Questions and answers

Despite the fact that flavanols and procyanidins are present in a variety of foods and beverages, the main sources in the context of a European diet are cocoa and chocolate products, tea, grape wine, apples, certain berries, and a couple of other fruit and vegetables.

Unprocessed cocoa seeds, and selected cocoa products manufactured by using flavanol-preserving food processing technologies contain predominantly (-)-epicatechin, some (+)-catechin, and a variety of procyanidins [with 2-10 flavanol subunits]. Principally, the type and amount of flavanols and procyanidins present in any food product, including cocoa, depends on various factors such as: the specific plant species and cultivar that represents the source; agricultural and growing conditions; post-harvest processing and storage conditions; food manufacturing and product design.

Despite the fact that the cocoa seed is a naturally rich source of flavanols, not all cocoa-products contain appreciable amounts of flavanols and procyanidins. Traditional cocoa processing often destroys much of the flavanols and procyanidins (for details see question No 6). All flavanol-containing products used in the context of Flaviola have been specially made and standardized using technologies developed for the preservation of flavanols and procyanidins during the food manufacturing process.

The flavanols and procyanidins that are present in the food products investigated in the context of Flaviola originate from cocoa, and a significant part of our current knowledge on the potential health benefits of flavanols and procyanidins originated from work using cocoa, cocoa products, and flavanols isolated from cocoa. This is, in part, due to the fact that high-quality data on cocoa flavanols already exist on which Flaviola can build on. In addition, a second reason exists, which although more practical in nature is nevertheless very important. The carrying out of high-quality and ultimately meaningful investigations in the context of human nutrition and health is a complex undertaking for many reasons. One such challenge is the need for a well characterized flavanol-containing test product in tandem with a proper flavanol-free control product in the context of dietary intervention trials. The control product would need to be almost identical to the test product in terms of appearance, taste, caloric content, and the amounts of macro- and micro-nutrients contained therein. The only significant difference between the test product and its control in this context should be that fact that the test product contains flavanols and procyandins, and the control does not. Only by using a characterized and standardized flavanol-containing test product and a proper flavanol-free control is it possible to undertake high-rigor research to obtain meaningful and reliable data. This is because it enables the establishment of a causality chain between flavanol intake and observed effects, and it enhances objectivity by excluding potential investigator- and participant-related bias.

However, considering the above, what would be a proper control for a cup of tea, an apple, blueberry juice, or a glass of wine? Researchers in Flaviola will use cocoa-based flavanol-containing food products that are well characterized and standardized with regard to their content of flavanols and procyanidins. Moreover, the control product developed in the context of Flaviola contains practically the same amounts of macro- and micro-nutrients [fat, sugar, protein, fiber, minerals, etc.], calories, caffeine, and theobromine as the flavanol-containing test product, but it does not contain cocoa flavanols. Thus, making it a proper control, and explaining, at least in part, why Flaviola is focused on cocoa and cocoa flavanols as a model for other flavanol-containing foods. While Flaviola focuses on cocoa-derived flavanols and procyanidins, the scientific understanding gained by undertaking this research will extend to other flavanol- and procyanidin-containing food sources.

FLAVIOLA is a special project because of several unique features: 1. FLAVIOLA implicates a multi-faceted, interdisciplinary orientated and translational research approach: The FLAVIOLA research team encompasses translational studies from bench to bedside including chemical analysis, cellular and organ studies as well as in vivo studies. Thus the FLAVIOLA project covers the whole nutrition-health paradigm by including parameters from chemical about biological as far as medical research. 2. FLAVIOLA has a striking impact on the European Society: European citizens benefit from FLAVIOLA in form of validation and development of optimized flavanol-based dietary food matrices allowing a nutritionally responsible food choice, which helps to decrease the risk of cardiovascular disease in Europe. This food choice will comprise efficacy- and food safety-based functional food products without altering the natural flavanol source or artificially enriching the dietary flavanol contents. FLAVIOLA can thereby optimise health and well-being of European consumers. 3. Finally FLAVIOLA establishes new links between research institutions/scientists/physicians and can thus enlarge the European nutrient research community. The FLAVIOLA training programmes and the cross-functional scientific networks allow the facilitated exchange of techniques and knowledge by providing a solid base of experimental and phase I/II clinical data to meaningfully support subsequent large, multinational, randomised, placebo-controlled trials on dietary flavanols and cardiovascular health.

Some of what we know today to be flavanol-containing foods have been used for their health benefits for over a thousand years. Julius Caesar, the Roman general and statesman, used special wine now believed to have had a high flavanol content to prevent gastrointestinal infections in his soldiers (Italy ca. 60–40 BCE). Hildegard of Bingen developed a hawthorn, grape and herb-based tonic, “Herzwein”, to treat what we might classify today as cardiovascular disease (Germany 1098–1179 CE). The health benefits of foods based on cocoa beans - which are now known to be rich in flavanols - are described in the Florentine Codex, an ancient text that provides an important account of Aztec culture (Mexico ca. 1540–1585 CE). Albert Szent-Györgyi won the Nobel Prize in 1937 for his work in the area of what we today call phytonutrients. He discovered and investigated vitamin C and is also responsible for the isolation and initial study of flavonoids, which he initially termed vitamin P.