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Are Phytochemicals Effective for CAD Prevention and Rehabilitation?

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Are Phytochemicals Effective for CAD Prevention and Rehabilitation? Are Phytochemicals Effective for CAD Prevention and Rehabilitation? Joe Carlson, PhD, RD Associate Professor Director Div Sports & Cardiovascular Nutrition, Dept of Radiology; College of Osteopathic Medicine Michigan State University, East Lansing, Michigan Are Phytochemicals Effective for CAD Prevention and Rehabilitation? I. Background – definitions; overview of evidence II. Phytochemical classification with food & beverage examples III. Summary of evidence phytochemical rich food & supplements IV. What is the best approach based on evidence to date? V. Summary-Applications and resource list. I. Background- What are Phytochemicals? Phyto = Plant; also called Phyto-nutrients A. Definitions: Many refer to non-nutrient plant food components with potential or known health benefits but do not have established intake recommendations like vitamins & minerals. • Biologically active but non-nutrient substances found in plants; includes antioxidants and phytosterols. Med Dictionary for the Health Profess & Nursing 2012 • The active chemical components, or constituents, present in a plant that account for its medicinal properties. Mosby's Medical Dictionary, 8th edition. © 2009, Elsevier. B. Are Phytochemicals Essential? Depends on definition -Most definitions do not classify as “nutrients” referring to essential vitamins & minerals that cause deficiency when not consumed. • FACT-selected phytochemicals are vitamin precursors or isomers; beta carotene- Vit A precursor, tocopherols & tocotrienols - Vit E isomers I. What is the best Approach for prevention and Management of CAD? • Evidenced Based Heart Healthy Phytochemical Rich Dietary pattern? = ESTABLISHED BENEFITS • OR Evidenced Based Heart Healthy Dietary pattern and added phytochemical supplements? + = = +-? II. Big Picture Phytochemical Classification Exs commonly studied with known or potential vascular benefits PHENOLS TERPENES THIOLS (1 prim group) (6 prim groups) (4 prim groups) Flavanoids Carotenoids Tocopherols & Flavanones Carotenes Tocotrienols- Flavonols -Alpha & Beta -Alpha, -Quercetin -Lutein -Beta, -Luteolin - Lycopene -Gamma -Rutin Monoterpenes Allylic Sulfides Phyto-estrogens -Limonoids -Allicin Isoflavones -Capsaicin -S-AllylCysteine -Coumarin -Alpha Pinene Gluoslinates -Daidzein Diterpenes -Dithiolthiones -Geneistein -Ginkolides -Isothiocyanates -Lignans -Carnosol -Sulforphane Tannins Triterpenes Indoles & -Anthocyanins -Xanthophylis -Caffeic acid Phytosterols Epicatechins -Catechins Effects of HEART HEALTYH GUIDELINES Fiber and Nutrient and Phytochemical Rich Foods, on CAD Risk Factors: -Peterson et al Nutrition Rev 70(9) - M Bouchenek JourMed Food 2013 -RH LiuAm J Clin Nutr 2003;78; - F Visioli et al Cardiov Res 47(2000) - RH Liu J Cereal Sci 46 (2007) -P Kris Ethertonet al J of Nutrit 2007 ;138 TERPENE Ex) Carotenoids-Carotenes Sources- Key Forms Forms- Lycopene Functions & Health Implications: -carotene CAD Potential Benefits -Anti-oxidant roles -peroxyl radical & -carotene singlet O2 quenchers - Anti-thrombotic; Anti-inflammatory- Zeaxanthin Other Benefits • Eye Health- protect macula (lutein) • Reduce prostate Cancer risk (lycopene) Lutein Food vs. Supplements? • Optimal levels in blood, tissues unknown Phytoene • Krinsky, NI, Johnson EJ. (2005) Carotenoid actions and their relation to health and disease. Molecular Aspects of Medicine, Elsevier 26 459-516 Phytofluene Phytochemical Rich Phytochemical(s) Vegetable Examples THIOLS Allium vegetables-garlic, onions, chives, leeks Allylic sulfides--Allicin -S-AllylCysteine THIOLS – Glucosinolates Cruciferous vegetables- broccoli, cauliflower, -Dithiolthiones cabbage, Brussels sprouts, kale, turnips, -Isothiocyanates bok choy, kohlrabi -Sulforphane Indoles Compositae plants (artichoke) Silymarin Solanaceous vegetables -tomatoes, peppers TERPENES- TERPENES- Umbelliferous vegetables (carrots, celery, Carotenoids-Lycopene, cilantro, parsley, parsnips) Lutein Polyacetylenes Phytochemical Rich Foods & Beverage Phytochemicals Examples Citrus fruits TERPENES -limonene (oranges, lemons, grapefruit) Carotenoids- glucarates Non citrus Fruits grapes, berries, cherries, Flavonoids- quercetin, apples, cantaloupe, watermelon Phenols- many Legumes-Beans (soybeans) & Flavonoids (isoflavones) seeds (flax) Saponins PHENOLS, Flavonoids -lutein Whole Grains (wheat, oats, barley, rice,) zeaxanthin, b-cryptoxanthin Herbs, spices ginger, mint, rosemary, Flavonoids, thyme, oregano, sage, basil, tummeric, Terpenes caraway, fennel , ginger Coffee, Chocolate Green tea, black tea, PHENOLS- Glycyrrhizin, wine, beer Catechins, Quercetin III. What is the evidence that phytochemicals protect against CAD? STUDY TYPE Evidence Comments Epidemiological Studies: STRONG Well established relationship phyto-chemical rich foods, Limitations – no cause and effect food groups and patterns from cross-sectional. Does not isolate impact of individual phytochemicals Molecular & Nutri-genomic Promising mechanisms or pathways up or down- studies on selected But……. regulated by phytochemicals or drugs are phytochemical influenced by many factors. For ex) inflammatory pathways Experimental Studies: Phyto- STRONG •Can reduce CAD Risk factors chemical rich foods & food •Can reduce CAD progression patterns • Can reduce CAD morbidity & mortality * FOOD NUTRIENT SYNERGY IMPORTANT Experimental Studies: Mixed Examples – Soy; Garlic, Ginkgo biloba Isolated Phytochemical Some + Resveratrol, beet juice extracts supplements Some - ~ 25% US FDA approved drugs plant origins Many ?s •In US weak dietary supplement regulation, products &marketing lead to confusion The effect of a garlic preparation on plasma lipid levels in moderately hypercholesterolemic adults Christopher D. Gardner *, Lorraine M. Chatterjee, Joseph J. Carlson Atherosclerosis 154 (2001) 213–220 Food-Gene Interaction Examples Anti-inflammatory & Antioxidant Actions Tart Cherries Exs) Phytochemical Rich Food & CAD Risk Factors Ex 1) Lazarus et al JAMA 2004. Tomato Juice & Platelet Aggregation in Type II diabetes. Platelet Aggregation decreased sig in patients drinking tomato juice for 3 wks vs tomato flavored beverage. Is this only due to Lycopene? __________________________ Ex 2) Ferrara et al Arch Internal Med 2000 “Olive Oil & Reduced Need for anti- hypertensive medications” By replacing PUFA with Virgin Olive Oil resulted in sig lowering of Systolic & Diastolic BP & need for Meds Is this only due to polyphenols? Lipid lowering with ~ 75 grams or 2.5 oz nuts/ day Emilio Ros et al 2010 •Phytochemicals in nuts : carotenoids, β-Carotene, β-cryptoxanthin, lutein, zeaxanthin & flavonoids, henols, Chen C-Y O Asia Pac J Clin Nutr 2008; •What other components to nuts contain that may influence lipids? Summary of Nutrition & Vascular function • Impair Vascular Function • Improve Vascular Function • Saturated fat (animal fat, • Unsaturated fats (veg based hydrogenated fat, coconut oil) oils fats, nuts & fish oils) • Excess Animal PRO • Plant proteins (Methionine) (L-arginine & Isoflavones) • Excess sugars & low fiber • Vitamins C, E, folate & (sweets, low-nutrient density polyphenols CHOs) (fruits, veges & whole grains) * Dietary patterns high in sat fat, high in animal PRO & low in * Nutrient Dense Dietary patterns dietary fiber high in dietary fiber & low in sat. fat Refs: Adapted from West Current Opinions in Lipidology 2003; I. What is the best Approach for prevention and Management of CAD? • Evidenced Based Heart Healthy Phytochemical Rich Dietary pattern? = ESTABLISHED BENEFITS • OR Evidenced Based Heart Healthy Dietary pattern and added phytochemical supplements? + = = +-? Summary of Evidenced based cardiovascular Nutrition guidelines/ Rxs 2000- present . Nutrition effects multiple individual CAD Risk Factors . Evidence for Atherosclerotic regression; Improved coronary blood flow . ↓ CAD Morbidity ; ↓ CAD Mortality Key References • Van Horn, et al. The evidence for dietary prevention & treatment of CVD. 2008 JADA 108(2) • Lichtenstein, A. H., L. J. Appel, et al. (2006). "Diet & lifestyle recommendations revision 2006: a scientific statement from the AHA Nutrition Committee." Circulation 114(1): 82-96. • Krauss, R. M., R. H. Eckel, et al. "AHA Dietary Guidelines: revision 2000: A statement for healthcare professionals from the Nutrition Committee of the AHA." Circulation 102(18): 2284-99. • Executive Summary of The 3rd Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). (2001) JAMA. 285: 2486-97. • DRIs, Nat Academies Press, 2002, 2005. SUMMARY of CARDIOVASCULAR DISEASE RISK FACTORS INFLUENCED BY NUTRITION ESTABLISHED / TRADITIONAL RISK FACTORS * EMERGING/ PUTATIVE RISK FACTORS † Dyslipidemia ( ie. elevated total cholesterol , LDL Inflammation (ie, C-reactive protein) triglycerides , low HDL) Hypertension Thrombotic factors (ie, fibrinogen) Diabetes Mellitus Hyperhomocystienemia Obesity Impaired endothelial function Excess Alcohol intake Cardiac arrhythmias Metabolic syndrome Oxidative stress Inactivity ‡ Monocyte adhesiveness Smoking§ Elevated ADMA Poor hydration status Gene food interactions * Established/traditional cardiovascular disease (CVD) risk factors.Depression † Emerging/putative CVD risk factors. ‡ Inactivity: proper nutrition including adequate glycogen storage can influence ability to perform physical activity/exercise at an intensity and frequency that contributes to reduced CVD risk. § Smoking: nutritional factors can modulate oxidant stress in chronic smokers.
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