In the US, grocery stores now sell "Kitchen Prescription Chicken Broth and Noodles with Echinacea" to "support your immune system" and "Chunky Tomato with St. John's Wort" to "give your mood a natural lift." Although these "nutraceuticals" - functional foods - have been flooding on to American grocery store shelves, the flood is a trickle here as Health Canada attempts to develop a policy on the new products. The first legislation is not expected for 2 years.
Why all the fuss? Canadians have been eating fortified foods since iodine was first added to salt in the 1920s, but there's a big difference between fortified foods and nutraceuticals. The former is designed to prevent nutritional deficiencies while the latter are generally intended to treat or prevent either symptoms or diseases. Many of them contain chemicals, herbs or other products that aren't normally found in foods, such as Echinacea, and most of the items are being added so manufacturers can make enticing health claims and boost their prices and sales.
The US opened the nutraceutical floodgates in 1993 when the Food and Drug Administration ruled that products high in calcium, such as milk and yogurt, could claim that they provided protection against osteoporosis. Enterprising manufacturers began adding calcium to foods and beverages that normally don't contain the mineral, such as waffles and orange juice. That set the precedent.
Health Canada nutritionist Mary L'Abbé says that these functional foods pose several potential dangers, and warns that excess amounts of vitamins and minerals can be health hazards. For example, excess calcium can be deposited in soft tissue. Health Canada already sets recommended daily intake levels, or minimums, but no maximum levels. The department is now "harmonizing with the US" to set upper levels too.
L'Abbé warns that some people may think that these products must be good for them because the manufacturer stresses that they contain vitamins or minerals. What may not be as apparent is their high levels of fat, sugar or salt. Further, children may get the calcium they need from orange drinks containing calcium but they will miss out on the added vitamin D contained in milk.
"We don't want them [food claims] to become just another marketing tool," says L'Abbé, who manages Health Canada's review of policies concerning the addition of vitamins and minerals to foods. "There has to be benefit."
The department's Bureau of Nutritional Science is taking a 3-pronged approach to the issue: it is setting standards for health claims (including standards of evidence) and for the addition of vitamins and minerals, and it is reviewing nutritional labelling. "This is to put things in order rather than [doing it] piecemeal," explains L'Abbé.
Setting standards is a long-term project, and there likely won't be any results for several years. The group is examining the supporting documentation that the US demands from food manufacturers that want to make health claims and setting Canadian standards of evidence for new claims. "We're getting into whole new areas," says L'Abbé. "Drugs have clear clinical trials, but food manufacturers don't want to do the equivalent of drug trials. The question is how much should they do."
L'Abbé has been looking at the addition of vitamins and minerals to food since January 1998. There have been several consultations with interested parties, including medical associations, and policy recommendations are due in September. However, L'Abbé warns that it could be 2 years before legislation is changed.
In the interim, Health Canada is using Codex international standards and its own general policies as a guideline. For example, Vector, a new cereal-like type product from Kellogg's, has been deemed a meal replacement. Calcium fortified orange juice has been given a temporary permit provided the manufacturer provides Health Canada with information about who uses the product. "This is all so new that there are no precedents," says L'Abbé.
Current regulations provide a restricted list of foods that can be fortified and for what reasons. Products are usually fortified to replace vitamins lost in processing, as in flour, or to make them equivalent to other products, as when vitamin D is added to margarine to make it nutritionally comparable to butter. It is also done for public health reasons, as when iodine is added to salt. However, the addition of herbal products like Echinacea to food is another matter.
Health Canada's new policy will stipulate which foods are appropriate for fortification. According to L'Abbé, this is a major issue. The department wants to prevent manufacturers from fortifying junk food, allowing them to make health-related claims. The legislation will also specify minimum and maximum levels. Under the current proposal, "nutraceuticals" will be treated either as pharamaceuticals or as natural health products.