Cholesterol treatment guideline

The new Cholesterol guideline was published in November and is the result of a joint task force of the American College of Cardiology and the American Heart Association. The report was published in the journal Circulation.

Cholesterol moleculeFirst, a couple of caveats: Dietary supplements by law cannot claim to treat or prevent any illness. So to some degree, it makes sense that clinicians would not turn to them first to help patients who already have high cholesterol. Also, it should be noted that the guideline would be aimed first and foremost at specialists, who likely would be consulted only after a patient has been referred with a treatable condition.

Paucity of information on Cholesterol prevention

Nevertheless, it is telling that so little effort is spent in the guideline on discussing how to help patients to keep from crossing over the line into the treatment category, rather than spending page after page on how to fix the boat after it has sprung a leak. In the 120-page document, which includes 69 pages of actual text, only two short sections were devoted to lifestyle factors in the prevention of development of hyperlipidemia.

“Patients should consume a dietary pattern that emphasizes intake of vegetables, fruits, whole grains, legumes, healthy protein sources (low-fat dairy products, low-fat poultry (without the skin), fish/seafood, and nuts), and nontropical vegetable oils; and limits intake of sweets, sugar-sweetened beverages, and red meats,” the guideline states.

One other section of the guideline addresses prevention specifically.

“Primary prevention of ASCVD over the life span requires attention to prevention or management of ASCVD risk factors beginning early in life,” the guideline states. It then refers the reader to a table that includes one statement about encouraging a healthy lifestyle and then devotes the rest of the information on statin therapy, starting as early as age 8.

Lipid ingredients, polyphenols shown to have effects

A number of dietary ingredients have been researched for their positive effects on blood lipid profiles including lipid ingredients and many plants and fruit extracts rich in phytochemicals.

Omega-3s, for example, have been shown to have positive effects on high triglyceride levels, but the effects on LDL cholesterol specifically are less clear-cut. Levels can actually increase slightly, but the size of the LDL particles changes as well, which is a good thing. And HDL (the “good” cholesterol) goes up, too, indicating a generally positive overall trend.

Extra virgin olive oil, which is rich is some polyphenolic compounds such as hydroxytyrosol, has been suggested to benefit blood lipid profiles via a multifaceted action that includes both anti-inflammatory aspects and the promotion of cholesterol efflux. Olive is, of course, one of the main components of the Mediterranean diet, which is frequently recommended for heart health.

Drug hits one target –  supplements hit many

But this multifactorial approach doesn’t fit neatly into the mostly drug-focused paradigm of the new guideline, said James Kennedy, Ph.D. president of ingredient supplier Polyphenolics, which has a line of grape seed extracts which are among the more comprehensively researched polyphenol-based ingredients on the market.

“There is no question that statins can dramatically reduce your blood cholesterol levels,” Kennedy told NutraIngredients-USA. “They absolutely can reduce cholesterol much further than any polyphenol from a fruit or vegetable.”

“But for me it’s about lifestyle first. It just struck me as odd that here is a group concerned about our heart health and they were pretty much exclusively recommending drugs,” he said.

Kennedy said that cardiovascular disease is a multifaceted condition. Statins target one aspect of this situation and hits that nail squarely on the head. But natural ingredients, perhaps especially when offered in combination, take a more comprehensive approach to the problem.

Polyphenolics offers a line of grape seed extracts that includes MegaNatural BP, which has been researched for its effect on supporting blood pressure in the healthy range. That effect takes into account the healthy flow dynamics of the circulatory system, something that a myopic focus on cholesterol numbers glosses over.

Evidence backing many polyphenols

Grape seed extracts are just one of many polyphenol-based ingredients on the market that have been researched for their benefits in ameliorating the risk factors of CVD.

grapes are recommended in low cholesterol diets

“If you look at cardiovascular disease as a whole, a lot of polyphenols – and grape seed extract in particular – address the various areas including blood pressure and blood glucose as well as hypercholesteremia. Our industry offers a food-first approach which makes sense to consumers. They look at supplementation as a complement to everything else they are doing to address all aspects of heart disease, not just one piece of it” Kennedy said.

The entourage effect implied by the research backing polyphenols (they all appear to do slightly different things) is now starting to be borne out by research. A recent study in the journal Nutrients showed that just two weeks on a polyphenol-poor diet could alter vascular biomarkers in a group of healthy men.

And a recent review article in the journal Molecules had this to say: “Consumption of polyphenols from plant extracts and fruits increases antioxidant levels in plasma which protect vasculature and improve anti-inflammatory and lipid profiles, blood pressure, HDL-C, and vascular function.”  The review focuses on a number of polyphenols and other naturally occurring compounds, including gallic acid and punicalagin from pomegranate.

Combo products increasing in popularity

Kennedy said there is increasing interest among supplement product formulators in taking advantage of the evidence supporting the multifactorial effects of polyphenols.

“We do come into contact with customers who say they want to put together a heart health formula and want to know what they can combine our grape seed extract with,” he said.

“Recently we had a customer who wanted to combine our grape seed extract with a blueberry extract and a bergamot extract. When you go into the store you frequently see our extract in formulation with other ingredients,” Kennedy said.

The beauty of the natural approach to heart health is these ingredients can be combined with virtually no concern about antagonistic interactions, Kennedy said. Polyphenolics has continually worked on its GRAS dossier, with higher and higher dosages proven to be safe, he said.

“For the most part these are natural products and they are not known to have any cross indications. With statins, you have to dial the dose in and the patient has to be monitored very carefully.”

 

Soil health affects Nutrition Industry

soil health

Soil health as related to untangling food webs is the work of a lifetime.  That’s why it’s so difficult to predict the effect of large-scale inputs of chemicals into agricultural ecosystems.  And some of these effects don’t become apparent for decades.

Long-term effects of poor soil health

For example, the Haber/Bosch process is a little more than a century old.  This is a catalytic process, invented by German chemists in the early 1900s, by which nonreactive nitrogen—the stuff that makes up most of the atmosphere—can be converted into ammonia, the basis of chemical fertilizers.

The development was one of the most important of the industrial age, and is the mechanism by which the world’s billions are fed. Prior to this breakthrough, policymakers at the turn of the nineteenth century were looking forward to a world plagued by malnutrition and starvation. There was thought to be no way to raise agricultural production fast enough to feed the world’s rising population (about 1.6 billion in 1900) with the relatively small amount of reactive nitrogen at hand in the form of animal manure and compost.

Who could have predicted in the first bloom of the use of these nitrogen fertilizers the eventual consequences? These include oceanic dead zones utterly depleted of oxygen by rivers saturated with agricultural runoff. According to Scientific American, there were 49 such dead zones identified in coastal waters around the world in 1960. A study conducted in 2008 found there are now more than 400.

Vaclav Smil, Ph.D., a professor emeritus at the University of Manitoba in Canada, is one of the first researchers to have sounded the alarm about excessive nitrogen use.  In addition to the runoff problems, he said excess nitrogen also can contribute to the greenhouse effect and can work over time to demineralize soils.

Glyphosate use accelerating

Similarly unintended (or hidden, perhaps?) consequences affecting soil health can be ascribed to the use of many pesticides and herbicides, including glyphosate.  The use of this herbicide, marketed by Monsanto as RoundUp, has been accelerating rapidly in recent decades.  Recent studies have shown that by 2020, worldwide glyphosate use is expected to hit  1 million tons per year. Another study shows that in the US, the rate of growth has been accelerating. Between 1995 and 2004, glyphosate use grew by 356%. Between 2005 and 2014, it grew by 637%.

Studies have shown that plants exposed to high levels of CO2 grow faster, but contain fewer nutrients. The same appears to be true of crops treated with glyphosate.  One of the side effects of this heavy usage, which now includes spraying fields to desiccate the crops prior to harvest, is a lowered microbial diversity in the soil.

Committing to true sustainability

MegaFood and its parent company Food State is one organization that has been putting its money where its mouth is in terms of its sustainability message. Bethany Davis, MegaFood’s director of advocacy and government relations, said supporting soil health has now become part of the company’s core mission.  And getting the word out about the side effects of high glyphosate usage is part of that effort.

“People know about gut microbiome. They understand the importance of that. But the same thing is true of the soil,” Davis told NutraIngredients-USA.

Davis and others maintain that soil rich in a full suite of microbes, fungi, and viruses functions better in many ways. Plants grown in such soils are more nutrient dense, and soils with diverse, robust microbiomes absorb and hold more water, easing runoff and drought concerns.

And a key point that figures into the climate change debate: Rich soils store much more carbon than do their depleted counterparts.

Regenerative solution

Regenerative agriculture is the catchphrase for practices that have topsoil health, replenishment and, ultimately increase as a core principle.  It goes a step beyond organic, which is mostly about acceptable inputs, to take a holistic view of the agricultural ecosystem.  The need to address topsoil loss is illustrated by a 2011 report by the Environmental Working Group that highlighted data from the Iowa Daily Erosion Project coordinated through Iowa State University. The project estimated that agricultural fields in 440 townships encompassing 10.1 million acres may have suffered erosion at rates greater than the statewide average and that eight townships encompassing 184,000 acres experienced utterly disastrous average erosion rates exceeding 50 tons per acre.

“I like to joke that the reason why any of us are here is that there are six inches of soil and it rains sometimes,” Davis said.

“Our food is about 50% less nutritious on average than it was 40 or 50 years ago. Regenerative agriculture is integrally linked to nutrition. That is one of the reasons we stand for it, and it is confusing that so few people in our space stand for it,” she said.

Dietary supplement companies might observe that the sum total of ingredients used in our industry hardly amounts to skimming the froth from a huge vat of milk when talking about the large-scale effects of agricultural practices relating to soil health.  They are mere derivatives, in other words.

But, as the sellers of derivative mortgage securities discovered in 2008 and 2009, when the underlying market is unhealthy, everyone, even the bit players, suffers.  For dietary supplement companies touting a sustainability message, and exactly as we see in climate change issues, being part of the solution seems to be the place to be, rather than sitting on the sidelines.

Climate change and supplement industry

Recent mainstream media reports about climate change leave one wondering where the planet is headed when considering its effect on the supplement industry. Two are especially harrowing.

Ice disappearing because of climate change

climage change

In late September, the National Snow and Ice Data Center based at the University of Colorado, Boulder released its annual report on the extent of Arctic sea ice.  The report showed that at its lowest extent, the Arctic ice pack covered about 1.77 million square miles. This is tied for the sixth lowest extent on record.  In the past twelve years, the ice pack matched or exceeded the 1981-2010 average minimum of 2.4 million square miles only once.

“This year’s minimum is relatively high compared to the record low extent we saw in 2012, but it is still low compared to what it used to be in the 1970s, 1980s and even the 1990s,” said NASA climate change senior scientist Claire Parkinson. (NASA supports the ice data center.)

Insects are too

Another even more sobering report was published late last month in The New York Times.  Titled “The Insect Apocalypse is Here,” the report looked at still poorly understood population declines across insect species.  Conducting population studies is unglamorous, rigorous, time-consuming and grueling work, the article noted, which is why few of them have been done.

But the few that have been done have turned in alarming results. The Times article detailed a 2013 German study on insect abundance that was the work of a group of highly skilled and committed citizen scientists.

“The German study found that, measured simply by weight, the overall abundance of flying insects in German nature reserves had decreased by 75 percent over just 27 years. If you looked at midsummer population peaks, the drop was 82 percent,” the article noted.

Another researcher, entomologist Arthur Shapiro of the University of California Davis, has for the past 46 years been walking the same transects in California’s Central Valley and the Sierra Nevada foothills counting butterflies.  He has noticed a similar dearth of individuals as was seen in Germany.

Similar declines have been noted in a rain forest study in Puerto Rico.  The insects there have not been contending with pesticides and habitat loss, two concerns mentioned in the German study, which leads researchers to point to global temperature induced rise as the probable culprit.

Climate change is responsible

Despite White House tweets to the contrary, worldwide scientific consensus attributes blame for rising temperatures on increased greenhouse gas emissions which cause climate change.  These come from smokestacks at factories and power plants, from the tailpipes of hundreds of millions of vehicles and from the burning of tropical woodlands to create cattle ranches or palm oil plantations.

climate change and supplementsWhere does the dietary supplement industry fit into that equation?  From a practical standpoint, the industry’s footprint is minuscule.  Some ingredients, like fish oils, tropical botanicals, or krill oil, might get shipped around the globe more than once when all of the extraction, formulation and packaging steps are taken into account. But even so, the carbon footprint of these materials is still not even a rounding error when it comes to the global emissions problem.

So, should supplement companies just wave their hands and say, ‘not my problem?’

Effecting change

It appears this is an ethical consideration, not a marketing-driven one.  After all, how much does it matter if a company can nudge a particular consumer’s personal health needle in a positive direction if the environment that person is living in is falling off the edge of the table?

“I think absolutely supplement companies can be part of the solution,” consultant Steve Hoffman told NutraIngredients-USA. Hoffman, who is a principal in the consulting firm Compass Natural, was also tapped by Colorado governor-elect Jared Polis to serve as an adviser to his transition team as part of the on the Natural Resources & Energy and Agriculture committee.

Hoffman pointed to certain brands, such as Mercola, that have made big commitments to sustainable packaging. The energy that goes into packaging and shipping is part of the equation.  Other companies have made commitments toward restricting the flow of waste material off-site, or have announced goals for use of renewable energy.

Other brands such as Gaia Herbs and MegaFood, have committed to supporting regenerative agriculture. This is a concept that goes a step beyond traditional organic farming concerns, which is more about the nature of inputs.  It looks at the role agriculture can play in supporting local biodiversity (remember those insect declines?), creating rather than depleting topsoil and lessening the overall carbon footprint of agriculture.

The idea has coalesced into plans for certification called Regenerative Organic Certified.  Brands participating in the founding discussions are Horizon Organic, Guayaki, and Maple Hill Creamery.

Part of the solution

All of these may be small steps, mere drops in the ocean of the global climate change debate.  But it is also true that every journey can only begin from where you are.

As the author and activist Eldridge Cleaver is reputed to have said, “If you are not part of the solution, you are part of the problem.”