Editorial: Chasm or Continuum?

By Len Monheit

Words such as ‘nutraceuticals’, ‘bioactives’ and ‘functional’ ingredients are frequently used (or misused) interchangeably in efforts to gain traction with a target market or media. And on the finished product side, it is often quite difficult to determine the difference between supplement companies, natural products companies, natural health products companies and nutritional products companies. Sure, there are some regulatory criteria that apply for supplements and natural health products, but the real differences between these somewhat arbitrary categories are often quite unclear.

When you consider the concept of health foods or even healthier foods, it gets even more complex. First of all, what makes a food healthy or healthier?

Depending on scientific discipline and personal belief, you could get literally thousands of answers ranging from an analysis of nutritional content, to a list of ingredients and supporting science (from anecdotal to peer reviewed clinical studies), to an explanation of organic benefits, to a lesson in sustainability. Delving into the realm of science, the issue becomes even more complex (as do our systems) and very rarely is the evidence entirely one sided or the situation black and white.

We are seeing the introduction of possible solutions for overall health management including multi-disciplinary tactics using integrative medicine, lifestyle counseling and forays into what I will call ‘solutions for proactive health management by ingestion’ typically involving careful food selection and dietary choices, and supplementation including the entire scope of ‘phytoactives’ including vitamins, minerals, botanicals, amino acids, EFA’s and others. These are your building blocks, your inputs, if you will. Approaches to evaluation of these inputs vary widely depending on background and perspective of those involved in the evaluation. Biochemists, biologists, chemists, doctors, dieticians, nutritionists, and other disciplines will have different perspectives, defaults and priorities, and so do other influencers such as lawyers, regulators and legislators. Each will have a slightly different view of, say, iron consumption and sources, or the impact of omega-3s.

There have been careful maps designed to illustrate the relationships between food, supplements, natural health products and drugs, most frequently from a regulatory perspective, and frequently these even include the category of medical foods. We know certainly that the entire landscape is carefully monitored by the various regulatory agencies that do cover the scope, in North America this being FDA and Health Canada. In these and other jurisdictions there is also dialogue amongst various other government resources that might be involved on an issue by issue basis.

One can argue therefore that a regulatory relationship has been established to a certain extent, across the entire scope. This argument is challenged though by the fact that all the players with a potential stake, the other roles and disciplines mentioned above tend to come at the subject of ‘solutions for proactive health management by ingestion’ not from a realization of a continuum, but from the perspective of voices across a chasm. In general terms dieticians believe that ingestion through diet is what counts, and many physicians agree. Even when evidence determines that the normal diet is severely deficient in certain nutrients, the solution becomes ‘consume more’ rather than an examination of the continuum of solutions that can be explored, even on a personalized basis. (There is some evidence that this is changing, but some would argue not nearly fast enough.)

In science too, the approach often seems disconnected. The very focused and specialized nature of research runs contrary to a big picture, holistic examination, and if the issue is so complex and unresolved in one specialty, then surely a multidisciplinary approach would only further complicate already muddy waters.

Here’s where we encounter severe problems.

Some current issues demand a multidisciplinary approach and tapping into specialized unique resources and experience. One example is nutrient risk assessment and the establishment of recommended intake levels and maximum values. This ties quite closely to the safety submissions and expectations regarding either existing or new ingredients being launched into new markets, forms, applications and delivery system. A chasm-oriented approach only will almost certainly lead to redundancy, gaps, miscommunication and inefficiency.

Another area that is becoming problematic is communication. With the Internet emerging as dynamic communication vehicle speed is enhanced, analysis is curtailed and information overload prevails – and so does confusion. Increasingly, the audience is looking for consolidation of information and perspectives to get straight(er) answers.

This week I attended a symposium on functional foods and a physician in the crowd summed up much of the two-day event by saying, “This is great, I’m excited, but what does it mean?”

Human nature is driven to simplify, and the dangers of over-simplification are obvious. As FDA is finding out with their qualified health claims, there are also inherent dangers in using over-qualifying language. Is there a middle ground where a continuum exists and professionals can get together to generate substantial, meaningful information that is accessible and responsive to real audience needs, behaviors and realities? I certainly hope so.

As I write this I am struck, as I know many of you are, by the irony of failing health systems and rising costs, of increasing levels of diseases whose progress can at least be challenged by ‘solutions for proactive health management by ingestion’, yet the will to put in effect these solutions as a collective, recognizing the continuum that exists, is not shared by all the stakeholders.

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