Fear of Friendly Bacteria
Much of U.S. consumers' reluctance to embrace probiotics stems from a cultural aversion to bacteria. While the adult body harbors 10 times as many bacterial cells as human cells, Americans have come to believe that nearly all bacteria are bad. Over the years, antibacterial soaps, lotions and gels have become increasingly popular as consumers seek to rid themselves of "harmful" or "dirty" bacteria.

Probiotic bacteria reside in the digestive tract and can provide several health benefits, ranging from lowering cholesterol and boosting immunity, to reducing the effects of lactose intolerance, constipation, diarrhea, irritable bowel syndrome, and even gum disease. In addition, specific strains of probiotic bacteria, such as L. acidophilus, L. plantarum, L. casei and B. bifidus, can be used to prevent the growth of "unfriendly" bacteria-researchers believe they may play a role in combating the growing problem of antibiotic-resistant bacteria.

Recent studies have also shown that probiotics may have additional benefits. A 2003 study published in The Lancet, in which babies who were considered at high risk for allergies received probiotics for six months after birth, showed that probiotics cut the infants' incidence of eczema by 40%. A 2004 study in the Journal of Clinical Gastroenterology also demonstrated that probiotics could help prevent or mitigate food allergies, while another 2004 study in the same journal found a link between probiotics and the reduction of certain intestinal inflammations accompanying cystic fibrosis.

The Role of Prebiotics
Prebiotics, such as inulin, short chain fructo-oligosaccharides (scFOS) and oligofructose (the enzymatic hydrolysis product of inulin), often go hand-in-hand with probiotics. They are vital to maintaining a healthy level of probiotic bacteria in the gut because they create a hospitable atmosphere for probiotic bacteria to grow and thrive. However, they are also known to impart other health benefits.

Typically prebiotic ingredients are very versatile. They can be used in a wide variety of food systems due to their high solubility. Originally prebiotics were used because they served a functional purpose in foods, however, within the last decade or so prebiotics, especially in the U.S., are rising to prominence for their health purpose.

Prebiotics cannot be digested or absorbed by the body and thus pass through to the colon where they stimulate the growth and activity of friendly bacteria, as well as promote bowel regularity. But prebiotics offer more than bowel regularity, according to Linda Douglas, PhD, RD, scientific affairs manager, GTC Nutrition, Golden, CO. "Lately, companies are interested in the calcium absorption attributes of prebiotics," she said. "Also on their radar screens are digestive health, immune enhancement, heart health and diabetes."

Application areas for prebiotics currently include yogurts, fermented dairy products, smoothies and soy products, says John Martin, project leader, Orafti Active Food Ingredients, Malvern, PA. But Mr. Martin believes the most popular use for prebiotics is as a source of dietary fiber. "This is because most consumers do not have any familiarity with prebiotics and what they do," he explained. "Instead, there is much more recognition and understanding for dietary fiber and its role in maintaining health."

Going forward several challenges remain for the prebiotics category-starting with the word prebiotics. Dr. Douglas said, "With the market in its infancy, the biggest challenge right now is differentiating between the different prebiotics as some are much more effective than others. Unfortunately, many people see prebiotics as one ingredient, rather than a category of many different ingredients."

Given the challenges in the category, Mr. Martin says education is the only solution. "Most consumers are not aware of the health benefits associated with prebiotics. On top of that they are not really comfortable with digestive health," he said. To remedy that situation, Mr. Martin believes it will take a lot of PR and consumer education. As for who should bear that burden, he said it should be anyone with a vested interest in this area. "We are giving consumer education a shot because it is a key factor in our growth," he said, adding, "We are also exploring a few different avenues and at the same time trying to convince the industry and consumers of the benefits of prebiotics."

Discussing the growth potential, Dr. Douglas commented, "If the international market is any indication, we have a lot to look forward to. We have seen the beginning phases of a very active growth period."

Formulation Challenges
Although many advances have been made to make sure that probiotic bacteria remain viable up until the point of consumption, some of the same challenges still remain. Despite probiotic bacteria's myriad health benefits, it is often difficult to determine the efficacy of functional health products containing them. Much of this is due to complexities associated with the formulation of functional health products that contain probiotic bacteria. High temperatures can kill the bacteria, making pasteurization tricky and baking nearly impossible. Additionally, exposure to high levels of oxygen, moisture or direct light can cause probiotic bacteria to deteriorate.

Perhaps the most significant challenge facing ingredient companies and finished product manufacturers is ensuring that enough friendly bacteria survive the trip through the digestive tract to adhere to the gut. A serving of a probiotic food, beverage or supplement must generally contain between 100 million and 1 billion live and active cultures per dose in order to be considered efficacious. However, many of these cultures cannot withstand stomach acid's high pH or cannot hold fast to the intestinal lining. Dairy products are the most common delivery method, as they help to increase the chance that friendly bacteria will survive the journey into the intestine by acting as a buffer, helping to neutralize stomach acid pH.

Shelf life is another common issue facing manufacturers. Bacteria often do not survive for long periods of time at levels high enough to be considered effective. Furthermore, some experts believe the process of formulating and pressing a supplement into pill or tablet form may kill the majority of bacteria present. As a solution, many supplement manufacturers will use airtight, opaque bottles, or add higher levels of bacteria than needed to account for the expected loss, but these methods cannot stave off a reduction in efficacy indefinitely. In 1999, Scientists at the University of California, Davis, developed a method of entrapping bifidobacteria in a calcium alginate gel to improve the chances of survival in stomach acid and the gastrointestinal tract. These findings could potentially improve the shelf life and efficacy of probiotic yogurts, supplements and beverages.

Gut Concerns: Good News/Bad News
A recent report by Datamonitor in conjunction with Nutraceuticals World, "U.S. Functional Food, Beverages and Supplements," found that concern for gut health is widespread among Americans. A consumer survey found that 47% of U.S. adults worry about digestive health on a regular basis. The good news is that consumers seem to recognize that functional foods, beverages and supplements are effective in preventing or delaying gut health woes. Indeed, 63% of those surveyed believed that nutraceuticals could be used to address gut health issues.

The bad news is that U.S. consumers are not as aware of probiotics as they are of other, more common functional nutraceutical ingredients, such as calcium, fiber and antioxidants. In fact, according to the survey, only 16% of consumers noted an awareness of probiotics. Furthermore, only 6% of respondents claimed that the presence of probiotics in functional health products would influence their purchases.

Manufacturers may have their work cut out for them when it comes to educating consumers about probiotics, but the groundwork is already in place. In fact, major manufacturers are already working to promote the benefits of bacteria among U.S. consumers. Dannon is taking steps to increase U.S. consumer awareness of the positive benefits of probiotics. The company recently launched the Dannon Probiotics Center, a website aimed at disseminating "digestible information about healthy bacteria."

Evidence suggests that the timing might be right for the U.S. to embrace probiotics. Consumers are growing more aware of their digestive health, and are concerned with maintaining a healthy and regular digestive system. A 2002 report published in American Family Physician stated that more than two million physician visits each year are the result of constipation. With about four million cases of frequent constipation afflicting consumers each year, digestive irregularities are among the most frequent reasons for patient self-medication. As such, millions of consumers are turning to over-the-counter drugs and functional health products to alleviate digestive discomfort.

Another reason to be excited is that pre- and probiotics are receiving increased recognition from the medical community. Doctors often recommend the usage of pre- and probiotic products to alleviate constipation, representing a significant opportunity for products in these areas. Manufacturers may also want to take note that according to the Datamonitor/Nutraceuticals Word report, 62% of consumers worry about oral health, and 41% are concerned for their cardiovascular well-being, which are also key health areas pre- and probiotics have also been shown to be beneficial.

The Tide is Turning
As probiotics gain acceptance in the U.S., functional health products containing the friendly bacteria are focusing on a wide range of health benefits to gain wider appeal among consumers.

Although several products contain bacteria, most manufacturers are not drawing attention to this benefit. Perhaps responding to Americans' squeamishness regarding digestive health, constipation and bowel regularity, advertising and product labeling has focused instead on immunity benefits and the ability of prebiotic fiber to promote calcium absorption. Probiotic products sold in the U.S. also tend to use the term "live and active cultures" rather than "bacteria". According to Datamonitor's Productscan Online, 37 products using this claim were launched in 2004, and 48 in 2003-compared with just 17 in 2002.

Dannon, for example, introduced its first probiotic beverage in the U.S. in February 2004. Called DanActive Immunity Cultured Dairy drink, the dairy drink is a renamed version of Danone's popular European offering, Actimel. Rather than focusing on its benefits for digestive health, DanActive is advertised as being clinically proven to help naturally strengthen the body's defense system. In contrast, European countries such as Sweden and Europe advertise the product as "harmonizing the stomach's natural bacterial flora."

Stonyfield Farm takes a similar approach with its Organic Smoothie beverage, which is advertised as containing six live active cultures and inulin, which helps to boost calcium absorption. The fact that inulin is also used as a prebiotic to stimulate growth of probiotic bacteria is not a focus of the product's advertising.

Signs are emerging that consumer awareness and cultural stigmas may be shifting, however. In fact, U.S. consumers have shown a tendency to be far less squeamish about digestive health as it relates to children and infants, and manufacturers are picking up on this trend. Indeed, Mountain High's Luv'n Baby Yogurt is advertised as "tender care for tiny tummies," while Stonyfield Farm's Yo Baby Drinkable Yogurt for babies and toddlers emphasizes its role in promoting good digestive health. Manufacturers may be able to shift that momentum and positive attitude toward probiotic products targeting adults.

The value of functional health products aimed at gut health and immunity serve as strong indicators of the size and future growth of probiotics. Sales of functional health products targeting gut health totaled $389 million in 2003, according to Datamonitor, and this figure is expected to more than double by 2008. At the same time, spend on immunity-boosting functional ingestibles reached $644 million in 2003 and will grow nearly 50% by 2008.

Overseas Trends: An Indication of What's to Come
The U.S. still lags behind the Japanese and European markets, where probiotics have been an accepted part of a healthy diet for decades, and many functional health products containing prebiotics have been launched over the last five years. Manufacturers can look to the pattern of growth overseas for clues as to the possible direction the pre/probiotics market may take at home.

Generally less squeamish and more accepting of products containing high levels of friendly bacteria, European consumers regularly purchase popular Yakult and Danone probiotic products. Unlike the U.S., labels on probiotic products in Europe and Japan make no effort to gloss over the presence of bacteria in cultured foods and beverages, often including the name of the bacteria prominently on the label. In countries such as Belgium, Denmark and Poland, Danone's popular Actimel probiotic beverage features the term "L. casei defensis" directly under the product name, while in Spain the phrase "con L. acidophilus" figures prominently onto the probiotic NaturActiva beverage by Central Lechera Asturiana.

European tastes also tend to trend more toward bitter flavors and more fluid textures. Stabilizers and artificial sweeteners are not as popular in yogurts and dairy beverages as they are in the U.S., where yogurts and fermented drinks tend to have a more custard-like texture and are laden with sugars or other substitutes to mask the taste.

Probiotic beverages and foods are also beginning to branch out into juices in Europe. In Austria, the recently released Well & Active probiotic drink, a whey-based wellness drink, is mixed with fruit juices for sweeter flavor. In addition, cheeses, hard candies and spreads with probiotic benefits are also finding success in the marketplace.

Japan, on the other hand, has long been at the forefront of innovative delivery methods for probiotics, including jellies, candies and desserts. The popular Meiji brand has introduced a line of probiotic hard candies in fruit and yogurt flavors. In March 2004, Snow Brand rolled out a line of probiotic cheesecake desserts aimed at children. Many of the probiotic beverages and foods in Japan also contain added nutrients to assuage with pollen allergies, and probiotics are often added to infant formulas to prevent future allergies

Probiotic "shots" are an established trend in Japan, where probiotic beverages made by Yakult, Danone, Meiji, Calpis and Snow Brand Milk products are some of the most popular functional health products on the market. Likewise, such "shot" products have also proven popular in Europe, where ProViva and Yakult offer single-serving bottles of probiotic liquid that can be carried in a bag or purse and be ingested on-the-go. This delivery method may find traction in the U.S., where "shot" style beverages are familiar to consumers and have been successful for other functional products, such as energy-boosting drinks.

Summary
Despite U.S. consumers' somewhat negative attitude toward bacteria and relatively low levels of awareness surrounding functional health products with probiotic benefits, the market is headed toward a period of steady, above-average growth. Technological advancements are improving efficacy, and science is linking more health benefits with friendly bacteria. It now remains up to the markets to convince consumers of the huge range of health benefits of pre- and probiotic products-and with so many benefits to choose from, it should be an easy task.

About the author: Tanya Seaton is lead analyst in Consumer Markets for Datamonitor, New York, NY. She can be reached at 212-652-5351; E-mail: tseaton@datamonitor.com.

About the report: This report was compiled by business intelligence firm, Datamonitor, New York, NY, in conjunction with Nutraceuticals World magazine. It examines the U.S. functional food, beverage and supplement market, consolidating key market, manufacturer and consumer opinion, and product trends from around the world, as well as unique data sets on the "Inside-Beauty" market.