And there are more risk factors where those came from, including overweight, obesity, hyperglycemia—even the inevitable passage of time. Given that each predisposes a person as much to endothelial disease specifically as to cardiovascular disease more generally, it should come as no surprise that “a large percentage of the population is thus at risk of developing endothelial dysfunction and the subsequent development of atherosclerosis,” says Jimmy Salas Rushford, MD, a San Juan, PR–based internal-medicine specialist and an advisor to Maypro Industries (Purchase, NY).
For those in the supplement industry, the question, then, becomes, “How can we prevent endothelial dysfunction, and if such dysfunction occurs, what can we do to help the body heal?” Salas Rushford concludes. The most obvious answer, he says, is to attack the risk factors most within our control—excess weight, inactivity, smoking—while warding off others like high levels of blood pressure, blood sugar, and blood cholesterol.
Most relevant to industry: “All this should be accompanied by proper nutrition and supplementation with ingredients that help with the pro-inflammatory state that characterizes endothelial damage,” he says.
Antioxidants and Nitric Oxide
To be sure, one attribute that characterizes cardiovascular risk factors is their tendency to promote inflammation, Salas Rushford says. That inflammation, in turn, causes endothelial dysfunction that “may lead to a loss of vasodilator and prothrombotic products,” and it also involves an increased presence of reactive oxygen species, or pro-oxidative free radicals. So it’s promising to note that antioxidants “have been shown to help modulate the capacity of the endothelium to deal with oxidative stress,” Salas Rushford says.
One such antioxidant is a patented, flavanol-rich blend of lychee fruit extract and green tea that’s been processed to convert its native high-molecular-weight proanthocyanidins to more bioavailable, lower-molecular-weight forms. It’s in part thanks to this depolymerization, Salas Rushford says, that the ingredient—trade-named Oligonol and marketed by Maypro—“can provide superior antioxidant activity with higher bioavailability.”
“Studies have shown increases in circulation following Oligonol ingestion, and this is thought to be through the enhancement of nitric oxide production,” he explains. This matters because nitric oxide (NO) is an intracellular signaling molecule that modulates vasorelaxation, endothelial regeneration, and platelet adhesion along the endothelium, among its other functions. Damage to endothelial cells impairs their ability to produce, liberate, and use NO to such an extent that diminished NO bioavailability is a recognized sign of endothelial dysfunction. The upshot, Salas Rushford says, is that compromised NO bioavailability or effectiveness “translates into a more rigid blood vessel and a decreased ability of the endothelium to handle oxidative stress, such as that induced by diabetes or tobacco use.”
Pine Bark Promise
Another antioxidant that improves the endothelium’s NO profile is Pycnogenol, a natural plant extract harvested from the bark of the French maritime pine tree. The ingredient appears to activate an enzyme known as endothelial nitric oxide synthase (eNOS), allowing for a more efficient generation of NO from the precursor amino acid L-arginine.
As evidence of the compound’s efficacy, a study2 published this year in International Angiology evaluated the level of oxidative stress in 32 hypertensives, 31 hyperlipidemics, and 30 hyperglycemics, half of each group of whom supplemented with 150 mg/day of Pycnogenol and the other half of whom didn’t. (A group of 31 normal subjects participated as a control.) At eight and 12 weeks into the treatment, measures of oxidative stress were significantly decreased in the Pycnogenol subjects, while only minor differences emerged in the controls, indicating that daily supplementation with the ingredient may help improve endothelial function among those with borderline hypertension, hyperglycemia, and hyperlipidemia.
According to Carolina Burki-Sozzi, director of product development, Horphag Research (Hoboken, NJ), the worldwide exclusive supplier of Pycnogenol, the ingredient’s cardiovascular benefits represent its “strongest area of research, as it helps normalize blood pressure and platelet function and improve blood lipids, as well as blood sugar values,” she says. “It does so by increasing the blood vessels’ ability to enlarge when needed, which improves blood flow overall, and helps to reduce blood clots.” Further studies show that it enhances the body’s innate ability to counteract vascular constriction, which “naturally helps maintain blood pressure that is already in the normal range,” Burki-Sozzi says.
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