Berry Nutrition

Author: Marie Spano, M.S., R.D., Contributing Editor

Nutritionally speaking, good things come in sweet—and tart—little packages. Research is discovering berries pack a nutritional punch due to their vitamin, fiber and antioxidant content.

Botanically speaking, berries are indehiscent fruits (they don’t need to be opened to release their seeds) that ripen through the ovary wall. However, any small, edible fruit with multiple seeds is typically considered a berry.

In addition to lending flavor and brilliant colors to a wide variety of dishes, all berries are packed with an array of antioxidants, nutrients and potential health benefits. Berries that are especially antioxidant-rich include fresh crowberries, bilberries, black currants, wild strawberries, blackberries, blueberries, goji berries, sea buckthorn, blueberries and cranberries. However, the antioxidant content of berries varies based on the geographical growing condition. And, while fresh berries are an excellent source of antioxidants, total phenol content drops during processing. In fact, processed berry jams and syrup contain approximately half the antioxidant capacity of fresh berries, and juices show the greatest loss of anthocyanins and tannins due to the removal of seeds and skin (Nutrition Journal, 2010; 9:3; Journal of Agricultural and Food Chemistry, Jan 13, 2012).

Botanical berries
Shiny, scarlet-colored cranberries are rich in vitamin C, loaded with antioxidants, including flavonoids, and score higher in their ORAC score than many other fruits (“Oxygen Radical Absorbance Capacity (ORAC) of Selected Foods—2007”, USDA ARS). Cranberries are perhaps best known for the role their juice plays in the prevention of urinary tract infections (UTI) in women, particularly those with recurrent UTIs (Cochrane Database Systems Review, 2008; 23:CD001321). However, cranberries may also inhibit the growth and proliferation of some types of cancer cells (Journal of Nutrition, 2007; 137:186S-193S), reduce low-density lipoprotein (LDL) oxidation and platelet aggregation, and improve vascular function (Nutrition Reviews, 2010; 68:168-177; Nutrition Reviews, 2007; 65:490-502). In addition, polyphenols isolated from cranberries appear to inhibit the formation of cariogenic bacteria and reduce both inflammation and the production of enzymes that contribute to the destruction of the extracellular matrix in periodontal disease, making them beneficial for oral health (Journal of the Canadian Dental Association, 2010; 76:a130).

Processing and storage affects the phytochemicals found in cranberries. Anthocyanins are present at much higher levels than flavonols in cranberries, but the reverse is true for cranberry juice, due, in part, to the instability of anthocyanins. Some flavonols are also degraded during processing but to a lesser extent than anthocyanins (Critical Reviews in Food Science and Nutrition, 2009; 49:741-781).

Also leading the nutritional way is the tiny blueberry. According to the U.S. Highbush Blueberry Council, Folsom, CA, blueberries are packed with vitamin C, dietary fiber, potassium and antioxidants, with a total of 6,552 ORAC units per 100 grams. Further, many studies have indicated blueberry supplementation can help mitigate age-related neurodegenerative diseases. In one study, for example, rats fed 18.6 grams of dried blueberry extract per kilogram of diet for eight weeks showed a reversal of age-related deficits in brain and behavioral function (The Journal of Neuroscience, 1999; 19:8,114-8,121). The phytochemicals in blueberries also may help protect against some cancers. A study that identified blueberry anthocyanins also determined their ability to inhibit the growth of colon, breast, oral and, especially, prostate cancer cell lines. The same study showed blueberries were effective in inducing cell death of colon-cancer cells (Journal of Agricultural and Food Chemistry, 2006; 54:9,329-9,339).

Other less commonly consumed berries show promising health benefits. Though relatively few health-related studies have been conducted using black, white and red currants, one study using mixed berries, including currants, found that consumption of two portions of berries daily (including black currant purée on alternating days) resulted in favorable changes in high-density lipoprotein (HDL) cholesterol, blood pressure and platelet functioning (American Journal of Clinical Nutrition, 2008; 87:323-331). Red and black currants are an excellent source of vitamin C, and black currants are also an excellent source of fiber and good source of manganese and potassium.

Wolfberries, otherwise known as goji berries, contain several antioxidants, notably zeaxanthin, one of the two antioxidants found in the retina of the eye. One double-blind, placebo-controlled study in healthy elderly subjects found that, compared to placebo, daily supplementation with goji berry (13.7 grams per day) for 90 days increased plasma zeaxanthin and antioxidant levels while protecting from hypopigmentation and soft drusen accumulation (yellow deposits under the retina) in the macula of the eye (Optometry & Vision Science, 2011; 88:257-262). Additional studies have found that goji berry juice improves antioxidant biomarkers in healthy humans (Nutrition Research, 2009; 29:19-25), subjective feelings of well-being, neurologic and psychologic performance and gastrointestinal functioning (Journal of Alternative and Complementary Medicine, 2008; 14:403-412).

More research needs to be done on the health benefits of gooseberries and muscadine grape berries, but they, too, have a great nutrition profile. Gooseberries are an excellent source of vitamins A and C, and a good source of potassium and fiber. Muscadine grape berries are an excellent source of manganese, a good source of fiber and contain reseveratrol (American Journal of Enology and Viticulture, 1996; 47:57-62).

Non-botanical berries
In addition to the nutrition attributes for botanical berries, non-botanical berries, including strawberries, chokeberries, blackberries and raspberries, are also loaded with nutrients and antioxidants.

Strawberries are an excellent source of vitamin C and also contain fiber, vitamins, potassium and phytonutrients. Animal research has shown that strawberries improve indices of memory and cognitive functioning (Current Opinion in Clinical & Metabolic Care, 2009; 12:91-94), while human intervention studies indicate that strawberries (in addition to chokeberries, cranberries and blueberries; fresh, as juice or freeze-dried) lead to significant improvements in LDL oxidation, lipid peroxidation, dyslipidemia and glucose metabolism (Nutrition Reviews, 2010;6 8:168-177).

Chokeberries (Aronia melanocarpa) contain a mix of many antioxidants, including procyanidins, anthocyanins and phenolic acids. A review of studies to date on chokeberries indicate they may be a promising functional food for diseases related to oxidative stress, but more rigorous scientific research is necessary (Phytotherapy Research, 2010; 24:1,107-1,114).

Blackberries are an excellent source of vitamin C and fiber. Studies show anthocyanin-rich fractions of blackberry extracts reduce UV-induced free radical damage to skin cells (Phytotherapy Research, 2012; 26:106-112), and freeze-dried blackberries reduce esophagus and colon cancer development in rodents (Nutrition and Cancer, 2006; 54:69-78).

Raspberries are an excellent source of vitamin C, manganese and dietary fiber, and a good source of vitamin K. However, much of the interest in raspberries stems from their anthocyanin and ellagic acid content. In vitro studies show ellagic acid is protective against cancer (Journal of Nutrition and Biochemistry, 2004; 15:672-678). And this antioxidant, as well as the overall antioxidant capacity of raspberries, is similar in fresh commercial, freshly picked and frozen raspberries (Journal of Agricultural and Food Chemistry, 2002; 50:5,197-5,201).

All berries are full of antioxidants and nutrients. And, the various colors, textures and different forms of berries, including frozen, fresh, dried and pulp, make berries a versatile, nutritious, eye-appealing and tasty addition to a variety of foods and beverages.

About the author:
Marie Spano, M.S., R.D., CSCS, is a nutrition communications expert whose work has appeared in popular press magazines, e-zines and nutrition-industry trade publications. She has been an expert guest on NBC, ABC and CBS affiliates on the East Coast.

February, 2012|Oral Cancer News|

Dietary supplements: friend or foe?

Author: Eleanor Mayfield

With research pointing to pros and cons of vitamin and mineral supplements, these dietary decisions become increasingly complex. Here’s a quick quiz:
1. Are you a cancer patient or survivor?
2. Do you take any dietary supplements such as vitamins, minerals, or herbs?
3. Have you discussed with your doctor the pros and cons of using these supplements?

If you answered yes to questions 1 and 2 and no to question 3, you’re not alone. A recent review in the Journal of Clinical Oncology found that supplement use is widespread among cancer patients and longer-term survivors and that most don’t discuss their supplement use with their doctors. In fact, in different studies 64 to 81 percent of respondents reported using vitamin or mineral supplements. Up to 68 percent of doctors were unaware of supplement use by their patients. Cancer patients and survivors tend to use dietary supplements at higher rates than the rest of the U.S. population, the review found. Supplement use was highest among women, breast cancer survivors, and people with higher levels of education.

People who take supplements generally believe that doing so will benefit their health. In studies included in the review, the reported reasons for supplement use included strengthening the immune system, helping cope with stress, improving the chance of a cure, and helping the user feel better.

Users may assume that the supplements they take can’t do them any harm. Research findings suggest, however, that supplements can sometimes be harmful. In cancer patients who are receiving radiation or chemotherapy, some dietary supplements may interfere with treatment effectiveness while others may accelerate cancer growth. This article summarizes what you need to know to make an informed decision about supplement use as a cancer patient or survivor.

What exactly is a dietary supplement?

The Dietary Supplement Health and Education Act, passed by Congress in 1994, defines a dietary supplement as “a product (other than tobacco) that…contains one or more dietary ingredients (including vitamins, minerals, herbs or other botanicals, amino acids, and other substances) or their constituents [and] is intended to be taken by mouth as a pill, capsule, tablet, or liquid.”

Dietary supplements must be safe or they wouldn’t be on the market, right?
Not exactly. Under the 1994 law, manufacturers of dietary supplements are not required to test their products in clinical trials to prove them safe and effective before putting them on the market, as drug manufacturers must do. The law considers supplements safe unless they are found to cause harm. The U.S. Food and Drug Administration (FDA) may stop a company from marketing a dietary supplement only if it proves that the product poses a significant health risk.

Since 1994 the FDA has found problems with some dietary supplements. Some products have been contaminated; others have not contained the ingredients listed on the label or have contained a lower or higher dose of the active ingredient than the label stated. Some supplements have caused damage to the liver, kidneys, or other organs. The supplement ephedra, often sold as a weight-control remedy and an energy booster, was taken off the market in 2003 after being linked to such health problems as high blood pressure and irregular heart rhythm.

Some supplements may pose particular risks for cancer patients. For example, St. John’s wort—an herb marketed as helpful for depression—has been shown to interfere with the body’s metabolism of the cancer drug Camptosar® (irinotecan). Folic acid—a vitamin that reduces the risk of some birth defects—may have biologic effects that promote the progression of colorectal cancer.1

“The term dietary supplements may lead people to think that these products can be used as you would use a spice to garnish your food,” says Patrick J. Mansky, MD, a medical oncologist and researcher at the National Center for Complementary and Alternative Medicine, part of the National Institutes of Health in Bethesda, Maryland. “But many products termed ‘supplements’ contain biologically active components that may be beneficial but are also potentially harmful if they interact adversely with medications or have other undesirable biologic effects.”

What about antioxidant supplements?
One category of supplements whose use by cancer patients is particularly controversial is antioxidants, such as beta-carotene, lycopene, selenium, and vitamins A, C, and E. These substances work in the body to slow or prevent damage to cells caused by unstable molecules known as free radicals. Antioxidants are found in many foods, including fruits, vegetables, grains, and nuts as well as some red meats, poultry, and fish.

Some cancer patients take high-dose antioxidant supplements in the hope that these products will help their bodies better tolerate treatment side effects or boost treatment effectiveness. Laboratory and animal studies have shown that antioxidants can protect cells against radiation and chemotherapy and may therefore reduce the adverse effects of radiation treatment and chemotherapy. Some lab studies suggest that antioxidants enhance the effectiveness of chemotherapy and radiation. Other studies, however, suggest that antioxidants may reduce the anticancer activity of these treatments.

“Radiation and many kinds of chemotherapy work by damaging the DNA of both tumor cells and normal cells,” explains Brian D. Lawenda, MD, a radiation oncologist at Naval Medical Center San Diego. “When you put high doses of antioxidants into the cellular environment, it has been shown that they can repair DNA damage and prevent cell death.” The bottom line: high doses of antioxidants may reduce the ability of radiation or chemotherapy to kill tumor cells, potentially reducing the effectiveness of treatment.

Dr. Lawenda is the first author of a recent review article published in the Journal of the National Cancer Institute, which concludes, “the use of antioxidant supplements during chemotherapy and radiation treatment should be discouraged because of the possibility of tumor protection and reduced survival.” The researchers base this conclusion on a review of all the randomized clinical trials they could identify in which patients received antioxidant supplements concurrently with radiation or chemotherapy.

Many of the trials they found enrolled fewer than 50 patients, Dr. Lawenda says, and therefore lack the statistical power to support conclusions about the benefits or risks of antioxidant supplements. In the largest trial they identified, 540 patients with head and neck cancer received radiation therapy plus either antioxidant supplements or placebo pills. Compared with those in the placebo group, patients who received the antioxidant supplements had fewer severe side effects from treatment, but their tumors were more likely to come back and their overall survival was poorer. ,

The results of this trial don’t prove that it’s unsafe for cancer patients to take antioxidant supplements, says Dr. Lawenda, but they suggest it may be unsafe. “The studies done so far don’t provide a definitive answer,” he says. “What we need are more large clinical trials designed specifically to look at survival and tumor control endpoints in cancer patients who receive high-dose antioxidant supplements. We recommend that patients not take high-dose supplemental antioxidants during treatment until we have better research that shows this is safe.”

This advice is consistent with that issued in 2006 by an expert panel convened by the American Cancer Society. “Whether antioxidants or any other dietary supplements are beneficial or harmful is…without a clear scientific answer at this time,” the panel wrote. “Given this uncertainty, until more evidence is available that suggests more benefit than harm, it is prudent for cancer survivors receiving chemotherapy or radiation therapy to avoid exceeding more than 100 percent of the daily value for antioxidant-type vitamins such as vitamins C and E during the treatment phase.”

Antioxidant supplements may offer no health benefits to those who are cancer-free, either. In a recent review of 67 randomized trials, participants who took high doses of beta-carotene, vitamin A, or vitamin E had a higher risk of death than those who took either no supplements or a placebo. Vitamin C supplements had no effect on death rates. In some studies selenium supplements seemed to reduce death rates, but the evidence was not conclusive. Some participants were healthy while others had various diseases, but this made no difference to death rates.

So what about antioxidants in food?
Many fruits and vegetables—especially berries, tomatoes, and dark green leafy vegetables—are rich in antioxidants. If antioxidants might interfere with cancer treatment, should patients avoid eating these foods? Absolutely not, says Dr. Lawenda. So why are antioxidant-rich foods okay if antioxidant supplements are potentially harmful?

The answer is that the body makes better use of antioxidants that are “packaged” along with many other nutrients in a fruit or vegetable than it does of isolated antioxidants consumed as supplements, says Karen Collins, MS, RD, nutrition adviser to the American Institute for Cancer Research (AICR). “When antioxidants are consumed in food, you get a wide variety of other nutrients as well and they work synergistically—their healthful effects are stronger together than alone; plus you don’t get too much of any single nutrient,” she explains. “More is not always better—you can have too much of a good thing.”

Why should I tell my doctor what supplements I take?

Much has been learned over the past few years about how supplements—particularly herbs and other supplements derived from plants—can interact with prescription medications, says Dr. Mansky: “Not just cancer drugs, but blood pressure medications, antibiotics, antiviral drugs, blood thinners, and cholesterol-lowering agents. As a physician you want to be aware of a patient’s whole situation so that you can provide the best care. Patients should be as informed and aware as possible about supplements they are taking or considering taking. You want an informed patient talking to an informed healthcare provider.”

Are any supplements recommended during cancer treatment?
A regular multivitamin (not a “megavitamin”) may be helpful and is unlikely to be harmful, those interviewed for this article agree. If a patient has lost weight or has no appetite, a protein or calorie supplement might be appropriate, says Collins. If someone is deficient in a specific nutrient, supplementation of that nutrient may help eliminate the deficiency. “Recommendations for supplementation should be individualized based on what type of treatment a patient is receiving and how well they’re able to get the nutrients they need through food,” she adds.

Can supplements prevent cancer or stop it from coming back?
In a comprehensive report published by AICR in November 2007, scientists concluded—after reviewing more than 7,000 studies on diet and cancer prevention—that no dietary supplement can currently be recommended to prevent cancer.

Some supplements may reduce the risk of certain types of cancer but increase it for others, says Collins. “Calcium supplements probably lower colon cancer risk, but in excessive doses they may increase the risk of prostate cancer. Selenium supplements may help reduce prostate cancer risk but may increase the risk of skin cancer. Right now we can’t identify who is likely to be helped by these supplements and who might be harmed. Until we can do that, it’s premature to recommend any supplements for cancer prevention.”

How can I be a savvy supplement user?
Be aware that supplements may be helpful in some circumstances but possibly harmful in others. If you’re receiving treatment for cancer, inform yourself about the pros and cons of using supplements. If you’re hoping to prevent cancer, don’t count on supplements to do it. Don’t use supplements as a substitute for a healthy diet. Finally, always talk with your doctor about supplements you’re taking or considering taking.

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December, 2008|Oral Cancer News|