Immunity is all about balance. One minor disruption in that balance can propel an individual toward sickness, or in the most severe cases, death. According to Activate Your Immune System by Leonid Ber and Karolyn Gazella, the immune system holds the key to optimum health as it determines if one will get the flu, how long allergy symptoms will last, and even if one will succumb to the ravages of cancer or AIDS. In large part the immune system will dictate how one lives and how one will die.
On a daily basis humans are bombarded with several pathogens, most of which the body can handle. But living in a post September 11th world where the threat of bioterrorism is very real, building a strong immune system has never been more important. Because of this and other issues such as antibiotic resistance, a problematic healthcare system and a paradigm shift from treatment to prevention, nutraceuticals companies have an unprecedented opportunity to take advantage of these trends.
That said, it is no surprise that the immune support market has become a bustling segment playing host to a wide variety of ingredients. From mushrooms to herbs to vitamins and minerals, the immune support market is poised for explosive growth
Defining Immunity & Examining Trends
The definition of immunity can be simply stated as the body's ability to defend itself against viruses, toxins, bacteria, fungi, yeast and parasites. But immunity can mean so much more.
Brien Quirk, technical director of herbal supplier Draco Natural Products, San Jose, CA, discussed immunity from his perspective. "Immunity is the ability of the body to distinguish between self and non-self, and then defend against non-self," he said, adding, "That includes tumors and cancer because if there is a mutation in a cell, the body will recognize that. Everyday a person has a cell that turns into a cancer cell but the immune system is responsible for destroying it."
Playing into immunity is autoimmunity, which Mr. Quirk described as a situation when the body cannot distinguish between self and non-self and starts to attack itself. He said this happens in most cases because the immune system is weak. Examples of some of the autoimmune diseases or conditions include lupus, chronic fatigue syndrome (CFS) and Crohn's disease.
Defining immunity in more detail was Dr. Zheng-Xian Liu, principal consultant, GeroNutra, Hayward, CA, and consultant to GCI Nutrients and a scientific advisory board member of the NutrientNetwork Library, Burlingame, CA. "There are two basic lines of immunity, innate immunity and acquired immunity. Innate or natural immunity is inherited from parents and acquired or adaptive immunity is developed against individual invading agents (bacteria, viruses, toxins, foreign cells or tissues and cancer cells)," he said. "Immune defense is a holistic complex integrated system. Decreased immunity results in increased susceptibility to virtually all kinds of diseases (especially frequent infections, chronic fatigue and inflammation), accelerated degenerative processes (cancer and aging) as well as slowed healing processes."
Dr. Phil Brown, Ester-C product manager, Inter-Cal, Prescott, AZ, discussed some of the factors that can enhance immune support. "Pathogens that get past the skin and mucous membranes must be destroyed by special white blood cells called T-cells (cellular immunity) and immunoglobulins, or B-cells (humoral immunity)," he said. "The health of these cells and thus their ability to ward off invading agents can be greatly enhanced with proper nutrition, rest, exercise and supplements. Immune-enhancing supplements such as vitamin C and E, and minerals such as zinc can act to either stimulate the immune system or modulate it or keep it in balance."
According to Ram Chaudhari, senior executive vice president of research and development, Fortitech, Schenectady, NY, concern for immunity is a major global trend. "Immunity is a fast growing area of interest not only in North America but all over the world. The trend toward immunity is of interest because of the prevalence of infectious diseases, which relates to the breakdown of the immune system in some respect," he said.
Randy Kjelden, president of colostrum supplier Sterling Technology, Brookings, SD, said immunity is just starting to hit the radar screen in terms of importance. "It was said that 2000 would be the decade where consumers would become more aware of their immune system. That is definitely being played out and I am definitely seeing more awareness and use of immune support products," he stated. "People understand that they have to take care of their immune system because we are faced with a lot of issues that we weren't faced with in the past. Today, there are a lot of things that we can do for the immune system to keep the challenges to a minimum."
The category for immune support products is growing rapidly in popularity not only among consumers but researchers as well, according to Suzanne McNeary, vice president of marketing for mushroom supplier Tradeworks Group, Brattleboro, VT. "Natural product surveys are indicating that the immuno-stimulant category is one of the fastest growing areas for dietary supplements because health conscious consumers are using these types of products to fend off a variety of conditions and viral infections such as colds and flu," she said. "In addition, several researchers, health practitioners and patients are turning to alternative medicines to aid in immunology against more serious health conditions such as cancer." In fact, she said, the National Cancer Institute in the spring of 2000 stated that it was focusing more time and money on immunology research (the process of stimulating the body's own natural immune system to fight cancer cells) and apoptosis (programmed cell death) and the means of inducing it.
Developing an Immunity Formula
Mixing immune support ingredients together seems like a good idea in theory because of the possible synergism that might result in a combination formula. However, some experts urge caution when it comes to putting several ingredients together in a product because the interaction between components may not be well defined.
Draco's Mr. Quirk discussed the former. "I think combinations are the way to go because you need to balance all the different functions of immunity with a balanced formulation," he said. "The key is to take something on a long term basis instead of short term."
BI Nutraceuticals' Mr. Lenoble said the body is a very complex dynamic system and it doesn't have one pathway to immunity. "Just like the body has multiple systems it also needs multiple support systems. Vitamin C is going to work in one pathway and probiotics are going to work in another and echinacea in yet another. Also, it depends on whether you are trying to maintain immunity or just putting the immune system on alert."
David Law, president of mushroom supplier IGI International and CFO, Gourmet Mushrooms Inc., Sebastopol, CA, said companies should be careful when thinking about combining ingredients. "Once divergent components are put into a mix it will be very difficult to identify what is working. It will take a very large scale and long term observation to prove that a mix is indeed effective," he said, adding, "Of course, any folk remedy had its beginning sometime in the past."
Dr. Liu also expressed concern for combination products. "A combination of 'a little bit of everything' does not necessarily result in optimum immune support," he explained. "The selection for ingredients in the combination needs to be more specific with clear scientific data, and nutrient-nutrient interactions/nutrients-immune response interactions need to be considered. Another issue in combination products is the balance of different functions."
Katie Ferren, marketing director of Los Angeles, CA-based OptiPure/Soft Gel, which supplies Maitake BetaPure and Maitake BetaPreme, said companies fall into both camps. "I think people still go both ways. Take echinacea for example, I have always been told that it should not be taken in the middle of a cold and that it should be taken right when someone feels sick. If echinacea is combined with some of the other immune support ingredients, the person taking echinacea in the middle of the cold might actually prolong it," she said, adding, "In some cases combinations are great because you are targeting different areas of immune support but in other areas you need to take a specific product during a specific time."
Lori Siegler, marketing manager, Larex, White Bear Lake, MN, suppliers of ImmunEnhancer arabinogalactan, said both single ingredient and combination products are available but it is ultimately in the consumers hands to figure out which best suits their needs. "On the market you are going to see both types of products," she said "I think the combination products are going to be better for prevention or overall wellness based on the fact that different immune ingredients may act differently on the immune system." In fact, Ms. Siegler said, arabinogalactan has been combined with several immune support ingredients including beta glucan, colostrum, mushrooms and vitamin C. What consumers choose, she said, comes down to how much research they have done on immune support ingredients.
Michael Shahani, director of operations for probiotic supplier Nebraska Cultures, Walnut Creek, CA, said combination products are possible but preliminary. "Combinations would certainly be possible, and the combined effects of various immune boosting substances could very well have a positive symbiotic effect. However, this is an area in which much research is still to be done," he said.
Dan Wright, marketing manager, human nutrition, BASF, Mount Olive, NJ, said consumers are looking for products that meet certain needs. "In the market there are more and more products targeted toward specific indications and that is how the consumer looks at these products," he said. "In their mind there is not just one pill or one food that does everything that they need. People are looking to take more specific treatments for specific indications."
From a regulatory perspective, Rod Lenoble, technical director, BI Nutraceutials, Longmont, CO, said companies must use caution when positioning immune support products. "From an FDA or FTC approach companies are not allowed to portray a product as an immune booster, and they must be careful about AIDS and cancer claims. AIDS represents a compromised immune system, so anything that says 'fortifies the immune system' or 'stimulates the immune system' may get you into trouble," he explained. "You can say 'maintains a normal or healthy immune system.' The better the immune stimulating properties, the more likely the product is to be used as a drug."
Consumer Awareness
Although awareness is growing, most experts agree that more education needs to take place in order to teach consumers what immunity is and what the consequences are for not maintaining it. Speaking to this was Ms. McNeary of Tradeworks, who said, "Awareness is growing about the importance of maintaining a healthy immune system. If marketers took more time to educate consumers about immunity, and not just about colds and flus in the winter but about how the immune system protects against serious illness, they would see their immune product sales grow even faster."
Ms. McNeary continued on saying that most health professionals and researchers would concur that the foundation of good health is a strong and proactive immune system. It therefore makes sense, she said, to make immune support a top priority because it would be a compelling story that health conscious consumers would embrace and act upon.
Mr. Lenoble of BI Nutraceuticals said consumer awareness for immunity has increased because of AIDS but it still remains a low priority health concern because it is a difficult health message to communicate. "I don't think your common consumer considers immunity a top priority as they may consider heart and bone health, which carry easy messages," he said. "This is not like calcium and bone health, which is a one to one relationship. Immunity is much more complex because there are so many roles and pathways."
Dave Parish, president and CEO, Designed Nutritional Products, Orem, UT, which supplies a range of immune support ingredients, also discussed education and how consumers rank immunity amongst other health concerns. "I think we still have a long way to go in terms of education but I think we have come a long way in the last decade," he said. "I would say immune support is definitely within the top 10 in terms of health concerns for consumers and possibly in the top five."
Jerakae Jensen, director of research and development for Tahitian Noni producer Morinda, Orem, UT, suppliers of Tahitian Noni, offered a different perspective on consumer awareness. "Most consumers' awareness of immunity is low. In the 1960s and 1970s people were more aware of immunity because of the effort by the government to immunize the public against certain communicable diseases such as polio, smallpox, mumps and measles," he said, "Today that awareness is not as high. Most parents are made aware they should immunize their children, but the percentage that do is not as high as it was in the past."
Vitamins & Minerals
Vitamin C. Vitamin C is an ingredient that most consumers are familiar with when it comes to immunity, primarily as a result of orange juice consumption. Inter-Cal's Dr. Brown explained vitamin C's role specifically. "Vitamin C has long been associated with reducing the incidence and severity of colds," he said, adding, "Vitamin C also enhances activities of natural killer (NK) cells, which act as biological fire fighters that go anywhere there is a flaming antigen."
Most recently a study was conducted on Inter-Cal's Ester-C in the U.K., which is known for its harsh weather and high incidence of colds. It is soon to be published in a peer reviewed journal. Dr. Brown explained the details of the trial. "We took almost 200 people and put half on placebo and half on Ester-C. It was a blinded placebo controlled study that examined lifestyles of individuals on the Ester-C product and those on placebo. We questioned them as to whether or not they became sick at all throughout the year while taking this product and how it compared with the previous year," he said. "We found a significant difference between those on Ester-C and those on placebo."
Zinc. Gaining a lot of ground in the immune support market is zinc, especially in the area of the common cold. It is included in popular products such as Zicam, which, according to its manufacturer, Gel Tech, Phoenix, AZ, can reduce the duration of the common cold by an average of 71% when taken at the onset of symptoms.
Allondra Stevens, marketing services manager, InterHealth Nutraceuticals, Benicia, CA, which supplies OptiZinc and higher potency L-OptiZinc (patented forms of methionine-bound zinc) also supports the capabilities of the mineral. "Zinc is a well known essential trace element needed to support the immune system. In addition, OptiZinc and L-OptiZinc act as antioxidants (similar to vitamins E, C and beta-carotene), by neutralizing harmful free radicals, which may cause cell death and damage in the body," she said.
Beta Glucans
Beta glucans from yeast are branched with beta 1,6 and 1,3 glucans, according to Biopolymer Engineering, Eagan, MN. The company's Imucell WGP product works directly with the immune system as an immune modulator by activating the macrophage, which identifies and destroys foreign invaders, and coordinates the body's other defenders. WGP beta glucan is extracted and purified from the cell walls of food grade baker's yeast, which is permitted for use in food by the FDA. Currently, Imucell is being studied by major universities including Harvard and the University of Louisville as well as the U.S. and Canadian Department of Defense agencies. According to Dr. Gary Ostroff, vice president of research and development, the company was approached by the Canadian government to further the research on anthrax based on published research with its injectable formulation of beta glucan. Dr. Ostroff said the injectable formulation of beta glucan would be of very limited use in the case of an anthrax outbreak, so the company and the Canadian government started to heavily investigate an orally active formulation of beta glucan that could be more widely produced and available to consumers. So far, said Dr. Ostroff, the oral formulation of the beta glucan has been able to withstand the same battery of tests and provide broad anti-infective protection.
Beta glucans function in several areas of health including sports nutrition. Mr. Parish explained the application of Designed Nutritionals' beta glucan product, which is plant derived. "Our Glycogen beta glucan, which we use for sports nutrition, has a role in the immune support market because it has been shown to possess anti-tumor effects. Additionally, it may also improve host resistance to several types of infections and reverse radiation damage." In terms of its application in the sports nutrition market, Mr. Parish said, "When engaging in strenuous physical exercise the body can be compromised. If you are not getting the immune support that you need, then someone who is heavily involved in sports can be more susceptible to infection and disease. Using something to provide energy as well as immune support and boost white blood cells can be a really good thing."
Mushrooms
One of the fastest growing categories for immunity is mushrooms, which have gained a lot of ground within the last five years. The medicinal qualities have been known in Asia for several centuries but only recently have the health benefits been touted in the Western world. There are several types of mushrooms that have a place in the immune support market. Of these, maitake and shiitake are specifically highlighted.
Mushrooms have been singled out for their beta glucan content but IGI's Mr. Law suggested that it is the whole nutritional profile of mushrooms that are of value to immune enhancement. "With mushrooms it is not just about the beta glucans, it is the whole mushroom that has a significant effect on the immune system. We think in mushrooms there are a lot of materials that affect challenges in the immune system," he said, adding, "We are currently sponsoring several clinics in the U.K. to undergo clinical observations on the effects of our mushroom products. These observations are conducted more from a curiosity standpoint as we feel that the actions of mushrooms in our bodies are multi-factorial, which do not fit the modern pharmaceutical model (single ingredient, single symptom)."
Shiitake (Lentinula edodes). The Shiitake mushroom has been hailed for its water soluble polysaccharide, also known as Lentinan, which is an approved anti-cancer drug in Japan. As stated in Growing Gourmet and Medicinal Mushrooms, the mode of activity appears to be the activation of killer and helper T-cells. Also, according to the book, it is interesting to note that while Lentinan has been studied extensively outside the U.S., it is not the only component of shiitake to yield positive health benefits. There are several components in shiitake, which show promise. In fact, a researcher in 1997 found that shiitake's mycelium produces a water soluble lignin-polysaccharide fraction, unique from lentinan, which has potent antiviral and immunopotentiating activities in vitro and in vivo.
Maitake (Grifola frondosa). In terms of the maitake mushroom, Growing Gourmet and Medicinal Mushrooms by Paul Stamets stated, "In vitro studies at the National Cancer Institute of the powdered fruit bodies of Grifola frondosa showed significant activity against the HIV (AIDS) virus when tested through its Anti-HIV Drug Testing System under the Developmental Therapeutics ProgramOne of the polysaccharide fractions responsible for the immunostimulatory activity is three branched beta 1,6 glucan known as grifolan."
Proteins
Immunoglobulins. According to Proliant, Ames, IA, immunoglobulins (a collective term for antibodies) are proteins that are found in the blood and other body fluids, which are produced when the body has been exposed to an antigen. Their basic functions are neutralization and opsonization of bacteria, viruses and other environmental pathogens. Immunoglobulins are so important to the effectiveness of the immune system that immunoglobulin concentrations are the primary measure of immune system health. Playing into this is Proliant's ImmunoLin product, which contains a natural, concentrated source of immunoglobulin and other immuno-proteins that are derived from cattle specifically raised for food.
What sets ImmunoLin apart from other immune support ingredients is its immediate effects, becoming useful as soon as it is soluble. This ingredient is particularly rich in the immunoglobulins IgG, IgM and IgA as well as endotoxin-binding proteins and other acute phase proteins that can provide added immune support benefits.
Thymic Protein A. Another ingredient showing promise is Thymic Protein A, which may play a role in those suffering from chronic fatigue and immune dysfunction syndrome (CFIDS). Thymic protein is depleted in humans due to the shrinkage of the thymus gland, which begins at puberty. The loss of thymic function results in a lowering of immune readiness and reduced ability to handle infectious agents when they attack the body. Thymic Protein A acts as a potent immune regulator by activating the key T-4 helper white blood cells and restoring immune function, according to George Klabin of Longevity Science, Los Angeles, CA, producer of ProBoost. Most recently, a study on Thymic Protein A was published in the Journal of Nutritional and Environmental Medicine. The study was designed to determine if oral administration of Thymic Protein A would produce noticeable results in 23 patients suffering from CFIDS. Sixteen of the 23 patients in the study showed marked improvement in immune system function, with a corresponding improvement of the clinical symptoms of CFIDS.
Whey Protein Isolate (WPI). WPI has been well established for its role in the sports nutrition market but recent studies have begun to explore the immune modulating effects of WPI as well, according to Howard Simon, president, American Ingredients, Anaheim, CA, which supplies a full range of immune support ingredients. "WPI contains many important protein molecules such as glycomacropeptides (GMP) and IgG (immunoglobulin) that play a newly recognized role in strengthening the immune system," he explained. "WPI also has a positive effect on glutathione, a vital water soluble antioxidant present in the body that plays a critical role in the body's immune system, reducing oxidative stress, maintaining general well being and assisting proper liver function."
In terms of recent research, Mr. Simon revealed that several newly published clinical studies have suggested the helpfulness of whey protein in conjunction with conventional treatment in a variety of diseases including HIV, hepatitis, high blood pressure, ulcers, chronic fatigue, immune system dysfunction and bacterial and viral infections. These studies, he said, have shown initial positive results but additional work must be completed in order to substantiate claims more fully.
Herbs
Astragalus (Astragalus membranaceus). According to Draco's Mr. Quirk, astragalus has incredible possibilities because it is capable of increasing so many aspects of immunity. "It can do several things including increase energy and interferon production and directly interfere with viral replication," he said. "It also increases secretary IgA, which is an important immune substance that directly inactivates viruses and bacteria." Mr. Quirk cited one study, which was done in China on 1000 subjects that were given an oral administration or nasal spray containing astragalus. Astragalus decreased the incidence of colds in a significant number of individuals and also shortened the duration as well.
Echinacea (Echinacea angustifolia & Echinacea purpurea). Echinacea's role has always been in immune modulation and sometimes promotion, according to BI Nutraceuticals' Mr. Lenoble. What modulation would include, he said, is taking an intact healthy immune system and priming it for an event that may occur. "A lot of people will get a cold and take echinacea to shorten the duration and severity and there is some data to support that, but the real use for echinacea is to help prevent the onset of a cold," he said.
Garlic. According to American Ingredients' Mr. Simon, garlic provides a high concentration of allicin and other important naturally occurring enzymes. "Garlic has powerful anti-microbial, antibacterial and antioxidant effects," he said. "Its antioxidant activity helps to fight free radical damage throughout the body and can help to stimulate immunity in the gut by helping to maintain a proper balance of beneficial bacteria in the intestinal tract. Its anti-microbial/anti-fungal action helps to maintain gut health by killing off pathogenic bacteria such as h. pylori and Candida albicans." According to Mr. Simon, most research on garlic focuses on heart health and its role in maintaining good cholesterol levels. However there are new studies that have begun to focus on the immune enhancing effects of garlic and its role in cancer, and cold and flu prevention. "The preliminary research results seem encouraging, but more in depth studies are needed in order to substantiate the preliminary results," he added.
Ginseng. Ginseng has a particular component that has been examined for its immune stimulating properties. According to Planta Med, the acidic polysaccharide from Panax ginseng, also known as ginsan, is 12 times stronger than lentinan in activating an important part of the immune response against tumors. Draco's Mr. Quirk said the water soluble component of ginseng is a unique polysaccharide that is not present in most ginseng extracts because it is not soluble in ethanol or hexane, which are the extraction solvents commonly used. In fact, he said, the solvents kick out or precipitate (i.e., make insoluble) these polysaccharides, which then don't end up in the final extract. "Many ginseng extracts are standardized to ginsenosides only and these compounds stimulate cortisol release, an adrenal hormone glucocorticoid that is immunosuppressive," Mr. Quirk explained. "This type of ginseng extract is very imbalanced in its immune response because of lacking the important polysaccharides.
Lycii Berry (Lycium chinensis). Commonly referred to as wolf berry, this herb has been slow in gaining recognition in the U.S. Because of its potential, however, Draco's Mr. Quirk suggested it should grow in popularity in the future. Also commenting of wolf berry was Dr. Liu, who said, "Wolf berry fruit (Gou Ji Zi, Fructus Lycii, Lycium barbarum) nourishes the liver and kidney and is "Yin" tonic. Studies show that wolf berry fruit has excellent beneficial effects for the immune system (enhancing innate and humoral immunity)," he said, adding, "Among the various species of Chinese wolf berries, Ningxia wolf berry fruit is the most potent one, and it has the highest levels of immune-stimulating polysaccharides."
Probiotics
Probiotics. In terms of probiotics, specifically DDS-1, Nebraska Cultures' Mr. Shahani said, "The DDS-1 strain of L. acidophilus has been shown to effectively boost immune response. Among other peer-reviewed scientific journals, this was reported by two separate research studies found in the Journal of the American Nutraceutical Association" However, he said, "Much research still needs to be done showing the effect of probiotics on the immune system, but the completed research shows that probiotics are effective in modulating the immune response."
Joanna Wozniak, marketing coordinator for probiotic supplier Institut Rosell, Montreal, Canada, said the company's probiotic strains, L. acidophilus Rosell-52 and L. rhamnosus Rosell-11, have been researched for their immune modulating effects. "Their primary site of action is on the intestinal wall where they interact with immune cells by direct contact or by stimulating cytokine production (cytokines are immune cell mediators that facilitate communication and coordination within the immune system)," she explained. "For instance, L. acidophilus Rosell-52 can increase the number of immune cells ready to fight against intestinal pathogens. Further, studies have shown that L. acidophilus Rosell-52 stimulates the production of antibodies."
Other Ingredients
Arabinogalactan. According Larex's technical director, Dr. Richard Lamb, 66-75% of the human immune system is located along the intestinal tract. Because of this, Larex's prebiotic fiber, ImmunEnhancer has a vital role to play in the immune support market because it helps maintain a healthy gut. "One of the things that arabinogalactan has going for it is its ability to detoxify the body, which can reduce the load on the immune system-this is where you get a lot of the association between gut health and immunity," Dr. Lamb explained. ImmunEnhancer is an FDA approved direct food ingredient and is also self affirmed GRAS.
Colostrum. Colostrum is a valuable source of immune components including immunoglobulins, lactoferrin, cytokines and growth factors. Sterling Technology's Mr. Kjelden referred to it as a 'stand in immune system.' "Colostrum is really the only thing in nature whose specific purpose is to provide an immune system for the offspring of the animal. The components of colostrum have direct jobs to do throughout the body, from the mouth throughout the whole digestive tract," he said. "It takes care of a lot of the day to day challenges, so that the body is able to handle bigger challenges down the road."
Mr. Kjelden views colostrum as a maintenance ingredient, as opposed to echinacea, which is taken for colds/flus. "Echinacea seems to work well for colds but at the same time you can't take echinacea everyday, so by taking relatively small amounts of colostrum daily the bacteria and viruses will be kept at bay," he offered.
Elderberry. In addition to its antioxidant capabilities, elderberry has also been cited for its immune protective properties, according to Western Medicinal Plants and Herbs by Steven Foster and Christopher Hobbs. The book states, "Recent laboratory and clinical studies show that elderberry fruit extracts are protective against different strains of the flu virus, thus supporting traditional useProven biological effects include anti-fungal, antibacterial, antiviral, diuretic, hypotensive, anti-inflammatory and liver protective properties."
Germanium. According to Designed Nutritional Products, germanium, specifically its Ge-132 product, supports the immune system as a potent gamma interfon inducer. "Gamma interferon has a broad spectrum approach to immunity and as such it is very effective in alleviating and preventing viral conditions. It is also very effective in many mutagenic or malignancies or cancerous conditions," Mr. Parish explained. "Boosting gamma interferon can be very beneficial toward cancer cells and the influenza virus. Currently on the market there are many synthetic forms of interferons but often they have undesirable side effects. Ge-132 can boost the body's natural production of interferon through an orally active pathway."
Noni (Morinda citrifolia). The research on noni's effects on the immune system is still very preliminary as few studies have been conducted in this area. One study, which was published in Phytotherapy Research in 1999 stated, "The fruit juice of Morinda citrifolia (noni) contains a polysaccharide-rich substance (noni-ppt) with anti-tumor activity. Therapeutic administration of noni-ppt significantly increased survival time of tumor bearing mice. Results also suggested the possibility that noni-ppt may suppress tumor growth through activation of the host immune system. Noni-ppt was also capable of stimulating the release of several cytokines from immune cells."
Phytosterols. Dr. P.J. Bouic of the University of Stellenbosch in South Africa has been one of the main researchers in the area of phytosterols and immunity. In a recent review of research, he stated, "Over the last 15 years several reports have appeared in the literature indicating that phytosterols have some immunological activity as highlighted in animal models of inflammation or even in in vitro and in vivo models of cancer (colorectal and breast cancer). These findings were paralleled by epidemiological studies correlating the reduced risk of numerous diseases and the dietary intake of phytosterols," he said. "It is only in the last 10 years, however, that their direct immune modulatory activity on human lymphocytes has been proven and the mechanism of action in cancer cells has been elucidated. The use of phytosterols as supportive therapies in certain chronic conditions has been tested under clinical trial conditions." One industry expert commented that awareness for phytosterols and immune support is very low but the work being done remains an interesting area of focus.