Talking Heart Health With Carl Germano CNS, CDN

Carl Germano CNS, CDN, Vice President of Verdant Nature, Consultant for Bluebonnet Nutrition, NY Bd. Certified Clinical Nutritionist, Sugar Land, TX (

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, over 75 percent have some form of CVD. In one paragraph, please highlight what types of products (not brands) and what types of ingredients should retailers promote to customers interested in heart health?

Itโ€™s important to understand that while certain nutraceuticals have shown promise in supporting heart health, their effectiveness can vary greatly depending on individual factors and existing health conditions. However, here are some potential heart healthy nutraceuticals with promising research behind them:

For lowering cholesterol:

โ€ข Berberine: can help the liver clear โ€œbadโ€ LDL cholesterol and increase โ€œgoodโ€ HDL cholesterol, mimics the action of insulin, improving blood sugar control and reducing the risk of type 2 diabetes. This, in turn, can positively impact heart health by preventing diabetes-related complications like heart disease and stroke. It also possesses potent anti-inflammatory properties, helping to calm inflammation throughout the body, including in the arteries, and protecting against cardiovascular issues.

โ€ข Thymoquinone: a potent cardioprotective nutraceutical that possesses anti-fibrotic activity, reduces fasting blood sugar levels and hemoglobin HbA1c levels, and decreases the synthesis of LDL cholesterol in the liver, while potentially increasing the removal of LDL from the bloodstream and promoting the production of HDL cholesterol.

โ€ข Omega-3 fatty acids (EPA and DHA): can help lower LDL cholesterol and raise HDL cholesterol, lower triglycerides, reduce inflammation, improve blood flow, and prevent arrhythmias.

โ€ข Red yeast rice: Contains monacolin K, a compound similar to statin drugs, which can effectively lower cholesterol, has anti-atherosclerotic and stabilizing unstable plaque effects, and shown to improve cardiovascular outcomes and lipid profiles.

โ€ข Plant sterols and stanols: Found in some fortified foods and supplements, these can block cholesterol absorption in the gut. Consuming around 1.5 โ€“ 2g of plant sterols, in combination with a healthy diet, can help lower blood cholesterol levels and specifically reduce your blood levels of LDL (bad) cholesterol.

โ€ข Niacin: Niacin can significantly reduce LDL cholesterol, helps boost HDL cholesterol, effectively lowers triglyceride levels, and helps reduce inflammation throughout the body, including in the arteries, potentially offering some protection against cardiovascular issues.

For blood pressure control:

โ€ข Coenzyme Q10 (CoQ10): CoQ10 is essential for mitochondrial energy production, and some studies suggest its deficiency could contribute to high blood pressure. By improving mitochondrial function, CoQ10 might indirectly help regulate blood pressure especially in people with congestive heart failure.

โ€ข Magnesium: Plays a role in blood pressure regulation, and deficiencies can contribute to high blood pressure. Magnesium supports healthy blood pressure by relaxing blood vessels, acts as a natural calcium channel blocker, increases nitric oxide levels, and reduces endothelial dysfunction, which is an imbalance between relaxing and contracting factors in blood vessels.

โ€ข Hawthorne: helps relax blood vessel walls, leading to vasodilation and improved blood flow. This reduces resistance in the arteries, resulting in lower blood pressure, some studies suggest hawthorn can boost nitric oxide production that promotes smooth muscle relaxation in blood vessels, and has mild ACE-inhibitory properties that can block the production of angiotensin II, a molecule that constricts blood vessels and raises blood pressure.

โ€ข Taurine: can directly relax blood vessel walls, leading to vasodilation and improved blood flow, acts as a natural calcium channel blocker, preventing excessive calcium influx into smooth muscle cells of blood vessels so they can relax, can enhance nitric oxide production, can help excrete sodium and act as a natural diuretic, and may play a role in downregulating hormones that regulate blood pressure.

โ€ข Hibiscus: possesses mild diuretic properties and promotes the excretion of sodium, can block the production of angiotensin II, a molecule that constricts blood vessels and raises blood pressure, can boost nitric oxide production, a natural vasodilator that relaxes blood vessels and improves blood flow. This, in turn, can help lower blood pressure.

โ€ข Berberine: activates adenosine monophosphate-activated protein kinase (AMPK), an enzyme that leads to vasodilation and improved blood flow, ultimately reducing blood pressure, stimulate the production of nitric oxide that relaxes blood vessels and improves blood flow, and mimics the action of insulin, improving blood sugar control and influencing blood pressure since high blood sugar can contribute to hypertension.

โ€ข Thymoquinone: similar to berberine, thymoquinone can relax blood vessel walls, leading to vasodilation and improved blood flow, enhance nitric oxide production that promotes blood vessel relaxation and improves blood flow, and possesses anti-inflammatory properties, reducing inflammation throughout the body, including in the arteries.

Up to 50 percent of the U.S. population is magnesium deficient. Vitamin D canโ€™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?

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.

โ€ข 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.

โ€ข Vitamin D: 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.

Impact of Magnesium on Vitamin D:

โ€ข 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.

โ€ข 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.

Choosing the Right Form of Magnesium: the following are the most important absorbable forms of magnesium: Citrate, Glycinate, Bis-glycinate, Threonate, Aspartate, Malate

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


โ€ข Vitamin B6, B12, & Folic Acid: Helps lower homocysteine levels, an amino acid linked to increased heart disease risk & stroke.

โ€ข Vitamin C & E: Powerful antioxidants that protects cells from damage, helps lower blood pressure, and improves blood vessel function.

โ€ข Vitamin K2: Activates proteins involved in blood clotting and bone health, reduces the risk of arterial calcification and improves cardiovascular health.

โ€ข Vitamin D: Studies show a correlation between low vitamin D levels and higher risks of heart disease, stroke, and heart failure. Other studies suggest a benefit of vitamin D supplementation for people with existing heart conditions like heart failure or high blood pressure as well.


โ€ข Calcium/Magnesium/Potassium: while these electrolytes deserve more detail for each, many studies have demonstrated that some of the most crucial minerals for heart health include magnesium, potassium, and calcium. These minerals play very specific roles in the generation of a proper heartbeat. Calcium and magnesium work together to control muscle contraction, while sodium and potassium help the nerve cells send electrical signals that signal the muscles to contract. Calcium and magnesium are important for coordinating the activity of the cardiac muscles and low magnesium increases oneโ€™s risk for cardiac arrhythmias and heart palpitations. Along with calcium and magnesium, potassium helps maintain a normal electrical rhythm and prevents irregular heartbeats known as arrhythmias as well. Potassium also helps remove sodium from the body, relaxes blood vessels, making them less stiff and constricted to improves blood flow and further reduces blood pressure.

โ€ข Chromium: plays a role in insulin metabolism and may improve insulin sensitivity, particularly in individuals with prediabetes or type 2 diabetes. This can indirectly benefit heart health by reducing risk factors like high blood sugar and inflammation. Additionally, some studies suggest a potential for lowering LDL cholesterol levels and potentially increasing HDL cholesterol levels. Lastly, animal studies suggest a possible role of chromium in lowering blood pressure.

โ€ข Selenium: a crucial component of several selenoproteins, which are enzymes with antioxidant properties to combat harmful free radicals and reactive oxygen species including those in your heart and blood vessels that contribute to the development of heart disease. They also help regulate the production of pro-inflammatory molecules thereby reducing overall inflammation in the body and protecting your heart and blood vessels. Lastly, they help regulate the ability of blood vessels to constrict and expand, and they also have anti-thrombotic properties, meaning they help prevent blood clots from forming. These functions help maintain optimal blood flow and prevent the development of atherosclerosis, the buildup of plaque in arteries that can lead to heart attacks and strokes.

Recently, JAMA Cardiology published a paper called โ€œHealth Claims and Doses of Fish Oil Supplements in the U.S.,โ€ 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. Comment on this please.

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 law giving FDA 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 โ€“ 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 healthcare professionals before taking any supplements are also crucial elements in addressing misinformation and safety issues.

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?

Product Placement and Information:

โ€ข 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.

โ€ข 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.

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

Promotional Strategies:

โ€ข Discounts and specials: Offer promotions and discounts on healthier fats to encourage trial and adoption. Consider bundling them with relevant complementary supplements listed in question #1 as well as products like fruits, vegetables, or whole grains.

โ€ข Cooking demonstrations and recipe suggestions: Organize in-store or online cooking demonstrations showcasing healthy fat recipes and highlighting their versatility in dishes. Provide recipe cards with purchase or through online downloads.

โ€ข Partnership with health experts: Collaborate with nutritionists or chefs to develop healthy fat-focused recipes and educational content for in-store and online platforms.

โ€ข Reduce shelf space for unhealthy fats: Eliminate the availability of highly processed snacks, fried foods, and products with high saturated and trans fats. This makes healthy choices the natural default for shoppers.

โ€ข Introduce โ€œhealthier aislesโ€ or sections: Dedicate an area of the store to products containing predominantly healthy fats and whole foods, further guiding consumers towards healthier choices.

โ€ข Develop loyalty programs that reward healthy fat purchases: Implement point systems or discounts for buying healthier fats, incentivizing continued adoption of these products.

Healthy Fats to Promote:

The healthiest fats are generally unsaturated fats, especially:

โ€ข Monounsaturated fats: Found in olive oil, avocados, nuts, and seeds. These fats may help lower LDL (โ€œbadโ€) cholesterol and raise HDL (โ€œgoodโ€) cholesterol.

โ€ข Polyunsaturated fats: Two main types include omega-3 and omega-6 fats. Omega-3s from fatty fish, walnuts, and flaxseeds are especially beneficial for heart and brain health. Omega-6s are found in vegetable oils and nuts, but should be consumed in moderation compared to omega-3s.

โ€ข Saturated Fats: While saturated fat (found in meats, dairy, poultry, butter, coconut oil, etc.) isnโ€™t inherently bad if limited, consuming it in excess contributes to unhealthy cholesterol levels.

โ€ข Trans fats: often found in processed foods, should be totally avoided.

Remember, every retailer can play a role in promoting healthier choices. By implementing these strategies and focusing on unsaturated fats, especially omega-3s, we can collectively make a positive impact on public health and well-being.

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

โ€ข Retailers looking to stock heart-healthy botanicals rich in OPCs and organosulfur compounds like grape seed extract and garlic should consider several factors:

โ€ข Strength of research: Choose products supported by credible scientific studies demonstrating their effectiveness for heart health benefits like improving blood pressure, reducing cholesterol, or enhancing circulation. Look for products based on clinical trials or meta-analyses over anecdotal evidence.

โ€ข Specificity of claims: Avoid exaggerated or unsubstantiated claims. Make sure product claims align with the level of research available for the specific botanical and its component compounds.

โ€ข Ingredient purity and potency: Verify the product contains the advertised amount of OPCs or organosulfur compounds per serving. Look for standardized extracts with guaranteed potency levels rather than raw herbs with variable concentrations.

โ€ข Source and processing: Choose products using sustainably sourced botanicals and ethical processing methods. Organic certification may be a good indicator for some customers.

โ€ข Manufacturing standards: opt for products manufactured under good manufacturing practices (GMP) or other recognized quality control standards to ensure safety and purity.

โ€ข Brand reputation and transparency: Choose brands with strong reputations for quality and transparency. Look for companies willing to share information about their sourcing, processing, and research backing their products.

By being mindful of these factors, retailers can make informed decisions when choosing heart-healthy botanicals like grape seed extract and garlic to offer their customers. Prioritizing scientifically backed products, quality standards, and consumer appeal can contribute to promoting responsible choices and supporting overall wellness.


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