By
Jenny Pereza and Amanda Reatb
aABC Education
Coordinator
bABC Dietetic Intern
(Texas State, 2013)
Editor’s note: Every other month, HerbalEGram highlights a conventional food
and briefly explores its history, traditional uses, nutritional profile, and
modern medicinal research. We also feature a nutritious recipe for an
easy-to-prepare dish with each article to encourage readers to experience the
extensive benefits of these whole foods. With this series, we hope our readers
will gain a new appreciation for the foods they see at the supermarket and
frequently include in their diets. We would like to acknowledge ABC Chief
Science Officer Stefan Gafner, PhD, and HerbalGram
Associate Editor Hannah Bauman for their contributions to this project.
Overview
Plants
belonging to the genus Cynara are
known as thistles and typically are large and spiny. These members of the daisy
family (Asteraceae) are native to the Mediterranean region, northwest Africa, and
the Canary Islands.1-4 The cultivated artichoke (Cynara cardunculus ssp. scolymus) and the cultivated leafy
cardoon (C. cardunculus var. altilis)
both descended from the wild cardoon (C.
cardunculus).5,6 The subspecies name comes from the word scolymos, which means “spiny” in ancient Greek, and refers to thistles
in general and specifically to the spines found on the bracts that enclose the
flower heads of the edible portion of artichoke.6,7 The wild cardoon
evolved into these common food crops through human cultivation and selection
pressure for desirable traits such as large, non-spiny heads (artichoke) or
non-spiny, large-stalked tender leaves (cardoon).
In dry,
subtropical climates, the artichoke plant is cultivated as an herbaceous
perennial while the cardoon is grown as an annual.1,6 Both have deeply
toothed, greyish-green leaves with pointed lobes that grow up to three feet
long. The sturdy flower stalks arise from a basal rosette and can grow eight feet
tall, producing three to five fleshy flower heads that are enclosed in thick,
green, edible bracts.2,5 The most commonly consumed part of
artichokes are the large immature flowers that are harvested when very young or
before the numerous triangular-shaped bracts curl away, which indicates that
the flower head will soon open and no longer be edible.3,7,8 At the
base of each flower head is an edible fleshy receptacle known as the artichoke
heart. The immature florets, called the choke, are inedible and removed before
processing the artichoke heart for culinary applications.8,9 If
flowers are allowed to open and mature, they produce a thistle-like violet-blue
bloom and can reach up to seven inches across.5 The cardoon is
cultivated for its fleshy stems and leaf stalks.
Historical and Commercial Uses
The
history of the Cynara genus dates
back to ancient Greece. The first written record of Cynara appeared in the writings of Theophrastus in the fourth
century BCE.4 In the first century CE, Pliny the Elder recommended artichoke and cardoon for intestinal distress
and freshening the breath; he also recommended it for more unusual
applications, including curing baldness and the conception of boys.10
Both Greeks and Romans used the artichoke leaf as a choleretic
(bile-increasing) agent and a diuretic.1
While cardoon originally was domesticated within Spain or France, artichokes were first cultivated in the Naples region of Italy in the mid-15th century and
gradually continued throughout other parts of Europe.5,6,8 Italian
noblewoman Catherine de Medici introduced artichokes to France when she became
queen in 1547. The artichoke also gained a reputation as an aphrodisiac and eventually
became known throughout Europe. It even appeared on the tables of monarchs,
including Henry VIII of England. French colonists brought the artichoke to
North America in the 1800s and by the early 20th century, artichokes were
extensively cultivated in California.5
Today,
artichokes are still enjoyed as an important vegetable, especially in France,
Italy, Spain, and Belgium, where it is commonly cultivated.8 In the
United States, 100% of all commercially grown artichokes are cultivated in
California.11 Numerous cultivars have been developed to improve flavor
and hardiness.3
When
artichokes are served whole, the leaf bracts are pulled off one by one and
scraped against the teeth to eat the pulp at its base. After the leaves are
removed, the choke is peeled away to reveal the sweet and tender artichoke heart.12
Artichokes, whole or the hearts, are commonly preserved in brine or spiced oil
and are also stuffed, eaten with butter or cream sauce, or in salads or
casseroles.8 Cardoon leaves are enjoyed as a regional cuisine in
Mediterranean countries where they are baked, boiled, fried, or braised.13
Mature artichoke and cardoon flowers contain proteolytic enzymes that act as
natural coagulants and are used as a vegetarian alternative to rennet in cheese-making.14,15
Many of
the traditional uses of artichoke and cardoon focus on liver health as a
hepatoprotective agent.1 However, the plant has also been
traditionally used to stimulate appetite and enhance digestion by increasing
bile flow from the liver, which has natural laxative effects.1,7,16,17
In Germany, Sweden, and Finland, herbal preparations made from artichoke leaves
are still used for these purposes and as an appetite stimulant in pediatric
populations.1,18 Cynar, an Italian liqueur made from artichoke, is
bittersweet and consumed either before (aperitif) or after (digestif) meals to
enhance digestion.14
Nutrients and Phytochemicals
A
traditional component of Mediterranean diets, artichokes are a low-calorie
vegetable, providing only 60 calories per 100-gram serving.4,8 The
edible portion of an artichoke contains cholesterol-lowering dietary fiber and has
no fat or cholesterol.11,19 Artichoke hearts are an excellent
dietary source of vitamin C and folate and a good source of minerals, including
magnesium, potassium, and phosphorus.4,8 Artichoke hearts are high
in fiber and can counteract constipation.20 Beyond its basic
nutritional value, artichoke hearts are considered a functional food with
natural components that reduce the risk of specific diseases.14,21 An
indigestible carbohydrate known as inulin is most concentrated in the external
bracts and flower heads of the artichoke.7 Inulin has been used to
replace fat in table spreads, baked goods, fillings, dairy products, frozen
desserts and salad dressings.15 Inulin acts as a natural prebiotic
that “feeds” the beneficial bacteria, specifically Bifidobacterium, in the large intestine of humans and animals,
increasing the efficiency and frequency of bowel movements.6,14 Enhanced
gut microflora is associated with improvements in mineral absorption, blood lipid
composition, and the prevention of colon cancer.7
The
heads and leaves of artichoke and cardoon have high levels of important
phytochemicals. Phenols, flavonoids, and anthocyanins are all potent
antioxidants which protect the cells of the body from damage and inhibit
low-density lipoprotein (LDL) cholesterol oxidation. The total antioxidant
capacity of artichoke flower heads is one of the highest reported for
vegetables, and artichokes are ranked seventh on the USDA’s Top 20 Foods High
in Antioxidants.23 This is attributed to the high levels of
bioactive polyphenols such as caffeoyquinic acids (e.g., cynarin and
chlorogenic acid) and flavonoids in the artichoke’s inner bracts and
receptacles.21 While cooking artichoke can decrease its overall
flavonoid concentration, steaming has been found to increase its antioxidant
capacity considerably.15,24 In addition to cynarin and chlorogenic
acid, research indicates that artichoke and cardoon contain other phytochemicals
that reduce cholesterol and inflammation and have potential cancer-preventing
properties. These phytochemicals and their associated properties are listed in
Table 1.
Table
1: Polyphenols in Artichokes and Cardoons
Phytochemical
|
Type of Compound
|
Plant Part
|
Associated Properties and Actions
|
Cynarin
|
Caffeoylquinic
acid derivative
|
Flower
bud and leaf
|
Antibacterial,
cytotoxic, antioxidant, choleretic (stimulates bile production), cholagogue
(promotes bile discharge)7,14,16,25
|
Chlorogenic
acid
|
Caffeoylquinic
acid derivative
|
Flower
bud and leaf
|
Antioxidant,
antibacterial, cytotoxic14,25
|
Luteolin
|
Flavonoid
|
Flower
bud and leaf
|
Reduces
cholesterol4,21,26,32
|
Apigenin
|
Flavonoid
|
Flower
bud and leaf
|
Neuroprotective
antioxidant, anti-inflammatory22
|
Sophoroside
|
Anthocyanin
|
Flower
bud
|
Antioxidant4
|
Cyanidin-3-O-glucoside
|
Anthocyanin
|
Flower
bud
|
Antioxidant4
|
Beta-sitosterol
|
Phytosterol
|
Flower
bud and seed
|
Reduces
cholesterol absorption19
|
Stigmasterol
|
Phytosterol
|
Flower
bud and seed
|
Reduces
cholesterol absorption19
|
Cynaropicrin
|
Sesquiterpene
lactone
|
Flower
bud and leaf
|
Bitter
flavor, stimulates digestion, cholesterol reduction, antispasmodic,
antiphotoaging (protects against UV damage) and cytotoxic4,14,15,21,35
|
Taraxasterol
|
Triterpene
|
Leaf
|
Cholesterol
reduction14,35
|
Arctigenin
|
Lignan
|
Leaf
|
Antioxidant,
anti-inflammatory14,35
|
Modern Research and Potential Health Benefits
Current
research supports the long-standing medicinal uses of artichoke and cardoon
leaf extracts as a cardioprotective, hepatoprotective, and intestinal soothing
agent, as well as its cancer chemopreventive properties. The main biological
activities attributed to both artichokes and cardoons are hepatoprotection, prevention
of colon cancer, stimulation of bile secretion, and lowering of cholesterol.14,16,25
A limitation of current research is the lack of studies that have specifically
investigated the effects of artichoke heart consumption.19 Further
studies are necessary to further investigate artichoke metabolites and their
mechanisms of action.14
Cardioprotective Effects
High
cholesterol is a risk factor for cardiovascular disease. There is an increasing
interest in natural lipid-lowering compounds that may delay or circumvent
conventional antihypercholesterolemic drug therapy.26 Artichoke and
cardoon are a fundamental part of the Mediterranean diet, which offers an array
of nutrients and phytochemicals that promote overall health.
While
artichoke hearts provide sufficient cholesterol-lowering fiber, recent clinical
trials have shown that artichoke leaf extract (ALE) has greater potential to
reduce total cholesterol and LDL cholesterol levels and, in some cases, reduce
trigylceride levels and increase high-density lipoprotein (HDL) cholesterol levels.18,27-31
Artichoke and cardoon’s ability to lower cholesterol is in part attributed to
improving bile salt excretion via bowel movements.32 Additionally,
the inulin in the plant has been shown to increase production of beneficial
bacteria (i.e., Bifidobacteria) which, in turn, produces positive
effects on blood lipid composition.4
A 2013
Cochrane Review of three randomized, controlled trials for ALE found a modest
positive effect on total and LDL cholesterol levels, with the suggestion that
patients with severely elevated cholesterol levels may benefit more from ALE
treatment than those with moderately high levels.31 Reported adverse
events were mild, transient, and infrequent. While the available clinical trial
literature was insufficient for the authors to recommend ALE as a treatment for
high cholesterol, they concluded that the lipid-lowering effects shown in in
vitro and animal studies, along with the clinical trials reviewed, were
promising enough that larger and better-controlled clinical trials were needed
to establish whether ALE was a safe and effective treatment for patients with
high cholesterol on a long-term basis as a lipid-lowering therapy.
A 2017 meta-analysis
by Sahebkar et al. reviewed nine randomized, controlled clinical trials
investigating the LDL-lowering effects of ALE. ALE supplementation, ranging
from 500-2,700 mg per day, was associated with significantly reduced total
cholesterol and LDL cholesterol levels in patients with moderate-to-severe
hypercholesterolemia with an average baseline LDL level of 213 mg/dL.26
The cholesterol-lowering effect appeared to be unrelated to dose and duration
of treatment, but ALE’s efficacy was directed related to baseline LDL
cholesterol levels.26 These findings are similar to those of the
2013 Cochrane Review. Overall, the data support the potential clinical use of
ALE supplementation to achieve a mild but significant reduction in LDL
cholesterol. ALE treatment did not have any effect on reducing triglyceride
levels or increasing HDL cholesterol levels. Further clinical trials are needed
to determine if ALE, alone or in combination with lipid-lowering drugs such as
statins, can reduce risk of atherosclerosis and improve long-term clinical
outcomes in the treatment of high LDL cholesterol.19
Gastrointestinal Effects
Although
less research has focused on the gastrointestinal benefits of artichoke,
studies show that ALE is associated with improvements in dyspepsia (abdominal
discomfort) symptoms.33,34 More specifically, supplementation with ALE
has been shown to significantly reduce abdominal pain and discomfort, cramps,
acid reflux, the feelings of fullness, pressure, bloating, nausea, and
vomiting.18.34,35 Due to the significant overlap between symptoms of
dyspepsia and irritable bowel syndrome (IBS), one-third of individuals with
functional dyspepsia also suffer from IBS.18 Several studies have
indicated that artichoke leaf extract can be an effective treatment for IBS
symptoms.18,36 Furthermore, ALE is also thought to be an
antispasmodic agent, a property that may contribute to the relief of intestinal
cramps, nausea, and vomiting.35 Research suggests that the moderate
amounts of cynaropicrin present in ALE greatly contribute to its widespread use
for relieving dyspeptic symptoms.
Hepatoprotective Effects
Nonalcoholic
fatty liver disease (NAFLD) is the most common cause of chronic liver disease
globally, and other than dietary modification and regular exercise, there are limited
therapeutic treatments available. This disease occurs when the liver’s ability
to metabolize fats is impaired, making it more susceptible to injury and
inflammation.32 NAFLD is associated with metabolic syndrome;
therefore, obesity, insulin resistance, impaired glucose tolerance, and high
cholesterol often are disease cofactors. Weight loss alone may not be enough to
reverse the progression of liver damage.
Cynarin
is associated with artichoke and cardoon’s choleretic and hepatoprotective
properties.14 ALE supplementation reduces high cholesterol,
especially LDL cholesterol. In a pilot clinical trial that tested the ability
of ALE to improve NAFLD, patients receiving ALE for a two-month period showed
significant improvements in NAFLD severity (reduced liver size and portal vein
diameter and increased blood flow to the liver) as determined by liver
sonography, compared to placebo.32 Total bilirubin, aspartate
aminotransferase (AST), alanine aminotransferase (ALT), and uric acid levels were
significantly reduced. In addition, the AST/ALT ratio and the AST/platelet
ratio (APRI) improved, indicating improved liver function in the patients
supplementing with ALE. Finally, patients supplementing with ALE experienced an
indirect improvement of NAFLD indices via a decrease in body mass index (BMI),
which is crucial to improving NAFLD patient outcomes.
According
to the World Health Organization, approximately 700,000 people die annually
from hepatitis C-related liver diseases.35 Managing oxidative stress
and subsequent liver damage is crucial to slowing the progression of
hepatitis-C viral (HCV) infections. Cynaropicrin, a water-soluble compound
isolated from artichoke, is a powerful antioxidant and anti-inflammatory
compound. In vitro and in vivo studies have demonstrated the protective and
regenerative effects that cynarin and cynaropicrin, present in ALE, have on
liver health. Cynaropicrin, specifically, appears to be an anti-HCV entry
inhibitor and may play a key role in helping patients with end-stage liver
diseases undergoing liver transplantation, where reinfection of the graft is
common and can accelerate progression of liver diseases. Clinical trials on ALE
have demonstrated that it is safe and well tolerated, with little to no adverse
effects reported. However, these finding need to be confirmed with larger,
randomized clinical trials to further investigate ALE’s clinical efficacy.16,32
Consumer Considerations
During
the last 20 years, artichoke consumption has increased by 40%.15 Currently,
Italy is the leading producer of artichokes, followed by Spain, France, and
Greece.4,14 Cardoon has much more limited cultivation, though it has
traditional importance as both food and medicine in northern Mediterranean
areas. Commercially, globe artichokes are available fresh, canned, or frozen. More
than 1,678,872 tons of artichokes are produced annually, of which more than 60%
is produced in Europe.14, North African countries, including Egypt,
Morocco, and Algeria, also contribute to worldwide artichoke production. China
is the only Asian country that is among the top 10 global artichoke producers.36
The United States is the ninth largest producer of artichokes, with most of the
crop originating in the state of California.
Artichoke
and cardoon thrive in dry Mediterranean conditions where most rainfall occurs
during the winter season.13 Their deep root systems helps them
withstand periods of low rainfall. The bitter compounds present in the leaves,
such as cynaropicrin, make them less appealing to common garden pests.4,21,35
Given
that artichokes are grown for only their immature flower heads, a significant
amount of biomass (80-85%) from the inedible parts of the artichoke, including
the leaves, external bracts, and stems, still contains high levels of
polyphenols and inulin, and these byproducts are being investigated for use as
a food additive, plant dye, biofuel, and in paper-pulp production.4,14
Plants and stems are traditionally used as nutritious forage for hens, goats,
and other farm animals.14,15
Nutrient Profile38
Per 1 medium artichoke (approx. 128 g)
Macronutrients
60 calories
4.2 g protein
13.5 g carbohydrate
0.2 g fat
Micronutrients
Excellent source of:
Dietary
Fiber: 6.9 g (27.6% DV)
Vitamin C: 15 mg (25% DV)
Vitamin K: 18.9 mcg (24% DV)
Folate: 87 mcg (21.8% DV)
Very good source of:
Magnesium: 77 mg (19.3% DV)
Potassium: 474 mg (13.5% DV)
Phosphorus:
115 mg (11.5% DV)
Good source of:
Iron:
1.64 mg (9% DV)
Niacin: 1.34 mg (6.7% DV)
Calcium: 56 mg (5.6% DV)
DV =
Daily Value as established by the US Food and Drug Administration, based on a
2,000-calorie diet.
Mediterranean
Roasted Artichokes
Courtesy of The Mediterranean Dish39
Prep Time: 20 minutes
Cook Time: 40 minutes
Total Time: 1 hour
Yield: Serves 12
Ingredients:
6 large globe artichokes 1/2 cup plus 2 tablespoons lemon juice, divided Salt and black pepper, to taste Extra virgin olive oil 12 garlic cloves, peeled 2 small shallots, peeled and thinly sliced (More information on the benefits of shallot is available here.40) 2 tablespoons capers (More information on the benefits of caper is available here.41) Crumbled feta cheese, to taste 1 cup chopped fresh dill 2 teaspoons honey
Directions:
Heat oven to 400°F. To clean artichokes: Cut off the stem/stalk. Peel off the tough outer layers by hand. Upon reaching the softer layers, use a serrated knife to cut off about 3/4 inches from the top. Cut artichoke in half lengthwise then, using a sharp paring knife or a serrated spoon, scrape out all the choke (the “hairs”) on the inside. Sprinkle the cut sides of each artichoke half with 1/2 teaspoon lemon juice to prevent the artichoke from discoloring. On a large baking sheet, place each artichoke half in a piece of lightly oiled foil that is large enough to fold around the artichoke. Season artichokes with salt and pepper and nestle one garlic clove in the center of each artichoke half. Drizzle generously with olive oil. Close the foil around artichokes and roast for 40 minutes. Carefully open the foil pouches. Remove the roasted garlic from the center of artichoke, reserve, and close the foil back until ready to serve. Let garlic cool to room temperature. In the bowl of a small food processor, add the roasted garlic along with remaining 1/2 cup of lemon juice, dill, honey, and salt and pepper to taste. Pulse until smooth. Remove the artichokes from foil. Arrange on a serving platter and generously drizzle with the roasted garlic-dill vinaigrette. Top with shallots, capers, and crumbled feta cheese.
|
Image credits:
All images ©2020 Steven Foster
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