Heart Health

 

Introduction
Cardiovascular disease is still the UK’s biggest killer with over 200,000 people dying each year. Perhaps even more importantly, data from the 2003 Health Survey for England set the level of coronary heart disease - angina or heart attack - at around 7.4% in men and 4.5% in women (8% and 6% respectively for Scotland). 

Furthermore, cardiovascular disease is one of the major causes of premature deaths, representing 31% of deaths before the age of 75 in men and 23% in women. (British Heart Foundation)
 
The good news is that experts estimate that about 80% of premature heart disease is preventable by diet and lifestyle management. The major diet and lifestyle measures which can be taken to reduce the risk of heart disease and promote heart health are listed below: 
  • Stop smoking.
  • Increase exercise level to approximately 30 minutes 3-5 times per week.
  • Maintain weight within the normal range. 
  • Keep alcohol consumption at moderate levels of less than 20 units per week.
  • Maintain a balanced diet with plenty of fruit and vegetables and with a maximum of 30% of calories as fat – this is about 70g per day of total fat for women and 80g per day for men.  
In addition to the above, there is now substantial evidence that some nutrients have specific benefits in helping to prevent heart disease. These nutrients are normally undersupplied in the typical UK diet and as such the possibility of supplementation of these nutrients is an option worthy of consideration.  
 
A brief review of the nutrients which have specific heart health benefits are outlined below. They have been divided into those where there is substantial evidence of benefit and those where benefits have less proof.  
 
 
Nutrients with substantial evidence of benefit:
  • Omega-3 (Fish and Cod Liver Oils)
  • Plant Sterols
  • Fibre
 
Nutrients with some evidence of benefit:
  • Vitamin C and E
  • Vitamin B12 and Folic acid
  • Garlic
  • CoQ10
  • Policosanol
 

Nutrients with Substantial Evidence of Benefit

 
OMEGA-3 (FISH AND COD LIVER OILS)
These are probably the most well established and most proven nutrients in helping to improve heart health. Research across many population groups has shown that lowered risk of heart disease and improved heart health occurs as a result of increased consumption of fish containing omega-3s. Trials of specific fish oils have also shown consistent benefits.
  
The nutrients in fish and cod liver oils which are responsible for the benefits to heart health are the omega-3s, EPA and DHA.  Our total intake of EPA and DHA combined, either from diet and/or supplements needs to be a minimum of 450mg per day - with increasing benefits likely as intakes rise to about 2g per day.
 
As a guideline, unless you are eating at least two large portions of oily fish twice per week you will not be reaching the minimum intake and therefore supplementation is an option worth considering.
   
 
 
PLANT STEROLS
One of the major risk factors in heart health is elevated cholesterol level. Plant sterols which are found in small amounts in olive, sunflower and other plant oils, have been consistently found to lower cholesterol levels by preventing its absorption from the intestine, including that which is recycled in the bile. This unabsorbed cholesterol is then eliminated via the bowel.
  
Numerous trials have now shown that levels between 1-2g per day can lower levels of the harmful LDL-cholesterol by between 10 and 18%. Given that our average intake from dietary sources is only between 178mg and 463mg, there is a potential benefit of bridging this gap by supplementation. Although not yet particularly common or well known it is likely that more plant sterol containing products will be introduced in the near future.
   
 
 
FIBRE
Increased dietary fibre has a positive impact of cardiovascular as well as digestive health. These benefits are mainly associated with the viscous type of soluble fibre found in vegetables, fruits and some grains such as oats.
The benefits on heart health mainly arise from increased intakes of fibre reducing blood levels of both cholesterol and total fats. For example in one major analysis of 20 different trials it was found that as intake of soluble fibre increased so the level of cholesterol in the blood decreased, with reductions in cholesterol of up to 15% being achievable.   
  
Similarly, other trials have shown the benefits of increased fibre intake on individuals with type 2 diabetes.
Our recommended total fibre intake should be around 25- 30g per day but in the UK the average intake is only about 12-14g. Hence, to achieve the type of benefits outlined above in heart health it is normally necessary to increase intake by a minimum of 5g/day.
Some of the new fibre products on the market supply this level of soluble fibre and are worth considering in a diet designed to help maintain heart health. Finally, the heart health benefits associated with increased fibre intake will require a supplementtion period of at least 3 months to be measurable and then indefinite further supplementation to maintain these benefits.    
 
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Nutrients with Some Evidence of Benefit

 
VITAMINS C AND E
Vitamins C and E operate largely as powerful antioxidants in the body, neutralising harmful ‘free radicals’ which can disrupt cell function and eventually damage our cells if allowed to accumulate. 
 
There is strong evidence that the ‘furring up’ of arteries that causes most heart attacks involves the participation of ‘free radicals’ and that this process may be offset by greater intake of antioxidants particularly vitamin C, E and CoQ10.
 
However, when these vitamins have been supplemented in trial conditions only some have been shown to be positive, whilst others have provided little effect.
 
The advice of the SC panel is that although the RDA values of vitamins C and E are 60mg and 10mg respectively it may be possible to increase potential benefits, particularly for heart health, by raising intake levels upto 500mg and 200mg respectively.
  
 
FOLIC ACID, AND VITAMINS B6 AND B12
Elevated blood levels of an amino acid called homocysteine is known to be an independent risk factor for cardiovascular disease, and by lowering levels of homocysteine that risk is reduced.
 
Increasing intake of folic acid and vitamin B12 and to a lesser extent vitamin B6 has been shown in numerous trials to significantly lower homocysteine. In one large trial it was estimated that long term intake of 1000mcg of folic acid per day prevented elevation of homocysteine.      
 
As such, the SC guideline is that an intake of 1000mcg of folic acid and a minimum of 50mcg of vitamin B12 over the long term should be considered as sufficient to help control homocysteine levels.
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GARLIC
Garlic has been used for thousands of years as an anti-infective, but recently more interest has been shown in its´ potential ability to improve heart and circulatory health. There is now a consistent level of evidence which shows that garlic has moderate ability in:
  •  lowering cholesterol level
  •  reducing blood pressure
  •  promoting blood thinning
 
In attempting to achieve these effects, products at their daily recommended dosage should deliver a minimum of 10mg of alliin, which is equivalent to 4mg of allicin. This in turn is equivalent to approximately 4g of fresh garlic (approximately 2 cloves).
 
 
 
COENZYME Q10                                                 
CoQ10 is found in all cells of the body, and is critical in the generation of energy and as a very important antioxidant.
 
Several studies have found that CoQ10 status is lowered in people with heart disease and additionally there is some but not conclusive evidence that supplementation with CoQ10 may be helpful in people with heart disease and hence may be useful in maintaining heart health. It is considered by the SC expert panel that the minimum daily level of CoQ10 supplementation necessary to potentially assist in heart health is 20mg. It is likely that supplementation at this level for a minimum of 4 months would be required to deliver the expected benefits in heart health.
POLICOSANOL
Like plant sterols, policosanol is a normal substance found in many plants. Some recent research has shown that policosanol may have effects in improving cholesterol balance by increasing levels of the good type of cholesterol called HDL cholesterol. However, the quantity of research is not nearly as great and the evidence is not as convincing as some of the other nutrients mentioned above.
 
As such, more evidence needs to be accumulated before an unequivocal positive statement can be made. Overall, this would be a worthy addition to a heart health product, only if the more compelling nutrients are provided first. The evidence which exists suggests that between 10-20mg of policosanol per day is required to provide the expected improvement in cholesterol balance.