Claims

Healthy & Wholesome — A regulatory perspective

Health claims were first introduced into legislation with the introduction of R146 in 2010. This legislation has a standard list of specific claims and also a list of words that indicate some form of health claim that may not be used.

The prohibited words are: health, healthy, wholesome, nutritious and any indication that a food can provide balanced or complete nutrition. In the course of consulting I have regularly encountered food marketers who insist that their food is healthy, wholesome or nutritious so why can they not say so?

The simple answer is no food is in itself healthy. Any given food can only be considered healthy if part of a balanced diet. Nobody can argue with the fact that water is necessary for daily life and therefore is healthy. But it is only healthy as part of a balanced diet that includes numerous other foods. Conversely sodium is considered unhealthy by many, but a diet that excludes sodium in its entirety would be harmful. These simple examples hopefully illustrate why no single food can be labelled using any of the above mentioned words.

Industry has attempted to get around this law with numerous methods, two commonly used (or attempted) are the use of endorsements and registering words as a brand.

The regulations published in 2010 closed the gap on endorsements. No product may be endorsed by a health practitioner or related organisation or even individuals that may insinuate a specific health aspect of food. There is exception made for organisations who are registered with the Department of Health for use of specific logos. This has not stopped companies still using this methodology of marketing whether it be by using a reference to a certain diet or having an Olympian training in the background of advertisements. Some of these products have been removed from the market, but walking through the supermarket many of these products are still on the shelf. This is indicative more of a lack of enforcement on the ground than a retraction of this part of the regulation.

The second avenue, registration of words as trademarks, is dealt with in the current draft regulation where this practice is outlawed. There is some indication that a grace period will be given for those brand names registered prior to 1995, although the dates given in the draft are now long come and gone. It will be interesting to see how far this regulation is taken. Will only specific use of words be targeted or any hint of the use? Words such ‘Pure’, ‘Fresh’ and ‘Natural’ appearing in brand names come to mind.

An issue with how nutrient content claims are currently dealt with is that generally only one requirement needs to be fulfilled e.g. for low fat a product simply has to have less than 3 g of fat per 100 g. This allowed manufacturers to push up for example sugar levels and use synthetic substitutes to make up for mouth feel and taste while still being low fat. Ultimately this does not make for a “healthier” product. A nutrient profile calculator has been introduced in the draft regulations requiring a food product to achieve a certain score before a claim can be applied to the product. The score takes into account total energy contribution, sugar, fats, sodium, protein, fibre, fruit and vegetable content. This can almost be seen as an attempt to create a scoring system for the term healthy, although this word may not be used.

A criticism of this system in previous drafts has been that some seemingly “healthy” foods would then not be allowed to carry a claim. This has been largely solved by having different categories of food products namely beverages, naturally high fat foods (e.g. oils and cheeses) and other food products.
Although no system is perfect this has gone some way to close the gaps in the regulation.

The use of any term on a label must be substantiated by sufficient scientific evidence, normally some form of laboratory study. Where no specific test can be associated with a claim e.g. there is no test that can prove “healthy”. So as a food marketer if you can’t substantiate a claim through legal reference the chances are that the specific word may not be used.

Article by: Norah Hayes

CAMS

Complementary & Alternative Medicines

What are Complementary & Alternative Medicines? Complementary and Alternative Medicines (CAMS) are various traditional supplements and treatments that are not considered to be mainstream registered or conventional (allopathic) medicines. Conventional medicines are regulated by the Medicines Control Council (MCC) through Act 101 of 1965. Medicines are regulated under four categories A, B, C and category D. The most crucial requirement of regulating medicines, which now applies to CAMS products (category D) is showing efficacy and safety. Essentially manufacturers must show that the product is safe for consumption and can fulfil its function as claimed, at its intended dosage.

In terms of the guidelines for CAMS, a complementary medicine means “any substance or mixture of substances which a) originates from plants, minerals or animals; b) is used or intended to be used for, or manufactured or sold for use in assisting the innate healing power of a human being or animal to mitigate, modify, alleviate, or prevent illnesses, or the symptoms thereof or abnormal physical or mental state, and c) in accordance with the practice of the professions regulated under the Allied Health Professions Act, 1982 (Act No 63 of 1982).”

What does this mean for manufacturers of food products? The food labelling regulations R. 146 of 2010 (clause 13(g)) prohibit the sale of any foodstuff which bears a medicinal claim, including prophylactic and therapeutic claims. Simply put, a foodstuff bearing any health claim relating to the prevention or treatment of a disease will be regulated as a CAMS product. These include claims relating to diabetes, cancer, blood pressure, osteoporosis, heart disease etc.

What are the requirements for CAMS products? Since 2013, CAMS are now regulated under categories A and D of the Medicines Act (R. 870 of 2013). Category D includes homeopathy, naturopathy, Ayurveda, osteopathy, phytotherapy and aromatherapy. Category A, one of the categories for conventional medicines now includes CAMS medications such as high potency Vitamins.

Labelling for these newly regulated CAMS must comply with the requirements for medicines by February 2014. Registration of various groups of medicines now falling under category D would be called up in batches:

Is your product affected?

March 2014: 20.2.8 Antiviral agents; 21.2 Oral hypoglycaemics (Diabetes); 6 Cardiac medicines; and 26 Cytostatic agents.
November 2015: 32.3 Slimming preparations (weight reduction products); and 7.1, 21.7, 21.8, 21.9 Sexual stimulation products.
May 2016: 32.16 (Other) Immune boosters; 17 Medicines acting on muscular system (body building products); and 22 (Vitamins) Sport supplements containing vitamins and minerals exceeding the upper limit allowed
November 2019: All remaining pharmacological classifications, including products in Category D and other categories.

What is the responsibility of manufacturers of CAMS? All manufacturers and wholesalers of CAMS must now be licenced by the MCC. This registration process is intended to be simplified compared to that of conventional medicines, but must show evidence of safety of the product, as well as appropriate manufacturing standards (Good manufacturing practices) and efficacy. If an applicant cannot provide suitable information to the Council, they must remove the product from the market, until registration with the MCC. Alternatively the product may remain on sale, but no medicinal claim may be made in any published information including advertising, labels and product inserts. By November 2019 the legislation will have come into effect for all complementary medicines affected by R. 870 of 2013.

In addition, the product label, package insert and patient information leaflet of all Category D medications must comply with CAMS labelling requirements. The requirements for CAMS products include that the label must indicate the category and pharmacological classification of the medicine and the discipline (for example homeopathy). In addition if it has not been registered by the MCC it must bear the statement “This medicine has not been evaluated by the Medicines Control Council. This medicine is not intended to diagnose, treat, cure or prevent any disease”.

Then what claims are allowed on “foodstuffs”? Currently only nutrient content claims are permitted on food products. Nutrient content claims are claims regarding the levels of a particular nutrient or energy present in a foodstuff. These include claims relating to fat, carbohydrates, protein, vitamins, minerals etc. These are prescriptive claims and there are strict conditions regarding their use, provided in the regulations.

Phase two of the food labelling regulations which are currently in draft will address nutrient-function claims and disease risk claims, these will be generic statement and include claims such as “Diets low in saturate fat and cholesterol that contain 2 g of plant sterol esters and plant stanol esters daily, may reduce the risk of heart disease by lowering cholesterol” and “vitamin C contributes to normal collagen formation for the normal function of skin”. However, phase two of the regulations has not yet been passed and until such time as they are, such statements will be prohibited on the labelling of foodstuffs.

In summary? Currently any health related claim that is not a nutrient content claim on a food product is prohibited, unless the product complies to the CAMS regulations and is registered with the Medicines control council. CAMS products require that manufacturers produce their product under Good Manufacturing Practice conditions and show safety and efficacy. Additional labelling requirements for CAMS products under Regulation 8 of the Medicines and Related Substances Act, 1965 are also required to be met.

Article by: Gillian de Villiers

CAMS

CAMS and the consumer

“Do you believe that the company that makes the product has to give proof of this claim? … I would like to believe it.”

CAMs, or Complementary and Alternative Medicines are an interesting grey area for the average consumer – somewhere between a medicine and a food. The shelves are full of them, so obviously we are buying them! But what does the man on the street think about the health claims made by these products?

We’ll be examining exactly what is regulated and how a little later in the newsletter – but for now let’s take a look into the mind of the average consumer. Do we believe that solid science and thorough testing back up every health claim that appears on marketed products?

I asked a few people in the medicine aisle of a few local grocery stores three questions:

1. When you see a health claim on a product such as “reduces blood pressure” “assists the immune system”, “aids in weight loss” or “lowers cholesterol” etc – do you believe it?

2. Do you feel that enough information is given on health claims as to how the product does this? Or don’t you feel this information needs to be included?

3. Do you believe that the company that makes the product has to give proof of this claim in order to be allowed to print the claim?

My first telling observation was that for the most part, people seemed surprised by the questions. This would lead me to think that many people hadn’t thought to question these claims – but perhaps I was wrong. Once presented with the questions, they came up with a few surprising answers. While overwhelmingly they seemed to believe that these claims should be strictly governed – many said that you had to employ ‘common sense’ when faced with a health claim on any product. These were often the same people who replied that they didn’t think enough information about how the product accomplished its health claim was given.

So it seems that while we obviously have a lot of consumers who do believe that health claims are strictly governed and can be trusted there is definitely a group which feels you can’t take a claim at face value. One participant mentioned something interesting – that they felt a claim like ‘reduces blood pressure’ should be backed up with proof, while a claim like ‘assists in weight loss’ was “more marketing than a real health claim”.

Some remarked that they rely on brand name when it comes to whether or not they trust a claim. If it is a well-known brand they are more likely to trust the claim, whereas one participant said you need to be more careful with a “dodgy” brand. Most participants said they felt the product should give more information about how it achieves what it claims – but one participant’s honest answer: “It would be too hard for me to understand” might give an indication as to why many products do not. Would a product that stated “Reduces blood pressure through the action of angiotensin- converting enzyme inhibitors” really give the average consumer any more useful information? Unlikely.

What did pleasantly surprise me was that many respondents felt it was important to do their own research before purchasing a complementary medicine, vitamin supplement or herbal remedy. In the Information Age, it seems the customer is starting to become more aware of their own power in making informed purchases – what they do want however is a guarantee that an authority is still looking out for us too. As one respondent replied to the question: ‘Do you believe that the company that makes the product has to give proof of this claim in order to be allowed to print the claim?’ “I would like to believe it.”

For a look into the mind of a more educated consumer, I asked my local pharmacist about these types of products – mainly herbal remedies – and why they stocked them. She confirmed that customer demand is one of the main factors in the pharmacy’s decision to stock them, but that they felt the products definitely benefited their customers too. What she was concerned about was how little information pharmacists have access to with regards to how these medicines could potentially interact with their patient’s prescription medications, but overall she felt the potential benefits of these types of medicines were often overlooked and warranted further study. When questioned about these products not being controlled by the MCC (Medicines Control Council) she made a good point – that she doesn’t need MCC approval to tell pharmacy visitors that increasing their fruit and vegetable consumption is good for them, so why should she discourage them from taking a herbal immune booster? That said, it would be hard to overdose on fruits and vegetables, which do not have written health claims attached to their packaging.

My opinion? My own journey has led me to believe that our lifestyle and dietary choices need to be addressed together with any other therapy – be it an alternative medicine or a prescription drug. And when it comes to health claims, I’m the kind of consumer who emailed a major supplement brand to find out whether their Vitamin B12 supplement contained methylcobalamin or cyanocobalamin – so let me place myself on the pernickety side of the consumer scale!

It’s also very important to mention of course that while there are many manufacturers selling products on the market that have blatantly misleading claims, there are also many manufacturers doing their best to comply to government requirements, ensure the customer’s safety and back up the effectiveness of their product with genuine health claims.

While I can’t quite shake the feeling that society needs to be more aware that every product they see on the shelf is there strictly for the purpose of getting you to buy it – perhaps times are changing. I still feel that we need to become more responsible consumers, that there’s no excuse in today’s world for simply taking a health claim at face value without doing our own research. And I think it’s just as important to Google “why XYZ supplements don’t work” in addition to why they do.

But I was impressed at the level of scepticism I encountered – while it’s very important that health claims are regulated where they can be to protect the consumer, an alert and educated public has the power to protect itself too.

Article by: Catherine Robinson

Claims

Food for thought

Food for Thought – How useful are Nutrition labels to the average South African?

With escalating rates of lifestyle-related health issues globally, it has never been more important that consumers are aware of the factors which are under their control when they make food choices. Understanding and correctly interpreting food labels can enable consumers to make informed decisions about the foods they choose to purchase and provide to their families.

In the 2011 study Consumers’ knowledge of food label information: an exploratory investigation in Potchefstroom, South Africa, some valuable insights were gained despite the limited scope.

The study was limited to a group of 299 participants, of which the largest component was Afrikaans-speaking females with a tertiary education and no children. However, 4% and 38% of respondents had below grade 12 or up to grade 12 levels of education respectively.

While information such as best before dates, storage instructions and identifying symbols such as Halaal or Heart Foundation endorsements were easily and accurately identified by the vast majority of respondents, only 53% of respondents were able to calculate how many serving sizes were included in a product. Since many food labels give nutritional information ‘per serving’ – this indicates a clear problem in correct application of the information, even if the values themselves are largely understood, and the participants are well educated. In addition, manufacturers are required to include nutritional values per 100g – however whether this will be of benefit to a consumer making an in-store decision under a time constraint is debatable.

While many consumers may be aware that is it recommended for them to cut back on saturated fat, only 3% of respondents could correctly identify a food as being low in saturated fat.

Under the current labelling regulations (R146/2010) the amount of saturated fat ‘per serving’ and ‘per 100 g’ are mandatory where nutritional information or claims are provided.

Even more importantly, as long as a food manufacturer does not make any nutritional claims about their product – it is not compulsory for them to publish these details at all. And this is not entirely negative – smaller manufacturers without the funds to have their product analysed by an accredited laboratory every 3 years should certainly not be prevented from entering the marketplace in the first place; and they will still be required to provide a list of ingredients, additives, allergens, storage information, etc.

But does reading and understanding food labels actually lead to improved choices?

According to Food and nutrition labelling: the past, present and the way forward (Koen et al., 2016), the short answer is yes. People who make use of food labels were found to be more likely to make informed food choices in practice – with their diets reflecting a reduced fat, cholesterol, sodium, and overall energy intake, and increased consumption of fibre, iron and vitamin C.

In light of this since the publication of the latest regulations relating to the labelling and advertising of foodstuffs, or R146/2010, we have certainly made some progress towards food labelling practices which are easier for the average consumer to understand, however there is still significant room for improvement.

Looking at the largest South African study to date conducted after the implementation of the new regulations, conducted by Bosman et al. with 1997 respondents across four ethnic groups – some general areas of interest were uncovered:

• Most consumers are able to locate the nutritional information on packaging, however some expressed uncertainty in their understanding of the information provided.

• Consumers who did not read labels on a frequent basis indicated lack of interest, habitual purchasing, price concerns and time constraints as the main reasons.

Furthermore, in 2008, 41% of women and 21% of men in South Africa were classified as obese, with 32% of females and 35% of males with high blood pressure, which are considered to be diseases of lifestyle. (WHO, 2014). Between 2010 and 2011, the Department of Health enacted laws governing Trans- Fat and saturated fat in foods and their labelling. Similarly, Sodium reduction laws, currently being revised, were published in 2013, for enforcement between 2016 and 2019.

In essence, many consumers still have difficulty putting their knowledge into action when making purchasing decisions, even with the current labelling systems. While there may be scope to improve the current R146 regulations and make them more accessible to the average consumer – a certain degree of accountability must be taken by individuals as well. Fine tuning the regulations and bringing them in line with global best practices is a goal we certainly need to strive towards, however the education of the public in making food choices is clearly just as vital.

Engagement invitation: What are your thoughts? Do you find nutritional labels hard to decipher? Let us know in the comments section below.

Article by: Catherine Robinson

References

1. van der Merwe D, Bosman M, Ellis S, de Beer H, Mielmann A. Consumers’ knowledge of food label information: an exploratory investigation in Potchefstroom, South Africa. Public Health Nutr 2012: 16(3) 403-408.
2. Koen N, Blaauw R, Wentzel-Viljoen E. Food and nutrition labelling: the past, present and the way forward. S Afr J Clin Nutr 2016: 29(1) 13-21.
3. World Health Organization. Noncommunicable Diseases (NCD). Country Profiles, 2014.