Hypertension, the Kuna, and the Epidemiology of Flavanols

Abstract

A low sodium diet has often been implicated in the protection of low blood pressure populations from hypertension, but several other dietary factors, including those as yet unidentified, may also be involved. The Kuna Indians of Panama are free of hypertension and cardiovascular disease, but this is changing with migration to urban areas. We compared the indigenous diet of Kuna Indians living on remote islands in Panama (Ailigandi), whose lifestyle is largely hunter-gatherer, with those who have moved to a suburb of Panama City (Vera Cruz). Between April and October 1999, members of a Kuna research team administered a 118-item food frequency questionnaire to133 adult Kuna from Ailigandi and 183 from Vera Cruz. Single 24-hour urine collections and nonfasting blood samples were obtained. The Kuna in Ailigandi reported consuming a 10-fold higher amount of cocoa-containing beverages, 4 times the amount of fish, and twice the amount of fruit as urban Kuna (P<0.05 by t test). Salt added was ample among those living in Ailigandi and Vera Cruz according to both self-report (7.1+/-1.1 and 4.6+/-0.3 tsp weekly) and urinary sodium levels (177+/-9 and 160+/-7 mEq Na/g creatinine), respectively. The low blood pressure of island-dwelling Kuna does not seem to be related to a low salt diet. Among dietary factors that varied among migrating Kuna, the notably higher intake of flavanol-rich cocoa is a potential candidate for further study.

Repression of calcitonin gene-related peptide expression in trigeminal neurons by a Theobroma cacao extract

“…Based on epidemiological studies, populations that consume foods and drinks rich in polyphenols have a lower incidence of chronic inflammatory diseases such as arthritis, atherosclerosis, and chronic heart failure (Stoclet et al, 2004;Goggs et al, 2005;Buijsse et al, 2006;McCullough et al, 2006). The beneficial effects of polyphenols in cardiovascular disease have been shown to involve inhibition of key enzymes and transcription factors that are known to promote inflammation (Bode and Zigang, 2003;Yoon and Baek, 2005).…”

(–)-Epicatechin mediates beneficial effects of flavanol-rich cocoa on vascular function in humans

“…One contributing factor seems to be dietary because the Kuna living on San Blas customarily consume large amounts of flavanol-rich cocoa (26). In the current study, urine samples collected from a subset of individuals, who were partaking in a larger study aimed at investigating diet-blood pressure correlations in the Kuna (27), were analyzed for flavanol metabolites and nitriteϩnitrate concentrations. All volunteers partaking in this study where matched for age, gender, and weight.…”

Use of dark chocolate for diabetic patients: a review of the literature and current evidence

“…Thus, the availability of nitric oxide (NO) likely plays a role in initiating cellular response to insulin. The ability of cocoa extract to increase bioavailability of NO and the possible relationship between dark chocolate consumption and insulin resistance led to several investigations in human special populations, particularly the hunter-gatherer Kuna in Panama, whom have significantly lower cardiovascular disease and cancer death rates than the USA population and a higher consumption of cocoa-containing beverages when living on the Ailigandi Islands, but have increasingly migrated to urban areas and adopted a more Western diet with subsequent increases in cardiovascular disease, diabetes, and cancer [21]. …”