Juice Plus: A Critical Look
Stephen Barrett, M.D.
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." [1] Its flagship product — Juice Plus+®—was introduced in 1993 and hit $6 million per month by the
end of its first year [2].
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 [3]. 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
[4]. 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:
These are some of the benefits found
by people taking Juice Plus+. Some noticed these signs after
a few days, others after weeks or months. These benefits may
not apply to you, but you may want to look out for them: general
sense of well-being; more alert; more energy; more regular; better
digestion; better appetite; sleep better; need less sleep; wake
up easier; wake up earlier, less urge to snack; less craving
for sweets; crave fruit, vegetables & salad; weight loss;
weight gain (if desired); loss of inches from waist & hips;
better skin tone; nails grow stronger and faster; hair grows
stronger and faster; look better; clearer eyes; easier to quit
smoking; easier to start exercise program; handle stress more
easily; better recovery after workout; able to work harder; higher
athletic performance; faster recovery from injury; reduced allergies
& sinusitis; reduced arthritis pain; fewer headaches; less
pain; lower blood pressure; improved blood sugar [5].
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 [6]. Subsequently, his defense
attorneys presented medical testimony that Simpson was so crippled
by arthritis that he could not have committed the murders [7].
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 [8].
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 [9].
Peculiar Claims
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
[10], 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." [11]
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 [13].
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 [14]. 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:
Natural Alternatives is a discount pass-through
program. . . . Participating Natural Alternatives providers and
vendors are solely responsible for the products and services
they provide. Providers or vendors offering discounts under Natural
Alternatives may not have been credentialed or reviewed by Aetna
U.S. Healthcare. By making these discounts available, Aetna U.S.
Healthcare does NOT endorse these providers or vendors or their
services or make any guarantee as to availability or quality
of providers or discounts under this program. Aetna U.S. Healthcare
gives no warranty, expressed or implied, as to description, quality,
merchantability, fitness for any particular purpose, or any other
matter for any product or service purchased by you using a Natural
Alternatives discount [15].
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:
- Considerable research shows that diets
high in grains, fruits, and vegetables are associated with lower
rates of certain cancers, cardiovascular disease, and several
other types of degenerative disease
- Many Americans do not eat the recommended
number of servings
- Epidemiologic studies have found that
these diseases are associated with low blood levels of certain
phytonutrients
- An NSA-sponsored study of 15 healthy
individuals found that supplementation with Juice Plus+ for 28
days raised the blood levels of five phytonutrients: beta-carotene,
alpha carotene, lutein/zeaxanthin, lycopene, and vitamin E. The
study found, for example, that beta-carotene levels were five
times as high and lycopene levels were 20 times as high [16].
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 [17]. USA's
main product was its Master Formula, which included large
amounts of beta-carotene and vitamin E [18]. 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 [19].
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 [22]. 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." [23]
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." [24] 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 [25]. The published studies include:
- One study showed
that taking Juice Plus+ increased a few markers of immune activity
[26]. Another study concluded that giving Juice Plus+ to healthy men and women helped protect DNA from oxidative as measured in the the nuclei of white blood cells [27]. However, neither of these studies involved measurement of health outcome.
- Two studies have found that taking Juice Plus+ decreased the blood level of homocysteine
[28,29], a substance thought to contribute to coronary artery disease.
The results
of these studies were predictable because Juice Plus+ contains
folic acid, which is known to reduce homocysteine levels. However,
people concerned about homocysteine levels should begin by having
them measured and then, under medical supervision, use folic acid,
vitamin B12, and/or vitamin B6 to reach the desired levels. Using
Juice Plus+ for this purpose would be silly because the standard
regimen would cost less than $2 per month and would be more effective
for people who need B12 to achieve the desired levels.
- Another
study [30] found that Juice Plus+ reduced the adverse effect of
a high-fat meal on the functioning of a wrist artery. Many studies
have shown similar effects with supplementation with antioxidant
supplements, but whether this has practical value is not known
and the effect can be achieved with very inexpensive products.
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." [31]. 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 [32]. 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:
While it is true that nutritional supplementation is important in maintaining health in many segments of the population, particularly the elderly, none of the scientific studies undertaken have sought to prove that Juice Plus+® is more effective or more bioavailable than other supplements. In addition, no studies exist to compare the physiologic effects of supplementation with Juice Plus+® and eating whole fresh fruits and vegetables. Juice Plus+® is distributed through a multi-tiered marketing scheme with exaggerated value and cost [33].
Libel Activities
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 [34].
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?
References
- NSA profile. Brochure, March 1997.
- Company of the month: National Safety
Associates, Inc. Money Makers Monthly, Aug 1994.
- NAS Committee on Diet, Nutrition, and
Cancer. Diet, Nutrition, and Cancer. Washington, DC: National
Academy Press, 1982.
- USDA Human Nutrition Service: The Food
Guide Pyramid. House and Garden Bulletin
No. 252. Washington, D.C., 1992, US Departments of Agriculture
and Health and Human Services.
- Juice Plus+: Letters, Testimonials
and Articles. Undated booklet, distributed in 1994.
- Transcript, cross-examination of Dr. Robert Huizenga, July 18, 1995.
- Switzer J. Unofficial summary of the Russ Limbaugh Show for Wednesday July 19, 1995.
- NSA's Guide for New Distributors. Memphis,
TN: National Safety Associates, Oct 1997.
- NSA, Inc. participates in NAD self-regulatory forum. NAD News, April 25, 2005.
- Santillo H. The Missing Link to Radiant
Health. AZ: Holm Press, 1987.
- Santillo H. NSA Audiotape.
- Santillo H. Natural Healing with Herbs.
Prescott, AZ: Holm Press, 1990.
- Tyler VE. Book review: Natural Healing with Herbs. Nutrition Forum 8(4):32, 1991.
- Aetna U.S. Healthcare announces Natural Alternatives Program. Press release, Dec 31, 1998.
- Natural Alternatives Provider Listing, Accessed April 21, 2000. Current (2006) wording is slightly different.
- Wise JA, Morin RJ and others. Changes
in plasma carotenoid, alpha-tocopherol, and lipid peroxide levels
in response to supplementation with concentrated fruit and vegetable
extracts: A pilot study. Current Therapeutic Research 57:445-461, 1996.
- Barrett S. The Rise and Fall of United Sciences of America.
Quackwatch, Sept 19, 1999.
- Barrett S. Health or Hype? A Report
on United Sciences of America. New York: American Council on
Science and Health, 1987.
- Natural Alternatives International. Annual 10-K report to the Securities and Exchange Commission. Filed Sept 28, 1999. Page 41 of the report
indicated that three companies (NSA, NuSkin International, and
Pharmavite were responsible for 16%, 23%, and 32% of NAI's sales
during the reporting period. However, the report did not indicate
which company was responsible for which number.
- Rapola JM and others. Randomised
trial of alpha-tocopherol and beta-carotene supplements on incidence
of major coronary events in men with previous myocardial infraction. Lancet 349:1715-1720, 1997.
- Omenn GS and others. Effects
of a combination of beta carotene and vitamin A on lung cancer
and cardiovascular disease. New England
Journal of Medicine 334:1150-1155, 1996.
- Why megadoses of beta carotene may
promote lung cancer. USDA Agricultural Research Service Food
& Nutrition Research Briefs, Jan 1999, p. 1.
- Vitamin supplements. The Medical Letter
on Drugs and Therapeutics 40:75-77, 1999,
- DuBois R. Homocysteine, Oxidative Stress,
Pathogenesis and Prevention of Disease. NSA Videotape, 1998.
- Juice Plus+ clinical research. Juice Plus Web site, accessed , January 2006.
- Inserra PFand others. Immune function in elderly smokers and nonsmokers improves during supplementation with fruit and vegetable extracts.
Integrative Medicine 2:3-10, 1999.
- Smith MJ and others. Supplementation with fruit and vegetable extracts may decrease DNA damage in the peripheral lymphocytes of an
elderly population. Nutrition Research 19:1507-1518, 1999.
- Samman S and others. Supplementation with a mixed fruits
and vegetable concentrate increases plasma antioxidant vitamins
and lowers plasma homocysteine in men. Journal of Nutrition 133:
2188-193, 2003.
- Panunzio MF and others. Supplementation with fruit and vegetable concentrate decreases plasma homocysteine levels in a dietary
controlled trial. Nutrition Research 23:1221-1228, 2003.
- Plotnick GD and others. Effect
of supplemental phytonutrients on impairment of the flow-mediated
brachial artery vasoactivity after a single high-fat meal.
Journal of the American College of Cardiology 41:1744-1749, 2003.
- Juice Plus Children's Research Foundation.
IRS Form 990 (Return of organization exempt from income tax),
1999, Downloaded from Guidestar
Web site, Feb 28, 2004.
- Barrett S. Questionable research by the
Juice Plus Children's Research Foundation. MLM Watch Web
site, March 1, 2004.
- Juice Plus. About Herbs database, Memorial Sloan-Kettering Cancer Center Web site, Aug 23, 2005.
- Barrett S. A response to Tim Bolen. Quackwatch, updated Nov 1, 2005.
This article was revised on January 29, 2006.
Source:
http://www.mlmwatch.org/04C/NSA/juiceplus.html
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