“Maintaining your immune system is a critical aspect of wellness and quality of life in general,” said Kevin Mehring, global business director for supplements and immune health for Danisco USA in Madison, WI. “Poor immunity in the general population also has a huge negative economic impact when one considers lost productivity in the workplace, in schools and even within the family unit. As the speed and stress of life continues to increase, a strong immune system is more essential than ever.”
The H1N1 virus, and the higher mortality rates it caused among young children with under-developed immune systems and people with compromised immune systems, heightened public awareness about the importance of a strong immune system. As a result, many consumers became more proactive in maintaining immune health through proper diet and supplementation with nutraceuticals.
“Immune health has evolved into stronger sales for products designed to aid daily digestive health and support people coping with everyday stress,” said Cheryl Sturm, director of marketing for Embria Health Sciences, Ankeny, IA. “Interestingly, the downturn in the economy, combined with the increased pass-down of health insurance costs to employees, has actually helped the dietary supplement industry as consumers shift their mindset from treatment to preventive regimens.”
According to the Natural Marketing Institute’s Health and Wellness Trends Report, consumers continue to believe that maintaining good immune health is the number one way to prevent illness—an encouraging trend. However, even though H1N1 increased awareness of the importance of immunity, “this did not necessarily translate into increased awareness of the nutraceuticals market among consumers,” pointed out Sarah Staley, vice president of business development for FrieslandCampina Domo USA Inc. in Paramus, NJ. “In instances of pandemic viruses, consumers tend to revert to proven solutions like vaccines, rather than change their behavior. In addition, the vaccine and medicinal approaches are still the most heavily promoted by health professionals and authorities.”
One of those authorities—FDA—actually issued explicit instructions to media and the nutraceutical industry not to publish alternative treatments that addressed H1N1. “Only the vaccine data was allowed to be publicized as an effective H1N1 treatment,” said Dr. Andrew Keech, founder and managing director for APS BioGroup in Phoenix, AZ. “Immunologists were not permitted to comment on or explain the possible benefits of nutraceuticals regarding the H1N1 infection, which was great for vaccine sales and drug companies.”
Keeping the Body Safe
Scientific advances have provided great insights and understanding about how the immune system functions. “The term immunity today describes not only resistance to infection and disease, but also preventive mechanisms that help to maintain and support the immune system,” said Friesland’s Ms. Staley.
The immune system is a complex network of different functions, which operate together to defend against infectious agents such as pathogenic bacteria and viruses. “The function of the system is tightly regulated, which is critically important, since an overly active immune system can be very detrimental to the host,” said Sampo Lahtinen, health and nutrition innovation platform manager for Danisco in Kantvik, Finland.
A properly functioning immune system does a good job of recognizing potentially harmful agents and killing them off; however, when the system is out of balance it may even attack its host, mistaking “self” cells for invading pathogens, resulting in debilitating autoimmune diseases such as lupus and rheumatoid arthritis. “
Allergies can also result when the immune system mistakes an innocuous particle such as pollen for an invading pathogen,” stated Larry Robinson, vice president of scientific affairs for Embria Health Sciences. “In addition, years of chronic low-level inflammation, another indicator of an out-of-balance immune system, can contribute to diseases such as cancer and cardiovascular disease.”
The first line of defense for the body is its barriers, such as the skin and mucosal membranes. “Most infectious agents enter the body via the epithelial surfaces of either the upper respiratory, digestive or genito-urinary tract,” said APS BioGroup’s Dr. Keech. “Once these agents have penetrated the body, a variety of physical and chemical defense mechanisms [the immune system] are activated to help protect the body from these infections.”
The immune system has two parts: innate and adaptive. The innate system is the first to face the onslaught of invaders. This broad spectrum of non-specific responses proves effective against most infective agents; although it is activated quickly, the innate system does not provide long-lasting effects. If the microbes outlast the innate system, the adaptive immune system springs into action.
“The adaptive system gets its strength from previous exposures to infectious agents and offers long-term protection,” Mr. Lahtinen explained. “The adaptive part of the immune system ‘remembers’ the previous encounters with infective agents and is therefore ready to quickly make specific antibodies against such agents.”
Ironically, an immune system that does not combat pathogens on a regular basis can become defective. In fact, the increasing trend toward overactive immune systems causing autoimmune conditions has been related by many researchers to the “hygiene hypothesis.” Because individuals today have not been as exposed to as many microorganisms as people were in decades past, they have not developed resistances and therefore their immune systems have no “memory” to mount an effective adaptive response.
“For example, the hygiene hypothesis attributes the increase in allergic responses in children in developed countries to reduced exposure to common infective agents in early childhood development,” commented Muhammed Majeed, founder of Sabinsa Corporation in East Windsor, NJ. “Autoimmune diseases such as rheumatoid arthritis or multiple sclerosis are expressions of hypersensitivity mediated by the immune response.”
Because of these and other challenges, there is an ever-increasing need to keep the immune system in balance—not just boost it temporarily or suppress it. Today the scope of compounds and products that are considered important to immunity is much broader than the traditional categories of pharmaceutical and biological compounds. Natural products have the greatest chance for helping people maintain healthy, balanced immune systems with minimal or no side effects.
Nutraceuticals and the Immune System
The most basic and well-known ingredients associated with immune support are vitamins A, C and E, zinc and echinacea, all of which are found in heavily marketed cold and flu products. Vitamin C is still the most commonly associated immune health ingredient. More companies, however, are combining these traditional immune ingredients with proprietary products or conducting research on lesser-known biomaterials and their role in immune function, such as their effect on immune cell production, cytokine response, inflammation, pH and nutrient absorption. What follows are some natural components that are getting increased attention as immune-system protectors.
Fucoidan. For centuries this seaweed substance has been an important dietary component for many island and coastal nations such as Japan, Polynesia and Tonga. “Fucoidan is a sulfated polysaccharide composed mainly of fucopyranoside and natural sulphate,” said Marina Linsley, marketing director for NP Nutra in Rancho Dominguez, CA. “Fucoidan has been found to support and enhance the immune system in several ways, including stimulating the body’s natural killer cells and increasing certain proteins that are produced by white blood cells.” As reported in a recent study by I.D. Makarenkova (Vopr Virusol, January-February 2010), fucoidan exhibited strong virucidal activity against the highly virulent avian influenza virus influenza A/H5N1, suppressing virus production within 24 hours of infection.
Selenium. Epidemiological studies show a high positive correlation between levels of selenium, an antioxidant trace mineral nutrient, and overall good health. “Selenium modulates the immune system by increasing killer cell activity and is believed to have a stimulatory effect on antibody production,” said Sabinsa’s Dr. Majeed. “Selenium nutritional status is also considered to be the driving force for influenza virus mutations. For example, studies indicate that a nonvirulent virus in a selenium-deficient host mutates to become super virulent—a killer virus. Therefore a healthy selenium nutritional status may be beneficial in containing epidemics by providing enhanced immunity to infection, inhibiting the spread of the virulence and generating a robust response to infection or severe inflammation.”
Ashwagandha. Also known as Withania somnifera or Indian ginseng, this plant is native to India and parts of Africa. For more than 4000 years it has been used as an immune-system stimulant and remedy for nervous disorders. “Flavonoids and compounds called withanolides are believed to account for its many medicinal applications, including supporting the immune system and alleviating anxiety and panic,” said Ms. Linsley.
According to research conducted by the Indian Institute of Integrative Medicine (IIIM), Jammu, India, chemically standardized leaf extract of Withania somnifera activates the immune system by enhancing cytokine expression and stimulating the proliferation of T cells. “Our studies demonstrate the possible usefulness of Ashwagandha as an immune adjuvant for chronic infectious ailments,” stated Fayaz Malik, a research scientist at IIIM.
Colostrum. This remarkable substance is produced by mammals within the first 12 hours after birth. “Through its natural richness in biological compounds, colostrum enhances the immune system, promotes gut health and improves sports performance,” said Kaare Axelsen, business development manager for Ingredia, Arras, France. “Colostrum naturally contains immuno-stimulating immunoglobulins, of which the most abundant are type G immunoglobulins (IgG), lactoferrin, lactoperoxidase, lysozyme and proline-rich polypeptides.”
“Colostrum is nature’s perfect first food,” agreed APS BioGroup’s Dr. Keech. “It is estimated colostrum triggers at least 50 processes in the newborn, including transferring the immune factors and the memory from the mother’s own immune system. The most important active ingredients are the proline-rich polypeptides (PRPs). Proline-rich polypeptides are identical in all mammals and have the unique ability to modulate the immune system, increasing its activity level in the case of a suppressed immune state, and decreasing its activity level when the immune system is overactive. When an infection is detected by scout immune cells or dentric cells, chemical signals go out to mobilize other cells to come to the defense and fight off the infection.”
Prebiotics & Probiotics. Once relegated primarily to yogurt and high-fiber fare, the demand for food and beverage products fortified with probiotics and prebiotics is accelerating, particularly as digestive health continues to emerge as a high-growth market. According to market researcher Packaged Facts, the global retail market for probiotic and prebiotic foods and beverages was $15 billion in 2008, a 13% increase over 2007. Packaged Facts projects that value will exceed $22 billion by 2013, driven largely by innovations in probiotic and prebiotic formulations that allow more products to be enhanced with these ingredients, as well as heightened consumer awareness about the relationship between digestive health and immunity.
The gut is a key part of the immune system—this is where the body is constantly exposed to toxins and foreign antigens, including those originating from food and microbes. “Recent studies have highlighted the importance of gut microbiota in the development and regulation of the gut immune system,” said Danisco’s Mr. Lahtinen. “Imbalances in the gut microbiota may be associated with imbalances in the immune system function, ranging from reduced immunity against infectious agents to allergies and states of chronic inflammation. In recent years, the role of chronic inflammation in many serious diseases has been particularly highlighted.”
“Some of the most commonly used dietary ingredients in products targeted at immune health and immune support are prebiotics and probiotics,” Friesland’s Ms. Staley added. “This is because colonic fermentation has a significant impact on digestive health, which in turn is directly linked to immune health and immune support. In fact, it is estimated that the colon accounts for up to 70% of the immune system. Specific prebiotics are selectively fermented by beneficial probiotics to modify the digestive ecosystem, resulting in immune protection.”
Large clinical studies have highlighted the potential of probiotics to reduce the risk of common winter infections in healthy populations, most likely through the enhancement of innate immune functions. “Nutraceuticals such as probiotics may also have an important role in the regulation of inflammation,” Mr. Lahtinen said. “By improving the microbiota composition in the mucosal layers and by modulating the host immune cell status, probiotics may help to reduce or prevent aberrant inflammatory status. Metabolites of gut microbes such as short chain fatty acids have also been shown recently to regulate host inflammatory status. Such metabolites may contribute to the beneficial effects of probiotics, but may also be induced by the use of prebiotics, which enhance the natural microbiota of the host and therefore can affect short chain fatty acid production.”
Vitamin D. Vitamin D deficiency has reached epidemic status throughout the world, and it typically goes undiagnosed by physicians. Adequate levels are needed to keep the immune system functioning at a high level. “Even in the sunniest areas, vitamin D deficiency is common when most of the skin is shielded from the sun,” said Michael Holick, a Boston University professor and one of the world’s leading vitamin D experts in “Vitamin D Deficiency,” his 2007 paper in the New England Journal of Medicine. “In the United Arab Emirates, Australia, Turkey, India and Lebanon, 30-50% of children and adults had 25-hydroxyvitamin D levels under 20 ng per milliliter [40-70 is considered normal]. Without vitamin D, only 10-15% of dietary calcium and about 60% of phosphorus is absorbed. The interaction of 1,25-dihydroxyvitamin D with the vitamin D receptor increases the efficiency of intestinal calcium absorption to 30-40% and phosphorus absorption.”
An abundance of research continues to show how the lack of vitamin D is related to a number of serious health conditions. As reported in the Archives of Internal Medicine last year, individuals with vitamin D deficiency were 36% more likely to suffer respiratory infections than those with sufficient levels. The risk of respiratory infection was also twice as high among vitamin D-deficient patients with chronic obstructive pulmonary disease (COPD) compared to lung patients with normal vitamin D levels.
“Vitamin D deficiency is associated with cancer, cardiovascular disease, hypertension, stroke, diabetes, multiple sclerosis, rheumatoid arthritis, inflammatory bowel disease, osteoporosis, periodontal disease, macular degeneration, mental illness, propensity to fall and chronic pain,” stated John Cannell, MD, director of the Vitamin D Council, San Luis Obispo, CA. “Adult vitamin D deficiency is the rule rather than the exception in industrialized nations. A high number of otherwise healthy children and adolescents are also vitamin-D deficient. Rickets, a disease of the industrial revolution, is being diagnosed more frequently, especially in breastfed infants.”
Through the Vitamin D Council Dr. Norris Glick, a physician at the Central Wisconsin Center (CWC) in Madison, shared his recent experience with the H1N1 outbreak last year. CWC has 800 staff and is a long-term care facility for about 275 residents with developmental disabilities. Vitamin D levels have been monitored in virtually all the residents for several years and patients are supplemented to maintain normal levels of vitamin D. In June 2009, at the height of the H1N1 outbreak in Wisconsin, two CWC residents developed an influenza-like illness (ILI) and had positive tests for H1N1: one was a long-term resident and the other was a child who had been recently transferred to the facility with what was later proven to be H1N1. On the other hand, 60 staff members developed ILI or were documented to have H1N1, and an additional 43 staff members called in sick with ILI.
“So,” said Dr. Glick, “it is rather remarkable that only two residents of 275 developed ILI, one of which did not develop it here, while 103 of 800 staff members had ILI. It appears that the spread of H1N1 was not from staff to resident but from resident to staff and between staff, implying our staff was susceptible and our residents protected.”
Concerned about the economy and the skyrocketing cost of healthcare, consumers are looking for ways to maintain their health and their bottom line at home. “We are seeing people take a more proactive approach to maintaining their wellness by looking for natural ways to stay healthy and maintain a balanced immune system,” said Embria’s Ms. Sturm. “Mothers are also interested in their children’s immune health and with the recall of over-the-counter children’s cough and cold remedies last year, we’re seeing more of a demand for natural children’s products.”
Baby Boomers also represent a huge segment of the population that will come increasingly into play as they approach retirement. Boomers are determined to live active lifestyles as they age and will be proactive in seeking out economical, simple and preventative ways to maintain their health. “To meet this demand, immune health ingredients will be finding their way into a wider variety of dietary supplements, as well as additional functional foods and beverages,” said Ms. Sturm. These will be formulated into a variety of delivery systems, including tablets, capsules and soft gels, chewables, ready-to-drink beverages, nutrition bars, chewing gum, lozenges, powdered drinks, effervescents and gummies, to name a few.
“The scientific community is learning more every day about modes of action of nutraceuticals on immune health and is motivated in general to further advance this knowledge,” said Danisco’s Mr. Mehring. “Companies that supply these ingredients and finished products to the consumer are investing more time and money than ever before in proving their products deliver the benefits they say they do.”
Although immunity is not often mentioned as a key trend in the nutraceutical industry reports, some experts believe it is positioned for strong growth. “As emerging science continues to show the role of various ingredients on immune support, the market opportunities are likely to expand,” predicted Friesland’s Ms. Staley.
What will drive these market opportunities, according to APS BioGroup’s Mr. Keech, is increased public awareness and consumer education. “Growth may be slow or limited in the immune market because a healthy immune system reduces the incidences of disease in humans, thus reducing traditional drug sales,” he cautioned. “The key will be continued education of the general public on the benefits of having a balanced immune system.”
About the author: Mark Crawford is a freelance writer based in Madison, WI. Armed with a science background, he writes about a variety of subjects, from manufacturing to discovery to commercialization to testing/verification to market performance. Personally, natural health is one of his favorite fields. He can be reached at email@example.com.
Enhanced efficiency of ingredients and increasing scientific evidence of the advantages of probiotics are major factors facilitating market growth.
Global Industry Analysts has released a new report on the probiotics market. According the report—“Probiotics, A Global Strategic Business Report”—the market is still in its infancy stage, but predicted to reach almost $29 billion by 2015. The market is set to witness impressive growth as consumers become more conscious about their health and switch to preventive healthcare due to rising healthcare costs.
GIA says that probiotics are increasingly being considered as an important healthcare concept in the new century. Probiotic food in particular is gaining ground as a form of preventive medicine, with the rising healthcare costs globally acting as a major stimulant to the industry’s growing popularity. The global H1N1 pandemic also acted as a major catalyst, boosting growth in the probiotics segment, which witnessed a minor hiccup during the economic recession. Rising healthcare awareness and the consequent gravitation toward digestive and functional foods has managed to offset the high cost disadvantage and sustain growth momentum in the industry.
Already used extensively by the Europeans and in some parts of Asia, probiotics are gaining in popularity worldwide, particularly in the U.S. Europe represents the largest as well as the fastest-growing market. Within Europe, Germany and the U.K. account for about 45% of the total market. Japan, the second largest market, is demonstrating signs of maturity, and is expected to grow at more moderate rates, the report said.
Growth in the market is also being driven by the enhanced efficiency of ingredients, which offer products with bio-therapeutic properties. The increased consumption is also a result of the availability of probiotic products in the form of dietary supplements and food, such as baked and dairy products, which induced major players to integrate probiotics with products such as chocolates, cheese, muffins and sausages.
With further advancement in technology, probiotic usage is likely to extend beyond the current realms of gut, dental and immune health to several other areas of human health. As consumers across the world are becoming increasingly aware of the favorable benefits of “friendly” bacteria, the market is likely to reap rich gains in the coming years. Fortified products such as probiotic baked products, probiotic ice creams and probiotic chocolates are likely to gain popularity as consumers are willing to incur additional costs to enjoy health benefits.
Lured by the vast market potential, the probiotic market is witnessing extensive scientific research as new probiotic strains and new applications are under development. Global probiotics giants are making great efforts and applying their experiences from traditional markets such as Europe and Japan, where these food supplements are already in wide acceptance. Probiotics are increasingly being targeted to provide relief in new areas such as inflammatory diseases, allergy prevention, cholesterol reduction and prevention of colon cancer, apart from traditional benefits that they provide in terms of gut health.