Possible impact of the macrobiotic diet on cardiovascular diseases

In recent decades, cardiovascular disease (CVD) research has focused on the cellular and molecular mechanisms that cause it, in particular on endothelial dysfunction and chronic inflammation, two key factors in its progression.
Endothelial dysfunction is a multifactorial oxidative and inflammatory process associated with dyslipidemia and the formation of atherosclerotic plaque.

The Nrf2/HO-1 system plays a central role, regulating cellular defense against oxidative stress and being considered a promising target for protecting endothelial cells. Several natural compounds – in particular phenylpropanoids, flavonoids, and terpenoids – show protective effects.
Flavonoids (such as quercetin, kaempferol, myricetin, apigenin, and luteolin), found in fruit, vegetables, tea, and red wine, are associated with a reduced risk of CVD.

Functional foods and plant-based phytochemicals, thanks to polyphenols, can reduce LDL cholesterol oxidation and support the body's antioxidant systems. However, more recent studies show that the significant antioxidant activity of polyphenols occurs mainly in the gastrointestinal tract, where they limit lipid oxidation and the absorption of oxidized cholesterol.

It has also emerged that the use of isolated antioxidants at high doses is not recommended, as it can be ineffective or harmful. The safest and most effective way to harness the antioxidant effect is through a balanced diet rich in functional foods, where various compounds act in a synergistic and complementary manner.

Fruit, vegetables, and whole grains are important sources of antioxidants, fiber, vitamins (C and E), polyphenols, folic acid, potassium, and plant sterols, all compounds that help reduce total cholesterol, oxidative stress, and, consequently, the risk of cardiovascular disease (CVD) and hypertension.

Recent research confirms that a macrobiotic diet rich in fruit, vegetables, whole grains, nuts, and seeds, and generally polyphenols, can improve cardiovascular biomarkers, promote endothelial function, reduce platelet aggregation, and offer anti-inflammatory and antithrombotic effects.

According to epidemiological studies, the consumption of up to 800 g of fruit and vegetables per day is associated with a reduced risk of CVD, stroke, and overall mortality (Aune et al., 2017; Zurbau et al., 2020).
High intake also reduces the risk of hypertension:

·         800 g/day → −11% risk compared to 40 g/day

·         550 g/day → −19% risk compared to 8 g/day (Madsen, Sen, Aune, 2023).

The most beneficial foods appear to be apples, pears, citrus fruits, blueberries, grapes, avocados, broccoli, carrots, and leafy green vegetables.

The benefits stem from several physiological mechanisms:

·         Reduction of pro-inflammatory pathways and increased production of nitric oxide (NO), which promotes vasodilation and prevents inflammation and platelet aggregation.

·         Polyphenols (quercetin, catechins, proanthocyanidins) with strong antioxidant effects, capable of neutralizing free radicals and protecting against atherosclerosis.

·         Curcumin, catechin and silymarin, which improve metabolic parameters such as BMI, triglycerides, total cholesterol, liver enzymes and insulin resistance.

Furthermore, a high intake of fruit and vegetables is associated with a smaller increase in weight over time and contributes to healthier dietary patterns by reducing the consumption of harmful foods.

The macrobiotic diet, rich and varied in fruit and vegetables, thanks to polyphenols and other bioactive compounds, is an essential pillar of heart health, the prevention of hypertension, and protection against cardiovascular disease.

Dietary fiber, especially soluble fiber found in whole grains, oats, barley, legumes, nuts, fruit, and vegetables, plays a fundamental role in the prevention of cardiovascular disease (CVD).

Numerous studies show that a higher intake of fiber:

·         reduces total cholesterol (TC) and LDL cholesterol (LDL-C);

·         lowers diastolic blood pressure;

·         reduces the risk of heart attack, stroke, and angina;

·         reduces mortality from all causes and CVD.

A systematic review highlighted that a high intake of total fiber reduces:

·         overall mortality by 23%,

·         cardiovascular mortality by 26%,

·         and cancer mortality by 22%.

Insoluble fiber appears even more effective than soluble fiber in reducing the overall risk of death.
In particular:

·         fiber from whole grains and vegetables is associated with lower overall mortality;

·         that from nuts and seeds reduces cardiovascular mortality by up to 43%.

Furthermore, clinical studies confirm that adding soluble fiber to the diet helps to reduce blood pressure and the overall cardiovascular risk.

A macrobiotic diet with regular consumption of fiber-rich foods, especially whole and plant-based, is closely linked to greater longevity and better heart health.

Omega-3 and “good” fats

Omega-3 fatty acids, found in fatty fish (salmon, mackerel) and plant sources (flaxseeds, chia seeds, walnuts), have cardioprotective effects:

• they reduce triglycerides (TG) and total cholesterol (TC),
• improve arterial function and
• reduce the risk of heart attack, sudden death, and cardiovascular mortality (by up to 50%).
  The effect is dose-dependent: the more omega-3s you consume, the greater the cardiovascular protection.

Walnuts, almonds, hazelnuts, and pistachios, rich in unsaturated fats, also help lower LDL-C and total cholesterol, reducing the risk of cardiovascular disease (CVD).

Phytosterols and plant stanols

Phytosterols and stanols (such as β-sitosterol and soy saponins), found in fruit, vegetables, seeds, and nuts, help to:

• lower total cholesterol, LDL-C, triglycerides and blood pressure,
• reduce inflammation (C-reactive protein),
• and protect against CVD.

Cacao and dark chocolate

Cacao (Theobroma cacao) is rich in flavonoids, particularly proanthocyanidins (PACs), which:

• improve vasodilation by increasing nitric oxide (NO);
• reduce blood pressure, LDL cholesterol, triglycerides and inflammation;
• increase HDL-C and insulin sensitivity.

Consuming dark chocolate  for 2–18 weeks:

• moderately reduces systolic blood pressure (~4.7 mmHg) and diastolic blood pressure (~2.8 mmHg),
• decreases the risk of stroke and CVD by up to 37%.
• The effects stem from antioxidant, antiplatelet, and vasodilating properties.

Black tea

Tea, rich in catechins such as EGCG, inhibits the oxidation of LDL and prevents atherosclerosis.
Regular consumption of two or more cups a day:

• reduces the risk of cardiovascular mortality and stroke;
• lowers blood pressure, TC, LDL-C, and inflammatory markers (TNF-α, IL-6).
  
  

Garlic (Allium sativum)

Garlic contains flavonoids, saponins, sulfur compounds (such as allicin) and has numerous effects:

• antioxidant, anti-inflammatory, antihypertensive, antidiabetic, and cardioprotective.
  Regular intake (especially of garlic extract or powder) can:
• lower blood pressure, BMI, total cholesterol, LDL-C, and TG;
• increase HDL-C and improve arterial elasticity, microcirculation, and endothelial function.
  The effects are more pronounced with moderate doses and prolonged treatments, especially in individuals with CVD.

Scientific evidence on a macrobiotic diet rich in omega-3s, phytosterols, cacao, tea, and garlic provides powerful natural support for cardiovascular health, acting on cholesterol, triglycerides, blood pressure, inflammation and vascular function. These foods, consumed regularly and in combination, represent an effective and safe strategy for the prevention and management of heart disease.

Conclusions

Cardiovascular diseases (CVD), including hypertension and stroke, are among the leading causes of mortality and disability worldwide. Scientific research has shown that these conditions are underpinned by chronic inflammatory processes and endothelial dysfunction, which impair blood vessel health and promote disease progression.

The macrobiotic diet plays a central role in the prevention and management of CVD. In particular:

·         Fruit, vegetables, and whole grains, rich in polyphenols, fiber, vitamins, and minerals, help improve endothelial function, lower total cholesterol (TC), and counteract oxidative stress.

·         Omega-3 fatty acids, obtained from oily fish and plant seeds (such as flax and chia), reduce triglycerides (TG), improve arterial flexibility, and reduce the risk of cardiovascular events.

·         Walnuts, almonds, and other nuts, thanks to their unsaturated fat content, lower LDL cholesterol (LDL-C) levels and promote better cardiovascular health.

·         Cocoa and high-flavonoid dark chocolate promote vasodilation, improve endothelial function, and help lower blood pressure.

·         Tea, rich in catechins, has positive effects on cardiovascular biomarkers and reduces cardiovascular mortality.

·         Garlic, with its polyphenols and sulfur compounds, has anti-inflammatory, antioxidant, and lipid-lowering effects, helping to lower cholesterol and improve hemodynamic parameters.

Overall, scientific evidence shows that a macrobiotic diet can significantly reduce the risk of CVD by acting through multiple physiological mechanisms (antioxidant, anti-inflammatory, vasodilating, and lipid-lowering). However, the consumption of these foods should be part of a healthy lifestyle that includes regular physical activity, weight control, reduced intake of salt, sugar, and saturated fats, and smoking cessation.