Immune Health

I
f all the systems that compose the human body, the immune
system is the most awesome, bands down. Its complexitythe wide array of cells that have specific jobs to do, working
in harmony with one another-is simply amazing.
The human body is quite alluring to a legion of microbial foreigners: bacteria, fungi, viruses and parasites, aJl of which can gain entry
via inhalation, the skin and our oral-digestive pathway_ The immune
system is made up of the lymphatic highway, cells, tissue and organs that-when healthy and uncompromised-work in Ouent synergy to isolate, attack and destroy incoming microbial marauders.
The immune system modulates between active and resting siales,
according to Steve Holtby, president and CEO of Los Angeles, CAbased Soft Gel Technologies, Inc. It remains in a resting state until it
recognizes a challenge and then switches to an active state. When
fully activated, the chemicals (cytokines, chemokines and ~ntibod­
ies) made by the immune system to protect the body are at high levels. When the immune system is resting, these same chemicals exist
at very low levels.
Unfonunately, the immune system breaks down over time. "As
we age, especially for those over 50, our immune systems stan to decline and become less responsive to 'normal' pathogens such as
viruses and bacteria," explains Richard Passwater, Ph.D., vice president of research and development for Solgar Vitamin and Herb, Leonia, NJ. "There arc many reasons why our immune systems become
less effective and wear out as we age. In pan, the integrity of our
cells and DNA has been compromised. The accumulated damage and
the years of transcription errors are passed on from generation to
generation of new cells."
This article is timely in that one of the biggest enemies of the immune system is stress. We are living in very stressful times with the
continued financial crisis that incites anxiety and fear in many. Now
O
II
WHOlEFooos • NOVEMBER 2008
is the perfect time for retailers to spotlight both anti-stress and immune-suppon products together, as well as work more closely with a
naturopath andlor a stress counselor.
Market Dynamics:
Boosting Consumers' Immune IQ
The good news is that most people have a passing awareness and
understanding that "keeping their immune systems strong" keeps
them healthy. "The immune category itself continues to be among the
top categories in tenns of consumer interest and value," says Bryan
Rodriguez, technical marketing and scientific affairs manager, Lanza
Inc., Allendale, NJ. "The dynamics of the category allow customers
to continue to learn more and more about immune products, while
new ones are being developed and introduced at the same time."
However there is so much more work the retail society can do to
ensure that i'ndividual customers know what to select and why. Raw
materials suppliers and their partner dietary supplement manufacturers have done tremendous work in research and formulation to provide immune-suppon supplements that have an excitingly significant
track record of efficacy in immune nourishment and fortification.
Notes Rodriguez, "The challenge remains for manufacturers to
clearly communicate the immune benefits of ingredients so they are
clear and understandable for the consumer. Whoever accomplishes
this will have found a way to reach the consumer in a more effective
manner Ihan most other companies marketing immune health product'S." He explains that manufacturers who provide clear, concise science-backed infonnation 10 the public that is stripped of its marketing language "present a true, trustworthy message that the consumer
is constantly seeking."
Richard Mueller. president and CEO of Biothera, Eagan, MN,
sees the rapid growth of this category as a result of consumer and
I
une Health
manufacturer recognition of its importance
in overall weliness-even if consumers
don't und{:rstand the complexities, "the
value they place on maintaining immune
health as part of an overall weJlness plan has
reached critical mass," he observes.
Further, he notes, a major driver of this
growth is the inunune system being covered
more in the media, notably about the impact
upon it from HIV and pandemic diseases
(e.g., SARs, West Nile Virus and bird nul.
Following a burgeoning trend, consumers
continue to educate themselves on ways to
maintain and enhance their health in response to stress, aging,lifestyle changes and
environmental challenges and finding that a
strong immune system is critical to overall
health. Marketers are picking up on this
trend and talking directly to consumers
about immune health, which builds further
awareness.
Hank Cheatham, director of sales and
marketing at Quality of Life Labs, Purclllase.
NY, observes that most consumers have
BOOS'IlING YOUR SHELVES
No doubt about it-the supplement industry is bountiful in products that address
immune health and support. Scrutinize how
much real estate you give to this section, as
you may 'lYant to expand it. It also may make
sense to pllace immune health produets adjacent tQ tlJle multivitamin section, because it
makes selllse to buttress one's daily support
with specific immune support for a true dynamic wellness duo. The following is a sampling of some key category offerings.
American BioSciences makes ImmPower (AHCC), which the company says
helps maintain peak NK cell function, aid
cylokine IProduction and promote optimal Tcell and macrophage activity. Its Avemar
suppleme:nt (from fermented wheat germ)
"supports cell metabolic regulation, promotes immune system modulation and maintains healthy cellular, humoral (Th Itrb2)
immune balance, and promotes optimal NK
cell taIgeiling ability and the coordinated response of macrophages, B-cel1s, and Tcells."
Echinaforce (echinacea) from Bioforce
USA has a proven mode of action, both how
it acts on' e immune system and which constituents of the echinacea have the effect,
proven bi'oavailability, proven for treatment
efficacy, raven for prevention and proven
for prophylaxis. New from Bioforce USA is
Echinaforce Junior for children.
Biothera manufactures Wellmune WOP,
which the: company says activates innate immune cells to more quickly recognize and
deslroy foreign intrude". Specifically, Wellmune welP binds to certain receptn" (CR-3)
on neutrophils to prime them for action. Research ani the sllpplement has been published
in numerous peer-reviewed journals.
Herb:alist & Alchemist offers botanical
fonnulas including Ultimate Echinacea with
three ty~les of Echinacea, Herbal ReLeaf
throat sp'lray. Sinus Support Formula for
sinus discomfort, elderbeny solid extract
also suita.ble in a hot tea and a suite of five
Lung ReLeaf fonnulas for specific characteristics of mucosal discharge and cough. In
addition. \he company provides products for
the dee~p immune system such as
Ginsenw.'Schisandra Compound, Adrenal
Balance Compound, Seven Rrecious Mushrooms '"'id Fu Zheng Compound.
The slrains in Jarrow Formulas' Jarro·
Dophilus EPS, were selected based on their
ability to up- or down-regulate immune re-
II
WHOlEFooDS • NOVEMBER 2008
spouses or both. According to the company,
L. aaidophUus R52 and L. rhanmosus RII
modulate the immune system by inducing
immune cell proliferation and functions to
up-regulate several cylokines, as well as to
down-regulate other inflammatory cytokines. Bifidobacterium breve R70 adheres
to human intestinal cells and blocks the adherence ofpathogenic bacteria.
ResistAid from Lonza Inc. is sourGed
from tbe bark and wood of Larch trees and
consists of the soluble polysaccharide arabinogalactan and bioactive flavonoids. Larch
arabinogalactan has been shown to suppoJ'tl
natural killer cells, cytokines and
macrophages as well as have an antioxidant
capacity.
Maitake Products' Maitake D-fraction
has broad actions on the immune system by
increasing the numbers of key immune players, increasing activity ofthe immune system
and possibly improving the functioning and
efficacy as well. There is some newer evidence to suggest that it may also display the
actions of an immune modulator as an immune booster. As with several other companies featured in this story, Maitake Products
has invested its resources into clinical trials
of Maitake D-fraction and its specific efficacyon the immune system.
The systemic enzyme formulation
Wohenzym N (combination plant-based enzymes bromelain and papain, natural pancreatic enzymes trypsin and chymotrypsin, and
the antioxidant flavonoid rutin) from Mucos
LLC helps maintain and support a healthy
immune system.
Research shows that fish oil (omega-3
fatty acid) can help the production of pro-inflammatory and pain-sensitizing messenger
molecules (immune modulating molecules).
At the same time, fish oil may help raise the
levels of anti-inflammatory self-healing
molecules. Fish oil specialist, Nordic Naturals (which manufactures numerous highquality fnnnulas), explains, "Prostaglandin
E3 (POE3) is derived from the omega-3 fatty
acid, EPA. Higher levels of POE3 reduces
sensitivity to pain, relaxes blood vessels, inGreases blood flow and supports the body's
natural anti-inflammatory response."
NOW Foods makes N0WImmune
Renew, a blend of eight organically grown
medicinal mushrooms plus standardized astragalus. The company's AlI.iBiotic eR contains zinc and vitamins A and C to support
immune responses plus olive leaf, garlic
(allicin) and oil of oregano to stimulate immune response. NOW Air Defense combines andrographis (Paractin), elderbelfTY,
astragalus, arabinogalactan from larch, vitamins A-C-E and beta-carotene, zinc and
key amino acids to naturally support
healthy immune functions.
Quality ofLife Labs produces Kinoko
AHCC and lmmunoComplex, whicb help
enhance the immune system by increasing
the activity of the white blood cells. Clilnical studies show that Kinoko AHCC Will
increase activity and count of
macrophages and NK, Lymphokine Alctivated Killer, B-, T-, helper T-, neutrophils
and cytotoxic lymphocytes. The product is
said to be highly bioavaiJable. ImmullloComplex is an immune-enhancing bl<md
of AHOC comhined with echinacea. asltragalus and vitamin C.
Soft Gel Technologies' WasabiSol
(Wasabia japoIJica) supports enhanced
liver detoxification and healthy immune
function. It contains high concentrations
of active compounds called isothiocyanates, which are suggested to have iimportant biological benefits, including supporting detoxification and immulDe
function, as well as exhibiting antimic:robial activity.
Solgar offers a variety of products: to
support immune health. "1 have alwiays
stressed L-glutamine (Solgar L-Olutamine
500 g Vegetable Capsules) as being critical for maintaining a healthy immune system and, a few years ago,l also began recommending Solgar AC-II vegeta"ble
capsules as well." Richard A. Passwater,
Ph.D., the company's director of research
and development, relates. Solgar's AO-II
addresses proper nutrition and the cells'
ability to utilize ingested nutrients. says
Passwater, adding that AC-li enhances
nutrient uptake due to its patented active
ingredients/ Carboxy Alkyl Est,ers
(CIilis). 'The CAEs present in AC-II H.elp
to normalize the viscosity of the cell mf:mbrane thus improving cell-to-cell cOlDljnunication and nutrient uptake. AC-II has
also been shown in numerous studie~; to
improve our own response to DNA damage by means of enhancing the nattlral
DNA repair process ... [thus] our genc~tic
potential can be maintained more perfectly
througbout our lives."
very little understanding of the immune system and the importance of immune selfcare. "The prevalence of immune-related
diseases increases as the population ages
and there is more awareness of immunity
and immune self-care now than al any time
previously, making for exciting category potential. Many consumers are aware of the
connection betwcen immune status and discases and other ailments related to vimses
and bacteria, a most auspicious slart," he says.
"The reality of the world we live in is
one in which immune products will always
be a key component of self-care," notes
Mark Kaylor, M.H., C.N., Ph.D., for
Mailake Products,lnc., East Rutherford, NJ.
"The rise in 'new' microbes, increasingly
resistant microbes, ever-presenl concerns
and fear about cancer and allopathy's inability to effectively treat the common cold
mean that alternative and preventative measures are here for a long time."
Kaylor attests that it is difficult to accurately assess the level of understanding
found in health food consumers since this
has become an extremely varied group, not
like in the old "hippie" days. The advent of
information technology has also created
highly educated consumers. "Overall,
though, I'd have to admit to a lack of sophis-
tication in the average consumer. There is
still a dominating tendency to view any and
all immune products on an equal level with
regards to aClions and efficacy."
Keri Marshall, M.S., N.D., advisor 10
Nordic Naturals, Watsonville, CA, identifies
several key factors about immune heahh
that many consumers don't understand: its
complexity and protective role in more than
just not catching a cold, its integral role in
regulating inflammatory pathways that play
a role in the development of almost every
chronic disease, and its health dictates the
body's ability to defend against cancer development. "When most consumers think of
immune supplements they think of echinacea and vitamin C. They do not immediately recognize that many products such as
mushrooms and omega-3 fatty acids are also
effective immune-modulating supplements," she says.
David Winston, RH (AHG), founder of
and clinical herbalist for Herbalist & Alchemist, Washington, NJ, holds a similar
view. The major issue in this category, he
says, is confusion and lack of education.
"There is a lack of understanding of how the
immune system works by consumers, retailers and often practitioners as welL" he
states. And, individuals are nol clear how
products designed to support the immune
system work, when they work and when
they are not appropriate. "People often look
at one of these product's and think 'oh, this
will be good for my immune system.' Well,
that would be great if the immune system
was a simple thing. But, it isn't. Virtually
every single tissue in the body has either
overt or passive immune activity. You can't
separate your immune system from your
emotional state, your endocrine status, your
level of happiness and your nutritional status. All these things playa role."
In tandem. observes John O'Connor,
B.S., quality control specialist of Los Angeles, CA-based Jarrow Formulas, there are
many consumers who "are still of the disturbing mindset that if an herb or a nutrient
has been shown to benefit the immune system in some capacity, then more must always be better. They really need to be disabused of this notion, because it is nearly
always not the case. Taking more than Ihe
commonly accepted dose can have negative
consequences on one's health:'
He offers zinc as an example. Zinc has
been widely publicized as having the ability
to manage symptoms of the common cold.
The "more is better because it's harmless"
mentality in this case can be detrimental,
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O'Connor asserts, because a surplus of zinc
can suppress levels of copper, which may
lead to anemia and lower superoxide dismutase (SOD) levels. SOD is a critical endoge~
nous antioxidant enzyme needed to protect
cells from free radical damage.
Eileen Sheets, managing director, Bio~
force USA, Ghent, NY, notes that echinacea
and a few other herbs have dominated the
immune support category for quite a while.
"As we know, just a few years ago, echi~
nacea was sideswiped in the media causing
consumer confidence in use of this herb to
plummet," she relates. In the meantime,
many new products have come to the fore~
front for immune support. Also, she notes,
several significant newer studies have been
published proving that some echinacea
products actually do work. Echinacea sales
have increased in response, demonstrating
that much of the confidence in this botani~
cal has been restored.
Boost or Modulate?
Indeed, semantics count in the immune
category. One of the primary conundrums
faced by consumers is "what's the difference between immune enhancement, imnHlDe boosting and immune modlllation~
and which product type will benefit my
individual needs?"
Unfortunately, says Kaylor, "these temlS
are freely and interchangeably used by companies, writers, retailers and consumers when
there is an important action difference."
Boosting, he says, "simply means an increase in immune function, activity or numbers in some way."
An immune booster, adds Mueller, temporarily increases and stimulates the number of specific white blood cells and should
only be taken for a short duration.
Modulating, on the other hand, "implies
a more tonic and balancing action," Kaylor
notes and continues, "Immune modulators
basically up-regulate an under~active sys~
tem as well as down~regulate an overactive
immune system as can be seen in the long~
used traditional remedy, reishi."
Mueller believes that immune modula~
tion is the preferable choice for many con~
sumers because it enhances the body's nanl~
ral ability to respond to a challenge and also
maintains a healthy and viable immune system balance. Immune boosting creates an
artificial and unnatural state and is not rec~
ommended. "An immune-modulating
(priming) compound, such as Wellmune
WGP, makes the existing immune cells
'battle-ready' without stimulation so that
when they encounter a foreign challenge
they more quickly engage and destroy that
challenge," he says.
In agreement is Jarrow Formulas' 0'Connor, who explains that "compounds that
are immune boosting are one-dimensional
in the sense that they have the capacity to
•
WHOLEFooDS • NOVEMBER 2008
stimulate or increase the body's immune response through promoting the synthesis or
activation of immune cells (e.g., Iympho~
cytes and pbagocytes) along with the expression of cytokines and activation of enzymes that the'se cells release, in response
to invasion by bacteria or viruses, or the inhalation of pollen, dust mites and so on.
Some compounds (e.g.. lactoferrin, echinacosides) may also augment the immune re·
sponse by being able to kill invading organisms directly."
Conversely, O'Connor adds, because
compounds that are immune modulating
have a dual capacity to increase and decrease immune response, they "appear to be
the more desirable as the former may be
contraindicated in the cases where stimulating the immune system can have a negative
effect, as in the case of autoimmune condi~
tions such as lupus. There are times when
an increase in the inflammatory process
would be desirable and times when sup~
pressing inflammation or preventing exces~
sive inflammation is important. A compound or formula that can do both is
immune modulating and hence would be
advantageous."
Sheets reflects that this category was all
about immum~ boosting for years, which
gave rise to the commonly held be-lief that
one should not use echinacea for more than
several weeks because it may over·stimulate the immune system. Bioforce researchers in Switzerland performed a study
to investigate this. In an in vitro study, they
added low concentrations of a branded echinacea supplement (Echinaforce) to isolated
human immum~ cells, which were then analyzed with bioc::hemical and molecular biology methods to detemline its effect on these
immune cells. They found that the supplement's alkylamides bind specifically to the
CB2-receptor" on the immune cells exerting
a modulatory I~ffect on TNF-a. "We therefore now know Echinacea exerts a modulating effect. not a boosting or stimulating effect because nothing happens until the body
comes into contact with a pathogen," she
explains. "At that point, the immune cells
were shown to become active in a moderate
and longer lasting fashion. Without Echi~
naforee, the immune system responds to a
challenge with more TNF-a, but the re~
sponse is much more short lived. With Echinaforce, the TNF~a response does not spike
as high, but it lasts much longer, providing a
.more effective response. From this re~
search, we now know that it is safe and ap~
propriate to use Echinaforce prophylati·
cally."
Cheatham says that supplements such as
Quality of Life Labs' Kinoko AHCC are
modulators because they enable the im·
mune system, specifically lymphocytes or
the white blood cells, to distinguish good
cells from dise:ased cells and to attack only
the abnormal ones. This process is not easy
because irregular cells act as chameleons,
blending in with healthy cells to avoid de~
tection by the patrolling natural killer (NK)
cells and other white blood cells that find
and destroy diseased cells. The modulators
will not over-stimulate healthy cells and
will identify abnormal cells creating targets
for the white blood cells to recognize and to
destroy.
Published research by Drexler Univer~
sity on another AHCC supplement (lmmPower from American BioSciences, Inc.)
showed that those who received the supplement had more NK cells and extra NK cell
activity in response to influenza infection.
Taking the supplement is said to reduce the
severity of flu symptoms.
Other inlportant players in the category are
polysaccharides like arabinogalactan, which
also closely mimics the host-pathogen rela~
tionship. "due to the sugar components that
make up the polysaccharide. These different
sugar components are typically part of the cell
wall of different bacteria and viruses and
therefore the immune system recognizes the
sugar components of the polysaccharide," Ro~
driguez explains.
Winston points out that allergies and au~
toimmune conditions are examples of an
overactive immune system and that regulatory herbs can help down~regulate exccssive immune response. He uses a self-developed model to clarify the major classes of
immunity:
• The sill/ace immllne system is the body's
ability to respond to what is referred to in
Chinese medicine as "external pernicious
influences" such as changes in weather,
acute bacteria or viral infections. The surface immune system corresponds to
macrophage/phagocyte activity.
• The deep immune system is the body's
ability to respond to systemic viral, bacterial or fungal infections as well as to cancer
and includes many types of immune cells,
such as T-4, T~8, K+, NK cells.
• The immune reservoir describes the fundamental ability of the body to mount the appropriate immune response to any situation
or need. It is an artificial construct; a model
of an individual's total immune potential.
• The hypothalamiclpitllitmJladrenal (HPA)
axis controls all endocrine function, as well as
significant aspects of immune and nervous
system function. Snldies clearly show chronic
stress, anger, depression or anxiety can inhibit
immune response.
Sales Immunity
With such a complex category as immune support, effective retailing may be a
challenge.
"There are no shortcuts in this category,"
asserts Sheets, who suggests seeking out
manufacturers that invest in their products
to understand how and why they work and
Immune Health
are willing and able to dispense this infor~
mati on to retailers and consumers. "One of
the mosl frustrating things to me, both as a
manufacturer and as a health food store cuslamer myself are stores tbat are not set up to
receive this information and pass it on," she
says. "This industry was founded on exceptional and personal customer service, but
unfortunately it has gone by the wayside in
some stores and products are expected to
sell themselves."
Mueller believes thaI retailers should
consider segmenting the immune product
section into two categories: prevention and
therapeutic. Many immune products are positioned as remedies to be taken at the outset
of uncomfortable symptoms, but, he says,
many of these products are often missing an
opportunity by being limited to seasonal
marketing. So in addition to the traditional
marketing focus on therapeutic benefits, he
suggests positioning immune products as
support for certain health and lifestyle challenges such as travel, stress and environmental factors; this then opens this type of
immune product to a year-round market.
"This approach helps eliminate a key barrier
to purchase; Why buy an immune product
when I feel fine?" he offers.
It's back to basics, Winston notes, industry and retailers need to really understand
what they are selling. It really is not as simple as "this is good for your immune system," which he says he hears constantly. Immune health and support is uniquely
individual and requires more in-depth
knowledge and understanding of why one
product is good for the immune system of
any particular customer. For example, does
she have hyper or hypo immune response?
Is it stress induced? Does he have nutritionally induced immune suppression? Keep in
mind, Winston advises, retailers have limits
on addressing serious conditions that should
be under a practitioner's care, but they can
steer customers in the right direction of
products that may be appropriate for individual inunune status.
"As a long-time retailer myself," relates
Neil Levin, nutrition education manager of
NOW Foods, Bloomingdale, IL, "I found
that a concern about the cost of an item was
frequently a way for the customer to express
concern over its efficacy. After all, any item
is too expensive if it doesn't work! And the
person may have had experience with remedies that failed for him or her and is more
conscious of the price as a result. I f you can
convince your customers of that efficacy,
then you can usually overcome that particular objection."
Levin adds that the plethora of immune
products can be overwhelming. It would be
helpful to subcategorize them. Equally, staff
help should be invaluable in matching products to consumers; retailers can be successful in this category and others by taking full
advantage of the extensive education avai.lable in trade magazines, at tradeshows and
on some manufacturers' Web sites to increase staff knowledge.
HoItby agrees that marketing immune
support supplements is tough because FDA
laws prevent marketers from saying what a
product is capable of doing beyond a structure/function claim. "Every supplement
company is trying to find new ways to promote their immune support products, and
some even take the risk of making cancer
claims," he says. "This exposes that brand to
enforcement action by the FDA. and tarnishes the reputation of the supplement industry in general. Retailers should support
those brands that don't make outlandish
claims, but only reference that their antioxidant and/or immune formula supports
proper immune system function."
Meanwhile, he adds, retailers can consider creating various sections in their stores
for immune products, as many of them fit
into several condition-specific categories
such as antioxidants. detoxification,
stress/energy, cold and flu/well ness and
general immune health. WF
Lisa Schofield is a freelallce writer based ill
Freehold, Ni.
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WHOLEFooDS • NOVEMBER
200811