Of all the systems that compose the human body, the immune system is the most awesome, hands down. Its complexity—the wide array of cells that have specific jobs to do, working in harmony with one another—is simply amazing.

The human body is quite alluring to a legion of microbial foreigners: bacteria, fungi, viruses and parasites, all of which can gain entry via inhalation, the skin and our oral–digestive pathway. The immune system is made up of the lymphatic highway, cells, tissues and organs that—when healthy and uncompromised—work in fluent synergy to isolate, attack and destroy incoming microbial marauders.

The immune system modulates between active and resting states, according to Steve Holtby, president and CEO of Los Angeles, CA-based Soft Gel Technologies, Inc. It remains in a resting state until it recognizes a challenge and then switches to an active state. When fully activated, the chemicals (cytokines, chemokines and antibodies) made by the immune system to protect the body are at high levels. When the immune system is resting, these same chemicals exist at very low levels.

Unfortunately, the immune system breaks down over time. “As we age, especially for those over 50, our immune systems start to decline and become less responsive to ‘normal’ pathogens such as viruses and bacteria,” explains Richard Passwater, Ph.D., vice president of research and development for Solgar Vitamin and Herb, Leonia, NJ. “There are many reasons why our immune systems become less effective and wear out as we age. In part, the integrity of our cells and DNA has been compromised. The accumulated damage and the years of transcription errors are passed on from generation to generation of new cells.”

This article is timely in that one of the biggest enemies of the immune system is stress. We are living in very stressful times with the continued financial crisis that incites anxiety and fear in many. Now is the perfect time for retailers to spotlight both anti-stress and immune-support products together, as well as work more closely with a naturopath and/or a stress counselor.

Market Dynamics: Boosting Consumers’ Immune IQ
The good news is that most people have a passing awareness and understanding that “keeping their immune systems strong” keeps them healthy. “The immune category itself continues to be among the top categories in terms of consumer interest and value,” says Bryan Rodriguez, technical marketing and scientific affairs manager, Lonza Inc., Allendale, NJ. “The dynamics of the category allow customers to continue to learn more and more about immune products, while new ones are being developed and introduced at the same time.”

However, there is so much more work the retail society can do to ensure that individual customers know what to select and why. Raw materials suppliers and their partner dietary supplement manufacturers have done tremendous work in research and formulation to provide immune-support supplements that have an excitingly significant track record of efficacy in immune nourishment and fortification. Notes Rodriguez, “The challenge remains for manufacturers to clearly communicate the immune benefits of ingredients so they are clear and understandable for the consumer. Whoever accomplishes this will have found a way to reach the consumer in a more effective manner than most other companies marketing immune health products.” He explains that manufacturers who provide clear, concise science-backed information to the public that is stripped of its marketing language “present a true, trustworthy message that the consumer is constantly seeking.”

Richard Mueller, president and CEO of Biothera, Eagan, MN, sees the rapid growth of this category as a result of consumer and manufacturer recognition of its importance in overall wellness—even if consumers don’t understand the complexities, “the value they place on maintaining immune health as part of an overall wellness plan has reached critical mass,” he observes.

Further, he notes, a major driver of this growth is the immune system being covered more in the media, notably about the impact upon it from HIV and pandemic diseases (e.g., SARs, West Nile Virus and bird flu). Following a burgeoning trend, consumers continue to educate themselves on ways to maintain and enhance their health in response to stress, aging, lifestyle changes and environmental challenges and finding that a strong immune system is critical to overall health. Marketers are picking up on this trend and talking directly to consumers about immune health, which builds further awareness.

Hank Cheatham, director of sales and marketing at Quality of Life Labs, Purchase, NY, observes that most consumers have very little understanding of the immune system and the importance of immune self-care. “The prevalence of immune-related diseases increases as the population ages and there is more awareness of immunity and immune self-care now than at any time previously, making for exciting category potential. Many consumers are aware of the connection between immune status and diseases and other ailments related to viruses and bacteria, a most auspicious start,” he says.

“The reality of the world we live in is one in which immune products will always be a key component of self-care,” notes Mark Kaylor, M.H., C.N., Ph.D., for Maitake Products, Inc., East Rutherford, NJ. “The rise in ‘new’ microbes, increasingly resistant microbes, ever-present concerns and fear about cancer and allopathy’s inability to effectively treat the common cold mean that alternative and preventative measures are here for a long time.”

Kaylor attests that it is difficult to accurately assess the level of understanding found in health food consumers since this has become an extremely varied group, not like in the old “hippie” days. The advent of information technology has also created highly educated consumers. “Overall, though, I’d have to admit to a lack of sophistication in the average consumer. There is still a dominating tendency to view any and all immune products on an equal level with regards to actions and efficacy.”

Keri Marshall, M.S., N.D., advisor to Nordic Naturals, Watsonville, CA, identifies several key factors about immune health that many consumers don’t understand: its complexity and protective role in more than just not catching a cold, its integral role in regulating inflammatory pathways that play a role in the development of almost every chronic disease, and its health dictates the body’s ability to defend against cancer development.

“When most consumers think of immune supplements they think of echinacea and vitamin C. They do not immediately recognize that many products such as mushrooms and omega-3 fatty acids are also effective immune-modulating supplements,” she says.

David Winston, RH (AHG), founder of and clinical herbalist for Herbalist & Alchemist, Washington, NJ, holds a similar view. The major issue in this category, he says, is confusion and lack of education. “There is a lack of understanding of how the immune system works by consumers, retailers and often practitioners as well,” he states. And, individuals are not clear how products designed to support the immune system work, when they work and when they are not appropriate. “People often look at one of these products and think ‘oh, this will be good for my immune system.’ Well, that would be great if the immune system was a simple thing. But, it isn’t. Virtually every single tissue in the body has either overt or passive immune activity. You can’t separate your immune system from your emotional state, your endocrine status, your level of happiness and your nutritional status. All these things play a role.”

In tandem, observes John O’Connor, B.S., quality control specialist of Los Angeles, CA-based Jarrow Formulas, there are many consumers who “are still of the disturbing mindset that if an herb or a nutrient has been shown to benefit the immune system in some capacity, then more must always be better. They really need to be disabused of this notion, because it is nearly always not the case. Taking more than the commonly accepted dose can have negative consequences on one’s health.”

He offers zinc as an example. Zinc has been widely publicized as having the ability to manage symptoms of the common cold. The “more is better because it’s harmless” mentality in this case can be detrimental, O’Connor asserts, because a surplus of zinc can suppress levels of copper, which may lead to anemia and lower superoxide dismutase (SOD) levels. SOD is a critical endogenous antioxidant enzyme needed to protect cells from free radical damage.

Eileen Sheets, managing director, Bioforce USA, Ghent, NY, notes that echinacea and a few other herbs have dominated the immune support category for quite a while. “As we know, just a few years ago, echinacea was sideswiped in the media causing consumer confidence in use of this herb to plummet,” she relates. In the meantime, many new products have come to the forefront for immune support. Also, she notes, several significant newer studies have been published proving that some echinacea products actually do work. Echinacea sales have increased in response, demonstrating that much of the confidence in this botanical has been restored.

Boost or Modulate?
Indeed, semantics count in the immune category. One of the primary conundrums faced by consumers is “what’s the difference between immune enhancement, immune boosting and immune modulation—and which product type will benefit my individual needs?”

Unfortunately, says Kaylor, “these terms are freely and interchangeably used by companies, writers, retailers and consumers when there is an important action difference.” Boosting, he says, “simply means an increase in immune function, activity or numbers in some way.”

An immune booster, adds Mueller, temporarily increases and stimulates the number of specific white blood cells and should only be taken for a short duration.

Modulating, on the other hand, “implies a more tonic and balancing action,” Kaylor notes and continues, “Immune modulators basically up-regulate an under-active system as well as down-regulate an overactive immune system as can be seen in the long-used traditional remedy, reishi.”

Mueller believes that immune modulation is the preferable choice for many consumers because it enhances the body’s natural ability to respond to a challenge and also maintains a healthy and viable immune system balance. Immune boosting creates an artificial and unnatural state and is not recommended. “An immune-modulating (priming) compound, such as Wellmune WGP, makes the existing immune cells ‘battle-ready’ without stimulation so that when they encounter a foreign challenge they more quickly engage and destroy that challenge,” he says.

In agreement is Jarrow Formulas’ O’Connor, who explains that “compounds that are immune boosting are one-dimensional in the sense that they have the capacity to stimulate or increase the body’s immune response through promoting the synthesis or activation of immune cells (e.g., lymphocytes and phagocytes) along with the expression of cytokines and activation of enzymes that these cells release, in response to invasion by bacteria or viruses, or the inhalation of pollen, dust mites and so on. Some compounds (e.g., lactoferrin, echinacosides) may also augment the immune response by being able to kill invading organisms directly.”

Conversely, O’Connor adds, because compounds that are immune modulating have a dual capacity to increase and decrease immune response, they “appear to be the more desirable as the former may be contraindicated in the cases where stimulating the immune system can have a negative effect, as in the case of autoimmune conditions such as lupus. There are times when an increase in the inflammatory process would be desirable and times when suppressing inflammation or preventing excessive inflammation is important. A compound or formula that can do both is immune modulating and hence would be advantageous.”

Sheets reflects that this category was all about immune boosting for years, which gave rise to the commonly held belief that one should not use echinacea for more than several weeks because it may over-stimulate the immune system. Bioforce researchers in Switzerland performed a study to investigate this. In an in vitro study, they added low concentrations of a branded echinacea supplement (Echinaforce) to isolated human immune cells, which were then analyzed with biochemical and molecular biology methods to determine its effect on these immune cells. They found that the supplement’s alkylamides bind specifically to the CB2-receptor on the immune cells exerting a modulatory effect on TNF-a. “We therefore now know Echinacea exerts a modulating effect, not a boosting or stimulating effect because nothing happens until the body comes into contact with a pathogen,” she explains. “At that point, the immune cells were shown to become active in a moderate and longer lasting fashion. Without Echinaforce, the immune system responds to a challenge with more TNF-a, but the response is much more short lived. With Echinaforce, the TNF-a response does not spike as high, but it lasts much longer, providing a more effective response. From this research, we now know that it is safe and appropriate to use Echinaforce prophylatically.”

Cheatham says that supplements such as Quality of Life Labs’ Kinoko AHCC are modulators because they enable the immune system, specifically lymphocytes or the white blood cells, to distinguish good cells from diseased cells and to attack only the abnormal ones. This process is not easy because irregular cells act as chameleons, blending in with healthy cells to avoid detection by the patrolling natural killer (NK) cells and other white blood cells that find and destroy diseased cells. The modulators will not over-stimulate healthy cells and will identify abnormal cells creating targets for the white blood cells to recognize and to destroy.

Published research by Drexler University on another AHCC supplement (ImmPower from American BioSciences, Inc.) showed that those who received the supplement had more NK cells and extra NK cell activity in response to influenza infection. Taking the supplement is said to reduce the severity of flu symptoms.

Other important players in the category are polysaccharides like arabinogalactan, which also closely mimics the host–pathogen relationship, “due to the sugar components that make up the polysaccharide. These different sugar components are typically part of the cell wall of different bacteria and viruses and therefore the immune system recognizes the sugar components of the polysaccharide,” Rodriguez explains.

Winston points out that allergies and autoimmune conditions are examples of an overactive immune system and that regulatory herbs can help down-regulate excessive immune response. He uses a self-developed model to clarify the major classes of immunity:

• The surface immune system is the body’s ability to respond to what is referred to in Chinese medicine as “external pernicious influences” such as changes in weather, acute bacteria or viral infections. The surface immune system corresponds to macrophage/phagocyte activity.
• The deep immune system is the body’s ability to respond to systemic viral, bacterial or fungal infections as well as to cancer and includes many types of immune cells, such as T-4, T-8, K+, NK cells.
• The immune reservoir describes the fundamental ability of the body to mount the appropriate immune response to any situation or need. It is an artificial construct; a model of an individual’s total immune potential.
• The hypothalamic/pituitary/adrenal (HPA) axis controls all endocrine function, as well as significant aspects of immune and nervous system function. Studies clearly show chronic stress, anger, depression or anxiety can inhibit immune response.

Sales Immunity
With such a complex category as immune support, effective retailing may be a challenge.

“There are no shortcuts in this category,” asserts Sheets, who suggests seeking out manufacturers that invest in their products to understand how and why they work and are willing and able to dispense this information to retailers and consumers. “One of the most frustrating things to me, both as a manufacturer and as a health food store customer myself are stores that are not set up to receive this information and pass it on,” she says. “This industry was founded on exceptional and personal customer service, but unfortunately it has gone by the wayside in some stores and products are expected to sell themselves.”

Mueller believes that retailers should consider segmenting the immune product section into two categories: prevention and therapeutic. Many immune products are positioned as remedies to be taken at the outset of uncomfortable symptoms, but, he says, many of these products are often missing an opportunity by being limited to seasonal marketing. So in addition to the traditional marketing focus on therapeutic benefits, he suggests positioning immune products as support for certain health and lifestyle challenges such as travel, stress and environmental factors; this then opens this type of immune product to a year-round market. “This approach helps eliminate a key barrier to purchase: Why buy an immune product when I feel fine?” he offers.

It’s back to basics, Winston notes, industry and retailers need to really understand what they are selling. It really is not as simple as “this is good for your immune system,” which he says he hears constantly. Immune health and support is uniquely individual and requires more in-depth knowledge and understanding of why one product is good for the immune system of any particular customer. For example, does she have hyper or hypo immune response? Is it stress induced? Does he have nutritionally induced immune suppression? Keep in mind, Winston advises, retailers have limits on addressing serious conditions that should be under a practitioner’s care, but they can steer customers in the right direction of products that may be appropriate for individual immune status.

“As a long-time retailer myself,” relates Neil Levin, nutrition education manager of NOW Foods, Bloomingdale, IL, “I found that a concern about the cost of an item was frequently a way for the customer to express concern over its efficacy. After all, any item is too expensive if it doesn’t work! And the person may have had experience with remedies that failed for him or her and is more conscious of the price as a result. If you can convince your customers of that efficacy, then you can usually overcome that particular objection.”Levin adds that the plethora of immune products can be overwhelming. It would be helpful to subcategorize them. Equally, staff help should be invaluable in matching products to consumers; retailers can be successful in this category and others by taking full advantage of the extensive education available in trade magazines, at tradeshows and on some manufacturers’ Web sites to increase staff knowledge.

Holtby agrees that marketing immune support supplements is tough because FDA laws prevent marketers from saying what a product is capable of doing beyond a structure/function claim. “Every supplement company is trying to find new ways to promote their immune support products, and some even take the risk of making cancer claims,” he says. “This exposes that brand to enforcement action by the FDA, and tarnishes the reputation of the supplement industry in general. Retailers should support those brands that don’t make outlandish claims, but only reference that their antioxidant and/or immune formula supports proper immune system function.”

Meanwhile, he adds, retailers can consider creating various sections in their stores for immune products, as many of them fit into several condition-specific categories such as antioxidants, detoxification, stress/energy, cold and flu/wellness and general immune health. WF

Lisa Schofield is a freelance writer based in Freehold, NJ.