Transcript Chapter 3: Complementary Nutrition

Complementary Nutrition:
Functional Foods and Dietary
Supplements
Chapter 3
Functional Foods
• Foods with beneficial physiological or
psychological effects beyond providing
essential nutrients
• May be referred to as medical foods or foods
for medical purposes
• Contain naturally occurring or added
nonnutrients
• Foods enhanced with functional
ingredients/Regulatory issues
Functional Foods
• Functional foods are foods that provide health
benefits beyond (in addition to) basic nutrition
• Many foods may be considered functional
foods:
– Catechins in black and green tea reduce risk of
cancer
– Sulforaphane in broccoli reduces cancer risk
– Omega-3 fatty acids in fish or flaxseed reduce risk of
heart disease & aid joints
– Fruits and vegetables contain many different
phytochemicals which reduce risk for cancer and
heart disease
More Functional Foods
– Garlic has sulfur compounds that reduce risk for
cancer and heart disease
– Oats and oat-containing foods, with soluble fiber
beta glucan, reduce cholesterol level
– Polyphenolic compounds in purple grape juice
support normal, healthy cardiovascular function
– Soy protein reduces cholesterol levels
– Lycopene in tomatoes and products reduce risk for
cancer
– Yogurt and fermented dairy products contain
probiotics which may improve gastrointestinal
health
Functional Foods
• Provide health benefits
beyond nutrition
• Phytochemicals:
– Antioxidants
• Neutralize free radicals
• Reduce heart disease,
cancer risk
– Found in fruits,
vegetables, whole grains,
and legumes, wine
Photos © PhotoDisc
Free Radicals
• Think of them as a kind of acid
produced by normal metabolism
• Greatly increased by the stress of
athletic exertion/exercise
• Tear down DNA and cell walls, cause
degenerative DZ and cancers
• Profoundly linked to “aging”
• Neutralized by Antioxidants
What do the fruits and veggies do?
Provide antioxidants that the body cannot make on its own,
thereby blocking free radical damage.
What does that damage look
like?
Skin
Wrinkles
Joints
Arthritis
Arteries
Heart Disease
Brain
Alzheimer's
DNA
Cancer
Phytochemicals Make Food
Functional
• Phytochemicals make food functional
– Substances in plants
– Promote health
– Are not essential
for life
– Are a benefit to
the plant itself
© Stephen Coburn/ShutterStock, Inc.
Phytochemicals
• A phytochemical is a chemical that acts
as dietary supplement that comes from
plants
– Isoflavones from soy
– Antioxidants from vegetables
– Lycopene from tomatoes
Antioxidants aim to:
Antioxidants
• prevent food containing fat or oil from going rancid due to
oxidation, i.e. developing an unpleasant odour or flavour;
• prevent the browning of cut fruit, vegetables and fruit juices
(and so increase shelf life and appearance).
For example, vitamin C, also known as ascorbic acid, or
E300, is one of the most widely used antioxidants.
Phytochemicals Make Food
Functional
• Benefits of phytochemicals
– Anticancer activity
– Prevent chronic disease
• Phytoestrogens
– Neutralize free radicals
Phytochemicals Make Food
Functional
• Adding phytochemicals to your diet
– More fruit
– More vegetables
– Make half of
your grains
whole
Courtesy of Produce for Better Health Foundation
What’s in a clean
fresh apple?
Over 9,000
phytonutrients in
the proper
balance for
optimal use by
our bodies.
The colors we need in our lives
• Reds – tomatoes, strawberries,
watermelon…loaded with Lycopene
to protect from prostate cancer
Beets contain iron and folic acid.
Cranberries have strong antibiotic
qualities.
• Greens– full of calcium, folic acid,
potassium, lutein zeaxanthine,
heavy with antioxidants. Kale has
50% more absorbable calcium than
milk! Folic acid needed to lower
homocysteine, prevent spina bifida
and process seretonin which eases
depression.
The colors we need in our lives
• Yellows and oranges – Carrots
are an awesome source of beta
carotene. Pineapple is a natural
anti-inflammatory.
• Blues and purples – Grapes
with flavinoids decreases the
stickiness of our blood.
Blackberries reduce colon
cancers. Elderberries fight
viruses. Blueberries are the
highest in antioxidants.
Phytochemicals Make Food
Functional
• Foods enhanced with functional
ingredients
– Adding health promoting
properties during processing
Photo © Jones and Bartlett Publishers
Phytochemicals Make Food
Functional
• Regulatory issues
– Food
– Drugs
– Dietary supplements
• Additives in functional foods
– Herbs and other novel ingredients
– GRAS guidelines apply (Generally
recognized as safe)
Food Additives
• Direct additives
– Added to foods for specific reason
• Indirect additives
– Unintentionally become part of a food
What is a Food Additive?
Sec. 201(s) FFDCA: Definition
The term ''food additive'' means any substance the
intended use of which results or may reasonably be
expected to result, directly or indirectly, in its
becoming a component or otherwise affecting the
characteristics of any food (including any substance
intended for use in producing, manufacturing, packing,
processing, preparing, treating, packaging,
transporting, or holding food;….
if such substance is not Generally Recognized As Safe,
21 CFR 170.3(e)(1)
OFAS’s “Food Ingredients” Universe
•
Direct Food Ingredients
•
Sweeteners; Preservatives; Fat;
Nutrients; Texturizers (thickeners,
Emulsifiers, etc.); Flavors
•
Color Additives
In food, animal feed, drugs,
cosmetics,medical devices(i.e. sutures
and contact lenses)
•
GRAS Ingredients
Enzymes; Fiber; Proteins;
Lipids; Sugars; MSG; Antimicrobials;
Phytosterols/stanols; Flavors;
Infant formula ingredients
•
Foods/Ingredients produced
using modern biotechnology
Plants w/herbicide resistance or insect
resistance, delayed ripening, etc.;
often use GRAS concept
Processing Aids
Antimicrobials(meat and poultry
Processing); Defoamers; Ion exchange
resins
•
Food Irradiation Equipment
To process food
To inspect food
• Food Packaging/Food
Contact Substances
Coatings (paper, metal, etc);
New/recycled plastics including both
polymers and monomers; Paper;
Adhesives; Ingredients in Pkgs.(i.e.
colorants, antimicrobials, antixoxidants,
etc.);Packaging material for use during
food irradiation,; Food packaging
“formulations”
Food Additives
• Purpose of direct additives
– Maintain product consistency
– Improve or maintain nutritional
value
– Keep food appetizing and
wholesome
– Provide leavening
– Enhance flavor or color
Photos © Corbis Digital Images
Food Additives
• Regulation by FDA
– Food additives: FDA approval; manufacturer
must prove safety
– Color additives: FDA approval; FDA tests
batches for purity
– Generally Recognized as Safe (GRAS)
– Prior sanctioned substance
What is a
Food Contact Substance?
(Section 409(h)(6) of the FFDCA)
Any substance intended for use as a
component of materials used in
manufacturing, packing, packaging,
transporting, or holding food if such
use is not intended to have any technical
effect in food.
Unintentional Additives:
• Insecticides
• Fungicides
• Herbicides
• Plant Growth Regulators
• Hormones and Antibiotics
Functions/Purposes:
• Prolong shelf life
• Change/preserve color
• Enhance flavor
• Improve nutritional value
Functions/Purposes: cont.
• Compensate for vitamin and mineral
deficiencies
• Maintain freshness
• Prevent spoiling
• Facilitate food processing
Food Additives
• Subject to Delaney Clause
– Apply to food additives
– Apply to color additives
– No approval if additive causes cancer
• Humans
• Animals
Delaney Clause, 1958
• No substance known to cause cancer
in animals or humans at any dose
level shall be purposefully added to
food.
Claims for Functional Foods
• Nutrient content claims
• Health claims
• Structure/function claims
– Based on food’s nutrition value
Strategies for Functional Food Use
• Stick with the science
– Eat fruit and vegetables
– Eat nutrition-fortified products as needed
– Read, read, read (scientific articles)
– Be critical of advertising and hype
If it sounds too good to be true, it
probably is!
Dietary Supplements
Foods or Drugs?
Dietary Supplements
• Alternative therapies and
natural remedies
– (Holistic Medicine)
• Dietary supplements = 6.5
billion / Prescription Drug
sales = 85 billion
• Increased consumer
dissatisfaction with
conventional health care
• ½ of US population use
Dietary Supplements
History of Dietary Supplements
• 1990 Nutritional Labeling and
Education Act
– Permitted use of therapeutic claims made
about vits/mins
• 1994 President Clinton signed Dietary
Supplement, Health and Education Act
(DSHEA) into law
• Defined D/S as “separate regulatory
category of food”
Dietary Supplements
• Traditionally defined as products
made of one or more essential
nutrients such as vitamins, minerals,
and proteins, but…
• DSHEA broadened definition to
include almost any product
intended for ingestion as a
supplement to the diet
• Must be identified on label as a D/S
Dietary Supplements:
Vitamins and Minerals
• Various forms
• Moderate doses
• Megadoses
Dietary Supplements:
Vitamins and Minerals
• Moderate supplementation
– Increased nutrient needs
and/or poor intake
• Pregnant and
breastfeeding women
• Women with heavy
menstrual losses
• Children
• Infants
Dietary Supplements:
Vitamins and Minerals
• Moderate supplementation
– Increased nutrient needs and/or poor
intake
• People with severe food restrictions
• Strict vegetarians
• Elders
– No more than 150% of DV
Dietary Supplements:
Vitamins and Minerals
• Megadoses
– Conventional medicine
• Drug interactions
• Malabsorption syndromes
• Treatment of deficiencies
• Druglike effects
– Orthomolecular nutrition
• Proposed for disease prevention
– Risks: toxicity from large doses
Dietary Supplements:
Natural Health Products
• Herbal therapy (phytotherapy)
– Traditional medical practices
– Little scientific evidence of efficacy, safety
• Helpful herbs: examples
– St. John’s wort
antidepressant
– Milk thistle
dyspepsia; diabetes
– Ginkgo biloba
improve the mind
– Saw palmetto extract prostate problems
– Cranberry juice
Prevents UTI
Dietary Supplements:
Natural Health Products
• Helpful herbs, harmful herbs
– Strong enough to help, strong enough to
hurt
– Can interfere with standard medicines
– DANGER: Examples of products with toxic
side effects
• Yohimbe erectile dysfunction
• Ephedra weight loss
• Chaparral Wounds; skin probs etc
• Comfrey multiple ailments
Dietary Supplements:
Natural Health Products
• Quality control issues
– Contaminants
– Poorly standardized strength or potency
• Regulations
– Current good manufacturing practices
• Other dietary supplements
– Hundreds of products
Dietary Supplements in the Marketplace
• Freedom of speech and press
• The FTC and supplement advertising
– Federal Trade Commission
• The FDA and supplement regulation
– Dietary Supplement Health and Education
Act
– Dietary supplements are not drugs
– Dietary supplements are not food additives
– Approval by FDA is not required
Dietary Supplements
• Distinguished from Drugs:
– Drug = article intended to diagnose,
cure, mitigate, treat, or prevent
disease
– Both intended to affect structure and
function of body
– Drug must undergo FDA approval after
clinical studies to determine
effectiveness and safety
– D/S = no pre-market testing
Dietary Supplements in the Marketplace
• Supplement labels
– Ingredient information
– Supplement fact panel
Dietary Supplements
• Distinguished from Drugs:
– Drug = article intended to diagnose,
cure, mitigate, treat, or prevent
disease
– Both intended to affect structure and
function of body
– Drug must undergo FDA approval after
clinical studies to determine
effectiveness and safety
– D/S = no pre-market testing
Dietary Supplements
• Distinguished from Foods:
– Foods not intended to affect structure
and function
– D/S intended only to supplement diet
• Not represented for use as
conventional food
• Not intended as sole item of a meal
or the diet”
Dietary Supplements
• No premarket approval
• Manufacturer responsible for safety
evaluation
• If D/S contains a new ingredient:
– Manufacturer must submit information that
ingredient “can reasonably be expected
to be safe” within 75 days of marketing
– Safe = no significant risk of illness
Labeling of Dietary Supplements
• DSHEA authorized to provide accurate
information to consumers
• Label must include:
– Name of each ingredient
– Quantity of each ingredient
– Total weight of all ingredient if a blend
– Identity of part of plant derived from
– Term “Dietary Supplement”
• Must contain nutritional labeling information also
– Calories, fat, sodium
Dietary Supplements in the Marketplace
Health Claims
• DSHEA authorized use of FDA approved
“Health claims” on label
• Describe the connection between a
nutrient or food substance and a disease
or health-related condition
– (diet/disease relationship)
• Statements may be included on the label that
give the manufacturers description of the role
of the D/S
– Not authorized by FDA
– Manufacturer resp. for accuracy and truth of statement
Dietary Supplements in the Marketplace
• Supplement labels
– Claims allowed
• Health claims (approved by FDA)
–Examples
• Calcium and osteoporosis
• Folate and neural tube defects
FDA Approved Health Claims
• Folic acid and neural tube
pregnancies
• Calcium and osteoporosis
• Sodium and hypertension
• Fruits and vegetables and cancer
• Dietary lipids and cancer
• Saturated fat and cholesterol and
coronary artery disease
Structure and Function Claims
• Manufacturers may use S/F claims
– Not authorized by FDA
• Must be true and not misleading
• Must be accompanied by disclaimer
– “This statement has not been evaluated
by the FDA. This product is not
intended to diagnose, treat, cure or
prevent any disease”
• Examples:
– “Calcium builds strong bones”
– “Antioxidants maintain cell integrity”
Dietary Supplements in the Marketplace
• Structure/function
claims
– Link substance and
effect on the body
– No approval required
– Must have
“disclaimer” statement
on label
Other Claims:
• Health-maintenance claims:
– “Maintains healthy circular system”
• Non-disease claims:
– “helps you relax”
– “for muscle enhancement”
• Cannot make maintenance claims about
osteoporosis and other “serious diseases”
• Can make health claim about relationship
between a product or substance and the
disease if approved
Dietary Supplements in the Marketplace
• Nutrient content claims
– Consistent with definitions approved for
foods
• Canadian regulations
– Natural health products
Dietary Supplements in the Marketplace
• Choosing dietary supplements
– Is the quantity enough to have an effect?
– Is the product new to you?
– Consider the dose used in the study
– What is its bioavailability?
– Does the product promise too much?
– Who is selling the product?
– U.S. Pharmacopeia verification
Dietary Supplements in the Marketplace
• Fraudulent products
– Secret cure (“breakthrough”)
– Pseudomedical jargon (e.g., “detoxify”)
– Cures a wide range of diseases
– No side effects, only benefits
– Backed by “scientific research” you can’t find
– Remember, if it sounds too good to be true…
Complementary and Alternative
Medicine (CAM)
• Complementary
– Practices used in
addition to conventional
medicine
• Alternative
– Practices used in place
of conventional
medicine
Complementary and Alternative
Medicine (CAM)
• Nutrition in CAM
– Vegetarian diets
– Macrobiotic diet
– Food restrictions
and prescriptions
– Need for scientific
evaluation
PREVALENCE OF CAM
•
•
•
•
General population - 46% at some time
Breast cancer patients - 23%
$27 billion annually
Most common - herbals, megavitamins
MAIN POINTS
• Balance the rationale and intuition
• Tell your doctor what your doing
• Don’t forego proven treatments
• Find peace with your approach