It’s that old, familiar feeling: For too many people, digestion woes are a part of their routine. Whether it’s heartburn, irritable bowel syndrome (IBS) or one of the many other common digestive tract discomforts, their condition is something planned around and accounted for ahead of time. It can limit what one eats, as well as where and when. Gastrointestinal (GI) difficulty can even be debilitating, and can thus be a limiting factor in one’s quality of life.
U.S. consumers have taken to digestive health aids only gradually, but the current boom can be attributed to growing awareness of digestive health’s foundational role in overall wellbeing. Indeed, its importance is hard to overstate. “The gut is essentially the second brain of the body,” says Trisha Sugarek, B.S., M.S., and national educator/R&D specialist for Bluebonnet Nutrition Corp., Sugar Land, TX. Those for whom these issues have become too acute to ignore, as well as those who are just sick and tired of dealing with minor bowel and stomach issues here and there, have taken to the natural digestive health market in force.
It’s no wonder this is a growing category, what with a majority of people claiming one GI affliction or another, and our denatured Western diets offering no help to our natural digestive processes. To fill the gap left by enzyme-deficient processed foods, and to counter the devastating effects of stress-filled lifestyles on digestive health, natural supplements are ready at hand.
GI Bill of Health
A major reason so many people experience GI issues is that, though our digestive system produces some enzymes itself, it wasn’t meant to do it all. We are, in essence, taking food into our GI tract without the natural toolkit to break it down once it gets there. Anthony Collier, president and CEO of National Enzyme Company, Forsyth, MO, explains that before modern times, man consumed the majority of his food in a raw or lightly cooked state. “These foods are rich in enzymes and can play a pivotal role in human digestion. By contrast, the typical American diet consists of highly processed enzyme-deficient cooked foods, rich in artificial ingredients and other chemicals,” Collier says.
In a general sense, digestion is the process of pulling apart macromolecules into their constituent parts. Within these terms, it is easy enough to define what a digestive issue is. “The inability to breakdown food particles into the smallest unit necessary to benefit from nutrient absorption constitutes a disruption of the digestive system,” says Rachel Szpond, scientific affairs and quality assurance with Enzymedica, Port Charlotte, FL.
The digestive devil, however, is in the details. Each person is dealing with a different array of digestive enzymes, and of both helpful and harmful gut flora, explains Sunil Kohli, COO of Health Plus Inc., Chino, CA. This means that there is a lot of variability to be accounted for. “It is not uncommon to hear that one common food gives someone gas while that food has no such effect on someone else,” Kohli says.
Enzymes in action. Having noted the uniqueness of each individual’s GI tract, it is important to discuss how commonly encountered enzyme deficiencies line up with common digestive symptoms. According to Scott Ravech, CEO of Deerland Enzymes, Inc., Kennesaw, GA, the four basic digestive enzymes are protease, amylase, lipase and cellulase, and they are responsible for breaking down the molecular bonds of proteins, carbohydrates, lipids and cellulose respectively. When these enzymes are lacking, whether as a result of genetic predisposition or insufficient dietary intake, digestive symptoms like bloating, gas, cramping and diarrhea can occur.
When the decision is made to take a single enzyme or enzyme blend in supplement form, it is important for consumers to pay attention to the “activity” measurement of a given product, Ravech says. “Activity is one of the prime differences you will see when comparing price points of the various products,” he states. A 500-mg enzyme supplement, for example, may in fact be less effective than a 200-mg product that has a higher concentration of enzymes.
Before consumers get to the point of selecting a digestive aid, they’ll need to identify the problem they’re facing. “Find out if they experience upper digestive issues, which are felt just under the breast bone, or if they are experiencing lower digestive issues, which are located below the navel,” suggests Brenda Watson, president and founder of ReNew Life Formulas, Palm Harbor, FL. For upper digestive issues that typically occur after meals, like heartburn, Watson recommends digestive enzyme supplementation.
However, the interplay of acid (pH) levels and enzymes is complex in the early stages of the digestive process, and pinning down the culprit isn’t easy. “If symptoms such as bloating, belching, burning and flatulence occur immediately after meals or within 30 minutes of a meal, it is often a sign of lack of hydrochloric acid,” says Michael T. Murray, N.D., director of product development and education for Natural Factors Nutritional Products, Inc., Everett, WA.
The notion that acid deficiency could be a digestive issue may be counterintuitive, considering the widespread use of antacids and acid-blocking pharmaceuticals for indigestion. These solutions, according to Murray, will raise gastric pH above 3.5, a range that inhibits the action of the enzyme pepsin, important for protein digestion but often irritating to the stomach. So while this approach may reduce symptoms, it can also impair protein digestion as well as lead to the overgrowth of Helicobacter pylori, an undesirable gut flora, Murray says. He adds that if the same symptoms listed above occur around 45 minutes to an hour after a meal, the likely problem is a pancreatic enzyme deficiency.
Enzymes derived from plants are a good option when dealing with protein digestion problems, according to Neil E. Levin, CCN, DANLA, and nutrition education manager for NOW Foods, Bloomingdale, IL. “Because proteins are such complicated molecules, it takes a long time and multiple enzymes to completely break them down into amino acids,” he says. Plant enzymes can uniquely aid that process, because they stay intact in a wider pH range, helping to compensate for a lack of pancreatic enzymes and/or too little acid in the stomach.
It should be understood that enzymes are not a solution for digestive issues that have become severe and caused organ damage. “Enzymes can only remove potential stressors (undigested food materials) from those damaged systems,” says Dave Barton, director of education for Enzymedica, Port Charlotte, FL. The healing of these organs is a separate issue from any potential symptom alleviation that may derive from supplementing with enzymes.
Angelica Vrablic, Ph.D., nutrition research manager at American Health, Ronkonkoma, NY, talks about the age-factor as it relates to enzyme deficiency: “As we age, we may have difficulty digesting certain foods because we produce less digestive enzymes, or none at all.” She cites lactase as an example of an enzyme totally absent in many adults. This results in the well-known inability to digest dairy products properly. For these people, lactase supplementation with meals is an obvious and effective tool.
Collier reminds us, though, that dairy products consist of more than just lactase. To fully relieve the gastrointestinal distress experienced by dairy intolerant people, a more complex approach may be needed. “Dairy fat and protein can also be a challenge for some individuals, so it is important to consider a complete dairy digestive supplement that includes lactase with proteases and lipases for the most effective result,” Collier says.
Meanwhile, the age-related concerns just described constitute a real danger to overall health, believes Shaheen Majeed, marketing director for Sabinsa Corp., East Windsor, NJ. About this propensity for decreased enzyme activity, he states, “These events may contribute to a vicious cycle of failing immunity and escalating diseases, especially in the elderly.” This is one reason why it is vital that digestive health not only be addressed as-needed, but viewed as necessary for securing long-term health.
Sugarek notes that individuals, even those experiencing similar digestive discomforts, will respond differently to enzyme supplementation. So, it is best to begin by taking a product as directed, and then to adjust the dose upward or downward to achieve an optimal response. “The dosage should also roughly correspond to the amount of food being eaten, so more enzymes should be taken with a heavy meal, and less with a lighter meal,” Sugarek says, adding, “Digestive enzymes should not be mixed with extremely hot foods or beverages to avoid inactivation of the enzymes.”
Beneficial bugs. Enzymes are necessary for digestive health, but probiotics are equally so, and are especially interesting because they’re alive. They’re already inside us by the billions, so supplementation is merely the addition of more friendly bacteria, with the goal of creating a better balance of flora in the GI tract. Those experiencing symptoms like acid reflux and indigestion, especially those who’ve just made a major change in diet, may benefit most from extra enzymes, says Vrablic. Those with bowel symptoms and irregularity, on the other hand, would do well to try probiotics.
Watson echoes the notion that lower digestive symptoms call for better biological balance in the intestines. The results of an imbalance, such as gas, bloating, constipation and the like, are very noticeable, and the reasons behind them are complex. “Many contributing factors result in what is known as dysbiosis—an imbalance between the ‘good’ and the ‘bad’ bacteria in the gut,” Watson says.
A consumer’s first encounter with probiotic supplementation often comes from a doctor’s recommendation. “Consumers may initially come into the category to deal with a short-term issue such as recovery of gut microflora after a course of antibiotics,” Vrablic says.
But more and more people are learning to stick with the program as the benefits of probiotics become better recognized. “I feel stabilizing and reconditioning the digestive system with a viable broad-spectrum probiotic formula would improve most, if not all, the digestive issues people are experiencing today,” says Kathy LaForce, director of business development for Essential Formulas Inc., Farmers Branch, TX.
Whether it’s a post-antibiotics replenishment program or short-term fix consumers are looking for, many consumers still stop supplementing once they feel better. “But research has shown that there is a great deal of benefit to daily consumption of probiotics, regardless of the presence of any type of symptomology,” says Mike Bush, vice president of business development, Ganeden Biotech Inc., Mayfield Heights, OH.
As they colonize the gut and edge out bad bacteria for prime living quarters, probiotic strains have proven able to support digestive health, support immune health, reduce inflammation and benefit those with food allergies, according to Jay Levy, director of sales for Wakunaga of America, Mission Viejo, CA. “What’s more, these beneficial bugs also produce certain enzymes like lactase that are needed during digestion,” he says.
To illustrate the role probiotics can play, Bush describes the mechanisms of action for one strain of Bacillus coagulans that allow it to aid digestion. In addition to producing a form of lactic acid that makes the gut less hospitable to bad bacteria, this strain helps with the metabolism of carbohydrates. It also possesses some of the enzyme-producing activity to which Levy alludes, and produces bacteriocins that limit the growth of other strains of less-desirable bacteria.
“Of course, no matter how beneficial a probiotic product is, if people don’t take it, it won’t help them. Manufacturers need to be mindful of this when designing products,” says Michael Shahani, director of operations for Nebraska Cultures, Inc., Walnut Creek, CA. Probiotics supplements have long been confined to the refrigerator, and though they are still vulnerable to moisture and heat, strides made in the stability of these products have allowed some to survive without refrigeration for months, according to Shahani.
Speaking to this trend, Marci Clow, MS, RD, senior director of product research for Rainbow Light Nutritional Systems, Santa Cruz, CA, says, “Sporulated strains of probiotics such as Bacillus coagulans (a.k.a. lactobacillus sporogenes) are becoming well known for their shelf-life stability.” Sporulation is the biological process by which many bacteria enter a dormant, more protected state (1). Stored in this form, they are able to withstand harsher conditions for longer periods of time. There is more to product convenience than just shelf-life, however, as we will discuss later.
Probiotics and enzymes aren’t the only game in Digestive Health town. Other approaches are available, and many of them are being formulated in combination with the mainstay digestive aids detailed above. Fiber supplements, to begin with, are not just for weight management. “Fiber contributes to a healthier intestinal and colonic atmosphere by providing bulk and stimulating the intestinal muscles,” says Tom Bacon, marketing director for Nutrition Now, Inc., Vancouver, WA. He explains that this stimulation allows food to pass through the GI tract faster and easier, with the result being the relief of symptoms like diarrhea or constipation.
Watson breaks down the roles of soluble and insoluble fiber in aiding digestion. “Think of fiber like a yellow dish sponge. The yellow side is like the soluble fiber, which soaks up toxins as it travels through the digestive tract. The green side is like the insoluble fiber, which helps to ‘scrub’ the sides of the intestine, providing bulk that helps to get you moving,” she says.
Prebiotics such as the oligosaccharides in many fiber supplements serve as food for probiotic bacteria, allowing them to flourish in the GI tract, aiding digestion in the process (2). Psyllium husk is a form of fiber that can promote regularity, according to Kohli. Other agents such as sagrada bark and fennel may work synergistically to achieve these benefits.
Certain colostrum products have been found to enhance tissue repair in people with a distressed GI tract, according to Dilip A. Patel, Ph.D., R&D director at Sterling Technology, Brookings, SD. This benefit can be attributed to the growth factors and bioactives found in the colostrums, which directly influence epithelial cell proliferation and restitution, Patel says.
Individuals may find themselves waking up in the night with abdominal pain, and according to Murray, a peptic ulcer could be present in these cases. He suggests the use of deglycyrrhizinated licorice (DGL) to ease the discomfort. DGL is also an option for heartburn sufferers; it can support healthy stomach and esophagus linings, according to Murray. “ DGL improves both the quality and quantity of the protective substances that line the intestinal tract, increases the lifespan of the intestinal cell, and improves blood supply to the intestinal lining,” he says.
For gastroesophageal reflux disease (GERD), IBS and other like conditions, Murray recommends trying enteric-coated peppermint oil. This substance, in capsules coated to stay intact past stomach acids and the small intestine, may help smooth the excessive contraction of intestinal muscle that is a root cause of some of these conditions. Kaori Dadgostar, Ph.D., technical specialist for Jarrow Formulas, Inc., Los Angeles, CA, points out that though peppermint oil has over 100 constituents, menthol is the primary one. Studies have lent support to the notion that peppermint oil aids IBS, even when more conventional approaches have failed (3).
Dadgostar says that the amino acid L-glutamine, as a fuel source for cells in the GI tract that also helps repair its mucosal lining, is commonly included in digestive aids. L-glutamine can also stimulate the re-absorption of water from the stool, reducing the frequency of bowel movements.
Omega-3 fatty acids can reduce pro-inflammatory molecules in the gut by replacing omega-6 fatty acids in cell membranes. Omega-6s secrete prostaglandins and other molecules that produce inflammation, which is a chief factor in digestive distress. D-limonene, according to Dadgostar, is a major constituent of citrus oils that is able to neutralize gastric acid naturally. It has been used historically for relieving GERD as well as heartburn.
These options are only the beginning. Many of the substances described, as well as other nutrients, are often found in the nutrient blends that manufacturers combine with enzymes or probiotics. As the digestive heavyweights do their work, nutrient absorption is typically enhanced, so consumers are able to benefit from the intake of a wide-range of nutrients all the more. Collier gives one example of the way this occurs, stating, “By supplementing an enzyme that hydrolyzes the glycosidic bond, isoflavones are better absorbed and available for use in our bodies as antioxidants and for other metabolic functions.”
There are other factors to consider when addressing digestive distress. While statistically unlikely, it is possible that an individual is dealing with an issue in need of more immediate medical attention. “Gastrointestinal disorders are associated with bacterial pathogens also, but usually fever would ensue. Food poisoning or pathogen related digestive illnesses are recognizable and are treated differently,” says Patel.
Symptoms of supplementation. The old adage that says things get worse before they get better may apply when it comes to the use of some natural digestive aids. Within the first several days of use, according to Bacon, symptoms like loose stools, gas and bloating have been associated with supplements containing otherwise beneficial flora. “This is typically attributed to a ‘die-off reaction,’ as yeast and other undesirable intestinal inhabitants are eliminated during the shift in intestinal environment,” Bacon says.
Adding to the complexity of taking meal-time digestive aids, Levin describes the importance of swallowing some of these supplements strategically. When dealing with an enzyme supplement containing Betaine HCL (hydrochloride), he explains, it’s best to wait until some point past the middle of the meal before ingesting it. “Otherwise, it may signal the body to produce less of its own (HCL), creating a dependency,” Levin says.
Hear that? It’s the sound of an ever-growing mob of consumers with grumbling, upset stomachs, stampeding their way to their local natural products store in search of digestive aids. The uptick in this market segment is primarily being driven, it seems, by one component of the market.
The three categories that natural products market watch firm SPINS divides digestive health into are fiber and laxatives, digestive enzymes, and pre- and probiotics. These three combined amount to $400 million annually, according to Watson’s estimate. “While fiber and enzymes remain fairly flat, the probiotics subcategory in the natural channel is growing at 21% according to the latest SPINS report, for the 52 weeks ending 4/16/11, which drives up the entire digestive care category growth,” she says.
SPINS predicted this growth, when it cited pre- and probiotics as a trend to watch for 2010 (4). None of this is surprising, given the raw numbers of people affected. A report from the National Institute of Diabetes and Digestive and Kidney Diseases, cited by Vrablic, puts the number of Americans affected by digestive issues at up to 70 million (5).
Consumer uncertainty is another factor in this growth. Rising healthcare costs have caused an upsurge in consumer interest in preventive healthcare, says Majeed, adding, “Consequently, an increasing number of consumers are relying on nutritional supplements as an alternative means to evade the high-priced pharmaceutical medical paradigm.” The market in this country has been racing to satisfy this new consumer interest. “While the United States has been somewhat behind many countries in consumer demand for digestive health products, the array of offerings now available is catching up,” says Levin.
The virtues of the category itself are also driving growth. Dadgostar says, “Many consumers are now aware that digestion can contribute to additional biological functions, including immune function, energy production and mental/emotional health.” The trends within this market on the rise are shifting predictably, meanwhile, along the lines of consumer preferences.
How soon is now? Those with long-standing digestive woes have already waited too long for comfort. So when they finally look to the aid of natural supplements, some of which promise fast results, experts caution that retailers may be confronted with a question: “When you say it’s going to happen quickly, when exactly do you mean?” These individuals are often squirming with discomfort from moment to moment, so the promise of immediate relief can prove disappointing.
Knowing the timeframe in which to expect relief is the right of the consumer. The dilemma is whether a given individual should choose a comprehensive, long-term supplement program, or a quick fix, meal-centered application. This is an issue largely determined by the individual’s affliction. Generally speaking, those that are in need of probiotics may have to wait a while, whereas those supplementing with enzymes can typically enjoy a discomfort- free meal right away.
According to Vrablic, digestive enzymes provide results sooner rather than later, as they begin to assist digestion shortly after being ingested. Probiotic products, she says, may take a few days to a week to prove effective. Clow emphasizes that the timeframe for effectiveness often depends on the severity of the issue. Some people, she says, feel the effects of enzymes within hours, while others can wait days. “The nice thing about addressing digestive issues is that results are often felt over a short time period, or even immediately,” Watson says.
The early returns from probiotic supplementation, as has been noted, are often discouraging, but this is merely due to the establishment of new bacterial colonies, according to Dadgostar. Factors like diet and stress level can delay or hasten the time it takes for these regimens to begin working. As well, though changes in the digestive system may be present, these changes may go unnoticed until much later. “On average, people report seeing and feeling the difference in their gastrointestinal conditions within a month or two after initiating natural supplements for digestive health,” Dadgostar says.
Do these considerations affect the way products are marketed? “By their very nature, natural digestive aids like probiotics work in a comprehensive way to improve the gastrointestinal tract,” Levy says. That’s why they fall under the marketing rubric of “long-term” solution. “Other natural digestive remedies like colon cleansers and herbal laxatives offer more immediate relief,” Levy says, adding that these are presented to the public as “use when needed” products, instead of daily supplements that offer long-term functional benefits.
Though a single targeted product may take care of the symptoms of any one condition, the comprehensive approach remains open to everyone, and experts encourage it for maintenance purposes. “As shoppers have become more sophisticated, they increasingly understand that a three-prong approach to digestive health is optimal: Detoxify seasonally, replenish with probiotics daily, and support with targeted digestive enzymes at every meal,” says Julia Craven, Enzymedica’s vice president of national accounts.
Whether long-term or short-term approaches to digestive care will end up with more market share remains to be seen. It will probably be more a matter of consumer preference than of the optimal approach to overall health dictating what sells. The way it will all shake out is intimately connected to the question of convenience.
Ease of access. Appealing to customers “on-the-go” is paramount in this category. They are usually seeking to rid themselves not only of discomfort, but also of the burden that their GI distress places on their daily lives. Vrablic points to the success of convenience-oriented roll packs, containing chewable digestive care formulas, as evidence of the need for speed and portability.
It makes twice the sense when one considers that enzymes are often taken with meals. Having a supplement that is easy to tote along can save a lot of thinking. Keeping the number of servings per day to a minimum is also a factor manufacturers consider, Vrablic says. Convenient delivery forms for probiotics are important, too, says Shahani. Forms such as capsules and sachet packs make supplements “easy to take and take along,” he says. Having long-term programs and as-needed options housed under one brand has become important, Kohli explains, stating, “Many people have trouble sustaining compliance for any type of program; or they just don’t want to be bothered with something they feel is more complicated.”
Chewable gummy supplements that contain probiotics or enzymes, according to Bacon, aren’t popular only for their convenience. Capsules and gummies have also risen in popularity because of the taste factor, he says. One more reason for the success of chewables is their appeal to a certain demographic. “Gummies have been very popular, especially with parents, because their children love them and will take them,” Clow says.
Digestive complexity. “More sophisticated and complex formulations are quickly becoming the norm,” Ravech says. The practice of combining multiple approaches (enzymes with prebiotics, botanicals with probiotics, etc.) is becoming commonplace because of growing baseline expectations of value on the part of consumers.
Within the probiotics segment, innovation is perhaps even more accelerated. Continuous discovery of new bacterial strains that are beneficial to human health is driving companies to incorporate everything they can, says Levy. “Another trend is towards probiotic supplements specifically geared toward children. These products are offered at a lower potency,” he adds.
The cutting edge in digestive care supplements, Majeed argues, is multi-functional ingredients. The existence of ingredients with more than one specific health benefit is not the novelty; promoting them more heavily is (6). “This marks the departure of the long-standing marketing approach of associating only one major health benefit to each functional ingredient,” Majeed says.
Of a slightly different tinge is the trend, noted by Dadgostar, toward marketing products as condition-specific: A natural digestive product, for instance, that is positioned as a targeted option for IBS. Dadgostar cites the case of the probiotic strain Lactobacillus plantarum 299v.
It is included in products tailored specifically to IBS sufferers, and one recent study backs up the benefit claims. A randomized, placebo-controlled clinical trial with the strain examined 214 IBS patients. After four weeks of treatment with either a daily capsule containing 10 billion active cultures of the strain or a placebo, the non-placebo group showed significant improvements in all declared symptoms (7). WF
1. “Sporulation in Bacteria,” www.microbiologyprocedure.com/microorganisms/sporulation-in-bacteria.htm, accessed May 27, 2011.
2. S. Abrams, et al., “A Combination of Prebiotic Short- and Long-Chain Inulin-Type Fructans Enhances Calcium Absorption and Bone Mineralization I=in Young Adolescents,” Am. J. Clin. Nutr. 82 (2), 471–476 (2005).
3. J.C. Wu, “Complementary and Alternative Medicine Modalities for the Treatment Of Irritable Bowel Syndrome: Facts or Myths?” Gastroenterol Hepatol 6 (11), 705–711 (2010).
4. “Trend Predictions, 2010,” SPINS, www.spins.com/assets/pdf/Trends_2010.pdf, accessed May 27, 2011.
5. National Institute of Diabetes and Digestive and Kidney Diseases. (2008). The Burden of Digestive Diseases in the United States. (NIH Publication No. 09-6443). Washington, DC: US Government Printing Office. Retrieved from www2.niddk.nih.gov/AboutNIDDK/ReportsAndStrategicPlanning/BurdenOfDisease/DigestiveDiseases
6. B. Keating, E. Leigh, “Multi-Talented Ingredients Tout Benefits: Multifunctional Health Positions for Functional Foods Are Energizing the Functional Foods Marketplace,” Prepared Foods, June, 2005, http://findarticles.com/p/articles/mi_m3289/is_6_174/ai_n27856753, accessed May 27, 2011.
7. P. Samart, et al., “Evaluation of Lactobacillus plantarum 299v Efficacy in IBS: Results of a Randomized Placebo-controlled Trial in 200 Patients,” T2030- Poster Session: Prebiotics and Probiotics in the intestine: activities and function. Digestive Disease Week 2010, New Orleans.
Published in WholeFoods Magazine, July 2011