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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.

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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

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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

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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

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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)

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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

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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

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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).

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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.

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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...

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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

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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

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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.

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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

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2012

Berberine with lifestyle modification versus lifestyle modification alone or plus placebo

Berberine with lifestyle modification versus lifestyle modification alone or plus placebo

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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

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Berberine vs. Oral Hypoglycemics

Berberine vs. Oral Hypoglycemics

Berberine vs. Oral Hypoglycemics

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Berberine Combined with Oral Hypoglycemics vs. the Same Hypoglycemics

Berberine Combined with Oral Hypoglycemics vs. the Same Hypoglycemics

2013

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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.

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2013

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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

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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

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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!