1. Lecture 5c 3 Feb 2014 Atherosclerosis - Functional Foods and Nutraceuticals

2. Functional foods are only marginally capable of modifying the factors involved in atherosclerosis relative to nutraceuticals Are functional foods of any value regarding prevention or improvement of the atherosclerotic process?

3. Class activity - Factors that limit use of nutraceuticals

4. Nutraceuticals-impacts on lipids and lipoproteins Note: none = no studies found in humans Fish oils -lower triglycerides-mechanism is controversial -modest decrease or no impact on cholesterol and LDLc -may slightly increase or decrease or have no impact on HDLc

5. Nutraceuticals-impacts on lipids and lipoproteins Evening primrose oil- -most effective at lowering cholesterol in hypercholesterolemic persons -rise in HDLc only in hypertriglyceridemics- due to inverse relationship in response between triglycerides and HDLc

6. Nutraceuticals-impacts on lipids and lipoproteins -borage oil -no impact of up to 5.4 g GLA /day

7. Nutraceuticals-impacts on lipids and lipoproteins -blackcurrant oil- -drops triglycerides, LDLc and total cholesterol and raises HDLc especially in hyperlipidemics -normolipidemics there is no effect to date

8. Nutraceuticals-impacts on lipids and lipoproteins -garlic capsules -LDLc and cholesterol is lowered modestly by 10–15 %-allicin fingered though mechanism is not clear -atheroma regression -reduction of oxidation of lipids -may play a role in reduced platelet activity since oxidized LDL has been suggested to more aggressively increase platelet reactivity- Jialal at UC-Davis disputes this

9. Nutraceuticals-impacts on lipids and lipoproteins Beta-carotene, vitamin E, and vitamin C -antioxidant principles -some have suggested atheroma lessening though this is controversial

10. Nutraceuticals-impacts on platelets -fish oils -reduction of arachidonic acid in platelet membrane phospholipid -increased EPA in platelet membrane phospholipid -generates thromboxane A 3 weakly pro-aggregatory - generates PGI 3 –very antiaggregatory

11. Nutraceuticals-impacts on platelets -evening primrose oil -DGLA-generates PGI 1 -PGI 1 -antiaggregatory evening primrose oil-some show an increase in aggregation at higher GLA doses (300 mg/day) -at lower doses (<300 mg GLA/day)- decreased aggregation

12. Nutraceuticals-impacts on platelets -borage oil- no impact of up to 1.3 g GLA /day -5.24 g GLA/day increased aggregation -higher doses-hyper-reactivity – possibly due to formation of a hydroxy DGLA -blackcurrant oil-mix of omega 3 and 6 -no impact on aggregation

13. Nutraceuticals-impacts on platelets -garlic capsules -lower aggregation in vitro -problem with in vitro (usually washed or platelet-rich plasma)-may not be physiological -bleeding times are better- Ivy bleeding time- this is more physiological

14. Blood pressure and nutraceuticals - more elaboration when we get to hypertension -fish oils-modest blood pressure lowering -may be in part due to PGI 3 (possibly -no PGI 3 human studies found) -may also be due to drops in AA- related eicosanoids

15. NUTRACEUTICALS AND BLOOD PRESSURE -evening primrose oil -modest drops (possibly due to PGI 1 - no human PGI 1 studies found) -PGE 1 related drops in blood pressure -borage oil-more pronounced drops than evening primrose oil observed -blackcurrant oil- most pronounced drops of the studies done

16. Nutraceuticals and Blood pressure -garlic capsules -lower blood pressure due to increased nitric oxide-allicin fingered as cause of increased nitric oxide

17. Nutraceuticals and Obesity -olive oil -may result in weight loss -mechanism obscure (possibly oleic acid related) -fish oils -none -evening primrose oil -one study-no effect

18. Nutraceuticals and Obesity -borage oil -none -blackcurrant oil -none -garlic capsules -none

19. Nutraceuticals and Renal Disease Various Pathogens -no nutraceuticals yet studied that specifically alleviate the problems of infection that are hypothetically linked to atherosclerosis Nitric oxide -garlic capsules- increase in nitric oxide production that reduces blood pressure that reduces risk of renal disease and its progression