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Responding To Inflammation

Phase 2

Awareness of inflammation has come to the forefront in the scientific and medical communities—now health conscious consumers are catching on as well.

In the past, inflammation has been viewed as an acute (short term) response to tissue injury that produces characteristic symptoms and usually resolves spontaneously. However, more contemporary revelations show chronic inflammation to be a major factor in the development of degenerative disease and loss of youthful functions.

“Chronic, low-grade inflammation is very common among Americans due to an imbalance of certain fats in the typical Western diet,” said Chief Medical Officer Keri Marshall, MS, ND with California-based Nordic Naturals.

“Specifically, this has to do with the over consumption of pro-inflammatory omega-6 fats that are now abundant in the American diet. Omega-6 fats are found in refined foods, cooking oils and conventional meats. These types of foods have surged with the advent of large-scale food manufacturing in the 20th century. Unfortunately, inflammation is implicated in major illnesses across the spectrum, from cognitive decline to heart disease, diabetes and metabolic disorders. It is critically important that Americans lower their intake of foods high in pro-inflammatory omega-6 fats and consume foods with more antiinflammatory omega-3s. Restoring a nutritional balance of roughly 2:1 omega-6 to omega-3 essential fatty acids will go a long way in reducing chronic inflammation and the diseases in which inflammation plays a role.”

According to Nena Dockery, technical services manager with Missouri-based Membrell, inflammation is a normal immune system response that our bodies use on a regular basis as part of the process of self-healing. Therefore, determining the prevalence of inflammation that is out of the norm is very difficult. “Acute inflammation caused by an immune system response to irritants or allergens, as well as tissue injury and inflammation resulting from periodic acute events in those individuals with certain disease conditions is very different from ongoing chronic inflammation.”

Dockery added that chronic inflammation in which the body is in a constant inflammatory condition is definitely becoming increasingly more common and is an area of increased medical scrutiny. “However, the causes and repercussions of this type of inflammation as well as its prevalence are the subjects of much medical debate. Some medical experts only recognize chronic inflammation as a persistent state of acute inflammation due to autoimmune responses or viruses, bacteria or other pathogens that the body’s immune system cannot degrade,” she said. “Others also recognize sub-clinical chronic inflammation that is potentially a root cause, an effect or an indicator of diseases such as cardiovascular disease, cancer or even obesity. Of increased interest more recently have been the disorders that are characterized by chronic inflammation but for which there is still much debate as to their causes. Conditions such as chronic fatigue syndrome or fibromyalgia can be frustrating for both those suffering as well as for their physicians.”

Dockery pointed to a recent article in the Wall Street Journal (July 16, 2012) that addressed the increased awareness of how chronic inflammation can have a critical effect on our development of a wide variety of disease conditions. “Though the exact numbers of Americans with chronic inflammation would be hard to ascertain, it can be safely estimated that half of the U.S. population has some level of this silent condition,” she said.

According to Sayan Sarkar, CEO of New York-based Invigorate Now, along with a tremendous lack of nutritional substance and quality in our daily diets, stress and environmental factors exacerbate inflammation. “Modern diets are full of processed, highly refined foods that are practically devoid of nutritional value. Along these lines, refined grains, sugars, commercially raised meats and various oils—even the ‘healthy’ ones like canola or vegetable oil— are high in omega-6 fatty acids. We need to reduce consumption of these foods in favor of natural, preferably organic foods to shift the omega-6:omega-3 ratio in our body to the other side (some studies show Americans’ ratios are as high as 30:1 of omega-6:omega-3 when they should likely be around 4:1 or 2:1).”

Market Share

Cheryl Myers, chief of education and scientific affairs at Wisconsin-based EuroPharma, Inc., said the market is strong for natural products that address inflammation. “You have a lot of people who want—and need—to stay physically active longer and later in life. They don’t want the health risks that come with so many of the conventional pain relief products, and are looking for supplements that actually work with the body to reduce inflammation, protect the joints and help repair muscle tissue.

“People are beginning to realize that inflammation is about a lot more than just dealing with physical pain,” she added. “It damages tissues throughout the body, and sets a variety of dysfunctions into motion. So, aside from conventional inflammation or pain relief, I think you’re going to see more people seeking out natural options to reduce systemic inflammation, whether it’s occurring in the digestive system, the brain and nervous system, or the muscles and joints.”

Category Ingredients

Some of the most researched ingredients for inflammation have evolved dramatically. Two in particular are curcumin from turmeric and boswellia.

As for curcumin, Myers explained that the majority of turmeric products on the market are regular formulas, comprised of standardized 95 percent curcumin. “Unfortunately, this formulation of curcumin is poorly bioavailable, so it doesn’t pass easily from the gastrointestinal tract into the bloodstream. Additionally, much of the curcumin that does reach the bloodstream quickly converts into other compounds,” she said. “None of this has gone unnoticed, and there have been many attempts to make curcumin more absorbable and have it remain in the bloodstream longer at a therapeutic level so it can be more beneficial.”

Europharma utilizes BCM-95®, a high-absorption curcumin that combines micronized (small particle size that is not nano) curcumin with turmeric essential oils. The ingredient has been shown in published human studies to have up to 10 times the absorption than standard 95 percent curcumin extracts, Myers pointed out. “That is why this specific bioavailable curcumin is being used in important research around the world. It is natural, easily-absorbed (so no need for huge dosage levels) and has published safety studies.”

Invigorate Now also utilizes curcumin in its formulation. “It is our opinion that natural, herb-based ingredients that are rich in antioxidants and anti-inflammatory capabilities are the best form of protection,” Sarkar explained. “This is because these products offer the same level of support that pharmaceutical grade products do (that is adjusting levels of the COX-2 enzyme), but with all the holistic properties of natural ingredients. There are currently some natural, herb/whole food anti-inflammatories on the market, but they are few and far between.”

Additionally, Sarkar said the company has found that although these products are well known and often-used, some manufacturers have sacrificed quantity of ingredients in favor of variety. “In other words, the consumer may receive 10 or more different ingredients, but will only receive them in smaller portions. This may reduce the potential for long-term inflammation support. We feel the best course of action is to give the best of both worlds—that is, offering a wide variety of ingredients, which are provided in balanced and beneficial amounts, while also providing a tremendous amount of the most important, natural anti-inflammatory of all time (turmeric and its curcumin extract). We have 550 mg of a 95 percent standardized curcumin extract in each serving, which is more than is found in single bottles of curcumin on most vitamin store shelves.”

Nordic Natural’s Marshall noted that over the years, nearly 17,000 scientific studies (more than 8,000 clinical studies) have been done on fish oil and these important fatty acids. “If one thing has been shown by such studies, it is that EPA and DHA promote the body’s natural anti-inflammatory response by converting to anti-inflammatory prostaglandins. For this process to occur, however, sufficient amounts of EPA and DHA must exist within cell membranes, and be ready for release and conversion. Further, space for fats within cell membranes is limited, which is why it’s important to consume a healthy amount of omega-3s alongside the more prevalent omega-6s.”

Marshall also noted the benefits of curcumin to inhibit pro-inflammatory substance COX 2 and it’s ability to work with omega-3s. “Curcumin has been found to be a selective delta 5 desaturase inhibitor, which prevents excess conversion of linoleic acid (DGLA specifically) to arachadonic acid (AA),” she said. “This helps to further prevent production of pro-inflammatory markers and allows the omega-3 pathways to more efficiently make antiinflammatory markers.”

Another beneficial ingredient is New Jersey-based Proprietary Nutritionals’ Perluxan.™ It is a proprietary, standardized extract of hops cones (Humulus lupulus L.) with multiple mechanisms of action based on alpha acids. These fractions were found to be potent and specific inhibitors of pro-inflammatory chemicals and derivatives, giving Perluxan the power to reduce pain-causing compounds in a short time with a low dose.

Perluxan works in concert with numerous biochemical pathways responsible for inflammation with both enzymatic and non-enzymatic sources. Instead of taking weeks or months to begin working, Perluxan may activate to help relieve minor pain beginning with the first dose, according to the company.

Membrell’s Dockery noted that ingredients such as bioflavonoids, turmeric, boswellia, ginger and proteolytic enzymes are marketed to individuals who experience some degree of inflammation associated with a specific activity or health challenge. However, she noted that they are not designed to remedy the cause of the inflammation, but simply to help diminish the pain associated with it. “There are also those ingredients that help diminish the inflammation while supporting the underlying tissue as well. Ingredients such as natural eggshell membrane (NEM®), and to a lesser extent, glucosamine can help decrease inflammation and also support the health of the underlying tissue.”

Ingredient Advancements

Ingredients used in natural products for inflammation have undergone other improvements. “Even familiar ingredients such as boswellia and turmeric have evolved into specialized ingredients with enhanced features,” said Dockery. “On the other hand, glucosamine does not have as much of the positive appeal that it once did. The high dosing, inconsistent supply source and the increase in alternative products have all had an impact on its popularity.”

One of the ways that these ingredients have evolved is through their focus on shortening the time period for experiencing a benefit, she said. “Increasingly, more suppliers of natural ingredients are refining their ingredients for increased efficacy within a short time period. For people with discomfort and stiffness associated with inflammation, this can be a real plus in selecting a product. Most of these products function through their positive effect in decreasing the activity of the body’s pro-inflammatory substances. Membrell’s JointHealth product containing natural eggshell membrane helps diminish inflammation through its impact on pro-inflammatory substances, but it also provides benefit quickly.”

Product Innovation

There are several natural ingredients that have beneficial characteristics, but ensuring that they reach their destination in the body to produce a positive physiological effect can be challenging.

“By definition, a dietary supplement must be ingested and this type of dosing can be challenging because the ingredient(s) must pass through the rigors of the body’s digestive system, be absorbed in an active form through the intestinal wall (a natural barrier) and then be utilized by the body at a specific location,” said Dockery. “Unfortunately, many very good natural anti-inflammatories are either broken down completely by the body’s digestive process or are poorly absorbed through the intestinal wall. Many of the current innovations have centered on improvements in protecting ingredients from digestion and improving their absorption rates. Turmeric/curcumin is a very good example of an ingredient that has been improved through either its combination with other ingredients, such as piperine from black pepper, or by manufacturing processes that increase its survival and absorption.”

Recent published in vitro research on NEM has demonstrated that not only does this natural ingredient pass successfully through the digestive tract without the need for protective coatings, but its absorption and positive effects on inflammatory processes are actually improved by the digestive process without addition of other ingredients or manipulation of the ingredient itself, making it an ideal ingredient for oral administration.

In the omega-3 industry, EPA and DHA remain the key essential fatty acids that are used in supplements to support the body’s natural anti-inflammatory response, Marshall noted, and there has been increased attention to a unique omega-6 gamma-linolenic acid (GLA) that also confers anti-inflammatory support, particularly with respect to skin. “New delivery systems are becoming more common as well,” she said, noting that Nordic Naturals’ effervescent formula enables people to drink their omegas, rather than take soft gels or liquid fish oil. The company’s latest release, Nordic Omega-3 Jellies™, is a chewable omega-3 product for kids that provides 250 mg EPA+DHA in one serving. Its emulsion technology marks advancement in delivery systems used to reach these high levels of omega-3, Marshall stated.

Research & Real Life

Natural product suppliers and distributors are always interested in reports that have been issued by the allopathic health community as well as general health related articles. “Unfortunately, many times the natural product suppliers are Put in a position of defending natural remedies against research that bears inherent bias,” said Dockery.

“However, other publicized reports provide wonderful opportunities for the industry,” she added. “The recent article publicized in the Wall Street Journal regarding chronic inflammation is a perfect example of how health studies and statistics can support natural ways of dealing with health issues.

“Some published health studies and news reports also provide indirect support for the joint health market. For example, an article in the July 23rd online edition of Archives of Internal Medicine reports the link between hip and knee replacement surgery and heart attack risk. This type of news-worthy report can provide sufficient incentive for many to try to do what they can to protect their joints, ideally through a combination of weight loss, an appropriate exercise regimen and the right joint support supplement.”

Retailer Sales

Tim Hitt, supplement buyer and manager with Fiesta Nutrition Center in Monroe, LA, a single, 4,400-square-foot retail store four hours north of New Orleans, said that a lot more consumers are educated and doing their homework when it comes to their health and, more specifically, knowledge about inflammation. “It is one of the top five reasons customers are in the store,” he said. Customers are mostly concerned about joint and muscle issues, bone problems and arthritis. As for the age group, “At the low end they’re around 40-years-old, but we might see some younger customers with a sports injury or a vehicle accident.”

Oftentimes, customers are asking for products with turmeric root. “This is hugely popular, right after fish oils,” Hitt said, adding that he believes issues with money, the economy and lack of health care that out of necessity are producing much smarter, health conscious consumers. “People are reading health magazines and are using good old Google.” Europharma’s Curamin is the store’s bestseller by far, he added. “Terry Lemerond has really taken the industry by storm with that product.”

At Wheatsfield Co-Op in Ames IA, Wellness Manager Kim McDermott agreed that quite a few of her customers are knowledgeable when it comes to inflammation and are asking for fish oil supplements. “I would say Nordic Naturals Omega 3 is one of our best sellers and we sell quite a bit of Carlson’s liquid fish oils.” Honorable mention go to Eclectic Institutes Infla-Prin POW-der and another strong seller is New Chapter’s Zyflamend herbal formula, according to McDermott.