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Prescription 2017: Improving Endothelial Function

January 22, 2017 Written by JP       [Font too small?]

The allopathic treatment of poor circulation typically focuses on two areas: anticoagulant medications (aspirin, Coumadin, Plavix) and/or surgical interventions such as angioplasty and stents. Anticoagulants interfere with excessive clotting allowing blood to flow freely in a liquid state. Angioplasties and stents address circulation that is impeded by blockages or narrowing in arteries. Sometimes, these invasive and pharmaceutical measures are necessary due to advanced cardiovascular disease. However, in many cases, circulation can be effectively and safely improved by addressing an often neglected part of vascular system: the endothelium.

Endothelial cells form the inner lining of blood vessels. Healthy endothelial function (EF) results in proper circulation throughout the body via dynamic constriction and dilation. For instance, when you eat a meal, blood flow will be preferentially directed to your digestive system. When exercising, the muscles involved will be the primary recipient of robust circulation. During academic activity, the brain gets more attention and so on. But, when the endothelium isn’t functioning properly, it causes blood to stagnate and is implicated in the development of atherosclerosis – hardening and narrowing of the arteries. Obviously, that’s something to avoid. Here are some evidence-based, natural options to help keep your endothelium in tip-top shape.

Not Just Vitamin C - Endothelial function is especially sensitive to decline after eating and in overweight individuals. A recent study reveals that flavanone-rich oranges counteract the effects of overeating by “attenuating transient impairment in FMD” or flow mediated dilation. Another trial reports that supplementing with lemon and sour orange peel extracts has a similar effect in young, obese patients. The authors of the citrus peel research believe that a number substances, including flavanones, pectin and Vitamin C, may be responsible for the noted benefits.

Curcumin or Curry - Curcuminoids are believed to be some of the most active components in dried and fresh turmeric. That is why many supplement manufacturers feature products with concentrated levels of purified curcuminoids. These products are often referred to as curcumin instead of turmeric. Experiments from 2016 and 2017 demonstrate clinically significant improvements in vascular function in healthy adults who supplemented with curcumin. In both cases, patented forms of this turmeric extract (Longvida and CurcuWIN) were used because of enhanced bioavailability. Interestingly, even traditional turmeric sources, such as curry, also minimize postprandial endothelial dysfunction.

Black Tea Please - Green tea reigns supreme among many holistic health enthusiasts and physicians. But, those looking to support their endothelial cells may want to opt for a darker brew. Researchers have found that about three cups a day of black tea provides meaningful vascular benefits by increasing the number of circulating endothelial progenitor cells. CACs, as they’re known, “maintain and repair the endothelium regulating its function”. In effect, this renders arteries less stiff.

Magnesium and/or Taurine - Magnesium is an essential mineral which is often deficient in the population at large. Taurine is a semi-essential amino acid that can also be scarce in some diets. Three publications from 2016 and 2017 inform that supplementing with magnesium (between 340 – 600 mg/day) or taurine (1.6 – 3 grams/day) boosts vasodilation and supports the health of arteries and the endothelium by reducing blood pressure and oxidative stress. Personally, I use and recommend a form of magnesium known as magnesium taurate. This is a mineral chelate that chemically binds magnesium and taurine together.

The French Paradox - Over the years, there’s been a lot of back and forth about the elusive merits of supplemental resveratrol. In my opinion, it’s been both over-hyped and under appreciated. What’s clear is that most of current data lend support for resveratrol with regard to circulatory benefits. Relatively low dosages (75 – 100 mg/day) have been shown to enhance blood flow to the brain by reducing the number of circulating endothelial microparticals and systemic inflammation – “important links in the pathogenesis of atherosclerosis”. Another promising finding is that resveratrol supplementation has an acute and sustained effect in at-risk individuals such as type-2 diabetics.

A nutrient-dense diet and plenty of physical activity are the foundation of cardiovascular wellness. Protecting against endothelial dysfunction is an extension of that principle, and it’s clearly worth the effort. Without healthy blood flow, nothing in your body functions as it should. The foods and supplements listed above are intended as add-ons to an eating plan that’s rich in low glycemic fruits, herbs, nuts, seeds, spices and vegetables. These are abundant sources of antioxidants and cardioprotective minerals, including magnesium and potassium. Taurine is easily obtainable in animal-based proteins such as beef, eggs, pork and wild game. Vegetarians can opt for dairy sources, including buffalo milk, cottage cheese, goat’s milk and yogurt. And, vegans have the option of supplementing with either taurine alone or as magnesium taurate.

Note: Please check out the “Comments & Updates” section of this blog – at the bottom of the page. You can find the latest research about this topic there!

Study 1 - The Vascular Endothelium and Human Diseases … (link)

Study 2 - Flavanones in Grapefruit, Lemons, and Limes: A Compilation … (link)

Study 3 – Flavanone-Rich Citrus Beverages Counteract the Transient(link)

Study 4 - Effect of the Peels of Two Citrus Fruits on Endothelium (link)

Study 5 - Curcumin Supplementation Improves Vascular Endothelial (link)

Study 6 - Novel Form of Curcumin Improves Endothelial Function in (link)

Study 7 - Single Consumption of Curry Improved Postprandial Endothelial (link)

Study 8 - Black Tea Increases Circulating Endothelial Progenitor Cells (link)

Study 9 - Effect of Black Tea Consumption on Brachial Artery Flow-Mediated (link)

Study 10 – Black Tea Consumption Dose-Dependently Improves Flow-Mediated (link)

Study 11 - Oral Magnesium Supplementation Improves Endothelial Function (link)

Study 12 - Taurine Supplementation Lowers Blood Pressure and Reduces (link)

Study 13 - Taurine and Magnesium Supplementation Enhances the Function (link)

Study 14 - Resveratrol More Effectively Than Quercetin Reduces Endothelium … (link)

Study 15 - Concentration Dependent Effect of Plasma Resveratrol on (link)

Study 16 - Low Dose Resveratrol Improves Cerebrovascular Function in Type (link)

Study 17 - Effects of a Lifestyle Intervention on Endothelial Function in Men (link)

Study 18 - The Effects of a Low-Carbohydrate Diet vs. a Low-Fat Diet on Novel … (link)

Study 19 - Effects of Sodium and Potassium Supplementation on Endothelial (link)

Study 20 - Taurine in Milk and Yoghurt Marketed in Italy (link)

Study 21 - The Taurine Content of Common Foodstuffs (link)

Exercise Promotes Healthy Endothelial Function

Source: Oxid Med Cell Longev. 2016;2016:3583956 (link)

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9 Comments & Updates to “Prescription 2017: Improving Endothelial Function”

  1. JP Says:

    Updated 01/22/17:

    http://onlinelibrary.wiley.com/doi/10.1113/JP272453/abstract

    J Physiol. 2016 Sep 15;594(18):5329-42.

    Passive heat therapy improves endothelial function, arterial stiffness and blood pressure in sedentary humans.

    KEY POINTS: A recent 30 year prospective study showed that lifelong sauna use reduces cardiovascular-related and all-cause mortality; however, the specific cardiovascular adaptations that cause this chronic protection are currently unknown. We investigated the effects of 8 weeks of repeated hot water immersion (‘heat therapy’) on various biomarkers of cardiovascular health in young, sedentary humans. We showed that, relative to a sham group which participated in thermoneutral water immersion, heat therapy increased flow-mediated dilatation, reduced arterial stiffness, reduced mean arterial and diastolic blood pressure, and reduced carotid intima media thickness, with changes all on par or greater than what is typically observed in sedentary subjects with exercise training. Our results show for the first time that heat therapy has widespread and robust effects on vascular function, and as such, could be a viable treatment option for improving cardiovascular health in a variety of patient populations, particularly those with limited exercise tolerance and/or capabilities.

    ABSTRACT: The majority of cardiovascular diseases are characterized by disorders of the arteries, predominantly caused by endothelial dysfunction and arterial stiffening. Intermittent hot water immersion (‘heat therapy’) results in elevations in core temperature and changes in cardiovascular haemodynamics, such as cardiac output and vascular shear stress, that are similar to exercise, and thus may provide an alternative means of improving health which could be utilized by patients with low exercise tolerance and/or capabilities. We sought to comprehensively assess the effects of 8 weeks of heat therapy on biomarkers of vascular function in young, sedentary subjects. Twenty young, sedentary subjects were assigned to participate in 8 weeks (4-5 times per week) of heat therapy (n = 10; immersion in a 40.5°C bath sufficient to maintain rectal temperature ≥ 38.5°C for 60 min per session) or thermoneutral water immersion (n = 10; sham). Eight weeks of heat therapy increased flow-mediated dilatation from 5.6 ± 0.3 to 10.9 ± 1.0% (P < 0.01) and superficial femoral dynamic arterial compliance from 0.06 ± 0.01 to 0.09 ±0.01 mm(2)  mmHg(-1) (P = 0.03), and reduced (i.e. improved) aortic pulse wave velocity from 7.1 ± 0.3 to 6.1 ± 0.3 m s(-1) (P = 0.03), carotid intima media thickness from 0.43 ± 0.01 to 0.37 ± 0.01 mm (P < 0.001), and mean arterial blood pressure from 83 ± 1 to 78 ± 2 mmHg (P = 0.02). No changes were observed in the sham group or for carotid arterial compliance, superficial femoral intima media thickness or endothelium-independent dilatation. Heat therapy improved endothelium-dependent dilatation, arterial stiffness, intima media thickness and blood pressure, indicating improved cardiovascular health. These data suggest heat therapy may provide a simple and effective tool for improving cardiovascular health in various populations.

    Be well!

    JP

  2. JP Says:

    Updated 01/22/17:

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4819099/

    Int J Hypertens. 2016;2016:6791519.

    Beneficial Effects of Dietary Nitrate on Endothelial Function and Blood Pressure Levels.

    Poor eating habits may represent cardiovascular risk factors since high intake of fat and saturated fatty acids contributes to dyslipidemia, obesity, diabetes mellitus, and hypertension. Thus, nutritional interventions are recognized as important strategies for primary prevention of hypertension and as adjuvants to pharmacological therapies to reduce cardiovascular risk. The DASH (Dietary Approach to Stop Hypertension) plan is one of the most effective strategies for the prevention and nonpharmacological management of hypertension. The beneficial effects of DASH diet on blood pressure might be related to the high inorganic nitrate content of some food products included in this meal plan. The beetroot and other food plants considered as nitrate sources account for approximately 60-80% of the daily nitrate exposure in the western population. The increased levels of nitrite by nitrate intake seem to have beneficial effects in many of the physiological and clinical settings. Several clinical trials are being conducted to determine the broad therapeutic potential of increasing the bioavailability of nitrite in human health and disease, including studies related to vascular aging. In conclusion, the dietary inorganic nitrate seems to represent a promising complementary therapy to support hypertension treatment with benefits for cardiovascular health.

    Be well!

    JP

  3. JP Says:

    Updated 01/22/17:

    https://www.karger.com/Article/Abstract/445359

    Ann Nutr Metab. 2016;68(3):213-9.

    Middle-Term Dietary Supplementation with Red Yeast Rice Plus Coenzyme Q10 Improves Lipid Pattern, Endothelial Reactivity and Arterial Stiffness in Moderately Hypercholesterolemic Subjects.

    AIM: The aim of our study was to investigate whether treatment with red yeast rice added with Coenzyme Q10 is associated with changes in endothelial function and arterial stiffness.

    METHODS: This double blind, placebo-controlled, randomized clinical trial was carried out on 40 non-smoker moderately hypercholesterolemic subjects (ClinicalTrial.gov ID NCT02492464). After 4 weeks of diet and physical activity, patients were allocated to treatment with placebo or with an active product containing 10 mg monacolins and 30 mg Coenzyme Q10, to be assumed for 6 months. Endothelial reactivity and arterial stiffness have been measured through the validated Vicorder® device.

    RESULTS: During monacolin treatment, patients experienced a more favorable percentage change in low density lipoprotein (LDL)-cholesterol (after monacolin treatment: -26.3%; after placebo treatment: +3.4%, p < 0.05). Endothelial reactivity (pulse volume displacement after monacolin treatment: +6.0%; after placebo treatment: -0.3%, p < 0.05), and arterial stiffness (pulse wave velocity (PWV) after monacolin treatment: -4.7%; after placebo: +1.1%, p < 0.05) also significantly improved only after monacolin treatment.

    CONCLUSION: The long-term assumption of the tested dietary supplement is associated with an improvement in LDL-cholesterolemia, endothelial reactivity and PWV in moderately hypercholesterolemic subjects.

    Be well!

    JP

  4. JP Says:

    Updated 01/22/17:

    http://www.ashjournal.com/article/S1933-1711(16)30548-4/abstract

    J Am Soc Hypertens. 2016 Oct 26.

    Omega-3 fatty acids supplementation improves endothelial function and arterial stiffness in hypertensive patients with hypertriglyceridemia and high cardiovascular risk.

    Association between hypertriglyceridemia and cardiovascular (CV) disease is still controversial. The purpose of this study was to compare omega-3 and ciprofibrate effects on the vascular structure and function in low and high CV risk hypertensive patients with hypertriglyceridemia. Twenty-nine adults with triglycerides 150-499 mg/dL were divided into low (<7.5%) and high (≥7.5%) CV risk, randomized to receive omega-3 fatty acids 1800 mg/d or ciprofibrate 100 mg/d for 12 weeks. Treatment was switched after 8-week washout. Clinical evaluation and vascular tests were assessed at baseline and after intervention. Peripheral (131 ± 3 to 125 ± 3 mm Hg, P < .05) and aortic (124 ± 3 to 118 ± 2 mg/dL, P < .05) systolic blood pressure were decreased by ciprofibrate in low-risk patients. In high-risk patients, pulse wave velocity was reduced (10.4 ± 0.4 to 9.4 ± 0.3 m/s, P < .05) and flow-mediated dilation was increased (11.1 ± 1.6 to 13.5 ± 1.2%, P < .05) by omega-3. In conclusion, omega-3 improved arterial stiffness and endothelial function, pointing out the beneficial effect of this therapy on vascular aging, in high-risk patients.

    Be well!

    JP

  5. JP Says:

    Updated 01/25/17:

    http://www.tandfonline.com/doi/abs/10.1080/19390211.2016.1267059?journalCode=ijds20

    J Diet Suppl. 2017 Jan 24:1-11.

    Taurine Supplementation Improves Functional Capacity, Myocardial Oxygen Consumption, and Electrical Activity in Heart Failure.

    BACKGROUND: Taurine is an amino acid found abundantly in the heart in very high concentrations. It is assumed that taurine contributes to several physiological functions of mammalian cells, such as osmoregulation, anti-inflammation, membrane stabilization, ion transport modulation, and regulation of oxidative stress and mitochondrial protein synthesis. The objective of the current study was to evaluate the effectiveness of taurine supplementation on functional capacity, myocardial oxygen consumption, and electrical activity in patients with heart failure.

    METHODS: In a double-blind and randomly designed study, 16 patients with heart failure were assigned to two groups: taurine (TG, n = 8) and placebo (PG, n = 8). TG received 500-mg taurine supplementation three times per day for two weeks.

    RESULTS: Significant decrease in the values of Q-T segments (p < 0.01) and significant increase in the values of P-R segments (p < 0.01) were detected following exercise post-supplementation in TG rather than in PG. Significantly higher values of taurine concentration, T wave, Q-T segment, physical capacities, and lower values of cardiovascular capacities were detected post-supplementation in TG as compared with PG (all p values <0.01).

    CONCLUSIONS: Taurine significantly enhanced the physical function and significantly reduced the cardiovascular function parameters following exercise. Our results also suggest that the short-term taurine supplementation is an effective strategy for improving some selected hemodynamic parameters in heart failure patients. Together, these findings support the view that taurine improves cardiac function and functional capacity in patients with heart failure. This idea warrants further study.

    Be well!

    JP

  6. JP Says:

    Updated 02/08/17:

    https://bmccomplementalternmed.biomedcentral.com/articles/10.1186/s12906-017-1603-9

    BMC Complement Altern Med. 2017 Feb 2;17(1):92.

    Effects of an L-arginine-based multi ingredient product on endothelial function in subjects with mild to moderate hypertension and hyperhomocysteinemia – a randomized, double-blind, placebo-controlled, cross-over trial.

    BACKGROUND: Nutrition plays an important role in prevention and management of cardiovascular diseases (CVD) in early stages. Recent research demonstrated beneficial effects of various nutritional ingredients on vascular health. The aim of the current study was to evaluate the effects of an L-arginine-based multi ingredient product (AbMIP) on vascular function.

    METHODS: Twenty-five male and female subjects, aged between 45 and 65 years with elevated blood pressure and hyperhomocysteinemia were included in this cross-over trial. Subjects were randomly assigned to one of the two sequence groups (AbMIP -placebo or placebo – AbMIP). AbMIP and placebo were taken for 4 weeks, each. Endothelial function under fasting conditions, blood pressure, postprandial endothelial function after consumption of a high fat meal, homocysteine, asymmetric dimethyl arginine (ADMA) and Hba1c were determined.

    RESULTS: AbMIP significantly improved fasting endothelial function determined by EndoPAT™ when compared to placebo (p = 0.047). Similarly, homocysteine levels were significantly decreased after verum supplementation when compared to placebo (p < 0.0001). Systolic blood pressure decreased significantly under AbMIP (p = 0.002) and the reduction was more pronounced when compared to placebo. However, due to placebo-effects no significant difference could be found between groups (p = 0.586). The effects on postprandial endothelial function were stronger for AbMIP when compared with placebo but did not reach significance (p = 0.201). No significant effects of AbMIP were observed regarding HbA1c, ADMA and diastolic blood pressure.

    CONCLUSIONS: Due to improvement on endothelial function, decrease of elevated homocysteine levels and excellent tolerability, AbMIP was demonstrated to be a beneficial option for dietary treatment of endothelial dysfunction and hyperhomocysteinemia in early stages of CVD.

    Be well!

    JP

  7. JP Says:

    Updated 02/27/17:

    https://www.ncbi.nlm.nih.gov/pubmed/28236615

    Altern Ther Health Med. 2017 Feb 27.

    Effects of Music Therapy on Endothelial Function in Patients With Coronary Artery Disease Participating in Aerobic Exercise Therapy.

    Context • Pleasant music that evokes a positive emotional response may activate brain pathways of the insular cortex, central nucleus of the amygdala, and lateral hypothalamus, which are involved in the integration of emotional and ambient sensory input, with corresponding autonomic responses. Exercise training can improve endothelium-dependent vasodilatation, both in epicardial coronary vessels and in resistance vessels, for patients with coronary heart disease.

    Objective • The aim of the present study was to evaluate the effects on endothelial function when patients with stable coronary artery disease (CAD) listened to their favorite music.

    Design • The study was a randomized controlled trial.

    Setting • The study occurred at the Institute of Cardiology, Niska Banja, Faculty of Medicine, University of Nis (Nis, Serbia).

    Participants • Participants were 74 patients with stable CAD.

    Intervention • Participants were randomly assigned to 1 of 3 groups: (1) exercise training only (T) group (n = 33), (2) listening to music and exercise training (MT) group (n = 31), and listening to music only (M) group (n = 10). Participants in the T and MT groups received usual medical care and underwent 3 wk of supervised aerobic exercise training. In addition to the exercise training, participants in the MT group listened to their favorite music for 1.5 h every day. Participants in the M group received the usual medical care and listened to their favorite music for 1.5 h every day.

    Outcome Measures • At baseline and postintervention, outcomes were assessed through measurement of the changes in circulating blood markers of endothelial function-the stable end product of nitric oxide (NOx), asymmetric dimethylarginine, symmetric dimethylarginine, and xanthine oxidase-and through the results of submaximal or symptom-limited exercise test.

    Results • After 3 wk, the NOx significantly increased in both in MT and T groups, with P < .001 and P < .01, respectively. The level of NOx was associated with an improvement in exercise capacity, which increased in the T, MT, and M groups, with P < .001, P < .001, and P < .05, respectively. At the end of the study, the xanthine oxidase was significantly lower in the T, MT, and M groups, with P < .001 and P < .05, respectively.

    Conclusions • The patients with stable CAD significantly improved their endothelial function by listening to their favorite music in addition to participating in regular exercise training. Having a patient listen to his or her favorite music can be proposed as an additional nonpharmacologic intervention for improving a CAD patient’s endothelial function. The music program should be adjusted individually to fit with a well-established training program for aerobic exercise, according to a patient’s preferences.

    Be well!

    JP

  8. JP Says:

    Updated 04/21/17:

    http://ajcn.nutrition.org/content/early/2017/04/18/ajcn.116.146803.abstract

    Am J Clin Nutr. 2017 Apr 19.

    A Mediterranean diet lowers blood pressure and improves endothelial function: results from the MedLey randomized intervention trial.

    Background: The consumption of a Mediterranean diet (MedDiet) is associated with a lower risk of cardiovascular disease. However, its impact on blood pressure and endothelial function is not clear.Objective: We sought to determine the effects of adhering to the consumption of a MedDiet for 6 mo on blood pressure and endothelial function in older, healthy Australians.Design: A total of 166 men and women aged >64 y were allocated via minimization to consume either a MedDiet (n = 85) or their habitual diet (HabDiet; control: n = 81) for 6 mo. The MedDiet comprised mainly plant foods, abundant extra-virgin olive oil, and minimal red meat and processed foods. A total of 152 participants commenced the study, and 137 subjects completed the study. Home blood pressure was measured on 5 consecutive days at baseline (n = 149) and at 3 and 6 mo. Endothelial function (n = 82) was assessed by flow-meditated dilatation (FMD) at baseline and 6 mo. Dietary intake was monitored with the use of 3-d weighed food records. Data were analyzed with the use of linear mixed-effects models to determine adjusted between-group differences.Results: The MedDiet adherence score increased significantly in the MedDiet group but not in the HabDiet group (P < 0.001). The MedDiet, compared with the HabDiet, resulted in lower systolic blood pressure (P-diet × time interaction = 0.02) [mean: -1.3 mm Hg (95% CI: -2.2, -0.3 mm Hg; P = 0.008) at 3 mo and -1.1 mm Hg (95% CI: -2.0, -0.1 mm Hg; P = 0.03) at 6 mo]. At 6 mo, the percentage of FMD was higher by 1.3% (95% CI: 0.2%, 2.4%; P = 0.026) in the MedDiet group.Conclusion: Australian men and women who consumed a MedDiet for 6 mo had small but significantly lower systolic blood pressure and improved endothelial function.

    Be well!

    JP

  9. JP Says:

    Updated 05/02/17:

    http://www.clinicalnutritionjournal.com/article/S0261-5614(17)30150-4/abstract

    Clin Nutr. 2017 Apr 20.

    Effect of nut consumption on vascular endothelial function: A systematic review and meta-analysis of randomized controlled trials.

    OBJECTIVE: Nut consumption has consistently been found to be associated with a reduced risk of cardiovascular diseases (CVD) and mortality in prospective studies. However, its effect on endothelial function, a prognostic marker of CVD, is still controversial in clinical trials. This meta-analysis of randomized controlled trials (RCTs) aimed to quantitatively assess the effect of nuts on vascular endothelial function.

    METHODS: Major electronic databases were searched for published RCTs that reported the effect of nuts on flow mediated dilation (FMD) as a measurement of endothelial function in the adult population (age eighteen years or over). We calculated the pooled estimates of weighted mean differences (WMDs) and their 95% confidence intervals (CIs) by using random-effects models.

    RESULTS: A total of nine papers (10 trials) involving 374 participants were included. The pooled estimates found that nut consumption significantly improved FMD (WMD: 0.41%; 95% CI: 0.18%, 0.63%; P = 0.001). Moderate and marginally significant heterogeneity was observed among the studies (I2 = 39.5%, P = 0.094). Subgroup analyses indicated that walnuts significantly improved FMD (WMD: 0.39%; 95% CI: 0.16%, 0.63%; P = 0.001). In addition, nut consumption had a significant effect on FMD in the trials with study duration <18 weeks, nut dose <67 g/d, or subjects with baseline FMD ≥8.6%.

    CONCLUSIONS: Nut consumption significantly improved endothelial function. However, the beneficial effect was limited to walnuts. More studies examining the effect of other nuts on endothelial function are needed in the future.

    Be well!

    JP

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