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Juice Plus: A Critical Look
National Safety Associates (NSA) president Jay Martin likes to turn simple ideas into megamillion-dollar sales. An NSA brochure states by 1997, his company had generated over $3 billion in sales by "developing and introducing innovative new products that are on the leading edge of whole new industries": home fire detectors in the 1970s, water filters in the early 1980s, and air filters in the late 1980s. But its "biggest hit yet," is a line of "natural food-based products designed to help prevent disease."  Its flagship product — Juice Plus+®—was introduced in 1993 and hit $6 million per month by the end of its first year .
The Juice Plus+ recipe for success is very simple: Fruits and vegetables are good for us. Capture their goodness in convenient products. Add endorsements, testimonials, a pinch of fear, a scientific veneer, and several dollops of deception. And harness the power of multilevel marketing (MLM) to spread the word. All of these ingredients have been around for many years. But NSA has developed a winning mix.
It is well established that dietary strategies can help prevent certain cancers and reduce the risk of cardiovascular disease. Popularization of the diet-cancer link began during the early 1980s when the National Academy of Sciences (NAS) reported that people who eat lots of whole-grain cereals, fruits, and vegetables have a lower incidence of certain cancers . Since that time, research has shown that emphasizing these foods can also help prevent heart attacks and strokes. These ideas have been quantified in the Food Guide Pyramid System (1992), which recommends 6-11 servings of grain products, 2-4 servings of fruit, and 3-5 servings of vegetables per day, depending on the individual's caloric level . Since it was not known which dietary factors, if any, might be helpful, the NAS report specified that supplementation with individual nutrients was not advisable. Within a few months after the report was issued, however, several products containing dehydrated vegetables and/or various nutrients were marketed as though the report had supported their use for cancer prevention. Government regulatory actions drove some of the early products from the marketplace, but new studies (particularly of antioxidants), new marketing techniques, and lax federal enforcement have enabled many more to take their place.
NSA would like you believe that everyone should take Juice Plus+. This article explains why I disagree.
The Power of MLM
MLM is a form of direct sales in which independent distributors can make money not only from their own sales but also from those of the people they recruit. Its roots date back to the 1930s when a California businessman began offering friends a commission for selling a food supplement to their friends. The operation evolved into Nutrilite Products in 1939 and began significant interstate distribution in 1945. In 1959, two highly successful distributors formed a new company that evolved into the multibillion-dollar, international conglomerate now called Amway. Shaklee Corporation, another MLM giant, was founded in 1956 by a retired chiropractor. Since that time, hundreds of other companies and millions of "independent distributors" have joined the fray.
Until the mid-1980s, claims made for health-related MLM products were conveyed mainly through direct personal contact in which the salesperson's personal success story (health or financial) played an important role. Since that time, however, many companies have added slick videotapes and audiotapes to spread their story, telephone conferences to train large groups of salespeople, a scientific advisory board to seem more authoritative, company-sponsored research to appear more authentic, and endorsements from prominent persons to lend prestige. Many companies use scare tactics and cite scientific research to suggest that their products will prevent disease. NSA does all of these things effectively.
Testimonials Are not Reliable Evidence
The "success" of network marketing lies in the enthusiasm of its participants. Most people who think something has helped their health enjoy sharing their success with their friends. Testimonial-givers are usually motivated by a sincere wish to help their fellow humans. Since people tend to believe what others tell them about personal experiences, testimonials can be powerful persuaders. An NSA distributor manual notes that "as people use the product, they begin to build their own Juice Plus+ story to share with others." Although NSA literature states, "We do not make any claims . . . involving the prevention, cure, mitigation of any disease," NSA distributors are circulating statements that Juice Plus+ products have relieved a wide variety of discomforts. In 1994, I even even acquired a 69-page booklet of endorsements and testimonials which stated:
Testimonials, of course, should not be regarded as valid evidence. Without well-designed tests, it is usually impossible to tell whether changes that take place after taking a product are the result of the product, a placebo effect, or other factors such the fact that symptoms often change with the passage of time. Nor is it possible to tell whether enthusiastic, financially motivated salespeople accurately report what they experience.
The unreliability of testimonials was dramatically illustrated by the case of former football star O.J. Simpson, who was charged with stabbing his wife and her friend Ronald Goldman. In March 1994, shortly before these murders took place, he was videotaped telling 4,000 distributors at a sales meeting that Juice Plus+ had cured his arthritis. Testimony in the murder case indicated that he was also taking sulfasalazine, a standard anti-inflammatory drug that could have relieved his symptoms . Subsequently, his defense attorneys presented medical testimony that Simpson was so crippled by arthritis that he could not have committed the murders .
What's in Juice Plus+?
NSA's Guide for New Distributors, a 94-page loose-leaf manual dated October 1997, stated that 17 foods are juiced to extract their nutritional essence and then reduced to powders using a proprietary process that avoids high temperatures. During the process, sugar, salt, and most of the calories and fiber are removed. "Orchard Blend" capsules are derived from acerola berries, apples, cranberries, oranges, papaya, peaches, and pineapple. "Garden Blend" capsules contain barley, beets, broccoli, cabbage, carrots, kale, oats, parsley, spinach, and tomato. Both products are also said to contain corresponding soluble and insoluble fibers, phytochemical "food actives," vitamins, minerals, and enzymes. Additional fiber and enzymes are added, and the products are encapsulated by a company called Natural Alternatives International .
Neither the product labels nor the product literature I have seen indicate the quantities of these ingredients in Juice Plus+ capsules. The 1997 manual advised taking Orchard Blend and Garden Blend at separate times because "fruits are digested differently from vegetables and your system can handle them more efficiently if they're dealt with separately." However, Juice Plus+ "Better Bars" combined both concentrates with "real fruits, oats, bran, and a host of other natural ingredients." NSA has also marketed a meal-replacement drink, Juice Plus+® Lite, each serving of which provided 110 calories, 4 grams of dietary fiber, and significant amounts of 12 vitamins and a few minerals. The current (2006) products include a chewable pill for children, JP+ Gummies® (said to be a healthy alternative to candies), and Juice Plus Thins®, said to be a snack "specially designed and formulated to help curb your appetite." The Juice Plus+ Web site contains no data showing that taking the product helps curb appetite.
NSA stresses that government guidelines recommend eating 5-9 servings of fruits and vegetables per day. However, it fails to put this recommendation into proper perspective. The primary purpose is not to ensure adequate vitamin intake (which is achieved with fewer servings) but to (a) get adequate fiber intake and (b) create a dietary mix that is low to moderate in fat. Juice Plus+ provides the nutrients in fruits and vegetables, but includes far more beta-carotene than most experts would recommend. In addition, it lacks the fiber and people who think it substitutes for fruits and vegetables might wind up with a higher dietary fat content.
In 2005, the National Advertising Division of the Council of Better Business Bureaus advised NSA to modify certain advertising claims to avoid the implication that Juice Plus+ Gummies®, are an alternative for, or nutritionally comparable to fruits and vegetables .
Pages 41 and 42 of the 1997 manual suggested that each food source offered a special health benefit. Apples, for example, were said to "contain boron a trace mineral that affects the electrical activity of the brain, increasing mental alertness." Oranges are said to "contain every class of cancer inhibitor known." Acerola cherries were "a source of vitamin C, known to relieve symptoms of osteoarthritis." Carrots were said to lower cholesterol, parsley to be "good for the heart and immune system," kale to be a "powerful cancer fighter," and cabbage was "thought to block breast cancer." Even if these claims were true, there is no reason to conclude that taking Juice Plus+ capsules could provide the same benefit.
Page 43 stated, "The food enzymes in Juice Plus will facilitate digestion of your food, making it more usable to your body. This also conserves the body's own enzyme supply to do other important things like fighting off disease." This statement is false because: (a) most people have enough enzymes in their intestinal tract to digest their food; (b) most of the enzymes in food are destroyed during digestion; and (c) the body's production of metabolic enzymes does not depend upon the amounts of enzymes in the digestive tract.
Such enzymatic nonsense reflects the ideas of Humbart "Smokey" Santillo, author of Food Enzymes: The Missing Link to Radiant Health , to whom NSA attributes the Juice Plus+ concept. Santillo's credentials include a bachelor of science degree from Edinboro State Teacher's College; a doctor of naturopathy degree from a nonaccredited correspondence school (the Anglo-American Institute of Drugless Therapy), an iridology "certificate of merit," a master herbalist certificate from the herbalist John Christopher's School of Natural Healing, and eight years of study at the Concept Therapy Institute (which teaches a biotheistic chiropractic technique). One of NSA's audiotapes featured Santillo claiming that whole fruits and vegetables should not be eaten closely together as foods but are safely combined but in Juice Plus+. He also claimed that Juice Plus+ Lite helped people manage their weight because. "It has so much food value and is so easy to digest. Once they start absorbing all that food, they just don't have the same hunger . . . and lose weight automatically." 
Santillo's basic concepts of health, disease, and treatment include a hodgepodge of naturopathy and traditional Chinese medicine. His book Natural Healing with Herbs, spouts the naturopathic dogma that most diseases are "really the result of an overtaxed eliminative system" and that "by using a cleansing diet and short fasts, cleaning the colon by using enemas, aiding eliminative processes and purifying the blood through the proper choice of herbs, and by other methods," disease can be quickly cleared up by "clearing the underlying toxic state." [12:3] But he also states that "diseases can be classified as either hot or cold, yin or yang, excess or deficient, internal or external." [12:5]. Varro E. Tyler, Ph.D., a world-renowned herbal authority who was professor of pharmacognosy at Purdue University, concluded that the book was riddled with errors and is a "nearly perfect example" of irrational advice about herbs .
The Aetna U.S. Health Care "Endorsement"
In 1998, Aetna U.S. Health Care (the largest HMO) began offering a "Natural Alternatives Program," under which subscribers can obtain discounts of 20% or more for various products and services . Several Juice Plus+ distributors have notified me that Aetna U.S. Health Care was "recommending" Juice Plus+ under this program. However, the site describing the program stated otherwise:
The Scientific Veneer
Juice Plus+ promoters also claim there is scientific proof that Juice Plus+ is good for people's health. NSA's most powerful sales aids are tape-recordings by Richard DuBois, M.D., a board certified internist who is described as "one of the world's leading authorities on infectious disease." Citing scientific studies, DuBois correctly notes that:
To further support his argument, DuBois correctly describes how clinical trials have found that supplementation with individual nutrients sometimes does more harm than good. But he then asserts that the Juice Plus+ nutrients are safe and more effective, because the phytonutrient content of plants is "balanced." Based on all of the above assumptions, he concludes that everyone should take Juice Plus+.
The above reasoning is not valid. Nearly all of the evidence relating disease rates to dietary composition is epidemiologic. Epidemiologic studies do not prove cause and effect. And even if causal connections are established, they do not prove that dietary supplements will remedy a poor diet or that Juice Plus+ is an optimal supplement. (In fact, it is not likely to be optimal because it lacks vitamin B12 and most of the minerals included in full-spectrum multivitamin/multimineral pills.) Nor is there any logical reason to conclude that Juice Plus is "balanced" simply because its ingredients were extracted from foods. Only well-designed, long-term clinical trials can determine whether taking Juice Plus+ or any other pill or potion can actually prevent disease.
But that's not all. Much of the protective effect of fruits and vegetables is due to their fiber content. Juice Plus+ pills have nearly all the fiber removed. Moreover, eating the recommended portions of grains, fruits, and vegetables does not merely provide high levels of phytochemicals. It usually means that the overall diet is low or moderate in fat. Nobody knows whether adding a product like Juice Plus+ to a high-fat or low-fiber diet would provide much benefit. The bottom line is that if someone's diet is low in fruits, vegetables, or grains, the most prudent action is fix the diet.
Curiously, in 1986, two authors of NSA's phytonutrient study were associated with United Sciences of America (USA), a multilevel company that sold supplements with illegal claims that they could prevent many diseases. Lead author John A. Wise, Ph.D., was USA's vice president of science and data information; and second author Robert J. Morin, M.D., was a scientific advisor who helped design the products. State and federal enforcement actions drove the company out of business in 1987 . USA's main product was its Master Formula, which included large amounts of beta-carotene and vitamin E . Today, Wise is vice president, science and technology and is a stockholder of Natural Alternatives International (NAI), of San Marcos, California, which manufacturers the Juice Plus+ products. NSA was responsible for at least 16% of NAI's sales during the year ending June 30, 1999 .
Even more curiously, DuBois himself has cast doubt on his claim that Juice Plus+ provides "balanced nutrition." In the 1998 NSA videotape, "Homocysteine, Oxidative Stress, Pathogenesis and Prevention of Disease," he states extra carotenoids are stored in the skin and that his own skin has turned orange from the pills. Beta-carotene supplements have been associated with increased cancer rates in two large clinical studies [20,21] and have been found to increase precancerous changes in ferrets exposed to cigarette smoke . The highly respected Medical Letter on Drugs and Therapeutics—a peer-reviewed newsletter for physicians—has concluded that "no one should take beta-carotene supplements."  But rather than noting the risk, DuBois claims that "When you turn orange, you have neutralized your oxidative stress" (a purported measure of harmful free-radical activity) and therefore reduced your odds of getting certain diseases. He even describes how his patients say, "I want to look like you. I want that carotenoid gloss."  How can he possibly know that years of living with orange skin will do more good than harm?
The Research Veneer
Several studies sponsored by Juice Plus+ have been completed and many more are underway . The published studies include:
In 1999, NSA launched the Juice Plus+® Children's Health Study, which it described as a large, multi-year health survey that would help determine whether adding Juice Plus+® fruit and vegetable supplements to the family diet can affect the health and well-being of children ages 6 to 15. In the study, each child participant is paired with an adult participant, usually a parent. The children under 12 are given products free or charge, but payment is required for the other participants. Completed questionnaires are tabulated by the Juice Plus Children's Research Foundation, which was set up to support programs that "advance the principle that improved nutrition leads to healthier lifestyle and overall better health in children." . The "preliminary report"—said to have been based on the first 25,000 responses—contains many claims that the regimen led to improvements in the child's health status and interest in health promotion. However, the questionnaire is poorly designed, no control groups were used, and the resultant data are meaningless . As far as I can tell, the study is just a gimmick to promote sales.
Many Juice Plus+ distributors have been tricked into believing that these studies "prove" that taking Juice Plus+ makes people healthier. Real proof, however, would require that people taking the product have a better specific health outcome (fewer colds, for example) than comparable people who don't take the product. No such study has been published. Even if a study found a better health outcome, it would not make sense to use Juice Plus+ if dietary modification or a less expensive supplement could do the same thing. Experts at the Memorial Sloan-Kettering Cancer Center have concluded:
In an attempt to counter my criticisms, some Juice Plus+ distributors have been circulating statements suggesting that my medical license was revoked. I retired from psychiatry in 1993 with my license in good standing and have never been subjected to any regulatory activity. The false claims about my license are part of a vicious libel campaign by people whose activities I have criticized .
The Bottom Line
NSA sales aids acknowledge that taking Juice Plus+ is not as good as eating the recommended amounts of grains, fruits, and vegetables. But they also state that everyone should take Juice Plus+, including people whose diets contain adequate amounts of the nutrients in Juice Plus+. NSA's "Preferred Customers" who buy a four-month supply of Juice Plus+ capsules at a time, pay about $480 per year. If every American did this, the total annual cost would exceed $100 billion. Do you think this would be a wise allocation of our national resources?
This article was revised on January 29, 2006.