As we enter a new year and the beginning of a new decade, theres no better time to make sure your digestive health aisle is well-stocked: Products that heal and nourish the gut are likely the helping hand your customers will need to achieve all their health resolutions in 2020. The composition of the gut microbiome influences every aspect of our physiology and regulatory processes, which affects not only digestive health but also systemic health and ones risk for developing diseases, asserts Samantha Ford, Business Development Director, AIDP Inc.
Indeed, over the past decade, study after study has uncovered new ways that the trillions of bacteria in the gut can influence everything from nutrition absorption to hormone balance to protection against pathogens like the flu virus. People typically consider probiotics for digestive health. However, based on scientific research it is becoming increasingly clear that they have other health benefits as well, notes Andrew G. Swick, M.S., Ph.D., Chief Scientific Officer, Life Extension. A healthy gut microbiome promotes healthy immunity, metabolism, mood, heart, liver and other organ systems.
All told, this growing awareness of the microbiome has the digestive health market booming, and it stands to soar even higher in the coming decade: A report by Grand View Research Inc. projects global sales of digestive health products will reach $57.5 billion by 2025a big jump from the $31.2 billion of 2017 (1). Significant growth is anticipated in the digestive health category, affirms Hank Cheatham, Vice President, Daiwa Health Development. With the awareness of the connection between gut health, overall health and cognitive function as well as athletic performance, growth seems to be a sure thing. In addition, researchers have only just begun to identify methodology to define a healthy microbiome; as this investigation evolves, growth in the market will occur, not only in personalized medicine, but overall.
That said, its not just probiotics and other microbiome-nourishing supplements fueling the market. Theres also a big opportunity to gain loyal customers who are dealing with specific digestive complaints like IBS, GERD and leaky gut and want to avoid the side effects and costs associated with traditional OTC and prescription treatments. According to the Natural Marketing Institutes (NMI)/Nielsens recently published report Opportunities in Digestive Health, 37% of consumers consider themselves to be managing some type of digestive health issue, Cheatham notes. People look to digestive remedies to help with the side effects of unhealthy diets and stressful lifestyles.
To help you navigate this increasingly flooded market so you can point your customers in the right direction to optimize their health, we tapped leading industry insiders for the low-down on the most promising new trends and technological advances in probiotics and microbiome support, as well as the research-backed natural options for the most common digestive concerns.
A study published in the journal Frontiers in Pharmacology posited that if everyone in the U.S. took probiotics, health care payers would save an estimated $373 million in medical bills and sick days would be reduced by 54.5 million, saving the economy approximately $1.4 billion per year in medical costs and lost productivity (2). And thats just savings associated with probiotics immune-boosting ability to fend off respiratory tract infections that cause cold and flu-like symptoms in healthy individuals.
With recent scientific advances, probiotics for obesity, dental health, diabetes and even heart disease could become a reality over the next decade. A wide variety of probiotic strains are being investigated for viability in specific health areas, such as oral health, mood/cognitive support, cholesterol management and more, notes Sam Michini, Vice President of Marketing & Strategy, Deerland Probiotics & Enzymes. Condition-specific action and support is the future of probiotics.
Dr. Swick agrees. With advancing technology, scientists have been able to select specific strains of organisms to accomplish precise tasks. Here, just a few strains shown to deliver targeted benefits that are already on the market:
Immune support. More than 70% of your immune system is in your gut, says Dr. Swick. He recommends a probiotic blend like Life Extensions Immune Support that combines B. lactis BS01, L. plantarum LP01, L. plantarum LP02, L. rhamnosus LR04, and L. rhamnosus LR05, which have been demonstrated to promote a healthy immune response.
Mood support. Experts estimate that up to 90% of the bodys serotonin is produced in the gut. Clinical and pre-clinical studies indicate that gut microbes can support mood and behavior by affecting the gut-brain axis, a complex communication network that links your gut with your brain, explains Dr. Swick, noting that innovative probiotic strains, L.helveticus Rosell-52 and B. longum Rosell-17, which are found in Life Extensions Florassist Mood Improve, are particularly helpful here: In two randomized controlled trials, study participants given these strains reported significant mood, stress response and emotional balance support as compared to placebo.
Also of interest for women who are pregnant or have recently given birth: The probiotic strain Lactobacillus rhamnosus HN001 is backed by clinical data in mood and anxiety support post-partum, says Ford. AIDPs Actazin in combination with HN001 has been shown to fuel the growth by as much as 140% in-vitro.
Fitness performance: Our spore-forming probiotic strain, Bacillus subtilis DE111, has the science to show its viability in fitness and athletic achievement, notes Michini. He points to a recent study published in the Journal of Strength and Conditioning Research that showed DE111, in conjunction with adequate post-workout nutrition, produced statistically significant improvements in the reduction of body fat percentage, and a strong trend indicating improved performance of the deadlift exercise (3.) In a separate study, DE111 was also found to promote tissue recovery and reduce the likelihood of injury.Weight management.Studies have suggested that there is an association between gut bacterial diversity and body weight, notes Dr. Swick. While specific strains are still being investigated, L. rhamnosus and L. gasseri show great promise in preliminary studies.
Whether your customers are shopping for a general health probiotic or a benefit-specific one, its better to focus on getting a diverse mix of bacteria strains rather the quantity or number of live active cultures, advises Neil E. Levin, CCN, DANLA, Senior Nutrition Education Manager, NOW Foods. Diversity and variety are important for gut health. A healthy gut will have no fewer than 50 to 100 probiotic strains present and that amount is actually at the low end of whats required. He notes that NOW Foods generally provides between at least 8 to 10 strains in their probiotic formulas to help foster this diversity.
Diversity can also be achieved by combining targeted strains found in a supplement along with probiotic food sources like yogurt, kimchi, kombucha and kefir, as well as functional snacks enriched with heat-resistant microbes like Kerrys spore-forming probiotic GanedenBC30. Some experts also recommend changing up the brand or formula of your probiotic supplement every few months to introduce new strains to the microbiome.
Trisha Sugarek MacDonald, BS, MS, Sr. Director of Research & Development/National Educator, Bluebonnet Nutrition Corporation, adds that its also critical to understand the quality of the probiotic, and each strains specific applications. Genetic DNA identification is the only way to ensure that you are getting the most effective probiotic strains, she says, noting that all probiotic strains in Bluebonnets Advanced Choice SingleDaily Probiotic formulas have been genetically identified and characterized by the Pasteur Institute, the scientific non-profit foundation dedicated to the study of microorganisms. Depending on ones food sensitivities, dietary benefits, such as made with non-GMO ingredients and free of most allergens, may also be important to look for on the label.
Survivability through the GI tract is also a consideration, but Levin believes theres little need to sweat it. We all know that probiotic foods are often effective without special delivery systems, and fortunately for both consumers and manufacturers, many modern probiotics are robustly acid-tolerant. For example, acidophilus literally means acid loving, he notes. Acidophilus and other common strains such as bifidobacteria have been tested for their ability to survive stomach acid for an hour at body temperature, and are rated at over 90% survivability. That can eliminate the need for enteric coatings, which contain some controversial ingredients and add to costs.
Many of the health-promoting effects of a balanced microbiome come not from the probiotics themselves, but from the short-chain fatty acids that are produced when bacteria ferment indigestible fibers, dubbed prebiotics, as food. Fermentation of certain fibers leads to the production of short-chain fatty acids, other metabolites and some vitamins, explains Kyle Krause, Product Manager, Functional Fiber and Carbohydrates, Beneo. Science demonstrates that short-chain fatty acids, achieved through this prebiotic fermentation, can reach the brain and other organs directly through the blood, or indirectly via the stimulation of immune cells, the hormonal or nervous system and the release of messenger substances. As a result, the gut microbiota can influence digestive health, an individuals inner well-being and overall health.
These prebiotic fibers play a critical role in helping good gut bacteria to thrive and multiply. While its possible to get sufficient prebiotics from food sources (onion, garlic, artichokes, bananas, barley, oats, beans and apples are all good sources of inulin and other soluble fibers and resistant starches), Michael Bush, President and CEO, Prenexus Health and Executive Board Member of the International Probiotics Association (IPA), cautions that most people struggle to get enough through diet alone. Dietary fiber is great but only 5% of Americans consume the recommended amount of dietary fiber, so supplemental prebiotics are necessary to properly feed the good bacteria that is already found in the gut. Plus, notes Cheryl Myers, Chief of Scientific Affairs and Education at EuroPharma, Inc., Supplemental prebiotics have the benefit of being consistentwhich is exactly what probiotics need to thrive.
Fortunately, theres no shortage of ingredients on the market that are effective in small doses and can be easily snuck into functional food and beverage. For instance, inulin and oligofructose, such as BENEOs chicory root fiber-derived Orafti Inulin and Oligofructose, can be easily and undetectably added to food and drink products, and have been shown to contribute to better digestive health and inner well-being by first and foremost selectively promoting the growth of beneficial microbiota, notes Krause. Studies also show improvements in bowel regularity as well as in calcium absorption and thus bone health. BENEOs prebiotic fibers have been proven to support weight management. This all results in an improved quality of life.
Xylooligoscacharides, or XOS, found in AIDPs propeitary ingredient PreticX, also show promising health perks. PreticX selectively feeds beneficial bacteria, without feeding the bad bacteriacausing a favorable alteration in gut microbiome, notes Ford. This is a tremendous advantage over other, higher dose prebiotics, which tend to feed all the bacteria, without a meaningful impact in the gut ratio. She points to a clinical trial which found that a dose of 2 grams of PreticX daily significantly increased levels of the bacteroidete B. fragilis strain, without increasing the firmicutes strain Lactobacillus. This suggests that PreticX may foster a more beneficial Bacteroidetes/Firmicutes ratio, which has been linked to improved metabolic response and benefits to weight management.
Consumers who are sensitive to starch or fiber based prebiotics may want to consider emerging phage technology, advises Michini. Phages are minuscule bundles of DNA or RNA enrobed in a protein shell. Phages are diverse and abundant: there are 10-fold more phages than bacteria populations in the human body. The role of each type of phage is to overtake a specific bacterium. He explains that phages, like those found in Deerlands PreforPro, work as a dual action prebiotic. These compounds destabilize the cell wall of the bad bacteria, which then provides nutrients as well as space for the good bacteria to grow. Whats more, he notes, PreforPro is effective in a small dose (15 mg) and does not incur bloating or flatulence because it doesnt become fermented.
Also showing promise as a prebiotic: Antioxidants like anthocyanins from berries, notes Melanie Bush, Director of Science, Artemis International, Inc. Studies have shown that flavonoids essentially behave as prebiotics and modulate a healthy balance of good bacteria in the gut. Additionally, researchers studied how gut microbes can metabolize berry flavonoids into metabolites that have significant health benefits.
SOS for digestive distress
Chronic digestive issues, including inflammatory bowel disease, acid reflux and food intolerances, can be painful, frustrating and downright embarrassing. And often, the long-term side effects of the OTC and prescription treatments can be as troubling as the condition itself. Case in point: An alarming new study published in the BMJ found that extended use of proton pump inhibitors (PPIs), which are routinely prescribed to treat heartburn, ulcers and acid reflux, was associated with a 17% increased risk of early death (4). No wonder so many Americans are trying to get off their PPIs. A new survey from the University of Michigan Medical School revealed that 79% of patients had at least some concern about PPI side effects, even if they couldnt necessarily name any specific side effects, and 83% had attempted to get off of the meds without a doctors recommendation (5).
If customers come in looking for a natural solution to digestive problems, be sure to advise them to talk to their healthcare practitioner about transitioning off meds, notes Levin. But there is natural help to be found for GERD and IBD, and its largely compatible with OTC meds, notes Myers. Some consumers choose to take their OTC and the natural product together for a week or two, then slowly wean off the OTC drug. Once inflammation (especially 5-LOX inflammation, seen in many inflammatory bowel diseases) is under control or eliminated with natural products, the digestive relief and symptom remission is going to be much more sustainablewithout the potential side effects of OTCs.
Help for heartburn, acid reflux or GERD. Myers notes that the PPIs typically used to treat reflux and heartburn shut down acid production, which may temporarily stop the pain, but used long term, it leaves users vulnerable to other problems, including increased susceptibility to food poisoning, bone density loss, and increased rates of other infections. Stomach acidity is a natural barrier against microbes entering the body along with food or liquids since the low pH discourages the growth or most organisms, explains Levin. If the acidity level is too weak, foods wont be properly digested and that immune barrier would be compromised.
Whats more, Levin notes, its been estimated that perhaps half of those taking antacids have insufficient stomach acid production to enable digestion (and provide a proper immune barrier). The clinical pearl that clinical nutritionists learn is to consider the timing of heartburn after a meal. Delayed onset heartburn is an indication to look at the probability of the acid being too weak to actually digest the food, especially protein. When this is the case, he recommends exploring a supplement with betaine HCl to supplement the stomachs own acid production and pepsin, the stomach main digestive enzyme.
Other reflux soothers: Two of the best ingredients to fight heartburn and GERD naturally are d-limonene and sea buckthorn, says Myers. D-limonene is a clinically tested component of citrus oil that appears to coat and protect the stomach walls and mucosa from the potential damage of stomach acid (without interfering with acid production), and supports healthy peristalsisthe muscle action of the intestines that moves food through the digestive system. In one study, she notes, 19 adults with a history of mild to moderate symptoms of heartburn or GERD were asked to discontinue their OTC or prescription medications and take d-limonene instead. By the second day of taking d-limonene, 32% of the participants experienced symptom relief. After 14 days, 89% of the participants were symptom free.
Seabuckthorn works another way, Myers continues. It has a protective effect on the stomach and actually helps prevent and heal gastric ulcers. It also soothes the mucosal in the digestive tract. Similarly protective of the esophagus is deglycyrrhizinated licorice (DGL) extract, adds Levin. Licorice has been shown to support healthy concentrations of compounds that promote mucus production, which may provide an improved protective barrier between the delicate lining of the esophagus and the acidic stomach contents.
Help for inflammatory bowel disease. One of the most effective botanicals for dealing with IBS or other digestive issues is boswellia, says Myers. She notes that this botanical, found in BosMed Intestinal Bowel Support, fights 5-lipoxygenase (5-LOX) inflammation. Inflammation through the small bowel and colon may be one of the physical causes and effects of IBS and other diseases. Because boswellia stops the 5-LOX cascade, it is a valuable ally. For example, in the case of Crohns disease, individuals were treated with either boswellia or the drug mesalazine (a drug commonly used to treat Crohns, ulcerative colitis, and IBS). Boswellia performed as well as the drug, but without the dangerous side effects.
Another smart supplement: Zinc L-carnosine offers a comprehensive approach to protect your stomach lining and promote gastric health, notes Levin. Several clinical studies showed that 150mg daily of zinc L-carnosine significantly reduced factors associated with gastric discomfort within eight weeks.
Help for food sensitivities or intolerances. A broad-spectrum enzyme blend can be a great solution for those who experience digestive discomfort when they eat, as it helps facilitate better digestion of the many components of a mealfats, carbohydrates and proteins, says Michini. But if a food sensitivity is claimed by your customer to be an issue, point them to supplements containing specific enzymes. Deerland makes a trio of targeted enzyme ingredients, ProHydrolase, Dairylytic and Glutalytic, that can help customers consume hard-to-digest protein peptides (like those in meat or protein powders), dairy and gluten with fewer digestive symptoms. Glutalytic is also clinically proven to reduce levels of IgA and CRP, supporting a proper immune response, he notes.
Help for leaky gut. Leaky gut is caused when inflammatory compounds (like gluten in people with gluten intolerances) and other toxins damage the digestive tract lining, creating microscopic tears that allow endotoxins and waste to leak out of the GI tract and into the bloodstream. This is notoriously difficult to treat, but Miles Sarill, National Educator, CV Sciences, sees big potential for a raw CBD component called cannabidiolic acid (CBDA) for speedier healing. He explains that this compound, which is found in CV Sciences new raw CBD oil, is a non-psychoactive precursor to CBD that has been shown in preliminary animal studies to actually facilitate healing of the digestive health tract. CBDA cant cross the blood-brain barrier, so it goes to work within the body along with 500 other anti-inflammatory compounds in a full spectrum oil, he explains. Full spectrum raw CBD oil can be deeply supportive for both inflammation response, as well as that gut barrier and the microbiome.
When it comes to growing your digestive health sales, Dr. Swick notes, It is important to educate consumers about the importance of probiotics and how they play a beneficial role within and outside the gut. Specifically, with respect to condition specific probiotic strains and how they can complement other interventions. For example if you are promoting mood support with traditional herbs or amino acids, also consider a probiotic product that has been studied and demonstrated to support the same health concern.
Myers agrees, Having printed materials that explain the connection between gut health and overall wellness are essential, too. It gives customers something to think aboutand ideally, some other lifestyle and supplemental optionsthat can encourage them to return to the store. Also, stores can invite guest speakers and experts to talk about the connection between gut health and well-being that may resonate in more direct ways than printed material.
Dont be afraid to make use of the complexity of the digestive health in illustrations or imagesthey can draw customers in, adds Michini. The gut is the bodys main manufacturing facilityit processes all the raw materials taken in from food, beverages, supplements to pharmaceuticals. This concept works well for visual storytelling, which can be used in store on a white board or other display, as well as in social media. Get the consumer involved in a way that rewards him or her. WF
Grand View Research, Digestive Health Products Market Size Worth $57.54 Billion By 2025,GrandViewResearch.com. Posted 2/19. Accessed 12/3/19. https://www.grandviewresearch.com/press-release/global-digestive-health-products-market
Lenoir-Wijnkoop, et al. Probiotics Reduce Health Care Cost and Societal Impact of Flu-Like Respiratory Tract Infections in USA,Frontiers in Pharmacology. Published 8/28/19. Accessed 12/3/2019. https://www.frontiersin.org/articles/10.3389/fphar.2019.00980/full
Toohey, et al. Effects of Probiotic (Bacillus subtilis) Supplementation During Offseason Resistance Training in Female Division I Athletes,The Journal of Strength and Conditioning Research. Published 06/26/18. Accessed 12/3/2019. https://journals.lww.com/nsca-jscr/Abstract/publishahead/Effects_of_Probiotic__Bacillus_subtilis_.95273.aspx
Kristina Sauerwein, Heartburn drugs linked to fatal heart and kidney disease, stomach cancer, Washington University School of Medicine in St. Louis. Publised 5/30/19. Accessed 12/3/19. https://medicine.wustl.edu/news/popular-heartburn-drugs-linked-to-fatal-heart-disease-chronic-kidney-disease-stomach-cancer/
Jina Sawani, Many Americans Are Worried About Taking PPIs and Have Tried Stopping Them Without Doctor Approval, University of Michigan Health Lab. Published 5/22/19. Accessed 12/3/19. https://labblog.uofmhealth.org/industry-dx/many-americans-are-worried-about-taking-ppis-and-have-tried-stopping-them-without
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