We all witnessed the swell of focus on and interest in immune health when COVID-19 hit. So it’s not surprising that the category for dietary supplements positioned for immune health is still recalibrating after such a meteoric rise. Sales are down 4.3% for the 52 weeks ending Aug. 13, 2023, according to SPINS data.

Although immune category sales have dropped, the pace is slowing. “I think we can expect that while this category may still see some decline, it won’t be as high as it was after the pandemic growth winded down,” said Haleigh Resetar, corporate communications specialist at SPINS.

In addition to the continued slowing trend many manufacturers, vendors, and retailers are still dealing with overstock issues after purchasing immune products in large quantities during the height of the pandemic. This is a “one-two punch,” according to Leslie Gallo, president of Artemis International, echoing what other experts expressed. Although, “this doesn’t mean that immune support is any less important, it just creates an opportunity for innovation,” she added.

Still, a recent consumer survey from Kerry Group, spanning 16 countries and 13,000 people, determined that immune support is now the number one health benefit sought across all age groups. However, people’s ideas about what it takes to support healthy immunity is changing.

Immune Category Reset

One reason for the decline in category sales is that for today’s consumer, supporting immune health means more than just the standard products.

Consumers are realizing that supporting immune health goes beyond, “taking vitamin C during the winter months,” according to Shawn Baier, vice president of business development, TSI Group.

Consumers “are more open to the long-term approach when it comes to their immune health,” he added. “This is an incredible opportunity for our industry.”

In fact, 65% of global consumers are now taking a more proactive approach to their health and wellbeing, according to FMCG Gurus’ Top Ten Trends for 2023 report.

Once you go beyond the typical immune health products, there’s a wide array of categories primed for growth. “While immune products are still important to consumers, categories such as sleep health, cognitive health, and mood support are growing as shoppers realize the impact these can have on their wellness,” said Resetar.

Sleep-Stress-Immune Connections

With consumers taking the “long-term approach,” and learning more about the fundamentals of supporting immune health, it’s no surprise they are making the connection between stress, sleep, and immune function.

According to a study published in 2023, healthy sleep is undeniably linked to physical and mental health, as shown by the negative impact of lack of sleep on neurological, metabolic, respiratory, psychiatric, cardiovascular, and immune systems.¹

“Chronic stress—something that plagues many of us—can directly affect the immune system by decreasing the lymphocyte cells that help fight off infection. Even physical stress can have a detrimental effect on the immune system, as evidenced by the tendency to come down with a cold after extreme exertion like a marathon,” said Gallo.

“Prolonged stress conditions affect the regulatory cellular signals which in turn affect the immune system,” said David Law, president/CEO and co-founder of Gourmet Mushrooms, Inc., who launched his mushroom company with a friend in 1976. “People with poor sleep habits and under constant stress have poor health outcomes such as allergy, frequent respiratory infections, and other symptoms relating to poor immune health,” he added.

Naturally, with consumers’ growing awareness of the sleep-stress-immune health connection, interest in adaptogens is also increasing, and for good reason. Adaptogens help the body adapt to stress by regulating homeostasis of the neuro-endocrine-immune complex including the hypothalamic-pituitary-adrenal axis (HPA), which is intimately involved in immune function, according to a review published in the American Botanical Council’s HerbalGram.²

The global adaptogens market size was valued at $10.3 billion in 2021, and is projected to reach $20.3 billion by 2031, growing at a CAGR of 7.3%, according to a report published by Allied Market Research.

“We see a significant growing awareness and subsequent demand for using adaptogens, like ashwagandha, to help promote a more robustly balanced immune system,” said Rajat Shah, co-founder and executive director of Nutriventia. “This is a long-term approach to immune support, as it is akin to building a strong foundation upon which other immune-support supplements (e.g., elderberry) can be added to buttress the adaptogen’s properties,” he added.

A research review published in 2020 determined that adaptogens including rhodiola, eleutherococcus, and schisandra, can be useful for the treatment of viral infections by modulating anti-inflammatory activity, as well as the innate and adaptive immunity.³ Adaptogens, according to the review, also detoxified and repaired oxidative stress-induced damage, and exhibited antiviral effects by inhibiting viral docking and replication, while also improving quality of life during convalescence.

Another 2022 review revealed that molecules, including ligands, from a range of adaptogenic herbs exert a positive influence on several organ systems including immunity.⁴

The Mushroom Boom

Mushrooms have really burst onto the scene, and they have not let up.

“The COVID-19 pandemic has brought the subject to the fore with sales rising 50% during this time,” according to Law.

Research on mushrooms’ immune supporting functions continues to emerge. For example, a research review published in 2023 determined mushroom polysaccharides exhibit anti-tumor and immune-enhancing activities.⁵

Another study published in 2023 determined that “dietary reishi mushroom is a source of beta-glucan which can significantly boost immune responses.”⁶ Of course, these study results are just some of the most recent in a long history of research on medicinal mushrooms.

The global functional mushroom market was valued at $26.7 billion in 2021 and is expected to expand at a CAGR of 10.8% from 2022 to 2030 (valued at $65.8 billion), according to a Grand View Research report.

According to SPINS, turkey tail, chaga, reishi, shitake, lion’s mane, cordyceps, and maitake have been leading the pack.

Categories with the biggest unit growth included condition-specific products, functional foods and beverages, as well as shelf-stable baking mixes/ingredients/flour (especially for shiitake).

The mushroom category also piqued interest in April 2023, when Fungi Perfecti revealed counterfeit products were being sold on Amazon imitating the company’s Host Defense lineup. Around the same time, Nammex (North American Medicinal Mushroom Extracts), a leading supplier of certified organic mushroom extracts, filed a Citizen Petition with the U.S. Food and Drug Administration requesting the agency address the mislabeling of dietary supplements and functional foods that contain other fungal parts or fail to disclose added grain ingredients.

As sales and consumer interest in mushrooms are expected to continue to increase, questions about accountability, integrity, and transparency are also emerging.

Product Integrity Reinforced

Simply put, “product integrity is everything,” said Gallo. And “in many cases, it’s the difference between a product that is authentic and efficacious for the consumer, and one that is not,” she added.

While a desire for exceptional quality and transparency are part of the very fabric of today’s consumer, at the same time, costs are rising exponentially. In addition to rising costs, immune category sales are slowing, and companies are dealing with overstock issues for some immune products. This imperfect storm is leading many companies to cut costs which, at times, can also diminish quality.

However, “switching to a less concentrated ingredient or sourcing from a cheaper supplier at the expense of product quality is not a win-win. The consumer loses in that scenario and in turn, so does the entire immune supplement industry,” said Gallo.

Regardless of what manufacturers and suppliers are dealing with, “the cost-of-living crisis means consumers are more discriminating about how they spend their money,” said Niamh Hunt, senior global marketing manager at Kerry. 

One area important to today’s discriminating consumer is scientific validation, with 60% reporting that scientifically substantiated health claims influence their health-product purchasing decisions, according to FMCG Gurus.

“Clinically proven” is the most sought-after claim for more than 80% of consumers seeking products that target immune health. Furthermore, 78% of consumers reported that they are more likely to buy immune-supporting products with scientific claims to support their ingredients’ efficacy.

“Kerry’s own research underscores how critical it is that science-backed benefits for healthy lifestyle products are clearly communicated, with 79% of consumers saying they actively research ingredients for themselves,” said Hunt.

Many companies are meeting consumer demand for both scientific validation as well as transparency by making their quality control measures and lab reports accessible online. For example, Gourmet Mushrooms maintains in-house microbiological testing and HPTLC fingerprinting, a culture bank verified by PCR sequencing, as well as genetic sequencing and methodology of its procedures, which are available to customers.

For many supplement categories, including immunity, consumer interest in third-party certifications, certified organic, cGMP, kosher, vegan, gluten-free, and Fair Trade continues. For example, 55% of Millennials are willing to pay more for Fair Trade Certified products even with inflation, according to a report from Fair Trade USA.

Manufacturers and suppliers are responding to consumer interest with their own pursuit of third-party certifications.

“Simply put, our products are ‘California grown and everything certified.’ This is a significant trust indicator for consumers,” said Nirmal Nair, CEO and founder of Sempera Organics, which grows organic mushrooms in its lab farm. The company’s Immune Core is a blend made from California-grown-and-processed mushroom species that may activate key immune cells, modulate immune response mechanisms, and strengthen innate immunity.

Consumers also want to know about botanical origins, farming practices, and worker conditions for the people harvesting raw materials.

Fundamentally, “as consumer empathy for others deepens, our commitment to nurturing our relationships with the indigenous peoples is a highly attractive attribute for the brand partners that incorporate our ingredients,” said Annie Eng CEO at HP Ingredients.

For ingredients like maqui berry and tongkat ali, HP Ingredients hires indigenous tribes to harvest the botanicals. It also supports initiatives that secure future harvests and help support families and communities for future generations.

“It is only natural, we believe, that showing enduring gratitude to those who care-take the raw materials we use will keep the communities healthy and thriving,” said Eng.

What’s Next for Product Formats & Formulations?

Pill fatigue is real, and manufacturers have long responded with a variety of delivery systems. The immune category is no different, with a burgeoning interest in gummies, powders, stick packs, and more.

Convenience continues to be a strong consideration for consumers, “especially when thinking about implementing long-term changes (like taking immune health supplements) into their health and wellness journey,” said Baier. “That’s why it’s not surprising that the functional beverage space is growing and expanding.”

Hunt echoed that trend, saying Kerry’s research found that functional beverages offering immune support are particularly popular, “with 52% favoring fruit and vegetable juice applications, 45% sports nutrition drinks, and 44% enhanced waters,” he noted.

According to Nair, “we are seeing a broader acceptance of mushroom solutions in the shift from dietary supplement formats such as capsules into gummies and now increasingly additions to beverages such as coffee. We expect to see more innovation in blended solutions that confer immunity benefits along with daily nutrition.”

Along with the expansion of consumer awareness and understanding of immune health, “so is the demand for well-rounded formulas and solutions,” said Baier. “Focusing on one stick pack a day dosing can make immune health products more mainstream and popular among the Millennials and Gen Z generations,” he added.

According to TSI, the company’s Hobamine (2-HOBA) ingredient has been shown to improve as many as 15 inflammatory biomarkers in healthy individuals, thereby promoting a healthy balance of the immune system.

Multi-function products are also a popular trend in formulating dietary supplements and nutraceutical ingredients. “Having a 2-in-1 or even 3-in-1 product helps consumers consolidate their purchases and reap multiple benefits. For example, a formula that addresses both immune and gut health makes sense, since the gut and immune systems are closely related,” said Gallo.

A recent study supported the prebiotic benefits of Artemis’ ElderCraft ingredient, a polyphenol-standardized extract made from European Black Elderberry, including significant changes in microbial diversity measures.

There continues to be interest in using familiar ingredients, in novel ways. Turmeric, for example, has been popular for a long time as an antioxidant and to support healthy inflammation. Now it’s gaining ground with emerging research supporting its usage for immune health.

For example, a 2022 study found that curcumin modifies the body’s immune defense by interacting with immune cells including macrophages, dendritic cells, B, T, and natural killer cells.⁷

A 2023 study suggested that curcumin-based nanomedicines can be used as an adjuvant for immune-mediated diseases such as rheumatoid arthritis, inflammatory bowel disease, and COVID-19.⁸ Another 2023 study demonstrated that curcumin from turmeric may prevent oxidative stress and regulates immune responses in sepsis.⁹

“We believe that turmeric will see growth in the immune-support product sector,” said Shah, adding, “our TurmXtra 60N is well positioned to help our brand partners grow in this area. It has been shown to be effective at a once-daily dose of 250 mg, due to its high concentration of 60% curcuminoids and excellent dissolution in water.”

Nutriventia also offers its Prolanza ashwagandha, which contains a broad spectrum of 20 withanolides. 

While immune sales may have slowed, emerging is a whole new way of categorizing immune health and new approaches to maintaining and sustaining overall health. Consumers have a broader definition of what immune health means, encompassing virtually every body system. No doubt, industry will continue responding to this opportunity with innovative, quality solutions.

References

1. Fisicaro F, Lanza G, Figorilli M. (2023). Special Issue “Sleep Disorders: From Clinical Research to Daily Practice.” J Clin Med. 2023 Aug 13;12(16):5271. doi: 10.3390/jcm12165271

2. Panossian A, Wagner H. (2011). “Adaptogens: A Review of their History, Biological Activity, and Clinical Benefits.” HerbalGram. Issue 90, Summer 2011, Page: 52-63 https://www.herbalgram.org/resources/herbalgram/issues/90/table-of-contents/feat_adaptogens/

3. Panossian A, Brendler T. (2020). The Role of Adaptogens in Prophylaxis and Treatment of Viral Respiratory Infections. Pharmaceuticals (Basel). 2020 Sep 8;13(9):236. doi: 10.3390/ph13090236

4. Sulaiman MK, Lakshmanan J. (2022). Systemic and Anticancer Potential of Adaptogenic Constituents Isolated from Traditional Herbs - A Mini-Review. Anticancer Agents Med Chem. 2022 Aug 4;22(16):2811-2821. doi: 10.2174/1871520622666220408091610

5. Dong Y, et al. (2023.) Polysaccharides Derived from Mushrooms in Immune and Antitumor Activity: A Review. Int J Med Mushrooms. 2023;25(8):1-17. doi: 10.1615/IntJMedMushrooms.2023049062

6. Saha TK, et al. (2023). Immuno-physiological effects of dietary reishi mushroom powder as a source of beta-glucan on Rohu, Labeo rohita challenged with Aeromonas veronii. Sci Rep. 2023 Sep 5;13(1):14652. doi: 10.1038/s41598-023-41557-9

7. Allegra A, et al. (2022). The Impact of Curcumin on Immune Response: An Immunomodulatory Strategy to Treat Sepsis. Int J Mol Sci. 2022 Nov 25;23(23):14710. doi: 10.3390/ijms232314710

8. Laurindo LF, et al. (2023). Curcumin-Based Nanomedicines in the Treatment of Inflammatory and Immunomodulated Diseases: An Evidence-Based Comprehensive Review. Pharmaceutics. 2023 Jan 10;15(1):229. doi: 10.3390/pharmaceutics15010229

9. Vieira BM, et al. (2023). Impacts of Curcumin Treatment on Experimental Sepsis: A Systematic Review. Oxid Med Cell Longev. 2023 Jan 30;2023:2252213. doi: 10.1155/2023/2252213