Tag Archives: cardiovascular disease

Alcohol, blood pressure, and hypertension

Many studies have shown a direct, dose-dependent relationship between alcohol intake and blood pressure, particularly for intake above two drinks per day.
This relationship is independent of:

  • age;
  • salt intake;
  • obesity;
  • finally, it persists regardless of beverage type.

Furthermore, heavy consumption of alcoholic beverages for long periods of time is one of the factors predisposing to hypertension: from 5 to 7% of hypertension cases is due to an excessive alcohol consumption.
A meta-analysis of 15 randomized controlled trials has shown that decreasing alcoholic beverage intake intake has therapeutic benefit to hypertensive and normotensive with similar systolic and diastolic blood pressure reductions (in hypertensive reduction occurs within weeks).

CONTENTS

Alcohol intake and prevention of hypertension

AlcoholGuidelines on the primary prevention of hypertension recommend that alcohol (ethanol) consumption in most men, in absence of other contra, should be less than 28 g/day, the limit in which it may reduce coronary heart disease risk.
The consumption limited to these quantities must be obtained by intake of drinks with low ethanol content, preferably at meals (drinking even lightly to moderately outside of meals increases the probability to have hypertension). This means no more than 680 ml or 24 oz of regular beer or 280 ml or 10 oz of wine (12% ethanol), especially in hypertension; for women and thinner subjects consumption should be halved1.
To avoid intake of drinks with high ethanol content even though the total ethanol content not exceeding 28 g/day.

Relationship between ethanol intake and blood pressure

Anyway, uncertainty remains regarding benefits or risks attributable to light-to-moderate alcoholic beverage intake on the risk of hypertension.
In a study published on April 2008, the authors examined the association between ethanol intake and the risk of developing hypertension in 28848 women from “The Women’s Health Study” and 13455 men from the “Physicians’ Health Study”, (the follow-up lasted respectively for 10.9 and 21.8 years). The study confirms that heavy ethanol intake (exceeding 2 drinks/day) increases hypertension risk in both men and women but, surprisingly, found that the association between light-to-moderate alcohol intake (up to 2 drinks/day) and the risk of developing hypertension is different in women and men. Women have a potential reduced risk of hypertension from a light-to-moderate ethanol consumption with a J-shaped association2; men have no benefits of light-to-moderate ethanol consumption but an increased risk of hypertension.
However, guidelines for the primary prevention of hypertension limit alcohol consumption to less 2 drinks/day in men and less 1 drink/day in thinner subjects and women.

1. A standard drink contains approximately 14 g of ethanol i.e. a 340 ml or 12 oz of regular beer, 140 ml or 5 oz wine (12% alcohol), or 42 ml or 1,5 oz of distilled spirits (inadvisable).

2. Many studies have shown a J-shaped relationship between ethanol intake and blood pressure. Light drinker (no more than 28 g of ethanol/day) have lower blood pressure than teetotalers; instead, who consumes more than 28 g ethanol/day have higher blood pressure than non drinker. So alcohol is a vasodilator at low doses but a vasoconstrictor at higher doses.

References

Pickering T.G. New guidelines on diet and blood pressure. Hypertension 2006;47:135-6. doi:10.1161/01.HYP.0000202417.57909.26

Sesso H.D., Cook N.R., Buring J.E., Manson J.E. and Gaziano J.M. Alcohol consumption and the risk of hypertension in women and men. Hypertension 2008;51:1080-87. doi:10.1161/HYPERTENSIONAHA.107.104968

Writing Group of the PREMIER Collaborative Research Group. Effects of comprehensive lifestyle modification on blood pressure control: main results of the PREMIER Clinical Trial. JAMA 2003;289:2083-2093. doi:10.1001/jama.289.16.2083

World Health Organization, International Society of Hypertension Writing Group. 2003 World Health Organization (WHO)/International Society of Hypertension (ISH) statement on management of hypertension. Guidelines and recommendations. J Hyperten 2003;21:1983-92.

Relationship between potassium intake, blood pressure and hypertension

High dietary potassium (K+) intakes and blood pressure are inversely related: animal studies, observational epidemiological studies, clinical trials, and meta-analyses of these trials support this.
Furthermore, the prevalence of hypertension tends to be lower in populations with high K+ intakes than in those with low intakes.
Finally, an increase in potassium intake (2.5-3.9 g/d) reduces blood pressure in normotensive and hypertensive, and to a greater extent in blacks than in whites.

Diet high in potassium, blood pressure, and ictus

Controlled feeding studies, such as “The Dietary Approaches to Stop Hypertension (DASH) Study” and “OmniHeart Trial”,  have highlighted the role of a good potassium intake, along with other minerals and fiber, in blood pressure reduction.
These studies have shown that a dietary pattern rich in fruits, vegetables, and low-fat dairy products, with whole grains, poultry, fish and nuts but poor in fats, red meat, sweets, and sugar-containing beverages reduces blood pressure. And such dietary patterns are characterized by foods high in potassium, as well as magnesium, calcium and fiber, but poor in total fat, saturated fat and cholesterol. The best result on lowering blood pressure are with black participants than white participants.
In another study, a systematic review of the literature and meta-analyses has been conducted on potassium intake in apparently healthy adults and children without renal impairment. The study showed that, in adult with hypertension, an increased potassium intake reduced systolic blood pressure by 3.49 mm Hg and diastolic blood pressure by 1.96 mm Hg. No effect was seen in adult without hypertension and in children. In addition, there was no effect of increased potassium intake on blood lipids, or catecholamine concentrations in adults, whereas an inverse statistically significant association was seen between its intake and the risk of incident stroke. Hence, this study suggests that, in people without impaired renal function, increased potassium intake is potentially beneficial for the prevention and control of elevated blood pressure and stroke.

Potassium, sodium and blood pressure

The effects of potassium on blood pressure depend on the concurrent intake of sodium and vice versa:

  • an increased intake of K+ has:

a greater blood pressure-lowering effect when sodium intake is high;

a lesser blood pressure-lowering effect when sodium intake is low;

  • on the other hand, the blood pressure reduction from a lowered sodium intake is greatest when potassium intake is low.

An high K+ intake also increases urinary excretion of sodium, the so-called natriuretic effect.
In the generally healthy population with normal kidney function the recommended potassium intake level is 3.1 g/day. But, in the presence of impaired urinary potassium excretion, a K+ intake less than 3.1 g/day (120 mmol/d) is appropriate, because of adverse cardiac effects (arrhythmias) from hyperkalemia, that is, blood potassium level higher than normal.

Mediterranean Diet and K+ intake

PotassiumAs already pointed out, the best strategy to increase K+ intake is to consume legumes, and fruits and vegetables in season, i.e. foods high in  potassium, that is also accompanied by a variety of other nutrients. No supplements are needed.
Therefore, it is sufficient to follow a  Mediterranean dietary pattern, for:

  • meet the daily requirements of the mineral;
  • consume K+ intake in adequate amounts to ensure its blood pressure-lowering effect.

Potassium content in some foods

High content: >250 mg/100 g of product

  • Dried legumes (chickpeas, beans, lentils, peas and soybeans) and fresh beans;
  • garlic, chard, cauliflower, cabbage, Brussels sprouts, broccoli, artichokes, cardoons, fennel, mushrooms, potatoes, tomatoes, spinach, zucchini;
  • avocados, apricots, bananas, fresh and dried chestnuts, watermelon, kiwi, melon, hazelnuts;
  • sweet dried fruits (apricots, dates, figs, prunes, raisins etc..) and oily dried fruits (peanuts, almonds, walnuts, pine nuts, pistachios, etc.);
  • oat flour, whole wheat flour and spelt;
  • ketchup;
  • roasted coffee;
  • milk powder (also rich sodium);
  • yeast;
  • cocoa powder.

Medium content: 150-250 mg/100 g of product

  • asparagus, beets, carrots, chicory, green beans, fresh broad beans, endive, lettuce, peppers, fresh peas, tomatoes, leeks, radishes, celery, tomato and carrot juice, pumpkin;
  • pineapple, oranges, raspberries, blueberries, loquats, pears, peaches, grapefruit, grapes;
  • meat and fish products, both fresh and preserved (the latter, however, should be avoided because of their high sodium content).

Note: cooking methods tend to reduce the K+ content of the food.
To reduce potassium loss, avoid boiling in plenty of water, for more than an hour, vegetables cut into small pieces (this increases the “exchange area” with water).

References

Aburto N.J., Hanson S., Gutierrez H., Hooper .L, Elliott P., Cappuccio F.P. Effect of increased potassium intake on cardiovascular risk factors and disease: systematic review and meta-analyses. BMJ 2013;346:f1378. doi:10.1136/bmj.f1378

Appel L.J., Brands M.W., Daniels S.R., Karanja N., Elmer P.J. and Sacks F.M. Dietary approaches to prevent and treat HTN: a scientific statement from the American Heart Association. Hypertension 2006;47:296-08. doi:10.1161/01.HYP.0000202568.01167.B6

Cappuccio F.P. and MacGregor G.A. Does potassium supplementation lower blood pressure? A metaanalysis of published trials. J Hyperten 1991;9:465-73.

Geleijnse J.M., Witteman J.C., den Breeijen J.H., Hofman A., de Jong P., Pols H.A. and Grobbee D.E. Dietary electrolyte intake and blood pressure in older subjects: the Rotterdam Study. J Hyperten 1996;14:73741.

Mahan LK, Escott-Stump S.: “Krause’s foods, nutrition, and diet therapy” 10th ed. 2000

Matlou S.M., Isles C.G. and Higgs A. Potassium supplementation in Blacks with mild to moderate essential hypertension. J Hyperten 1986;4:61-4.

Pickering T.G. New guidelines on diet and blood pressure. Hypertension 2006;47:135-6. doi:10.1161/01.HYP.0000202417.57909.26

Rose G. Desirability of changing potassium intake in the community. In: Whelton P.K., Whelton A.K. and Walker W.G. eds. Potassium in cardiovascular and renal disease. Marcel Dekker, New York 1986;411-16

Shils M.E., Olson J.A., Shike M., Ross A.C. “Modern nutrition in health and disease” 9th ed., by Lippincott, Williams & Wilkins, 1999

Writing Group of the PREMIER Collaborative Research Group. Effects of comprehensive lifestyle modification on blood pressure control: main results of the PREMIER Clinical Trial. JAMA 2003;289:2083-2093. doi:10.1001/jama.289.16.2083

World Health Organization, International Society of Hypertension Writing Group. 2003 World Health Organization (WHO)/ISH statement on management of HTN. Guidelines and recommendations. J Hyperten 2003;21:1983-92.

Blood pressure, hypertension and dietary sodium

A high sodium (Na+) intake (the main source is salt or sodium chloride NaCl) contributes to blood pressure raise, and hypertension development.
Many epidemiologic studies, animal studies, migration studies, clinical trials, and meta-analyses of trials support this, with the final evidence from rigorously controlled, dose-response trials. Furthermore, in primitive society Na+ intake is very low and people experience very low hypertension, and the blood pressure increase with age does not occur.
Probably, sodium intake effect sizes are to be underestimated!

CONTENTS

Recommended daily intake

Sodium’s physiologic requires are very low; in fact, the minimum recommended Na+ intake for maintain life is 250 mg/day (Note: iodized salt is an important source of dietary iodine in the United States and worldwide).
An Americans consumes the mineral in great excess of physiologic requires: despite the guidelines from the Departments of Agriculture and Health and Human Services, during the period from 2005 through 2006 the average salt intake in USA is of 10.4 g/day for the average man and 7.3 for the average woman, amount in excess regarding preceding years.
A study published on February 2010 on “The New England Journal of Medicine” have shown that “A population-wide reduction in dietary salt of 3 g per day (1200 mg of Na+ per day) is projected to reduce the annual number of new cases of coronary heart disease (CHD) by 60,000 to 120,000, stroke by 32,000 to 66,000, and myocardial infarction by 54,000 to 99,000 and to reduce the annual number of deaths from any cause by 44,000 to 92,000″ (Bibbins-Domingo et all., see References). These benefits are similar in magnitude to those from:

  • a 50% reduction in tobacco use;
  • a 5% reduction in body mass index among obese adults;
  • a reduction in cholesterol levels.

These benefits regard all adult group age, black and nonblack, male and female. The benefits for black are greater than nonblack, in both sex and all age group. It’s estimated an annual savings of $10 billion to 24 $ billion in health care costs.
Clinical trials have also documented that a reduced Na+ intake can lower blood pressure in the setting of antihypertensive medication, and can facilitate hypertension control.
But, in USA dietary salt intake is on the rise!
So, it is recommended, to prevent hypertension development, a reduction in its intake and, in view of the available food supply and the currently daily Na+ intake, a reasonable recommendation is an upper limit of 2.3 g/day (5.8 g/day of salt).
How achieves this level? It can be achieved:

  • cooking with as little salt as possible;
  • refraining from adding salt at the table;
  • avoiding highly salted, processed foods.

Food sources of sodium

They include:

  • salt used at the table: up to 20% of the daily salt intake;
  • salt or sodium compounds added during preparation or processing foods: between 35 to 80% of the daily sodium intake comes from processed foods.A major source of sodium is salt, or sodium chloride

    Which foods are?
    Processed, smoked or cured meat and fish e.g. sliced salami, sausage, salt pork, tuna fish in oil etc.; meat extracts and sauce, salted snack, soy sauce, barbecue sauce, commercial salad dressing; prepackage frozen foods; canned soup, canned legumes; cheese etc.
    There are also many sodium-containing additives as disodium phosphate (e.g. in cereals, ice cream, cheese), monosodium glutamate (i.e. meat, soup, condiments), sodium alginate (e.g. in ice creams), sodium benzoate (e.g. in fruit juice), sodium hydroxide (e.g. in pretzels, cocoa product), sodium propionate (e.g. in bread), sodium sulfite (e.g. in dried fruit), sodium pectinate (e.g. syrups, ice creams, jam), sodium caseinate (e.g. ice creams and other frozen products) and sodium bicarbonate (e.g. baking powder, tomato soup, confections).
    So pay attention to ingredients!

  • Inherent sodium of foods. Generally low in fresh foods.

The blood pressure response to lower dietary Na+ intake is heterogeneous with individuals having greater or lesser degrees of blood pressure reduction. Usually the effect of reduction tend to be greater in blacks, middle-aged and older persons, and individuals with hypertension, diabetes or chronic kidney disease.
Furthermore genetic and dietary factors influence the response to sodium reduction.

Diet modifies response of blood pressure to sodium

Some components of the diet may modify response of blood pressure to sodium.

  • A high dietary intake of calcium and potassium rich foods, such as fruit, vegetable, legumes (e.g. Mediterranean diet), and low-fat dairy products (e.g. DASH diet), may prevent or attenuate the rise in blood pressure for a given increase in sodium intake.
  • Some evidences, seen primarily in animal model, suggest that high dietary intake of sucrose may potentiate salt sensitivity of blood pressure.

Note: high Na+ intake can contribute to osteoporosis: they result in an increase in renal calcium excretion, particularly if daily calcium intakes are low.

References

Appel L.J., Brands M.W., Daniels S.R., Karanja N., Elmer P.J. and Sacks F.M. Dietary approaches to prevent and treat HTN: a scientific statement from the American Heart Association. Hypertension 2006;47:296-08. doi:10.1161/01.HYP.0000202568.01167.B6

Bibbins-Domingo K., Chertow G.M., Coxson P.G., Moran A., Lightwood J.M., Pletcher M.J., and Goldman L. Projected effect of dietary salt reductions on future cardiovascular disease. N Engl J Med 2010;362:590-9. doi:10.1056/NEJMoa0907355

Cappuccio FP. Overview and evaluation of national policies, dietary recommendtions and programmes around the world aiming at reducing salt intake in the population. World Health Organization. Reducing salt intake in populations: report of a WHO forum and technical meeting. WHO Geneva 2007;1-60.

Chen J, Gu D., Jaquish C.E., Chen C., Rao D.C., Liu D., Hixson J.E., Lee Hamm L., Gu C.C., Whelton P.K. and He J. for the GenSalt Collaborative Research Group. Association Between Blood Pressure Responses to the Cold Pressor Test and Dietary Sodium Intervention in a Chinese Population. Arch Intern Med. 2008;168:1740-46 doi:10.1001/archinte.168.16.1740

Denton D.,  Weisinger R., Mundy N.I., Wickings E.J., Dixson A., Moisson P., Pingard A.M., Shade R., Carey D., Ardaillou R., Paillard F., Chapman J., Thillet J. & Michel J.B. The effect of increased salt intake on blood pressure of chimpanzees. Nature Med 1995;10:1009-16 doi:10.1038/nm1095-1009

Ford E.S., Ajani U.A., Croft J.B., Critchley J.A., Labarthe D.R., Kottke T.E., Giles W.H, and Capewell S. Explaining the decrease in U.S. deaths from coronary disease, 1980-2000. N Engl J Med 2007;356:2388-98. doi:10.1056/NEJMsa053935

Geleijnse J.M., Witteman J.C., den Breeijen J.H., Hofman A., de Jong P., Pols H.A. and Grobbee D.E. Dietary electrolyte intake and blood pressure in older subjects: the Rotterdam Study. J Hyperten 1996;14:73741.

Harlan W.R. and Harlan L.C. Blood pressure and calcium and magnesium intake. In: Laragh J.H., Brenner B.M., eds. Hypertension: pathophysiology, diagnosis and management. 2end ed. New York: Raven Press 1995;1143-54

Holmes E., Loo R.L., Stamler J., Bictash M., Yap I.K.S., Chan Q., Ebbels T., De Iorio M., Brown I.J., Veselkov K.A., Daviglus M.L., Kesteloot H., Ueshima H., Zhao L., Nicholson J.K. and Elliott P. Human metabolic phenotype diversity and its association with diet and blood pressure. Nature 2008;453:396-400. doi:10.1038/nature06882

Mahan LK, Escott-Stump S.: “Krause’s foods, nutrition, and diet therapy” 10th ed. 2000

Pickering T.G. New guidelines on diet and blood pressure. Hypertension 2006;47:135-6. doi:10.1161/01.HYP.0000202417.57909.26

Shils M.E., Olson J.A., Shike M., Ross A.C. “Modern nutrition in health and disease” 9th ed., by Lippincott, Williams & Wilkins, 1999

Simpson F.O. Blood pressure and sodium intake. In: Laragh J.H., Brenner B.M. eds. Hypertension: pathophysiology, diagnosis and management. 2end ed. New York: Raven Press 1995;273-81

Strazzullo P., D’Elia L., Kandala N. and Cappuccio F.P. Salt intake, stroke, and cardiovascular disease: meta-analysis of prospective studies. BMJ 2009;339:b4567 doi:10.1136/bmj.b4567

Tzoulaki I., Brown I.J., Chan Q., Van Horn L., Ueshima H., Zhao L., Stamler J., Elliott P., for the International Collaborative Research Group on Macro-/Micronutrients and Blood Pressure. Relation of iron and red meat intake to blood pressure: cross sectional epidemiological study. BMJ 2008;337:a258 doi:doi:10.1136/bmj.a258

Weinberger M.H. The effects of sodium on blood pressure in humans. In: Laragh JH, Brenner BM, eds. Hypertension: pathophysiology, diagnosis and management. 2end ed. New York: Raven Press 1995;2703-14.

Writing Group of the PREMIER Collaborative Research Group. Effects of comprehensive lifestyle modification on blood pressure control: main results of the PREMIER Clinical Trial. JAMA 2003;289:2083-2093. doi:10.1001/jama.289.16.2083

World Health Organization, International Society of Hypertension Writing Group. 2003 World Health Organization (WHO)/International Society of Hypertension (ISH) statement on management of hypertension. Guidelines and recommendations. J Hyperten 2003;21:1983-92.

Green tea benefits for health

Tea drinking, particularly green tea, has always been associated, at least in East Asia cultures (mainly in China and Japan) with health benefits. Only recently, the scientific community has begun to study the health benefits of tea consumption, recognizing its preventive value in many diseases.

Benefits in preventing cancer

Several epidemiological and laboratory studies have shown encouraging results with respect to possible preventive role of tea, particularly green tea and its catechins, a subgroup of flavonoids (the most abundant polyphenols in human diet) against the development of some cancers like:

  • oral and digestive tract cancers;
  • lung cancer among those who have never smoked, not among smokers.

Tea polyphenols, the most active of which is epigallocatechin-3-gallate (EGCG), seem to act not only as antioxidants, but also as molecules that, directly, may influence gene expression and diverse metabolic pathways.

Green tea and cardiovascular disease

Cardiovascular disease is the main cause of deaths worldwide, particularly in low- and middle-income countries, with an estimate of about 17 million deaths in 2008 that will increase up to 23.3 million by 2030.
Daily tea consumption, especially green tea, seems to be associated with a reduced risk of developing cardiovascular disease, such as hypertension and stroke.
Among the proposed mechanisms, the improved bioactivity of the endothelium-derived vasodilator nitric oxide (NO), due to the action of tea polyphenols that enhance nitric oxide synthesis, and/or decrease superoxide-mediated nitric oxide breakdown seem to be important.

Green tea and antioxidant properties

Tea polyphenols may act, in vitro, as free radical scavengers.
Since radical damage plays a pivotal role in the development of many diseases such as atherosclerosis, rheumatoid arthritis, cancer, or in ischemia-reoxygenation injury, tea polyphenols, particularly green tea catechins, may have a preventive role.

Benefits in weight loss and weight maintenance

Green tea, but also oolong tea, that is, catechins and caffeine rich teas, has a potential thermogenic effect. This has made them a potential tool for:

  • weight loss, by increasing energy expenditure and fat oxidation;
  • weight maintenance, ensuring a high energy expenditure during the maintenance of weight loss.

Indeed, it has been shown that green tea and green tea extracts are not an aid in weight loss and weight maintenance, since:

  • they are not able to induce a significant weight loss in overweight and obese adults;
  • they are not helpful in the maintenance of weight loss.

Green tea and preventing dental decay

Animal and in vitro studies have shown that tea, and in particular its polyphenols, seems to possess:

  • antibacterial properties against pathogenic action of cariogenic bacteria, as Streptococcus mutans, particularly green tea EGCG;
  • inhibitory action on salivary and bacterial amylase (it seems that black tea thearubigins and theaflavins are more effective than green tea catechins);
  • it is able to inhibit acid production in the oral cavity./li>

All these properties make green tea and black tea, beverages with potential anticariogenic activity.

References

Arab L., Khan F., and Lam H. Tea consumption and cardiovascular disease risk. Am J Clin Nutr 2013;98:1651S-1659S doi:10.3945/ajcn.113.059345

Dwyer J.T. and Peterson J. Tea and flavonoids: where we are, where to go next. Am J Clin Nutr 2013;98:1611S-1618S doi:10.3945/ajcn.113.059584

Goenka P., Sarawgi A., Karun V., Nigam A.G., Dutta S., Marwah N. Camellia sinensis (Tea): implications and role in preventing dental decay. Phcog Rev 2013;7:152-6 doi:10.4103/0973-7847.120515

Grassi D., Desideri G., Di Giosia P., De Feo M., Fellini E., Cheli P., Ferri L., and Ferri C. Tea, flavonoids, and cardiovascular health: endothelial protection. Am J Clin Nutr 2013;98:1660S-1666S doi:10.3945/ajcn.113.058313

Hursel R. and Westerterp-Plantenga M.S. Catechin- and caffeine-rich teas for control of body weight in humans. Am J Clin Nutr 2013;98:1682S-1693S doi:10.3945/ajcn.113.058396

Hursel R., Viechtbauer W. and Westerterp-Plantenga M.S. The effects of green tea on weight loss and weight maintenance: a meta-analysis. Int J Obesity 2009;33:956-961 doi:10.1038/ijo.2009.135

Jurgens T.M., Whelan A.M., Killian L., Doucette S., Kirk S., Foy E. Green tea for weight loss and weight maintenance in overweight or obese adults. Editorial group: Cochrane Metabolic and Endocrine Disorders Group. 2012:12 Art. No.: CD008650 doi:10.1002/14651858.CD008650.pub2

Lagari V.S., Levis S. Phytoestrogens for menopausal bone loss and climacteric symptoms. J Steroid Biochem Mol Biol 2014;139:294-301 doi:10.1016/j.jsbmb.2012.12.002

Lambert J.D. Does tea prevent cancer? Evidence from laboratory and human intervention studies. Am J Clin Nutr 2013;98:1667S-1675S doi:10.3945/ajcn.113.059352

Lethaby A., Marjoribanks J., Kronenberg F., Roberts H., Eden J., Brown J. Phytoestrogens for menopausal vasomotor symptoms. Cochrane Database Syst Rev 2013:10;12 Art. No.: CD001395 doi:10.1002/14651858.CD001395.pub4

Levis S., Strickman-Stein N., Ganjei-Azar P., Xu P., Doerge D.R., Krischer J. Soy isoflavones in the prevention of menopausal bone loss and menopausal symptoms: a randomized, double-blind trial. Arch Intern Med 2011:8;171(15):1363-9 doi:10.1001/archinternmed.2011.330

Lorenz M. Cellular targets for the beneficial actions of tea polyphenols. Am J Clin Nutr 2013;98:1642S-1650S doi:10.3945/ajcn.113.058230

Sharma V.K., Bhattacharya A., Kumar A. and Sharma H.K. Health benefits of tea consumption. Trop J Pharm Res 2007;6(3):785-792.

Yang Y-C., Lu F-H., Wu J-S., Wu C-H., Chang C-J. The protective effect of habitual tea consumption on hypertension. Arch Intern Med 2004;164:1534-1540 doi:10.1001/archinte.164.14.1534

Yuan J-M. Cancer prevention by green tea: evidence from epidemiologic studies. Am J Clin Nutr 2013;98:1676S-1681S doi:10.3945/ajcn.113.058271

Human health and carotenoids

Carotenoids belong to the category of bioactive compounds taken up with diet, that is, molecules able to provide protection against many diseases such as cardiovascular diseases, cancer and macular degeneration. They are also important for the proper functioning of the immune system.
Among the mechanisms that seem to be at the basis of their human health-promoting effects have been reported (Olson, 1999, see References):

  • the capability to quench singlet oxygen (see above);
  • the scavenging of peroxyl radicals and reactive nitrogen species;
  • the modulation of carcinogen metabolism;
  • the inhibition of cell proliferation;
  • the enhancement of the immune response;
  • a filtering action of blue light;
  • the enhancement of cell differentiation;
  • stimulation of cell-to-cell communication

Carotenoids and antioxidant activity

Carotenoids, with the adaptation of organisms to aerobic environment, and therefore to the presence of oxygen, have offered protection against oxidative damage from free radicals, particularly by singlet oxygen, a powerful oxidizing agent (see also below).
Carotenoids stabilize singlet oxygen acting both chemical and physical point of view:

  • chemical action involves the union between the two molecules;
  • in physical action, the radical transfers its excitation energy to the carotenoid. The result is a low energy free radical and an excited carotenoid; later, the energy acquired by the carotenoid is released as heat to the environment, and the molecule, that remains intact, is ready to carry out another cycle of stabilization of singlet oxygen, and so on.
Human health and carotenoids
Fig. 1 – Free Radical

The capability of carotenoids to quench singlet oxygen is due to the conjugated double-bond system present in the molecule, and the maximum protection is given by those molecules that have nine or more double bonds (moreover, the presence of oxygen in the molecule, as in xanthophylls, seems to have a role).
Carotenoids are involved not only in singlet oxygen quenching, but also in the scavenging of other reactive species both of oxygen, as peroxyl radicals (therefore contributing to the reduction of lipid peroxidation) and nitrogen. These reactive molecules are generated during the aerobic metabolism but also in the pathological processes.

Lycopene, xanthophylls and human health

Lycopene, a carotene, canthaxanthin and astaxanthin, two xanthophylls present in foods of animal origin, are better antioxidants than beta-carotene but also than zeaxanthin that, with lutein, is involved in prevention of age-related macular degeneration.
Lycopene, in addition to act on oxygen free radicals, acts as antioxidant also on the radicals of vitamin C and vitamin E, that are generated during the antioxidant processes in which these vitamins are involved, “repairing them”.
Finally, lycopene exerts its antioxidant action also indirectly, inducing the synthesis of enzymes involved in the protection against the action of oxygen free radicals and other electrophilic species; these enzymes are quinone reductase, glutathione S-transferase and superoxide dismutase (they are part of the enzymatic antioxidant system).

Vitamin A and human health

Vitamin A, whose deficiency affects annually more than 100 million children worldwide, causing more than a million deaths and half million cases of blindness, is a well-known carotenoid derivative with many biological actions, being essential for reproduction, growth, vision, immune function and general human health.
In the human diet, the major sources of vitamin A are the preformed vitamin, which is found in foods of animal origins (meat, milk, eggs, etc), and provitamin A carotenoids, present in fruits and vegetables. In economically deprived countries, fruits and vegetables are the main source of vitamin A being less expensive than food of animal origin.
Of the more than 750 different carotenoids identified in natural sources, only about 50 have provitamin A activity, and among these, beta-carotene (precisely, all-trans-beta-carotene isomer) is the main precursor of the vitamin A.
Among the other carotenoids precursors of vitamin A, alpha-carotene, gamma-carotene, beta-cryptoxanthin, alpha-cryptoxanthin, and beta-carotene-5,6-epoxide have about half the bioactivity of beta-carotene.

Human health and vitamin A
Fig. 2 – Provitamin A Activity

Spinach, carrots, pumpkins, sweet potatoes (yellow) are example of vegetables rich in beta-carotene and other provitamin A carotenoids.
Acyclic carotenes, such as lycopene (the main carotenoid in the human diet), and xanthophylls, except those mentioned above (beta-cryptoxanthin, alpha-cryptoxanthin, and beta-carotene-5,6-epoxide), cannot be converted to vitamin A.

References

de la Rosa L.A., Alvarez-Parrilla E., Gonzàlez-Aguilar G.A. Fruit and vegetable phytochemicals: chemistry, nutritional value, and stability. 1th Edition. Wiley J. & Sons, Inc., Publication, 2010

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