Green Tea for Cardiovascular Protection and Longevity Extension

Green tea is enjoyed by millions worldwide, with Asia leading the way in consumption. As the health benefits of green tea have become better known, the use of green tea as a dietary supplement in the U.S. is on the increase. Science has learned a great deal about how green tea works. Green tea has a high content of “polyphenols”, naturally occurring compounds that exhibit an ability to protect the cardiovascular system, largely by functioning as antioxidants. But do these protective effects, as discovered in animal studies and “in vitro” (test-tube) experiments, translate to demonstrable health benefits? A large-scale population-based study was undertaken in Japan to find out.

The Ohsaki National Health Insurance Cohort Study followed 40,530 adults from 1995 to 2005. As reported in the Journal of the American Medical Association, the findings revealed that “green tea consumption was inversely associated with mortality due to all causes and due to cardiovascular disease.” In plain language, the statistics on green tea drinking showed that death rates decreased proportionally with the frequency of consumption. While overall mortality and cardiovascular mortality was lower, death due to cancer was unaffected. “Green tea consumption is associated with reduced mortality due to all causes and due to cardiovascular disease but not with reduced mortality due to cancer,” the report concludes.

Extracts of green tea are available in dietary supplements that contain concentrated amounts of polyphenols. Green tea supplements provide a convenient and practical alternative to drinking copious amounts of green tea on a daily basis.

References:
Hsieh SR, et al. Molecular targets for anti-oxidative protection of green tea polyphenols against myocardial ischemic injury. Biomedicine 2014;4:23 Epub 2014 Nov 20.

Kuriyama S. et al. Green tea consumption and mortality due to cardiovascular disease, cancer, and all causes in Japan: the Ohsaki study. JAMA 2006 Sep 13;296:1255-65.

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Critical Tools for a Healthy Liver: Green Tea Catechins

This is part of our ongoing The Best Kept Secrets to Healthy Aging spotlight. Each week, we will be posting some of the great information that’s packed into our book, The Best Kept Secrets to Healthy Aging.

Today’s topic:
Critical Tools for a Healthy Liver: Green Tea Catechins

One cup of brewed green tea contains about 200 mg of polyphenols, about half of which is (–)-epigallocatechin-3-gallate (EGCG). As shown in a study published in Biomedical Research, drinking green tea (which has a high content of catechins) protects the liver from the damage caused by free radicals.1 The results of another recently published study confirmed that the liver, bile duct and gallbladder all receive valuable support from the phytonutrients present within green tea.14

Next Best Kept Secrets to Healthy Aging topic:
Critical Tools for a Healthy Liver: N-Acetylcysteine

References:
1. Abe K, Ijiri M, Suzuki T, Taguchi K, Koyama Y, Isemura M. Green tea with a high catechin content suppresses inflammatory cytokine expression in the galactosamine-injured rat liver. Biomed Res 2005;26:187-192.
14. Abe K, Ijiri M, Suzuki T, Taguchi K, Koyama Y, Isemura M. Green tea with a high catechin content suppresses inflammatory cytokine expression in the galactosamine-injured rat liver. Biomed Res 2005;26:187-192.

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Green Tea for Relaxation

This is part of our ongoing The Best Kept Secrets to Healthy Aging spotlight. Each week, we will be posting some of the great information that’s packed into our book, The Best Kept Secrets to Healthy Aging.

Today’s topic:
Green Tea for Relaxation

The amino acid L-theanine is unique to tea leaves and is primarily obtained in the diet by drinking green tea. Studies in rats and humans have demonstrated that the consumption of L-theanine increases the release of dopamine and serotonin in the brain and increases brain alpha-wave activity, a sign of relaxation and increasing calmness. Research suggests that the consumption of 200 mg of L-theanine about one hour before bedtime can help one relax, which may enhance the ability to sleep.

Next Best Kept Secrets to Healthy Aging topic:
Volatile Oils to Support Healthy Sleep

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A Word about Black Tea

This is part of our ongoing The Best Kept Secrets to Healthy Aging spotlight. Each day, we will be posting some of the great information that’s packed into our book, The Best Kept Secrets to Healthy Aging.

Today’s topic:
A Word about Black Tea

Black and green teas are both derived from the same plant. Black tea is produced by fermenting tea leaves. Thus the catechins that are present in green tea are fermented to theaflavins in black tea. Theaflavins have been studied recently and found to have unique beneficial effect for cardiovascular health that go beyond the effects shown by catechins. While catechins may be more potent as antioxidants, the theaflavins support the cardiovascular system by enhancing endothelial health. A recent study found that green tea and black tea are equally effective in supporting blood vessel vasodilation and nitric oxide (NO) production.35 Theaflavins also have potential liver-protective properties. A study found that theaflavins prevented the accumulation of lipids in the liver, suppressed the synthesis of fatty acids and stimulated fat breakdown in both laboratory and animal experiments, indicating an ability to support fat metabolism and promote liver health.36

Furthermore, theaflavins may help with maintaining cholesterol levels that are already in the normal range.37 A theaflavin-enriched green tea extract was administered to 240 adult men and women in a placebo-controlled study conducted in China. The researchers found that the theaflavin-enriched green tea combination was significantly more effective than the placebo pill at supporting normal cholesterol levels when given in conjunction with a low-fat diet plan. Thus, while green tea catechins are highly beneficial, theaflavins from black tea are important compounds with cardio-protective properties.

Next Best Kept Secrets to Healthy Aging topic:
More on Pycnogenol

References:
35. Lorenz M, Urban J, Engelhardt U, Baumann G, Stangl K, Stangl V. Green and black tea are equally potent stimuli of NO production and vasodilation: new insights into tea ingredients involved. Basic Res Cardiol 2009;104(1):100-10.
36. Lin CL, Huang HC, Lin JK. Theaflavins attenuate hepatic lipid accumulation through activating AMPK in human HepG2 cells. J Lipid Res 2007;48(11):2334-43.
37. Maron DJ, Lu GP, Cai NS, Wu ZG, Li YH, Chen H, Zhu JQ, Jin XJ, Wouters BC, Zhao J. Cholesterol-lowering effect of a theaflavinenriched green tea extract: a randomized controlled trial. Arch Intern Med 2003;163(12):1448-53.

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Green Tea Optimizes Oral Health

This is part of our ongoing The Best Kept Secrets to Healthy Aging spotlight. Each day, we will be posting some of the great information that’s packed into our book, The Best Kept Secrets to Healthy Aging.

Today’s topic:
Tea Optimizes Oral Health

Wouldn’t it be great if something you put into your mouth actually made it healthier? Look no further – just drink green tea. The phytonutrients in teas, especially green teas, are partially absorbed through the soft tissues of the oral cavity and “attach” to every surface, including the surfaces of the teeth. Research has shown that tea phytonutrients keep tooth surfaces clean and healthy and the tiny amount of fluoride in tea helps strengthen tooth enamel.33 Even more impressively, a study using hamsters showed that consuming tea enhanced dental health and tooth integrity.34 The composition of human teeth and hamster teeth is similar – so when it comes to a healthy mouth, tea consumption appears to have great potential.

There can be no doubt – for good health and healthy aging, green tea and green tea catechins are among your strongest allies.

Next Best Kept Secrets to Healthy Aging topic:
A Word about Black Tea

References:
33. Yu, H., Oho, T., Xu, L. X. Effects of several tea components on acid resistance of human tooth enamel. J Dent 1995;13:101-105.
34. Linke HA, LeGeros RZ. Black tea extract and dental caries formation in hamsters. Int J Food Sci Nutr 2003;54:89-95.

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Green Tea Helps Keep Healthy Kidneys Healthy

This is part of our ongoing The Best Kept Secrets to Healthy Aging spotlight. Each day, we will be posting some of the great information that’s packed into our book, The Best Kept Secrets to Healthy Aging.

Today’s topic:
Tea Helps Keep Healthy Kidneys Healthy

The kidneys are major organs involved in filtering and eliminating toxins from the body and preserving electrolytes and water. The correct performance of these functions is essential to life and critical to health and wellbeing. Green tea can help support the health of these essential organs.

Excellent scientific research vouches for the benefits your kidneys derive from tea. In a landmark study of 81,093 women who were 40 to 65 years of age when the study began in 1986 (part of the Nurses’ Health Study), the investigators found that every cup of either caffeinated or decaffeinated tea consumed daily progressively enhanced the maintenance of healthy kidney function.31 An earlier study in men had found a similar per-cup enhancement in kidney health.32

These findings mean that drinking a cup of green tea at every meal can be a wise choice for individuals looking to support healthy kidney function and those interested in prevention. The findings also mean that drinking 5 or 6 glasses of tea daily could be extremely beneficial. Likewise, since the benefits of tea for kidney health are probably due as much to the phytonutrients in tea as to the associated increase in water consumption, adding a dietary supplement containing the catechin equivalent of 48 ounces of tea (about 1000 mg total catechins) may yield significant benefits for healthy kidneys.

Next Best Kept Secrets to Healthy Aging topic:
Tea Optimizes Oral Health

References:
31. Curhan GC, Willett WC, Speizer FE, Stampfer MJ. Beverage use and risk of kidney stones in women. Ann Intern Med 1998;128:534-540.
32. Curhan GC, Willett WC, Rimm EB, Spiegelman D, Stampfer MJ. Prospective study of beverage use and the risk of kidney stones. Am J Epidemiol 1996;143:240-247.

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Drink Green Tea to Keep that Belly in Line

This is part of our ongoing The Best Kept Secrets to Healthy Aging spotlight. Each day, we will be posting some of the great information that’s packed into our book, The Best Kept Secrets to Healthy Aging.

Today’s topic:
Drink Tea to Keep that Belly in Line

In men and women, the degree of body fat, whether expressed as percent body fat or the ratio of waist circumference to hip circumference, tends to decrease as green tea intake increases.22 Green tea contributes to the maintenance of healthy body weight in several ways.

One of the least appreciated properties of green tea is its ability to limit the absorption of the fat taken in from the diet. Green tea catechins (especially EGCG) interfere with the lipase (fat-digesting) enzymes in the stomach and small intestine. The resulting incomplete digestion of fats produces some lipid droplets that are not able to enter intestinal cells and that therefore remain unabsorbed. These effects have produced significant decreases in the absorption of dietary fats by rats consuming green tea. While it is not known how effective green tea is in blocking fat absorption in humans, any interference with the normally highly efficient digestion and absorption of dietary fats could figure prominently in any effort to manage weight effectively.

In addition to decreasing the efficiency of absorption of fatty acids from the diet, green tea catechins interfere with the production of fat for storage in adipose tissue depots. Green tea leaf extract rich in EGCG, as well as purified EGCG itself, reduces the activity of fatty acid synthase, the enzyme that controls how rapidly the body produces fat for storage. This effect is consistent with a body of literature reviewed recently in the journal Molecular Nutrition and Food Research that shows how EGCG inhibits new fat formation (“lipogenesis”) and fat storage within adipocytes.23 Tea helps to absorb less fat from the diet and can directly interfere with the storage of fat in adipocytes, a dual mechanism for supporting healthy body weight.

The dominant green tea catechin, EGCG, also entices the body to shift some of its manner of producing energy from glucoseburning to fat-burning. There are two ways to accomplish this and EGCG seems to do both. First, if the amount of glucose available to tissues, especially the skeletal muscles, is reduced, then more fat must be metabolized to carbon dioxide and water in order to satisfy energy needs. During times when glucose is in short supply, the liver synthesizes glucose from a variety of precursors, including amino acids released by muscle cells. The first enzyme in this synthetic (“gluconeogenic”) pathway, phosphoenolpyruvate carboxykinase (PEPCK), is inhibited by EGCG. Blocking this enzyme reduces the rate of formation of new glucose, requiring cells to switch to burning fat for energy.

In an example of exquisite biochemical coordination, EGCG also stimulates the conversion of fatty acids to energy. In cell culture studies, EGCG has increased the rate of utilization of fatty acid breakdown products instead of glucose to produce energy. In a series of experiments, mice, often studied because the way they obtain energy is pretty much the same as the way humans do, have responded to the addition of catechin-rich green tea extract to a high-fat diet with less weight gain and less fat accumulation within their bodies than mice fed the same high-fat diet but not fed catechins, despite eating just as much. This phenomenon has been studied in depth. In a recent study dietary supplementation of exercising mice with tea catechins forced skeletal muscles to switch from using their glycogen reserves as energy sources to increasing their reliance on burning fats from adipose depots.24 This “switch” is so reproducible that the researchers can predict when it will happen. The powerful phytonutrients (catechins) in green tea and green tea extract can recruit muscles to help stored fat get used up faster!

In humans, such a shift from glucose-burning to fat-burning will be seen as an increase in heat production (or thermogenesis). In a convincing demonstration of the fat-burning, thermogenic effects of green tea catechins, 24-hour heat production was measured in healthy lean to overweight young men during days in which they remained essentially at rest and consumed identical diets, no caffeine-containing foods or beverages, and either a placebo, 150 mg of caffeine alone or 150 mg of caffeine plus 270 mg of EGCG and 105 mg of other mixed catechins.25 These investigators observed that the consumption of placebo or 150 mg of supplemental caffeine alone during a 12-hour period failed to affect the utilization of fat or glucose to supply energy. In contrast, the consumption of green tea catechins during a 12-hour period increased same-day 24-hour total energy expenditure and heat production. This increase in energy usage was caused by increased fat-burning and decreased use of glucose for fuel.

Because under the conditions of this experiment all energy expenditure was essentially “resting” energy expenditure, the catechin-induced increase in resting energy expenditure reflects enhanced thermogenesis. That is, more heat production as a “byproduct” of energy production. Since increased heat production to satisfy the same energy demand means that the efficiency of energy production decreased, more stored energy needed to be “burned” – accelerating the rate at which energy stored in fat depots would become depleted. Of course, as stored fat becomes depleted, both body weight and fat depot size decrease.

The increase in fat utilization in this experiment, which was minimized by keeping the subjects in a “resting” state, could result in the loss of one pound of excess body weight in 1 to 2 months and a loss of 6 to 12 pounds in a year. Consistent with this rough prediction, overweight adults consuming 270 mg of EGCG daily for 3 months experienced an average loss of 4.6% of total body weight, with an average decrease in waist circumference of 4.5%.26 This thermogenic effect of green tea catechins, when combined with a healthy diet and exercise, could be extremely beneficial for those looking to support weight management efforts.

Beneficial results also were obtained in a “gold standard,” randomized placebo-controlled clinical trial, published recently in the American Journal of Clinical Nutrition.27 In this study healthy men supplemented their diets with either 22 mg or 690 mg of total catechins daily for 12 weeks. At the end of the experiment, the men who were consuming 690 mg of total catechins daily had lost more weight, more inches off their waist, more total body fat and more abdominal fat.

What about Stress and Abdominal Fat?

A growing body of evidence indicates that in both men and women, stress and mood issues are associated with increased abdominal fat storage and a larger waistline. How is stress and belly fat connected?

Stress can increase the secretion of a hormone called cortisol. This hormone increases the rate of fat accumulation by abdominal fat cells. Even among healthy individuals, repeated episodes of stress-related cortisol secretion is implicated in increased abdominal fat.28

What Can Green Tea Do About It?

Green tea contains an unusual amino acid – L-theanine. This amino acid comprises up to 2.5% of the total dry weight of unfermented green tea leaves, is absorbed efficiently and can enter the brain from the blood. Within the brain, L-theanine exerts relaxing physiologic effects. In so doing, L-theanine may act to reduce perceptions of stress with possible beneficial effects on abdominal fat formation. For example, mice fed L-theanine have gained less weight and accumulated less abdominal fat.29,30 By supporting the body’s stress response, green tea and green tea extracts containing L-theanine can make important contributions to healthy weight maintenance.

Next Best Kept Secrets to Healthy Aging topic:
Tea Helps Keep Healthy Kidneys Healthy

References:
22. Wu CH, Lu FH, Chang CS, Chang TC, Wang RH, Chang CJ. Relationship among habitual tea consumption, percent body fat, and body fat distribution. Obes Res 2003;11:1088-1095.
23. Wolfram S, Wang Y, Thielecke F. Anti-obesity effects of green tea: From bedside to bench. Mol Nutr Food Res 2006;50:176-187.
24. Murase T, Haramizu S, Shimotoyodome A, Tokimitsu I, Hase T. Green tea extract improves running endurance in mice by stimulating lipid utilization during exercise. Am J Physiol Regul Integr Comp Physiol 2006;290:R1550-R1556.
25. Dulloo AG, Duret C, Rohrer D, Girardier L, Mensi N, Fathi M, Chantre P, Vandermander J. Efficacy of a green tea extract rich in catechin polyphenols and caffeine in increasing 24-h energy expenditure and fat oxidation in humans. Am J Clin Nutr 1999;70:1040-1045.
26. Chantre P, Lairon D. Recent findings of green tea extract AR25 (Exolise) and its activity for the treatment of obesity. Phytomedicine 2002;9:3-8.
27. Nagao T, Komine Y, Soga S, Meguro S, Hase T, Tanaka Y, Tokimitsu I. Ingestion of a tea rich in catechins leads to a reduction in body fat and malondialdehyde-modified LDL in men. Am J Clin Nutr 2005;81:122-129.
28. Rosmond R, Dallman MF, Bjorntorp P. Stress-related cortisol secretion in men: Relationships with abdominal obesity and endocrine, metabolic and hemodynamic abnormalities. J Clin Endocrinol Metab 1998;83:1853-1859.
29. Juneja LR, Chu D-C, Okubo T, Nagato Y, Yokogoshi H. L-theanine, a unique amino acid of green tea and its relaxation effect in humans. Trends Food Sci Technol 1999;10:199-204.
30. Zheng G, Sayama K, Okubo T, Juneja LR, Oguni I. Anti-obesity effects of three major components of green tea, catechins, caffeine and theanine, in mice. In Vivo 2004;18:55-62.

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A Healthy Skeleton Benefits from Green Tea

This is part of our ongoing The Best Kept Secrets to Healthy Aging spotlight. Each day, we will be posting some of the great information that’s packed into our book, The Best Kept Secrets to Healthy Aging.

Today’s topic:
A Healthy Skeleton Benefits from Tea

Several decades ago, several scary articles received a great deal of publicity.16,17 These articles attempted to show that drinking beverages containing caffeine somehow could weaken a woman’s bones. — Wrong! — The real story: three more recent studies proved that the earlier articles had shown that women who drank even large amounts of beverages containing caffeine experienced reductions in bone density only if they also were deficient in calcium or vitamin D!18-20 In fact, research shows that caffeine intake has no effect on bones in anyone at any age.19,20

Drinking at least 2 cups of phytonutrient-packed black or green tea every day enhances bone health and strength. This was shown most powerfully in the 91,465 postmenopausal women who participated in the U.S. government’s Women’s Health Initiative study.21 The results of this study, published in the American Journal of Epidemiology make it quite clear that instead of avoiding tea, women who drink at least 2 cups of tea every day can enjoy optimized bone mass throughout their bodies, and especially in parts of the vertebral spine.

Next Best Kept Secrets to Healthy Aging topic:
Drink Tea to Keep that Belly in Line

References:
16. Ilich JZ, Brownbill RA, Tamborini L, Crncevic-Orlic Z. To drink or not to drink: How are alcohol, caffeine and past smoking related to bone mineral density in elderly women? J Am Coll Nutr 2002;21:536-544.
17. Kiel DP, Felson DT, Hannan MT, Anderson JJ, Wilson PW. Caffeine and the risk of hip fracture: The Framingham Study. Am J Epidemiol 1990;132:675-684.
18. Rapuri PB, Gallagher JC, Kinyamu HK, Ryschon KL. Caffeine intake increases the rate of bone loss in elderly women and interacts with vitamin D receptor genotypes. Am J Clin Nutr 2001;74:694-700.
19. Lloyd T, Rollings NJ, Kieselhorst K, Eggli DF, Mauger E. Dietary caffeine intake is not correlated with adolescent bone gain. J Am Coll Nutr 1998;17:454-457.
20. Lloyd T, Johnson-Rollings N, Eggli DF, Kieselhorst K, Mauger EA, Cusatis DC. Bone status among postmenopausal women with different habitual caffeine intakes: A longitudinal investigation. J Am Coll Nutr 2000;19:256-261.
21. Chen Z, Pettinger MB, Ritenbaugh C, LaCroix AZ, Robbins J, Caan BJ, Barad DH, Hakim IA. Habitual tea consumption and risk of osteoporosis: A prospective study in the Women’s Health Initiative Observational Cohort. Am J Epidemiol 2003;158:772-781.

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Green Tea Helps Keep Your Blood Flowing

This is part of our ongoing The Best Kept Secrets to Healthy Aging spotlight. Each day, we will be posting some of the great information that’s packed into our book, The Best Kept Secrets to Healthy Aging.

Today’s topic:
Tea Helps Keep Your Blood Flowing

There is some scientific evidence that drinking tea helps to maintain healthy blood vessel function and the delivery of oxygenated blood to the heart to keep tissues healthy. Regular tea consumption also has been reported to help blood vessels respond properly to vasodilating stimuli – in other words, the vessels expand to allow more blood to pass when more oxygenated blood is needed, especially to the heart muscle. Tea maintains circulatory function through the heart and to the peripheral tissues and organs.

The catechins in green tea not only help blood vessels respond properly to stimuli, they also help protect the interior lining of blood vessels from invasion by over-stimulated smooth muscle cells (blood vessels that can expand and contract are surrounded by smooth muscle cells that control the vessels’ diameter). Catechins can thus support the pliability of vessel tissue, keeping vessels healthy and keeping them functioning as they are intended. The results of a study published recently in Cardiovascular Research have shown that the catechins in green tea extract prevent the secretion of enzymes by over-stimulated vascular smooth muscle cells, supporting the integrity of the lining of blood vessels and ensuring they remain healthy and undamaged, maintaining their normal structure and function. This modulatory effect of green tea catechins on blood vessel health leads to their ability to healthfully support cardiovascular function.15

Next Best Kept Secrets to Healthy Aging topic:
A Healthy Skeleton Benefits from Tea

References:
15. El Bedoui J, Oak MH, Anglard P, Schini-Kerth VB. Catechins prevent vascular smooth muscle cell invasion by inhibiting MT1-MMP activity and MMP-2 expression. Cardiovasc Res 2005;67:317-325.

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Green Tea Helps Keep Your Heart Healthy

This is part of our ongoing The Best Kept Secrets to Healthy Aging spotlight. Each day, we will be posting some of the great information that’s packed into our book, The Best Kept Secrets to Healthy Aging.

Today’s topic:
Tea Helps Keep Your Heart Healthy

Tea, especially green tea, is great for the heart. It helps keep arteries healthy, the heart pumping strong and protects cholesterol and lipids from free radical damage.

Scientists have found that tea is heart protective and the incidence of heart-related events is inversely proportional to the consumption of green tea.11 In other words, the more green tea (or green tea catechins) you consume, the better your chances of staying heart-healthy longer.

More evidence of green tea’s heart prowess comes from additional research. In one 25-year long study of the same group of elderly men in Europe, the habitual daily consumption of at least 86 mg of total catechins (equivalent to one-half cup of green tea) was found to double the chances of having optimal cardiac function with age.12 Investigators who pooled the results of previous studies worldwide calculated that every cup of black or green tea consumed on a regular daily basis reduced the risk of heart-related events by about 4%.13 They explained that they found a weaker effect in the overall results because in the U.S. few men drink tea. Nonetheless, these reports are consistent in concluding that healthy hearts are more common among tea drinkers.

Due to the antioxidant benefits among tea drinkers, cardiac protection is increased. The catechins in green tea may directly contribute to healthy heart function by scavenging various free radical species that could be detrimental to heart tissue. Studies show again and again that those individuals consuming tea are more likely to have stronger hearts than those who consume less or none at all. For example, a study performed through Harvard University examining about 1900 men and illustrates this point well.14 Among these men and women, those who drank one or two cups on a routine daily basis lived on average 28% longer and those who drank an average of more than two cups daily lived about 44% longer.

While it is not clear exactly what attribute of tea improved the survival and longevity of these study subjects, and a number of theories have been suggested, including the benefits of an increased antioxidant status among tea drinkers, it is clear that the benefits to the heart of tea and catechin consumption cannot be denied.

Next Best Kept Secrets to Healthy Aging topic:
Tea Helps Keep Your Blood Flowing

References:
11. Sano J, Inami S, Seimiya K, Ohba T, Sakai S, Takano T, Mizuno K. Effects of green tea intake on the development of coronary artery disease. Circ J 2004;68:665-670.
12. Arts IC, Hollman PC, Feskens EJ, Bueno de Mesquita HB, Kromhout D. Catechin intake might explain the inverse relation between tea consumption and ischemic heart disease: The Zutphen Elderly Study. Am J Clin Nutr 2001;74:227-232.
13. Peters U, Poole C, Arab L. Does tea affect cardiovascular disease? A meta-analysis. Am J Epidemiol 2001;154:495-503.
14. Mukamal KJ, Maclure M, Muller JE, Sherwood JB, Mittleman MA. Tea consumption and mortality after acute myocardial infarction. Circulation 2002;105:2476-2481.

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