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Functional Foods

Functional Foods. …functional foods, including whole foods and fortified, enriched, or enhanced foods, have a potentially beneficial effect on health when consumed as part of a varied diet on a regular basis, at effective levels. JADA 1999;99:1278-128 adjunctive to dietary goals

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Functional Foods

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  1. Functional Foods • …functional foods, including whole foods and fortified, enriched, or enhanced foods, have a potentially beneficial effect on health when consumed as part of a varied diet on a regular basis, at effective levels. JADA 1999;99:1278-128 • adjunctive to dietary goals • soluble fiber • plant stanols/sterols • soy protein • -3 fatty acids

  2. Soluble Fiber • Viscous fibers from legumes, pectin, B-glucan from barley, oats, guar gum and psyllium husk • Inverse association between soluble fiber, IHD mortality and MI(Jacobs DR; Am J Clin Nutr. 1998;68:248-257) • Diet + soluble fiber • Cholesterol  11% • LDL-C  14% (in hypercholesterolemic subjects) • LDL-C  10% (in normolipemic subjects) (Glore SR; J Am Diet Assoc. 1994;94:425-436) (Ripsin CM et al. JAMA 1992;267(24):3317-3325)

  3. Soluble fiber in foods • Oat bran, 1/2 cup 3.6 g • Oatmeal, 1/2 cup 2.0 g • Cheerios, 1 1/2 cups 1.5 g • Apple, 1 medium 1.0 g • Banana, 1 medium 0.7 g • Broccoli, 1 cup 2.8 g • Baked potato w/skin, 1 small 1.0 g • Kidney beans, 1/2 cup 2.8 g • Split peas, 1/2 cup 1.1 g • Psyllium seed husks, 3 tsp. 10 g (Psyllium data: Bell LP; JAMA 1989;261:3419-3423)

  4. Soluble fiber: mechanisms • Depletion of bile acid pool • Inhibition of hepatic cholesterol synthesis by short-chain FA produced by colonic fermentation • Increased LDL-c catabolism •  Sat. fat and cholesterol intake due to lower fat choices higher in soluble fiber (Glore SR; J Am Diet Assoc. 1994;94:425-436)

  5. Summary Notes: Soluble Fiber • Appears to lower LDL by up to 8% • Adjunctive to other dietary and pharmacological measures to lower LDL • Recommended as therapeutic option by ATP III: 10 to 25 g/day

  6. Plant sterols/stanols • Structurally resemble cholesterol; not synthesized by humans •  Serum cholesterol: inhibit absorption of dietary and biliary cholesterol from small intestine by up to 65% • Present in normal diet but not in therapeutic amounts • Sitostanol (saturated sterol) most effective • Commercial spreads: Benecol® (stanol) and Take Control® (sterol) (Hallikanienen M and Uustupa MI; Am J Clin Nutr. 1999;69:403-10) (Lichtenstein AH et al; Circulation 2001;103(8):1177-9) (Neils HAW et al. Atherosclerosis 2001;156:329-37)

  7. Plant sterol-containing margarines

  8. Plant stanol margarines • Randomized, double-blind • 153 subjects w/mild hypercholesterolemia • 3g x 6 mo., then 2g sitostanol per day vs. control • Dose:response relationship • 12-mo. maximum: • total cholesterol 10.2%; LDL-c 14.1% • no change in HDL or triglycerides • Values returned to baseline after 2 months (Miettinen TA et al. N Engl J Med. 1995;333:1308-12)

  9. Plant stanol margarinesHallikainen MA et al. J Nutr. 2000:130:767-776.

  10. Randomised controlled trial of use by hypercholesterolemic patients of a vegetable oil sterol-enriched fat spreadNeil HAW et al. Atherosclerosis 2001;156:329-37 • Double-blind, placebo-controlled crossover (2 periods x 8 weeks) • 30 w with familial hypercholesterolemia on statins; 32 w/type IIa not on drug therapy • Usual diet + 2.5 g plant sterols • Significant reduction in total and LDL-cholesterol (10%) after 8 weeks • No difference in response between patients on statins and those not on drug therapy • Well tolerated and effective as an additive therapy in statin-treated familial hypercholesterolemia

  11. Plant stanol-containing margarines: 2-3 TB per day

  12. Omega-3 Fatty Acids • No recommendations by ATP III • Populations with diets high in fish and other marine animals suggest high intakes of n-3 FA: low incidence of CVD • Intake of EPA (C20:5n-3) and DHA (C22:6n-3) from seafood: may platelet aggregation and coronary spasm; accumulation of myocardial cytosolic calcium during ischemia (Siscovick DS et al. JAMA 1995;274(17):1363-67) (Drevon, CA Nutr Reviews 1992;50(4):38-45)

  13. Omega-3 Fatty Acids • Lyon Diet-Heart Study: risk cardiac death by 76% w/diet enriched in -linolenic acid (18:3) (in some nuts, canola oil, flaxseed) (de Lorgeril M, et al. Circulation 1999;99:779-85) • DART: 2033 men, post-MI add 300g fish per week (3 sv.)  29%  in 2-year all-cause mortality; 33%  in IHD mortality (Burr ML et al. Eur Heart J. 1992;13(2):166-70) • Others find no association between fish intake and incidence of CHD (Ascherio A, et al. N Engl J Med. 1995;332:977-82; Gualler E, et al. J Am Coll Cardiol. 1995;25:287-94)

  14. Omega-3 Fatty Acids • Case-control study: Are dietary long-chain n-3 PUFAs linked to  vulnerability to life-threatening arrhythmias? • Assessed intake of 35 types of seafood; estimated dietary EPA and DHA; and dietary fat • Assayed RBC membrane FA levels (biomarker) • Intake of 2.9 g n-3 PUFA (2 fish meals per month): 30% reduction in risk of primary cardiac arrest (OR 0.7; CI 0.6-0.9) • Intake of 5.5 g n-3 PUFA (1 fish meals per week): 50% reduction in risk of primary cardiac arrest (OR 0.5; CI 0.4-0.8) • May decrease vulnerability to ventricular fibrillation (Siscovick DS et al. JAMA 1995;274(17):1363-67)

  15. Omega-3 Fatty Acids

  16. Summary notes: Omega-3 Fatty Acids • Not addressed by ATP III, possibly due to equivocal data • Most powerful effect is on triglycerides • Food sources (fish and seafood, certain oils) most often preferable to supplements • May reduce risk for coronary events or mortality

  17. Soy protein • High quality protein, low in saturated FA • Good source of phytoestrogens: isoflavones believed to be most active • Substitute soy for animal protein: cholesterol  • ? Protective mechanisms: • Inhibition of LDL oxidation • Maintenance of blood vessel flexibility • Prevention of thrombosis (Platt R. Prev Cardiol. 2000;3:83-87)

  18. Soy protein: LDL by 5%

  19. Breakfast 1 cup oatmeal 1 TB Benecol® Light 1 oz. raisins 4 oz. Skim milk 1 small orange Lunch 2 oz. Harvest Burger® (soy) 2 tsp. Mayonnaise 2 leafs romaine lettuce 2 slices wholegrain bread 1 small apple 3 oz. Baby carrots 4 oz. Skim milk Dinner 3 oz. Filet of sole ½ cup brown rice 1 cup broccoli 2 tsp. canola oil 1 cup strawberries Snack 1 slice wholegrain bread 1 TB Benecol® Light 8 oz. Skim milk Sample Eating Pattern(1500 kcals, 23% fat, 50% CHO, 11 g soluble fiber, 3.4 g stanol esters)

  20. Summary • Cardioprotective changes through individualized eating patterns can be achieved • Most successful with team/behavioral approach • Nutrition professional facilitates translation of clinical recommendations into changes in eating behavior by fully assessing risk factors and tailoring to fit medical and lifestyle needs; other behavioral/activity professionals have key roles • Nutritional + other lifestyle changes alone may be sufficient to normalize lipids; approaches are adjunctive to pharmacological rx, when needed, and may allow lower dose • More investigation needed on ratio of CHO:fat and type(s) of fat to optimize risk reduction • Selected functional foods are promising

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