It's a different "world" and it's going to offer some very lucrative opportunities for nutraceutical manufacturers. On one hand, American companies have a unique opportunity to globally market cutting edge anti-stress, weight loss, energizing and other products geared to a fast paced and unfortunately unhealthier lifestyle quickly becoming the norm worldwide. On the other hand, we have the luxury of adopting a wide variety of "pre-tested" natural therapies, creative products and preventatives from a diversity of countries and cultures. Clearly, the best of both worlds!

Early in the next century, coronary vascular disease (CVD) will overtake infectious diseases and malnutrition as the world's leading cause of death and disability. While motivated consumers worldwide are taking action to reduce risks, a surge in life expectancy and CVD risk factors in underdeveloped countries ensures they will be part of this global epidemic (WHO, 1999). European manufacturers (49%) ranked CVD #1 in terms of conditions having a "very" great influence on the functional food market, followed by cancer (37%), obesity (37%), osteoporosis (27%), gut health (21%) and immunity (17%) (Leatherhead R. A. Survey, 1999, Table 1).

With the exception of China, cholesterol and blood pressure levels have also soared worldwide (WHO, 1999). Today, 125 million Europeans have high cholesterol levels and "lowers cholesterol" is the second most desired food product health claim in France, fifth in the U.K. (McNeil Nutritionals, 1999; Leatherhead, 1999). Japanese serum cholesterol levels are 15/mg/dL higher than 10 years ago and CVD drugs are now Japan's fastest growing pharmaceutical segment. Globally, this market is growing at 20+%/year (Japanese Ministry of Health, 1998; IMS World Health Review, 1999).

Obesity-no longer restricted to highly developed countries-is also skyrocketing. Global sales of weight control products and services will jump from $64 to $77 billion by 2002 (Marketdata Enterprises, 1998). Almost one third of Western Europeans are overweight and one in ten is obese (IASO Org., 1999). Obesity levels range from 5-22% in Western Europe and approach 40% for women in Eastern Europe and the Mediterranean countries (Knoll Obesity Symposium, 1998). European shoppers say obesity is the top health condition controllable via diet, followed by tooth decay, cholesterol and CVD (Leatherhead, 1999). Although only 1.8% of Japanese men (+20 yrs.) and 2.6% of women are obese, male obesity has doubled since 1982. One in three Japanese men in their 30's is at least "slightly overweight." The incidence of obesity in women age 20-29 is increasing, +1.8 times since 1976. Japan is also facing a crisis in terms of the number of overweight children who are taller and heavier than earlier generations (Japan Ministry of Education, 1998).

With more women working and stress levels rising it is not surprising that "gives energy" is now the most preferred health claim in the U.K. and France and fourth in Germany. Energy levels, physical appearance and absence of illness are the top criteria for judging one's state of health (Leatherhead, 1999). From 1986-97, per capita consumption of energy "pep" drinks in Europe increased from .1 to 3.7 liters/person, surpassing traditional sports varieties in Germany, Austria, U.K. and Switzerland (Beverage World, 1998).

"Boosts immunity" (#1 desired claim in Germany; #2 in France); "promoteshealthy bones" (#2 in U.K./Germany) and "reduces the risk of breast cancer" (#4 in U.K.) are also "ready" mega international markets. Likewise, the desire for organics, vegetarian products and GMO-free continues to accelerate (Figure 1).

Probiotics: Going Gut?
Products that aid digestion-probiotics, prebiotics and synbiotics-are an integral part of the global functional food market. European executives rank probiotics second (84%), after antioxidants (86%), as the most important functional ingredient for the next five years (Leatherhead, 1999). In Japan, with a market of $1.1 billion U.S. in 1998, 80% of FOSHU claims involved "gut health" (Takanashi, Milk Products, 1999). "Yakult 400," launched a year ago, contains 40 billion Lactobacillus casei Shirota and is selling one million+ bottles/day. With 121 million Americans popping antacids, 70+ million suffering from digestive problems and $9 per capita spending on digestive aids, consumers will embrace foods offering relief without medication and prevention longer term.

While products launched by Danone (BIO/Actimel), Nestle (LC1) and Yakult formed the cornerstones of the international probiotic market, statements that a product contains probiotic bacteria is no longer good enough. Smart companies have identified and patented superior probiotic strains, pursued synbiotics-a hybrid of pre and probiotics-and explored unique and unexpected product categories. More and more, global consumers are linking specific bacterial strains to individual health benefits.

For example, in addition to immune boosts and enhanced gut health, Danone's L. casei imunitass also reduces the severity of diarrhea in children; Nestlé's L. johnsonii (La1) blocks adhesion of E. coli and Helicobacter pylori; while oat-based ProViva's plant derived L. plantarum 299 acts best on irritable bowel. Sitia-Yomo SpA offers synbiotic mixtures direct to consumers to add to their own foods while Nutrica has site-directed mixtures, e.g. that focus on pathogenic organisms that tend to colonize the anaerobic part vs. those like Staphylococci and Rotaviruses present in the aerobic part. While yogurt products, fermented dairy drinks, butter milks and infant formulas represent the traditional types of probiotic products, probiotic ice cream, gelato, cheeses, sausages, luncheon meats, chocolates, puddings and pet foods are some of the most recent new product additions. Watch for infant foods and breakfast cereals to lead the way into the next generation.

While "Yakult Ladies" sell their product face to face across Asia, America's "Culture Wars" are just beginning. In 1998, Stonyfield Farms' initiated claims of "America's only yogurt with six live, active cultures," featuring L. reuteri's role in aiding digestion, lactose intolerance, calcium absorption, immunity and cancer prevention. L. reuteri produces reuterin, a broad spectrum antimicrobial and conjugated linoleic acid, a chemo-protective agent. Danone, which recently purchased a 20% equity stake in Lifeway Foods, is test marketing Actimel with L. casei imunitass in Arizona and Colorado.

Today, as 18% of U.S. marketing and 13% of R&D food executives believe "yogurt cultures" are increasing in importance, while 32% of consumers report trying to eat more yogurt to reduce disease risk, the U.S. probiotic market will continue to emerge (Prepared Foods Survey, 1999; HealthFocus, 1998). However, at the present time, probiotics and prebiotics are both 11/2 years away from reaching mass market status (Sloan Trends & Solutions' TRENDSENSE, 1999, Figure 2). Until Americans become more accepting of "good bacteria," wise manufacturers would do well to focus on the other highly desirable health benefits of probiotics, letting "familiar" claims pave the way to the "gut health" market.

Prebiotics: The Newfangled Fiber?
Compared to probiotics, prebiotics and synbiotics are the "hot" new arrivals on the global "gut health" scene. Last year close to 38 new prebiotic products were introduced in Western Europe and 3 in Japan (Table 2, New Product News, 1999). In Japan, 85–90,000 tons of oligosaccharides were produced in the last half of the 90's vs. 10-15,000 tons in Europe (Sensus Holland, 1999). The oligosaccharide market in Japan is estimated at $800 million (Yamaguchi & Associates, 1999).

Prebiotics currently-most commonly fructooligosaccharides (FOS) and inulin-stimulate growth of Bifidobacteria, ensuring gut health, keep harmful bacteria in check and boost immunity. They improve mineral absorption, lower triglycerides/cholesterol and, as a dietary fiber, decrease fecal transit time, increase stool weight and prevent constipation. Low in calories and suitable for diabetics, they may well be a major asset for detoxification products as well.

Prebiotics have been added to a wide range of products including bars/confections/candy, cookies/biscuits, pasta, brioche, puddings, cheese, teas, sausages, luncheon meats and breakfast drinks. "Actisucre" (Beghin-Say) is a unique new sugar with FOS, "Bifidofibres." Prebiotic breads-"Cult," "Wonderwit" and "Prokorn blond"-could well become a staple within the functional foods market, matching the success of the yogurt segment. Prebiotic cereals-"Bran Musli," "Crusli," "Kinder-Flakes" and "Pro Muesli"-also have enormous potential to come stateside. Lastly, synbiotic breakfast drinks-like Mueller's orange "Procult" and Spain's Hero's first synbiotic fruit juice named "Bienestar" (which translates as well-being)-would make an ideal addition to these multibillion dollar U.S. markets.

While the Europeans and the Japanese have focused more attention on inulin and oligosaccharides, the U.S. has relied more heavily on dietary fiber. As Americans are more familiar with fiber than live organisms, prebiotics may well have advantages over probiotics in capturing the $4+ billion U.S. "gut health" market. Although only 14% of U.S. R&D and 4% of food marketing executives believe prebiotics are increasing in importance, up from 5% in 1995, the time is right to start incorporating inulin and FOS into U.S. products not only in anticipation of the increasing interest in gut health, but for increased bioavailability and functional purposes. With the vast array of health benefits, prebiotics–if properly positioned-could well be the next reincarnation of the dietary fiber craze. Without additional promotional activity, however, just like probiotics, the market is still 11/2 years away from mainstreaming (TRENDSENSE, 1999).

Five Major Market Makers
There are a number of nutraceutical markets that are gaining strength around the world and, although still somewhat limited, have a particular relevance and potential for the U.S. market. The following key markets offer interesting product applications and appeal:

• Dental Care. Although dental health has long been a strong market overseas, with presweetened cereals carrying a "safe for teeth" seal in Sweden and Switzerland in the late 70's, it is only recently that it has begun to move into the functional foods limelight. "Promotes healthy teeth" is the third most desirable health claim in the U.K. and Germany, with chewing gum having the strongest anti-cavities connection. Ezake Glico Co., Ltd., a key player with 7% of the Japanese market, recently licensed "Xylitol" and "XyliFresh" for sale in Japan.

• Allergy. Anti-allergy claims have become increasingly common in both the U.S. and Japan in the non-foods market. Recently, a number of Japanese companies have introduced anti-allergy claims on chewing gums, candy and soft drinks. Techna, a type of Chinese tea, and perilla, a member of the mint family, are the major ingredients aimed at curbing pollen allergies. Lotte's anti-allergy gums and Kabaya's Kafun Chuiho anti-allergy candy with techna are two such examples. The name means "hay fever warning."

• Vision. Three years ago Japan saw a surge in products for eye health, primarily with anthocyanins, lutein and zeaxanthin appearing in supplements and blueberry extracts in confections and drinks. This trend is taking hold in Europe and beginning to emerge in the U.S. Just recently, "Centrum" introduced a new SKU featuring lutein, while traditional marketer Jenny Craig offers the "OcuGuard Plus" vision supplement line to its clients.

• Mental Cognition. Although 29% of U.S. men and 36% of women are "very" concerned about mental acuity, mental cognition and its effect on performance may just be the biggest market segment yet. Recently, confectionery giant M&M Mars repositioned its "Mars" bar in Europe, based on studies in The Netherlands and the U.K., claiming it improves mental cognition and reduces stress. In addition, a number of massive epidemiological studies in Europe are pointing to the key role of the A, C, E antioxidants in mental cognition. Stateside, a number of new university studies are reconfirming the importance of the earlier Iowa Breakfast studies to both adult and child "performance." Corporate and USDA/ state school authorities are taking note, with after-school sponsored snacks now the fastest growing market segment.

• GMO-Free. Although 75% of Americans believe that biotechnology will provide benefits for their family in the next five years, it is likely that the global anti-GMO movement will soon cross the "pond" (Wirthlin, 1999). In the U.K., both food retailers and restaurateurs face stiff fines for not disclosing GMO ingredients (up to £5000) and 77% in the U.K. support a ban on commercial growing of GMO crops. In March, a European Consortium was formed to insure that even supermarket private label products are GMO free. In an 11 European nation survey, 61% of shoppers tried to avoid GMO products (Healey and Bakers). Protein Technologies, Intl., which has developed an Identity Preservation system and is selling GMO-free soy products, reports sales have increased 400% in the U.K. since January. In the U.S., Green Peace and the Chef's Collaborative have 1500 chef's signatures never to serve "FrankenFoods." With the Grocery Manufacturers Association reporting that up to 60% of products on U.S. supermarket shelves contain GMO's, clearly this trend will have a major impact on our food industry. However, at this point, the mainstreaming of the GMO movement is still 6-9 months away (TRENDSENSE, 1999).

Some Better Ideas To Watch And Work On
With a newly approved health claim, soy is clearly the hottest topic in the U.S. nutraceutical market today. Sales are expected to reach $2.59 billion next year and grow at an even faster rate than the current 23% (SoyaTech, Bar Harbor, ME). With 74% of consumers perceiving soy as "very" healthy and 65% saying they would eat their favorite foods enriched with soy protein, their future looks great. Not only is awareness extremely high, but now 60% of consumers can link soy to specific health conditions (PTI, Inc., 1999). In terms of product possibilities, we need only look at all the concepts for soy that have been coming out in Europe or Japan for dozens of years.

Likewise, with cholesterol control on the front burner, there is a wealth of new ideas worldwide. For example, Finland's Huittestern Lihapojat has created cholesterol-lowering meat products-frankfurters, sandwich meats, sausages and meatballs-containing a patented rapeseed oil product high in omega 3,6 and 9 PUFA's. Norwegian Mills DA has added "Liquid Vita," a cholesterol-lowering PUFA oil for commercial bread mixes, from sunflower and rapeseed oil, lowering cholesterol by 14% and LDL by 13%. "Phytrol"-recently licensed to Novartis, which recently debuted it in its "Aviva" line in the U.K. and Switzerland-is a wood sterol-derived ingredient proven to have cholesterol-lowering properties.

Lastly, here is a list of up-and-coming, highly translatable categories and ingredients:

• Near Water. Functional, fortified and fruit waters is now a $1.82 billion market in Japan, while fortified soft drinks are making great gains in Europe.

• Effervescent Supplements. Presently, effervescent VMS represent one-third of all sales in Europe and are expected to grow from $2.1 billion to $4.0 billion (U.S.) by 2001. Currently, the U.S. market is under $100 million (Bristol Meyers/Squibb, 1999).

• Lactoferrin. Best known for its antimicrobial, immune boosting, iron transport and cellular functions, this key ingredient is now being added to yogurts, sports formulas, beverages, pet foods, cosmetics and infant formula.

• Beta Glucan. Beta-1,3/1,6-glucans, derived from yeast and mushrooms, have been shown to possess a wide variety of immune-stimulating properties.

• Oats. From hit products like "Milk Milk" to "ProViva" to functional breads and beverages, watch for oats-and maybe rye-to make their mark on the functional foods market.

• Inner Beauty. Japanese cosmetic companies Shiseido and Kanebo are launching functional food lines, capturing "inner beauty"-offering formulations to improve the skin by nutrition on the inside.

• Fruit and phytochemical extracts. Watch for fruit powders and extracts of veggies-naturally high in a wide diversity of phytochemicals-to bridge the gap between natural goods and good health.

The opportunity for an international exchange of ideas, ingredients and products has never been better. With diseases and afflictions of affluent societies becoming of prime importance throughout the world, novel U.S. products will enjoy an unprecedented opportunity. And with underdeveloped countries experiencing the maladies of our fast paced society, the market is assured of long-term sustainability. Creative marketers will not only explore new international territories for product distribution, but will keep a keen eye to international trends and developing traditions.