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Functional--or dysfunctional--foods
Is it practical to ‘eat your medicine’ instead of taking pills?

pictures of CocoVia, Silk Enhanced Soy milk, DanActive yogurt, and Enviga
 
Soda that melts away calories. Chocolate bars that protect your heart. Yogurt that boosts your immune system. “When Hippocrates said, ‘Let food be thy medicine,’ he couldn’t have anticipated that today’s food manufacturers would take it so literally,” says Ruth Frechman, R.D., a spokeswoman for the American Dietetic Association.

Over the last 15 years the global market for so-called functional foods, or “nutraceuticals,” has grown to an estimated $60 billion annually. The creation of food-drug hybrids has outpaced the government’s ability to define and regulate the products and their associated health claims. The Food and Drug Administration initiated hearings in December 2006 to begin carving out new regulations for functional foods. Meanwhile, is there any reason to use any of these powered-up foods?


HYPERNUTRITION

The typical American diet could use extra help, proponents of these engineered products contend. “These foods simply provide another option for people trying to manage their health,” says Clare M. Hasler, Ph.D., an authority on functional foods and executive director of the Robert Mondavi Institute for Wine and Food Science at the University of California, Davis.

In the best cases, functional additives encourage sound nutritional choices. For example, calcium-fortified orange juice is a reasonable choice for people who don’t consume the recommended three daily servings of dairy and dislike taking supplements. The juice is inherently nutritious and the calcium citrate added is readily absorbed by the body.

But critics say that most functional foods are largely unnecessary. “Many of us cringe at the thought of some of these foods,” such as margarines laced with cholesterol-lowering additives, says Diane Birt, Ph.D., distinguished professor of food science and human nutrition at Iowa State University. “If you really want to lower your cholesterol, you don’t need to add more fat to your diet.”

Some nutritional additives seem to be merely a ploy to disguise junk food as health food. A sugary juice drink, made without actual juice, is still a nutritional negative, even with a few vitamins and minerals tossed in.

And then there are the fantasy foods--candy bars, chocolates, cookies, and the like--that showcase medicinal ingredients to justify indulgence. CocoaVia, for example, advertises that the cocoa flavanols, vitamins, and plant sterols in its candies and snack bars help “lower bad cholesterol” and “promote healthy circulation.” Those druglike claims are “false” or “misleading” because of the high saturated fat content of several of the products, warned the FDA in a letter sent to the company in May 2006. Furthermore, the agency, which strictly regulates folic-acid fortification because high levels can mask anemia, found the inclusion of that nutrient in snacks worrisome.

On a practical level, to get the purported heart benefits from CocoaVia products you’d need to eat two of the treats daily, up to 200 calories worth. Over a year, that could amount to a 20-pound weight gain unless you cut back elsewhere or exercised more. “These products still fall under the category of discretionary calories,” Frechman says, “and you just don’t have that many of those in your day. ”

To help you make sense of this brave new world of foods, here’s the lowdown on some of the main categories of functional additives:
  • Cholesterol-lowering sterols and stanols. These plant derivatives, found in products like Benecol and Take Control margarines and Your Ultimate Milk, interfere with the absorption of cholesterol and have been proved to lower LDL “bad” cholesterol levels by as much as 17 percent. The minimum effective dose is 800 milligrams (mg) per day, typically about two servings of a fortified product.

    But don’t overdo it. Evidence suggests that consuming more than 2,000 mg daily provides no additional benefit. Possible side effects of consuming sterols and stanols may include constipation, diarrhea, indigestion, and nausea. Also, they may interfere with the absorption of beta carotene and vitamin E.

  • Heart-protective omega-3s. It would take 10 one-cup servings a week of cooked Barilla Plus Spaghetti or four of Silk Enhanced soy milk to supply you with the 2,000 mg a week of omega-3s recommended by the American Heart Association for preventing heart disease. Two servings a week of fatty fish, such as salmon, should also supply the right amount. For people with heart disease, the recommended 1,000 mg a day of omega-3s is nearly impossible to consume without including some fortified foods or taking fish-oil pills.

    If you get your omega-3s from fortified foods or supplements, watch the doses. Excessive amounts of omega-3s could increase the risk of bleeding, so to be safe, keep your intake under 3,000 mg daily. People taking blood thinners such as daily aspirin, warfarin (generic, Coumadin), or clopidogrel (generic, Plavix) should check with their doctors before taking supplements or eating lots of omega-3 fortified foods.

  • Gut-friendly probiotics. Studies suggest that probiotics may help relieve diarrhea, irritable bowel syndrome, constipation, and atopic eczema. There is little published research about the effects in healthy people, but some studies suggest that foods containing probiotics may help protect against various infections and possibly colon cancer.

    Dannon cites results from published clinical trials to support its claims that the bacteria in its Activia yogurt speed wastes through the digestive system and that those in DanActive yogurt drinks improve certain markers of immunity in the intestines. CONSUMER REPORTS lab testing confirms Dannon’s claim that some of the beneficial bacteria survive the trip through the digestive tract and arrive in the colon as living cultures.

    Unfortunately, many other yogurt products provide few details about the bacteria they contain. Even when the label lists the number of live cultures, it typically doesn’t mention the presence of the strains associated with most of the health benefits. Look for the National Yogurt Association’s Live & Active Cultures seal, which indicates that the product contained viable bacteria when it was manufactured.

  • Metabolism-boosting tea extracts. Coca-Cola boasts that you can burn 60 to 100 calories daily by drinking three cans of Enviga, a new beverage containing caffeine, calcium, and epigallocatechin gallate (EGCG), the main polyphenol in green tea and a powerful antioxidant. As support for the claims, the company offered a small in-house study. Two independent trials, each involving only about a dozen healthy men, suggest that the combination of EGCG and caffeine can modestly boost metabolism.

    Green, black, and oolong tea all contain polyphenols, although it’s not yet clear whether the disease-fighting ability of tea comes from those constituents or the entire chemical cocktail. Currently much of the marketing hype is focused on EGCG. Brewed tea is a relatively inexpensive and low-caffeine way to get the polyphenol, but three cans of Enviga will set you back nearly $4.50 and add 300 mg of caffeine to your daily intake, about as much as three cups of coffee.

    Even if the claims are eventually borne out in larger studies, you can still burn at least as many calories and reap other health benefits with a brisk 10- to 15- minute walk.

  • Mineral and vitamin additives. Foods with added calcium or potassium may be helpful to those who don’t consume the recommended daily servings of dairy, fruit, and vegetables. Using a potassium-enriched salt, such as Morton’s Lite, helped decrease the risk of dying from heart disease in a June 2006 study of nearly 2,000 older Taiwanese men.

    Antioxidant vitamins are added to a whole range of products, including Smart Start Antioxidant cereal with added betacarotene and vitamin E. Products like these are not necessarily healthier. Several large clinical trials found that isolated phytochemicals, or plant nutrients--including the antioxidants beta-carotene and vitamin E--did not reduce the likelihood of heart attack and stroke. In some studies, the supplements increased cardiovascular or cancer risk.

WHAT TO ASK BEFORE YOU BUY A FUNCTIONAL FOOD

Should I be eating this? The product should be a healthy choice regardless of the functional additives. Be wary of adding foods to your diet just to get the medicinal ingredient.

How meaningful is the claim? Product claims that specify a positive link between disease risk and a food as part of a healthy diet are typically credible because they must be backed by scientific research and approved by the FDA. Claims about how a product affects the body-- “supports the immune system” or “enhances mood”--do not need government approval and the science behind them may be weaker.

Do I need this additive? Healthy people who eat well-balanced diets may have no need for functional foods at all. Even if your diet is lacking a specific nutrient, you needn’t buy products laced with an entire alphabet of additives.

Am I overdosing? Too much of almost anything can be toxic. Before consuming a functional food, make sure you know how much of the additive it contains, how much is safe, and how much you are getting from other sources. Calcium, for example, is usually safe in amounts of up to 2,500 mg a day. The recommended daily potassium intake is 4,700 mg.



This article first appeared in the February 2007 issue of Consumer Reports on Health.


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