Top ingredients for heart health

Any condition that is the leading cause of death presents clear opportunities for product developers to utilise a range of functional ingredients to pump up the health profile of food, beverage or supplement formulations. Chris O'Brien surveys the top nutrients to use

Cardiovascular health is a major emphasis for new product launches worldwide. Lowering cholesterol levels, while perhaps the most common symptom to address, is hardly the only item of interest to product developers. As the boomers age, lifestyle- and diet-related illnesses such as obesity, late-onset diabetes and metabolic syndrome continue to rise, all of which weigh on cardiovascular health in the adult and ageing populations. Ingredients marketers, as well as end-product manufacturers, are homing in on these significant health issues, and hundreds of new products are being launched every year to address various factors associated with heart health and cardiovascular function — everything from cholesterol levels to endothelium elasticity to blood platelet thinning to strengthening the heart muscle.

Following is a list of some of the top heart ingredients on the market today.

Soy protein
Since 1999, soy protein has enjoyed an FDA-approved health claim. Products with 6.25g of soy protein per serving may claim to reduce the risk of coronary heart disease. According to the FDA, 25g of soy protein daily is needed to show significant cholesterol-lowering effect. Twenty-five grams of soy protein can be found in about 8oz of tofu, one to two cups of soy milk or an ounce of soy flour.

Soy works, in part, by replacing dietary animal protein, in turn reducing intake and concentrations of cholesterol in the blood.1,2,3 In the body, the exact metabolic mechanism of soy protein is not known, though several theories exist. One suggests that soy protein blocks cholesterol absorption in the body.4 Another says the phyto-oestrogens (isoflavones) bind to receptors in the body and produce an LDL-lowering effect.5 A meta-analysis found that the isoflavones typically found in soy products are safe for consumption, despite their possible oestrogenic effects.6

The FDA has not granted soy protein isolate GRAS status, although certain branded ingredients, such as Schouten's three per cent isoflavone concentrate SoyLife, have self-affirmed GRAS status, meaning they have performed all the necessary tests to declare a nutrient GRAS even if they have not submitted to the FDA for such approval.

Omega-3 fatty acids
Fatty acids also qualify for a (qualified) health claim for reduced risk of coronary heart disease in conventional foods that contain eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) omega-3 fatty acids. The FDA recommends that consumers not exceed more than a total of 3g per day of EPA and DHA omega-3 fatty acids, with no more than 2g per day from dietary supplements. At these levels, marine-derived omega-3s have GRAS status although fatty acids from flaxseed do not.

Omega-3 fatty acids can protect against coronary heart disease, and can be particularly effective at preventing complications following a heart attack.7 Omega-3s have been found to provide cardio support by providing anti-inflammatory, antithrombotic, antiarrhythmic and anti-atherogenic effects.8

New micro-encapsulation technologies are making it easier than ever to incorporate fish oils into a broad variety of foods and beverages without any issues regarding taste or odour of fishiness. Couple that with a combination of continuing research and sustainably harvested oils, mostly from sardines and anchovies, and the market potential looks quite robust.

Coenzyme Q10 is known to power cellular mitochondria, assisting production of adenosine triphosphate. Co-Q10 concentrates in the heart, helping the muscle. Poor cell and muscle function can be a result of a deficiency of co-Q10, and can also be reversed through supplementation.9 Unfortunately for patients (though an opportunity for functional-ingredients suppliers), statin drugs used to treat individuals with chronic heart failure actually deplete the heart of co-Q10.10

Various forms of co-Q10 are available, which improve the breadth of products available beyond supplements. These include DSM's Actilease, a beadlet form of co-Q10 suitable for food and beverage applications. DSM also makes all-Q for tablet formulations. Tishcon supplies Q-Gel, a 1-micron co-Q10 particle that offers excellent suspension in liquids. In one study, all-Q and Q-Gel were found to have the same bioavailability.11 All-Q and some other brands including KanekaQ10 have self-affirmed GRAS status.

Whole grains
Whole grains have been found to lower cholesterol and prevent against atherosclerotic cardiovascular disease.12 According to one study, "Diets rich in whole-grain foods tend to decrease serum LDL-cholesterol and triacylglycerol levels as well as blood pressure while increasing serum HDL-cholesterol levels. Whole-grain intake may also favorably alter antioxidant status, serum homocysteine levels, vascular reactivity and the inflammatory state."13

A study published in October 2007 evaluated the association between whole-grain breakfast-cereal intake and the incidence of heart failure among more than 21,000 participants from the Physicians' Health Study I. It found that a bowl a day of whole-grain cereal reduces risk of heart failure by 28 per cent, while even a bowl a week was good for a 14 per cent decreased risk.14

Research suggests that a diet containing soluble fibre-rich whole oats can significantly reduce the need for antihypertensive medication and improve BP control.15

In 1999, thanks to a petition by General Mills, the FDA approved a cardiovascular health claim for foods containing at least 51 per cent whole grains. Whole grains must contain all three layers of the grain: the endosperm, the bran and the germ.

The Coronary Drug Project, a decade-long trial involving 8,341 men aged 30 to 64 years who had previously suffered a heart attack, found that niacin reduced the incidence of recurring, nonfatal heart attack.16 A 15-year follow-up to the study found that the niacin group had an 11 per cent lower mortality rate.

Niacin is thought to work in certain metabolic pathways resulting in lower LDL and higher HDL levels in the body.17 It is also considered safe for diabetics.18 As one study says, "Lipid-modifying dosages of niacin can be safely used in patients with diabetes and niacin therapy may be considered as an alternative to statin drugs or fibrates for patients with diabetes in whom these agents are not tolerated or fail to sufficiently correct hypertiglyceridemia or low HDL-C levels."19

The recommended dose is 2g/day, which was found in one study to decrease total cholesterol by 12.1 per cent, LDL by 16.7 per cent, triglycerides by 34.5 per cent and lipoprotein by 23.6 per cent, while increasing HDL by 25.8 per cent.20

Magnesium deficiency has been found to play a role in heart disease.21 Magnesium is an essential electrolyte that is integral in more than 300 enzymatic reactions, and is critically involved in energy metabolism, glucose utilisation, protein synthesis, fatty acid synthesis and breakdown, ATPase functions, and virtually all hormonal reactions.22

Magnesium works to support heart health by maintaining cellular ionic balance with sodium, potassium and calcium. Deficiency can be caused by diet or the use of diuretics, and may be complicated by diabetes.

Conditions that may be associated with magnesium deficiency include hypertension, congestive heart failure, arrhythmia, myocardial infarction, diabetes mellitus and preeclampsia. In clinical studies, magnesium supplementation has been found beneficial for many of these conditions.23 Magnesium's RDA is 420mg/day for males and 320mg/day for females, but up to 1,000mg/day may be taken as a supplement. One study found that a dose of 365mg, three times a day for eight weeks, effectively lowered blood pressure.24

Phytosterols have documented cholesterol-lowering properties going back decades.25 These plant stanols and sterol esters, including phytostanol, sitosterol, campesterol and stigmasterol, appear to work by blocking cholesterol absorption in the body,26 possibly by decreasing the solubility of cholesterol and preventing it from binding to the bile.27 Phytosterols have been shown to reduce LDL without having an effect on HDL.28,29

In 2000, the FDA authorized a labelling health claim for plant sterol and stanol esters, allowing sterol-containing products to state they reduce the risk of coronary heart disease. To qualify for the claim, a food must contain at least 0.65g of plant sterol esters per serving or at least 1.7g of plant stanol esters per serving, based on the FDA's assessment that 1.3g per day of plant sterol esters or 3.4g per day of plant stanol esters in the diet are needed to show a significant cholesterol-lowering effect. The claim should also say that the daily dose should be consumed at two separate times and taken with other food.

Sterols as a group have not been given GRAS status by the FDA although a branded blend, Archer Daniels Midland's CardioAid, has been granted GRAS status.

Vitamin E
This nutrient has stirred quite a scandal lately. Last August, a study from the Harvard School of Public Health on the effects of vitamin E and other nutrients came out with what seemed like promising results for heart health, although both of the author's conclusions and media coverage painted a picture of ineffectiveness.30

Specifically, the study concluded, "There were no overall effects of ascorbic acid, vitamin E, or beta-carotene on cardiovascular events among women at high risk for CVD."

However, the actual result of 8,171 women taking 600IU vitamin E, 500mg vitamin C and 50mg beta-carotene, or various combinations of these nutrients, for more than nine years, found that vitamin E led to:

  • 22 per cent reduction in the risk of heart attack
  • 27 per cent less risk of stroke
  • 9 per cent lower risk of death from CVD
  • 23 per cent lower combined risk of heart attack, stroke and cardiovascular-related death.

This results-vs-conclusions conflict has ignited protest in some parts of the nutritional industry.

Further complicating the issue, a December 2007 study considering contradicting evidence in the scientific literature pointed out that while observational studies on vitamin E show cardio benefits, some recognised randomised clinical trials (RCTs) do not.31

And going back to 1999 and 2000, petitions for a cardio health claim for vitamin E were repetitively declined due to "no significant scientific agreement for a relationship between vitamin E supplements and CVD risk," according to the FDA.32

At this point in time, epidemiological studies as well as long-term anecdotal evidence from nutritionists and natural-products experts show cardio benefits for vitamin E while RCTs have largely failed to do so. A study published in October 2007 suggested the reason for the equivocal evidence surrounding vitamin E's effectiveness was one of dose, and that 1,600 to 3,200IU/day vitamin E is required to reduce oxidative stress.33 It is hoped that this significant finding will redirect future research studies to consider higher doses as part of the study design.

Several branded vitamin Es have self-affirmed GRAS status including Covitol and Covi-ox from Cognis.

Grape-seed extract and OPCs
OPCs (oligomeric proanthocyanidins) are antioxidants derived from grape seeds or pine bark. Experts agree that oxidative stress plays a critical role in cardiovascular disease. One study found that grape-seed proanthocyanidin extract (GSPE) provides superior antioxidant efficacy as compared to vitamins C and E, and beta-carotene.33 The same study said that a human clinical trial on hypercholesterolemic subjects found that GSPE supplementation significantly reduced oxidized LDL.34

According to research, at a 100mg/l concentration, GSPE exhibited a 78-81 per cent inhibition of superoxide anion and hydroxyl radical. Under similar conditions, vitamin C inhibited these two oxygen free radicals by approximately 12-19 per cent.35

Flavangenol, a branded OPC ingredient, has self-affirmed GRAS status.

Vitamin K2
Vitamin K2 (menaquinone) differs from vitamin K1 (phylloquinone). K1 is found in dark leafy greens; K2 is manufactured by bacteria in the gut and found in natto, a Japanese fermented soy product. K1 plays a role in blood clotting whereas K2 supports bone and heart health. Most K2 supplements offer dosages of 100mcg.

K2 inhibits arterial calcification and supports bone health by taking calcium out of the arteries and carrying it into the bones.36 Arterial and vascular calcification has long been considered a passive process connected to accumulating dying or damaged cells in the walls of veins and arteries.37 However, studies have shown that the calcifying vessel wall shares many similarities with bone in that the process is regulated by vitamin K-dependent proteins.38

A recent study found a strong connection between vitamin K2 intake and reduced arterial calcification as well as a 50 per cent lower risk of heart attack.39

According to NattoPharma, manufacturer of MenaQ-7, a K2 ingredient, vitamin K2 has GRAS status in the US.

Keeping the beat
Most of the ingredients in this list have significant cardiovascular benefits that are backed by valid scientific studies. This presents a big opportunity for new variations on foods and supplements for heart health. However, blending them all into one heart-health bar may not be the best approach as each ingredient has specific effects when taken in the right dosages and under the right conditions.

It's also important to note that with all the different branded ingredients and variations available, product parity can't be assumed. Manufacturers should take their research beyond clinical studies, production costs and market trends and into the real source, design and efficacy of individual ingredients. Proper investigation and formulation can go a long way to produce a truly effective product in a market with such hearty demand.

Monascus purpureusRed yeast rice: Market it at your own peril
BACKGROUND: Monascus purpureus is a type of yeast grown on rice, traditionally used in China to generate a safe reddish food colouring (hence 'red yeast rice'). In the 1990s, Chinese scientists working with the M. purpureus Went strain, using specific and carefully monitored growing conditions, were able to make powdered red yeast rice (RYR). A 2006 meta-analysis of 93 published, randomised, controlled clinical trials reported that, when taken orally at 1,200-2,400mg/day, it can lower total cholesterol by 35mg/dL, LDL cholesterol by 28mg/dL, and triglycerides by 36mg/dL, and increase HDL cholesterol by 5.8mg/dL.3 The active compounds in red yeast rice include monacolins, one of which, 'monacolin K,' is identical to the drug lovastatin (Mevacor).

FIRST ACT: The FDA moved to ban RYR products in 1998. The FDA position was that the products were unapproved new drugs. A protracted legal effort ended in March 2001, and the products disappeared from the market.

SECOND ACT: Red yeast rice products began to reappear in the US market in 2003. A reasonable guess is that those RYR products were not necessarily cultured or extracted to maximise monacolin content. Comparative laboratory analysis showed a 10-fold range in monacolin content. Most labels and websites said no more than "fermented according to traditional Asian methods" or "similar to that used in culinary applications." Some labels made no statements related to cholesterol or heart health.

THIRD ACT: By 2007, there were at least 25 RYR products on the market. Label language ranged from specifying a monacolin content >> and claiming cholesterol-lowering activity to no mention of content or function. A few were coy about content or function, but inferred the same by having cautionary language similar to that of 'statin' drugs, or were co-formulated with coenzyme Q10, a liver compound depleted by statin drugs.

The FDA responded in August 2007. One warning letter noted a company's website that specified a lovastatin content and was a "cholesterol-fighting formula." Another warning letter to a different company was more interesting because nothing about the product went beyond typical structure/function language — but analysis of the product by an FDA laboratory discovered that the product did contain lovastatin in more than trace amounts — hence a drug and forbidden. Neither company markets the products anymore.

The FDA also issued a press release warning consumers "…not to buy or eat red yeast rice products … that may contain an unauthorized drug that could be harmful to health." The rationale for "harmful to health" was that consumers might not understand that the dangers of monacolin-containing RYR could be the same as those of prescription statin drugs. There are at least two case report studies in the literature of patients who developed muscle weakness and damage from consuming a red yeast rice product.4,5

Of importance to companies that continue to market RYR products, the FDA's action became a catalyst to law firms seeking as potential clients people who consumed a RYR product and believe that they suffered an illness as a result. These legal activities will expand to include any RYR product claiming monacolin content, having warning statements alluding to health risks similar to those seen with statin drugs, or if the products have a measurable monacolin content without stating so on the label.

To recap
An RYR product that:

  • Contains monacolins and says so: subject to FDA action (and lawsuits)
  • Contains monacolins and does not say so: subject to FDA action (and lawsuits)
  • Does not contain monacolins but says so: subject to FDA action
  • Does not contain monacolins and does not say so: Caveat emptor, or at least exercise cautrion until the FTC decides that the term 'red yeast rice' constitutes false advertising, even if no further advertising claims are made for function or content

David A Mark, PhD, is president of dmark consulting.

You're the expert!
What are your top 10 cardio ingredients? Go to to make your list, and compare it to your colleagues'.

Len Monheit, NPI Center

  • EPA
  • Sterols
  • Krill
  • Co-Q10
  • Polyphenolics
  • Niacin
  • Garlic
  • Vitamin E
  • Carnitine
  • Vitamin K
  • Soy isoflavones

Anthony Almada, IMAGINutrition

  • Magnesium
  • Vitamin E
  • Vitamin C
  • Phytosterols/phytostanols
  • Pomegranate
  • N-acetyl-L-cysteine (NAC)
  • Garlic
  • Red wine/red-grape extracts
  • Niacin
  • EPA + DHA

Select suppliers: Cardio ingredients run the gamut
Krill oil supplier has a distribution agreement with Enzymotec to supply an alternative to fish-sourced EPA/DHA.

Ribose is a simple carbohydrate widely used in foods and nutrition as an energy-enhancing nutraceutical that helps the body manufacture ATP and thus fights fatigue and accelerates energy recovery.

Complete line of essential fatty acids including from fish, flax, borage, evening primrose, blackcurrant, perilla and CLA, as well as flax concentrates and functional-foods ingredients. One notable offering is a water-soluble EFA powder. BioFlaxElite is a branded combination of flax with beta-glucan.

Blue California
COQ10-WS is water soluble in cold water and ideal for beverages, chewable tablets and functional foods.

CoroWise plant sterols do not affect the taste or texture of the foods or beverages to which they are added.

Malaysian company offers Tocomin, natural full-spectrum palm tocotrienol/tocopherol complex; Stelessterol, a natural palm phytosterol complex; Spectra, natural palm tocotrienol/tocopherol with mixed carotenoids.

Covitol natural-source vitamin E is extracted from soybean oil, sunflower oil, corn oil, and other grains and seeds. It is suitable for a variety of applications. Covi-ox is a branded mix of tocopherols. Vegapure vegetable sterol esters are available for soft-gel capsules or as a water-dispersible powder for drink mixes or energy bars.

Denomega 100 and Denomega Powder are natural taste- and odour-free omega-3 oils from food-quality cod liver. They are finding a home in baked goods, dairy, beverages, margarines and spreads, and fish and meat products. Denotaste CLO is for supplements.

Diana Naturals
Healsea, based on Fucus vesiculosus, a unique brown algae extract, is an 11 per cent polyphenol phloroglucinol equivalent for artherosclerosis prevention.

All-Q is a bioavailability-enhanced, water-soluble co-Q10 for foods, beverages and supplements. All-Q Plus is co-Q10 with vitamin E for topical cosmetic applications.

Epax condition-specific EPA/DHA fish oil formulas contain specific concentrations and ratios of EPA/DHA for mood and mind health, joint health, pre- and postnatal health, eye health, cognitive health, cardiovascular health, and inflammation.

Global dairy foods and nutritional ingredients group recently acquired Pizzey's Milling, which produces omega-3 ingredients derived from flaxseed.

Niamax is the brand name for a sustained- release niacin tablet, used as a feed/food additive, as a dietary supplement and in multivitamin preparations.

Ocean Nutrition Canada
Meg-3 omega-3 EPA/DHA fish-oil concentrates can contain up to 70 per cent combined EPA/DHA and up to 75 per cent total omega-3s for supplements. Powder-loc is a patented micro-encapsulation technology for seamlessly incorporating the fish oils into a range of food products.

PL Thomas
MenaQ7 natural vitamin K2 is supplied from Natto Pharma out of Norway and distributed in North America by PL Thomas. Japan's KanekaQ10, the primary brand of co-Q10 used in National Institutes of Health studies, is now marketed by PL Thomas. It is ideal for food and beverage applications.

MegaNatural BP is a patent-pending grape seed extract. MegaNatural Gold Grape Seed Extract guarantees a minimum 90 per cent polyphenols. Other brands include MegaNatural GSKE, GSKE040 grape extract, MegaNatural red-wine concentrate, and nutraceutical- grade grape-pomace extract.

Prolisse isolated soy protein product line was recently acquired from Cargill. Solae has recently confirmed that none of its soy-based materials, such as soy protein, soy fibre and soy lecithin, used in products produced at its facilities outside China are of Chinese origin.

Q-Gel dietary-supplements line is a highly bioavailable co-Q10 that is USP verified. Derma Q-Gel cream is now available.

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