Quackwatch Home Page "Training" For Health Food Retailers Odom Fanning One way "health food" retailers get information is by attending national and regional trade shows where manufacturers display their wares and various spokespeople deliver the industry viewpoint on food and nutrition issues. Natural Foods Expo '85 East, held October 25-28, 1985, at the Washington, D.C., Convention Center, attracted some 4,000 retailers, most of them from the eastern United States. More than 200 exhibits were staffed by friendly sales personnel who passed out literature and abundant samples of foods and food supplements. The exhibitors came from all over the country and included many regulars from the established sister show, Natural Foods Expo West, held each Spring in Anaheim, California. These shows are sponsored by New Hope Communications, of New Hope, Pennsylvania, publisher of Natural Foods Merchandiser and Delicious! magazines. Expo '85 East featured 40 seminars and workshops covering all aspects of merchandising, store management and industry trends. One of the most popular seminars--which filled three hours on the final morning--was "Nutritional Selling: A Powerful Customer Service." Attended by more than 150 health food store operators, it was led by Jeffrey S. Bland, Ph.D., whom many of the participants held in obvious awe. Dr. Bland, who is on leave from his biochemistry professorship at the University of Puget Sound, Tacoma, Washington, has a B.S. in biology from the University of California at Irvine and a Ph.D. in chemistry from the University of Oregon. But much of his aura stems from his current position as research associate and director of the Laboratory for Nutrient Analysis at the Linus Pauling Institute of Medicine, Palo Alto, California. Bland is also president of JSB & Associates, Gig Harbor, Washington, which "specializes in wellness program development and delivery." Bland is undoubtedly the health food industry's most prolific publicist and interpreter of nutrition-related scientific developments. In addition to appearing frequently at trade shows, he writes and edits books, edits and publishes a magazine (Complementary Medicine), produces audio and video tapes, conducts courses for professionals, and serves as a consultant to several organizations which share the industry's views. Many of Bland's products were available for purchase at the meeting. Expo's nutritional selling seminar included several skits in which Bland played storekeeper and customers were played by three retailers: Kay Peterson, of Hazelwood, Missouri; Dale Bennett, of Winter Park, Florida; and Peter Brodhead, of Savannah, Georgia. Members of the audience were also invited to act as customers and ask their "toughest question" to the four panelists acting as clerks. The quotes throughout this article were taken from Nutrition Forum's tape-recorded transcript, edited to remove some of the grammatical errors, repetitious words and other minor artifacts of speaking. How to Avoid "Overtly Prescribing" Much of the seminar concerned how product information might be communicated without "prescribing" (which would be practicing medicine without a license). One skit was set at an "information center" located near the vitamin department of a health food store. A 69-year-old man who is a fairly regular customer comes in, walking considerably more slowly than usual. He explains that he has developed arthritis and asks what he could take to help it. After inquiring about common symptoms such as headaches, joint problems, intestinal problems and stuffiness of the nose, Bland suggested that "food hypersensitivity" was a factor and that milk, wheat and red meat might be contributing to the man's arthritis by "aggravating his immune system." Bland then proposed that intake of these foods be reduced and consumption of complex carbohydrates be increased. "Fortunately," he added, "there are some emergent bodies of literature and good medical studies that indicate that things like fish oil . .. the product on our shelves over here . . . have been shown to help stabilize the immune system in people that may have a tendency toward arthritis." Bland also directed the customer's attention to literature in the store so he could read about these matters and possibly discuss them with his doctor. Bland's reference to "emergent" studies was typical of his presentation throughout the seminar. His delivery is rapid-fire, with frequent use of biochemical concepts and research findings (usually preliminary in nature) which he considers relevant and encouraging. In the ensuing discussion, Ms. Peterson remarked that although "the Arthritis Association categorically says that food has nothing to do with arthritis," doctors may still be receptive to information from retailers. Bland said he would try to make it clear to customers that he is concerned about their medical management, that they have been seeking good care, and that he was not practicing medicine but "trying to support them with nutritional information adjunct to traditional medical care." He also warned that requests for specific product information should be handled cautiously to avoid being "nailed for prescribing." With a customer who says he read about a product for relieving arthritis pain but doesn't remember its name, Bland suggested this approach: I'm not sure exactly what you're talking about, but I have seen a couple of articles on amino acids like dl-phenylalanine. Could that have been what you were referring to? If he says yes, it is an easy lead-in to reiterate what you learned in the article. But never say "that's what you can take." If he says no, you can say, "Let me give you the gist of what I read." Then you can say, "Dl-phenylalanine was suggested as being a modulator of a substance called enkephalin which is the body's own native pain-deadening process and that this is a part of the endorphin family. Have you ever heard of endorphins?" The person would say yes or no, and you can take the conversation on like that, making it educational and informational. That, to me, is the real position this industry should be in. It is not diagnostic, it is not treatment, because product sales are based on that individual's considered interest and belief system. You'll sell more products by providing information with less legal jeopardy than going right out and saying, "Here's what you really should be taking on the following dose schedule," which is certainly overtly prescribing. Mr. Bennett agreed: "Keep in mind that there is a very fine line in what you can and can't say . . . Once you attach a claim to a product, you are prescribing. So, you must teach your salespeople that very, very carefully. Because today you don't know who you are talking to in your stores . . . When we talk about nutrition I don't really think we can get into too many problems . . . We're not just selling a bottle of vitamins, what we're selling is the concept of good health. And we can keep hammering away at the diet." Commenting on the abundance of helpful literature available, Ms. Peterson said: "We must make the most of what is in the public's mind. We're riding a wave of the education that's out there. And we're providing a product . . . There's so much printed information available. A few years ago, there was practically none. Every manufacturer puts information forward. Never suggest the number of tablets the customer should take . . . Simply read the label instructions. Say, 'The manufacturers have recommended this. Through their laboratory analysis, they have found this.' Divert the information from your spoken word to some written piece of information that you have." The right place for advice? The audience was then asked to act as customers and present difficult or frequently asked questions to the panel. Here are some excerpts: Customer: I've been going to a doctor and have discovered, much to my alarm, that I have a fibrocystic lump in my breast. I heard somewhere that vitamin E is good for helping this, and also recently I read something about a macrobiotic diet, and I am wondering if this is some kind of a curative diet for my problem. I don't think the cyst is malignant. I'd like to find some kind of way to help myself without having some doctor cut me up. Peterson: How recently have you been to your doctor? Customer: Two weeks ago. I've had some time to think about this. Peterson: Did they do a complete mammogram? How did they diagnose it? Customer: No, it was just a manual diagnosis. They told me it was the size of a small lima bean. Peterson: You are seeking additional information, and certainly we would like to tell you that you have come to the right place . . . If you would be interested in changing your lifestyle--on the basis that the way you have lived to date has not been conducive to keeping your body free from that growth--I can show you information. We have classes on the macrobiotic way of living, and we work with people who teach it. The information you have come across on Vitamin E has probably come from Dr. Carlton Fredericks' book. I'd very much encourage you to read that so that you can also prevent further growth. And there's a lot of information we work with that the government has issued. One, for instance, is diet, nutrition and cancer prevention. There is an 800 number to get it: 1-800-4-CANCER. Customer: Are you saying that vitamin E does prevent further growth of this? Peterson: Dr. Fredericks' book addresses that issue, and I would very much encourage you to read that. Bland then commented: Kay, that was a nice job. I would have probably done one other thing myself. Because there are two types of fibrocystic conditions--one of which is more discomfiting than it is a warning sign of cancer -- I would have tried to get some quick information. Is this a long-term problem? Does it come close to your menstrual cycle? Have you had it come and go, or is it just in the last few months? Because if it has just come on -- a lump that is not inflamed and tender--it would be of higher order-risk for malignancy. If, however, it's been associated with the menses, been with her for many years, then it's probably the kind of thing Bob London talks about in his work with vitamin E and fibrocystic disease, lower fat diet, and so forth. You want to be very cautious that you don't alarm the person about having cancer if there is no need to alarm them. But you don't want to miss the possibility that it's not a menstrual cycle-related, long-term cystic mastitis, that it's a recent one and there is some concern about its pathology. When another "customer" asked whether taking 50 mg of zinc might deplete his body copper level and possibly lead to high levels of uric acid and triglycerides, Bland said probably not and offered to look at the product's label to determine whether the zinc-to-copper ratio was appropriate. He also suggested that the customer read more about "ways diet relates to triglycerides and uric acid from other avenues, such as a higher protein diet." To another questioner he advised that sustained-release vitamins might be advantageous because they maintain higher blood levels. Dealing with Resistance Several members of the audience pretended to be skeptical customers: Skeptic #1: Last week I kind of got carried away with your enthusiasm and I bought an entire vitamin program that you recommended. Then after I got home I really started thinking about it. I started reading some publications that neighbors gave me when they saw these vitamins that you recommended. Even such reputable magazines as Consumer Reports said that our diet is entirely adequate, and that they tested McDonald's and other fast foods and found that, based on the numbers of the RDA, that B-vitamins were at best useless and at worst can do some harm. So my question is, how do you know what I need and can you test me? Or is there a place I go to get tested, because I don't want to take something without knowing exactly what my needs are. Bennett: I can understand what you're saying because there is a lot of confusion in the marketplace. I remember my clerk talking to me about you when you had left because you had an awful lot of good questions. I understand that you're an athlete, a triathlon competitor. Well, your needs probably might be greater than a lot of other people's needs. You're talking about some of the high-potency vitamins that you are maybe a little afraid of. They said that you didn't think you were getting the proper diet, that you get up early in the morning and don't eat breakfast. What you may want to do is just gradually work into some of these. Don't take ten vitamins all at one time because maybe your system is not ready for them. You may want to start with multiple vitamins today and possibly additional C and additional E that you have here. And after two days, maybe add this amino acid to it along with it and try to build up. Just don't jump into it all at once. Does that make sense? Skeptic #1: Yes, it does. It's just a little different than the advice I was given initially . . . The main question about it all is basically how do I tell what exactly my nutrition needs are. Peterson: There are many tests. We can channel you to some doctors that we work with, or we have a clinical lab where you can have evaluations done for blood, hair analysis, and we have two doctors' offices that work with us. We'd be glad to refer you to them. * * * * * Skeptic #2: My friends take vitamins, but I don't think I need them. I eat well, exercise and get enough rest every night. I have some stress on the job site, but I cope with everything. Do I need to take vitamins? . . . Peterson: Do your friends eat as well as you do? Skeptic #2: I think so. Peterson: Since your friends' indication that they feel better when taking vitamins has raised the question in your mind, perhaps you should try a B-complex when you have a stress situation arising and see if that helps you cope better. Then you would have your own proof. You could also read some of the books related to stress. Mr. Bennett said he tells customers: "Genetics is very important . . . stress is very important, pregnancy is very important. Now these are all reasons that we need supplements. We need probably 60 nutrients every day in our diet to totally feed ourselves properly. Very few diets out there are accomplishing that." Bland added that customers who question the need for supplements can be steered toward nutrient-dense foods in the store by saying, "That's wonderful. Do you realize we have a whole series of good foods that can support you in your quest towards healthy living and high nutrient intake? You're doing a great job, and we want to reinforce it. Over here is a whole section of organic foods. If later you have some concerns about vitamins and minerals, we can talk about it." When a customer asked why natural C and B-vitamins cost more, Brodhead replied that the vitamin C in his products is made from corn by an enzymatic process--"the same process that is taking place internally in animals when they convert vitamin C from blood levels of glucose." He claimed that drugstore products may contain talc, shellac, artificial coloring, flavoring and preservatives, and may be coated so heavily with carnuba wax that they "completely pass through the body without being absorbed." A retailer from the audience said she tells customers that "perhaps that good diet was true in their grandparents' time when foods were grown in soil that was nutrient-rich and they had fewer environmental assaults. I tell them about a study on a pig fed corn grown in Iowa 30 or 50 years ago that did well. That same pig today would die." When asked how to handle a customer whose interest seems to have flagged, Bland suggested giving the customer a health appraisal form with questions about lots of symptoms that may surface and bring him back after he has had time to think further. When asked whether research by Linus Pauling may show that vitamin C can build up the immune system and make it more difficult to get AIDS, Bland replied that Dr. Ewan Cameron and others at the Pauling Institute are collaborating with an AIDS specialist at San Francisco General Hospital to explore the role of vitamin C and carnitine in AIDS. "The studies are not yet completed," Bland said, "but the testimonial anecdotes that we're getting from some of the participants are quite encouraging. In fact, the hospital doctor himself commented off-the-record recently that he was quite interested in the vitamin C connection with AIDS. So, I do believe it is well worthy of continued study and may offer an immunochemical supporting regime towards immune deficiency conditions." Regarding questions about stress, Bland commented: I would say, "What does the word stress mean to you,"because it's a very personalized definition. They could say, "It means buzzing in my ears, or high blood pressure, or I can't cope, or I get stomach upset, or I get diarrhea or feel confused." These are interesting ways of using that patient's/client's own identification system. Then say, "You've identified stress as insomnia. Let's talk about the things that we know about sleep disturbances. Are you getting regular exercise? Are you staying away from excessive sugar in your diet? Are you getting adequate B-complex nutrients--because the brain which represents only 6% of our body weight consumes about 20% of our energy, and it's a very nutrient-dense part of our body. If you're not properly nourished, the brain is probably the first part of the body that is adversely affected. That's why you can get changes in behavior and perception and sleep disturbances. Therefore, we want to concern ourselves with the B-complex nutrients. And we want to look at magnesium because that's another nutrient extremely important for normalizing proper nervous system function." So using their own symptoms of stress, you can work down into the holistic approach towards stress management. "High-Tech" Information When asked what else retailers should become knowledgeable about, Bland rattled off a long list of biochemical terms and tidbits, including: therapeutic uses of serotonin, phenylalanine, and catecholamines; use of tyrosine as a supposed brown fat activator substance because of its supposed noradrenalin relationship; and use of lysine and arginine in balance--lysine as an anti-viral substance, arginine as an inotropic agent which tends to stimulate the thymus gland output of thymosin which is an immune-activating hormone. "These are all exciting areas that require some technical competency on dose, how they work, their route of administration and dose schedule--things you should have in the back of your mind even though you're not going to prescribe for treatment." Bland also mentioned chromium, selenium, manganese, copper and zinc. "All of these have their own specific types of physiological functions. What you have to have at your fingertips or memory tips is some little vignette on each of those minerals, their bioavailability, the foods that they come in, why they are commonly the most deficient elements in the standard American diet. Eighty percent of them are lost by processing whole grains to white flour products. In the high-sugar, high-fat diets, where two-thirds of the calories come as sweet fats, there are very few trace elements. So there is a major area that the nutrition products industry can say something very well substantiated about the quality of the American diet." He also listed fish oils, linseed oil, antioxidants, free radical pathology, antioxidants, chain-breaking antioxidants, lipid peroxides, rancidity factors, glutathione, coenzyme Q, superoxide dismutase, betaine hydrochloride, intestinal ecology, toxic bowel, and high-fiber foods. Bland advised that adding "high-tech" in the form of journals, topical literature files, slides and audio tapes "would show people you are really looking at the science of nutrition." But he warned: "It is very easy to give up the high-touch type of format that makes this industry unique. It's extremely important not to compromise personal attention for technical expertise. A person really wants to have their needs dealt with by a caring, humanistic salesperson who has some level of competency, but I would say the competency is second to the personal concerns. If we trade off technology for concern then we've made a real bad mistake about the direction of this industry." "A few well-informed highly motivated consumers are your best advertising and sales force. My mother, who is a tremendously zealous advocate of nutritional products, has virtually made one of our health food store's business. She goes to all of her clubs and her social events. She is a missionary, saying 'You ought to be down there talking to the local health food place.' Because they have confidence in my mother, that kind of word-of-mouth confidence-builder then comes back to you. It is like training hundreds of salespeople to go out in the community." When asked about the value of hair analysis, Bland replied: Nutritional assessment is certainly justified on the basis of nutrition education and information either by computer, diet scan, or whatever diet technology you use. This is a valuable part of your service that customers may not be getting anywhere else, probably not from a doctor, for very few doctors are doing nutritional scans or evaluations. Hair analysis and similar diagnostic or prognostic screening tools have no place in a standard health food store. If you are into education or community service, the last thing you need is to be stigmatized as a quack or repository of cultist information. So by staying away from hair analysis and putting that into the hands of professionals who are licensed to do so, you can do your job best: education transfer, information, and nutritional counseling. Another retailer asked about the limits of advice: "A lot of people come into the store seeking alternative medical answers. For example, two weeks ago, a friend of mine came in and said he had gallstones. I told him my wife's father had had gallstones, had refused surgery, and went through a specific treatment that worked. It wasn't a wives' tale. It worked. Do you have any comment on how far legally we should or shouldn't go in sharing things like this with customers?" Bland replied: If a client asks a question that specific, you need to decide whether he is a client or a friend, and how well you know him. If he is a friend, then I would take him out to lunch, away from your store and talk to him as a friend. Don't talk as the store proprietor because that would be diagnosis and treatment. No matter what you think you are offering as a service, you are really, by the letter of the law, doing things that could be interpreted as diagnosis and treatment. However, if, as a friend, you anecdotally talk about your experience as a human being, there's no law that prevents freedom of speech. Ominous Implications? What are the implications of this seminar? What does it tell us about the attitudes of the health food industry? Do retailers really benefit from exposure to a long list of preliminary research findings? What do they do with this information? Are they qualified to understand it, or do they merely absorb clichés for use in selling supplement products? How much do retailers think about their limitations? Do seminars of this sort encourage them to go beyond their limitations? Is there really a difference between giving advice ("prescribing") and steering a customer to a piece of literature that gives the advice? Does anyone in the health food industry ever suggest that retailers faced with anecdotal evidence try to distinguish between cause-and-effect and coincidence? And what of Bland? Has he considered that retailers might lack sufficient background to utilize what he talks about? Does he really think they should form opinions and advise customers about types of breast lumps? What is his purpose in mentioning preliminary studies (pertaining to products in their stores) and then saying don't use them yet as a basis for recommending products? Many of his ideas about nutrient needs run counter to those of the scientific nutrition community. Does he deliberately slant his presentations to promote sales of the health food industry's products? Jeffrey Bland's Sales Aids (1986) "Hesitant to answer questions your customers may have about their nutritional concerns? For $79.95, add a doctor to your sales staff." So begins a recent ad in Natural Foods Merchandiser for four items produced by Jeffrey S. Bland, Ph.D.: Why Nutrient Supplementation? ($79.95), a 20-minute videotape or 35mm slide/audiocassette program, is intended for in-store customer viewing. In it Bland claims that: (a) "marginal deficiencies" are common in the United States; (b) many people who are under the presumption that they are healthy because they are not diseased would actually benefit from higher levels of health if they were taking a regular nutritional supplement; (c) if you eat a balanced diet, the need for supplementation may be reduced; and (d) "prudent nutritional supplementation" can "optimize nutrient quality" to help augment health and prevent disease. Bland also lists ten situations where supplements are supposedly needed, but says nothing about how individuals can determine whether they fit these supposed categories. (Presumably, those listening to the tape will either "play it safe" by buying a supplement or ask the retailer for advice on "optimization.") Introductory Nutrition ($120), a 12-hour audiocassette home-study course, "reviews the contemporary information concerning nutritional therapeutics including the use of vitamin and mineral supplements . . . for the serious student of nutritional biochemistry." Immunity and Nutrition ($100), a 12-hour audiocassette course, "presents the latest nutritional implications in such conditions as AIDS, Epstein-Barr virus, hepatitis, herpes, food allergy and hypersensitivity, arthritis and other autoimmune diseases, inflammatory bowel disorder, and chronic candidiasis" and examines the supposed role in "normalizing the immune system" of vitamin C, zinc, iron, copper, manganese, vitamin E, gammalinoleic acid, folic acid, vitamin B12, arginine, EPA, DHA, selenium, and lysine. Complementary Medicine Magazine ($30/year), published bimonthly by Dr. Bland, is "dedicated to providing you with the information you need to stay at the leading edge of preventive medicine." It is also said to be aimed at "wellness oriented physicians." Each issue contains articles and ads promoting unproven practices and products. -- Stephen Barrett, M.D. ______________________ The above article and Dr. Barrett's note were published in the May 1986 issue of Nutrition Forum newsletter. Mr. Fanning was a freelance science writer who produced the nationally syndicated consumer action column, "Help-Mate," and was Nutrition Forum's Washington correspondent. He was also editor and publisher of Con$umer New$weekly. Quackwatch Home Page This article was posted on December 2, 2003.