The Microbiome Through the Life

Stages:
Life Stage Probiotics in a Digital World

Consumer engagement and the move towards

life stage probiotic products.

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www.lumina-intelligence.com
Contents

Introduction…………………………………………………………………………………3
It’s time to listen to the consumer..………………………………………………..…….4
Probiotics supplements enjoy highest consumer engagement………..………….5
The bugs and us – a lifelong relationship………………………………...……….…..7
The first 1,000 days matter.………………………………………………….…..……….8
Colic and diarrhoea the most common infancy problems………..……………….10
Young women most prone to Irritable Bowel Disease…..……………………..….12
Probiotics underutilised in Sports Nutrition……………………………………..….13
Seniors – content with probiotic constipation relief…….……………………..….16
Recommendations……………………………………………………………………….18

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Introduction

The terrain for developing and marketing probiotics is changing fast. Research into the human
microbiome and how its impact on health varies over the course of a lifetime is revolutionising the
therapeutic applications of probiotics. In tandem with this, the rapidly evolving online retail space is
providing industry with a unique way of gauging the level of consumer satisfaction with their
products. The strategic value of this, however, is far from being optimised.

Lumina Intelligence’s research covers 20 key markets globally, capturing close to 2,500 brands and
brand variants of probiotic products, comprising supplements, cosmetics, juice and kombucha. We
closely examine the consumer engagement generated by these products in terms of product reviews
and ratings. This data demonstrates, for example, that consumers are, on the whole, much more
satisfied with probiotic products than some observers may previously have believed. It also shows
the direction in which probiotics are moving, namely towards life stage products whose relevance is
easy for consumers to grasp and whose benefits are equally easy to observe.

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1.1 It’s time to listen to the consumer

It is probably safe to say that the buoyant growth rates achieved by probiotics in the first decade of
the 2000s, both in foods and supplements, are a thing of the past. Today’s market environment for
these products is rather more sluggish and more competitive than ever before. Over the past couple
of decades, the industry has poured enormous efforts into various key areas to help boost the
uptake of probiotics. Communication between brand owners and probiotic ingredients
manufacturers, for example, has been admirably productive, resulting in the development of
numerous different strains of probiotic bacteria (many of which are proprietary), innovative
formulations, products, formats and delivery systems.

At the same time, there has been a considerable investment in scientific research to further the
understanding of probiotic organisms, their interactions and their impacts on human health. In the
legal arena, getting health claims approved by regulatory bodies continues to be a costly uphill
battle, demanding much perseverance and tenacity.

In short, the industry has demonstrated both diligence and a high level of creative capacity in
working with stakeholders like research institutions and allied businesses along the supply
chain. Where it has been less adept, however, is in its communications with the end
consumer. This is not meant to devalue the industry’s considerable achievements in
educating its consumer base about what probiotics actually are and promoting some
of their core benefits, particularly in the areas of digestive wellness and immunity.
The point is rather that this communication has, so far, been mostly one way.

This is where Lumina Intelligence steps into the breach. The power of its
data, gleaned from analysing consumer engagement in online retail,
lies in enabling businesses to turn communication into a two-way
street. Armed with this information, manufacturers can base
their brand strategies on consumer feedback, creating
products that are 100% relevant to their audience.

Before launching into this, let’s first take a look at a

global snapshot of consumer engagement with
probiotic products.

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1.2 Probiotics supplements enjoy highest consumer engagement

Lumina Intelligence can reveal that probiotic products gained an astounding 11.5 million customer
reviews in 2018 driven, first and foremost, by China, South Korea and the US. Within probiotic
products, it was probiotic supplements which achieved a higher engagement rate than other sub-
categories like skin care, juices and kombucha. The main reason behind this, of course, is that there
are far more probiotic supplements on the market compared to these other probiotic products.

Reviews of probiotic products across 18 countries

Probiotic supplements are far in the lead where consumer engagement is concerned, but other categories still
achieved noteworthy review numbers. Lumina Intelligence recorded 5,000 reviews on probiotic skin care
products in December 2018, for example. Note: China and South Korea are broken out separately below.

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 Reviews of probiotic products in China

Reviews of probiotic supplements in China were up by 10 million in Q3-Q4 of 2018.

Reviews of probiotic products in South Korea

In South Korea probiotic juice is gaining traction.

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 Across 19 countries (China has been removed from the data in the above graph) probiotics for children
generate more consumer engagement than probiotics aimed at any other life stage. In China, by contrast,
consumer engagement is driven by probiotics for adults. Both in China and the rest of the world, probiotics
aimed at seniors scored highest in terms of ranking.

2.1 The bugs and us – a lifelong relationship

The human body is inhabited by trillions of microbes. Many of these are commensal, interacting in a
synergistic manner with the host. They are found on the skin, the mucous membranes, the genito-
urinary tract and, above all, throughout the digestive tract, which is where the vast majority of the
body’s microbial population resides.

The discovery that the composition of the microbiome is strongly influenced by environmental
factors as well as the life stage which the individual is currently passing through, and that it can be
therapeutically modulated to achieve specific health outcomes, is in the process of revolutionising
nutritional – and also medical! – science.

The human microbiota has three primary functions: it forms a barrier that protects the host against
pathogenic organisms, it facilitates a number of metabolic functions and it helps to nourish the host,
e.g. by synthesising certain vitamins and boosting the absorption of nutrients.

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During the first life stage, an infant’s developing microbiome aids in the digestion and metabolism of
colostrum, breast milk and/or formula, and, later on, weaning foods.1 As a person matures and
moves towards adulthood, the microbiome becomes increasingly rich in terms of species diversity,
until the onset of old age, when microbiome complexity starts to wane again.

It is no coincidence that the very old and the very young are population groups most susceptible to
infectious diseases – this phenomenon is directly related to a lack of microbiota diversity.

2.2 The first 1,000 days matter

As soon as a new life begins, the environment starts to impact on the development of the
microbiome, both positively and negatively. “The first 1,000 days” refers to the period of
development from conception to the end of the infant’s second year. It is recognised that this time
window is of crucial importance for mental and physical growth with far-reaching consequences for
health and wellbeing for the rest of an individual’s life.

The concept has been leveraged by the World Health Organisation and UNICEF for a number of years
with a focus on improving maternal and infant health of at-risk populations in developing
countries.2,3 However, providing a new human being with the best possible start in life and thereby
increasing his or her chances of living a long, healthy and productive life is a universal desire
espoused by parents, making the first-1,000-days concept relevant to all. Besides physical growth
and neurological development, a healthy microbiome also appears to play an essential role in

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preventing chronic diseases, like obesity and diabetes, which afflict both developing and
industrialised countries in equal measure.

The microbiome of a newborn lacks the diversity of that found in adults. The question, whether the
colonisation of the foetal gut microbiome already starts in utero or whether the baby picks up its
very first microbes as it passes through the birth canal, is hotly contested by scientists.4 What is
certain, however, is that during the first 1,000 days, the infant’s microbiota quickly becomes much
more diverse.

Natren Life Start, by Nutribrand Fulfillment Ltd – an example of a probiotic product targeted at babies born by
caesarean section, who have missed out on the chance of picking up their microbiome starter culture. Image
Source: https://natren.org.uk/life-start/

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2.3 Colic and diarrhoea the most common infancy problems

Among common health issues affecting

infants, diarrhoea and colic are the most
researched in the context of probiotics. A
baby of less than three months of age is
diagnosed with colic if it cries excessively.
Colic is believed to be caused by trapped
wind or other types of digestive troubles.
The condition is extremely distressing to
both babies and parents. A link seems to
exist between a compromised gut flora
(“dysbiosis”) and colic in young babies.

Recent studies suggest that low counts of intestinal lactobacilli may play a role in colic and that the
symptoms can be improved by oral administration of these organisms. A meta-analysis published in
2018, for example, found that breastfed infants treated with Lactobacillus reuteri DSM 17938 were
almost twice as likely to show reduced incidence of crying and fussing. For bottlefed babies,
however, the results were less conclusive, indicating a need for further research.5

Children have a developing immune system, which can generally mean that they are more
susceptible to picking up different bugs. As a result, diarrhoea and gastroenteritis can be relatively
common. Both come with the potential side effect of wiping out the good bacteria present in the
intestine and hence a healthy gut flora needs to be rebuilt. Parents are understandably concerned
about the discomfort for the child and also the daily disruption that illness can bring. Hence, they are
looking for risk-free ways to minimise the incidence of diarrhoea in their children.

A large number of clinical trials are published on the role of probiotics in treating sporadic infectious
diarrhoea in children. From this, a few, well-identified probiotic strains have emerged as being of
benefit: Lactobacillus rhamnosus (LGG), Saccharomyces boulardii and Lactobacillus reuteri.

There are many products on the market featuring these strains and leveraging the relevant benefits.
One example is Culturelle, a leading American brand, with its Culturelle Kids! Packets Probiotic
claiming to “help reduce occasional digestive upset including diarrhoea.” Another is Mommy’s Bliss,
also an American brand, which claims to “help with occasional diarrhoea”. Lumina research shows
that Culturelle is the most reviewed brand of infant probiotics globally, accumulating around 78,300
reviews and an appreciable satisfaction rating of 4.7. Mommy’s Bliss ranks 5th in terms of consumer
engagement, mustering fewer than a thousand reviews and a lower satisfaction rating of 3.9. Brands
can view unfavourable rankings and critical comments either as an existential threat or as an

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opportunity to enter into a dialogue with consumers, possibly with the objective to position and/or
re-formulate.

Many of the most reviewed infant probiotics receive high ratings, indicating that parents are happy with their
efficacy.

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3. Young women most prone to Irritable Bowel Syndrome (IBS)

The International Foundation for Functional Goastrointestinal Disroders (IFFGD) and the American
College of Gastroenterology estimate that between 5% and 20% of people suffer from a form of IBS.
Those who report IBS symptoms are typically female. And it is young women, in particular, who
appear to be most affected. According to figures based on United Nations and CIA (World Factbook)
statistics, up to 220 million young females could be affected across the 20 markets researched by
Lumina Intelligence.

As indicated in the graph below, consumer satisfaction with products marketed on a digestive health
platform among women’s health positioned probiotics is, on the whole, high, achieving a score of
around 4.6. However, when it comes to bloating, which is also a common symptom of IBS, both
score and consumer engagement (reviews) turned out to be rather low. This suggests an area that
brands might want to pay more attention to in the future.

Urinary tract infections and vaginal health issues (e.g. recurring yeast infections) are also common in the young
female demographic. The data demonstrates that probiotic products positioned on these platforms enjoy high
consumer satisfaction with ratings of just above 4.4.

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4. Probiotics underutilised in Sports Nutrition

Young males tend to be hard to reach with health and wellness messages, and our research has
shown that their engagement with probiotics is considerably lower than women’s. One promising
way of targeting probiotics at young men is by using sports nutrition products as a vehicle, since this
category exerts a high appeal over this group. Immunity, digestibility of protein, muscle recovery and
benefits connected to the gut-brain axis are four key areas where probiotics have demonstrated to
benefit athletes in a number of scientific studies, and so they make for promising positioning
platforms.

What is surprising about Lumina Intelligence’s findings is that barely 2% of the sports nutrition
protein powders captured featured probiotic ingredients. On top of that, our research only managed
to identify sports nutrition protein powder products with added probiotics in 15 countries out of the
20 reviewed.

Top 25 Most Reviewed Protein Powder Brands in Sports Nutrition, 20 countries, Q3 2018

Caption: Probiotics were only found in four out of the 25 top-reviewed sports nutrition powder brands.

A further indication of how underdeveloped the sports nutrition sector is when it comes to
leveraging probiotics is the relatively limited number of probiotic strains employed by the products
we analysed.

In 2018, there were 20 strains used in formulations of sports nutrition products captured by Lumina.
The three most popular (as well the most robustly researched) strains were Bacillus coagulans,

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Lactobacillus acidophilus and Lactobacillus plantarum. Bacillus coagulans, including the proprietary
strain BC30, was the leading strain present in 13 countries and in 24 products captured. As evident
from the chart below, it accounted for one quarter of probiotic-containing sports nutrition products.
This lack of diversity implies plenty of pent-up NPD potential.

Diversity of probiotic strains in sports nutrition products, 20 countries Q3 2018

Now let’s turn to what consumers are interested in when it comes to the health positionings of their
probiotic sports nutrition products, and how they rate these products. At this point, it is well worth
mentioning that probiotic sports nutrition products garnered over twice as many reviews as well as
higher rating scores compared to their non-probiotic counterparts. In terms of consumer

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engagement, as illustrated in the chart below, it was joint health and digestive health, which topped
the review chart. As also evident from the chart, consumer satisfaction rated fairly high, with
digestive health products around the 4.1 star mark and joint health reaching around 4.5.

Prevalence of health claims across protein powders, 20 countries, Q3 2018

Probiotics give sports nutrition products a competitive edge. They can add purposeful, observable
benefits to formulations and allow brand portfolios to diversify and expand. In sports nutrition
products targeted at young males, immune and digestive health are particularly attractive areas for
NPD, since they are highly relevant to both dedicated athletes as well as a more mainstream
audience wanting to follow an active lifestyle. There is also exciting research looking into the impact
of probiotic intervention on muscle recovery.

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5. Seniors – content with probiotic constipation relief

As we move towards old age, our gut microbiota undergoes a number of profound changes, which
are potentially detrimental to health. For example, microbial diversity declines, there is a shift in
dominant species, a reduction in beneficial organisms (e.g. Bifidobacteria) as well as less availability
of short chain fatty acids, which serve as a food source for the resident microbiota. The reasons for
this are multifactorial and include changes in dietary patterns, the impact of medical drugs, reduced
production of digestive secretions, reduced gut motility and an increase in gut permeability.

The consequences of these changes for ageing an individuals’ health status are equally diverse. They
may manifest in increased susceptibility to infections, inflammatory diseases, bowel disorders,
colorectal cancer, cardiovascular disease, Parkinson’s disease, hypertension and dementia, including
Alzheimer’s.7,8

Our data (refer to graph below) identifies constipation, immunity and wellbeing in general to be of
key concern for seniors. Constipation generated the most consumer engagement with an average of
over 1,300 reviews per product globally. Consumer satisfaction was also extremely high for probiotic
products positioned as alleviating constipation, achieving close to a perfect 5 star rating.

The fact that seniors appear to be content with probiotic products promising digestive health
benefits is certainly an encouraging finding that attests to the efficacy of the products on offer. On
the other hand, the data indicates that more might be done to strengthen the standing of probiotics
in the area of boosting immunity in the elderly.

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Constipation, immunity and wellbeing of key concern for seniors

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6. Focus on life stage products, where efficacy is easy for consumers to judge

For brand owners promoting probiotic products, the rise of the online review and ratings culture has
opened up a new avenue for underlining the usefulness and efficacy of their offerings without solely
having to rely on officially approved health claims.

Outside of the EU, generic health claims for probiotics are fairly widespread. This implies that they
don’t really afford much of an advantage to brands in terms of product differentiation. By contrast, a
specific health claim, approved by a regulatory body for a proprietary strain, represents the Holy
Grail in setting a product apart from the competition. Because of the rigorous documentation
required to achieve approval, this tends to be a lengthy as well as a costly undertaking and therefore
prohibitive for smaller players. In any case, the wording of official health claims tends to be rather
technical and therefore hard to understand by the layperson.

And while it is important for the industry to continue to invest in the science, encouraging
consumers to communicate their experiences and level of satisfaction with probiotic products, and
to systematically mine the wealth of information they so freely provide, may prove to be a much
more fruitful strategy. The key tenet underpinning this approach is to focus on health benefits,
which are easy for the consumer to observe and measure. Such observable benefits include a
lessening in the severity of eczema, improved protein digestion (measurable by the absence of
intestinal gas) in young males consuming a protein-rich diet and the alleviation of constipation in
seniors, for example.

Furthermore, the industry needs to focus not just on identifying those health concerns where
probiotics may offer a useful level of support, but on how to appeal to consumers according to what
life stage they find themselves at. How can the product improve their quality of life? If this is not
communicated with sufficient clarity, consumers may fail to see the relevance of a product.

A further point which is likely to help probiotic brands in moving forward is that public health bodies
and the community of mainstream health professionals are slowly starting to open up to probiotics.
For example, the UK National Health Service (NHS) states in its advice intended for the general public
that probiotics may be useful with certain health issues, like IBS and diarrhoea. The organisation
concedes that probiotics appear to be safe and it openly encourages consumers to give them a try.9
This more favourable attitude towards probiotics is bound to have a positive impact on the overall
market climate.

Disclaimer: Lumina Intelligence has not verified the scientific validity of any of the claims promulgated by the
product examples cited in this paper. The information has been drawn from the details provided by the
manufacturer on product packaging and websites.

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References

1 The Infant Microbiome: Implications For Infant Health and Neurocognitive Development. Nursing
Research (2016) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4681407/

2 Essential Nutrition Actions – Improving Maternal, Newborn, Infant and Young Child Health and
Nutrition. World Health Organization (2013)
https://apps.who.int/iris/bitstream/handle/10665/84409/9789241505550_eng.pdf;jsessionid=0106
0E1B1EAD212FE859A18B0D2C9E36?sequence=1

3 The First 1,000 Days of Life: The Brain’s Window of Opportunity. UNICEF (2019)
https://www.unicef-irc.org/article/958-the-first-1000-days-of-life-the-brains-window-of-
opportunity.html

4 Could Baby’s First Bacteria Take Root Before Birth? Nature (2018)
https://www.nature.com/articles/d41586-018-00664-8

5 Lactobacillus reuteri to treat infant colic: A Meta-analysis. Pediatrics (2018)

https://pediatrics.aappublications.org/content/141/1/e20171811

6 Probiotic gives long-standing protection against childhood eczema, study finds. University of Otago
(2018) https://www.otago.ac.nz/news/news/otago701886.html

7 Nutrition and the gut microbiome in the elderly. Gut Microbes (2017)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5390822/

8 Gut microbiome and aging: Physiological and mechanistic insights. Nutrition and Healthy Aging
(2018) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6004897/

9 Probiotics. National Health Service (NHS) (2019) https://www.nhs.uk/conditions/probiotics/

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About the providers of this paper

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