Digestive health has been shrouded in cultural taboo (even more so than sex) for decades, but with the rate of digestive ailments reaching epidemic proportions, especially in the U.S., the need to tackle the issue, on many levels, is way overdue. According to the American Gastroenterological Association, half of the population in the U.S. is affected by a digestive disease of some kind. More specifically, the Centers for Disease Control and Prevention (CDC) estimates that over 25 million Americans will suffer from an ulcer at some point during their lifetime, and the American Cancer Society says that colorectal cancer, or cancer of the colon or rectum, is the second leading cause of cancer-related deaths in the U.S. (148,300 new cases will be diagnosed in 2002). Add to this the overuse of antibiotics and over-the-counter (OTC) medicines, and it seems nutraceuticals have a large role to play in this market.

Awareness amongst consumers is low but with all of the issues facing the current gut health market, they are undoubtedly ready for a solution. Marketers must find a way to communicate the importance of gut health in a positive, uncomplicated manner. Companies that can achieve this will have a market that is theirs for the taking.

Is Gut Health a Gateway to Optimal Health?
Keeping the digestive system functioning efficiently goes beyond preventing occasional bouts of diarrhea. In fact, some experts believe that keeping the gut healthy can improve other areas of health, especially in the long term.

Rhonda Witwer, director of business development, National Starch & Chemical, Bridgewater, NJ, producers of NOVELOSE®, said the importance of gut health in relation to overall health should not be underestimated. "If you don't have gut health, then you have a sick body, in one form or another" she said. "I would very much like that understanding to permeate every consumer in the world because many of the diseases that enter the body, or afflict consumers, begin in the gut."

Linda Douglas, manager of scientific affairs, GTC Nutrition, Golden, CO, makers of NutraFlora®, said optimal health cannot be attained without a healthy gut. "The gut plays many roles in maintaining good health. As the gut is the body's primary organ for nutrient and energy absorption, it must be seen as a gateway," she said.

A poorly functioning gut can also have an emotional impact as well. Dan Murray, associate director of technical development-Nutrition, Lonza, Inc., Fairlawn, NJ, exclusive distributor of PeptoZin™, said "How we feel is so critical to our everyday attitude and emotional state. In the sense that gastrointestinal problems can interfere with what we eat and even our social interactions, it's fair to say gut health plays a major role in our overall state of health and happiness."

Thomas Tompkins, director of research, Institut Rosell, Montreal, Canada, supplier of several probiotic strains, provided a few examples of how mental well being is affected. "In autistic children it seems to be that the progression of that disease may be related to improper digestion of foods in the intestinal tract," he said. "We see a lot of impact on appetite and mood disorders. In addition, those that have constant diarrhea are experiencing depression, perhaps caused by the pain."

Deanne Dolnick, technical services education supervisor for Optipure/Chemco Industries, Los Angeles, CA, which produces Algium™, said some digestive disorders can lead to other conditions. "If you look at something like Crohn's disease, which can happen anywhere in the intestinal tract and literally affects all of the layers of the intestinal tract, it can lead to other autoimmune conditions like arthritis. I don't think people realize until they start having problems how important it is to keep the gut functioning properly. You don't realize it until you lose it, and unfortunately that is the way it is for a lot of health issues," she said.

Discussing the specific health benefits of maintaining digestive health was Steve Young, technical advisor to Matsutani America, Decatur, IL, makers of Fibersol-2™. "Without making or implying any health claims, it has been shown that good intestinal health impacts not only the physical and chemical health of the host intestinal tract, but also has secondary impacts on overall good health," he said. "Such areas could include the maintenance of healthy serum triglycerides and cholesterol levels and their secondary impact on coronary heart disease and other conditions. In addition, management and regulation of blood chemistry could impact conditions such as diabetes, hypoglycemia, deposition of fat and weight management. As an example, increasing dietary fiber is a key component of many evolving weight management programs."

Translating gut health as a means to overall health has been difficult in the U.S., according to Eric Weaver, director of the Health Division for Proliant, Ames, IA, producers of ImmunoLin™. "Consumers must develop a greater understanding of the important role of the digestive tract in maintaining their health," he said. "Gut health products have been very successful in other markets and we need to bring the keys to those successes to the U.S."

Formulating a Gut Health Product
Delivering a gut health product in food or supplement form is a topic of debate these days. Some experts feel that food is more convenient for the consumer, while others feel that supplements provide a more targeted approach.

Silvano Arnoldo, sales manager-North America, for probiotic supplier Chr. Hansen, Montreal, Canada commented on the former. "I think that one of the trends is to develop technologies that will permit the addition of probiotics to foods because this application is more appealing for consumers. In Japan, many functional foods are intended for intestinal health. However, in the U.S. this is not the case but I think we are moving toward that," he said.

Expressing a different view was Randy Kjelden, president of colostrum supplier Sterling Technology, Brookings, SD. "Getting what you need from food is good. But there are not as many foods that can do as much as supplements can. Food is meant to go into a healthy gut, not so much to make a healthy gut."

Rich Barndt, head-innovation, regulatory and scientific affairs, Nutrinova, Somerset, NJ, suppliers of Caromax™, said that a gut health product should contain many components because of the complex nature of the digestive system. "I believe the answer to maintenance of proper gastrointestinal health will not be found in a silver bullet approach due to the complexity of our digestive system and the range of health issues. A solution could lie in a combination of functional components that could be delivered through our foods in a systems approach to affect overall gastrointestinal (GI) health." he said.

Another issue that must be considered when formulating gut health products is addressing the actual origin of the digestive problem rather than the symptoms. Institut Rosell's Mr. Tompkins commented on this concern. "In the past a lot of the gut health products were only looking at the symptomologies, with products such as antacids and products that would coat the stomach and basically treat the discomfort associated with intestinal distress. However, these products don't really have much impact on the source of the disease or discomfort. Probiotics and other ingredients can play a vital role because they challenge the cause of the disease state or discomfort and fix the problem, so that there is no chronic reoccurrence," he said.

Dr. S.K. Dash, president of probiotic supplier UAS Laboratories, Minnetonka, MN, said an important issue, in the case of probiotics, is the lack of quality control standards. "Specific criteria should be established so companies know which strains to use for specific conditions. All humans have a unique genetic make-up and selecting the right strain in the right amount is crucial."

Consumer Awareness & Education Issues
Awareness of the importance of maintaining a healthy GI tract is pitifully low due to cultural issues and the lack of education. Because of the embarrassing nature of some GI problems, consumers will ignore most GI upsets unless they warrant medical attention.

Bill Darby, vice president, marketing & sales, Concentrated Aloe Corporation (CAC), Ormond Beach, FL, discussed the latter. "Most people consider gut health to be secondary unless they are having serious gut health problems. If they are not having problems, they simply view the stomach as the central control for the ingredients they digest," he said.

Michael Shahani, director of operations for probiotic supplier Nebraska Cultures, Walnut Creek, CA, concurred. "I think intestinal health has been an area that has been neglected. People aren't aware of having an unhealthy gut because if minor digestive upsets occur, they are ignored most of the time," he said. "The professional community is very interested in promoting general gut health but still, the topic is not very glamorous."

Increasing awareness hinges on finding a more upbeat message to bring to the consumer, according to Kathy Niness, vice president of marketing & sales, Orafti Active Food Ingredients, Malvern, PA, which supplies Raftiline® and Raftilose®. "People don't really like to talk about digestive issues. They just want to take something when an ailment arises to make it go away. But if people understand the ramifications of digestive health in terms of their overall health in a more positive way, I think people would be more interested in preventative care."

Mark Izzo, director of science and technology for Orafti expanded on this perspective. "If you look at the market right now and how things are being communicated, it is all negative. Instead of communicating negative messages, I feel it would be beneficial to tie in digestive health with vitality and long term health."

So who is responsible for educating the consumer? Mr. Murray from Lonza said, "I think we all hope to benefit from the consumer's general knowledge base, so I think we all play a role in the educational effort. I don't see one particular group being responsible."

Gary Bennett, marketing manager, National Enzyme Company (NEC), Forsyth, MO, said his company is doing its part in the education process through its non-commercial website for both retailers and consumers. Speaking about enzymes specifically, he said, "To help teach retailers and consumers about enzymes, NEC offers a web site called Enzyme University located at www.enzymeuniversity.com. This is a non-commercial website devoted to informing the public about the benefits of using supplemental enzymes."

The Future: Painting a Brighter Picture
With the bleak consumer awareness situation and the millions of people suffering from some form of digestive dysfunction, the good news is that the situation can only get better. Ms. Niness of Orafti said the trend for people to start taking care of their digestive system is only getting stronger as we move into the future for several different reasons. "First, the world is definitely getting smaller and people are traveling more and more. When traveling to different parts of the world, eating different foods and exposing yourself to different types of pathogens, digestive strength really plays a role," she said. "A second key driver is stress. Everyone is under more stress these days and the first place people feel it is in the gut." She continued, "In addition, a large segment of the population-the baby boomers-are aging and none of these people want to look or feel old. As we age we tend to have more digestive issues. And if your digestive tract is not working well then you don't feel well. And when you don't feel well you are not going to look good. So even from a surface beauty perspective, digestive health really plays a role."

For the future, Proliant's Mr. Weaver said that products will include ingredients beyond fiber and probiotics and target more serious conditions. "The industry has relied a little too heavily on probiotics and fiber as components for gut health products. People with needs for improvements in GI health will not respond very well to either of these ingredients," he said. "For example, probiotics will not work in the presence of antibiotics and fiber is not tolerated at all by individuals with irritable bowel syndrome (IBS), which is a major problem in the U.S. We need to look at products that will both help restore and maintain the health and function of the digestive tract."

Jeff Barrie, sales manager, Aloecorp, Broomfield, CO, said good gut health begins with what we eat, but most Americans don't eat healthy and because of this the market for gut health products can only get bigger. "The market is going to continue to grow because Americans are not changing their lifestyle or eating habits," he said, adding, "We also need products that will take the place of the OTC products like TUMS and Rolaids."

Discussing the future of fiber was National Starch's Ms. Witwer. "In the area of gut health we are seeing a significant trend in the promotion of dietary fiber. The whole re-evaluation of the definitions of dietary fiber by the National Academy of Sciences (NAS) and expectations that there will be new recommendations on recommended dietary intakes to promote dietary fiber at the public health level, we see as very much going to impact the gut health market." (As we went to press, the final definitions for fiber were not yet released, although they were expected by the end of July.)

On the probiotic front, the future seems promising. According to Rosell's Mr. Tompkins, the World Health Organization (WHO) recently convened an expert committee to review the benefits of probiotics. "The WHO set up a joint expert committee to evaluate probiotics in food for gut health and what they came up with were a few interesting aspects," he said, adding, "They decided that there was enough scientific evidence to support the use of probiotics in improving gut health. They also developed some definitions and guidelines in terms of calling a product a probiotic. These guidelines have been passed on to the codex alimentarius, so I think you will start to see more incorporation of these ingredients into mainstream foods as well as into mainstream pharmaceuticals."