In my previous post I talked about how in the future foods could be personalized to our genotype. While there are no answers yet, there are some functional foods already on the market which can be viewed for the personalized nutrition trend beyond low fat and low sugar. Consumer demand for functional foods to prevent or delay the onset of chronic diseases is increasing and is currently nearly a $180 billion industry. Some products already available on shelves are naturally considered functional such as nuts, whilst others have specific health claims attached to them. In this post, I will look at how some of the functional food products already on the market relate to genotype in treating chronic diseases and how practitioners can use (or avoid) these in clinical practice for specific client groups.
ACE inhibitory Milk Tripeptides and High Bood pressure – Milk proteins contain ACE inhibiting peptides that have long been known to have blood pressure reducing health benefits in the East. Studies have found that milk fermented with Lactobacillus Helveticus or S.cerevisiae release the lactotripeptides from their protein structure which most probably results in impacting the renin-angiotensin system whereby the conversion of Angiotensin 1 to Angiotensin II (which is a powerful vasoconstrictor) is reduced. Studies have shown that after an intake of 3mg-53mg/d of the lactotripeptide over a 8-12 week period, subjects experienced on average a reduction of 13mmHg Systolic BP and 8mmHg Diastolic BP with the biggest reductions seen within the first 1-2 weeks. Previously it was concluded that these effects are only observed in people of Asian descent but a recent meta analysis indicates that Europeans can also experience a modest drop of just over 1mmHg in Systolic and 0.59mmHg in diastolic BP(1). Although the lactotripeptides have not received EFSA approval, products such as Calpis and Valio Evolus (which also contains added stanols) are already on the market. Previous studies have shown that individuals who have inherited the GG version of the Angiotensin (AGT) gene are not responsive to salt restriction in comparison to AA carriers (2). AA carriers are very responsive to the effects of the DASH diet therefore having access to other functional food products as an additional strategy to lifestyle changes could be effective. The frequency of the A allele variant is 88% in Africans, 41% in Europeans and 83% in Asians. Even small reductions of 2mmHg DBP would result in a 14% reduction in the risk of stroke and 6% reduction in Coronary Heart disease(3). Therefore using lactotripeptides together with other lifestyle changes such as a DASH diet, reduction in alcohol, cessation of smoking and regular exercise would do no harm in the moderately hypertensive patients groups, but is it worth the money for a drop of 1mmHg when the real hard work lies in behaviour change and breaking a sweat?, Consumers will vote with their wallets I´m sure. I was unable to find a study that looked at lactotripeptide intake in AA allele (AGT) genotype specifically, but it looks like the verdict is still out on regular use in populations beyond Asians and larger long-term trials are required to assess effectiveness.
Beta-Glucans & HyperCholesterolemia- These peptides can be found in oats,barley and mushrooms. Beta glucans have received EFSA approval for health claims related to a reduction in cholesterol as well reduce blood sugar peaks after meals (4). A therapeutic dose of 3g or more of beta glucans per day which can be found in 1 serving of Oatwell or Kellogg´s Optivita products for instance. After 5 weeks of use, you can expect a reduction of 5- 15% in LDL. It is well documented that Individuals with the APOE4 isoform are more susceptible to higher cholesterol levels and therefore you would assume an ideal target group to recommend regular beta-glucan consumption at therapeutic doses.This is however not reflected in the research. A small study found that ApoE4 carriers were not as responsive to beta-glucan intervention in comparison to E2 and E3 carriers (5). It appears therefore that early preventative strategies such as regular exercise and a polyphenol rich diet such as the Mediterranean diet which includes the consumption of wholegrains, remain the current focus in lipid lowering and heart health.
Stanols and Hypercholesterolaemia- – Stanols are found in soy and plant products which have received EFSA approval and are effective for reducing cholesterol levels when consuming 2g/d of stanols (6). Consuming the therapeutic amounts for 4 weeks leads to a reduction of around 10% in LDL levels . It is currently only recommended for people with existing high cholesterol levels and people on statins should take stanol-containing products under medical supervision. Stanol containing products can be easily found on store shelves in the forms of spreads, yoghurts and milk drinks. Several studies have shown that cholesterol levels are reduced after consumption of sterol containing products irrespective of genotype. Interestingly, a recent study however showed that individuals with the APOE4 genotype experienced less reduction of cholesterol, triglyceride and APoB levels in comparison to E2 & E3 carriers AND E2 carriers experienced the biggest drop (6). Therefore whilst stanol containing products are currently recommended for hypercholesterlaemia, there may be variability in response which could be due to genotype. There is no doubt that functional food come at a cost, however in this current climate of pill-popping and fast lifestyles, we have to come to terms that people want and need foods that are easy to incorporate into their diet & lifestyle that contain therapeutic doses of health ingredients to benefit health and prevent disease in the long run. There is still a lot of research that needs to be done before we can recommend genotype-specific functional foods and before we know the long-term health impact of these bioactive compounds, but with technologies developing at such a rapid pace, who knows what this post might look like after a few years? In Part 2, I will be looking at Glucosinolates, omega-3 fats and Soya in the prevention of chronic diseases. Have you recommended or used the above functional foods in your practice or as a result of a genotype report? I would love to hear your experience!
This post is based on personal opinion of the author and is not intended as medical advice. See a registerded healthcare professional before using any of the products mentioned above. No remuneration was received by any of the companies or brands to write this post.
Mariëtte Abrahams MBA RD is a freelance dietitian, nutrigenomics nutritionist and nutrition business consultant. She is the director of Pomegranate Nutrition Consulting which provides technical expertise on personalized nutrition to the (Bio)Technology, Functional Food and PR industry. W:https://marietteabrahams.com, E: mariette”at”marietteabrahams.com
1. Cicerol A et al. Do the lactotripeptides IPP and VPP reduce Systolic Blood pressure in European sunbjects? A meta-analysis of randomized controlled trials.Am jrn of Hypertension (2013) 26(3):442-449
2. Svetkey LP, Moore TJ, Simons-Morton DG, Appel LJ, Bray GA, Sacks FM et al. (2001). Angiotensinogen genotype and blood pressure response in the Dietary Approaches to Stop Hypertension (DASH) study. J Hypertens 19, 1949–1956
3. Cook NR, Cohen J, Hebert PR, et al. (1995) Implications of small reductions in diastolic blood pressure for primary prevention.Arch Intern Med 155, 701–709.
4. http://www.efsa.europa.eu/en/efsajournal/pub/2207.htm (EFSA opinion on Beta-glucan)
5. Uusitupa MIJ, Ruuskanen E, Makinen E, Laitinen J,Toskala E, et al. 1992. A controlled study on the effect of beta-glucan-rich oat bran on serum lipids in hypercholesterolemic subjects: relation to apolipoprotein E phenotype. J. Am. Coll. Nutr. 11:651–59
6. http://www.efsa.europa.eu/fr/scdocs/doc/825.pdf (EFSA opinion on stanols)
7. Plat J, Mensink RP. Relationship of genetic variation in genes encoding apolipoprotein A-IV, scavenger receptor BI, HMG-CoA reductase, CETP and apolipoprotein E with cholesterol metabolism and the response to plant stanol ester consumption. Eur J Clin Invest. 2002;32:242–50.
8. Lei Bao et al. Effect of oat intake on glycaemic control and insulin sensitivity: a meta analysis of randomised controlled trials. Br Jrn Nutrition Aug 2014