The Expanding Market of Probiotics

In January 2006, Dannon launched Activia, its low-fat yogurt with its trademarked Bifidus Regularis™ probiotic culture, scientifically known as Bifidobacterium animalis DN-173 010. Marketing for Activia boasted of its ability to relieve bloating and promote regularity by reducing long intestinal transit time.¹ After Dannon’s yogurt launch, probiotics stepped into the limelight and started to gain awareness fostering other probiotic product launches.

“Prior to Activia, probiotics were largely limited to a relatively small percentage of the population and concentrated among natural products shoppers,” said Mike Smith, technical sales and marketing manager, Specialty Enzymes and Biochemicals Co. “Growth was accomplished mainly by recommendations from nutritionists, alterative health care provides, natural products magazines and word-of-mouth.” He noted Activia’s launch was really the first time consumers learned about probiotics and their positive effects on health.

“Multimillion-dollar launches from food giants such as Dannon with Activia and Kraft with LiveActive have sprouted large marketing campaigns about [probiotics’] benefits,” said Luis Echeverria, business development and marking manager, Pharmacenter. “The main consensus of the American population is that ‘if it is good enough for the food industry, it must be good enough for me.’ In addition, scientific research has exploded on the scene showing the health benefits of probiotics. This has also bled out into mass media and has been echoed on daytime talk shows such as Oprah with Dr. Oz, Dr. Phil, etc.”

Natural Marketing Institute’s (NMI) Health and Wellness Trends Survey (2008 HWTD) reported U.S. consumer (general population) awareness of the term “probiotics” skyrocketed in 2008 to 48 percent, up from 31 percent in 2007. And that’s after 2007 saw a 50 percent increase from only 20 percent awareness in 2006.

“Traditional cultured foods have been with us for generations,” said Tim Gamble, vice president of Nutraceutix Inc. “Of late, the massive food marketing machine has adopted probiotics as a beneficial ‘additive’ and has thrown enormous sums of money behind their promotion. It is unclear whether these probiotic-supplemented food products have any real efficacy beyond what they may already possess; however, it is very clear that the hype and consumer awareness that has been generated has benefited all of us in the probiotics industry.”

Talking to friends and family about probiotics is much easier now. How many products on the market do you know that have been studied for their benefits on immune health,² allergies,³ infant diarrhea,^4,5 inflammatory bowel conditions,^6,7 antibiotic-induced diarrhea,⁸ cholesterol management,⁹ gut transit time/bowel function,^10,11 lactose maldigestion,¹² colic in infants,¹³ bacterial vaginosis,¹⁴ irritable bowel syndrome¹⁵ and respiratory infections?¹⁶ Probiotics are amazing microorganisms that offer so many perks in the body. And the research continues to mount. Jacques Milette, vice president Americas for Institut Rosell-lallemand, added, “In 2000, probiotics became the first health ingredient in numbers of scientific publications—a quick search on PubMed shows up to 800 publications between 2000 and 2007, a figure rising constantly. The medical community has followed the same trend thanks to increased clinical data to substantiate the use of probiotics.”

Nena Dockery, technical resources manager for National Enzyme Co., agreed, “Probiotics are one of the natural treatments that have gained respect even within the allopathic medical community.”

Smith addressed a valid point, maybe even a selling point, for those skeptical or resistant to taking probiotics: not everyone may have digestive ailments, but probiotics are good for so much more. “Of course you want probiotics to treat issues like diarrhea; however, research demonstrates the beneficial use of probiotics in more extensive, e.g., immune function, allergy, inflammatory bowel disorders, etc. The hope is that consumers will take probiotics to prevent problems rather than wait for symptoms.”

“More and more people are beginning to understand what probiotic means,” said S.K. Dash, Ph.D., president and director of research at UAS Labs. “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.”

However, there is still work to be done in the area of marketing probiotics to consumers. There is a disconnect between consumers’ knowledge and familiarity with terms, and the facts. “There is still relatively low consumer awareness,” said Silvano Arnoldo, probiotics specialist for Jarrow Formulas Inc. “The term probiotic is not very popular. In the area of supplements, consumers are more familiar with the term ‘acidophilus’. There is confusion regarding differences between what a bacterial species is, what a strain is and, furthermore, what a documented strain is. In other words, there is a lack of understanding between strains that are science-based and supported by clinical documentation and strains that are not.” The industry must strive to heighten consumers’ awareness and feed their knowledge with facts and their accessibility to those facts.

The Research

All this talk about powerhouse probiotics is great, if you can back it up. Fortunately, probiotics have a colossal amount of research to stand on. In fact, a study confirmed its use in immune response in the March issue of Postgraduate Medicine when researchers said, “The patented GanedenBC30 (as Sustenex®, from Ganeden Biotech Inc.) probiotic may be a safe and effective therapeutic option for enhancing T-cell response to certain viral respiratory tract infections.”¹⁷ But while research has shown the benefits of this strain for immune health and digestive health, more interesting is the recent research that has lauded different strains of probiotics for their unique usages.

In Taiwan, the authors of a study published in Vaccine found long-term consumption of Lactobacillus caseirhamnosus T cell-1 decreased the incidence of bacterial infection.¹⁸ The double blind, randomized, control 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 (GI) 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.¹⁹ 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 quality of life (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.²⁰ 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.²¹

And lastly, a Swedish study from the University Hospital in Lund, Sweden, found the bacterial strain Lactobacillus plantarum 299 may stave off pneumonia.²² 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.

Milette noted a study on Probio'Stick, a specific formula from Institut Rosell-Lallemand, demonstrated its effectiveness in reducing the GI symptoms experienced by individuals suffering with chronic stress.²³ “More recently, an animal study showed this probiotic preparation displayed an ‘anxiolytic-like’ effect and was able to reduce signs of anxiety. Such an effect had never been previously described with probiotics and offers promises for new applications.”

Sometimes, as previously stated, the struggle with marketing probiotics to consumers is they don’t feel the need to supplement with them unless they have a digestive ailment of some kind. But research shows how they work in prevention and maintenance.

NMI’s 2008 HWTD additionally reported 14.5 percent of consumers consider their diet deficient in probiotics, up from 12 percent in 2007. Greg Stephens, vice president of strategic consulting at NMI, said, “We know consumers are aware of the term [probiotic] and based on sales data, many are buying probiotics (in some forms); however, consumers remain confused as to why they need probiotics. In the 2008 HWTD survey, 70 percent of consumers could not identify any benefits of consuming probiotics. The first identifiable benefit was digestive/colon health with 19.5 percent of consumers making that association (probiotics = digestive health); this was followed by immune support at 9.3 percent of consumers making the link.”

The research is there; the challenge is relaying the whole truth about probiotics to consumers. The good news is the market is expanding, the term “probiotics” is becoming more popular and the number of functional foods incorporating probiotics is only increasing.

Informative Web sites are popping up geared at both consumers and formulators. Natasha Trenev, a probiotics researcher, launched TruthAboutProbiotics.com, a forum created to help consumers sort fact from fiction and to share their views on probiotic-fortified foods and dietary supplements.

“Many consumers do not even know what probiotics are, let alone how probiotics might help them,” said Michael Shahani, director of operations, Nebraska Cultures Inc. “Consumer education is the key in getting probiotics in the hand of people that need them.”

USProbiotics.org provides a highlight of the various strains of probiotics and their uses as all probiotic strains do not function the same way in the body; and the same goes for the probiotic products sold on the shelves. For example, Activia incorporates B. animalis DN-173 010 known for gut transit time and bowel function; Next Foods’ GoodBelly™ juice has L. plantarum 299v known to benefit irritable bowel syndrome symptoms; Yo-Plus yogurt has B. lactis Bb-12 known for immune support; and VSL#3, a medical food for the dietary management of ulcerative colitis or an ileal pouch, has an eight strain combination, including three Bifidobacterium, four Lactobacillus and one S. thermophilus strains.

But choosing a probiotic strain can seem a little overwhelming and daunting. In hopes of offering guidance, UAS Labs released a paper, “Selection Criteria for Probiotics” offering assistance on this crucial process.

Applying the Goods

Once a formulator has reviewed the studies on various probiotics’ health effects, it’s time to examine various delivery forms and applications. And, apparently, there are a lot of options. According to the market research firm Mintel, in 2008, 142 new foods and beverages were launched in the digestive health category.

Gamble noted, “We see a lot of new applications for probiotics come and go, including a baffling array of fads and gimmicks that, from our perspective, do nothing to strengthen the science and track record of probiotics, but do certainly expose probiotics to a wider audience than might have learned about them otherwise.”

Dash echoed Gamble’s comments. “Some companies have taken advantage of the probiotic bandwagon and now they sell probiotics with many marketing gimmicks without valid scientific data,” he said. “They invite FDA and other regulatory agencies to investigate. On the other hand, the pharmaceutical industry and cash-rich companies have been exploring the need to go through the drug-approval process. This will have a great effect on small probiotic companies.”

Milette added, “Recently, the link between the microbiota and obesity has set new directions for probiotics applications. Another emerging area already recognized by animal health experts is stress management, with growing evidences about the interactions of the microbiota with the brain-gut axis.”

Echeverria added, “With our unique division of probiotics and particularly with our Bacillus coagulans strain, we have been tapping in to the market as a leader in the manufacturing and distribution of this strain. This very unique strain will give us a lot to talk about in the near future due to its ability to survive high temperature, humidity, cold, stomach acids and bile salts.”

Dockery also pointed out the diversity in probiotic applications. “Sources for probiotics are no longer limited to their natural presence in fermented products such as yogurt, kefir and buttermilk,” she said. “They are available as encapsulated supplements and are now added to a variety of food products.”

For example, in January 2009, Nestle Healthcare Nutrition rolled out a new drink for children 1 to 13 years old. The drink delivers probiotics through a straw in addition to 25 vitamins and minerals, antioxidants and 7 g of protein.

“In spite of the economic downturn and a reduction in overall consumer spending on dietary supplements, sales of probiotics is increasing,” Gamble said. “This is a trend we’ve seen for a few years due to increased brand and consumer awareness resulting from the publication of a wealth of research demonstrating favorable results associated with probiotic supplementation. More recently, the increase we’re seeing seems to come from a consolidation of dietary supplement spending by the consumer. Consumers are eliminating fringe and discretionary buying choices and focusing on what will simply be their daily basics.” He noted the consolidation and increase in sales of probiotics is outpacing the decrease in sales witnessed by the dietary supplement industry at large, resulting in a net gain in sales of probiotics.

Echeverria sees an opportunity for probiotics to expand into the cosmeceutical sector, internal medications and pet nutrition. “The cosmeceutical applications will encompass therapeutics for acne, wound care, skin irritation, burns and more,” he said. “In the future, internal medical applications will expand into products such as nasal wash, ear drops, mouth wash, douches, etc. Also a large number of animal (pet, large animal, poultry) applications will start being developed as the benefits to the animal GI tracts get studied. The same way humans benefit from certain therapeutic uses animals do as well. This also creates a large opportunity to veterinary products that will reduce the cost of production by reducing application of other APIs to prevent specific diseases.”

“I think we will see more movement of probiotics into food and beverage categories, and for supplements we will see more combination products,” Albert Dahbour, M.B.A., chief sales officer for Wakunaga of America Co. Ltd. “However, companies have to be careful in how they protect the probiotics during the manufacturing process which often includes heat and moisture, not to mention the addition of other actives (fruit/herb extracts, etc.) which could kill the probiotics.”

However, some applications have not been as successful as anticipated. Despite the surge of probiotics in the marketplace, Kraft reported its probiotic cheese did not do well with the public and overall. Euromonitor reported fortified and functional cheeses accounted for less than 1 percent of the $100 billion global cheese market.

“It is hard to predict new applications,” Dockery said. “Probiotic cheese has not yet found a following, probably because of the increased cost. It would seem that in order for a new application to succeed, it will need to be priced competitively with the non-probiotic form or will need to establish a benefit that is unique over other less-expensive sources.”

The Future

The future of probiotics is bright. Research is being conducted on an ongoing basis and new, innovative applications are continually popping up, spurring market growth. “The future of probiotics looks bright, but it won’t necessarily be easy to get there,” Gamble said. “Success depends on brands, retailers and consumers continuing their education about probiotics and avoiding the lure of unnecessary fads and gimmicks that have plagued the dietary supplement industry in the past.”

Dr. Dash added, “At some point, probiotics will be considered more important than multivitamins and will be taken daily by a majority of consumers.”

References on the next page...

References for "The Expanding Market of Probiotics"

1.      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

2.      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

3.      Arthur C. Ouwehand “Antiallergic Effects of Probiotics” J Nutr. 137:794S-797S, March 2007

4.      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

5.      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

6.      Fedorak RN, Madsen KL. "Probiotics and prebiotics in gastrointestinal disorders." Curr Opin Gastroenterol. 20, 2:146-55, 2004

7.      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.

8.      Benchimol EI, Mack DR. "Probiotics in relapsing and chronic diarrhea." J Pediatr Hematol Oncol. 26, 8:515-7, 2004.

9.      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

10.  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

11.  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

12.  de Vrese M et al. “Probiotics--compensation for lactase insufficiency” Am J Clin Nutr. 2001;73(2 Suppl):421S-429S

13.  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

14.  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

15.  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

16.  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

17.  Mira Baron, MD “A Patented Strain of Bacillus coagulans Increased Immune Response to Viral Challenge” Postgraduate Med. 2009;121(2); DOI:10.3810/pgm.2009.03.1971

18.  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

19.  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

20.  “Probiotics help with alcohol-damaged liver and bowel flora” Alcohol  2008;42(8):675-682

21.  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

22.  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.

23.  Laurent Diop Sonia Guillou and Henri Durand “Probiotic food supplement reduces stress-induced gastrointestinal symptoms in volunteers: a double-blind, placebo-controlled, randomized trial” Nutr Res. 2008;28(1):1-5

24.  S. Fujimori et al. “A randomized controlled trial on the efficacy of synbiotic versus probiotic or prebiotic treatment to improve the quality of life in patients with ulcerative colitis” Nutrition Published online ahead of print 8 February 2009, DOI:10.1016/j.nut.2008.11.017

25.  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.