4/18/2019
1
Dr. Jim Painter PhD, RD
University of Texas –Houston, School of Public Health
@DrJimPainter
OutlineHeart Healthy Portfolio diet
1. Plant sterols
2. Soluble fiber
3. Soy
4. Nuts
Additional Supplements
5. Garlic
6. Chocolate
Supplements for Type 2 Diabetes
7. Berberine
8. Cinnamon
1. Stanol/Sterol Esters
(Sterols)
(Stanols)
Stanol/Sterol esters work by increasing cholesterol output into the bile and by transferring cholesterol back into the intestinal track.
4/18/2019
2
Plat & Mensink, 2002; FASEB J 16:1248-1253
Products
Recommendations• Usual dose is 800 mg – 6.0 grams/d
• Divided equally and given before meals
• Doses above 2.0 g/day do not appear to add additional benefits.
Nies, 2006. Complimentary and Alternative Therapies for the Management of Dyslipidemias
4/18/2019
3
2. Soluble (Viscous) FiberEffects:
Reduces total and LDL cholesterol
Reduces CHD risk
Psyllium or Oat Bran and LDL Cholesterol in Normal and Hypercholesterolemic Men
66 participants (normal= 36, hypercholesterolemic=30) consumed 0.6g, 1.7g, or 2.8g soluble fiber from wheat bran, psyllium, or oat bran respectively
8 wk controlled clinical trial
Romero,AL, Romero,JE, Galaviz, S et al. (1998). Cookies Enriched with Psyllium or Oat Bran Lower Plasma LDL Cholesterol in Normal and Hypercholesterolemic Men from Northern Mexico . Journal of the American College of Nutrition, 17, (6)601-608.
Changes between baseline and 8 weeks in plasma triglyceride hypercholesterolemic (cholesterol>220mg/dL) subjects
0
10
20
30
40
50
60
Baseline 8 Weeks
ControlPsylliumOat bran
4/18/2019
4
Changes between baseline and 8 weeks in LDL cholesterol of hypercholesterolemic (cholesterol>220mg/dL) subjects
0
20
40
60
80
100
120
140
160
Baseline2 8 Weeks
ControlPsylliumOat bran
Wei et al., 2009, Euro J Clin Nutr, 63: 821-827.
LIVER
Duodenum Ileum
Hepatic
Portal Vein
Bile Duct
Bile Salt
Psyllium
Mechanism: Soluble Fiber
Anderson, et al., Am. J. Clin. Nutr. 71:472, 2000
LDL
Receptor
4/18/2019
5
Sources: Fiber
oatmeal, cooked
peas
kidney beans
potato, baked with skin
whole wheat bread
bran flake cereal
spinach
certain fruits
apples
bananas
oranges
pears
psyllium (grain found in some cereal products)
3. Soy/ legumes
Low in saturated fat
Contains protein and other compounds that help lower blood cholesterol
Effect = reduced risk of heart disease
Reduction of Total Cholesterol by Soy
0 20 40 60
127-198
201-255
259-332
>335
Init
ial C
ho
leste
rol
(mg
/dl)
Average Total Cholesterol Reduction
(mg/dl)
4/18/2019
6
0
5
10
15
20
25
30
Red
ucti
on
in
Blo
od
Ch
ole
ste
rol
mg
.
25 50 75
Soy Intake (grams)
Reduction of Blood Cholesterol with Soy Consumption
Sources: Soy Protein
Soy Food Amount Soy Protein
Soy milk, plain 1 cup 8 g
Tofu ½ cup 10 g
Soy flour, defatted ¼ cup 8 g
Soybeans, cooked ½ cup 13 g
Roasted soynuts ¼ cup 12 g
Tempeh ½ cup 16 g
Source: United Soybean Board
4. NutsEffects:
Lower the risk of coronary heart disease
Lower TC and LDL when consumed in moderation as part of a low fat diet Fiber
Phytosterols
MUFA/PUFA
Antioxidants
Amino Acids
4/18/2019
7
Research studies: NutsStudy Sample
description
Amount of nuts Effects
Adventist Health
Studies
(3 studies total),
1976
35,000 California
Seventh-Day
Adventists for up
to 12 years
Consume nuts 5
or more times per
week
Reduced risk of
heart attack
Lower lifetime
risk of CHD
Nurse’s Health
Study,
1984
86,000 women
for 14 years
5 or more ounces
per week
35% reduced
risk for CHD
Reduced risk of
heart attack
Iowa Women’s
Health Study,
1986
35,000
postmenopausal
women without
CHD for 7 years
Consume nuts
and seeds more
than 4 times a
month
40% reduced
risk of CHD
Physician’s
Health Study,
2002
21,454 males
without CHD for
12 months
Consumed nuts 2
or more times/wk
Reduced CHD
risk by ~30%
Individual Research Studies: NutsStudy Sample
description
Amount of nuts Effects
Rajaram et al.,
2009
25 normal-
hyperlipidemic
adults (23-65
years)
42.5g walnuts
twice/wk for 4
weeks
Reduced CHD
risk ~18.6%
Sheridan et al.,
2007
15 adults (36-75
years) with
moderate
hypercholesterole
mia
2-3 oz pistachio
nuts/day for 4
weeks
Reduced LDL-
C/HDL-C ~14%
Reduced LDL-
C ~9%
Griel et al., 2007 25 healthy adults
(25-65 years)
~1.5 oz
macadamia
nuts/day
Reduced TC
and LDL-C
concentration
Reduced MI
risk ~17%
Jalali-Khanabadi
et al., 2010
30 males with
mild
hyperlipidemia
(38-52 years)
60g almonds for
4 weeks
Reduced LDL
by ~14%
Diet & Lifestyle Study
Harvard University Lifestyle and Long-term Weight Gain Study
20 year study
Relationships between changes in food and beverage consumption and weight
4/18/2019
8
Plant sterols (1.0 g/1000 kcal)Soy protein foods including soy milks and soy burgers, (21.4 g/1000 kcal)Almonds (14 g/1000 kcal)Viscous fibers from oats, barley, psyllium, okra and eggplant (10 g/1000 kcal)
Jenkins, et al. Direct comparison of a dietary portfolio of cholesterol-lowering
foods with a statin in hypercholesterolemic participants, Am J Clin Nutr 2005;81:380 –7.
Jenkins first studied a portfolio of four foods in 2002 to reduce LDL-C in combination with a very low SFA diet. For all 7 weeks of the study, the subjects were on a very low saturated fat diet which approximated the National Cholesterol Education Program (NCEP) Step II diet. After one week on the very low SFA diet, the test diet was initiated for 1 month in duration before returning to the very low SFA diet on week 4. The intervention diet included plant sterols (1 g/1,000 kcal), soy protein (23 g/1,000 kcal), almonds (28g/day) and viscous fibers (9g/1,000 kcal).
Percent change from baseline in the ratio of LDL:HDL on the combination diet (n = 13).
4/18/2019
9
Jenkins again compared the LDL-C lowering capacity of a portfolio of four foods to an NCEP II diet, but quantified the percentage of the effect attributed to the portfolio. Twenty-five hyperlipidemic subjects consumed either a very low-saturated fat diet (n = 12) based on whole-wheat cereals and low-fat dairy foods or a very low saturated fat diet (n = 13) including a portfolio of cholesterol lowering foods
Percent change from baseline in LDL-C and the ratio of LDL:HDL-C on the portfolio (n = 13) and control (n = 12) diets.
Jenkins et al. conducted a parallel-design study of 351 participants with hyperlipidemia. Previous studies assessed the effectiveness of a portfolio of cholesterol-lowering foods in addition to a low saturated fat diet, this study compared the two diets. Participants were randomized into one of three condition, a low-saturated fat diet (control) or one of two levels of a dietary portfolio that incorporated plant sterols, soy protein, viscous fibers, and nuts.
4/18/2019
10
The study was a randomized crossover design; 34 participants completed all three 1-month treatments, which were separated by 2–6-week washout periods. The treatments were: control, 20 mg Lovastatin, and dietary portfolio of foods. There were 4 main components of the dietary portfolio of cholesterol-lowering foods...
4/18/2019
11
V. Garlic Garlic has been used in traditional and folk medicine for over 4,000
years
Garlic contains sulfur compounds
Eating one clove of garlic per day may help decrease blood cholesterol levels
Effects: Garlic
Prevents platelet “stickiness”
Inhibits constriction of arteries
Reduces LDL oxidation (leads to clotting)
Prevents high blood pressure
Reduces blood lipids
Ackermann et al., 2001, Arch Intern Med, 161: 813-24.
Butt et al., 2009, Crit Rev Food Sci Nutr, 49(6): 538-51
Component Responsible for Lipid Lowering
Allicin, a sulfur compound Volatile sulfur compounds are not present in intact cells Release by:
chopping steaming crushing
4/18/2019
12
Garlic Compounds and the
Effect on HMG-CoA Reductase
Liu & Yeh, 2002, J Nutr 132: 1129-1134
Recommendations: Garlic Experts still researching optimal dose
Conservative estimate = 1-3 cloves per day
6. Chocolate
Cocoa processed with alkali is not beneficial
High fat chocolate is not beneficial
High sugar chocolate is not beneficial
Cocoa is beneficial
4/18/2019
13
Antioxidants in the form of Flavonoids!
Klos, B. (n.d.). Chocolate: Temptation or Health Food?. Print-
Article. Retrieved June 9, 2014, from
http://www.intelihealth.com/print-article/chocolate-temptation-
or-health-food
Anti-inflammatory Responses to Cocoa
3 Samples:
1. Dark (75% cocoa, highest flavonoid
content),
2. milk (20% cocoa), or
3. white chocolate (no flavonoids)
Out of the 3 samples dark chocolate
inhibited
collagen-induced platelet
Aggregation (inflammation)
Ding, E. L., Hutfless, S. M., Xin, D., & Girotra, S. (2006). Chocolate and
Prevention of Cardiovascular Disease: A Systematic Review. Nutrition &
Metabolism, 32-12. doi:10.1186/1743-7075-3-2
Cocoa Inhibits Blood flow and Vessel Dilation
Subjects 20 individuals at risk of CHD
Consumed a cocoa drink
2 groups high and low flavanol
Brachial artery flow and dilation were measured
Sies, et al. 2005. Cocoa Polyphenols and Inflammatory Mediators. American Journal of Clinical
Nutrition, 81, 304s-12s.
4/18/2019
14
Vaso-dilation with Cocoa Flavanols
0
1
2
3
4
5
6
7
Low flavanol
cocoa
High flavanol
cocoa
% FMDBefore
2 hr After
FMD (Flow-mediated Dilation)Sies, et al. 2005. Cocoa Polyphenols and Inflammatory Mediators. American Journal of Clinical Nutrition, 81, 304s-12s.
7. Berberine
4/18/2019
15
2012
Berberine with lifestyle modification versus lifestyle modification alone or plus placebo
Berberine with lifestyle modification versus lifestyle modification alone or plus placebo
4/18/2019
16
Berberine with Lifestyle Modification Versus Lifestyle Modification Alone or Plus Placebo
Berberine with Lifestyle Modification Versus Lifestyle Modification Alone or Plus Placebo
Berberine vs. Oral Hypoglycemics
4/18/2019
17
Berberine vs. Oral Hypoglycemics
Berberine vs. Oral Hypoglycemics
Berberine vs. Oral Hypoglycemics
4/18/2019
18
Berberine Combined with Oral Hypoglycemics vs. the Same Hypoglycemics
Berberine Combined with Oral Hypoglycemics vs. the Same Hypoglycemics
2013
4/18/2019
19
4/18/2019
20
4/18/2019
21
Mono-therapeutic Effects Of Metformin and Berberine
0
2
4
6
8
10
12
Baseline End Point
FBG (mmol/L)
Metformin Berberine0
2
4
6
8
10
Baseline End Point
HbA1c (%)
Metformin Berberine
0
5
10
15
20
25
Baseline End Point
PBG (mmol/L)
Metformin Berberine
8. Cinnamon
2007
This is the first U.S. study to evaluate the effects of
cinnamon on blood glucose … with type 2 diabetes.
We found that cinnamon taken at a dose of 1 g daily for
3 months produced no significant change in fasting glucose.
4/18/2019
22
2013
4/18/2019
23
4/18/2019
24
2014
FBG and PPG levels of diabetic rats after 30 days of cinnamon polyphenol extract administration. Values are expressed as the mean ± SD, n = 6 in each group; where P < 0.05 significantly different from *normal group; #diabetic control and $standard extract group.
glibenclamide
4/18/2019
25
The relative blood sugar lowering efficacy of de-coumarinated polyphenol-rich extracts (procynCi-45 and procynCi-70) after 30 days of oral supplementation; which is depicted with respect to standard cinnamon extract containing 17.4% polyphenol as ‘blood sugar lowering index’ of the various extracts. Values are
expressed as the mean ± SD, n = 6 in each group; where P < 0.05 significantly different from *normal group, #diabetic control and $standard extract group.
Additional Herbs Turmeric
Fenugreek
Ginger
Dahl
Bean extract
Ginsing
4/18/2019
26
Thank You!
Take Home Messages for heart health1. Focus on foods to add to reduce risk and teach how to find and use them
1. Soluble fiber,
2. Phyto sterols,
3. nuts,
4. legumes
2. Supplements for reduce inflammation
3. Supplements for Type 2 Diabetes
1. Berberine
2. Cinnamon
Thank you!