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| {{Foodbox | |||
| | name = Juice Plus | |||
| | image = ] | |||
| | caption = A 4-month supply of Juice Plus.<br>Ingredients shown are for Garden Blend, as listed on the product label, though three studies have indicated that the label's amounts are not entirely accurate.<ref name=plotnick/><ref name=environmental/><ref name=Consumerlab/> | |||
| | serving_size = 2 capsules (750 mg each) | |||
| | calories = 0 | |||
| | calories_from_fat = | |||
| | total_fat = 0 | |||
| | cholesterol = | |||
| | sodium = 10 mg | |||
| | total_carbohydrate = 1 g | |||
| | dietary_fiber = < 1 g | |||
| | sugars = | |||
| | protein = < 1 g | |||
| | vitamin_a = 140% | |||
| | vitamin_c = | |||
| | vitamin_e = 80% | |||
| | calcium = 4% | |||
| | iron = 2% | |||
| | folate = 70% | |||
| | ingredients = vegetable juice powder and pulp from carrots, parsley, beets, kale, broccoli, cabbage, spinach, and tomato; gelatin, lipase, amylase, protease, cellulase, beet fiber, barley bran, oat bran, cabbage fiber, glucomannan, plant cellulose, dried plant fiber, Lactobacillus acidophilus, vegetable-derived magnesium stearate, anthocyanins, allicin, lycopene, polyphenol catechins, Dunaliella salina (algae), and indole carbinols. | |||
| | source = Juice Plus Garden Blend U.S. bottle label | |||
| | notes = Amounts vary with other brands, such as Orchard Blend | |||
| }}'''Juice Plus''' is a branded line of ]s containing concentrated fruit and vegetable juice extracts fortified with added vitamins and nutrients. Sold via direct or ], the supplements are advertised as "the next best thing to fruits and vegetables." Marketing claims made about Juice Plus products suggest that they can provide benefits such as reducing ] and promoting ] health. A few sources have argued that there is no scientific proof that Juice Plus offers significant health benefits, and that deceptive claims are used in the product's marketing information. Several studies which have set out to test the effects of Juice Plus have generated conflicting and controversial results. | |||
| ==Product description== | |||
| Juice Plus is manufactured by Natural Alternatives International in ] and distributed by National Safety Associates (NSA; ]) via direct or ]. There are several Juice Plus products, with the primary ones being '''Orchard Blend''' and '''Garden Blend''' capsules, which are sold together in 4-month supplies at a cost, in 2007, of approximately $160 USD.<ref name=jphome/> NSA recommends consumption of four capsules per day (see infobox at right for nutrient breakdown). | |||
| ==Product research== | |||
| Juice Plus is marketed as a dietary supplement that can provide some of the nutritional benefits of fruits and vegetables; however, multiple studies of varying standards have produced conflicting results as to the truth of these claims. | |||
| The products examined in the majority of the studies were Garden Blend and Orchard Blend; two studies were performed on Vineyard Blend taken in combination with Garden and Orchard Blend,<ref name=plotnick/><ref name=nantz/> and one study was on Juice Plus Gummies.<ref name=stewart/> | |||
| ===Nutrient absorption=== | |||
| Though Juice Plus contains some nutrients, concerns have been raised that these nutrients may not be ], meaning not effectively absorbed by the human body, and that some of the nutrients claimed to be in the products may not be present in significant amounts.<ref name=watzl/><ref name=stewart/> Studies on nutrient absorption showed that subjects taking Juice Plus had elevated blood levels of folate and beta-carotene<ref name=kiefer>{{cite journal | title = Supplementation with mixed fruit and vegetable juice concentrates increased serum antioxidants and folate in healthy adults | author=Kiefer I, Prock P, Lawrence C, Wise J, Bieger W, Bayer P, Rathmanner T, Kunze M, Rieder A | date = 2004 | journal = J Am Coll Nutr | volume=23 | issue=3 | pages= 205-11 | url=http://www.jacn.org/cgi/reprint/23/3/205.pdf | format=pdf}}</ref><ref name=smith>{{cite journal | title = Supplementation with fruit and vegetable extracts may decrease DNA damage in the peripheral lymphocytes of an elderly population | author= Smith MJ, Inserra PF, Watson RR, Wise JA, O'Neill KL | date = 1999 | journal = Nutr Res | volume=19 | issue = 10 | pages= 1507-18}}</ref> <ref name=samman>{{cite journal | author = Samman S., et al. | year = 2003 | title = A mixed fruit and vegetable concentrate increases plasma antioxidant vitamins and folate and lowers plasma homocysteine in men | journal = J Nutr | volume = 133 | issue = 7 | pages = 2188-93 | url = http://jn.nutrition.org/cgi/reprint/133/7/2188 | format = pdf}}</ref> but the effects on blood levels of vitamin E and vitamin C were inconsistent. Some studies have shown significant increases in vitamin E<ref name=wise/><ref name=kiefer/> and C levels,<ref name=wise/><ref name=kiefer/><ref name=leeds/> while other studies have shown much weaker effects on vitamin E<ref name=leeds/><ref name=samman/> and C levels<ref name=samman/>, and that the levels of the two vitamins are not significantly increased.<ref name=smith/><ref name=bloomer>{{cite journal | title = Oxidative stress response to aerobic exercise: comparison of antioxidant supplements | author= Bloomer RJ, et al. | date = 2006 | journal = Med Sci Sports Exerc | volume=38 | pages= 1098-1105}}</ref> Studies have also found that Juice Plus does not raise the blood levels of other key phytonutrients from fresh fruits and vegetables, such as ],<ref name=smith/><ref name=samman/> ],<ref name=smith/><ref name=samman/> ],<ref name=smith/><ref name=samman/><ref name=nantz>{{cite journal | title = Immunity and antioxidant capacity in humans is enhanced by consumption of a dried, encapsulated fruit and vegetable juice concentrate | author= Nantz MP, Rowe CA, Nieves C Jr, Percival SS. | date = 2006 | journal = J Nutr | volume=136 | pages= 2606-10 }}</ref> and beta-cryptoxanthin.<ref name=smith/><ref name=inserra>{{cite journal | author = Inserra PF, Jiang S, Solkoff D, Lee J, Zhang Z, Xu M, Hesslink R, Wise J, Watson RR | year = 1999 | title = Immune function in elderly smokers and nonsmokers improves during supplementation with fruit and vegetable extracts | journal = Integr Med | volume = 2 | issue = 1 | pages = 3-10 }}</ref><ref name=samman/><ref name=nantz/> | |||
| ===Antioxidant activity=== | |||
| NSA claims that Juice Plus is an effective antioxidant, and quotes a study, funded by the manufacturer, which showed a 75% reduction in lipid peroxidation (an ] marker) after 7 to 28 days.<ref name=wise/> Other studies sponsored by the manufacturer have also reported reductions in lipid peroxidation<ref name=leeds>{{cite journal | title=Availability of micronutrients from dried, encapsulated fruit and vegetable preparations: a study in healthy volunteers | author=Leeds AR, et al. | year = 2000 | journal = J Hum Nutr Diet | volume=13 | pages=21-7 }}</ref> and DNA oxidation.<ref name=smith/> These studies were not blinded or placebo-controlled, included few participants (in one case no more than 15), and did not include monitoring or control of the participants' food intake. One such study was criticized as “a particularly poor study” by Rosemary Stanton in the Australian journal, '']''.<ref name=stanton/> | |||
| Three other studies which were conducted under more rigorous conditions, meaning ], ], ]-controlled studies, longer in duration and with more subjects, found no significant reductions in lipid peroxidation,<ref name=samman/><ref name=bloomer/> DNA oxidation, <ref name=bloomer/><ref name=kiefer/><ref name=nantz/> or other markers of oxidative stress.<ref name=samman/><ref name=bamonti/> | |||
| One study, which used an ] test of ] activity, found that 1 g of Juice Plus Garden Blend/Orchard Blend powder had the corresponding antioxidant capacity to approximately 10 g (fresh weight) of fruit or vegetable, amounting to 30 g (roughly one-third of a serving) per 4 capsules.<ref name=chambers>{{cite journal | author = Chambers SJ, et al.| year = 1996| title = Evaluation of the antioxidant properties of a methanolic extract from ‘Juice Plus fruit’ and ‘Juice Plus vegetable’ (dietary supplements) | journal = Food Chem | volume = 57 | issue = | pages = 271-274 }}</ref> | |||
| One ]-controlled study conducted in 2002 found that Juice Plus Gummie candies did not significantly improve the ] status of children, as indicated by negative results from 6 different antioxidant tests.<ref name=stewart>{{cite journal | author = Stewart, R.J. et al.| year = 2002 | month=November | title = Antioxidant status of young children: Response to an antioxidant supplement | journal = ] | volume = 102 | issue = 11 | pages = 1652-7}}</ref> The authors explained this by saying it was possible that the supplement did not contain enough of the proper antioxidants to make a significant difference or that the antioxidants extracted in the fruit/vegetable extract were not ]. | |||
| ===Cardiovascular effects=== | |||
| Several studies have examined the effects of Juice Plus capsules on biochemical parameters associated with ] function, again with conflicting results. | |||
| One non-controlled study found a 37% decrease in ] levels.<ref name=panunzio>{{cite journal | title = Supplementation with fruit and vegetable concentrate decreases plasma homocysteine levels in a dietary controlled trial | author=Panunzio MF, et al. | date = 2003 | journal = Nutr Res | volume=23 | pages= 1221-8 }}</ref> | |||
| Other more rigorous studies, including two that were ], double-blind, placebo-controlled trials, found that ] levels were not reduced<ref name=plotnick/><ref name=bamonti>{{cite journal | title=Increased free malondialdehyde concentrations in smokers normalise with a mixed fruit and vegetable juice concentrate: a pilot study | author=Bamonti F, et al. | year=2006 | journal=Clin Chem Lab Med | volume=44 | issue=4 | pages= 391-6 }}</ref> or were reduced only marginally (7%).<ref name=samman/> | |||
| Two randomized, double-blind placebo controlled studies have examined the effect of Juice Plus on serum cholesterol and ] levels. One study found that Juice Plus had no significant effects;<ref name=samman/> the other found slight decreases in cholesterol (6%) and LDL (9%) in subjects that took Orchard/Garden Blend, but no reductions among subjects who took Juice Plus Vineyard blend in addition.<ref name=plotnick/> | |||
| One study found that Juice Plus had no effect on ] in healthy subjects.<ref name=plotnick/> This study also reported that a combined regimen of Juice Plus Orchard Blend and Garden Blend significantly decreased the impairment of brachial artery vasoactivity caused by a high-fat meal; however, the addition of Vineyard Blend to this regimen had no additional effect on brachial artery vasoactivity and led to an increase in total and low-density lipoprotein.<ref name=freeman>{{cite journal | title = High-fat diets and cardiovascular disease. Are nutritional supplements useful? | author=Freedman JE. | date = 2003 | journal = J Am Coll Cardiol | volume=41 | pages= 1750-2 | url = http://www.sciencedirect.com/science?_ob=MImg&_imagekey=B6T18-48MY548-K-1&_cdi=4884&_user=10&_orig=search&_coverDate=05%2F21%2F2003&_sk=999589989&view=c&wchp=dGLbVtb-zSkWb&md5=a6fb191bfaaafb167556efa7ff7e4a25&ie=/sdarticle.pdf | format = pdf }}</ref> | |||
| ===Adverse effects=== | |||
| Since Juice Plus is not regulated as a drug, information on ] has not been collected through a systematic monitoring program imposed by any national regulatory agency. However some adverse effects were reported in two studies on Juice Plus. In one of the studies, subjects who took Orchard Blend and Garden Blend developed a ]-like rash.<ref name=inserra/> Another study reported adverse effects (upper-], ], and ]) in roughly a third of the participants who took the products for 7 days. These events resolved spontaneously and were deemed by the researchers to be unrelated to treatment.<ref name=leeds/> | |||
| Other adverse effects listed in the Juice Plus Franchise Owner's Manual and the Special Nutritional Adverse Event Monitoring System include gastrointestinal ], ], ], ], ], and ].<ref name=vfom>{{cite book | last = | first = | authorlink = | coauthors = | title = Virtual Franchise Owner's Manual (December 2002) | publisher = National Safety Associates | date = | location = | pages = | url = | doi = | id = }}</ref><ref name=snaems>{{cite web | last = | first = | authorlink = | coauthors = | title = FDA SN/AEMS Web Report | work = | publisher = U.S. Food and Drug Administration | date = 1998-10-20| url = http://www.thememoryhole.org/feds/fda-nutritionals-reports.htm| format = | doi = | accessdate = 2006-10-15}}</ref> Heartburn, abdominal pain, diarrhea, gas with foul odor, and indigestion have been noted as very common risks associated with taking Juice Plus Orchard and Garden Blend, and nausea and vomiting as less common risks;<ref name=IRB>{{cite web | last = | first = | authorlink = | coauthors = | title = CCCWFU #60A02 Protocol Amendment #12 | work = | publisher = Institutional Review Board, Comprehensive Cancer Center of Wake Forest University | date = 2006-19-17| url = http://www1.wfubmc.edu/NR/rdonlyres/778FDC88-D432-415D-BE62-F3726C374086/0/60a022006CRstampedconsentform.pdf | format = | doi = | accessdate = 2007-02-11}}</ref> in some cases these side effects may be serious and long lasting, persisting after use of the supplement has been stopped. | |||
| ==Juice Plus Children's Research Foundation== | |||
| The Juice Plus Children's Research Foundation,<ref name=nsajpcrf>{{cite web | last = | first = | authorlink = | coauthors = | title = Juice Plus Children's Research Foundation homepage | work = | publisher = National Safety Associates | date = | url = http://www.childrensresearch.org | format = | doi = | accessdate = 2006-10-15}}</ref> founded in 1997, is a non-profit organization whose stated goal is to initiate and/or support programs that advance the principle that improved nutrition leads to healthier lifestyle and overall better health in children. The foundation is chaired by executives of National Safety Associates and operates from the company's head office in ]. | |||
| As of 2007, no research had been published by the Foundation, but it does conduct an ongoing survey which seems to link Juice Plus consumption to a general improvement in diet and lifestyle habits. Critics, including the ] Wellness Letter and Dr. ] of MLMWatch, question the survey's scientific value, and state that the Foundation is being used mainly as a marketing gimmick to get families to buy Juice Plus products.<ref name=jpcrf>{{cite web | last =Barrett | first = Stephen | authorlink = Stephen Barrett | title =Questionable Research by the Juice Plus Children's Research Foundation | publisher = MLM Watch | date = | url =http://www.mlmwatch.org/04C/NSA/crf.html | accessdate = 2007-02-05}}</ref><ref name=ucbwl2>{{cite web | last = | first = | authorlink = | coauthors = | title = Juiced Up and Dried Out | work = | publisher = University of California Berkeley Wellness Letter | date = | url = http://www.berkeleywellness.com/html/ds/dsJuicePlus.php | format = pdf | doi = | accessdate = 2006-10-15}}</ref> | |||
| ==Criticism== | |||
| According to '']'', in 2005, National Safety Associates used advertising featuring Dr. William Sears, which implied that Juice Plus Gummies are low in sugar and a nutritional alternative to fruits and vegetables. This claim resulted in consumer complaints to the ]'s National Advertising Division (NAD). The BBB issued a complaint that NSA's claims were misleading, and as a result, NSA promised to modify its ads and stop calling Gummies “the next best thing to fruits and vegetables”.<ref name=consumerreports>{{cite web | last = | first = | authorlink = | coauthors = | title = How Product Testimonials Bend The Rules | work = | publisher = '']'' | date = | url = http://www.consumerreports.org/cro/personal-finance/producttestimonialtricks-of-the-trade-106.htm | format = | doi = | accessdate = 2006-10-15}}</ref> However, as of 2007, the Juice Plus homepage still advertizes that the products are “the next best thing to fruits and vegetables”, though not specifically in reference to the Gummies.<ref name=jphome>{{cite web | last = | first = | authorlink = | coauthors = | title = Juice Plus homepage | work = | publisher = National Safety Associates | date = | url = http://www.juiceplus.com | format = | doi = | accessdate = 2006-10-15}}</ref> | |||
| Concerns have also been raised about the accuracy of product labeling. Three studies which included chemical analyses of Juice Plus have indicated nutrient amounts that differ from the amounts listed on the product labels.<ref Name=plotnick>; Corretti MC, Vogel RA, Hesslink, Jr. R, Wise JA. (2003). "" (pdf). ''J Am Coll Cardiol'' '''41''' (10): 1744-9.</ref><ref name=environmental> {{cite news | title=EN Squeezes the Raw Truth Out of Juice Plus Claims | date = March 2002 | publisher= Environmental Nutrition | url = http://www.environmentalnutrition.com/pub/25_3/asken/150372-1.html}}</ref><ref name=Consumerlab> {{cite news | title=Multivitamin/multimineral product review: ingredient comparison tables | date = 2006 | publisher= Consumer Lab}}</ref> An unpublished chemical analysis of Juice Plus reported by GNLD International, a competing supplement company, is claimed to have shown that Juice Plus Orchard/Garden Blend did not contain detectable levels of alpha-carotene, lycopene, or lutein.<ref name=GNLD> {{cite news | title = Are all antioxidants what they claim to be? | date = | publisher= GNLD International | url = http://ww1.gnld.com/pages/businessguide_cd1005/gnldbustools_web/content/pdf/YouDecide/2001/YouDecide_Feb_01.pdf | format = pdf}}</ref> | |||
| Doubts have been raised about the benefits of Juice Plus by the ], the ] and other critics. Specific criticisms include: the product’s marketing being unsupported by research data, the product contains too little fruit and vegetable powder to offer significant clinical benefits, concerns that the effects can be attributed to the inclusion of added ] vitamins and micronutrients, and complaints that the products are excessively priced relative to their potential benefits.<ref name=watzl>{{cite journal | author = Watzl, B. | coauthors=Bub, A. | yeacr = 2003 | title = Letter to the Editor:Fruit and Vegetable Concentrate or Vitamin Supplement? | journal = J Nutr | volume = 133 | issue = 7 | pages = 3725 | url = http://jn.nutrition.org/cgi/reprint/133/11/3725 | format = pdf}}</ref><ref name=mscc>{{cite web | last = | first = | authorlink = | coauthors = | title = Juice Plus| work = | publisher = Memorial Sloan-Kettering Cancer Center | date = | url = http://www.mskcc.org/mskcc/html/11571.cfm?RecordID=637&tab=HC | format = | doi = | accessdate = 2006-10-15}}</ref><ref name=ucbwl1>{{cite web | last = | first = | authorlink = | coauthors = | title = Juice Plus—and minus | work = | publisher = University of California Berkeley Wellness Letter | date = | url = http://www.berkeleywellness.com/subCorner/pdf/2000/0011.pdf | format = pdf | doi = | accessdate = 2006-10-15}}</ref><ref name=ucbwl2/><ref name=goodwin>{{cite web | last = Goodwin | first = Kathy | authorlink = | coauthors = | title = Dietary supplements: facts about Juice Plus | work = | publisher = The Diet Channel | date = | url = http://www.thedietchannel.com/Dietary-Supplements-Facts-About-Juice-Plus.htm | format = | doi = | accessdate = 2006-10-15}}</ref><ref name=stanton>{{cite journal | title = Nutrition: who can you believe?| author= | date = 2000 | journal = ]| volume=20 | issue=4 | pages= 23-7 | url = http://www.skeptics.com.au/journal/2000/4_nutrition.pdf}}</ref><ref name=mlmw2>{{cite web | last = Barrett| first = Stephen | authorlink = Stephen Barrett| coauthors = | title = Juice Plus: A Critical Look | work = | publisher = MLM Watch| date = | url = http://www.mlmwatch.org/04C/NSA/juiceplus.html | format = | doi = | accessdate = 2006-10-15}}</ref> | |||
| Juice Plus has drawn criticism as a result of connections with the now-bankrupt supplement company United Sciences of America, Inc. (USAI).<ref name=mlmw2/> Several of the research articles published on Juice Plus were authored by John A. Wise,<ref name=plotnick/><ref name=kiefer/><ref name=smith/><ref name=inserra/><ref name=wise/> who is the Chief Science Officer and a shareholder of the company that manufactures Juice Plus (Natural Alternatives International; NAI). Immediately prior to joining NAI in 1987, Wise had served as Executive vice-President of Research & Development for USAI. In October 1986, USAI was the subject of an expose produced by ], which revealed the company’s use of fraudulent scientific claims and deceptive advertising.<ref name=farley>{{cite journal | author = Farley, Dixie | year = 1987| title = The eyes of Texas were upon them - and FDA - United Sciences of America Inc | journal = FDA Consumer | volume = | issue = October | pages = | url = http://findarticles.com/p/articles/mi_m1370/is_v21/ai_5273121/pg_1 | format = }}</ref> | |||
| The FDA subsequently investigated USAI for pyramid-scheming, the use of false and misleading promotional materials, and for making prohibited disease treatment claims. Attorneys General in California, New York and Texas simultaneously filed lawsuits ordering USAI to change its marketing plan and sales claims. In response, USAI filed for bankruptcy and ceased operations in 1987, at which time John A. Wise began employment with NAI. USAI’s deceptive sales and marketing tactics were reviewed in several articles published in 1986-1987.<ref name=stare>{{cite journal | author = Stare, F.J. | coauthors=. | year = 1986 | title = Marketing a nutritional "revolutionary breakthrough". Trading on names. | journal = N Engl J Med | volume = 315 | issue = 15 | pages = 971-3 | url = | format = }}</ref><ref name=young>{{cite journal | author = Young, E.A. | coauthors= Schenker, S., Weser, E. | year = 1987 | title = United Sciences of America, Incorporated: an "optimal" diet? | journal = Ann Intern Med. | volume = 107 | issue = 1 | pages = 101-3 | url = | format = }}</ref><ref name=renner>{{cite journal | author = Renner, J.H. | coauthors= | year = 1986 | title = Science or scam? | journal = N Engl J Med | volume = 315 | issue = 15 | pages = 971 | url = | format = }}</ref><ref name=holden>{{cite journal | author = Holden, C. | coauthors= | year = 1986 | title = Scientists get flak over marketing plan | journal = Science | volume = 234 | issue = 4780 | pages = 1063-4 | url = | format = }}</ref><ref name=money>{{cite journal | author = | coauthors= | year = 1987 | title = USA: The strange rise and fall of one MLM | journal = Money | volume = | issue = June 1 | pages = | url = http://money.cnn.com/magazines/moneymag/moneymag_archive/1987/06/01/83881/index.htm | format = }}</ref> | |||
| == References == | |||
| {{reflist}} | |||
| ] | |||