Stroll the aisles of any large natural-foods store – or any high-quality grocery store – these days, and you’ll be inundated by sales pitches for foods specially formulated to improve your health. Some labels make explicit claims (“Proven to significantly lower cholesterol”); others make more general assertions (“Diets low in saturated fat and cholesterol that include 25 grams of soy protein a day may reduce the risk of heart disease”). Many more simply hint at the effect a food, or one of its ingredients, may have on the body.
These products, and others like them, fall under the general category of “functional foods,” a term the International Food Information Council (IFIC), in Washington, D.C., broadly defines as either whole foods or dietary components “that may provide a health benefit beyond basic nutrition.”
Fruits and vegetables may be the ultimate functional foods, of course, but Brussels sprouts, broccoli and other whole foods aren’t driving the market interest in this category. Food companies are keen on developing a subset of this growing niche: functional foods that are enhanced through processing. Meanwhile, consumers have shown a willingness to pay a premium for products that offer both ready-to-eat convenience and the possibility of health benefits.
The proliferation of nutritionally enhanced foodstuffs on grocery-store shelves is, in part, the result of high-tech tinkering by food makers. Food scientists are expanding the functional-food category beyond nature’s traditional offerings, developing new products that contain myriad vitamins, minerals and other health-promoting elements. One company is adding lutein (which may promote eye health) to salad dressing. To increase omega-3 levels in eggs, farmers are feeding flaxseed to hens. Yogurt makers are isolating new strains of bacteria that may aid digestion and boost immunity. The food giant Cargill has developed, among other products, a blend of plant sterols that can be added to other foods, a soy protein isolate for drinks and a fiber that can be added to baked goods.
Stir in a healthful component or two, it seems, and – voilà! – virtually any basic food can become a functional food. Not surprisingly, health-conscious Americans are increasingly interested in such nutritionally enhanced foods as a means of warding off disease. In 2003, according to estimates published by Nutrition Business Journal, U.S. consumers spent $100 billion dollars on “healthy foods” (a category that includes organic and other products as well as functional foods).
Health now rivals convenience as “the most important new food-product attribute,” says A. Elizabeth Sloan, PhD, a nutritionist and business consultant who follows the industry closely. But can these functional, enhanced foods really improve your health?
The Benefits of Enhancement
The idea of adding healthy ingredients to food is hardly new. Iodine was first added to salt to prevent goiters in 1924. Vitamin D has been added to milk to prevent rickets since the 1930s.
There is little doubt that consumers generally stand to benefit from enhanced foods. But how much they stand to benefit, and whether the cost/value tradeoff is a good one, is a matter of some debate. Not all would-be functional foods are created equal. Nor are they equally useful for all individuals.
Accordingly, consumers would do well to be moderately skeptical of the health claims on food labels. You probably won’t be harmed by any of the functional enhancements, but there’s no guarantee that you’ll directly benefit from the added nutrients, either. Here are three examples of popular enhanced foods that may (or may not) benefit you, and why.
Calcium-Enriched Orange Juice
One of the most popular functional foods is orange juice fortified with calcium, a mineral that can help prevent osteoporosis. Today, such souped-up juice can be found in any supermarket, but for food scientists, adding calcium to orange juice was no trivial task: They had to make sure that calcium did not make the OJ unpalatable and, more important, that the mineral would be “bioavailable,” meaning that once combined with the juice, it would remain stable and in a form that could be absorbed by bones. Without bioavailability, the calcium, no matter how abundant, would have had no actual health value.
Assessing the nutritional value of calcium-fortified orange juice is a relatively straightforward proposition. The federal government recommends that adults on a 2,000-calorie diet get 1,000 milligrams of calcium daily. An 8-ounce glass of fortified orange juice provides 30 percent of that recommended daily value, so it can be especially helpful to those who dislike milk or have trouble digesting milk products.
According to the Food and Drug Administration (FDA), there is “significant scientific agreement” that consuming adequate amounts of calcium decreases the risk of developing osteoporosis, especially in certain more-vulnerable populations (including white and Asian women). In fact, calcium’s benefits are so well known that many companies don’t even bother touting them on labels, beyond announcing the presence of calcium in big, bold letters.
But drinking more calcium-enriched OJ may not be the solution to all your problems, particularly if you are watching your weight. Some fruit juices rank high on the glycemic index, and they cause insulin levels to rise rapidly during digestion. An 8-ounce glass of orange juice also contains 110 calories – a full 5 percent of a 2,000-calorie-per-day diet. So if you aren’t already downing a glass of juice, adding one purely for calcium purposes (without adjusting your caloric or sugar intake elsewhere) may not be a terrific idea.
Roger Clemens, DrPH, a professor in the school of pharmacy at the University of Southern California and an expert in functional foods, says consumers should evaluate the benefits of calcium-fortified OJ in light of their complete dietary intake and nutritional needs. He also cautions against simply substituting calcium-fortified OJ for milk and other calcium-rich foods. “Milk provides protein and other nutrients that may help manage weight and blood pressure, as well as other benefits,” he says. Individuals who bypass dairy foods in favor of OJ should try to get those additional nutrients from other foods.
Spreads with Sterols
Concerns about high cholesterol have led many Americans to avoid the supermarket shelves containing butter, margarine and other spreads. In recent years, however, several companies have developed enhanced spreads, such as Take Control, Benecol and Smart Balance, that contain sterol or stanol esters, which are derived from lipids that naturally occur in vegetable oils. These esters inhibit intestinal absorption of cholesterol, thus lowering LDL, “bad,” cholesterol levels and improving the ratio of HDL, “good,” cholesterol to LDL.
In September 2000, the FDA ruled there is evidence that consuming adequate amounts of plant sterol (1.3 grams a day) and stanol (3.4 grams a day) esters “may reduce the risk of heart disease.” Research published in the New England Journal of Medicine showed that Benecol lowered LDL levels 14 percent.
But these studies required that subjects consume 6 tablespoons a day of the spread for at least eight weeks. That’s not an insignificant number of calories (Benecol has 80 calories per tablespoon, though there’s a light version available), so unless you use the spread to replace another fat source (like butter) already in your diet, you could end up gaining weight.
Perhaps more problematic, many people simply don’t like to eat the same thing twice a day, every day, for weeks on end. Depending on what they choose to eat during the course of a week, they may get two servings of a particular enhanced food on one day, none the next. “The problem with all the claims that have to do with lowering cholesterol is that you generally have to eat several doses a day,” says Mary Ellen Camire, PhD, professor of food science and human nutrition at the University of Maine and a spokesperson for the Institute of Food Technologists. “That’s not practical for most people.”
“Probiotic” literally means “for life.” The term refers to micro-organisms, especially live bacteria, that grow in the digestive system and have beneficial effects on health. The global food giant Dannon boasts that its enhanced beverage, DanActive (which it calls a “probiotic cultured dairy drink”), contains “10 times more cultures” than ordinary yogurt. According to Dannon’s Web site, the company sells 6 million single-serving bottles of DanActive a day around the world (some under the name Actimel). This year, the company dramatically increased marketing of DanActive in the United States.
Dannon touts DanActive as an elixir that “helps naturally strengthen your body’s defense system.” Carefully worded – and suitably vague – this is what the FDA regards as a “structure/function claim.” It describes the role of a food, nutrient or dietary ingredient that is “intended to affect the structure or function in humans.” The quintessential example is “calcium builds strong bones.” The FDA does not formally approve structure/function claims, though it does require that they be truthful and not misleading.
The FDA has not approved any health claims for either specific products or probiotics in general, but companies are going to extraordinary lengths both to develop and differentiate their probiotic products. On its Web site, New Hampshire– based Stonyfield Farm (which is 85 percent owned by Dannon’s France-based parent, Groupe Danone), tells consumers that it adds six types of bacteria to its yogurt and cultured soy products, including the bacteria commonly found in yogurt, Lactobacillus acidophilus, and a form of the bacterium Lactobacillus reuteri, which the manufacturer says, “was isolated from the breast milk of a woman living in the Peruvian Andes – someone living in perfect harmony with nature.”
Friendly bacteria such as those found in yogurt are crucial to a properly functioning digestive system. Much of the human immune system is located in the intestines; and though the exact mechanism is unclear, probiotics are thought to balance and stimulate this immune machinery in a way that puts unhealthy bacteria at a disadvantage.
At least some experts are convinced of the value of probiotics. “The science is there,” says Camire. “The consumer demand just hasn’t caught up.” But not all bacteria strains have the same beneficial effects. And those that are beneficial must be present in sufficient quantity and quality to have an impact.
Healthy or Hyped?
As companies large and small rush to add functional claims to their labels, the distinction between product marketing and accurate health information has increasingly become blurred, says James Tillotson, PhD, MBA, a professor at the Friedman School of Nutrition Science and Policy at Tufts University. The result is, in his words, “a surge of marketing claims that are not based on stringent scientific information.”
Tillotson, who worked for years in the food industry, suggests that we’re perilously close to revisiting a time before federal regulation of health claims – a time, he says, when “‘snake oil’ claims were rampant.” Indeed, surveys by the IFIC and the FDA show that many Americans have difficulty evaluating the claims on functional foods. Essentially, we’re left to figure out for ourselves which functional-food products are worthwhile.
So what are we to make of, say, a salad dressing that boasts of having 500 micrograms of lutein per serving (and costs $7 a pint)? At best, it’s probably safe to assume that such overhyped products pose little real danger (except, perhaps, to the wallet). On the other hand, there’s also relatively little reliable evidence to support the majority of their health claims.
Surveying this brave new world of functional foods, Clemens, Camire and many other nutritional experts give age-old advice: Eat a healthy, well-balanced diet, with plenty of whole grains, fruits and vegetables. In selecting processed foods, even functional foods, evaluate claims with reserve.
Still, Clemens, the USC professor, remains enthusiastic about functional foods. He praises the research done by some companies to develop sound products that truly benefit human health. Yet he also points out that research may never be able to establish precise links between particular outcomes and specific foods, no matter how healthy they might be. Science is by its very nature limited in its ability to understand something as complex as human nutrition, he notes. The scientific method works by eliminating variables – it seeks, for example, to identify a single chemical that explains the health benefits of blueberries. Nature, by contrast, tends to work in complex synergies.
This raises important questions, Clemens asserts: What if the value of a food derives from a whole constellation of chemicals and how they all interact? What if the nutritional benefits of whole grains lie in the balance of their constituent parts? What if the immunity boost that chicken soup provides simply can’t be packed into a pill? As promising as nutritionally enhanced products may be, he points out, we must never underestimate the value that lies within “the natural matrix” of the wholesome foods that nature itself provides.