Finding Heart Health in Fruit Extracts
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Apples, pomegranates, and Bergamot citrus for cardiovascular health
“An apple a day keeps the doctor away,” my nephew sings before biting into the honey crisp he’s holding. “But…” he thinks as he chews and then clarifies to me, his doctor-auntie, “I don’t want you to go away.”
Where did he learn the saying about an apple a day? Where did I, for that matter? Probably from the same place where we learned the golden rule about doing unto others, and that a stitch in time saves nine. And, as it turns out, apples are indeed of value to our health, especially when it comes to cholesterol and heart health.
While most if not all plant-based foods are part of a healthy lifestyle, two other fruits in particular are worth mentioning when it comes to cardiovascular health: pomegranate and Bergamot citrus.
Let’s take a closer look at these tasty – and heart healthy – wonder fruits:
Although they aren’t particularly rich in vitamins and minerals (other than vitamin C), apples nevertheless contain potent therapeutic value in the form of polyphenols, a type of phytonutrient. Much like those found in green tea and grape seed extract, the polyphenols in apples are well known for their antioxidant, detoxifying, and cancer-preventative benefits.,,,
Much like those found in green tea and grape seed extract, the polyphenols in apples are well known for their antioxidant, detoxifying, and cancer-preventative benefits.
Apple polyphenols have been shown to trigger a domino of antioxidant effects by activating Nrf2, a protein responsible for detoxification, glutathione synthesis, and other antioxidant functionality., In fact, in vitro studies suggest that apple extracts (high in polyphenols) have a significant antioxidant potential – with only 0.4% of the effect coming from vitamin C. This is likely why apple polyphenols have been shown to support cardiovascular health and fight the oxidation of low-density lipoprotein (LDL) cholesterol (which contributes to fatty plaques formation in the arteries),,,
Apple polyphenols not only reduce the oxidation of cholesterol, but also help reduce the overall levels of harmful types of cholesterol – in other words, they optimize both the quality and the quantity of cholesterol in the bloodstream. Specifically, animal studies have shown that apple polyphenols reduce cholesterol production, limit cholesterol transport, and facilitate the fecal excretion of cholesterol and its oxidation products.,, Improvements in cholesterol balance with supplementation of apple polyphenols also have been observed in humans. In a randomized, double-blind, placebo controlled (RDBPC) study, healthy adults with slightly elevated cholesterol levels were given apple polyphenols at a dosage of 300, 600, or 1,500 mg per day for four weeks. Apple polyphenols were shown to reduce total cholesterol levels in a dose-dependent manner and to significantly decrease LDL (aka “bad cholesterol”) at higher dosages. In another RDBPC study, overweight individuals in otherwise good health were given apple polyphenols at a dosage of 600 mg/day for 12 weeks. These individuals were found to have significantly lower total cholesterol and LDL levels compared to their baseline, with a significant reduction seen as quickly as four weeks after the start of supplementation. Decreases in visceral fat (the deep fat that surrounds the organs) and body weight were also seen.
As a new apple grows on a tree, the polyphenols it contains offer protection against ultraviolet radiation and harmful bacteria. It’s likely for this reason that the total polyphenol content of an unripe apple is 10 to 100 that of a ripe one. Given the thin skin of apples, it’s also important to go with products derived from sources free of pesticides, herbicides, and fungicides. Apples are often high on the Environmental Working Group’s list of the “Dirty Dozen,” a ranking of fruits and vegetables highest in pesticide contaminations. For this reason, it’s likely worth the extra effort to choose organic when shopping for apples.
Epidemiological evidence correlates apple consumption with a decreased risk of lung cancer, chronic obstructive pulmonary disease (COPD), asthma, type 2 diabetes, cardiovascular disease, coronary mortality, thrombotic stroke in women, and possibly coronary heart disease in men. Although eating apples is indeed an effective way to give the body a healthy dose of polyphenols, taking polyphenols in supplemental form is another easy way to boost polyphenol intake.
Named for the city of Punica, the “punic apple” – or pomegranate, as we call it today – has been consumed as far back as the early Green and Roman civilizations. To this day the fruit carries the Latin name of Punica granatum.
Like the apple, the pomegranate is rich in polyphenols, delivering potent antioxidant functionality to the body. Pomegranate consumption has been shown to protect against cellular changes that can lead to cancer, slow the proliferation of cancer cells,, retard the progression of chronic inflammatory diseases (including autoimmune and neurodegenerative diseases), and improve metabolic dysfunction in adults and children alike.,,,
Consumption of pomegranate extract has also been shown to improve several markers of cardiovascular health.
Consumption of pomegranate extract has also been shown to improve several markers of cardiovascular health. In patients with a history of heart attack taking the indicated pharmaceutical medications, 300 mg of pomegranate extract (containing 30% punicalagins, a type of polyphenol) taken twice daily for four weeks yielded significantly greater improvements in triglycerides, total cholesterol, LDL, high-density lipoprotein (HDL) (aka “good cholesterol”), and non-HDL cholesterol levels than seen in those who only took pharmaceuticals. The pomegranate group also experienced significantly greater reductions in oxidized LDL cholesterol, homocysteine, and high sensitivity C-reactive protein (hs-CRP) levels. Of the patients in the study who also had type 2 diabetes, significant improvements in blood sugar and hemoglobin A1c levels were also observed. Other clinical studies have reported similar outcomes,,, and yet other studies have shown pomegranate juice and/or its extracts to lower blood pressure,,, and decrease carotid intima media thickness (CIMT) – a marker of coronary heart disease risk – by up to 30%.48
Although most of us wouldn’t be able to identify a Bergamot orange in the market, we might nevertheless recognize its bright, floral fragrance rising from a cup of Earl Grey tea. In fact, the fragrance of Bergamot citrus has been shown to lift mood, lower cortisol, and reduce fatigue,, which has lead researchers to wonder if it could be a non-pharmacological therapy for anxiety.
The fruit of Bergamot citrus has also been studied for its heart health benefits, especially with respect to cholesterol levels. As with the other fruits explored above, Bergamot citrus peel and juice are rich in polyphenols.,, Conjugates of these polyphenols are structurally similar to statins (the pharmaceutical drugs used to lower cholesterol levels), and have been shown to work in a similar fashion. Because statin medications come with a slew of unpleasant side effects, however, researchers are eager to find natural therapies that can be used in conjunction with or in lieu of these drugs.
In an open-label, parallel group, placebo-controlled study, patients were randomized to receive one of the following treatments for 30 days: (a) placebo, (b) rosuvastatin (a statin drug) at a dosage of 10 or (c) 20 mg/day, (d) 1,000 mg of Bergamot polyphenols (BPs) a day, or (e) 1,000 mg of BPs plus 10 mg of rosuvastatin. The findings of this study were quite compelling: both rosuvastatin and BPs were observed to significantly reduce both total and LDL cholesterol and increase HDL cholesterol. A combination of 10 mg of rosuvastatin and 1,000 mg of BPs had an effect similar to 20 mg of rosuvastatin alone. Interestingly, treatment with BPs (both alone and in combination with rosuvastatin) significantly reduced triglyceride levels – almost twice as effectively as either dosage of rosuvastatin alone. In other words, when it came to triglyceride levels, BPs outperformed the statin drug.
Treatment with Bergamot polyphenols (both alone and in combination with rosuvastatin) significantly reduced triglyceride levels – almost twice as effectively as… rosuvastatin alone.
Triglycerides are often elevated in those with diabetes and pre-diabetes. Understanding that high cholesterol and high blood sugar often go hand-in-hand, this effect on triglycerides might make BPs a wise choice for those battling high blood sugar who also have high cholesterol levels. This is further supported by the findings of the animal studies in which BPs were shown to fight insulin resistance and fatty liver.,
In those unable to tolerate the side effects of statins, 1,500 mg of BPs daily taken for 30 days resulted in a 25% reduction in total cholesterol and a 27.6% reduction in LDL cholesterol, without the recurrence of any statin-related side effects. These findings suggest that BPs may help lower cholesterol levels sufficiently enough to allow individuals to either lower their statin dose or avoid statins altogether.
BPs may help lower cholesterol levels sufficiently enough to allow individuals to either lower their statin dose or avoid statins altogether.
Even lower doses of bergamot extract may significantly support healthy cholesterol levels. In a study of adults with moderately high cholesterol, supplementation with 400 mg of Bergamot extract (providing 150 mg BPs per dose) taken daily for six months lead to significant reductions in both total and LDL cholesterol – 12% and 20%, respectively. BPs also dropped triglyceride levels by up to 17% and increased HDL cholesterol by up to 8%.
Although citrus is typically a health-friendly food, it’s worth noting that citrus extracts naturally contain furocoumarins, compounds that can affect the body’s metabolism of certain medications. This is why pharmacists often recommend that patients avoid drinking grapefruit juice while taking pharmaceutical drugs. Furocoumarins can also make the skin more sensitive to sunlight, thereby increasing the chance of rash or burn with sun exposure. For this reason, it’s a good idea to purchase Bergamot (and other citrus) products from companies that remove furocoumarins in the manufacturing process.58
Natural foods yet again save the day. As drug companies race to develop new drugs, the healing power we seek might just come from a source as simple, nourishing, and tasty as, well, fruit salad. Given the limited availability of certain fruits year round and the chemicals often used in the food industry, however, supplemental extracts might be the next best thing. And they certainly carry fewer side effects than what we might find at the pharmacy.
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Dr. Erica Zelfand
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