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Juice Plus+® is a branded line of nutritional supplements containing powdered fruit or vegetable juice extracts fortified with added vitamins and nutrients. Juice Plus is manufactured by Natural Alternatives International (NAI; San Marcos, CA) and is distributed by National Safety Associates (NSA; Collierville, TN) only through direct or multi-level marketing. Several versions of the product are marketed including Orchard Blend capsules (containing unknown amounts of powdered fruit juice extracts) and Garden Blend capsules (containing unknown amounts of powdered vegetable juice extracts), chewable and gummy candy supplements for children, and a version for dogs and cats.

Product Labeling

The Juice Plus Garden Blend bottle label contains the following information. The Reference Daily Intake size is 2 capsules (750 g each), which contain the following nutrients (as percentages of the U.S. recommended daily intake): vitamin A (as beta-carotene) 140%, calcium 4%, vitamin E 80%, vitamin C 70%, iron 2%, and folate 70%. A 2-capsule serving contains no fat or cholesterol, 10 mg sodium, 1 g carbohydrate, and less than 1 g each of fiber and protein. The ingredients listed in descending order of amount (exact amounts not listed) are: 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 acidophillus'', vegetable-derived magnesium stearate, anthrocyanins, allicin, lycopene, polyphenol catechins, Dunaliella salina (algae), and indole carbinols.

The Juice Plus Orchard Blend bottle label contains the following information. The recommended daily serving size is 2 capsules (750 g each), which contain the following nutrients (as percentages of the U.S. recommended daily intake): vitamin A (as beta-carotene) 110%, calcium 2%, vitamin E 70%, vitamin C 320%, iron 2%, and folate 35%. A 2-capsule serving contains no fat or cholesterol, 5 mg sodium, 1 g carbohydrate (less than 1 g each of dietary fiber and sugars), and less than 1 g protein. The ingredients listed in descending order of amount (exact amounts not listed) are: fruit juice powder and pulp from apple, orange, pineapple, cranberry, peach, acerola cherry, and papaya; gelatin, bromelain, papain, lipase, amylase, protease, and cellulase; apple pectin, cirus pectin, date fiber, prune powder, glucomannan, citrus bioflavenoids, dried plant fiber, Lactobacillus acidophillus, vegetable-derived magnesium stearate, anthrocyanins, polyphenol catechins, Dunaliella salina (algae), and indole carbinols.

Two capsules per day of each of these products (4 capsules in total) constitute the usual daily regimen.

Juice Plus products do not contain certified organic ingredients.

Support From the Medical Community

The following doctors support Juice Plus+® and recommend it to their patients: Richard E. DuBois, M.D. (Internal Medicine and Infectious Diseases, Atlanta, Georgia), Titus Duncan, M.D. (Laparoscopic and Bariatric Surgery, Atlanta, Georgia), Frank K. Eggleston, D.D.S. (Restorative and Operative Dentistry, Houston, Texas), Marla Friedman, Ph.D. (Psychology and Nutrition, Glen Cove, New York), Delia Garcia, M.D. Radiation Oncology (St. Louis, Missouri), Doug Odom, M.D. (Obstetrics and Gynecology, Jackson, Mississippi), Mitra Ray, Ph.D. (Research Biologist Bellevue, Washington), William Sears, M.D. (Pediatrics San Clemente, California), Susan Silberstein, Ph.D. (Executive Director, Center for Advancement in Cancer Education, Philadelphia, Pennsylvania), Paul Stricker, M.D. (Pediatric and Adolescent Sports Medicine, San Diego, California), Gerald Tulzer, M.D. (Pediatric Cardiology, Vienna, Austria), Rick Wilson, M.D. (Dermatology and Dermatologic Surgery, Plano, Texas)

From this list, it is clear that the medical community stands behind the efficacy of the Juice Plus+® product. In fact, one can see the suport of not only the medical community, but also the definitive support of the international scientific community. Any criticism of the Juice Plus +® product must be understood in the context of the stature of these professionals.

Dr DuBois has recommended:

"Studies have proven that whole foods are the best source of micronutrients, in part because antioxidants and other micronutrients work together in ways we've just begun to understand. Whole foods also have thousands of yet-to-be identified phytochemicals that will prove beneficial for human nutrition. I tell my patients: Eat whole foods and take Juice Plus+®." (from http://www.juiceplus.com/nsa/pages/RichardDuBois.soa)

Dr Ray has recommended: "Most disease is really little more than unhealthy cells. The human body has an amazing ability to maintain healthy cells — and even repair unhealthy ones — provided it has the building blocks to work with. That comes from eating healthy, nutritionally balanced FOOD. Unfortunately, most people don't eat the right foods, especially lots of fresh, raw fruits and vegetables. Juice Plus+® provides a nutritional ‘safety net’ for everyone." (from http://www.juiceplus.com/nsa/pages/MitraRay.soa)

Adverse Event Profile

Adverse events associated with the use of Juice Plus have been monitored and reported in only one study (Inserra et al. Integrative Medicine 1999; 2:3-10), which indicated that approximately 1/20 subjects who completed the study developed a hive-like rash (although the actual incidence of adverse events may have been higher since several subjects dropped out of the study for unspecified reasons). Other adverse effects reported anecdotally include gastrointestinal cramps, gas, diarrhea, and constipation. The majority of users have successfully taken Juice Plus without adverse effects.

Research

Nine studies on Juice Plus have been published in peer-reviewed journals. Three were randomized, double-blind, and placebo-controlled trials. Most of the studies were funded and co-written by the manufacturer. To date, the products that have been examined in all of the studies were Garden Blend and Orchard Blend (2 capsules of each taken daily in most of the studies), with the exception of one study on Vineyard Blend taken in combination with Garden and Orchard Blend (Plotnick et al. J Am Coll Cardiol 2003;41:1744-9), and one study on Juice Plus Gummies (Stewart et al. J Am Diet Assoc. 2002;102:1652-7).

Criticisms

While NSA maintains that the published studies establish the efficacy of Juice Plus, other sources have argued that the research is flawed and that claims made about the product have been overly vague, misleading, or innacurate. In 2003, Dr. Bernhard Watzl and Dr. Achim Bub of the Federal Research Centre for Nutrition in Karlsruhe, Germany, published a critical commentary in response to a Juice Plus study by Dr. Samir Samman and colleagues (J Nutr 2003; 133:2188-93), claiming that Juice Plus contained at least 4 nutrients (beta-carotene, vitamin C, vitamin E, and folate) that were added to the plant powders to restore nutrients lost during processing. This claim was acknowledged by Dr. Samman in a published reply (J Nutr. 2003;133:3726.), and it suggested that any of the potential benefits of Juice Plus could be attributed to the spiked nutrients rather than to those that may have been present in the original plant sources. Similarly, Dr. Jane Freedman of Boston University School of Medicine published a critical commentary (J Am Coll Cardiol 2003;41:1750-2) regarding a Juice Plus study by Dr. Gary Plotnick and associates (Ibid; p. 1744–9), which raised concerns about the reliability of that study's results and conclusions.

Several of the studies on Juice Plus showed poor results with regard to (a) the content and absorption of several key nutrients and antioxidants, (b) antioxidant effects, and (c) effects on homocysteine, LDL, and cholesterol levels. Other studies are in progress but have not been published.

A 2003 placebo-controlled study Dr. R.J. Stewart and colleagues (J Am Diet Assoc. 2002;102:1652-7) from the University of Utah, showed that vitamin-fortified Juice Plus Gummie candies did not significantly improve the antioxidant status of subjects, according to the results of 6 different antioxidant tests. The authors stated “It is 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 biologically available”. They also showed that the product consisted mainly of 2 ingredients: corn syrup (85%) and beef gelatin (10%).

Critics also claim that much of the scientific basis for Juice Plus is argued solely per an ad verecundiam argument; a logical fallacy which states that since an authority or journal has done a study involving Juice Plus, then all marketing claims must be true.

Product Claims and Counterclaims

Claim: Juice Plus is “the next best thing to eating fruits and vegetables”.

Counterclaim: According to Consumer Reports, the Better Business Bureau's National Advertising Division said in April 2005 that NSA advertising featuring Dr. William Sears misleadingly implied that Juice Plus Gummies are low in sugar and are a nutritional alternative to fruits and vegetables. NSA had allegedly promised to modify its ads and stop calling Gummies “the next best thing to fruits and vegetables”, but continues to use this claim to describe Juice Plus on the product website.

Claim: Juice Plus contains a far wider variety of naturally occurring vitamins and minerals than traditional vitamin supplements, and also the antioxidants/phytonutrients and fiber found in fresh, raw fruits and vegetables.

Counterclaim: There is no evidence to support the claim that Juice Plus contains a far wider variety of naturally occurring vitamins and minerals than traditional vitamin supplements, or a significant number or amount of the antioxidants, phytonutrients, and fiber found in fresh, raw fruits and vegetables. The product label indicates that Juice Plus contains certified amounts of only 6 nutrients and very small amounts of fiber (less than 1 g).

Claim: Four daily Juice Plus capsules provide the vitamin C of four oranges

Counterclaim: According to a March 2002 report by Environmental Nutrition “Independent analysis of the product’s nutrient content is curious and contradictory, showing nowhere near the amount of vitamin C as in four oranges, as the product claims, for example. Moreover, there's no way the fiber is retained, an important benefit of fruits and vegetables. Not surprisingly, Juice Plus doesn’t come cheap—about $450 a year.”

Claim: Juice Plus is “the” simple, convenient, and inexpensive way to add more nutrition from fruits and vegetables to the diet.

Counterclaim: Some critics have stated that Juice Plus is more expensive (as well as less effective) than simply purchasing a sufficient amount of fruits and vegetables.

External links

Product Homepage

• Juice Plus+® homepage Provides product promtional information and excerpted research abstracts.

Full-text Research Available Online

• Effect of supplemental phytonutrients on impairment of the flow-mediated brachial artery vasoactivity after a single high-fat meal. Company sponsored research.
• A mixed fruit and vegetable concentrate increases plasma antioxidant vitamins and folate and lowers plasma homocysteine in men. Company sponsored research.

Critical Commentary in Peer-Reviewed Journals

• Fruit and vegetable concentrate or vitamin supplement? A critique of Juice Plus research by Dr. Bernhard Watzl and Dr. Achim Bub of the Federal Research Centre for Nutrition, Karlsruhe, Germany.
• High-fat diets and cardiovascular disease. Are nutritional supplements useful? A critique of Plotnick et al (2003) by Dr. Jane Freedman, Boston University School of Medicine

Other Critical Commentary

• Juice Plus: A Critical Look Commentary by Dr. Stephen Barrett of Quackwatch
• A critique of Juice Plus from Memorial Sloan-Kettering Cancer Center
• Juiced Up and Dried Out A critique by the University of California Berkeley
• Juice Plus—and minus Additional critique by the University of California Berkeley
• Consumer Reports: How product testimonials bend the rules (Jan 2006) Consumer complaints with the Better Business Bureau's National Advertising Division regarding misleading Juice Plus testimonial advertisements featuring Dr. William Sears.

• Business models
• Nutrition