projected size of the global immune health
This season, medical advisors are cautioning that we should brace for “a pretty bad flu season.” One reason: Australia is seeing a more severe season than usual, which experts say could be an indication of what we will see in the U.S. What’s more, says Hank Cheatham, Vice President, Daiwa Health Development, “We don’t have as many strict public health interventions as we did last year, and we’ve seen a big surge in rhinovirus cases and common colds. We have also seen surges in RSV, so the next thing we expect to see is the flu, because that’s the way they normally follow each other in a regular respiratory season.”
On the upside, consumers may be better prepared this year because of lifestyle shifts they’ve already implemented. “Over the last few months, consumers across the world have changed in massive proportions and are continually developing new habits,” Cheatham says. “The most pronounced has been the massive shift in consumer perspective towards health and wellness. They are now, more than ever, inclined towards wholesome and healthy food products that promise vitamins, minerals, and other healthy immunity-boosting ingredients.”
Michael Modjeski, Chief Commercial Officer at Wakunaga of America Co., Ltd., sees similar. “In general, people are beginning to realize that a healthy immune system is vital all year long, not just during specific seasons like cold and flu or allergy season. COVID also put a spotlight on how everyday habits—diet, sleep, physical activity, and stress—can impact immunity for better or worse.” He adds that these changes in attitudes are, at least in part, changing how manufacturers approach the immune market.
And while the category has stabilized, demand is still higher than pre-pandemic. The global immune health supplements market was around $18B in 2020, reports Maggie McNamara, Marketing Director, Gencor. “The impact of COVID-19 on this market was staggering. The market exhibited a considerable growth of 11.6% in 2020 as compared to the average year-on-year growth between 2017-2019. The market is projected to grow from $20B in 2021 to $31.50B by 2028, at a CAGR of 6.6% in the period 2021-2028. A sudden fall in CAGR is attributable to this market’s demand and growth returning to pre-pandemic levels once the pandemic is completely over.”
Citing data from FMCG Gurus Global Health Survey 2022 and Natural Marketing Institute, Joana Carneiro, Chief Executive Officer, NutriLeads, says 66% of global consumers rank immune health as their top priority over digestive health (55%), heart health (53%), and mental well-being (48%).
“However,” Carneiro acknowledges, “consumer perceptions, behaviors and motivations are shifting. Today more than three-fourths of consumers understand the importance of immunity to both the susceptibility and resiliency of their health to all types of challenges. Seven in 10 consumers now say the top measure of immune health is how quickly they recover from illness. Most consumers also recognize the symbiotic relationship between gut health and the immune system. Not surprisingly, a recent survey found that 75% of U.S. adults would likely take an immune supplement. However, only 21% of supplement users think that currently available immunity supplements are effective. That means there is a huge opportunity for innovative products that deliver multifunctional benefits and are backed by strong clinical research.”
Outlining the opportunity, Carneiro shares more data from FMCG Gurus: “We expect demand for natural products that support immune health to remain strong. Even though many consumers have made diet and lifestyle changes the past few years, many have health insecurities. In fact, 57% of global consumers see themselves as vulnerable to illness and disease, compared with 39% before the pandemic. Two-thirds of consumers say they are concerned about exposure to germs, viruses and bacteria and even more—71%—worry about future waves of coronavirus.”
Innovating in Immune
“Vitamin D, elderberry, C, and zinc are still popular due to consumer awareness,” says McNamara. “Other ingredients with long-term use benefits such as Palmitoylethanolamide (PEA)—which is an endogenous fatty acid amide produced naturally in the body in response to injury and stress and has more than 350 papers on its immuno-modulatory, anti-inflammatory, and analgesic properties—should be considered a staple for immune formulators. Long-term is where consumers should be looking, yet I am not sure they really have gotten to that point—primarily due to lack of education on ingredients for long-term use. There needs to be consideration for other ‘outside the box’ ingredients.”
Also driving change: “For years, the immune space focused on boosting the body’s defenses,” says Modjeski. “The problem is, continually keeping immunity on high alert could open the door to allergies or autoimmune disorders. Now, a growing number of studies are finding that, instead of overreacting or underreacting, a balanced immune system provides an appropriate response when faced with pathogens or other harmful threats. Research reports that one of the very best ways to balance immunity is with a blend of plant sterols and sterolins—like those found in Moducare—delivered in a proven ratio of 100:1.”
NOW is innovating in this category as well, says Neil Edward Levin, CCN, DANLA, Senior Nutrition Education Manager. The company introduced immune-support products in response to consumer demand and ingredient availability due to supply chain disruptions, most of which included tried-and-true immune support ingredients, Levin reports. “C-1000 Zinc Immune combines 1,000 mg of ascorbic acid with 15 mg of elemental zinc in one vegan-friendly capsule for powerful immune system support. This product utilizes TRAACS Zinc Bisglycinate, a form of zinc that has been shown in clinical studies to have superior bioavailability compared to other forms of supplemental zinc. NOW also launched AlliBiotic CDZ, formulated for seasonal immune system support. It contains vitamins C and D plus zinc, nutrients that are critical for healthy immune system function. AlliBiotic CDZ also has garlic extract, which has a very long history of use to promote overall wellness. Olive leaf extract and oregano oil complete this comprehensive enteric-coated softgel formula.”
Another known ingredient getting a science update: black seed oil (BSO). Morris Zelkha, CEO at TriNutra, points to the synergistic effects of TriNutra’s full-spectrum black seed oil, ThymoQuin, as an example: “A recently published clinical study found that the mixture of our patented and standardized black seed oil to 3% thymoquinone (the extract’s main active) with vitamin D3 improved immune function and aided in a healthy inflammatory response. A recent human study found that the mixture of our ThymoQuin with omega-3 or astaxanthin improved immune functionality and supported respiration response.”
Zelkha cautions: “Consumers should be aware that not all BSOs are created equal. The quality of the oil starts with the growing conditions through to extraction, storage, and final packaging. Several clinical studies show that the higher standardization of thymoquinone, the primary phytochemical compound, combined with low free fatty acids, provides superior effects to other BSOs on the market.” TriNutra, he says, offers non-GMO thymoquinone varietals that yield three to four times the thymoquinone content of other varieties; patent-pending ThymoQuin is cold-pressed and standardized to 3% BSO.
Also innovating: “Our immune health ingredient BeniCaros has received industry accolades for innovation and research since it was launched last year,” says Carneiro. “BeniCaros is a natural, soluble prebiotic carrot fiber known as RG-I (Rhamnogalacturonan-I) that trains the immune system to respond faster and more effectively when challenged. BeniCaros’ unique dual mode of action prepares innate immune cells for a heightened state of readiness and selectively increases beneficial gut microorganisms and their metabolites that support immune responses. Clinical research shows that just 300 mg of BeniCaros daily accelerated protective immune responsiveness, reduced airway symptom severity (20-33%) and duration (25-43%) and minimized the impact on quality of life following a controlled challenge with a common cold virus.”
And from Daiwa Health Development comes a proprietary immune-enhancing complex. “PeakImmune4 is new to many retailers and would provide a perfect nutraceutical addition to their immune-enhancing arsenal,” says Cheatham. “PeakImmune4’s active ingredient is Rice Bran Arabinoxylan Compound (RBAC) [derived from rice bran, modified by Shiitake mushroom enzyme]. It is shown in clinical studies to enhance the immune system by increasing the activity of the lymphocytes or white blood cells. RBAC can enhance Natural Killer (NK) cell function, increase the count of T and B lymphocytes, and increase the macrophages and cytokines…Shown in research studies to be a true immune modulator and proven safe, RBAC has been tested in over 70 research studies and clinical trials.”
Immune Plus: Sleep, Stress, Gut
Along with strong demand for innovative branded ingredients that enable formulators to create products that standout in a crowded marketplace, Carneiro says the hottest market segment is immune health products that also support gut health. “Eight in 10 consumers recognize the connection between gut microbiota health and immune health. A growing number of consumers understand the important role of the microbiota-immune axis to their overall health and wellness.”
Offering insights into this axis, Cheatham explains, “The microbiome is a collection of microorganisms that are predominantly found in your gut. For example, your gut bacteria have many beneficial roles such as regulating your metabolism, mood, cognitive function, appetite, digestion and immunity. Just as most of the microbiome lives in the gut, so does about 70% of your immune system. The gut is a great place for the majority of the immune system to be located since this space is where many harmful pathogens, including viruses, parasites and harmful bacteria, first enter your body. The immune system and gut therefore have a symbiotic relationship, meaning that both the immune system of the human and the microbiome benefit from this connection. The good bacteria that are part of the microbiome train the immune cells to distinguish between ‘non-self’ and ‘self’ while the gut signals the immune system to generate the appropriate immune responses. The immune system on the other hand, helps to maintain a healthy microbiome with plenty of diversity. This delicate two-way communication between your gut and immune cells can be supported through the right lifestyle choices and specific nutrients such as PeakImmune4.”
Zelkha points to research looking at the combination of ThymoQuin with astaxanthin. The study demonstrated that the combo supports the gut-immune-brain axis and improves mood following the stress of endurance training.
“The immune category has evolved to include ingredients that are relatively new to the immune support party and we introduced several,” Levin adds. “NOW Respiratory Care Probiotic is a probiotic combination featuring L. acidophilus NCFM, which has been used in over 60 scientific studies. When used alone or in combination with B. lactis Bl-04, NCFM has been shown to support a robust, but balanced, immune response to seasonal respiratory challenges, as well as to support an active lifestyle. NCFM can rapidly populate the intestine and adhere to the intestinal wall, which is helpful for use during and after temporary disruptions to intestinal microbiota.”
Another dual-benefit opportunity centers on stress and immune support. Cheatham cites a 2019 Gallup poll that found more Americans were stressed and worried in 2018 than they have been at any other time during the past decade. And today? “The level of stress, worry and anxiety has increased several times more than in 2018 because of the pandemic,” he says. “According to a more recent Gallup poll, 55% of Americans surveyed said they had experienced stress during the previous day, and 45% said they felt worried a lot. Stress can compromise the immune system. Astute retailers will address this issue with customers seeking relief from stress related concerns by recommending PeakImmune4 as an efficacious immune modulator.”
Jay Levy, National Sales Director, Wakunaga of America, explains, “Stress undermines a healthy immune response because it elevates our cortisol levels. Often called the ‘stress hormone,’ too much cortisol can lower the number of key immune cells called lymphocytes that protect the body from infection. That’s why we often get sick after a stressful event.”
Counteracting stress requires a multi-pronged approach, according to Levy. “Promoting balance with plant sterols and sterolins like those in Moducare, fostering calm with the B vitamins and other stress-specific nutrients like those in Kyolic Stress & Fatigue Relief, and encouraging a diverse gut microbiome with a well-researched probiotic like Wakuaga’s Kyo-Dophilus.” This, he says, is because the gut significantly impacts both immunity and the neurotransmitters involved in the body’s stress response.
McNamara says companies like Gencor are investing heavily in clinical trials and scientific research to make highly effective nutritional supplements to not only support immunity, but also to support overall health. “The combination of pre- and probiotics with other immune ingredients seems to be picking up. Looking at other health conditions that may affect immunity and addressing those in combination with immunity-supporting ingredients is innovative and beneficial to consumers. For example, offering a sleep ingredient as restful sleep contributes to the body building and maintaining a healthy immune system. And the connection between chronic stress and a weak immune system means that formulators can consider using stress support ingredients (affron for example) in their formulations. Sleep is another contributor, so adding something like Levagen+ which is a branded PEA, would be a good consideration.”
Summing up, McNamara says, “Any ingredient that has an impact on stress, for example, ashwagandha, affron, etc., would have a positive impact on the immune system. Stress has a significant negative impact on the immune system. Additionally, ingredients for stress would also have a positive impact on gut health for the same reason. Tying stress, gut, cognition and immune health is intricate. Supporting any one of the four areas can and should have an impact on the others.”
Looking to the Future
“Even though targeted herbs and nutrients can still play a role in immune health when faced with an acute threat,” says Modjeski, “consumers are becoming aware that long-term immunity may be even more important. Not only does balanced, long-term immunity protect against everyday illness, it can also help to maximize both lifespan and healthspan by helping to protect against chronic disease.”
McNamara also forecasts a move to long-term immune support products for prevention. “This would be an increase in interest compared to pre-pandemic years. Customers are gradually looking for efficient products that they believe might boost immunity and the body’s defense capability. Overall health is one of the highest priorities now for consumers, and they are expecting products that contain ingredients that are clinically proven and efficacious.” McNamara adds that ingredients with proven effectiveness for long-term use, such as Wellmune, Bioglena, and ImmunoLin, are gaining traction due to their ability to support the immune system and get it ready to react when we are exposed to pathogens.
It’s important to improve consumer knowledge about what specifically immune ingredients do, adds McNamara. “Example: Many omega-3 products were claiming immune support, which is true, but it is for the inflammatory response of the immune system and not for helping protect against pathogens. A consumer may see the claim of immune support and think it would help them not get the flu or recover from a cold, when in reality it will have little to no impact on their health in that regard. This type of marketing should not be popularized.”
Just as savvy consumers are taking smart action to support year-round immune health, they are increasingly focused on making smart choices in the products they select, looking for science- backed ingredients from trustworthy companies. “We think a market shakeout is underway,” forecasts Carneiro. “During the panic of the pandemic, the market was flooded with many products with some type of immune health claim. Many consumers have become savvier shoppers and they will gravitate towards products that offer immune health benefits that make a difference. And these benefits will be backed by strong clinical research.”
Seconding the call for quality and science: “Providing consumers with truthful claims backed by well-researched ingredients is a winning strategy that Wakunaga of America has used for the past half century,” says Levy. “These values and practices are at the core of what we do and who we are.”
To be sure products meet consumer demand, Carneiro points to more data from FMCG Gurus Global Health Survey 2022 showing that 80% of global consumers want to read three claims on the labels of immune-supporting products:
- Clinically proven
- Supports a healthy lifestyle.
Of course, the product has to deliver on those claims—that’s the best way brands can win and keep consumer trust, Levin stresses. “The immune category is one where people can tell if they are getting the support they expect. When people stay relatively healthy throughout the fall and winter seasons, they may feel confident that whatever it is they are doing to support their immune health is effective.” WF
The Hygiene Connection
Consumers have started looking for small things they can do to improve their health, and hygiene is a big part of that, says Nathan Jones, Founder and President of Xlear. “Even people that have a weak immune system have a better chance of fighting off an infection if, through hygiene, we keep knocking down the viral/bacterial load in our nose, mouth and gut.” Jones points to research associating periodontitis with higher risk of ICU admission, need for assisted ventilation, and death of COVID-19 patients, and with increased blood levels of biomarkers linked to worse disease outcomes. In addition, Jones says, there is evidence that nasal washing can help people ward off infection. And a 2022 study from researchers at Medical College of Georgia at Augusta University determined that starting twice daily flushing of the nasal cavity with a mild saline solution soon after testing positive for COVID-19 can significantly reduce hospitalization and death.
“While immunity may not cover oral and nasal health, understanding that the oral and nasal microbiome are gateway microbiomes…if our mouth and nose are not healthy, we are not going to be healthy,” says Jones. “Using hygiene products that don’t destroy the microbiome is incredibly important. And while mainstream brands marketing a mouthwash as ‘kills 99.9%’ of bacteria might sound good, only about 15% of the bacteria in a mouth are harmful. Most of the bacteria help us digest our food and help keep bad bacteria in check.”