The Florida Department of Citrus would like you to believe that Florida citrus products have special health properties. Citrus fruits are are rich in vitamin C, contain significant amounts of folic acid and potassium, and, when eaten whole, contain significant amounts of dietary fiber . But for many years the department has produced ads that exaggerate their value. The most recent example, appearing both on television and on its Web site, suggests that drinking a single glass of orange juice per day can greatly reduce the odds of having a stroke. According to a press release on its Web site:
A study published in the October 6  edition of the Journal of the American Medical Association (JAMA) found that drinking a glass of orange or grapefruit juice every day may lower the risk of stroke by 25 percent. . . .
What makes this latest study different, is that while it found that increasing overall fruit and vegetable consumption could reduce stroke risk up to 30 percent, it actually identified two foods as being particularly effective at reducing stroke risk: citrus juices, like orange and grapefruit juice, and cruciferous vegetables.
According to the JAMA report, Harvard University researchers Dr. Kaumudi Joshipura and Dr. Walter Willett analyzed the fruit and vegetable intake of more than 110,000 men and women participating in the Nurses Health Study and the Health Professionals Follow-Up Study.
They found that increasing overall vegetable consumption reduced the risk of stroke by just four percent, but increased consumption of cruciferous vegetables (broccoli, Brussels sprouts, cauliflower, etc.) cut the risk by 32 percent. As for fruit, increasing overall consumption lowered stroke risk by 11 percent, but simply drinking a glass of orange juice every day reduced the risk of stroke by 25 percent .
This study, which was well designed, was supported by grants from the U.S. Office of Dietary Supplements and by the Florida Department of Citrus. The researchers examined data on 75,596 women, ages 34 to 59, who were followed for a 14-year period and on 38,683 men, ages 40 to 75, who were followed for 8 years. All of the participants were free of cardiovascular disease when the studies began. The study found that those with the highest intake of fruits and vegetables — particularly cruciferous vegetables, green leafy vegetables, and citrus fruit and juice — had the lowest incidence of strokes caused by obstruction of blood supply to the brain. The researchers noted, however, that “the analyses of individual fruit and vegetable items did not show any single fruit or vegetable that was strikingly more protective than others.”  The Citrus Department’s “25%-reduction” figure was derived from a table showing that the people reporting consumption of 1 serving per day of citrus juice had 20% fewer ischemic strokes than the 20% of people who consumed the fewest number of servings of fruits and vegetables. The study provides strong support for the prevailing scientific recommendation to consume at least five servings of fruits and vegetables a day. But it cannot predict the effect of adding citrus juice to your current diet — as the ad suggests.
The Florida Citrus Commission has advertised deceptively for many years. In October 1986, an ad in Health Magazine stated:
Keeping healthy and fit takes work. And all that work takes its toll; like the loss of fluids and elements your body needs. Florida’s got a refreshing way to give them back. 100% grapefruit juice. It’s high in potassium, the one thing active people can’t get enough of in their diets. Potassium balances sodium levels to regulate blood pressure and fight off fatigue.
During the same month, a similar ad in Prevention Magazine included the message: “Florida grapefruit juice. It’s sodium free and full of potassium, a combination that helps control blood pressure.” These statements, of course, were a mixture of fact, fantasy, and outright falsehood.
- The idea that potassium is “the one thing active people can’t get enough of in their diets” is ridiculous. The idea that the “work” of keeping fit “takes its toll” by causing “loss of fluids and elements your body needs” is misleading. People who exercise on a hot day will need to replace fluid loss. But “keeping fit” does not create any special nutritional needs that require special attention to one’s diet. Nor do people who “keep fit” have a greater need for grapefruit than anyone else.
- Lowering dietary sodium won’t help everyone with high blood pressure, but only those “sensitive” to sodium. High-blood-pressure patients taking diuretics that increase potassium excretion need to have adequate intake of potassium and are sometimes advised to consume potassium-rich foods. But people at significant risk of potassium depletion from diuretics usually require a potassium supplement.
- The statement that “potassium balances sodium levels to regulate blood pressure and fight off fatigue” suggests that eating grapefruit can help prevent high blood pressure — which is false.
- Eating grapefruit does not “fight off fatigue.” Perhaps the origin of this statement was the idea that potassium depletion caused by diuretics can cause muscle weakness. But the amount of potassium needed in such situations is more than grapefruit is likely to supply.
After seeing these ads, I fired off a complaint to the the National Advertising Division (NAD) of the Council of Better Business Bureaus in New York City. When NAD investigated, a Citrus Commission spokesperson said that the potassium deficiency claims were based on an opinion survey of athletes conducted by a nutrition consultant plus a study of the effects of intense conditioning in young men undergoing basic military training. In addition, a literature survey was provided as substantiation of the roles of sodium and potassium as nutritional factors in controlling blood pressure. NAD’s investigator replied that the data obtained from the studies could not support broadly stated claims and expressed concern that the ad overstated the benefits of drinking normal quantities of grapefruit juice .
The spokesperson informed NAD that the claims had been discontinued and that a new campaign would promote grapefruit as a significant source of potassium when part of a healthy regimen, including proper diet and exercise . However, an ad from the “new” campaign stated that grapefruit juice was “high in potassium with no sodium: a combination that, along with proper diet and exercise, can help control blood pressure.” This ad was still misleading because no study had shown that drinking normal quantities of grapefruit juice would actually lower blood pressure. When a local dietitian inquired, the Florida Department of Citrus’s publicity director said that the ads were written by an advertising agency and reviewed by the department’s scientific research department for accuracy .
In 1993, the department distributed a booklet containing several pages of misleading information about vitamin C. Among other things, the booklet suggested that vitamin C “may offer remarkable protection against heart disease” and “can help prevent tuberculosis.” The “tuberculosis” claim is attributed to “Dr. Irwin Stone,” but does not indicate that Stone’s doctora; credential was a “Ph.D” from nonaccredited Donsbach University. The booklet also claimed that vitamin C must be ingested daily because it cannot be stored in the body. This claim was false, because the body normally stores about a month’s supply.
The department web site states:
- The American Cancer Society says a healthy diet including Florida orange juice could reduce the risk of some cancers.
- The American Heart Association has certified Florida grapefruit and grapefruit juice as part of a heart-healthy diet.
- The March of Dimes tells us the vitamin folic acid in orange juice could prevent certain birth defects
These statements are true, but in 1997, Cable News Network revealed that the department had donated $1 million to the American Cancer Society in exchange for the right to advertise that, “In health news, the American Cancer Society reports that along with a healthy diet, drinking more Florida orange juice may actually reduce your risk of some cancers.”  Although eating fruits and vegetables can help prevent several types of cancers, the ad was misleading because orange juice has no unique or special properties as a cancer-fighter and oranges from Florida are not more healthful than other oranges. The department is also a sponsor of the March of Dimes WalkAmerica program to raise money to fund research on birth defects.
Health Claims Regulation
During the mid-1980s, the tendency of food producers to make claims about individual food components triggered FDA concerns and stimulated the agency to propose rules for health-related messages on food labels . When controversy erupted, Congress clarified the situation by passing the Nutrition Labeling and Education Act of 1990, which increased the FDA’s authority . The FDA then proposed tighter rules that defined “health claim” as any type of communication in labeling that is intended to suggest “a direct beneficial relationship between the presence or level of any substance in the food and a health or disease-related condition.”  Its current regulations, which took effect in 1994, permit claims only when:
- A food substance is associated with a disease or health-related condition for which the general U.S. population or a an identified subgroup is at risk;
- The claim is made in the context of the product’s relationship to overall diet;
- The claim is supported by publicly available scientific evidence, including experiments that are well designed and properly conducted;
- There is significant agreement among qualified experts that the claims are supported by such evidence; and
- The claims must be “complete, truthful, and not misleading.” 
The Florida Citrus Commission’s claims about orange and grapefruit juice have certainly not been “complete, truthful, and not misleading.” But the remarkable thing about them is not their content but the fact that they were placed by the Florida Department of Citrus — a government agency! Funded by an excise tax on citrus fruits, its functions include supervision of the citrus industry, scientific research, and “a forceful advertising and promotional program.”  Public criticism of its ads has had no visible effect on its tendency to exaggerate.
- Nutrients in citrus. Florida Department of Citrus Web site. Accessed May 9, 2000.
- Harvard research offers stroke preventive news everyone can use. Florida Citrus news release, Oct 6, 1999.
- Joshipura KJ and others. Fruit and vegetable intake in relation to risk of ischemic stroke. JAMA 282:1233-1239, 1998. [Download PDF]
- Advertising modified or discontinued: Florida Citrus Commission, Grapefruit juice (DFS Dorland Advertising Agency). NAD Case Report 17:11, 1987.
- Barrett S. Misleading claims made for grapefruit juice. Nutrition Forum 4:56, 1987.
- CNN. Ads criticized that promote orange juice as cancer-fighter. CNN Web site, posted May 24, 1997.
- Fanning O. FDA considering policy for health messages on food labels. Nutrition Forum 3:89-91, 1986.
- FDA. Food labeling; public health messages on food labels and labeling. Federal Register 52:28843-28849, 1987.
- FDA. Food labeling; health messages and label statements; reproposed rule. Federal Register 55:5175-5192, 1990.
- Barrett S. New food labeling regulations issued. Nutrition Forum 10:25-27, 1993.
This page was posted on May 11, 2000.