The first time I heard the term "probiotics," I was at dinner with a friend
and she had just returned from visiting her sister in Italy who raved about
these things called probiotics—probi-what? Her sister claimed her children
didn't get sick all year and credited the probiotics. My friend immediately
started taking them and spreading the word. Her brother, who suffers from
irritable bowel syndrome (IBS), also started supplementing probiotics and
attested to their effects on his IBS symptoms. So, of course, I ran out to my
local natural market and picked up a bottle. My personal testimony, along with
many others, is proof of probiotics' credible health benefits. Word of mouth has
an enormous impact and as a retailer this can be a powerful selling point. You
want to inform your customer, increase sales and help customers' overall
well-being? Then practice what you preach—start taking probiotics and tell your
own story on how they boosted your immune system or lessened the symptoms of a
digestive ailment. Even if you don't suffer from digestive problems, probiotics
offer a plethora of health benefits.
More Than a Gut Feeling
But it isn't necessary to rely on personal testimony; probiotics have a
strong foundation of research and are proving to be a cornerstone in the dietary
supplement industry, advantageous to immune health,(1) allergies,(2) infant
diarrhea,(3,4) inflammatory bowel conditions,(5,6) antibiotic-induced
diarrhea,(7) cholesterol management,(8) gut transit time/bowel function,(9,10)
lactose maldigestion,(11) colic in infants,(12) bacterial vaginosis,(13) IBS(14)
and respiratory infections(15).
"A wealth of research suggests the importance that probiotics have in terms
of our overall well-being and immune health, not just gut health," said Tim
Gamble, vice president of sales and marketing, Nutraceutix Inc. "Nutraceutix's
Immunobiotix® product was the focus of a now-published academic research study
that demonstrated ‘daily ingestion of a nutritional probiotic supplement
enhances innate immune function in healthy adults.' Also, unlike many dietary
supplements, including others placed in the digestive health category, natural
non-GMO (genetically modified organism) probiotics have long been considered
safe and are rarely, if ever, counter indicated in research."
In Taiwan, the authors of a study published in Vaccine found long-term
consumption of Lactobacillus casei rhamnosus T cell-1 decreased the
incidence of bacterial infection.(16) The double blind, randomized, controlled
trial evaluated the treatment and prevention of pediatric infectious diseases of
three commercial probiotic products. In total, 1,062 test subjects, under the
age of 5, were distributed randomly into four groups. The investigation showed
L. casei rhamnosus can control bacterial, viral and respiratory
infections; a multi-species probiotic reduced gastrointestinal disease
significantly.
And, although it may seem odd that probiotics can help you sleep, researchers
at Osaka University, Japan, found Lactobacillus helveticus fermented milk
may have a more favorable effect on improving sleep in healthy elderly people as
compared with a placebo.(17) The prospective, randomized, double blind,
placebo-controlled, crossover study included 29 healthy elderly subjects aged 60
to 81 years. It included two intervention periods of three weeks each, separated
by a three-week washout period. Subjects took 100 g/d of a fermented milk drink
or a placebo drink (artificially acidified milk) in the first supplementary
period and the other drink in the second supplementary period. There was a
significant improvement in sleep efficiency (P=0.03) and the number of wakening
episodes (P=0.007) in actigraph data after intake of fermented milk, whereas no
significant changes were observed for the placebo. Fermented milk did not
improve the SF-36 scores significantly from the baseline period. In the GH
domain (general health perception) of the SF-36, however, there was marginal
improvement as compared to the baseline period. Although the difference between
fermented milk and placebo was not statistically significant for any of the
sleep or QOL parameters, fermented milk produced slightly greater mean values
for many parameters.
A joint study by doctors at the Northern State Medical University in Russia
and the University of Louisville School of Medicine, Kentucky, revealed
probiotics improved liver function in heavy drinkers.(18) The study, published
in the December 2008 issue of Alcohol, said heavy drinkers given
probiotics for five days had better liver function and a higher number of
beneficial gut bacteria than subjects given the standard therapy.
Finnish researchers reported in the British Journal of Clinical Nutrition
that probiotics may improved blood glucose control even in a normoglycaemic
population and may provide potential novel means for the prophylactic and
therapeutic management of glucose disorders.(19)
And lastly, a Swedish study from the University Hospital in Lund, Sweden,
found the bacterial strain Lactobacillus plantarum 299 may stave off
pneumonia.(20) Researchers said Lactobacillus plantarum 299 may protect
intubated, critically-ill patients from ventilator-associated pneumonia (VAP),
which occurs when harmful bacteria from the mouth, throat or breathing tube are
inhaled into the lungs, just as effectively as antiseptics, such as
chlorhexidine (CHX) or antibiotics.
Which Probiotics for Which Health Claims
There are numerous probiotic strains that serve different functions in the
body; and the same goes for the products stocking retail shelves. Probiotic
products, no matter whether they are delivered via a supplement, yogurt or bar,
are either multipurpose or targeted at a specific health benefit, including,
immune, digestive or oral health. "There is much confusion in the public
regarding which strains are both stable and beneficial to humans," said Justin
Marsh, director of marketing and CEO of Arthur Andrew Medical. "Blending an
efficacious probiotic formula is not an easy task."
Silvano Arnoldo, probiotic consultant at Jarrow Formulas, agreed: "There is a
lack of knowledge and lot of confusion in regard to what a species is, what a
strain is and what a clinically documented strain is. Scientific studies have
shown that not all strains within a species are the same. The efficacy of a
particular strain does not necessarily apply to another strain within the same
species."
Many companies have a passion for probiotics and their advantageous claims on
health and choose their probiotic strains based on the specific health benefits
they want to address. "ReNew Life is passionate about improving digestive care
awareness through education and outstanding consumer support," said Brenda
Watson, president of ReNew Life Formulas. "For this reason, we rely on our
retailers to help us communicate the message that vibrant health and wellness
begins in the digestive tract."
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No matter if customers are looking to improve gut health, immune health or
treat specific gut conditions, many companies have a method to their probiotic
"recipe," versus a random concoction of probiotic strains. For example, Natren
offers several probiotic products, but its flagship product, Healthy Trinity has
30 billion CFUs (colony-forming units) of three specific strains designed to
enhance the GI system. "We chose three specific strains to target each part of
digestion: small intestine, large intestine and the transient flora," said
Natasha Trenev, owner and founder of Natren. "For the small intestine, we
feature the NAS L. acidophilus strain, which helps regulate immune function and
maximizes food absorption. For the large intestine (colon), we feature
Bifidobacteria bifidum malyoth strain, which is considered by Japanese
researchers the most important bacteria for human health. It finalizes
absorption, helps to flush out toxins and stimulates regularity. The final
strain is Lactobacilus bulgaricus LB-51, which travels with the food
producing enzymes to break down the food in the proper nutrient size, without
adversely affecting the immune system." Trenev referred to LB-51 as the "crowd
control" organism because it travels with the food throughout the entire
intestinal tract. "Up to 40 percent of dry-weight fecal matter is hundreds of
species of bacteria, and therefore, this strain is very important to prevent
other types of bacteria from taking hold and interfering with proper
absorption."
Greg Jacobson, senior marketing director, Garden of Life, noted the company
carefully selects the probiotics for all of its Primal Defense products. "They
must be resistant to both acid in the stomach and bile acids in the duodenum, by
choosing hardier, more resistant probiotics, we do not need to use special
enteric coatings and therefore are probiotics are readily available to colonize
in the small intestine," she said. "We give our consumers a choice of powder or
caplets."
Health Plus offers Ultra Fiber Biotic that combines the efforts of both
probiotics and prebiotics for GI health. "Stress directly affects digestion and
can impede the normal healthy absorption process," said Sunil Kohli, chief
operating officer for Health Plus. "The combination of superior-quality fiber
with known probiotics and the prebiotic that feeds them is a colonic restorative
as well as a preservative of thriving gut flora colonies."
Arthur Andrew Medical also believes in the synergistic effects of probiotics
and prebiotics, but in its synbiotic blend Syntol, Arthur Andrew Medical added a
twist with the addition of a Candida yeast cleanse. "The western diet, which
contains high levels of processed flours, sugars, preservatives and chlorinated
water, as well as increased stress levels are factors leading to improper
balance of intestinal flora and an increase of Candida yeast," Marsh said. "Some
doctors argue that 60 to 80 percent of the population may be affected by an
overgrowth of Candida yeast. Much of this is caused by the overuse of
prescription antibiotics. If left untreated, the yeast can form a fungus,
developing rhizoids (plant-like roots) that penetrate and attach themselves to
the inside of the intestinal wall. These roots can dig deep enough to cause
permeability (leakage) in the intestinal tract and allow toxic material to flow
into the blood. This condition is known as Leaky Gut Syndrome (LGS). Beneficial
bacteria also attach themselves to the intestinal wall helping to repair and
clean the mucosa rather than destroy it. Bad bacteria, good bacteria and Candida
all fight for available attachment points along the intestinal wall. When enough
beneficial probiotics are introduced, Candida are overtaken and normal
intestinal flora may colonize in their place."
Still, a newer sector for probiotics is oral and nasal health. Companies such
as Healthy Biototics are designing products that address oral health in addition
to coating the entire digestive system. "I wanted to provide functional,
all-natural probiotic products that address the need for supplementation from
over-use of antibiotics and other indiscriminate antibacterial products" said
Rick Swartzburg, D.C., president of Healthy Biotics Inc. "I also wanted to come
up with niche solutions to problems that were not normally addressed in a
natural and healthy way."
Sedona Labs developed iFlora® Nasal Health-, a patent-pending
combination of four probiotic strains with N-Acetyl-Cysteine (NAC) to benefit
nasal and bronchial health. "The four strains in this formula support a healthy
immune response that supports healthy levels of bacteria in the nose," said
Michael Lee, product development manager for Sedona Labs. "NAC is an all-natural
detoxifier and antioxidant that supports production of healthy mucus in the
nose. The combination of strains is selected by microbiologists based on synergy
of the strains and published research." Lee cited a study published in the
American Journal of Clinical Nutrition, in which regular intake of four
probiotic strains (Lactobacillus GG (ATCC 53103), Bifidobacterium
sp B420, Lactobacillus acidophilus 145 and Streptococcus thermophilus)
reduced potentially pathogenic bacteria in the upper respiratory tract, in
addition to indicating a linkage of the lymphoid tissue between the gut and the
upper respiratory tract.(21)
The Booming Probiotic Market
In 2008, the Natural Marketing Institute's (NMI) Health and Wellness Trends
Survey (2008 HWTD) reported U.S. consumer (general population) awareness of the
term "probiotics" skyrocketed to 48 percent, up from 31 percent in 2007, and up
from 20 percent in 2006. What's more, in 2008, the research firm Mintel reported
142 new foods and beverages were launched in the digestive-health category. So
what's driving this ever-growing market of probiotics?
"What's driving the market is massive spending on advertising and marketing
hype," Trenev commented. "But what's dangerous is when people try these products
and they don't work, they'll be turned off in general to the whole concept of
probiotics, which is a very important one!"
Marsh added, "The public is obsessed with detoxing and colon cleansing.
High-fiber diets, colon hydrotherapy, antibiotics, preservatives and diet are
factors leading to improper balance of intestinal flora. Health conscious
individuals are becoming aware that probiotics are important to replenish after
detoxing. As the detoxing trend becomes larger so will the demand for probiotics."
(For more on detoxification and dietary supplements, see page TK.)
Probiotics have received a lot of press attention lately, whether that is due to
the launch of Activia, media hype or celebrity-driven detoxes is debatable; but,
the market drive also stems from probiotics' efficacy. "The fact that probiotics
work to make people feel better is driving the market," Lee said. "People try
them, their digestion improves, they feel better, they continue to take them and
tell their friends about them. The immune benefit is probably more subtle and
hard to measure. However, in general, people feel better taking them so they
keep taking them."
E. Frank Hodal, Jr., founder and CEO of Little Calumet Holdings LLC,
manufacturer of Vidazorb™, said new offerings will keep the market on an upward
incline. "Innovation in terms of products and ingredients will remain primary
drivers," he said.
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Kohli agreed: "We constantly foray into a variety of natural products stores
and pharmacies to see what's selling and how products are positioned and
promoted. From those observations, I believe that innovation drives this market,
notably in the functional beverage category. This is in tandem with the popular
press touting probiotics for good health. For example, in many pharmacies, you
can thumb through all the popular magazines and you will see health articles
about probiotics. This is a category that will continue to flourish."
And fortunately, the probiotics market has not been stifled by the economy,
and new, innovative ways to deliver probiotics are still finding their way into
the marketplace.
GoodBelly serves up 20 live and active cultures, including Lactobacillus
plantarum 299v (Lp299v) and Bifidobacterium lactis in fruit juices
and is dually designed to improve overall digestive regularity and promote
immunity "Many issues with well-being begin with digestive and immune system
issues—good digestive health and immunity (which probiotics help to foster) are
essential to optimal wellness," said Todd Beckman, president and chief operating
officer of NextFoods. "Your body is an eco-system, and digestion and immunity
(both found in the gut) are highly connected to how things are working, or in
some cases, not working, in ‘your gut.' These important systems need both good
nutrition as well as friendly bacteria to help keep everything in balance."
Phillip W. Harvey, Ph.D., RD, FACN, CNS, chief scientific officer for Max
Muscle USA, commented on Max Muscle's recent probiotic/protein offering, Max
Crunch: "It is unique to the marketplace as the first protein/probiotic bar.
Probiotics may help metabolize the protein and enhance protein bioavailablity."
The bar was designed as a healthy snack, not as a meal replacement. Dr. Harvey
also noted a recent unpublished study from Glenn Gibson, Ph.D. at the University
of Reading, United Kingdom, demonstrated GanedenBC30™, from Ganeden BioTech
Inc., the probiotic strain used in Max Crunch, germinates the gut, helps
metabolize protein and metabolize lactose.
Digestive health awareness is emerging as a very hot topic, turning the
public's eye to supplements such as probiotics. But work still needs to be done
and consumers are still confused as to why they need probiotics and what purpose
they serve in the body.
"We estimate that a maximum 15 percent of the population is aware of
probiotics at this time, and even fewer are fully aware of probiotics' inherent
health benefits," Beckman said. "However, early adopters, such as natural foods
aficionados, vegans, etc. are aware of probiotics and understand their health
benefits, while the average consumer has very little awareness of probiotics."
Marina Nikolenko, marketing executive for Lifeway Foods, agreed, "We think
consumers by and large are not that aware, but that awareness is increasing."
Price noted most consumers think of yogurt when they think of friendly
bacteria, but "most consumers are not well educated about the benefits of
probiotics beyond Lactobacillus acidophilus."
But S.K. Dash, Ph.D., president and director of research at UAS Labs feels
consumer knowledge is growing and the probiotic industry is reaching a larger
pool of consumers. "More and more people are beginning to understand what
probiotic means. The massive advertising programs of food companies in the
fermented dairy field have reached more consumers than ever before. Consumers
are beginning to understand that probiotics are more important than
multivitamins and should be taken daily," he said.
And, to help clear up some of the probiotic confusion, Trenev launched
TruthAboutProbiotics.com as a forum to help consumers sort fact from fiction and
to share their views on probiotic-fortified foods and dietary supplements.
For the Retailer
As a retailer, probiotics can be an overwhelming area to promote, as every
product incorporates an array of differing strains, designed for a unique
purpose, scattering probiotics across several aisles in the store. "Because the
range of probiotic products encompasses pills, refrigerated powders, food and
beverages, they are scattered around the store," Kohli said. "Retailers may want
to institute a Probiotic Awareness Month, wherein they heavily promote all these
products and perhaps bring in a probiotic specialist, a naturopath, to discuss
the concept and introduce consumers to all the products so they can select
accordingly. Remember, too, that anyone at any age can benefit from consuming
probiotics, so this is a great opportunity to address moms in your community."
A similar educational approach is online lectures, but for the staff. "We
offer comprehensive educational resources for retailers so that they can
increase their knowledge of natural digestive care and feel comfortable and
confident when speaking with customers," Watson said. "Store owners and staff
are encouraged to participate in our informative online lectures, as well as our
toll-free telephone training support. We also provide a wealth of
product-related and condition-specific literature and exclusive magazines and
newsletters focusing on digestive wellness and immunity for retailers to give to
customers. In addition, we have several Web sites for retailers to recommend to
consumers, and we offer books by Brenda Watson, C.N.C."
Educational resources help equip retail staff to accurately inform and assist
consumers looking to purchase a probiotic. "Retailers must understand what
constitutes a good probiotic and at the same time have some knowledge of the
functioning of the gastrointestinal tract and immune system," said Arnoldo.
"There is a lot of science behind clinically documented strains and the value of
this must be understood and communicated in a way that consumers can
understand. A consumer who is satisfied with a probiotic product will most
likely return for repeated purchases and share his/her experience with other
people."
As established in the beginning of the story, one of the most effective ways
to spread the "probiotic word" is word-of-mouth. So try them for
yourself, rep the benefits and share your story.
1. Klein A. et al. “Lactobacillus acidophilus 74-2 and Bifidobacterium
animalis subsp lactis DGCC 420 modulate unspecific cellular immune response
in healthy adults” Eu J Clin Nutr. 2008;62:584-93
2. Arthur C. Ouwehand “Antiallergic Effects of Probiotics” J Nutr.
137:794S-797S, March 2007
3. Weizman Z, Asli G, Alsheikh A. "Effect of a probiotic infant formula
on infections in child care centers: a comparison of two probiotic agents."
Pediatrics. 115, 1:5-9, 2005
4. Thibault H, Aubert-Jacquin C, Goulet O. "Effects of long-term
consumption of a fermented infant formula (with Bifidobacterium breve c50
and Streptococcus thermophilus 065) on acute diarrhea in healthy infants."
J Pediatr Gastroenterol Nutr. 39, 2:147-52, 2004
5. Fedorak RN, Madsen KL. "Probiotics and prebiotics in gastrointestinal
disorders." Curr Opin Gastroenterol. 20, 2:146-55, 2004
6. Miele E et al. “Effect of a probiotic preparation (VSL#3) on induction
and maintenance of remission in children with ulcerative colitis” Am J
Gastroenterol. 2009;104(2):437-43.
7. Benchimol EI, Mack DR. "Probiotics in relapsing and chronic diarrhea."
J Pediatr Hematol Oncol. 26, 8:515-7, 2004.
8. T A Larkin et al. “ Dietary combination of soy with a probiotic or
prebiotic food significantly reduces total and LDL cholesterol in mildly
hypercholesterolaemic subjects” Eu J Clin Nutr.2009;63:238-45
9. ibid. Marteau P et al. “Bifidobacterium animalis strain DN-173 010
shortens the colonic transit time in healthy women: a double-blind,
randomized, controlled study” Aliment Pharmacol Ther.
2002;16(3):587-93
10. Koebnick C et al. “Probiotic beverage containing Lactobacillus casei
Shirota improves gastrointestinal symptoms in patients with chronic
constipation” Can J Gastroenterol. 2003;17(11):655-9
11. de Vrese M et al. “Probiotics--compensation for lactase
insufficiency” Am J Clin Nutr. 2001;73(2 Suppl):421S-429S
12. Francesco Savino, MD et al. “Lactobacillus reuteri (American Type
Culture Collection Strain 55730) Versus Simethicone in the Treatment of
Infantile Colic: A Prospective Randomized Study” Pediatrics.
2007;l19(1):e124-e130
13. Anukam K et al. “Augmentation of antimicrobial metronidazole therapy
of bacterial vaginosis with oral probiotic Lactobacillus rhamnosus GR-1 and
Lactobacillus reuteri RC-14: randomized, double-blind, placebo controlled
trial” Microbes Infect. 2006;8(6):1450-4
14. Niedzielin K, Kordecki H, Birkenfeld B. “A controlled, double-blind,
randomized study on the efficacy of Lactobacillus plantarum 299V in patients
with irritable bowel syndrome” Eur J Gastroenterol Hepatol.
2001;13(10):1143-7
15. D. A. Power et al. “Preliminary investigations of the colonisation of
upper respiratory tract tissues of infants using a paediatric formulation of
the oral probiotic Streptococcus salivarius K12” Eu J Clin Microbio
Infect Dis. 2008;27(12):1261-63
16. Lin JS et al. “Different effects of probiotic species/strains on
infections in preschool children: A double-blind, randomized, controlled
study” Vaccine. 2009;27(7):1073-9. Epub 2008 Dec 27
17. S Yamamura et al. “The effect of Lactobacillus helveticus fermented
milk on sleep and health perception in elderly subjects” Eu J Clin Nutr.
2009;63:100-105, DOI:10.1038/sj.ejcn.1602898
18. “Probiotics help with alcohol-damaged liver and bowel flora”
Alcohol 2008;42(8):675-682
19. Kirsi Laitinena et al. “Probiotics and dietary counselling contribute
to glucose regulation during and after pregnancy: a randomised controlled
trial” Br J Nutr. 2008, DOI:10.1017/S0007114508111461
20. B. Klarin, et al. “Use of the probiotic Lactobacillus plantarum 299
to reduce pathogenic bacteria in the oropharynx of intubated patients: a
randomised controlled open pilot study.” Critical Care. 2008 Nov;
12:R136.
21. Ulrich Glück and Jan-Olaf Gebbers “Ingested probiotics reduce nasal
colonization with pathogenic bacteria (Staphylococcus aureus,
Streptococcus pneumoniae, and ß-hemolytic streptococci)” Am J Clin
Nutr. 2003;77( 2):517-520
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