Post on 26-May-2018
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NMDM121
MEDICINAL FOOD SCIENCE
Session 19
Fruits Part II:
Antioxidant-Rich Fruits
and Other Fruits
Nutritional Medicine Department
© Endeavour College of Natural Health endeavour.edu.au 2
• Define “ORAC” and discuss the value and limitations of
using ORAC scores to rank the antioxidant potential of
foods and beverages.
• Discuss the nutritional value, phytochemical profiles and
therapeutic benefits of antioxidant-rich fruits and other
fruits:
‒ Berries, Pomegranate, Cherries
‒ Dates, Apples, Grapes
Session Summary
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ORAC Values
• There are many methods available to assess the
antioxidant capacity of foods.
• Oxygen Radical Absorption Capacity is one of these
methods.
• The ORAC score represents the ability of a substance to
stabilise peroxyl radicals in vitro.
‒ Not necessarily an indicator of actions in vivo.
• Serves as a useful tool when making healthy choices but
has limitations.
‒ A low ORAC score does not represent a lack of nutrition.
(Winter, 2011)
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ORAC Values
• ORAC values are generally expressed in micromoles of
Trolox Equivalents per 100 grams of sample, although
other measurements can also be used.
• This is important to consider when making comparisons
between foods. For example 100 grams of a ground
spice is likely to be much denser in phytochemicals and
therefore have a higher ORAC score than a piece of raw
fruit, which has a high water weight. It is much easier
(and safer) to eat 100 grams of fruit than 100 grams of
dried spices.
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Antioxidant Capacity
Some of the methods used to assess antioxidant capacity
include:
• ORAC – Oxygen Radical Absorbance Capacity
• TEAC – Trolox Equivalent Antioxidant Capacity
• FRAP – Ferric-Reducing Ability of Plasma
• CAA – Cell-based Antioxidant Activity
• DRSC - 2,2-diphenyl-1-picrylhydrazyl (DPPH) Radical
Scavenging Capacity
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Berries
Overview
• In botanical language, a berry or true berry is a simple
fruit having seeds and pulp produced from a single
ovary.
• True berries based on this botanical definition include:
• Grapes
• Tomatoes and other species of the Solanaceae family such as
Capsicum and Goji berries
• Barberry
• Currants
• Elderberry
• Gooseberry
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Berries
Overview
Family Name of berry
Ericaceae (Heath) family Bilberry/blueberry, cranberry
Rosaceae (Rose) family Blackberry, raspberry, strawberry
Moraceae (Mulberry) family Mulberry
Grossulariaceae (Currant)
family
Gooseberry
From a culinary perspective the term “berries” includes
those listed above.
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Berries
Constituents
• There is a great deal of research interest in berries due
to their phytochemical content.
• Berries are a good source of anthocyanins which give
them their bright red, blue and purple colours.
• They also contain a range of nutrients and other
phytochemicals.
• This session begins by looking at the phytochemicals
found in berries generally, together with an overview of
the biological activities associated with these
phytochemicals. Specific types of berries are then
discussed in more detail.
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Berries
Constituents
Anthocyanins Water-soluble; give blue, purple, red colour; concentrated
in skin of berries; also in flesh of cherries and strawberries;
antioxidant effect; beneficial effect on blood vessels;
protective effect on visual function during inflammation
(animal studies)
Catechins More abundant in the skin and external tissues of fruits
than internal tissues; catechins found in cranberries are
similar to those found in green tea; possible cancer
protective role.
Ellagic acid Reported to have antiviral, antibacterial, anti-inflammatory
and chemopreventive effects.
Gallic acid Antioxidant found in berries, black tea and red wine;
cytotoxic activity in-vitro against various cancer cell lines.
(Nile & Park, 2014)
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Berries
Therapeutic Effects • Small human trial by Torronen et al. (2013) to determine
whether berry consumption with white or rye bread had any
effect on glucose and/or insulin response.
• Consumption of 150 grams of berries (as whole berry puree)
by healthy females in 3 randomised, controlled, crossover 2-
hour meal studies.
• Main finding was that berries attenuated the postprandial
insulin response to bread with little or no effect on the glucose
response.
• The lower insulin response after consumption of berries
implies that less insulin is required and secreted for
maintenance of normal or slightly improved postprandial
glucose metabolism. This could have health benefits.
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Berries
Therapeutic Effects
• In the short term, a lower insulin response prevents
hypoglycaemia and inappropriate increases of free fatty acids
and stress hormone concentrations, which are often seen
during the late postprandial period after consumption of
refined carbohydrate-rich foods.
• Regular consumption of diets with a low postprandial insulin
response may increase first-phase insulin secretion, indicating
improved pancreatic β-cell function, and modulate the
inflammatory status.
• The mechanism of action is not yet understood; however,
berries contain citric and other organic acids with a pH of ~3
and previous studies with addition of vinegar or lactic acid in
sourdough bread have shown similar responses.
(Torronen et al., 2013)
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Berries
Therapeutic Effects
Emerging Impact on Cardiovascular Health
• “Data reported from the Kuopio Ischemic Heart Disease Risk
Factor Study showed a significantly lower risk of CVD-related
deaths among men in the highest quartile of berry intake
(>408g/day) versus men in the lowest intake (<133g/day) over
a 12.8y period.”
• “While limited epidemiological data inversely associate
consumption of berries with inflammation and CVD, these
conclusions need to be strengthened in future case control or
cohort studies investigating the long term health benefits of
berries in specific populations.”
(Basu et al., 2010)
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Berries
Research Emerging Impact on Cardiovascular Health
• “Clinical studies in healthy humans, subjects with diabetes
mellitus, dyslipidaemia, metabolic syndrome, hypertension or in
smokers, show a significant decrease in CVD risk factors,
especially glucose, lipids and lipid peroxidation and systolic blood
pressure following berry intervention.”
• “The principal mechanisms of action underlying the potential
cardioprotective effects of berries include counteracting free
radical generation, attenuating inflammatory gene expression,
down regulating foam cell formation, and up regulating eNOS
expression; through these effects, progression of atherosclerosis
is slowed and normal vascular function and blood pressure are
preserved.”
(Basu et al., 2010)
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Berries
Cranberry
Vaccinium macrocarpon
http://smoochsmile.co.za/cranberries
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Cranberry: Therapeutic Effects
• The medicinal use of cranberry dates back to the 17th century
when it was a popular treatment for scurvy and gastric
problems.
• Phytochemicals of interest include flavan-3-ols, anthocyanins,
A-type proanthocyanidins, benzoic acid and ursolic acid.
• Proanthocyanidins from cranberry are composed of repeating
epicatechin units with at least one A-type linkage.
• Much of the research on cranberries has focused on the
potential of cranberry proanthocyanidins to inhibit the
adhesion of pathogenic bacteria to mucosal membranes, thus
potentially preventing infections.
(Mukherjee et al., 2014)
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Cranberry: Therapeutic Effects
• The distinction between A-type and B-type
proanthocyandins (PACs) is important because the
differences can influence their biological properties.
• The A-type PACs exhibit significantly greater inhibition of
in-vitro adhesion of P-fimbriated E. coli bacteria to
uroepithelial cells than the B-type PACs.
• Many plant foods such as apple, grape and cocoa
contain high amounts of PACs, but only plums, peanuts,
avocados, cinnamon, lingonberry and cranberry contain
A-type PACs with cranberries and lingonberries
containing the highest amount.
(Blumberg et al., 2013)
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Cranberry: Therapeutic Effects
Effect of processing on cranberry phytochemicals
• Cranberry is rarely consumed fresh due to its tart and
astringent taste. It is often consumed as processed juice.
• Multi-step processing for juice leads to a substantial loss
of phytochemicals; anthocyanins are most affected with
losses of > 50%.
• Flavanols and PAC are somewhat heat stable but can be
affected by high heat which is sometimes used when
cranberries are processed into powders.
• The juice is often diluted or blended with other fruits with
further diminishes or modifies the phytochemicals.
(Blumberg et al., 2013)
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Cranberry: Therapeutic Effects
• Most of the research interest has focused on cranberry for the
prevention of urinary tract infections.
• Despite promising in-vitro studies and a biologically plausible
mechanism being demonstrated, results from clinical trials
have shown mixed results.
• Interventions testing the efficacy of cranberry juice and
cranberry supplements have been confounded by poor
compliance, high drop-out rates and variable doses of
bioactives from a range of different products.
• The optimal dose has not been determined.
• The effect may differ amongst population groups, e.g. young
women, older women in residential care, children or men.
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Cranberry: Cautions
• Cranberry generally has a record of safety, although
long-term safety data are lacking.
• No significant herb-drug interactions have been reported.
• A small study found a statistically significant rise in
urinary oxalate levels prompting a caution that regular
use of cranberry may increase the risk of kidney stone
formation in people with a history of oxalate calculi.
• Cranberry juice is acidic and requires sugar or other
sweeteners which may contribute to tooth
demineralisation and formation of dental caries.
(Mukherjee et al., 2014)
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Berries
Blueberry
Vaccinium myrtillus
www.organicgardening.com
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Blueberry
• Blueberries contain pterostilbene which is structurally similar
to resveratrol; it has been reported to have antioxidant, anti-
inflammatory and anticarcinogenic properties (McCormack &
McFadden, 2013).
• Blueberries are high in anthocyanins.
• Animal studies using blueberry extracts suggest they may be
of benefit in age-related neuronal deficits either through their
ability to lower oxidative stress and inflammation and/or by
directly altering the signalling involved in neuronal
communication (Giacalone et al., 2011).
• Blueberry anthocyanins have been shown to protect retinal
cells from UV damage (based on in-vitro studies) (Liu, et al.,
2012).
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Blueberry
• One of the most researched berries with health benefits
linked to reduced cognitive decline, longevity, decreased
cancer risk and improved cardiovascular health.
• The precise mechanism remains unknown, however with
age-related decline it is believed they enhance existing
neuronal connections, improve cellular communication
and stimulate neuronal regeneration.
• The flavonoids in blueberries have also been shown to
induce memory improvements through the activation of
signalling proteins via specialised pathways in the
hippocampus.
(Payne, 2009)
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Berries
Strawberry
Fragaria x ananassa
www.organicfacts.net
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Research
Strawberry
• Provide a significant amount of vitamin C and is a good
source of folate (250g provides ~ 60mcg of folate = 30%
RDI).
• “Strawberry studies are few…hypothesised health
benefits related to strawberry consumption include their
role in prevention of inflammation, oxidative stress and
cardiovascular disease, certain types of cancers, type 2
diabetes, obesity and neurodegeneration.”
(Giampiere et al., 2011)
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Research
Strawberry
• A study on healthy humans looked
at the levels of plasma TAC (total
antioxidant capacity) after an acute
or protracted intake of
strawberries.
• There were significant increases in
TAC largely due to the high
concentration of vitamin C and the
phenolic compounds like
ellagitannins and anthocyanins in
strawberries.
(Giampiere et al., 2011)
http://www.storyhack.com/
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Research
Strawberry
“Several reports have demonstrated various
cardiovascular, antiproliferative, and neurologic
benefits associated with the consumption of
strawberries. Although most health-promoting effects
were initially observed with in vitro studies, there is
increasing animal and clinical research focused on
translating the in vitro evidence into in vivo outcomes.”
(Giampiere et al., 2011)
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Pomegranate Punica granatum
fitnessheat.com
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Pomegranate
Overview
• Native to Persia (modern day Iran).
• Pomegranate is both Arabic and Hebrew for ‘fruit of
paradise’.
• Historically is affiliated with “abundance, blessings, fertility,
immortality, invincibility, posterity, prosperity and the
endurance of marriage.”
• The fruit served as a way of transporting liquid while
travelling through the dessert.
• Commonly used in traditional medicine systems including
Ayurveda, TCM and Sowa-Rigpa (Tibetan).
(Engels et al., 2014)
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Pomegranate
Overview
• In Ayurvedic medicine, “the pomegranate is considered a
pharmacy unto itself and is used as anti-parasitic agent, a
blood tonic and to heal aphthae, diarrhoea and ulcers.” (Jurenka, 2008)
• The seed is consumed raw; the fleshy outer portion of the
seed is the part that is desired.
• The tannins provide the distinctive taste.
• Pomegranates are used mainly in
Middle Eastern and Mediterranean cuisines,
utilising fresh fruit, juice or syrups.
www.freepik.com
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Pomegranate
Constituents
• The synergistic action of pomegranate constituents as a whole appears to be superior to that of a single constituent (Jurenka, 2008).
• The main pomegranate phytochemicals that have been researched
include:
‒ Anthocyanins such as delphinidin, cyanidin and pelargonidin,
which give the juice its red colour.
‒ Hydrolysable tannins, such as punicalagin and gallagic acid.
‒ Other polyphenolic components of possible interest include
kaempferol, quercetin and luteolin.
‒ The seed oil also contains many compounds of interest with
known antioxidant and anti-cancer activities, e.g. punicic acid
(present at about 1–5 μg/mL in juice).
(Wang & Martins-Green, 2014)
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Pomegranate
Therapeutic EffectsThere is a lot of research interest in the potential of pomegranate
juice/pomegranate extract to reduce the risk of prostate cancer
and/or delay its progression:
• Recent research has shown that pomegranate juice (PJ)
and/or pomegranate extracts (PE) significantly inhibit the
growth of prostate cancer cells in culture.
• In preclinical murine models, PJ and/or PE inhibit growth
and angiogenesis of prostate tumours.
• Three components of PJ, luteolin, ellagic acid and punicic
acid together, have been shown in animal models to have
inhibitory effects on prostate cancer growth, angiogenesis
and metastasis.
• Continued on next slide:
(Wang & Martins-Green, 2014)
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Pomegranate
Therapeutic Effects
Results from clinical trials are also promising:
• To investigate the effects of PJ consumption on prostate cancer
progression in men, a phase II clinical trial for men with rising PSA
after surgery or radiotherapy was conducted in 2006.
• Patients were treated with 250 mL of PJ daily until disease
progression. During the trial, there were no serious adverse events
reported and the treatment was well tolerated. Mean PSA doubling
time significantly increased with treatment from a mean of 15
months at baseline to 54 months post-treatment (p < 0.001).
• PJ treatment suppressed cell proliferation and increased apoptosis
in the prostate cancer cell line LNCaP as well as increasing serum
nitric oxide and reducing the oxidative state and sensitivity to
oxidation of serum lipids in patients. No patients developed
metastases during the period of the trial period.
(Wang & Martins-Green, 2014)
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Pomegranate
Therapeutic Effects
• In 2014 results from a double-blind, placebo-controlled
randomised trial using an oral capsule containing a blend
of pomegranate, green tea, broccoli and turmeric
showed that the supplement delayed prostate cancer
progression as indicated by slower increases in PSA
levels.
• The median increase in PSA levels in the supplement
group was 14.7% as compared to 78.5% in placebo
group, suggesting the great potential of the food
supplement to prevent prostate cancer progression.
(Thomas et al., 2014)
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Pomegranate
Therapeutic Effects
Other areas of research include:
• In preliminary laboratory research and human pilot studies, pomegranate juice has been shown to reduce cardiovascular disease risk factors, including:
‒ Decreased oxidative damage in atherosclerosis (De Nigris 2005).
‒ Decreased LDL and the progressive risk of atherosclerosis (De Nigris 2006).
‒ Reductions seen in total cholesterol (Esmaillzadeh, 2004).
‒ Reduction in systolic blood pressure by inhibiting serum angiotensin-converting enzyme (ACE) (Aviram 2001).
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Pomegranate
Therapeutic Effects
The main therapeutic actions of pomegranate are:
• Antioxidant
• Anti-inflammatory
• Anti-atherogenic effects
• Anti-tumourigenic
Other areas of research include:
• Decreased proteoglycan breakdown in-vitro
osteoarthritis model (Ahmed, 2005) and decreased
inflammation and degradation in rheumatoid arthritis
animal model (Shukla, 2008).
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Pomegranate
Therapeutic Effects
• A 2012 randomised, double-blind, placebo-controlled
trial looked at 101 chronic haemodialysis patients. The
study group was given 100mls of pomegranate juice 3
times per week.
• The pomegranate group experienced:
• Reduced inflammation biomarker levels
• Reduced protein and lipid oxidation
• This resulted in fewer second hospitalisations as a result
of infections and problems with atherosclerosis.
• The beneficial effects disappeared 3 months after the
study ended.
(Engels et al., 2014)
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Cherry Prunus avium
http://www.foxnews.com/health/2013/07/09/5-health-benefits-cherries/
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Cherries
Overview
• Cherries belong to the Rosaceae family.
• They are the smallest of all stone fruits.
• There are over 100 different types of cherries.
• In folk medicine, the juice was
used to treat rheumatism.
healthowealth.com
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Cherries
Constituents
• The sweetness in cherries is mainly due to glucose, fructose and
sucrose (which combined, make up about 13g/100g).
• Sour cherries have less simple sugars (8g/100g) and have more malic
acid.
(Ferretti et al., 2010)
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Cherries
Constituents
• The phenolic compounds increase in cherries as they ripen.
• Chlorophyll is degraded while phenolic compounds and
anthocyanins accumulate.
Phytochemical
class
Constituent
Phenols Tannins ,cyanidin 3-glycoside, cyanidin 3-rutinoside,
cyanidin 3-sophoroside, pelargonidin 3-glucoside,
pelargonidin 3-rutinoside, 3-glucoside and peonidin 3-
rutinoside.
Phenolic acids Neochlorogenic acid and p-coumaroylquinic acid
Flavonols Catechin, epicatechin, quercetin 3-glycoside,
quercetin 3-rutinoside and kaempferol 3 - rutinoside
(Ferretti et al., 2010)
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Cherries
Constituents
• Many of the constituents found in cherries work
synergistically to demonstrate antioxidant, anti-
inflammatory and anti-cancer actions.
(Ferretti et al., 2010)professionalmedical.wordpress.com
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Cherries
Constituents
(Ferretti et al., 2010)
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Cherries
Therapeutic Effects
Anti-inflammatory action
• A study in healthy men and women looked at the effects
of cherry consumption on CRP and NO blood levels.
‒ Study participants consumed ~280g cherries (total
weight 300g, depitted at time of consumption,
approximately 45 cherries) for 28 days.
Findings
• Serum concentration of CRP decreased by 8% by day 14
and 25% by day 28.
• Nitric oxide reached maximum reduction of 18% within 14
days.
(Kelley et al., 2006)
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Cherries
Therapeutic Effects
“In conclusion, supplementing the diets of healthy
men and women with cherries reduced the
serum/plasma concentrations of some markers of
inflammation…
The anti-inflammatory effects of cherries may be of
clinical significance and should be investigated in
further studies.”(Kelley et al., 2006)
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Cherries
Therapeutic Effects
Gout • Zhang and colleagues (2012) investigated the risk of recurrent
gout attacks and cherry consumption on 633 individuals with
gout. This was a case-crossover study.
Findings
• Cherry intake was associated with a 35% lower risk of
recurrent gout attacks and intake of cherry extract showed a
similar inverse association.
• “When cherry intake was combined with the use of allopurinol,
the risk of gout attacks was 75% lower than during the period
without either exposure.” (Zhang et al., 2012)
© Endeavour College of Natural Health endeavour.edu.au 54
Cherries
Therapeutic Effects
Findings
• The exact mechanism through which these effects are
demonstrated is unknown, however the authors speculate that
cherries may have a urate-lowering effect through increased
glomerular filtration rate or reducing tubular reabsorption.
“Our findings suggest that cherry intake is
associated with a lower risk of gout attacks. Cherry
products could provide a novel
nonpharmacological option for the prevention of
gout attacks.” (Zhang et al., 2012)
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Cherries
Therapeutic Effects
Cherries and Sleep
• Because cherries, especially tart cherries, contain
melatonin there has been interest in investigating
whether cherry juice and/or concentrated cherry
products might help with treatment of insomnia.
• Several small human trials have shown promising
results; however, further research is required (Garrido et
al., 2013).
• Sour cherries contain 15-18 ng of melatonin per gram
(ng = nannogram; 1 microgram = 1,000 nannograms).
This is a very tiny amount. Therapeutic doses of
melatonin are usually 3-5 milligrams.
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DatesPhoenix dactylifera
www.fragrantica.com
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Dates
Overview• A staple food of the Middle East for thousands of years.
• Believed to have originated around the Persian Gulf
• Cultivated since ancient times from Mesopotamia to prehistoric Egypt,
possibly as early as 4000 B.C.
• High tannin content; traditionally used as medicine for their
cleansing power and as an astringent in intestinal troubles.
• Traditionally made as an infusion, decoction, syrup or paste,
dates may be administered for sore throat, colds, bronchial
catarrh and taken to relieve fever and number of other
complaints.
• The seed powder is also used in some traditional medicines.
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Dates
Constituents• Energy-dense food – 100 grams provide
~1200 kilojoules.
• Contain good amounts of selenium,
potassium, copper and magnesium.
100 grams can provide > 15% of RDI
of these minerals.
• Good source of antioxidants, mainly
carotenoids and phenolics.
• Dried dates have a GI of 31-62 and a 60
gram serve has a GL of 14-22.
• Excellent source of dietary fibre. www.tropicaloasisfarms.com
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Apple
Overview
• The tree originated from Central Asia, where its wild ancestor is still found today.
• There are more than 7,500 known cultivars of apples resulting in a range of desired characteristics.
http://itswrittenonthewalls.blogspot.com.au/2012/08/its-all-about-apple-yummy-things.html
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Apple: Constituents
Category Sub-class Examples
Fibre Soluble fibre Pectin - associated with lowering of
cholesterol and lower glycaemic effect.
Polyphenols Flavonol Quercetin – antioxidant effect; animal
studies have shown anti-inflammatory effect
and broncho-relaxant effect; down-regulation
of mast cell activation.
Phenolic acids Hydroxyxinnamic acids – e.g. chlorogenic
acid – antioxidant effect
Flavan-3-ols Procyanidin B2, epicatechin, oligomeric
procyanidins
Anthocyanins In red peel
Dihydrochalcones Phloridzin
(Hyson, 2011)
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Apple: Therapeutic Effects
Health effect Evidence
Cancer protective There have been several cohort and case-control
studies suggesting apple consumption may be
associated with reduced risk of cancer, especially lung
cancer.
CVD protective Several cohort studies have shown reduced risk of CVD
with higher apple consumption.
Antioxidant effects A daily dose of fresh apples (2 g/kg bw) for 1 month
showed increased superoxide dismutase and
glutathione peroxidase in erythrocytes and increased
overall antioxidant potential in plasma.
Asthma and
pulmonary function
Several cohort studies have shown inverse association
between apple consumption and asthma.
(Hyson, 2011)
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Apple: Therapeutic Effects
Health effect Evidence
Ageing and
cognitive processes
Animal studies show neuroprotection from apple juice
consumption.
Diabetes One large cohort study found apple consumption
associated with reduced risk of type 2 diabetes.
Weight loss Small human trial with high drop out rate suggested
apples may be helpful for weight loss due to low-energy
density and high fibre.
Bone health Very preliminary studies – apple consumption may have
positive effect on markers related to bone health.
Gastrointestinal
protection from
drugs or injury
Preliminary animal studies show that phenolic-rich
extracts of freeze dried apples may have a protective
effect on gastrointestinal mucosa.
(Hyson, 2011)
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GrapesVitis vinifera
www.medicalnewstoday.com
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Grapes
Overview
• Cultivation of grapes dates back to around 6500–6000 BC.
• There are around 600 different species.
• Grape leaves have traditionally used for their astringent
and anti-inflammatory action.
• Haemorrhages and minor bleeding
• Grapes belong to the Vitaceae family.
• In Ancient Rome, grapes signified fertility and eating
grapes or raisins was seen as a way of strengthening
mental capabilities.
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Grapes
Overview
Grape products include:
• Grapes (fresh fruit)
• Raisins (dried fruit)
• Grape juice
• Wine
• Grape seed oil
• Grape seed powder
• Grape seed extract
• Grape skin powder
• Grape skin extract
• Pomacewww.medicalnewstoday.com
© Endeavour College of Natural Health endeavour.edu.au 69
Grapes: Constituents
Flavonoids Anthocyanins - 3-O-monoglucosides or 3,5-O-diglucosides
of malvidin, cyanidin, peonidin, delphinidin, pelargonidin
and petunidin (Anthocyanins are only found in red, purple
grapes – they accumulate mainly in the berry skin.)
Flavonols - 3-O-glycosides of quercetin, kaempferol,
myricetin
Flavanols - (+)-catechin, (−)-epicatechin, (−)-epicatechin-3-
O-gallate
Proanthocyanidins (accumulate in grape skins and grape
seeds)
Phenolic acids Gallic acid, caftaric acid, coutaric acid
Stilbenes Resveratrol
(Georgiev et al., 2014; Vislocky, 2010)
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Grapes: Therapeutic Effects
Grape and phytochemicals have been found to have the
following actions (based on in-vitro and animal studies):
• Antioxidant
• Anti-inflammatory
• Antimicrobial and antiviral
• Neuroprotective
• Hepatoprotective
• Anticancer
(Georgiev et al., 2014)
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Grapes
Therapeutic Effects
(Vislocky, 2010)
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Grapes
Therapeutic Effects
• Human studies have demonstrated improved vasodilation
with regular consumption of grape juice.
• 8ml/kg of grape juice for 2 weeks increase flow-mediated
vasodilation of the brachial artery.
(Vislocky, 2010)
• A study on healthy males
consuming a freeze dried
preparation of red, green and
blue-black grapes (equivalent to
1.25 cups of fresh grapes)
found that endothelial function
remained normal following a
high fat meal. http://post.jagran.com
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Grapes
Therapeutic Effects
“Numerous studies have documented a decrease in
oxidative stress and inflammatory markers in
humans following supplementation with grape
powder, grape juice or grape seed extract.”
• A study on pre- and post-menopausal women found that
daily supplementation of grape powder over 4 weeks
(equivalent to approx. 1 ½ cups of fresh grapes) reduced
whole body oxidative stress markers and plasma
concentrations of TNF-α. (Vislocky, 2010)
(Vislocky, 2010)
© Endeavour College of Natural Health endeavour.edu.au 74
Grapes
Therapeutic Effects
“7ml/kg body weight of
purple grape juice over 14
days decreased superoxide
production and inflammatory
markers, while increasing
plasma antioxidant
capacity.” (Vislocky, 2010)
authenticselfwellness.com
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Grapes
Therapeutic Effects
Grape Seed Extract
consciouslifenews.com
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Grape Seed Extract
Oligomeric Procyanidins (OPCs)
Grape Seed Extract
• Grape Seed Extract is available in tablet/capsule or
liquid extract form. It is made from the whole seeds of
grapes.
• Grape seed extract is a rich source of plant flavonoids
called oligomeric procyanidins, or more commonly,
OPCs.
• Maritime Pine Bark Extract also called French Pine Bark
Extract (Pycnogenol®) is also a rich source of OPCs.
© Endeavour College of Natural Health endeavour.edu.au 77
Grape Seed Extract
Oligomeric Procyanidins (OPCs)
OPCs have demonstrated the following potential
therapeutic actions (based on in-vitro and animal studies);
• Stabilising capillary walls and preventing increases in
capillary permeability. Connective tissue, blood
vessels and capillary walls are all supported
structurally by a collagen matrix. OPCs support
collagen structures and help to prevent destruction of
collagen.
• Antioxidant.
© Endeavour College of Natural Health endeavour.edu.au 78
Grape Seed Extract
Therapeutic Effects
Therapeutic actions of Grape seed extract (based on in-
vitro and animal studies):
• Reduced platelet aggregation
• Enhanced NO release
• Improved human endothelial function
• Reduces oxidative stress, especially that caused by smoking
• Rat studies have demonstrated anti-hyperglycaemic effects
in diabetic-induced animals.
• Preliminary data is investigating the use of grape seed
extract on cancer cell and prevention rates.
(Kar et al., 2006)
© Endeavour College of Natural Health endeavour.edu.au 79
Grape Seed Extract
Oligomeric Procyanidins (OPCs)
Therapeutic Effects
Based on biological actions, supplements rich in OPCs
such as grape seed and pine bark extracts, might be useful
for the following conditions, although good quality clinical
trials are needed:
• Chronic venous insufficiency, varicose veins,
haemorrhoids
• Fluid retention
• Skin health – UV protection and anti-ageing
• Conditions associated with oxidative stress
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OPC Supplements: Cautions
• Grape seed and pine bark extracts are not recommended
during pregnancy or breastfeeding as their safety hasn’t been
researched.
• Caution required for those with autoimmune disorders as it
might upregulate the immune system.
• Caution required for those taking immunosuppressing drugs –
e.g. corticosteroids, cyclosporine; caution required for those
taking drugs that increase the risk of bleeding such as
warfarin; may interact with blood pressure-lowering drugs.
• Stop using at least 2 weeks before surgery.
• May cause dizziness, gastrointestinal problems, headache or
mouth ulcers in some.
(Medline Plus, 2014)
© Endeavour College of Natural Health endeavour.edu.au 82
Session Summary
• Define “ORAC” and discuss the value and limitations of
using ORAC scores to rank the antioxidant potential of
foods and beverages.
• Discuss the nutritional value, phytochemical profiles and
therapeutic benefits of antioxidant-rich fruits and other
fruits:
‒ Berries, Pomegranate, Cherries
‒ Dates, Apples, Grapes
© Endeavour College of Natural Health endeavour.edu.au 83
References
Ahmed, S., Wang. N., Hafeez, B. B., Cheruvu, V. K. & Haqqi, T. M. (2005). Punica
granatum L. extract inhibits IL-1beta-induced expression of matrix
metalloproteinases by inhibiting the activation of MAP kinases and NF-kappaB
in human chondrocytes in vitro. Journal of Nutrition, 135(9), 2096-2102.
Aviram, M. & Dornfeld, L. (2001). Pomegranate juice consumption inhibits serum
angiotensin converting enzyme activity and reduces systolic blood pressure.
Atherosclerosis, 158(1), 195-198.
Basu, A., Rhone, M. & Lyons, T. J. (2010). Berries: emerging impact on
cardiovascular health. Nutrition Reviews, 68(3), 168-177.
Blumberg, J. et al. (2013). ‘Cranberries and their bioactive constituents in human
health. Advances in Nutrition, 4, 618-632.
D’Andrea, G. (2010). Pycnogenol: A blend of procyanidins with multifaceted
therapeutic applications? Fitoterapia, 81, 724 – 736.
De Nigris, F., Williams-Ignarro, S., Lerman, L. O., Crimi, E., Botti, C., Mansueto, G.,
D'Armiento, F. P., De Rosa, G., Sica, V., Ignarro, L. J., & Napoli, C. (2005).
Beneficial effects of pomegranate juice on oxidation-sensitive genes and
endothelial nitric oxide synthase activity at sites of perturbed shear stress.
Proceedings of the National Academy of Science USA, 102(13), 4896-4901.
© Endeavour College of Natural Health endeavour.edu.au 84
References
De Nigris, F., Williams-Ignarro, S., Botti, C., Sica, V., Ignarro, L. J., & Napoli, C.
(2006). Pomegranate juice reduces oxidized low-density lipoprotein
downregulation of endothelial nitric oxide synthase in human coronary
endothelial cells. Nitric Oxide, 15(3), 259-63.
Engels et al. (2014). Pomegranate. Herbalgram, 100, 1-8.
Esmaillzadeh, A., Tahbaz, F., Gaieni, I., Alavi-Majd, H., & Azadbakht, L. (2004).
Concentrated pomegranate juice improves lipid profiles in diabetic patients with
hyperlipidemia. Journal of Medicinal Food, 7(3), 305-308.
Ferretti, G., Bacchetti, T., Belleggia, A. & Neri, D. (2010). Cherry antioxidants: from
farm to table. Molecules, 15, 6693-7005.
Garrido, M. et al. (2013). A Jerte valley cherry product provides beneficial effects on
sleep quality. Influence on aging. Journal of Nutrition in Health and Ageing,
17(6), 553-560.
Giacalone, M. et al. (2011). Antioxidant and neuroprotective properties of blueberry
polyphenols: a critical review. Nutritional Neuroscience, 14(3), 119-125.
http://www.maneyonline.com/doi/pdfplus/10.1179/1476830511Y.0000000007
© Endeavour College of Natural Health endeavour.edu.au 85
ReferencesGeorgiev, V. et al. (2014). Recent advances and uses of grape flavonoids as
nutraceuticals. Nutrients, 6, 391-415.
Giampieri, F., Tulipani, S., Alvarez-Suarez, J., Quiles, J., Mezzetti, B. and Battino, M.
(2011). The strawberry: composition, nutritional quality and impact on human
health. Nutrition, 28, 9–19.
Hyson, D. (2011). A comprehensive review of apples and apple components and
their relationships to human health. Advances in Nutrition, 2, 408-420.
Jurenka, J. (2008). Therapeutic applications of pomegranate (Purnica granatum L.):
a review. Alternative Medicine Review, 13(2), 128- 144.
Kar, P. et al. (2006). Flavonoid-rich grape seed extracts: a new approach in high
cardiovascular risk patients? Journal Compilation, 60(11), 1484–1492.
Kelley, D. et al. (2006). Consumption of Bing sweet cherries lowers circulating
concentrations of inflammation markers in healthy men and women. Journal of
Nutrition, 136(4), 981-986.
Keser, S., Celik, S., Turkoglu, S. (2013). Total phenolic contents and free-radical
scavenging activities of grape ( Vitis vinifera L.) and grape products.
International Journal of Food Sciences & Nutrition, 64 (2), 210-216.
Liu, Y. et al. (2012). Blueberry anthocyanins: protection against ageing and light-
induced damage in retinal pigment epithelial cells. British Journal of Nutrition,
108(11), 16-27.
© Endeavour College of Natural Health endeavour.edu.au 86
References
McCormack, D. & McFadden, D. (2013). A review of pterostilbene antioxidant
activity and disease modification. Oxidative Medicine and Cellular Longevity,
Published online 4 April, 2013.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3649683/
Medline Plus. (2014). Pycnogenol. Medline Plus, viewed on 15 December 2014,
http://www.nlm.nih.gov/medlineplus/druginfo/natural/1019.html
Mukherjee, M. et al. (2014). Exploring the role of cranberry polyphenols in
periodontitis: A brief review. Indian Society of Periodontology, 18(2), 136-139.
Nile, S. & Park, S. (2014). Edible berries: Bioactive components and their effect on
human health. Nutrition, 30, 134-144.
Shukla, M., Gupta, K., Rasheed, Z., Khan, K. A., & Haqqi, T. M. (2008).
Consumption of hydrolyzable tannins-rich pomegranate extract suppresses
inflammation and joint damage in rheumatoid arthritis. Nutrition, 24(7-8), 733-
743.
Thomas, R., Williams, M., Sharma, H., Chaudry, A., Bellamy, P. (2014). A double-
blind, placebo-controlled randomised trial evaluating the effect of a polyphenol-
rich whole food supplement on PSA progression in men with prostate cancer—
The U.K. NCRN POMI-T study. Prostate Cancer Prostatic Diseases, 17, 180–
186.
© Endeavour College of Natural Health endeavour.edu.au 87
References
Torronen, R., Kolehmainen, M., Sarkkinen, E., Poutanen, K., Mykkanen, H. &
Niskanen, L. (2013). Berries reduce postprandial insulin responses to wheat
and rye breads in healthy women. Journal of Nutrition, 143, 430-436.
Vislocky, L. & Fernandez, M. (2010). Biomedical effects of grape products. Nutrition
Reviews, 68(11), 656-670.
Wang, P. (2013). The effectiveness of cranberry products to reduce urinary tract
infections in females: a literature review. Urologic Nursing, 33(1), 38-45.
Wang, L. & Martins-Green, M. (2014). Pomegranate and its components as
alternative treatment for prostate cancer. International Journal of Molecular
Sciences, 15, 14949-14966. doi:10.3390/ijms150914949. Retrieved from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4200766/pdf/ijms-15-14949.pdf
Winter, J. (2011). Beyond ORAC. Functional Ingredients, 112, 28-32.
Zhang, Y. et al. (2012). Cherry consumption and the risk of recurrent gout attacks.
Arthritis and Rheumatology, 64(12), 4004–4011. doi:10.1002/art.34677.
Retrieved from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3510330/pdf/nihms-401649.pdf