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Consumers Prioritizing Immune

Health in Light of Pandemic,
Says New MarketPlace Survey
Sebastian Krawiec

A
A new new survey from MarketPlace (St. Louis, Missouri)
found that immunity and prevention are top purchase
survey from drivers for U.S. supplement users. For example, while
MarketPlace immunity ranked fifth on the list of consumer demands
found that in 2019, updated research following the COVID-19 pandemic found
that immunity moved to third place, after disease prevention/overall
immunity and wellness and gut/digestive health. Additionally, 61% of U.S. dietary
prevention are supplement consumers state they increased their supplement usage to
top purchase support immunity.

drivers for U.S. According to the study, between March and June of 2020,
supplement supplement users were most likely to buy vitamin D (54%), vitamin
C (53%), probiotics (35%) and zinc (21%). The strong demand for
users. probiotics might indicate that more consumers are buying gut health
products with immunity in mind, says MarketPlace.

Survey data also shows that the pandemic prompted dietary

JULY 2021 | NUTRITIONAL OUTLOOK 2 SPONSORED CONTENT

 Consumer Immune Health
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changes, with 44% of U.S. supplement

consumers stating they changed their diets
Sebastian Krawiec
to boost immune health. Among those
Associate Editor
buying immune-supporting supplements,
Nutritional Outlook
more than half said the pandemic prompted
This article first appeared in Nutritional Outlook,
them to change their diet (51%), eat more Aug. 25, 2020, https://www.nutritionaloutlook.
fruit (54%) or increase usage of vitamin and com/view/consumers-prioritizing-immunehealth-in-
mineral supplements (61%). MarketPlace light-of-pandemic-says-newmarketplace-survey.
also found that demand for sleep support
supplements increased as well, moving from
ninth place on a list of consumer demands to
fourth, just behind immune health.

Along with the increased consumption of

dietary supplements, consumer preferences
for delivery formats are also shifting.
The preference for pills has declined to
72% compared to 89% the previous year,
while the preference for gummies grew to
59% compared to 45% the previous year.
However, 70% of supplement users stated
that effectiveness was important to them
when deciding to purchase a supplement,
which points to a need for equally effective
alternative supplement formats.

“Innovative formulations that address pill

fatigue and increase the bioavailability of
immunity-boosting ingredients, especially
tea and yogurt applications, are growth
opportunities for functional food and
beverage brands and ingredient suppliers,”
said Jon Copeland, MarketPlace’s research
strategist, in a press release. “The data reveal
seismic shifts in the wellness consumer’s
lifestyle and outlook on personal health. We
believe long-term demand will remain strong
for preventive health and immunity support.”

JULY 2021 | NUTRITIONAL OUTLOOK 3 SPONSORED CONTENT

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Beyond Healthy
Sebastian Krawiec

I
Immune mmune health isn’t merely of interest to consumers; it is one of
the top five reasons why they take dietary supplements today,
health is now period. According to the Council for Responsible Nutrition’s latest
a significant Consumer Survey on Dietary Supplements, published last fall,
leader in the immune health is one of the top reasons consumers surveyed said
they take supplements, alongside reasons like energy, healthy aging,
supplements filling nutrient gaps and staying well overall. In the survey conducted
space. with more than 2000 U.S. adults in 2019, 27% of those who use
dietary supplements cited immune health as a reason they take
supplements.

Market numbers also reflect this interest. According to market

researcher IRI (Chicago), dollar sales in the immune health
supplement category grew 12% in 2019 over the previous year.

Another consumer survey conducted by Kerry International (Beloit,

Washington) also saw high interest in immune health. “We asked

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consumers to choose five options from a list
of 13 health areas and rank them in order
of importance. Nearly two-thirds (63%)
chose immune system support, ahead of
healthy bones and joints, good digestive
health, energy levels and heart health
support,” says John Quilter, vice president
and general manager, ProActive Health, for
Kerry International. Demand for immune
support products is particularly high in
Asia-specifically China, where 50% of survey
respondents said they had used an immune
health product in the previous six months,
while 29% said they would consider doing so
in the future.
So what does this mean if you’re an
immune health product company? “This
means that immune health markets are
increasingly competitive,” Quilter says.
“The best way to stand out is to use
scientifically substantiated, well-recognized
ingredients that can complement and
enhance your brand.”
A number of brands are hard at work doing
just that, choosing suppliers investing in
research and helping manufacturers
develop products that are not only
efficacious but also encourage use and
enticement through innovative delivery
formats beyond traditional dietary
supplements. Not only that, but ingredient
suppliers and researchers are exploring the
various pathways by which ingredients can
support immune health-particularly, the way
ingredients interact with the gut to impart
immune benefits.
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Market Trends Research Round-up
Herbal Stars
Some of the best-performing herbs on the
market are popular ingredients for immune
health products, perhaps an indication of the
immune health category’s overall strength.
For example, according to figures from
SPINS reported by the American Botanical
Council’s HerbalGram journal in its annual
Herb Market Report in September 2019,
the bestselling herbs in the U.S. mainstream
multioutlet channel in 2018 were horehound
and echinacea.1 Total 2018 sales of
horehound, the #1 bestselling herb in the
U.S. mainstream multioutlet channel per the
HerbalGram report, hit nearly $147 million
that year. Echinacea, meanwhile, ranked as
the #2 bestselling mainstream herb, growing
to $110 million in sales in 2018.
Aside from those two market giants, perhaps
the most impressive sales growth among herbs
in the immune health space in 2018 went
to elderberry. According to the HerbalGram
report, in 2018 elderberry grew 138.4% in
sales to nearly $51 million in the mainstream
channel, and grew 93.9% to $25 million in the
natural channel, making elderberry the #4 top-
selling herb in the mainstream channel and the
#3 top-selling herb in the natural channel in
2018. Pretty impressive.
Elderberry’s star continued to rise in
2019, too. In recent numbers provided to
Nutritional Outlook by SPINS, cross-channel
sales (mainstream, natural and specialty
retailers) of elderberry grew 83.4% in the
52 weeks ending October 6, 2019, to total
sales of $113 million. In the mainstream
 Consumer Immune Health
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multioutlet channel alone during that period,
elderberry grew in sales by 116% to nearly
$63 million.
Elderberry, which has a long history of
traditional usage, experienced a surge of
popularity after a particularly intense flu
season in 2018 that saw a shortage of over-
the-counter flu medicines, leaving natural
remedies like elderberry to fill the void.2
Consequently, more consumers became
aware of the ingredient and learned more
about its benefits.
While a number of factors led to elderberry’s
rise in popularity, Devon Bennett, CEO
of North American elderberry supplier
INS Farms (Purdy, Missouri), believes that
elderberry is more than a trend and is here
to stay. “Elderberry will become a lifestyle
ingredient, with more research and science
to follow,” Bennett predicts.
Elderberry already has some research under
its belt, which gave the ingredient more clout
during the severe 2017-2018 flu season. For
example, the most significant study to date,
using a branded elderberry extract from
Artemis International (Fort Wayne, Indiana)
called ElderCraft, was conducted in travelers
over a 21-month period in 2013-2014 by
the School of Pharmacy at Griffith University
(Queensland, Australia).3
“This has become the highly reviewed and
cited ‘Tiralongo long-haul flight study,’
a randomized, double-blind, placebo-
controlled human clinical trial involving 312
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healthy adults (economy-class passengers),”
explains Chris Tower, vice president of sales
and business development for Artemis.
“Results of the study revealed ElderCraft
demonstrated a significant reduction in cold
duration and symptoms in air-travelers,
resulting in 50% fewer cold episodes,
33% shorter illness duration, 50% fewer
symptoms and 33% less severe symptoms.”
He adds: “Notably, the 2016 Tiralongo
study on ElderCraft was published one
year in advance of what later proved to be
a particularly severe and long flu season
(2017-2018), with ER doctors and general
practitioners on record supporting the
use of elderberry, and social media further
drawing increased attention to elderberry
as a supplemental frontline treatment for flu
and colds.”
The benefits of elderberry are attributed
to the anthocyanins found in the berries.
Anthocyanins are the black pigments
that give the black elderberry its color.
“Studies have indicated that European black
elderberry can effectively boost the body’s
natural immune response by way of cytokine
stimulation to ‘ready the soldiers’ for fighting
off pathogens,” explains Melanie Bush,
director of berry science for Artemis.
Bush adds that the polysaccharides present in
the fruit—but which are often stripped away
during extraction—may also provide antiviral
benefits. “Artemis International’s ElderCraft
extract is uniquely produced without the use
of harsh chemical solvents, thus retaining the
 Consumer Immune Health
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polysaccharides along with concentrating the
important flavonoid actives, making a truly
superior and efficacious immune supporting
ingredient,” she says.
Being a fruit, elderberry lends itself to a
variety of applications. “We see the greatest
opportunity for elderberry in both traditional
supplements and food and beverage-both
growing markets with consumers seeking a
way to preempt sick days and/or a visit to the
doctor,” says Leslie Gallo, president of Artemis.
Alternative delivery formats, previously
reserved for children, now apply to the larger
population of adults experiencing pill fatigue,
and elderberry fits in nicely with many of these.
“Traditional supplements are not so
‘traditional’—not your grandmother’s pills
and tablets—as gummy delivery continues to
lead the pack, with liquid supplements close
behind,” Gallo says. “Confection delivery
(i.e., lozenges, lollipops), infusions, as well
as shots, powder sticks and chewables are
growing in popularity.”
Through the Gut
The way manufacturers are using elderberry
is changing as well, says Gallo. For example,
in beverages, while it’s not unusual for
manufacturers to utilize elderberry for
flavor or color, typically its use as an
ingredient with functional benefits had
been less common. Now, however, use
of elderberry as a functional immune
support ingredient has gained greater
consideration. “We are fielding more
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inquires for beverages, most notably in
the hot and cold tea markets, in addition
to elderberry as a prebiotic in the
pre-/probiotic beverage market,”
explains Gallo.
The relationship between immune and
digestive health is gradually coming to light
as research continues on pre- and probiotics.
The potential prebiotic nature of elderberry
provides a synergistic opportunity to finished
product formulation. Research is exploring how
flavonoids such as the anthocyanins found in
elderberry interact with the gut microbiome.4
“There are several ways that polyphenols
from berries and the gut interact with each
other. One way is that the berries have been
shown to exert prebiotic-like activity and
influence the overall composition of the
microflora of the gut,” explains Bush. “There
have been several studies evaluating this
concept. For example, in 2011, a six-week
consumption5 of a wild blueberry drink in
human volunteers significantly increased
Bifidobacteria strains compared to a placebo.
These particular types of bacteria are
beneficial to the host, demonstrating the
ability of the berries to positively modulate
the composition of the intestinal microbiota,
just as conventional prebiotics do.”
“Berries can play a role through both diet
and supplementation, as they are full of fiber
when eaten fresh, and also concentrated
extract ingredients can contribute flavonoids
that have been scientifically shown to
support gut health,” she adds.
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INS Farms also sees the potential of
elderberry in the prebiotic space, recently
partnering with Taiyo International
(Minneapolis, Minnesota) to combine
its Elder Pure elderberry juice powder
with Taiyo’s Sunfiber partially hydrolyzed
guar gum to create Elder Pure Elderberry
Prebiotic Juice Powder. “Sunfiber currently
has over 180 published studies, and we
are excited to be involved in an exclusive
relationship with them with our conventional
and organic elderberry ingredients,” says
INS’s Bennett. Research on how the
combined product will support immune
health is in the works.
Elderberry is not the only herb with prebiotic
potential. Take echinacea. A recent review
published in Biomolecules investigated
the potential relationship between the
immunomodulatory and antiviral activity of
echinacea and its inulin-type fructan (ITF)
content.6 ITFs are prebiotic compounds that the
authors of the study say may act as signaling
molecules and antioxidants. According to the
review, echinacea has been shown in research
to have antiviral activity against viruses such as
human and avian influenza viruses, H3N2-type
IV, H1N1-type IV, herpes simplex, rhinoviruses
and reversed virus-induced pro-inflammatory
responses. While researchers already studied
the way echinacea’s phenolic compounds
and alkamides activate immunomodulatory
pathways, the role of ITFs in echinacea are less
understood.
The immune health benefits of ITFs in
echinacea can be inferred based on research
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Market Trends Research Round-up
of other ingredients. For example, ITFs derived
from ingredients such as the traditional
Japanese herbal medicine (Chikuyo–Sekko–To)
and chicory have antiviral properties that could
be attributed to the enhanced production of
nitric oxide, which is a viral replication inhibitor.
Fructans from aged and fresh garlic have also
shown capacity to activate macrophages and
subsequently phagocytosis in combination
with a release of nitric oxide, write the authors.
The immune health benefits of prebiotic
compounds alone are becoming more
evident. Another study recently published
in the Journal of Nutrition found that inulin-
type fructans from chicory root fiber not
only supported digestive health but also
reduced the severity of illness.7 In the study,
children between the ages of 3 and 6 were
given either placebo or a dose of 6 g per
day of chicory root fiber for six months.
Results showed that compared to placebo,
supplementation with the fiber softened
stool and reduced the number of fevers
that required medical attention. Subjects
taking the fiber also saw a higher count of
beneficial bacteria, such as Bifidobacterium
and Lactobacillus.
Aside from prebiotic ingredients, a number
of other established immune health
ingredients are also known to operate by
way of the digestive tract. For example,
Wellmune from Kerry International, a
proprietary yeast beta-1,3/1,6-glucan
substantiated by over a dozen published,
peer-reviewed clinical studies, supports
immune health by modulating the gut.
 Consumer Immune Health
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“In terms of its mechanism of action,
[Wellmune] enters the body through the
gut, where macrophages break it down into
smaller fragments that bind to neutrophils,
the most abundant immune cells in the
body,” explains Kerry’s Quilter. “Primed by
Wellmune, the neutrophils move more quickly
to recognize and kill foreign challengers.”
Another firm, Kemin Industries (Des Moines,
Iowa), released a proprietary strain of Euglena
gracilis, a nutrient-rich algae with greater
than 50% 1,3-beta-glucan content, called
BetaVia Complete. In an unpublished study
conducted by the firm, the ingredient was
found to significantly reduce symptoms of
upper respiratory tract infections (URTI).
Healthy adult subjects taking 375 mg/day of
BetaVia Complete for 90 days experienced
70% fewer URTI symptoms, four fewer sick
days and 10 fewer URTI symptoms days.
A similar, but different, ingredient from
Embria Health Sciences (Ankeny, Iowa) called
EpiCor is a whole-food fermentate comprising
proteins, fibers, polyphenols, vitamins, amino
acids, beta-glucans and other beneficial
metabolites that work together to support
immune health. In
two randomized, double-blinded,
placebo-controlled trials conducted by Embria
Health on both vaccinated and unvaccinated
subjects, EpiCor was found to significantly
reduce cold and flu symptoms over the course
of 90 days.8,9 In another study, EpiCor was
found to significantly reduce gastrointestinal
discomfort and constipation through the
modulation of the gut microbiome.10
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While the popularity of probiotics continues,
and interest in prebiotics grows, EpiCor
may open the doors to a related ingredient
category called postbiotics (metabolic
byproducts of probiotic bacteria).
“Postbiotics have the potential to disrupt
the digestive health category. Made through
fermentation, postbiotics contain bioactive
compounds and metabolites that can convey
a health benefit,” says Justin Green, director
of scientific affairs for Embria Health. “Our
ingredient EpiCor, a whole-food fermentate,
is a postbiotic ingredient with clinical studies
showing that it supports immune health and
has emerging science that suggests it may
positively modulate gut microbiota. With a
clinically tested dosage of 500 mg, EpiCor can
easily be formulated into capsules and tablets
for gut microbiota support formulations.”
Until postbiotics gain more traction,
probiotics continue to be reliable and
in-demand immune health ingredients.
According to Kerry, consumers are
increasingly aware of the connection
between gut health and immune health,
both of which are at play when it comes to
probiotics. “In our survey, we found that 46%
of consumers recognize that probiotics can
support the immune system,” says Quilter.
Kerry’s proprietary probiotic ingredient,
Ganeden BC30, was recently found to
support immune health in school-aged
children. In the study, 80 healthy children
were given either the probiotic in a
flavored water or placebo for 12 weeks.11
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Results showed that supplementation
with the probiotic significantly decreased
the incidence of upper respiratory tract
infection symptoms, including nasal
congestion, bloody nasal mucus, itchy nose,
and hoarseness, as well as decreasing the
duration of a number of symptoms, including
hoarseness, red eyes, headache, and fatigue.
Besides these impressive results, the
study also demonstrated an effective
delivery format in the form of a flavored
beverage, highlighting an opportunity for
product formulators-one that is currently
underexploited.
“One example of the exciting, and often
untapped, potential of immune health
ingredients is the kids’ beverage category,”
says Quilter. “Despite the fact that immune
support is one of the health benefits
parents are most likely to seek for their kids,
immune system claims were found on only
2% of children’s food and drink products
launched globally between 2012 and 2017.
Furthermore, the global drive to reduce
added sugar and artificial ingredients means
many beverages could use a ‘halo polish.’
The enrichment of products with functional
benefits-for example, for immunity-can help
increase the appeal of kids’ drinks in the eyes
of parents.”
Children are always vulnerable to illness
and therefore an important demographic
to consider targeting. Parents need easier
and effective ways to deliver immune health
benefits to their children.
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Another area ripe with opportunity is sports
nutrition. Athletes, even the casual sort,
are also vulnerable to illness and immune
stressors due to exertion, and, if attending
a gym, from exposure to other patrons who
might be sick. “A recent survey in the U.K.
found that 37% of consumers would buy a
sports drink that supported their immune
system,” says Quilter, citing a Mintel survey.
Another vulnerable population is older
adults, which Kaneka Probiotics (Newark,
California) targets with its Floradapt
Longevity probiotic formulation. This
formula combines two patented strains of
Lactobacillus plantarum (KABP-031 and -032)
with specific vitamins and minerals, including
folic acid, pyridoxine, cyanocobalamin,
ascorbic acid, zinc, selenium and retinol.
“Our original premise is based on the fact
that human gut microbiota composition
changes as we age, which translates into
effects on an individual’s quality of life,”
explains Sid Shastri, MSc, Kaneka’s director
of product development and marketing.
“Additionally, it’s known that nutritional
status also changes with age. As people
become older, they can secrete less acids,
nutrient uptake into the body declines, diet
quality typically declines—all resulting in
suboptimal nutritional status.”
One study published in 2011 found that the
patented strains used in this formula at two
different doses increased the concentration
of cells that modulate the immune system.12
In 50 elderly subjects, a dose of 5 billion
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CFU consumed over 12 weeks increased
the percentage of T-suppressor and natural
killer cells, while a lower dose of 500 million
CFU increased T-helper lymphocytes, B
lymphocytes, and antigen-presenting cells.
Supplementation with probiotics also
significantly decreased the concentration
of the inflammatory cytokine TGF-Beta 1.
Mortality was also significantly lower in the
probiotic groups compared to placebo.
Another study published in 2012 randomized
60 immunized subjects between the ages
of 65 and 85 to receive two different
doses of the patented probiotic or placebo
for three months.13 Results showed that
supplementation with the probiotics
increased the levels of influenza-specific IgA
and IgG antibodies, improving the response
of the influenza vaccine.
“This market has a high potential as”—according
to the U.S. Census Bureau—”the population
trends in the U.S. indicate that by 2030, the
number of elderly people will be greater than
the number of children for the first time in U.S.
history,” says Shastri. “Furthermore, we are
monitoring the latest aging research, which has
revealed that the microbiota in centenarians
(models of extreme age) had high capacity for
central metabolism, especially glycolysis and
fermentation to short-chain fatty acids (SCFAs).
This 2019 research14 proposes a strong impact
of gut microbiota on human health.”
References:
1. Smith T et al. “Herbal supplement sales in US
increase by 9.4% in 2018.” HerbalGram, no. 123
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(September 2019): 62-73
2. Krawiec S. “2019 ingredient trends to watch for
food, drinks, and dietary supplements: Elderberry.”
Nutritional Outlook, vol. 22, no. 1 (2019): 19-20
3. Tiralongo E et al. “Elderberry supplementation
reduces cold duration and symptoms in air-
travellers: A randomized, double-blind placebo-
controlled clinical trial.” Nutrients, vol. 8, no. 4
(2016): 182
4. Decker KJ. “Elderberry supports prebiotic,
probiotic formulations, studies suggest.”
Nutritional Outlook. Published online
February 9, 2018.
5. Vendrame S et al. “Six-week consumption
of a wild blueberry powder drink increases
bifidobacteria in the human gut.” Journal of
Agricultural and Food Chemistry, vol. 59, no. 24
(2011): 12815-28820
6. Dobrange E et al. “Fructans as immunomodulatory
and antiviral agents: The case of echinacea.”
Biomolecules, vol. 9, no. 10 (2019): 615
7. Lohner S et al. “Inulin-type fructan
supplementation of 3 to 6 year-old children is
associated with higher fecal Bifidobacterium
concentrations and fewer febrile episodes
requiring medical attention.” The Journal of
Nutrition. Published online ahead of print July 3,
2018.
8. Moyad MA et al. “Effects of modified yeast
supplement on cold/flu symptoms.” Urological
Nursing, vol. 28 (2009): 50-55
9. Moyad MA et al. “Immunogenic yeast-based
fermentate for cold/flu-like symptoms in non-
vaccinated individuals.” Journal of Alternative and
Complementary Medicine, vol. 16 (2010): 213-218
10. Pinheiro I et al. “A yeast fermentate improves
gastrointestinal discomfort and constipation by
modulation of the gut microbiome: Results from
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Market Trends Research Round-up
Research Ingredients

a randomized double-blind placebo-controlled

pilot trial.” BMC Complementary and Alternative
Medicine, vol. 17, no. 1 (2017): 441
11. Anaya-Loyola MA et al. “Bacillus coagulans
GBI-30, 6068 decreases upper respiratory
and gastrointestinal tract symptoms in healthy
Mexican scholar-aged children by modulating
immune-related proteins.” Food Research
International, vol. 125 (2019)
12. Mañé J et al. “A mixture of Lactobacillus plantarum
CECT 7315 and CECT 7316 enhances systemic
immunity in elderly subjects. A dose-response,
double-blind, placebo-controlled, randomized
pilot trial.” Nutrición Hospitalaria, vol. 26, no. 1
(Jan-Feb 2011): 228-235
13. Bosch M et al. “Lactobacillus plantarum CECT7315
and CECT7316 stimulate immunoglobulin
production after influenza vaccination in elderly.”
Nutrición Hospitalaria, vol. 27, no. 2 (March-April
2012): 504-509
14. Wu L et al. “A cross-sectional study of
compositional and functional profiles of gut
microbiota in Sardinian centenarians.” Host-
Microbe Biology, vol. 4, no. 4 (2019)

Sebastian Krawiec
Associate Editor
Nutritional Outlook
This article first appeared in Nutritional Outlook,
vol. 23, no. 1 (January/February 2020): 68-73.
SizeSquare’s/stock.adobe.com

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Katsiaryna/stock.adobe.com

Immune-Health Supplement Drivers:

Trends & Innovation in Ingredients
& Delivery
Claire Morton Reynolds, Andrew Myers and Claudia Valla

I
Consumers are mmunity has been making headlines across the
increasingly dietary supplement landscape for several years running, but the
interested in the relevance it has attained since the beginning of
2020 is remarkable.
role of nutritional
supplements on Consumers are now keen to support their immune health in any way
immune health. they can—including dietary supplementation. Fortuitously, research
This executive into the relationship between nutrition and immunity reveals
summary reviews scientifically supported evidence of improvements in immunity-
supporting formulations, along with advances in innovative and
the current and
effective ingredient delivery options.
future immune
supplement market Because of these advances, there is significant impact to the growth
with a focus on of the immune health segment. As a result, all brand stewards should
vitamin D. increase their understanding of the drivers and the science behind
the ingredients and formulations if they are to better serve this
growing market.

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FIGURE 1: Annual cold, flu and immunity sales estimated to have grown to $5.2B in
2020.
The Immunity Market:
2020 and Beyond
According to the mid-year 2020 projections
by the Nutrition Business Journal (NBJ),
total supplement sales will rise 12.1%,
growing the market value to $54 billion,
representing both the industry’s highest
growth rate in almost a quarter century and
an estimated $3 billion boost over pre-
COVID-19 projections.1
Not surprisingly, immunity formulations are
expected to contribute to 2020’s growth.
Mid-year projections of product sales
positioned to address cold, flu, and immunity
were forecasted to account for 10% of the
supplement industry’s overall revenue, but
with growth forecast at 52.2%, the immunity
sector alone could be worth $5.2 billion
by the close of 2020—well up from 2019’s
already-robust value of $3.5 billion.2
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Demand for cold, flu, and immunity
supplements often tracks the severity of the
cold and flu season at hand. Sales spiked
during particularly severe years, such as the
10% growth seen in 2009 during Influenza
H1N1 and again in the similarly severe 2017
flu season.2
But from a dollars-added perspective, NBJ
predicts that the segment’s current outsized
strength could last, which would bring the
category’s value to a potential $6 billion
by 2023.2
Among the top trending immune-
related ingredients, elderberry witnessed
considerable success in 2020 and could
triple its existing annual sales in 2021, while
probiotic products with an immune focus
grew more than 40% in 2020 and drove a
resurgence in the category overall (FIGURE 1).
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FIGURE 2: When asked how they support their immune health, consumers cited
vitamins most frequently.
In a survey conducted by New Hope Network
in August 2020, consumers were prompted
with an open-ended question about how
they support their immune health. Data from
the survey, shown in FIGURE 2, represents the
frequency of words appearing in the open-
ended responses, and revealed that vitamins
were most frequently mentioned, which is
perhaps to be expected as vitamins held the
largest share of the market.
Consider what’s happening with vitamin D,
sales of which have historically contributed
only a small percentage to the cold, flu,
and immunity category—projected at just
4% in 2020, according to NBJ. Yet now,
with vitamin D attracting attention as an
immunity enhancer, total vitamin D sales
have grown nearly 10%, while sales of
vitamin D supplements aimed specifically at
immunity have expanded by as much as 65%,
according to NBJ projections.
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Even more impressive, NBJ observed
vitamin D’s growth to have continued into
2021, keeping the nutrient’s sales above
$250 million annually in the coming years
and demonstrating a lasting change to the
immunity market (see FIGURE 3).
Vitamin D’s Role in
Immune Health and Function
A healthy immune response is helped or
hampered by several factors, including
stress, sleep status, and the effects of certain
medications. But among the most important
influences is nutrition.
It is widely known that undernutrition
impairs immune function, with specific
nutritional deficiencies limiting function of
key components of the immune system.
While vitamin C and zinc are two nutrients
widely associated with immune support,
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FIGURE 3: Sales of vitamin D for
immunity projected to remain above
$250 million annually.
evidence is mounting that vitamin D is also
essential in supporting several aspects of the
immune system.3–8
Therefore, it makes sense that vitamin
D supplementation has become a core
component of consumers’ approach to
sustaining a baseline level of immune health
along with optimizing it.
FIGURE 4: Vitamin D recommendations.
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Widespread nutritional testing reveals that a
vitamin D deficiency exists in roughly three-
quarters of U.S. teenagers and adults—a
staggering proportion of the population.9
While age, body weight, stress, and poor
nutrition all contribute to this deficiency, lack
of exposure to sunlight is emerging as a key
factor. Why? Exposure to sunlight triggers the
body’s endogenous conversion of cholesterol
in the skin into active vitamin D, but with
more people spending more time indoors,
attaining the daily sunlight exposure required
to trigger optimal conversion is more difficult.
Furthermore, limited seasonal sunlight
exposure north of the 37th parallel (covering
roughly the northern half of North America
and nearly all of Europe) is low enough
to weaken the body’s natural vitamin D
production, exacerbating deficiencies (see
FIGURE 4). This is where nutrition comes in.
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In summary, the general consensus among
experts suggests dietary intake of between
2,000 IU and 4,000 IUs of vitamin D is essential
to avoid deficiency and derive the immune
benefits needed for long term health.10
How to Bring Vitamin D
into Your Brand
Consumers have historically treated
supplementing for immune support—with
vitamin D or other nutrients—as a seasonal
need that comes and goes with winter’s
colds and flus. This need usually translates
into increases in purchases of seasonally
relevant ingredients, like echinacea, for
immune support.
More recently, however, consumers’ immune
support strategies have evolved from this
seasonal approach to the adoption of daily
regimens that include long-term, consistent use
of ingredients that support immune function.
FIGURE 5: Vitamin D in supplements.
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Market Trends Research Round-up
When continually supporting immune health
this way, it becomes critical to choose
ingredients that provide safe, long-term
immune support.
Vitamin D proves foundational as a reliable
means of supporting a healthy immune system.
Vitamin D is mainly available as either
vitamin D2, usually derived from non-
animal sources, and vitamin D3, typically
sourced from lanolin, an animal derivative.
Traditionally, brands seeking to meet the
demands of those with vegan, vegetarian, or
other restricted diets would not use animal-
derived vitamin D3, which tends to be more
popular because of its apparent superiority
at raising blood levels.11 Today, there is good
news for brands that seek to serve the plant-
based market while still delivering potent
and bioavailable vitamin D3: A novel form of
vitamin D3 is now available that is chemically
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FIGURE 6: Vegicaps® capsule technology creates 100% plant-based softgels.
and nutritionally identical to the animal-
derived analogue yet is produced from algae.
Because it is lipid-soluble, vitamin D3 has
always been an ideal candidate for delivery
via softgel. Corresponding with the increased
consumer interest in vitamin D3, data
show vitamin D3 softgel sales growing
continuously over the past several years (see
FIGURE 5). However, producing plant-based
formulations containing animal-derived
gelatin precludes consumer segments
with dietary and or cultural restrictions.
To respond to more consumers’ need for a
delivery format that caters to their needs,
Catalent developed Vegicaps® capsule
technology, made from 100% plant-
based ingredients, as an alternative to the
traditional gelatin softgel (FIGURE 6).
Completely plant based, Vegicaps capsules
can accommodate a wide variety of
nutritional ingredients. The
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Market Trends Research Round-up
plant-based capsules work well with
sensitive active ingredients and a wide
range of complex formulations. Just as
important, Vegicaps capsule technology
fits the healthy lifestyle choices and
desire for diversified supplementation
that more consumers are now adopting.
There are immunity benefits of additional
supplement candidates including beta-
glucans, omega-3 fatty acids from algal oil
and mushroom species—along with the
established antioxidants vitamin C, zinc
and selenium.
Particularly compelling is the prospect
of building supplement systems that
incorporate plant-based vitamin D3
with vitamin K2, both of which are
essential and complementary nutrients
that research shows help maintain
healthy bones and blood vessels over
a lifetime.
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FIGURE 7: An assortment of Catalent’s drug delivery technologies.
As formulation opportunities grow, brands
will need experienced partners to help them
bring the latest generation of immune-
support products into their portfolios.
Catalent’s proactive approach to delivering
nutritional innovation helps brands do
just that. By matching an understanding
of what drives consumer engagement and
needs with deep knowledge of scientifically
compelling ingredients and advanced
delivery technologies, Catalent helps its
partners launch products that stand out in an
increasingly competitive market.
Catalent’s range of technologies has helped
to deliver high quality, innovative products in
the consumer health industry for more than
85 years (FIGURE 7). These technologies—
from the RP Scherer® Softgel solutions, to
more recent technologies such as the plant-
based Vegicaps technology and chewable
Easyburst® softgels—demonstrate the tools
Catalent brings to innovation partnerships
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Market Trends Research Round-up
that focus on customer growth, a stronger
immunity positioning for brands and a
stronger nutritional defense for consumers.
References:
1. “2020 Supplement Business Report.” Nutrition
Business Journal. Accessed at: https://store.
newhope.com/products/2020-supplement-
business-report
2. “2020 Condition Specific Report.” Nutrition
Business Journal. Accessed at: https://store.
newhope.com/products/2020-condition-specific-
report
3. Martens, PJ et al. “Vitamin D’s Effect on Immune
Function.” Nutrients, vol. 12, no. 5 (2020)
4. Koivisto, O et al. “Key Vitamin D Target Genes
with Functions in the Immune System.” Nutrients,
vol. 12, no. 4 (2020)
5. Prietl, B et al. “Vitamin D and immune function.”
Nutrients, vol. 5, no. 7 (2013)
6. von Essen, M et al. “Vitamin D controls T cell
antigen receptor signaling and activation of
human T cells.” Nature Immunology, vol. 11 (2010)
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7. Cantorna, MT et al. “Symposium 3: Vitamin

D and immune function: from pregnancy to
adolescence.” The Proceedings of the Nutrition
Society, vol. 71, no. 1 (2012)
8. Aranow, C et al. “Vitamin D and the Immune
System.” Journal of investigative medicine: the
official publication of the American Federation for
Clinical Research, vol. 59, no. 6 (2011)
9. Lite, J. “Vitamin D deficiency soars in the U.S.,
study says.” Scientific American. March 23, 2009
10. “Vitamin D Fact Sheet for consumers.”
National Institutes of Health Office of Dietary
Supplements. Accessed at: https://ods.od.nih.gov/
factsheets/VitaminD-Consumer/
11. Romagnoli, E et al. “Short and long-term
variations in serum calciotropic hormones
after a single very large dose of ergocalciferol
(vitamin D2) or cholecalciferol (vitamin D3) in the
elderly.” The Journal of Clinical Endocrinology and
Metabolism, vol. 93, no. 8 (2008)

Andrew Myers, ND
Chief Science Advisor, Nutritional Products
Catalent Consumer Health

Claudia Valla
Product Development Advisor
Catalent

Claire Morton Reynolds

Senior Industry Analyst
Nutrition Business Journal
Valerii Honcharuk/stock.adobe.com

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Vitamin D, Vitamin C, Zinc, Echinacea

Immune-Health Benefits Explored in
New Review
Jennifer Prince

A
A review of 82 new review1 of 82 existing studies on vitamins C and
studies found D, zinc and echinacea (Echinacea purpurea) adds further
that vitamin C, support to those nutrients’ ability to help maintain
immune health and reduce the severity and duration
vitamin D, zinc
of cold symptoms. The review, which was published in the journal
and echinacea Evidence-Based Complementary and Alternative Medicine, found that
can help boost vitamin C, vitamin D, zinc and echinacea can help boost immune-
immune-system system barriers often involved in fighting the common cold, including
barriers often physical barriers, innate immunity and adaptive immunity. The
review also provides advice on the best dosage amounts and the
involved in fighting
ideal time and duration to supplement with vitamin C, vitamin D, zinc
the common cold, and echinacea in order to reduce cold symptoms.
including physical
barriers, innate The study authors wrote that maintaining a healthy immune defense
immunity, and system lowers the severity of common cold symptoms, as well
as the duration of a cold episode. In this review, the researchers
adaptive immunity.
sought specifically to determine the efficacy of supplementation

JULY® 2021 | NUTRITIONAL OUTLOOK 21

 Consumer Immune Health
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with vitamins C and D, zinc and echinacea
on three main immune-health interactive
clusters: physical barriers, innate immunity
and adaptive immunity. Physical barriers,
they wrote, include a low pH caused by
various fatty acids and enzymes, which can
limit bacteria growth; mucus secretion and
the acidity of the stomach. Innate immunity
refers to the immune system cells, such
as NK cells, cytokines, macrophages and
neutrophil granulocytes. The third barrier,
adaptive immunity, is acquired later in life-for
example, after an immunization-and involves
lymphocytes T and B.
Upon reviewing the existing data, the
researchers found that regular vitamin C
supplementation (1 g to 2 g/day) reduces
the duration and severity of common cold
symptoms by 8% in adults and by 14% in
children. Zinc was found to shorter the
duration of colds by roughly 33%, but the
authors also point out that subjects may
be instructed to consume zinc within 24
hours after the onset of cold symptoms.
Vitamin D, meanwhile, protected against the
common cold. In the studies analyzed in the
current review, patients with a deficiency in
vitamin D experienced the most significant
immune-health benefits from vitamin D
supplementation. Subjects who supplemented
with echinacea (2400 mg/day for prevention
and 4000 mg/day during acute stages of
colds) over a period of four months appeared
to have fewer occurrences of cold symptoms.
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All of the nutrients included in this
review, “have pivotal roles of three main
immunoreactive clusters (physical barriers,
innate and adaptive immunity) in terms of
prevention and treatment (shortening the
duration and/or lessening the severity of
symptoms) of common colds,” wrote the
study authors. They concluded that the
current review adequately demonstrated that
supplementation with vitamin C, vitamin D,
zinc and echinacea can be an effective way to
attenuate symptoms of the common cold, and
to boost immune health.
References:
1. Rondanelli M et al., “Self-care for common colds:
the pivotal role of vitamin D, vitamin C, zinc,
and Echinacea in three main immune interactive
clusters (physical barriers, innate and adaptive
immunity) involved during an episode of common
colds-practical advice on dosages and on the
time to take these nutrients/botanicals in order
to prevent or treat common colds,” Evidence-
Based Complementary and Alternative Medicine.
Published online April 29, 2018.
Jennifer Prince
Associate Editor
Nutritional Outlook
This article first appeared in Nutritional Outlook,
Aug. 8, 2018, https://www.nutritionaloutlook.
com/view/vitamin-d-vitamin-c-zinc-echinacea-
immune-health-benefits-explored-new-review