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2006
A Review of:
Functional Foods
2006
“Super foods”
• Beans
• Berries
• Cruciferous vegetables
• Chocolate
• Citrus fruits
• Pumpkin
• Fish
• Soy
• Spinach
• Sweet Potatoes
• Tea
• Tomatoes
• Nuts
• Whole grains
• Yogurt
2006
Beans
An Overview
• The United States is by far the world
leader in dry bean production.
• Each year, U.S. farmers plant 1.5 to 1.7
million acres of edible dry beans.
• Although US is the chief consumer of these
beans, around 40% of these beans are
shipped to international markets in more than
100 different countries.
CDC
2006
Beans
Nutritional Value
• Dry beans or legumes are an inexpensive and healthy
way to include additional servings of vegetables
into your diet.
• Cooked beans are low in calories, loaded with
complex carbohydrates, and contain little fat.
• In addition, beans are good sources of B vitamins,
potassium, and fiber, which promotes digestive health
and relieves constipation.
Introduce beans into your
diet gradually.
Beans count as a
substitute for meat.
A good tip would be to
replace meat with a bean
entrée twice a week.
CDC
2006
Beans
• The demand for bean products is growing because of the
presence of several health-promoting compounds in edible
bean products known as saponins, which are naturally occurring
compounds widely distributed in all cells of legume plants.
• Clinical studies have suggested that saponins have the ability to:
– Help protect the human body against cancers
– Lower cholesterol
– Lower blood glucose responses
In epidemiological studies,
saponins have been shown to
have an inverse relationship
with the incidence of kidney stones.
J Med Food. 2004; 7(1): 67-78.
2006
Berries
An Overview
• Berries are one of the nation’s most
well liked fruits.
• Berries are believed to have been first
incorporated into the diets and lifestyles
of Native Americans.
• Traditionally, when we think of berries,
we think of things like blueberries,
strawberries, raspberries, and
blackberries, but there are also other
varieties such as cranberries,
boysenberries and gooseberries .
CDC
2006
Berries
Nutritional Value
• Many berries are suitable to eat raw
after rinsing and most types of berries
vary from 50 to 100 calories per serving
when eaten raw.
• Berries are loaded with:
vitamin C, potassium, and fiber.
• All berries with strong red and blue
colors have phytochemicals that can
potentially reduce cancer rates and
other chronic diseases.
• Oxygen radical absorptive capacity (ORAC),
is a way to measure the antioxidant capacity of fruits and vegetables.
• Berries have some of the highest antioxidant levels of any fresh fruits!
CDC
2006
Berries
Strawberries
• Because of the antioxidant power found in strawberries, regular
consumption of this fruit has been shown to have the potential to lower
one’s risk of heart disease.
• In addition, studies have shown that
strawberries are involved in inhibiting
inflammatory enzymes. This reduces the
inflammatory response that is involved in
the etiology of many diseases.
Cr Rev Food Sci Nutr. 2004; 44:1-17.
2006
Strawberries
Recent Findings
• Studies on two antioxidant compounds in strawberries
(ellagic acid and quercetin) have demonstrated that these substances:
– Have anticancer activity
– Work to block the initiation of carcinogenesis
– Suppress progression and proliferation of tumors
Cr Rev Food Sci Nutr. 2004; 44:1-17.
2006
Cruciferous Vegetables
Overview
• Cabbage, broccoli and Brussels sprouts are in
the family of cruciferous vegetables.
• The health benefits associated with cruciferous
vegetables has been attributed to their high
concentration of glucosinolates.
J Postgrad Med. 2004; 50(2): 145-9.
2006
Cruciferous Vegetables
Nutritional Value
• Cabbage is one of the oldest vegetables around. It continues to be a dietary
staple for many and is an inexpensive source of vitamins A and C, and fiber.
• Broccoli is a good source of:
vitamins A and C, potassium, folacin, iron, and fiber.
• It has as much calcium per ounce as milk!
• Brussels sprouts contain significant amounts of the antioxidants vitamins A and
C and is a good source of fiber. This vegetable is also a good source of
vegetable protein. However, this protein is not complete protein, and should
be combined with whole grain and other protein foods.
CDC
2006
Cruciferous Vegetables
Health Benefits
The consumption of cruciferous vegetables has been
associated with a reduced risk of cancer of the lung,
stomach, colon, and rectum.
J Postgrad Med. 2004; 50(2): 145-9.
2006
Chocolate
An Overview
• Cocoa and chocolate are food products made from cacao beans.
• Although consumed by the Olmecs, Mayans, and Aztecs long
ago, cacao beans were first introduced to the Old World in 1502
by Christopher Columbus when he brought them back to Spain.
• Over the past three decades, chocolate has been viewed more as a
confectionary rather than as a medicine. In 2001-2002, the average world
cocoa consumption was 1.17 pounds per person, with approximately
$73.2 billion dollars going to the confectionery market globally.
Nutrition Reviews. 2005; 63(12): 427-30.
2006
Antioxidant Capacity
• Cocoa powder and cocoa extracts have been shown
to exhibit a high antioxidant capacity.
• When compared to several other flavanol-rich foods and food
extracts, cocoa powder and cocoa extracts were found to
exhibit a higher antioxidant capacity than:
– Green and black tea
– Red wine
– Blueberries
– Garlic
– Strawberries
Am J Clin Nutr. 2005; 81(suppl): 298S-303S.
2006
Cocoa Antioxidants & Disease
• The antioxidants found in cocoa enhance vascular function and decrease
platelet stickiness and therefore influence the cardiovascular system beneficially.
• Several studies support the suggestion that the consumption of flavanol-rich
foods, such cocoa powders and dark chocolates, may be associated with a
reduced risk for vascular disease.
Am J Clin Nutr. 2005; 81(suppl): 298S-303S.
2006
Oranges
• Oranges are highly valued for their vitamin C content.
• They are the primary source of vitamin C for most Americans.
• However, oranges are also a good source of:
folacin, calcium, potassium, thiamin, niacin, and magnesium.
• The juice contains more vitamin C per serving than does the whole fruit.
• However orange juice does not contain fiber, whereas the fruit does.
• Oranges belong to a class known as “citrus fruits.”
CDC
2006
Citrus Fruits
• Citrus fruits contain phytochemicals called flavonoids.
• The flavonoid hesperidin was first described about two centuries ago.
• Research throughout past years has confirmed that hesperidin is an
anti-inflammatory agent used to treat many conditions. Hesperidin blocks an
enzyme involved in an inflammatory reaction such as the release of histamine.
Current Medicinal Chemistry. 2001; 8: 135-153.
2006
Citrus Flavonoids & Cancer
• Research has shown that citrus flavonoids and
their metabolites are potent antioxidants. It is
believed that they are able to suppress many
of the events of cancer and inflammation which
involve reactive oxygen species.
• Some of the flavonoids in citrus fruits such as
tangerine and orange are the most potent
cancer fighting compounds, particularly against
lung and prostate cancer cells.
Current Medicinal Chemistry. 2001; 8: 135-153.
2006
Pumpkin
Benefits
• Pumpkins are loaded with an important antioxidant,
beta-carotene, and are a good source of potassium.
• Beta-carotene is one of the plant carotenoids
converted to vitamin A in the body.
• Foods high in beta-carotene are believed to:
– Offer protection from the development of cancer
– Offer protection against heart disease
Pumpkin Nutrition
2006
Pumpkin
Benefits
• Pumpkin seeds and oil are also dietary sources of
the omega-3 fatty acid, alpha-linolenic acid.
• There is strong evidence which supports the
beneficial effects of alpha-linolenic acid in the
prevention of cardiovascular disease (CVD).
Med Pregl. 2003; 56 (Suppl 1): 19-25.
2006
Fish
Overview
• Over 30 years ago, Danish researchers
found that the lower rates of heart disease
found in Greenland Eskimos were
associated with their higher intake of
seafood, particularly cold water fish.
• There are two classes of essential fatty
acids: omega-3 and omega-6.
• Fish oil is the most significant source of
dietary omega-3 fatty acid, and it consists
of both: eicosapentaenoic acid (EPA) and
docosahexaenoic acid (DHA).
JABFP. 2005; 18: 28-36.
2006
Which Kinds and How Much?
• Fish is a good source of protein and low in saturated
fat. The following types of fish are especially good
sources of omega-3 fatty acids:
– Mackerel
– Lake trout
– Herring
– Sardines
– Albacore tuna
– Salmon
Fatty Fish have the highest levels of
omega-3 FA
The American Heart Association
recommends eating fish
(particularly fatty fish) at least
two times per week.
AHA
2006
Fish Oil & CVD
• Numerous observational studies have shown that
omega-3 FA enriched diets are associated with a reduction of:
– Cardiovascular mortality
– Heart attack
– Sudden death
• In several studies, a higher fish intake was associated
with a decreased incidence of coronary artery disease
(CAD) and cardiovascular mortality.
Overall, it has
been shown that a
minimum of one
fish meal per week
translates to a
52% reduction in
sudden cardiac
death.
JABFP. 2005; 18: 28-36.
2006
Fish Oils & Rheumatoid Arthritis
• Over 15 clinical trials and 2 meta-analyses
favor the use of fish oil in patients with
rheumatoid arthritis (RA).
• A double-blind placebo controlled trial
showed that fish oil supplementation of 130
mg/kg of body weight each day decreased
the following in the control group:
– Number of stiff joints
– Duration of morning stiffness
– Pain
– Global arthritis activity
JABFP. 2005; 18: 28-36.
Increased fish oil intake allows some
with RA to reduce or even eliminate the
use of non-steroidal anti-inflammatory
drug (NSAID) use.
2006
Soy
An Overview
• There is a growing recognition of the health effects of soy on cholesterol levels.
• A recent U.S. survey revealed that 76 percent of consumers considered soy
products to be healthy.
• In 1999, the Food and Drug Administration (FDA) approved a health claim for
the cholesterol-lowering properties of soy protein.
• One year later, the American Heart Association (AHA) recommended that
patients with elevated cholesterol should include soy protein foods in their diets.
J Nutr. 2002. 132: 547S-551S.
2006
Adding Soy into the Diet
• A daily intake 25 grams of soy protein per day
is considered beneficial.
• Most don’t realize it, but a lot of foods that are
eaten every day contain soy.
• Soybean oil accounts for 79% of the edible fats used annually in the U.S.
• The ingredient lists of several commonly consumed food items show that soybean
oil is high on the list: mayonnaise, margarines, salad dressings, and vegetable
shortenings.
FDA
2006
Soy Isoflavones
Benefits
• Soy has phytoestrogens called isoflavones. Two of the most
common ones are daidzein and genistein.
• Soy isoflavones are believed to play a role in
prostate cancer, where supplementation with isoflavones has
shown a reduction in prostate cancer risk in studies.
• Soy isoflavones, and possibly soy proteins as well, are
believed to play a role in bone health.
J Nutr. 2002. 132: 547S-551S.
2006
Soy Protein
Benefits
• There is also the biologically active non-isoflavone
component of soy that has received much attention
in past years– soy protein.
• The protein part is believed to be responsible for the
additional benefits seen from soy consumption, which are:
– Cholesterol-lowering effects
– Blood pressure-lowering effects
– Reduction of cancer risks
– Favorable effects on kidney function
J Nutr. 2002. 132: 547S-551S.
2006
Spinach
• Spinach is one of the most important
antioxidative vegetables and is consumed
either fresh or cooked.
• Spinach is composed of various active
compounds, such as flavonoids and other
polyphenolic active ingredients. These
compounds are believed to act in
combination with one another as:
– Anti-inflammatory agents
– Antioxidative agents
– Anticancer agents
Nutrition and Cancer. 2003; 46(2): 222-231 and CDC
2006
Spinach
Active Components
• The active compounds are believed to be highly available to the body.
• A powerful, water-soluble, natural antioxidant mixture (NAO) was identified in
spinach leaves, which contains its main active compounds.
• NAO is stable at high temperatures and is nontoxic. It is used in studies of
chemoprevention and dietary intervention in humans.
Nutrition and Cancer. 2003; 46(2): 222-231.
2006
Sweet Potatoes
• Sweet potatoes are believed to have been first cultivated in 1648 in the U.S.
• Today, in the South sweet potatoes are generally preferred to Irish potatoes as a
staple food. In the North, the reverse is true.
• The sweet potato blends with herbs, spices and flavorings producing delicious
dishes of all types. From processed baby foods to the main dishes, casseroles,
salads, breads and desserts, sweet potatoes add valuable, appetizing nutrients and
color to any meal.
Sweet Potato Facts, CDC
2006
Sweet Potatoes
Nutritional Value
• One baked sweet potato (3 ½ ounce serving) provides about twice the
recommended daily allowance for vitamin A.
• One baked sweet potato contains only about 140 calories and
this nutritious vegetable provides:
– 42 percent of the Recommended Daily Allowance (RDA) for vitamin C
– 6 percent of the RDA for calcium
– 10 percent of the RDA for iron
– 8 percent of the RDA for thiamine for healthy adults.
Sweet Potato Facts
CDC
2006
Sweet Potatoes
• It is low in sodium and is a good source of fiber and other important
vitamins and minerals.
• Because sweet potatoes are a good source of beta carotene, consumption
of this food is likely to help reduce your risk of certain cancers.
Sweet Potato Facts
CDC
2006
Tea
• Tea, in the form of green or black tea, is one of the
most widely consumed beverages in the world.
• Although its consumption does varies from place to
place, it is believed to be second only to water.
• Black tea is consumed predominantly in Western
countries, along with some Asian countries,
whereas green tea is consumed predominantly in
China, Japan, India, and a number of countries in
north Africa and the Middle East.
J Alt Compl Med. 2005; 11(3): 521-528.
2006
Green Tea
Overview
• Green tea comes from the mature leaves of
the plant and is sold as either fresh or dried
unfermented leaves.
• The very early shoots are highly sought
after and from these, white tea is made.
• Total polyphenols in these early shoots
comprise about 20-30% by weight,
60 to 80 percent of which are catechins.
• Mature leaves naturally contain lesser
amounts of catechins than do the early
leaves, and with the processing of green
tea, the concentration is further
decreased (~15%).
J Alt Compl Med. 2005; 11(3): 521-528.
2006
Black Tea
Overview
• Unlike green tea, the preparation of black tea requires fermentation.
• During this process, catechins in black tea are partially converted to theaflavins.
• A less extensive fermentation leads to a lighter flavored tea, called oolong tea.
• Therefore, of the teas mentioned, white tea has the highest concentration of
catechins, followed by green tea, oolong tea and, lastly, black tea.
J Alt Compl Med. 2005; 11(3): 521-528.
2006
Green Tea
Health Effects
• The catechins found in green tea have been shown to possess biological activity
which may be beneficial in the prevention and treatment of various forms of cancer.
J Alt Compl Med. 2005; 11(3): 521-528.
Green tea is also believed to exhibit
beneficial effects on the following:
Arthritis
Bone Density
Stress
In addition, it has also found to exhibit:
Antiviral properties
Anticariogenic effects
Ultraviolet skin protection
2006
Tomatoes
Overview
• Lycopene is the pigment principally responsible for the deep-red color
of ripe tomato fruits and tomato products.
• Tomato products, including ketchup, tomato juice, and pizza sauce, are the
richest sources of lycopene in the U.S. diet, accounting for > 80% of the total
lycopene intake of Americans.
• The consumption of tomatoes and tomato products containing lycopene have
been shown to be associated with decreased risk of chronic diseases like
cancer and cardiovascular diseases in several recent studies.
Plant Physiology. 2002; 130: 1077-1078.
2006
Tomatoes and Prostate Cancer
HPFS Study
• In 1995, a study was conducted examining the relationship
between the intake of various carotenoids, fruits, and
vegetables and the risk of prostate cancer.
• Of the 46 fruits, vegetables, and related products that
were analyzed in the study, only four were significantly
associated with a lower prostate cancer risk.
• Of these four, tomato sauce, tomatoes and pizza sauce, but
not strawberries, were primary sources of lycopene.
Plant Physiology. 2002; 130: 1077-1078.
2006
Processed or Fresh
Tomatoes?
• Studies have found that tomato paste and other processed
tomato products are even more effective than fresh tomatoes
in preventing prostate cancer. This seems to be in contrast to the
messages that we hear, of consuming fresh fruits and vegetables
whenever possible for maximum health benefits.
• However, numerous studies have revealed that tomato processing actually
increases the bioavailability of lycopene to humans. This is because
processing converts much of the trans-form of lycopene found in fresh
tomatoes into the cis-form, which is much more readily taken up in humans.
Plant Physiology. 2002; 130: 1077-1078.
2006
Tomatoes and Other Effects
• The evidence suggests that the anti-proliferative properties of lycopene
may extend it’s effects to other types of cancer, beyond just that of prostate cancer.
• In addition, lycopene may be useful in preventing heart disease.
• Studies have shown that lycopene inhibits cholesterol synthesis and enhances the
breakdown of the bad cholesterol, low-density lipoprotein (LDL).
Plant Physiology. 2002; 130: 1077-1078.
2006
Nuts
Overview
• In 2003, the U.S. FDA approved this package label:
– “Scientific evidence suggests but does not prove that eating 1.5
ounces per day of most nuts, as part of a diet low in saturated fat
and cholesterol, may reduce the risk of heart disease.”
• According to FDA, "Types of nuts eligible for this claim are
restricted to almonds, hazelnuts, peanuts, pecans, some pine
nuts, pistachio nuts and walnuts..”
Nuts for Nutrition
2006
Nuts
Nutritional Value
• Nuts are important for what they don’t offer:
– 1. Nuts do not contain cholesterol.
– 2. Nuts only contain trace amounts of sodium.
(Unless it has been added to the nuts during processing)
• Nuts are usually thought of as a high fat food. Although, this is true–
nuts are high in fat-- it is not the same as animal fat. Nuts are mostly high
in heart-healthy unsaturated fats, the fats that lower your bad cholesterol.
Nuts for Nutrition
2006
The Importance of Specific
Nuts
• Walnuts
– One ounce of walnuts (about 14 shelled walnut halves) is all that is needed
to meet the 2002 dietary recommendations for omega-3 FA. The type of
omega-3 FA found in walnuts is alpha-linolenic acid, which can be
transformed into either EPA or DHA in humans and animals.
• Almonds
– One ounce of almonds (about 20-24 shelled whole almonds) provides 35%
of the daily value for vitamin E.
• Peanuts
– Although it is often discussed with nuts, peanuts are actually a legume,
along with dry beans, peas and lentils. One ounce of roasted peanuts
provides about 10% of the daily value for folate.
Nuts for Nutrition
2006
The Importance of Specific
Nuts
• As discussed earlier, omega-3 fatty acids (alpha-linolenic acid
found in walnuts and other sources included) help to decrease
one’s risk for CVD.
• Vitamin E is an antioxidant and is important in that it is believed
to help promote healthy aging. A recent study has also
suggested that a diet rich in foods containing vitamin E may
help protect some against the development of Alzheimer’s
disease.
• Folate is a B vitamin that has been recognized for some time
now, particularly for women of childbearing age, as it is
believed to help reduce the incidence of birth defects and lower
the risk of heart disease.
Nuts for Nutrition
2006
Whole Grains
An Overview
The outer bran layer is rich in B
vitamins and phytonutrients such
as flavonoids and indoles, along
with a small amount of protein. The
endosperm is predominantly
carbohydrate, and the germ layer is
concentrated with minerals such as
iron and zinc, along with the
antioxidant vitamin E.
• As defined by the 2005 Dietary Guidelines
for Americans, a whole grain is a grain that
contains the entire grain kernel:
- Outer bran layer
- Endosperm
- Inner germ layer
Proceedings of the Nutrition Society. 2003; 62: 123-127.
Mypyramid.gov
2006
Grains
The Milling Process
• The milling process, which removes both the bran and the germ, determines how much
of the whole grain is retained. It impacts the nutritional value of the end product.
• A refined grain is a grain that has been milled. Milling has negative effects in that it
takes dietary fiber, iron, and many B vitamins from the grain.
• To make up for this loss of nutrients during the milling process, most refined grains are
enriched after processing, where certain B vitamins (such as thiamin, riboflavin, niacin,
and folic acid) and iron are added back. However, the fiber content of the original grain
is not restored.
Mypyramid.gov
Proceedings of the Nutrition Society. 2003; 62: 123-127.
2006
Whole Grains
How Much?
• Benefits associated with whole wheat foods can be achieved at relatively low
levels of intake (between 2 and 3 servings/d).
• However, the consumption of whole wheat foods in some Western countries
has been noted to be less than one serving per day, which is equivalent to less
than one slice of whole wheat bread per day.
Proceedings of the Nutrition Society. 2003; 62: 123-127.
2006
2005 Dietary Guidelines for
Americans
“Make Half Your Grains Whole”
The new recommendations for Americans tell us that half of the grains
we consume daily should be whole grains.
Why is this
Important?
Because regular consumption of whole grain foods has been
associated with a reduction in:
Incidence of cardiovascular disease
Incidence of diabetes
Cancer mortality at certain sites
Premature death
Proceedings of the Nutrition Society. 2003; 62: 123-127.
2006
Yogurt
• In recent years, many studies have been published on the
heath effects of yogurt and the bacterial cultures used in the
production of yogurt.
• The lactic acid-producing bacteria (LAB) used in the U.S.
include Lactobacillus and Streptococcus species
• Dairy products are generally considered an excellent source of
high-quality protein, calcium, potassium, phosphorus,
magnesium, zinc, and the B vitamins riboflavin, niacin, vitamin
B-6, and vitamin B-12. However, the final nutritional value of
yogurt depends on several factors.
Am J Clin Nutr. 2004; 80: 245-56.
2006
Yogurt as a Probiotic?
• In 2002, a definition was proposed by the Joint Food and Agriculture Organization/World
Health Organization Working Group. They state that a probiotic is a:
– “Live microorganism which when administered in adequate
amounts confer a health benefit to the host.”
• Current scientific concepts agree that yogurt cultures are probiotics if two criteria are met:
– 1. A beneficial physiological effect can be obtained by consumption of the live cultures
– 2. The benefit has been sustained appropriately in human studies.
Br J Nutr. 2005; 93: 783-786.
2006
Benefits of Yogurt
• The benefits of yogurt and LAB on gastrointestinal health have been explored mainly
in animal models and, occasionally in human subjects as well.
• In some studies using yogurt, individual LAB species, or both, promising health
benefits were found for individuals with:
– Lactose Intolerance
– Constipation
– Diarrheal diseases
– Colon Cancer
– Inflammatory Bowel Disease (IBD)
– Helicobacter pylori infection
– Allergies
Am J Clin Nutr. 2004; 80: 245-56.
2006
Web References
• http://www.cdc.gov/nccdphp/dnpa/5ADay/month/beans.htm
• http://www.cdc.gov/nccdphp/dnpa/5ADay/month/berries.htm
• http://www.cdc.gov/nccdphp/dnpa/5ADay/month/cabbage.htm
• http://www.cdc.gov/nccdphp/dnpa/5ADay/month/broccoli.htm
• http://www.cdc.gov/nccdphp/dnpa/5ADay/month/brussels_sprouts.htm
• http://www.cdc.gov/nccdphp/dnpa/5ADay/month/orange.htm
• http://www.urbanext.uiuc.edu/Pumpkins/nutrition.html
2006
Web References
• http://www.americanheart.org/presenter.jhtml?identifier=4632
• http://www.fda.gov/fdac/features/2000/300_soy.html
• http://www.cdc.gov/nccdphp/dnpa/5ADay/month/spinach.htm
• http://aggie-horticulture.tamu.edu/plantanswers/vegetables/sweetpotato.html
• http://www.cdc.gov/nccdphp/dnpa/5ADay/month/sweet_potato.htm
• http://lancaster.unl.edu/food/ftmar04.htm
• http://www.mypyramid.gov
2006
Article References
o Shi J et al. Saponins from edible legumes: chemistry, processing, and
health benefits. J Med Food. 2004; 7(1): 67-78.
o Hannum S. Potential impact of strawberries on human health:
a review of the science. Cr Rev Food Sci Nutr. 2004; 44:1-17.
o Heber D. Vegetables, fruits and phytoestrogens in the prevention of
diseases. J Postgrad Med. 2004; 50(2): 145-9
o Ariefdjohan M, Savaiano D. Chocolate and cardiovascular health:
is it too good to be true? Nutrition Reviews. 2005; 63(12): 427-30
o Keen C et al. Cocoa antioxidants and cardiovascular health.
Am J Clin Nutr. 2005; 81(suppl): 298S-303S
o Manthey J, Guthrie N, Grohmann K. Biological properties of citrus
flavonoids pertaining to cancer and inflammation. Current Medicinal
Chemistry. 2001; 8: 135-153
2006
Article References
o Ristic-Medic D, Ristic G, Tepsic V. Alpha-linolenic acid and cardiovascular
diseases. Med Pregl. 2003; 56 (Suppl 1): 19-25
o Oh, R. Primary applications of fish oil (Ω-3 fatty acids) in primary care.
JABFP. 2005; 18: 28-36
o Messina M, Gardner C, Barnes S. Gaining insight into the health effects of
soy but a long way still to go: commentary on the fourth international
symposium on the role of soy in preventing and treating chronic disease.
J Nutr. 2002. 132: 547S-551S
o Lomnitski L, et al. Composition, efficacy, and safety of spinach extracts.
Nutrition and Cancer. 2003; 46(2): 222-231
2006
Article References
o Cooper R, Morre J, Morre D. Medicinal benefits of green tea:
part 1- review of noncancer health benefits. J Alt Compl Med.
2005; 11(3): 521-528
o Minorsky P. Lycopene and the prevention of prostate cancer.
Plant Physiology. 2002; 130: 1077-1078
o Lang R, Jebb S. Who consumes whole grains, and how much?
Proceedings of the Nutrition Society. 2003; 62: 123-127
o Adolfsson O, Meydani S, Russell R. Yogurt and gut function.
Am J Clin Nutr. 2004; 80: 245-56Guarner F et al. Should yoghurt
cultures be considered probiotic? Br J Nutr. 2005; 93: 783-786

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Overview_of_Functional_Foods.ppt

  • 2. 2006 “Super foods” • Beans • Berries • Cruciferous vegetables • Chocolate • Citrus fruits • Pumpkin • Fish • Soy • Spinach • Sweet Potatoes • Tea • Tomatoes • Nuts • Whole grains • Yogurt
  • 3. 2006 Beans An Overview • The United States is by far the world leader in dry bean production. • Each year, U.S. farmers plant 1.5 to 1.7 million acres of edible dry beans. • Although US is the chief consumer of these beans, around 40% of these beans are shipped to international markets in more than 100 different countries. CDC
  • 4. 2006 Beans Nutritional Value • Dry beans or legumes are an inexpensive and healthy way to include additional servings of vegetables into your diet. • Cooked beans are low in calories, loaded with complex carbohydrates, and contain little fat. • In addition, beans are good sources of B vitamins, potassium, and fiber, which promotes digestive health and relieves constipation. Introduce beans into your diet gradually. Beans count as a substitute for meat. A good tip would be to replace meat with a bean entrée twice a week. CDC
  • 5. 2006 Beans • The demand for bean products is growing because of the presence of several health-promoting compounds in edible bean products known as saponins, which are naturally occurring compounds widely distributed in all cells of legume plants. • Clinical studies have suggested that saponins have the ability to: – Help protect the human body against cancers – Lower cholesterol – Lower blood glucose responses In epidemiological studies, saponins have been shown to have an inverse relationship with the incidence of kidney stones. J Med Food. 2004; 7(1): 67-78.
  • 6. 2006 Berries An Overview • Berries are one of the nation’s most well liked fruits. • Berries are believed to have been first incorporated into the diets and lifestyles of Native Americans. • Traditionally, when we think of berries, we think of things like blueberries, strawberries, raspberries, and blackberries, but there are also other varieties such as cranberries, boysenberries and gooseberries . CDC
  • 7. 2006 Berries Nutritional Value • Many berries are suitable to eat raw after rinsing and most types of berries vary from 50 to 100 calories per serving when eaten raw. • Berries are loaded with: vitamin C, potassium, and fiber. • All berries with strong red and blue colors have phytochemicals that can potentially reduce cancer rates and other chronic diseases. • Oxygen radical absorptive capacity (ORAC), is a way to measure the antioxidant capacity of fruits and vegetables. • Berries have some of the highest antioxidant levels of any fresh fruits! CDC
  • 8. 2006 Berries Strawberries • Because of the antioxidant power found in strawberries, regular consumption of this fruit has been shown to have the potential to lower one’s risk of heart disease. • In addition, studies have shown that strawberries are involved in inhibiting inflammatory enzymes. This reduces the inflammatory response that is involved in the etiology of many diseases. Cr Rev Food Sci Nutr. 2004; 44:1-17.
  • 9. 2006 Strawberries Recent Findings • Studies on two antioxidant compounds in strawberries (ellagic acid and quercetin) have demonstrated that these substances: – Have anticancer activity – Work to block the initiation of carcinogenesis – Suppress progression and proliferation of tumors Cr Rev Food Sci Nutr. 2004; 44:1-17.
  • 10. 2006 Cruciferous Vegetables Overview • Cabbage, broccoli and Brussels sprouts are in the family of cruciferous vegetables. • The health benefits associated with cruciferous vegetables has been attributed to their high concentration of glucosinolates. J Postgrad Med. 2004; 50(2): 145-9.
  • 11. 2006 Cruciferous Vegetables Nutritional Value • Cabbage is one of the oldest vegetables around. It continues to be a dietary staple for many and is an inexpensive source of vitamins A and C, and fiber. • Broccoli is a good source of: vitamins A and C, potassium, folacin, iron, and fiber. • It has as much calcium per ounce as milk! • Brussels sprouts contain significant amounts of the antioxidants vitamins A and C and is a good source of fiber. This vegetable is also a good source of vegetable protein. However, this protein is not complete protein, and should be combined with whole grain and other protein foods. CDC
  • 12. 2006 Cruciferous Vegetables Health Benefits The consumption of cruciferous vegetables has been associated with a reduced risk of cancer of the lung, stomach, colon, and rectum. J Postgrad Med. 2004; 50(2): 145-9.
  • 13. 2006 Chocolate An Overview • Cocoa and chocolate are food products made from cacao beans. • Although consumed by the Olmecs, Mayans, and Aztecs long ago, cacao beans were first introduced to the Old World in 1502 by Christopher Columbus when he brought them back to Spain. • Over the past three decades, chocolate has been viewed more as a confectionary rather than as a medicine. In 2001-2002, the average world cocoa consumption was 1.17 pounds per person, with approximately $73.2 billion dollars going to the confectionery market globally. Nutrition Reviews. 2005; 63(12): 427-30.
  • 14. 2006 Antioxidant Capacity • Cocoa powder and cocoa extracts have been shown to exhibit a high antioxidant capacity. • When compared to several other flavanol-rich foods and food extracts, cocoa powder and cocoa extracts were found to exhibit a higher antioxidant capacity than: – Green and black tea – Red wine – Blueberries – Garlic – Strawberries Am J Clin Nutr. 2005; 81(suppl): 298S-303S.
  • 15. 2006 Cocoa Antioxidants & Disease • The antioxidants found in cocoa enhance vascular function and decrease platelet stickiness and therefore influence the cardiovascular system beneficially. • Several studies support the suggestion that the consumption of flavanol-rich foods, such cocoa powders and dark chocolates, may be associated with a reduced risk for vascular disease. Am J Clin Nutr. 2005; 81(suppl): 298S-303S.
  • 16. 2006 Oranges • Oranges are highly valued for their vitamin C content. • They are the primary source of vitamin C for most Americans. • However, oranges are also a good source of: folacin, calcium, potassium, thiamin, niacin, and magnesium. • The juice contains more vitamin C per serving than does the whole fruit. • However orange juice does not contain fiber, whereas the fruit does. • Oranges belong to a class known as “citrus fruits.” CDC
  • 17. 2006 Citrus Fruits • Citrus fruits contain phytochemicals called flavonoids. • The flavonoid hesperidin was first described about two centuries ago. • Research throughout past years has confirmed that hesperidin is an anti-inflammatory agent used to treat many conditions. Hesperidin blocks an enzyme involved in an inflammatory reaction such as the release of histamine. Current Medicinal Chemistry. 2001; 8: 135-153.
  • 18. 2006 Citrus Flavonoids & Cancer • Research has shown that citrus flavonoids and their metabolites are potent antioxidants. It is believed that they are able to suppress many of the events of cancer and inflammation which involve reactive oxygen species. • Some of the flavonoids in citrus fruits such as tangerine and orange are the most potent cancer fighting compounds, particularly against lung and prostate cancer cells. Current Medicinal Chemistry. 2001; 8: 135-153.
  • 19. 2006 Pumpkin Benefits • Pumpkins are loaded with an important antioxidant, beta-carotene, and are a good source of potassium. • Beta-carotene is one of the plant carotenoids converted to vitamin A in the body. • Foods high in beta-carotene are believed to: – Offer protection from the development of cancer – Offer protection against heart disease Pumpkin Nutrition
  • 20. 2006 Pumpkin Benefits • Pumpkin seeds and oil are also dietary sources of the omega-3 fatty acid, alpha-linolenic acid. • There is strong evidence which supports the beneficial effects of alpha-linolenic acid in the prevention of cardiovascular disease (CVD). Med Pregl. 2003; 56 (Suppl 1): 19-25.
  • 21. 2006 Fish Overview • Over 30 years ago, Danish researchers found that the lower rates of heart disease found in Greenland Eskimos were associated with their higher intake of seafood, particularly cold water fish. • There are two classes of essential fatty acids: omega-3 and omega-6. • Fish oil is the most significant source of dietary omega-3 fatty acid, and it consists of both: eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). JABFP. 2005; 18: 28-36.
  • 22. 2006 Which Kinds and How Much? • Fish is a good source of protein and low in saturated fat. The following types of fish are especially good sources of omega-3 fatty acids: – Mackerel – Lake trout – Herring – Sardines – Albacore tuna – Salmon Fatty Fish have the highest levels of omega-3 FA The American Heart Association recommends eating fish (particularly fatty fish) at least two times per week. AHA
  • 23. 2006 Fish Oil & CVD • Numerous observational studies have shown that omega-3 FA enriched diets are associated with a reduction of: – Cardiovascular mortality – Heart attack – Sudden death • In several studies, a higher fish intake was associated with a decreased incidence of coronary artery disease (CAD) and cardiovascular mortality. Overall, it has been shown that a minimum of one fish meal per week translates to a 52% reduction in sudden cardiac death. JABFP. 2005; 18: 28-36.
  • 24. 2006 Fish Oils & Rheumatoid Arthritis • Over 15 clinical trials and 2 meta-analyses favor the use of fish oil in patients with rheumatoid arthritis (RA). • A double-blind placebo controlled trial showed that fish oil supplementation of 130 mg/kg of body weight each day decreased the following in the control group: – Number of stiff joints – Duration of morning stiffness – Pain – Global arthritis activity JABFP. 2005; 18: 28-36. Increased fish oil intake allows some with RA to reduce or even eliminate the use of non-steroidal anti-inflammatory drug (NSAID) use.
  • 25. 2006 Soy An Overview • There is a growing recognition of the health effects of soy on cholesterol levels. • A recent U.S. survey revealed that 76 percent of consumers considered soy products to be healthy. • In 1999, the Food and Drug Administration (FDA) approved a health claim for the cholesterol-lowering properties of soy protein. • One year later, the American Heart Association (AHA) recommended that patients with elevated cholesterol should include soy protein foods in their diets. J Nutr. 2002. 132: 547S-551S.
  • 26. 2006 Adding Soy into the Diet • A daily intake 25 grams of soy protein per day is considered beneficial. • Most don’t realize it, but a lot of foods that are eaten every day contain soy. • Soybean oil accounts for 79% of the edible fats used annually in the U.S. • The ingredient lists of several commonly consumed food items show that soybean oil is high on the list: mayonnaise, margarines, salad dressings, and vegetable shortenings. FDA
  • 27. 2006 Soy Isoflavones Benefits • Soy has phytoestrogens called isoflavones. Two of the most common ones are daidzein and genistein. • Soy isoflavones are believed to play a role in prostate cancer, where supplementation with isoflavones has shown a reduction in prostate cancer risk in studies. • Soy isoflavones, and possibly soy proteins as well, are believed to play a role in bone health. J Nutr. 2002. 132: 547S-551S.
  • 28. 2006 Soy Protein Benefits • There is also the biologically active non-isoflavone component of soy that has received much attention in past years– soy protein. • The protein part is believed to be responsible for the additional benefits seen from soy consumption, which are: – Cholesterol-lowering effects – Blood pressure-lowering effects – Reduction of cancer risks – Favorable effects on kidney function J Nutr. 2002. 132: 547S-551S.
  • 29. 2006 Spinach • Spinach is one of the most important antioxidative vegetables and is consumed either fresh or cooked. • Spinach is composed of various active compounds, such as flavonoids and other polyphenolic active ingredients. These compounds are believed to act in combination with one another as: – Anti-inflammatory agents – Antioxidative agents – Anticancer agents Nutrition and Cancer. 2003; 46(2): 222-231 and CDC
  • 30. 2006 Spinach Active Components • The active compounds are believed to be highly available to the body. • A powerful, water-soluble, natural antioxidant mixture (NAO) was identified in spinach leaves, which contains its main active compounds. • NAO is stable at high temperatures and is nontoxic. It is used in studies of chemoprevention and dietary intervention in humans. Nutrition and Cancer. 2003; 46(2): 222-231.
  • 31. 2006 Sweet Potatoes • Sweet potatoes are believed to have been first cultivated in 1648 in the U.S. • Today, in the South sweet potatoes are generally preferred to Irish potatoes as a staple food. In the North, the reverse is true. • The sweet potato blends with herbs, spices and flavorings producing delicious dishes of all types. From processed baby foods to the main dishes, casseroles, salads, breads and desserts, sweet potatoes add valuable, appetizing nutrients and color to any meal. Sweet Potato Facts, CDC
  • 32. 2006 Sweet Potatoes Nutritional Value • One baked sweet potato (3 ½ ounce serving) provides about twice the recommended daily allowance for vitamin A. • One baked sweet potato contains only about 140 calories and this nutritious vegetable provides: – 42 percent of the Recommended Daily Allowance (RDA) for vitamin C – 6 percent of the RDA for calcium – 10 percent of the RDA for iron – 8 percent of the RDA for thiamine for healthy adults. Sweet Potato Facts CDC
  • 33. 2006 Sweet Potatoes • It is low in sodium and is a good source of fiber and other important vitamins and minerals. • Because sweet potatoes are a good source of beta carotene, consumption of this food is likely to help reduce your risk of certain cancers. Sweet Potato Facts CDC
  • 34. 2006 Tea • Tea, in the form of green or black tea, is one of the most widely consumed beverages in the world. • Although its consumption does varies from place to place, it is believed to be second only to water. • Black tea is consumed predominantly in Western countries, along with some Asian countries, whereas green tea is consumed predominantly in China, Japan, India, and a number of countries in north Africa and the Middle East. J Alt Compl Med. 2005; 11(3): 521-528.
  • 35. 2006 Green Tea Overview • Green tea comes from the mature leaves of the plant and is sold as either fresh or dried unfermented leaves. • The very early shoots are highly sought after and from these, white tea is made. • Total polyphenols in these early shoots comprise about 20-30% by weight, 60 to 80 percent of which are catechins. • Mature leaves naturally contain lesser amounts of catechins than do the early leaves, and with the processing of green tea, the concentration is further decreased (~15%). J Alt Compl Med. 2005; 11(3): 521-528.
  • 36. 2006 Black Tea Overview • Unlike green tea, the preparation of black tea requires fermentation. • During this process, catechins in black tea are partially converted to theaflavins. • A less extensive fermentation leads to a lighter flavored tea, called oolong tea. • Therefore, of the teas mentioned, white tea has the highest concentration of catechins, followed by green tea, oolong tea and, lastly, black tea. J Alt Compl Med. 2005; 11(3): 521-528.
  • 37. 2006 Green Tea Health Effects • The catechins found in green tea have been shown to possess biological activity which may be beneficial in the prevention and treatment of various forms of cancer. J Alt Compl Med. 2005; 11(3): 521-528. Green tea is also believed to exhibit beneficial effects on the following: Arthritis Bone Density Stress In addition, it has also found to exhibit: Antiviral properties Anticariogenic effects Ultraviolet skin protection
  • 38. 2006 Tomatoes Overview • Lycopene is the pigment principally responsible for the deep-red color of ripe tomato fruits and tomato products. • Tomato products, including ketchup, tomato juice, and pizza sauce, are the richest sources of lycopene in the U.S. diet, accounting for > 80% of the total lycopene intake of Americans. • The consumption of tomatoes and tomato products containing lycopene have been shown to be associated with decreased risk of chronic diseases like cancer and cardiovascular diseases in several recent studies. Plant Physiology. 2002; 130: 1077-1078.
  • 39. 2006 Tomatoes and Prostate Cancer HPFS Study • In 1995, a study was conducted examining the relationship between the intake of various carotenoids, fruits, and vegetables and the risk of prostate cancer. • Of the 46 fruits, vegetables, and related products that were analyzed in the study, only four were significantly associated with a lower prostate cancer risk. • Of these four, tomato sauce, tomatoes and pizza sauce, but not strawberries, were primary sources of lycopene. Plant Physiology. 2002; 130: 1077-1078.
  • 40. 2006 Processed or Fresh Tomatoes? • Studies have found that tomato paste and other processed tomato products are even more effective than fresh tomatoes in preventing prostate cancer. This seems to be in contrast to the messages that we hear, of consuming fresh fruits and vegetables whenever possible for maximum health benefits. • However, numerous studies have revealed that tomato processing actually increases the bioavailability of lycopene to humans. This is because processing converts much of the trans-form of lycopene found in fresh tomatoes into the cis-form, which is much more readily taken up in humans. Plant Physiology. 2002; 130: 1077-1078.
  • 41. 2006 Tomatoes and Other Effects • The evidence suggests that the anti-proliferative properties of lycopene may extend it’s effects to other types of cancer, beyond just that of prostate cancer. • In addition, lycopene may be useful in preventing heart disease. • Studies have shown that lycopene inhibits cholesterol synthesis and enhances the breakdown of the bad cholesterol, low-density lipoprotein (LDL). Plant Physiology. 2002; 130: 1077-1078.
  • 42. 2006 Nuts Overview • In 2003, the U.S. FDA approved this package label: – “Scientific evidence suggests but does not prove that eating 1.5 ounces per day of most nuts, as part of a diet low in saturated fat and cholesterol, may reduce the risk of heart disease.” • According to FDA, "Types of nuts eligible for this claim are restricted to almonds, hazelnuts, peanuts, pecans, some pine nuts, pistachio nuts and walnuts..” Nuts for Nutrition
  • 43. 2006 Nuts Nutritional Value • Nuts are important for what they don’t offer: – 1. Nuts do not contain cholesterol. – 2. Nuts only contain trace amounts of sodium. (Unless it has been added to the nuts during processing) • Nuts are usually thought of as a high fat food. Although, this is true– nuts are high in fat-- it is not the same as animal fat. Nuts are mostly high in heart-healthy unsaturated fats, the fats that lower your bad cholesterol. Nuts for Nutrition
  • 44. 2006 The Importance of Specific Nuts • Walnuts – One ounce of walnuts (about 14 shelled walnut halves) is all that is needed to meet the 2002 dietary recommendations for omega-3 FA. The type of omega-3 FA found in walnuts is alpha-linolenic acid, which can be transformed into either EPA or DHA in humans and animals. • Almonds – One ounce of almonds (about 20-24 shelled whole almonds) provides 35% of the daily value for vitamin E. • Peanuts – Although it is often discussed with nuts, peanuts are actually a legume, along with dry beans, peas and lentils. One ounce of roasted peanuts provides about 10% of the daily value for folate. Nuts for Nutrition
  • 45. 2006 The Importance of Specific Nuts • As discussed earlier, omega-3 fatty acids (alpha-linolenic acid found in walnuts and other sources included) help to decrease one’s risk for CVD. • Vitamin E is an antioxidant and is important in that it is believed to help promote healthy aging. A recent study has also suggested that a diet rich in foods containing vitamin E may help protect some against the development of Alzheimer’s disease. • Folate is a B vitamin that has been recognized for some time now, particularly for women of childbearing age, as it is believed to help reduce the incidence of birth defects and lower the risk of heart disease. Nuts for Nutrition
  • 46. 2006 Whole Grains An Overview The outer bran layer is rich in B vitamins and phytonutrients such as flavonoids and indoles, along with a small amount of protein. The endosperm is predominantly carbohydrate, and the germ layer is concentrated with minerals such as iron and zinc, along with the antioxidant vitamin E. • As defined by the 2005 Dietary Guidelines for Americans, a whole grain is a grain that contains the entire grain kernel: - Outer bran layer - Endosperm - Inner germ layer Proceedings of the Nutrition Society. 2003; 62: 123-127. Mypyramid.gov
  • 47. 2006 Grains The Milling Process • The milling process, which removes both the bran and the germ, determines how much of the whole grain is retained. It impacts the nutritional value of the end product. • A refined grain is a grain that has been milled. Milling has negative effects in that it takes dietary fiber, iron, and many B vitamins from the grain. • To make up for this loss of nutrients during the milling process, most refined grains are enriched after processing, where certain B vitamins (such as thiamin, riboflavin, niacin, and folic acid) and iron are added back. However, the fiber content of the original grain is not restored. Mypyramid.gov Proceedings of the Nutrition Society. 2003; 62: 123-127.
  • 48. 2006 Whole Grains How Much? • Benefits associated with whole wheat foods can be achieved at relatively low levels of intake (between 2 and 3 servings/d). • However, the consumption of whole wheat foods in some Western countries has been noted to be less than one serving per day, which is equivalent to less than one slice of whole wheat bread per day. Proceedings of the Nutrition Society. 2003; 62: 123-127.
  • 49. 2006 2005 Dietary Guidelines for Americans “Make Half Your Grains Whole” The new recommendations for Americans tell us that half of the grains we consume daily should be whole grains. Why is this Important? Because regular consumption of whole grain foods has been associated with a reduction in: Incidence of cardiovascular disease Incidence of diabetes Cancer mortality at certain sites Premature death Proceedings of the Nutrition Society. 2003; 62: 123-127.
  • 50. 2006 Yogurt • In recent years, many studies have been published on the heath effects of yogurt and the bacterial cultures used in the production of yogurt. • The lactic acid-producing bacteria (LAB) used in the U.S. include Lactobacillus and Streptococcus species • Dairy products are generally considered an excellent source of high-quality protein, calcium, potassium, phosphorus, magnesium, zinc, and the B vitamins riboflavin, niacin, vitamin B-6, and vitamin B-12. However, the final nutritional value of yogurt depends on several factors. Am J Clin Nutr. 2004; 80: 245-56.
  • 51. 2006 Yogurt as a Probiotic? • In 2002, a definition was proposed by the Joint Food and Agriculture Organization/World Health Organization Working Group. They state that a probiotic is a: – “Live microorganism which when administered in adequate amounts confer a health benefit to the host.” • Current scientific concepts agree that yogurt cultures are probiotics if two criteria are met: – 1. A beneficial physiological effect can be obtained by consumption of the live cultures – 2. The benefit has been sustained appropriately in human studies. Br J Nutr. 2005; 93: 783-786.
  • 52. 2006 Benefits of Yogurt • The benefits of yogurt and LAB on gastrointestinal health have been explored mainly in animal models and, occasionally in human subjects as well. • In some studies using yogurt, individual LAB species, or both, promising health benefits were found for individuals with: – Lactose Intolerance – Constipation – Diarrheal diseases – Colon Cancer – Inflammatory Bowel Disease (IBD) – Helicobacter pylori infection – Allergies Am J Clin Nutr. 2004; 80: 245-56.
  • 53. 2006 Web References • http://www.cdc.gov/nccdphp/dnpa/5ADay/month/beans.htm • http://www.cdc.gov/nccdphp/dnpa/5ADay/month/berries.htm • http://www.cdc.gov/nccdphp/dnpa/5ADay/month/cabbage.htm • http://www.cdc.gov/nccdphp/dnpa/5ADay/month/broccoli.htm • http://www.cdc.gov/nccdphp/dnpa/5ADay/month/brussels_sprouts.htm • http://www.cdc.gov/nccdphp/dnpa/5ADay/month/orange.htm • http://www.urbanext.uiuc.edu/Pumpkins/nutrition.html
  • 54. 2006 Web References • http://www.americanheart.org/presenter.jhtml?identifier=4632 • http://www.fda.gov/fdac/features/2000/300_soy.html • http://www.cdc.gov/nccdphp/dnpa/5ADay/month/spinach.htm • http://aggie-horticulture.tamu.edu/plantanswers/vegetables/sweetpotato.html • http://www.cdc.gov/nccdphp/dnpa/5ADay/month/sweet_potato.htm • http://lancaster.unl.edu/food/ftmar04.htm • http://www.mypyramid.gov
  • 55. 2006 Article References o Shi J et al. Saponins from edible legumes: chemistry, processing, and health benefits. J Med Food. 2004; 7(1): 67-78. o Hannum S. Potential impact of strawberries on human health: a review of the science. Cr Rev Food Sci Nutr. 2004; 44:1-17. o Heber D. Vegetables, fruits and phytoestrogens in the prevention of diseases. J Postgrad Med. 2004; 50(2): 145-9 o Ariefdjohan M, Savaiano D. Chocolate and cardiovascular health: is it too good to be true? Nutrition Reviews. 2005; 63(12): 427-30 o Keen C et al. Cocoa antioxidants and cardiovascular health. Am J Clin Nutr. 2005; 81(suppl): 298S-303S o Manthey J, Guthrie N, Grohmann K. Biological properties of citrus flavonoids pertaining to cancer and inflammation. Current Medicinal Chemistry. 2001; 8: 135-153
  • 56. 2006 Article References o Ristic-Medic D, Ristic G, Tepsic V. Alpha-linolenic acid and cardiovascular diseases. Med Pregl. 2003; 56 (Suppl 1): 19-25 o Oh, R. Primary applications of fish oil (Ω-3 fatty acids) in primary care. JABFP. 2005; 18: 28-36 o Messina M, Gardner C, Barnes S. Gaining insight into the health effects of soy but a long way still to go: commentary on the fourth international symposium on the role of soy in preventing and treating chronic disease. J Nutr. 2002. 132: 547S-551S o Lomnitski L, et al. Composition, efficacy, and safety of spinach extracts. Nutrition and Cancer. 2003; 46(2): 222-231
  • 57. 2006 Article References o Cooper R, Morre J, Morre D. Medicinal benefits of green tea: part 1- review of noncancer health benefits. J Alt Compl Med. 2005; 11(3): 521-528 o Minorsky P. Lycopene and the prevention of prostate cancer. Plant Physiology. 2002; 130: 1077-1078 o Lang R, Jebb S. Who consumes whole grains, and how much? Proceedings of the Nutrition Society. 2003; 62: 123-127 o Adolfsson O, Meydani S, Russell R. Yogurt and gut function. Am J Clin Nutr. 2004; 80: 245-56Guarner F et al. Should yoghurt cultures be considered probiotic? Br J Nutr. 2005; 93: 783-786