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Super Fruit Juices – The New Snake Oil

The core principle of science-based medicine is that health care decisions should be based upon our best current scientific evidence and understanding. When applied to the regulation of health products this means that health claims should first be required to meet some reasonable threshold of scientific evidence before they are allowed. Admittedly this is not a purely scientific question but the application of scientific knowledge to an essentially political question – the balance of protection vs freedom.

Regardless of where one thinks this balance should be, I think most would agree that is it a problem if the public generally wants more protection than it is getting, or believes it is currently getting more protection than it is. A Harris poll from 2002 indicates that the majority of Americans believe that companies cannot make health claims about supplements unless they have been proven scientifically and approved by the FDA, when in fact this is not the case. The Dietary Supplement Health and Education Act of 1994 (DSHEA), largely through the efforts of Senator Orin Hatch from Utah, removed supplements from the control of the FDA and specifically allowed for so-called structure function claims to be made about products without any burden of proof. Most Americans are not aware of this fact.

Since DSHEA there has been an explosion in the supplement industry with products making the exact kind of claims that the law now allows without prior approval. In many ways we have returned to the time of the patent medicine craze, prior to the creation of the FDA, when dubious remedies of all kinds (so-called snake oil) were sold out of the back of traveling carriages. Now the internet is the favorite venue, and snake-oil salesmen have learned how to thrive within the current system – but their claims and marketing ploys are otherwise not very different from the purveyors of patent medicine from last century.

Fad medicines tend to come and go with the fashions of the marketplace. In recent years super juices have been particularly popular. Companies selling exotic fruit juice, usually from a tropical island, for exorbitant prices make a host of health claims for their magic elixir. Over the last decade Tahitian Noni has been popular. More recently XanGo juice has scored billions of dollars in sales.

Here are some of the claims made for XanGo on the company website:

XanGo® Juice boasts a proprietary whole–fruit formula, harnessing a concentrated rush of xanthones—a vigorous family of next–generation phytonutrients. Sounds complex. But here’s the straight scoop. Research shows xanthones possess potent antioxidant properties that may help maintain intestinal health, strengthen the immune system, neutralize free radicals, help support cartilage and joint function, and promote a healthy seasonal respiratory system.*

The asterix links to the following small-print disclaimer:

*These statements have not been evaluated by the FDA. This product is not intended to diagnose, treat, cure or prevent any disease.

You will notice that the company makes those claims that are specifically allowed for by DSHEA without the need for any evidence – that their product “maintains intestinal health,” “strengthen the immune system,” and “support cartilage and joint function.” The disclaimer is also required by DSHEA, so the company is completely within the law, at least as far as their website goes.

But is the public served by allowing this type of marketing? Despite the disclaimer, most people think these claims have been proven scientifically and approved by the FDA, and the distinction between “structure function” claims and actual health claims is deliberately blurred. Does “maintain intestinal health” mean that this juice will help with irritable bowel syndrome or crohn’s disease? The company is not allowed to make such claims – ones that refer to specific diseases, but they can infer it all they want.

The other component to the marketing strategy is to simply refer to basic science claims (as opposed to clinical claims) – just list some of the ingredients in the juice as if they have been proven to be healthful. Antioxidants are among the most popular recently, but as I have discussed recently there is no evidence that routine supplementation with antioxidants has any measurable health benefit.

Are these claims of superior content (regardless of their health implications) even true? Recently the Associated Press did an independent analysis, just to find out about the antioxidant content of XanGo. This is what they report:

For the lab test, The Associated Press shipped a 750-milliliter bottle of XanGo to Oregon State University’s Linus Pauling Institute at Corvallis. The institute measured its antioxidant strength against store-bought juices that sell for a few dollars a bottle.

On a scale of molecular weight, XanGo’s antioxidants measured 14,884 “micromoles” per liter — slightly higher than cranberry juice, but lower than black cherry and less than half the power of blueberry juice. Apple juice finished last in this test.

“In terms of its antioxidant capacity, XanGo is in the middle of the pack,” said Balz Frei, the institute’s director and chairman.

So XanGo is likely just ordinary fruit juice. It contains calories and nutrients, and is probably reasonably good nutrition, but no more so than many other more common fruit juices. The difference, however, is that XanGo costs $40 per bottle and is sold with a host of pseudo-health claims, while cranberry juice is not.

XanGo maintains, however, that it’s product is “a rich cocktail of other beneficial chemicals barely known to science” If they are barely known to science, then how does this company know about it? There is no evidence that they have conducted any research, published papers, or otherwise established that their product has any special “beneficial chemicals.” I would also point out that “beneficial chemicals” sounds an awful lot like drugs. Yet they are not studied or regulated as such.

It is also interesting to note that both Noni juice and XanGo are sold through multi-level marketing. Critics of MLM companies point out that only the top 1% of distributors actually make any money. The rest are really consumers who are forced to stockpile product they may never sell, and who at best sell enough product to support their own use. In essence, and by their own admission, XanGo has “700,000 unsalaried sales associates in 17 countries.” That is a huge free sales force, that doubles as a customer base, making money for the top 1%. I will also note that both Tahitian Noni and Xango (like much of the supplement industry) are based out of Utah, the home state of Orin Hatch (the man behind DSHEA).

The MLM strategy also allows the company to make one-on-one sales pitches. There is no way to track what individual sales people say to their potential customers – if the claims are not on the company website or in official sales publications.  This gives the company of layer of protection from the FDA and FTC. To see this in practice, the AP reports:

XanGo has been warned by the FDA for claiming that mangosteen could ward off disease or cancer. The company insists those claims were printed by a third party on a brochure at a recruitment seminar and it’s not responsible.

The current experience with the “super juice” nutritional supplements highlights many weaknesses of our current system. The public believes that it is getting more protection, and more assurance of honesty and safety, than it is currently getting. Claims are allowed that are virtually designed to be deceptive. Marketing claims go far beyond the evidence. Also, the supplement industry has no incentive to perform meaningful research. Research is a lose-lose proposition: it will cost them money, it may turn out negative, and in any case they already have access to their market without the need to provide scientific evidence.

Unless and until the current regulations change, consumers need to be very aware of DSHEA and exactly what it means. The current system relies heavily on the principle of let the buyer beware – which means consumers need to have sharp criticism toward any supplement claims.

Posted in: Herbs & Supplements

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17 thoughts on “Super Fruit Juices – The New Snake Oil

  1. PalMD says:

    I’ve always felt that the “Quack Miranda Warning” required by DSHEA is rather deceptive, but it does give a nice warning that anything preceding the statement is snake oil.

  2. Joe says:

    Most people probably know about it; but Dan Hurley has an excellent book on the DSHEA: “Natural Causes”
    http://www.amazon.com/Natural-Causes-Politics-Americas-Supplement/dp/0767920422/ref=pd_bbs_sr_1?ie=UTF8&s=books&qid=1202910761&sr=1-1

    Around the 10th anniversary of the law, a panel recommended a slight tightening of the regulations; but Orrin Hatch just said “no” and that was the end of it.

  3. james gaulte says:

    I could not agree more re: the theme of these super juices as snake oil. Granted that the testing of one of these juices showed it to have no more “antioxidant strength” than some other much cheaper juices my question is what do these tests mean anyway.Are you aware of any data that link health outcomes to the level of antioxidant strength as determined by that particular testing or for that matter any testing method?

  4. Egaeus says:

    I have a co-worker that keeps trying to get me to buy MonaVie. Seriously, if this stuff is all it’s cracked up to be, then why aren’t they competing in the marketplace instead of using MLM? If they sold a proven cure for cancer with MLM I’m not sure I’d buy it.

    But on a related note, not normally being credulous, I was quite skeptical when my doctor recommended Sambucol (black elderberry extract) a few months ago when I had a cold while in his office about an unrelated issue. But being desperate (it was the Friday before Christmas, I tried it anyway, and I am now a convert.

    I’ve never gotten over a cold in less than 2 weeks, and often it takes 3-4. My immune system has always been a bit slow that way. I was completely rid of the cold in 7 days total. When colds have gone around the office, I always got them, but not the last 2. If I got a scratchy throat, I’d take Sambucol and it’d go away. I’m now working on long-term data for myself, but so far (3 office colds) it’s batting 1.000.

    I know that there is limited data on it’s efficacy, and I’d sure like to see more. However, it works so far, so if it’s BS, then it’s the best placebo ever. I mean, colds are not subjective like “how much do you hurt.”

    If taking it makes me a fool, then at least I’m not a sick fool. :)

  5. Wicked Lad says:

    XanGo maintains, however, that it’s product is “a rich cocktail of other beneficial chemicals barely known to science” If they are barely known to science, then how does this company know about it? There is no evidence that they have conducted any research, published papers, or otherwise established that their product has any special “beneficial chemicals.” I would also point out that “beneficial chemicals” sounds an awful lot like drugs. Yet they are not studied or regulated as such.

    Right. To expand on this point, it seems to me that if a substance or other treatment is effective, we need the science to know what its effects are. The effects could just as likely be harmful as helpful. If the treatment is ineffective, it’s a waste of money. So I’m not buying into any treatment on the basis of a mere reasonable-sounding story, much less a blatant claim of “chemicals barely known to science.”

  6. regis2 says:

    From: http://www.ncahf.org/digest03/03-10.html

    From 1998 to 2001, while Hatch’s son Scott worked for a lobbying firm with close ties to his father, supplement industry clients paid the company more than $1.96 million, more than $1 million of it from clients involved with ephedra.

    In 2002, Scott Hatch opened his own lobbying firm in partnership with two of his father’s close associates. So far, the firm has received at least $30,000 in retainers from the National Nutritional Foods Association and a major manufacturer of ephedra (Twinlab) , both of whom were clients of the previous firm.

    During the past decade, Orrin Hatch has received nearly $137,000 in campaign contributions from the supplements industry.

  7. DavidCT says:

    I would like to recommend Brian Dunning’s recent podcast on this topic at Skeptoid.com. His short narration points out that while apple juice may be a little weak, actually eating an apple is a much better source of nutrition than anything other than blueberries. It does, however, require chewing which might be too much effort for some woo miesters.

  8. skidoo says:

    And what’s with this $35 to $45 per bottle consistency among these scams. Is this some sort of collusion? Do we need super-juice antitrust regulations? Call the FTC!!! :-)

  9. daedalus2u says:

    At $35 to $45 per bottle, the obvious thing to do is dilute it which will make it more powerful.

    After the first bottle is empty, just fill the empty bottle with water and shake it. The residual juice in the bottle is about 1/100 (or less) of the original making the new fluid 1c. Do that every day and in a year it will be 365c and in a decade 3,650c, in a century it will be 36,500c and in a millenia it will be 365,000c. With it getting stronger each time you do it, no doubt you will live forever. Unless the 3,650,000c gives you such strength that you jump out of the Earth’s atmosphere and asphyxiate in the vacuum of space!

  10. qetzal says:

    FDA has some interesting FAQs on supplements here.

    These seemed particularly noteworthy:

    What is FDA’s role in regulating dietary supplements versus the manufacturer’s responsibility for marketing them?

    …Under DSHEA, a firm is responsible for determining that the dietary supplements it manufactures or distributes are safe and that any representations or claims made about them are substantiated by adequate evidence to show that they are not false or misleading. This means that dietary supplements do not need approval from FDA before they are marketed. Except in the case of a new dietary ingredient, where pre-market review for safety data and other information is required by law, a firm does not have to provide FDA with the evidence it relies on to substantiate safety or effectiveness before or after it markets its products….

    Who has the responsibility for ensuring that a dietary supplement is safe?

    By law (DSHEA), the manufacturer is responsible for ensuring that its dietary supplement products are safe before they are marketed. Unlike drug products that must be proven safe and effective for their intended use before marketing, there are no provisions in the law for FDA to “approve” dietary supplements for safety or effectiveness before they reach the consumer. Also unlike drug products, manufacturers and distributors of dietary supplements are not currently required by law to record, investigate or forward to FDA any reports they receive of injuries or illnesses that may be related to the use of their products. Under DSHEA, once the product is marketed, FDA has the responsibility for showing that a dietary supplement is “unsafe,” before it can take action to restrict the product’s use or removal from the marketplace.

    Do manufacturers or distributors of dietary supplements have to tell FDA or consumers what evidence they have about their product’s safety or what evidence they have to back up the claims they are making for them?

    No, except for rules described above that govern “new dietary ingredients,” there is no provision under any law or regulation that FDA enforces that requires a firm to disclose to FDA or consumers the information they have about the safety or purported benefits of their dietary supplement products. Likewise, there is no prohibition against them making this information available either to FDA or to their customers. It is up to each firm to set its own policy on disclosure of such information….

    So in theory, manufacturer’s claims must be true, but they’re under no obligation to back up their claims, ever, either to FDA or to consumers!

  11. Sastra says:

    By law (DSHEA), the manufacturer is responsible for ensuring that its dietary supplement products are safe before they are marketed.

    Strange, but a lot of the same people who are suspicious and hostile towards Big Business and capitalism in general seem to switch sides when the business involved invokes images of natural folk medicine “they” don’t want you to know about.

    Manufacturers policing their own products? Not to be trusted — unless the “manufacturer” wears sandals and beads while growing her own herbal remedies based on the ancient wisdom of the East. Or maybe it’s a “little guy” who struggled up on his own, from the streets. The Big Business of the supplement industry is apparently appealing to rugged individualism, on multiple levels.

  12. buffalodavid says:

    I live in a small town,in Utah of all places, where I’ve seen MLM come and go and come again. So often its “faith based”. People are told that if they have any doubts about the company, they should pray over it. Well, that almost always strikes the hook. Anyone who tells you to pray must be honest and true.

    The town I live in has less than 500 people, and yet these people sign up to be distributors, knowing that the only way to make any money in this scam is to become a distributor and have people sell to you. Try to explain to them that by just a few levels every man woman and child will have to buy AND sell this product to each other to ALMOST break even.

    So far Ive seen one man loose his real business, and another loose his house. Because of this, MLM is on the shit list right now, but give it time.

  13. Freddy the Pig says:

    Most people do not understand the implications of the exponential growth required support MLM because people have a hard time conceptualizing non-linear relationships and therefore do not realize how these things will run out of steam after a few levels even if it each person is limited to 2 distributors immediately below them as in USANA.

    I like to use the fable of the chessboard and the king.

    A craftsman made a beautiful chessboard inlaid with with the fineset wood. The king offered to but this chesboard, offering an equivalent volume of gold. The craftsman told the king that all he wanted some rice to feed his family – one grain of rice for the fist square of the chessboard, 2 grains of rice for the second square, 4 grains for third square and so on. The king went bankrupt since this is more rice than is grown in the world in a year.

    What is it with Utah and MLM?

    Regis2 – that seems like an awful lot of money for lobbying – was it effectively a bribe in the form of a huge overpayment to a relative?

  14. Egaeus says:

    Freddy, what’s scary is that the people who are taken in by MLM often should know better. My coworker, the MonaVie pusher, has an electrical engineering degree, but he believes that he can make 80-90 thousand per week selling overpriced acai juice. That’s what his upline says that he makes, so why not, right?

    According to your example (two distributors per person), you will reach the population of the US in around 28 levels, and exceed the population of the earth in 33 levels.

  15. Freddy the Pig says:

    Egaeus – does your co-worker ever wonder why his upline isn’t living a 80-90 thousand per week lifestyle or retired yet?

    An engineering degree does not gaurantee critical thinking skills any more than a medical degree does, although I would expect an engineer, especially an EE would have enough intuitve math sense to know MLMs can’t grow past the first few levels – perhaps he thinks he is getting in on the ground floor.

    On the other hand, I remember another engineer and myself try to explain to a third engineer that the log of a negative number was not negative without much success.

    I know someone who is a USANA distributor who is finding that most of the people they approach already know someone who is a USANA distributor so that one has probably already reached saturation.

  16. Egaeus says:

    Hey, I didn’t say he had good critical thinking skills, I just said that he *should* know better. Take my word for it, that’s not the only way in which he’s deluded.

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