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Functional Foods Revision

Cassie Byrne Functional Foods English 200 cards

How are Functional Foods developed?

Cards in this deck (200)

  1. 1Definitions: 1. Medicines 2. Fortified Foods 3. Supplements 4. Novel Foods1. Drugs/pharmaceuticals that are regulated
    2. Foods where extra nutrients have been added (enriched foods)
    3. Something added to something else in order to complete or enhance it
    4. A food that wasn't consumed in Europe before 1997 (strict legal definition)
  2. 2Functional Food DefinitionA food containing health-giving additives - but there is no strict definition as these aren't regulated. The definition will vary depending on whether someone is a consumer or works for the food industry, regulatory authority, etc.
    No legal definition -> it's a concept/idea that keep evolving (originated in Japan in early 1980s)
  3. 3Definitions: 1. Nutraceuticals 2. Phytochemicals1. 'Nutrient-rich products' (online: 'another term for functional food')
    2. Non-nutrient plant secondary metabolites with a possible positive health effect. Commonly consumed: soya extracts, isoflavones, etc. which are meant to have estrogenic activity
  4. 4Dietary Supplements DefinitionTraditionally defined as products made of one or more essential nutrients such as vitamins, minerals, and proteins… but more recently broadened definition to include almost any product intended for ingestion as a supplement to the diet – phytochemicals, non-traditional food extracts
  5. 5Dietary Supplements- Not regulated
    - 50% of American population take some form of dietary supplements
    - E.g. vitamin supplements: unless there's a medical reason why you need them, what does scientific evidence suggest? If not deficient, taking them can be harmful
  6. 6Supplements vs. Drugs- In many countries supplements are legally distinguished from drugs
    - Drugs must undergo approval after extensive clinical studies to determine effectiveness and safety
    - Pharmaceutical drugs are regulated, the subjects of laws and regulations whereas supplements aren’t, even if they might have the same intended function
  7. 7Importance of Functional Foods1. Important to the industry (growth, new products, added-value, jobs). Need attractive new products for industry to grow
    2. There are scientific questions and opportunities. Linking FFs to health benefits - research
    3. The government is interested and has 2 roles: in terms of regulation and the law & can they change the health patterns in the population?
    4. The consumer is interested because they want to increase life expectancy and live healthily and actively
  8. 8FOSHU(Foods for Specified Health Uses)
    After the Japanese government set up 3 research projects, with the aim and driving force of trying to reduce the rapidly escalating cost of health care, they set up FOSHU (1991).
    Refers to foods containing ingredients with functions for health and officially approved to claim its physiological effects on humans
  9. 9EU Grouping - EU Concerted Action on FF Science in Europe New definition for FF- Came up with a definition incorporating some of FOSHU's ideas
    - 'Demonstrating to affect beneficially one or more target functions in the body beyond adequate nutritional effects (important bit)’
    - 'They must demonstrate their effects in amounts that can normally be expected to be consumed in the diet’ (not included in FOSHU definition but a key phrase)
  10. 10What do EU Grouping and FOSHU definitions each talk about in terms of FFs?Talking about:
    o Foods
    o Scientific testing
    o Beyond adequate nutritional effects
    o Improved state of health and reduction of risk (not prevention) of disease (as that starts to get much more legal)
    o Part of a normal diet
  11. 11Other FF definitions...• ‘…Foods in which the concentration of one or more ingredients have been manipulated or modified to enhance their contribution to a healthful diet’ – Committee on Opportunities in the Nutrition and Food Sciences
    • ‘…Branded foods which claim explicitly or implicitly to improve health or well-being’ – Nestlé
    • ‘Foods which provide a health benefit beyond basic nutrition’ – International Food Information Council
    • ‘Those foods in which concentrations of one or more ingredients have been manipulated or modified to enhance their contribution to a healthful diet’ – Institute of Medicine of the National Academy of Sciences
    • ‘A food where a new ingredient(s) (or more of an existing ingredient) has been added to a food and the new product has an additional function (often one related to health-promotion or disease prevention) – Agriculture and Agri-Food Canada
  12. 12How do you effect the change in a food that suddenly makes it a FF? (Types of Approaches)- Need to change the levels (common idea) so you might alter the growing conditions if it’s a plant-based product, in order to alter the levels of a particular group of components
    - Might add something/a component – e.g. sterols/stanols
    - More contentious: where a component normally present has been removed – e.g. reduction of saturation fatty acid content (But can it be a functional food if you’ve taken something out?)
    - Might change the bioavailability of something – basically the levels are the same but you change something else so that you absorb more of it (would be useful) - In which the bioavailability of one or more components has been increased to provide greater absorption of a beneficial component
  13. 13FortificationIs in one sense a legal thing where you have to do it, and if you have to do it because that’s the rule or law in that country then it’s a fortified food and not a functional food – because it’s coming under a different heading. Is margarine a functional food because it’s fortified? No. Is flour a functional food because it’s fortified? Important to get distinctions clear
  14. 14Functional Foods: a conceptual definition (Paper from 2008) What 4 key concepts did they identify from the definitions reviewed?- Reviewed over 100 FF definitions
    1. Health benefits
    2. The nature of the food
    3. Level of function
    4. Consumption pattern
  15. 15Functional Foods: a conceptual definition (2008) Explain the 1st key concept from the paperHealth benefits:
    - There has to be some sort of health benefit otherwise it is not a functional food
    - The concept of health benefits appears to be central to most definitions as illustrated by its mention in the 26 definitions selected
    - Only 2 definitions indicate that the health benefits should be proven, neither specified the type of proof
    - Can you justify that a food has a health benefit when there’s no proof? To Mike, it’s obvious that you shouldn’t be able to do that. However, the argument is to what level should that proof be
    - In different countries within the EU in particular, we’ve taken that level of proof to a very extreme level
  16. 16Functional Foods: a conceptual definition (2008) Explain the 2nd key concept from the paperThe nature of the food:
    - It’s got to be food – might sound obvious but why does it have to be like food? Why can’t it be pills or capsules so long as there is a health benefit?
    - Important point – if you are going to try prove the health of the population (not individuals) then why not think about pills/capsules/supplements rather than foods as a whole?
    - In some definitions, they talk about removal of components/allergens/things detrimental to health e.g. salt and sugar…
    - ‘Who thinks the definition should include removal of things?’ No one
    - Idea that you could claim something as being a functional food just by taking something out that seems to be deterious therefore enhancing health benefits, isn’t right
    - If you can take something out of a food that is deterious then you should do so, but this doesn’t mean you can call it a functional food just because it’s more healthy
    - Another aspect of this, something the food industry has been terribly bad at over the years: they’re happy to jump on any bandwagon going
  17. 17Functional Foods: a conceptual definition (2008) Explain the 3rd key concept from the paperLevel of function:
    - ‘Benefits beyond its basic nutritional functions’… First key point is what is a nutrient? Vitamins, minerals, proteins, certain fats, etc. So what is the definition? A nutrient is something that, if you take it away from the diet you get ill – if you put it back in again you get better (If you deprive yourself of vit C, you get scurvy, but if you start taking it again you get better)
    - A nutrient has a very clearly defined function, and you won’t be able to survive very well if you are completely deficient in individual nutrients
    - Not talking about nutrients, but talking about beyond adequate nutrition – the reason for this is because we have an expectation that our food will provide nutrients and where it doesn’t then regulations have been put in place to fortify foods with nutrients
    - Can’t have an orange as a FF; it contains nutrients but it should. If you genetically modify it to change its ability to lower the risk of a disease then it could be a functional food, but as it is it can't be
  18. 18Functional Foods: a conceptual definition (2008) Explain the 4th key concept from the paperConsumption pattern:
    - Important, quite difficult to implement
    - To do with how we consume the stuff
    - ‘A functional food must be part of a normal diet or fit a normal consumption pattern in a specific geographic and/or cultural context
    - Mike’s implication that he would read into this is that its contribution as part of a normal diet must be a contribution that gives rise to the health benefits… In other words, the dose that you’re receiving as part of your normal diet must be sufficient to give you that health benefit
  19. 19Functional Foods: a conceptual definition (2008) Final Functional Food Definition‘A functional food is, or appear similar to, a conventional food. It is part of standard diet and is consumed on a regular basis, in normal quantities. It has proven health benefits that reduce the risk of specific chronic diseases or beneficially affect target functions beyond its basic nutritional functions’
  20. 20Functional Foods: a conceptual definition (2008) What does ‘A functional food is, or appear similar to, a conventional food’ mean?This implies that the food is not, for example, a pill. This sentence doesn’t exclude the possibility that the food could be enriched or improved as long as the food’s appearance is mentioned
  21. 21Functional Foods: a conceptual definition (2008) What does ‘It is part of standard diet and is consumed on a regular basis, in normal quantities’ mean?The definition allows for adaptation to cultural differences, including widely differing ‘standards’ among culture and countries.
  22. 22Functional Foods: a conceptual definition (2008) What does ‘Consumed on a regular basis’ mean?– Mike’s understanding = could be once a year, doesn’t have to be every day or 3 times a day, provided it’s a dose that beneficially affected your health or reduced the risk of disease then that would be fine. Doesn’t necessarily have to be something you eat 3 times a day
    o This also implies that such a food wouldn’t be consumed solely for therapeutic purposes and it reinforces the idea that is has to be art of a normal diet
  23. 23Functional Foods: a conceptual definition (2008) What does ‘In normal quantities’ mean?Implies that the food must contain a certain level or concentration of a specified molecule (minimal intensity) to be beneficial. In other words, the dose – can’t say that ‘this molecules stops you from getting this’ without stating the dose. The dose has to be at a right level
  24. 24Functional Foods: a conceptual definition (2008) What does ‘It has proven health benefits’ mean?‘A food that is not functional today might be functional tomorrow, if health benefits are found and proven’: Mike’s not sure about this, it’s still a food and you have actually changed the food. Mike’s understanding is that you have to do something to the food, you have to change something, and that allows you to claim it as a functional food
  25. 25Functional Foods: a conceptual definition (2008) What does ‘Basic nutritional functions’ mean?Providing vitamins minerals, energy is standard, what food should do… Refers to the role of nutrients in growth, development and maintaining the organs and systems of the human body. Therefore, the basic functions of a good are to provide vitamins, minerals and energy derived from the proteins, carbohydrates and lipids required for the well-being of the human body
  26. 26Functional Foods: a conceptual definition (2008) What was the paper's conclusion?‘To reach their full market potential, functional foods need to move from a blurred idea with many and sometimes conflicting definitions to a sharply defined and quantifiable concept. In contrast to marketing, where value added could only be perceived, the value added associated with functional foods must be real.’
  27. 27Why have FFs and 'functional cosmetics' attracted people's attention?- Percentage of Chronic Diseases Potentially Preventable by Lifestyle Modification (Willett, 2002): 70% of colon cancer is avoidable, 70% of stroke is avoidable, >80% of CHD is avoidable and >90% of T2D cases are avoidable
    - All preventable by lifestyle modifications!
  28. 28What was the big problem in the mid 1900s?Nutrient deficiency:
    - Even in the UK, Western Europe, North America, there was nutrient deficiency from before 1900 up to possibly 1950 or so – on a grand scale
    - Now, in these countries, if nutrient deficiencies exist they do so at quite a low scale and are probably avoidable (in that it relates at least partly to choices that people make in their lifestyle)
    - Late 1900s: now we have other extreme and have the problem of chronic diseases (cancer, heart disease, diabetes, etc.)
  29. 29The Office of National Statistics data ‘Pounds spent per week’2011, UK data:
    - Health and education very low
    - Food quite high
    - Transport is highest
  30. 30The Office of National Statistics data 'Household expenditure'Different years, UK data:
    - % of household income spent on food and non-alcoholic drinks has gone from 20% down to less than 10% in 38 years
    - Most dramatic set of data = food (going down dramatically) - Why?
    ~Rise and power of supermarkets to drive the price of food they're selling down has been a major factor
    ~Talking about percentages and we've had far more disposable income compared to in 1970
    - Transport seems to have stayed at the same % and not changed much
    - Alcoholic drinks and tobacco has a great curve going down
    - Recreation and culture going up as we have a lot more recreational time
  31. 31The Office of National Statistics data ‘% Of Household Expenditure on Food (eaten in)’Different years, UK data:
    - Different in other countries
    - % has gone down and down, we're eaten out far more than ever before
    - Assuming it's not just that we're eating less but that we're eating out and have a higher income (not just restaurants but snacks during the day too)
  32. 32The Office of National Statistics data ‘Looking at age groups; net rent, mortgage payments, council tax, maintenance/etc.’2012, UK data:
    - Net rent decreases as you go up in age because people are moving from renting to buying
    - Biggest contributor is in 30-49 group where mortgage payments are extremely high, but as you pay these off this number reduces
    - Council tax - quite similar (less in rented accomm. as council tax is probably less)
    - Maintenance - maybe less bothered with increasing age, could explain this by looking at 65-75 onward, housing expenditure is much less so, going back to disposable income, these people have more money
  33. 33The Office of National Statistics data ‘Average annual food expenditures as a function of household income’USA, 2009 (by quantiles of income before taxes):
    - Divided into food eaten away from home and food eaten at home
    - As expected, if you look at food eaten away from home it goes up
    - There's a trend with spending more money on food and highest income
    - These people don't need this food, it's part of their disposable income and they spend it how they want
  34. 34The Office of National Statistics data ‘UK citizens aged over 65 years as a percentage’UK data, 2010-2030:
    - Percentage is going up each year, might not be a dramatic rise but financially, politically, economically, going up to 22% from 17% is a significant rise
  35. 35The Office of National Statistics data ‘The ageing UK’UK data, 1992-2030:
    - Can see in the forecast that this percentage is only going to increase - why? Improved health case has affected one group of the population far more than any other -> babies.
    - Better nutrition overall, 65 years olds would be born around 1950 (around when nutrition improved)
    - Healthier mothers, healthier pregnancy, healthier foetus and more healthy when born
    - There’s a paradox between the problems of over nutrition and eating too much, and how if you read papers and listen to nutritionists they all say dooms day is around the corner when actually we’re living longer (answer: yes we’re living longer but we may not be as healthy in the future)
  36. 36The Office of National Statistics data ‘Age of Population'UK data, 1901-2010:
    - In 1901, had much fewer people of 85+ years of age whereas now they've survived and carry on getting older
    - 65-69 = difference here is phenomenal
  37. 37Why is there a growing importance of the over 50s population?- They account for 41% of all adults (19.5 million adults in the UK), there’s loads of them and they have lots of money (collective pot of £175 billion disposable income – 30% more than the under 50s)
    - 85% have private pensions and possess 80% of all private wealth
    - On top of this, recent governments have looked after pensioners very well… Why? Because they vote. The reason we’re coming out of the EU is because young people didn’t vote
    - First generation to have been advertised to throughout their lives –they are advertising savvy
    o When did TV with adverts come along in the UK?
    o There was a time when there were no adverts
    o They came along in 1958
    o First advert = toothpaste
    - In a society where adverts are everywhere you almost don’t notice them, and they’re always there invading your consciousness… And this age group of 65 years of age have lots of money
  38. 38What is the spending power of the over 50s?• Collective pot of £175 billion
    • 30% higher disposable income than the under 50s
    • 90% own their own homes of which 72% have no mortgage
    • 85% have private pensions
    • Possess 80% of all private wealth
  39. 39Over 50s - an audience without conditioned purchasing habits...Talking about a large group of the population who will change their purchasing habits:
    o 59% try new products
    o 38% try something new after seeing an advert
    o 28% often buy a new brand to see what it’s like
    o 25% love buying new gadgets and appliances
    o 23% are tempted by products they’ve seen advertised
  40. 40Why shouldn't industries ignore the over 50s population?- They are the largest sector of the population
    - Fastest growing
    - Most affluent with the highest disposable income
    - People with the least financial ties
  41. 41What links the over 50s population to Functional Foods?Factors affecting growth of functional foods:
    - An aging population (more interested in their health)
    - Self-efficacy or autonomy in healthcare
    - Increased healthcare costs (even in a country with free health service - NHS - cost of prescriptions, etc.)
    - Advancing evidence/research that diet can regulate disease progression (many people realize the link between diet/lifestyle and disease)
    - Changes in food regulation (affects population as they hear and read about it - these people have the resources and time to do something about it so will change their behaviour)
    -> Companies often target ads and promotions at young people but these have less disposable income... This is why over 50s are the perfect target market for FFs!
  42. 42What is a dramatic example of where Functional Foods could work incredibly successfully if you can get the market right?Gluten-free food:
    - 13% of Brits avoid gluten
    - <1% have an allergy to wheat
    - Number of Coeliacs might be 2-3% (who have good reason to avoid gluten)
    - Where are the rest coming from? A market that the industry has picked up on
    - In 2014, 1 in 10 new food products were GF (Mintel)
    - The UK market for GF food is the biggest in Europe
    - GF items = up to 200% more expensive than gluten-containing foods
    - Seems that putting 'gluten free' on a wrapper means the price can suddenly be doubled
  43. 43What is a particular aspect incredibly important in allowing the FFs market to grow?Environment:
    - The food industry grows very slowly (1-2%/year)
    - The industry needs/loves areas like FFs in order to maintain market share, add value, and to try and get growth over competitors
    - E.g. Unilever: they don't 'innovate' very much and their whole industry model is about brands with enormous recognition. If brands are losing their name then Unilever drops them, even if they're still making money
  44. 44What is the number one top priority/battle in industries?Maintaining market share:
    - If you can add value (and make more) and your profit margin is even slightly bigger than before that's a good thing as it helps to think about growing that... Then, increasing market share will help get more growth
    - That has to come at the expense of your competitors: although we're doing our best to make sure we eat more so everyone can grow, that's not a game we can play forever
    - Therefore, FFs are really important in that content
    - 'Health' hasn't been mentioned as, from an industry point of view, it's not their job to look after the nation but rather to produce products, employ people, etc.
  45. 45How much does the Functional Food market grow?- However one tries to define FFs, the growth is rapid
    - All estimates say it's growing (although by how much varies) - the growth in this market is greater than the growth of any other aspect of food
    - Figures of 10%+ have been discussed
    - Global Nutraceutical industry = apparently growing at 7-22%
    - FF drinks in Malaysia - numbers going up increasingly
    - India: market is enormous but not just in food industry. Nutraceuticals = small market in India
  46. 46What are the factors affecting the growth of the Functional Foods market?- Depends who/when/how you ask
    - One factor (in terms of definition) = proof. Consumers want proof that FF products deliver the benefits promised. However, people often say this but even when not proved by substantiated independent means people aren't too bothered
    - There's a thriving homeopathic market (nonsense but still a very large one)
    - EFSA: people responsible for assessing proof. They reject most of the claims that get admitted to them as the level of proof has to be so high. This shows the difficulty companies face in getting new products to market with substantiated claims which may slow down innovation
    - The state of economy in any one country: this affects whether things do well or not (in recession = we buy more food - counter-intuitive but true)
    - People don't buy the same food: they shift in where they shop
    - Health, nutrition and wellness area: this area and how well you get message over is a big factor
  47. 47What is important to consumers in regards to Functional Foods?- Taste, quality: product must taste good and have some sort of sensory reward (especially as they are foods and not medicine)
    - Price: strange issue-> in recession, top and bottom end supermarkets continued to do well, but not in between.
    - Convenience: consumers won't buy something and spend hours to prepare it -> must be convenient and easy to produce/consume
    - 'Modern': consumers look for something modern
    - 'Trustworhiness' of health claims
    -> Must remember that FFs are still foods
  48. 48How are Functional Foods developed?Discovery -> marketable product -> improve public health (hopefully)
    - Not the industry's job to improve public health
    - Many things need to go into production of these new products
    - Might involve plant breeding or something to do with food processing
    - Some sort of advantage here leading you to discover the idea of new products with increased/enhanced bioactivity
    - Must do efficacy and safety studies and hopefully then get a product that could contribute to improving public health
    - These things below feed into consumer interest in FF
    - Regulations in EU are quite light, it's more the advertising regulations that control this
    - Consumer interest will feed into market opportunity which will be affected by regulation
    - With technological advances, this means a lot of research for academics
    - All of this will feed in and develop FF market    How are Functional Foods developed?
  49. 49Where should we look to target new Functional Foods?- Cancer: how many products are advertised or sold on the basis that they may prevent cancer? None because of strange relationship with cancer so this isn't really an area for FF
    - CVD/heart disease: another big area
    - Obesity: would make a fortune if you could figure this out
    - Brain health: big thing, how do we make our brain function better? There's different senses of brain function... Doing better in an exam from eating a certain food or certain foods relating to Alzheimer's and slowing this down, etc.
    - Anti-aging: anything that implies youth and vitality is a big area
    - Sports nutrition
    - Diabetes: interesting - are you marketing your food as prevention of diabetes or for those who already have it? As long as this is made clear in marketing head then it'd work
  50. 50What are the potential target areas for Functional Foods?- Cancer prevention/anti-carcinogenesis: scientifically could be an area but practically it isn't
    - Cardiovascular health/cholesterol lowering/antioxidants(?)
    - Eye health: would be a great target
    - Gut health/pre- and pro- biotics: already somehow a great target
    - Bone health/anti-arthritis: especially in an aging population
    - General health and well-being/antioxidant(?)/anti-inflammatory/detoxification/immune system (products with immune system on them do well)
    - ETC.
  51. 51How International is the potential for FF market? Market Growth by Product Category...- To emphasize international aspect -> info from China
    - Size of market (millions of $) and rate of growth
    - There are areas that seem grouped together
    - Whole areas of vitamins, supplements, etc. is a large market that's fairly mature
    - Female beauty, weight loss pills, healthy wine, weight loss: a large a fast-growing market
    - Some emerging areas = child vitamins, energy bars, low card food, meal replacement, etc.
    - All sorts of types of areas but also types of products, some of which are traditional and some of which are more modern    How International is the potential for FF market? Market Growth by Product Category...
  52. 52What is one of the biggest areas in the market?Energy:
    - We're all eating too much and problems with obesity are increasing yet we can't stop buying energy drinks/bars/etc.
    - Energy is the largest single category in this US study    What is one of the biggest areas in the market?
  53. 53What 'Direct' Dietary Factors Affect CVD?There are various factors that impact on CVD:
    - Cholesterol
    - Lack of things (fibre, etc.)
    - Fats
    - Calories
  54. 54What happens in Cardiovascular Disease?Going from a normal blood vessel where, gradually over time with the wrong circumstances, you increase fatty deposits to the point where you virtually completely block the vessels which is a problem in itself.
    But also if you get bits breaking off this and going around the system that isn't good
  55. 55What happens in Atherosclerotic Plaque Development?- Going from normal to really bad through various stages
    - In an actual picture you can see how much a vessel is occluded by a plaque that's been deposited
    - When you get these things happening it can lead to different forms/manifestations of atherosclerosis    What happens in Atherosclerotic Plaque Development?
  56. 56What are the Clinical Manifestations of Atherosclerosis?- Coronary heart disease
    - Cerebrovascular disease
    - Peripheral arterial disease
    This can cause problems all over the body, isn't always related to the heart
    Sometimes we talk about other things when we mean CVD... Underlying problem = often similar
  57. 57History Perspectives of CVD Epidemiology- Your heart works very hard for many years so doesn't seem unreasonable to think that as time goes on and you get older, its performance will deteriorate
    - A lot of issues arose around heart disease. Going back a few years, people used to argue about the idea that lifestyle factors (such as diet) could actually have an effect on the heart
    - The idea that lifestyle could impact quite dramatically on some of the heart's functions was very new and revolutionary (an idea many people refused to believe for a long time)
  58. 58What is the Framingham Heart Study?- A study that began in 1948 that started to look at factors related to coronary vascular disease
    - First large-scale epidemiological study involving 5,209 men and women
    - Showed that there were correlations between risk factors (e.g. cigarette smoking, blood pressure, cholesterol) and incidence of CHD
    - Hard to get across how revolutionary these ideas were, even the idea that cigarette smoke could have some deleterious effect wasn't believed
    - The concept of 'risk factors' involved gaining understanding of factors predisposing the occurrence of CVD (coined by the Framingham Heart Study)
    - Once this was done, many studies came along showing similar findings
  59. 59What did the Migrant Study by Ni-Hon-San show?- Showed Japanese living in Japan to have lowest cholesterol levels and lowest rates of CHD
    - They then looked at Japanese people who'd moved to different parts of the world and tried to link up heart disease and cholesterol levels
    - Showed an association which is indicative of a possibility however doesn't prove anything
    - Those living in Hawaii had intermediate rates for both, and those living in San Fran had the highest cholesterol levels and CHD incidence
  60. 60What are the most common risk factors for heart disease?High LDL (bad) cholesterol
    Smoking
    Low HDL
    High blood pressure (^ older = ^ BP)
    Lack of physical activity
    Diabetes (automatic high risk)
    Obesity
    Age
    Family history
    Genetic and lifestyle factors
    (Salt? Probably most recent of factors to be identified and there's still much controversy. Much evidence for involvement of salt but still many people argue saying it isn't a problem. However, the UK and most governments seem to accept that salt intake needs to be reduced)
  61. 61What are some of the Misconceptions involved with heart disease risk factors and what do they actually mean?- Blood pressure: doesn't need to increase with age provided other factors are looked after - originally though to be normal to rise with age to ensure adequate perfusion as arteries narrowed. Elevated diastolic blood pressure was thought to cause all problems.
    - Cholesterol: skepticism, mostly related to cholesterol intake. Idea that high cholesterol = risk factor is clear and definite. Idea that this automatically related to cholesterol intake = slightly more problematic. Having high blood chol may not be due to high consumption of chol
    - Exercise: before epidemiological studies, physical activity was thought to be dangerous to CHD candidates.
    => CHD is a multifactorial process involving many issues/mechanisms and therefore many predisposing factors
  62. 62Data regarding death and the causes: 'Death rate for England and Wales 1901-2009'- Peak in graph = influenza
    - Peak for men is much higher than women as 'men get it worse'
    - Why is the line for women and men different? Because of difference in life expectancy
    - Lines are coming closer together for various reasons, probably because of some of the major issues we've been dealing with which will be discussed in the next bit...    Data regarding death and the causes: 'Death rate for England and Wales 1901-2009'
  63. 63Data regarding death and the causes: 'Global causes of all deaths, WHO'CVD 31%, communicable/maternal/perinatal 27%, cancer 13%, etc.
    - If you look worldwide, this is a very large proportion
    - Looking in the UK, USA, Northern Europe = would be much lower
    - Cancer in the US, UK, etc. would probably be a bigger proportion
    - Diabetes is a relatively small number here but an increasing number everywhere
  64. 64Data regarding death and the causes: 'Death rates for selected leading causes (particular diseases) of death among people age 65 and over, 1981-2004 (global)'- Declining line for heart disease = because we've identified the risk factors and as a population have done something about it. Other reason = medical treatment has improved significantly
    - Diseases of heart is still the biggest cause!
  65. 65Data regarding death and the causes: 'Coronary Heart Disease Mortality - death rates from CHD in different countries at different ages'- The countries in the data are not enormously dissimilar (all European countries)
    - May be differences between northern and southern Europe...
    - Yet, can see that the lines aren't super imposable - even though they show different patterns - telling you there are different things going on in different countries
    - Standout country = Scotland: life expectancy is a lot lower, partially due to statistics being very different to everywhere else (bad diet, smoke/drink lots - combined -> lower life expectancy)
    - Looking at Scotland vs. Spain and France = so different - mostly related to diet
  66. 66Data regarding death and the causes: 'Top 10 Countries by CVD Death Rates, 2002'- Data from WHO that show there are differences
    - Again, not that different but if you compare them to the US there's quite a difference
    - CHD and CVD are not inevitable but there are things you can do about it
    - Highest = Ukraine, Russia, Bulgaria, etc.
    - Lowest = US, Moldova, Romania, Serbia and Montenegro, etc.
  67. 67Data regarding death and the causes: 'Prevalence of CVDs in Americans Age 20+ by Age and Sex'- Data for men and women are different - why? Hormones
    - % of people in US with CVD at different age groups - affected by hormones
    - Women are protected against heart disease in general - lifestyles won't be very different to men so they're protected until they get to age of menopause when Oestrogen levels go down so they lose protection until they get to a point where it's similar to men (45-54)
    - But the rates go up and exceed that of men, why? (next set of data)
  68. 68Data regarding death and the causes: 'CVD Mortality Trends for Males and Females, USA 1979-2002'- Decline in death rates is mostly to do with men, why?
    - Smoking is a contributory factor: women took up smoking later than men but they're giving up smoking at a later and slower pace to men (because they find it harder to give up)
    - The reason is related to the following set of data: CHD is a killer in women, but women don't worry about it as it's perceived to be a male disease (they worry about breast cancer instead)
  69. 69Data regarding death and the causes: 'Women and Heart Disease'- 1/2-3 women die of CHD, but only 4% fear of dying from it
    - 1/27 women die of breast cancer, but 40% fear of dying from it
    - Women worry about dying of breast cancer but actually the chances of them dying of CHD are much higher
    - In terms of identifying risk factors and doing something about it, men have done quite well in dealing with that, whereas women haven't and are a bit of a target for this sort of stuff
  70. 70Out of all the risk factors, why is cholesterol particularly important?- We can make cholesterol (fatty substance) in the body, we make it in the liver and consume it in the diet (dietary component)
    - It's a very hydrophobic, fatty material and is an important constituent of our cell membranes: we have to have chol - all our cell membranes are made of chol in a lipid bilayer and also...
    - Used to insulate nerve cells, to form membranes, and a steroid hormone precursor (all steroid hormones are derived from chol)
    - If you have too much chol floating about then it'll contribute to atherosclerotic plaques which leads to a build up in the arteries (increasing risk of heart attack and stroke)
  71. 71How is cholesterol transported?- Cholesterol isn't soluble so it's hydrophobic - doesn't go float around in blood on its own: needs to be transported
    - Highly water soluble and will not be soluble in blood
    - There's 2 key lipoproteins (LDL & HDL) that bind to cholesterol and carry it throughout the body
  72. 72What's the difference between LDL and HDL lipoproteins?HDL 'good' = binds cholesterol and removes it from the arteries and carries it to the liver where it's broken down and excreted
    LDL 'bad' = can bind cholesterol and actually has tendency to build up on the walls of arteries and be entrapped in plaques in arteries and veins (this is harmful and increases the risk of heart disease/stroke)
  73. 73What are the standard levels of cholesterol for a normal population?- Cholesterol total = < 200mg/dl blood
    - LDL = < 100mg/dl blood is optimal/better (if you have risk of heart disease or have/had it, this should be as low as poss)
    - HDL = > 40 mg/dl blood but ideally > 60 mg/dl as this would lead to heart disease risk being significantly lowered
    - A 1% drop in blood chol translates into a 2% drop in risk factor for heart disease
  74. 74What are triglycerides?- A form of fat found in food and in body fat (normal fats found in body)
    - Fat is transported in blood as triglycerides
    - A major energy source
    - However, a risk factor! High levels may increase the risk for heart disease (not as dominant a factor as chol but can be)
    - Probably reflect other aspects of lifestyle
    - 150-500 mg/dl = considered high, > 500 mg/dl = very high
  75. 75What does a diet contributing to a healthy heart consist of?- Fibre: contributes to this area, there's an idea that it's an insoluble plant material. Higher consumption of fibre tends to reduce blood and LDL chol, which happens for a number of reasons: provides satiety and can displace less beneficial components, associated with other beneficial components and activities, decreases risk for heart attack, etc. Fibre binds to things and stops them being absorbed (binds to chol) and alters other metabolic activities in the colon which will contribute to lowering certain chol.
    - Good fats: primarily monounsaturated fats = olive, peanut, flaxseed, primarily PUFAs = sunflower, soybean, corn, omga-3 fats = fatty fish, flaxseed, walnuts.
    - Limit foods high in sat fat, trans fat and chol: full fat dairy products, fatty meats, tropical oils, margarine, foods with hydrogenated oils, etc. reducing consumption of these is important!
    - Exercise: has an effect on metabolism so contributes and plays a role (e.g. in increasing HDL chol levels). Beneficial in lowering triglycerides!
  76. 76What are a few Community-wide CVD Prevention Programs?- Stanford 3-Community Study (1972-75): showed mass media vs. no intervention in high-risk residents to result in 23% reduction in CHD risk score
    - North Karelia (1972-): showed public education campaign to reduce smoking, fat consumption, blood pressure and cholesterol
    - Stanford 5-City Project (1980-86): showed reductions in smoking, cholesterol, BP and CHD risk
    - Minnesota Heart Health Program (1980-88): showed some increases in physical activity and reductions in women smoking
  77. 77How do you change the health statistics of a population?- With enormous difficulty
    - As an individual one can choose to exercise more and reduce/increase consumption of certain things but for population as a whole this doesn't help
    - An awareness program (telling people)? This doesn't work on it's own as there's many things we know aren't right but do anyway
    - Tax? Evidence that tax works isn't great, seems to make government feel better (e.g. sugar - what government has done probably won't change anything; smoking - always been highly taxed but now you see very little smoking in UK... Why? Perhaps because it was always regarded as acceptable then suddenly became unacceptable)
    => Need to change people's perceptions and behaviour and not just by tax - tax may be a factor but it isn't awareness, although it's clearly an important factor. You have to do a whole raft of things if you're going to change the health statistics for the population
  78. 78What is the Finnish Experience?Related to one of the community-wide CVD prevention programs:
    - Particularly successful program
    - North Karelia had the highest death rate from heart disease in the world (very rural economy) -> diet rich in animal fats
    - People tended to have high chol, high BP so there was an initiative to try change this
    - The Finnish Experience project had a significant effect on the public - public health campaign funded by government
    - Number of deaths from CHD fell by a drastic 82%!
    => One of major products that came out of this = Benecol
  79. 79Benecol and the North Karelia Study- Benecol (benefits cholesterol) = product widely available
    - Benecol has been proven to work and there's no doubt it does - vast number of studies in different countries with different types of studies
    - Feeding people Benecol/compounds in Benecol does work!
    - Simple representation of this can be seen in 12-month intervention in 153 people using Benecol spreads
    - Those who had stanols all quite significantly showed reduction in chol
    - After a year, when they stopped taking the stanols, their chol went back up again
    - Similar results were shown in another study where stanol group had significant reduction in LDL chol (as opposed to placebo) - 10% reduction in LDL chol levels has a 20-25% reduction in risk of CV events
  80. 80What products have been proven to reduce cholesterol levels?Benecol and Flora Pro-Activ (compounds in this are present in soybeans too)
    -> Each have been proven to reduce LDL cholesterol
  81. 81What is the dose you should consume to see the benefits of plant sterols/stanols?- Less clear in terms of dose
    - Benefit after 1g/day continues to go down then after 2-2.5g/day there is little further benefit
    - Results seem to have shown you do see a benefit
  82. 82What studies have shown further benefit in increased consumption of plant sterols/stanols?- Reduction in LDL chol compared with controls in 26 studies of plant sterols esters and stanols esters (2002): benefit goes up and up but never really see plateau
    - Average effects on LDL chol concentrations for different dose ranges phytosterols (2014): doesn't seem convincing that you wouldn't get even more benefits at higher levels
    - Dose-effect relationship between plant stanols dose and LDL-C change in 5 studies with plant stanols doses between 2-10g/day (2012): does seem to be benefits to having a higher dose, at least in terms of LDL
  83. 83What have studies shown with regards to doses of plant stanols/sterols required to see benefits?- Consensus is that somewhere around a couple of grams/day is what you need
    - May be other reasons why people don't increase doses
    - Results don't seem to say there's a plateau but literature seems to say this
    - Evidence is clear - people are now working on higher doses
    - If there was any caution before, companies are now thinking 'we need to stimulate market so need to make products with higher levels'
    - There's recent talk about upping daily intakes from say 3g to 6g
    - If you could affect LDL chol then you could reduce risk of CVD... But just knowing they work isn't enough in itself
    - Dose in small pots = < 2g (usually 1.3-1.5g) as you make up difference by consuming the rest in other foods in diet
  84. 84What is Benecol?- A product, containing plant stanol esters, that pioneered the 'cholesterol-reducing' category
    - First of these products to come along, first launched in 1999 in UK/Ireland (following success in Finland)
    - Flora Pro-Activ followed about 18 months later
    - Own-brands now available in supermarkets
    - Been tested by EFSA and are proven to work
    - The product used to have warning about not consuming more than 3g of plant stanols per day but this was removed with realisation that plateau effect wasn't true
  85. 85What is the difference between Benecol and Flora Pro-Activ?- No difference in terms of their effects
    - They contain different materials/active ingredients
    Benecol = plant stanol esters (hydrogenated form of plant sterols)
    Flora Pro-Activ = plant sterol esters
    - Benefit = Benecol ester means you can use it for cooking whereas if you try cook with plant sterols they break down
    - Although Benecol is a more complicated material to produce, there's a benefit in producing it in that it's more heat stable
  86. 86What are plant sterols?- Part of plant cell membranes (sort of plant equivalent of chol)
    - Cholesterol = key component of animal cell membranes & sterols = key component of plant cell membrane
  87. 87What are the 3 most abundant plant sterols?1. ß-sitosterol
    2. Campesterol
    3. Stigmasterol
  88. 88What is the structure of cholesterol (an animal sterol)?What is the structure of cholesterol (an animal sterol)?
  89. 89What is the structure of sitosterol (a plant sterol)?(Similarity between chol and sitosterol is noticeable)What is the structure of sitosterol (a plant sterol)?
  90. 90What is the structure of sitostanol (a plant stanol)?(Stanols = hydrogenated sterols - so double bond in sitosterol is saturated and hydrogenated -> this is only difference from sitosterol and sitostanol, side chains are the same)What is the structure of sitostanol (a plant stanol)?
  91. 91What is the structure of sitostanol ester?(The ester, stuff in Benecol, is derivatised/you make an ester derivative through hydroxyl group at bottom left of sitostanol)What is the structure of sitostanol ester?
  92. 92How to you make the esters found in Benecol and Flora Pro-Activ?Quite easy - mix sterols with rapeseed oil and a chemical reaction takes place (saturation or separation) without too much encouragement, then you get esterification and then you have the chemical product that you can use in these food products
  93. 93How much/where do sterols and stanols appear in our daily diet?- Cholesterol comes from animal sources and we can consume, depending on our diet, about 300-400 mg/day
    - Plant sterols found in edible plant oil - we consume a fair amount anyway but 150-300 mg/day
    - Plant stanols, from grains and pine tree oil - we consume 20-50 mg/day (much less common)
    => Flora product is mostly derived from soya, so it's not quite so obvious where the stanol is coming from for the Benecol but this will be further looked at
  94. 94What is the composition of a plant stanol ester?- Stanol = +- 60% of the weight (very poor absorption, not metabolized, no energy value - stanol is the active part)
    - Fatty acid = +- 40% of the weight (absorbed, source of energy, etc.)
    - The hydroxyl group is produced by treating the free stanol with rapeseed oil giving you the product of this ester
    - For some people, this is quite important in that it obviously contributes a fair bit to this molecule and can be used as a source of energy (in other words it does contribute a tiny amount extra to calories - e.g. 120 calories compared to 75 calories)
  95. 95What are the similarities between plant sterols and stanols?- Both found in plants
    - The stanol esters aren't found in plants but are manufactured separately
    - The sterols - can consume about 300 mg/day normally in the diet
    - Mostly, consuming around 1.3 g/day is recommended for chol control
    - Can compete with chol for absorption into the body
    - 1.3 g/day can reduce LDL by about 10-15% (a level of reduction equivalent or greater than some statins people get prescribed - a pharmaceutical agent)
  96. 96Novel Foods & Genetically Modified Foods- Novel foods = ‘a novel food is defined as food or food ingredient which does not have a significant history of consumption within the EU before May 1997’
    - If a material doesn't have this significant history then you have to go through pre-market safety assessments and do loads of work to prove your product is safe
    - This novel food regulation was developed purely and simply to stop the import of GM foods and makes it much harder than it would be
    - May 1997 = a purely arbitrary date that has no meaning except in terms of GM foods
  97. 97What is the significance of the Novel Foods date (1997)?- Benecol came along in 1999, after the novel food regulations
    - For sterols, it's not a great problem as you can argue there's a history of consumption of them since we eat 300 mg/day but it's different for the stanols
    - Where do we get the compounds? Pine wood pulp
  98. 98Is Benecol a Functional Food, Novel Food or Dietary Supplement?- Benecol contains ß-sitosterols from pine wood pulp
    - Prior to 1997, was there a history of consumption of pine pulp?
    - Cheap source of these materials, which is why they use it
    - Benecol didn't have to go through novel foods regulations -> interesting/shocking as it should've done
  99. 99Are sterols/stanol-enriched products novel foods?- Sterols could argue they're not
    - However, stanols would be much harder to argue that they're not
    - By definition, clearly they're not as they didn't have to go through the safety assessment that novel foods have to go through
    - So it appears they're not novel foods
    - In America, FDA's odd view is that these products (or some of them) were in the form of spreads and replaced butter and similar foods and are therefore a food and not a supplement
    - Not clear whether or not they are functional foods... Are they food? They seem to have more in common with pharmaceutical drugs than they do with food
    - They certainly fulfill other requirements and have demonstrable, proven effects on a risk factor (reducing LDL chol)
    - If they're not foods, are they supplements? Not pharmaceutical drugs although they share common characteristics
  100. 100How does normal dietary and biliary cholesterol interact in the intestine?Imagine this is a bit of the intestine and top left is some food coming in (chol from diet but also from bile that you're shifting into the intestine)
    - What normally happens is your absorb about 50% of this amount that's in the intestine and the rest disappears out at the other end    How does normal dietary and biliary cholesterol interact in the intestine?
  101. 101What happens if you supplement what you're eating with sterols or stanols?- Now you only absorb 20-30% of that cholesterol
    - We don't absorb the stanols very well so not all of that is absorbed
    - The rest, 70-80% disappears    What happens if you supplement what you're eating with sterols or stanols?
  102. 102What explains the difference between normal dietary cholesterol and supplementation with stanols/sterols?- 2 main mechanisms (and a 3rd to do with transporters)
    1. The co-precipitation of cholesterol and plant sterols/stanols
    2. The competition for space in mixed micelles
    3. Linked to transporters
  103. 103What is the first mechanism which explains the difference between normal dietary cholesterol and supplementation with stanols/sterols?Mechanism 1: ‘The co-precipitation of cholesterol and plant sterols/stanols’: in the intestinal lumen, cholesterol is found in solution with other fats. However, as monoglycerides and fatty acids are absorbed from the gut, concentration of the less well absorbed substances, e.g. sterols increases. When their concentration reaches a critical level, similar substances can precipitate from the solution. This may happen with cholesterol and plant sterols/stanols, because of their similarity in structure. Both cholesterol and plant sterols/stanols in the free state are poorly soluble in fat and micelles and in fact mutually limit each others solubility. Hence the greater the amount of plant sterols/stanols, the lower the solubility and perhaps the greater the amount of cholesterol precipitated. Cholesterol in the crystalline form cannot be absorbed.
  104. 104What is the second mechanism which explains the difference between normal dietary cholesterol and supplementation with stanols/sterols?Mechanism 2: ‘The competition for space in mixed micelles’: micelle or mixed micelles are very efficient detergent-structures that solubilise the lipids secreted in the small intestine. Mixed micelles are composed of bile salts, phospholipids, tri, di- and monoglycerides, fatty acids, free cholesterol and fat soluble micronutrients. As there is only limited capacity in the micelles for carrying cholesterol, compounds with similar structures to cholesterol such as plant sterols and stanols, can compete with cholesterol for this space. Therefore increasing the amounts of plant sterols and stanols results in less and less cholesterol in mixed micelles and thereby decreased absorption of cholesterol from the gut. In the process of absorption, cholesterol in the micelles is transported from the lumen of the small intestine across the intestinal mucous and into the lymph. The precise mechanism of cholesterol transport from the micelles into the intestinal cells is not fully understood. However, it is known that micelles are not absorbed intact, but that the fats, including cholesterol,*
  105. 105Continued*pass through the brush border membrane into the cells, probably with the involvement of binding proteins and passive transport mechanisms.
    => Overall: So you have precipitation because you’ve got an extra concentration of these water insoluble compounds, and then you’ve got the displacement of cholesterol from micelles which would normally be absorbed so there’s less cholesterol in those micelles therefore less cholesterol is absorbed
  106. 106LOOK OVER MECHANISMS THAT EXPLAINDIFFERENCE IN DIETARY CHOL AND SUPPLEMENTS
  107. 107What is the third mechanism which explains the difference between normal dietary cholesterol and supplementation with stanols/sterols?- Here’s a micellar structure with its bilayer. Cholesterol is normally carried in membrane structures, but when you have sterols and stanols there as well, the cholesterol gets displaced and therefore not absorbed
    - Stanol/sterol molecules, shown by the white rectangle, are very similar in structure to cholesterol, shown by the red rectangle. They mimic cholesterol, binding to micelles but with greater affinity, thereby displacing a cholesterol molecule, which is in turn lost in the faeces    What is the third mechanism which explains the difference between normal dietary cholesterol and supplementation with stanols/sterols?
  108. 108How can this third mechanism be better explained?- To try and illustrate better, next diagram: here’s micelles shown as if they’re completely made of cholesterol, coming up to the intestinal surface and being absorbed and the cholesterol disappears off into the system
    - But when you have stanols/sterols, they also get incorporated into these micelles, they displace cholesterol so less is absorbed into the system    How can this third mechanism be better explained?
  109. 109If we're absorbing 20-30% less of our intestinal cholesterol, why don't we see our blood cholesterol go down by 20-30% instead of 10-15%?- We have a mechanism to explain why we absorb less
    - The reason why we don't see that entire benefit is because we make cholesterol in the liver
    - So we make a bit more to try and compensate for the reduced absorption of cholesterol, but it doesn't entirely compensate
    - Cholesterol absorption reduced by about 30-60%, but this entire benefit isn't seen because cholesterol synthesis goes up (partially) compensate
    => This is why reduction isn't 10-15%
  110. 110Explain cholesterol synthesis- Diagrammatically, here’s our intestine again and we pump our bile in there, have our dietary sources of cholesterol, and if we’re taking sterols/stanols as well they’re being mixed up… We absorb less of it and therefore we push cholesterol synthesis up to try and compensate but not entirely
    - The liver is then secreting less cholesterol off back out to blood supply/bile and back into the small intestine and so therefore, because there’s less going out, our LDL is going down
    - No damaging effect on HDL, only on bad cholesterol LDL    Explain cholesterol synthesis
  111. 111What are the effects of the synergy of Benecol with low fat diet?- Additional 8-14% LDL lowering with plant stanols ester
    - Particularly for people with very high cholesterol
    - Do you get benefits using more than one strategy to get cholesterol levels down? Yes!
    - If you follow a low fat diet as well as consuming stanol esters you can get additional health benefits in terms of reductions in LDL
  112. 112What are statins and what role do they have with regards to cholesterol?- Statins are very commonly prescribed for the over 50s in order to reduce cholesterol levels and reduce heart disease risk
    o LDL-C down by 18-55%
    o HDL-C up by 5-15%
    o TG down by 7-30%
    o Inhibits HMG-CoA to mevalonate; inhibits cholesterol biosynthesis in the liver
    o More than one mechanism involved in how statins work! They inhibit certain enzymes
    - Can get benefits from taking statins and sterols/stanols together -> give good benefits, along with following low fat diet
    - There are discussions now and again about making it compulsory for everyone over 50 to start taking statins, which of course some people aren’t keen on
  113. 113What issues arise by making it compulsory for over 50 populations to take statins?- It comes back to argument of – how are you going to change the health statistics for a population?
    - If you want to do something with a population, you have to actually do things. The idea that you give people statins has a lot to commend it if you really want to do someting
    - But this arises other arguments: e.g. if 30% of a population over 50 are going to die of heart disease or related events... If you could prevent that by giving everyone statins but say 5% of some side effects, is that still beneficial?
    => Yes, because instead of 30% dying there would only be 5% dying
  114. 114Statins - Dose Response- Some different statin drugs and the sorts of levels you can get with either a minimum dose or a maximum dose
    - Light colours = minimum dose
    - There's an extra benefit if you take a higher dose
    - If you take sterols and stanols on top of these statins, then you can add another 10-15% reduction in LDL which would be beneficial    Statins - Dose Response
  115. 115What are the cholesterol-lowering effects of phytosterols?- Additive to that of a healthy diet and lipid-lowering medications such as statins
    - High LDL chol = risk factor for heart disease so people shouldn't wait til they get to 50
    - Females should not ignore it because the risk is the same, if not more, as men    What are the cholesterol-lowering effects of phytosterols?
  116. 116What are the other particular dietary components that can contribute to reducing levels of cholesterol?- Things like viscous fiber (essentially ß-glucans) will contribute by yet another mechanism to reducing your chol
    - Soy protein, less convincing, has been suggested to be able to reduce LDL in the body
    - If you add these alone up, you can see a fairly big % of reduction
    => Should know what sort of foods reduce and have an effect on LDL chol levels in the body (not just sterols/stanols)    What are the other particular dietary components that can contribute to reducing levels of cholesterol?
  117. 117What are possible issues in regards to safety that come with plant sterols/stanols?- People in early days were worried about safety
    - We consume these and they're not toxic so in that respect there's no safety considerations
    - However, the most important concern of plant sterols/stanols is that they reduce the absorption of other fat soluble materials/vitamins (have effects on things like ß-carotene, vitamin E, etc.)
    - Randomized trials have shown that plant sterols and stanols have lowered blood concentrations of ß-carotene, vit E, etc. and thus can reduce absorption
    - This is why if you're pregnant or a young child you shouldn't interfere with vitamin absorption in these groups
    - Having said that, since most vitamins protect LDL chol from oxidation, a good recommendation would be to consume more fruit and veg to counter the decrease in absorption
  118. 118What issues come with LDL cholesterol?- Is LDL chol a worthwhile target for health? Yes
    - Claims/efficacy? Do these things work? Seems like more than almost anything else in the FF area
    - Functional food/supplement/novel food? They seem more like medicine...
    - Can CHD be reduced in the population using daily 'doses' of stanol/sterol? Yes it can be but only if you make large %s consume the stuff, must be part of a bigger strategy.
  119. 119What are one of the things that can really help a population-based strategy to improve health?- That you make the positive side of the behaviour acceptable and the negative side unacceptable
    - E.g. UK - quite successful in reducing smoking, by tax/changing law/advertising bans/etc. which have all contributed but none have worked unless there was a climber of trying to make smoking unacceptable)
    - There are other countries where they may have even tougher laws but there isn't that climber of smoking being unacceptable
    - Another thing the UK is quite good at: using seatbelts in cars. You can change the law and say it's compulsory, but what changed was making it unacceptable not to put a seatbelt on
    - If you change society such that having high blood cholesterol/LDL-C is perceived as not being a good thing, you'd be in a much better position to reduce CHD
  120. 120Might individuals be more likely to have bad dietary habits if they took daily Benecol/Flora Pro-Activ?- This applies to a lot of other types of intervention. If there's a positive characteristic and you get people involved in this, do you get people turning around saying 'I've done that, so I'm allowed to go eat thing?'
    - So if you go eat these products, will you go and eat loads of fat?
    - In the case of sterols/stanols, doesn't seem true partially due to the price and cost of the activity - the type of people that will do this aren't the sort to trade this beneficial activity off for negative activity
    - E.g. if you tax sugar out of existence, would you get lots more people eating fat? Yes, and this certainly wouldn't be good. But sterols/stanols aren't at this level yet
  121. 121Are there issues with safety with regards to consuming Benecol/Flora Pro-Activ?Not a great issue at the moment, people buying the products aren't fat-soluble/vitamin compromised
  122. 122Would other strategies be better in reducing LDL cholesterol?Probably not, trying to encourage people to consume more Benecol and Flora Pro-Activ is good and this should be used in association with other strategies (e.g. medical interventions with statins) and improving other aspects of the diet
    => All the claims for sterols and stanols have been approved by EFSA so there isn't a doubt about their benefits
  123. 123Who is Hugh Sinclair?- A doctor who was the first to propose the idea that omega 3 FAs might have a relationship with heart disease
    - He looked at Greenland Eskimos in the arctic and noticed that, despite eating vast amounts of fat, they had very low rates of heart disease (significantly reduced mortality from CHD compared with control populations)
    - Very fixed on the idea that EFA are v important and he pushed his legacy
  124. 124Why was there controversy surrounding Sinclair's idea about EFA (essential FAs) deficiency and atherosclerosis?His letter to the editor of the Lancet (1956):
    - 'a very important change in the dietaries of the more civilized countries that has been occurring over recent decades with increasing intensity'
    - 'Our own experimental work, humble in scope, combines the careful assessment of the literature and has led us to exactly the opposite conclusion'
    => Professors of nutrition are often wrong and think they're always right
  125. 125What other idea did Sinclair propose?- That low lung cancer rates in high smoking countries Spain and Japan (low heart disease rates too) might be related in some way to a diet high in EFA
    - It is known that in certain parts of the world (e.g. Japan) where there are high levels of smoking, it seems that there's relatively low level of lung cancer (= idea that this is related to diet, in particular fish, is obvious)
  126. 126What is the link between eicosapentaenoic acid and thrombosis and atherosclerosis?Lancet - study:
    - Eskimos in Greenland, trying to relate low incidence of acute myocardial infarction with low levels of certain fats (low lipid intake)
    - They analysed different blood fractions of LDL, VLDL, HDL, etc. and saw the pattern of these was rather unexpected and the levels were associated with a low risk of specific heart disease
    - The reason they could be certain it wasn't genetic = the relationship with Scandinavia, Norway, Denmark, etc. in evolutionary history
  127. 127What can we see by looking at the hominin fossil record?- There are no Neanderthals because they're extinct as is every other homosapien species
    - This tells us that at some point homosapiens won't exist anymore - evolution tells us we won't be around forever
    - In evolutionary time we've hardly been around, we are recent which does have implications as we shall see
    - Agriculture/farming came about 10,000y ago... For humans, because of the time it takes to reproduce, that's such a short time which has been difficult for our genetics to change over time
    - Too recently on an evolutionary time-scale for the human genome to adjust
  128. 128How has the homosapien diet changed since 10,000 years ago? What are the key differences in the diet?- Dairy: there wasn't any dairy whereas not it makes up a huge proportion of our energy intake
    - Cereals, especially refined
    - Sugar
    - Also possibly salt
  129. 129What are the altered nutritional characteristics from ancestral hominin diets?- Glycaemic load
    - FA composition
    - Macronutrient composition (e.g. in terms of things like plant cell walls)
    - Micronutrient density
    - Acid-base balance
    - Sodium-potassium ratio
    - Fibre content
    -> In general, these are some of the major differences that occurred in that time-scale (one that's so short we haven't had time to adapt/change our responses to the diets)
  130. 130What idea did Cordain et al. (2005) come up with?‘The evolutionary collision of our ancient genome with the nutritional qualities of recently introduced foods may underlie many of the chronic diseases of Western civilisation’
    - But 12 years later they might not use term 'Western civilisation' because of the changes seen globally
  131. 131What are the patterns of sugar consumption over time?- Consumption of sucrose in England from 1815-1970 (Cordain et al., 2005): have imported a lot of it, during the WWs sugar consumption declined because shipping was disrupted - but otherwise has been increasing for a long time
    - Sugar consumption in the US: goes down as the US was involved in WWII but then back up - increasing drastically over time
    - Sugar intake in the UK from 1700-1978 (Johnson et al., 2007) with obesity plotted: no direct link shown between obesity and sugar consumption
  132. 132What type of sugar are people consuming?- Consumption of refined sugars in the UK from 1980-2000 (Cordain et al., 2005): used to be mostly sucrose but that's gone down a lot and high fructose corn syrup has increased drastically. Why? Manufacturing technology (how you produce things)
  133. 133What is the Australian Paradox?- 'A substantial decline in sugar intake over the same time-frame that overweight and obesity have increased' (an idea where sugar = seen as very bad...)
    - In Australia and UK, sugar consumption isn't increasing over the same timescale that obesity is going up
  134. 134What are the patterns of animal fat consumption in the US over the last ~100 years?- It's thought that it has increased but this is false
    - Fat derived from plants = increased but fat derived from animals = decreased
    - Consumption of fats like margarine and shortening was only possible when hydrogenation was developed (1897)
    - Hydrogenation = introduces novel trans fatty acid isomer - consequently, quantitative and qualitative aspects of fat intake were significantly changed at the turn of the last century
  135. 135What are caribous and what's interesting about their body fat percentages?- Wild animals (reindeer)
    - Total body fat % fluctuate throughout seasons because of availability of foods
    - Caribous need to build up food supplies in their bodies for winter (so fat levels increase) and then start to drop
    - Why are male and female patterns different? Females have babies in spring to allow them to build up in order to survive winter. Females need to maintain body fat for longer in order to provide nutrition for the developing caribou
  136. 136Discuss the types of fat in caribous and their seasonal fluctuations- Saturated fat, MUFA, PUFA and protein
    - Vary through the year - % of sat fat increases in winter then declines
  137. 137What do the fluctuations in caribou types of fat tell us about humans?- Depending on when you're consuming the animal, the composition of fat will change
    - Caribous, like cows and sheep, are farmed so the composition of fat will be similar each month
    => Composition of fat we're consuming is likely to be much more homogeneous
  138. 138What is the composition of fat?- Fats are acylglycerols: compounds in which a FA molecule is linked to a glycerol molecule by an ester bond
    - Almost all dietary and storage fats are triacylglycerols (where 3 FA molecules are bound to a single glycerol)
    - FA = one of 3 major categories: SFAs (saturated FAs), MUFAs (monounsaturated FAs), PUFAs (polyunsaturated FAs divided into n-3 and n-6 PUFAs)
  139. 139What is the structure of a fatty acid?E.g. steric acid: carbon chain on acid, defined by number of carbonsWhat is the structure of a fatty acid?
  140. 140What are the important fatty acids in the diet?SFA = stearic acid (C18:0)
    MUFA = oleic acid (C18:1, 18 carbons and 1 double bond)
    PUFA:
    - n-6 = linoleic acid (C18:2), arachidonic acid (C20:4)
    - n-3 = eicosapentaenoic acid - EPA (C20:5), docosahexaenoic acid - DHA (C22:6)
    N.B. a:b where a = carbons and b = double bonds; n-3 or n-6 because first double bond appears at carbon 3 or 6    What are the important fatty acids in the diet?
  141. 141Occurrence and intake of different fats- Different foods have varying fat compositions
    - Saturated, MUFA, PUFA are all at different levels
    - E.g. sunflower oil = mostly PUFA, butter = mostly SFA
  142. 142What is the fatty acid intake in adults like in the UK?- 36% of energy comes from total fat (87g/day)
    - Omega-3 is the lowest at 2.3g/day in men and 1.7g/day in women
  143. 143What is the consumption of PUFAs in the US?- Has increased tremendously
    - Sunflower oil contains mostly PUFA
    - So the reason for this drastic increase is partially due to the increased 'health connotation' attached to it
  144. 144What is the Eskimo Paradox?- Traditional diet = diet very high in fat and protein, low in fruit, fibre and leafy green veg but there's little evidence of heart disease and low blood cholesterol levels
    - Eskimos have a greater intake of seal, whale and fish (all containing high levels of DHA and EPA - the 2 main n-3 FAs) whilst also having a lower intake of n-6 FAs
  145. 145What can you notice by looking at a Scandinavian population and an Eskimo population?- See enormous differences in levels of phospholipid, cholesterol esters and triglycerides
    - There's a biological consequence of this
    - EPA doesn't induce platelet aggregation and arachidonic acid does
    - Platelet aggregation is probably a risk factor for heart disease - this gives a clue that there might be a biochemical mechanism behind a higher consumption of omega-3 in the diet
  146. 146What was the first indication that EPA might be beneficial?- Since higher consumption of EPA means no induced platelet aggregation, it could be beneficial
  147. 147What is EPA's benefit and by what potential mechanism?Epidemiology shows lower incidence of heart disease is related to high intake of EPA (and low intake of AA)
    How?
    EPA = doesn't induce platelet aggregation (risk factor)
  148. 148What effects does EPA and DHA concentrations have on HDL blood cholesterol and triacylglycerol?The higher the EPA+DHA intake => the higher your HDL cholesterol
    The higher the EPA+DHA => the lower your TAG (positive effect)
  149. 149What is the association between long chain n-3 PUFA status and the relative risk of sudden death?Albert et al. (2002):
    - Seems to be good relationship between n-3 blood levels and not dying suddenly
    - Also shows relative risk adjusted for other things (BMI, diabetes, hypertension, etc.) and not just adjusted for age and smoking, many studies don't do this and report an inverse correlation between fish consumption or n-3 PUFA status and CHD => Evidence doesn't seem clear!
  150. 150Why is evidence unclear?- Measuring food intake is extremely difficult
    - Measuring supplement intake is easy but not simple: chemical composition of them can differ and how you take them affects how much is absorbed
    - Instead of giving people fish and waiting 20 years to see if they develop heart disease, why not give it to those who already have it and see what happens?
    - Problems of health status of study volunteers
  151. 151What other diseases have been associated with n-3 intake?Coronary heart disease and stroke
    Autoimmune disorders
    Crohn's disease
    Cancer
    etc.
    Seems to be the most support scientifically for CHD and least for brain development
  152. 152Should we increase omega-3 FA consumption?- Lots of evidence saying we should eat more oily fish despite lots of diversity in literature
    - Most authorities have therefore recommended we increase consumption
  153. 153What are the regulatory authorities' recommendations?- FDA (USA), 2004: recognize that the work isn't absolutely conclusive and recommend that consumers don't exceed >3g/day (EPA+DHA) with no more than 2g/day from dietary supplements
    - Committee on Toxicity (UK), 2004: an increase in oily fish to one portion/week (was 1/3 portion/week)
    - UK: 'people should eat at least 2 portions of fish/week, of which one should be oily'
    - Inter-committee subgroup stated this recommendation should also apply to pregnant and lactating women, subject to restrictions on certain fish due to methylmercury contamination
    => Not much evidence on the dangers of pregnant women consuming oily fish, seems precautionary more than reality
  154. 154What are the safety concerns related to omega-3 FA intake?- Increased bleeding times
    - Possibility of hemorrhagic stroke (internal bleeding causing stroke, related to increased bleeding times)
    - Oxidation of n-3 omegas forming biologically active oxidation products (toxic)
    - Increased level of LDL or apoproteins associated with LDL chol among diabetics and hyperlipidemics
    - May be reduced glycemic control among diabetics
    - Dioxin, dioxin-like contaminant intake
  155. 155What are the practical recommendations for omega-3 FAs?- If taking supplements, should use highest quality fish oils with a concentration of at least 60% EPA and DHA
    - For general health, 1g of EPA+DHA per capsule (1000mg daily)
    - Limit fatty fish consumption to no more than 2 servings per week (because of safety issues)
  156. 156What are the explanations for the levels of total fat, trans fat and omegas in the hunter gatherers' diet?- Total fat: since we've been able to farm more intake of dairy foods in particular, fat consumption in diet has gone up
    - Trans fat: gone up because we've been able to produce them chemically
    - Most important results: consumption of n-6 have gone up at the same time n-3 have gone down
  157. 157What does the increased consumption of plant fats suggest?- Have increased consumption of plant fats and animals are farmed (and fed more grain rather than grass)
    - This leads to an increased level of n-6 in the animals compared to n-3
    - This has allowed people to develop the idea that it's not just the amount of these being consumed but also to do with the ratio
  158. 158How has the omega6:omega3 ratio changed over time?- In the hunter gatherer diet the ratio was 2:1 or 3:1
    - The ratio now is about 12:1 to 15:1 (much higher)
    - An increased consumption of n-6 and probably reduced consumption of n-3 omegas shows the idea is related to the ratio
  159. 159What is the common misconception about omega 6 and omega 3s?Omega 6 = bad, omega 3 = good
    => WRONG!
    -> Omega 6 and 3 both have beneficial effects but if you get them out of proportion things start to go wrong (going along with hypothesis)
    - The metabolism and biochemical activities of each omega when consumed is different
    - Omega 6 = tend to be pro aggregatory where omega 3 = tend to be anti-aggregatory
    - This recent ratio might be the reason for the incidence of heart disease
  160. 160Why might the change in ratio be so important? Biochemistry - how the materials are metabolized in the body- Omega 6s (short chain) go through a series of chemical reactions that involved desaturase enzymes, elongation enzymes, etc. and we get omega-6-derived eicosanoids (which tend to have pro-aggregatory effects)
    - Omega 3s go through similar reactions which results in omega-3-derived eicosanoids (tend to have anti-aggregatory effects)
    = look similar but can't interchange these, they're completely independent pathways
  161. 161Why can't you interchange omega 3 and omega 6 pathways?- Because of the specificity of the enzymes involved
    - Have desaturase and elongase enzymes
    - In omega 3 = produce C20:4 then C22:5 (eventually C22:6-DHA)
    whereas in omega 6 = produce C20:3 then C22:4 (eventually C22:5)
    - Altered ratio at the bottom because they're separate pathways
    - Our limited ability to elongate omega 6s and 3s gets worse as we get older (not good at carrying out this pathway)
  162. 162Why is important to create a balance?- Ratio = important
    - Omega 6 intake is too high because of veg fat intake and omega 3 intake is too low because of reduced intake of marine animals
    - Omega 6 = excess of these promote inflammation
    - Omega 3 = reduce inflammation levels
    - Idea is that we need to get balance back to where it used to be at 3:1 (n-6:n-3) instead of ~10:1
  163. 163What is the hypothesis about balance in ratio?Because we have these levels wrong and therefore have an imbalance in 'western' diet, this leads to a rising rate of inflammatory disease (such as CVD)
  164. 164Which fats are beneficial and which are detrimental?- MUFAs and some PUFAs = beneficial
    - Most SFAs and trans fats = detrimental (especially when consumed in excessive quantities)
  165. 165What are the two essential fatty acids?1. Linoleic acid (omega 6 FA): seeds and seed oils (sunflower, hemp, grape, pumpkin, sesame), nuts and nut oils, grains and grain oils, soybean and soybean oil
    2. Alpha linolenic acid (omega 3 FA): seeds and seed oils (flax, hemp, canola), nuts and nut oils (walnuts), green leaves of plants, sea veg -> contributes 85-95% of omega 3 PUFA intake in UK adults
    = We consume both of these but must remember that our ability to derive the longer chain omega 3s and 6s from these isn't great and gets worse
  166. 166What is the structure of alpha-linolenic acid?What is the structure of alpha-linolenic acid?
  167. 167How is alpha-linolenic acid metabolically related to long chain omega 3 PUFAs?- Desaturase enzymes (create the double bonds) and elongation enzymes combine to give us EPA and DHA (end points before you produce eicosanoids)
    - To produce eicosanoids (with bioactivity), must produce EPA and DHA or take them in
  168. 168What are EPA and DHA?- Major examples of long chain omega 3 fatty acids
    - EPA = 20:5, eicosapentaenoic acid
    - DHA = 22:6, docosahexaenoic acid
    Desaturase and elongase enzymes put in more double bonds whilst also making the chains longer
  169. 169How are eicosanoids produced from the point of consumption from diet?How are eicosanoids produced from the point of consumption from diet?
  170. 170Which part of this pathway are humans not very good at?- Any shortfall in consumption of alpha-linolenic acid is almost made worse because the pathway is quite inefficient in the body
    - There are all sorts of studies that have shown this
    - The enzymes are entirely non-convertible in higher animals and humans. If you feed people stable isotopes and look at where they go you know where but the conversion of dietary linolenic acid to EPA is very limited and to DHA marginal at best (even in healthy individuals)
    - As you get older and have diseases that will possibly affect your metabolism then it'll get even worse    Which part of this pathway are humans not very good at?
  171. 171Should we take steps to increase our consumption of EPA and DHA?Must emphasize that argument that we should increase our EPA and DHA intake seems convincing but proof has been must more difficult to absolutely establish - for all sorts of reasons (difficulty of trying to measure composition of these compounds over many years, difficulty of trying to relate that to disease outcome, etc.)
    - Despite lack of absolute 100% proof and evidence, most seem convinced by this which is why so much authorities recommend the increased consumption of oily fish or supplements derived from it
  172. 172What is linoleic acid (n-6 PUFA) converted to?It can be elongated and desaturated to arachidonic acid and similar compounds (precursors for pro-inflammatory and pro-aggregatory eicosanoids)
  173. 173What is linolenic acid (n-3 PUFA) converted to?It is elongated and desaturated to EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) (precursors for anti-inflammatory and anti-aggregatory eicosanoids)
  174. 174What are the effects of long-chain omega-3 PUFAs on mediators of atherosclerosis?An example of why you need balance of omega 3s and 6s: clotting times = if you have stroke or heart attack you're put on drugs straight away to stop blood clotting. So to some extent that is a beneficial behaviour... But generally if we're not having a stroke then it doesn't do us much good -> so there must be a balance between the 2 activitiesWhat are the effects of long-chain omega-3 PUFAs on mediators of atherosclerosis?
  175. 175What are the potential mechanisms by which omega-3 FAs may reduce risk for CVD?Whole load of mechanisms related to omega-3-derived eicosanoids that could be involved in the protection against CVD...
    - Reduce susceptibility of the heart to ventricular arrhythmia
    - Antithrombogenic
    - Hypotriglyceridemic (fasting and postprandial)
    - Retard growth of atherosclerotic plaque
    - ETC.
  176. 176Where are long chain omega-3 PUFAs?- In sea animals
    - Mostly in things mackerel/oily fish
    - Cod and haddock (not oily fish) = quite low
    - Get 10x more in oily fish like prawns, crab, salmon
    = to increase consumption of long chain omega 3 FAs - each more oily fish or supplements
    = average intake of them is low (<0.2g/day)
  177. 177Why should we increase oily fish consumption?- We're bad at n-3 to EPA and DHA pathway
    - Amount of them that we're producing relative to our consumption of alpha-linolenic acid is poor
    - Therefore, we must increase oily fish consumption or products derived therefrom
  178. 178What are vegetarians' intake of omega 6 and omega 3 like?- Their intake is even higher than non-vegetarians as more of these are widely available from plants
    - But since they don't consume fish their levels of DHA and EPA are going to be corresponding (n-3 long chain FAs)
    - How much plant food (containing short chain omega 3) they consume doesn't matter as their ability to turn that into EPA and DHA is quite poor
  179. 179Are EPA and DHA essential dietary components?- Since they may have beneficial effects on CVD, does this make them essential dietary components
    - E.g. vitamin C = essential dietary component as you get ill if you don't get enough
    - Good argument saying they should be regarded as essential but since we can make them (even if badly) then some argue they're not necessarily essential
    => Extremely close to being essential!
  180. 180What are omega 3 PUFAs important in?- Membrane structure
    - Brain and visual development (optimal brain growth, optimal visual and neural function)
    - Maintenance of cognitive and neurological function (during development and with aging)
    - Regulation of: blood pressure; platelet function, thrombosis; vascular function; etc.
    => Have a lot of bioactivity in the body
  181. 181What might omega 3 PUFAs be protective against?A whole range of diseases:
    - Hypertension
    - Thrombosis
    - Cardiac arrhythmias
    - CVD
    - Allergic conditions
    - Immune dysfunction
    - Some cancers
    - Etc.
    But the evidence varies a lot!
  182. 182DHA concentration in different human tissues...- Levels are quite high in the brain and retina
    - Therefore, if they're high here people believe that if you take more they will function better
    => Incorrect logic!
  183. 183Can fish be used as a brain food?- Fish is high in DHA and the brain has high DHA levels
    - There has been many studies on school children and studies of patients with Schizophrenia and ADHD - may show that increasing levels of DHA has beneficial impact on brain function? Need to look at the Hawthorne effect first
  184. 184What is the Hawthorne Effect?- 1932: involving Committee on the Relation of Quality and Quantity of Illumination to Efficiency in the Industries chaired by Thomas Edison (who wanted more electric light)
    - Set up committee and asked if better lighting increased productivity
    - When light levels were increased = productivity improved
    - When light levels were reduced = productivity improved even more
    - Placebo effect?
    => Shows that it's difficult doing studies in humans, must design experiments properly as observing humans when they're aware changes their behaviour
  185. 185Where do functional foods stand in the context of omega 3s?We must consider:
    - If there's a valid health claim
    - If the food provides a reasonable dose
    - If the dose is absorbed and if it has a biological function
    - If the food contributes to improved health outcome when consumed 'normally'
  186. 186An example of a product that was removed from the market...CleverMilk used to be on the market but got removed. Why?
    - 'Omega 3 may enhance learning and concentration' (indication of first problem? no evidence to support this)
    - Can't make claims that can't be proven true
    - The dose was quite low (probably because of the taste)
    - It was expensive (which is fine if people buy into it)
    FSA reacted with 'evidence on the cognitive benefits of the omega 3 fatty acids is currently uncertain' => not true
    Joint Health Claims Initiative (JHCI) similarly said 'there is insufficient evidence to assert that omega 3 improves brain power'
  187. 187An example of a product on the market that is honest...Columbus Omega 3 eggs:
    - 'Helps maintain a healthy heart and supple joints' (is this true)
    - Omega 3 comes from diet high in oil-rich seeds that hens were fed
    - Despite expert recommendations, average UK diet contains only half the omega 3 needed (possibly less)... Therefore, a Columbus egg contains over half the recommended daily amount
    - PUFA omega 3 content of normal eggs = 0.5% vs. Columbus egg = 13%
    - PUFA omega 6 content of normal eggs = 15% vs. Columbus egg = 13%
    -> More of a 1:1 ratio
    => Ratio is important!
    Why might some prefer to eat these instead of oily fish? Taste
  188. 188Another example of an honest product on the marketMuller Vitality with Omega 3:
    - Fat free, feel good, probiotic (everything people want!)
    - 'Omega 3 is an essential nutrient for the functioning of the brain' (not necessarily true)
    - 'Omega 3 can help to maintain a health heart', 'the average UK diet contains only 50% of the omega 3 required'
    - 'Every bottle of muller vitality contains 75mg of omega 3 (EPA and DHA)
    - Important to look at EPA and DHA of products and not just omega 3. Why? If they're short chain n-3 fatty acids you won't be able to do much with it as you can't efficiently make EPA and DHA
    - The omega 3 content is about 50% of recommended level so product isn't too bad
  189. 189What other products are available as sources of n-3 FAs?- Bassetts chewy 'helps to promote brain and eye development; healthy bones; teeth; eyes and skin; healthy immune system'
    - Cod liver oil tablets 'contain EPA and DHA which contribute to the normal function of the heart'
    - Triple Omega Action 'Contributes to the maintenance of normal brain function and vision'
    - Flaxseed linseed oil capsules 'Contributes to the maintenance of normal blood cholesterol levels'
    - Birdseye omega 3 fish fingers 'A daily intake of 250mg of DHA contributes to maintenance of normal brain function'
    - Goldenlay Omega 3 eggs 'Omega 3 fatty acids have been proven
    to decrease inflammation', 'The brain and nerve cells are mainly
    constructed of structural fats, the
    Omega 3 fatty acids', 'Omega 3 can help at various stages of
    life with problems such as high blood
    pressure, inflammation, blood clots and
    cardiac arrhythmia (the government endorses a health claim for long chain omega 3 (DHA, DPA & EPA)'
  190. 190ALA (alpha-linolenic acid) =Precursor to EPA (eicosapentaenoic acid) & DHA (docosahexaenoic acid)
  191. 191Why is consuming plants (or plant-derived products) containing omega 3s not enough?- These tend to be short chain fatty acids and we can't make the long chain EPA and DHA so isn't necessarily that good for you
    - People are starting to research into genetically modifying plants in order to up the long chain fatty acid levels - but this arises problem of 'will people eat genetically modified plants rather than oily fish?'
  192. 192What is another issue that comes with consuming omega 3-containing products?Whether we absorb the dose...
    - Especially in terms of supplements: literature suggests this has been problematic
  193. 193Why might you not absorb a reasonable amount from supplements?1. Supplements/capsules contain different substances - even if they're cod liver oil capsules, to add value some companies do stuff to the material to make it stand out and look different (e.g. chemically esterify the fatty acids, which alters how they'll be absorbed)
    2. If you eat fatty fish then you're eating a meal, whereas if you take a capsule in the middle of the day you're not so it's not unreasonable to think absorption might be different under those two circumstances
    3. Commercial interests: companies trying to push their products
  194. 194What is the difference between absorption of omega 3 from salmon and from supplements?Visioli et al. (2003):
    - 'Dietary intake of fish vs. formulations leads to higher plasma concentrations of n-3 fatty acids'
    - Looked at absorption of n-3 from salmon (in one particular form) compared to absorption of the ethyl ester of some omega 3s from distilled fish oil supplements
    - Those from fish were more effectively incorporated into plasma lipids than when administered as capsules: in other words you're not getting as good a benefit consuming the capsules as you are by eating the fish
    - This probably isn't right because of reasons above: if you took the same ethyl esters with a high fat meal the absorption would be more similar to that from fish
  195. 195What are contributing factors affecting absorption?- Absorption story = complex and not made easier by incomplete studies supported by supplement companies (unsurpisingly pushing their own products)
    - Is absorption of the same chemical form being compared?
    - What other foods are involved in the experiment? What period are you looking at?
    => All contributing factors to absorption!
  196. 196What other research has been done in relation to absorption of n-3 fatty acids?Harris et al. (2007):
    'Comparison of the effects of fish and fish oil capsules on n-3 FA content of blood cells and plasma phospholipids'
    - Were the n-3 from fish consumed weekly or daily?
    - They said that as long as you did them in a defined way, both of these routes were equally effective and you absorbed the same amount of omega 3 from the supplements as you did from the fish
    - If you take supplements, must take them with a meal!
    - The findings suggest that consumption of equal amounts of EPA and DHA from oily fish on a weekly basis or from fish-oil capsules on a daily basis is equally effective at enriching blood lipids with n-3 fats
  197. 197What's the difference between plant sterol/stanol consumption and omega 3 consumption?With plant stanols/sterols it might be more relevant when older whereas with omega 3 evidence says starting early and consistently continuing is important
  198. 198What product of Flora Pro-Activ was removed from the market and why?Raspberry yoghurt drink that 'helps control blood pressure':
    - 'Contains dairy peptides proven to help control BP to maintain a healthy heart'
    - The product contained AmealPeptide (special dairy peptides that naturally occur in dairy foods - milk proteins)
    - 'Scientific studies show that they actively help control BP as part of a healthy diet'
  199. 199Do dairy peptides help to reduce blood pressure?Seppo et al (2003):
    - Some change in systolic blood pressure and diastolic pressure and time along x-axis
    - Fairly consistent and significant difference between the 2 groups (control and those receiving peptides)
  200. 200How do dairy peptides work?- To do with system in the body called the renin-angiotensin system (partly to do with controlling BP)
    - When we digest proteins, we chop them into smaller and smaller peptides down to a single amino acid - but not always!
    - There's always the possibility of absorbing quite short peptides from the intestine
    - In the body, you have hormones and other signaling agents that are protein-based so clearly there's a lot of specificity involved in that interaction
    - That's based on particular peptides within the proteins, however if you could reproduce that with other peptides you'll still get binding
    - With peptides, you could get one the same as the binding peptide within the larger protein
    - With food peptides, given that you absorb so many different proteins you have a very large potential diverse range of peptides that you could generate (so doesn't seem unreasonable that you might be able to create peptides from food-derived proteins that are able to interact with target systems in the body

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Functional Foods Flashcards on Functional Foods Revision, created by Cassie Byrne on 08/05/2017.
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