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Antioxidants in Food, Vitamins and Supplements Antioxidants in Food, Vitamins and Supplements Prevention and Treatment of Disease Amitava Dasgupta, PhD, DABCC Professor of Pathology and Laboratory Medicine, University of Texas Medical School at Houston Kimberly Klein, MD Assistant Professor of Pathology and Laboratory Medicine, University of Texas Medical School at Houston AMSTERDAM(cid:1)BOSTON(cid:1)HEIDELBERG(cid:1)LONDON(cid:1)NEWYORK(cid:1)OXFORD PARIS(cid:1)SANDIEGO(cid:1)SANFRANCISCO(cid:1)SINGAPORE(cid:1)SYDNEY(cid:1)TOKYO Elsevier 525BStreet,Suite1900,SanDiego,CA92101-4495,USA 32JamestownRoad,LondonNW17BY,UK 225WymanStreet,Waltham,MA02451,USA Copyrightr2014ElsevierInc.Allrightsreserved Nopartofthispublicationmaybereproduced,storedinaretrievalsystem,ortransmittedinanyformor byanymeanselectronic,mechanical,photocopying,recordingorotherwisewithoutthepriorwritten permissionofthepublisher. PermissionsmaybesoughtdirectlyfromElsevier’sScience&TechnologyRightsDepartmentinOxford, UK:phone(144)(0)1865843830;fax(144)(0)1865853333;email:[email protected], visittheScienceandTechnologyBookswebsiteatwww.elsevierdirect.com/rightsforfurtherinformation. Notice Noresponsibilityisassumedbythepublisherforanyinjuryand/ordamagetopersons,orpropertyasa matterofproductsliability,negligenceorotherwise,orfromanyuseoroperationofanymethods,products, instructionsorideascontainedinthematerialherein.Becauseofrapidadvancesinthemedicalsciences, inparticular,independentverificationofdiagnosesanddrugdosagesshouldbemade. Medicineisanever-changingfield.Standardsafetyprecautionsmustbefollowed,butasnewresearch andclinicalexperiencebroadenourknowledge,changesintreatmentanddrugtherapymaybecome necessaryorappropriate.Readersareadvisedtocheckthemostcurrentproductinformationprovidedby themanufacturerofeachdrugtobeadministeredtoverifytherecommendeddose,themethodandduration ofadministrations,andcontraindications.Itistheresponsibilityofthetreatingphysician,relyingon experienceandknowledgeofthepatient,todeterminedosagesandthebesttreatmentforeachindividual patient.Neitherthepublishernortheauthorsassumeanyliabilityforanyinjuryand/ordamagetopersons orpropertyarisingfromthispublication. BritishLibraryCataloguing-in-PublicationData AcataloguerecordforthisbookisavailablefromtheBritishLibrary LibraryofCongressCataloging-in-PublicationData AcatalogrecordforthisbookisavailablefromtheLibraryofCongress ISBN:978-0-12-405872-9 PrintedandboundintheUnitedStatesofAmerica 14 15 16 17 18 10 9 8 7 6 5 4 3 2 1 Preface We all know about antioxidants. Some of us take antioxidant vitamins and supplements to promote health. As such, this industry is now a multibillion dollar business. Currently, it is estimated that more than 40% men and 50% women age 60 years or older take at least one vitamin or mineral supplement daily. In popular health magazines, antioxidant supplements are advertised as magic bullets capable of preventing all chronic illnesses. However, free radicals are not villains becausethe human body requires modest amounts of them for normal physiological functions. Therefore, scavenging all free radicals by taking too many antioxidant supplements actually causes more harm than good. In fact, a balanced diet rich in fruits and vegetables and a healthy lifestyle is the best approach to combat oxidative stress. A healthy diet supplies more than enough antioxidants. Vitamins and antioxidant supplements may be needed only for special populations suffering from specific illnesses, and pregnant womenmaytakefolatesupplements. Thepurposeofthisbookistopresentcurrentmedicalknowledgeregardingthe role of antioxidants in health and disease in a concise manner so that health care professionals and medical students can get a balanced overview of this broad topic. We have attempted to provide an enjoyable reading experience, and we avoided detailed discussion of molecular pathways by which oxidative stress triggers individual diseases. However, we provide an overview of such molecular pathways and a long list of references in each chapter so that more advanced readers or those interested in antioxidant research will also find this bookhelpful. We also deliberately avoid chemical structures and detailed discussion of the chemistry of antioxidants, but we cover all important aspects of the chemistry of free radicals and methods used by investigators in the field of antioxidant research.Inordertounderstandwhatelevatedmalondialdehydeconcentration in a disease implies, it is important to know basic chemistry of malondialde- hyde and how it is measured in a biological matrix. We cover basic chemistry of free radicals in Chapter 1, and in Chapter 2 we discuss various analytical methodsusedinlipidperoxidationandfreeradicalchemistryresearch. xiii xiv Preface Air pollution, sunlight, cigarette smoke, and even household chemicals can induce oxidative stress. How our environment induces oxidative stress is addressed in Chapters 3(cid:1)5. We provide a detailed discussion of the link betweenoxidativestressandvariousdiseasesinChapters7(cid:1)11.InChapter12, we discuss various foods that are good sources of antioxidants and present several tables for easy reference on the antioxidant potential of various fruits andvegetables.Inthischapter,theglycemicindexofvariousfruitsisalsogiven because many people throughout the world suffer from diabetes. Tea, coffee, and chocolate are full of antioxidants, and drinking tea or coffee or both is goodforhealth.Whereaschocolateisrichincalories,teaandcoffeearealmost devoidofcaloriesifmilkandsugararenotadded(Chapter13).InChapter14, the benefits of drinking alcoholic beverages in moderation are discussed. However, consuming excessive alcohol is detrimental to health. Wine, especially red wine, is rich in antioxidants, especially resveratrol, which is an excellent antioxidant. In Chapter 15, antioxidant vitamins are discussed, and herbal supplements that are antioxidants and nonherbal supplements with antioxidantproperties are discussed in Chapter 16. However, current research indicates that taking antioxidant supplements or antioxidant vitamins has noaddedhealth benefits but maycauseharm.InChapter17, thebestwayto combat oxidative stress—a healthy lifestyle—is discussed, and references are provided that clearly indicate that daily exercise, pet ownership, interaction with friends and family, and even yoga or mediation can significantly reduce oxidativestress. The purpose of this book is to provide health care professionals with an in-depth knowledge of the current state of research in oxidative stress and antioxidants. This book will provide clinicians, nurses, medical students, nursing students, and pharmacists with a clear understanding of this impor- tant aspect of health and nutrition. This is not a reference book, and it is not intended for experts in this field because there are already excellent reference books on antioxidants. However, students entering the field of antioxidant researchwillfind this book useful. We thank Professor Robert Hunter, our department chair, for encouraging us to write the book and for his support during preparation of the manuscript. Furthermore, we thank our loving spouses, Alice and Chad, respectively. Preparation of the manuscript required an exorbitant amount of time and energy; without theirloveandsupport,this workwouldnot havebeen possi- ble. Wehope you,the readers,willfind this bookuseful;ifyoudo,our effort will be duly rewarded. Amitava Dasgupta Kimberley Klein CHAPTER 1 Introduction to Free Radicals and the ’ Body s Antioxidant Defense 1.1 INTRODUCTION CONTENTS The “oxygen paradox” is defined by the fact that aerobic organisms require 1.1 Introduction oxygen for survival but oxygen is also inherently toxic to these organisms ...............................1 due to its association with free radical generation and oxidative stress. Various freeradicalsare commonproducts ofrespiration andother biochem- 1.2 Free Radicals ...............................1 icalreactionsincellsthatarenormalphysiologicalprocessesessential forsur- 1.2.1 VariousSources vival. To survive in an unfriendly oxygen environment, living organisms ofFreeRadicals.........2 generate water- and lipid-soluble antioxidants that can neutralize these 1.2.2 Damageof highly reactive free radicals [1]. For healthy living, a delicate balance must be BiomoleculesbyFree maintained between oxidative stress and antioxidant defense of the body. If Radicals......................8 the body’s antioxidant mechanism does not operate optimally, excess free 1.2.3 Physiological RoleofFree radicals can damage various biomolecules, including lipids, proteins, carbo- Radicals....................10 hydrates, andnucleic acids. 1.3 The Body’s Antioxidant Defense..............11 1.2 FREE RADICALS 1.3.1 Enzymesas A free radical is defined as an atom or molecule containing one or more Antioxidants............11 1.3.2 Chain-Breaking unpaired electrons that are capable of free existence. Free radicals can be gen- Antioxidants............13 erated as products of homolytic, heterolytic, or redox reaction, and they usu- 1.3.3 Exerciseand ally consist of reactive oxygen species or reactive nitrogen species. Reactive AntioxidantStatusof oxygen species include oxygen-carrying free radicals as well as other reactive Blood.........................14 1.3.4 Markersfor oxygen species such as hydrogen peroxide, which is not a free radical. OxidativeStressin Similarly, reactive nitrogen species include both nitrogen-containing free HumanBlood...........15 radicalsandotherreactive moleculesinwhichthereactivitycenterisnitrogen 1.4 Conclusion..16 [2]. Common free radicals and oxidantsare summarized in Box 1.1. References.........16 Free radicals are generated during normal respiration and cellular functions. Under normal physiological conditions, approximately 2% of oxygen con- sumed by the human body during respiration is converted into superoxide 1 A.DasguptaandK.Klein:AntioxidantsinFood,VitaminsandSupplements.DOI:http://dx.doi.org/10.1016/B978-0-12-405872-9.00001-X ©2014ElsevierInc.Allrightsreserved. 2 CHAPTER 1: Introduction to Free Radicals and Antioxidant Defense Box 1.1 COMMON FREE RADICALS AND OXIDANTS ENCOUNTERED IN HUMAN PHYSIOLOGY FreeRadicals (cid:3) Thiylradical (cid:3) Superoxideanionradical (cid:3) Proteinradical (cid:3) Hydroxylradical Oxidants (cid:3) Hydroperoxylradical (cid:3) Singletoxygen (cid:3) Peroxylradical (cid:3) Ozone (cid:3) Lipidradical (cid:3) Hydrogenperoxide (cid:3) Lipidperoxylradical (cid:3) Hypochlorite (cid:3) Lipidalkoxylradical (cid:3) Nitrousacid (cid:3) Nitricoxide (cid:3) Peroxynitrousacid (cid:3) Nitrosylcation (cid:3) Nitrousoxide anion free radical, which is negatively charged (O (cid:1)2) [3]. The human body 2 also contains approximately4.5mg ofiron,most ofwhichis found in hemo- globin and other proteins. However, a small amount of iron that is found formingcomplexes with avariety ofsmall molecules can react with hydrogen peroxide, producing the hydroxyl radical (Fenton reaction). In general, oxygen-centered free radicals (reactive oxygen species), such as superoxide, the hydroxyl radical, peroxyl radical, and alkoxy radical, and nitrogen oxide, play animportant role in inducing oxidativestress [4]. Nitric oxide (NO(cid:1)) is synthesized from L-arginine by many cell types through nitric oxide synthesis. Nitric oxide and superoxide are the major reactive spe- cies produced in cells. Both superoxide and nitric oxide can react with other species, producing reactive oxygen species and reactive nitrogen species, respectively. Nitric oxide can also bind to transition metals such as ferrous ions, and it plays an important role in the formation of cyclic guanosine monophosphate, a second messenger [5]. In general, superoxide anion radi- cals and nitric oxide are primary free radicals generated by cells during nor- mal physiological functions. 1.2.1 Various Sources of Free Radicals There are two sources of free radicals: endogenous sources and exogenous sources. Major endogenous sources of free radicals are summarized in Table 1.1. The most common reactive oxygen species are superoxide anion, hydrogen peroxide, hydroxyl radicals, peroxyl radicals, singlet oxygen, and ozone. The production of superoxide occurs mostly within mitochondria. The mitochondrial electron transport chain is the main source of energy that is stored in adenosine triphosphate (ATP) molecules. Movement of electrons 1.2Free Radicals 3 Table1.1 EndogenousSourcesofFreeRadicals PhysiologicalProcess Comment Mitochondrialrespiration Essentialprocessoflifethatgeneratessuperoxideanion radical. Autoxidation Autoxidationofmanybiologicalmolecules(hemoglobin, myoglobin,catecholamines,etc.)inthehumanbodycan producefreeradicals.Superoxideistheprimaryfreeradical formed. Enzymaticreaction Manyenzymaticreactionsinvolvingxanthineoxidase, lipoxygenase,aldehydeoxidase,etc.cangeneratefree radicals. Respiratoryburst Thisisaprocessinwhichphagocytesconsumealarge amountofoxygenduringphagocytosis. Metalions Metalionssuchascopperionandferrousion,whichare essentialforthebody,canreactwithhydrogenperoxideto producefreeradicals. Strenuousexercise Mayactivatexanthineoxidase,producingfreeradicals. Infection Mayproducefreeradicalsbecausetheimmunesystemmay trytoneutralizeinvadingmicroorganismswithaburstoffree radicals. Ischemia/reperfusion Mayactivatexanthineoxidase,causingfreeradical generation. from oxidizable organic molecules to molecular oxygen is responsible for ATP production by the mitochondrial electron transport system. During this process, superoxide anions are generated due to leaking of electrons to oxy- gen. Superoxide is also formed enzymatically in the process of reduction of molecular oxygen mediated by nicotinamide adenine dinucleotide phos- phate oxidase (NADPH oxidase) and xanthine oxidase in mitochondria. Superoxide has a relatively longer half-life than that of other free radicals, but it is less reactive than the hydroxyl radical. Inflammatory cells also produce relatively large amounts of superoxide. Superoxide is membrane impermeable but can diffuse within cells [5]. Peroxisomes are another significant source for free radicals. Peroxisomes are specialized cytoplasmic organelles that carry out important physiological functions such as β-oxidation of long-chain and very-long-chain fatty acids and degradation of uric acid. Peroxisomal oxidase is capable of generating hydrogen peroxide. The reaction of xanthine and xanthine oxidase produces the superoxide anion and hydrogen peroxide through one-electron and two- electron reduction of molecular oxygen, respectively, to form uric acid. Hydrogen peroxide is a relatively stable agent that is permeable to cell membranes.Hydrogenperoxide can generatefreeradicals such as the hydroxyl radical but cannot directly oxidize lipid or DNA. Therefore, cytotoxicity of 4 CHAPTER 1: Introduction to Free Radicals and Antioxidant Defense hydrogen peroxide is due to its ability to produce hydroxyl radicals through metal-catalyzed reactions such as the Fenton reaction. However, hydroxyl radicals are highly reactive and can damage any biomolecules close to their site of generation. These radicals are some of the most dangerous free radicals encountered in physiology [6]. Singlet oxygen is an electronically excited form of oxygen, but it is not a free radical. However, singlet oxygen is a reactive oxygen species generated during dismutation of superoxide anion in water. Another endogenously produced oxygen free radical is the peroxyl radical (ROO(cid:1)), the simplest form of which is HOO(cid:1), which is the protonated form of superoxide. Hydroperoxy radical is known to initiate lipid peroxidation. As mentioned previously, nitric oxide (NO(cid:1)) is synthesized from L-arginine through nitric oxide synthases (NOS) in many cell types. Nitric oxide is a water-soluble,short-lived free radicalthat plays an important role as asignal- ing molecule in the body. Mammalian cells contain three genes encoding NOS (NOS1, NOS2, and NOS3), with 51(cid:1)57% homology between isomers. NOS1, also known as nNOS (isoform first purified from neuronal tissue), and NOS3, also known as eNOS (isoform first found in endothelial cells), are also termed constitutive because they are expressed continuously in neu- rons and endothelial cells, respectively. These enzymes also require an increase in calcium concentration in tissues for their activity, thus producing low transient concentration of nitric oxide. In contrast, NOS2 is an inducible calcium-independent form also known as iNOS [7]. The reaction of superox- ide with nitric oxide producesperoxynitrite, whichis a strong oxidizing agent capable ofdamaging proteinand DNA. Respiratory burst, a process by which phagocytic cells such as white blood cells consume a large amount of oxygen during phagocytosis, is another source of endogenous free radicals. Phagocytosis is an important function of immune defense that produces free radicals, mostly superoxide, and also hydrogen peroxide (respiratory burst). In addition, myeloperoxidase is also secreted. Myeloperoxidase, which is highly expressed in neutrophils, catalyti- cally reacts with hydrogen peroxide in the presence of physiological concen- tration of chloride, producing hypochlorous acid (HOCl). This short-lived and diffusible oxidant plays an important role in killing invading microor- ganisms [8]. During ischemia, xanthine oxidase enzymes may be activated, causing oxidative stress by generating free radicals. In addition, the concen- tration of antioxidant enzymes may be reduced. During reperfusion, oxida- tive stress is also increased. Strenuous exercise also increases oxidative stress due to production of free radicals, but the body has the capability to neutral- ize these excess free radicals. Therefore, regular exercise has health benefits. Wagner et al. [9] reported that in 42 male subjects who participated in Ironman triathletes, markers of oxidative stress in blood increased 1.2Free Radicals 5 moderately after the race and returned to normal levels after 5 days. They concluded that despite a temporary increase in oxidative stress, because there was appropriate antioxidant intake and protective alteration in antioxidant defenseof the body, there was no DNAdamage. There are also external sources of free radicals. For example, breathing pol- luted air may expose people to free radicals. These external sources are sum- marized in Table 1.2. Epidemiological studies indicate that fine particulates found in polluted air that are less than 10 μm in diameter (PM 10) can increase the risk of asthma attack and chronic obstructive pulmonary disease. These small particulates in polluted air have free radical activities causing lung inflammation and damage to lung cells [10]. Organic compounds and metal ions, which are major components of these particulates, may originate from industrial source. Air pollution due to automobile exhaust may also contain harmful polycyclic aromatic hydrocarbons that are not only capable of generating free radicals but also act as carcinogens. Reducing exposure to air pollution by using face masks is recommended for patients who are more susceptible to the harmful effects of air pollution, such as patients with coro- nary heart diseases [11]. If possible, it is preferable to stay indoors as much as possible, especially when air quality is poor on hot days, when free radi- cals containing particulates may be at the ground level. In general, air quality is superiorin rural areas compared tourbanareas (see Chapter 3). Table1.2 ExternalSourcesofOxidativeStress ExternalSource Comment Airpollution Exposuretoparticulatemattersinpollutedaircan producesignificantoxidativestress,increasingtheriskfor asthma,cardiovasculardiseases,chronicpulmonary obstructivedisease(COPD),andlungcancer. Inorganicparticlesinair Ingestionofmineralparticlesfromdustinindividuals workinginindustrymaycauseoxidativestress, particularlyifaircontainsfinemineraldust(quartz,silica, andasbestos). Tobaccosmoking Oxidantspresentintobaccosmokecandamagelungs, causingCOPDandevenraisingriskoflungcancer. Somemedications Medicationssuchasbleomycin,adriamycin,and sulfasalazinemayproduceoxidativestress. Industrialsolvents Someindustrialsolvents,suchaschloroformandcarbon tetrachloride,ifinhaledmaycauseoxidativedamage. Exposuretoradiation Exposuretoexcessiveultravioletlight,prolonged exposuretothesun(sunbathing),andtreatmentwith radiationaspartofcancertherapyincreaseoxidative stress.

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Antioxidants in Food, Vitamins and Supplements bridges the gap between books aimed at consumers and technical volumes written for investigators in antioxidant research. It explores the role of oxidative stress in the pathophysiology of various diseases as well as antioxidant foods, vitamins, and all
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