Getting to the Heart of It: Experts Weigh In

The panel:

Ramona Billingslea, Marketing Manager, Betsy’s Health Foods, Spring, TX,

Ed Dosz, Senior Scientist and Regulatory Specialist, NOW, Bloomingdale, IL,

Carl Germano, CNS, CDN, Vice President of Verdant Nature, Consultant for Bluebonnet Nutrition, Sugar Land, TX,

Jay Levy, Director of Sales, Wakunaga of America, Mission Viejo, CA,

Dan Lifton, CEO, Quality of Life Labs, Purchase, NY,

Cheryl Myers, Chief of Scientific Affairs and Education, EuroPharma, Green Bay, WI,

Jolie Root, Carlson Senior Nutritionist and Educator, Carlson Labs, Arlington Heights, IL,

Mona Rosene, MS, RD, Global Director of Scientific Affairs, ChromaDex, Los Angeles, CA,

Cardiovascular disease (CVD) is the leading cause of death in the United States, accounting for 928,741 premature deaths in the year 2020. In men and women aged 60 to 79, more than 75 percent have some form of CVD.

Vitamin Retailer (VR) has invited a panel of industry experts to provide some valuable insights.

VR: Briefly describe the market for heart-health supplements.

Lifton: The global cardiovascular health supplement market was estimated at $10.88 billion in 2022, according to Grand View Research, and was expected to grow at 9.06 percent from last year through 2030.

Myers: I would say that the state of the market is strong, and that’s because there is always going to be a need for heart health supplements. According to the Centers for Disease Control (CDC), heart disease is the No. 1 killer in the United States, claiming a life every 36 seconds. The right changes in diet and exercise, with an assist from high quality supplements, can help reduce that terrible statistic. I think we all have our work cut out for us on that front, but it is absolutely a worthy effort.

Billingslea: Heart and brain health are probably the two hottest categories in our store. Because the American lifestyle and diet can be particularly challenging for the heart, many seek support to help them keep everything in balance. Also, so many have a history of heart issues in their families that they come in looking to support their hearts now, before any issues might develop.

VR: Cardiovascular disease (CVD) is the leading cause of death in the United States. Briefly highlight what types of products and what types of ingredients should retailers promote to customers interested in heart health?

Lifton: Fortunately, while awareness of the pre-eminent value of CoQ10 and resveratrol has expanded greatly over the last decade, these nutrients are typically difficult for the body to properly absorb, leading to the realization that consumers need sustained-release and enhanced-bioavailability versions of these products.

This is precisely why Quality of Life offers unique sustained release formulations that feature MicroActive ingredients which encapsulate the active, offering timed release and superior absorption for greater efficacy.

If retailers are looking to offer the best in heart health supplements with supporting science, our products Resveratrol-SR, CoQ10-SR, OptiStatin CoQ10-SR fit the bill.

We also have two other ingredients that provide clinically researched cardiovascular benefits. Oligonol has been shown to enhance circulation, relax blood vessels, improve endurance, and reduce visceral belly fat. Another well-researched option is Ameal-BP, which works to inhibit the angiotensin-converting enzyme which leads to the constriction of blood vessels, allowing for better blood circulation, maintenance of blood pressure within a normal range, and less stress on the heart.

Billingslea: We always begin with CoQ10, in large part because many people seeking heart health are already on a statin medication and need CoQ10 to restore what the statin repletes. The next thing would be to provide magnesium, which is also important to the heart as well as overall health. Plus, most of us are deficient in this vital mineral.

Fish oil, something most of us can benefit from because of its broad range of support of overall health, is next on our list for its effect on cell wall permeability and good blood flow.

Some of the herbs to consider for heart health are turmeric, hawthorn, olive leaf extract, red yeast rice with CoQ10, reishi mushroom, garlic and lycopene.

We also use circulatory support for blood pressure, especially fish peptides and celery seed extract. Considering that there is also a gut-heart connection, we also consider probiotics.

VR: Up to 50 percent of the U.S. population is magnesium deficient. Vitamin D can’t be metabolized with insufficient magnesium intake and, so, remains stored yet inactive for many Americans. How important is intake of the correct forms of magnesium and vitamin D, and which forms are best?

Germano: Magnesium deficiency is a surprisingly prevalent issue in the U.S., affecting up to 50 percent of the population. This deficiency can indeed hinder the activation and utilization of vitamin D, leading to a cascade of potential health consequences. Addressing both magnesium and vitamin D intake is crucial for optimal health and preventing deficiencies.

In fact, magnesium plays a vital role in over 300 biochemical processes, including energy production, muscle function, blood pressure regulation, and bone health. Deficiency can lead to fatigue, muscle cramps, high blood pressure, osteoporosis and other health problems.

Vitamin D is essential for calcium absorption, bone health, immune function, and mood regulation. Deficiency can contribute to bone diseases like rickets and osteomalacia, increased risk of infections, and mood disorders like depression.

Magnesium is a cofactor for enzymes involved in activating vitamin D in the liver and kidneys. Without sufficient magnesium, vitamin D remains in its inactive form (25(OH)D) and cannot exert its vital functions.

Studies suggest that individuals with magnesium deficiency may have lower levels of active vitamin D (1,25(OH)D) even if their vitamin D intake is adequate. In addition, choosing the right form of magnesium is important. The following are the most important absorbable forms of magnesium: citrate, glycinate, bis-glycinate, threonate, aspartate and malate.

Billingslea: Of course, we have been touting the superiority of D3 (cholecalciferol) for a long time (we also add K2 to this vitamin when possible to help the body properly manage calcium, so that the calcium the D3 helps the body retain goes to the bones rather than hanging out in the blood where it can deposit and cause problems).

For magnesium and heart health, we like magnesium taurate and magnesium glycinate. Every customer we see could benefit from some form of magnesium because most of us are deficient. We also have many customers who need D3 because it does so many things for us. We encourage our customers to have their D3 levels tested periodically to help them in their pursuit of better health.

Root: Correcting vitamin D levels is of the utmost importance as vitamin D plays a role in supporting healthy blood pressure levels and has been shown to down regulate inflammatory markers associated with cardiovascular health challenges, such as CRP, TNFa and IL6. The correct form is vitamin D3. Magnesium can be taken is several forms—magnesium glycinate and magnesium citrate are highly bioavailable.

Lifton: It’s important for retailers to avoid stocking supplements that use magnesium stearate as an anti-caking ingredient, since it has been linked to weakened immunity, gastrointestinal (GI) side effects, poor digestion and impaired nutrient absorption. Magnesium silicate is another anti-caking agent that is best to avoid. We believe that Maypro’s Sucrosomial Magnesium is the best form of magnesium available today.

As for vitamin D, always stock supplements made with vitamin D3, cholecalciferol.

Magnesium is involved in 300-plus biochemical reactions including the metabolism of vitamin D. Without sufficient magnesium intake, vitamin D cannot be properly metabolized and remains stored but inactive in the body. Since sucrosomial magnesium is absorbed better, consumers actually get greater benefits through enhanced absorption.

VR: What other minerals (including chromium and selenium) and vitamins (including K2) should retailers make sure to stock?

Rosene: The understanding of vitamin K2’s role in heart health is improving. Its primary role is regulating calcium homeostasis. Supplementing with vitamin K2 has been strongly linked to improved cardiovascular outcomes via modulating systemic calcification and arterial stiffness. The type of vitamin K2 that’s typically recommended is what is known as MK-7 (menaquinone-7). This form is the natural form vs. MK-4, which is synthetic. MK-7 is more bioavailable and can increase serum vitamin K levels while MK-4 cannot.

VR: Recently, JAMA Cardiology published a paper called “Health Claims and Doses of Fish Oil Supplements in the U.S.,” which asserted that since most fish-oil products make structure-function claims, instead of qualified health claims, that somehow increased regulation of dietary supplement labels is now needed to avoid misinformation and safety issues. Please comment on this.

Root: Looking at the mechanisms by which EPA and DHA support cardiovascular health one must appreciate the folly of waiting for qualified health claims before suggesting the people correct low intake and achieve optimal omega-3 index scored. To quote a review Marine Omega-3 (N-3) Fatty Acids for Cardiovascular Health: An Update for 2020, “Meta-analyses demonstrate that EPA and DHA lower triglycerides, lower the blood pressure (both systolic and diastolic), reduce the heart rate and increase heart rate variability, and reduce platelet aggregation, whilst appearing to increase both low density lipoprotein (LDL)- and HDL-cholesterol.” Fish oil companies are following DSHEA guidelines by stating structure function claims.

Germano: First and foremost, we must dismiss the absurd notion and robotic, knee-jerk reaction by others who continue to disseminate misinformation that the supplement industry needs more regulation. The industry is well regulated under DSHEA (Dietary Supplement Health and Education Act of 1994) law giving FDA (U.S. Food and Drug Administration) jurisdiction over label claims and good manufacturing practices. As to the article on claims and fish oils, the study analyzed labels of nearly 3,000 fish oil supplements and found that 74 percent made at least one health claim, mostly in the form of structure-function claims—structure-function claims that are allowable by FDA!

Stricter regulation for all structure-function claims might be overly broad and hinder responsible manufacturers providing accurate information about the potential benefits of their products. A targeted approach, perhaps focusing on claims specific to fish oil or other supplements with significant variability in content or potential safety concerns, may be more effective. Consumer education and awareness about interpreting supplement labels and seeking guidance from health care professionals before taking any supplements are also crucial elements in addressing misinformation and safety issues.

Billingslea: This sounds like [the medical establishment] realizes how valuable fish oil can be to improve health outcomes and doesn’t want the supplement industry to provide this product safely and effectively at prices people can afford. They finally see that they could make money on fish oil if they could eliminate it from the natural health industry.

Levy: While manufacturers are solely limited to structure/function claims, reputable supplement companies provide accurate ingredient information in any given product, as well as the exact amounts provided per serving under DSHEA. Dietary supplements do not require any increased regulation as DSHEA already allows the FDA to adequately oversee and deal with any manufacturer that does not comply with existing requirements.

VR: While the intake of trans fats has decreased, the intake of saturated fat has increased. How can we help retailers help consumers improve their consumption of healthier fats, and what fats do you believe are the healthiest?

Germano: Start with these three things:

1. Prominent placement: Place healthier fats like olive oil, avocado oil, canola oil, and nut butters at eye level and near high-traffic areas. This increases visibility and accessibility compared to less healthy options.

2. Clear labeling: Make it easy for shoppers to identify healthy fats by using clear labels and icons highlighting unsaturated fats, omega-3s and low saturated fat content.

3. Educational signage: Provide informational flyers or cards near healthier fat options explaining their benefits for heart health, cooking uses and taste profiles.

Root: Retailers could take advantage of the American Heart Association’s initiative “Life’s Essential Eight” which includes clear directives to follow a heart healthy diet such as the Mediterranean, DASH or MIND diets all of which feature clear reductions in saturated fat intake and increased intake of healthy monounsaturated fats such as olive oil, avocado, walnuts and eating omega-3-rich fish.

GOED, the Global Organization of EPA, DHA produces educational handouts for consumers and monthly promotional materials for retailers. Retailers can access the GOED materials at The healthiest fats are the monounsaturated fats mentioned above and the omega-3s EPA, DHA and DPA.

VR: Since cardiovascular disease is so prevalent, what types of products and what types of ingredients should retailers promote to customers interested in heart health?

Levy: It’s important for retailers to promote products and ingredients that have been clinically studied and shown in numerous clinical trials to effectively and safely benefit heart health by minimizing cardiovascular risk factors like high cholesterol or high blood pressure. Examples of scientifically verified ingredients that have been subjected to randomized clinical trials include aged garlic extract (AGE), coenzyme Q10 and hawthorn.

Dosz: Maintaining healthy levels of blood pressure is an important part of heart health. This is why NOW offers MegaNatural-BP, a patented and clinically tested grape seed extract standardized for polyphenols. MegaNatural-BP has flavonoids that can support healthy arterial function and may help maintain blood pressure already within a healthy range.* Made from finely milled unfermented California wine grape seeds, the smaller particle size enhances the solubility of this grape seed extract over conventional grape seed extracts.

Maintaining energy production is also important. Since the heart utilizes over 20 percent of the energy produced in the body, coenzyme Q10 is an important nutrient required to produce energy in the mitochondria of cells. Years of scientific research have shown that CoQ10 helps to maintain a healthy heart and vascular system.

Healthy blood fats are important, too. Bergamonte is a standardized polyphenolic extract that can help to support cardiovascular health, as well as proper blood sugar management. Plant sterols (phytosterols, especially beta-sitosterol) are also known to support healthy cholesterol levels already within the normal range.

VR: Looking at heart-healthy botanicals, such as those rich in oligomeric proanthocyanidins (OPCs) or organosulfur compounds, like grape seed extract and garlic, what should retailers be aware of when choosing which products to stock?

Levy: Retailers should educate themselves in how various compounds can benefit their customer’s health. For instance, retailers should be aware that organosulfur compounds, which are abundant in garlic, possess powerful antioxidant and anti-inflammatory properties that can benefit the cardiovascular system. However, these compounds can be unstable and reactive.

But, during the process of aging garlic, reactive organosulfur compounds such as allicin are converted to their stable isoforms like S-Allylcysteine (SAC). While small amounts of SAC are present in fresh garlic or garlic supplements, beneficial amounts are formed during the aging process.

In a 2023 study that appeared in the European Heart Journal, researchers found that the SAC in AGE provide cardio-protective benefits through mitochondrial preservation and CSE/hydrogen sulfide pathway.

AGE is also a good source of other organosulfur compounds like alliin, allicin, diallyl sulfide, diallyl disulfide, diallyl trisulfide, ajoene. As such, AGE has been shown to provide a wide range of cardiovascular benefits. In fact, a number of clinical trials show that organosulfur-rich AGE effectively lowers blood pressure and cholesterol levels, improves arterial health by discouraging plaque buildup, enhances circulation, and halts and even reverses the accumulation of coronary artery calcification.

Dosz: Quality and Purity: With so many companies out there today, it can be tough to accurately assess their reputation. With something as complex as herbal products it can be beneficial to go with a well-established manufacturer such as NOW Foods. A reputable brand will adhere to good manufacturing practices and use test methods to validate the purity and source of the material used in a finished good. Along with this a reputable brand will also test for pesticide residues and heavy metal content.

Research: While many herbs haven’t been well studied using modern scientific methods, there are a growing number of herbs and botanicals with good clinical data to back up their purported benefits. If you’re in doubt, check reputable websites for clinical research on a botanical you’re considering. Manufacturers must be able to back up any health claims they make with a solid body of supporting scientific evidence. So, when you’re choosing which herbal supplements to offer to your customers, read the label. If the brand is making outrageous claims about the health benefits of their herbal supplements, that brand may not be the best choice to stock.

Standardization: Most herbs have an active component; that’s the constituent on which research has focused and is presumed to be responsible for the lion’s share of its benefits. A standardized herbal product is one that has been specially manufactured to provide a certain level or percentage of this active component. Sometimes a standardized herbal extract will also be a branded ingredient, and sometimes patented. Both standardization and an intellectual property protected brand offer additional assurances of a product or ingredient’s efficacy and safety.

Lifton: OPC-rich resveratrol is a powerful botanical, but regular resveratrol products have a short half-life and don’t stay in the bloodstream long—making it hard for end-users to reap its full potential.

Quality of Life Labs’ Resveratrol-SR, however, features the MicroActive Resveratrol Complex, which releases resveratrol over 12 hours while providing 2.5 times better bioavailability than regular resveratrol.

Our Oligonol product—featuring a standalone antioxidant ingredient made from lychee fruit—has been clinically shown to support healthy circulation.

Billingslea: Retailers must consider their customer base. Most of us have tiers of support, ingredients that may be less proven or effective but priced for people who can’t afford pricier items, all the way up to the cream of the crop. We also need to know our customers’ main needs to help us choose ingredients/products that best match their needs. These days, staying on top of trending ingredients in social media isn’t a bad idea, either.

VR: Discuss the latest and greatest innovations in heart-health ingredients—in harvesting, processing, product development, or something else.

Lifton: Sucrosomial Minerals were developed to enhance mineral absorption through a unique technology that allows for better absorption—and thus improved bioavailability. Several laboratory and animal tests have shown that the sucresters (sucrose esters of fatty acids) utilized in sucrosomial technology are effective vehicles for improving solubility, dissolution, absorption and bioavailability.

Because Sucrosomial Magnesium is covered by phospholipids and a matrix of sucrose esters of fatty acids, its absorption is not impacted by the presence of other nutrients, unlike conventional forms of magnesium. A head-to-head test demonstrated that Sucrosomial Magnesium had faster absorption and 20 percent higher bioavailability than magnesium citrate, one of the most bioavailable forms of magnesium on the market.

MicroActive formulations are another important advance, since they are designed to optimize the bioavailability and sustained-release capabilities of active ingredients.

For example, MicroActive CoQ10 is a complex where one side of the molecule is fat-soluble and holds the CoQ10, while the other side is water-soluble and makes for efficient transport through the digestive system.

A study of MicroActive CoQ10 found that ingredient was 3.7x more bioavailable than crystalline CoQ10 and uptake peaked at six hours followed by sustained release up to 24 hours.

Rosene: Key research is pointing to a potential therapeutic that has significant results in Stage C heart failure patients. Raising levels of the critical molecule nicotinamide adenine dinucleotide (NAD+) via oral supplement Nicotinamide Riboside (NR) demonstrated increased respiration and decreased proinflammatory immune cells in Stage C heart failure patients.

The consumer supplement, Tru Niagen, features Niagen as the key active ingredient and is the best form of NR available because it is backed by the highest scientific rigor and quality standards and features the most efficient NAD+ precursor. Tru Niagen recently launched clinical strength, NSF Certified Tru Niagen PRO 1,000 mg, recommended by physicians and clinically proven to elevate NAD+ up to 150 percent. Additionally, 1,000 mg of Niagen is used in over 50 percent of clinical research conducted on NR. Furthermore, studies have shown maintaining NAD+ levels is essential to mitochondrial health for vital optimal function of highly energetic organs, like the heart.

VR: In a paragraph or two, what one (or two) finished products or flagship proprietary ingredients should retailers be aware of and why?

Lifton: Quality of Life’s heart-healthy finished products include: Ameal BP, CoQ10- SR, Oligonol, Resveratrol-SR and Yellow and Black Turmeric with Curcumin-SR.

Root: Carlson Elite Omega-3 with vitamin D-3 and K2. A triglyceride form omega-3 formula with the added support of vitamins D3 and K2 to support healthy blood vessels and arterial elasticity. Carlson Maximum Omega-2000, which provides 2000 mg omega-3s in triglyceride form in two soft gels. Two grams of omega-3s daily will support most adults reaching the ideal level of 8 percent on the Omega-3 Index, which is cardioprotective.

VR: What are your projections for the healthy-heart category?

Rosene: Inflammaging describes the connection between chronic low-grade inflammation and age-associated dysfunction and is marked by an influx of pro-inflammatory immune cells, such as IL-6 and tumor necrosis factor (TNF) levels. It is thought to contribute to the development of many age-associated disorders, including cardiovascular disease, diabetes, Alzheimer’s and other neurodegenerative diseases.

Research has shown that a boost in NAD+ is accompanied by anti-inflammatory action. Seven clinical studies have demonstrated NR’s anti-inflammatory effect. This ever-growing body of clinical evidence demonstrates NR may reduce levels of inflammatory cytokines in individuals, with the potential for more robust effects among the elderly or diseased populations who tend to have compromised NAD+ and higher inflammation status.VR

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