Rapid Responses to:
|
|
Rapid Responses: Rapid Responses published:
-
![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Drugs or Functional Foods ?
- Dr Harsha Kumar H N, Dr. M Sulochana (19 May 2007)
-
Re: Drugs or Functional Foods ?
- Eddie Vos (21 May 2007)
-
Functional foods and statins
- Gilbert R. Thompson (31 May 2007)
-
Prospective studies testing relevant clinical endpoints are needed
- Oliver Weingartner (11 July 2007)
-
Re: Functional foods and statins
- Nynke de Jong, Olaf H Klungel, Hans Verhagen (13 July 2007)
-
Functional Foods: Already a feature of every-day practice
- Ian R Wallace (3 October 2007)
|
|
|||
|
Dr Harsha Kumar H N, Epidemiologist and Assistant Professor Department of Community Medicine, KMC, Mangalore, India.91--575001, Dr. M Sulochana
Send response to journal:
|
Whenever a new drug is released to the market, a Phase VI research is carried to study the effects that have not been observed on the small samples tested before the release in to the market. Some drugs ( Cox 2 inhibitors for instance ) have been withdrawn after reported adverse effects. Similar is the case with even supplements of some Vitamins and anti-oxidants ( Vitamin A, Vitamiin D, Vitamin E where increased incidence of death was noted in clinical trials conducted to test their anti-oxidant efficacy even though the cause of death was not clear ). Most of the routinely available "Functional Foods" in the market can as well be called as "Drugs" based on their composition. In some cases (Supplements for the body builders for instance) the composition makes distinction between "Drugs" and "Functional Foods" less clear. In view of this the authors have rightly observed that a similar procedure ( as followed for Drugs) be followed for the "Functional Foods" which are being consumed by unsuspecting people in large numbers. Competing interests: None declared |
|||
|
|
|||
|
Eddie Vos, maintains www.health-heart.org Sutton (Qc) Canada J0E 2K0
Send response to journal:
|
With all due respect to the Indian doctors, hypothesizing
risk of 'functional foods' from deaths from excess vitamins is clearly
not the issue. To my knowledge no deaths have ever been recorded from food
fortification with any essential nutrient including those mentioned,
vitamins A (retinol), D (cholecalciferol) and E (tocopherol).
Comparing nutrients with drugs also misses the point since there are no drug deficiency diseases, only nutrient deficiency diseases with each of the >40 recognized essential nutrients having a plethora of agreed or debated deficiency conditions. The case in point is particularly India where about $0.50/year of food
fortification, i.e. functional foods, can restore known
To propose that nutrients should be evaluated like drugs forgets the simple fact that one patient dies every 5 minutes in an American hospital from prescription drugs [JAMA 1998] as opposed to none from nutrient enriched functional foods. Let's put our effort where it should lie: first, urgently introduce fortified foods, especially in India, to head off what threatens to become one of the largest epidemics of heart and deficiency disease the world has seen and, second, reduce the deaths from prescription drugs that post-fortification may just be less needed. Fear mongering about nutrients therefore may increase deaths from both causes. vos{at}health-heart.org 1. Misra et al Hyperhomocysteinemia, and low intakes of folic acid and vitamin B12 in urban North India.Eur J Nutr. 2002 Apr;41(2):68-77. Competing interests: None declared |
|||
|
|
|||
|
Gilbert R. Thompson, Emeritus Professor of Clinical Lipidology Imperial College, Hammersmith Hospital, London W12 0NN
Send response to journal:
|
I wish to take issue with the statement by de Jong et al that "a lower dose of statin can never be compensated for by the intake of functional foods" i.e. plant sterols or stanols. It is well accepted that doubling the dose of any given statin will decrease low density lipoprotein (LDL) cholesterol by an additional 6% whereas the addition of plant sterols or stanols 2g daily as esters has been shown to decrease LDL cholesterol by an additional 7-11% [1]. Hence, contrary to to the assertion by de Jong et al, a lower dose of statin can be more than compensated for by the addition of plant sterols or stanols, preferably the latter for the reasons given in their article. 1. Thompson GR. Additive effects of plant sterol and stanol esters to statin therapy. Am J Cardiol, 2005;96(Suppl):37D-39D. Competing interests: None declared |
|||
|
|
|||
|
Oliver Weingartner, M.D. Universitatsklinikum des Saarlandes, Department of Cardiology and Angiology, 66421 Homburg, Germany
Send response to journal:
|
Rapid Resonses to: ANAYSIS: Nynke de Jong, Olaf H Klungel, Hans Verhagen, Marion CJ Wolfs, Marga C Ocke, and Hubert GM Leufkens. Functional foods: the case for closer evaluation. BMJ 2007; 34:1037-1039. De Jong and colleagues call for closer evaluation of "functional foods" after their introduction to the market and their exposure to a broad public. In my opinion this is an issue of uttermost importance. As pointed out by de Jong, very little is known about long-term effects, drug- interference and - most important - safety issues of functional foods in disease prevention. Even the best studied of these foods "sterol enriched foods" are still controversially debated in the scientific community and concerns had been raised about possible atherogenic effects of plant sterols (1). With an increasing body of evidence that plant sterols themselves might be involved in atherosclerosis food supplementation with plant sterols should be carefully evaluated (2, 3, 4). This can only be achieved by prospective studies that evaluate not only the effects of cholesterol reduction, but also relevant clinical endpoints such as vascular events. As long as results of such trails are pending recommendation of functional foods supplemented with plant sterols to reduce serum cholesterol concentrations will be a matter of controversial debate. In view of this the authors have rightly observed that a similar procedure (as followed for drugs) be followed for "functional foods" which are being consumed by unsuspecting people in large numbers. 1. Patel MD, Thompson PD. Phytosterols and vascular disease. Atherosclerosis 2006; 186:12-19. 2. Thiery J, Ceglarek U, Fiedler GM, Leichtle A, Baumann S, Teupser D, Lang O, Baumert J, Meisinger C. Elevated campesterol serum levels--a significant predictor of incident myocardial infarction: results of the population-based MONICA/KORA follow-up study 1994-2005. Circulation 2006, supplement II, Vol 114, No 18, II-884, A 4099. 3. Weingartner O, Sudhop T, Kanig J, von Bergmann K, Schafers HJ, Laufs U, Bahm M. Relation of serum plant sterol levels to tissue concentrations--effects of diet and family history. Circulation 2006, supplement II, Vol. 114, No 18, II-114, A 676. 4. Weingärtner O, Lütjohann D, Weisshoff N, List F, Böhm M, Laufs U. Differential effects of plant sterols compared to ezetimibe on atherogenesis in apoE -/- mice. J Am Coll Cardiol. 2007; 49(9) Suppl. A: 336. Oliver Weingartner M.D.
Universitatsklinikum des Saarlandes
Klinik fur Innere Medizin III
Abteilung fur Kardiologie, Angiologie und internistische Intensivmedizin
Kirrberger Strasse
Gebaude 40,
66421 Homburg,
Germany
Competing interests: None declared |
|||
|
|
|||
|
Nynke de Jong, project director 3720 BA Bilthoven, Olaf H Klungel, Hans Verhagen
Send response to journal:
|
Dr. Thompson argues that a lower dose of statins may very well be compensated by the addition of plant sterols or stanols to the daily diet. We do agree that the data of several randomised clinical trials indicate that with an optimal dosing regimen plant sterols or stanols have additive effects to statin therapy on LDL cholesterol lowering [1;2]. However, in daily practice it is shown that people are not consuming the recommended plant sterol or stanol dosages [3]. Adherence to both the drug treatment regimen and the plant sterol or stanol recommendations will then be suboptimal in the real life case of ‘compensation’. The eventual additional effects of plant sterols or stanols on LDL cholesterol are not studied yet, but it is very likely that they are insufficient. 1. Blair SN, Capuzzi DM, Gottlieb SO, Nguyen T, Morgan JM, Cater NB. Incremental reduction of serum total cholesterol and low-density lipoprotein cholesterol with the addition of plant stanol ester- containing spread to statin therapy. Am J Cardiol 2000;86:46-52. 2. Katan MB, Grundy SM, Jones P, Law M, Miettinen T, Paoletti R et al. Efficacy and safety of plant stanols and sterols in the management of blood cholesterol levels. Mayo Clin Proceedings 2003;78:965-78. 3. Wolfs M, de Jong N, Ocke MC, Verhagen H, Monique Verschuren WM. Effectiveness of customary use of phytosterol/-stanol enriched margarines on blood cholesterol lowering. Food Chem Toxicol 2006;44:1682-8. Competing interests: None declared |
|||
|
|
|||
|
Ian R Wallace, FTSTA in Endocrinology Lagan Valley Hospital, Lisburn, Northern Ireland. BT28 7JP
Send response to journal:
|
Sales of functional foods or neutraceuticals account for billions of dollars annually worldwide. A number of recent articles in the BMJ have highlighted the case for scrutiny of this sector.1,2,3 I feel there are benefits and also dangers to the use of functional foods. I feel this sector requires scrutiny of marketing practices and monitoring of the long -term effects and possible interactions of ingestion of these substances. In my own daily practice I am regularly encountering patients on various supplements and fortified foods. I now make a point of being thorough and asking about drug allergies, prescription medications, over- the-counter medications, illicit drug use and also about any dietary supplements they are taking. A rapid response to the recent articles stated that functional foods can replace dietary deficiencies.4 They hence can be beneficial and we as doctors have been treating dietary deficiencies for years by prescribing iron, thiamine, Vitamin B12 and others. These are given to those with a clinical need and also have the benefit of years of monitoring and stringent production procedures. Functional foods by contrast are not prescribed by doctors and the patients are not reviewed for adverse effects. My limited experience would suggest that it is not those who are deficient in nutrients who are taking functional foods. I do agree with Mr Vos that in the right subject groups functional foods replacing nutrients can assist in disease prevention. I would like to close by raising a number of points. 1. Functional foods are in common usage and as clinicians we need to ask about them. 2. Marketing of these substances is aimed at a certain profitable sector of the market, which may not correspond to the sector which may gain benefit from these substances. 3. There are undoubted benefits to replacing nutritional deficiencies, but is an unregulated functional food market the way to do this. Would it not be better to have these foods manufactured to high standards and monitored over many years, along the lines of the pharmaceutical industry. Should we not be supportive of attempts by the European Union and FDA to apply controls to this sector. 4. The ingestion of functional foods may have unexpected effects. References: 1. de Jong N, Verhagen H, Wolfs MCJ, Ocke MC, Klungel OH, Leufkens HGM. Functional foods: the case for closer evaluation. BMJ 2007; 334: 1037- 1039. 2. Lang T. Functional foods: Their long term impact and marketing needs to be monitored. BMJ 2007; 334: 1015-1016. 3. Katan MB. Health claims for functional foods. BMJ 2004; 328: 180- 181. 4. Vos E. Re: Drugs or Functional Foods? eBMJ 2007; Rapid Responses. www.bmj.com/cgi/eletters/334/7602/1037 Competing interests: None declared |
|||