** Post by Anh Thu V. Tran, MS, MD- Medical Director and Nutrition Consultant, Cyvex Nutrition

Crisp, refreshing to pleasantly tart, the white-flesh apple wrapped in red, yellow, or green colored skin is the most commonly-consumed fruit not only for its taste, but also for its evidence-based health benefits.  Ironically the apple has been used to describe body types not necessarily representing optimal health, but rather the opposite.  The apple figure is almost universally associated with impaired glucose function and subsequent Type 2 diabetes mellitus with the rare occasions of Type 1, in addition to other clinical presentation of Metabolic syndrome such as dyslipidemia, hypertension, hyper-coagulated and hyper-inflammatory state.  Apple figures are defined as fat localized within the abdomen, which tend to easily distribute into the bloodstream compared to other areas, hence the complications as such.  Waist to hip ratio for women above 0.8 and for men above 1.0 is suggestive of an unhealthy accumulation of fat in the midsection.  This excess fat is often related to insulin resistance diabetes mellitus in addition to co-morbities commonly associated with diabetes as mentioned above and microvascular complications to the eyes, kidneys, and nerves.  This excess weight in the mid-region of our bodies increases the risk for heart disease up to 2.5 times in men and up to 8 times in women with diabetes mellitus with this shape.*

Phlorizin, a crystalline glycoside sweet to taste found in apples, pears, or cherries was formally used as a tonic and in the treatment of malaria, but is more commonly used now in research focused in diabetes mellitus and obesity.  As a flavonoid, phlorizin has demonstrated its potent antioxidant potential, but more specifically it has been shown to stabilize blood glucose levels (Judge H et al., 2008). Initial in vivo work with Rosettie and team demonstrated that a reduction of beta-cell mass leads to the development of insulin resistance (otherwise known as diabetes mellitus Type 2), and correction of hyperglycemia with phlorizin, without change in insulin levels, normalizes insulin sensitivity.  These results provide the first in vivo evidence that hyperglycemia per se can lead to the development of insulin resistance and phlorizin found in apples, pears, or cherries (Rossetti L et al., 1987) can help thwart hyperglycemia.  Epidemiological studies demonstrate that apple consumption may also be associated with lower risk of diabetes.  In a Finnish study of 10,000 people, a reduced risked of Type 2 diabetes was associated with the consumption of apples and the higher quercetin intake, the flavonoids found most abundant in the peels was associated directly to the findings (Knekt P et al 2002).  Amelioration of blood glucose associated with apples was also seen in a study in Brazil on weight loss in middle-aged over-weight women (n = ~ 400) that had high cholesterol.  These women were randomly split into three groups who ate the following: oat cookies, apples, or pears.  Each consumed one of each supplement three times per day for twelve weeks.  The study demonstrated that not only was the consumption of either fruit associated with significant weight loss of 1.21kg, but the fruits also significantly lowered and stabilized blood glucose levels (de Oliviera M et al., 2003).  More recent work narrowed the main culprits being flavonoids as the active components behind such benefits.*

The National Food Research Institute in Japan in an in vivo study of streptozotocin-induced diabetic mice found phlorizin reduced blood glucose levels and specific gene expression in the small intestine after 14 days of consumption (et al., 2009).  Procyanidins, another group of flavonoids, are oligomeric forms of catechins that are abundant in red wine, grapes, cocoa, and especially apples.  Paraoxonase acts as an antioxidant enzyme and protects low-density lipoprotein-cholesterol against oxidation.  This is the first study to show an association between paraoxonase status and grape seed extract (GSE) supplementation and demonstrated that GSE increased paraoxonase activities, presumptively from activity of procyanidins. This beneficial effect of GSE was more obvious in the diabetic group, which was more prone to atherosclerotic events compared to the healthy population.  Diabetics with complications such as dyslipidemia responded to procyanidin supplementation against oxidation of “bad” cholesterol, low-density cholesterol (Kiyici A et al, 2010).  Those consuming food containing high levels of phlorizin and other flavonoids not only had more more manageable and stable blood glucose levels, but aided in consequential complications of diabetes.*

We have always been told an apple a day keeps the doctor away, but now we can specifically add that it will keep that apple figure away as well, so pick up an apple or 2 today!

References:

Gosch C et al., “Phloridzin biosynthesis, distribution and physiological relevance in plants,” Phytochem, 2010; 71:838-43.

Kiyici A et al., “The effect of grape seed extracts on serum paraoxonase activities in streptozotocin-induced diabetic rats,” J Med Food, 2010 ;13:725-8.

Jugde H et al., “Isolation and characterization of a novel glycosyltransferase that converts phloretin to phlorizin, a potent antioxidant in apples,” FEBS J, 2008; 275, 3804-14.

Masumoto S et al., “Dietary phloridzin reduces blood glucose levels and reverses Sglt1 in the small intestine in streptozotocin-induced diabetic mice,” J Agric Food Chem, 2009; 57:4651-6.

*These statements have not been evaluated by the Food and Drug Administration.  This product is not intended to diagnose, treat, cure or prevent any disease.

Author’s bio: Dr. Anh Thu V. Tran is the Medical Director & Nutrition Consultant for Cyvex Nutrition, PGY-1 Resident with  UC Davis Family Medicine Residency Network, and Founder of Strive to Live Well.  She holds a M.D. from St. George’s University, a M.S. in Nutrition from Loma Linda University, and a B.Sc. in Biology & Women’s Studies from UC Irvine.

** By Anh Thu V. Tran- Medical Director & Nutrition Consultant, Cyvex Nutrition

From the light- to medium-bodied prancing to the puckering power boldly dancing, full-bodied reds, aired, swirled, and sipped, experiencing each dynamic flavor from plum to currant to smoke and so forth, red wine in its nature not only provides a taste like no other, but also has been well supported to hold health benefits with moderate consumption.  Despite diets of high amounts of saturated fats including butter and cheese, the paradox goes, the French have a relatively low incidence of cardiovascular events, which many have attributed to regular drinking of red wine.  Filled with plentiful polyphenols, it is resveratrol that stands in the spotlight as it and its metabolites provide the antioxidant and HDL stimulating potential supporting a heart healthy lifestyle.*

What if a glass of wine a day was equivalent to the recommended daily intake of baby aspirin or statins prescribed by a doctor?  What if a glass of wine demonstrated protective effects against not only cardiovascular conditions, but also protected the cerebral vascular system, in other words, potential protection from stroke?   Initial studies more than a decade ago, demonstrated the first evidence of partial neuroprotective action of chronic administration of resveratrol in vivo, suggesting a possible model for neurodegenerative injury (Virgili M et al., 2000).  Five years later, subsequent studies showed pre-infused resveratrol protected the spinal cord from ischemic reperfusion injury in vivo by which resveratrol was found to decrease oxidative stress and increased nitric oxide release (Kiziltepe et al 2004).  Further investigation led to findings that it not only acted as an antioxidant, but also directly inhibited voltage-gated K+ channels, which have been implicated in neuronal apoptosis (cell death) supporting another possible mechanism of action (Gao ZB et al., 2005, 2006).  Indeed, resveratrol has been noted for its potential pre-dose protection, but recent studies also demonstrated post-ischemic dose immediately after traumatic brain injury reduced oxidative stress and lesion volume, which could be explained by its ability to relax smooth muscle in the wall of basilar artery contributing yet another role as a vasodilator (Ates O et al., 2007, Karaoglan A et al 2008).*

Resveratrol’s beneficial effects include: (1) antioxidation (free radical scavenger and modulation of neuronal energy homeostasis and glutamatergic receptors/ion channels, (2) vasodilatory effects in pre- and post-treatment infusion protection of ischemic reperfusion injury, (3) directly increases sirtuin 1 (SIRT 1) activity and NAD (+) related to increased lifespan in various species similar to calorie restriction, and (4) pretreatment protection against cerebral ischemia and other organ systems, which could be a great potential target for further studies in treatment modalities.*

More recently, an additional mechanism which resveratrol was suggested to have included anti-inflammatory characteristics as well.  Zhang and team explained both in vitro and in vivo studies highlighting inhibition of activated microglia (2010).  In doing so, microglia are unable to release pro-inflammatory factors, which produced reactive oxygen species, and activated signal pathways leading to neuroinflammation.  With that being said, Parkinson’s disease (PD) and many other neurodegenerative diseases arise from over active microglia-mediated inflammation.  As a subsequent follow-up study, Zhang and team applied resveratrol in vivo primary midbrain neuron-glia cultures that demonstrated clear protection of neurotransmitters (in the case of PD – dopamine) against LPS-induced neurotoxicity through the inhibition of microglial activation.  In addition to these findings, Johns Hopkins University Anesthesiology and Critical Care Medicine team revisited resveratrol’s effect on stroke, demonstrating in vivo resveratrol pretreatment dose dependently protected against the ischemic reperfusion stroke model.  Heme oxygenase was selectively deleted to suggest a potential intracellular pathway by which resveratrol can provide cell/organ resistance against neuropathological conditions (2010).*

Indeed further studies are in order to determine specific dose and timing of resveratrol for optimal neuroprotective effects, but what is certain is that moderate consumption of resveratrol does demonstrate neuroprotective effects.  As you air, swirl, and sip that dark red tonight and experience its dynamic nature in flavor and consistency, also realize its vast effect on your overall health.  Cheers to the heart, cheers to the brain, cheers to deep reds <cling, cling>.

References (For an extended list please contact us)

Sakata Y et al., “Resveratrol protects against experimental stroke: putative neuroprotective role of heme oxygenase 1,” Exp Neurol, 2010; 224, 325-9.

Zhang F et al., “Anti-inflammatory activities of resveratrol in the brain: role of resveratrol in microglial activation,” Eur J Pharmacol, 2010; 636:1-7.

Zhang F et al., “Resveratrol protects dopamine neurons against lipopolysaccharide-induced neurotoxicity through its anti-inflammatory actions,” Mol Pharmacol, 2010; 78:466-77

*These statements have not been evaluated by the Food and Drug Administration.  This product is not intended to diagnose, treat, cure or prevent any disease.

Author’s bio: Dr. Anh Thu V. Tran is the Medical Director & Nutrition Consultant for Cyvex Nutrition, PGY-1 Resident with  UC Davis Family Medicine Residency Network, and Founder of Strive to Live Well.  She holds a M.D. from St. George’s University, a M.S. in Nutrition from Loma Linda University, and a B.Sc. in Biology & Women’s Studies from UC Irvine.

**By Anh Thu V. Tran, MS, MD- Medical Director and Nutrition Consultant, Cyvex Nutrition

From getting kids off to school and getting to work, attending board meetings, making soccer practices and dance recitals, we are all in constant motion.  Unfortunately, most of us are strapped for time and find it difficult to stay fluid with the current as we fall behind in meeting nutritional needs or wish to reach optimal health by consuming nutrition to meet daily requirements.  Either way, as we become more knowledgeable of how effective a balanced and/or optimal diet is to our health, the demand for a quick and easy solution to keep up with our lifestyles is a must.  The “do-it-yourself” mentality influenced by the recession has produced wellness-focused consumers.  From low-calorie/low-sugar, sugar-free, naturally-sweetened, and all natural, functional beverages are the new black, as lifestyle consumers are wearing the latest creations from the inside out.

With an annual expected growth rate of 6.1 percent from 2007 to 2012, the United States has the largest functional food and beverage market in the world worth almost $700 billion in 2008.  In 2009 alone, U.S. sales of functional foods and beverages reached almost $40 billion, up 2.7% from previous year with $21.6 billion from beverages, making it the largest functional segment.  Traditional beverage companies have expanded their products by adding functional ingredients and/or introducing functional products to their line.  Functional drinks among dieters and/or weight lifters have always been around, but it is the new trend of optimizing time and nutrition in a bottle that drives this market forward.  Recent studies demonstrate consumers are more likely to purchase a product that claims health versus nutrition benefits (Verbeke W et al., 2009).  Scientific evidence and crafty formulations help consumers readily accept new ingredients as well as the more popular ones which owe their success to appropriate delivery and clear communication of health benefits.

In response, functional beverages are tailored towards specific gender, age, and body type/weight.  The safety, optimal doses, interactions, and long-term benefits have more research necessary to be determined, but many of the added ingredients have been linked to some science-based health claims.  As consumers become more health conscience, the demand and market value for health promoting products will continue to increase as should more focused research behind these products to determine the mechanism of action to optimize their formulations.  A recent study comparing 3,100 foods, beverages, spices, herbs, and supplements of total antioxidant content demonstrates the start of such work to further elucidate the health benefits of antioxidants (Carlsen MH et al., 2010).  However, more research in this direction is a must to keep up with the market.  From a metabolic, antioxidant, alertness/cognitive, immune, digestive boost and anti-aging potential to replacing the routine multivitamins supplements, functional beverages as a segment is keeping up with the current by aiming to aid health as well as quench thirst.

References:

Carlsen MH et al., “The total antioxidant content of more than 3,100 foods, beverages, spices, herbs, and supplements used worldwide,” Nutr J; 2010, 9:3.

Verbeke W et al., “Consumer appeal of nutrition and health claims in three existing product concepts,” Appetite; 2009, 52:684-92.

Author’s bio: Dr. Anh Thu V. Tran is the Medical Director & Nutrition Consultant for Cyvex Nutrition, PGY-1 Resident with  UC Davis Family Medicine Residency Network, and Founder of Strive to Live Well.  She holds a M.D. from St. George’s University, a M.S. in Nutrition from Loma Linda University, and a B.Sc. in Biology & Women’s Studies from UC Irvine.

**By Anh Thu V. Tran, MS, MD- Medical Director & Nutrition Consultant, Cyvex Nutrition

The growing segment of active sixty-five years and over Americans not only denotes successful commitment for research towards extension of lifespans, but also the acknowledgment that it really does not mean much if you can live longer, if you can’t enjoy it.  The key emphasis is longevity, however in light of extended lifespans and improved longevity is the expected eventual overdrive the body must undergo to maintain some state of homeostasis – the efforts to stay balanced in the aging process.

Of the many protectors of our body – the basic immune response to disturbances, such as infection and trauma, involves Inflammation.  However, it is also this process that can easily speed out of control against our bodies either in the natural progression of aging or accelerated destruction of disease and other pathological processes.  It is obvious this double-edged sword walks the fine line as we age.  What’s promising is that adopting a healthier lifestyle that includes adequate rest, daily physical exercise, specific diets, and halting poor choices (e.g. tobacco smoking) proactively work against such acceleration.

We previously discussed how flavonoids are effective even at a young age (Holt EM., et al 2009).  High consumption of fruits and vegetables reduce markers related to inflammation and oxidative stress among adolescents; this is supported on a molecular level and can be applicable to the immune process at any age and in associated disease processes.*  The Agricultural Research Service (ARS) of the University of California, Davis, has conducted numerous studies in the past decade demonstrating how inflammation favors the risk of cancer and chronic diseases such as Cardiovascular Disease (hypertension and dyslipidemia) and Diabetes Mellitus Type II (insulin resistance).  Dr. Daniel H. Hwang and team, after exhausting filtering of numerous phytochemicals, has finally placed the spotlight yet again on flavonoids in their role against certain inflammatory triggers (TMK-1 kinase and IRF1 dimerization and phosphorylation).  Luteolin among the 6 other phytochemicals most effectively targets these enzymes in its cascade of biochemical signaling that lead to the formation of gene products known to trigger inflammation (Lee JK et al 2009).*  Luteolin, found in food such as celery, green peppers, chamomile tea, and thyme, demonstrated to be the most effective of all other flavonoids studied (quercetin, chrysin, eriodicytol, hesperetin, and naringenin).

In addition, recent data suggests a promising role for luteolin as a possible candidate in developing immune-modulatory and neuroprotective agents on central nervous system (brain and spinal cord) against a specific trigger: the microglia.  The microglia has been confirmed as a major culprit in age-related disease progression.  Although protective, it also takes on that double-edged detriment.  The Institute of Human Genetics, University of Regensburg investigation showed inhibitory effects of luteolin on pro-inflammatory cytokine expression in microglia.  With the identification of several novel luteolin-regulated genes, their findings provide a molecular basis to understand the versatile effects of luteolin on microglial homeostasis (Dirscherl K., et al 2010).*

In the uncertainties of life – certainty does exist.  Making effective lifestyle choices are within your control and although not necessarily capable of halting the double-edged sword, but at least taming as such by the choices we make, including which fruits and vegetables we consume,  is the best we can do to help prevent diseases and slow-down the progression of aging.

References:

Holt EM., et al., “Fruit and vegetable consumption and its relation to markers of inflammation and oxidative stress in adolescents,” J Am Diet Assoc, 2009; 109:414-21.

Lee JK., et al., “Suppression of the TRIP-dependent signaling pathway of Toll-like receptors by luteolin,” Biochem Pharmacol, 2009; 77:1391-400.

Dirscherl K., et al., “Luetolin triggers global changes in the microglial transciptome leading to a unique anti-inflammatory and neuroprotective phenotype,” J Neuroinflammation, 2010; 14:7-3.

*These statements have not been evaluated by the Food and Drug Administration.  This product is not intended to diagnose, treat, cure or prevent any disease.

Author’s bio: Dr. Anh Thu V. Tran is the Medical Director & Nutrition Consultant for Cyvex Nutrition, PGY-1 Resident with  UC Davis Family Medicine Residency Network, and Founder of Strive to Live Well.  She holds a M.D. from St. George’s University, a M.S. in Nutrition from Loma Linda University, and a B.Sc. in Biology & Women’s Studies from UC Irvine.

**By Anh Thu V. Tran, MS, MD- Medical Director and Nutrition Consultant,  Cyvex Nutrition

Sunscreen use increases as July and August months bring on the warmer weather for t-shirts, tank tops, shorts, skirts, and bikinis.  Unbeknownst to many of us, protection from sun exposure is important all year round and should not be limited to poolsides, beaches, hiking trails, or other outdoor wonders of warmer months.  Cloudiness and hazy days do not protect us from the UV rays, but rather reach our bodies as if it were actually a bright and sunny day.  3.5 million cases in two million people are diagnosed annually with skin cancer in the United States and the incidence is more than the combined incidences of cancers of the breast, prostate, lung and colon (American Cancer Society, 2009, Skin Cancer Foundation 2010).

The current CDC recommendations against UV sun-damage is as follows: (1) use of sunscreen of sun protective factor (SPF) 15 or higher with UVA and UVB protection, (2) wear protective clothing, (3) wear protective hat to shade face, head, ears, and neck, (4) wear sunglasses with UV block , and (5) seek shade especially during midday hours (2010).  UVA is related to skin aging and UVB is associated with skin cancer.    The reality is that the warmer months are spent underneath the sun, with minimal clothing at peak UV exposure from 10AM to 4PM, and most people actually enjoy seeking out the sun rather than shade, which emphasizes the importance of and dependency on sunscreen.  However, what if there was an additional protective factor?  What if this factor were to work on defending you against UV radiation from the inside and outside of your body?  What if this product could be applied as in topical creams/lotions and also as an option one could add as a side to a lunch or dinner plate. Among the top superfoods (for good reason), this green vegetable, resembling a tree, filled with  rich vitamins, minerals, fiber, and plentiful phytochemicals has been suggested in the protection and repair of UV sun damage to the skin.*  It is no surprise this superfood spotlight shines on broccoli (yet again).

Recent in vivo studies demonstrated 25 percent less skin tumors following chronic UV exposure for 17 weeks when  fed broccoli extract for 13 weeks than compared to standard protective agents on hairless animal model at Johns Hopkins University.  In addition, tumors that were developed were 70% smaller in diameter and depth (Dinkova-Kostova AT, et al. 2010).  Replication of this animal model to confirm such protection is in the works with subsequent anticipated clinical studies to follow. Dinkova-Kostova and team demonstrated that exposure to UV accompanied with sulforaphane glucosinolates (SGS) also provided the validity behind selection of sprouts over mature broccoli (2010).  Previous in vivo studies using both animal and human skin demonstrated immediate cellular defenses resulting from UVR-induced inflammation and edema in mice and reduction in susceptibility to erythema (redness) arising from narrow-band 311 nm UVR in humans, presenting potential in topical application of cruciferous extracts (Talalay P, et al. 2007).*  Optimizing products for broccoli sprout applications in supplements, functional foods, and/or topical products would be advantageous in providing the greatest potential of effectiveness and uniqueness to products.

What are the actives within broccoli and other cruciferous vegetables (cauliflower, cabbage, and Brussels sprouts) that provide such protection?  Beyond the already known nutritious richness, these vegetables also have high levels of a group of phytochemicals called glucosinolates, which are further metabolized by the body into isothiocyanates.  Phenythyl isothiocyanates (PEITC) and sulforaphane have also been applied as adjunct therapy in chemotherapy in halting the proliferation of tumor cells.  Sulforaphane is the main metabolite and has been associated with mobilizing cellular defenses against UV damage.  Its precursor, glucoraphanin (sulforaphane glucosinolates – SGS) at optimized levels can be found in the sprouts of broccoli compared to the mature vegetable.  Eating your vegetables, yet again, holds weight in a healthier diet.  So next time someone asks if you would like a side of broccoli, remember, you are not only getting a side of vegetables with a punch of rich nutrients, but also a side of sun protection!

References:

Dinkova-Kostova AT et al., “Dietary glucoraphanin-rich broccoli sprout extracts protect against UV radiation-induced skin carcinogenesis in SKH-1 hairless mice,” Photochem Photobiol Sci, 2010; 9: 597-600

Talalay P et al., “Sulforaphane mobilizes cellular defenses that protect skin against damage by UV radiation,” PNAS, 2007; 104:17500-17505

*These statements have not been evaluated by the Food and Drug Administration.  This product is not intended to diagnose, treat, cure or prevent any disease.

Author’s bio: Dr. Anh Thu V. Tran is the Medical Director & Nutrition Consultant for Cyvex Nutrition, PGY-1 Resident with  UC Davis Family Medicine Residency Network, and Founder of Strive to Live Well.  She holds a M.D. from St. George’s University, a M.S. in Nutrition from Loma Linda University, and a B.Sc. in Biology & Women’s Studies from UC Irvine.