Around the holidays, "have a heart" is a common plea by those collecting for charities, but year round we all strive to have a healthy heart.
Coronary heart disease (CHD) is the leading cause of death in the U.S., and heart attacks cause one of every five adult deaths, according to the American Heart Assn. More than 1.2 million heart attacks occur each year in the U.S. alone, and about 460,000 of them are fatal, notes the National Institutes of Health. In fact, coronary heart disease accounts for about 17 million (approximately 30 percent) deaths annually throughout the world, making it the leading cause of death in the world, according to the World Health Organization.
Based on those frightening statistics, the market for foods with a heart benefit claim is proliferating. In France, Germany, Italy, Spain and the UK, the heart-healthy food market was valued at $2.61 billion in 2009 by UK-based Leatherhead Food Research. The U.S. market for foods making cardiovascular health claims was $7.18 billion, reflecting the use of FDA-approved structure-function claims for whole grains, soy and beta glucan-delivering oats.
Although physicians worldwide agree smoking, lack of exercise, stress, excess weight and family history are the most important contributors to heart disease, doctors and nutritionists do not always agree on the role of food. Current wisdom says eating a low-cholesterol, low-fat diet is the best dietary option, but it gets complicated after that, sometimes downright contentious.
Last year, researchers at Population Health Research Institute, Hamilton Health Sciences and the Departments of Medicine and Clinical Epidemiology and Biostatistics at McMaster University, Hamilton, Ontario, analyzed 189 prior studies involving millions of people and foods that may protect the heart from CHD. The findings, which appeared in the Archives of Internal Medicine (April issue), include a relatively short list of foods with strong supporting evidence: vegetables, nuts and the Mediterranean diet. Harmful factors were foods with trans-fatty acids and those with a high glycemic index or load. Moderate positive evidence was found for fish, marine omega-3 fatty acids, folate, whole grains, dietary vitamins E and C, beta-carotene, alcohol, fruit and fiber. It is notable the study did not analyze specific combinations of those nutrients in foods, something the food industry is pursuing in heart-healthy- and wellness-targeted foods and beverages.
The Mediterranean diet is rich in vegetables and fruit (it recommends nine servings a day), nuts, whole grains, fish, olive oil and moderate consumption of red meat and wine. It's associated with lower levels of oxidized low-density lipoprotein, or bad cholesterol, which is likely to build up deposits in arteries that lead to heart attacks. Fortunately for foodies, the diet does not prohibit other foods eaten in moderation (and that probably relieves some stress).
"Almonds deliver deliciously on heart health and consumers know it," says Stacey Humble, director of global strategic initiatives and North America marketing for the Almond Board of California. "No fewer than nine clinical studies to date indicate almonds can help you maintain a healthy cholesterol level as part of a diet low in saturated fat. Even the FDA states, 'Scientific evidence suggests, but does not prove, that eating 1.5 oz per day of most nuts, such as almonds, as part of a diet low in saturated fat and cholesterol may reduce the risk of heart disease.' "
U.S. health claims
There are five FDA-accepted label claims directly related to heart disease, involving:
- Fruits, vegetables and grain products that contain fiber, particularly soluble fiber.
- Soluble fiber from [other] foods.
- Soy protein.
- Plant sterol/stanol esters.
- Diets low in saturated fat and cholesterol, and as low as possible in trans fats.
And two more (sodium and potassium) relating to hypertension.
Plus, there are four qualified health claims ("Scientific evidence suggests but does not prove…") involving:
- Walnuts specifically.
- Omega-3 fatty acids (EPA and DHA).
- Monounsaturated fatty acids from olive oil and canola oil.
Guiding consumers to easily spot heart-healthy choices since 1995, the Heart-Check mark stands as the most trusted (63 percent) and the most recognized (83 percent) health symbol among food icons tested on U.S. consumers, according to the American Heart Assn. And this consumer awareness also translates to increased sales. In-store sales data from September 2009 revealed the Heart-Check mark boosts incremental sales an average of 5 percent when certified products were highlighted with a shelf hangtag promotion along with messages distributed at supermarket check out.
FDA health claims rules are complicated, and manufacturers are warned to be careful in making claims on packages. In 2009, FDA regulators chastised General Mills, the maker of the iconic Cheerios brand, saying it made inappropriate claims about the cereal's ability to lower cholesterol and treat heart disease by using specific amounts ("you can lower your (LDL) cholesterol 4 percent in six weeks" and "10 percent in one month." In a warning letter, FDA said the language on the Cheerios box suggested the cereal is designed to prevent or treat heart disease, and only FDA-approved drugs are allowed to make such claims.
Some of that is semantics. General Mills responded that the health claims on Cheerios have stood for 12 years, the science was not in question, four peer-reviewed studies support the claims and the FDA's complaints dealt more with language. Nevertheless, General Mills went back to the safer, FDA-dictated claim: "3g of fiber daily from whole grain oat foods like Cheerios cereal, in a diet low in saturated fat and cholesterol, may reduce the risk of heart disease. Cheerios cereal provides 1g of fiber per serving."
The difficulties are not just with U.S. health claims. Food product manufacturers are opting for more general claims as uncertainty continues around European Food Safety Authority (EFSA) rules on health claims. The Netherlands-based Innova Market Insights counted 1,960 new products with an "active health" positioning January through June of this year, compared to 2,189 new products with this positioning in the corresponding period in 2009. This decline in "active" health claims came despite 18 percent growth in "passive" claims ("low-" and "light") on new products in the same periods.
Nevertheless, product launches positioned on a heart-health platform nearly tripled over the past five years and accounted for nearly 1.5 percent of total food and drinks launches recorded over the 12 month period ending April 2010. The U.S. and Europe account for two-thirds of heart-health launches, and the bakery and cereals sector dominates with over a quarter of the total of new products, ahead of dairy products (12 percent), ready meals and meal components (10 percent) and soft drinks (9 percent). Other sectors featuring significant heart health launches include hot beverages; meat, fish & eggs; fruit & vegetable products and soups, sauces & seasonings.
Products for cholesterol reduction continue to dominate the heart health market in numbers of launches, although the heart-health sector fared better than many, with heart healthy ingredients such as plant sterols/stanols for cholesterol reduction and the Fruitflow anti-thrombotic tomato extract (both providing sufficient evidence to have their health claims approved by EFSA.)
Innova also notes that while some products have a specific heart-health positioning, there are many other products not included where the benefit may be implied but not specifically mentioned. The key is ingredients perceived by consumers to be heart healthy. Ingredients falling into this category include omega-3 fatty acids, whole grains, oats and soy. All of these have also been linked with other health benefits, such as joint health and cognitive health for omega-3 fatty acids, digestive health for whole grains, controlled energy release for oats and women's health and bone health for soy.
There are some new circulatory health ingredients in the offing. The anti-hypertensive market remains relatively limited, according to Innova, but has seen some new developments involving peptides, sourced from milk proteins, in Europe and from sardines in Japan. The use of antioxidant ingredients for heart health is another area that is relatively undeveloped and may have potential, particularly if the antioxidants come from cocoa and fruit, which have additional health halos.
Doctors are beginning to recognize vitamins C and E may be important for your heart, reports Prevention magazine. It isn't known whether a lack of these nutrients can lead to heart disease, but recent research seems to confirm some link.
A 10-year Women's Health Study of 40,000 healthy women, the longest and largest trial ever conducted on vitamin E supplementation, found it significantly reduced (24 percent) the risk of death from cardiovascular disease. Results from the Nurses' Health Study following 85,000 women over 16 years found vitamin C intake of more than 359mg a day from diet plus supplementation reduces CHD risk by 27-28 percent. Based on long-term health studies, other healthy nutrients recommended by physicians include folic acid, selenium and zinc.