Update! Digestive Health Category

With COVID-19 driving awareness about the link between digestive health and overall wellbeing, the potential for this category continues to climb. Here’s what you need to know now.

Digestive health is a massive market, covering -biotics, enzymes, herbs, and more, affecting everything from immune health to energy. Consumers are more than aware of this. Looking at the U.S. specifically, Cashtyn Lovan, Marketing Manager, Cargill, tells WholeFoods: “We recently partnered with Harris Poll to gain a deeper insight into consumers’ understanding of issues around digestive health as well as immunity. We found over half of Americans (58%) think it’s important to have a healthy gut because it helps maintain good general health and wellbeing. Roughly half of consumers also recognize the link between gut health and the immune system (54%) and understand a healthy gut helps protect against bad bacteria (53%). While there remains room for additional education, it’s clear that many consumers realize that the benefits of good digestive health extend well beyond the gut.”

Thinking globally, citing its own consumer survey and the Health Focus International Global Trend Study 2020, Beneo shared some numbers:

  • 84% of health-aware consumers in the 50+ age group choose digestive health food & beverages to maintain general health & wellness
  • 22% of European consumers have read some news lately on the topic of digestive health
  • 78% of global consumers say digestive health is extremely or very important for their health

Plus, pointing to a Health Focus International 2020 Global Gut Health Report, Beneo noted the top three benefits associated with gut health:

  • overall physical health (78%)
  • overall mental well-being (69%)
  • immune function (68%)

Beneo offers inulin and oligofructose prebiotics, which have been shown in studies to support normal bowel function, increase calcium absorption, support satiety, support energy intake, and improve stool consistency in infants.

Brittany Lisanti, Global Project Manager, IFF Health, pointed to a major cause of this category’s recent growth: COVID-19. “Largely in response to the COVID-19 pandemic, consumers are becoming more familiar with the ways in which their digestive health can affect their overall wellbeing. From the gut-brain axis to a healthy microbiome’s immune-boosting benefits, digestion-focused products are taking the market by storm.”

Nor is the category slowing down. In fact, Kurt Cameron, CMO, Diem Direct, suggests that it may well explode. “The digestive health category is poised to grow by as much as 75% over the next five years, according to recent reports. The popularization of home testing kits for food intolerances, colon health, gut microbiome analysis and the like is certainly a driver here. Resistant starches and other innovative fiber products appear to be trending.” Part of this, he suggests, is an understanding of what, precisely, constitutes digestive health struggles—and struggles that can actually be impacted: “At Diem Direct we are seeing rapidly increasing demand for our enzyme products that address dietary intolerances, specifically Histamine Intolerance and Fructose Malabsorption, which we believe will continue as public awareness grows and more people begin to understand the nuances between different dietary triggers. The trend of gluten intolerance as the answer to all digestive ills is fading as folks learn that the causes of their concerns are more complex.”

Kim Hapke, N.D., Metabolic Maintenance, agrees: public knowledge in this area is growing. “Though gluten has been a worry for some time, people are worried now about a broader array of food sensitivities as well as chemicals such as glyphosate which may be ingested in the diet. Concerns about how these are affecting their GI tract and overall health have increased greatly in the last few years. They are asking questions about sourcing ingredients, ingredient makeup, and the third-party testing we do at Metabolic Maintenance as a result.”

Here, a rundown on what’s important in this category.

Going Functional 

Digestive health is a perfect match for functional foods and beverages—what makes more intuitive sense than eating things that are good for the stomach? And IFF’s Brittany Lisanti says it’s time for brands to move in this direction: “As consumers take a more proactive approach to their health while simultaneously moving away from pills and capsules, it will be important for retailers to explore formulating with new ingredients in innovative delivery formats. Given the 2020 sales of fortified/functional foods and beverages totaling over $276 billion USD, according to Euromonitor, and the future anticipated growth, brands should look to these categories for inspiration and direction. A unique opportunity to illustrate this trend is to combine functional ingredients like probiotics, botanicals and/or fruits and vegetables in concepts that mimic traditional beverages, protein bars and chocolates, to name a few. Offering products that seamlessly integrate into a consumer’s lifestyle allows brands to entice individuals across the entire health-conscious spectrum, while also addressing their desire for natural and complete solutions.”

IFF is working to leverage its own ingredient portfolio to help create products for functional food & beverage applications, according to Lisanti.

Enzymes

Digestive enzymes break down food, allowing for nutrient absorption. These enzymes are largely secreted by the pancreas, although the mouth, stomach, and small intestine also make some enzymes. They come in three main types:

  • Amylase, which breaks carbohydrates and starches into sugar molecules;
  • Lipase, which works with liver bile to break down fats;
  • Protease, which breaks protein into amino acids, and helps keep bacteria, yeast, and protozoa out of the intestines.

But it’s more complicated than simply tossing the three in a pill and handing it out. Neil E. Levin, CCN, DANLA, Senior Nutrition Education Manager at NOW, explains: “We see targeted formulas becoming more important to consumers. While general formulas for people over the age of 2 years are popular, we see that many people prefer formulas aimed at more specific ages, sexes, and concerns. For example, while vegetarian-based enzyme formulas are still extremely popular, our Super Enzymes formulas with ingredients that aren’t in the vegetarian products are also valued by many consumers. These ingredients include ox bile for fat absorption in the small intestine, betaine hydrochloride to boost stomach acid, pork pancreatic enzymes for digestion of fats, proteins, and carbohydrates in the small intestine, plus other supporting enzymes.”

Levin notes several reasons why different formulas may prove useful to different people: “Since digestive enzyme and stomach acid production tend to decline with age, wide-ranging formulas made with pancreatic enzymes may be more popular with older folks. However, our internal production of pancreatic enzymes (pancreatin) is known to decline when taking supplemental pancreatin, which is not an issue with vegetarian enzymes. So vegetarian enzymes tend to add to digestive capability, while pancreatin supplements tend to replace our own pancreatic enzymes to some extent.” There are also helpers that may not be necessary for some, Levin adds. NOW’s Super Enzymes formula also supplies hydrochloric acid, which is not needed by everyone and which may be avoided by some people. Ox bile supplements an individual’s own bile supply, which is collected and stored in the gall bladders. For those whose gall bladders have been removed, a supplemental source may be needed, but Levin explains that those with good fat absorption may not need to supplement with this digestive aid.

And then, of course, there are particularly specialized products. NOW offers Gluten Digest, formulated to promote the complete digestion of cereal grains. “DPP IV (Dipeptidyl peptidase IV) is a unique enzyme with specific activity against the characteristic proline bonds found in cereal grain proteins,” Levin explains. “Gluten Digest also includes proteases and amylases that address other protein and carbohydrate components that commonly co-occur in these foods. Some of my gluten-intolerant colleagues use this formula when eating at places where the gluten-free status of foods is not guaranteed.”

Different diets may warrant different blends, as well. Pure Essence, for instance, offers Omnivore, Keto, Vegan, and Vegetarian products, with varying formulas based on expected dietary intake of macronutrients.

Herbs 

The herbal approach, in digestion, focuses strongly on soothing stomachs and stomach acid. “When we look at digestion, we can divide it into three processes: digestion, absorption, and elimination,” explains David Winston, RH(AHG), President and Founder of Herbalist & Alchemist. “Many things can affect digestion: what you eat; how much you eat; chronic stress; a lack of gastric HCl; too much gastric HCl—which is actually much less common than too little stomach acid; impaired liver, gallbladder, pancreatic or small intestine function; nutritional deficiencies including B vitamins; gut dysbiosis; medications that inhibit gastric HCl production; as well as various illnesses and GI disorders such as gastroparesis, GERD, SIBO and IBS, wherein these last three conditions are associated with achlorhydria or too little stomach acid.”

Herbs, Winston says, can be “incredibly effective” for enhancing stomach acid production and relieving heartburn. “Combining warming bitters like Angelica root and Orange peel, with cooling bitters such as Artichoke leaf and Dandelion root, creates a balanced formula that enhances the entire process of digestion, nutrient absorption and elimination via the liver and bowel. In my clinical practice, at least 60% of my patients have chronic GI issues, and for many I like to say ‘everything gets better with bitters.’ But bitters are not a one-size-fits-all category of herbs. There are cooling bitters, warming bitters, spices (for spiced bitters), non-alkaloidal bitters (for promoting digestion), alkaloidal bitters (for stimulating liver and gallbladder function), and fragrant bitters which are used to treat intestinal infections caused by amoeba and amoeba-like organisms. Creating appropriate bitter formulas with different flavor profiles and actions, allows for greater specificity for each person who has unique GI issues.”

Winston points to four products offered by H&A:

  • Original Bitters – The classic balanced formula. It contains Angelica root, orange peel, dandelion root, gentian, with a hint of the carminative peppermint.
  • Spiced Bitters – This formula has a Chai-like flavor profile, it is useful for people with gas, abdominal bloating, and dyspepsia.
  • Old World Bitters – Classic European herbs with a “Hops” flavor note. This formula works well for people who have intestinal spasms or GI discomfort.
  • Bitter Roots – Earthy and grounding flavor notes for those preferring a hardy bitter that enhances liver and gallbladder function.

Herbs can also be helpful for those looking to support the stomach lining itself. NOW offers Gastro Comfort, which, Levin says, features PepZin GI, a proprietary form of zinc complexed with carnosine that has been shown to support the integrity of the stomach lining by promoting its own natural healing processes. Slippery elm and aloe vera help support a healthy digestive system, as well.

There are also uses for some oils. “Peppermint Gels have peppermint oil, which has been recommended for centuries by traditional herbalists for the support of healthy digestion,” Levin explains. “More recently, it has been found to support normal gastrointestinal function. We’ve combined peppermint oil with ginger and fennel oils to better support intestinal comfort. NOW Peppermint Gels are enteric coated to allow passage through the stomach and release within the intestines where it can be helpful in providing relief from occasional minor bowel discomfort.”

Heartburn

Heartburn is a complicated thing: While people generally assume they have too much stomach acid, it could be the opposite. “Ironically, some people with heartburn actually have too little stomach acid, which seems counterintuitive,” says NOW’s Neil Levin. “The clinical ‘pearl’ of wisdom is that an immediate heartburn when eating may indicate either too much stomach acid or an improperly closed lower esophageal sphincter (possibly due to food sensitivities) that allows the stomach contents to back up into the esophagus and cause the burning sensation. By contrast, a delayed heartburn after eating may occur because there is simply too little stomach acid to properly break apart foods to extract nutrients including vitamins, minerals, and proteins.”

There are aids available. NOW, for one, offers Acid Relief lozenges. Levin explains: “They supply both a natural alkaline calcium carbonate along with vegetarian-sourced enzymes to both soothe acidity while supporting proper digestion of fats, protein, and carbohydrates; as opposed to simply neutralizing some acid needed for normal digestion and leaving the food intact.”

Another option comes from Enzymedica. Heartburn Soothe contains alginate/alginic acid, a compound found in the cell walls of brown algae that can hold 200-300 times its own weight in water. In the stomach, according to Enzymedica’s website, the substance gels together and works like a raft, floating on top of stomach contents after a meal and preventing acid from entering the esophagus. Besides aiding with occasional heartburn, this also allows the esophagus the opportunity to heal.

Biotics

The microbiome is a macro space within the digestive health field—not just because of how new it is, or its market growth, but also because of how much it affects. “We are learning that probiotics are beneficial for much more than just gut health: We now know they can support immune function, healthy weight management, emotional wellbeing, and clear skin, to name a few,” says Trisha Sugarek MacDonald, BS, MS, Sr. Director of R&D, Bluebonnet Nutrition Corporation. “It has been said that the gut is the ‘second brain’ of the body. The gut—i.e., enteric nervous system, ENS—and the brain—i.e., central nervous system, CNS—share many of the same neurotransmitters and work in tandem to support the body. So, the brain rules the mind and body, while the gut rules the digestion process and immune function of the body. The gut is the dominant player in the entire digestion and elimination process, bearing primary responsibility for maintaining, cleaning, and regulating your intestinal tract. However, more importantly, the gut defends the intestinal tract from pathogens, orchestrates the proliferation of the friendly bacteria crucial for a healthy gut and proper digestion. That is why maintaining the gut is so important, especially if the immune function is compromised. Plus, to compound the issue, stress and the aging process both contribute to digestive issues through hormonal and neurotransmitter feedback systems.”

Moreover, digestive issues can lead to nutrient deficiencies, which can compromise a variety of bodily systems. Sugarek MacDonald notes that this understanding is leading to category growth: “According to the current analysis of Reports and Data, the global probiotics market was USD 47.1 Billion in 2018 and is projected to grow at a compound annual growth rate (CAGR) of 6.8% from 2019 to 2026.”

And, of course, COVID-19 impacted this market—more people began taking probiotics. “Notably, probiotic supplements during February and March of 2020 were considered the top functional ingredient during the height of the pandemic panic buying, according to Kathryn Peters, SPINS EVP Business Development,” Sugarek MacDonald says. “Consumers are aware of the close connection between the bacteria in your gut and immune health—it is all about the microbiome these days, so this makes sense.”

As the market grows, it’s vital that education keeps pace, according to Andrea Bonina, Managing Director, Bionap: “Consumers are becoming more aware of the microbiome and how products like probiotics and prebiotics play an important role in maintaining health. It’s important for retailers to understand the differences among these products and how each plays a role to improve digestive health.”

Lisanti has stats to match. “While consumers will require further education on the advantages of prebiotics, 35% of adults in the U.S. say they are interested in trying products with prebiotics despite not having done so in the past, according to Mintel. And given the familiarity and positive association of probiotics among consumers, brands can leverage these good bacterial strains to increase value and create differentiation in the market.” IFF offers a line of HOWARU probiotics, as well as Litesse Polydextrose studied as a prebiotic.

Another way to differentiate a product: Use science-backed ingredients. Bonina reports a new in-vitro study demonstrating prebiotic activity for Bionap’s MUCOSAVE FG, a combination of prickly pear and olive leaf. “The results showed that MUCOSAVE FG produced significant bifidogenic activity comparable to inulin,” he reports. “Further preclinical data also support the prebiotic activity of MUCOSAVE FG, which is able to modulate the gut microbiota either by direct growth stimulation of beneficial gut bacteria or through antimicrobial effects on bacterial pathogens.”

With regards to postbiotics, while newer, Lovan shares the promising news that awareness is on the grow: “We tracked consumers’ understanding of the term postbiotics, finding that about one-third of consumers (35%) associate postbiotics with a healthy gut, and more than a quarter (28%) know they help support immunity. Those results are encouraging, as postbiotics are still relative newcomers to the digestive health scene. It was only this year that the International Scientific Association for Prebiotics and Probiotics (ISAPP) published a consensus definition, making postbiotics a globally recognized category.” Cargill’s EpiCor is a whole food fermentate that supports a healthy microbiome, has been clinically shown to support both digestive and immune health, and can be used in food and beverage products as well as supplements, Lovan says.

Adding more data, Jacqueline Rizo, Content Coordinator at Stratum Nutrition, points out: “Google searches related to digestive health are unmistakable. Postbiotics are the fastest growing trend over the past two years with a 1,300% increase in online searches. Consumers are interested in specific formats, with an upsurge in searches for ‘postbiotic supplements,’ ‘postbiotic foods,’ and ‘postbiotic powders.’”

Nena Dockery, Scientific and Regulatory Affairs Manager at Stratum, offered a definition, as well as examples: “Postbiotics are the cellular components of heat-treated beneficial bacteria and/or the nutrient media (supernatant) in which they are grown that contains their by-products or metabolites. Postbiotics can possess the good attributes of human-derived probiotics without the gut or shelf-stability concerns. Some products on the market contain one isolated metabolite of bacterial metabolism, such as short-chain fatty acids. Others contain just the cellular components of heat-treated bacteria or just the cell-free supernatant. Others contain both the bacterial components and the supernatant. These products can possess a wide range of benefits. One such postbiotic is LBiome (Lactobacillus LB). This postbiotic has been used in Europe for over one hundred years as a digestive aid. Lactobacillus LB contains the heat-treated cellular biomass as well as the fermentate generated by Limosilactobacillus fermentum and Lactobacillus delbrueckii ssp. delbrueckii, two human-derived bacterial species. It is supported by an impressive research portfolio that includes support for its use as a digestive in both adults and in children of all ages. The bulk of the studies are clinical trials focusing on digestive challenges that manifest themselves as diarrhea, including ‘traveler’s’ diarrhea, bacterial and viral pathogen infections, and IBS-D.”

The Lifestyle-Gut Axis

There are plenty of ways to affect the gut via direct intervention, but Metabolic Maintenance’s Dr. Kim Hapke suggests that a lifestyle overhaul might be a good place to start. “Setting up a good environment for digestion means being calm. Smelling food cooking creates the release of saliva and starts a digestive cascade including the release of hydrochloric acid. Many of our meals are not eaten this way. Rushed or stressful eating may result in less optimal release of hydrochloric acid and digestive enzymes in the body. Changes in the way food is broken down affects nutrient absorption and the microbiome further down the digestive tract. Supplementing with betaine HCl or with digestive enzymes can support optimal digestion when the eating environment is not optimal for digestion. Herbs are also good for this as they can have multiple effects such as support calm while providing bitter components that stimulate digestion.”

Education on the link between gut health and stress, Dr. Hapke adds, may make a big difference. “When I work with anxious patients, I assume that their digestion is not optimal even if that is not a top complaint,” she shares. “We have tended to focus on GI issues as physical and stress issues as mental. However, when in a sympathetic state we don’t release the same amounts of hydrochloric acid and digestive enzymes. As a result, we don’t break down our food as thoroughly, we don’t mobilize food the same way through the digestive tract. This results in poorer uptake of nutrients and potentially negative effects on the microbiome. For people with GI complaints, a reduction of stress levels may be more important than directly addressing the GI issue. Awareness around this is certainly growing but people tend to be focused on their physical issues so sometimes you have to make the link for them. Highlighting pairs of products for calming and GI support may be one way to suggest this. For instance, a soothing product with calming herbs like Metabolic Maintenance’s Anxiety Control Plus taken during the day combined with a digestive enzyme like GluDaZyme at mealtimes.”

Dr. Hapke is looking forward to greater innovation in the gut-brain axis arena, to support precisely this issue.

Retailer Tips 

How can you stand out as a provider of quality products that work? Our sources offered some tips.

Expertise. Being in-the-know can go a long way in establishing retail as superior to Amazon. “When it comes to their health, consumers are looking for products that are supported by science,” says Lovan. “They’re doing more research, looking for ingredients with clinically proven track records. Formulations that showcase science-backed ingredients will resonate with these information-seeking, health-conscious shoppers.” And a staff that can meet those needs will be a remarkably useful resource. “At the retail level, a knowledgeable staff can go a long way toward building trust and establishing a loyal customer following. The digestive health space is rapidly evolving as our understanding of gut health expands and it can be hard for consumers to keep up. That’s why Cargill’s Health Technologies business launched a multi-faceted consumer campaign designed to build awareness for EpiCor postbiotic. We know that ‘postbiotic’ is a novel term for consumers, so education and building awareness are key goals for our campaign.”

It’s also about expertise in those doing the purchasing. Winston notes: “Digestive health is one of those categories where the consumer will be able to tell immediately if your recommendations work for them, which is why it’s especially important to select your product offerings with care. Choose products that are well formulated based upon deep knowledge and experience. Herbalist & Alchemist’s wholesale customers have access to our Herbal Salons, which offer monthly free web seminars that will give them the knowledge to guide customers to the right products. Past sessions are archived so they can search by topic. Our customers say this helps them sell our products, and supports the health of their customers, which is why we have been offering them for years.”

Store-to-Digital—and Back Again. Cameron says that making the in-store market more digital can help: “We’re fans of shelf talkers and displays with QR or ELI codes for access to broader education, for instance. We’re working to develop social media content-sharing programs to drive interest and store traffic as well.”

Bringing the in-store marketing to the web can help, too, while providing education opportunities. “Consumers appreciate education opportunities, and they are fantastic ways to get customers’ attention,” Rizo shares. “If consumers do not know the benefits of a product, they aren’t likely to purchase it. One of the easiest ways to reach consumers is to take in-store promotions and move them onto a digital platform, whether that be through a website, email newsletters, or through their social media channels. With consumers spending more time online, this is an easy, cost-effective way to reach consumers both in the store and out. By going digital, retailers can deepen consumer education with posts specifically focused on individual products, benefits, ingredients, etc. When people feel informed, they take action.”

Merchandising. “By providing endcaps and displays that focus on quality formulations including DNA verified and made-to-survive strains in addition to clean label initiatives such as allergen-free and non-GMO, retailers can immediately generate interest across every demographic in the probiotic category,” Sugarek MacDonald says. “Focusing on beneficial structure/function applications and creating visually appealing displays based on these can also accelerate product sales. For example, enhancing mood and emotional wellbeing, aiding in nutrient absorption, promoting immune health, and relieving gastrointestinal distress are all enticing applications of probiotics.”

Cameron suggests product placement as equally useful. “We encourage the concept of co-merchandising our products alongside grocery items that present the challenges our supplements can help overcome. For instance: Histamine Digest near the wine or fermented foods; Fructose Intolerance near the high-sugar foods and beverages.”

The final word from NOW’s Levin: “The digestive health category includes plant-derived enzymes, animal-derived enzymes, herbs and other botanicals, probiotics, prebiotics and other fibers. They range from simple formulations to comprehensive blends of a dozen or two active ingredients that target more types of food components. Options include vegetarian and non-vegetarian, biologics/probiotics and the fiber that is needed for them to thrive in our bodies, digestive aids, soothing formulas, and support for digestive tissues and structures. The more you can differentiate these products by form and function, the easier it will be for both staff and customers to find the right products for their particular needs.” WF