Defend and manage: The role of supplements in protecting immune health and managing illness

The cold and flu supplement category is among the best selling in both the mainstream multioutlet and natural channels. According to data from the market research firm SPINS, based on the 52 weeks ending October 6, 2024, the cold and flu category was the best-selling health focus with $1,133,413,789 despite a 9.9% decline in sales compared to the previous year. In the natural channel, cold and flu was the number two best-selling health focus with $87,712,090, also experiencing a slight decline of 6.7%. Within the natural category, immune health as a health focus also ranked in the top 10 best-selling health focuses with $54,120,238 and 5% sales growth compared to the previous year. There is quite a bit of overlap in ingredients like elderberry, vitamin C, zinc, and echinacea within the cold and flu and immune health categories. The appearance of both cold and flu as well as immune health in the natural channel indicates that there are two ways these products are marketed and/or being used by consumers. Because cold and flu implies existing illness, products within this category are being used to alleviate symptoms and shorten duration of illness while the immune health category is more preventative. Let’s explore the popular ingredients in this space and how they can be positioned based on their benefits.

Vitamins and Minerals

When it comes to vitamins and minerals, vitamin C and zinc remain the most popular. They are well recognized and trusted by consumers as a go-to option for immune support. A 2021 systematic analysis and review published in BMJ Global Health found that based on 24 clinical trials with a total of 10,961 adults, supplementation with vitamin C was associated with areduced risk of acute respiratory infection (ARI) by 4% and shortened duration of symptoms by 9%.¹ Interestingly, that study found that the effects were stronger among men, reducing their risk of ARI by 18%, while the reduction was not statistically significant for women.¹ A different review from Cochrane found that regular supplementation with vitamin C reduced the risk of developing a cold by 8% in adults and 14% in children, while those exposed to extreme physical stress reduced their risk of developing a cold by 52%.²

The 2021 review found that supplementation with zinc did not reduce one’s risk of ARI, but did substantially reduce the duration of symptoms by 47%.¹ The researchers even cite research indicating that zinc supplementation can prevent mortality related to severe pneumonia. They explain that zinc is a “component of hundreds of enzymes and transcription factors, and plays critical roles in gene expression, cell division and immunity.”

It’s worth pointing out that vitamin D was also found to a offer modest 3% risk reduction and shortened duration of symptoms by 6%.¹ A different systematic analysis and review of vitamin D supplementation published in BMJ found that supplementation with the vitamin reduced risk of ARI by 12% but that this effect was only beneficial to participants who took supplements daily and weekly.³ Effects were also stronger for those with a lower baseline serum vitamin D status.

Vitamins and minerals are crucial for maintaining overall health, with vitamins C, D, and the mineral zinc positively impacting the immune system. While it’s not always possible to avoid getting sick, thankfully these vitamins and minerals help make the illness more manageable and may even shorten the duration of illness. With research pointing out that individuals experiencing high levels of physical stress see a substantially higher benefit, it may also be worth incorporating these ingredients into sports nutrition and endurance products as these populations may be at higher risk of getting sick.

Herbs

Elderberry and echinacea also benefit from consumer recognition and have some research to back up their benefits. One randomized, double-blind, placebo-controlled study investigated the impact of elderberry supplementation on air travelers.⁴ That study found that out of 312 participants assigned to take either an elderberry supplement or placebo prior to international travel from Australia, the elderberry group saw fewer instances of cold episodes (12 compared to 17 in the placebo group), and experienced significantly shorter and less severe cold episodes compared to placebo. While the differences in number of cold episodes was not statistically significant, the differences in length and severity were. Additionally, a review of four clinical trials with a total of 180 participants found that supplementation reduced the duration of upper respiratory infections and that this effect was particularly more pronounced in those with influenza.⁵

Echinacea, for its part, may work better for reducing the risk of getting sick than alleviating the severity or length of symptoms. A 2019 review of nine clinical trials found that compared to placebo, echinacea supplementation reduced the risk of developing upper respiratory tract infections by 22%, but did not affect the duration of infection.⁶ Based on this research, elderberry may be better positioned to help consumers manage symptoms, while echinacea offers substantial benefits for prevention.

While not technically an herb, another popular ingredient is bee propolis which is seeing double-digit sales growth in the cold and flu and immune health categories in the natural channel (19.5% and 40.5%, respectively). This is substantial considering that many of the more popular ingredients have seen a sales decline. Propolis, referred to as “bee glue,” is a combination of beeswax and saliva that acts as a defense mechanism for the hive.⁷ Its composition is complex and the compounds found in propolis include: phenolic acids, flavonoids, esters, diterpenes, sesquiterpenes, lignans, aromatic aldehydes, alcohols, amino acids, fatty acids, vitamins and minerals.⁷ More human research is necessary to demonstrate its immune health benefits, but propolis is known to have antioxidant, anti-inflammatory, as well as antimicrobial effects. Collectively, the compounds in propolis prevent bacterial cell division to inhibit bacterial activity and growth.⁷ Because of these benefits, propolis has been incorporated into a number of applications, including oral sprays, toothpaste, and lozenges.

References

1. Abioye, A.I.; Bromage, S.; Fawzi, W. Effect of micronutrient supplements on influenza and other respiratory tract infections among adults: a systematic review and meta-analysis. BMJ Glob Health. 2021, 6 (1), e003176. DOI: 10.1136/bmjgh-2020-003176
2. Hemilä, H; Chalker, E. Vitamin C for preventing and treating the common cold. Cochrane Database Syst Rev. 2013, 2013 (1), CD000980. DOI: 10.1002/14651858.CD000980.pub4
3. Martineau, A.R.; Jolliffe, D.A.; Hooper, R.L.; Greenberg, L.; Aloia, J.F.; Bergman, P.; Dubnov-Raz, G.; Esposito, S. Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data. BMJ. 2017, 365, i6583. DOI: 10.1136/bmj.i6583
4. Tiralonga, E.; Wee, S.S.; Lea, R.A. Elderberry Supplementation Reduces Cold Duration and Symptoms in Air-Travellers: A Randomized, Double-Blind Placebo-Controlled Clinical Trial. Nutrients. 2016, 8(4), 182. DOI: 10.3390/nu8040182
5. Hawkins, J.; Baker, C.; Cherry, L.; Dunne, E. Black elderberry (Sambucus nigra) supplementation effectively treats upper respiratory symptoms: A meta-analysis of randomized, controlled clinical trials. Complement Ther Med. 2019, 42, 361-365. DOI: 10.1016/j.ctim.2018.12.004
6. David, S.; Cunningham, R.Echinacea for the prevention and treatment of upper respiratory tract infections: A systematic review and meta-analysis. Complementary Therapies in Medicine. 2019, 44, 18-26. DOI: 10.1016/j.ctim.2019.03.011
7. Braakhuis, A. Evidence on the Health Benefits of Supplemental Propolis. Nutrients. 2019, 11 (11), 2705. DOI: 10.3390/nu11112705