The effects of polyphenol rich chocolate on cardiovascular risk and glycaemic control in type 2 diabetes mellitus

Background:Type 2 diabetes mellitus (T2DM) is characterised by increased rates of morbidity and mortality, much of which is related to cardiovascular disease. T2DM is considered to be a non-communicable disease, with its cause and aetiology linked to a number of genetic factors, which are influenced by dietary behaviours and lifestyle. Diet has a significant role to play in the prevention and management of T2DM. Both in vitro and in vivo studies suggest that plant flavanols may have beneficial effects for people with diabetes, including potentially those found in cocoa and chocolate. Cesar Fraga suggested in 2005 that perhaps we should eat more chocolate to prevent and manage diabetes, following a study of just 15 healthy individuals, which demonstrated improvements in insulin sensitivity and blood pressure. Despite this remark seven years ago, almost no work has been published outside of that presented in this thesis has investigated the effect of chocolate containing only its native flavanols (predominantly epicatechins) on glycaemic control and markers of cardiovascular risk in T2DM.Methodology:An exploratory review of the literature suggested that the effect of chocolate might be greater than that seen with cocoa. This thesis considered the published literature to ascertain whether chocolate provides greater efficacy over cocoa supplementation using a meta-analysis. This led into a series of clinical trials aimed at testing chocolate supplementation at levels which provide an adequate dose of flavanols without leading to excess energy or sugar intake. The first of the three studies consisted of a proof of concept study feeding 45g of chocolate over eight weeks in a double-blinded randomised crossover design (n=12). The second, using 13.5g again used a doubleblinded randomised crossover design to assess the acute effects of flavanols rich chocolate over a three-hour period in individuals with T2DM with an induced transient hyperglycaemia caused by a 75g oral glucose load (n=10). The final clinical trial was a three-arm randomised double-blinded parallel study aimed to investigate the effects over a 12-week period of milk chocolate enriched with flavanols in an attempt to maximise palatability.Results:The exploratory review with meta-analysis demonstrated that chocolate supplementation resulted in significantly greater reduction in blood pressure (both systolic and diastolic, sub-group analysis, p0.05). This effect was accompanied by a simultaneous reduction in urinary 15-F2t-isoprostane (a marker of oxidative stress). The final study using a milk chocolate and lower doses of epicatechin did not have an adverse effect on weight or glycaemia after 12 weeks, with participants actually gaining weight in the four weeks immediately after the completion of the study (p=0.002). No clear beneficial effects of any one chocolate were seen.Conclusion:The work in this thesis finally provides evidence to support Fraga’s suggestion, that there are benefits in terms of improved lipid profile and endothelial function with chocolate supplementation for individuals with T2DM. The equivocal results from the final study which used a chocolate containing about a third of the epicatechin dose of the first two studies, suggest that the dose required for benefit may be at least that accepted as being beneficial with respect of endothelial function (EFSA, 2012a) at200mg of flavanols in the general population for individuals with T2DM

The Role of Food Science and Technology in Navigating the Health Issues of Ultra-Processed Foods

Food processing is seen as a double-edged sword. It is argued to have helped to provide a stable and safe food supply to urbanised societies, however with NOVA definition of ultra-processed foods it has now been linked to disease. Food science and technology has arguably been a major contributor to both. These potential harms are not a deliberate act, they simply meet the legal and market obligations placed on food businesses to be successful. So how food science and technology be pivoted back to improve health needs exploration, which will need to be consider within other issues including sustainability. Additionally, the increasing demand for plant-based meat alternatives and the role of fortification along with sustainable packaging and logistics to either enhance the physical properties and nutritional value of foods alongside minimising the need to process to transport them from farm to plate are further challenges. Finally, it will be considered how our food system might be supported to go through its next scientific and technological revolution to deliver a food environment and supply that has its primary objective of supporting human and planetary health, but in a way that is economically successful for all members of society

A Review of the Potential Health Benefits of Low Alcohol and Alcohol-Free Beer: Effects of Ingredients and Craft Brewing Processes on Potentially Bioactive Metabolites

Beer is a beverage of significant historical and cultural importance. Interest in the potential health effects of alcoholic beverages has largely focused on wine; however, there are a number of potentially beneficial bioactives that beer may contain that warrant further investigation. The challenge of considering any potential health benefits of beer are restricted by the negative consequences of its alcohol and energy content. There is potential to enhance the bioactive qualities of beer whilst reducing the alcohol and energy content through novel brewing approaches often used in craft brewing, in terms of ingredients, brewing methods and type of fermentation. Consumer demand to produce a greater variety of beer types, including alcohol-free beers, may also help to increase the number of beers which may have greater potential to improve health, with lower levels of alcohol, while still being tasty products. As low alcohol, prebiotic and bioactive containing beers are developed, it is important that their potential health benefits and risks are fully assessed

Cocoa and chocolate, their clinical benefits:Insights in study design

Randomized controlled trials and meta-analyses have demonstrated the potential protective effect of cocoa and chocolate consumption with respect to cardiovascular disease (CVD) risk markers. Findings from experimental studies are in concordance with observational data, which include reduction in clinical disease (especially stroke) being associated with chocolate consumption. However, the effect size of any benefit, and the exact mechanism of action due to variability in reporting of dose and type potential bioactive compounds remains unclear. Thus, the present review aimed to analyse the published work where cocoa and chocolate have been assessed for their potential to protect against CVD and highlight the role of study design and type of product used in the variances of outcomes and how that might be used in formulating health advice

The Effect of Juicing Methods on the Phytochemical and Antioxidant Characteristics of the Purple Prickly Pear (Opuntia ficus indica)—Preliminary Findings on Juice and Pomace

Prickly Pear (PP) is often overlooked due to its’ short shelf-life. Juicing may improve marketability but often affects quality, thereby warranting investigation. Purple PP (whole (WF) and flesh (FF)) was juiced using blenders; stick (SB) and jug (JB); and juicers; commercial (CJ) and cold-pressed (CP). Juices and methanolic (70%) pomace extracts were analysed for; bioactives; Total Phenolic (TPC; µgGAE/mL), Flavonoid (TFC; µgCE/mL) and Betalain Content (TBC; mg/100 g; Betacyanin; BE; Betaxanthin; IE); and antioxidant characteristics; DPPH, FRAP (µMTE) and vitamin C (mgAAE/mL). Juicing techniques had effects on phytochemicals in; juice: TPC (WF/FF; p = 0.022–0.025), TFC (FF; p = 0.034), Betacyanin (WF/FF; p = 0.029–0.026), FRAP (WF/FF; p = 0.016–0.024) and Vitamin C (WF/FF; p = 0.015–0.016); and pomace: TPC (WF/FF; p = 0.015), TBC (FF; p = 0.034), Betacyanin (FF; p = 0.047), Betaxanthin (FF; p = 0.017), DPPH (WF/FF; p = 0.016–0.024), FRAP (WF/FF; p = 0.015–0.023) and Vitamin C (WF/FF; p = 0.016–0.022). Processing-style (blend/juice) affected; TPC, DPPH and FRAP in juice and pomace. Overall, fruit-preparation (WF/FF) had minimal effects. Additionally, correlations existed between; juice TFC and TBC (p = 0.001; τ = −0.044); TBC and vitamin C (p = 0.001; τ = −0.637); pomace TPC and DPPH (p = 0.003; τ = 0.440), TPC and vitamin C (p = 0.011; τ = 0.440); and TFC and FRAP (p = 0.001; τ = 0.519). The best methods overall for juice were SB (FRAP), JB (TPC, TBC), CJ (TFC) and CP (DPPH, VitC); and for pomace extracts; SB(FRAP), JB (TPC, VitC), CJ(TFC), and CP (TBC, DPPH)

Aspartame in conjunction with carbohydrate reduces insulin levels during endurance exercise

Gold OAAs most sport drinks contain some form of non-nutritive sweetener (e.g. aspartame), and with the variation in blood glucose regulation and insulin secretion reportedly associated with aspartame, a further understanding of the effects on insulin and blood glucose regulation during exercise is warranted. Therefore, the aim of this preliminary study was to profile the insulin and blood glucose responses in healthy individuals after aspartame and carbohydrate ingestion during rest and exercise. Each participant completed four trials under the same conditions (45 min rest + 60 min self-paced intense exercise) differing only in their fluid intake: 1) carbohydrate (2% maltodextrin and 5% sucrose (C)); 2) 0.04% aspartame with 2% maltodextrin and 5% sucrose (CA)); 3) water (W); and 4) aspartame (0.04% aspartame with 2% maltodextrin (A)). Insulin levels dropped significantly for CA versus C alone (43%) between pre-exercise and 30 min, while W and A insulin levels did not differ between these time points. Aspartame with carbohydrate significantly lowered insulin levels during exercise versus carbohydrate alone.Peer Reviewe

Does a Ketogenic Diet Have a Place Within Diabetes Clinical Practice? Review of Current Evidence and Controversies

Carbohydrate restriction has gained increasing popularity as an adjunctive nutritional therapy for diabetes management. However, controversy remains regarding the long-term suitability, safety, efficacy and potential superiority of a very low carbohydrate, ketogenic diet compared to current recommended nutritional approaches for diabetes management. Recommendations with respect to a ketogenic diet in clinical practice are often hindered by the lack of established definition, which prevents its capacity to be most appropriately prescribed as a therapeutic option for diabetes. Furthermore, with conflicted evidence, this has led to uncertainty amongst clinicians on how best to support and advise their patients. This review will explore whether a ketogenic diet has a place within clinical practice by reviewing current evidence and controversies

Effects of the Consumption of Prickly Pear Cacti (Opuntia spp.) and its Products on Blood Glucose Levels and Insulin: A Systematic Review

Background and Objectives: There is confusion as to which component of the Opuntia spp. cacti has demonstrated anti-hyperglycemic effects or anti-diabetic properties. It is important to clarify these health benefits due to the increasing need for prevention and treatment of chronic diseases. The aim of this review is to identify the effects of Opuntia spp. cacti consumption on biomedical measures; glucose and insulin with consideration of its' components; fruit, leaf and combined or unidentified Opuntia spp. products. Materials and Methods: Prior to commencing the searches, this systematic review was registered with PROSPERO (CRD42018108765). Following the PRISMA 2009 guidelines, six electronic databases (Food Science and Technology Abstracts (EBSCO), Medline, Scopus, CINAHL, Web of Science and Cochrane) were searched for articles investigating the effect of Opuntia spp. consumption on glucose and insulin in humans. Results: Initially, 335 articles were sourced and filtered by exclusion criteria (human interventions, control trials and articles published in English) resulting in 20 relevant articles. The included studies were characterized by such plant components as fruit (n = 4), cladode (n = 12), and other Opuntia spp. products (n = 4), further separated by clinical populations ('healthy', hyperlipidemic, hypercholesterolemic, Type 2 Diabetes Mellitus). The findings of this review indicate variations in effects between cacti components and products. Cladode and select Opuntia spp. products predominately demonstrated significant reductions in serum glucose and insulin, indicating potential as a functional food candidate. Prickly Pear fruit was predominately reported to have no significant effects on glucose or insulin. The quality of evidence appeared to vary based on the type of Opuntia spp. product used. Studies that used specifically the fruit or cladode had high risk of bias, whereas studies which used combined Opuntia spp. products had a lower risk of bias. Numerous mechanisms of action were proposed where positive findings were reported, with emphasis on dualistic glucose-dependent and independent actions, however, mechanisms require further elucidation. Conclusion: Currently, there is a lack of evidence to support the recommendation of using Opuntia spp. fruit products as an alternative or complementary therapy in the reduction of risk or management of Type 2 Diabetes Mellitus. The Cladode does however show promise in potential glucose-lowering effects which warrant further investigation