Immune Health Is in Season Year-Round

Help Your Customers Keep Their Systems in Check

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When the immune system goes wrong, it can create issues throughout the body. If it is too weak, the body is left open to infection; if it is overactive, it can cause inflammatory diseases. While all medical problems should be taken to a doctor, and supplements cannot cure or prevent disorders or infections, there are plenty of ways to support immune health, from the holistic to the specific.

Prevention
The concept of prevention is nothing new, but it’s worth reinforcing. Hank Cheatham, VP of marketing and sales for Daiwa Health Development, Gardena, CA, stresses it’s important to think year-round about supporting the immune system. Customers “should be aware that their bodies are constantly exposed to foreign invaders,” he says, “not only during the winter months of cold and flu.”

Cheatham ticks off a list of all-weather sickness-inducing factors including stress, pollution, sleep deprivation, heredity, improper diet, surgery and aging.

“Some people want to be able to work hard, not rest, eat horribly, and still feel better,” says Robin Rogosin, VP of product development and corporate responsibility at LifeSeasons, Lewisville, TX. “They’re not looking for dietary supplements, they want drugs. For the reasonable people that care about their health, great options are preventative … The relationship between the immune system and stress has people talking about meditation, deep breathing, and the need for better sleep to help bolster immunity.”
Annie Eng, CEO of HP Ingredients, Bradenton, FL, agrees that while “people are more concerned about ‘winter sicknesses,’ e.g. colds and especially flu, this serves as an outstanding entrée for retailers to open a discussion about how immune care is important for overall strong immune system function all year long.” They’re looking for “support, to enable their immune systems to function optimally,” she says. When people ask for fast-acting supplements, remind them not to think in terms of a once-a-year drop in immunity. Think of it as a sub-optimal immune system failing at the harshest time of the year.

A recent consumer study conducted by the Natural Marketing Institute and commissioned by Basel, Switzerland-based Lonza, found that 36% of U.S. respondents were very likely to purchase supplements that support immune health. Awareness seems to be growing among millennials, with the research showing a 162% increase in the number of millennials using immune health supplements, said Juliana Erickson, senior marketing manager at Lonza Consumer Health and Wellness.
Even those customers who only get sick once a year might find consistent all-year prevention useful. One study published in Evidence-Based Complementary and Alternative Medicine looked at echinacea usage in air travel and discovered that passengers who took echinacea preventatively were less likely to develop respiratory illness (1). Along the same lines, a meta-analysis of 14 different studies found that echinacea decreased the odds of developing the common cold by 58%. For those who caught a cold, its length was shortened by 1.4 days in those who took echinacea, suggesting those who want to give their immune system a helping hand might want to start early (2).

Moreover, that once-a-year need for support might not hold steady the older one gets. Age-related changes in the immune system, or immunosenescence, lead to a higher rate of infections and diseases (3). As life expectancy increases and medical advances are made, this is becoming a bigger issue. Cheatham says “baby boomers, especially, are concerned about prevention, as they become more acutely aware of family members and friends who are dealing with serious diseases and other maladies.”

Holistic Prevention
Here are some of the major areas that can affect the immune system:
Sleep. A 2013 analysis of a 2010 survey of adults 45 years and older found that less-than-optimal or more-than-optimal levels of sleep were significantly associated with chronic heart disease, stroke and diabetes (4). Another study found that people who got fewer than six hours of sleep had a significantly increased risk of stroke, cancer and overall chronic illness (4).

Oral Health. Tooth-brushing might not be the first thing that springs to mind when contemplating immune health. A 2014 study found that the oral bacterium associated with periodontitis can subvert host immunity entirely, managing to maintain inflammation without being removed by the immune system, creating problems like gingivitis (5). Tooth loss and periodontal disease have been connected to a significantly higher incidence of chronic heart disease (6). A toothbrush might not seem like immune support, but it might be more important than we realize.

Stress. “An honest assessment here,” Eng says, “will help retailers create a sound supplement regimen to help combat the effects of stress, which will then impact immune function.” A 1993 meta-analysis found “substantial evidence for a relation between stress and … immune measures in humans” (7). The analysis found that while acute stressors are associated with an increase in NK cell function, chronic stress is associated with reliable decreases in response time to antigens and in NK cell activity. While the decrease was low to moderate, it was consistent across parameters and studies, and any drop in normal immune activity is undesirable.

I believe it’s only a matter of time before microbiome becomes a primary selling point.

Digestion. Here’s a cliché: you are what you eat. Doug Reyes, sales and marketing manager for Embria Health Sciences, Ankeny, IA, says Embria has been focusing on the link between digestive health and immune benefits for some time. “I believe it’s only a matter of time before microbiome becomes a primary selling point.” If your customer isn’t eating well, they probably won’t feel well, and if their gut bacteria are out of proportion or unhealthy, they won’t be able to properly digest their supplements. Remind your customers that just because a saying is cliché doesn’t mean it’s wrong.

Supplements
What do you give people when they’ve gotten past the holistic stage? Here are a few of the most common and most popular supplements.

Ashwagandha. This plant hits the immune system in two ways: by reducing stress and by helping to boost the immune system. A study from 1999 found that ashwagandha increased white blood cell and platelet counts in mice with induced immunosuppression (8). A randomized, double-blind, placebo-controlled study conducted on 64 adults with a history of chronic stress found that 300mg of high-concentration, full-spectrum ashwagandha root extract significantly reduced stress-assessment scores, which should, in turn, help prevent the immune system from weakening (9).

Beta-Glucan. Beta-Glucans are naturally occurring polysaccharides that make up the cell walls of certain bacteria and fungi, such as mushrooms. They have been shown to decrease upper respiratory tract infections (URTI) in children aged 1 to 4 years old, in a study with 156 participants split into a placebo group and two groups with different dosages (10). The placebo group had a significantly higher number of URTIs than either dosed group (11). Another study found that beta-glucan elicits a cellular response by modulating the activities of cytokines, transcriptional factors, and growth factors, and that it shows anticarcinogenic activity (12).

Omega Fatty Acids. Omega-3 and omega-6 fatty acids are polyunsaturated fats, meaning their chemical structure contains several double bonds (13). The most common omega-3 fats are eicosapentaenoic acid (EPA), which reduces inflammation; docosahexaenoic acid (DHA), which makes up around 8% of brain weight and is necessary for normal brain function; and alpha-linolenic acid (ALA), which is mainly used for energy (13). Omega-6 fatty acids are mostly used for energy, but some, such as arachidonic acid (ARA), are pro-inflammatory (13). Together, they have immunomodulatory effects.

Apart from helping to balance the inflammatory response, a 2012 study found that, in addition to suppressing T lymphocyte function, fish oil also enhances B cell function, making omega fatty acids an important supplement for healthy immune support, and demonstrating they interact with the immune system in more ways than just as pro- and anti-inflammatories (14).

That said, the omegas are not to be supplemented equally. Both omega-3 and omega-6 are processed by the same enzymes, meaning too much of one prevents the body from processing the other. A 2002 study showed that, although we should be eating a diet with a 1:1 ratio of omegas 6 and 3, we are actually getting a diet with a ratio between 15:1 and 16.7:1. Cardiovascular disease, colorectal cancer, breast cancer, rheumatoid arthritis and asthma have all been shown in clinical studies to respond beneficially to a ratio of around 4:1 (15).

The answer, however, is not to up omega-3 intake to match omega-6 intake. A 2013 analysis found that too much omega-3 can dampen the immune system entirely (16). A better solution would be for customers to bring their omega-3 intake up to standard, and then try to cut out foods containing omega-6 fatty acids – a list that includes corn chips, most fast foods, tofu, safflower oil, cured meats and creamy soups (17).

Probiotics. Probiotics are live bacteria that help keep the gut healthy. There are two main types, lactobacillus and bifidobacterium, both of which are made up of several different strains. Strains from lactobacillus are most common: they’re in yogurt and fermented foods, and they can help with diarrhea or help those who are lactose intolerant (18). Strains from bifidobacterium are generally found in dairy products, and they can help ease the symptoms of irritable bowel syndrome (17). They affect nerves that control gut movement, thus sending food through the gut, and different strains might help with different problems, ranging from irritable bowel syndrome to easing allergy symptoms (17).

Rogosin sees probiotics as a good place to start: “detoxification, digestion, and immunity are clearly connected, and probiotics and digestive enzymes are a clear intersection point.” She points to a study by J. Fan et al showing that two strains of bifidobacterium enhanced macrophage effectiveness and NK cell activity in mice (18). Another study devotes an entire section to the ways in which probiotics modulate the functions of dendritic cells, macrophages and T and B lymphocytes, suggesting that digestion interacts with the immune system directly (19). A comprehensive review looked at studies showing a wide range of potential benefits for taking probiotics: prevention of obesity, amelioration of colitis, relief from asthma, and, of course, showing their anti-inflammatory effects on the immune system (20). The review further suggested that lactobacillus and bifidobacterium may have the potential to prevent a wide scope of immunity-related diseases, and warranted further study in relation to immune health (20).

Rice Bran. Rice Bran Arabinoxylan Compound (RBAC) is gaining traction as an immune supplement. A 2015 study found that RBAC stimulated NK cell cytotoxic activity overnight and decelerated neuroblastoma growth in vivo (21); a 2014 study found that RBAC increased IFN-y secretion (22); a 2012 study found that NK cell sytotoxicity, IFN-y secretion, and a host of other cells attained optimal levels within 30 days without any adverse reactions (23). That 2012 study came to the conclusion that RBAC is an immunomodulator—rather than dampening inflammation until it fails even under appropriate circumstances, or pumping up the immune system until it becomes overactive, RBAC actually optimizes the immune system.

Cheatham notes that, furthermore, RBAC shows no side effects, has no interactions with pharmaceuticals, and maintains its effectiveness over time, making it appropriate for daily use. “It is also shown to have significant efficacy, even at a low dose of 500mg to 1g per day,” he says. Eating more rice doesn’t confer the same benefits— in rice, the molecules are too large for the body to break down, whereas a supplement can be combined with other enzymes to break down those molecules properly. Daiwa’s RBAC product, PeakImmune4, for instance, is combined with the enzyme from the shiitake mushroom. “The result is greater bioavailability than similar immune products,” Cheatham says.

Vitamins. Vitamins play various roles, not the least of which is to modulate the immune system. Vitamin D3, once it’s been metabolized through several different cells, exerts an inhibitory effect on macrophages, dendritic cells and T and B cells, preventing their proliferation and the problems that come with an overactive immune system. Retinoic acid, a metabolite of vitamin A, has been shown, depending on the signaling system, to help B-cells proliferate or inhibit B-cell proliferation and cause apoptosis, suggesting a modulatory role. It can help boost tumor-specific T-cell responses, it can modulate T-cell balances and it can increase helper cell responses. Vitamin E blocks the release of pro-inflammatory cytokines and decreases certain T cells; and vitamins C, B6, and A are antioxidants (24).

Devil’s in the Details
Here’s how to ensure that your customers get what they’re looking for.

Delivery System. Erickson says “consumers are looking for simple and effective ways to consume their nutrients. Ready-to-drink beverages, soft chews and nutritional bars have all seen the largest growth in the last eight years.” Reyes points out that ease-of-use might be set aside in favor of other factors. “They might want the sensation of drinking a refrigerated probiotic beverage that has a ‘soothing’ feeling on their gut. This is a benefit that tablets and capsules can’t provide.” If adding yet another pill into an existing regimen is hard for customers to swallow, suggest drinks or functional foods instead.

What better way to fail the consumer than to sell products with sub-efficacious doses?

Dosage. “Natural product retailers should be very aware about efficacious doses in the products on their shelves,” Reyes says. “What better way to fail the consumer than to sell products with sub-efficacious doses?” Dosages should have been determined through scientific studies. For instance, beta-glucan has performed well in clinical studies at either 35 or 75 mg per day, and while the differences between the 35mg and the 75mg group were not statistically significant, they were still there: 47% of the 35mg group experienced an infectious illness, as opposed to 32% of the 75mg group (11). Products with a higher dosage than shown to be effective should provide scientific studies showing that the effects of the product increase in a dose-based manner, and those with a lower dosage than shown to be clinically effective shouldn’t be on your shelves.

Science. Ensure the products you sell have scientific backing, and not just for the general category—for instance, just because probiotics as a whole have science on their side doesn’t mean that every probiotic strain is useful: a customer suffering from or at risk for IBD may find L. casei, L. plantarum, or L. acidophilus helpful, but a customer looking to raise NK cell activity would find B. longum or B. adolescentis more useful (19, 18).
Scope. Don’t just look at the supplements. “It’s important to ask customers questions about their sleep, stress levels, digestion and lifestyle,” Rogosin says. “Stress support and sleep promoting supplements can be a great ally for helping the immune system function more optimally.” Even when looking just at supplements, look beyond the one the customer is specifically looking to buy. A pro-inflammatory like omega-6 combined with an anti-inflammatory like vitamin E might cancel each other out. It might prove an opportunity to introduce them to something new — offering a sleep-enhancing or stress-reducing supplement might help as much as an immune health supplement. WF

References:

  1. E. Tiralongo et al, “Randomised, Double Blind, Placebo-Controlled Trial of Echinacea Supplementation in Air Travellers,” Evidence-Based Complementary and Alternative Medicine, 2012. https://www.hindawi.com/journals/ecam/2012/417267/abs/
  2. Sachin A Shah et al, “Evaluation of Echinacea for the prevention and treatment of the common cold: a meta-analysis,” The Lancet Infectious Diseases, 7(7), 473-480 (2007). https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(07)70160-3/abstract
  3. Danielle Aw, Alberto B. Silva, Donald B. Palmer, “Immunosenescence: emerging challenges for an ageing population,” Immunology, 120(4), 435-446 (2007). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2265901/
  4. Y. Liu et al, “Sleep duration and chronic diseases among U.S. adults age 45 years and older: evidence from the 2010 Behavioral Risk Factor Surveillance System,” Sleep, 36(10), 1421-1427 (2013). https://www.ncbi.nlm.nih.gov/pubmed/24082301/
  5. A. von Ruesten et al, “Association of sleep duration with chronic diseases in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam study,” Public Library of Science One, 7(1), 2012. http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0030972
  6. Tomoki Maekawa et al, “Porphyromonas gingivalis Manipulates Complement and TLR Signaling to Uncouple Bacterial Clearance from Inflammation and Promote Dysbiosis,” Cell Host and Microbe, 15(6), 768-778 (2014). https://www.cell.com/cell-host-microbe/fulltext/S1931-3128(14)00183-8
  7. K.J. Joshipura et al, “Poor Oral Health and Coronary Heart Disease,” Journal of Dental Research, 75(9), 1631-1636 (1996). http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.555.8810&rep=rep1&type=pdf
  8. Tracy Bennett Herbert and Sheldon Cohen, “Stress and Immunity in Humans: A Meta-Analytic Review,” Psychosomatic Medicine, 55, 364-379 (1993). https://pdfs.semanticscholar.org/e190/a3123f75a04aa3fbeeff5d1467039f10ed86.pdf
  9. R. Agarwal et al, “Studies on immunomodulatory activity of Withania somnifera (Ashwagandha) extracts in experimental immune inflammation,” Journal of Ethnopharmacology, 67(1), 27-35 (1999). https://www.ncbi.nlm.nih.gov/pubmed/10616957
  10. K. Chandrasekhar, J. Kapoor, S. Anishetty, “A prospective, randomized double-blind, placebo-controlled study of safety and efficacy of a high-concentration ufll-spectrum extract of ashwagandha root in reducing stress and anxiety in adults,” Indian Journal of Psychological Medicine, 34(3), 255-62 (2012). https://www.ncbi.nlm.nih.gov/pubmed/23439798
  11. F. Meng, “Baker’s Yeast Beta-Glucan Decreases Episodes of Common Childhood Illness In 1 to 4 Year Old Children during Cold Season in China,” Journal of Nutrition & Food Science, 2016. https://www.wellmune.com/2016/01/18/bakers-yeast-beta-glucan-decreases-episodes-of-common-childhood-illness-in1-to-4-year-old-children-during-cold-season-in-china/
  12. Dalia Akramienė et al, “Effects of Beta-glucans on the immune system,” Medicina (Kaunas), 43(8), 597-606 (2007). https://www.ncbi.nlm.nih.gov/pubmed/17895634
  13. Ruairi Robertson, “Omega-3-6-9 Fatty Acids: A Complete Overview,” 2017, https://www.healthline.com/nutrition/omega-3-6-9-overview. Accessed 8/21/18.
  14. Eric A. Gurzell et al, “DHA-enriched fish oil targets B cell lipid microdomains and enhances ex vivo and in vivo B cell function,” Journal of Leukocyte Biology, 93, 463-470 (2013).
  15. A.P. Simopoulos, “The importance of the ratio of omega-6/omega-3 essential fatty acids,” Biomedicine and Pharmacotherapy, 56(8), 365-379 (2002). https://www.ncbi.nlm.nih.gov/pubmed/12442909/
  16. Jenifer I. Fenton et al, “Immunomodulation by dietary long chain omega-3 fatty acids and the potential for adverse health outcomes,” 89(6), 379-390 (2013). https://www.plefa.com/article/S0952-3278(13)00192-0/fulltext
  17. “What are Probiotics?” WebMD. Accessed 8/21/18. https://www.webmd.com/digestive-disorders/what-are-probiotics#2
  18. J. Fan et al, “Effect of Bifidobacterium on the immunity in BALB/c mice,” Wei Sheng Wu Xue Bao, 55(4), 484-91 (2015). https://www.ncbi.nlm.nih.gov/pubmed/26211323
  19. Marieta Georgieva, Kaloyan Georgiev, and Peter Dobromirov, “Probiotics and Immunity,” Immunopathology and Immunomodulation, Chapter 9, 2015. https://www.intechopen.com/books/immunopathology-and-immunomodulation/probiotics-and-immunity
  20. Rostyslav V. Bubnov et al, “Probiotics and immunity: provisional role for personalized diets and disease prevention,” The EPMA Journal, 6(14), 2015. https://link.springer.com/content/pdf/10.1186%2Fs13167-015-0036-0.pdf
  21. A. Pérez-Martínez et al, “Arabinoxylan rice bran (MGN-3/Biobran) enhances natural killer cell-mediated cytotoxicity against neuroblastoma in vitro and in vivo,” Cytotherapy, 17(5), 601-12 (2015).
  22. Ji-young Choi et al, “Dietary supplementation with rice bran fermented with Lentinus edodes increases interferon-y activity without causing adverse effects: a randomized, double-blind, placebo-controlled, parallel-group study,” Nutrition Journal, 13(35), (2014). https://www.researchgate.net/publication/261800519_Dietary_supplementation_with_rice_bran_fermented_with_Lentinus_edodes_increases_interferon-g_activity_without_causing_adverse_effects_A_randomized_double-blind_placebo-controlled_parallel-group_study
  23. Karriem H. Ali et al, “An open-label, randomized clinical trial to assess the immunomodulatory activity of a novel oligosaccharide compound in healthy adults,” Functional Foods in Health and Disease, 2(7), 265-279 (2012).
  24. J. Rodrigo Mora, Makoto Iwata, Ulrich H. von Andrian, “Vitamin effects on the immune system: vitamins A and D take centre stage,” Nature Reviews Immunology, 8, 685-698 (2008). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2906676/

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