Evidence for health benefits of plant phenols: local or systemic effects?

Plant phenols are mostly products of the phenylpropanoid pathway and comprise a large variety of compounds: cinnamic acids, benzoic acids, flavonoids, proanthocyanidins, stilbenes, coumarins, lignans and lignins. They are strong antioxidants and might prevent oxidative damage to biomolecules such as DNA, lipids and proteins which play a role in chronic diseases such as cancer and cardiovascular disease. Plant phenols may interfere with all stages of the cancer process, potentially resulting in a reduction of cancer risk. Only flavonols have been investigated in observational studies. Five out of seven studies showed an inverse association of flavonol intake with subsequent cardiovascular disease (CVD). A protective effect against cancer was only found in one out of four studies. Thus the epidemiological evidence does not yet allow a firm decision on the involvement of flavonols in the aetiology of either CVD or cancer. The epidemiology of flavonols points to a systemic effect. The epidemiology of tea, as a rich source of various phenols, shows inconsistent data for colon cancer, which also does not support a local effect of plant phenols. The absorption and bioavailability of plant phenols have been inadequately studied. Dietary flavonoids were thought to be poorly absorbed because of their presence as P-glycosides (conjugates of sugars). However, conjugation with glucose enhanced human absorption. Flavonoids and other plant phenols are extensively metabolised by colonic bacteria: the ring structure is cleaved, giving a range of phenolic acids which are then absorbed. Human studies showed that only about 1% of a well-absorbed flavonoid was excreted with an intact flavonoid backbone into urine. Major questions to be answered are whether the effective concentrations found in in vitro systems really reflect physiological concentrations. (C) 2001 Society of Chemical Industry.