Nuts & Chocolate: The Perfect Pair

Transcription

1 Nuts & Chocolate: The Perfect Pair Penny Kris-Etherton, The Pennsylvania State University Tuesday, April 12, :30 a.m. 1. Research has shown positive health benefits for consumption of small amounts of cocoa/chocolate. But are there negative results when a more realistic amount of cocoa/chocolate is consumed daily? This would depend upon what is considered to be a realistic amount. We believe the recommendation of 1 tbsp. natural cocoa or 20 g dark chocolate is a reasonable amount that also provides positive health benefits. As with any energy-dense food, however, if larger portions are consumed daily this could contribute to weight gain and the negative health outcomes associated with weight gain. 2. Why is peanut butter excluded from nut health benefits? Much of the evidence is based on observational research which may be influenced by confounding variables such as how the peanut butter is being consumed and with what foods. Additionally, some brands of peanut butter contain higher levels of sodium and lower levels of niacin than peanuts. The addition of partially hydrogenated vegetable fats (trans fats) to peanut butter during the time these studies were conducted may be another reason we don t see the same health benefits. 3. How do manufacturers apply nuts research to confectionery when a serving of nuts doesn t meet requirements for healthy claims? Will saturated fat limitations lighten with recent research? FDA has just launched an initiative to redefine healthy based on different criteria than previously (SFA, sodium and sugar). It may be that nuts will be defined by FDA as healthy. Stay tuned. 4. Does dry roasting of peanuts or tree nuts impact health benefits either way? In a study conducted by Bolling et al. (2010), roasted almonds had 26% less total phenols and 34% less ferric reducing antioxidant power (FRAP) than raw, but equivalent flavonoids and phenolic acids (FP) (n=12). Storing almonds at 4 and 23 C for 15 months resulted in gradual increases in FP, up to 177% and 200%, respectively (n=13). Nonetheless, there are many studies with roasted nuts and peanuts that have shown convincing health effects. Thus, the bioactives that remain have biological effects. Of note, is that if nuts are roasted inappropriately (time/temperature), more bioactives will be lost (Almond Board of CA Fact Sheet, Hot Air Roasting of Almonds, July 2014). 5. Is there enough information available to believe other nuts provide similar blood glucose level blunting effects after a meal like peanuts? There is evidence in the literature that other nuts (specifically, almonds, walnuts and pistachios) confer similar blood glucose effects. 6. Was the health claim for cocoa/dark chocolate at such a low level because they wanted to discourage high sugar intake which generally pairs with chocolate consumption? Page 1 of 5

2 The health claim is based on the amount that has been shown to achieve health benefits, without contributing excessive calories. In 2013, the EU approved the cocoa flavanol health claim that 200 mg of cocoa flavanols in cocoa beverages or dark chocolate contribute to normal blood flow. The specific claim is: Cocoa flavanols help maintain the elasticity of blood vessels, which contributes to normal blood flow ( The claim can be used only for cocoa beverages (with cocoa powder) or for dark chocolate which provide at least a daily intake of 200 mg of cocoa flavanols with a degree of polymerization. 7. You used a high-fat, high-calorie meal in your feeding study. Why did you make that decision versus a normal/more healthful meal? Would you expect nuts to be as beneficial in a normal diet? High fat/high calorie meals are typically used in postprandial studies as a means of eliciting an inflammatory response. This allows us to assess the beneficial effects of a food or nutrient on attenuating that response. 8. You quote that small amounts of chocolate can reduce blood pressure by 2-3 mm mercury. On what is the base line blood pressure for this? That amount was based on the Cochrane Review (Ried et al., 2012) which states: Our previous meta-analysis revealed a difference in effect of cocoa products on blood pressure dependent on hypertension status at baseline. While blood pressure was significantly lowered in people with systolic hypertension ( 140 mm Hg) or diastolic prehypertension ( 80 mm Hg), no significant effect of cocoa on people with normal blood pressure (120/80 mm Hg) was evident (Ried 2010). The inclusion of five additional trials in this meta-analysis provided a similar result. A significant blood pressure lowering effect was evident in the hypertensive subgroup (> 140 mm Hg) but not for SBP < 140 mm Hg at baseline: Hypertensive subgroup: mean SBP difference (95%CI): (-7.02, -0.97) mmhg, p=0.01; Normotensive subgroup: mean SBP difference (95%CI): (-4.64, 0.57) mm Hg, p=0.13. However, the separation into the two subgroups (hypertensive and normotensive) was not supported by the test for subgroup differences (I2=0%). A significant blood pressure lowering effect was evident independent of baseline diastolic blood pressure. 9. Is it important to get small amounts of dark chocolate daily, or is every other day or once a week also beneficial? There is evidence that 50 g/week decreases stroke risk (Larsson 2014). In the Physicians Health Study, chocolate consumption 2 times per week decreased risk of diabetes (Matsumoto et al., 2015). 10. Have studies been done to see at what point too much chocolate consumption has the opposite effect and actually increases risk of cardiovascular disease and other diseases? There is some limited information that acute consumption of dark chocolate (37 g) increases Page 2 of 5

3 resting blood pressure by 4 mmhg. However, daily consumption for four weeks increased vasodilation (West et al., British Journal of Nutrition. 2014). 11. In the peanut study, what type of peanut was consumed (dry roasted, oil roasted, salted/unsalted, shelled/blanched)? The peanuts were provided by the Peanut Council. They were dry roasted with the skins. 12. Have any studies been done on the difference between effects of consumption of peanuts versus consumption of peanut butter? Observational studies have separated peanuts from peanut butter and the results have been mixed with some studies showing no difference (Luu et al., 2015) and others showing benefit of peanuts only (van den Brandt & Schouten, 2015). In the study that we conducted at Penn State, we used both peanuts and peanut butter together (about 1 to 1) and saw benefits of the peanut/peanut butter treatment group on cardiovascular disease risk factors (Kris-Etherton et al., 1999). 13. How much sugar was in the chocolate? Participants in the chocolate and almond study received six pieces of dark chocolate daily (210 calories, 20 g of sugar). 14. Do the effects of cocoa and dark chocolate remain so beneficial at higher (more realistic) daily intake levels? Most of the studies use 1-5 g. In a study of vascular health by Monahan et al. (2011) they found increasing benefits of cocoa with doses ranging from 2 to 26 g. In a study comparing consumption of 6 g vs 25 g of dark chocolate (Desch et al., 2010), found similar reductions in blood pressure between groups. 15. Do macadamia nuts fall into the good for you category? While all nuts do provide heart healthy unsaturated fats, some have higher levels of saturated fat which exclude them from meeting the guidelines for a qualified health claim. Macadamia nuts, Brazil nuts and cashews, for example, are too high in saturated fat to qualify for the health claim, with 6 g and 4.5 g per 50-g serving, respectively. However, Dietary Guidelines continue to recommend nut consumption as part of a healthful diet but do not specify any particular nut. 16. How do other nuts compare to peanuts? Are other nuts better? Are any nuts not beneficial? Tree nuts and the legume, peanuts, have similar health benefits. 17. What has to happen to achieve a qualified health claim? As a result of the Consumer Health Information for Better Nutrition Initiative, FDA acknowledged that consumers benefit from more information on food labels concerning diet and health. As part of this initiative, the agency established interim procedures whereby Qualified Health Claims (QHCs) can be made not only for dietary supplements but for conventional foods as well. FDA began considering QHCs under its interim procedures September 1, While Health Claims require Significant Scientific Agreement (SSA) based on the totality of publicly available scientific evidence, QHCs are still based on the totality of publicly available evidence but the scientific support does not have to be as strong as that for SSA. Page 3 of 5

4 To date, most nuts have an FDA-approved health claim that states, "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." Only almonds, hazelnuts, peanuts, pecans, some pine nuts, pistachio nuts and walnuts feature the approved health claim, since these nuts all provide no more than 4 g of saturated fat per 50-g sample which is a little more than 1.5 oz., or in most cases about one handful of nuts each day. As mentioned above, macadamia nuts and cashews are too high in saturated fat to qualify for the health claim, with 6 g and 4.5 g per 50-g serving, respectively. 18. Peanuts are legumes. Do you expect other legumes (e.g. peas, lentils) have similar effects as shown in your studies? Two systematic reviews and meta-analyses reported benefits of pulses on body weight (Kim et al., 2016) and blood pressure (Jayalath et al., 2014). However, additional research is needed and there needs to be a side-by-side comparison of peanuts with other legumes. 19. What was the age of the elderly men? Men aged 65 to 84 years were invited to participate. The mean age was 72 years. 20. If I eat 1 ½ oz. of chocolate and nuts every day, will I be able to feel the health effects? Based on the energy provided and the potential effects of satiety you may feel fuller longer after eating these foods, however you will likely not feel other beneficial effects such as reductions in BP, lipids or glucose. 21. Chocolate has cocoa flavanols what is the active component of nuts? Nuts are a nutrient-dense food rich in many micronutrients, healthy fatty acids, dietary fiber, plant sterols, plant protein and arginine and countless bioactives yet to completely characterized and studied. 22. How do we move chocolate from a moderate to strong evidence? The USDA Nutrition Evidence Library (NEL) provides evaluation criteria for judging the strength of the body of evidence supporting the recommendations. They are based on 5 elements, risk of bias (quality), quantity, consistency, impact and generalizability. Based on set criteria for each element the evidence is given a rating of strong, moderate, limited or no assignable. The chart used for assessing the evidence as part of the guidelines may be found here (click the link for NEL grading rubric): Why did peanut butter not work in the first study you presented? Not included, or shelf peanut butter has other fats? Does grinding affect the health benefits? In the one study that I presented, peanut butter did not show benefits compared with peanuts. However, other studies such as the Nurses Health Study and the Iowa Women s Health Study both showed benefits of peanut butter consumption on diabetes. The Nurses Health Study showed benefits of peanut butter on CVD risk. In the Penn State study, we used peanuts and peanut butter Page 4 of 5

5 (1:1) and showed benefits on CVD risk factors compared with an average American diet. Grinding (including chewing more) makes the energy and nutrients in nuts and peanuts more bioavailable. 24. Will all of the slides be available for study in the proceedings? The slides will be available. 25. If peanuts help the effects of a high-fat meal, will peanuts blunt the high fat (30+% cocoa butter) of chocolate? If yes, what are the chances of getting a qualified health claim? Based on the research that we did, peanuts should blunt a high fat meal that is high in cocoa butter. This needs to be studied to be certain. Much research is needed before a Qualified Health Claim is issued. 26. Nuts and weight is this association causative or associative? In other words, do overweight subjects just prefer potato chips vs. healthy weight people prefer nuts? Much of the research on this topic comes from epidemiologic studies which only demonstrate associations. There is exciting new research that shows that the energy available from nuts is less than measured by bomb calorimetry. It could be that people consuming nuts are ingesting fewer calories. 27. Is there any possibility that chocolate can get re-classified as seeds? Cocoa beans are the seeds of the fruit (pods) of the Theobroma cacao tree. This is for the FDA to decide. 28. Why are there health benefits from peanuts, but not peanut butter? There is research that shows benefits of peanuts and peanut butter. Perhaps, studies that do not show benefits of peanut butter could be due to the sugar, salt or stabilizers used in the peanut butter studied. 29. What is the best way to measure (test for) cacao health benefits of polyphenols? Is there an approved laboratory that can test for this? Controlled clinical trials are the best way to evaluate the health benefits of any food, nutrient or bioactive. A university researcher or a CRO can conduct these trials. 30. Does a lower roasted nut have more benefits than a higher roasted product? Many studies have been done with roasted nuts and peanuts and shown multiple health benefits. However, it is possible to destroy some of the bioactives if the roasting process (time/temperature) is inappropriate. 31. For peanuts why, in light of the same level of fat, do triglycerides go down? This is a paradox. What is the cause of this effect? It is not clear what the mechanism is. It could be that less fat is absorbed or the fat that is absorbed is cleared faster from the blood. Page 5 of 5