Common technical questions

Common Questions Concerning the Pharmanex® BioPhotonic Scanner

Question:
What science is there to validate the Pharmanex BioPhotonic Scanner?

RESPONSE:
The Pharmanex BioPhotonic Scanner is backed by science.
The use of Raman spectroscopy for biological measurements is an established scientific discipline backed
by years of research. The Pharmanex BioPhotonic Scanner is a patented application of Raman spectroscopy
for the measurement of carotenoid antioxidant nutrients in living tissue for the improvement of nutrition.
The use of biophotonics to assess biological molecules in living tissue is a distinct scientific discipline, and
the Pharmanex BioPhotonic Scanner is an instrument that is based on this scientific discipline.

The use of Raman spectroscopy for the assessment of human tissue carotenoids has been validated by at
least eight peer-reviewed studies conducted by third party entities unrelated to Pharmanex or the
supplementation industry. (Bernstein, 1998, 2002; Ermakov, 2004a, 2004b; Gellermann, 2004, 2002; Hata,
2000; Zhao, 2003). Raman spectroscopy is an established and accepted detection method; a Medline search
for the term raman spectroscopy yields over 4,400 articles. Most importantly, validation of Raman
spectroscopy is recognized through the award of Nobel Prize to Sir CV Raman for its discovery in 1930.

Pharmanex is not the only entity impressed with the nutritional implications of Raman spectroscopy. In
2003 the National Cancer Institute (a division of the National Institutes of Health) awarded researchers at
Yale University a $1 million grant to conduct a study using Raman detection of carotenoids as an objective
measure of fruit and vegetable intake. Most large-scale nutritional studies rely on diet recall surveys, which
are subject to errors of reporting fruit and vegetable consumption. The study will be completed in 2006
(Mayne et al, 2003; YCC News Release, 2003).

Importantly, Pharmanex has validated the use of Raman spectroscopy for the measurement of carotenoids
in 3 studies including a large-scale clinical screening study with 1,375 subjects that confirmed a correlation
between antioxidant status and lifestyle parameters (Smidt, 2003). A second study established efficacy of
LifePak® to improve the antioxidant status of subjects over a 12-week period (Smidt, 2002), and a third
study established a highly significant correlation (r=0.78, p < 0.001) between serum carotenoid levels and
skin carotenoid levels as assessed by the Pharmanex BioPhotonic scanner (Smidt, 2004a). More studies are
ongoing; a study in conjunction with the University of Utah looking at the correlation between skin
carotenoid levels and levels of water soluble antioxidants; a large-scale Pharmanex in-house correlation
study; and a study conducted at the Rippe Lifestyle Institute focusing on the antioxidant effects of weight-
loss. These studies after peer review will be published in scientific journals.

The Pharmanex BioPhotonic Scanner is consistently well received by experts in all areas of science.
Pharmanex Scientists have presented the science behind LifePak® and the BioPhotonic scanner at a number
of scientific meetings. In February 2003, Pharmanex scientists joined with Dr. James Rippe and the
inventor of the biophotonic scanner, Dr. Werner Gellermann in a presentation at the New York Academy of
Sciences. In February 2003 and 2004, Pharmanex Scientists attended scientific meetings on antioxidants
organized by the Oxygen Club of California in Cadiz, Spain, and Santa Barbara, California. Dr. Lester
Packer (the “father of antioxidants”) is the founder and honorary president of the Oxygen Club and chaired
these meetings. Dr. Carsten Smidt presented a scanner study at the Santa Barbara meeting. In April 2003
and 2004, Dr. Carsten Smidt attended the Federation of American Societies for Experimental Biology
(FASEB) meetings in San Diego and Washington DC, and presented the results of two different scanner
studies. The FASEB meeting is attended by more than 10,000 scientists from around the world, but only a
small percentage are selected to present. In January of 2004, Dr. Carsten Smidt attended and presented the
scanner/serum correlation study at the prestigious Gordon Research Conference on Carotenoids in Ventura,
California. Dr. Smidt also scanned 60 of the top antioxidant researchers in the world at this conference. In
all instances the Pharmanex BioPhotonic Scanner has been very well received by the scientific community.

Prepared by GCheney, Pharmanex Tech Com
Approved by NJackson; JChang; CSmidt; EKamauoha
Updated 20May2004

Question:
If the BioPhotonic Scanner measures only carotenoids, how can it be used to infer the status of other
nutrients?

RESPONSE:
Serum carotenoids correlate to overall antioxidant status
Carotenoid molecules are not regenerated like other antioxidants, and are degraded in the process of
neutralizing free radicals or reactive oxygen species. A typical carotenoid molecule like lycopene or β-
carotene is able to sustain more than 20 free radical hits by lipid radicals before it becomes completely
destroyed (Tsuchiya, 1994). Lycopene and β-carotene are just two examples of antioxidants among
hundreds of antioxidants that make up the antioxidant network. Carotenoids act sacrificially to protect other
members of the antioxidant network (such as vitamins E and C) from having to sustain free radical hits; in
this way carotenoids will support the entire antioxidant network consequently reducing the danger from
oxidative stress (Packer, 1994; Packer and Coleman, 1999). Conversely, high levels of oxidative stress
(e.g., with smoking) adversely affect the antioxidant network, and the resulting increased free radical
activity leads to a depletion or reduction in tissue carotenoids (Smidt and Shieh, 2003; Gollnick and
Siebenwirth, 2002, Dietrich, 2003).

A recent study conducted by Svilaas et al. established carotenoids as a reliable indicator of other dietary
antioxidants. Svilaas and his colleagues assessed antioxidant intake from diets of more than 2,670 adults,
and evaluated blood serum antioxidants of 61 individuals for seven consecutive days. Svilaas et al. found
the ability of carotenoids to predict serum levels of other antioxidants was stronger than the predictive
ability of alpha, beta, delta, and gamma-tocopherols as well as glutathione (Svilaas, 2004). Carotenoids are
not only convenient biomarkers because they are accurate predictors of overall antioxidant status, but also
they are Raman active and can be detected without the concerns of blood samples (Bernstein, 1998, 2002;
Gellermann 2002a; Zhao, 2003, Ermakov, 2004b). Furthermore, carotenoids are delivered to tissues by the
same mechanism as other fat-soluble antioxidants. This shared LDL delivery mode is the proposed
mechanism to explain the correlation between tissue carotenoids and other fat-soluble antioxidants in
multiple studies (Lasheras et al., 2002; Steinberg & Chait, 1998).

Serum carotenoids correlate to skin carotenoids
Skin carotenoids analyzed by HPLC were shown to correlate significantly to serum carotenoid levels
(Peng, 1995). The significant correlation between skin biopsy-levels of carotenoids and serum carotenoid
levels eliminates the need for routine skin removal. A more recent study showed a highly significant
correlation between serum total carotenoids and skin carotenoids as assessed by Raman Spectroscopy (r =
0.78, p < 0.001) (Smidt, 2004). These data bridge the findings of Svilaas, and Peng, to validate Raman
Spectroscopy as a method to assess skin carotenoid status as an indication of broad-spectrum antioxidant
status, without the inconvenience of skin and blood samples.

Carotenoids accepted as indicator of fruit and vegetable intake
Carotenoids include more than 50 antioxidants widely distributed among fruits and vegetables. When
ingested from dietary sources, the presence of carotenoids in living tissue is an indicator for the presence of
other important nutrients common to those dietary sources (Svilaas, 2004). Based on this correlation, the
National Cancer Institute awarded a $1 million research-grant to Yale scientists to conduct a study using
the Raman-detection of carotenoids as an objective measure of fruit and vegetable intake (Mayne et al,
2003; YCC News Release, 2003). The correlation between carotenoids and other nutrients applies to
nutritional supplements only to the degree they deliver optimal amounts of all essential and generally
beneficial nutrients. For this reason, LifePak® is formulated as a broad-spectrum multivitamin, mineral,
antioxidant supplement, which contains nutrients in amounts similar to a diet rich in fruits and vegetables.

Question:
What aspects of health are positively affected by proper carotenoid nutrition?

RESPONSE:
Carotenoids has been shown in countless studies to support many areas of health

Updated 20May2004

The scanner is not intended to diagnose, mitigate, treat, or cure any disease. Nonetheless, convincing
evidence suggests that certain carotenoids have been linked to health benefits including reduced risk of age-
related macular degeneration, cataracts, cardiovascular disease, and prostate cancer. A review article
written by Pharmanex scientists will appear in the peer-reviewed journal Current Trends in Nutraceutical
Research. The article includes a review of the role of carotenoids in human health and is summarized
below (Smidt and Burke, 2004).

Eye Health
A number of studies support the protective role of carotenoids in the prevention of age-related eye diseases.
For example, reduced risks of cataracts (Brown et al., 1999; Chasan-Taber et al., 1999) and age-related
macular degeneration (Seddon, 1994; Bone, 2000, 2003; Landrum, 1997, 1996; Elless, 2000; Bernstein,
2002, Richer, 1999; Hammond, 1997) have been associated with high intakes of vegetables rich in the
carotenoids lutein and zeaxanthin.

Cardiovascular Health
The carotenoids lutein and lycopene have been shown separately to support multiple aspects of
cardiovascular health. Studies show positive health implications of lutein including decreased risk of
mortality from cardiovascular disease (Kouris-Blazos, 2002), decreased progression of pre-atherosclerotic
conditions (Dwyer, 2001), and other cardioprotective effects (Olmedilla, 2001; Cardinault, 2003).

The cardioprotective effects of lycopene have also been shown in multiple studies including reduced risk of
myocardial infarction (Kohlmeier, 1997), lower risk of cardiovascular disease (Sesso, 2004), reduced LDL
oxidation (Agarwal, 1998), and reduced production of LDL cholesterol (Fuhrman et al., 1997).

Cancer
Epidemiological studies have shown that high intakes of tomatoes and tomato products, rich in lycopene, as
well as high blood levels of lycopene are significantly associated with decreased prostate cancer risk
(Deming, 2002; Giles, 1997; Giovanucci, 1995, 2002; Lu, 2001; Vogt, 2002). The finding of Kucuk et al.
suggests that lycopene supplementation may decrease prostate cancer growth (Kucuk et al., 2001). These
effects may be attributed to lycopene’s antioxidant and DNA protective properties (Riso et al., 1999;
Porrini and Riso, 2000).

Carotenoids may also play a role in cancer prevention because they can enhance gap junctional
communication (GJC) between cells. (Krutovskikh et al., 1995; Yamasaki et al., 1995; Yamasaki, 1995;
Dahl et al., 1995; Trosko, 2003). Lycopene and -carotene have been shown to enhance GJC
significantly, and these effects are not related to their known antioxidant properties (Sies and Stahl, 1997;
Stahl et al., 1997; Zhang et al., 1991). Thus, carotenoids may act via two distinct mechanisms of action to
protect from cancer: as antioxidants to prevent mutagenic DNA alterations, and as promoters of GJC.

Oxidative Stress correlates to skin carotenoid concentration
Many of the above diseases are known to be linked to oxidative stress. A population study of 1,375 subjects
was conducted at the Pharmanex Research Institute and found that individuals with high oxidative stress
generally have low skin carotenoid levels as measured by Raman spectroscopy, independent of subjects’
dietary carotenoid consumption. This correlation was demonstrated by using Urinary MDA test, a proven
model for oxidative stress (Smidt and Shieh, 2003).

Question:
Are other methods of testing more accurate at assessing antioxidant status?

RESPONSE:
Raman spectroscopy has been shown to be more reliable than other methods and more suitable for
routine measurements reduced probability of error
Before Raman detection of carotenoids, established methods of measuring antioxidant status included the
analysis of blood, urine, or tissue samples. These tests are expensive, invasive (e.g. skin biopsies; blood
draw), have a higher probability of error (multiple steps involved in sample preparation and quantification
all increase the magnitude of the overall error). Moreover, it may take weeks to receive the results. Also,

Updated 20May2004

the accuracy of tests using blood/serum or urine is placed in question due to possible effects of recent meals
as the timing that the biological sample is taken (blood or urine) influences the outcome. A recent clinical
study showed that Raman measurement of carotenoids in humans skin (palm of hand) correlates very
highly with total serum carotenoid levels quantified from fasted serum (Smidt, Gellermann, & Zidichouski,
2004). The BioPhotonic Scanner is a great way to measure carotenoid levels safely and non-invasively at
the site of action with the added advantage that it is well suited for routine measurements in large
populations. The ability to assess carotenoid status through Raman spectroscopy will lead to further
advances in nutritional and biological measurement.

Question:
How do Pharmanex formulations address the issue of excessively high levels of antioxidants acting as
pro-oxidants?

RESPONSE:
Pharmanex products contain nutrient amounts proven to be safe in clinical studies
The levels of all nutrients found in Pharmanex products are based on well documented epidemiological,
clinical, pre-clinical and safety studies. LifePak® is formulated to provide optimal nutrition with
substantiated levels of nutrients that will not induce a pro-oxidative state. Included in the comprehensive
blend of antioxidants is a balanced carotenoid combination in amounts similar to those provided by diets
high in fruits and vegetables: 7.5 mg β-carotene, 5 mg lycopene, 2 mg α-carotene and 2 mg lutein. Each
ingredient in LifePak® is present in amounts that are documented to be safe for long-term supplementation.
Further, LifePak is safe when taken in conjunction with a diet high in fruits and vegetables. The daily
amounts of all vitamins and minerals are well below the No-Observed Adverse Effect Levels (NOAEL)
established by the Council for Responsible Nutrition (CRN) in 1997 and the Upper Limits (UL) established
by the Food and Nutrition Board of the National Research Council.

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Updated 20May2004

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Updated 20May2004

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Updated 20May2004

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Updated 20May2004

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60799

Updated 20May2004

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