Chocolate, red wine, peanuts – heal

A

Ann

th foods or indulgences?

lison Coates, PhD, RNutr

ual Food Industry Forum for Nutrition Research August 31 st 201 0

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Functional Foods

• Chocolate, red wine and peanuts can all be considered as functional foods! – Functional Foods: foods that provide health benefits beyond

simple nutrition

• What do they have in common?

– Bioactive nutrients w hich have been associated with heart health

What’s in chocolate? Cocoa solids, cocoa butter, vegetable oils, refined s ugar, milk p owder

~2163kJ/100g

• 50% energy from fat • High in stearic acid (~30%)

Minerals • Zinc, potassium, magnesium

Polyphenols • Catechins, flavonol glycosides,

anthocyanins, procyanidins

• Theobromine, caffeine

What’s in red w ine?

• 10-14% alcohol ~285kJ/100ml

• Contains>9000 different polyphenols1 • Anthocyanosides • Proanthocyanidins • Catechins

Wine is the major • Stilbenes anthocyandin

source for Australian adults

(NNS 1995)2

1German and Walzem Annu. Rev. Nutr. 2000. 20:561–93 2Johannot and Somerset. Public Health Nutr 2006; 9: 1045–1054.

What’s in a peanut?100

High Energy Density ~2376kJ/100g 80

60% Energy

40

20

0

7

19

Carb

Protein

Fat 74

>80% MUFA

Arginine (precursor to nitric oxide

which dilates blood vessels)

What’s in a peanut?monounsaturated fat

Arginine (precursor to nitric oxide

which dilates blood vessels)

fibre

plant sterols

Folate

Vitamin E Polyphenols

Griel et al. (2004) J Am Coll Nutr 23(6): 660-668.

So how do these foods provide

a heart health benefit?

personalbrandingblog.com

kjri-sydney.org.au

http:personalbrandingblog.com

Endothelial function

- maintaining blood vessel health

eNOS

Relaxation Vasodilation

http://www.cvphysiology.com

http:http://www.cvphysiology.com

Hypertension

Insulin smoking resistance

Endothelial Dysfunction

High fat Ageing Oxidative diet stress

Taddei et al Hypertension 1996; 28:576–82; Esen et al Circ J. 2004;68(12):1123-6; Vanhoutte. Eur Heart J Supplements 2002; 4 (Suppl A): A8–A17

Endothelial dysfunction So what happens when the

endothelium becomes dysfunctional?

eNOS

http://www.cvphysiology.com/Blood%20Flow/BF011.htm

Relaxation Vasodilation

Gupta et al AIDS 2010; 4(9): 1377-1380

Action of polyphenols polyphenols How polyphenols improve

++ blood vessel function • eNOS expression (via stimulation of Ca2+)

eNOS • NO bioavailability (by reducing its degradation mediated by reactive oxygen species)1

• synthesis of vasoconstrictors (endothelin-1)2

• expression of adhesion molecules • inflammatory status

http://www.cvphysiology.com/Blood%20Flow/BF011.htm • proliferation and migration of Relaxation Vasodilation smooth muscle cells

• platelet aggregation

Endothelial function = CV h ealth 1. Nutr Metab Cardiovasc Dis 2001;11:47– 50; 2Nature 2001;414(6866):863– 4.

What is the evidence?

http://www.youthserviceslitigation.com/articles/mental-health-research/

http://www.youthserviceslitigation.com/articles/mental-health-research

The benefits of cocoa flavanols

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Traditionally consume >5 cups of flavanol-rich cocoa per day

urbanisation = cocoa consumption =

protection against age-related hypertension

J Cardiovasc Pharmacol. 2006;47 Suppl 2:S103 -9.

http://www.panamahttp:http://www.tropicaldiscovery.com

Zutphen Elderly Study1 470 elderly men, 15-year follow up

Amount of cocoa/chocolate consumed Adjusted Lowest Middle Highest P Relative risk (2.25 g/d) for trend Cardiovascular 1.0 0.70 0.50 0.0004 Mortality

All cause 1.0 0.73 0.53

Cocoa and endothelial function Before

8 * Acute response 2hrs After

7 after single dose FMD 6

(%) 5 Flavanol content 4

3HF cocoa = 902 mg 2

LF cocoa = 36 mg 1 0

LF HFLow energy density FMD 8

(%) 7 Week 0 490 kJ per dose Week 6 * *6

Week 12 5

Chronic response

measured > 10hrs after 4

previous dose 3

2

BP also decreased 1 following HF chronic

supplementation 0 LF HF Davison, Coates et al 2008 Int J Obes (Lond) 32(8): 1289-1296.

Chocolate Conclusion • Cocoa polyphenols can provide CV benefit t hrough a range of

mechanisms: – antioxidant Better endothelial function – anti-inflammatory Better blood pressure regulation – anti-atherogenic activity

• If dietary cocoa polyphenol intake is due to chocolate its high energy content needs to be taken into account.

Erdman et al 2008. Asia Pac J Clin Nutr. 17 Suppl 1:284-7; Desch et al 2010 Am J Hypertens. 23(1):97-103.

The benefits of red wine polyphenols

http://forthebenefit.wordpress.com/2009/02/22/what-to-do-with-leftover-wine/

http://forthebenefit.wordpress.com/2009/02/22/what-to-do-with-leftover-wine

Red wine and endothelial function

30 male patients with CHD

Acute administration of Red grape polyphenol

extract (600mg)

Lekakis et al Eur J Cardi Prev Rehab 2005; 12(6):596-600

Red wine and endothelial function-resveratrol

Resveratrol (3,4',5-trihydroxystilbene) • Polyphenol found in skin of red grapes/red wine, peanuts skins and

dark chocolate

• Resveratrol content per serve • red wine/grape juice > cocoa/chocolate > roasted peanuts1.

Resveratrol studies with cell culture and animal models show improved endothelial function

• eNOS in vitro acutely2

• NO levels and endothelin-1 level leading to a higher FMD response in rabbits after 12 weeks3

1 Hurst et al J Agric Food Chem. 2008 Sep 24;56(18):8374-8. 2 Leikert et al Circulation 2002;106:1614–1617; 3Zou et al Int J Mol Med 2003; 11:317–320.

Acute FMD response to resveratrol 19 overweight/obese volunteers with mildly

0

1

2

3

4

5

6

7

8

9

10

FMD

resp

onse

(%)

+1.9 +2.4

+3.4

+1.5

+2.5 +2.4

+3.7

Red wine polyphenol

extract (600mg)1

Cocoa flavanols (902mg)2

Tea (450ml)3

EGCG (300mg)4

elevated BP

0 30 90 270 Wong et al Nutr Metab Cardiovasc Dis. 2010 Jul 29. [Epub ahead of print]

Resveratrol dose (mg) 1Lekakis et al. 2005;Eur J Cardiov Prev Rehab:12:596-600, 2Davison et al. 2008;Int J Obes: 32:1289-1296, 3Widlansky et al. 2005; Free Rad Bio Med: 38:499506, 4Widlansky et al. 2007; J Am Coll Nutr: 26:95-102

National Heart Foundation of Australia -strategies to reduce CVD risk

The Heart Foundation does recommend the following. • Drink as part of a healthy balanced diet,

– cocoa made from raw cocoa powder.

The Heart Foundation does not recommend the following for the prevention or treatment of CVD.

• Consuming milk or dark chocolate • Drinking red wine or other types of alcoholic drinks

NHF position statement: Antioxidants in food, drinks and supplements for cardiovascular health. Updated August 2010 (2010)

What about peanuts?

Hazel handed in her notice, because she was tired of working for peanuts......

Physicians Health Study 21,454 men 40-84 years

began 1982 - diet questionnaire in 1983 17 year follow-up - 201 sudden deaths

Peanuts account for > 50% o f all nuts

Frequency of all nut consumption consumed in USA

2/wk P

Relative Risk for trend

Coronary 1.0 0.89 0.90 0.7 0.06 Heart Disease (0.9-1.2) (0. 9-1.0) (0.5-0.9)

Sudden Death 1.0 0.98 0.85 0.64 0.01 (0.7-1.4) (0.6-1.3) (0.4-1.0)

Albert CM. Arch Intern Med 2002;162:1382-1387

Nurses Health Study 86,016 women aged 34-59 years

began 1976 - diet Questionnaire in 1980

14 year follow-up - 1255 major CHD events

Frequency of all nut consumption

Relative Risk Almost never

1-3/mth to 1/wk

2-4/wk >5/wk P for trend

Coronary Heart Disease

1.0 0.91 (0.8-1.0)

0.78 (0.6-0.9)

0.66 (0.47-0.93)

0.005

Fatal Coronary Heart Disease

1.0 0.76 (0.6-0.9)

0.60 (0.4-0.96)

0.60 (0.3-1.1)

0.004

• adjusted for other diet components, risk factors

• nut eaters were leaner and drank less alcohol

Hu FB. BMJ 1999;317:1341-1345

Peanuts and endothelial function • No study to date has test the effects of peanuts on endothelial

function • ARC-Linkage grant between PCA and UniSA established to do this

• 2010-2013, (Coates, Berry, Howe, Buckley, Bryan)

• Studies in walnuts and pistachios have reported improvements in endothelial function Pistachios: 4wk, 20% E in healthy men, 30% relative increase (P=0.002)1

Walnuts: acute consumption (+4hrs), 40g walnuts vs 25g olive oil in 12 healthy subjects and 12 patients with hypercholesterolemia improved FMD (P=0.006)2

1 Sari et al 2010 Nutrition;26(4):399-404; 2 Cortes et al J Am Coll Cardiol. 2006;48(8):1666-71.

Peanuts are better than NCEP low fat diets (Step 1, 2) for improving blood lipid profiles

15

10

5

% change 0

-5

-10

-15

-20

*

LDL HDL Triglycerides

Step 1 Step 2 Olive Oil Peanut Oil Peanuts & peanut butter

*, p=0.028

Kris-Etherton , P.M. et al Am J Clin Nutr 1999, 70(6): 1009-15.

*

*

Peanuts and Obesity Does nut consumption lead to excessive energy intake?

Can this contribute to obesity and diabetes?

Energy Intake of Peanut Users and Nonusers 3000

Users Kcal 2570 27Nonusers 2500 2215

26.5 2000 1727 1546

1500 26

1000 25.5

500

250 Men Women Men Women *P

Summary • Cocoa and peanuts could be incorporated into a

healthy diet for cardiovascular health

• Red wine is not recommended as a way to increase intake of polyphenols

• Low energy density foods enriched with these

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bioactive compounds may be an effective way to increase polyphenol intake without increasing • Energy

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• Saturated fat • Refined sugar • Alcohol

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Acknowledgements

•

– DSM Nutritional Products

The NPRC team • The sponsors

– Mars Inc

– Peanut Company of Australia

Chocolate, red wine, peanuts – health foods or indulgences?Functional FoodsSlide Number 3Slide Number 4Slide Number 5Slide Number 6Slide Number 7Endothelial function �- maintaining blood vessel healthSlide Number 9Endothelial dysfunctionAction of polyphenolsSlide Number 12Slide Number 13Zutphen Elderly Study1�470 elderly men, 15-year follow upCocoa and endothelial functionChocolate ConclusionSlide Number 17Red wine and endothelial functionSlide Number 19Slide Number 20National Heart Foundation of Australia - strategies to reduce CVD riskSlide Number 22Physicians Health Study��21,454 men 40-84 years�began 1982 - diet questionnaire in 1983�17 year follow-up - 201 sudden deaths�Nurses Health Study� 86,016 women aged 34-59 years�began 1976 - diet Questionnaire in 1980 �14 year follow-up - 1255 major CHD eventsPeanuts and endothelial functionPeanuts are better than NCEP low fat diets (Step 1, 2) for improving blood lipid profilesSlide Number 27SummaryAcknowledgements