Perhaps the most quickly rising category of all supplements, probiotics continue to be innovated, expanded and desired. Here’s a look at what’s impacting this market.
The word “bacteria” may still carry a poor health stigma, especially in the age of COVID-19— although that is a virus.
However, more people know that there is such a thing as “good bacteria” that help them regain health or remain healthy. Probiotics continue to surge: According to Statista.com, the global probiotics market reached a value of nearly $50 billion in 2018—and (pre-COVID-19) was expected to surge to nearly $70 billion by 2023.
A 2019 Kerry Global Consumer Survey on immune health of consumers in global markets found that immune health (a key driver in consumer use of probiotics) is a priority. In nearly all markets surveyed, supporting immune health function was the most important reason why consumers purchase dietary supplements and other natural health products.
“Consumers have a solid understanding of probiotics and their health benefits for digestive, immune and women’s UTI (urinary tract infection) health,” observed Don L. Summerfield, co-founder and vice president of integrative medicine for Pharmaca, Boulder, CO. “Prebiotics is an emerging product category with early adopter consumer interest.”
Based on sales data, Summerfield continued, probiotic consumers predominately purchase probiotics for digestive health. It’s estimated that close to 90 percent of Americans experience some form of digestive discomfort, thus the interest in taking probiotics for digestive care. “And I believe consumers are aware of probiotics’ immune system support, but it’s not the only reason for making a probiotic purchase,” he stated.
At Garners’ Natural Life of Columbia, SC, Store Manager Nick Beers, related that customers typically look for a probiotic for a chronic digestive issue. And while probiotics are conveyed as a huge help for those issues, probiotics that are targeted to other areas and conditions are also discussed. “Our best-selling probiotic brand would have to be Garden Of Life’s RAW and doctor-formulated lines. Especially because of the many options they have for different kinds of people’s needs, whether that is daily support, chronic issue support, men’s, women’s, kids’ or an immediate relief concern,” he said.
According to Adam Sutter, quality director of California-based ChildLife Essentials, the skyrocketing growth of probiotics and prebiotics has largely been driven by two factors. “The first is recognition of the intimate relationship between digestive health and both immune and mental health, i.e. you cannot have one without the other, and the growing list of offerings of branded, clinically backed probiotics.”
And, just like the way consumers view the multivitamin, they are now beginning to see probiotics as one of the essential daily supplements to help maintain digestive health and immune function. “The old thinking was that probiotics were only appropriate when the digestive system is out of balance,” commented Jason Mitchell, co-founder and co-CEO, Probulin (Topeka, KS). The growth, he added, is largely caused by more people adding probiotics to their routines and experiencing meaningful benefits. Another growth accelerator is the increased research on more strains, and that show additional health benefits.
Jennifer Weinhardt, BS, MS, senior R&D specialist for Texas-based Bluebonnet Nutrition, elaborated that scientific knowledge and tools have become available to properly evaluate how probiotics affect well-being as well as the specific metabolic influences they exert on health. “For example, we are learning that probiotics are beneficial for much more than just gut health; we now know they can support immune function, healthy weight management, emotional wellbeing and skin luminescence, to name a few. The explosion of publications and interest in probiotics has resulted in a body of collective research that points toward great promise. And this has driven the growth of the category.”
Mitch Sirgent, senior vice president of healthcare engagement, Bio-K+ International Inc. Laal Quebec, Canada, observed, “All manner of probiotics have been buoyed by very robust scientific publications elucidating more health benefits and potential mechanisms of action related to the microbiome. Some now call the microbiome the ‘master organ.’”
He added that although this is indeed great for probiotics as a category and the industry, it presents a key challenge for consumers and health care professionals—having to wade through and discern quality products from all the products supported by little to no evidence of efficacy.
The Pandemic Effect
One health benefit global citizens are seeking now and for their futures is immune resistance. The 2020 pandemic has positively affected the entire natural health and dietary supplement industry, with excessive demand for all things immune—including probiotics.
In the viewpoint of Jay Levy, director of sales, Wakunaga of America, California, which has been manufacturing probiotics for 30 years, there is an unexpected benefit of this health crisis: “we are seeing more people pay attention to their health and looking to whole foods and natural supplements to improve their well-being. Many surveys have shown that we are seeing new consumers turn to supplements. This is an opportunity to share knowledge and introduce natural products to a completely new audience,” he said.
Weinhardt agreed that the pandemic has accelerated probiotic use for immune support. In fact, she reported, probiotic supplements during February and March of this year were considered the top functional ingredient during the height of the pandemic panic buying, according to Kathryn Peters, SPINS’ executive vice president of business development. “Consumers are aware of the close connection between the bacteria in their gut and immune health, and as such, retailers should expect continued growth in this category, especially during the times of seasonal affliction,” she said.
Year after year, more consumers seem to purchase dietary supplements such as vitamin C, elderberry and zinc (among others) to nourish their immune system during winter, and probiotics has been gaining sales for this purpose as well, according to Mitchell. “Time will tell if the pandemic will alter how they use probiotics; these events may create a desire to be more consistent about taking daily immune support [supplements].”
Mitchell advised that retailers create a plan for how they market immune-related products now. Key is refraining from linking any immune support product to COVID-19. Instead, he suggested, “create an immune support feature section that provides tools to help consumers take a proactive approach to supporting their immune health every day. I envision an end cap or display of the top favorites for immune support.”
Besides Probulin Total Care Probiotic and Total Care “My Little Bugs” for Kids, he said, the items he would place in the immune display would include Gaia Black Elderberry Syrup, Country Life Buffer pH Vitamin C, Sovereign Silver Colloidal Silver, and Country Life vitamin D3 vegan soft gels.
Category Confusion
As with any mammoth category that has experienced tremendous innovation, growth and publicity, probiotics has its fair share of factors that cause confusion among consumers. Three key areas include refrigerated versus shelf stable, CFU (colony-forming unit) authenticity and veracity, and multi-strain efficacy.
CFU: CFU has been a mainstay term in describing probiotic bounty per dose for quite a few years. But, noted Weinhardt, “Science has shown that quantity should not always be the priority. It is far more important to understand the quality of the probiotic product, and each strain’s specific structure-function applications. For example, depending on one’s food sensitivities, dietary benefits, such as non-GMO (genetically modified organism) and allergen-free, may be more vital.”
Mitchell added that the idea that the more CFUs taken, the better—and, he stressed, “this is not true.” Published research has repeatedly shown that consuming higher CFU counts did not always translate to better outcomes. The research revealed that taking the correct potency and taking it consistently is best. Although there is no harm in taking 50 billion or 100 billion CFUs per dose or serving, Mitchell said that typically, between 10 to 20 billion CFU “is all that is really necessary.”
According to Levy, currently, there is no scientific recommended daily dose for probiotics, but research suggests, and there is a general expert consensus that says a healthy person should take up to 10 billion CFU to maintain good health.
Strains: Another source of confusion is strain inclusion—some probiotic products contain up to a dozen or so. In Sutter’s opinion, “while we appreciate the value of gut microbiome diversity, at this current time the single strain products currently on the market, or those with up to three or four strains, appear to be the right direction, compared with those products that contain very small amounts of 10-plus different strains.”
And, similarly with CFU count, Sutter said, “Consumers must understand that more isn’t always better, particularly when amounts provided are very low.”
However, noted Weinhardt, some probiotic blends can be effective when formulators know which strains are complementary to one another. “Compatibility is essential. Tests have shown that dominant probiotic strains can kill off less resilient strains even before consumption. To ensure compatibility and efficacy, probiotic formulas must combine multiple, scientifically supported probiotic strains relevant to a specific use.”
Levy agreed, asserting that when considering a multi-strain product, look at the science, which should provide an explanation to how many are needed and which ones are effective for specific purposes.
Further, strains belong to species, and many studies will describe species’ efficacy rather than specific strains. (Ex. Lactobacillus paracasei is a species, L. paracasei CNCM I-1572 is a strain). “Although many studies do not list specific strains, they do indicate the benefits that each species has shown for various conditions, such as IBS (irritable bowel syndrome), allergy symptoms, cognitive function, etc.,” he said, advising, “start your conversations with customers around species that are well documented and shown to be efficacious.”
Strain identity is a growing concern. As consumers become much more discerning, they want to know that the probiotic they are going to consume is what is listed on the bottle. According to Weinhardt, “DNA identification and/or verification by facilities such as the Pasteur Institute, the prestigious scientific non-profit foundation dedicated to the study of microorganisms, is important because they characterize the DNA sequence of each probiotic strain and bring to light that not all strains are created equal.”
Refrigeration v. Shelf Stable: “Stability is an area that we feel is the cornerstone of probiotics,” Levy asserted. Probiotics survive from point of origin, to manufacturing, shipping, warehousing, sitting on a store shelf and arriving into the consumer’s cabinet at home, but the journey isn’t done; they need to endure the GI (gastrointestinal) chemicals and live through colonization or implantation. He contended that the bacteria starting material needs to be stable and resilient. “Refrigerated or not refrigerated, the bottom line is knowing that the probiotics are alive when you ingest them,” he underscored. “Today you can have confidence with a product that has not been refrigerated.”
He added that Probulin probiotics undergo a two-year, real-time room temperature stability study, and Probulin is manufactured with a chemical-free delivery system called MAKTrek 3-D that has shown to help deliver more surviving probiotic bacteria than other systems. “To protect the integrity of probiotics, it is important that the manufacturer uses advanced technology, such as freeze-drying each strain under low temperature and pressure, which protects them from the normal acidic conditions of the GI tract (pH 3 or 4) until they reach their target site of action—the lower small intestine,” Weinhardt said.
Retailer Pharmaca doubled its probiotic assortment when it launched a shelf-stable probiotic set, according to Summerfield. “For many years we only offered refrigerated probiotics, believing they were the most therapeutically viable products. But with advancements in packaging and the development of viable, heat-stable probiotic strains, we decided to expand into the shelf-stable probiotic category.”
Yogurt: There are numerous varieties that tantalize the palate and provide solid nutritional value but not really enough of probiotics for specific probiotic benefit, according to several sources. Customers who believe that eating yogurt every day will suffice the optimal, health-promoting probiotic level may be wrong.
Said Summerfield, “Retailers need to consistently educate consumers that probiotics included in foods like yogurt and beverages, such as kombucha do not provide meaningful strains or potency to be considered a substitute for a daily probiotic dietary supplement.”
Fellow retailer Beers agreed, stressing, “The biggest myth that we’re finding is that most customers think they can get the same amount of cultures and strains from one container of yogurt that they can with a probiotic supplement. That has been the topic we’ve had to educate our customers the most on about the different strains and cultures of prebiotics/probiotics and the many benefits they could provide.”
Overall, as the probiotic market continues to see advancements in research and in product development to satisfy the surge of consumer demand, Summerfield shared guidelines to help select inventory:
• Look for probiotics with clinically documented strains that have been researched in scientific study.
• Choose probiotics with strain identifications listed in the supplement facts panel for strain transparency. (e.g. “B. Longum BB536” vs. “B. Longum”)
• Choose a brand with a reputable probiotic history that sources from only the finest probiotic suppliers and researchers—you would need to research this heavily.
• Individuals with compromised digestive systems (which are many probiotic product seekers) may want to choose probiotics with enteric coating to ensure probiotic survival through the stomach barrier and delivery into the intestines.
Current Impacts
According to Sirgent, medical-grade probiotics are gaining more prominence. Finished probiotic products that have demonstrated through randomized clinical trials, an ability to treat or prevent specific disease conditions or significantly improve important disease biomarkers. He predicted that these will meet a similar level of evidence for safety and efficacy as pharmaceutical drugs. “Until then, probiotics will not get the full respect they deserve, health care practitioners will be reluctant to endorse them fully and consumers will still be confused about what works and what does not,” he stated.
Probiotics and the microbiome are so widely discussed and marketed that the venerable TV magazine, “60 Minutes” devoted a segment to it on June 28, 2020. However, the majority of the piece was an urgency to reduce the quality and quantity of research about the efficacy and value of taking probiotics.
Coincidentally, this piece aired only 19 days after the official announcement by the American Gastroenterological Association (AGA) declaring that the association “does not recommend the use of probiotics for most digestive conditions.” The statement said, “New AGA guideline finds that evidence to support use of probiotics to treat digestive disease is greatly lacking,” and there were “only three clinical scenarios” where research shows probiotics are beneficial.
However, according to the Council for Responsible Nutrition (CRN), these guidelines for practitioners focus more on disease states and the concept of patients relying on probiotics as a treatment or preventative agent. Overall, probiotics are necessary for maintaining good health, balance and digestive function, as part of a healthy lifestyle. But, of course, they are not intended to be used as a treatment in the face of GI diseases.
That said, with the tone of the “60 Minutes” segment, you may have customers questioning if probiotics are indeed good for their health.
There are literally hundreds of published studies examining the effects of probiotics on digestive health. Some are small, and others are sizable mega-analyses. According to Weinhardt, a review from the Cochrane Collaboration concluded that probiotics shorten episodes of acute infectious diarrhea, and a Health Canada 2011 monograph stated that products containing certain probiotics (e.g., Lactobacillus rhamnosus GG) help manage acute infectious diarrhea and antibiotic-associated diarrhea.
Further, a 2012 review published in the Journal of the American Medical Association found that probiotics reduced the risk of antibiotic-associated diarrhea by 42 percent. A 2017 Cochrane review of 14 trials also concluded that probiotics could have a beneficial impact on diarrheal conditions and related gastrointestinal symptoms.
In its response to the “60 Minutes” segment, CRN asserted, “Probiotics have been shown to support good health and continue to be a growing category with consumers. Their repeated purchases and positive consumer outcomes undercut the reporter’s supposition that benefits can be attributed to a placebo effect.”
Industry can certainly attest to the health-promoting benefits of probiotics, which have years worth of research validating this link. “I firmly believe that a probiotic could eventually become an essential nutrient with an assigned RDI (recommended daily intake) value,” Mitchell emphasized. “At least I hope that that happens. Research certainly supports the use of probiotics and how important they are.” VR
For More Information:
Bio-K+ International Inc., www.biokplus.com
Bluebonnet Nutrition, www.bluebonnetnutrition.com
ChildLife Essentials, www.childlifenutrition.com
Probulin, www.probulin.com
Wakunaga of America, www.kyolic.com
