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Template:FoodboxJuice Plus+ is a branded line of dietary supplements containing concentrated fruit and vegetable juice extracts fortified with added vitamins and nutrients. Introduced in 1993 and sold via direct or multi-level marketing, the supplements are advertised as "the next best thing to fruits and vegetables," a claim which has stirred considerable controversy. Marketing claims made about Juice Plus+ products suggest that they can provide benefits such as reducing oxidative stress and promoting cardiovascular health. Critics 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. 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 San Marcos, CA and distributed by National Safety Associates (NSA; Collierville, TN) via direct or multi-level marketing. 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. NSA recommends consumption of four capsules per day.

According to information on the product labels, the suggested daily 4-capsule Juice Plus regimen provides the following nutrients (in % Reference Daily Intake with corresponding amounts in parentheses): folate 105% (420 µg), vitamin C 390% (234 mg), vitamin E 150% (45 IU), beta-carotene 250% (7.5 mg), calcium 6% (61 mg), and iron 4% (0.72 mg). These nutrients are purchased from third-party suppliers and added as fortifiers to the product's plant powders. According to the manufacturer, the additives are used to restore the levels of micronutrients lost during processing and to ensure uniformity.

Juice Plus Gummies, a candy-like supplement for children, were shown to consist of 85% corn syrup and 10% beef gelatin and to contain the following nutrient amounts, based on the recommended daily regimen of 6 gummies (approximate percentage of the adult Reference Daily Intake in parentheses): vitamin C 107.1 mg (179%); vitamin E 82.6 IU (275%); vitamin A 14.8 mg (494%); thiamin 1.39 mg (93%); riboflavin 0.05 mg (3%); niacin 2.51 mg (13%); pyridoxine 0.64 mg (32%); zinc 0.62 mg (4%); magnesium 13.65 mg (3%), calcium 94.5 mg (9%); potassium 58.4 mg (2%); and copper 0.32 mg (16%).

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, and one study was on Juice Plus+ Gummies.

Nutrient absorption

Though Juice Plus+ contains some nutrients, concerns have been raised that these nutrients may not be bioavailable, 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. Studies on nutrient absorption showed that subjects taking Juice Plus+ had elevated blood levels of folate and beta-carotene but the effects on blood levels of vitamin E and vitamin C were inconsistent. Some studies have shown significant increases in vitamin E and C levels, while other studies have shown much weaker effects on vitamin E and C levels, and that the levels of the two vitamins are not significantly increased. Studies have also found that Juice Plus+ does not raise the blood levels of other key phytonutrients from fresh fruits and vegetables, such as lycopene, lutein, zeaxanthin, and beta-cryptoxanthin.

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 oxidative stress marker) after 7 to 28 days. Other studies sponsored by the manufacturer have also reported reductions in lipid peroxidation and DNA oxidation. 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, The Skeptic.

Three other studies which were conducted under more rigorous conditions, meaning randomized, double-blind, placebo-controlled studies, longer in duration and with more subjects, found no significant reductions in lipid peroxidation, DNA oxidation, or other markers of oxidative stress.

One study, which used an in vitro test of antioxidant 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.

One placebo-controlled study conducted in 2002 found that Juice Plus+ Gummie candies did not significantly improve the antioxidant status of children, as indicated by negative results from 6 different antioxidant tests. 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 bioavailable.

Cardiovascular effects

Several studies have examined the effects of Juice Plus+ capsules on biochemical parameters associated with cardiovascular function, again with conflicting results.

One non-controlled study found a 37% decrease in homocysteine levels.

Other more rigorous studies, including two that were randomized, double-blind, placebo-controlled trials, found that homocysteine levels were not reduced or were reduced only marginally (7%).

Two randomized, double-blind placebo controlled studies have examined the effect of Juice Plus+ on serum cholesterol and LDL levels. One study found that Juice Plus+ had no significant effects; 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.

One study found that Juice Plus+ had no effect on blood pressure in healthy subjects. 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.

Adverse effects

Since Juice Plus is not regulated as a drug, information on adverse effects 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 hive-like rash. Another study reported adverse effects (upper-respiratory tract, urinary, and musculoskeletal) 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.

Other adverse effects listed in the Juice Plus Franchise Owner's Manual and the Special Nutritional Adverse Event Monitoring System include gastrointestinal cramps, fever, nausea, bloating, diarrhea, and constipation. 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; 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, 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 Collierville, Tennessee.

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 University of California Berkeley Wellness Letter and Dr. Stephen Barrett 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.

Criticism

According to Consumer Reports, 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 Better Business Bureau'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”. However, as of 2007, the Juice Plus+ homepage still advertises that the products are “the next best thing to fruits and vegetables”, though not specifically in reference to the Gummies.

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. 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.

Doubts have been raised about the benefits of Juice Plus+ by the Memorial Sloan-Kettering Cancer Center, the University of California Berkeley 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 exogenous vitamins and micronutrients, and complaints that the products are excessively priced relative to their potential benefits.

Juice Plus+ has drawn criticism as a result of connections with the now-bankrupt supplement company United Sciences of America, Inc. (USAI). Several of the research articles published on Juice Plus+ were authored by John A. 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 NBC, which revealed the company’s use of fraudulent scientific claims and deceptive advertising. 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.

References

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• Dietary supplements