According to Dan Murray, associate director-Nutrition, Lonza, Inc., Fair Lawn, NJ, exclusive distributor of PepZin GI™, the importance of gut health in relation to overall health should not be underestimated, "Even though stomach and gut health issues don't usually make headlines, they significantly affect our everyday lives," he said. "If you don't feel well and can't enjoy food and beverages associated with social and work gatherings, it can be awkward and often lead to social withdrawal. Even sleep can be affected by gut health."
However, despite an increased recognition of gut health issues, there is still a long way to go. According to statistics from the National Digestive Diseases Information Clearinghouse (NDDIC), 60 to 70 million people in the U.S. are affected by all types of digestive diseases, including Irritable Bowel Syndrome (IBS) and ulcers. In addition, the American Cancer Society says colorectal cancer is the third most common cancer found in men and women in the U.S. There will be about 106,370 new cases of colon cancer and 40,570 new cases of rectal cancer in 2004 in the U.S. Combined they will cause about 56,730 deaths.
Opportunities abound for nutraceuticals, as more consumers are turning away from the side effects associated with traditional prescription medications and seeking alternative methods of prevention of gut health problems. Through educational efforts set forth by both industry and government, the public is becoming more aware that a proper diet and sufficient exercise, when combined with certain nutritional components, including fiber, enzymes, aloe vera and probiotics, can help ensure a healthy digestive system.
The Importance of Maintaining Digestive Health
Digestion, absorption and elimination are all part of a healthy digestive system. In addition to ensuring that we effectively absorb nutrients from our food, a healthy digestive system is also extremely important for healthy immune function.
Discussing the role of gut health in overall health was Eric Weaver, president and CEO, Proliant Health Ingredients, Ankeny, IA, producers of ImmunoLin™. "The gut is a major organ of the body, which contributes two critical functions to our health, including the digestion and absorption of nutrients and the defense of the body's exposed surface against the external environment, known as gut immunity," he explained. "Most consumers take the health of the gut for granted until either they or someone close to them has a problem. Unfortunately, gut health issues are very common in the U. S. Ulcers, diarrhea, IBS, inflammatory bowel disease (IBD) and other less common conditions affect 10-20% of the U.S. population. The industry has been more successful in marketing products for digestion than it has with products for improving gut immunity, even though gut immunity contributes more, both to the health of the gut and to our overall health."
Addressing gut immunity further was Mary Ellen Sanders, research professor of dairy science at the Dairy Products Technology Center at California Polytechnic State University, San Luis Obispo, CA. "When we have penetration of the gut barrier, this can lead to infection and allergy," she said. "We have more immune cells concentrated in our gut than in any other region of our body. Therefore, the gut is very important to proper immune system development."
Michael Shahani, president, CEO and director of operations, Nebraska Cultures, Inc., West Hills, CA, which offers a variety of probiotic products, pointed out a variety of conditions, which can upset the balance of microflora in the gut. He offered, "Any sub-optimal or unhealthy conditions, including stress, onset of disease, ingestion of antibiotics and/or medicines, improper food intake and lack of rest, and harmful environmental conditions, may endanger the fine balance of the intestinal flora, resulting in the reduction of the friendly or beneficial bacteria in the gut."
Going into further detail about the importance of maintaining a balance of gut microflora was Barbara Homs, sales and marketing manager, GTC Nutrition LLC, Golden, CO, which supplies NutraFlora®. "The gastrointestinal (GI) tract is also host to billions of resident microflora, some of which are probiotic, or life-supporting. These microflora serve overall health in the generation of certain vitamins and also produce substances that directly and favorably affect gut structure and function." She added, "The large intestine, for example, must be supplied with local nutrition in addition to that supplied by the circulatory system. This nutrition is provided by the probiotic bacteria, which when properly nourished, produce short chain fatty acids. The short chain fatty acids provide crucial local nutrition, assist mineral absorption and gently adjust the pH of the lower GI tract to retard the growth of pathogenic bacteria."
Offering a specific perspective on the health benefits of probiotics was Dr. S. K. Dash, president of probiotic supplier, UAS Laboratories, Eden Prairie, MN. "Probiotics improve digestion, protect against leaky gut, control yeast infection and improve colon health," he explained. "In addition, probiotic bacteria produce natural antibiotics, including acidophiline, lactic acid and hydrogen peroxide, thus inhibiting the growth of pathogenic bacteria throughout the GI tract. Probiotics in the colon also complete the digestive process by breaking down complex molecules that cannot be dismantled anywhere else in the GI tract."
What should also be a concern in the digestive health arena is the prevalence of OTC products that buffer and block the production of stomach acid, which often interrupts or denies the proper digestive mechanism. "Proper digestion depends on the presence of very low pH stomach acid. Stomach acid is necessary to breakdown food stuffs and kill harmful bacteria entering the digestive system via food," Lonza's Mr. Murray explained. "The promotion of OTC products, including proton pump inhibitors and H2 receptors by pharmaceutical companies, has focused on short-term heartburn and pain management for acid reflux, and downplayed the long-term interruption of the normal digestive process."
A poorly functioning gut can also have an emotional impact on an individual as well, says Bill Pine, vice president of sales, Improve USA, DeSoto, TX, suppliers of aloe vera. "When the stomach is upset or hurting, from simple nausea to the more serious issues of IBS or acid reflux and Chrone's disease, an unhealthy gut can make life miserable," he offered.
Trends & Issues in the Gut Health Market
The consensus around the industry is that the digestive health ingredients market is primed for growth. As interest in supplements expands to address healthcare issues, gut health will be a key market, in addition to heart and brain health, according to Lonza's Mr. Murray. "Despite the fact it's a more difficult market to build awareness for, digestive products are growing at a healthy pace. The demographics of the gut health market are staggering, with tens of millions of Americans challenged with ulcers, heartburn and IBS." However, Mr. Murray pointed out, while people are okay with sharing their success stories about joint health products, they are less likely to detail an unpleasant digestive problem.
Mr. Murray also said one of the greatest challenges these days is reducing inflammation and associated pain without creating stomach bleeding and ulcers. "Pain products in the non-steroidal anti-inflammatory drugs (NSAIDs) category are notorious for gut health side effects and are considered by some to be a silent epidemic," he explained. "Maintaining a healthy stomach lining may play a role in reducing these serious side effects."
John Martin, project leader, Orafti Active Food Ingredients, Malvern, PA, suppliers of Raftilose® and Raftiline®, said the good news is that consumers are becoming more aware of how to remedy certain gut health issues. "Consumers are becoming more informed about how to deal with leaky gut, IBS, good bugs versus bad bugs, gas and bloating, among other issues," he said. "Until recently these types of articles were reserved for only the most scientific health journals, but now they're mainstream."
Mr. Martin also said that the popularity of low carbohydrate diets is going to put some strain on digestive health. "Low-carb mania deals with the issues of diabetes and weight control, and the ingredient market is poised to respond with a deluge of products geared to satisfy consumer needs to reduce sugar and carbohydrates to control weight and help quell the rise in diabetes," he said. "However, this quick response with low-carbohydrate foods begs the question, 'how healthy is the market?' With the rise in low-carbohydrate foods, there is also a rise in use of all types of substitute ingredients to deliver these popular foods, and some ingredients are healthier than others. Many ingredients will challenge the digestive health of even the healthiest individuals, and to date there is no clinical data to help consumers determine how much of a good thing is not good for them."
Discussing the relevance of demographics to the gut health market was Nena Dockery, director of technical services, National Enzyme Company, Forsyth, MO. "The incidence of many of the most common GI disorders, such as constipation and indigestion, increases significantly in people over 60 years of age and, therefore, are on the rise due to the aging of our population. Many of the current trends in gut health products reflect the needs of this demographic," she said. "Although OTC and prescription antacid products continue to be on the rise, many individuals are approaching gastric discomfort with more of a long-term cure in mind, rather than instant relief. Therefore, there has been an increase in the demand for digestive enzyme and probiotic products designed to restore healthy functioning to the digestive tract."
Functional foods that promote gut health is also a major trend, according to Ms. Dockery. "In 2002, sales of functional food products marketed for their gut health benefits generated the most sales by value, compared to functional foods designed for other purposes, even though more consumers are diagnosed and at-risk for both bone and heart health problems," she said.
Compared the European gut health market, most experts say the U.S. market for these products is in its infancy. According to Greg Miller, senior vice president-Nutrition and Product Innovation, Dairy Management Inc. (DMI), Rosemont, IL, European consumers are ahead of the U.S. in valuing gut health in general and probiotics in particular. "The concept has not yet resonated with U.S. consumers, where health marketing claims are tightly regulated," he said. "We're more conservative here. But U.S. consumer understanding of probiotics will change in the future, as we build the scientific base to give us the platform to go out and tell the probiotics story."
Fiber is also popular these days for delivering a "one-two punch" of functional and nutritional benefits, according to Sharrann Simmons, vice president, Colloides Naturels, Inc., Bridgewater, NJ, makers of FibreGum. Additionally, she pointed said, "If you combine the aging American population with a lot of people on low-carbohydrate diets, you're looking for a higher need for fiber," she said. "Consumers may not understand precisely why fiber is good for them, but there is a good understanding that fiber is needed for a healthy diet. More companies are fortifying with fiber to take advantage of the label claims. If you have over 10% of the daily requirement, which would equal 5 grams, you can claim the product is a good source of fiber on the label."
Going forward, Ms. Simmons said that while fiber sources tend to be relatively inexpensive compared to other fortification nutrients, anytime cost is added to a product there is going to be some level of resistance from the consumer. "The real challenge is to educate people as to the value of fiber in relation to digestive health in general, so that over time they will be willing to pay more for a product fortified with fiber," she said.
Moving Forward Through Education
The digestive health market presents a bit of a conundrum. While consumers desire solutions to gut health problems, which can be very restrictive and uncomfortable, they remain reluctant to talk about it. As a result, the gut health market remains a sensitive and challenging one in which to talk about and promote products.
Discussing these issues was Rhonda Witwer, business development manager-Nutrition, National Starch & Chemical Co., Bridgewater, NJ, producers of Hi-maize™ and NOVELOSE® brands of resistant starches. "Proper digestion and colon health do not receive nearly enough attention by any population," she said. "Within the U.S., consumers haven't been particularly interested in gut health ingredients. We generally don't talk about our digestive tract, and colon health isn't exactly polite conversation."
On the bright side, Ms. Witwer said, "Other subjects that have once been taboo have been changed by consumer perceptions, which is a reason to be positive about the future of the gut health category. For instance, impotence was never a topic until the pharmaceutical industry started advertising drugs for it and now the market is different. We are starting to see the same evolution with gut health."
Indeed, Lonza's Mr. Murray believes that with millions of Americans seeking improved digestive health, the category should prosper for many years, as long as education and research are part of the equation. "The ingredient and supplement manufacturers have recognized that consumers are searching for educational materials and scientific data, and this is especially true in the gut health market," he said. "Once a troubled consumer has ruled out serious medical problems, they search for solutions through diet and supplements. In the past, products could be supported with anecdotal evidence but today the market seeks more thorough and specific research."
Unfortunately, said Rohit Medhekar, director-Research & Development, National Enzyme Company, consumers still do not recognize the importance of taking gut health products as a preventative measure. "This sentiment is pervasive among consumers because most of them have accepted typical digestive maladies such as gas, bloating, constipation and heartburn as part of life they can do nothing about," he said. "In addition, many medical professions do not pay enough attention to proper digestion of food since it is not glamorous or exciting. What they fail to realize, though, is that most health problems arise due to improper digestion or an unhealthy diet."
In order to grow, the gut health market must expand beyond digestive enzymes, probiotics and fiber, according to Proliant's Mr. Weaver. "Products that can both improve digestion and address the immune function of the gut will perform better for the gut-focused consumer," he said. "Just like the eye health market responded to lutein, the gut health market can grow with products that address gut immunity."
For the future, Mr. Martin foresees the subject of digestive health being dissected and fragmented into many different segments according to types of digestive health problems, each with their own unique prompting factor.
