Here’s a look at ingredients driving that growth.
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Immune health isn’t merely of interest to consumers; it is one of the top five reasons why they take dietary supplements today, period. According to the Council for Responsible Nutrition’s latest Consumer Survey on Dietary Supplements, published last fall, immune health is one of the top reasons consumers surveyed said they take supplements, alongside reasons like energy, healthy aging, filling nutrient gaps, and staying well overall. In the survey conducted on more than 2000 U.S. adults in 2019, 27% of those who use dietary supplements cited immune health as a reason they take supplements.
Market numbers also reflect this interest. According to market researcher IRI (Chicago), dollar sales in the immune health supplement category grew 12% in 2019 over the previous year.
Another consumer survey conducted by Kerry International (Beloit, WA) also saw high interest in immune health. “We asked consumers to choose five options from a list of 13 health areas and rank them in order of importance. Nearly two-thirds (63%) chose immune system support, ahead of healthy bones and joints, good digestive health, energy levels, and heart health support,” says John Quilter, vice president and general manager, ProActive Health, for Kerry International. Demand for immune support products is particularly high in Asia-specifically China, where 50% of survey respondents said they had used an immune health product in the previous six months, while 29% said they would consider doing so in the future.
So what does this mean if you’re an immune health product company? “This means that immune health markets are increasingly competitive,” Quilter says. “The best way to stand out is to use scientifically substantiated, well-recognized ingredients that can complement and enhance your brand.”
A number of brands are hard at work doing just that, choosing suppliers investing in research and helping manufacturers develop products that are not only efficacious but also encourage use and enticement through innovative delivery formats beyond traditional dietary supplements. Not only that, but ingredient suppliers and researchers are exploring the various pathways by which ingredients can support immune health-particularly, the way ingredients interact with the gut to impart immune benefits.
Some of the best-performing herbs on the market are popular ingredients for immune health products, perhaps an indication of the immune health category’s overall strength. For example, according to figures from SPINS reported by the American Botanical Council’s HerbalGram journal in its annual Herb Market Report in September 2019, the bestselling herbs in the U.S. mainstream multioutlet channel in 2018 were horehound and echinacea.1 Total 2018 sales of horehound, the #1 bestselling herb in the U.S. mainstream multioutlet channel per the HerbalGram report, hit nearly $147 million that year. Echinacea, meanwhile, ranked as the #2 bestselling mainstream herb, growing to $110 million in sales in 2018.
Aside from those two market giants, perhaps the most impressive sales growth among herbs in the immune health space in 2018 went to elderberry. According to the HerbalGram report, in 2018 elderberry grew 138.4% in sales to nearly $51 million in the mainstream channel, and grew 93.9% to $25 million in the natural channel, making elderberry the #4 top-selling herb in the mainstream channel and the #3 top-selling herb in the natural channel in 2018. Pretty impressive.
Elderberry’s star continued to rise in 2019, too. In recent numbers provided to Nutritional Outlook by SPINS, cross-channel sales (mainstream, natural, and specialty retailers) of elderberry grew 83.4% in the 52 weeks ending October 6, 2019, to total sales of $113 million. In the mainstream multioutlet channel alone during that period, elderberry grew in sales by 116% to nearly $63 million.
Elderberry, which has a long history of traditional usage, experienced a surge of popularity after a particularly intense flu season in 2018 that saw a shortage of over-the-counter flu medicines, leaving natural remedies like elderberry to fill the void.2 Consequently, more consumers became aware of the ingredient and learned more about its benefits.
While a number of factors led to elderberry’s rise in popularity, Devon Bennett, CEO of North American elderberry supplier INS Farms (Purdy, MO), believes that elderberry is more than a trend and is here to stay. “Elderberry will become a lifestyle ingredient, with more research and science to follow,” Bennett predicts.
Elderberry already has some research under its belt, which gave the ingredient more clout during the severe 2017-2018 flu season. For example, the most significant study to date, using a branded elderberry extract from Artemis International (Fort Wayne, IN) called ElderCraft, was conducted in travelers over a 21-month period in 2013-2014 by the School of Pharmacy at Griffith University (Queensland, Australia).3
“This has become the highly reviewed and cited ‘Tiralongo long-haul flight study,’ a randomized, double-blind, placebo-controlled human clinical trial involving 312 healthy adults (economy-class passengers),” explains Chris Tower, vice president of sales and business development for Artemis. “Results of the study revealed ElderCraft demonstrated a significant reduction in cold duration and symptoms in air-travelers, resulting in 50% fewer cold episodes, 33% shorter illness duration, 50% fewer symptoms, and 33% less severe symptoms.”
He adds: “Notably, the 2016 Tiralongo study on ElderCraft was published one year in advance of what later proved to be a particularly severe and long flu season (2017-2018), with ER doctors and general practitioners on record supporting the use of elderberry, and social media further drawing increased attention to elderberry as a supplemental frontline treatment for flu and colds.”
The benefits of elderberry are attributed to the anthocyanins found in the berries. Anthocyanins are the black pigments that give the black elderberry its color. “Studies have indicated that European black elderberry can effectively boost the body’s natural immune response by way of cytokine stimulation to ‘ready the soldiers’ for fighting off pathogens,” explains Melanie Bush, director of berry science for Artemis.
Bush adds that the polysaccharides present in the fruit-but which are often stripped away during extraction-may also provide antiviral benefits. “Artemis International’s ElderCraft extract is uniquely produced without the use of harsh chemical solvents, thus retaining the polysaccharides along with concentrating the important flavonoid actives, making a truly superior and efficacious immune supporting ingredient,” she says.
Being a fruit, elderberry lends itself to a variety of applications. “We see the greatest opportunity for elderberry in both traditional supplements and food and beverage-both growing markets with consumers seeking a way to preempt sick days and/or a visit to the doctor,” says Leslie Gallo, president of Artemis.
Alternative delivery formats, previously reserved for children, now apply to the larger population of adults experiencing pill fatigue, and elderberry fits in nicely with many of these.
“Traditional supplements are not so ‘traditional’-not your grandmother’s pills and tablets-as gummy delivery continues to lead the pack, with liquid supplements close behind,” Gallo says. “Confection delivery (i.e., lozenges, lollipops), infusions, as well as shots, powder sticks, and chewables are growing in popularity.”
Through the Gut
The way manufacturers are using elderberry is changing as well, says Gallo. For example, in beverages, while it’s not unusual for manufacturers to utilize elderberry for flavor or color, typically its use as an ingredient with functional benefits had been less common. Now, however, use of elderberry as a functional immune support ingredient has gained greater consideration. “We are fielding more inquires for beverages, most notably in the hot and cold tea markets, in addition to elderberry as a prebiotic in the pre-/probiotic beverage market,” explains Gallo.
The relationship between immune and digestive health is gradually coming to light as research continues on pre- and probiotics. The potential prebiotic nature of elderberry provides a synergistic opportunity to finished product formulation. Research is exploring how flavonoids such as the anthocyanins found in elderberry interact with the gut microbiome.4
“There are several ways that polyphenols from berries and the gut interact with each other. One way is that the berries have been shown to exert prebiotic-like activity and influence the overall composition of the microflora of the gut,” explains Bush. “There have been several studies evaluating this concept. For example, in 2011, a six-week consumption5 of a wild blueberry drink in human volunteers significantly increased Bifidobacteria strains compared to a placebo. These particular types of bacteria are beneficial to the host, demonstrating the ability of the berries to positively modulate the composition of the intestinal microbiota, just as conventional prebiotics do.”
“Berries can play a role through both diet and supplementation, as they are full of fiber when eaten fresh, and also concentrated extract ingredients can contribute flavonoids that have been scientifically shown to support gut health,” she adds.
INS Farms also sees the potential of elderberry in the prebiotic space, recently partnering with Taiyo International (Minneapolis, MN) to combine its Elder Pure elderberry juice powder with Taiyo’s Sunfiber partially hydrolyzed guar gum to create Elder Pure Elderberry Prebiotic Juice Powder. “Sunfiber currently has over 180 published studies, and we are excited to be involved in an exclusive relationship with them with our conventional and organic elderberry ingredients,” says INS’s Bennett. Research on how the combined product will support immune health is in the works.
Elderberry is not the only herb with prebiotic potential. Take echinacea. A recent review published in Biomolecules investigated the potential relationship between the immunomodulatory and antiviral activity of echinacea and its inulin-type fructan (ITF) content.6 ITFs are prebiotic compounds that the authors of the study say may act as signaling molecules and antioxidants. According to the review, echinacea has been shown in research to have antiviral activity against viruses such as human and avian influenza viruses, H3N2-type IV, H1N1-type IV, herpes simplex, and rhinoviruses, and reversed virus-induced pro-inflammatory responses. While researchers already studied the way echinacea’s phenolic compounds and alkamides activate immunomodulatory pathways, the role of ITFs in echinacea are less understood.
The immune health benefits of ITFs in echinacea can be inferred based on research of other ingredients. For example, ITFs derived from ingredients such as the traditional Japanese herbal medicine (Chikuyo–Sekko–To) and chicory have antiviral properties that could be attributed to the enhanced production of nitric oxide, which is a viral replication inhibitor. Fructans from aged and fresh garlic have also shown capacity to activate macrophages and subsequently phagocytosis in combination with a release of nitric oxide, write the authors.
The immune health benefits of prebiotic compounds alone are becoming more evident. Another study recently published in the Journal of Nutrition found that inulin-type fructans from chicory root fiber not only supported digestive health but also reduced the severity of illness.7 In the study, children between the ages of 3 and 6 were given either placebo or a dose of 6 g per day of chicory root fiber for six months. Results showed that compared to placebo, supplementation with the fiber softened stool and reduced the number of fevers that required medical attention. Subjects taking the fiber also saw a higher count of beneficial bacteria, such as Bifidobacterium and Lactobacillus.
Aside from prebiotic ingredients, a number of other established immune health ingredients are also known to operate by way of the digestive tract. For example, Wellmune from Kerry International, a proprietary yeast beta-1,3/1,6-glucan substantiated by over a dozen published, peer-reviewed clinical studies, supports immune health by modulating the gut.
“In terms of its mechanism of action, [Wellmune] enters the body through the gut, where macrophages break it down into smaller fragments that bind to neutrophils, the most abundant immune cells in the body,” explains Kerry’s Quilter. “Primed by Wellmune, the neutrophils move more quickly to recognize and kill foreign challengers.”
Another firm, Kemin Industries (Des Moines, IA), released a proprietary strain of Euglena gracilis, a nutrient-rich algae with greater than 50% 1,3-beta-glucan content, called BetaVia Complete. In an unpublished study conducted by the firm, the ingredient was found to significantly reduce symptoms of upper respiratory tract infections (URTI). Healthy adult subjects taking 375 mg/day of BetaVia Complete for 90 days experienced 70% fewer URTI symptoms, four fewer sick days, and 10 fewer URTI symptoms days.
A similar, but different, ingredient from Embria Health Sciences (Ankeny, IA) called EpiCor is a whole-food fermentate comprising proteins, fibers, polyphenols, vitamins, amino acids, beta-glucans, and other beneficial metabolites that work together to support immune health. In two randomized, double-blinded, placebo-controlled trials conducted by Embria Health on both vaccinated and unvaccinated subjects, EpiCor was found to significantly reduce cold and flu symptoms over the course of 90 days.8,9 In another study, EpiCor was found to significantly reduce gastrointestinal discomfort and constipation through the modulation of the gut microbiome.10
While the popularity of probiotics continues, and interest in prebiotics grows, EpiCor may open the doors to a related ingredient category called postbiotics (metabolic byproducts of probiotic bacteria).
“Postbiotics have the potential to disrupt the digestive health category. Made through fermentation, postbiotics contain bioactive compounds and metabolites that can convey a health benefit,” says Justin Green, director of scientific affairs for Embria Health. “Our ingredient EpiCor, a whole-food fermentate, is a postbiotic ingredient with clinical studies showing that it supports immune health and has emerging science that suggests it may positively modulate gut microbiota. With a clinically tested dosage of 500 mg, EpiCor can easily be formulated into capsules and tablets for gut microbiota support formulations.”
Until postbiotics gain more traction, probiotics continue to be reliable and in-demand immune health ingredients. According to Kerry, consumers are increasingly aware of the connection between gut health and immune health, both of which are at play when it comes to probiotics. “In our survey, we found that 46% of consumers recognize that probiotics can support the immune system,” says Quilter.
Kerry’s proprietary probiotic ingredient, Ganeden BC30, was recently found to support immune health in school-aged children. In the study, 80 healthy children were given either the probiotic in a flavored water or placebo for 12 weeks.11 Results showed that supplementation with the probiotic significantly decreased the incidence of upper respiratory tract infection symptoms, including nasal congestion, bloody nasal mucus, itchy nose, and hoarseness, as well as decreasing the duration of a number of symptoms, including hoarseness, red eyes, headache, and fatigue.
Besides these impressive results, the study also demonstrated an effective delivery format in the form of a flavored beverage, highlighting an opportunity for product formulators-one that is currently underexploited.
“One example of the exciting, and often untapped, potential of immune health ingredients is the kids’ beverage category,” says Quilter. “Despite the fact that immune support is one of the health benefits parents are most likely to seek for their kids, immune system claims were found on only 2% of children’s food and drink products launched globally between 2012 and 2017. Furthermore, the global drive to reduce added sugar and artificial ingredients means many beverages could use a ‘halo polish.’ The enrichment of products with functional benefits-for example, for immunity-can help increase the appeal of kids’ drinks in the eyes of parents.”
Children are always vulnerable to illness and therefore an important demographic to consider targeting. Parents need easier and effective ways to deliver immune health benefits to their children.
Another area ripe with opportunity is sports nutrition. Athletes, even the casual sort, are also vulnerable to illness and immune stressors due to exertion, and, if attending a gym, from exposure to other patrons who might be sick. “A recent survey in the UK found that 37% of consumers would buy a sports drink that supported their immune system,” says Quilter, citing a Mintel survey.
Another vulnerable population is older adults, which Kaneka Probiotics (Newark, CA) targets with its Floradapt Longevity probiotic formulation. This formula combines two patented strains of Lactobacillus plantarum (KABP-031 and -032) with specific vitamins and minerals, including folic acid, pyridoxine, cyanocobalamin, ascorbic acid, zinc, selenium, and retinol.
“Our original premise is based on the fact that human gut microbiota composition changes as we age, which translates into effects on an individual’s quality of life,” explains Sid Shastri, MSc, Kaneka’s director of product development and marketing. “Additionally, it’s known that nutritional status also changes with age. As people become older, they can secrete less acids, nutrient uptake into the body declines, diet quality typically declines-all resulting in suboptimal nutritional status.”
One study published in 2011 found that the patented strains used in this formula at two different doses increased the concentration of cells that modulate the immune system.12 In 50 elderly subjects, a dose of 5 billion CFU consumed over 12 weeks increased the percentage of T-suppressor and natural killer cells, while a lower dose of 500 million CFU increased T-helper lymphocytes, B lymphocytes, and antigen-presenting cells. Supplementation with probiotics also significantly decreased the concentration of the inflammatory cytokine TGF-Beta 1. Mortality was also significantly lower in the probiotic groups compared to placebo.
Another study published in 2012 randomized 60 immunized subjects between the ages of 65 and 85 to receive two different doses of the patented probiotic or placebo for three months.13 Results showed that supplementation with the probiotics increased the levels of influenza-specific IgA and IgG antibodies, improving the response of the influenza vaccine.
“This market has a high potential as”-according to the U.S. Census Bureau-”the population trends in the U.S. indicate that by 2030, the number of elderly people will be greater than the number of children for the first time in U.S. history,” says Shastri. “Furthermore, we are monitoring the latest aging research, which has revealed that the microbiota in centenarians (models of extreme age) had high capacity for central metabolism, especially glycolysis and fermentation to short-chain fatty acids (SCFAs). This 2019 research14 proposes a strong impact of gut microbiota on human health.”