Wholeheartedly Healthy

In 2011 the American Heart Association (AHA) created Strategic Impact Goals to drive organizational priorities: By 2020, to improve the cardiovascular health of all Americans by 20%, while reducing deaths from cardiovascular diseases and stroke by 20%. The goals introduced a new concept of cardiovascular health characterized by seven metrics, including health behaviors (diet quality, physical activity, smoking, and BMI) and health factors (blood cholesterol, blood pressure, and blood glucose).

Focusing on the nutrition aspect of heart health, a heart-healthy diet should include a variety of fruits and vegetables, whole grains, low-fat dairy products, skinless poultry and non-fried fish (oily fish such as salmon, trout, and herring, which are high in omega-3 fatty acids), nuts and legumes, and non-tropical vegetable oils. According to an AHA Statistical Update, between 2003–2004 and 2011–2012 in the United States, the mean healthy diet score improved in both children and adults (Benjamin et al. 2017). These improvements were largely attributable to increased whole grain consumption and decreased sugar-sweetened beverage consumption. Other significant changes between 1999 and 2012 included increases in consumption of nuts, seeds, legumes, and whole fruit and decreases in consumption of 100% fruit juice and white potatoes.

The food industry offers a variety of heart-healthy ingredients. Here is a rundown of some of them.

Fish and Fish Oil
In an AHA advisory, the authors recommend that diets include one to two seafood meals per week to reduce the risk of congestive heart failure, coronary heart disease, ischemic stroke, and sudden cardiac death, especially when seafood replaces the intake of less healthy foods (Rimm et al. 2018.) Studies continue to show the beneficial effects of seafood long-chain omega-3 polyunsaturated fatty acids and cardiovascular disease. Several potential mechanisms have been investigated, including anti-arrhythmic, anti-inflammatory activities.

In a meta-analysis of clinical trials, Mozaffarian et al. (2005) showed that fish oil consumption reduced heart rate in humans. The findings provided firm evidence for an effect of fish oil consumption on cardiac electrophysiology in humans. In another meta-analysis of 16 prospective cohort studies, fish consumption was associated with significantly lower risk of coronary heart disease (CHD) mortality. Compared with no consumption, an estimated 250 mg of long-chain omega-3 fatty acids per day was associated with 35% lower risk of CHD death (Harris et al. 2009).

Antarctic krill is one fish oil that is a source of omega-3 fatty acids and proteins. Parolini et al. (2017) showed that diets that contained krill oil were able to reduce cholesterol levels, inhibit plaque development, and prevent liver damage. Krill proteins also reduced atherosclerosis development through mechanisms not involving lipid metabolism.

Heart-Healthy Oils
Heart-healthy diets stress restricted intakes of saturated and trans fatty acids and replacement with polyunsaturated or monounsaturated fatty acids.

Olive oil, which is a major part of the Mediterranean diet, has been shown to contribute to this diet’s observed heart benefits. Guasch-Ferre et al. (2014) demonstrated that olive oil consumption, specifically the extra-virgin variety, is associated with reduced risks of cardiovascular disease and mortality in individuals at high cardiovascular risk. The study included 7,216 men and women at high cardiovascular risk, aged 55 to 80 years.

Participants were randomized to one of three interventions: a Mediterranean diet supplemented with extra virgin olive oil, a Mediterranean diet supplemented with mixed nuts, or a control low-fat diet. Each increase of 10 g/day in extra-virgin olive oil intake was associated with a 10% reduction in the risk of cardiovascular events.

Canola oil boasts a qualified health claim based on its content of unsaturated fats. The claim states: Limited and not conclusive scientific evidence suggests that eating about 1½ tbsp (19 g) of canola oil daily may reduce the risk of coronary heart disease due to the unsaturated fat content in canola oil. To achieve this possible benefit, canola oil is to replace a similar amount of saturated fat and not increase the total number of calories eaten in a day.

Saedi et al. (2017) showed that dietary fats in the form of canola oil or sunflower oil effectively lowered serum cholesterol, LDL cholesterol, and triglyceride concentrations. They also resulted in an increase in serum concentration of HDL cholesterol. Baril-Gravel et al. (2015) demonstrated that DHA-enriched canola oil exerts anti-inflammatory effects compared with polyunsaturated fatty acids from plant sources. The researchers investigated the effect of five oils containing various amounts of alpha-linolenic acid (ALA), linoleic acid (LA), oleic acid (OA), and docosahexaenoic acid (DHA) on plasma inflammatory biomarkers and expression levels of key inflammatory genes and transcription factors in whole blood cells.

Oil companies have been developing oils that offer improved stability and healthier nutritional profiles. For example, Cargill introduced a low saturated fat, high-oleic canola oil made from a canola hybrid that contains 4.5% or less saturated fat. The oil maintains high fry and shelf-life performance, freshness, and taste. It reduces saturated fat content 35% from previous canola oil generations. Cargill’s high-oleic, low-saturated canola oil joins other oils and shortenings offered commercially under the Clear Valley brand.

High-oleic soybean oils are also available. These oils contains 0 g of trans fat per serving as well as lower saturated fat and three times the amount of beneficial monounsaturated fatty acids, compared to conventional soybean oil. According to information from QUALISOY, more developments in soybean oil are to come. For example, increased omega-3 soybean oils are rich in stearidonic acid (SDA) omega-3 fatty acids. SDA omega-3s are more efficiently converted by the body into eicosapentaenoic acid (EPA), so increased omega-3 soybeans are a land-based source of the beneficial fatty acids found in fish.

Nuts
Nuts such as walnuts, almonds, and pistachios play beneficial roles in heart-healthy diets. Not only do they offer healthy snacking options, they also contain heart-healthy nutrients.

Walnuts are a rich source of alpha-linolenic acid (ALA), containing 2.5 g of ALA/oz. These may help in fighting inflammation. Recently, Holscher et al. (2018) showed that walnut consumption affected the composition and function of the human gastrointestinal microbiota, reducing microbially derived, proinflammatory secondary bile acids and LDL cholesterol. The results suggested that the gastrointestinal microbiota may contribute to the underlying mechanisms of walnut consumption’s benefits. The authors explained that the microbes that increased in abundance were from the Clostridium clusters of microbes, which have the ability to make butyrate.

Almonds are cholesterol-free, have 1 g of saturated fat, and 13 g of unsaturated fat per 1 oz serving. Nishi et al. (2014) showed that people who ate almonds as part of a heart-healthy diet significantly improved certain factors associated with heart disease risk.

Whole Grains
Whole grain consumption has been linked to reduced risk of heart disease as well as stroke, inflammation, and better weight management. Whole grains are sources of dietary fiber, vitamins, protein, and minerals. Zong et al. (2016) demonstrated inverse associations of whole grain intake with total and cause-specific mortality. Findings were particularly strong for cardiovascular disease mortality. These findings support the current Dietary Guidelines for Americans, which recommends at least 3 servings per day of whole grains. The meta-analysis showed that compared to people who ate the least whole grains, people who ate the most whole grains had a 16% lower risk of death from all causes, an 18% lower risk of death from heart disease, and a 12% lower risk of death from cancer.

More Ingredients for Heart Health
A 2014 Frost and Sullivan Report showed that if U.S. adults over the age of 55 with CHD took phytosterol dietary supplements at the preventive intake levels identified in the report, it could lead to individual and societal healthcare savings by reducing risk of CHD-related medical events by more than 11% (Shanahan and de Lorimier 2014). The study was conducted through a grant from the Council for Responsible Nutrition Foundation. According to the report, if U.S. adults over the age of 55 with CHD take phytosterol dietary supplements, nearly 2.3 million CHD-related medical events could be avoided between 2013 and 2020, totaling $34 billion in avoided expenditures over the time period.

Phytosterols help prevent cholesterol buildup by inhibiting cholesterol absorption in the intestine. Cargill offers CoroWise plant sterols, as does BASF, which supplies Vegapure plant sterols. An FDA health claim may be used with phytosterols when a food contains at least 0.5 g per serving of phytosterols and is eaten with meals or snacks for a daily total intake of 2 g of phytosterols and is part of a diet low in saturated fat and cholesterol.

Hydroxytyrosol is an olive extract with antioxidant properties. Wacker offers a nature-identical hydroxytyrosol, HTEssence, which was shown to significantly reduce LDL cholesterol (Wacker 2017). In a randomized, double-blind, placebo-controlled crossover study, 30 healthy volunteers consumed 30 mg of hydroxytyrosol per day for a total of four weeks with two weeks washout between treatments. The hydroxytyrosol was supplemented either as HTEssence or as olive extract in comparison to placebo. Results showed a significant reduction of LDL cholesterol in the blood plasma by 9.4 mg/dL with HTEssence.

Fruitflow from DSM is an extract from the jelly around the seeds of sun-ripened tomatoes. Selected tomatoes are crushed to paste, the skin and seeds are removed, and the bioactive compounds in the extracted clear juice are concentrated. The result is Fruitflow, a highly concentrated form of bioactives that is lycopene-free and contains more than 30 known anti-platelet compounds. It helps maintain normal platelet aggregation, which contributes to healthy blood flow.

Linda Milo Ohr,
Contributing Editor
Denver, Colo.
[email protected]

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