Sean Moloughney03.01.10
“Change begins small.” And there is a little bottle—filled with billions of tiny micro-organisms—that is making a huge impact on human health and the world of preventative medicine.
Yakult, a fermented dairy drink with well-watered roots in Japan, promotes better health by delivering a specific strain of bacteria to the intestines. Research indicates it promotes healthier intestinal activity, suppresses the growth of harmful bacteria in the gut and helps to activate the body’s natural immune system.
While probiotics may be among the smallest nutritional/dietary ingredients on the market today, in terms of sheer size, their potential continues to grow alongside an already lengthy dossier of clinical evidence.
Americans are only beginning to understand the concept of beneficial bacteria and are generally unclear about the term probiotics, which the Food and Agriculture Organization of the United Nations (FAO)/World Health Organization (WHO) define as “live microorganisms which when administered in adequate amounts confer a health benefit to their host.”
Located in Tokyo, the bustling capital of Japan—where the concept of functional food originated—Yakult Honsha Co., Ltd. has been hard at work becoming the premier probiotics company, leading through science, education and sustainable development.
Recently, as part of an ongoing program to educate trade and consumer media, Yakult invited a group of journalists to tour its facilities in Japan, to learn about the research behind probiotics and the Yakult brand and to gain perspective on the Japanese healthcare system.
Rooted in Science
The origin of Yakult dates back to 1930, when Dr. Minoru Shirota was working in a microbiology lab at Kyoto Imperial University’s School of Medicine. In 1933 he became the first person to succeed in culturing a fortified strain of lactic acid bacteria beneficial to human health. This bacterium was named Lactobacillus casei strain Shirota, and provided the building blocks for Yakult.
Dr. Shirota gained inspiration from Russian scientist Ilya Metchnikoff, a Nobel Prize winner for medicine, who helped establish the theory that lactic acid could prolong life. In the 1930s, Japan was not a wealthy nation, and many children fell victim to infectious diseases and poor nutrition. Dr. Shirota focused on developing a stronger strain of lactic acid bacteria that would help destroy the harmful bacteria living in the intestines, and therefore improve and maintain the health of Japanese citizens.
Yakult—which takes its name from the Esperanto word “Jahurto,” meaning yogurt—was introduced to the market in 1935. Fast-forward 75 years, and the recipe for Yakult hasn’t changed. But the health of the Japanese people has, dramatically. Japan has one of the highest life expectancy rates in the world (79 years for men and 86 years for women). With a traditional, healthy diet centered on fish and vegetables, alongside a healthcare system the WHO has ranked in the top 10, Japan has actively embraced the concept of preventative medicine.
Yakult is not just about probiotics. The company is based on three basic tenets of its founder’s philosophy: a healthy intestine leads to a long life, preventive medicine and bringing good health to people at a reasonable price. These principles comprise the foundation for “Shirota-ism,” which is at the core of everything Yakult does.
The company’s corporate philosophy states: “We contribute to the health and happiness of people around the world through pursuit of excellence in life science in general and our research and experience in microorganisms in particular.”
In fact, Yakult’s business model has taken corporate social responsibility to a new level, partnering with the government, local organizations, schools and other groups to educate people about probiotics and the role they play in supporting general health and wellness.
But science continues to be the company’s chief focus. The Yakult Central Institute for Microbiological Research in Tokyo was established in 1955 and involves basic and application research for functional food products, as well as pharmaceuticals and cosmetics. Yakult also opened its European Research Center in 2005 in Ghent, Belgium to conduct research on European intestinal flora and to gather scientific proof of its dairy products in European populations. Today, Lactobacillus casei strain Shirota is one of the most clinically studied probiotic strains in the world.
Evidence supporting the use of probiotics to treat or prevent various health conditions continues to mount. For example, world-renowned scientist Hideki Ishikawa, of the Department of Molecular-Targeting Cancer Prevention, Kyoto Prefectural University of Medicine, presented research that Lactobacillus casei powder can be used for prevention of colorectal tumors. Details were published in Nature Clinical Practice Gastroenterology & Hepatology in 2005. His research is ongoing and follow-up to this study is set to publish in the coming year, he said.
Dr. Ishikawa also presented a randomized trial of the effect of Bifidobacteria-fermented milk on ulcerative colitis, which indicated that supplementation was successful in maintaining remission and had possible preventive effects of relapse. These results were published in the Journal of the American College of Nutrition in 2003.
Probiotic therapy has also been beneficial for pediatric surgical patients, according to Yutaka Kanamori, MD, from the Department of Pediatric Surgery, Graduate School of Medicine, University of Tokyo. His work demonstrated that probiotics effectively improve intestinal microbiota, prevent severe infections and promote physical growth in these patients. Additionally, therapeutic use of synbiotics (probiotics in combination with a prebiotic) can be quite effective in critically ill pediatric surgical patients with abnormal intestinal microbiota, he added.
Masanobu Nanno, senior researcher at the Yakult Central Institute, noted significant evidence that probiotics can activate the human body’s innate immune defense system, supporting the idea that these powerful microorganisms are invaluable tools in the field of preventative medicine.
The evidence is overwhelming. And the science is ongoing.
FOSHU
Acknowledging the value of dietary ingredients like probiotics, the Japanese government established a formal system in 1984 that recognizes “Foods for Specified Health Uses” (FOSHU). These foods contain functional ingredients and are officially and individually approved to claim beneficial effects on the human body. In order to gain approval, scientific evidence must be included in the application material demonstrating a product’s efficacy, safety and quality.
FOSHU represents a category of products—distinctly separate from medical drugs—that target people with generally mild symptoms, below the threshold for drug intervention. The first FOSHU product was approved in 1993, and as of August 2009, the market included a total of 894 products. In terms of market size, FOSHU represented about ¥680 billion, or $7.6 billion, as of 2007. Products that offer health benefits for gastrointestinal conditions represent the largest FOSHU market. Ingredients used in these products, alongside lactic acid bacteria, include bifidobacteria, oligosaccharides, dietary fiber, guar gum and others. The government started FOSHU to avoid consumer confusion. Today, products carrying the FOSHU symbol are widely recognized across Japan.
Yakult products extend beyond the company’s signature probiotic drink. For example, Pretio is a FOSHU-approved product designed to lower blood pressure that contains more than 10 mg of GABA (gamma-amino butyric acid) and is produced by a patented process that mixes L. casei strain Shirota and Lactococcus lactis. Other drinkable, hard and soft type yogurts include Joie, Sofuhl and Puala, alongside a host of fermented milks and other functional beverages, many of which carry the FOSHU symbol.
Shokuiku
Incorporating FOSHU products into a traditional Japanese diet that is high in omega 3 fatty acids and fiber has served the Japanese people well. However, Japan is not immune to the stress of modern 21st century life, as health officials have acknowledged an increase in so-called “lifestyle-related diseases.”
Diets have changed to meet the rigor of a fast-paced society, leading to irregular and nutritionally unbalanced meals, diabetes, obesity—and an excessive desire to be slim—dependence on food from abroad, food safety issues and a loss of traditional food culture, according to experts.
In response, in 2005 the government introduced “Shokuiku,” which basically means food and nutrition education. “For citizens to cultivate health and humanity throughout their lives, Shokuiku is the acquisition of knowledge about food and nutrition as well as the ability to make appropriate decisions through practical experience with food, with the aim of developing people’s ability to live on a healthy diet,” according to official language.
Health authorities consider Shokuiku the foundation for living, and have positioned this law as the basis for intellectual, moral and physical education. Shokuiku has been promoted as a national movement, at home, in schools and in all related elements of the community, including health centers, medical institutions, agricultural, forestry and fishery production and food manufacturing, processing and distribution points, according to Naomi Aiba of the Nutritional Education Program, National Institute of Health and Nutrition (NIHN).
Dr. Aiba said the U.S. and Japan are dealing with similar problems. “We are faced with common challenges, like obesity and lifestyle-related diseases and metabolic syndrome. Japan is trying to use Shokuiku as a tool to confront those challenges. We believe preventative medicine is indispensable. Also, education is very important. Education will increase the probability of preventing these diseases.”
Just as people need to take responsibility for their health, food companies are in a unique position and need to play their role in helping consumers make better, more informed food choices, she added.
Shokuiku is perhaps best represented in schools, where healthy eating is based on certain dietary guidelines that include eating well-balanced meals. At Nishikasai Elementary School in the Edogawa District of Tokyo, school lunch is actually a class, where students often prepare meals in groups while also learning the importance of eating grains, fruits and vegetables. Students also inherit Japanese food culture by incorporating dishes that use traditional Japanese ingredients. Many schools also contract with local farmers, supporting the local community and economy.
Yakult Ladies
Perhaps most representative of Yakult’s relationship with the broader community, the company launched a unique, door-to-door delivery system in 1963 called the Yakult Ladies. They help customers fully understand the benefits of lactobacilli by hand-delivering products to people throughout Japan and other countries—by bicycle, motorbike, car, cart and foot.
According to Yakult, the unique system “is an inseparable part of the Yakult business, which is based on Dr. Shirota’s philosophies.” Currently, there are 41,483 Yakult Ladies working in Japan, with 2599 sales centers located throughout the country. Overseas, there are about 36,500 Yakult Ladies.
A typical part-time Yakult Lady (average age of 42) is also a full-time mother. And so there are 1373 daycare facilities near sales centers to help maintain a working environment for these women. Traveling by bicycle in a suburb of Tokyo, the personal impact of such a system becomes very apparent. Yakult Ladies develop meaningful relationships with their customers, checking on the safety and well-being of the elderly, while offering counsel, support and a friendly smile.
Distribution
Yakult Honsha (Honsha means “head office” in Japanese) has been expanding its international sales for decades. From 1964 to 1990 this expansion was out of necessity, according to Yoshihiro Kawabata, head of Yakult’s international business department.
Today the emphasis is on making Yakult an internationally-recognized brand.
Those little bottles—appropriately sized for the smallest of hands—are now sold in 32 countries, and consumed by about 28 million people every day. Overseas sales have risen from 10% of Yakult’s business in 1996, to 26% in 2008, according to Mr. Kawabata.
Yakult was introduced to the first mainstream U.S. market in September 2007, starting in California and gradually rolling out to other states, including Arizona, Nevada and Texas. Currently, Yakult’s U.S. sales stand at around 100,000 bottles per day in six states. “One of the keys to our steady growth is our honest and sincere approach to educate our customers about their health,” said Teruo Tabuchi, vice president and COO, Yakult U.S.A., Torrance, CA, which was established in 1999.
Furthering its quest to educate and promote health through balanced nutrition and consumption of probiotics, Yakult Honsha plans to build its first U.S. production facility by 2012 and extend sales into other areas of the country. Yakult U.S.A. Inc. currently imports the beverage from Guadalajara, Mexico. No location has been chosen for the U.S. factory yet.
“We are very satisfied with the progress and impact Yakult has been making in the U.S. market and hope it continues,” said Mr. Kawabata. “While the sales are impressive, our company stays true to its mission—to help improve the health and happiness of people everywhere.”
One ‘Small’ Takeaway
The information, philosophies and concepts presented during Yakult’s journalist tour went far beyond the company’s Central Institute or its unique Yakult Lady delivery system. Crossing paths with world-renowned scientists, government representatives and ordinary Japanese citizens—from Tokyo to Kyoto—revealed a broader, complex network that weaves the country’s healthcare system together.
Realistically, many of the Japanese approaches to healthcare probably wouldn’t fly in the U.S., where bitter partisan divides over a broken health insurance system and debate about the role government should play in people’s lives continue to stall any chance of meaningful reform. But as the U.S. continues to spend nearly 20% of its GDP on healthcare—just about all of it on disease treatment—those little bottles of Yakult are looking a lot more appealing.
After all, “change begins small.”
