Juice Plus
Encyclopedia
Juice Plus+ is a brand
Brand
The American Marketing Association defines a brand as a "Name, term, design, symbol, or any other feature that identifies one seller's good or service as distinct from those of other sellers."...

ed line of dietary supplement
Dietary supplement
A dietary supplement, also known as food supplement or nutritional supplement, is a preparation intended to supplement the diet and provide nutrients, such as vitamins, minerals, fiber, fatty acids, or amino acids, that may be missing or may not be consumed in sufficient quantities in a person's diet...

s containing concentrated fruit
Fruit
In broad terms, a fruit is a structure of a plant that contains its seeds.The term has different meanings dependent on context. In non-technical usage, such as food preparation, fruit normally means the fleshy seed-associated structures of certain plants that are sweet and edible in the raw state,...

 and vegetable
Vegetable
The noun vegetable usually means an edible plant or part of a plant other than a sweet fruit or seed. This typically means the leaf, stem, or root of a plant....

 juice extracts fortified with added vitamins and nutrients. It is produced by Natural Alternatives International
Natural Alternatives International
Natural Alternatives International is an American company based in San Marcos, California which manufactures nutritional supplements such as Juice Plus. NAI was founded in 1980 by Mark A. LeDoux, and had 241 employees in 2007...

 of San Marcos, CA for National Safety Associates
National Safety Associates
National Safety Associates is a privately-owned marketing company based in Collierville, Tennessee, best known for selling a line of water and air filters, and then the nutritional supplement Juice Plus, via multi-level marketing.-History:...

 (NSA; Collierville, TN). Introduced in 1993, the supplements are distributed by NSA via multi-level marketing
Multi-level marketing
Multi-level marketing is a marketing strategy in which the sales force is compensated not only for sales they personally generate, but also for the sales of others they recruit, creating a downline of distributors and a hierarchy of multiple levels of compensation...

.

Studies of Juice Plus' effects have generated conflicting and controversial results. Although Juice Plus claims its products' efficacy is backed by research, critics have argued that there is no scientific proof that Juice Plus offers significant health benefits and that deceptive claims are used in the product's marketing information. Some marketing claims made about Juice Plus products have been disputed by consumer watchdog organizations and governmental agencies as misleading.

History

Juice Plus was NSA's first nutritional product. Previously, since its foundation in 1970, NSA had been known for other products such as water filters
Filter (water)
A water filter removes impurities from water by means of a fine physical barrier, a chemical process or a biological process. Filters cleanse water to various extents for irrigation, drinking water, aquariums, and swimming pools.-Methods of filtration:...

, air filter
Air filter
A particulate air filter is a device composed of fibrous materials which removes solid particulates such as dust, pollen, mold, and bacteria from the air. A chemical air filter consists of an absorbent or catalyst for the removal of airborne molecular contaminants such as volatile organic compounds...

s, fire-protection equipment, and educational games for pre-schoolers., which were also distributed by multi-level marketing. Naturopath Humbart "Smokey" Santillo is credited with having developed the Juice Plus concept and nutritional philosophy and for creating what has been described as the “original formula” for the product. According to Santillo, he also worked with NSA to develop other Juice Plus products.

The primary products in the Juice Plus line are "Orchard Blend" (a fruit juice powder-based supplement) and "Garden Blend" (vegetable juice powder-based) capsules, which are sold together in a four-month pack at a cost of approximately $167 USD (2009). Other supplement products available in the Juice Plus line are (in 2011) Vineyard Blend (grape/berry juice powder-based) capsules, Juice Plus Complete (meal replacement powder), Juice Plus Chewables (Orchard and Garden Blends), and Juice Plus Chewables (Vineyard Blend). Discontinued products include Juice Plus Gummies, Juice Plus Thins (wafers), chewable tablets, and a vitamin formulation for dogs and cats.

Manufacturing

The main ingredients in Juice Plus Orchard Blend and Garden Blend capsules (vegetable and fruit juices, fibers, plant enzymes, and food actives) are reduced to powder through a proprietary process by an unrelated supplier, and then blended and encapsulated by NAI, who produce the finished product. Juice Plus capsules are “enriched with pure β-carotene, ascorbic acid, vitamin E, and folic acid”. According to the manufacturer these are added to restore the levels of micronutrients lost during processing and to ensure uniformity.” Two NAI-sponsored studies mention that the fruit and vegetable powders in Juice Plus include standardized levels of natural β-carotene
Carotene
The term carotene is used for several related unsaturated hydrocarbon substances having the formula C40Hx, which are synthesized by plants but cannot be made by animals. Carotene is an orange photosynthetic pigment important for photosynthesis. Carotenes are all coloured to the human eye...

 derived from Dunaliella salina
Dunaliella salina
Dunaliella salina is a type of halophile green micro-algae especially found in sea salt fields. Known for its anti-oxidant activity because of its ability to create large amount of carotenoids, it is used in cosmetics and dietary supplements. Few organisms can survive in such highly saline...

and soy-derived d-α-tocopherol
Tocopherol
Tocopherols are a class of chemical compounds of which many have vitamin E activity. It is a series of organic compounds consisting of various methylated phenols...

 (vitamin E), which are supplied by the Henkel Corporation (now doing business as Cognis Corporation
Cognis
Cognis is a worldwide supplier of specialty chemicals and nutritional ingredients, headquartered in Monheim am Rhein, Germany. The company employs about 5,600 people and operates production or service centers in almost 30 countries....

), and ascorbic acid
Ascorbic acid
Ascorbic acid is a naturally occurring organic compound with antioxidant properties. It is a white solid, but impure samples can appear yellowish. It dissolves well in water to give mildly acidic solutions. Ascorbic acid is one form of vitamin C. The name is derived from a- and scorbutus , the...

 derived from acerola cherry
Acerola
Malpighia emarginata is a tropical fruit-bearing shrub or small tree in the family Malpighiaceae. Common names include acerola, Barbados cherry, West Indian cherry and wild crapemyrtle....

, which is supplied by Schweizerhall Pharma.

Reception

Juice Plus+ Garden Blend was tested by ConsumerLab.com
ConsumerLab.com
ConsumerLab.com is a provider of independent test results and information to help consumers and healthcare professionals evaluate health, wellness, and nutrition products. ConsumerLab.com was founded in 1999. It is subscription fee based....

 in their Multivitamin and Multimineral Supplements Review of 38 of the leading multivitamin/multimineral products sold in the U.S. and Canada. Testing included amounts of selected index elements, their ability to disintegrate in solution per United States Pharmacopeia
United States Pharmacopeia
The United States Pharmacopeia is the official pharmacopeia of the United States, published dually with the National Formulary as the USP-NF. The United States Pharmacopeial Convention is the nonprofit organization that owns the trademark and copyright to the USP-NF and publishes it every year...

 guidelines, lead contamination threshold set in California Proposition 65, and meeting U.S. Food and Drug Administration
Food and Drug Administration
The Food and Drug Administration is an agency of the United States Department of Health and Human Services, one of the United States federal executive departments...

 (FDA) labeling requirements.

Garden Blend failed ConsumerLab's test as it contained only 76.4% of its claimed calcium, which was noted was low to start (labeled as just 4% of the Daily Value per serving.) On 23 June 2011, ConsumerLab was informed of misinformation circulated by a Juice Plus distributor incorrectly stating the variation was due to the analytical method used. ConsumerLab responded that their analytic method used was ICP-MS (Inductively Coupled Plasma Mass Spectrometry), a "highly precise and sensitive method of testing calcium". ConsumerLab also noted that the calcium deficiency in Juice Plus was confirmed with this method in two independent laboratories prior to publication of their Review.

Sales

Juice Plus products are marketed by individual distributors who receive sales commissions ranging from 6% (for enrolling five customers in 30 days) to 14% (for enrolling twenty customers in 30 days). Detailed sales figures for Juice Plus are not publicly available, but NSA representatives claimed that Juice Plus achieved monthly sales of $6 million USD in 1993 and that it was the company’s most successful new product. According to NSA vice-president John Blair, sales of Juice Plus in 2008 were "approaching 300 million but have leveled off due to economic factors."

Product research

National Safety Associates, the owner of Juice Plus, claim that it is “the next best thing to eating fruits and vegetables”, containing the “nutritional essence of 17 different fruits, vegetables, and grains” with key phytonutrients and that the product is absorbed by the body, reduces oxidative stress, promotes cardiovascular wellness, supports a healthy immune system, and helps protect DNA. Multiple studies have produced conflicting results as to the truth of these claims. Doubts have been raised about the advertised benefits of Juice Plus by Memorial Sloan-Kettering Cancer Center
Memorial Sloan-Kettering Cancer Center
Memorial Sloan–Kettering Cancer Center is a cancer treatment and research institution founded in 1884 as the New York Cancer Hospital...

, University of California Berkeley, Center for Science in the Public Interest
Center for Science in the Public Interest
Center for Science in the Public Interest is a Washington, D.C.-based non-profit watchdog and consumer advocacy group focusing on nutritional education and awareness.-History and funding:...

, and other sources. The product has been criticized on the basis that: its marketing is unsupported by research data, it contains too little fruit and vegetable powder to offer significant clinical benefits, its effects can be attributed to the inclusion of added exogenous
Exogenous
Exogenous refers to an action or object coming from outside a system. It is the opposite of endogenous, something generated from within the system....

 vitamins and micronutrients, and it is excessively priced relative to its potential benefits. Memorial Sloan-Kettering Cancer Clinic referred to Juice Plus as a “pricey supplement” that is “distributed through a multi-tiered marketing scheme with exaggerated value and cost."

Of the published peer-reviewed
Peer review
Peer review is a process of self-regulation by a profession or a process of evaluation involving qualified individuals within the relevant field. Peer review methods are employed to maintain standards, improve performance and provide credibility...

 studies on Juice Plus products, the majority were funded and/or authored by the manufacturer, Natural Alternatives International (NAI); or the main distributor, NSA.; two were funded by individual Juice Plus distributors; and one was conducted independently.

Nutrients and phytochemicals

Concerns have been raised that these nutrients in Juice Plus+ capsules may not be bioavailable, not effectively absorbed by the human body, and that some of the nutrients claimed to be in the products may not be present in significant amounts. Studies on nutrient absorption showed that subjects taking Juice Plus had elevated blood levels of folate and β-carotene
Beta-carotene
β-Carotene is a strongly-coloured red-orange pigment abundant in plants and fruits. It is an organic compound and chemically is classified as a hydrocarbon and specifically as a terpenoid , reflecting its derivation from isoprene units...

, but the effects on blood levels of vitamin E
Vitamin E
Vitamin E is used to refer to a group of fat-soluble compounds that include both tocopherols and tocotrienols. There are many different forms of vitamin E, of which γ-tocopherol is the most common in the North American diet. γ-Tocopherol can be found in corn oil, soybean oil, margarine and dressings...

 and vitamin C
Vitamin C
Vitamin C or L-ascorbic acid or L-ascorbate is an essential nutrient for humans and certain other animal species. In living organisms ascorbate acts as an antioxidant by protecting the body against oxidative stress...

 were inconsistent. Some studies have shown significant increases in vitamin E and C levels, while other studies have shown much weaker effects on vitamin E and C levels, and that the levels of vitamin E are not significantly increased. and vitamin C Juice Plus was found to increase blood lycopene
Lycopene
Lycopene is a bright red carotene and carotenoid pigment and phytochemical found in tomatoes and other red fruits and vegetables, such as red carrots, watermelons and papayas...

 levels in several studies, while other studies have indicated that Juice Plus does not raise blood levels of lycopene or other phytochemicals in fresh fruits and vegetables such as lutein
Lutein
Lutein is a xanthophyll and one of 600 known naturally occurring carotenoids. Lutein is synthesized only by plants and like other xanthophylls is found in high quantities in green leafy vegetables such as spinach and kale...

, zeaxanthin
Zeaxanthin
Zeaxanthin is one of the most common carotenoid alcohols found in nature. It is important in the xanthophyll cycle. Synthesized in plants & some micro-organisms, it is the pigment that gives paprika , corn, saffron, and many other plants & microbes their characteristic color.The name is derived...

, and β-cryptoxanthin
Cryptoxanthin
Cryptoxanthin is a natural carotenoid pigment. It has been isolated from a variety of sources including the petals and flowers of plants in the genus Physalis, orange rind, papaya, egg yolk, butter, apples, and bovine blood serum.-Chemistry:...

.

Concerns have also been raised about the accuracy of product labeling. Three studies which included chemical analyses of Juice Plus have indicated nutrient amounts that differ from the amounts listed on the product labels.

According to Consumer Reports
Consumer Reports
Consumer Reports is an American magazine published monthly by Consumers Union since 1936. It publishes reviews and comparisons of consumer products and services based on reporting and results from its in-house testing laboratory. It also publishes cleaning and general buying guides...

, in 2005, National Safety Associates used advertising featuring Dr. William Sears
William Sears (physician)
William Penton Sears is an American pediatrician and the author or co-author of more than 30 parenting books, most notably several in the "Sears Parenting Library." He is a frequent guest on television talkshows, where he goes by the name Dr. Bill...

 (a distributor of Juice Plus products), which implied that Juice Plus Gummies were low in sugar and a nutritional alternative to fruits and vegetables. This claim resulted in consumer complaints to the Better Business Bureau
Better Business Bureau
The Better Business Bureau , founded in 1912, is a corporation consisting of several private business franchises of local BBB organizations based in the United States and Canada, which work through their parent corporation, the Council of Better Business Bureaus .The Better Business Bureau, through...

's National Advertising Division (NAD). The BBB issued a complaint that NSA's claims were misleading, and as a result, NSA promised to modify its ads and stop calling Gummies “the next best thing to fruits and vegetables”. The Juice Plus homepage continues to advertise Juice Plus as “the next best thing to fruits and vegetables”; the Gummies product has since been discontinued; the product "Chewables" has been introduced.

In December 2007, the Center for Science in the Public Interest
Center for Science in the Public Interest
Center for Science in the Public Interest is a Washington, D.C.-based non-profit watchdog and consumer advocacy group focusing on nutritional education and awareness.-History and funding:...

 (CSPI) filed a complaint with the U.S. Food and Drug Administration (FDA) to “halt the marketing of NSA's Juice Plus Orchard Blend and Garden Blend capsules because the products appear to be adulterated and misbranded”. CSPI said it was “concerned that the products' claim, ‘the next best thing to fruits and vegetables,’ may lead consumers to believe the pills are closer to real fruits and vegetables than is likely to be the case." According to CSPI, the labels say the capsules contain high levels of vitamins A and C and folate naturally, but “do not disclose that these vitamins and minerals are added to the capsules during processing and are nutrients only characteristic of the original fruit and vegetable sources.”

Registered dietician Fudeko T. Maruyama and nutritional education specialist Mary P. Clarke of Kansas State University commented that “the promotional literature for Juice Plus, billed as a whole food concentrate, is a carefully worded blend of incorrect information, misleading health claims, and nonscientific jargon” and concluded that “Juice Plus probably won't harm you, but can hurt your pocketbook." Others have provided similar skeptical assessments of Juice Plus+.

In November 2007, the Complaints Resolution Panel for the Therapeutic Goods Administration
Therapeutic Goods Administration
The Therapeutic Goods Administration is the regulatory body for therapeutic goods in Australia . It is a Division of the Australian Department of Health and Ageing established under the Therapeutic Goods Act 1989 ...

 Advertising Code Council ruled that statements on NSA’s Juice Plus website were in breach of Australia
Australia
Australia , officially the Commonwealth of Australia, is a country in the Southern Hemisphere comprising the mainland of the Australian continent, the island of Tasmania, and numerous smaller islands in the Indian and Pacific Oceans. It is the world's sixth-largest country by total area...

’s Therapeutic Goods Advertising Code. According to the panel, the “clear message” in the ads was that Juice Plus tablets/capsules are “equivalent to fruits and vegetables” and that “consuming Juice Plus tablets would help Australians to consume the ‘recommended 5–7 servings’ of fruits and vegetables”. NSA was sanctioned by the Council to withdraw any representations that the products “are equivalent to fruits and vegetables or that their consumption can aid in meeting dietary recommendations relating to fruits and vegetables.”

Antioxidant activity

NSA claims that Juice Plus is an effective antioxidant, and quotes a study that showed a 75% reduction in lipid peroxidation
Lipid peroxidation
Lipid peroxidation refers to the oxidative degradation of lipids. It is the process in which free radicals "steal" electrons from the lipids in cell membranes, resulting in cell damage. This process proceeds by a free radical chain reaction mechanism...

 (an oxidative stress
Oxidative stress
Oxidative stress represents an imbalance between the production and manifestation of reactive oxygen species and a biological system's ability to readily detoxify the reactive intermediates or to repair the resulting damage...

 marker) in subjects that took Juice Plus for 7 to 28 days. This report was criticized as “a particularly poor study” by nutritionist Rosemary Stanton in the Australian journal, The Skeptic. Other studies have also reported reductions in lipid peroxidation and DNA oxidation
DNA oxidation
DNA oxidation is the process of oxidative damage on Deoxyribonucleic Acid. It occurs most readily at guanine residues due to the high oxidation potential of this base relative to cytosine, thymine, and adenine. It is widely believed to be linked to certain disease and cancers.-RNA Oxidation:RNAs in...

. These three studies were not blinded or placebo-controlled, included few participants (in one case no more than 15), and did not include monitoring or control of the participants' food intake. Other studies conducted under more rigorous conditions (randomized
Randomized controlled trial
A randomized controlled trial is a type of scientific experiment - a form of clinical trial - most commonly used in testing the safety and efficacy or effectiveness of healthcare services or health technologies A randomized controlled trial (RCT) is a type of scientific experiment - a form of...

, double-blind
Double-blind
A blind or blinded experiment is a scientific experiment where some of the people involved are prevented from knowing certain information that might lead to conscious or subconscious bias on their part, invalidating the results....

, placebo
Placebo
A placebo is a simulated or otherwise medically ineffectual treatment for a disease or other medical condition intended to deceive the recipient...

-controlled, longer in duration and with more subjects), found no significant reductions in lipid peroxidation, DNA oxidation, or other markers of oxidative stress.

One study, which measured in vitro
In vitro
In vitro refers to studies in experimental biology that are conducted using components of an organism that have been isolated from their usual biological context in order to permit a more detailed or more convenient analysis than can be done with whole organisms. Colloquially, these experiments...

 antioxidant
Antioxidant
An antioxidant is a molecule capable of inhibiting the oxidation of other molecules. Oxidation is a chemical reaction that transfers electrons or hydrogen from a substance to an oxidizing agent. Oxidation reactions can produce free radicals. In turn, these radicals can start chain reactions. When...

 activity, found that 1 g of Juice Plus Orchard Blend/Garden Blend powder (500 mg of each combined) had the corresponding antioxidant capacity to approximately 10 g (fresh weight) of fruit or vegetable, amounting to 30 g (roughly one-third of a serving) per four capsules. Tests of antioxidant activity of polyphenol
Polyphenol antioxidant
A polyphenol antioxidant is a type of antioxidant containing a polyphenolic substructure. Numbering over 4,000 distinct species, many of these compounds have antioxidant activity in vitro but are unlikely to have antioxidant roles in vivo...

s (such as those in Juice Plus capsules) in vitro
In vitro
In vitro refers to studies in experimental biology that are conducted using components of an organism that have been isolated from their usual biological context in order to permit a more detailed or more convenient analysis than can be done with whole organisms. Colloquially, these experiments...

 likely show higher results than the negligible antioxidant activity in vivo
In vivo
In vivo is experimentation using a whole, living organism as opposed to a partial or dead organism, or an in vitro controlled environment. Animal testing and clinical trials are two forms of in vivo research...

 following oral ingestion and digestion.

One placebo
Placebo
A placebo is a simulated or otherwise medically ineffectual treatment for a disease or other medical condition intended to deceive the recipient...

-controlled study conducted in 2002 found that Juice Plus Gummie candies did not significantly improve the antioxidant status of children, as indicated by negative results from 6 different antioxidant tests. The authors explained this by saying it was possible that the supplement did not contain enough of the proper antioxidants to make a significant difference or that the antioxidants extracted in the fruit/vegetable extract were not bioavailable. The study was originally sponsored by NSA, but because the results were disappointing, NSA officials elected to remove the company’s name from the published article.

Jim Sears, a pediatrician and Juice Plus distributor/spokesperson who co-hosts the syndicated daytime television talk show The Doctors
The Doctors (2008 TV series)
The Doctors is an American syndicated talk show airing daily in the U.S., Canada, Mexico, Ireland, Sweden and Finland. It debuted on September 8, 2008. The hour-long daytime program is produced by Phil McGraw and his son Jay McGraw and is distributed domestically and globally by CBS Television...

, claimed on a February 27, 2009 episode of the program that Juice Plus “helps fight cancer”. In October 2009, Dr. Barrie R. Cassileth
Barrie R. Cassileth
Barrie R. Cassileth, PhD, is a researcher of complementary and alternative medicine, and has published extensively on alternative cancer treatments. She founded the Integrative Medicine Service at the Memorial Sloan-Kettering Cancer Center, where she remains the chief, and holds the Laurance S....

, Chair and Chief of Integrative Medicine
Integrative medicine
Integrative medicine or integrative health is the combination of the practices and methods of alternative medicine with conventional medicine. The term is relatively recent, and is mainly promoted by proponents of alternative therapies in the west...

 at Memorial Sloan-Kettering Cancer Center, cautioned that while Juice Plus is being “aggressively promoted to cancer patients based on claims of antioxidant effects”, the supplement should not be taken by patients because it can interfere with chemotherapy, nor should it be considered a substitute for fruits and vegetables.

Cardiovascular system

Several studies have examined the effects of Juice Plus capsules on biochemical parameters associated with cardiovascular function, again with conflicting results. In October 2009, Dr. Barrie R. Cassileth, Chair and Chief of Integrative Medicine
Integrative medicine
Integrative medicine or integrative health is the combination of the practices and methods of alternative medicine with conventional medicine. The term is relatively recent, and is mainly promoted by proponents of alternative therapies in the west...

 at Memorial Sloan-Kettering Cancer Center
Memorial Sloan-Kettering Cancer Center
Memorial Sloan–Kettering Cancer Center is a cancer treatment and research institution founded in 1884 as the New York Cancer Hospital...

, noted that the results of Juice Plus studies on plasma homocysteine
Homocysteine
Homocysteine is a non-protein amino acid with the formula HSCH2CH2CHCO2H. It is a homologue of the amino acid cysteine, differing by an additional methylene group. It is biosynthesized from methionine by the removal of its terminal Cε methyl group...

 levels were not reproducible, and that studies on cardiovascular effects, such as blood pressure
Blood pressure
Blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels, and is one of the principal vital signs. When used without further specification, "blood pressure" usually refers to the arterial pressure of the systemic circulation. During each heartbeat, BP varies...

 and cholesterol
Cholesterol
Cholesterol is a complex isoprenoid. Specifically, it is a waxy steroid of fat that is produced in the liver or intestines. It is used to produce hormones and cell membranes and is transported in the blood plasma of all mammals. It is an essential structural component of mammalian cell membranes...

, were inconclusive.

The effects of Juice Plus on blood levels of homocysteine have been reported in the following five studies all conducted in subjects with normal homocysteine levels (15 μmol/L). An initial study, which was not double blinded or placebo controlled, reported a 37% decrease in homocysteine
Homocysteine
Homocysteine is a non-protein amino acid with the formula HSCH2CH2CHCO2H. It is a homologue of the amino acid cysteine, differing by an additional methylene group. It is biosynthesized from methionine by the removal of its terminal Cε methyl group...

 levels in subjects taking Juice Plus. More rigorous studies, including three that were randomized, double-blind, placebo-controlled trials, found that homocysteine
Homocysteine
Homocysteine is a non-protein amino acid with the formula HSCH2CH2CHCO2H. It is a homologue of the amino acid cysteine, differing by an additional methylene group. It is biosynthesized from methionine by the removal of its terminal Cε methyl group...

 levels were not reduced or were reduced to a much lesser extent than originally reported.

Two randomized, double-blind placebo controlled studies have examined the effect of Juice Plus on serum
Blood plasma
Blood plasma is the straw-colored liquid component of blood in which the blood cells in whole blood are normally suspended. It makes up about 55% of the total blood volume. It is the intravascular fluid part of extracellular fluid...

 cholesterol
Cholesterol
Cholesterol is a complex isoprenoid. Specifically, it is a waxy steroid of fat that is produced in the liver or intestines. It is used to produce hormones and cell membranes and is transported in the blood plasma of all mammals. It is an essential structural component of mammalian cell membranes...

 and LDL levels. One study found that Juice Plus had no significant effects; the other found slight decreases in cholesterol (6%) and LDL (9%) in subjects that took Orchard/Garden Blend, but no reductions among subjects who took Juice Plus Vineyard blend in addition.

A study reported that a combined regimen of Juice Plus Orchard Blend and Garden Blend significantly decreased the impairment of brachial artery
Brachial artery
The brachial artery is the major blood vessel of the arm.It is the continuation of the axillary artery beyond the lower margin of teres major muscle. It continues down the ventral surface of the arm until it reaches the cubital fossa at the elbow. It then divides into the radial and ulnar arteries...

 vasoactivity caused by a high-fat meal in healthy subjects. The addition of the Vineyard Blend product to this regimen had no additional effect on brachial artery vasoactivity and led to an increase in total lipoprotein
Lipoprotein
A lipoprotein is a biochemical assembly that contains both proteins and lipids water-bound to the proteins. Many enzymes, transporters, structural proteins, antigens, adhesins, and toxins are lipoproteins...

 and LDL as compared with Orchard Blend/Garden Blend alone. This study also found that Juice Plus had no effect on blood pressure
Blood pressure
Blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels, and is one of the principal vital signs. When used without further specification, "blood pressure" usually refers to the arterial pressure of the systemic circulation. During each heartbeat, BP varies...

.

In a randomized placebo-controlled, crossover study in overweight insulin-resistant adults, 8-week supplementation with Juice Plus had no significant effect on vascular endothelial function, serum insulin, blood glucose, body weight, total cholesterol, or LDL cholesterol.

Immune system

A non-randomized, non-blinded, non-controlled study in elderly cigarette smokers and non-smokers examined the effects of Juice Plus Orchard Blend and Garden Blend on 9 immunologic parameters, including stimulated T-cell cytokine
Cytokine
Cytokines are small cell-signaling protein molecules that are secreted by the glial cells of the nervous system and by numerous cells of the immune system and are a category of signaling molecules used extensively in intercellular communication...

 production (IL-2
Interleukin 2
Interleukin-2 is an interleukin, a type of cytokine immune system signaling molecule, which is a leukocytotrophic hormone that is instrumental in the body's natural response to microbial infection and in discriminating between foreign and self...

, IL-6
Interleukin 6
Interleukin-6 is a protein that in humans is encoded by the IL6 gene.IL-6 is an interleukin that acts as both a pro-inflammatory and anti-inflammatory cytokine. It is secreted by T cells and macrophages to stimulate immune response, e.g. during infection and after trauma, especially burns or other...

, TNF-α and IFN-γ
Interferon
Interferons are proteins made and released by host cells in response to the presence of pathogens—such as viruses, bacteria, or parasites—or tumor cells. They allow communication between cells to trigger the protective defenses of the immune system that eradicate pathogens or tumors.IFNs belong to...

) and the activity of various immune cells (peripheral blood monocytes
PBMC
A peripheral blood mononuclear cell is any blood cell having a round nucleus. For example: a lymphocyte, a monocyte or a macrophage. These blood cells are a critical component in the immune system to fight infection and adapt to intruders. The lymphocyte population consists of T cells , B cells...

, natural killer [NK] cells, T-helper cells, and cytotoxic T cells). Juice Plus significantly increased peripheral blood monocyte proliferation
Cell growth
The term cell growth is used in the contexts of cell development and cell division . When used in the context of cell division, it refers to growth of cell populations, where one cell grows and divides to produce two "daughter cells"...

 and NK cell cytotoxicity
Cytotoxicity
Cytotoxicity is the quality of being toxic to cells. Examples of toxic agents are a chemical substance, an immune cell or some types of venom .-Cell physiology:...

 in non-smokers but not in smokers, and increased in vitro IL-2 production by stimulated monocytes in both smokers and non-smokers. Juice Plus had no significant effect on cell counts (NK cells, T-helper cells, or cytotoxic T cells) or on the levels of IL-6, TNF-α, or IFN-γ in either smokers or non-smokers. Memorial Sloan-Kettering Cancer Center
Memorial Sloan-Kettering Cancer Center
Memorial Sloan–Kettering Cancer Center is a cancer treatment and research institution founded in 1884 as the New York Cancer Hospital...

 noted several faults with this study including that it lacked placebo controls and was not blinded, that the results do not necessarily correlate with an overall increase in immunity, and that it would have been more informative had clinical parameters been measured, such as whether fewer patients became sick.

A double-blind, randomized, placebo-controlled study examined the effect of Juice Plus Orchard Blend and Garden Blend on T cell counts, lymphocyte
Lymphocyte
A lymphocyte is a type of white blood cell in the vertebrate immune system.Under the microscope, lymphocytes can be divided into large lymphocytes and small lymphocytes. Large granular lymphocytes include natural killer cells...

 cytokine production, Epstein-Barr virus
Epstein-Barr virus
The Epstein–Barr virus , also called human herpesvirus 4 , is a virus of the herpes family and is one of the most common viruses in humans. It is best known as the cause of infectious mononucleosis...

 (EBV) antibody
Antibody
An antibody, also known as an immunoglobulin, is a large Y-shaped protein used by the immune system to identify and neutralize foreign objects such as bacteria and viruses. The antibody recognizes a unique part of the foreign target, termed an antigen...

 titers, and the incidence of illness in healthy subjects. The percentage of circulating γδ-CD3+ T cells and αβ-CD3+ T cells did not change significantly in subjects who took Juice Plus; however, at the end of the supplementation period, subjects taking the supplement had a significantly higher percentage of γδ-CD3+ T cells (7.2%) as compared with placebo (5.4%). IFN-γ produced by stimulated lymphocytes in vitro was reduced in the Juice Plus (68%) and placebo groups (41%), but the reduction was statistically significant only in the Juice Plus group. The levels of other cytokines (IL-4
Interleukin 4
Interleukin-4, abbreviated IL-4, is a cytokine that induces differentiation of naive helper T cells to Th2 cells. Upon activation by IL-4, Th2 cells subsequently produce additional IL-4. The cell that initially produces IL-4, thus inducing Th0 differentiation, has not been identified, but recent...

, IL-6, TGF-β) were unchanged and Juice Plus had no significant effect on the incidence and symptoms of illness or on EBV antibody titers.

A double-blind, randomized, placebo-controlled 28-week study examined the effect of Juice Plus (two capsules each of Orchard Blend, Garden Blend, and Vineyard blend per day) on cytokine (i.e., IL-6 and TNF-α) levels, and on the incidence of illness. Subjects who took Juice Plus had lower TNF-α levels than the placebo group at later time points in the study (week 16 and 28) but overall the effect was not statistically significant. Juice Plus was found to have no significant effect on IL-6 levels or on the incidence of illness during the course of the study.

Adverse effects

Adverse effects of Juice Plus have been mentioned in four studies, none of which was randomized, blinded, or placebo-controlled. No monitoring of adverse effects was reported in other published Juice Plus studies. Memorial Sloan-Kettering Cancer Center noted that in one study, some subjects who took Orchard Blend and Garden Blend developed a hive-like rash. Another study in 2000 reported adverse effects (upper-respiratory tract, urinary, and musculoskeletal) in roughly a third of the participants who took the products for 7 days. These events resolved spontaneously and were deemed unlikely to have derived from use of Juice Plus. In a third study from 2007, some subjects withdrew due to gastrointestinal distress possibly caused by the Juice Plus regimen (a combination of Orchard Blend, Garden Blend, and Vineyard Blend).
Lastly, a medical case report was published in which Juice Plus was identified as the probable cause of liver toxicity (hepatic inflammation) in a 51-year old female patient with endometrial cancer. The liver injury was reversed upon discontinuation of Juice Plus.

Conflicts of interest in studies

In a critique of Juice Plus, consumer health advocate and alternative medicine critic Stephen Barrett
Stephen Barrett
Stephen Joel Barrett is a retired American psychiatrist, author, co-founder of the National Council Against Health Fraud , and the webmaster of Quackwatch. He runs a number of websites dealing with quackery and health fraud. He focuses on consumer protection, medical ethics, and scientific...

 of MLM Watch remarked upon the previous association between two authors of a 1996 Juice Plus research study and United Sciences of America, Inc.
United Sciences of America, Inc.
United Sciences of America, Inc. was an American company that was accused of fraud and shut down in the 1980s. USA manufactured nutritional supplements such as "Master Formula," "Calorie Control Formula," "Fiber Energy Bar," and "Formula Plus," distributing them via multi-level marketing...

 (USAI), a multilevel marketing company that sold vitamin supplements with illegal claims that they could prevent many diseases. In 1986, lead author John A. Wise
John A. Wise
John A. Wise, PhD , was an American scientist and writer in the field of nutrition. He was honored in 2010 with the Lifetime Achievement Award by the Council for Responsible Nutrition, an industry association dedicated to responsible business practices in the nutrition industry...

, who later co-authored several other Juice Plus research studies, was USAI's Executive Vice-President of Research and Development; and second author Robert J. Morin was a scientific advisor who helped design the products. State and federal enforcement actions drove USAI out of business in 1987. Wise became a consultant to Natural Alternatives International (NAI) in 1987 and a company executive (Vice-President of Research and Development) in 1992. Barrett noted that Wise was also an NAI shareholder and that production of Juice Plus for National Safety Associates (NSA) was responsible for 16% of NAIs sales in 1999.

NSAs Juice Plus website cites various research articles in support of the company's marketing claims about the biological effects of Juice Plus, maintaining that these “studies were conducted by independent researchers” at various universities. Several of the studies were co-authored by Wise and Morin.

O.J. Simpson

University of California Berkeley Wellness Letter and MLMWatch also commented on the unreliability of Juice Plus testimonials provided by former professional athlete O.J. Simpson. Simpson, known commonly as "O.J." and "The Juice", signed a multi-year six-figure contract with NSA in January 1994 and became an official celebrity endorser of Juice Plus. In March 1994, Simpson was videotaped telling 4,000 Juice Plus distributors at a sales meeting that the product had cured his arthritis, improved his golf game, and freed him from using anti-arthritic drugs. However, regarding the murder
O. J. Simpson murder case
The O. J. Simpson murder case was a criminal trial held in Los Angeles County, California Superior Court from January 29 to October 3, 1995. Former American football star and actor O. J...

 of his ex-wife Nicole Brown Simpson
Nicole Brown Simpson
Nicole Brown Simpson was a former wife of professional football player O. J. Simpson.- Relationship with O. J. Simpson :...

 and her friend, Ronald Goldman
Ronald Goldman
Ronald Lyle "Ron" Goldman was an American waiter and an aspiring model. He was murdered along with Nicole Brown Simpson, former wife of O. J. Simpson, an actor and retired American football player. The subsequent criminal investigation and trial against O. J...

, for which Simpson was tried and acquitted, Simpson claimed in his defence that he was too incapacitated by arthritis to have committed the murders and had continued to take the anti-inflammatory drug sulfasalazine. As a result of the controversy surrounding Simpson, NSA cancelled his endorsement contract and stopped using the Simpson videotape to promote Juice Plus.

Juice Plus Children's Research Foundation

The Juice Plus Children's Research Foundation (JPCRF), founded in 1997, is a non-profit medical research organization (NTEE code H99) whose stated goal is to initiate and/or support programs that advance the principle that improved nutrition leads to healthier lifestyle and overall better health in children. The foundation is chaired by executives of National Safety Associates and operates from the company's head office in Collierville, Tennessee
Collierville, Tennessee
Collierville is a town in Shelby County, Tennessee, United States, and a suburb located in the Memphis metropolitan area. The town had a population of 43,965 at the 2010 census....

. In fiscal year 2007, the majority of funds donated to the foundation were disbursed to Volunteers of America
Volunteers of America
Volunteers of America, based in Alexandria, Virginia, is a national, nonprofit, faith-based human services organization providing support programs to more than two million people throughout the United States each year...

 (a faith-based social welfare organization) and to the Boys and Girls Clubs of Memphis.

The Foundation's website shows results of an ongoing customer survey (The Juice Plus Children's Health Study) which suggests a link between Juice Plus consumption and a general improvement in diet and lifestyle habits. The University of California Berkeley Wellness Letter and Stephen Barrett
Stephen Barrett
Stephen Joel Barrett is a retired American psychiatrist, author, co-founder of the National Council Against Health Fraud , and the webmaster of Quackwatch. He runs a number of websites dealing with quackery and health fraud. He focuses on consumer protection, medical ethics, and scientific...

 of MLM Watch questioned the survey's scientific value, and claimed that the Foundation is being used mainly as a marketing gimmick to get families to buy Juice Plus products. Barrett's organization Quackwatch
Quackwatch
Quackwatch is an American non-profit organization founded by Stephen Barrett with the stated aim being to "combat health-related frauds, myths, fads, fallacies, and misconduct" and with a primary focus on providing "quackery-related information that is difficult or impossible to get elsewhere."...

includes the JPCRF among its list of "Questionable 'Research' Entities".
The source of this article is wikipedia, the free encyclopedia.  The text of this article is licensed under the GFDL.
 
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