Disease Proof

Tomatoes protect against heart attack and stroke

Tomatoes. Flickr: MaplessInSeattle

Carotenoids are a family of over six hundred phytochemicals, including alpha-carotene, beta-carotene, lycopene, lutein and zeaxanthin. Carotenoids are abundant in green and yellow-orange vegetables and fruits and help to defend the body’s tissues against oxidative damage, which is a natural byproduct of our metabolic processes; oxidative damage from free radicals contributes to chronic diseases and aging.1

The levels of carotenoids in your skin are a good indicator of your overall health because the levels parallel the levels of plant-derived phytochemicals in general. In fact, I use a carotenoid skin testing method to non-invasively track my patients’ progress as they adopt a nutritarian diet. In a study of over 13,000 American adults, low blood levels of carotenoids were found to be a predictor of earlier death. Lower total carotenoids, alpha-carotene, and lycopene in the blood were all linked to increased risk of death from all causes; of all the carotenoids, very low blood lycopene was the strongest predictor of mortality.2

Lycopene is the signature carotenoid of the tomato. The lycopene in the American diet is 85 percent derived from tomatoes.3 Lycopene is found circulating in the blood and also concentrates in the male reproductive system, hence its protective effects against prostate cancer.4 In the skin, lycopene helps to prevent UV damage from the sun, protecting against skin cancer.5 Lycopene is known for its anti-cancer properties, but did you know that lycopene has also been intensively studied for its beneficial cardiovascular effects?

Links between blood lycopene and cardiovascular diseases

Many observational studies have made a connection between higher blood lycopene and lower risk of heart attack. For example, a study in men found that low serum lycopene was associated with increased plaque in the carotid artery and triple the risk of cardiovascular events compared to higher levels. Triple!6-8 In a separate study, women were split into four groups (quartiles) according to their blood lycopene levels; women in the top three quartiles were 50% less likely to have cardiovascular disease compared to the lowest quartile.9

A 2004 analysis from the Physicians’ Health Study data found a 39% decrease in stroke risk in men with the highest blood levels of lycopene.10 New data from an ongoing study in Finland has strengthened these findings with similar results. One-thousand men had their blood carotenoid levels tested and were followed for 12 years. Those with the highest lycopene levels had the lowest risk of stroke – they were 55% less likely to have a stroke than those with the lowest lycopene levels.11 Previous data from this same group of men found that higher lycopene levels were associated with lower risk of heart attack as well.12

How does lycopene work?

Lycopene is an extremely potent antioxidant; several studies that gave supplemental tomato products to volunteers found that their LDL particles were more resistant to oxidation – LDL oxidation is an early event in atherosclerotic plaque formation, and lycopene helps to prevent this.13-15 Another study found improved endothelial function after just two weeks of a tomato-rich diet; endothelial function refers to the ability of the endothelium (the inner lining of blood vessels) to properly regulate blood pressure, and oxidative damage can impair endothelial function.16

Lycopene also has non-antioxidant actions that may protect against cardiovascular disease. First, there is evidence that lycopene may inhibit HMG-CoA reductase, the enzyme responsible for making cholesterol (also the enzyme that is inhibited by cholesterol-lowering statin drugs).17 So as you might expect, trials that added extra tomato products to subjects’ diets reduced their blood cholesterol levels. A meta-analysis of 12 trials found that daily supplemental tomato products (approximately 1 cup of tomato juice or 3-4 tbsp. of tomato paste) reduced LDL cholesterol by 10% - this effect is comparable to low doses of statin drugs (with no risk of side effects, of course).18 Lycopene also has several anti-inflammatory actions and may prevent excessive proliferation of vascular smooth muscle cells, which is a contributor to atherosclerotic plaque development.19,20

Enjoy your tomatoes!

Of course, lycopene is not the only nutrient in tomatoes – tomatoes are also rich in vitamins C and E, beta-carotene, and flavonol antioxidants just to name a few.3 Single antioxidants usually don’t exert their protective effects alone; we learned this lesson from clinical trials of beta-carotene, vitamin C, and vitamin E supplements, which did not reduce cardiovascular disease risk.21 It is the interactions between phytochemicals in the complex synergistic network contained in plant foods that is responsible for their health effects, and this is something that we cannot replicate in a pill. Out of all the common dietary carotenoids, lycopene has the most potent antioxidant power, but combinations of carotenoids are even more effective than any single carotenoid – they work synergistically.22 Blood lycopene, as used in many of these studies, is simply a marker for high tomato product intake; similarly high alpha-carotene and beta-carotene levels are markers of high green and yellow-orange fruit and vegetable intake. Colorful fruits and vegetables provide significant protection.

In a given year, a typical American will eat about 92 pounds of tomatoes.23 Enjoy those 92 pounds and even add some more! Add fresh, juicy raw tomatoes to your salad, diced or unsulphured sun-dried tomatoes to soups, and enjoy homemade tomato sauces and soups. Be mindful of the sodium content of ketchup and other tomato products – choose the low sodium or no salt added versions. No salt added, unsulphured dried tomatoes are also great. Also keep in mind that carotenoids are absorbed best when accompanied by healthy fats – for example, in a salad with a seed or nut-based dressing.24,25 Lycopene is also more absorbable when tomatoes are cooked, so enjoy a variety of both raw and cooked tomatoes in your daily diet.26

 


Image credit: Flickr - MaplessInSeattle

References:
1. Krinsky NI, Johnson EJ. Carotenoid actions and their relation to health and disease. Mol Aspects Med 2005;26:459-516.
2. Shardell MD, Alley DE, Hicks GE, et al. Low-serum carotenoid concentrations and carotenoid interactions predict mortality in US adults: the Third National Health and Nutrition Examination Survey. Nutr Res 2011;31:178-189.
3. Canene-Adams K, Campbell JK, Zaripheh S, et al. The tomato as a functional food. J Nutr 2005;135:1226-1230.
4. van Breemen RB, Pajkovic N. Multitargeted therapy of cancer by lycopene. Cancer Lett 2008;269:339-351.
5. Rizwan M, Rodriguez-Blanco I, Harbottle A, et al. Tomato paste rich in lycopene protects against cutaneous photodamage in humans in vivo. Br J Dermatol 2010.
6. Rissanen TH, Voutilainen S, Nyyssonen K, et al. Low serum lycopene concentration is associated with an excess incidence of acute coronary events and stroke: the Kuopio Ischaemic Heart Disease Risk Factor Study. Br J Nutr 2001;85:749-754.
7. Rissanen T, Voutilainen S, Nyyssonen K, et al. Lycopene, atherosclerosis, and coronary heart disease. Exp Biol Med (Maywood) 2002;227:900-907.
8. Rissanen TH, Voutilainen S, Nyyssonen K, et al. Serum lycopene concentrations and carotid atherosclerosis: the Kuopio Ischaemic Heart Disease Risk Factor Study. Am J Clin Nutr 2003;77:133-138.
9. Sesso HD, Buring JE, Norkus EP, et al. Plasma lycopene, other carotenoids, and retinol and the risk of cardiovascular disease in women. Am J Clin Nutr 2004;79:47-53.
10. Hak AE, Ma J, Powell CB, et al. Prospective study of plasma carotenoids and tocopherols in relation to risk of ischemic stroke. Stroke 2004;35:1584-1588.
11. Karppi J, Laukkanen JA, Sivenius J, et al. Serum lycopene decreases the risk of stroke in men: A population-based follow-up study. Neurology 2012;79:1540-1547.
12. Karppi J, Laukkanen JA, Makikallio TH, et al. Low serum lycopene and beta-carotene increase risk of acute myocardial infarction in men. Eur J Public Health 2011.
13. Silaste ML, Alfthan G, Aro A, et al. Tomato juice decreases LDL cholesterol levels and increases LDL resistance to oxidation. Br J Nutr 2007;98:1251-1258.
14. Burton-Freeman B, Talbot J, Park E, et al. Protective activity of processed tomato products on postprandial oxidation and inflammation: a clinical trial in healthy weight men and women. Molecular nutrition & food research 2012;56:622-631.
15. Hadley CW, Clinton SK, Schwartz SJ. The consumption of processed tomato products enhances plasma lycopene concentrations in association with a reduced lipoprotein sensitivity to oxidative damage. J Nutr 2003;133:727-732.
16. Xaplanteris P, Vlachopoulos C, Pietri P, et al. Tomato paste supplementation improves endothelial dynamics and reduces plasma total oxidative status in healthy subjects. Nutr Res 2012;32:390-394.
17. Lycopene. Monograph. Altern Med Rev 2003;8:336-342.
18. Ried K, Fakler P. Protective effect of lycopene on serum cholesterol and blood pressure: Meta-analyses of intervention trials. Maturitas 2011;68:299-310.
19. Palozza P, Parrone N, Catalano A, et al. Tomato lycopene and inflammatory cascade: basic interactions and clinical implications. Curr Med Chem 2010;17:2547-2563.
20. Palozza P, Parrone N, Simone RE, et al. Lycopene in atherosclerosis prevention: an integrated scheme of the potential mechanisms of action from cell culture studies. Arch Biochem Biophys 2010;504:26-33.
21. Kris-Etherton PM, Lichtenstein AH, Howard BV, et al. Antioxidant vitamin supplements and cardiovascular disease. Circulation 2004;110:637-641.
22. Heber D, Lu QY. Overview of mechanisms of action of lycopene. Exp Biol Med (Maywood) 2002;227:920-923.
23. United States Department of Agriculture Economic Research Service. Food Availability (Per Capita) Data System. [http://www.ers.usda.gov/data-products/food-availability-(per-capita)-data-system.aspx]
24. Brown MJ, Ferruzzi MG, Nguyen ML, et al. Carotenoid bioavailability is higher from salads ingested with full-fat than with fat-reduced salad dressings as measured with electrochemical detection. Am J Clin Nutr 2004;80:396-403.
25. Goltz SR, Campbell WW, Chitchumroonchokchai C, et al. Meal triacylglycerol profile modulates postprandial absorption of carotenoids in humans. Molecular nutrition & food research 2012;56:866-877.
26. van het Hof KH, de Boer BC, Tijburg LB, et al. Carotenoid bioavailability in humans from tomatoes processed in different ways determined from the carotenoid response in the triglyceride-rich lipoprotein fraction of plasma after a single consumption and in plasma after four days of consumption. J Nutr 2000;130:1189-1196.

 

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Comments (4) Read through and enter the discussion with the form at the end
Nicole Stout - December 28, 2012 5:01 PM

I had no idea that cooked tomatoes were good as well. I so often feel raw is best. Do you know if this will help with high cholesterol levels?

Jen - December 28, 2012 9:09 PM

Tomatoes also contain the glyco-alkaloids tomatine and solanine, which can cause arthritis pain, migraines, and/or digestive distress (IBS, diverticulitis) to those who are sensitive to these glyco-alkaloids.

Switching to a nutritarian diet that eliminated other inflammatory foods made me realize that nightshade vegetables and other fruits and vegetables that contain solanine were aggravating my arthritis pain.

I've been eating these foods my whole life without problems, and started having pain issues 10 years ago, and only realized that certain foods further aggravated pain two years ago when I started eating them in high volume.

Christine - December 31, 2012 12:07 PM

My husband won't eat tomatoes as his doctor said it was bad for his arthritus. Any suggestions?

Deana Ferreri, PhD - January 2, 2013 10:34 AM

Keep in mind that a sensitivity to nightshade vegetables (such as tomatoes) is rare, only affecting a small number of arthritis sufferers.

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