Estimates of Savings in Clinical Care in Canada by Managing Elevations in Blood Cholesterol Levels (? 6.2 mmol/L) using Functional Foods with Nutraceuticals rather than Pharmaceuticals for Lipid-Lowering

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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
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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).  
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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).
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Nutraceuticals Functional Foods Wellness
Foods Medicinal Foods Pharma Foods
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Estimated Prevalence of Cardiovascular Disease
in Americans by Age and Sex
Percent of Population
Age (yr)
Sourcehttp//www.americanheart.org
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Partial Listing of Lifestyle-related and other
Disorders/Diseases where Nutraceuticals/Functional
Foods can play a Major Role in
Prevention/Management

1. Cardiovascular Diseases (CVD) and risk factors
   (blood lipids, b.p., etc.)
2. Type 2 Diabetes
3. Cancers (colon, prostate, breast, others)
4. Osteoporosis
5. Kidney Disorders
6. Inflammatory conditions (arthritis, bowel, etc.)
7. Psychiatric disorders
8. Others

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Health Care Expenditure in Canada
Parameter billion/yr
Cardiovascular Cancer Type 2 Diabetes Arthritis Drugs Diet-related Disorders Total 13 20 10 10 15 30 gt 100
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• 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 Canadas
  Guidelines for Healthy Eating (reluctance to
  change from Western-style diet).
• Current dietary patterns/foods in Canada dont
  provide sufficient intakes of natural
  nutraceutical components needed for optimal
  health promotion or disease prevention/management.

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

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1. High quit rate on pharmaceutical agents.
2. 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).
3. Other countries (physicians, etc.) routinely use
   nutraceutical/functional foods for health care.
4. Dramatic reduction in health care costs.
5. Boom to Canadian economy/production of products,
   job creation, reduced dependency on
   imported/costly pharmaceutical products, etc.
6. Others

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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
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.
(50 eligible for drug therapy) ( 40 have
CVD) (lt 10 eligible for drug therapy) (lt5 have
CVD)
(drug therapy)
(current)
(future if FFoods)
Ages
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Blood Plasma Triglyceride Levels (mmol/L) in the
Population (45-54 yr)
50
lt1.1
Percentage of Population
25
1.1-2.2
gt2.3
0
No-Low Risk
Moderate-High Risk No Clinical Management
High Risk Candidates for Clinical Management
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Effects of Selenium Supplementation for Cancer
Prevention in Patients with Carcinoma of the Skin
A Randomized Controlled Trial
(Clark et al. JAMA. 19962761957-1963)
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Reduction in Cancer
Total cancer incidence Total cancer mortality Prostate cancer incidence Colorectal cancer incidence 37 50 65 61
200 ug Selenium/day as nutraceutical
supplementation
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Some Examples of Natural Blood Triglyceride-Loweri
ng Nutraceutical Ingredients and their Potential
to Reduce Subsequent Heart Disease Treatment
Costs if Initiated as Preventive Foods in Healthy
Individuals
Nutraceutical Ingredient Wholesale Cost of Daily Ingredient to Lower Triglyceride (by 8) Expected Decrease in Disease Risk Reduced Expenditure for Heart Disease per year
Omega-3 Fatty Acids (EPA/DHA) 13 cents/day (yearly cost 47) 20 (in women) 7.5 (in men) 2.70 billion (both genders)
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.
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Potential Savings with Nutraceuticals/Functional
Foods

1. Via Disease Prevention 20 billion/yr
2. Via Disease Management 10 billion/yr
3. Total 30 billion/yr

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• 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).

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• Medical Research Council (CIHR) spends lt1 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

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1. 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.
2. 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.
3. 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.

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• 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.

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• 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.
  

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Functional Foods Can Become the Pharmacy for
Disease Prevention