Dr. Andrew Shao is Vice President of Scientific & Regulatory Affairs at the Council for Responsible Nutrition (CRN) and holds a Ph.D. in nutrition.
Q. Discuss consumer awareness of antioxidants. How has it evolved over the last few years in terms of their understanding of the category?
A. Awareness has tremendously increased over the last few years. Consumers equate the term antioxidants with health benefits. Their perception is if it’s an antioxidant or has antioxidants in it, it means it’s healthy for you. And it has increased quite a bit with the release of some high profile, large-scale trials on vitamin E, for example, and of course more and more manufacturers and suppliers are getting into the business of antioxidants.
Q. Do consumers have the knowledge of what health benefits are derived from antioxidants?
A. No, that’s where it gets a little dicey. I think consumers equate antioxidants with health benefits, but they probably couldn’t tell you which ones. Maybe those who are more the influencer, consumers that follow the information a bit more closely, might be able to say antioxidants prevent cancer or cardiovascular disease. But my guess is that many of them are unaware of the other health benefits associated with antioxidants.
Q. Do you see any trends concerning consumer’s preferred method of antioxidant delivery—supplements, foods or beverages?
A. It depends on what data you are looking at. If you ask a supplement manufacturer, they may say consumers prefer taking things by pill because it’s a lot easier. In the functional food industry, they would say research shows folks prefer getting their nutrients from foods. It depends on whom you ask. What I would say is it may depend on the specific consumer and their preferences, but it may depend more on what it is they are using the food or supplement for—what type of approach they are taking. Is it a long-term, “do it everyday as part of my overall regimen,” or a “I feel a cold coming on, I better take something to boast my immune system.” And in either of these cases, it may work better for someone as a pill or as a beverage or bar. I don’t know of any specific data that shows that consumers, as far as antioxidants are concerned, prefer one mode of delivery over another.
Q. Do consumers know what dosage of antioxidants to take?
A. The landscape is very crowded with antioxidants. The more mainstream antioxidants have been in the marketplace for a long time and have been well researched—this includes nutrients like vitamin E and C, and carotenoids. But the need to innovate has driven a lot of suppliers to introduce newer antioxidants to the market. There’s a lot less awareness about newer antioxidants and also less research on what dose is beneficial and what is it beneficial for. That’s a question a lot of consumers couldn’t answer—if you went beyond vitamin E and C, they wouldn’t know what dose to take.
Q. What are trends and issues happening in the antioxidants market today?
A. I mentioned one of the trends, which is the continual introduction of new antioxidants. The other trend is that more research is being conducted—longer term, larger scale, randomized, controlled trials on a lot of the carotenoids, like lycopene and lutein, and on vitamin C and E are taking place with more frequency. That’s a good thing because this is the type of data needed to substantiate claims and demonstrate the real benefits of using these as part of an overall approach.
A disturbing trend, however, is the generic use of the term “antioxidants” by folks in the industry because they know that there is a lot of awareness around that term and that consumers equate it with health, but it is used too loosely. Just about anything can be an antioxidant and can fall under that umbrella from a chemistry standpoint. So the term is often over used. You probably see the claims that such and such is a “powerful antioxidant”—in terms of a health benefit, what does that really mean? It’s not defined because the research hasn’t been done. When you talk about vitamin E and C and certain carotenoids you can identify exactly what the health benefit is because the research has been done in these cases.
Q. What about antioxidant testing? Is ORAC still the most preferred method?
A. I think ORAC is another one of those terms thrown around too much. It’s probably used a lot in the industry because there’s a high awareness of ORAC among researchers and marketers. At the same time, consumers are beginning to see the term and hear it a lot and know it relates to antioxidant capacity or how powerful an antioxidant is. The problem with ORAC and other methods like it is that it only measures antioxidant capacity in a test tube. While from a chemical standpoint it can identify how well the nutrient serves as an antioxidant, it really has no applicability as to what may happen in the body. There are other assays like a FRAP assay and a DPPH assay. The fact is one can find an assay that shows a compound is a powerful antioxidant, it just depends on which assay you use. Companies can also show that an antioxidant is more powerful than a competitor’s antioxidant. There isn’t one (assay) that is more indicative of another.
Q. Are more human clinical trials being done in the industry?
A. I think there are definitely more clinical trials being conducted on the mainstream antioxidants—vitamin E and C, and carotenoids. In fact, a really interesting study was just published in the American Journal of Clinical Nutrition by the group at Tufts and Rob Russell’s lab where they supplemented post menopausal women with various levels of carotenoids and tested their level of DNA degradation compared to placebo. They found those that used supplements had significantly less DNA degradation compared to placebo. That’s an interesting study and not terribly expensive, but it is revealing in terms of the health benefits and we would like to see a little more of that. They refer to them as ex vivo studies where they supplement subjects for a period of time and then take blood samples and do various tests with the blood samples. I see it done often with carotenoids.
Q. What does the latest research say about antioxidants as a whole?
A. Probably two things. In general, for healthy adults to benefit from antioxidant supplementation or fortification, they must make a long-term commitment to using them. Expectations also need to be modest. I think that the women’s health study is an example of this, where over 10 years of using vitamin E researchers were able to detect a benefit and it was primarily in older women.
The second thing is that one cannot necessarily take a single antioxidant or a single pill and believe that’s going to make the difference in whatever their health concern is. Antioxidants don’t work in isolation, they work in partnership with each other. So to think that a single nutrient is going to make a tremendous impact on overall health as a supplement is probably too high of an expectation. Despite this, researchers were able to show in the women’s health study the significant effects of vitamin E and I think this is an indication of how important vitamin E is. But in most cases, your expectations need to be tempered—you need to take a multi-faceted approach to health in the context of antioxidants.
Q. Is there any reason for concern in taking too many antioxidants?
A. Of course if you take mega doses of antioxidants, they can become pro-oxidants. If your diet is varied, as it should be, and includes lot of fresh fruits and vegetables, you probably won’t derive tremendous amount of benefit by supplementing with any single antioxidant. Antioxidants’ effects are going to manifest over many years.
Now there are specific subpopulations that do benefit from antioxidant supplementation in the short-term. These include smokers, who have very low antioxidant status; the elderly—the Tufts study proved that through vitamin E supplementation immune function improved in the elderly; and athletes, who benefit because intense exercise causes oxidation.
Q. So we can expect quicker results from antioxidants in these three groups?
A. These subpopulations have an increased need. The greater the need, the greater the impact from supplementation. And therefore you would more easily see and detect a benefit due to supplementation compared to someone who is otherwise normal. The one reason why we lack the research for showing that antioxidants or supplements in general have a preventative effect/prevent disease is because showing that an antioxidant prevents disease takes years and years of study. In normal people, it takes 10 to 20 years to develop a chronic disease, so in order to detect the effectiveness of supplementation, you would have to wait at least that long.
You might think the subpopulation of smokers and athletes are diametrically opposed but they are very similar in what they put their bodies through in terms of oxidation. They stimulate pro-oxidation through exercise and through the pro-oxidants in smoke. Of course, one is healthy for you and the other is not. So if they supplement with antioxidants, the benefit they receive is easier to detect earlier on. In the case of the elderly, often times their immune function is compromised for a variety of reasons. One reason could be that their diet isn’t where it needs to be or they don’t absorb nutrients very well. So supplementing with antioxidants has been shown to help them preserve their immune function, reduce upper respiratory infections and so forth.
Q. What do you see happening in the antioxidant market in five to 10 years?
A. I see a couple of things. One is that some of the more expensive antioxidants like SOD (superoxide dismutase) and alpha lipoic acid are going to become commoditized, so the prices are going to drop. And it’s good and bad depending what your perspective is. It’s good in that it’ll probably result in increased usage and more access both for consumers and for researchers. It’ll be bad if you are a supplier of these nutrients and the price drops. There are a lot of suppliers that are struggling now because their traditional business is in essential nutrients and it’s terribly commoditized with lots of pressure from China. And that’s going to continue to happen. Within the last five years all kinds of suppliers and distributors have popped up all over the place. So there is tremendous price pressure on these ingredients. We need longer term, larger scale, randomized, controlled trials studying disease risk or markers of disease risk. An example is lycopene’s effect on PSA (Prostate-Specific Antigen). There have been some pilot scale trials in this area. Larger, longer-term trials are needed and a drop in the price of these ingredients will help facilitate that.
And of course you’ll continue to see newer antioxidants come into the market.