Even when cardiologists aggressively manage their patients’ cholesterol and blood pressure levels, millions of Americans continue to suffer heart attacks and strokes. The reason is that many cardiologists fail to address the key underlying cause of coronary artery disease—that of endothelial dysfunction.
Endothelial dysfunction is the major cause of atherosclerosis—the blockage of arteries that increases the risk of heart attack, stroke, and congestive heart failure. Fortunately, it is never too late to start counteracting this circulatory breakdown, which is often a part of the aging process.
A wealth of research now points to several nutritional agents, such as cocoa polyphenols and pomegranate, that have been shown to dramatically improve arterial blood flow, helping promote youthful endothelial function and protect against the processes known to damage aging arteries.
Very few doctors discuss the importance of endothelial health with their cardiac patients. The endothelium comprises the thin layer of cells that line the interior surfaces of the entire circulatory system including the heart, blood vessels, the lymphatic system, and even the smallest capillaries. Essential to good health, the endothelium maintains uninterrupted circulation by allowing blood to flow smoothly to every part of the body and by participating in blood pressure control. One of its most important functions is the release of nitric oxide, which signals the surrounding smooth muscles of the arteries to relax and dilate, which increases healthy blood flow throughout the body.
But harmful oxidative stress, such as that which occurs in hypertension, hypercholesterolemia, diabetes, cigarette smoking, and the aging process itself inactivates nitric oxide, thereby contributing to endothelial dysfunction.
Damage occurs when the endothelium’s structural integrity is compromised and is no longer able to protect the artery walls against the infiltration of cholesterol, triglycerides, and low-density lipoprotein (LDL). Thus, endothelial dysfunction is one of the first steps in the creation of atherosclerosis—the buildup of arterial plaque that elevates the risk for heart attack, stroke, and congestive heart failure.
Unfortunately, as we age, our body continually loses optimal endothelial function. A research study published in the journal Gerontology that examined healthy people showed that endothelial function declines with increasing age. Even worse, some research has shown that the development of endothelial dysfunction can begin as early as the teenage years. Cardiovascular researchers believe the endothelium has an “enormous yet largely untapped diagnostic and therapeutic potential,” which is why a better understanding of endothelial dysfunction may help to prevent or delay deadly cardiovascular events. As scientists continue to unravel the numerous causes of heart disease and atherosclerosis, the importance of preserving endothelial health is gaining appreciation.
Fortunately, researchers have identified several innovative nutritional ingredients that appear to enhance endothelial health. Among them are cocoa and pomegranate. In studies published in peer-reviewed journals, these substances have been shown to have properties that protect against endothelial dysfunction, while helping reverse clinical markers of arterial plaque.
Centuries before European confectioners processed the beans of the Theobroma cacao plant to make a confection we call “chocolate,” cocoa was used in Mexico and parts of Latin America in its powdered form for medicinal purposes. Recent studies in medical journals have found that cocoa may actually be cardioprotective, and a new study showed it may even be able to reverse the effects of endothelial dysfunction by improving the dilation of blood vessels.
Cocoa has a high concentration of polyphenol compounds, specifically a class of natural compounds called flavonoids. Scientists have identified several cocoa flavanols, including epicatechin and catechin, which can benefit circulatory health. Cocoa flavanols improve endothelial function by enhancing nitric oxide bioactivity, increasing blood flow, reducing the tendency of blood clot formation, reducing moderately high blood pressure, and helping LDL resist oxidation, which may prevent the buildup of atherosclerotic plaque in artery walls.
A study published in the Journal of the American College of Cardiology found that giving flavanol-rich cocoa to diabetic patients improved their vascular function. In an editorial accompanying the research report, another team of scientists noted that the study provides “sizable evidence that cocoa flavanols have a positive effect on the health of the arteries.”
A recent clinical trial examined the effects of dark chocolate including liquid cocoa on endothelial function and blood pressure in overweight adults. Consumption of dark chocolate or liquid cocoa improved endothelial function and decreased blood pressure. Sugar-free cocoa produced greater improvements in endothelial function, compared with regular cocoa containing sugar. This led the study authors to conclude that sugar may decrease cocoa’s benefits for endothelial health and blood pressure, and that sugar-free cocoa preparations may offer superior benefits.
An exotic fruit whose taste and beautiful ruby-colored seeds have been revered since ancient times, the pomegranate (Punica granatum) has recently become universally prized for its cardiovascular health benefits.
Studies have found that pomegranate has powerful antioxidant properties that appear to protect the heart and blood vessels. Pomegranate juice may have anti-atherosclerotic properties, slowing the progression of arterial plaques. Most promising may be the results from studies showing that pomegranate juice improves stress-induced ischemia in patients who already had cardiovascular disease and atherosclerosis. Pomegranate even shows benefits in reducing systolic blood pressure. Punicalagins, tannins, and anthocyanins are the major components in pomegranate that are responsible for its antioxidant and cardiovascular health benefits.
One of pomegranate’s key mechanisms for supporting cardiovascular health is its ability to modulate nitric oxide activity. In endothelial cells, pomegranate enhances the bioactivity of nitric oxide synthase, an enzyme that generates nitric oxide. Pomegranate’s antioxidant effects also help protect nitric oxide against oxidative destruction, thus ensuring its availability for essential vessel-protective functions.
Preserving optimal endothelial function is essential to maintaining smooth flow of blood through the arteries and preventing the accumulation of atherosclerotic plaque that can contribute to heart attack, stroke, and other cardiovascular diseases. Powerful, natural antioxidant sources like cocoa and pomegranate have been shown to enhance cardiovascular health. In some studies, pomegranate and cocoa have been shown to limit or reverse atherosclerosis, lower high blood pressure, and improve endothelial function in people with the most serious arterial problems, including heart disease and diabetes.