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EDITORIALS: Martijn B Katan Health claims for functional foods BMJ 2004; 328: 180-181 [Full text]

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Benecol

Jonathan S Charlton   (27 January 2004)

beware of functional foods!

manan vasenwala   (28 January 2004)

fortified milk products - another example

hermin halim   (7 February 2004)

Vitamin K as a potential functional nutrient for bone health

Toshihiro Sugiyama, Shinya Kawai   (19 February 2004)

Benecol 27 January 2004
Jonathan S Charlton, GP principal ha2 6hl Send response to journal: Re: Benecol	Thank you for your article, Dr katan, who seems to be the only person apart from myself and my partner here at our practice who seem to have even considered that lowering cholesterol does not necessarily equate to lowering mortality rates. I wrote to the manufacturers of Benecol and asked them for any evidence they had on studies showing a reduction in MORTALITY rates with benecol and no such studies had at that time been even considered never mind commissioned. Flora Pro-acitve haven't replied to 2 letters. What is worse is that in view of the pan-european clofibrate study published in 1978 and the bezafibrate trial published in Jan 2003 in the BMJ both of which showed no decrease in the overall mortality rate (indeed clofibrate showed a higher mortality rate in the treated group despite the fact, for those of us old enough to remember, the normal cholesterol level in the 1970's was up to 8mmol). Isn't it about time the government insisted that medical claims for any supplements, foods, or any other approach to health / disease management is backed up by hard evidence? The public could hardly complain if we treated patients on a whim if others can do so too!! Jonathan Charlton GP Harrow Competing interests: None declared
beware of functional foods! 28 January 2004
manan vasenwala, consultant-cardiologist k.k.heart center, aligarh-202002.india Send response to journal: Re: beware of functional foods!	a plethora of functional foods have flooded the markets. the health benefits touted by them have the public at large really baffled. on one hand, allopathic medicines have fallen short of expectation due to a large number of side effects and as commercialisation is intense it is difficult for a lay man or even a doctor to undestand, what is what, and who is speaking the truth. in india, the matter is compounded by the availbility of ancient food supplements which contain lead, arsenic, gold and silver and other heavy metals. the very potency of these products is attributed to the presence of expensive gold and silver. all age groups are targetted. also these products come relatively cheap with indications for a simple flu to a heart disease or aging. because of economics, more and more people are attracted to these products. what good or rather what harm they do is anybody's guess. currently, heavy commercials are beamed on diabetic patients. i know of several patients who went for them and discontinued their time-tested allopathic drugs almost to their peril. government agencies have to get their act together. they have done a good job as far as allopathic drugs and food supplements are concerned, but more attention needs to be paid to these dubious functional foods produced by 'alternative medicines' doctors. Competing interests: None declared
fortified milk products - another example 7 February 2004
hermin halim, pharmacist, writer surabaya, INDONESIA 60292 Send response to journal: Re: fortified milk products - another example	I found it interesting to discover that many manufacturers keep making misleading claims on their food products, as discussed in this article. There is an increasing tendency to market ordinary food products (e.g. milk, breakfast cereals, baby food) which have been "enriched" by essential nutritions and making claims out of them (some of which are quackery). In my own country, various milk powder brands fortified with DHA, EPA, and ARA (arachidonic acid), even nucleotides, are being marketed under claims that they are beneficial to brain's proper growth and development, overlooking the fact that each of DHA, EPA, and ARA can be biosynthesised from linoleic and alpha-linolenic acids (this means that they should be non-essential nutrients, therefore do not need supplementation). Another seemingly contradictory fact is that, arachidonic acid actually plays a role in inflammatory process (where it undergoes modification into inflammatory mediators) which could be harmful and thus does not support the fortification of this substance into milk products. Regarding the addition of nucleotides into milk powder, I have some doubts that these nutrients could be absorbed in the intact form (without being hydrolysed by digestive enzymes in the gut before reaching the bloodstream). The nucleotides would have been cleaved into the corresponding nitrogen bases, along with ribose (or deoxyribose, if it comes from a DNA nucleotide) and phosphate, while these constituents would not build new nucleotides or even DNA and RNA, but undergo different metabolism pathways instead. Therefore, despite the (in vitro?) findings (and biochemical knowledge) that nucleotides are essential to generate energy for metabolism or to perform signal transduction, oral supplementation would unlikely be efficacious due to presystemic elimination of these substances. Based on the above considerations, I would conclude that while these nutrients add the economic value (i.e. cost and price) of the fortified products, it is doubtful that they would have some additional health benefits as well. Competing interests: None declared
Vitamin K as a potential functional nutrient for bone health 19 February 2004
Toshihiro Sugiyama, doctor Yamaguchi University School of Medicine, Yamaguchi 755-8505, Japan, Shinya Kawai Send response to journal: Re: Vitamin K as a potential functional nutrient for bone health	There is a growing interest in functional foods throughout the world, but the real ingredients of such foods remain unclear, and at the same time no consensus has been reached with regard to who safeguards the truth of claims.(1) Japan was the first country that separately categorized functional foods from other normal foods in 1991, and its regulatory system now consists of FOSHU (Foods for Specified Health Use) and FNFC (Foods with Nutrient Function Claims).(2) The health claims of FOSHU are similar to the enhanced function claims of Codex, and those of FNFC are similar to the nutrient function claims of Codex. The FNFC system has approved twelve vitamins (vitamins A, B1, B2, B6, B12, C, E, D, biotin, pantothenic acid, folic acid and niacin) and two minerals (calcium and iron) as functional nutrients. Here we propose vitamin K as a new functional nutrient for skeletal health. Vitamin K is a fat-soluble vitamin found in many natural food sources. The currently recommended level of vitamin K intake was determined based on the amount necessary for blood coagulation, but it is not enough for bone health. Serum vitamin K level decreases with age, and its intake is thought to be beneficial especially for the elderly. For example, vitamin K reduces fracture risk independently of bone mass, though this evidence is only poorly recognized. Because vitamin K as well as calcium and vitamin D is an important nutrient for skeleton, we have suggested the combination use of vitamin K as an essential supplement in the management of osteoporosis.(3) In addition, recent clinical investigations have suggested that vitamin K could be efficacious for preventing vascular calcification, lowering serum cholesterol and inhibiting cancer growth. Although vitamin K has not been approved as a functional nutrient, the FOSHU system in Japan approved three labels of the Japanese fermented soybean food (natto), which contains a large amount of vitamin K2 (menaquinon-7),(4) as foods for bone health. Patients being treated with warfarin should not eat foods high in vitamin K, but this vitamin has a very wide safety range for people who are not taking warfarin. Proteins that contain gamma-carboxyglutamate (Gla) residues, such as osteocalcin, need vitamin K in order to express their biological activities, and only carboxylated osteocalcin can be incorporated into bone. As serum osteocalcin carboxylation decreases during space flight, foods loaded with vitamin K may be efficacious for skeletal maintenance in astronauts during space flight.(5) Toshihiro Sugiyama doctor Shinya Kawai professor Department of Orthopaedic Surgery, Yamaguchi University School of Medicine, 1-1-1 Minamikogushi, Yamaguchi 755- 8505, Japan toshihiro.sugiyama@chive.ocn.ne.jp 1. Katan MB. Health claims for functional foods. BMJ 2004;328:180-1. 2. Shimizu T. Newly established regulation in Japan: foods with health claims. Asia Pacific J Clin Nutr 2002;11 (suppl):S94-6. 3. Sugiyama T, Tanaka H, Kawai S. Effects of parathyroid hormone and alendronate alone or in combination in osteoporosis. N Engl J Med 2004;350:189-92. 4. Kaneki M, Hedges SJ, Hosoi T, Fujiwara S, Lyons A, Crean SJ, et al. Japanese fermented soybean food as the major determinant of the large geographic difference in circulating levels of vitamin K2: possible implications for hip-fracture risk. Nutrition 2001;17:315-21. 5. Sugiyama T, Kawai S. The use of vitamin K may be a good choice for microgravity-induced bone disorder. J Bone Miner Res 2001;16:794-5. Competing interests: None declared