For the previous issue of Nutraceuticals World I offered my insights for the State of the Industry feature. I find it difficult to isolate incremental change in a yearly timeframe. However, I frequently reflect on changes since the time of my formal dietetic education more than three decades ago. It seems the industry is vastly different today—as is dietetic education. I was lucky enough to learn nutrition on the cellular level but some of the teachings really caught me off guard.

‘Nuts Among the Berries’

I recall a professor lecturing on the nutritional benefits afforded by progress in modern food science. I was surprised to learn then, for instance, that enriched white bread was just as nutritious as whole grain bread, and that all fats are bad for cardiovascular health, especially saturated fats. Hence, foods like avocados and nuts were to be avoided. Having been a vegetarian for quite a few years I was alarmed to learn how difficult it was for vegetarians to get complete nutrition; and vegans—well, good luck. I was an avid distance runner at the time and found some comfort when I read that Amby Burfoot, a vegetarian, won the 1968 Boston Marathon.

When we spoke of dietary supplements we were led to believe that under all but extreme circumstances they were unnecessary; you could get all the nutrition the body requires from conventional foods. We were also informed that excess protein in the diet would put undue stress on the kidneys, which we incorporated into diet instructions for athletes and weight loss.

Another dietitian educated in the same era mentioned to me that the book Nuts Among the Berries by Adelle Davis was required reading in her internship. They firmly believed that herbals and other such substances were “snake oil” and no argument was allowed. If people would only eat a balanced diet, they wouldn’t need supplements. Over the years, advances in science have shown us that many of those “kooky” substances that Adelle warned us about are very important to health and well-being.

Expectations for patient compliance have changed as well. In my dietetic practicum my first diet instruction was a low-sodium diet prescribed to a patient being treated at a major teaching hospital. I had rehearsed, was prepared and enthusiastic. When I entered the patient’s room I noticed his entire abdomen was bandaged and that he was handcuffed to his bed—riddled with what I later read in his chart were knife-inflicted wounds. I must admit to feeling a little naive and silly, sitting down in my pink dietetic student lab coat trying to help this patient understand the health implications of eating all those salty potato chips!

These are just examples that come to mind. I certainly wasn’t the only student questioning some of these practices and over the years we have seen many changes in the profession.

Consumer Knowledge…Or Lack Thereof

Most consumers in the U.S. do not feel very comfortable talking about the GI tract and its workings. When this is the subject in market research focus groups it’s challenging to get participants to open up and say what’s on their minds. However, discussing the same subjects in Europe and Asia is quite different. A well-functioning gut is understood as central to good health and most people are quite open while discussing it—sometimes down to minute details.

On several occasions in the late 1990s I conducted consumer focus groups on products providing gastrointestinal benefits. At that time, when we presented the concept of a probiotic-containing beverage, we first had to explain what a probiotic was. In several groups we heard the same initial reaction. Something to the effect of, “Let me get this straight; you want me to drink a beverage with live bugs in it?”

Certainly this attitude has changed over the past decade. The change we’ve seen in the U.S. isn’t limited to consumers’ knowledge and openness to discussing the benefits of a healthy GI tract. Mainstream healthcare professionals have changed their behaviors as well. Physicians, for instance, exhibit a growing respect for intestinal flora, and not just the pre/probiotic crowd. Most physicians today do not hesitate to recommend their patients consume yogurt or other probiotic-containing products when they prescribe antibiotics. These may seem like small steps but over time nutritional intervention is gaining credibility.

Some changes cycle back around. In years past, sugar just wasn’t that big a deal in mainstream nutritional education. The body broke everything down into simple sugars so the form you consume it in wasn’t perceived as significant. Of course, the calorie conscious crowd bolstered the use of artificial sweeteners, a healthier alternative. I recall an editorial during this period in which a public health official predicted that sugar consumption would decline significantly in the U.S. as consumers shifted to artificial sweeteners. As we all know, just the opposite has happened. Consumption of refined sugar increased along with use of artificial sweeteners. I suppose the U.S. palate has grown accustomed to sweet tastes.

Though use of a variety of artificial and low/zero calorie sweeteners has skyrocketed over the years, many of the same beverage marketers today are emphasizing that their products contain “real sugar.” To a great degree, this may be a consumer backlash against high-fructose corn syrup and perceived health issues.

Folk Remedies

The validation of “folk remedies” is another interesting change in our knowledge of nutrition. We’ve all heard we should eat chicken noodle soup when we feel a cold coming on or the phrase “An apple a day keeps the doctor away.” Many of us remember cringing every time we came face-to-face with the bottle of cod liver oil and thinking, “This had to be punishment; what health benefit could come from gagging this down?” Of course today, even the most conservative physicians support dietary supplementation with omega 3s and other polyunsaturated fatty acids, and advances in food science make the taste so much more pleasant.

Another example that comes to mind was my mother’s practice of treating her arthritis pain with a dose of raisins that had been soaked in gin. I didn’t think much about it until a friend who was researching nutritional interventions for joint pain suggested that she was simply using a rudimentary alcohol extraction of polyphenols in the grapes. It may have just been the shot of gin at bedtime, but it worked for her, regardless.

Shifting Perspectives

In addition to consumers and healthcare professionals, attitudinal changes have occurred in others in the natural products industry. I recall attending a major nutraceutical conference in the early 1990s. Two hot topics in the “State of the Industry” presentation were licensure by dietitians and the invasion of the industry by pharmaceutical companies. Sitting in the front of the room, I looked down at my nametag and there it was, an RD (Registered Dietitian) after my name and my company was major pharma. As the discussion grew rather heated I began to wonder if lynching was a possibility. I realized that dietitians have been attending natural food conferences and employed in the industry for many years but the primary purpose of my attendance was to identify potential acquisition candidates.

Like many dietitians it was a personal interest in healthy lifestyle, and in my case vegetarianism, that led me to a dietetics program and to get a scientific-based nutritional education. Reflecting on changes we have seen over the years is not to be critical of the profession or our industry. Rather, I think it is important that each of us try to appreciate others’ backgrounds. Change seems so much easier when you know others take the time to understand your perspective. As I heard so many times in sales training, “People care how much you know once they know how much you care.”

I would appreciate hearing your experiences and perceptions of changes since you entered the natural products industry.