Flaxseed: A Functional Food Fighting for You

Amanda Griffiths
NTR 402: Advanced Food Science
November 4, 2016
Flaxseed and its Link to Cardiovascular Disease
Obesity is a major problem plaguing over a third (36.5%) of the population in the United
States along with societys reliance on a diet filled with fast-food hamburgers and frozen TV
dinners (Ogden, Carroll, Fryar, & Flegal, 2015). Both of these factors help to contribute to the
major prevalence of heart disease among the United States population. Heart disease, which is a
general term that blankets many cardiovascular problems, is the number one killer of both men
and women in the United States, accounting for one of every four deaths each year (Center for
Disease Control and Prevention, n.d.). Under the general term of heart disease, the most
prevalent condition is coronary artery disease (CAD), thisis associated with plaque buildup in
arteries which can then cause restricted blood flow and weakening of the heart muscle (Center
for Disease Control and Prevention, n.d.). Peripheral artery disease (PAD) is similar to CAD in
that both result from atherosclerosis, plaque buildup. Peripheral artery disease is characterized by
limited blood flow to extremities while CAD is limited blood flow to the heart. The plaque
buildup associated with both conditions is generally composed of cholesterol, and while the body
is capable of making cholesterol on its own, many people consume high amounts of cholesterol
from diets high in saturated fat which causes the unhealthy buildup (Center for Disease Control
and Prevention, n.d.).
With the high prevalence and severity of coronary heart disease, it is important for people
to be aware of the risks of a diet high in saturated fats. For some people, however, simply
avoiding the harmful foods is not enough; some people search for foods that can reverse the

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damages that may have resulted from years of poor diet choices. In general, that is a tall order for
any one product to deliver, but in the recent years researchers have been studying flaxseed for its
many beneficial characteristics. In ancient times, flaxseed was utilized for its high fiber content
and incorporated into clothing and paper; the oils from the seed was used for animal feed (Goyal,
Sharma, Upadhyay, Gill, & Sihag, 2014, p. 1633). Today, however, researchers consider the use
of flaxseed as a functional food; a food similar in appearance to a conventional food, consumed
as a part of the usual diet, with demonstrated physiological benefits, and/or to reduce the risk of
chronic disease beyond basic nutritional functions (Goyal et al., 2014, p. 1636). The major
components of flaxseed include: soluble and insoluble fibers, proteins, antioxidants, omega-3
fatty acids, and alpha-linolenic acid (Goyal et al., 2014, p. 1633). Each of these components
contributes to the usefulness of flaxseed to fight and reduce the effects of chronic disease.
Flaxseed has been shown to lower high cholesterol levels which can cause both PAD and CAD.
With regards to cardiovascular patients, the high levels of omega-3 fatty acids and alphalinolenic acid contained in flaxseed is particularly of interest due to their physiological effects.
A Careful Balance of Omega-3 and Omega-6 Fatty Acids
Alpha-linolenic acid (ALA) is a type of omega-3 fatty acid which is essential for humans
to consume in their diets as the body is incapable of making the fatty acid on its own due to the
inability to produce a double bond past the ninth carbon on the carboxyl end of a fatty acid
(Kajla, Sharma, & Sood, 2015, p. 1859). Humans can consume omega-3 fatty acids from fish
such as mackerel, trout, and salmon. ALA on the other hand can be found in flaxseed, canola oil,
and certain types of walnuts. Once in the body, ALA is converted into eicosapentaenoic acid
(EPA) and docosahexanoic acid (DHA) which are then metabolized further. These metabolites,
such as prostaglandins, have an anti-inflammatory effect. Chronic inflammation can often times

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act as a precursor to atherosclerosis which then causes the artery to narrow a cause of both CAD
and PAD (Kajla, Sharma, & Sood, 2015, p. 1860).
While omega-3 fatty acids are known to have an anti-inflammatory response in the body,
omega-6 fatty acids display the opposite effect. Omega-6 fatty acids can be found in common
ingredients such as poultry, eggs, and canola oil and are essential in a healthy diet. Due to the
common ingredients in which they are found, omega-6 fatty acids are often consumed at much
higher rates than omega-3 fatty acids. Due to the fact that omega-3 fatty acids and omega-6 fatty
acids have antagonistic effects and utilize the same enzymes for processing, the level of
consumption of each should be relatively similar. It is recommended that people eat a ratio of
4:1, omega-6 to omega-3 fatty acids. Despite this recommendation, the ratio of omega-6 to
omega-3 fatty acid consumption is estimated to be 20-30:1 in western diets (Kajla, Sharma, &
Sood, 2015, p. 1860). This means that the inflammatory effect from omega-6 fatty acids is not
being balanced out proportionally by the anti-inflammatory effect of omega-3 fatty acids. This
could further impact the narrowing of arteries and lack of proper blood flow throughout the body
that is necessary for good health.
Flaxseed: Effect on Cholesterol Levels in PAD Patients
Testing cholesterol levels with a blood test can allow physicians to measure how much of
each type of cholesterol is circulating in the blood. The two major types of cholesterol are lowdensity lipids (LDL), which are commonly referred to as the bad cholesterol due to its ability
to buildup and create hard deposits along the arteries, and high-density lipids which are the
good type of cholesterol as it helps to remove LDL buildups (Center for Disease Control and
Prevention, n.d.). Patients with PAD tend to have high levels of LDL and low levels of HDL
which allows more plaque to build up, putting them at higher risk for heart attack and stroke

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(Edel et al., 2012, p. 750). With such severe risks associated with PAD, researchers are exploring
new avenues for treatment.
The FLAX-PAD Trial (2015) was a double-blind and randomized trial conducted in
Winnipeg, Canada that aimed to link an increase in flaxseed consumption to lower levels of
cholesterol. This experiment required all participants to have a documented diagnosis of PAD
among other exclusion factors; in total 110 participants fit all of the criteria required for
participation. Of the 110 patients, 58 were placed in the milled flaxseed treatment group and
52 were in the control group (Edel et al., 2012, p. 750). During the twelve-month trial,
participants were given products such as snack bars, bagels, and pasta, with the control group
receiving products with wheat incorporated into them and the experimental group receiving
milled flaxseed (flaxseed needs to be milled for the functional components to be bioavailable)
(Zeratsky, 2015). The participants were also given milled product that they could sprinkle over
foods already found in their diets. After eating one wheat or flaxseed product per day (an
equivalent of 30g), lipid levels were measured at baseline, one, six, and twelve months. After
statistical analysis, it was determined that there was a significant reduction of 11-15% in total
and LDL concentrations, respectively, in the blood stream for the experimental, flaxseed group at
the one-month mark (p=0.05) when compared to the placebo. The concentration of LDL was
determined to be insignificantly less for the flaxseed group at the six-month mark (p= 0.12) and
no different than the placebo group at the twelve-month measurement (p=0.33) (Edel et al., 2012,
p. 751).
Another key aspect of this trial was a subgroup of participants that were already on
cholesterol lowering medications, such as statins, before and during the trial. A secondary goal of
this trial was to determine if flaxseed consumption could enhance the LDL-lowering capabilities

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of medications. Thirty-six participants taking cholesterol lowering medication were given
flaxseed products (30g per day) and 26 were given the placebo wheat products in addition to
their medications. When comparing baseline and twelve-month measurements, it was determined
that the group that was taking the medication and receiving flaxseed experienced a significant
reduction of 8.5% in LDL concentration compared to the placebo and medication group which
experienced a 3.0% significant increase in LDL concentration (p= 0.03) (Edel et al., 2012, p.
751).
Despite the fact that the LDL concentrations were not significantly reduced at the six and
twelve-month measurements for the first subgroup, the researchers of the FLAX-PAD trial were
able to state that milled flaxseed in the diet does lower LDL concentration in patients with
preexisting PAD. Factors such as adherence over a relatively long trial (12 months) to a strict 30g
per day consumption requirement could have impacted the final results. Also, the sample size
(n=110) was relatively low which could also impact the significance of the findings (Edel et al.,
2012, p. 754). With regards to the subgroup of participants that were given cholesterol lowering
medication, researchers were able to confidently state that flaxseed consumption does not
interfere positively or negatively with the medication but rather works independently to lower
LDL concentration (Edel et al., 2012, p. 755). There are limitations to these statements however,
and a need for more research. Of the types of medications used, 90% were a type of statin (Edel
et al., 2012, p. 755). More research should be conducted to determine if flaxseed also works
independently to lower LDL concentration with other types of cholesterol lowering medications.
With the knowledge gained from these results, more public awareness and education should be
done to attempt to shift the mindset of the public from a reliance on medications and pills to
whole and healthy foods in order to improve cardiovascular health.

Flaxseed: Use for Prevention of Cardiovascular Disease Rather than Treatment

Unlike the previous trial which aimed to identify flaxseed as a functional food that can
help reduce the effects and causes of a disease after diagnosis, there is also much research
regarding the use of flaxseed by healthy people as a way to prevent diseases such as
cardiovascular disease (CAD and PAD). In a double-blind, randomized study conducted by
Kristensen et. al, 17 college students were recruited by the University of Copenhagen.None of
the participants had preexisting chronic diseases, and all maintained regular activity levels,
exhibited normal use of medication (as defined by the design criteria) and had a mean BMI of
23.8 (2012). The study consisted of three, one week periods of testing, each separated by a oneweek break. During this time, participants were given pre-portioned and premade meals that
simply needed to be reheated. The standardized meals were also supplemented with drinks and
breads that contained either flaxseed (5g) or modified corn starch (placebo) that were to be
ingested three times a day. At the end of the experiment, 16 subjects completed all three phases.
After statistical analysis, it was determined that the flaxseed drink lowered total cholesterol and
LDL concentrations significantly by 12-15% (p<0.001) when compared to the placebo, whereas
the flaxseed bread lowered total cholesterol and LDL concentrations less significantly by 7-9%
(p<0.05) (Kristensen et al., 2012, p. 4). There were no significant effects on fasting cholesterol
levels or HDL levels.
Despite the fact that the study yielded significant and favorable results, there are many
limitations. The biggest limitation to this study is the extremely small sample size. With only
sixteen subjects that completed the entire trial, the results of just one subject being skewed could

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drastically influence the results. The limited sample size also reduces the ability to generalize the
results of the study to a bigger population. Also, the study was only three weeks of testing which
limits the scope of the results; these results cannot be used to predict if flaxseed will have a
lasting effect on LDL and total cholesterol concentrations (Kristensen et al., 2012, p. 6).
While there are many limitations to this study there are still two beneficial results. This
study shows that an increase in flaxseed consumption indirectly relates to LDL and total
cholesterol levels which can be helpful for those looking for dietary ways to prevent and reduce
the risk of cardiovascular disease related to atherosclerosis. This study also shows that there are
differences in the effectiveness of flaxseeds nutrients depending on the preparation methods and
mediums used. Milled flaxseed is the preferred form as the components in processed flaxseed are
more bioavailable in the body and will allow the body to digest the seed more easily as opposed
to simply passing through (Kristensen et al., 2012, p. 6). There may also be differences in
functionality, availability, and digestibility depending on what form of flaxseed is consumed.
Another factor that is important to recognize is that flaxseed in certain products may be more
acceptable than others in regards to taste.
Incorporating Flaxseed into a Normal Diet
Despite the high nutrient content and numerous health benefits commonly associated
with flaxseed, recommendations to increase consumption will not be followed if the inclusion of
flaxseed into products yields an undesirable result. Many consumers choose their foods after
carefully judging products organoleptically. This means the food needs to look, smell, feel, and
even sound appealing rather than simply tasting good. For flaxseed to be incorporated into
preexisting recipes there needs to be no detectable change or a change that consumers may find
favorable. In a study that utilized the opinions of volunteer testers with limited training, the

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addition of 30 grams of flaxseed was evaluated in snack bars and muffins. Three different flavors
of snack bars were tested: orange cranberry, gingerbread raisin, and cappuccino chocolate chip.
Two flavors of muffins were tested: orange cranberry and apple spice (Aliani, Ryland, & Pierce,
2011, p. 2490).
A three-way ANOVA test was completed to statistically analyze the results. Overall, the
addition of flaxseed impacted the flavor and aroma of all of the products tested, albeit some
products were reported to be more effected than others. For example, the orange cranberry snack
bar with the flaxseed was significantly lower in detectable orange and bran flavors whereas the
cappuccino chocolate chip bar had a significantly increased bitter taste (p<0.05) (Aliani et al.,
2011, p. 2493). Similarly, with the muffins, the orange cranberry and flaxseed variation was
reported to have significantly lower sweet flavors and the apple spice and flaxseed muffin was
reportedly more bitter (p<0.05) (Aliani et al., 2011 p. 2493). Surprisingly, the addition of
flaxseed did not affect the orange flavor in the orange cranberry muffin as much as it did the
snack bars. These results indicate that every recipe is unique and that more research should be
conducted on the best ways to incorporate flaxseed into existing recipes. Also, it is important to
keep in mind that while someone may prefer a less pungent orange flavor, others may find it too
bland and undesirable. The widely varied perceptions of taste from person to person drastically
increases the difficulty of defining one method to incorporate flaxseed.
A similar study was conducted to determine if the inclusion of flaxseed in bagels altered
the flavor profiles. This study too, looked to incorporate 30 grams of milled flaxseed into various
flavors of bagels. Overall, it was determined that the flaxseed did alter the flavors and aromas of
the sample bagels (Aliani, Ryland, & Pierce, 2012, p. S68). Similar to the snack bars and
muffins, the flaxseed had different impacts on different flavors. For example, plain bagels with

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flaxseed were reported to have a significantly increased intensity of grain/flax flavor and aroma
(p<0.05), whereas cinnamon raisin and flaxseed bagels were significantly sweeter (p<0.05)
(Aliani et al., 2012, p. S69). One possible cause, as addressed by the researcher, is that the
omega-3 fatty acids present in flaxseed may oxidize when added to baked products which could
cause the unfavorable changes in flavor (Aliani et al., 2012, p. S66).
This study drew further conclusions based on the differences in recorded observations
associated with different age groups of testers. After an examination of the results, it was
determined that testers of older ages (35 to 64 years old) were more likely to accept the changes
in appearance and flavor caused by the addition of flaxseed. This could be potentially beneficial
for the use in clinical studies of participants with preexisting cardiovascular disease as people
with diagnosed cardiovascular disease are generally of an older age. This means older
participants may be more likely to adhere to the standardized diets of studies if they are more
accepting of the flaxseed products (Aliani et al., 2012, p. S66).
Overall Recommendation for Flaxseed Consumption and Call for More Research
Based on the research studies reviewed, there is an indirect correlation between
consumption of flaxseed and LDL concentration in the bloodstream; meaning an increased intake
of flaxseed helps to significantly lower LDL concentration. This is an important relationship to
understand and research as high levels of LDL cholesterol have been shown to cause
atherosclerosis, a buildup of plaque, which can lead to many other cardiovascular problems such
as peripheral artery disease and coronary artery disease. The effects of flaxseed are evident when
milled flaxseed is consumed daily in amounts ranging from 5 to 30g. A recommendation of
incorporating 30g of flaxseed to the diet may be difficult for some people to adhere to as many
findings suggest that the addition of flaxseed into baked goods may cause undesirable alteration

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to flavor profiles (Aliani, Ryland, & Pierce, 2012). Other studies have offered milled flaxseed to
participants and encouraged them to incorporate it in non-baked products; for example, by
sprinkling the seeds on top of Greek yogurt or in smoothies. To incorporate 30 grams of flaxseed
into a persons diet may be a drastic change, and acquiring the taste and acceptance for flaxseed
may be gradual. If the incorporation of 30g is not achievable for the average person, a
recommendation of incorporating as little as 5g may be more realistic. For the addition of both 5
and 30g, the benefits of flaxseed in the diet for both healthy people and those with preexisting
cardiovascular disease are significant enough where a little change in diet would be greatly
beneficial.
This recommendation is supported by several recent studies but many of the most up-todate findings come from research centers in Europe and Canada. While this research clearly
shows a relationship between flaxseed and health benefits, more research should be done in the
United States. The average diet in Europe and even Canada differ drastically from the typical
American diet of processed and fast food. It is important to expand upon the research already
completed to ensure that the results are replicated in the United States. Also, more research
should be done to come closer to fully understanding the many aspects of flaxseed as a
functional food. If one component in flaxseed, omega-3 fatty acids, can have such a significant
impact on a leading cause of the biggest killer in the United States (cardiovascular disease), more
research is needed to discover the many other potential applications and benefits flaxseed has to
offer.

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References
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