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- Cocoa (Theobroma cacao)
- Heart Failure
- Type 2 Diabetes
- Skeletal Muscle Function
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Date:
11-15-2013 | HC# 061335-484
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Re: Cocoa Consumption Improves Skeletal Muscle Structure in Patients with Heart Failure and Type 2 Diabetes
Taub
PR, Ramirez-Sanchez I, Ciaraldi TP, et al. Perturbations in skeletal muscle
sarcomere structure in patients with heart failure and type 2 diabetes:
restorative effects of (-)-epicatechin-rich cocoa. Clin Sci (Lond). 2013;125(8):383-389.
Patients
with heart failure (HF) often suffer from fatigability. Skeletal muscle (SkM)
atrophy, including reductions in mitochondrial volume, cristae abundance, and
myosin fiber content, can lead to loss of function. In patients with type 2
diabetes mellitus, perturbations in SkM are also observed. Because HF and type
2 diabetes often coexist, together they may cause increased alterations in SkM.
Exercise can improve HF or diabetes-induced changes in SkM structure and
function; however, patients with HF tend to be older and have restricted
mobility. Alternative safe and effective therapeutic interventions are needed.
The
authors previously demonstrated that administering the flavanol epicatechin to
mice led to improvements in exercise capacity correlating with increased
mitochondrial volume, cristae abundance, and capillarity in SkM and myocardium.1
They further conducted a pilot study of 5 patients with HF and type 2 diabetes
using epicatechin-rich cocoa (ERC; Theobroma
cacao) for 3 months.2 In that study, the consumption of ERC led
to "a notable recovery of SkM markers of mitochondrial biogenesis and of
cristae abundance, indicating improved microstructure and possibly,
bioenergetics," write the authors, further hypothesizing that improvements
in mitochondrial microstructure may allow myofibers to regenerate and have more
normal architecture. From that pilot study, the authors performed a subanalysis
of samples to search for changes in sarcomere microstructure, members of the
dystrophin-associated protein complex (DAPC) essential for maintaining SkM
structure and function, and regulators of SkM growth and regeneration. They
compared those measures before and after ERC intervention and to those of
healthy control muscle.
For
the pilot study, the authors recruited 5 men from the San Diego Veterans
Administration Center in San Diego, California, who had been diagnosed with
stage II/III HF (as defined by the New York Heart Association guidelines) and
non-insulin-dependent type 2 diabetes. All patients were being treated with
standard therapy for those conditions, with stable medical management for at
least 6 months.
The
patients consumed Hershey's Extra Dark 60% cacao chocolate and cocoa beverages
containing 18 g of natural cocoa powder (Hershey, Inc.; Hershey, Pennsylvania)
for 3 months (daily total of 100 mg epicatechin, with 390 calories and 18 g fat).
The patients underwent muscle biopsies from their quadriceps femoris before and
after ERC consumption. For comparison, 3 SkM biopsy samples were obtained from
healthy men aged 50 to 53 years.
During
the 3-month study, significant improvements were noted in high-density
lipoprotein cholesterol (from 38.2 ± 7.2 mg/dL to 44 ± 7.4 mg/dL) and a trend
in brain natriuretic peptide levels (used to determine HF) (from 218.9 ± 206.2
pg/mL to 107.4 ± 94.7 pg/mL), while no major changes were noted in total cholesterol,
low-density lipoprotein cholesterol, triglycerides, or hemoglobin A1c. Plasma
epicatechin concentrations increased on average 1.06 ± 0.3 μM after 3 months of
ERC consumption.
Treadmill
testing was used to measure maximum oxygen consumption (VO2 max)
levels. At the end of 3 months, VO2 max levels had increased, though
not statistically significantly, by 24%.
At
baseline, significant decreases were observed in the α-, β-, δ-sarcoglycan (SG)
transmembrane proteins and in dystrophin and utrophin expression (compared with
those of the healthy control subjects); those were restored by the ERC.
Reductions in DAPC, particularly dystrophin, can greatly affect muscular
function. "Given the magnitude of dystrophin loss and sarcomere
perturbations observed at baseline, the SkM of these patients could be
described as in a state of 'acquired muscular dystrophy,'" write the
authors. Though not significantly decreased at baseline, levels of the proteins
γ-SG, β-dystroglycan, and dysferlin increased with ERC.
High
at baseline, the myostatin levels were significantly reduced by ERC consumption
but remained higher than those of the healthy control subjects. On the other
hand, reduced levels of follistatin at baseline increased above those of the
healthy controls after treatment. The plasma follistatin/myostatin ratio
increased significantly with treatment (P=0.01). The authors explain, "Myostatin
and follistatin negatively and positively modulate SkM growth
respectively."
After
3 months of ERC consumption, significant increases were observed in these
markers of SkM growth and regeneration: myocyte enhancer factor 2 (MEF2;
P=0.022), myogenic regulatory factor 5 (Myf5; P=0.0077), myogenic
differentiation (MyoD; P=0.002), and myogenin (P=0.017) levels.
The
authors conclude that a severe perturbation of sarcomere microstructure at
baseline was strikingly restored with treatment. "Altogether, a coherent
signature of molecular events was documented, supporting ERC-induced improved
microstructure," they write, further offering this explanation of the
underlying mechanisms responsible for the recovery of muscle microstructure:
"It is possible that at baseline a state of catabolism predominated and
that following ERC treatment as mitochondria partially recovered, a more 'normal'
metabolic state ensued allowing for muscle regeneration to take place."
Although
ERC or pure epicatechin may be effective in treating muscle-wasting conditions,
the authors caution that it should not replace exercise as a proven beneficial
intervention. Further research is needed on the combined effects of the 2 interventions.
—Shari Henson
References
1Nogueira L,
Ramirez-Sanchez I, Perkins GA, et al. (-)-Epicatechin enhances fatigue
resistance and oxidative capacity in mouse muscle. J Physiol. 2011;589(Pt 18):4615-4631.
2Taub P,
Ramirez-Sanchez I, Ciaraldi TP, et al. Alterations in skeletal muscle
indicators of mitochondrial structure and biogenesis in patients with type 2
diabetes and heart failure: effects of epicatechin rich cocoa. Clin Transl Sci. 2012;5(1):43-47.
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