Making Sense of It

As research studies till date show, consistent evidence supporting antioxidant benefits in human trials has been disappointing. In vitro and animal studies suggest antioxidant supplementation provides benefits, however, some recent research demonstrates that in some cases antioxidant supplementation may actually do more harm than good. Individual antioxidants in the form of dietary supplements are more potent and bioavailable than they are in food matrices, and they do not exhibit the synergistic effects with other compounds found within natural food sources. Therefore, supplements most likely do not possess all the physiologically active components needed to be truly effective in preventing disease incidence and progression. In addition, individual genetics and/or physical status may have as significant an effect on health as antioxidant nutrients do. We saw in the early years of America that poor diets caused many nutrition-related, life-threatening, and debilitating diseases. Food fortification programs, such as vitamin D and iodine, proved to be beneficial and improved public health by eradicating or preventing most associated illnesses. Today nutrition deficiencies are rare in America. Poor diet is usually the result of individual choice, lack of knowledge, extreme poverty, or illness. The average American has the opportunity to obtain his or her daily nutrient needs from diet alone. Nevertheless, many Americans do not achieve optimal levels of vitamin C and E and perhaps the flavonoids.

There are also some suspicions that the food supply (specifically fruits and vegetables) is not as nutritious as it once was. At least one study carried out at the University of Texas at Austin found six out of thirteen major nutrients in fruits and vegetables (protein, calcium, phosphorus, iron, riboflavin, and ascorbic acid) have declined over the past few decades (see Table 6.1). Analyzing these studies is difficult as they depend upon analytical techniques that vary over the decades. Nevertheless, it is reasonable to assume that farming practices that increase crop yields (and profits) over time may deplete natural resource capabilities and result in what is known as the "dilution effect" when crops are grown in the same locations for a number of years. This dilution of

Table 6.1

Changes in Nutrient Content of USDA Crops

Nutrient Decrease in Nutrition Value (1950-1999)

Protein 6%

Calcium 16%

Phosphorus 9%

Iron 15%

Riboflavin 38%

Ascorbic acid (vitamin C) 20%

Source: Adapted from Davis, "Changes in USDA Food Composition Data for 43

Garden Crops, 1950 to 1999," J of Am Coll of Nutr 23, no. 6 (2004): 669-682.

minerals and vitamins in fruit and vegetable crops is the consequence of higher crop yields and shortened growing time (slower-growing crops have more time to absorb nutrients from the soil and sun).1 Some studies of organic crops have shown increased nutrient values over conventional crops. A review of studies reported in The Journal of Alternative and Complementary Medicine in 2001 found vitamin C, iron, magnesium, and phosphorus values were significantly increased (along with decreased nitrates from fertilizers) when compared to conventionally grown crops. Yet, even this field of study yields conflicting results.2 The theory that organic crops must combat more stresses as they grow, due to less protection from pesticides, appears to increase their nutrient and antioxidant phenolic values.3 But these study results have yet to be verified over the long term.

Possible decreased nutrient value of crops and an aging population that is living longer, has more disposable income, believes supplements to be safe and effective, and is willing to self-medicate in an effort to feel better and decrease health care costs has driven the popularity and increased use of antioxidant supplement sales. Almost daily media reports extolling the virtues of antioxidants for increased longevity and improved health have steadily increased this trend in use of antioxidant dietary supplements and functional foods/nutraceuticals. Some companies allow consumers to "custom design" their nutrients by offering single portion packets of nutrients, such as a mix of vitamin C and iron that can be sprinkled onto foods.4 Companies such as Pharmanex offer to a vulnerable public the BipPhotonic Scanner, which scans the skin on the palm of the hand for body carotenoid levels, and antioxidant testing kits (for $60 a urine sample) for testing oxidative stress levels. However, this scan measures only carotenoids and is not a true reflection of actual antioxidant levels in the body. Regarding the urine tests currently available, Garry Handelman, a nutrition professor at the University of Massachusetts, sums it up best: "I won't say that they're completely worthless, but they're about as close as they can get."5

Years of self-promoting lobbying efforts by the dietary supplement industry that urged Congress to preserve consumer freedom of choice and Congress, believing that all supplements were safe, allowed passage of DSHEA in 1994.6 DSHEA effectively deregulated supplements and weakened the FDA's ability to safeguard the public by allowing harm to occur before action can be taken to protect the public. As to the safety of these products "caveat emptor" is the rule of the day—the exact opposite of what the consumers assume is the case. Surveys of older Americans find that approximately 75 percent want the government to review and approve supplements for safety and verify all marketing claims before they are sold in the market.7 In many ways we have returned to pre-1906 legislation days when unproven and harmful patent medicines and cures were rampant.

While dietary supplement makers have enjoyed deregulation of supplements in recent years, they are beginning to experience repercussions. Media reports deriding supplement safety are increasing. Press coverage regarding the difficulties the FDA encountered when trying to ban ephedra supplements, even after numerous reports of adverse events and death, has been increasing. The National Nutritional Foods Association (NNFA), recognizing this increasing negative focus on supplement safety, supported the Dietary Supplement and Nonprescription Drug Consumer Protection Act,8 which puts some responsibility for safety back onto the manufacturer by requiring them to notify FDA about life-threatening events, hospitalizations, significant disabilities, birth defects, and medical interventions caused by their products. A contact number is now required on all labels should customers need to report problems.

Consumers themselves are also beginning to realize that many claims made about supplements and functional foods are marketing "hype" designed to increase product sales and manufacturer bottom lines, not necessarily to improve the health and safety of the consumer. Judy Foreman, a writer for the Boston Globe, sums up this growing disenchantment with supplements in her May 14, 2007 "Health Sense" column. She writes her "love affair with vitamins and supplements is over: with a few exceptions... I'm tossing them out." She further explains that reports about vitamins and minerals influenced her to take specific supplements, mostly antioxidants. But as scientific studies began to accumulate disputing previous claims of improved health or showed they could be dangerous, she stopped taking most of them. She does admit that multivitamins will remain a part of her daily regime for now because she fails to eat enough fruits and vegetables. But even this has her concerned after reading the recent ConsumerLab.com analysis that revealed many multivitamins are either contaminated with lead, do not dissolve properly, or do not contain the ingredients or amounts listed on the label. She notes one benefit of not taking these supplements is "the handful of twenties I'm not spending on supplements!"9

An article in the Chicago Tribune on April 19, 200710 reports Kraft Foods Inc. has identified functional foods, which are highly profitable, as the next product line they will be focusing on to improve their decreasing profit margins. Coca-Cola and PepsiCo, responding to decreasing soft drink sales, plan on introducing carbonated beverages fortified with vitamins and minerals (and

Table 6.2

Nutrient Composition of Select Functional Foods

Table 6.2

Nutrient Composition of Select Functional Foods

CocaVia,

Kellogg's SmartStart

Kellogg's

Original

Antioxidant Cereal

Cornflakes

Nutrient/serving

Chocolate Bar

(no milk)

(no milk)

Calories

100

190

100

Vitamin A

<2%

25%

10%

(10% as beta carotene)

Vitamin C

15%

25%

10%

Calcium

25%

0%

0%

Iron

4%

100%

45%

Vitamin D

10%

10%

Vitamin E

20%

100%

Thiamin

100%

25%

Riboflavin

100%

25%

Niacin

100%

25%

Vitamin B6

15%

100%

25%

Folic Acid

15%

100%

25%

Vitamin B12

15%

100%

25%

Panthothenate

100%

Phosphorus

8%

Magnesium

6%

Zinc

100%

Note: Values listed are the percent of the daily value (DV) for a healthy adult in one serving of this food. In general, 5 percent or less is considered low and 20 percent and above is considered high. For example, Kellogg's Cornflakes provides only 10 percent of the recommended daily value (% DV) for vitamin A based on a 2000 calorie daily diet. So if you ate approximately 2000 calories per day to keep your weight stable, you would only get 10 percent of your daily RDA for vitamin A from one serving of cornflakes and thus need to include other vitamin A food sources in that day's diet. If caloric needs are less, then even less of the DV would be taken in.

Source: Adapted from Kellogg's corporate Web site at http://www2.kelloggs.com/Product/ Product.aspx; dietfacts.com at http://www.dietfacts.com.

Note: Values listed are the percent of the daily value (DV) for a healthy adult in one serving of this food. In general, 5 percent or less is considered low and 20 percent and above is considered high. For example, Kellogg's Cornflakes provides only 10 percent of the recommended daily value (% DV) for vitamin A based on a 2000 calorie daily diet. So if you ate approximately 2000 calories per day to keep your weight stable, you would only get 10 percent of your daily RDA for vitamin A from one serving of cornflakes and thus need to include other vitamin A food sources in that day's diet. If caloric needs are less, then even less of the DV would be taken in.

Source: Adapted from Kellogg's corporate Web site at http://www2.kelloggs.com/Product/ Product.aspx; dietfacts.com at http://www.dietfacts.com.

no calories) in the spring of 2007.11 Kellogg's Smart Start Antioxidants cereal promises to "give your immune system a little help to work hard for you. With Vitamin A (including beta carotene), Vitamin C, Vitamin E, and zinc, Smart Start Antioxidants cereal is a serious combination of antioxidant protection."12 Mars, Inc. introduced it's CocoaVia Heart Healthy Snacks via the Internet in 2005 and retail stores in 2006. As CocoaVia's marketing information tells us, they are "tasty chocolate treats" that have a "twist of health" because of a production process that is "designed to protect and maintain the high levels of the naturally occurring cocoa flavanols."13 As Table 6.2 highlights, one serving of Smart Start Antioxidants cereal contains 100 percent of most important nutrients in the daily diet.

CocoaVia contains few nutrients in a 100 calorie portion size, claims benefits yet to be proven from flavanols, and also contains cholesterol-lowering sterols and stanols, which may interfere with absorption of fi-carotene and vitamin E. So even though fi-carotene and vitamin E are added nutrients, their absorption may possibly be negated by the stanols and sterols in this expensive functional food/nutraceutical. As these illustrations highlight, unless the daily diet is carefully planned, the potential for nutrient interactions and excess intakes is substantial. These products are just the tip of the iceberg. As food manufacturers enhance foods to enter the functional foods/nutraceuticals market, concerns about "hypersupplementation" will rise. The majority of supplement users are better educated, have higher incomes, are older, and take an active and preventive approach toward their health. However, as we have seen, antioxidant vitamin and mineral intakes from the available American diet provide sufficient, and at times more than, DRI levels of these essential micronutrients. In addition, dietary supplements and functional foods/nutraceuticals support the concept that food is medicine and may sway individuals from eating a balanced diet from natural food sources believing that they can acquire the same or superior benefits from supplementation at a lower overall cost. Instead of improving eating patterns to include more fruits, vegetables, and whole grains, people tend to eat the same foods they have always eaten (often processed and high in sugars and fats) with the "insurance" of a supplement to "fix" all that is wrong with their diet. Aging Americans, who also tend to have an increased use of pharmaceutical medications, have a tendency to incorporate supplements and functional foods/nutraceuticals into what may already be a nutritionally adequate diet. Nutrient and drug interactions, toxicities, and overdoses may contribute to a potential public safety disaster.

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