Immune health has been in the spotlight for quite some time now, and consumer understanding of it has grown—and shifted. Lori Lathrop Stern, Science Liaison, IFF Health, explains: “Consumers are increasingly prioritizing immune health before they get sick, as a long-term preventative solution.”

Preventative—and consistent, according to Erin Stokes, ND, Medical Director at MegaFood. “People are looking to support their immune health year-round. In the past, people would only focus on immune support with the change of seasons in the fall and then once spring came, immune health would once again go on the ‘back burner.’ Today, more people view immune health as a vital component of overall health.” Dr. Stokes points to interest in nutrients like zinc, which MegaFood pairs with elderberry and aronia, offering a range of phytonutrients.

Greg Ris, VP, Sales, Indena USA, seconds that, and suggests that immune positioning in stores will change in response: “More retailers will position immune products for ‘daily immune wellness.’ Previously, immune health products were primarily promoted in the cold & flu or allergy seasons. Now, consumers recognize the importance of daily immune health and retailers need to make this part of their ongoing sales and marketing efforts.”

With numbers to back this up, Andreas Koch, Marketing, Natural Path Silver Wings (NPSW), notes, “According to NBJ, cold/flu and immunity sales grew a whopping 72% from 2019 to 2020. According to WholeFoods Magazine’s 2021 annual Retailer Survey, 62% of independent retailers said that immune-boosting products had the greatest impact on their store’s sales.” NPSW saw the effects of this: “We have seen unprecedented demand for our highest strength 500 PPM liquid immune support bottles,” Koch shared. “Though the 50 PPM daily immune maintenance and 250 PPM enhanced formula have been also selling strong, the 500 PPM extra strength is trending far in the front; consumers want added peace-of-mind.”

There’s no need to let this trend slip away, even once the immediate concerns ease, according to Jacqueline Rizo, Content Coordinator at Stratum Nutrition. She points out that customers stepping back into the world means more exposure to germs as a whole, and retailers can help. “One way to do so is to strategically place immune products in both the cold-cough aisles and in the vitamin sections of their stores since their benefits could go under either category,” Rizo suggests. “Consumers now want to get in front of the health and to stay there. They now know they have some control over their own personal health. Retailers can capitalize on this desire by offering education at the shelf, online, in advertising, and through pharmacists and nutritionists.”

Retailers can also take this opportunity to point out the benefits of daily immune maintenance, to get customers in the habit of thinking about it and taking immune supplements. Immune modulators can help. Wakunaga’s Moducare, for instance, is a blend of plant sterols and sterolins that helps to balance the immune system, in order to avoid overworking it when not under a viral threat, while still supporting it.

And while customers are still looking at well-known ingredients that provide direct support, they’re also beginning to look at immune health from a holistic viewpoint, taking into account gut health, oral health, and stress, while taking a dive into herbal research to discover all their options.


Holistic Overview

Customers are looking for ways to support overall wellness, and thus bolster their immunity. Our experts pointed to a few categories they’ve seen on the rise.

Gut Health. The way to a customer’s immune system is through their stomach, according to IFF’s Lathrop Stern, who points out that 70% of the immune system is in the gut. She shares that customers are well aware of this: “In the midst of the global pandemic, we saw demand for probiotics skyrocket, with usage in the U.S. increasing by 66% from December 2019 to May 2020. Moving forward, it looks like the demand is here to stay. Indeed, the probiotics market is projected to reach $7.42 billion by 2024, with a CAGR of 4.4%.”

Retailers may need to work closely with their customers to choose the best product for each individual. “Personalized products that cater to a consumer’s personal immune health needs and life stage stand out on shelves and are more effective in the long run,” Lathrop Stern says. “From birth through old age, our immune systems and gut microbiota evolve—meaning probiotic strains for immune health are not ‘one-size-fits-all.’ Formulators must keep the user’s age and lifestyle in mind to deliver tailored results for consumer’s specific needs. By tapping into strain-specific benefits, brand owners can offer personalized, clinically demonstrated solutions that bolster consumers’ immune health and stand out on shelves.”

Lathrop Stern noted the ways in which different life stages require specific help:
  • Unborn babies are “essentially sterile,” she explains, making early bacterial exposure critical in shaping gut microbial communities; a strain like Lacticaseibacillus rhamnosus HN001 can help increase healthy bacteria levels in infants, and promote immune development with effects lasting for 11 years.
  • Toddlers, children, and teens are exposed to germs in daycares, schools, and after-school activities, making it important to choose a probiotic that inhibits pathogen growth while stimulating the immune response: Children experience, on average, five to six colds per year, twice as many as adults.
  • Adults are vulnerable to upper respiratory tract infections, and so may want to consider a strain like Bifidobacterium lactis BI-04, which has been found to help reduce risk of URTI episodes by 27% in adults.
  • Seniors may see changes in gut microbiota, which contributes to declining immune function and vaccine response. Bifidobacterium lactis HN019 has been shown to help increase beneficial bacteria in the guts of aging persons, and to help enhance cellular immune function.
How these probiotics work is also a subject of research. Nena Dockery, Scientific and Regulatory Affairs Manager for Stratum Nutrition, explains: “As the probiotic industry has evolved, so has the level of research into the mechanisms through which probiotics exert their influence on the immune system. One area that has been the focus of current research is in the production of short chain fatty acids (SCFA) within the colon. These products of bacterial fermentation appear to have broad positive influence, not just in the colon, but throughout the body. One 2019 study, published in Circulation, found that SCFA derived from gut microbiota metabolism play an important role in maintaining host immune composition and repair capacity after a heart attack. Another very recent unpublished research has also demonstrated a dramatic benefit from select probiotic supplementation on the prevention of gastric damage caused by aspirin therapy.” And, of course, gut health goes beyond probiotics—customers may want to consider prebiotics, too. “There is an increased understanding about the prebiotic benefits of polyphenols,” Bush shares. “Typically, prebiotics are considered to be dietary fibers; however studies have indicated that polyphenols from high-flavonoid berries can also influence the balance of microbes in the gut.”

Oral Health. Toothbrushing isn’t just about avoiding cavities anymore—it can also help support the immune system. “The oral cavity has become a focus of study within the last decade or so, resulting in the development of probiotics designed to work in the mouth and regions of the upper respiratory tract,” explains Dockery. “We now recognize that the oral cavity is home to some 700 species of bacteria, and that maintaining a healthy environment of bacterial species in the mouth is crucial to overall health. In addition to probiotics designed to support dental health, oral cavity probiotics can also be extremely beneficial to immune health, particularly in the upper respiratory tract. Ideally these probiotics are derived from species that are indigenous to the human oral cavity. Most function predominantly through competitive inhibition, crowding out detrimental species that enter the body through the nose and mouth. Others produce protective substances, called bacteriocin-like inhibitory substances (BLIS) that target unfavorable strains and limit their entry into the body.”

Looking at specific strains, Dockery points to Streptococcus salivarius, one of the most common strains in the oral cavity. Several strains, she says, do produce BLIS. “There is extensive background research establishing the safety and efficacy of these strains. One particularly beneficial S. salivarius strain is the K12 strain. This is a rare human-derived strain that is particularly beneficial in inhibiting such species as S. pyogenes and Moraxella catarrhalis. The breadth of human studies in young children make it a particularly desirable probiotic for supporting immune health in the very young.”

Stress. While immune support products have been all the rage for nearly two years now, people are beginning to look to stress products to help support overall wellness. And rightly so: “According to a Gallup poll released in 2019, more Americans were stressed and worried in 2018 than they had been at any other time during the past decade,” says Hank Cheatham, VP, Daiwa Health Development. “The level of stress, worry and anxiety has increased several times more than in 2018 because of the pandemic. According to a more recent Gallup poll, 55% of Americans surveyed said they had experienced stress during the previous day, and 45% said they felt worried a lot. Stress can compromise the immune system.”

Immune-Supporting Sips

What better way to get some wellness than by drinking it?

There are plenty of immune-boosting beverages out there. One option: Drinks from Uncle Matt’s Organic. The company’s Ultimate Immune, for instance, is made with orange juice and elderberry, and contains vitamins C and D and zinc. Ultimate Defense contains 500mg of whole root turmeric and 300% daily value of vitamin C per serving. Plus, the company offers Immunity and Energy shots, for on-the-go customers.

On the opposite end of the spectrum, customers who are ready to take a seat and a sip at the end of the day might want to consider teas. Bigelow, for instance is offering Blackberry Citrus Herbal Tea plus Zinc, joining the company’s Vitamin C line of teas, intended to support immune health.

Bio Nutrition, too, offers teas in addition to a variety of supplements. The company’s Black Seed Tea, for instance, may help support the immune system and digestive health, offering a holistic approach customers may enjoy.

For those looking to craft their own tea blend, Buddha Teas offers a wide range of individual herbs in tea form—elderberry tea, ginger root tea, holy basil tea, and more, offering customers the option of mixing and matching.

If your brand’s beverage doesn’t offer an easy way to get into the immune category—no worries, you can make it more functional. And many customers are looking for that, according to Artemis’ Melanie Bush. “Since the pandemic, there is a heightened awareness about proactive health and self-care as well as an increased interest in favor of functional foods and beverages as a way to load up on health-promoting actives. Brands have new opportunities to innovate by adding more functionality into everyday favorites. This is easily done with ingredients like berry flavonoids provided by dark berry extracts. Berry flavonoids have been in the news quite often lately for their ties to important health outcomes like brain health, but also because of their immune-supporting properties.”

An Herbal Point of View

“Consumers are researching and purchasing more specialized herbal products for specific ailments, and they are combining several herbs to suit their own catered needs,” says John Boyd, Co-Founder and CEO of Buddha Teas. “As a manufacturer, we try to offer combinations, but the permeations for individual needs are often too great, so we recommend simply combining different tea bags to suit different needs.”

However, customers may not know which teas or herbs to combine. It’s not enough to throw together several immune-boosting picks: When it comes to herbs, says David Winston, RH(AHG), President and Founder of Herbalist & Alchemist, it’s more important to understand the precise function of an herb than whether or not it acts on the immune system. “Herbs rarely affect only one aspect of this complex and interconnected system. Herbal research has shown us that botanicals can work via multiple mechanisms. Any herb that affects the immune system is an immune modulator, so I prefer to use terms with greater specificity that give a more precise sense of an herb’s actual actions and effects. Understanding the precise effects of herbs helps us to use the appropriate herbs and herbal formulas to address immune issues with greater efficacy and safety.”

Looking at specific herbs, Winston explains: “Some herbs such as Maitake, Reishi, Astragalus, Schisandra, Ashwagandha, Licorice, and Cat’s Claw, act as immune amphoterics. These herbs help to nourish and strengthen the immune system, promoting immune competence and effective self-regulatory capacity. They are used to treat hypo-immune (immune insufficiency), hyper-immune (allergies) and hyper/hypo- immune conditions (autoimmune disease).”

On the other end of it, Winston looks at immune stimulants: “Echinacea, Andrographis, Isatis, and Elderberry stimulate immunoglobulins and antibody production by up-regulating white blood cells, phagocytosis, and macrophage production. They are primarily used to treat bacterial or viral infections, or what is known as blood heat or damp heat in Traditional Chinese Medicine (TCM).”

And in between, there are immunoregulatory herbs. According to Winston, these are “systemic anti-inflammatories that down-regulate excessive immune response without being immuno-suppressive. They inhibit histamine production, mast cell degranulation, and the deposition of immune complexes. Examples of Immuno-regulatory herbs include Gotu Kola, Unprocessed Rehmannia, Chai Hu/Bupleurum, Cinnamon, Sarsaparilla, and Boswellia.”

In terms of what’s trending, Boyd lists: “Mullein sales skyrocketed, tulsi for stress support boomed, and we saw a huge upward trend of our Medicinal Mushrooms Teas, which support a range of health functions. Buddha Teas has noticed many of these trends via Amazon, but it would be nice for consumers to see these herbs offered in grocery stores as opposed to only online.”

Elderberry is always popular, and these days it’s easier to take than ever—Sambucol USA, for instance, offers its black elderberry product in effervescent powders, lozenges, drink powders, capsules, tablets, syrup, gummies, and in Infant Drops for babies.


Trend Watch: Synergy

When asked about trends, our experts nigh-exclusively pointed to synergy in products. “One of the biggest consumer trends we are seeing is the desire to have more than one health benefit in a single product; combination products, with probiotics and botanicals paired, are gaining popularity,” shares Lathrop Stern. That comes with challenges, though: “While they’re appealing on shelves, probiotics can be difficult for formulators to combine with certain ingredients, because the live bacteria strains may be compromised and rendered less effective.” IFF has developed certain combinations, such as HOWARU Protect Adult combined with echinacea or elderberry. “These are just a few of the exciting combinations we’re testing at IFF Health to enhance end product functionality and consumer appeal, without compromising the stability of the underlying probiotic strain. For formulators and retailers, understanding how to leverage these emerging trends towards immune support and preventative products can help them stay ahead of the competition and excite consumers.”

NPSW has seen this too, according to Koch: “More consumers than ever before have been reaching for colloidal silver with herbal blends. Enhancing silver’s immune supporting benefits with renowned ingredients such as echinacea, oregano and olive leaf extracts continues turning double-digit growth.”

NOW is working this into its product assortment, Levin shares. The company offers Effer-C packets, which provide 1,000mg of vitamin C including Transport C-PLUS, which is C combined with alpha lipoic acid; a full complement of B vitamins; seven minerals to help restore electrolytes; CoQ10 for added metabolic support; and 500mg of elderberry concentrate. The company also offers AlliBiotic CDZ, which contains vitamins C and D, zinc, garlic extract, olive leaf extract, and oregano oil, for all-around seasonal support.

Twinlab, too, offers synergistic immune products. The Advanced Immune Support product, for instance, offers vitamins C & D, zinc, and selenium, along with beta glucans and several herbs, in order to provide overall support.

Bush suggests that this trend towards synergy can mean bundling benefits, as well as ingredients. “New proprietary blends are also entering the marketplace that address immune support as well as multiple complementary health concerns,” she says. “For example, Artemis’ BerryDefense is a functional blend of high-flavonoid ingredients that have immune, cardiovascular, and vision support properties—all of which are very relevant to today’s post-pandemic consumer who has been trying to keep healthy, improve high-risk factors, and relieve screen-weary eyes.”

This sums up where customers are right now: Looking for an easy, value-added way to stay healthy. Retailers—and your staff—can be that easy, value-added way to buy products, making it more than worth it for a customer to walk through the door.

Shelf Tags Do the Talking

At Natural Products Expo East, the WholeFoods team attended a discussion on ELI codes—what David Williams, EVP, Business Development, Cornerstone Consulting, calls the “ultimate in-store engagement platform.” Go here to view that talk for free, and discover how ELI codes can create smart shelf tags that engage and educate customers and staff alike—and to find out why Fresh Thyme Market wants all retailers to use them.

Retailer Tips

Our experts called out a few ways that retailers can take advantage of this market, now and in the future:

Education. “In this era of the COVID-19 pandemic, auto-immune disorders, flu, and other diseases which challenge the immune system, it is essential for retailers to become knowledgeable about natural products that can provide prevention by supporting one’s immunity,” says Cheatham. “Retailers can capitalize in this environment by offering immune enhancing products and adaptogens that will provide protection against invading pathogens.” Cheatham recommends adaptogens, here, noting that Daiwa offers PeakImmune4, an immune modulator that has been shown in studies to optimize levels of white blood cell activity. The product is based on Rice Bran Arabinoxylan Compound (RBAC), which has been found to enhance Natural Killer cell function, as well as to increase the count of T and B lymphocytes, macrophages, and cytokines. RBAC is derived from rice bran modified by Shiitake mushroom enzyme.

Seconding that recommendation, Adam Goodman, VP Sales, Korean Ginseng Corp., says: “Retailers must do their homework. Make sure that what is on the label is actually beneficial for the consumer.” KGC offers Koreselect, a line of condition-specific ginseng products created based on the continuous research the company performs on its ginseng, so as to ensure that buyers always get what they’re looking for.

Melanie Bush, VP Science & Research, Artemis International, offers help for those who want to learn. “Retailers should make sure to support the quality brands that are formulating immune health products with integrity and efficacy to ultimately better serve the customer. We at Artemis International pride ourselves in going the extra mile to help educate at all levels to help brands, retailers, and consumers alike stay informed about the high-quality ingredients and suggested dosages in the supplements and functional foods/beverages that they buy.”

Dr. Jason DuBois, CEO and Founder of Hybrid Remedies, offers the same. “Beyond having great in-store product selection, customers are looking for quality information that can help them make an informed decision. As a brand, we committed to increasing our social media and blog content with a focus on education. Retailers who emphasize education ultimately come out on top when it comes to customer loyalty and repeat sales.”

It’s essential to get that education to the customer—and brands can help there, too. “Over the last 18 months people have turned to supplements for immune support in higher numbers than we’ve seen before,” said Winston. “It’s crucial that those consumers be given well-informed guidance towards well-designed products appropriate for their needs. Retailers can get excellent information from some manufacturers that they can use to do this. For example, our wholesale customers are invited to a monthly online education session we call the Herbal Salon where I speak in depth on herbs, which helps retailers make good recommendations to their customers.”

Dr. Stokes sees customer education as a major way that retailers can set themselves apart. “Retailers have an opportunity to provide an exceptional in-store experience for their customers by offering ‘next level’ education. Supplements in general, and the immune category in particular, can be very confusing for people, so educating them in a way that’s easy to understand is key. I like to divide immune supplements into three main categories. The first is immune supportive nutrients such as Vitamin C, Vitamin D3 and Zinc. The second is botanicals (aka herbs) to support a healthy immune system such as Elderberry and Astragalus. The third category is combination supplements that are a blend of vitamins, minerals and botanicals. The first step is to figure out what people are looking for, so you can help them meet their needs.”

Evaluate the Competition. “Look at what your competition might not be doing well and focus on that,” Goodman recommends. “Create an environment where you become an ‘immune destination.’”

Koch offered tips for retailers looking to become that immune destination. “Leverage what mass market giants are unable to do—provide condition-specific, detailed education and direct customer consultation about how they can help maintain a robust immune system and why it’s even more important than ever now. Keep the immune products in the spotlight in April and beyond. Change all of the ‘Seasonal Wellness Center’ signs in April to ‘Immune Support is Now YEAR-ROUND—Are You Protected?’ or similar. Dedicating year-round immune themed endcaps will remind shoppers about the importance of a 12-month immune supplement regimen. Spotlight top-recommended immune products on your website and on social media pages. Consider offering a 4-week discount promotion.”

Get employees involved, too. “Explore producing short ‘immune tips’ videos,” suggests Koch. “Even better to feature employees giving one or two tips each. Be sure to add on screen bullets to accompany each tip. Involving your own team members will also help train and build employee morale.” These videos can be played on small flat screens by endcaps or around the store, or posted on the website or social media pages.

Merchandising. While sorting by benefit is a fast and easy way to help customers find what they’re looking for—and help them understand the range of products you offer—bundling can also be a big help in this area, according to Neil E. Levin, CCN, DANLA, Senior Nutrition Education Manager, NOW. “Some retailers educate their customers by supplying lists or displays of related products, which also aids in building supplement regimens. Some of the original concepts included a Basic Five group that recommended one product from each of five categories: Multivitamins, Calcium & Magnesium, Vitamin C Complex, Vitamin E Complex, and a Fish Oil or other omega-3 product. Which product to include would depend on the customer’s requirements; vegetarian or vegan, kosher or halal, gluten-free or not, plus any strong preferences as to the form and size of the supplements and whether all were taken only once daily.”

This is particularly useful for customers who may not know much about immune support, as, today, these products go beyond vitamin C and elderberry: “Now we know that vitamin D, antioxidants (including but not limited to vitamin C), probiotics and prebiotics, plus herbs and other botanicals all have roles in immune function,” Levin says. “I even recommend that multivitamin formulas are immune-supporting because of their inclusion of vitamins A, D, and E, plus the minerals selenium, molybdenum, and copper; the last two being needed for the internal production of the important antioxidant glutathione from dietary methionine or cysteine.” Bundling—or offering lists of options—can help customers understand how wide-ranging a category this truly is.

Used properly, according to Boyd, merchandising can ensure that the customer doesn’t have to do much in order to understand the importance of these supplements. “Make sure that there is a section speaking to immune support products. This in the way of end-caps, placement at shelf, shelf tags that help the consumer understand product usage and benefits—leaving the hard work out of it. Regular store promotions, sales and coupons, and email and print media will ensure that you become a destination location for consumers looking for products to support their immune systems.”

Shelf Curation. This likely goes without saying, but our experts said it anyway. “Retailers should stock and promote science-based, nutraceutical dietary supplements that will enhance the immune response,” Cheatham said. “The natural products industry continues to grow each year despite the fluctuations of the economy and the devastation caused by the COVID-19 pandemic. As a result, there is a tremendous opportunity for retailers to improve the health of their customers while increasing the gross revenue of their stores.” And that opportunity will only last if customers can purchase products that work.

This is increasingly more important as the pandemic goes on and as the supply chains continue to be strained, Rizo points out. “As quickly as this market grows, new companies will continue to emerge without being fully vetted. Retailers ought to know what is out there in terms of new ingredients, claims, and research. Consumers place a high level of trust in companies and look to retailers to offer what is safe and effective. Retailers ought to seek out brands they trust and brands that use premium ingredients.”

This can also be a helping hand in the fight against Amazon. Amazon has an infinite shelf; you have a small-but-curated one. That doesn’t detract from your store’s worth; it’s an advantage. WF