September 2007
Phoods and Bepherages: The Phuture of Phunctionality
By Carol Ann Brannon, MS, RD, LD
Today’s Dietitian
Vol. 9 No. 9 P. 12
CDR Learning Codes: 2000, 2010, 2040, 2100; Level 2
Most U.S. consumers understand and accept the concept of functionality in foods, but the term has no advertising pizzazz and lacks a clear definition. Plus, there has been no way to categorize new so-called designer foods—fortified and modified foods (eg, Gatorade) created for a specific medical or health purpose.
So, we now read about phoods and bepherages. The “ph” comes from the word pharmaceutical—by definition, these products are packaged foods and beverages that provide a positive pharmaceutical benefit beyond basic nutrition by virtue of the inclusion of medically beneficial ingredients.1
This is not a legal definition, nor one regulated by the FDA, but neither is the term functional food. The key phrase is “medically beneficial ingredients,” even though the exact meaning of this phrase is also open to interpretation.1-5 But, like most neologisms, these words fill a need to describe a scientific innovation—and, of course, they catch the consumer’s eye.
Overall, the food industry is growing at 3% to 4%, but the functional foods segment is growing at 20%.3 Phoods and bepherages sold nearly $25 billion in 2006; sales are expected to reach $39 billion by 2011. Aging baby boomers in particular are spending a significant amount of money in their quest for health, fitness, wellness, and youthful vigor. Thirty percent of shoppers say they are more likely to buy phoods and bepherages because of their pharmaceutical benefits, even though scientific evidence to support many health claims is inconclusive.1-5
According to experts and members of the Institute of Food Technologists, the current functional food market is in its infancy. The potential opportunities for development of new phoods and bepherages are almost limitless.6,7 According to the American Dietetic Association, scientific studies that assess only the nutrient content of foods may be irrelevant given the advances in microbiology.6,7
Hippocrates wrote, “Let food be thy medicine, and medicine be thy food,” and his philosophy is slowly but steadily permeating Western culture and healthcare.8 Skyrocketing consumer demand makes it inevitable that RDs will be quizzed about the latest phoods and bepherages. More supermarkets are hiring RDs to assist their customers. Staying current is a daunting task, as advances in technology and plant engineering are making it possible to produce foods and beverages that provide a specific health benefit and/or alter a person’s risk of developing diseases, including cancer and heart disease.
It is impossible to address and discuss all the new phoods and bepherages here, so this article will focus on the two “hottest” phoods and bepherages: those enhanced or infused with omega-3 fatty acids and/or probiotics.6 There is substantial scientific evidence to support the health benefits of consuming a diet rich in foods that naturally contain omega-3 fatty acids—including alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA)—and probiotics.8
Omega-3 Enhancement
Omega-3 fatty acids are long-chain polyunsaturated fatty acids known as the “good” dietary fats. Omega-3 fatty acids include DHA and EPA, which exist naturally in fish oil, and ALA, abundant in flaxseed, soybeans, walnuts, and canola.
ALA, EPA, and DHA are unique in their chemical configuration, metabolic role, and health benefits. ALA is not equivalent in biological effects to the longer chain EPA and DHA, which are rapidly taken up and incorporated into various sites of the body. The body can convert ALA into EPA and DHA; however, this conversion is estimated to be only approximately 10% to 15% efficient. DHA, the most abundant fatty acid in the brain and retina, has become “the” omega-3 fatty acid to have in your diet.8
There is a general consensus that American dietary intake of omega-3 fats is below the recommended levels. The estimated dietary ratio of omega-6 to omega-3 fatty acids in the United States ranges from 8:1 to 12:1, but for some people, it is as high as 25:1.9,10 The World Health Organization (WHO) has recommended a ratio of omega-6 to omega-3 fatty acids ranging from 5:1 to 10:1. The concept of balancing omega-6 and omega-3 fatty acid intake for optimal health and disease protection is accepted globally.9 Thus, enrichment of foods with omega-3 fatty acids may be beneficial for Americans, especially those who do not consume fish.11,12
A deficiency of omega-3 fatty acids is associated with cardiovascular disease, cancer, inflammatory disorders, and mental and emotional problems. A diet rich in omega-3s can offer disease protection, as well as help treat depression, bipolar disorder, and possibly attention-deficit/hyperactivity disorder.8,13
In 2004, the FDA approved the following language for qualified health claims that may appear on a food label or in advertisements for foods or supplements containing EPA or DHA: Supportive but not conclusive research shows that consumption of EPA and DHA omega-3 fatty acids may reduce the risk of coronary heart disease. One serving of [name of food] provides [x] grams of EPA and DHA omega-3 fatty acids. (See nutrition information for total fat, saturated fat and cholesterol content.)14
This qualified health claim has helped increase consumer awareness and most likely played a role in the soaring sales of omega-3 phoods and bepherages.8,14
Omega-3 infused foods are the hottest selling phoods and bepherages. It is projected that sales of ALA-, DHA-, and EPA-infused foods will reach $7 billion by 2011, a compound annual growth rate estimated at more than 60% from 2002 to 2011. Due to advances in food technology, DHA/EPA- or fish oil-enriched foods no longer have a “fishy” taste or smell.6
Enhancing the omega-3 fatty acid content of animal foods is usually done through manipulation of animal feed. Hens fed a diet of ground fishmeal and algae produce an omega-3–rich egg. Two examples of omega-3–enriched eggs are Egglands’ Best (widely available in U.S. grocery stores) and Christopher Eggs (available nationwide at Super Wal-Mart stores and some regional stores). On average, an omega-3–enhanced egg has roughly 600 milligrams of omega-3 fatty acids compared with 35 to 40 milligrams in a conventional egg.11,12
Smart Balance has a complete line of products (oils, buttery spreads, peanut butter, popcorn, cheese) featuring omega-3 fatty acids and containing no hydrogenated fats or oils or trans fats. One product, Smart Balance Omega PLUS Buttery Spread, deserves special mention because it infuses marine omega-3 fatty acids—omega-3s from the sea—and plant sterols, functional ingredients scientifically proven to lower cholesterol and help maintain normal triglycerides.
Another Smart Balance product has flaxseed oil (ALA) as an ingredient. Smart Balance Light Buttery Spread with Flax Oil provides 300 milligrams of omega-3s per serving to achieve an ideal 4:1 ratio of omega-6s to omega-3s.15
Omega-3 Bepherages
Fish oil with your orange juice? Yes, that’s correct. Tropicana recently introduced its Tropicana Healthy Heart with Omega-3s, which includes a high-quality, specially encapsulated, marine-based source of omega-3 EPA and DHA fatty acids. Consumers can now get the benefits of fish oil at breakfast.16
Two other national companies have launched omega-3–enriched beverages. Odwalla, the nation’s leading health beverage company, introduced its Soy Smart beverage, available in Chai, Vanilla, and Chocolate. The “medically beneficial ingredients” in Soy Smart are omega-3s, as well as soy protein and fiber. Each 8-ounce serving of Soy Smart provides 6.25 grams of soy protein and 32 milligrams of DHA (20% of the 160 milligrams daily value) per serving. Another Odwalla product, Berries GoMega, delivers 1,300 milligrams of ALA in a 15-ounce bottle, enough to slightly exceed the daily adequate intake (AI) set by the National Academy of Sciences for women and nearly meet the AI for men. Not to be outdone, Silken has introduced its Silk Plus Omega-3 DHA with Life’s DHA, a trademarked, 100% vegetarian source of DHA. In addition, Silk Plus has ALA.17
Flaxseed has become a popular “functional” ingredient in many breakfast cereals, health bars, and breads. Flaxseed and flaxseed oil contain ALA and lignans, a type of phytoestrogen that promotes good health and appears to offer disease protection.11,12
Eliminating the fishy taste and smell of marine-derived DHA and EPA is an obstacle to enriching food with these omega-3 fatty acids. Martek Biosciences Corportation has overcome this article by obtaining DHA from microalgae.18,19 Fatty fish are a rich DHA source because they consume DHA-rich microalgae. In 2005, media reports announced that the Kellogg Company, in collaboration with Martek, would begin adding vegetarian-derived DHA to some of its products beginning this year. 18,19 As of July, however, a Kellogg representative said no information about DHA-fortified products was currently available.
But not everyone is pleased with the isolation of DHA and its addition to foods. The concern is that isolated DHA does not occur naturally in any food; it is always accompanied by EPA. The possible health effects of consuming large amounts of isolated DHA are unknown.19
Probiotic Phoods
Probiotics are emerging as significant dietary ingredients. Clinical studies support the beneficial role of these “friendly bacteria” in managing a wide spectrum of health conditions, especially in alleviating the symptoms of digestive disorders.8
The word probiotic means “prolife.” Approximately 400 different probiotic strains exist, each with unique properties and specific health effects. A variety of probiotics reside in the human gastrointestinal tract. The most common are Lactobacilli and Bifidobacteria strains.20 The manipulation of the intestinal mucosa to favor probiotics can potentially improve overall health through a variety of mechanisms.8,20
The proposed health benefits of probiotics include promoting and improving the following:
• digestive health;
• urinary and genital health;
• immune function;
• resistance to pathogens, infection, and inflammation;
• nutrient bioavailability;
• management of atopic allergies; and
• synthesis of vitamins (niacin, folic acid, biotin, and B6).
Probiotics also decrease the following:
• lactose intolerance;
• serum cholesterol levels; and
• the risk of certain cancers.
However, health benefits are probiotic strain-specific. Some strains may not confer any health benefits.8,20
Incorporating probiotics into foods, especially nondairy foods, is no easy task. Probiotics are extremely sensitive to heat, humidity, pH levels, and oxygen. To ensure probiotic viability, refrigeration is necessary, a short product shelf life is desirable, and exposure to humidity and oxygen should be minimal because probiotics are anaerobic.21
Dairy foods and beverages are the ideal delivery vehicles for probiotics. Probiotic fermentation enhances flavor and texture of dairy foods and their shelf life is short. Dairy foods buffer stomach acid and bile, thereby protecting probiotics from destruction by stomach acid. In addition, dairy foods and probiotics appear to have synergistic effects. For example, some in vitro studies indicate that lactoferrin in dairy foods may enhance Bifidobacteria growth.21
Culture-containing milk, fermented milk, smoothies, yogurt, cottage cheese, and kefir are the most common probiotic foods and represent the largest segment of the market, as shown in Table 2.22
• Yogurt. Perhaps the most successful probiotic products are yogurts. A wide variety can be found in nearly all grocery stores with animals and cartoon characters on labels to lure children, who especially like pourable and squeezeable ones, while sophisticated flavors, such as coffee or cheesecake, appeal to adults. A variety of organic and soy yogurts are available, so the U.S. government has established a definition: the standard of identity requires fermentation with at least L. bulgaricus and S. thermophilus.8,21
Yogurt has some beneficial effects and properties not found in milk, including improved gastric emptying, lactose digestion, and immune system functionality. Calcium in yogurt is more easily available to the body, and yogurt produces fewer atopic allergy symptoms. Research is exploring a potential cholesterol-lowering or modulatory effect, and epidemiological studies have shown a decreased risk of breast cancer associated with yogurt consumption.8,23
It is critical that the organisms in yogurt be alive and active during its shelf life to ensure that health benefits are received. Pasteurization often results in the death of many microorganisms. For this reason, organic yogurt, especially those containing prebiotics such as fructooligosaccharides (FOS) are preferable.21 Probiotic bacteria are quite stable in fluid milk because milk has a short shelf life and a near-neutral pH level (6.5 to 6.7), but their numbers tend to decline in yogurt because it is more acidic.8
Nearly as important as viability is the presence of enough probiotics to provide health benefits. Only California and Oregon mandate that a minimum level of probiotics be added to a dairy product. The National Yogurt Association, in an effort to help consumers, established a “Live & Active Culture” seal for use by yogurt manufacturers on labels. To use this label at the time of manufacture, refrigerated yogurt must contain 1 billion viable L. acidophilus, while frozen yogurt must contain 100 million. In general, yogurt supplies roughly 100 million bacteria per gram.10 However, there may be far fewer viable probiotics by the time the yogurt is consumed.8
It is important to note that probiotic counts can include starter culture bacteria and probiotic bacteria. Therefore, the label information may not be a true indication of probiotic content. Starter organisms (S. thermophilus and L. bulgaricus) are used for the purpose of acid production and should not be confused with probiotics (L. acidophilus, L. casei, L. reuteri, Bifidobacterium species, and others).8 Dietitians need to understand the factors that affect and may inhibit probiotic functionality.
• Kefir. Kefir, a creamy fermented milk product, originated centuries ago in the Caucasus Mountains of eastern Europe. The longevity of the Caucasus Mountain people was associated with their Kefir consumption. Throughout history, healing powers have been associated with kefir.24
The making of kefir begins with the formation of kefir grains, which are a composite of probiotic bacteria and yeasts held together by a polysaccharide matrix. Kefir contains several major strains of probiotics (L. Caucasus, Leuconostoc, Acetobacter species, and Streptococcus species) and beneficial yeasts not found in yogurt. When kefir grains are added to milk, a unique fermentation process occurs, converting the milk into kefir. The grains, which resemble cauliflower pieces, are removed by straining and can be used as a starter for more kefir.24
Some studies indicate that kefir may enhance immune function and exert both antitumor and antimicrobial activities. However, to date, no firm scientific conclusions can be made regarding kefir’s functionality. Kefir products vary significantly and so may the specific health benefits.8,24
Today, kefir is available in flavors like strawberry. Unflavored kefir can be sweetened with honey or maple syrup, eaten with fruit, put into a fruit smoothie, cereals, or on a baked potato. Fruit-flavored kefir can be enjoyed like a smoothie. Lifeway Foods has introduced ProBugs, a whole milk kefir for children. ProBugs contains 10 live and active kefir cultures and comes in two flavors.25
• Probiotic cereals. Kashi has created Vive, a high-fiber (12 grams of fiber per serving) cereal with Lactobacillus, a hint of ginger, and broccoli extract.25
• Probiotic tea. Kombucha tea is appearing in refrigerated sections of grocery stores alongside other specialty teas, such as green and white bottled tea. Kombucha tea is an acidic, sharp-tasting beverage that is best enjoyed when chilled.
This ancient tea is made by placing a kombucha “mushroom” (actually a symbiotic colony of bacteria and yeasts) in sweetened black tea. The mushroom’s bacteria and yeast cause the tea to ferment. The kombucha mushroom can duplicate itself during fermentation. This second mushroom can be split off and used to produce another brew of tea. This fermented tea is considered a traditional medicinal food. Kombucha tea is thought to have originated in the Far East centuries ago. Over time, it made its way to Russia and Europe.
Although there are no scientific studies to support the possible benefits of this tea, there is a wealth of anecdotal information. Most proposed benefits of kombucha tea are related to improved functioning of the digestive system.8
Regulatory Issues and the RD’s Role
As you’d expect, regulation issues are becoming complicated. Phoods and bepherages blur the lines between food, dietary supplements, and medicines, and FDA regulations do not perfectly address or accommodate this phenomenon.
Current FDA rules and regulations prohibit food companies from making any drug claims on their products. For example, FDA regulations mandate that a food manufacturer cannot put a claim on a product that it reduces cholesterol levels because that is a drug claim. However, the FDA does permit the qualified claim that the particular food “maintains normal cholesterol levels.” Thus, while the future of functional foods looks promising, regulating these foods is proving challenging. Currently, there is no global consensus regarding the definition and regulation of functional foods.4,7,8
Thus, the arrival of new phoods and bepherages is not without concerns. One is that people will inadvertently consume too much of a questionable ingredient. Another is that consumers may come to rely on nutritionally enhanced foods and beverages to make up for a poor diet. Also, phoods and bepherages may influence a patient’s drug compliance, as well as the effectiveness of his or her medication.26 For example, green tea may interfere with a wide variety of medications, including certain antibiotics, benzodiazepines (antianxiety medications), monoamine oxidase inhibitors, beta-blockers, blood-thinning drugs such as warfarin, and chemotherapy medications.27
Phoods and bepherages are not magic potions. The total nutrient content of the phood or bepherage must be considered, as well as the person’s total diet. Dietitians will need to be diligent in relaying the message that if it sounds too good to be true, it probably is. The best diet in the world, as supported by substantial scientific evidence, is one rich in whole grains, fruits, vegetables, and legumes, which are naturally packaged with rich amounts of essential vitamins, minerals, phytochemicals, and fiber. (Or is that phiber?)
— Carol Ann Brannon, MS, RD, LD, is a consulting dietitian at Fowler YMCA and in private practice in Georgia.
References
1. “Functional ‘Phoods’ to Become $39 Billion ‘Niche.’” Food & Beverage News. March 16, 2007. Available here.
2. “Health-Savvy Wonder Foods.” Business Week. March 14, 2007. Available here.
3. Welch M. “Phoods and Bepherages.” Business Week. April 2, 2007. Available here.
4. Gay L. “‘Phoods’ are only beginning of drug-altered products.” Red Orbit Breaking News. May 23, 2005. Available here.
5. Kirsche ML. “Food as medicine concept gaining steam.” Drug Store News. June 6, 2005.
6. “Omega-3 infused food and beverage sales to skyrocket to $7 billion by 2001.” GrainNet News, February 23, 2007. Available here.
7. Hasler CM, Bloch AS, Thomson CA, et al. Position of the American Dietetic Association: Functional Foods. J Am Diet Assoc. 2004;104(5):814-826.
8. Brannon CA. “Functional Foods, Part 2” Nutrition Dimension. Updated April 3, 2006. Available here.
9. Kris-Etherton PM, Taylor DS, Yu-Poth S, et al. Polyunsaturated fatty acids in the food chain in the United States. Am J Clin Nutr. 2000;71(1 Suppl):179S-188S.
10. Simopoulos AP, Leaf A, Salem N. Essentiality of and recommended dietary intakes for omega-6 and omega-3 fatty acids. Ann Nutr Metab. 1999;43(2):127-130.
11. Wade MA. Get fat to get fit—nutritional lipids—polyunsaturated fatty acids.” Prepared Foods. March 2004. Available here.
12. Larsen HR. “Omega 3 Oils: The Essential Nutrients.” Available here. Accessed December 27, 2005.
13. Klimaszewski A. “Flax for Health.” Biorignal Publishing. March 2000. Available here.
14. U.S. Food and Drug Administration. “FDA Announces Qualified Health Claims for Omega-3 Fatty Acids. FDA News. September 8, 2004. Available here.
15. Smart Balance Product Information. Available at: http://www.smartbalance.com/product.html. Accessed July 1, 2007.
16. Horovitz B. “Omega-3 pours into cereal, orange juice, eggs, pet food.” USA Today. January 1, 2007. Website available here.
17. BevNet Product News. Available here. Accessed July 1, 2007.
18. “Kellogg to develop products fortified with DHA.” USA Today. March 1, 2005. Available here.
19. “Omega-3 Fat Added to Kellogg Cereals.” Dr. Joseph Mecola’s eHleaty News You can Use. March 16, 2006. Available here. Accessed July 1, 2007.
20. Salminen SJ, Gueimonde M, Isolauri E. Probiotics that modify disease risk. J Nutr. 2005;135(5):1294-1298.
21. Haines B. “Dairy’s Probiotic Promise.” Prepared Foods. May 2004. Available here.
22. Dash SK. “Selection criteria for probiotic supplements.” Townsend Letter for Doctors and Patients. February-March 2003. Available here.
23. “Yoghurt: Eighty Years of Active Research for Health.” Danone Vitaple Symposium. Barcelona, Spain. March 1999. Available here.
24. Kefir — Yoghurt for Life. Available here. Accessed August 14, 2002.
25. Supermarket Savvy November 2006 Newsletter. Available here. Accessed July 1, 2007.
26. deJong N, Klungel OH, Verhagen H, et al. Functional foods: The case for closer evaluation. BMJ. 2007;334(7602):1037-1039.
27. Brannon CA. “Green Tea: Health Benefits From an Old Favorite?” Nutrition Dimension. 2007. Available here.
Examination
1. Functional foods:
a. are strictly regulated by the FDA as medicinal foods.
b. are strictly regulated by the USDA as fortified foods.
c. are regulated as dietary supplements by the FDA.
d. are not regulated by the FDA as a separate food category.
e. have not yet gained global attention.
2. The concept of functional foods:
a. is rooted in Eastern philosophy and culture.
b. encourages the medicinal use of food.
c. is embraced by aging baby boomers.
d. is the new frontier in nutrition.
e. all of the above
3. The typical or standard American diet:
a. includes a high ratio of omega-3 fatty acids to omega-6 fatty acids.
b. includes a balanced ratio of omega-6 to omega-3 fatty acids.
c. is deficient in omega-6 fatty acids.
d. has a high ratio of omega-6 fatty acids to omega-3 fatty acids.
e. offers heart disease protection.
4. The infusion of omega-3 fatty acids in phoods and bepherages is:
a. difficult because foods with omega-3 fatty acids have a slightly fishy taste.
b. limited to foods with an acidic pH.
c. generally not well-accepted by consumers.
d. easier today due to advances in biotechnology.
e. all of the above
5. The fatty acid receiving the most attention is:
a. alpha-linolenic acid.
b. linoleic acid.
c. docosahexaenoic acid (DHA).
d. eicosapentaenoic acid (EPA).
e. palmitic acid.
6. The two most popular and well-studied probiotic species are:
a. Lactobacillus and Bifidobacterium.
b. Bifidobacterium and Streptococcus.
c. Bacterocides and aerobic virus.
d. H. Pylori and Lactobacillus.
e. Lactobacillus and Streptococcus.
7. All yogurts in the United States are fermented with:
a. L. bulgaricus and S. thermophilus.
b. Lactobacteria bifidum.
c. L. reuteri.
d. L. casei.
e. Brewer’s yeast.
8. Probiotics:
a. can easily be infused in almost any food.
b. survive best in an acidic environment.
c. must have oxygen to survive.
d. have a relatively short shelf life.
e. all of the above
9. Kefir is:
a. a new designer food boasting probiotics and DHA and EPA.
b. made with the same probiotics as yogurt.
c. recommended for adults only.
d. currently only available in health food stores.
e. associated with improved immunity, digestion, and longevity.
10. The concerns regarding phoods and bepherages include:
a. consumers’ compliance with medication.
b. possibility of some consumers taking an excess of a nutrient.
c. consumers neglecting a well-balanced diet.
d. safety and effectiveness of isolating functional ingredients and infusing them in new foods.
e. all of the above
