholesterol, may reduce the risk of heart disease."
According to an assessment published by Enzymotec Ltd., (www.enzymotec.com), Migdal HaEmeq, Israel, phytosterols are now "among the strongest market leaders in terms of functional, science-based ingredients capable of addressing specific health benefit or health concern." The company's CardiaBeat brand sterol formulation is suitable as a fat replacer in such food applications as bars, dairy products, spreads, cooking oils and dressings. Products using the phytosterol can also be eligible to include functional claims for cholesterol or CVD risk reduction.
Note To Processors
ConAgra Foods Inc. R&D manager Elizabeth Arndt explains that one of the greatest challenges for processors is finding ways to deliver efficacious amounts of ingredients without affecting the taste or the appearance of the product. With Sustagrain, for example, formulators have to ensure the product delivers the required amount of soluble fiber in the reference serving. To formulate heart healthy bread, formulators need to ensure 51 percent of the product weight should consist of Ultragrain -- whole grain material. ConAgra has developed a series of particle sizes and particle shapes for various product types for ease of application and reformulation.
Cincinnati-based Cognis Corp. (www.cognis.com) makes Vegapure natural plant sterols for use in food and beverage formulations. "Phytosterols offer a safe, natural and clinically proven way to create products that command a real competitive advantage in the heart healthy sector," says Laura Troha, marketing manager.
The Vegapure line of plant sterol esters is available in liquid and water-dispersible powder forms suitable for a wide variety of products, including bread spreads, dressings, bars, yogurts, beverages, cereals, pastas, sauces, snacks, confections and even ground roasted coffee. The company offers co-branded consumer marketing support under its Heart Choice brand.
MultiBene Products Ltd. (www.multibene.com), Espoo, Finland, makes MultiBene, an ingredient that combines plant sterols with calcium or other beneficial mineral nutrients such as potassium or magnesium. The patented combination has proven effective in clinical trials at lowering elevated serum cholesterol and elevated blood pressure, and can also help to maintain bone health. The FDA has approved three health claims relating to increased amounts of phytosterols, calcium and potassium: "May reduce the risk of coronary heart-disease," "May reduce the risk of osteoporosis" and "May reduce the risk of high blood pressure and stroke."
Cargill Inc. (www.cargill.com), Minneapolis, is covering multiple ingredient angles of heart health with its highly successful Corowise plant sterols, as well as its Prolisse brand of soy protein isolate and its Barliv barley beta-glucan. Corowise plant sterols have been clinically shown to lower cholesterol, and products with Corowise are eligible to make the following approved health claim: "Foods containing at least 0.4g per serving of plant sterols, consumed twice a day with meals for a daily total intake of at least 0.8g, as part of a diet low in saturated fat and cholesterol, may reduce the risk of heart disease."
Antioxidants have a solid scientific track record for exhibiting positive effects on heart health. Antioxidants, especially those derived from newly popular "superfruits" such as açai, mangosteen, goji and pomegranate, are only getting more play as processors catch on to their suitability for a variety of products.
These fruits are all very high in antioxidant compounds, especially anthocyanins. Research has shown that not only do anthocyanins protect against oxidative damage to cells, they can help reduce inflammation in epithelial tissues, such as those which line arterial walls, counteracting the build-up of arterial plaque. (For more on these superfruits and their healthful compounds, see "Caution: Botanicals at Work")
Pomegranate, one of the hottest of the superfruits, may be effective at reducing atherosclerosis, hypertension and other cardiovascular disease in amounts as little as 50ml of pomegranate juice per day. One of the main pomegranate antioxidant compounds is a polyphenol called punicoside. PL Thomas Inc. (www.plthomas.com), Morristown, N.J., developed P40p, a pomegranate extract containing a minimum of 40 percent punicoside. The calorie-free product suitable for a wide range of functional foods is the only kosher-certified pomegranate extract available.
Resveratrol is an antioxidant polyphenol in a subclass called "procyanidins" which researchers believe is the ingredient in red wine and grape skins that contributes to heart health. Researchers found procyanidins suppress production of a protein called endothelin-1 that constricts blood vessels. Several beverage makers are currently testing new heart-healthy beverages with resveratrol from Indena (www.indenausa.com) Seattle, and Polyphenolics Inc. (www.polypheolics.com), Madera, Calif.
From Fish to Nuts
The omega oils, especially DHA and EPA, have earned an abundance of recognition for their value to heart health (as well as a number of other benefits: See "Wellness Foods Trends 2007") Omega-3 fatty acids help lower blood triglyceride levels, aid the anti-inflammatory response and help reduce arterial plaque. Increased omega-3 in the diet is directly associated with decreased blood triglycerides.
Keep It Legal
Health claims characterize the relationship of a substance to a disease or health-related condition and require prior FDA approval or notification to FDA of authoritative status. There are permissible health claims regarding the relationship between substances (including antioxidant vitamins) and heart disease.
If a product qualifies for an unqualified health claim (based on significant scientific agreement) or a qualified health claim (based on limited evidence), all labeling statements must be consistent with the summary of scientific information and the model health claims stated in the relevant regulation. FDA takes the position that the use of a heart symbol in labeling is an implied health claim. Under most circumstances, a food is not permitted to bear health claims if it contains a "disqualifying level" of fat, saturated fat, cholesterol or sodium. And the so-called "jelly bean" rule, which applies at least to health claims authorized under the Nutrition Labeling and Education Act (NLEA), requires that a food must generally contain, prior to fortification, at least 10 percent of the daily value for vitamin A, vitamin C, calcium, iron, protein or fiber.
Leslie Krasny, of Keller and Heckman LLP, San Francisco, is a contributing editor. Check out her regular column, Regulatory Issues.
Although marine-derived omegas have the highest bioavailability, the beneficial omegas are available from plant sources such as cranberries, flax and walnuts. Odorless, flavorless highly-stable versions of fish-derived omega-3s by such manufacturers as Ocean Nutrition Canada Ltd. (www.ocean-nutrition.com), Dartmouth, Nova Scotia, are fulfilling a worldwide demand for omega oils that's increasing by double-digit percentages.
Wright Group (www.thewrightgroup.net) Crowley, La., makes Supercoat omega-3, a microencapsulated omega-3 fatty acid available in two different powder forms. The microencapsulation process masks unpleasant taste, odor or organoleptic characteristics while enhancing stability, increasing shelf life and protecting against extreme temperature or pH fluctuations during processing, handling and shipping.
Martek Biosciences (www.martek.com), Columbia, Md., produces a marine-derived, vegetarian omega-3 product called life'sDHA, from microalgae. It's suitable for use in food and beverage formulations and infant formula.
In 2003, following a campaign by the International Tree Nut Council, the FDA issued a "qualified health claim," allowing that eating 1.5 oz. of most nuts "may reduce the risk of heart disease when they're part of a diet low in saturated fat and cholesterol." Nuts contain several antioxidants, including vitamin E and selenium, along with plant sterols and other phytochemicals. One study cited by the Almond Board of California (www.almondboard.com), Modesto, Calif., described how almonds reduce inflammation by about the same level as taking a first-generation statin drug.
Olive oil is a classic ingredient with a long research history of lowering LDL cholesterol without decreasing HDL. According to the Oldways Preservation Trust (www.oldwayspt.org) , Boston, developers of the Mediterranean Diet Pyramid, populations with high intake of olives and olive oil show lower incidence of CVD even with average dietary fat intakes of 35 percent.
Vitamins for the Heart
Because of its "best of both worlds" ability as a preservative and a nutraceutical, vitamin E tocopherol -- has become one of the most effective antioxidants used in food processing. Vitamin E is a strong antioxidant and may improve cardiovascular health in other ways, including maintaining epithelial-cell integrity and enhancing immunity.
Cognis Corp. makes Covi-ox T-95 EU, citing it as the "highest potency, natural mixed-tocopherol ingredient available (and) specifically developed to meet the expanding range of global applications for functional foods." Covi-ox acts as an effective antioxidant suitable to a broad range of foods, protecting against oxidation, extending shelf life and preserving a food's flavor, aroma and color.
Palm oil is a rich, natural source of antioxidants, especially the tocotrienol form of vitamin E. This tropical oil has also enjoyed increased attention as a desirable substitute for trans fats. Trans fats have been under fire for increasing the risks of CVD. (See "Transcending Trans Fats" in this month's Food Processing.) Although palm oil is a saturated fat, research shows saturated fats from plants do not seem to have the same negative cardiovascular effects as those from animal sources. Moreover, palm oil has been shown to favorably increase HDL levels.
Vitamin K has emerged as another ingredient for better cardiovascular health. Already well-established for its role in blood clotting, research supports K's strong role in building the blood vessel-wall matrix. Vitamin K2 is a newly recognized form of vitamin K that has been strongly linked to cardiovascular health, particularly preventing arterial calcification (hardening of the arteries).
Vitamin K-dependent proteins help inhibit vascular calcification, and vitamin K2 is needed to activate those proteins. PL Thomas just released its MenaQ7, an extract of fermented soy (natto) that provides natural vitamin K2 as menaquinone-7 (MK-7). In studies, it has proved to be the most bioactive and bioavailable form of all vitamin K forms.
Vitamin D is usually thought of in relation to bone health. But vitamin D plays a role in healthy hearts, too. It regulates calcium, vital for regulating the flow and exchange of ions throughout heart and vascular tissue and balancing the electric charge that keeps the heart ticking. Vitamin D also regulates the kidneys' production of renin, a hormone that controls blood pressure.
CoQ-10, although not a vitamin, is a vitaminelike coenzyme critical to heart health for its role in strengthening the heart muscle, acting as a powerful antioxidant that also enhances vitamin E and reducing the potential for cholesterol to stick to the arteries.
Grains and Fiber
Health experts note that increasing whole grains in the diet can reduce risk of CHD by up to 40 percent. Hundreds of studies over several decades have shown heart disease incidence and risk goes down as consumption of fiber and whole grains goes up. According to the Whole Grains Council (www.wholegrainscouncil.org), Boston, Americans are still not eating enough whole grain foods.
The council stresses the complete nature of whole grains when it comes to ingredients for a healthy cardiovascular system. Not only do whole grains contain fiber, they are replete with antioxidants, phytosterols, vitamin E, folate, omega-3s, beta-glucan, phytate, selenium, calcium and magnesium -- all of which contribute to keeping arteries clear and the heart pumping. A recent comprehensive review of the science in the European Journal Clinical Nutrition found "that regular consumption of whole-grain foods can reduce incidence of heart disease and stroke by 20 to 40 percent."
Oats, including oatmeal and oat bran, have proven particularly powerful at lowering levels of LDL cholesterol. The Quaker Oats Co. (www.quakeroats.com), Chicago, had the first product to receive the FDA heart-health claim oatmeal. Today, the company (a division of PepsiCo) is successfully building on its strong heart-health position with its Take Heart Instant Oatmeal line, targeting consumers concerned about high blood pressure and high cholesterol. It has 1.5g soluble fiber from whole-grain oats for lower cholesterol and added potassium to help lower high blood-pressure risk. It also includes added antioxidants, vitamins E and C, and vitamin B for healthy arteries.
General Mills Inc. (www.generalmills.com), Minneapolis, boasts one of the earliest successes in making heart-healthfulness a point of difference with its Cheerios brand. Made from whole grain oats, Cheerios is becoming an everyday health message. It is also billed as "the only leading ready-to-eat cereal that has been clinically proven to lower blood cholesterol levels when eaten as part of a diet low in saturated fat and cholesterol," according to the company.
This flagship brand of General Mills has done a fantastic job of convincing consumers how good it is for their hearts. The latest project has Cheerios partnered with "The Heart Truth" and "Women-Heart" efforts to raise awareness about the risk of heart disease in women.
Kellogg Co. (www.kelloggs.com), Battle Creek, Mich., has been leading the heart healthy fray since the 1990s, with its introduction of "Heartwise" made with psyllium, a source of soluble fiber. The company created Smart Start Healthy Heart, which it promotes as "the only national cold cereal with ingredients that may help lower both blood pressure and cholesterol." The cereal is certified by the American Heart Assn. and provides 2g soluble dietary fiber per serving, plus oat bran and potassium.
Kellogg also continues to expand its Kashi line in a heartfelt direction. Kashi's Heart to Heart breakfast foods are specifically tailored to help promote healthy arteries and healthy blood pressure. They're loaded with soluble oat fiber to help reduce cholesterol. The waffles, cold cereals and instant hot cereals read like a laundry list of right-for-your-heart ingredients: vitamins E, C and beta carotene, grape seed extract, green tea extract and lycopene. Heart to Heart foods also provide 100 percent of the daily values for vitamins B6, B12 and folic acid.
Other breakfast makers are carving their niches in heart health, too. Van's International (www.vanswaffles.com), Vernon, Calif., has a new heart-healthy line of waffles called Hearty Oats. Each serving boasts the antioxidant power of one whole pomegranate plus whole grains, calcium, 5g of fiber and protein.
ConAgra Foods Inc. (www.conagrafoods.com), Omaha, launched its decades-old Healthy Choice line after former CEO Charles Harper suffered a heart attack. Today, the company is promoting its Sustagrain barley as a new boon for formulators creating heart healthy foods. The barley, by carrying a unique micronutrient composition, delivers higher levels of fiber and protein and lower levels of starch than other cereal grains. Sustagrain also allows for a heart-health claim.
Another ConAgra grain suitable for formulations seeking a heart-health claim is Ultragrain. Chicago-based Sara Lee has tremendous success with Ultragrain in Soft & Smooth bread -- a single slice yields a "Good Source" with 8 g of whole grain, as does Kansas City-based Wonder Bread's Whole Wheat White bread.