As Trust Transparency Center’s Len Monheit and Scott Steinford forecast in their Tracking Transparency column, the term co-morbidity entered consumer lexicon in 2020 and will continue to influence behavior in 2021. “Brands and retailers that position around that concept,” they predict, “will do well in 2021 and beyond.”
That’s in addition to the fact that cardiovascular disease (CVD) is the world’s number one health threat, as Trisha Sugarek MacDonald, BS, MS, Sr. Director of R&D at Bluebonnet Nutrition, points out. “Cardiovascular disease, a variety of conditions that affect the heart—from infections to genetic defects and blood vessel diseases—can be prevented with healthy lifestyle choices, yet it is the world’s number one health threat. As the Baby Boomer generation continues to age—416 boomers turn 65 every hour—it is no wonder that heart health has been a considerable candidate for debate.”
Consumers, Sugarek MacDonald says, are becoming more knowledgeable about risk factors associated with heart health—everything from diet and exercise levels to lipoprotein profiles and homocysteine levels. Rather than just general one-a-day formulas, people are looking to take control of their heart health through lifestyle changes and the use of condition-specific formulas for blood pressure, cholesterol, antioxidant replenishment, and synthesis of prostaglandins (hormone-like substances that affect inflammatory responses).
Citing the International Food and Information Council and the Council for Responsible Nutrition, Pam Stauffer, Global Marketing Programs Manager at Cargill, expands on that point: “Not surprisingly, Americans are concerned about heart disease. Among consumers looking for health benefits from foods, heart health is one of the most sought-after benefits, ranking fourth behind weight management, energy, and digestive health. Similarly, heart health is a priority for supplement users, too. In its 2019 survey, CRN found nearly a quarter of supplement users sought heart health benefits.”
While it’s fair to say that exercise and managing stress levels are two major factors in heart health, Neil E. Levin, CCN, DANLA, Senior Nutrition Education Manager for NOW, notes: “Research shows that more than half of all sudden deaths from cardiovascular incidents—heart attacks and strokes—cannot be predicted or explained on the basis of known heart disease risk factors and established criteria such as blood pressure, serum cholesterol, smoking, weight, and ECG abnormalities. What else is happening that modern cardiology can’t explain with all of its advanced tools? Nutritional status!” There’s plenty of evidence supporting this view, much of which is noted below.
The Fat You Can’t See
While weight is often cited as a risk factor, Holtby says that the issue is more nuanced. “It is not just the amount of fat that is important but also the type of fat. In fact, reducing the fat you can’t see, called visceral fat, may be more important than overall lean body mass for reducing the risk of certain chronic health conditions.”When people gain weight, the location of the fat deposits makes a difference. Fat around the abdomen (central obesity) and internal organs (visceral fat) leads to an increased secretion of hormones and chemicals including pro-inflammatory cytokines, resulting in increased oxidative stress and inflammation, leading to increased insulin production and insulin resistance. The best way to reduce proinflammatory cytokines is by restoring a balance between pro- and anti-inflammatory foods—Holtby suggests olive oil and unprocessed foods like chicken, salads, and steamed vegetables—and ingesting extra antioxidant foods and supplements to offset years of damage.
Nutrients the Heart Loves
This category is expansive, but our experts narrowed the list down to highlight several science-backed standouts.Aronia: “For consumers looking for natural alternatives or adjuncts to their heart-health options, aronia berry (Aronia melanocarpa), also known as chokeberry, has earned a spot among the top options for cholesterol and blood pressure concerns,” says Bush. “In addition to its established antioxidant capacity and healthy circulation-promoting qualities, a recent meta-analysis—Hawkins et al., 2020—concluded that daily supplementation with a high quality aronia berry product has a significant reduction effect on systolic blood pressure and total cholesterol. Supplementation with aronia berry for a period of six to eight weeks is sufficient to produce a significant reduction in these markers, with stronger effects found among adults over the age of 50. The normalizing and targeted effects of aronia berry suggests applications that are very relevant to today’s heart health consumer.” The fact that heart health is such a concern right now, too, puts aronia in a good position to find popularity amongst consumers, Bush opines.
Berberine: Berberine is an essential nutrient for heart and metabolic health, according to EuroPharma’s Cheryl Myers, Chief of Scientific Affairs and Education. She explains that berberine has been shown in clinical trials to lower blood pressure, reduce triglycerides, reduce fasting plasma insulin, drop the insulin resistance index by 44%, and reduce overall blood sugar levels—all, Myers adds, without side effects. That said, it has a downside: “It is difficult for the body to absorb and use berberine effectively. That’s why you often see such high dosage levels—about 1,500 mg daily—for the nutrient. It takes that much to overcome absorption barriers. Even then, it’s estimated that only about 5% of any given dosage of berberine actually makes it into the bloodstream. Our Berberine MetX Ultra Absorption makes use of an enhanced delivery system—gamma-cyclodextrin—that has been shown to boost the absorption of multiple nutrients.” Terry Naturally/EuroPharma uses the same delivery system in its CoQ10 Chewable.
Coenzyme Q10: “CoQ10 has been shown to increase the ejection fraction of the heart in people who have a low ejection fraction,” says Raj Chopra, Co-founder and CEO of Tishcon. “It is also critical in the production of ATP, which is a high energy molecule—it provides energy to every cell in the body to keep us alive, and it has to be produced continuously 24 hours a day.” ATP is necessary to keep the heart pumping. Chopra also notes that we lose the ability to convert CoQ10 into ubiquinol—the active form—as we age, making it an attractive supplement for an older consumer base. Chopra and Jay Cook, VP, Sales, at Tishcon, advise retailers to make bioavailability a point of differentiation in this ingredient: “Selling heart products will be about telling the absorption story on CoQ10… although CoQ10 is a terrific ingredient, the problem is it has poor bioavailability. Consumers should look for brands that have put it into a highly absorbable state.”
Garlic: Aged Garlic Extract (AGE) has many benefits for heart health, according to Jay Levy, Director of Sales, Wakunaga of America, which offers Kyolic Aged Garlic Extract. “These benefits are a direct result from a unique aging process that promotes the heart-healthy compounds found in garlic while also eliminating garlic’s odor and harsh side effects. The resulting AGE has been the subject of more than 870 peer-reviewed published papers showing its abilities to lower cholesterol, normalize blood pressure, promote healthy blood flow, increase adiponectin levels, slow coronary artery calcification, reduce oxidative stress, and discourage the buildup of plaque in arteries.” Levy adds that Wakunaga offers Omeg-A-G-E, which combines AGE with Friend of the Sea-certified omega-3 fatty acids.
Glucosamine + Chondroitin: This combination has benefits beyond joint health, says Jolie Root, Senior Nutritionist and Educator, Carlson. “A fascinating paper drawn from the National Health and Nutrition Examination Survey from 1999 to 2010 has shown that people who reported using glucosamine/chondroitin supplements daily enjoy some important benefits. After controlling for confounding factors including participants’ age, sex, smoking status, and activity level, the research found that taking glucosamine/chondroitin every day for a year or longer was associated with a 39% reduction in all-cause mortality. It was also linked to a 65% reduction in cardiovascular related deaths. That’s a category that includes deaths from stroke, coronary artery disease, and heart disease.”
Magnesium: “Studies show an association between intravenously administered magnesium supplementation during the first hour of admission for myocardial infarction and decreases in morbidity and mortality,” said Hank Cheatham, VP of Daiwa Health Development. “The multiple physiological and cardio-protective activities of magnesium include antiarrhythmic effects, calcium channel-blocking effects, improvement in Nitric oxide release from coronary endothelium, and inhibition of blood coagulation.”
To this, Levin adds: “In the Nurses’ Health Study of 88,375 women followed for 26 years, the incidence of sudden cardiac death was 77% lower in those with the highest serum magnesium levels versus the lowest quartile.” Magnesium’s many benefits—and clear heart health benefits—may make this a no-brainer for your customers.
Women’s Health
SGTI’s Steve Holtby points to an important gap in knowledge: Women have different risk factors for CVD. “Most of our ideas about heart disease in women used to come from studying it in men,” Holtby explains. “Research is identifying gender differences in heart disease that may help fine-tune prevention, diagnosis, and treatment in women, by uncovering the biological, medical, and social bases of these differences. For example, many women don’t experience the crushing chest pain that is a classic symptom of a heart attack in men. Also, women have smaller and lighter coronary arteries than men do.” Holtby provided the following lists:Traditional risk factors common to both women and men:
- Obesity
- Smoking
- Diabetes
- High blood pressure
- Family history
- Metabolic syndrome – the co-existence of high blood pressure, obesity, and high glucose and triglyceride levels
- High levels of C-reactive protein – a sign of inflammatory disease that can occur along with other cardiovascular risk factors
- Relatively high testosterone levels prior to menopause
- Increasing hypertension during menopause
- Autoimmune diseases such as rheumatoid arthritis – more common in women than in men
- Stress and depression – also more common among women
- Low risk factor awareness – Lack of recognition of many of the above conditions as risk factors for heart disease is a risk factor in itself
Notoginseng: “We recently completed a three-year randomized, placebo-controlled, double-blind, parallel study on 100 healthy adults to determine the effect of Farlong NotoGinseng,” says Jing Struve, CEO and Executive Director of Farlong Pharmaceutical. “The findings demonstrated that Farlong NotoGinseng supplementation is well-tolerated and has a positive influence on risk of CVD by decreasing blood pressure and selectively increasing HDL-C. As more studies are completed, I believe natural ingredients will be used even more for both the prevention and treatment of heart health.” She added that notoginseng also helps support the neurological and muscular systems of the body, providing added value that customers want.
Nitric Oxide: Nitric oxide is a molecule naturally produced by the body, although production slows as we age. According to materials from Bionox, studies have found positive effects on the cardiovascular system from raising nitric oxide in the body, and that increase in nitric oxide is associated with increased blood flow, lowered blood pressure, and improved circulation. The company has created Bionox M3 and Bionox M3 + K2 to utilize all known nitric oxide conversion pathways.
Omega-3s: “Omega-3s have been found to be cardioprotective in a meta-analysis published in Mayo Clinic Proceedings,” says Root. “The in-depth review of 40 clinical trials affirms the importance of consuming more EPA and DHA omega-3 fats. The research concludes that EPA and DHA omega-3 intake is associated with reduced risk of CHD events and reduced risk of myocardial infarction, including fatal heart attack.”
Within this category, krill oil has been found useful. “Krill oil has been shown to have beneficial effects related to heart health, such as lowering fasting triglyceride levels, which are a risk factor for heart disease,” says Anca Vislie, Marketing Manager, Aker BioMarine Antarctic AS. “The science team at Aker BioMarine recently looked at krill oil and choline and found that krill oil is a safe, effective, and well-tolerated way to boost your necessary intake levels of choline without contributing to high plasma levels of TMAO, which is important for cardiovascular health.”
Root notes that increased dosage appears to be important here. “The researchers in the Mayo Clinic Proceedings study found that adding an extra 1000mg of EPA and DHA per day decreased the risk of cardiovascular disease and heart attack even more: Risk of CVD events decreased by 5.8% and risk for heart attack decreased by 9%. The study looked at dosages of up to 5,500mg/day.”
Consumers are aware of the importance of omega-3s, according to Cheatham. “The demand for heart health supplement products such as omega-3 is significantly high as they help in reducing risks related to cardiovascular conditions and diseases,” he says. “Omega-3 is known to impact the electrical activity in the heart in a positive manner, thus preventing uncontrolled heart beats. It further lowers the level of triglyceride in the blood.” Daiwa offers Superba 2 and Super Krill Oil, both composed of pure oil derived from Antarctic krill, which contains omega-3s, phospholipids, and antioxidants. Cheatham advises retailers to stay knowledgeable about heart health products, and notes that Daiwa responds to all retailer inquiries and provides opportunities for them to contact doctors and other healthcare practitioners who use Daiwa’s products.
Onion: “Since ancient times, people have used onions for boosting stamina and general health in India, the Middle East, and Europe, and its efficacies were also documented in numerous papers,” says Sugarek MacDonald. “According to these documents, the most promising effect of onion is that it helped with blood sugar support and cardiac and cerebrovascular health.” Bluebonnet uses an ingredient called OPtain120, a standardized extract of 50% onion and 50% pumpkin. “Pumpkin grown in Hokkaido, Japan, contains some of the most effective angiotensin-converting enzyme (ACE) inhibitory properties of any vegetable, thus lowering blood pressure,” Sugarek MacDonald continues. “Combining these two extracts enhances the ACE inhibitory activity and is proven to work together for maximum benefits. One clinical trial showed a 6% systolic drop in just 12 weeks. OPtain also helps promote the restoration of healthy endothelial function, which translates to proper blood flow and ultimately healthy blood pressure.”
Plant Sterols: Citing the CDC, Cargill’s Stauffer explains that an estimated 93 million U.S. adults age 20 or older have total cholesterol levels higher than 200 mg/dL, placing them at higher risk of heart disease. “Given the prevalence of the problem,” she says, “it’s not surprising that maintaining a healthy heart is a key concern for many consumers. Plant sterols offer consumers a safe, effective, and convenient approach to improving their LDL (good) cholesterol levels and reducing their risk of heart disease.” Plant sterols are found in many foods, but Stauffer notes that—particularly for those with a poor diet—it can be difficult to consume enough plants to have a cholesterol-lowering effect. “Cargill’s CoroWise plant sterols are a concentrated form of this plant compound that can be used to formulate products for shoppers concerned about their cardiovascular health.” CoroWise’s benefits, Stauffer adds, are supported by an FDA-approved health claim.
3 Strategies to Boost Sales
1. Cross merchandise: Sugarek MacDonald recommends cross-merchandising heart-healthy supplements with heart-healthy foods on an end cap, and rotating regularly to encourage a wider spectrum of knowledge.2. Get specific: Sugarek MacDonald also suggests dividing the heart health section into subcategories, separating out formulas for supporting homocysteine levels, blood pressure, cholesterol levels, triglyceride levels, general heart health, and a healthy weight. Holtby seconds this. “The more you can differentiate heart-health claims, the easier it is to communicate the benefits to consumers. ‘Supports heart health’ is a broad claim that still is functional in the marketplace, but ‘promotes healthy cholesterol levels’ or ‘supports healthy blood pressure’ are more specific claims that send a powerful message.” Manufacturers invest in education and clinical trials in order to get these claims across, Holtby says, recommending that retailers use those claims to help products stand out.
3. Focus on the positive: Lycored’s Ziegler advises merchandising by positive, rather than negative, terms. “In 2019, we carried out new market research in the cardiovascular health space,” he says. Besides the fact that healthy blood pressure was the top goal most people wanted to achieve, he notes that survey takers were asked: “How appealing do you find the idea of being able to ‘calm your heart’, in the same way you can ‘calm your mind’?” 95% said they found the concept either very appealing or somewhat appealing, and in the U.S., that figure was 99%. “Furthermore, over a third (35%) of consumers overall and 43% of those in the U.S. said they would be more likely to buy a CVH product if its branding or packaging included the word ‘calm.’ In other words, manufacturers of CVH products could gain from shifting their value proposition from a negative (the avoidance of risk) to a positive (the promotion of daily calm).”
And one last tip: “With so many different heart health products readily available on the shelves,” says Aker’s Vislie, “it is important for retailers to work with brands that are transparent about their products and ingredients. As transparency and openness are becoming the prerequisites in the supplement world, product traceability is essential.” Aker BioMarine is vertically integrated, and the company’s ingredients are made from wild caught Antarctic krill.Probiotics: “Researchers are escalating their clinical investigations into the links between probiotic consumption, the microbiome composition, and their effects on heart health,” says Sam Michini, VP of Marketing & Strategy, Deerland Probiotics & Enzymes. He points to new research showing cardiovascular benefits from the spore-forming probiotic Bacillus subtilis DE111: “In the study, 43 healthy adults consumed DE111 1 billion CFU daily for four weeks. At the end of the study, the researchers found that the probiotic consumption demonstrated improved endothelial function, support of healthy cholesterol levels, and a significant increase in reactive hyperemia index by 9.14%.” The mechanism of action is thought to be that DE111 accelerates production of the short-chain fatty acids propionic and butyric acid, which manage healthy cholesterol metabolism.
Also discussing the benefits of probiotics, Mike Kolifrath, VP of Kaneka Probiotics, says: “Nutritional science has developed a working knowledge on the relationship between diet and cardiovascular health. One major risk factor in the development of cardiovascular disease is the presence of elevated cholesterol, specifically oxidized cholesterol. Our scientists have researched special clinical strains of L. plantarum KABP and found them to impact blood lipids significantly as well as reduce oxidized LDL cholesterol.”
Tomato extracts: Zev Ziegler, Head of Global Brand & Marketing, Health, Lycored, points to Cardiomato, a tomato nutrient complex for heart health. “In our most recent clinical trial, researchers investigated its blood pressure-lowering effects in hypertensive subjects and found that it has beneficial outcomes for hypertensive patients. Cardiomato has also been shown to help reduce levels of LDL cholesterol and to support a healthy circulatory system.”
Looking specifically at lycopene, extracted from tomatoes, Steve Holtby, President and CEO of Soft Gel Technologies, Inc. (SGTI), which offers a lycopene ingredient, explains: “Lycopene has been the subject of a number of epidemiological studies that indicate there is an inverse relationship between blood lycopene level and cancer risk. Another study published in the journal Nutrition, Metabolism and Cardiovascular Disease has demonstrated that not only is lycopene a potent antioxidant, but that a synergistic mix of tomato phytonutrients in a similar ratio to that found in nature, renders LDL-C 90% more resistant to oxidation than LDL-C alone. Moreover, research conducted at the Soroka University Medical Center in Ben Gurion, Israel, found that a whole-tomato extract has a beneficial effect on blood lipids, lipoproteins, oxidative stress markers, in addition to lowering blood pressure at levels comparable to conventional treatment.”
Vitamins: You may tell your customers this all the time, but remind them again to take their vitamins. NOW’s Levin reels off some numbers: “The World Health Organization’s Monitoring Trends in Cardiovascular Disease Study reported that low serum levels of vitamin E predicted a heart attack 62% of the time, while high serum cholesterol predicted only 29% of the time and high blood pressure only 25% of the time. Another study followed 74,272 women and 44,592 men free of CVD and cancer at baseline and followed up to 12 years, reporting that men who had an intake of at least 600 IU of vitamin D per day had a CVD risk 16% lower than men who had an intake of less than 100 IU per day. Two study cohorts have shown significant reductions in CHD risk related to vitamin K intake, with a dose-dependent reduction in CHD risk in one study.”
Vitamin E in the form of tocotrienols stars in NOW’s Sytrinol Cholesterol Formula, intended to help maintain cholesterol and triglyceride levels. The company’s Pantethine features a bioavailable form of pantothenic acid, or vitamin B5, which helps support proper cholesterol production and fat storage processes in the liver, Levin says.
NattoPharma has two published clinical trials in healthy populations that show that a 180mcg daily dose of MenaQ7 vitamin K2 reduced arterial calcification, helping to stave off atherosclerosis, according to Elise Kaiser, VP Sales, Americas, with NattoPharma. “No other compound—drug or nutraceutical—has been shown to do this,” Kaiser said, “which is why the medical community is conducting its own trials to see if K2 could be a potential therapy for patients who express intense calcification due to their respective conditions. The results of one of those trials—VitaK-CAC, a 2-year trial in patients with coronary artery disease being given MenaQ7 in the hopes to slow the progression of coronary artery calcification—should be published in early 2021.”
Cheatham highlights vitamin B3: “High-dose niacin—nicotinic acid, or vitamin B3—is used in the treatment of hyperlipidemia and hypercholesterolemia to improve the plasma lipid profile and prevent atherosclerosis. Recent studies suggest that niacin additionally improves the vascular endothelial cell redox state, by inhibiting vascular inflammatory genes, oxidative stress, and key cytokines that are involved in atherosclerosis.” Nicotinic acid also positively affects cholesterol, Cheatham notes, and in a 2009 study improved endothelial function in patients with CHD who had low baseline HDL cholesterol.
Atherosclerosis
Atherosclerosis—the buildup of plaque inside the arteries—is gaining recognition as a cardiovascular risk marker, according to NattoPharma’s Elise Kaiser. “Over time, plaque—primarily made up of calcium—hardens and narrows the arteries. This limits the flow of oxygen-rich blood to your organs and other parts of the body,” she explains. “Atherosclerosis can affect any artery in the body, including arteries in the heart, brain, arms, legs, and kidneys. As a result, different diseases may develop based on which arteries are affected, including Coronary Heart Disease, Carotid Artery Disease, Peripheral Artery Disease, and Chronic Kidney Disease.”Dietary Dos
In addition to eating to optimize nutrients, there are some basic dietary recommendations you can give your customers.Cargill’s Stauffer points to the power of plant sterols. “The efficacy of plant sterols is supported by over 50 years of clinical research, indicating that eating plant sterols can significantly lower LDL cholesterol,” she says. “Excessive amounts of LDL cholesterol in the blood can build up on artery walls. Over time, this causes arteries to narrow, slowing or blocking blood flow to the heart. Lowering LDL cholesterol levels reduces the risk for developing heart disease and lowers the chance of heart attack. Plant sterols have been clinically shown to reduce LDL cholesterol in the body by blocking the absorption of cholesterol into the bloodstream. Consuming plant sterols as part of a healthy diet can help maintain cardiovascular health.”
These sterols can be sourced from fruits, vegetables, and grains. One notable grain: Khorasan wheat, an ancient grain that has never been modified or hybridized. On the Kamut website, Kamut.com, the company writes that Khorasan wheat is a source of magnesium, B vitamins, a variety of minerals, and anti-inflammatory polyphenols. The website also points to a 2013 study showing that Kamut products significantly reduced total cholesterol, glucose, and inflammatory cytokines, while increasing mineral levels. A 2015 study confirmed these findings, and a 2018 study found that, compared to modern wheat, Khorasan wheat improved blood pressure, triglycerides, and endothelial reactivity.
Myers notes pomegranate as another delicious choice: “Pomegranate has been shown to decrease LDL cholesterol aggregation (the clumping together of oxidized cholesterol in the arteries), lower blood pressure, and boost the activity of enzymes that protect LDL from oxidation. It has also been shown to raise levels of the antioxidant glutathione by 141% in patients with diabetes. Pomegranate also helps keep arteries flexible and strong.” She points to research published in Atherosclerosis showing that polyphenols in pomegranate inhibit angiotensin converting enzyme activity by 36%—activity that would otherwise lead to high blood pressure.
Customers should also consider lowering saturated fat intake. “Current guidelines suggest that dietary fat for a healthy adult should provide 20-35% of energy, while limiting the intake of saturated fatty acids,” says Patricia Williamson, Ph.D., Principal Scientist, Scientific & Regulatory Affairs, Cargill. “Dietary guidance to reduce saturated fatty acid intakes supports substituting with polyunsaturated fatty acids as it relates to cardiovascular health benefits. In November 2018, FDA determined there was credible evidence to support a qualified health claim that consuming oleic acid in edible oils, such as sunflower or canola oil, may reduce the risk of coronary heart disease. Edible oils must contain at least 70% oleic acid to meet the criteria for this qualified health claim.” Cargill offers high oleic sunflower oils and canola oil for use in everything from bakery to salad dressings.
Holtby recommends, if possible, a dietary overhaul incorporating the above suggestions. Noting that people have been consuming pro-inflammatory foods for years, he recommends unprocessed foods, coldwater fish, vegetables, and fruits. “A Mediterranean diet, exercise, marine lipids (a source of essential fatty acids), CoQ10 and other dietary supplements can impact oxidative stress and inflammation. Simple lifestyle factors—such as daily movement or exercise, sound dietary choices that include fresh fruits and vegetables, drinking at least eight 8-oz glasses of water every day, managing stress through meditation or focused breathing, getting enough sleep, and avoiding smoking—are some of the most powerful tools available for optimizing heart health.”
Kids' Health
Heart health isn’t just for seniors—younger customers and even kids can be thinking about heart health. A healthy diet starts at a young age. Bluebonnet’s Sugarek MacDonald points to key tactics shared by the American Heart Association:- Being a positive role model. Encouraging parents to eat healthy will encourage their children to eat healthy in turn.
- Setting aside a specific time for family dinner, which will help decrease snacking. Sugarek MacDonald adds: “Getting the kids involved in cooking and meal planning will provide time for building a stronger family unit and allow everyone to develop better eating habits.” Sharing kid-friendly recipes on social media can get kids involved in the cooking process, which can in turn make them more excited to eat their creations.
- Making a game of reading food labels, a habit that kids can carry into adulthood. In these times of concern regarding germs, an innovation like ELI codes can make this a safer practice. Hosting educational events regarding how to read labels and what to look for—in-person or virtually—can help parents and kids alike.
- Be an advocate for healthier children. Insist on good food choices in schools; promote physical activity by sponsoring local sports teams.
Looking at the Bigger Picture
Manufacturers and consumers alike are beginning to look for innovative ways of affecting heart health—while helping the rest of the body. Digestive health makes up a big part of this movement. Deerland’s Michini tells WholeFoods: “The heart and cardiovascular system are impacted and supported by nutrients and compounds conventionally used for other systems. Probiotics are a prime example of a class of nutraceuticals that have heart health benefits, and so are enzymes—stay on the lookout for branded supplements combining B. subtilis DE111 and nattokinase, an enzyme for systemic health. Nattokinase is the same as the enzyme found in natto, the popular Japanese fermented soybean curd that has been shown to support healthy blood pressure and clotting factors.”Nor are probiotics the only multifunctional product out there—Kaiser adds that cardiovascular health overlaps with bone health, as both are predicated on how the body utilizes calcium. “If one has enough vitamin K2, proteins in the body are activated—osteocalcin and matrix Gla protein (MGP), respectively—to ensure that calcium is directed to the bones while simultaneously stopping it from depositing in other parts of the body, namely the arteries and soft tissues where it can do harm.”
Kolifrath notes that customers are ready for probiotics in this area. “The fastest growth in customer engagement in the period of December 2017 to July 2020 was recorded by probiotics positioned to support cholesterol. The total number of reviews was up by 2567%. This is a clear indication that people will welcome a probiotic recommendation for heart health.”
Also in the multifunctional area, the natural equivalent of polypills is coming into fashion, according to Laetitia Petrussa, Ph.D., Technical Product Manager for IFF Health. Polypills, she explains, contain a combination of several ingredients commonly used to treat heart disease and high blood pressure. “Combining several anti-hypertensive drugs at low doses simultaneously targets multiple risk factors for the prevention of cardiovascular events and it is likely more effective and has fewer side-effects than high-dose therapy with a single drug. A growing interest in natural health solutions means consumers are looking for natural ingredients that can provide the same benefits as pharmaceutical polypills and have beneficial effects on several cardiovascular risk factors.” Thus, while condition-specific products may be more useful to those with specific concerns, Dr. Petrussa feels that those who are healthy and simply looking for overall support will go for a broader formula. “In the next couple of years, we expect a rise in strategic natural extract blends, working on even more aspects of cardiovascular protection, and leveraging these complementary actions to support cardiovascular health in a more convenient and more cost-effective way.”
Dr. Petrussa’s suggestion for this type of blend: “An ideal synergistic blend should work on supporting cholesterol reduction—or more importantly LDL cholesterol oxidation—blood pressure regulation as well as inflammation, blood clotting and endothelial function. Clinical efficiency studies will validate the effects and help determine the lowest and most convenient dosage.” IFF Health’s Benolea olive leaf extract acts on several targets of cardiovascular function, and the company’s triple Mediterranean blend CitroVen has clinically proven benefits on endothelial function, blood pressure regulation, inflammation, blood clotting, and LDL cholesterol oxidation.
Statins
If a customer is on statins, Bluebonnet’s Trisha Sugarek MacDonald suggests they talk to a doctor about having their vitamin D status assessed. The reasoning lies in the concept of cytochrome P450 (CYPs), a family of enzymes that oxidize steroids, fatty acids, and xenobiotics, They are involved in drug metabolism, and can be a source of adverse drug interactions—if one drug inhibits the CYP-mediated metabolism of another drug, the second drug may accumulate within the body and hit toxic levels. Alternatively, CYP activity can be inhibited by natural compounds such as bergamottin—found in grapefruit juice—leading to increased bioavailability and the risk of overdosing.“The first step of biotransformation for vitamin D to its active state takes place at the liver by way of CYP3A4, and so do statins,” says Sugarek MacDonald. “Therefore, naturally, it can be assumed that taking an oral vitamin D supplement, concurrently with a drug that undergoes first pass at the same site, may have some interaction.” The active form of vitamin D upregulates CYP3A4, CYP2B6, and CYP2C9 gene expression, she notes, and between the three of them they metabolize approximately 62-64% of all drugs available in the marketplace.
“Based on these elements of knowledge, it is reasonable to assume that vitamin D therapy, and subsequently, vitamin D serum levels, impact a broad range of therapeutic drugs and their overall performance, including statins. In fact, some clinical studies have found that concurrent use of vitamin D supplements with statins reduce medication plasma concentration levels, but collectively, the co-intake of these two together produces a stronger cholesterol-lowering effect, reducing the risk for morbidity and mortality from heart disease.”
Another issue for those on statins: The drug is known to reduce CoQ10 levels in the body. As statins block the synthesis of cholesterol, they also block the synthesis of CoQ10. Tishcon’s Raj Chopra explains that this makes CoQ10 “an essential micronutrient that has to be incorporated as a supplement.”
Final Takeaways
“The relationship between heart health parameters and their influence on other areas of health like immunity are more apparent now in a post-2020 world,” observes Bush. “If someone is seeking out ways to supplement their diet and get healthier overall, a healthy heart and cardiovascular system should be at the top of the list.”Cargill’s Stauffer agrees: “In recent years, concerns about cardiovascular health have been trending upward. The pandemic, which has heightened consumers’ focus on wellness and health, may well accelerate that trend. Significant media attention has highlighted the link between heart disease and worse outcomes, or even death, among COVID-19 patients. Those repeated warnings could serve as a wake-up call, bringing more Americans to the heart health category.”
When selling products and talking to consumers, Myers recommends keeping in mind that all things are connected. “Not to overwhelm potential customers, but it would be beneficial for retailers to emphasize that there are many factors to heart health that go beyond traditional blood pressure and the usual things we think about concerning heart disease. This may be an opportunity to mention how important it is to get inflammation under control—the full efficacy of the other nutrients requires it. You need to prepare the soil before you plant. So educating consumers is key. Whether you do that with in-store literature—and we would be happy to help you in that regard—with webinars or presentations, or with articles on your website, it’s important to bring everyone the knowledge they need to make heart-smart nutrient decisions.”
The final word from Wakunaga’s Levy: “Taking the extra time to listen to customers’ concerns not only helps to counteract negative information they may see in the media, it also helps to build trust with the retailer and the products they sell.” WF
