Kale is a cruciferous vegetable that is a member of the cabbage family. It contains nutrients like vitamins A, K, and C as well as phytonutrients like beta-carotene, lutein, zeaxanthin, and glucosinolates. Scientific studies show kale may have benefits like antioxidant, anti-inflammatory, and anticancer properties, though more clinical research is still needed. Kale is generally safe to consume but may cause allergic reactions in some individuals or interfere with blood thinners due to its vitamin K content. Cooking methods can impact the levels of nutrients and phytonutrients in kale.

1. FOOD AS MEDICINE:
KALE
BRASSICA OLERACEA (ACEPHALA)
By
Kevin KF Ng, MD, PhD.
Former Associate Professor of Medicine
University of Miami, Miami, FL., USA.
Email: kevinng68@gmail.com
A slide presentation for HealthCare Providers Nov 2021

2. PresentationOutline
▪ What is kale?
▪ Varieties of kale.
▪ Classification of kale
▪ Scientific studies
▪ Nutrient composition
▪ Phytochemical studies
▪ Safety issues
▪ Summary

3. WHAT IS KALE ?

4. What is kale?
▪ Kale is a vegetable and a member of the
cabbage (brassica oleracea) family.
▪ It is a cruciferous vegetable like cabbage,
broccoli, cauliflower, collard greens and
Brussels sprouts.
▪ The origin of kale is unknown
▪ There are many different types of kale.

5. Varieties of kale

6. Varieties of a single magical plant species
https://www.vox.com/xpress/2014/8/6/5974989/kale-cauliflower-cabbage-broccoli-same-plant

7. Top kale producing countries in th e world
https://www.tridge.com/intelligences/kale/export

8. Food Trends Each State loved From The Past Decade
(Based on Google Trends Data) Jan 2020
https://www.ktnv.com/positivelylv/top-food-trends-of-the-decade-by-state

9. Kale Is Good and Lots of People Still Like It (2019)
https://slate.com/business/2019/10/kale-good-popular-atlantic-wrong.html

10. SCIENTIFIC CLASSIFICATION
SCIENTIFIC STUDIES

11. Scientific classification of kale
https://en.wikipedia.org/wiki/Kale

12. Number of articles on “kale” in PubMed from
1904 to 2020
https://pubmed.ncbi.nlm.nih.gov/?term=kale

13. NUTRIENT COMPOSITION
PHYTOCHEMICALS

14. Macronutrient & micronutrient compositions per 100 g raw kale
https://fdc.nal.usda.gov/fdc-app.html#/food-details/1103116/nutrients

15. Major Phytochemicals in Kale

16. Some properties of phytochemicals in kale:
solubility, bioavailability & half life

17. ● PHARMACOLOGICAL ACTIVITIES
● BIOAVAILABILITY OF
GLUCOSINOLATES, FLAVONOIDS, PHENOLICS

18. Pharmacological activities of Kale
▪ Antioxidant
▪ Anti-inflammatory
▪ Immuno-modulatory
▪ Anticancer
▪ Hypoglycemic
▪ Hypolipidemic
▪ Hypotensive

19. Absorption of glucosinolates and their breakdown products
in the human gut. (2016)
https://www.frontiersin.org/articles/10.3389/fnut.2016.00024/full

20. Metabolism of flavonoids by gut microbiota
(2021)
https://www.researchgate.net/figure/Illustration-of-flavonoids-metabolism-by-gut-microbiota-After-the-ingestion-of_fig1_353686805

21. Interactions between dietary flavonoids and the gut microbiome:
a comprehensive review (2021)
https://www.cambridge.org/core/journals/british-journal-of-
nutrition/article/abs/interactions-between-dietary-flavonoids-and-the-gut-
microbiome-a-comprehensive-review/1E2CB10A973E0BBF2FB6AE384A4B84E1

22. EFFECTS OF COOKING

23. Cooking techniques improve the levels of bioactive compounds
and antioxidant activity in kale and red cabbage (2016)
▪ The aim of this study is to investigate the effects of different home cooking techniques
(boiling, steaming, and stir-frying) in kale and red cabbage, on the levels of bioactive
compounds (carotenoids, anthocyanins and phenolic compounds) determined by high-
performance liquid chromatography coupled with photodiode array and mass
spectrometry detectors (HPLC-DAD-MS(n)), and on the antioxidant activity evaluated by
ABTS, ORAC and cellular antioxidant activity (CAA) assays.
▪ The steaming technique resulted in a significant increase in phenolic content in kale
(86.1%; p<0.001) whereas in red cabbage it was significantly reduced (34.6%; p<0.001).
In the kale, steaming resulted in significant increases in antioxidant activity levels in all
of the evaluation methods. In the red cabbage, boiling resulted in a significant increase
in antioxidant activity using the ABTS assay but resulted in a significant decrease using
the ORAC assay.
▪ According to the CAA assay, the stir-fried sample displayed the highest levels of
antioxidant activity.
▪ Keywords: Anthocyanins; Antioxidant activity; Carotenoids; Cooked vegetable; Cooking
technique; Phenolic compounds.
https://pubmed.ncbi.nlm.nih.gov/26593594/

24. The amount of flavonols in fresh and cooked kale samples (2016)
https://www.tandfonline.com/doi/full/10.1080/10942912.2016.1188308

25. Effects of cooking methods on phenolics of kale (2016)
Adapted from https://www.tandfonline.com/doi/full/10.1080/10942912.2016.1188308

26. PRE-CLINICAL & CLINICAL STUDIES

27. Reported beneficial effects of Kale
▪ Antioxidant
▪ Anti-inflammatory
▪ Immuno-modulatory
▪ Anticancer
▪ Hypoglycemic
▪ Hypolipidemic
▪ Hypotensive
▪ Metabolic syndrome
▪ Cardiovascular disease

28. Immunostimulatory in Vitro and in Vivo Effects of a Water-
Soluble Extract from Kale (2011)
▪ The water-soluble fraction of kale (Brassica oleracea L. var. acephala DC.) had
immunoglobulin (Ig) production stimulating activity in human hybridoma HB4C5 cells
and human peripheral blood lymphocytes.
▪ The biochemical and physical properties of the main active substance in kale were
found to be a heat-stable protein with a molecular weight higher than 50 kDa. The Ig
production-stimulating factors were assumed to act on the translational and/or
secreting processes of Igs. T
▪ This Ig production-stimulating effect was also observed in lymphocytes from the
mesenteric lymph node and Peyer's patches of mice that had been administered
with the kale extract for 14 d.
▪ The partially purified kale extract was analyzed by LC-ESI-MS/MS, the result
indicating ribulose-1,5-bisphosphate carboxylase/oxygenase (rubisco) as an active
substance. Rubisco from spinach indeed exhibited Ig production-stimulating activity
in HB4C5 cells. These findings provide another beneficial aspect of kale as a
health-promoting foodstuff.
https://www.researchgate.net/publication/49749172_Immunostimulatory_in_Vitro_a
nd_in_Vivo_Effects_of_a_Water-Soluble_Extract_from_Kale

29. Kale suppresses postprandial increases in plasma glucose:
A randomized, double-blind, placebo-controlled, crossover study (2016)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5103670/

30. Change of plasma lipid levels of the subjects by GSTM1 and GSTT1
genotype after kale juice supplementation.(2015)
Nutrition Research and Practice 2015;9(1):49-56
Cholesterol TG HDL-C LDL-C

31. Effects of Kale Powder on BP in Subjects with Potential Metabolic Syndrome:
A Prospective Single-Arm Clinical Study (2016)
https://openaccesspub.org/jhc/article/391
SBP
DBP

32. Effect of green leafy and cruciferous vegetable (cauliflower, cabbage, cress,
bok choy, broccoli, kale, collard greens) on CVD incidence:
A meta-analysis (2016)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4973479/

33. Effect of highest-versus-lowest category of total cruciferous
vegetable/isothiocyanate consumption on lung cancer risk in
cohort and case-control studies (2009)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2735794/

34. Is there evidence that cruciferous vegetables can help reduce
cancer risk in people? (2012)
• Prostate cancer: Cohort studies in the Netherlands (4), United States (5),
and Europe (6) found little or no association with prostate cancer risk.
• Colorectal cancer: Cohort studies in the United States and the Netherlands
have generally found no association between cruciferous vegetable intake
and colorectal cancer risk.
• Lung cancer: Cohort studies in Europe, the Netherlands, and the United
States have had varying results
• Breast cancer: A meta-analysis of studies conducted in the United States,
Canada, Sweden, and the Netherlands found no association between
cruciferous vegetable intake and breast cancer risk
• A few studies have shown that the bioactive components of cruciferous
vegetables can have beneficial effects on biomarkers of cancer-related
processes in people. For example, one study found that indole-3-carbinol
was more effective than placebo in reducing the growth of abnormal cells
on the surface of the cervix.
https://www.cancer.gov/about-cancer/causes-prevention/risk/diet/cruciferous-vegetables-fact-sheet

35. SAFETY ISSUES
SIDE EFFECTS
PRECAUTIONS

36. Safety issues
▪ Side effects are rare when consumed in food amounts.
▪ No serious toxic effects have been reported.
▪ Kale may cause the following allergic symptoms:
▪ itchy skin.
▪ hives.
▪ mild swelling of the lips, tongue, and throat.
▪ dizziness.
▪ digestive distress.
▪ oral allergy syndrome.
▪ High concentration of vitamin K has been shown to
▪ potentiate the effect of anti-coagulants.
https://www.healthline.com/health/kale-allergy#whos-allergic

37. Can glucosinolates in kale cause hypothyroidism?
▪ Goitrin, a degradation product of glucosinolate in kale, reduces the
production of thyroid hormones such as thyroxine.
▪ However, they do not seem to alter thyroid function in humans at realistic
amounts in the diet.
https://pubmed.ncbi.nlm.nih.gov/26946249/
Thyroid

38. COMMERCIAL PRODUCTS
SOME DELICIOPUS CUISINE

39. Commercial kale products
Fresh kale Kale juice Kale chips Kale powder

40. Some delicious kale cuisne

41. Summary
▪ Kale has been called a super food because of its
nutrient and phytonutrient compositions.
▪ It is rich in potassium, calcium, vitamins A, K and C.
▪ The phytonutrients beta-caroteine, lutein, zeaxanthine,
glucosinolates, phenolic acids and flavonoids have
been shown to be beneficial for health.
▪ However, clinical studies are limited. Further research
is needed.

42. ANY QUESTION?
Other slide presentations available at:
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