MOM vs HEALTH FOOD INDUSTRY: You Pick!



88 year old Mom who eats a Mediterranean diet

 Many Americans, occasionally even myself, believe that our regulatory systems protect us from false claims. 
Let's look at the Health Food Industry.  There is a whole gamut - from supplements, to buying prepared meals to junk food.  Are all aspects cut from the same cloth?  What can you do to maximize health if you want to increase the good bacteria in your gut particularly if you do not have infinite time and/or money.

The food industry is regulated by the Food and Drug Industry (FDA).  In 1990 Congress passed a law that required "significant scientific consensus" and "a preponderance of  scientific evidence" for food companies to make scientific claims about their foods.  With a lot of controversy, in 2003 the FDA loosened these regulations for the food industry claims about the health benefits of their products.  Perhaps that explains why I see commercials on TV trying to convince me that cocoa cereals boost immunity, sugary cereals will help my child succeed in school and other breakfast cereals fight heart disease!  In 2010 however, Dannon did settled a lawsuit for $45 million because they claimed that their yogurts were "scientifically" and "clinically" proven to boost immunity and regulate the digestive system and had not proven it.  So what does their label say now?  Just "Helps regulate your digestive system"!  My mother still buys it because she believes that it does.  Advertising works.

I decided to look at a number of yogurts on the market that all had  "probiotic" on their label and all implied, although did not state, that their yogurt met the definition of a probiotic.  I looked at their websites. They all were careful NOT to say that their yogurt was a probiotic food but all IMPLIED that it was and that it had all the health benefits that one finds with probiotics.  Which one of these is the best?  Beats me.   Since the food companies are not going to go through the necessary testing to prove theirs have actual health benefits (ie double blind studies) I can't tell you which is the best. I can tell you what the standards are and how many colony counts are required for them to claim that their food is a probiotic.  And the fact that they are careful not to make the claim assures me that theirs is not a true "probiotic". (If they make the claim the FDA, if it has the funding, will go after them like they did Dannon.)  But they do want you to think that they will deliver on promises of health benefits.

I do believe that dairy products are an important part of a healthy diet.  And I do believe, after all my reading, that there are very specific health benefits to a real probiotic. (Probiotics) I just don't know where to find one, except in a lab.  And I don't think I'm going to get my yogurt from my local bio chem lab.  So how do you pick?  This is what I'm going to tell my daughter who has been asking me.  (Actually, I'm just going to tell her to read this, which she does anyway.)  I would go for ones that have live cultures and I would choose one that has the highest colony counts.  (Good luck finding that out!)  So  pick ones that have a bigger variety of organisms.  Then  pick ones based on taste because then you are more likely to actually eat them.  And finally I would go for the nonfat or the low fat  yogurt.  This is almost all I have to say on yogurt, except I just bought a yogurt maker.  I'll let you know in a future blog if it's worth the effort.

Although at a future date there may be be other probiotic foods for purchase, right now there are none. The only other possible way to increase your probiotics is to buy supplements.  However, again buyer beware.  There is no data that the organisms actually get to your gut. (All of them have the same wording "Statements and claims on this site have not been reviewed or evaluated by the FDA")

Prebiotics are a little more confusing in how you get them in your diet. Clearly they are good for you.  They are present in many fruits and vegetables.  Depending on what you want the prebiotic to do for you and what kind it is, you need anywhere from 5-15 grams per day in your diet.  (A 6 gram serving is about 1/4 lb of raw asparagus; 1 1/3 lbs of bananas, 1/4 lb of cooked onions or 2-3 raw onions)  But do you need to take a supplement?  How about snack foods?

Prebiotic supplements are fiber pills.  Most of their products have inulin or fructo-olisaccharides in them.  The many company advertisements state that that their claims have not been evaluated by the FDA. They, too, all use the same wording as above.  Most of their products have inulin or fructo-olisaccharides in them.  PepsiCo is working on "functional food snacks" (Snacks for a Fat Planet, The New Yorker, 5/16/2011) but they are still not available.

 If a diet rich in fruit and vegetables, ( as now recommended by the new USDA nutritional guidelines Choose My Plate), would need a supplement to reach 5-15 grams of prebiotics a day depends on whether or not the choices you make also are ones that have a high percentage of the types of dietary fiber that are considered functional.

What do I get from all of this reading and analysis of functional foods?  First of all, you can look at this from one of two ways - you can either say that functional foods have additional health benefits beyond their nutritional values OR you could say that the other foods have detrimental health benefits beyond their nutritional values!  What I mean is that perhaps poor food choices can encourage the growth of toxin-producing bacteria that lead to ill health.  If you stop eating foods that cause toxins, you improve your health.  Hence, you have increased your health benefit.  This is different than getting additional health benefits from the other foods - you are getting additional health benefits because you stopped doing something negative (like people who stopped smoking).  But either way you look at it, it is a good thing.

You have to eat something.  You can eat food that leads to bacteria that produce toxins.  Or you can eat food that is good for you.  Like Mom always said, EAT YOUR VEGETABLES!  Do you need to pay extra to get it in pill form?  Your choice. 

My next blog will  be back to food and will feature recipes for those of you who want "functional food" that tastes good!!!

PREBIOTICS - A HOLISTIC APPROACH TO HEALTH?

 Prebiotics work not only in the gut, but also have been proposed to play an important role in a large range of health benefits from reducing disease risk to possibly curing disease.  (As I write this, the words from Stephen Sondheim's "Pirelli's Miracle Elixir" from  Sweeney Todd are stuck in my brain.)  The claims are long but I will try to put them in large categories.

Prebiotics work on a limited number of gut microorganisms.  As a result of prebiotics' ability to change the growth OR the activities of certain gut organisms prebiotics are claimed to do the following:
1.  Improve the gut composition which leads to improved gut functions including stool regularity.
2.  Improve immune function
3.  Decrease the risk of colon cancer
4.  Improve mineral absorption
5.  Decrease GI infections
6.  Decreases obesity, metabolic syndrome and its related problems

This then leads to the myriad of health benefits that are all over the Internet.

I will again look at good studies in humans, explain results that have only occurred in labs, and what is theory.  The majority of studies have been done using food ingredients which belong to two groups - inulin-type fructans (ITF) and galacto-oligosaccharides (GOS).  These have been shown to stimulate lactobacilli and bifidobacteria, which are good bacteria.  To be classified as a prebiotic, it has to be resistant to hydrolysis and GI absorption before the colon, must be fermented by the intestinal micro flora and stimulate the intestinal bacteria associated with health of humans.

IMPROVE GUT COMPOSITION
In a normal gut, things go through the small intestine more quickly compared to the large intestine so there are more bacteria in the large intestine as well as more undigested food.  This is where the prebiotics work.  The food that we are unable to digest (fiber, complex sugars and proteins) as well lining substances of the gut are fermented by the bacteria and used as their energy source with metabolites left over.  These products influence the gut motility.
In only 2 studies were they able to show a positive effect in gut motility with patients that had Irritable Bowel Syndrome.  Those patients took 5-7 grams/day of a prebiotic to have an improvement in symptoms.  All the other well designed studies showed less good outcomes and they used lower or higher doses.

IMPROVE IMMUNE FUNCTION
There are some very good theories that prebiotics ought to influence the immune system because the gut, through the gut-associated lymphoid tissue (GALT) is significantly involved in both preventing and modifying disease.  The problem is that the human GI system is not easily accessible for study.  So far the best studies are done in the lab and none have been confirmed with well-designed human studies.
A number of clinical studies are being done in Inflammatory Bowel Disease (IBD).  The problems with the studies are many but the ingredients are safe and some of the early results deserve further investigation.
Prebiotics have been added to infant formula to make it more like breast milk, which does improve babies' immunity.  The stools do show an increase of bifidobacteria, but whether that translates to improved human health has yet to be proved.

COLON CANCER
The bacteria in your gut manufacture chemicals and some of them can be carcinogens and toxic.  Good bacteria produce a low number of carcinogens and bad bacteria produce a large number of toxins by comparison.  In theory, if you have good bacteria, you should have less production of toxic waste products in your gut and less risk of cancer.  In animals there is a a reduction in colon cancer and in humans, there seems to be a decrease in bio markers in patients at risk for colon cancer who were given symbionics (pre and probiotics.)  It has not been proven that there is a decrease risk of cancer in humans, but again, this is a difficult study to do.

MINERAL ABSORPTION
A number of well-designed studies have shown an increase absorption of calcium in prepubertal girls and boys and late post menopausal women.  In healthy infants, prebiotics increased iron and magnesium absorption; and in early menopause there is increased copper absorption.  In the studies that showed the best mineral absorption, it appears not only is the dose important, but that also using a combination of prebiotics made the mineral absorption more effective.

Whether or not increased absorption leads to improved health has only been proved in lab animals.  Although it seems reasonable, the bone metabolism of post-menopausal women is more complex and much of the previous dogma that we have taught women  to do (like take high dose calcium) is now being questioned. So far no decrease in the risk of osteoporosis has been shown with prebiotics.

DECREASED GI INFECTIONS
The studies show some effect in rats, and some moderate success in prevention of traveler's diarrhea in humans, but otherwise this has not been as successful as probiotics.

OBESITY AND METABOLIC DISORDERS
Most of the studies on this subject have been done in animals.  They have shown a decrease in fat mass, but not a decrease in weight.  Also, there is better glucose, lipid, triglyceride,  and cholesterol metabolism in the rats. The few human studies available seem to show that prebiotics work by producing a peptide that regulates appetite. But so far whether or not this will actually work in humans has not be shown. What the importance of the actual microbes in the gut are in humans has not been explored because the studies have all sorts of difficulties in trying to devise double blind studies with good placebos



AVAILABILITY OF FOOD
Many regular foods contain prebiotics.  These include leeks, onions, Jerusalem artichoke, garlic, asparagus and bananas, to name a few.  The quantity of what you have to eat of them to achieve a prebiotic effect differs with the food.  Also, the caloric quantity of the food changes which will modify the health benefits of the prebiotic.
SIDE EFFECTS of PREBIOTICS
Prebiotics are fermented in the large intestine, which means gas is produced.  The more prebiotics, the more flatulence, cramping and diarrhea.  Most people can handle 10-20 grams/meal, but some people complain of side effects with that amount.

So where does that leave us?  See my final blog as I try to summarize the health benefits of these topics and try to make sense on what you can do on a daily basis.

Buyer Beware: Health Promises of Functional Food

"Let food by thy medicine and medicine be thy food" so said Hippocrates.  If you search this phrase on the Internet you will find thousands of claims of how foods can cure you of everything.  It reminds me of the days when men would travel around with magic potions that could cure whatever ails you. Literature and theatre abound with tales and songs of miracle elixirs.  And there is an even longer history of the health-promoting aspects of certain foods.

For thousands of years fermented foods have been eaten throughout the world.  Abraham's long life is attributed to eating sour milk.    The Romans treated gastroenteritis with fermented milk products.  But I am still a sceptic as I look at all the claims on the Internet.  I decided to review the medical literature where there are more and more articles looking at food, and this topic specifically, and what it can do for health.  I will try and summarize the many studies that I reviewed to make some sense out of all that's out there so that you can decide what, if anything, you what to spend your money on. 

So today's blog will be an overview on what is a functional food and how scientists define prebiotics, probiotics and synbiotics.   The next blogs will go into specifics about them and what the studies have shown and haven't shown about their effects on health.  If there are a lot of comments and/or questions I will address them further.

FUNCTIONAL FOODS
When you look at the label on packaged food it gives you the nutritional value of the food (calories, vitamins, proteins, etc.) but it won't tell you its wellness-maintaining properties.  It doesn't address issues of its potential medicinal benefits.  But for a food to make the claim of being "functional" it should have some enhancement of health beyond its nutritional value.

I plan to focus this discussion on foods that have their effect on the gut.  In a normal gut, you would want the organisms that promote good health to predominate over the organisms that are potentially harmful.  Basically, the whole point of functional food is that after you eat this stuff, you will promote an increase number of healthy bacteria.  Therefore the food has a function "beyond nutrition".

PREBIOTIC
A prebiotic was first defined in 1995 and then further refined over the years.  Presently the accepted definition from the International Scientific Scientific Association for Probiotics and Prebiotics (ISAPP) meeting in 2008 is "A dietary prebiotic is a selectively fermented ingredient that results in specific changes, in the composition and/or activity of the gastrointestinal microbiota, thus conferring benefit(s) upon host well being and health."  This means that certain functional foods are not digested by the person but will actually be fermented by selective intestinal bacteria and promote their growth.  These bacteria are beneficial to the person's health.

PROBIOTIC
Although there are some variations in the definitions on what makes up a probiotic, they all agree that the probiotic microorganisms must be living and that scientifically there needs to be proven health effects.  Probiotics are defined as actual microorganisms which get to the intestines in an active form and in a large enough quantity so that the can exert a positive effect on health.  Although many people will use the term probiotics interchangeably with probiotic foods they are not the same thing.  Probiotic foods are foods that also contain organisms (probiotics) that will give an additional health benefit beyond that of the nutritional content of the food.

SYNBIOTICS
Symbiotics are a mixture of probiotics and prebiotics which when added together are supposed to act "synergistically" by promoting the implantation of the live organism (probiotic) and improve its survival (prebiotic).  For a food to be classified as a prebiotic or a probiotic, it has to be in certain quantities or concentrations.  Food companies have been launching more and more products and want to promote the health benefits of their foods, but they cannot classify them in either category because they do not meet criteria.  So what they are doing is putting both pre and pro biotics in their foods and labeling them as "synbiotics".   Often these foods do not have enough pre and pro biotics in them to act in the synergistic way the companies state to have the claimed health benefits.

In the next blogs I will address the myriad of potential health benefits and look at what has been proved, disproved, shown in animals only and thought to be possible from food.