Juice +: Critical review of fruit and vegetable concentrates

Welcome,

This is a fan requested post on juice plus (juice +), the potential health benefits fruit and veg (F+V) and whether or not these encapsulated concentrates offer what they say. WARNING: science involved! But who doesn't like a bit of that?

We have all been told to 'eat your greens' or make sure you get your 'five a day' or even the age old 'an apple a day keeps the doctor away'. These have been used for centuries and are still around, surely this points to the possibility that F+V are good for you. To save the suspense, they are! Unbelievably vital to prolonging a healthy life and preventing illness. Increased F+V consumption is associated with reduced risk of many chronic diseases [1,2]. So what is it that makes F+V so good?

What is so good about fruit and veg?

F+V contain vast amounts of antioxidants. These are agents that prevent oxidizing atoms (oxygen-containing free-radical cells) from causing oxidative stress (oxidizing things). This is extremely important to your health as these free-radical cells are highly unstable, charged and cause oxidative stress within cells. They can take or donate electrons at will causing unprecedented damage to cells, proteins, lipids, and even DNA. This DNA damage is a common origin of cancerous cells. This oxidative damage to lipids, proteins and DNA is linked to a number of chronic diseases [7]. It is impossible for us to avoid free-radical damage because our systems are far from perfect (some argue this is the primary cause for ageing) however the serious damage occurs when free-radical numbers accumulate beyond what is manageable by the antioxidants. Therefore, the war between free-radical cells and antioxidants looks best for you with the most antioxidants on the field. Antioxidants are predominantly available in vitamin E, vitamin C, and beta-carotene; so getting these in your diet is vital.

F+V contain folate or folic acid (a B vitamin) that has been inversely correlated with homocysteine levels. elevated levels of homocysteine is very dangerous and is linked to increased independent risk of cardiovascular disease [3]. Additionally, homocysteine levels are a predictor of all-cause mortality in adults [4] essentially stating that with increased homocysteine levels you are at a higher risk of death. Consequently, a higher folate status (and therefore lower homocysteine status) is something that everybody should strive for.

The list of positives from F+V does go on and on however journal articles primarily focus on physiological markers such as oxidative stress, antioxidant levels, folate status and homocysteine levels. As a result, this review will focus on these health markers to remain concise.

The sad truth

So if I tell you that F+V consumption can increase antioxidant levels (therefore neutralizing more free-radical cells) as well as increase folate status (therefore decreasing homocysteine levels) you would go eat them right? Maybe, but the chances are it would not last, this is a result of a statistical phenomena stating any extreme scores will regress towards the norm (reversion to mediocrity) and unfortunately for you and everybody else the norm is not looking too good. 50% of households were found to consume less than the recommended daily intake of F+V in the following countries: Germany, Belgium, Greece, Hungary, Republic of Ireland, Luxembourg, Norway, Poland, Spain, UK (year 2000) [5]. And it's not like the government is not trying to show the light to the public. Despite a USA national campaign for increased F+V consumption from 1991 - 2002 Americans' F+V consumption level did not significantly increase by 2002, only 32% of adults met their daily recommended intake [6].

At this point it is pertinent to bring in juice + and other F+V powder concentrates as these products present the potential to make greater F+V consumption easier and cheaper for the masses.

What do the journals have to say?

The study of juice + and other F+V concentrate capsules is not new to the science scene. Almost 20 years ago, in 1996, it was established that the antioxidant quality in juice + did not significantly differ compared to fresh F+V. This implies that in vitro assays measuring antioxidant potential, one capsule (1g) is equivalent to ~10g of F+V [8]. In 2004, 59 subjects were assessed (aged 40-60) over 14 weeks consuming a placebo or a F+V supplement. Significant increases in beta-carotene, vitamin C and E, selenium (antioxidants), and folate were observed after active supplementation [9]. Over a shorter period (6-weeks) supplementation  resulted in increased antioxidants, vitamin A and C in addition to reduced homocysteine count [10]. 60 Japanese subjects of mixed age, gender and smoking status demonstrated significantly increased beta-carotene (528%), folate (174.3%) and decreased homcysteine levels (-19.9%) while decreasing disease risk and oxidative stress after 28 days of consuming F+V concentrate. Additionally, it was noted that smokers and non-smokers responded similarly suggesting F+V concentrate supplements may assist in relieving disease risk brought about by smoking; even if cessation of smoking is preferably advised [11]. This is supported by Housten et al., [12], Novembrino et al., [13], and Bamonti et al., [14] who found in 2007, 2011, and 2013, respectively, that consumption of F+V capsules resulted in improved pulmonary and cardiovascular parameters, decreased blood pressure, total and LDL cholesterol, oxidative stress, homocysteine levels and increased artery compliance, folate status, beta-carotene, and important antioxidants. Daily ingestion of moderate amounts of juice concentration has also been shown to reduce the immediate adverse artery flow effects of high-fatty meals [15]. I will conclude this section with the main points of a 2011 systematic review assessing previous journal utilising F+V concentrates as clinical interventions. Overall the majority of studies demonstrate F+V capsules have a high bioavailability and as such are capable of improving serum concentrations of folate and major antioxidant vitamins (C+E) and carotenoids. The majority of studies also indicated a potential for F+V capsules to decrease inflammatory biomarkers and improve immune function in addition to decreasing oxidation of lipids, proteins and DNA. [16] ‘While these supplements are not meant to replace a healthy and well balanced diet rich in fruits and vegetables, they may provide a useful means by which individuals can improve intake of FV bioactives.’ [16].

There are always two sides to a story, and the other side of this story is short and under-researched but demands acknowledgement. A 2010 paper in the American journal of medicine reporting a 51-year old woman with endometrial cancer developed liver problems that dissipated 4-weeks subsequent to the cessation of juice + consumption [17]. It is speculated that juice + caused this liver inflammation. Some cancer treatments (chemotherapy) produce free-radical cells to fight the disease, it could be a possibility that the increase in antioxidants prevented the cancer treatments from working effectively. However, such speculation exists far beyond the scope of this blog. This case highlights the necessity for subjects suffering from illness to consult their doctor before taking to alternative treatments as some side-effects may be unknown at present. Nevertheless, this is the only case of liver inflammation associated with F+V concentrates to date, most people report mild (upset stomach to begin with; fairly typical of supplements) or no side-effects.

Conclusion

Are the final products bio-available? Do the F+V concentrates offer health benefits similar to fresh F+V? Are their any side-effects or dangerous drawbacks? 

From the current literature it can be posited that F+V concentrates offer similar nutritional benefits to F+V consumption. The bio-availability is high and it can therefore be speculated that the nutritional value of the original F+V is not significantly reduced or damaged . There is a report of a dangerous side-effect however these are exiguous. Howbeit, a close eye must be kept on up-to-date research to ensure what you are putting in your body is a good idea. With the evidence presented before you what conclusions do you draw? Would you feel good taking these capsules? I know what my answer is, but that is not really any use to you now is it? It does seems that whether male, female, European, American, smoker or non-smoker, you can benefit from this product. I cannot reinforce enough that you must consult your doctor if you have any pre-existing conditions. It feels good to publish this preventing my literature from descending into yet another controversial, fear promoting, and ultimately life-paralyzing blog. As for those sites and countless TV programmes...fear fosters in ideas not fully understood, spend time to wrestle with and understand the details of ideas. Knowledge will one day replace fear and ignorance but you must take it upon yourself to start the revolution.

I cannot thank you enough for reading and promoting this site,

your very own health nut,

Chris

Main sources:

[1] Hung, H.C., Joshipura, K.J., Jiang, R. Hu, F.B., Hunter, D., Smith-Warner, S.A., Colditz, G.A., Rosner, B., Spiegelman, D. & Willet, W.C. (2004) Fruit and vegetable intake and risk of major chronic disease. Journal of the National Cancer Institute, 96(21): pp1577-1584.

[2] Block, G., Patterson, B. & Subar, A. (1992) Fruit, vegetables, and cancer prevention: a review of the epidemiological evidence. Nutrition and Cancer, 18(1): pp1-29.

[3] Herrmann, W. (2001) The importance of hyperhomocysteinemia as a risk factor for diseases: an overview. Clinical Chemistry and Laboratory Medicine: CLM/FESCC, 39(8): pp666-674.

[4] Herrmann, W. & Knapp, J.P. (2002) Hyperhomocysteinemia: a new risk factor for degenerative diseases. Clinical Laboratory, 48(9-10): pp471-481.

[5] Naska, A., Vasdekis, V.G., Trichopoulou, A., Friel, S., Leonhauser, I.U., Moreiras, O., Nelson, M., Remaut, A.M., Schmitt, A., Sekula, W., Trygg, K.U. & Zajkas, G. (2000) Fruit and vegetable availability among ten European countries: how does it compare with the `five-a-day' recommendation? The British Journal of Nutrition, 84(8): pp549-556.

[6] Casagrande, S.S., Wang, Y., Anderson, C. & Gary, T.L. (2007) Have Americans increased their fruit and vegetable intake? The trends between 1988 and 2002. American Journal of Preventative Medicine, 32(4): pp257-263.

[7] Halliwell, B. (2007) Oxidative stress and cancer: have we moved forward? The Biochemical Journal, 401(1): pp1-11.

[8] Chambers, S,J., Lambert, N., Plumb, G.W. & Williamson, G. (1996) Evaluation of the antioxidant properties of a methanolic extract from ‘Juice Plus fruit’ and ‘Juice Plus vegetable’ (dietary supplements). Food Chemistry, 57(2): pp271-274.

[9] Kiefer, L., Lawrence, C., Wise, J., Bieger, W., Bayer, P., Rathmanner, T., Kunze, M. & ieder, A. (2004) Supplementation with mixed fruit and vegetable juice concentrates increased serum antioxidants and folate in healthy adults. Journal of the American College of Nutrition, 23(3): pp205-211.

[10] Samman, S., Sivarajah, G., Man, J.C., Ahmad, Z.I., Petocz, P. & Caterson, I.D. (2003) A mixed fruit and vegetable concentrate increases plasma antioxidant vitamins and folate and lowers plasma homocysteine in men. The Journal of Nutrition, 133(7): pp188-193.

[11] Kawashima, A., Madarame, T., Koike, H., Komatsu, Y. & Wise, J.A. (2007) Four week supplementation with mixed fruit and vegetable juice concentrates increased protective serum antioxidants and folate and decreased plasma homocysteine in Japanese subjects. Asian Pacific Journal of Clinical Nutrition, 16(3): pp411-421.

[12] Houston, M.C., Cooil, B., Olafsson, B.J. & Raggi, P. (2007) Juice powder concentrate and systemic blood pressure, progression of coronary artery calcium and antioxidant status in hypertensive subjects: a pilot study. Evidence-Based Complimentary and Alternative Medicine: eCAM, 4(4): pp455-462.

[13] Novembrino, C., Cighetti, G., De Giuseppe, R., Vigna, L., De Liso, F., Pellegatta, M., Gregori, D., Maiaavacca, R. & Bamonti, F. (2011) Effects of encapsulated fruit and vegetable juice powder concentrates on oxidative status in heavy smokers. Journal of the American College of Nutrition, 30(1): pp49-56.

[14] Bamonti, F., Pellegatta, M., Novembrino, C., Vigna, L., De Giuseppe, R., De Liso, F., Gregori, D., Noce, C.D., Patrini, L., Schiraldi, G., Bonara, P., Calvelli, L., Maiavacca, R. & Cighetti, G. (2013) An encapsulated juice powder concentrate improves markers of pulmonary function and cardiovascular risk factors in heavy smokers. Journal of the American College of Nutrition, 32(1): pp18-25.

[15] Plotknick, G., Corretti, M.C., Vogel, R.A., Hesslink, R. & Wise, J.A. (2003) 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(10): pp1744-1749.

[16] Esfhani, A., Wong, J.M., Truan, J., Villa, C.R., Mirrahimi, A., Srichaikul, K. & Kendall, C.W. (2011) Health effects of mixed fruit and vegetable concentrates: a systematic review of the clinical interventions. Journal of the American College of Nutrition, 30(5): pp285-294.

[17] Naing, A., Aaron, J. & Kurzrock, R. (2010) Juice plus or toxicity plus. The American Journal of Medicine, 123(1): e1-e2.