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Can pomegranate help endothelial function?

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If atherosclerosis is caused by aging, it’s not the years that cause it because there are older people who don’t have either arteries hardened by calcium deposits or plaque made of fats. Hardening of the arteries actually is caused by endothelial dysfunction.

And endothelial dysfunction can be slowed by certain natural forms of vitamins A, C, and E, provided the E vitamin contains all eight toctrienols, vitamin C is in its whole food state, and A is in a natural form of betacarotene obtained from natural foods with carotenoids. How does the reversing process work?

To reverse hardening of the arteries you have to first halt the process and then reverse the calcium and other materials in the plaque that has narrowed arteries for decades. Let’s say you have an ultrasound test of the carotid arteries in your neck. It gives you a reading of the blockage by measuring the thickness of the carotid artery walls.

You can ask for an IMT, also called an “intima-media thickness test.” When your LDL cholesterol is high, it means calcium is flowing into your bloodstream to clog your arteries instead of being deposited in your bones. Your balance of multiple minerals going in your body isn't quite right.

Before you start planning the next step, first read the article from the Journal of Nutrition. 2001 Aug; 131(8):2082-9, Aviram M, Rosenblat M, Gaitini D, et al. "Pomegranate juice consumption for 3 years by patients with carotid artery stenosis reduces common carotid intima-media thickness, blood pressure and LDL oxidation."

Also see an article in the scientific journal titled, Clinical Nutrition. 2004 Jun;23(3):423-33. In a controlled study involving people with severe carotid artery narrowing (stenosis), one group drank pomegranate juice with conventional drugs such as statins and high blood pressure medications. The other group didn’t consume any pomegranate but were on the same type and doses of drugs.

The findings in that study observed in the pomegranate group showed that severe carotid artery narrowing had been reversed

The study lasted three years, but what about people who don’t want to take drugs and just drink the pomegranate juice? Will the juice reverse the calcium and fat deposits in their narrow carotid arteries without any drugs? It’s difficult to get funding for people not taking drugs and just drinking pomegranate juice or taking some other nutrients with the pomegranate.

If you take away the drugs and give both groups just juice to drink and similar meals with the juice, will the arteries clean themselves? That’s the question, since studies usually involve people on conventional drugs rather than on juicing diets.

How many studies look at patients that stepped away from conventional medicine and are willing to drink certain amounts of various juices to see what the pomegranate or other juices are doing to their arteries? And how does pomegranate work on people over age 65 with similar issues who are not on drugs?

Read for yourself a few of the numerous medical articles that have tested pomegranate for its ability to reverse hardening of the carotid arteries include the following studies. Also find out what studies are coming up in the near future.

Why are so many people taking all eight parts of natural vitamin E and looking into research of any health benefits of pomegranate and citrus fruits such as lemon, lime, or oranges as part of a vegan diet?

What are the non-drug approaches that reverse atherosclerosis caused by aging? According to medical journal articles touting studies showing the ability of consumed pomegranate juice and a natural superoxide dismutase (SOD) –enhancing agent called GliSODin® to reverse “carotoid artery ultrasound markers” of hardening of the arteries (atherosclerosis) better than any prescribed commercial drug.

You may wish to check out the article in Life Extension Magazine, July 2007, “Reversing Atherosclerosis Naturally," by Dale Kiefer. The article notes, “In the past seven years alone, the amount of published research on pomegranate has increased seven-fold over all preceding years in the medical and scientific literature.”

The primary source for Life Extension Magazine's article’s conclusion is the medical journal study by Lansky EP, Newman RA. Punica granatum (pomegranate) and its potential for prevention and treatment of inflammation and cancer. Journal of Ethnopharmacology, 2007 Jan 19;109(2):177-206.

Also see the article on SOD and oxidative stress titled, “Oxidative stress and antioxidants: how to assess a risk or a prevention?” Science is looking at fruit juices, nutrients, and even hormones that slow the progression of hardening of the arteries and inflammation of the arteries. But can fruit juice actually reverse existing artery calcification, possibly due to a high LDL level of calcium in the blood instead of the bones? Without drugs, can a whole food reverse atherosclerosis?

Do you need protection from your heavy, high-fat dinner in the form of natural vitamins E and C? Many vitamin E studies of the past used synthetic vitamin E which contains only one part of the eight parts of natural vitamin E

Synthetic vitamin E is lab-made and counters the benefits of natural vitamin E that you get from food and/or natural vitamin E supplements that actually contain the entire eight parts, the tocotrienols in the vitamin E. Food is best, but what if heat, sanitizing, time in the refrigerator, or other processing has destroyed the vitamins in the whole foods?

See the research study, “Effect the antioxidant vitamins on the transient impairment of endothelium-dependent brachial artery vasoactivity following a single high-fat meal,” Plotnick, G.D., et al. Journal of the American Medical Association, 278; 20:682-86, Nov. 26, 1997. In plain language, Plotnick and team showed that if you have a high-fat meal that you consider ‘heavy’, and it’s late at night, you are at a much higher risk of having a heart attack in the morning, unless you take 500 mg of vitamin C and 800 IU of the natural type of vitamin E to counteract the damage.

How a single high-fat meal affects endothelial function

The actual study concluded in medical language that, “A single high-fat meal transiently reduces endothelial function for up to 4 hours in healthy, normocholesterolemic subjects, probably through the accumulation of triglyceride-rich lipoproteins. This decrease is blocked by pretreatment with antioxidant vitamins C and E, suggesting an oxidative mechanism.”

The reference also appears on page 8 in the book, The Cholesterol Hoax, by Sherry A. Rogers, M.D. Now the question remains should you use vitamin E to protect yourself against the foods you eat if you’re not on any drugs? Or should you use natural vitamin E to protect yourself if you’re on statin drugs and need not only vitamin E but also COQ10 to replace those same nutrients that statin drugs remove from your body?

Related to heart disease, vitamin E is believed to inhibit oxidative changes to LDL (“bad”) cholesterol that promote blockages in blood vessels leading to heart attack and stroke. Observational and clinical studies support this hypothesis. An observational study of approximately 90,000 nurses suggested that incidence of heart disease was 30% to 40% lower among nurses with the highest intake of vitamin E from diet and supplements.

The apparent benefit was mainly derived from vitamin E supplements because high intake of vitamin E from food alone was not associated with cardiac risk reduction

Similarly, a 1993 study of 40,000 male health professionals found those who took at least 100 IUs daily for two years had a third fewer cases of heart disease than those receiving no vitamin E supplements. A 1996 study from the National Institutes on Aging followed 11,000 elderly people for seven years and found the death rate for vitamin E users was a third of that of nonusers.

In an intervention study, the Cambridge Heart Antioxidant Study (CHAOS), researchers assigned 2,002 participants with established heart disease to receive either 800 IU or 400 IU of vitamin E or a placebo for a median of 510 days. Treatment with vitamin E substantially reduced the rate of non-fatal heart attack, with beneficial effects apparent after one year. Over a three-year period of vitamin E and vitamin C supplementation in men and postmenopausal women 45-69 years with elevated blood cholesterol levels, researchers in Finland observed a 74% reduction of atherosclerotic progression in men.

Vitamin E may also play a role in cancer risk reduction by protecting against free radicals implicated in cancer, blocking the formation of cancer-promoting nitrosamines, and helping to enhance immune function. Although research is limited, some studies associate higher intakes of vitamin E with a decreased incidence of specific types of cancer, such as prostate, breast, bladder, and colon. Evidence for a link between vitamin E and prostate cancer was compelling enough to be investigated in a large ongoing clinical trial of 35,000 men.

The National Institutes of Health launched the SELECT study (Selenium and Vitamin E Cancer Prevention Trial) to examine whether one or both of these dietary supplements may help reduce risk of prostate cancer. Other studies are underway to examine the potential benefits of vitamin E in reducing the risk of developing cataracts, age-related macular degeneration, Parkinson’s disease, and Alzheimer’s disease.

Vitamins and aging eyes

For example, the National Eye Institute launched a new study following the release of promising findings from the Age-Related Eye Disease Study (AREDS), a study of nearly 5,000 participants that found slower progression of age-related macular degeneration with a daily dose of vitamin E (400 IU), beta-carotene, vitamin C, zinc, and copper. The new study will examine if vitamin E, together with lutein and omega-3 fats, can slow the onset of age-related macular degeneration.
Questions Raised about Vitamin E

Recent data from the Women's Health Study, in which nearly 20,000 healthy, middle-aged women were given 600 international units of vitamin E every other day for roughly 10 years, suggest that vitamin E provides no overall benefit for major cardiovascular-related events or cancer, nor does it affect total mortality or decrease cardiovascular-related deaths in healthy women.

This double-blind, placebo-controlled trial also found that although overall there was no statistically significant cardiovascular benefit to vitamin E, there was a 24 percent reduction in cardiovascular deaths and a 26 percent reduction in major cardiovascular events among a sub-group of women who were 65 or older.

What type of vitamin E was used, synthetic or natural? And were all eight parts of the vitamin used?

Another randomized clinical trial known as the The HOPE Study (Heart Outcomes Prevention Evaluation Study found a lack of protection with vitamin E supplements. This study followed nearly 10,000 patients 55 years and older with vascular disease or diabetes. After about five years, the study was extended and renamed HOPE-TOO (HOPE- The Ongoing Outcomes) with nearly 7,000 patients for four more years.

The subjects who received 400 IU of vitamin E daily did not experience fewer major cardiovascular events or differences in cancer incidence, but were 13 percent more likely to develop heart failure compared to those not taking vitamin E. Researchers speculated that higher doses of vitamin E may disturb the balance of beneficial, naturally occurring antioxidants.

A review of 19 clinical trials conducted between 1993 and 2004 also found a lack of benefit associated with vitamin E supplements, especially at higher doses. With vitamin E supplements above 400 IU per day, researchers concluded that there was an increased risk for death among older, high-risk patients. This review may be somewhat limited in that it excluded studies reporting fewer than 10 deaths and did not consider the results of epidemiologic observational studies.

Not the Final Word on Vitamin E
Experts suggest there is good reason to be cautious about generalizing the findings of recent vitamin E studies. Experts point out that many studies with negative results were secondary prevention trials where study participants were older with existing disease. “The evidence simply does not support the use of vitamin E in reversing disease,” say some experts. Yet the effects on younger and healthier individuals may be more promising.

Despite a substantial amount of research on vitamin E, some experts advise that there is still much to learn—about how vitamin E works with other antioxidants and food components and, particularly, the optimal amount of vitamin E and other antioxidants for specific individuals that may produce favorable health outcomes.

Until more is known, it may be premature to make sweeping recommendations about whether to supplement with vitamin E. The question remains, if you use the natural form of vitamin E with all eight parts--including the tocotrienols, is it reasonable to suggest that the potential benefits of vitamin E seem to outweigh the risk (if any), especially for at-risk individuals? Is it premature to ask this question now? Or does research already point to a direction?

Studies suggesting greater risk with vitamin E supplements containing more than 400 IU observed no harm at lower levels, such as 100 IU per day. The IFIC Foundation and Institute of Food Technologists (IFT) Guidelines for Communicating the Emerging Science of Dietary Components for Health suggest that consumers should be guided to make lifestyle changes based on consensus science, rather than emerging science.

To do so, communicators are advised to:
• Convey emerging science on a continuum, based on the strength of the overall evidence as opposed to isolated studies.

• Provide context when new or emerging scientific evidence adds to and supports the body of research currently available or when the emerging science contradicts previous research, questioning established dietary guidance.

The Guidelines are discussed at the IFIC Foundation site. For more information on how to critically review scientific studies, see the IFIC Review: How to Understand and Interpret Food and Health-Related Scientific Studies.

The latest findings pose some perplexing questions about vitamin E, but do not revoke the body of evidence that supports the safety and potential benefits of vitamin E supplements for a healthy population, as well as at-risk individuals, at the most common daily doses (100-400 IU) found in vitamin E supplements.

One conclusion researchers can agree on: vitamin E, or any food component by itself, cannot match the most effective ways to reduce disease risk—not smoking, getting regular exercise, maintaining a healthy weight, and eating an overall healthful diet. But, is this advice really enough? Vary your oils. Try sesame seed oil for a change.

What does the ongoing research say?

Recommended Dietary Allowances for Vitamin E
Age (years) RDA for Vitamin E (mg alpha-tocopherol)*

1-3 6 (9 IU)
4-8 7 (10.5 IU)
9-13 11 (16.5 IU)
14 + 15 (22.5 IU)
Pregnancy 15 (22.5 IU)
Lactation 19 (28.5 IU)

* 1 mg ATE vitamin E = 1.5 IU (ATE: alpha-tocopherol equivalents)
Source: Institute of Medicine, Food and Nutrition Board. "Dietary Reference Intakes: Vitamin C, Vitamin E, Selenium, and Carotenoids." National Academy Press, 2000.

Vitamin E Issues

Nutritional issues also surround vitamin E studies. Some studies reported that people with heart disease grew worse and had more fatalities and heart attacks when taking vitamin E at certain dosages. Other studies showed vitamin E did no harm when taken at lower dosages by people who did not have heart disease.

Early studies at first showed vitamin E reduced the risk of heart disease. For example, in the Nurses’ Health Study, involving more than 87,000 women, Dr. Meir Stampfer and colleagues at Harvard Medical School and the Harvard School of Public Health in 1993 reported a 41 percent reduction in risk of heart disease among nurses that had taken vitamin E for more than two years.

Atherosclerosis is inflammation of and hardening of the arteries by calcium, plaque, and cholesterol. Researchers in the Nurses’ Health Study reported that a beneficial effect of vitamin E on heart disease "is plausible because of the substantial evidence indicating the importance of oxidation of LDL in atherosclerosis."

In a 1993 study of women’s consumption of vitamin E, reported in the New England Journal of Medicine, “Women who took vitamin E supplements for short periods had little apparent benefit, but those who took them for more than two years had a relative risk of major coronary disease of 0.59 (95 percent confidence interval, 0.38 to 0.91) after adjustment for age, smoking status, risk factors for coronary disease, and use of other antioxidant nutrients (including multivitamins).”

The numbers referred to as the “confidence interval” which is defined in plain language as the expected range of outcome in the study, actually means that the results do not prove a cause-and-effect relation. Instead, the early study suggested at that time that among middle-aged women the use of vitamin E supplements was associated with a reduced risk of coronary heart disease. As the years passed, more randomized trials of vitamin E in the primary and secondary prevention of coronary disease were being conducted with a variety of results.

In 1980, 87,245 female nurses 34 to 59 years of age who were free of diagnosed cardiovascular disease and cancer completed dietary questionnaires that assessed their consumption of a wide range of nutrients, including vitamin E. The average vitamin E intake in the lowest-risk group was 200 IU.

During follow-up of up to eight years (679,485 person-years) that was 97 percent complete, we documented 552 cases of major coronary disease (437 nonfatal myocardial infarctions and 115 deaths due to coronary disease). In that particular 1993 study, “further adjustment for a variety of other coronary risk factors and nutrients, including other antioxidants, had little effect on the results,” according to the abstract of that New England Journal of Medicine article. “Most of the variability in intake and reduction in risk was attributable to vitamin E consumed as supplements.”

The early 1993 vitamin E study with nurses didn’t prove a cause-and-effect relation

Instead, the study suggested that “among middle-aged women the use of vitamin E supplements is associated with a reduced risk of coronary heart disease.” Conclusions in the early study regarding public policy recommendations about the widespread use of vitamin E focused on waiting for the results of further randomized trials.

In 2005, a new study of the effects of taking vitamin E supplements appeared in The Annals of Internal Medicine appeared. The newer 2005 vitamin E study looked at 135,967 adults who also had previously participated in 19 studies. Many were older than 60 years of age.

Approximately 60% had heart disease or one or more risk factors for heart disease. Examples of some risk factors include smoking, a family history of heart disease, and high blood pressure.

What the scientists actually looked at were reported deaths in the 19 random trials and the dosages of vitamin E. These randomized trials compared vitamin E consumption with no treatment or a placebo. A pill or other medicine that has no effect on the body is what is called a placebo.

In order to find previous trials lasting more than a year that emphasized the effects of vitamin E, researchers also studied published medical literature dated until August 2004. The scientists wanted to look at the dosages of vitamin E and how the various low or high dosages affected the individuals.

The dosages in the trials varied widely--from 16.5 IU daily to 2000 IU daily. The next step focused on combining all the trial’s data showing individuals swallowing different amounts of vitamin E. Finally, researchers looked at the death rate among people taking these various vitamin E dosages.

The scientists found that the consumption of 400 or more IU of vitamin E each day for more than a year actually increased the risk for death. For those individuals who took less than 400 IU of vitamin E daily for longer than one year the results were unclear and uncertain as to whether or not vitamin E increased the risk for death.

This conclusion left an uncertainty in the air regarding vitamin E

What some nutritionists now advise is that adults should not take more than 400 IU of vitamin E daily because it is still uncertain to researchers what the upper safe limit of vitamin E is. The political issue for health food stores and those who sell vitamins is whether to sell or not to sell vitamin E containing more than 400 IU per dose.

Currently, nutritionists may be divided on issues related to vitamin E consumption. Politically, manufacturers and retailers of vitamin E supplements are at odds with researchers as the trails and studies are continuing on the vitamin E issue.

Several articles appeared in the mass media interpreting in plain language, the results of the 2004 studies on the effects of vitamin E on mortality rates. Then numerous nutritionists began to focus on rebuttals, claiming that up to 2,000 IU of vitamin E is safe.

Meanwhile, the rebuttals continue with nutritionists on both sides of the political arena. Those employed by the companies selling vitamin E will report the beneficial health effects of vitamin E. Nutritionists looking at death rates also will report those findings.

Which side is right? Since the studies are continuing, safety is an issue, and all the trial results are not yet in

The issue is very complicated and constantly changing. There are no final results regarding vitamin E. The question is whether studies were done for risk of heart attack among the studies of nurses or the studies of men? Were studies originally done on people free of heart disease and heart disease risks? How do the results compare with studies of individuals who had heart disease or its risks?

Another question is how did the medicines taken by those with heart disease interact with vitamin E? Were heart disease rates significantly lower in people taking vitamin E or higher?

Were the women studied totally free of heart disease before taking vitamin E? Was the total risk of heart attack mortality lowered by 24% in one study of vitamin E? The answers to all these questions are that the results are not yet clear. Also, what type of vitamin E was taken?

Was it the d-Alpha Tocopherol vitamin E or Gamma type of vitamin E in the studies?

According to recent in vitro tests, Gamma-Tocopherol inhibits the COX-2 enzyme. Is it an important factor for a healthy cardiovascular system? Or is vitamin E only important in small amounts? Should the COX-2 enzyme be inhibited? Or does inhibiting it increase heart problems?

All these issues become political issues when the economics behind vitamin E sales and additives to foods comes into focus. Another safety issue arises from other medicines or supplements that also inhibit the COX-2 enzyme.

Is Gamma-Tocopherol a more effective antioxidant than alpha-tocopherol?

Both are parts of natural vitamin E. Some nutritionists say that Alpha is better than Gamma. Nutritionists know that individuals get plenty of Gamma in soybean oil, which is quickly excreted by the body. But if you have to use cooking oil, why not use extra virgin olive oil? Or rice bran oil? Or grapeseed oil? There's also a study to look at, "Vitamin E - Linus Pauling Institute at Oregon State University."

That site notes that these limited findings, in addition to the fact that alpha-tocopherol supplementation lowers gamma-tocopherol levels in blood, have led some scientists to call for additional research on the effects of dietary and supplemental gamma-tocopherol on health (11). For more information, see the article, Which Form of Vitamin E, Alpha- or Gamma-Tocopherol, is Better?, in the Linus Pauling Institute Research Report. Importantly, relatively high plasma gamma-tocopherol concentrations may indicate a high level of vegetable and vegetable oil intake.

Research indicates that a ratio of gamma to alpha-tocopherol greater than 1:1 increases levels of both tocopherols in the body and that alpha-tocopherol alone may not be adequate to combat oxidative stress

Most consumers will not be able to interpret the research without some knowledge of how to interpret the results. For example, some forms of GAMMA E also contain tocotrienols from palm fruit which provides high concentrations of all tocotrienols, including: alpha, beta, gamma, and delta. In some forms of GAMMA E, sesame oil, rich in gamma-tocopherol, is used as the base rather than soy oil.

That’s why it’s up to the mass media, acting as interpreters, to explain in plain language the results of scientific research. There’s a proliferation of studies reported in medical journals found mostly in university libraries.

The issues of where to find current nutritional information increase as changing scientific studies are published. As newspapers and magazines merge, and major media consolidates, fewer science writers employed by the mass media are interpreting the newest results for the layman

What general consumers need to do is understand all sides of the issues. Without training in how to read and interpret scientific articles, consumers are in the hands of the general assignment reporter or science writer hired by mass media to interpret scientific facts in plain language.

About 30-33% of the members of the American Medical Writers Association have humanities degrees, but not all science writers are members of the American Medical Writers Association. There also are other professional associations that science writers for mass media publications belong to such as the National Association of Science Writers, the National Association of Medical Communicators, and the American Association of Journalists and Authors. Mass media science writers such as medical journalists, don’t have to be licensed, degreed in science, or belong to any professional or regulatory association. Physicians and medical students can join the American Medical Association.

Consumers don’t really know whether or not articles they read in newspapers or general consumer magazines are written by someone with training in nutrition, medicine, health, the life sciences, medical language, or in the science of understanding and interpreting the results correctly in easy-to-understand words. The goal for consumers is to have the technical jargon of medical and science journals explained correctly in plain language. And the vitamin E research continues. Also check out the IFIC Foundation and Institute of Food Technologists' (IFT) publication, "Guidelines for Communicating the Emerging Science of Dietary Components for Health."

Here is a list of some helpful studies: But be aware that GliSODin contains gluten

Cloarec M, Caillard P, Provost JC, et al. GliSODin, a vegetal sod with gliadin, as preventative agent vs. atherosclerosis, as confirmed with carotid ultrasound-B imaging. European Annals of Allergy Clinical Immunology. 2007 Feb;39(2):45-50.

de NF, Williams-Ignarro S, Sica V, et al. Effects of a pomegranate fruit extract rich in punicalagin on oxidation-sensitive genes and eNOS activity at sites of perturbed shear stress and atherogenesis. Cardiovascular Research. 2007 Jan 15;73(2):414-23.

Kaplan M, Hayek T, Raz A, et al. Pomegranate juice supplementation to atherosclerotic mice reduces macrophage lipid peroxidation, cellular cholesterol accumulation and development of atherosclerosis. Journal of Nutrition. 2001 Aug; 131(8):2082-9.

Aviram M, Rosenblat M, Gaitini D, et al. Pomegranate juice consumption for 3 years by patients with carotid artery stenosis reduces common carotid intima-media thickness, blood pressure and LDL oxidation. Clinical Nutrition. 2004 Jun;23(3):423-33.

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Follow Anne Hart's various Examiner articles on nutrition, health, and culture on this Facebook site and/or this Twitter site. Also see some of Anne Hart's 91 paperback books at: iUniverse, and Career Press. Or see the author's website. Please follow my columns on Pinterest or Pinterest Sacramento Nutrition Examiner.

For more info: please browse my books, How Nutrigenomics Fights Childhood Type 2 Diabetes & Weight Issues (2009). Or see my books, How to Safely Tailor Your Foods, Medicines, & Cosmetics to Your Genes (2003), How to Open DNA-driven Genealogy Reporting and Interpreting Businesses. (2007), or Do You Have the Aptitude and Personality to Be A Popular Author: Creative Writing Assessments - IUniverse. (2009). Neurotechnology with Culinary Memoirs (2009). There also are available Hart's numerous paperback novels and some books also are available as E-books. Please check out the book covers/titles slideshow of 50 of Anne Hart's 91 paperback books.



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