Scientists have long known about the benefits of flavanol, a type of antioxidant found in foods and beverages such as apples, berries, tea, cocoa, and red wine. These compounds are best known for supporting cardiovascular health, and for good reason—past research has found that a daily flavanol supplement of 500 milligrams (mg) in healthy older adults was associated with a 27% reduction in heart disease-related deaths.
But a new study, published in Food and Function, reveals that most Americans following current dietary guidelines aren’t getting 500 mg of flavanol a day.
Below, dietitians and a cardiologist explain why that is and share how you can adjust your meals to include more antioxidants for heart health.
Meet the Experts: Bharat Sangani, M.D., internal medicine cardiologist in Gulfport, Mississippi, and Dallas, Texas; Lauren Manaker, R.D., registered dietitian, nutritionist, and MegaFood partner; Michelle Routhenstein, M.S., R.D., C.D.C.E.S., C.D.N., preventive cardiology dietitian at EntirelyNourished.com.
What did the study find?
Researchers drew on data collected for two large-scale studies (COSMOS, conducted in the U.S., and EPIC Norfolk, conducted in the U.K.), analyzing urine samples collected from some 30,000 participants to determine flavanol intake based on biomarkers. They then compared those figures to the participants’ self-reported diets. Ultimately, the researchers found that 19.2% of COSMOS participants and 17.9% of EPIC participants—or less than one in five people—ingested the suggested 500 mg of flavanol per day. Even the participants with the healthiest overall diets were unlikely to meet the 500mg mark, revealing that following existing dietary recommendations does not guarantee that you’ll get enough flavanol.
Additionally, the researchers ran computer simulations estimating flavanol intake from commonly consumed U.S. produce (such as bananas, apples, tomatoes, grapes, oranges, and carrots), and found it was indeed unlikely that consumers would get 500 mg of flavanol from fruits and vegetables alone.
“Notably, the researchers chose biomarker thresholds designed to overestimate how many people hit the 500 mg target, so the real numbers are likely even lower than reported,” says Lauren Manaker, R.D., registered dietitian, nutritionist, and MegaFood partner.
“That’s a real gap,” says Bharat Sangani, M.D., an internal medicine cardiologist in Gulfport, Mississippi, and Dallas, Texas. While he cautions that “a varied, colorful diet is still the foundation” of good nutrition, Dr. Sangani believes “this study tells us flavanol-rich choices deserve a more deliberate spot in the larger mix.”
At the moment, the United States Department of Agriculture (USDA) doesn’t have a specific recommendation for dietary flavanols. The current guidelines simply advise Americans to consume five combined servings of fruits and vegetables per day.
Still, more research may be needed before experts think about changing the recommendations. “The 500 mg target comes out of a supplement trial, not food,” Dr. Sangani says. “Whether you get the same effect eating your way there is still not fully answered. Bioavailability from whole foods versus a capsule isn’t always equivalent.”
How to eat more flavanols
Foods high in flavanol include pome fruits like apples (with the skin), stone fruits like plums, as well as cranberries, blackberries, cherries, and green tea, among others, Manaker says. Other options include pinto and fava beans and cocoa-derived products.
Upping your intake could be as simple as swapping your afternoon banana for an apple, or having a cup of green tea with meals.
The bottom line
Dr. Sangani says that while eating the recommended servings of fruits and vegetables is a “good baseline,” the study underscores that meeting that threshold “doesn’t automatically get you where you need to be for flavanol-related heart benefits.” He adds, “People should think less about quantity and more about variety. And if you have cardiovascular risk factors, always talk to your doctor about your current diet.”
“The honest truth is that most people are not meeting their fruit and vegetable needs at all,” says Michelle Routhenstein, M.S., R.D., C.D.C.E.S., C.D.N., preventive cardiology dietitian at EntirelyNourished.com. “We need to prioritize that first, and then, within their fruit and vegetable intake, hone in on specific choices that provide cardiovascular phytonutrients and micronutrients in adequate amounts to support heart health.”
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