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Flavonoids and a Healthy Heart

Red wine and chocolate may have benefits beyond the dinner table

Elizabeth Hein’s racing heart would wake her up at night. It wasn’t exactly chest pain, but Hein knew something was wrong. But what? She was 27-years-old with no previous health problems, a non-smoker, runner and healthy eater. When she went running, sometimes her nail beds would turn bluish. Hein went to her doctor, who told her “that just happens” and advised her to take aspirin before running.

Hein says her symptoms were ignored until she wound up in the emergency room having a full-blown heart attack. Now 36, Hein volunteers for the American Heart Association’s Go Red For Women initiative, which seeks to raise awareness about heart disease among women.

“You can’t tell that someone has heart disease by looking at them,” Hein says. The Go Red For Women movement focuses efforts on educating women about their risks because heart disease has long been seen as a problem that affects men more than women, which has been proven untrue.

Hein lost her mother to heart disease in the fall of 2006. Her death has made her even more determined to talk about her experience in an effort to make more women aware of the cardiovascular risks they may face.

“Pay attention to your heart,” Hein says. “If something doesn’t feel right, push and push and push your doctors. If they don’t listen, scream until someone listens to you.”

February is American Heart Month, and the American Heart Association schedules many heart disease awareness events for this time of year. Heart disease is the number one killer of Americans and claims more lives each year than the next four leading causes of death combined (cancer, chronic lower respiratory diseases, accidents and diabetes), according to a 2006 study published by the American Heart Association.

Besides being American Heart Month, February is associated with the heart in another capacity—Valentine’s Day. It’s a time of year when many people are faced with gifts of candy, decadent dinners out and other temptations that can derail the best efforts of maintaining good health. Two indulgences often associated with Valentine’s Day—dark chocolate and red wine—are thought to have some characteristics that can actually improve heart health.

Dark chocolate can be healthy. Recent studies have found that chocolate with a high cocoa content contains flavonoids, powerful antioxidants that are found in some foods that come from plants. Other sources of flavonoids are green tea, grape skins and blueberries. This element present in dark chocolate is not found in milk chocolate, so eating milk chocolate does not have the same benefits.

A study published in the Journal of the American Heart Association in July of 2005 found that eating a daily bar of dark chocolate lowered blood pressure significantly and improved insulin resistance after 15 days. Flavonoids have a healthy effect on the heart by keeping cholesterol from gathering in blood vessels, reducing the risk of blood clots and relaxing arteries to allow more blood to flow through.

“All of these effects attack underlying contributors to heart disease,” says Tina Musselman, a registered dietician and a certified clinical nutritionist with Ingalls Memorial Hospital in Harvey.

Other experts also cite the positive effects that dark chocolate and other flavonol-rich foods can have on the heart.

Lynne Braun, Ph.D., is a nurse practitioner in the Preventative Cardiology Center and the Heart Center for Women, Rush Heart and Vascular Institute, Rush University Medical Center and an associate professor in the department of adult health nursing at Rush University Chicago. Braun also emphasizes that people who eat dark chocolate often wind up with healthier arteries. She says that there have been cases of people who have mildly elevated blood pressure and lower it by eating dark chocolate. However, she cautions that studies have not determined how much chocolate is beneficial.

“If 2 ounces [are] good, that doesn’t mean that 4 ounces [are] better,” Braun says.

This caution is important because of the calories and fat that chocolate contains. One 1.3 ounce bar of Dove dark chocolate contains 190 calories and 12 grams of fat. This makes it especially important that chocolate is not simply added to a diet. Instead, substitute other sweets with dark chocolate and offset the extra calories with plenty of exercise and make other healthy food choices.

Some of the heart healthy elements found in dark chocolate are also found in red wine, indicating the presence of flavonoids. The the deep, lush color of red wine primarily comes from the presence of grape skins in the wine. The skins contain proanthocyanidin, a type of flavonoid that can help prevent clotting, lower LDL (“bad”) cholesterol or prevent it from sticking to the arterial wall, reducing hypertension and increasing dilation of arteries.

Braun says that people who already drink a moderate amount of alcohol see a reduction in total mortality from heart disease and a reduction in arterial disease by almost 30 percent. Resveratrol is one substance in red wine that is thought to be good for the human vascular system.

“There are some supposed health benefits of alcohol, then red wine has the extra benefits [of flavonoids and resveratrol],” Braun says.

These substances maintain the health of the blood vessels by promoting formation of nitric oxide, a chemical that causes arteries to relax and dilate to allow blood to flow more easily. Red wine increases formation of nitric oxide, Braun says.

Resveratrol and other antioxidants have all of the mentioned benefits on the cardiovascular system and also help mend existing damage to arteries so that blockages and clots do not form around an injured spot in the artery.

“[Resveratrol is] like a magic paint to put on your car to prevent rust,” Musselman says.

There are some important caveats when discussing potential benefits of drinking red wine. There are no studies to confirm the possible health benefits of red wine because it would be scientifically unethical to involve alcohol in a study because of the risks associated with it. Excessive drinking can raise blood pressure, triglycerides, cause liver damage and other health problems.

“You can’t do a trial administering red wine to people,” Braun says. “It would never be approved.”

People who do not drink should not start because of possible health benefits, according to Musselman.

The American Heart Association (AHA) does not recommend red wine as being heart healthy, and the organization emphasizes that people who do not drink or have a history of alcoholism or other health problems should not start drinking. And whether adding dark chocolate or red wine or other items to a diet, experts caution to consume in moderation.

Musselman emphasizes that instead of just adding all of these foods to the diet, people need to replace something that they are already eating or they might dramatically increase their caloric intake, which can negate any health benefits.

“If you add these foods, you need to move more or take something out,” Musselman says. “You can’t add everything on top of everything. There are no miracle foods….It’s like an orchestra. It’s the interplay of all the foods in our diet [that’s important].”

As has been widely reported, obesity contributes to or causes many health problems. The good news about obesity is that it is largely avoidable, and experts agree that preventing the elements of heart disease, including obesity, high blood pressure, high cholesterol, diabetes, inactivity and smoking are the most important in maintaining cardiovascular health.

“Prevention is the best medicine,” Braun says. “Heart disease for most people takes years to manifest. Once heart disease manifests, though, it greatly impacts the quality of life and also the health care system….It’s the studies in prevention that have made the difference.”

The most important consideration is not to run after foods deemed healthy, but to make balanced replacements in diet and maintain an active lifestyle to promote heart health. Hein uses this approach, combined with regular electrocardiograms and visits with her cardiologist, to keep her heart healthy and avoid having another heart attack.  She has not had another heart attack since her first one nine years ago.

Hein also continues to work with the American Heart Association to raise awareness about the risks of heart disease—an illness that will touch the lives of most Americans in some way. She laughs a bit when she recites a line she heard years ago that has stuck with her. The quotation was originally said by Cher, Hein says, but she repeats it and hopes people will keep it in mind when thinking about improving their cardiovascular health:

“You don’t have to be perfect to start. You just have to start.”

Other Foods to Eat and Avoid for Heart Health

Red wine and dark chocolate have received lots of attention as having potential good effects on the heart, but there are many other foods that experts say can have positive effects—and some that have bad effects.

The Good—

Fish:  To replace red meat with a fatty fish like salmon, mackerel or tuna can work well because fatty, freshwater fish are a good source of omega-3 fatty acids, which have blood-thinning properties. Musselman  recommends that her clients incorporate omega-3 fatty acids into their diets, and fish is one way to do that.

Braun agrees. She says that people who do not eat fish should consider taking a fish oil pill each day to make sure they get omega-3s into their diets. Walnuts are also a good source of omega-3 fatty acids.

Oats: Soluble fiber sources like oats promote heart health because they help lower total cholesterol levels by carrying LDL cholesterol out of the bloodstream and to the liver where it can be processed and eliminated.

Other good sources of fiber are beans,  whole grains, vegetables and fruits.

The Bad—

Pastries:  Pastries and other baked or fried foods that need to be shelf-stable often contain trans or saturated fats, or both.

“A Cinnabon has 810 calories,” says Musselman. “That’s more than a Big Mac!”

Trans fats are more inflammatory inside the arteries, and they are a man-made fat.

“Our bodies are not prepared to process it,” Musselman says. “We don’t have the enzymes to break it down.”

Use caution in reading nutrition labels because the Food and Drug Administration only requires labeling of trans fats on products that contain 0.5 grams or more. But since experts recommend that people get their trans fat intake as close to zero as possible, this can add up quickly.

To avoid this, read not only the nutrition information but also the ingredient list. Any ingredient that contains the phrase “partially hydrogenated” has trans fat in it.

Braun and Musselman say people should avoid items made with hydrogenated oil, hard fat. “If it’s solid on your countertop, it will get solid in your body,” says Musselman.

Musselman also cautions that some food companies replace trans fats with saturated fats, which can also be extremely damaging to the heart.

Published: January 28, 2007
Issue: Winter 2007