Use of Natural Products Including Omega-3 Fatty Acids for Preventive Health Care and for Lowering Health Care Costs Prof

1. 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 Human Biology & Nutritional Sciences University of Guelph Guelph, ON, Canada Conference on Seal Oil, Collagen, and Protein Products June 7-8th, 2004 - DFAIT, Ottawa

2. ‘Nutraceuticals’ and ‘functional foods’ can be defined as follows by Health Canada: A ‘nutraceutical’ is a product isolated or purified from foods that is generally sold in medicinal forms not usually associated with food. A nutraceutical is demonstrated to have a physiological benefit or provide protection against chronic disease (Health Canada). A ‘functional food’ is similar in appearance to, or may be, a conventional food, is consumed as part of a usual diet, and is demonstrated to have physiological benefits and/or reduce the risk of chronic disease beyond basic nutritional functions (Health Canada).

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

4. ‘Nutraceuticals’ ‘Functional Foods’ ‘Wellness Foods’ ‘Medicinal Foods’ ‘Pharma Foods’

5. Estimated Prevalence of Cardiovascular Disease in Americans by Age and Sex Percent of Population Age (yr) Source:http://www.americanheart.org

6. Partial Listing of Lifestyle-related and other Disorders/Diseases where Nutraceuticals/Functional Foods can play a Major Role in Prevention/Management • Cardiovascular Diseases (CVD) and risk factors (blood lipids, b.p., etc.) • Type 2 Diabetes • Cancers (colon, prostate, breast, others) • Osteoporosis • Kidney Disorders • Inflammatory conditions (arthritis, bowel, etc.) • ‘Psychiatric disorders’ • Others

7. Health Care Expenditure in Canada

8. Selected Rationale for Introduction of Functional Foods into Marketplace and Health-Care System • Current Canadian health policy of medical treatment (pharmaceuticals, etc.) with or without dietary advice denies public the benefit offered by nutraceuticals/functional foods. • Most Canadians refuse to follow Health Canada’s Guidelines for Healthy Eating (reluctance to change from ‘Western-style’ diet). • Current dietary patterns/foods in Canada don’t provide sufficient intakes of natural nutraceutical components needed for optimal health promotion or disease prevention/management.

9. Lifestyle (diet)–related chronic diseases/disorders in Canada are major burden on health care costs (particularly with ageing population). • Offers low-cost and early control of risk factors for subsequent disease (e.g., heart disease). • Offers a ‘preventive’ model for disease prevention rather than the current ‘medical’ model. • Dietary advice often proven to be ineffective on longer-term (e.g., blood cholesterol-lowering by dietary advice). • Offers control of ‘moderately’ elevated risk factors (e.g., blood cholesterol, triglyceride, etc.) which current health-care system fails to control.

10. High ‘quit’ rate on pharmaceutical agents. • Functional foods can serve as optional or complementary approaches for risk factor control and disease management (not offered to Canadians today despite clinical/scientific evidence). • Other countries (physicians, etc.) routinely use nutraceutical/functional foods for health care. • Dramatic reduction in health care costs. • Boom to Canadian economy/production of products, job creation, reduced dependency on imported/costly pharmaceutical products, etc. • Others

11. Paradigm Shift in Health Care is Needed in Canada Current: ‘Medical Model’ (later in life) Medical Management with or without Dietary Advice of Chronic Disorders/Diseases (no Functional Foods/Nutraceuticals Future: ‘Preventive Model’ (early in life) Wide introduction and use of Functional Foods/Nutraceuticals for Prevention of Chronic Disorders/Diseases

12. . (~50% eligible for drug therapy) (~ 40% have CVD) (< 10% eligible for drug therapy) (<5% have CVD) (drug therapy) (current) (future if FFoods) Ages

13. Blood Plasma Triglyceride Levels (mmol/L) in the Population (45-54 yr) 50 <1.1 Percentage of Population 25 1.1-2.2 =>2.3 0 No-Low Risk Moderate-High Risk: No Clinical Management High Risk: Candidates for Clinical Management

14. Effects of Selenium Supplementation for Cancer Prevention in Patients with Carcinoma of the Skin A Randomized Controlled Trial (Clark et al.JAMA. 1996;276:1957-1963)

15. % Reduction in Cancer* * 200 ug Selenium/day as nutraceutical supplementation

16. Some Examples of Natural Blood Triglyceride-Lowering Nutraceutical Ingredients and their Potential to Reduce Subsequent Heart Disease Treatment Costs if Initiated as Preventive Foods in Healthy Individuals * 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 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 decrease in later disease and greater cost savings.

17. Potential Savings with Nutraceuticals/Functional Foods Via Disease Prevention = $20 billion/yr Via Disease Management = $10 billion/yr Total = $30 billion/yr

18. Barriers to Functional Foods Contributing to Human Health and Chronic Disease Prevention in Canada • Health Canada does not currently allow any ‘health claims’ on functional foods (labels, etc.) regardless of proof of efficacy, safety, published human/clinical trials, etc. Therapeutic claims are generally restricted to patented, costly, imported pharmaceutical (not natural) agents/chemicals. • Functional Food/Nutraceutical use in health care (health, disease prevention/management) not generally known by health care professionals (e.g., not taught in medical school curricula).

19. Medical Research Council (CIHR) spends <1% of its research budget on Functional Food – human research (incl. product development, other). This is a fraction of what is spent on research directed at evaluating imported pharmaceuticals (drugs). • Health coverage (insurance, OHIP, private plans, etc.) will not cover nutraceuticals/functional foods as therapeutic agents (only drugs) in contrast to other countries. • Numerous others

20. Diet-related chronic diseases and disorders (cardiovascular diseases, type 2 diabetes, many cancers, other) are of major and increasing prevalence in our population. These contribute to our present and accelerating health care expenditures with this trend continuing as our population ages. • Canadians have been denied access to functional foods with natural nutraceutical components for the prevention, delay of onset, retardation of disease, and disease management (including risk factor modification) despite overwhelming evidence-based published human studies showing their dramatic ability to be highly effective in these regards and to dramatically reduce health care costs. • The public have indicated their general unwillingness to significantly change the ‘western-style’ diet as now consumed. Functional foods and nutraceuticals can dramatically reduce disease incidence, severity, progression, etc. with or without any significant changes in overall dietary consumption patterns.

21. Health care costs in Canada can be reduced by a minimum of $20 billion/yr by early risk factor management and the accompanying disease prevention /retardation along with an additional minimal • $10 billion savings for disease management applications. • The agri-food industry/sector needs extensive government support if it intends to be an international participant at the forefront of producing functional foods for disease prevention and management (along with the economic benefits to Canada that can be derived from such a prioritizing of resources, research, job creation, marketing opportunities, use of our natural agricultural resources, etc.). The gross under-funding of research in the area of functional foods for disease prevention in this country is in striking contrast to the past and previous research allocations given to drug-related research (usually on patented pharmaceuticals from non-Canadian sources). Canada is lagging well behind other countries in this important area.

22. 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 ‘preventive health specialists’ from our vast pool of eager, young, and underemployed B.Sc. graduates in life sciences from across Canada. The preventive model should focus on early detection and functional food-based control of ‘moderate’ risk factors in our younger population using the ‘preventive’ specialists without a dependency on physicians. • Education and training of various health specialists and professionals as well as the public in functional foods and natural nutraceuticals for the prevention and management of disease is also needed. • The public, food industry, academic plus government scientists, and various health specialists/professionals have indicated their enthusiastic interest and support for the early and broad-based entry of functional foods with appropriate health claims into the Canadian marketplace. Functional foods need to become the ‘pharmacy’ for disease prevention as well as management. • Government leadership in launching functional foods with natural nutraceutical components is desperately needed in Canada as soon as possible.

23. Functional Foods Can Become the Pharmacy for Disease Prevention