From common ailments like indigestion and constipation, to more serious conditions like irritable bowl syndrome (IBS) and celiac disease, digestive troubles can easily motivate consumers to look for relief. The number of individuals affected by gut health issues is huge; according to the National Digestive Diseases Information Clearinghouse (NDDIC), Bethesda, MD, digestive disease affects 60-70 million people each year, with 104.7 million people in the U.S. seeking the care of a physician, and 13.5 million hospitalized. With gut health a major concern for so many, these digestively distressed consumers are looking for ways to improve their gastrointestinal function and manage existing illnesses.

Surveys show that “digestive health consistently registers in the top five health concerns of consumers,” stated Anke Sentko, vice president of regulatory affairs and nutrition communication for Belgium-based BENEO. And this concern translates to big bucks. Nutrition Business Journal, Boulder, CO, estimated the gastrointestinal health supplement category brought in $1.4 billion in consumer sales in 2011, growing 14% over 2010 sales levels.

“Simply put, consumers are clearly recognizing the connection between digestive health and their general well-being,” said Scott Ravech, CEO of Deerland Enzymes, Kennesaw, GA. “They’re becoming more knowledgeable, and in many cases creating personalized supplement plans that are consistent with their dietary preferences and quality of life.”

Disease & Intolerance
When looking for the root of the digestive health market’s power, many experts point to the overwhelming number of gastrointestinal diseases and the growing number of food intolerances seen in the general population. The NDDIC reported that IBS affects 15.3 million Americans; celiac disease affects one in 141 Americans; and inflammatory bowel diseases like Crohn’s disease and ulcerative colitis affect 359,000 and 619,000 Americans, respectively. Additionally, an estimated 30-50 million American adults suffer from lactose intolerance. As a result, producers of dietary supplements are looking to provide safe and effective products that can help consumers manage illness and intolerances, as well as promote overall health.

Mr. Ravech of Deerland Enzymes has found that “food intolerances and food-driven immune responses are becoming more and more recognized, calling for a more robust digestive health product.” His company produces Glutalytic and Dairylytic, which aid those with gluten and dairy intolerances. According to Mr. Ravech, these enzymes “not only break down the protein that causes the intolerance, but also break it down even further in order to address a potential immune response.” 

Addressing the needs of the 3 million U.S. citizens with celiac disease, the gluten-free market has seen significant growth in the last year. According to “Gluten-Free Foods and Beverages in the U.S.,” a report by Rockville, MD-based Packaged Facts, the market reached $4.2 billion in 2012, for a compound annual growth rate of 28% over the 2008-2012 period. While growth rates are expected to settle within the next five years, Packaged Facts projected U.S. sales of gluten-free foods and beverages will exceed $6.6 billion by 2017.

“Gluten-free products continue moving onto supermarket shelves and into the mainstream,” said Ms. Sentko of BENEO. “Consumers are increasingly interested in nutrition and believe that gluten-free food is a healthier choice. In fact, the top reasons people give for buying gluten-free reflect the perception that gluten-free products are healthier. Surprisingly, (according to a Packaged Facts survey from 2010) only 10% of purchases of gluten-free products are for celiac disease or gluten intolerance, while 30% of purchases are for weight management, and 22% of purchases were made because of a perceived higher quality.”

Gastroesophageal reflux disease (GERD) is also a common health problem for many individuals. Jeffrey Lind, vice president, Health Business Unit, for the Israel-based company Frutarom, stated, “Over 50 million adults in the U.S. will visit a doctor’s office this year and leave with a primary diagnosis involving a digestive disorder. One of the largest sub-categories of digestive disorders, with a steep increase over the last decade, has been the number of visits to primary care physicians related to symptoms of GERD. Diagnosis involving GERD and related effects saw a double-digit increase—over 30% in the number of visits by comparison, while the rise in visits to healthcare providers for other, non-GERD-related digestive health indications was steady, around 5% to 6%. (DiSilvestro et al, Anti-Heartburn Effects of a Fenugreek Fiber Product, Phytotherapy Research 2010).”

While not technically a chronic disease like many of the aforementioned digestive health issues, the typical American diet can also lead to severe digestive issues and overall poor health. Unhealthy diets lacking in proper nutrition are a major cause for digestive trouble, according to Neelesh Varde, product marketing manager for Roquette America, Geneva, IL. “When you consider that most Americans have a deficit of fiber intake of about 10 grams per day, and the fact that IBS is estimated to impact 10-15% of the population, it’s no surprise that products focusing on digestive health are doing very well in the marketplace.”

Good Bacteria, Healthy Gut
Without a doubt, among the most popular supplements in the market for digestive health are probiotics, which harness the power of beneficial bacteria to help digest food and cultivate healthy flora within the GI tract. Through the use of probiotics, either via supplements or functional foods, consumers are able to aid the digestive process naturally, assimilate vitamins and nutrients more efficiently in the body and promote a healthy functioning immune system.

Consumer awareness of these beneficial bacteria has helped probiotics develop into a dominant category in the gut health market. Michael Shahani, COO, Nebraska Cultures, Inc., Walnut Creek, CA, explained, “Bacteria are commonly thought of as being always ‘bad.’ This misconception is slowly changing among consumers, but there is still a lot of education to be done to show consumers that probiotic bacteria are not only helpful for good health, but are actually essential for life. That is, of course, what the word ‘probiotic’ means: ‘for-life.’”

Mike Bush, vice president of business development at Ganeden Biotech, Mayfield Heights, OH, voiced a similar perspective. “Consumer awareness about probiotics has never been better, but honestly, there is still a lot of room to grow. In 2006 only 20% of Americans were aware of probiotics. That number rose to 37% in 2009, and by 2011, 52% of Americans said they are aware of the term probiotic. And 44% of them defined probiotics correctly.”

With the aid of popular marketing campaigns and successful daytime talk shows, consumer understanding about probiotics has been propelled into the mainstream. Dr. S.K. Dash, president and founder of UAS Laboratories, Eden Prairie, MN, reported: “the current trend is up based on customers’ awareness. The market share of probiotics has gone up from $10 million in 1979 to $30 billion today.”

Growth in this $30 billion dollar industry is expected to continue. A recently published market analysis from Transparency Market Research reported global demand for probiotics was worth $27.9 billion in 2011, and predicted it would reach $44.9 billion by 2018, growing at a CAGR of 6.8% from 2013 to 2018.

However, government regulation, particularly in the European Union, threatens to stifle the probiotic market’s message to consumers.

Currently, under the European Food Safety Authority (EFSA), manufacturers and marketers are forbidden from labeling products with any health claims promoting beneficial effects of probiotics. Taking the regulation a step further, EFSA has also barred the use of the term “probiotic” itself, claiming the word implied a certain benefit the agency maintains has not been proven under EFSA regulations. Additionally, lack of harmony and consistency in the EU enforcing these regulations makes for a complicated and challenging marketplace for probiotic producers looking to reach European consumers.

“EFSA has restricted the use of the term probiotic as it has to date rejected all probiotic claims,” said Mr. Bush. “Fortunately, the European consumer is well-educated regarding probiotics and the lack of the term probiotic on packaging has resulted in little, if any, declines in sales. It will be interesting to see how the EU restrictions ultimately affect the market, but it is encouraging to see well-researched and characterized strains continuing strong sales throughout the EU.”

For many, avoiding claims all together seems like the best way to package and promote their product. Others have approached this obstacle through creative naming of their specific probiotic strains. Sam Wright IV, CEO of The Wright Group, Crowley, LA, noted that some companies like Danone have trademarked invented strain names on their consumer products. “Lactobacillus casei DN-114001 is now called lactobacillus defensis or immunitas, depending on whether it is targeted at digestive or immunity health markets. Bifidobacterium animalis is known as b. regularis to connote its digestive health benefit in the absence of stronger health claims. The jury is still out on what actions regulatory agencies may ultimately take on these shadow claims embedded in product names.”

Digestive Enzymes
An unhealthy diet lacking in fresh, unprocessed food and raw fruits and vegetables can easily leave the digestive tract depleted of natural enzymes it needs for proper digestion. Enzymes, whose role is to “break down food-derived fats, carbohydrates and proteins into smaller substances that our bodies can use,” are often destroyed during cooking and processing, thus stripping food of its nutritional and digestive benefits, explained Deerland Enzyme’s Mr. Ravech.

Further, many food intolerances or sensitivities are caused by a lack of certain digestive enzymes naturally produced in the body, causing difficulty in breaking down proteins such as gluten, or sugars like lactose. However, with the aid of supplemental digestive enzymes, consumers suffering from lactose intolerance or celiac disease have the ability to counteract these deficiencies.

In addition to poor diet and food intolerances, lifestyle can also have a major impact on how the body produces these essential enzymes. Anurag Pande, PhD, vice president of scientific affairs at Sabinsa Corporation, East Windsor, NJ, said, “Enzymes are usually produced by the body to aid in the digestion of food, however, various conditions affect enzyme production in the body. Change in lifestyle, stress, dietary habits and age can cause poor enzyme secretion, leading to difficulty in digesting food and getting nourishment, as well as food allergies.”

With enzymes targeting a wide range of digestive health issues, their prominence in the gut health market has seen steady growth. Mr. Ravech reported that “based on the significant growth we’ve experienced in recent years, we surmise that the enzyme side of the digestive health category is growing even faster than (2-3 times)  the supplement market as a whole.”

As consumer awareness for this unique category of dietary supplements grows, companies could begin to combine enzymes with other nutrients that can enhance their beneficial affects in the gut. Deerland Enzymes has been researching and developing such combinations, including multi-enzyme blends, as well as “combining enzymes with other natural ingredients such as peptides, essential oils and chelators,” said Mr. Ravech.

Fiber
Fiber has long been a popular remedy for promoting regularity, and many continue to use it for digestive health today. However, a growing number of consumers are now buying fiber because of its more generic  “good for you”  reputation.

A survey from Mintel in its report “Attitudes Toward Fiber and Digestive Health - US - March 2012” found that “65% [of consumers] … indicate that fiber is important when working to maintain good digestive health.” Interestingly, 54% associated fiber with “overall well-being,” which the report attributed to consumers’ knowledge of fiber’s ability to increase satiety and aid in weight management, as well as its benefits to cardiovascular health. The study concluded that “while the desire to achieve optimal digestive health drives use and interest in supplements and high-fiber foods, the perception that fiber provides a range of health benefits is what makes fiber such an important macronutrient to consider when developing new products to bring to market.”

Regardless of their motivation, more shoppers today look for fiber content in products they purchase, and grasp that incorporating fiber in their diet benefits their health in various ways.

Pam Stauffer, global marketing programs and communications manager for Cargill, Minneapolis, MN, found that “in looking at a compilation of sources, it appears that anywhere between 35-50% of consumers are looking for fiber/digestive health products. Also in an NMI (Natural Marketing Institute) Health and Wellness study from 2011 surveying what positive ingredients consumers want more of—including anything from whole grains to protein to vitamin D—fiber came out on top with 53% of consumers wanting more if it. Whole grains were a close second at 50%.”

Savvy manufacturers have picked up on this, and as a result, Ms. Stauffer said, “the number of whole grain and fiber product launches increased threefold globally within the last six years. In 2005 there were 216 high fiber/whole grain launches, and by 2011 these launches were up to 654 for the year.”

Prebiotics
The rising popularity of the overall fiber market can also be attributed in part to the growing prominence of prebiotics. While insoluble fibers such as whole grains and oat brans are associated with regularity and healthy digestion, “low viscosity soluble fibers, like resistant dextrins, are prebiotics,” explained Mr. Varde of Roquette. “Prebiotic fibers are fermented by the gut bacteria, and can enhance the balance of good to bad bacteria.”

Prebiotics, which are essentially “food” for beneficial gut bacteria, assist probiotics by helping them thrive in the GI tract. Asserting prebiotic’s importance, Ms. Sentko of BENEO said, “Prebiotic dietary fibers are certainly well-known and accepted ingredients that aid in digestive health. In fact, the prebiotic fibers inulin and oligofructose are the most researched prebiotics worldwide.” Further, she cited an expert panel residing under the International Life Science Institute (Roberfroid et al., 2010) that confirmed “the prebiotic effect is now a well established scientific fact. The more data are accumulating, the more it will be recognized that such changes in the microbiota’s composition, especially increase in bifidobacteria, can be regarded as a marker of intestinal health.”

In addition to popular prebiotics such as inulin and oligofructose, the fiber polydextrose also offers significant prebiotic benefits. DuPont Nutrition & Health, Madison, WI, offers Litesse polydextrose, which is “unique in that it is slowly and incompletely fermented throughout the colon, which leads to many positive health benefits, including optimal pH within the colon, reduced carcinogenic compounds throughout the colon, improved bowel function and minimal gas production,” said Michael Bond, health platform leader, digestive health and weight management, for the company.

With increased options and promising consumer awareness, the prebiotics market has room for future development. However, what appears to be preventing prebiotics from becoming a mainstream supplement like probiotics is lack of understanding by the public regarding importance in the diet, and how much fiber should be consumed on a daily basis. Ms. Sentko noted, “surveys show that consumers in the U.S. still fall short of the recommended daily levels of fiber intake. Whereas the recommended intake is 25 grams/day and 38 grams/day for women and men, respectively (Institute of Medicine, 2005), the reported intake levels are 13.5 grams/day and 17.9 grams/day. Food and beverages enriched with prebiotic dietary fibers can help to close this gap.” She suggested that functional prebiotic foods and snacks, in addition to a variety of natural fibers from fruits, vegetables and whole grains, could help Americans increase their prebiotic intake and thus improve their digestive health.

Following Gut Health Trends…
It’s no wonder that consumers concerned with their gut health are looking closely at what they eat and how functional foods can improve their diet. With convenience being a key issue for most supplement users, adding gut supporting ingredients to popular snacks and foods seems like a logical next step for producers in the digestive health space. However, Mr. Varde of Roquette warned that, “consumers are wary that a product with health claims is going to taste different. Ultimately, taste is still king.” Despite consumer concerns regarding taste, he still predicted an opportunity for this trend. “According to Mintel’s Global New Products Database, about 13% of all supplements launched in the past three years contained digestive health claims, compared with about 1% for functional foods. Certainly there are lots of opportunities for digestive health claims in foods.”

Mr. Bush of Ganeden had a more optimistic perspective on functional foods targeting digestive health. “We’re finding that the aware consumers are looking for foods and beverages containing functional benefits like digestive system support. They understand the benefits probiotics provide and want to make it part of their daily routine—like drinking a cup of coffee in the morning or enjoying a yogurt at lunch.” He added, “The probiotic industry is expected to reach $32 billion by 2015, of which nearly $30 billion will be generated through the sale of functional foods and beverages, with the largest portion being generated by the sale of drinkable and spoonable yogurt.”

With 60-70% of our immune cells residing in the gut, positioning digestive supplements as immune supporting products is a smart choice for marketers. Consequently, as more consumers are linking gut health with overall health, many are supplementing their diets with digestion supporting ingredients in an attempt to ward off various illnesses. From fending off the flu to managing the effects of a chronic illness, many have come to realize that a healthy gut is key to keeping the immune system primed for times of crisis. 

On the medical front, Mr. Wright IV of The Wright Group said, “there is growing knowledge among health practitioners and patients that there is an over reliance on antibiotics leading to resistant strains of infections, especially in hospitals and nursing homes. C. difficile infections as well as MRSA have become scourges.” He suggested that, “probiotics, in particular, as well as other dietary components that strengthen the immune system have a bright future” in protecting against these prevalent health threats.

Scientists from Lallemand Health Solutions in Montreal, Canada, have been exploring the link between the gut and the brain, and have found growing evidence that what we put in our stomach affects our mental well-being and cognitive function. Often referred to as the “second brain,” the gut has displayed a bidirectional dialogue with the brain in coordinating digestive functions. This “Gut-Brain Axis” and the role that the microbiota play in the communication between the brain and the gut, is an emerging area of study that has piqued the interest of many in the digestive supplement space.

Some scientists have even begun researching how microbiota are altered in patients with autism, anxiety and depression, and in turn has led them to explore whether supplementation of digestive ingredients could improve mental health. In a clinical study analyzing Probio-Stick, a stress-targeting probiotic developed by Lallemand, researchers examined whether probiotic supplementation could counteract symptoms associated with chronic stress. The study found that consumption of probiotics significantly reduced stress-related gastrointestinal symptoms, such as nausea, vomiting and abdominal pain. While there is still much to learn in this relatively new area of study, gut health ingredients supporting cognitive and mood health could be an intriguing market for manufacturers in the future.