Use of Natural Products Including Omega-3 Fatty Acids for Preventive Health Care and for Lowering Health Care Costs Prof. Bruce J. Holub Department of.

Use of Natural Products Including Use of Natural Products Including Omega-3 Fatty Acids for Omega-3 Fatty Acids for

Preventive Health Care and for Preventive Health Care and for Lowering Health Care CostsLowering Health Care Costs

Prof. Bruce J. HolubProf. Bruce J. HolubDepartment of Human Biology & Nutritional SciencesDepartment of Human Biology & Nutritional Sciences

University of GuelphUniversity of GuelphGuelph, ON, CanadaGuelph, ON, Canada

Conference on Seal Oil, Collagen, and Protein ProductsJune 7-8th, 2004 - DFAIT, Ottawa

‘‘NutraceuticalsNutraceuticals’ and ‘’ and ‘functional foodsfunctional foods’ can be defined ’ can be defined as follows by Health Canada:as follows by Health Canada:

A ‘A ‘nutraceuticalnutraceutical’ is a product isolated or purified from ’ is a product isolated or purified from foods that is generally sold in medicinal forms not foods that is generally sold in medicinal forms not usually associated with food. A nutraceutical is usually associated with food. A nutraceutical is demonstrated to have a physiological benefit or demonstrated to have a physiological benefit or provide protection against chronic disease (Health provide protection against chronic disease (Health Canada).Canada).

A ‘A ‘functional foodfunctional food’ is similar in appearance to, or may ’ is similar in appearance to, or may be, a conventional food, is consumed as part of a usual be, a conventional food, is consumed as part of a usual diet, and is demonstrated to have physiological benefits diet, and is demonstrated to have physiological benefits and/or reduce the risk of chronic disease beyond basic and/or reduce the risk of chronic disease beyond basic nutritional functions (Health Canada).nutritional functions (Health Canada).

The above definitions for nutraceuticals and The above definitions for nutraceuticals and functional foods, while helpful, fail to appreciate and functional foods, while helpful, fail to appreciate and allow for the important roles that these can also play allow for the important roles that these can also play in retarding disease progression, enhancing disease in retarding disease progression, enhancing disease management, and offering effective risk factor management, and offering effective risk factor modification in those with existing disease (as most modification in those with existing disease (as most Canadians have by their fifties).Canadians have by their fifties).

‘‘Nutraceuticals’Nutraceuticals’

‘‘Functional Foods’Functional Foods’

‘‘Wellness Foods’Wellness Foods’

‘‘Medicinal Foods’Medicinal Foods’

‘‘Pharma Foods’Pharma Foods’

Estimated Prevalence of Cardiovascular Disease inEstimated Prevalence of Cardiovascular Disease inAmericans by Age and SexAmericans by Age and Sex

Age (yr)

Per

cen

t of

Pop

ula

tion

Source:http://www.americanheart.org

0

10

20

30

40

50

60

70

80

90

20-24 25-34 35-44 45-54 55-64 65-74 75+

Males

Females

Partial Listing of Lifestyle-related and other Partial Listing of Lifestyle-related and other Disorders/Diseases where Nutraceuticals/Functional Disorders/Diseases where Nutraceuticals/Functional

Foods can play a Major Role in Prevention/ManagementFoods can play a Major Role in Prevention/Management

1.1. Cardiovascular Diseases (CVD) and risk factors (blood Cardiovascular Diseases (CVD) and risk factors (blood lipids, b.p., etc.)lipids, b.p., etc.)

2.2. Type 2 DiabetesType 2 Diabetes

3.3. Cancers (colon, prostate, breast, others)Cancers (colon, prostate, breast, others)

4.4. OsteoporosisOsteoporosis

5.5. Kidney DisordersKidney Disorders

6.6. Inflammatory conditions (arthritis, bowel, etc.)Inflammatory conditions (arthritis, bowel, etc.)

7.7. ‘‘Psychiatric disorders’Psychiatric disorders’

8.8. OthersOthers

Health Care Expenditure in CanadaHealth Care Expenditure in Canada

ParameterParameter $ billion/yr$ billion/yr

Cardiovascular Cardiovascular

CancerCancer

Type 2 DiabetesType 2 Diabetes

ArthritisArthritis

DrugsDrugs

Diet-related DisordersDiet-related Disorders

TotalTotal

1313

2020

1010

1010

1515

3030

> 100> 100

Selected Rationale for Introduction of Functional Selected Rationale for Introduction of Functional Foods into Marketplace and Health-Care SystemFoods into Marketplace and Health-Care System

1. Current Canadian health policy of medical treatment (pharmaceuticals, etc.) with or without dietary advice denies public the benefit offered by nutraceuticals/functional foods.

2. Most Canadians refuse to follow Health Canada’s Guidelines for Healthy Eating (reluctance to change from ‘Western-style’ diet).

3. Current dietary patterns/foods in Canada don’t provide sufficient intakes of natural nutraceutical components needed for optimal health promotion or disease prevention/management.

4.4. Lifestyle (diet)–related chronic diseases/disorders in Lifestyle (diet)–related chronic diseases/disorders in Canada are major burden on health care costs Canada are major burden on health care costs (particularly with ageing population).(particularly with ageing population).

5.5. Offers low-cost and early control of risk factors for Offers low-cost and early control of risk factors for subsequent disease (e.g., heart disease).subsequent disease (e.g., heart disease).

6.6. Offers a ‘preventive’ model for disease prevention rather Offers a ‘preventive’ model for disease prevention rather than the current ‘medical’ model.than the current ‘medical’ model.

7.7. Dietary advice often proven to be ineffective on longer-Dietary advice often proven to be ineffective on longer-term (e.g., blood cholesterol-lowering by dietary advice).term (e.g., blood cholesterol-lowering by dietary advice).

8.8. Offers control of ‘moderately’ elevated risk factors (e.g., Offers control of ‘moderately’ elevated risk factors (e.g., blood cholesterol, triglyceride, etc.) which current health-blood cholesterol, triglyceride, etc.) which current health-care system fails to control.care system fails to control.

9.9. High ‘quit’ rate on pharmaceutical agents.High ‘quit’ rate on pharmaceutical agents.

10.10. Functional foods can serve as optional or complementary Functional foods can serve as optional or complementary approaches for risk factor control and disease management approaches for risk factor control and disease management (not offered to Canadians today despite clinical/scientific (not offered to Canadians today despite clinical/scientific evidence).evidence).

11.11. Other countries (physicians, etc.) routinely use Other countries (physicians, etc.) routinely use nutraceutical/functional foods for health care.nutraceutical/functional foods for health care.

12.12. Dramatic reduction in health care costs.Dramatic reduction in health care costs.

13.13. Boom to Canadian economy/production of products, job Boom to Canadian economy/production of products, job creation, reduced dependency on imported/costly creation, reduced dependency on imported/costly pharmaceutical products, etc.pharmaceutical products, etc.

14.14. Others Others

Paradigm Shift in Health Care is Needed in CanadaParadigm Shift in Health Care is Needed in Canada

Current: ‘Medical ModelMedical Model’ (later in life)

Medical Management with or without Dietary Medical Management with or without Dietary Advice of Chronic Disorders/Diseases (no Advice of Chronic Disorders/Diseases (no Functional Foods/NutraceuticalsFunctional Foods/Nutraceuticals

Future: ‘Preventive ModelPreventive Model’ (early in life)

Wide introduction and use of Functional Wide introduction and use of Functional Foods/Nutraceuticals for Prevention of Chronic Foods/Nutraceuticals for Prevention of Chronic Disorders/DiseasesDisorders/Diseases

.

3

4

5

6

20 30 40 50

Blo

od C

hole

ster

ol (

mm

ol/L

)

(drug therapy)(drug therapy)

(current)(current)

(future if FFoods)(future if FFoods)

(~50% eligible (~50% eligible for drug therapy)for drug therapy)(~ 40% have (~ 40% have CVD)CVD)

(< 10% eligible (< 10% eligible for drug therapy)for drug therapy)(<5% have (<5% have CVD)CVD)

Ages

0

25

50

Per

cen

tage

of

Pop

ula

tion

<1.1

1.1-2.2

=>2.3

Blood Plasma Triglyceride Levels (mmol/L) in the Population (45-54 yr)

No-Low Risk Moderate-High Risk:No Clinical Management

High Risk: Candidates for

Clinical Management

Effects of Selenium Supplementation for Effects of Selenium Supplementation for Cancer Prevention in Patients with Cancer Prevention in Patients with

Carcinoma of the SkinCarcinoma of the Skin A Randomized Controlled TrialA Randomized Controlled Trial

((Clark et al.Clark et al. JAMAJAMA. . 1996;276:1957-1963)1996;276:1957-1963)

% Reduction in Cancer*% Reduction in Cancer*

Total cancer incidenceTotal cancer incidence

Total cancer mortalityTotal cancer mortality

Prostate cancer incidenceProstate cancer incidence

Colorectal cancer incidenceColorectal cancer incidence

3737

5050

6565

6161

* 200 ug Selenium/day as nutraceutical supplementation* 200 ug Selenium/day as nutraceutical supplementation

Some Examples of Natural Blood Triglyceride-Lowering Some Examples of Natural Blood Triglyceride-Lowering Nutraceutical Ingredients and their Potential to Reduce Nutraceutical Ingredients and their Potential to Reduce

Subsequent Heart Disease Treatment Costs if Initiated as Subsequent Heart Disease Treatment Costs if Initiated as Preventive Foods in Healthy IndividualsPreventive Foods in Healthy Individuals

Nutraceutical Nutraceutical IngredientIngredient

Wholesale Cost of Wholesale Cost of Daily Ingredient Daily Ingredient to Lower to Lower Triglyceride (by Triglyceride (by 8%)8%)

Expected % Expected % Decrease in Decrease in Disease RiskDisease Risk

Reduced Reduced Expenditure Expenditure for Heart for Heart Disease per Disease per year*year*

Omega-3 Fatty Omega-3 Fatty AcidsAcids

(EPA/DHA)(EPA/DHA)

13 cents/day13 cents/day

(yearly cost = $47)(yearly cost = $47)

20% (in women)20% (in women)

7.5% (in men)7.5% (in men)

$2.70 billion $2.70 billion (both genders)(both genders)

* Includes both reduced dependency on costly triglyceride-lowering drugs later life and the reduced * Includes both reduced dependency on costly triglyceride-lowering drugs later life and the reduced risk for later disease development needing costly medical treatment. Expected decrease (%) in risk for later disease development needing costly medical treatment. Expected decrease (%) in disease risk based on published literature giving blood lipid changes in relation to disease risk. disease risk based on published literature giving blood lipid changes in relation to disease risk. Higher intakes of nutraceutical ingredients in functional foods will give a corresponding lower Higher intakes of nutraceutical ingredients in functional foods will give a corresponding lower decrease in later disease and greater cost savings. decrease in later disease and greater cost savings.

Potential Savings with Potential Savings with Nutraceuticals/Functional FoodsNutraceuticals/Functional Foods

a)a) Via Disease PreventionVia Disease Prevention = $20 billion/yr = $20 billion/yrb)b) Via Disease ManagementVia Disease Management = $10 billion/yr = $10 billion/yrc)c) Total Total = $30 billion/yr = $30 billion/yr

Barriers to Functional Foods Contributing to Human Barriers to Functional Foods Contributing to Human Health and Chronic Disease Prevention in CanadaHealth and Chronic Disease Prevention in Canada

1.1. Health Canada does not currently allow any ‘health claims’ Health Canada does not currently allow any ‘health claims’ on functional foods (labels, etc.) regardless of proof of on functional foods (labels, etc.) regardless of proof of efficacy, safety, published human/clinical trials, etc. efficacy, safety, published human/clinical trials, etc. Therapeutic claims are generally restricted to patented, Therapeutic claims are generally restricted to patented, costly, imported pharmaceutical (not natural) costly, imported pharmaceutical (not natural) agents/chemicals.agents/chemicals.

2.2. Functional Food/Nutraceutical use in health care (health, Functional Food/Nutraceutical use in health care (health, disease prevention/management) not generally known by disease prevention/management) not generally known by health care professionals (e.g., not taught in medical school health care professionals (e.g., not taught in medical school curricula).curricula).

3.3. Medical Research Council (CIHR) spends <1% of its Medical Research Council (CIHR) spends <1% of its research budget on Functional Food – human research research budget on Functional Food – human research (incl. product development, other). This is a fraction of (incl. product development, other). This is a fraction of what is spent on research directed at evaluating what is spent on research directed at evaluating imported pharmaceuticals (drugs). imported pharmaceuticals (drugs).

4.4. Health coverage (insurance, OHIP, private plans, etc.) Health coverage (insurance, OHIP, private plans, etc.) will not cover nutraceuticals/functional foods as will not cover nutraceuticals/functional foods as therapeutic agents (only drugs) in contrast to other therapeutic agents (only drugs) in contrast to other countries.countries.

5.5. Numerous othersNumerous others

1.1. Diet-related chronic diseases and disorders (cardiovascular diseases, Diet-related chronic diseases and disorders (cardiovascular diseases, type 2 diabetes, many cancers, other) are of major and increasing type 2 diabetes, many cancers, other) are of major and increasing prevalence in our population. These contribute to our present and prevalence in our population. These contribute to our present and accelerating health care expenditures with this trend continuing as accelerating health care expenditures with this trend continuing as our population ages. our population ages.

2.2. Canadians have been denied access to functional foods with natural Canadians have been denied access to functional foods with natural nutraceutical components for the prevention, delay of onset, nutraceutical components for the prevention, delay of onset, retardation of disease, and disease management (including risk factor retardation of disease, and disease management (including risk factor modification) despite overwhelming evidence-based published human modification) despite overwhelming evidence-based published human studies showing their dramatic ability to be highly effective in these studies showing their dramatic ability to be highly effective in these regards and to dramatically reduce health care costs. regards and to dramatically reduce health care costs.

3.3. The public have indicated their general unwillingness to significantly The public have indicated their general unwillingness to significantly change the ‘western-style’ diet as now consumed. Functional foods change the ‘western-style’ diet as now consumed. Functional foods and nutraceuticals can dramatically reduce disease incidence, and nutraceuticals can dramatically reduce disease incidence, severity, progression, etc. with or without any significant changes in severity, progression, etc. with or without any significant changes in overall dietary consumption patterns. overall dietary consumption patterns.

• Health care costs in Canada can be reduced by a minimum of Health care costs in Canada can be reduced by a minimum of $20 billion/yr by early risk factor management and the $20 billion/yr by early risk factor management and the accompanying disease prevention /retardation along with an accompanying disease prevention /retardation along with an additional minimaladditional minimal

$10 billion savings for disease management applications. $10 billion savings for disease management applications.

• The agri-food industry/sector needs extensive government The agri-food industry/sector needs extensive government support if it intends to be an international participant at the support if it intends to be an international participant at the forefront of producing functional foods for disease prevention forefront of producing functional foods for disease prevention and management (along with the economic benefits to Canada and management (along with the economic benefits to Canada that can be derived from such a prioritizing of resources, that can be derived from such a prioritizing of resources, research, job creation, marketing opportunities, use of our research, job creation, marketing opportunities, use of our natural agricultural resources, etc.). The gross under-funding natural agricultural resources, etc.). The gross under-funding of research in the area of functional foods for disease of research in the area of functional foods for disease prevention in this country is in striking contrast to the past and prevention in this country is in striking contrast to the past and previous research allocations given to drug-related research previous research allocations given to drug-related research (usually on patented pharmaceuticals from non-Canadian (usually on patented pharmaceuticals from non-Canadian sources). Canada is lagging well behind other countries in this sources). Canada is lagging well behind other countries in this important area. important area.

6.6. A ‘preventive model’ using functional foods and not the regular ‘medical A ‘preventive model’ using functional foods and not the regular ‘medical model’ needs to be established as soon as possible using a new breed of model’ needs to be established as soon as possible using a new breed of ‘preventive health specialists’ from our vast pool of eager, young, and ‘preventive health specialists’ from our vast pool of eager, young, and underemployed B.Sc. graduates in life sciences from across Canada. The underemployed B.Sc. graduates in life sciences from across Canada. The preventive model should focus on early detection and functional food-based preventive model should focus on early detection and functional food-based control of ‘moderate’ risk factors in our younger population using the control of ‘moderate’ risk factors in our younger population using the ‘preventive’ specialists without a dependency on physicians. ‘preventive’ specialists without a dependency on physicians.

7.7. Education and training of various health specialists and professionals as well Education and training of various health specialists and professionals as well as the public in functional foods and natural nutraceuticals for the prevention as the public in functional foods and natural nutraceuticals for the prevention and management of disease is also needed.and management of disease is also needed.

8.8. The public, food industry, academic plus government scientists, and various The public, food industry, academic plus government scientists, and various health specialists/professionals have indicated their enthusiastic interest and health specialists/professionals have indicated their enthusiastic interest and support for the early and broad-based entry of functional foods with support for the early and broad-based entry of functional foods with appropriate health claims into the Canadian marketplace. Functional foods appropriate health claims into the Canadian marketplace. Functional foods need to become the ‘pharmacy’ for disease prevention as well as management.need to become the ‘pharmacy’ for disease prevention as well as management.

9.9. Government leadership in launching functional foods with natural Government leadership in launching functional foods with natural nutraceutical components is desperately needed in Canada as soon as possible. nutraceutical components is desperately needed in Canada as soon as possible.

Functional Functional Foods Can Foods Can

Become the Become the Pharmacy for Pharmacy for

Disease Disease PreventionPrevention