Gargle some mouthwash, brush and floss your teeth, and drop into the dentist’s chair a couple times each year. Sound familiar? Even if many people fall short of following it, the conventional wisdom for maintaining good oral health has become fairly ubiquitous. However, there may be more to the story.

The supplement world has produced a deluge of research, applications, and products relating to oral health in the last few years. From probiotic strains working to cultivate the proper bacterial climate, to omega-3 ingredients fighting periodontitis, there’s a mouthful of options for a market that may be gradually moving “beyond dental.” A mix of cost-efficiency, natural appeal, and promising research are all driving the hype.

One crucial element of oral health that conventional measures often fail to address is maintaining a healthy microbial balance. Most mouthwashes strive to rid the mouth of harmful bacteria that contribute to tooth decay and gingivitis, but do they go too far?

The problem with antimicrobial rinses and mouthwashes is that they “inhibit the growth and functioning of beneficial strains of bacteria that help protect the oral cavity from colonization by the pathogenic strains,” says Nena Dockery, technical support manager, Stratum Nutrition (St. Charles, MO). Beyond contributing to tooth decay and bad breath, these harmful strains may also infect the throat and upper respiratory tract.

To that end, the BLIS M18 and K12 probiotic strains from Stratum Nutrition are designed to restore protective bacteria in the oral cavity. Derived from 

, a naturally occurring oral bacteria, both strains are meant to “protect the oral cavity from occupancy by deleterious strains of bacteria through competitive inhibition,” says Dockery. But each strain takes a slightly different approach.

With three bacteriocins targeting harmful 

, BLIS M18 is intended to improve gum and tooth condition, especially among patients with poor periodontal health. Study results

 announced in January suggest Stratum may well be on the right track with this strain.

Researchers at the A.J. Institute of Dental Sciences (Mangalore, India) conducted a study of BLIS M18 probiotic lozenges on 28 participants aged 20-60 years who suffered from “varying degrees of poor periodontal health,” according to a press release. An experimental group took the lozenges every day for 30 days and was then examined at 15-day intervals for 60 days in comparison with a control group. All the participants underwent professional scaling and root planing at the outset of the study.

By the end of the 30-day probiotic administration period, “the M18 supplement group showed a significant reduction in all clinical parameters, including plaque index, gingival index, modified sulcular bleeding index, and probing pocket depth when compared to that of the control group,” says Dockery. At 60 days, the experimental group still scored higher on these parameters, but the periodontal health benefits did gradually decline after the probiotic administration stopped, reported the researchers. Dockery points out that “regular supplementation” would be necessary to sustain the possible benefits.

BLIS M18 also produces enzymes that are meant to neutralize acidic conditions that can wear down tooth enamel and degrade dextran, a component of dental plaque, says Dockery.

Although it acts by a similar mechanism, Stratum’s BLIS K12 targets a different harmful strain, 

, which can cause pharyngeal infections. K12 produces two bacteriocins that are meant to inhibit 

, among other harmful strains, says Dockery.

 in February 2014 explored possible benefits of K12 supplementation among children who suffer from recurrent oral streptococcal disorders. Thirty children aged 3-13 were treated for 90 days with a daily, slow-release oral tablet containing at least 1 billion colony-forming units/tablet of 

 K12. The experimental group was compared with a control group of 30 untreated children. It was a multicenter, open, nonrandomized, controlled clinical trial.

By the end of the 90-day period, the treated group experienced a 96.79% reduction of pharynogtonsilitis episodes caused by 

, and near-perfect patient tolerability and compliance. While the control group spent a combined 900 days taking antibiotics and missed 228 days of school or preschool, the BLIS K12 group spent only 30 combined days under antibiotics and missed just 16 days of school.

Beyond showing “excellent tolerability and ease of compliance of K12 supplementation,” this research “built upon prior studies showing that the K12 strain can be a valid therapeutic solution in the prevention of infections of the oral cavity, whether of streptococcal or viral etiology, and in particular those of a recurrent nature,” says Dockery.

Even if oral probiotics have shown promise in recent research, is the market there? One advantage may be the acceptance that probiotics have already found in other applications.

“Most consumers now recognize the benefits of probiotics in the GI tract, so they are more receptive to understanding the role that probiotics can have in supporting oral health as well,” says Dockery. “The market is definitely growing.”

Entering the probiotic market also poses the challenge of finding ways to market specific strains and make finished products stand out, according to Heather Thompson, global marketing manager, Stratum Nutrition. Rather than a weakness, the novelty of oral probiotics may actually be a strength for suppliers looking to differentiate new products.

“We are now trying to educate on another angle with a different kind of probiotic. The mouth is a primary entry point for all bacteria-good and bad,” says Thompson. “Why not be proactive in building the positive balance within this gateway to our overall health?”

Stratum’s probiotics are not intended as replacements for daily brushing and flossing, but Thompson hopes consumers will turn to oral probiotics more and more as part of a well-rounded oral health regimen.

Fighting Plaque? There’s a PAC for That

Another relative newcomer to the oral health world is the cranberry, which has recently begun making appearances in powders, toothpastes, and chewing gums as an ingredient aimed at reducing harmful biofilm in the mouth. Could it be that the same proanthocyanidins (PACs) often claimed to provide relief from urinary tract infections (UTIs) may also reduce dental plaque?

On the basis of two promising preliminary trials, Nexira (Rouen, France) is promoting its Exocyan cranberry extract as a “natural oral care solution for decreasing dental plaque.” Just last year, Nexira launched Exocyan Cran 70S, named for the up to 70% possible standardized PAC levels in the extract.

Dental plaque arises out of the formation of a white viscous layer of harmful biofilm, but Nexira says the PACs in Exocyan disrupt the formation of this biofilm due to their anti-adhesive properties. If the PACs are able to prevent bacteria from attaching and growing in the mouth, inhibiting biofilm formation, then it may be possible to decrease the “main risk factor of gingivitis and periodontitis,” according to Nexira.

Researchers at the University of Bordeaux (Talence, France) conducted two small preliminary human studies on Exocyan’s effect on oral health in chewing gum and toothpaste. In the chewing gum study, conducted in 2008, nine participants chewed four pieces of gum every day for four weeks, with each piece of gum containing 36 mg of Exocyan PACs. According to Nexira, researchers saw an average 28% decrease in dental plaque over the course of the study, as measured by the Turesky plaque index score.

The 2011 study on PAC toothpaste involved 18 participants who brushed their teeth three times daily with toothpaste containing Exocyan. After six weeks, researchers noted a 15% decrease in plaque, also measured by the Turesky plaque index score. In both studies, the participants were healthy volunteers without cavities who were approximately 21 years old. Both study results are unpublished but currently featured in Nexira’s marketing materials.

“The natural action in oral health of Exocyan, as well as its natural origin, makes it perfectly suitable for the formulation of healthy and clean-label products,” says Vanessa Agnolutto, marketing and communication manager, Nexira. She adds that Exocyan is available in organic grade and suitable for soluble and insoluble applications.

Cranberry ingredient supplier Fruit d’Or Nutraceuticals (Notre-Dame-de-Lourdes, QC, Canada) recently launched its own cranberry powder for oral health, called Oral Cran. Acting on the same biofilm-disrupting mechanism as Exocyan, Oral Cran is currently available in a powder that Fruit d’Or claims may help fight plaque buildup, cavities, gum bleeding, and bad breath.

A recent pilot study of 33 patients aged 33-80 showed promising potential for Oral Cran, according to Fruit d’Or. The participants all suffered from halitosis, gum bleeding, or generally poor gum condition prior to treatment. After two months of tooth brushing with Oral Cran powder, study organizer Hilary Rodrigues, PhD, reported overwhelmingly positive findings.

“The periodontal condition has improved, and in all cases bleeding from the gums has ended,” Rodrigues said in a press release. “Swelling of gums was reduced, bad breath was eliminated, and blue-tinged gums turned back to a normal pink color.”

The preliminary study consisted entirely of patients from Dr. Rodrigues’s private practice, and the results are unpublished, but Fruit d’Or has plans to launch a larger-scale study of Oral Cran, according to Stephen Lukawski, director, sales and business development. Lukawski also posits Oral Cran as a less expensive complement to professional teeth cleaning, especially for patients undergoing chemotherapy who are advised not to get their teeth cleaned for fear of infection.

Omega-3 fatty acids have racked up an expansive lineup of possible health benefits over the years, but we may soon be adding one more to the list. Recent research has shown omega-3s may ease several symptoms of periodontitis, possibly due to the anti-inflammatory action of the famous fatty acids.

A randomized, double-blind, placebo-controlled trial

explored the effect of omega-3 docosahexaenoic acid (DHA) on adults with moderate periodontitis. Over the course of three months, 46 participants took either 2000 mg per day of DHA or identical placebo capsules. All study participants also received 81 mg of aspirin per day, which was intended to reduce enzymatic inactivation of DHA and enhance possible “protection against inflammation-induced tissue and bone loss from periodontitis,” according to the researchers.

Although bleeding on probing and plaque index were not affected in either group, researchers at Beth Israel Deaconess Medical Center (Boston) observed a significant decrease of mean pocket depth and gingival index in the experimental group, two indicators of problematic inflammation and separation of the gum from the tooth. The proportion of DHA in red blood cell plasma membranes also increased from 3.6% to 6.2% in the omega-3 group, compared with no change among the control group.

The researchers concluded that “aspirin-triggered DHA supplementation significantly improved periodontal outcomes in people with periodontitis, indicating its potential therapeutic efficacy.”

Researchers at India’s Dental College and Research Centre (Kolhapur, India) also released the results of a similar study

 last year, except in this case aspirin was not included in the study design. For 12 weeks, 58 participants with moderate and severe chronic periodontitis were given either a 300-mg tablet of omega-3s daily or a placebo. Each omega-3 capsule contained 180 mg of eicosapentaenoic acid (EPA) and 120 mg of DHA. The trial was randomized, double-blind, and placebo-controlled.

Four parameters of gum health-gingival index, sulcus bleeding index, pocket depth, and clinical attachment levels-all saw significant reductions in the omega-3 group compared with the control group, researchers reported. They concluded that omega-3 supplementation may have “potential benefits as a host modulatory agent in the prevention and/or adjunctive management of chronic periodontitis.”

Clearly, the research for omega-3 applications in oral health is growing, but it’s still not a “slam dunk,” says Harry Rice, PhD, vice president of regulatory and scientific affairs, Global Organization for EPA and DHA Omega-3s (Salt Lake City). Rice is also a member of 

In the last five years, omega-3 research has taken enormous strides in moving from animal models to human trials, says Rice, but there is still a scarcity of companies marketing omega-3 products specifically for oral health. As always, a big question is: would there be a demand among consumers?

“Perhaps the appeal would be that omega-3s have additional benefits above and beyond cardiovascular health,” says Rice, adding that periodontists would likely need to begin endorsing omega-3 products to jumpstart the market. “Provided the research builds in support of a solid benefit, there could be a demand, but I think it would be a niche market.”

With so many new and promising options, dietary supplements are poised to play an evermore important role in consumers’ oral healthcare routines.

Scariya L et al. “Probiotics in periodontal therapy.” 

International Journal of Pharma and Bio Sciences

K12 in the prevention of streptococcal and viral pharyngotonsillitis in children.” 

Naqvi AZ et al. “Docosahexaenoic acid and periodontitis in adults: a randomized controlled trial.” 

Deore GD et al. “Omega 3 fatty acids as a host modulator in chronic periodontitis patients: a randomised, doubled-blind, palcebo-controlled, clinical trial.” 

Articles

Oral Health and the Role of Dietary Supplements

Watching sales trends in nutritional supplements is always great theater. The ebbs and flows in response to media flashes on studies either indicting or vindicating supplement claims and use are enough to leave anyone’s head spinning. And how about the swinging-pendulum debate over supplementation versus diet and which is the best way for consumers to optimize nutrition?

When the dust clears and we cut through the noise by looking at the data, IRI sees the following:

Nutritional supplement sales are growing-faster in years when innovative products are introduced.

To get their vitamins and minerals, consumers are increasingly using meal replacements versus traditional delivery systems like tablets, capsules, etc.

Shifts are beginning to show in the data in terms of where consumers buy their supplements-and portend changes to come.

 Buying Supplements-but Less So in Health Food Stores Lately

Despite the very nature of the category, health and vitamin stores-referred to collectively as health food stores-have seen declining sales since 2011, an outcome of a dwindling shopper base. Why? IRI believes that consumers are relying less often on the resources these specialized stores provide, for a few reasons.

Traditionally, health food stores were the first retail outlet where supplement manufacturers chose to debut new products because the store owners or managers were steeped in the knowledge required to teach consumers about the value of using those supplements, thus encouraging shoppers to try a product. In addition, because these stores specialize in supplements and health items, retailers purposefully sought a broad product selection, throwing the door open to a broader group of manufacturers.

Enter the Internet, which provides consumers easy access to information about nutrition and nutritional products, wherever they are. Today’s consumers are willing to do their own online research before even setting foot in a brick-and-mortar store. They can also get and take heed of product ratings online and in social media-something consumers put a lot of stock in. As a result, health food stores’ main reason for being is rapidly diminishing. Navigating what used to be a complex category of products has become easier. Many consumers do not require or make use of the advisory and educational role once owned by the health food store. Further, consumers can shop the Internet for a broader array of products than can be found in most health food stores.

The growth of the health food “store-in-a-store” concept at Wegmans, Whole Foods Market, and select stores within drug and mass chains is also accelerating consumer flight from the quintessential health food store to these more convenient outlets which offer one-stop shopping. Consumers shop there after conducting their own product research. Customary channels such as Walmart, grocery, and drug and mass today make up approximately 70% of category dollar sales, IRI data show. (See Figure 1 above.)

Though relatively small in size, sales of nutritional supplements through the Internet and dollar stores/value stores are also rapidly growing, underscoring convenience and value as key consumer needs.

Speaking of dollar stores/value chains, the story here, although still from a small base, is about the new frugality exhibited by consumers post-economic breakdown of 2008. As consumers increasingly gravitate to the value chains as their main “go to” stores, they will expect to find and are open to buying products like supplements from those stores. IRI is seeing this trend not only for supplements but for other over-the-counter healthcare items as well. The trick here is to provide the supplement product at the right price point.

IRI believes that the shift in sales from traditional outlets like health food stores to mass, Internet, and value chains will continue. Consumers are expected to get even more comfortable and accustomed to the convenience of researching and shopping online for regimen products like supplements. And as the practices of the value-conscious shopper continue to be “fashionable” as well as necessary for some, such consumers will be open to purchasing supplements in dollar store outlets to an increasing degree.

To some extent, IRI believes the health food store still plays an educational role. In IRI’s recent focus group sessions, consumers spoke of stopping by their local health food store to learn about a product and perhaps even buy it there the first time. But once the product becomes part of the consumer’s supplement regimen, they look to buy succeeding supplies based on price and convenience. To encourage repeat purchases and combat crossover to other channels, brick-and-mortar health food stores going forward will need to battle the challenge of getting the consumer to interact beyond just “showrooming”-that is, browsing, not buying.

Also read: What Supplements Are Customers Buying? More than Just Multis...

Robert Sanders, executive vice president and Healthcare Practice Leader for IRI, brings more than 30 years’ experience to the marketplace, sets the strategic initiatives for 

’s Home and Healthcare Practice, and is a frequent keynote speaker at healthcare industry events.

With so many shopping channels out there, is the health food store still relevant?

Are Health Food Stores Losing Relevance?

Few herbals can rival turmeric’s astronomical rise in popularity over the last few years. Named 2013’s top-selling herbal supplement in the U.S. natural health channel by the American Botanical Council, the famous orange rhizome has continued to gain momentum for its possible effects on everything from arthritis to depression.

Several turmeric manufacturers are looking to build off the craze by infusing beverages with curcumin, the active compound in turmeric 

. But formulating the ingredient into an attractive and palatable drink can prove more challenging than you might think.

Curcumin’s orange or vivid yellow coloring may be its signature characteristic, but it also presents certain obstacles. For one, the ingredient’s staining properties can be troubling for both manufacturers and consumers.

“Formulators find it hard to contain the yellow staining nature of curcumin in equipment and any facility handling curcumin products,” says Anurag Pande, PhD, vice president, scientific affairs, Sabinsa Corp. (East Windsor, NJ). Curcumin may also stain teeth, says Pande, which is why chewables or mouthwashes containing curcumin are basically “nonexistent.”

One of the ways Sabinsa addressed this problem was by launching C3 Reduct, “an off-white–to–white color [curcumin] extract which does not have staining properties,” says Pande. He expects the extract to open even more doors for the celebrated ingredient, especially in the oral health world.

Aside from staining concerns, curcumin’s hydrophobic nature often causes particles of the ingredient to settle at the bottom of beverage containers, forming an orange sediment that consumers may not find attractive. Exposure to light can also cause curcumin to degrade, further limiting the ways a curcumin beverage can be attractively presented. Opaque packaging is one option to address both of these dilemmas, but it can also be more expensive.

At Natural Products Expo West 2015, Sabinsa announced it may have a better solution to these challenges. The company is currently debuting 

, a new curcumin ingredient that “brings complete solubility to curcumin for the beverage market,” according to marketing materials.

uC3 Clear dissolves completely in water, avoiding the unsightly settling issue entirely, says Shaheen Majeed, marketing director, Sabinsa. He adds that uC3 Clear held up well in a photo-sensitive study and is therefore appropriate for beverages with clear packaging.

“The idea of launching uC3 Clear is to enhance the consumer experience of curcumin with a more convenient and improved delivery system,” says Majeed. The new ingredient contains 10%-15% curcuminoids, and Majeed recommends dosages of up to 200 mg/day.

One other measure turmeric formulators may need to take is storing the ingredient in closed containers. Like many organic materials, turmeric can degrade from oxidation when exposed to air, according to Lynda Doyle, vice president, global marketing, OmniActive Health Technologies (Morristown, NJ). OmniActive not only stores its CurcuWin turmeric extract in closed containers, it also combines the ingredient with antioxidants such as tocopherol to protect the curcuminoids against oxidation, says Doyle.

Cucumin’s bitter taste is also a factor to work around. Juice company Urban Remedy (San Rafael, CA) has found a simple way to mask the ingredient’s taste in its turmeric-containing Boost beverage.

“Turmeric has a very earthy flavor many don’t find appetizing,” says Urban Remedy Founder Neka Pasquale. “By freshening it up with some organic lemon juice and a little bit of stevia, we were able to offset the earthy flavor, making it more refreshing.” Another Urban Remedy beverage, Cold Crusher, launched in Fall 2014, combines turmeric, carrot, orange, and lemon.

Cashew milk, pineapple, carrot, ginger, beet, mango, apple, and maple syrup are a few of the other ingredients beverage companies have combined with turmeric.

Although it may not be a simple task to formulate turmeric beverages, these companies have clearly found innovative ways to do just that.

Turmeric: 2015 Ingredients to Watch for Food, Beverage, Supplements

Turmeric Beverages, Yellow or Not (Slideshow)

But the popular ingredient poses certain challenges for formulators

Next Stop: Turmeric Beverages 

Tips for building a brand in today’s supplement marketplace

When Jeff Hilton says “fascinating things” are happening in the supplement space, grab a chair and take notes. An old hand at health-and-wellness branding, the chief marketing officer and cofounder of BrandHive (Salt Lake City) has had both a front-row seat and a backstage pass to the industry’s evolution since Ronald Reagan was in the White House.

So when he predicts that we’re “in the early stages” of a major shift in how consumers approach health, he does so with some authority. And what his privileged perspective tells him is that an “entrepreneurial surge” is bringing about a bumper crop of brands backed by compelling stories, creativity, and resourcefulness to spare.

But those budding brands-and the industry as a whole-face a very different playing field than the one that existed back when nutritional supplementation meant taking the multivitamin you picked up at the grocery store. “We’re going through a thought revolution and a new-product revolution,” Hilton says, and the theme he sees underlying both is convergence: of channels, media, dayparts-even of foods and beverages with supplements themselves. It’s uncharted territory, for sure, but brands that follow these five key strategies will find “huge opportunity,” Hilton promises, as they navigate it.

“If you look at the landscape for supplements, foods, and beverages over the next 10 years,” Hilton says, “where the excitement and opportunity are is in the food and beverage sector.” That should come as no surprise to anyone who’s scanned a functional snack or smoothie label and realized there’s not much separating them nutritionally from the multivitamins of yore.

To nascent brands that already embrace edible and potable platforms for functionality, that’s encouragement to keep up the good work. But for old-school supplement marketers, “I think it’s a bit of a wake-up call,” Hilton says. “If I were a supplement manufacturer-and I tell my clients this-I’d be watching my back because I think the big-picture trend is away from popping pills and more toward adding functionality to what we’re already consuming.”

Need proof? Just ask a Millennial, who isn’t “going to pop 30 pills a day,” he says. Even Boomers, he adds, are “increasingly pill averse.” And while capsules and tablets aren’t going the way of the dodo just yet, consumers’ desire to make nutrition not just quick and convenient but an experience that’s “natural” and hedonically appealing explains why demand for functional bars, shots, gels, drinks, and snacks “is going through the roof,” Hilton says.

And remember: “The whole three-meal-a-day paradigm is dead or dying,” Hilton declares. Any brand that grasps how consumers are redefining traditional dayparts-turning breakfast, lunch, and dinner into the midmorning nosh, post-lunch perk, pre-workout refueling, trans-commute nibble, and so on-will meet those consumers where it matters.

And speaking of what matters, consumers don’t just insist on functional options that fit their lifestyles; they want products that fit their psychological and emotional constructs of what health and wellness really mean. That’s a cue to write a backstory for your brand that engages consumers. As Hilton says, “The brands that are succeeding are the ones that are trying to educate.”

It’s a lesson that Janie Hoffman, CEO and founder, Mamma Chia (Carlsbad, CA), knows by heart. “The greatest brands in the health-and-wellness space often come from an authentic place-a desire to better the world or enable people to live healthier lives. It’s this authenticity that can resonate with consumers and create a loyal following.” For her, authenticity involved sharing the benefits of chia with a wider audience. “Those tiny little seeds had a dramatic effect on my health and vitality,” she says, “and it was my passion for them that drove me to create Mamma Chia.”

In a happy coincidence, putting her brand narrative on the table made it easier to stand out on a crowded shelf. “We think less about our competition and focus our efforts more on making delicious, healthy, chia-based products and creating a sustainable and conscious company,” she says. “When your values align with your customers’ and your products fulfill their needs, sales will follow.”

That said, it still doesn’t hurt to stand out, and Hoffman wasn’t shy about giving consumers a product they’d notice. Her flagship chia drink “was unlike anything that existed at the time,” she says. Appearances helped, too, and she chose “a beautiful bottle with bright, eye-catching packaging that drew in consumers.” She’s taken a similar approach with her new Chia Granola Clusters and Vitality Bars, enveloping them in “bright packaging with strong, clear statements about the products’ attributes.”

Strong, clear statements about a product’s attributes are as much a part of the “education” mission that Hilton associates with success as are those feel-good product backstories. And given the proliferation of products bidding for consumers’ trust with good-for-you claims, you can understand why.

“Right now,” Hilton says, “I think one of the challenges for the consumer is that they’re trying to figure out the value of functionality.” While they’ll buy the 

 of enhanced protein, fiber, probiotics, and omega-3s, do they have the tools to calculate its actual monetary value? As Hilton asks, “Am I willing to pay an extra fifty cents for a yogurt because it’s got nutrients in it versus a salty snack that’s not going to do me any good?”

While that’s the consumer’s decision to make, “we as brands have to put out that knowledge and help create that value by telling them that they’re getting something special,” Hilton says. “We have to do our part in promoting value.”

And to the extent that “value” comes from delivering the nutrition your product promises, Hilton warns against providing what he calls “storefront functionality: a little hint of this or that, but nothing that’ll make a substantive difference” to wellness. Not only is the practice sneaky; consumers are growing increasingly savvy at asking the tough questions to suss it out, too.

Tip 4: Blind Them (Figuratively) with Science

The best shield against that kind of consumer skepticism is evidence-based formulation. “The separation of the wheat from the chaff,” Hilton says, “is going to come from products that are offering true functionality that’s valid and related to science.” That means telling consumers how much of an ingredient your product truly delivers and educating them about the studies demonstrating its efficacy. As Hilton says, “Science is key. It helps differentiate the real products from the imposters.”

It also attracts the attention of capital, while warding off that of regulators. As Grant Ferrier, founder and CEO, Nutrition Capital Network (NCN; San Diego), says, “Investors are skeptical of claims that may not hold up or that may cause FDA or FTC woes. And they certainly view a significant part of the value of a company as being locked up in its intellectual property, not just top-line sales or bottom-line EBITDA”-finance-speak for earnings before interest, taxes, depreciation, and amortization.

“There are still examples of marketing-based companies that show some success with relatively little scientific backing, or with borrowed science based on one ingredient or formula,” Ferrier concedes. “But the true pioneers”-and those companies with the highest potential for profit-“have either a proprietary application of a naturally occurring compound, or a formula that’s been properly tested in the lab, in animals, and, ultimately, in humans in a clinical-trial environment.”

That’s a tall order, the precise height of which will vary with the claims a marketer wants to make and the benefits a product proposes to deliver. But the growing role that researchers, investors, and other “outsiders” now play underscores just how many forces are converging on the health-and-wellness sector.

As further proof that “convergence” is a sign of the times, Hilton refers to what he calls “channel convergence”: that blurring of the lines between retail, online, multilevel marketing-all the venues available for making health-and-wellness purchases. Hilton notes that medical practitioners are even getting into the channel game, dispensing supplements in their practices.

So, he continues, “the fact that consumers have control over where and how they buy supplements has turned the paradigm upside down by allowing them to circumvent the retailers entirely.” While this could stymie brands unfamiliar with outlets beyond retail, those with new-channel and new-media chops should find channel convergence an opportunity to get ahead.

That’s how Hoffman sees it. “Social media has been an important marketing strategy for us from the very beginning,” she says. “Engaging your core customers personally and directly engenders brand loyalty and creates a coalition of ‘ambassadors’ who willingly share their love for your brand with the world. And by truly listening to those audiences, you can gain valuable insights that can help drive product development and line extensions.”

And Millennials, for now at least, dominate those online audiences. That being the case, Hilton can’t emphasize enough: “They’re not looking for the same experience or engagement as Boomers.” The ways in which the two groups apprehend health and wellness “are more different than they are alike,” he notes, with the upshot being that “you’ve really got to look at these markets individually.”

Take Millennials’ general opinion that bigger isn’t always better, especially when it comes to the companies that make and market their favorite products. “We know that Millennials love niche brands,” he points out. “Many are actually big-brand averse and would just as soon buy from a small brand because they feel like they can own it and have a part in it.”

And for brands that aren’t trying to conquer the world, that sounds fine. “We don’t believe in being all things to all people,” Hoffman says. “The key to success lies in having a product whose attributes are desirable to a sizeable audience but that aren’t so generic that you’re unable to generate demand.”

And she should know. The changing marketplace converged with her willingness to take a risk at just the right time. “The health-and-wellness industry changes almost daily,” she says. “Smaller, entrepreneurial organizations tend to be more nimble, allowing companies to introduce products faster and self-correct as needed. And don’t underestimate the power of passion! It often requires tenacious perseverance tosucceed in a crowded marketplace.”

What Comes First: The Ingredient or the Market?

So you want to break into the health-and-wellness market? Well, no matter what, make sure you secure a blockbuster functional ingredient first, and then develop a string of products that direct it at a handful of wellness need states…Or, wait. Maybe you should do the market analysis first, find out which health concerns are top of mind, and then build a stable of ingredients that address them…

To find the straightest route to success, we asked a few industry insiders what they thought. Not surprisingly, their answers depended on where within the industry they stand.

“Most developers are successful because they’ve devoted scientific research and product-development time to an ingredient or family of ingredients and have honed a formula or process to isolate or stabilize a blend of bioactive compounds. ‘Ingredient-driven’ is the answer. By all means, a developer also has to have an endpoint in mind for a need state with significant market-share potential to validate the business prospects of all their technical work. But starting from market demand and fishing about for a technical solution rarely works for an entrepreneur, although it’s often precisely what the big companies and well-funded investors look to do-i.e., identify five or six major need states and search a portfolio of potential technical solutions to evaluate and possibly invest in, buy, or license.”

-Grant Ferrier, founder and CEO, Nutrition Capital Network (NCN; San Diego)

“Building our brand around an ingredient has been the key to our success. Chia seeds are one of the world’s healthiest foods, with attributes that apply to a variety of different audiences. With chia, we could appeal to athletes, fitness and outdoor enthusiasts, and wellness seekers, as well as to those concerned with energy, weight loss, and heart health. This gave us a broad platform from which to build our brand.”

-Janie Hoffman, CEO and founder, Mamma Chia (Carlsbad, CA)

“I definitely have a bias for outside-in development. Looking to the market is what I do; others may not feel that way. But I think success can come both ways. [Ideally, both approaches] kind of meet in the middle. But my personal bias is always that the marketplace should speak to the opportunity. It doesn’t matter what widget you have if there’s no demand for it.”

-Jeff Hilton, chief marketing officer and cofounder, BrandHive (Salt Lake City)

Dietary Supplement and Natural Product Brand Building: From Lightbulb to Launch

What’s in a name? To hear suppliers of branded ingredients tell it, you might think it’s the key to a supplement’s very success. And while that may overstate the case by half, there’s no denying that nutritional ingredients with a recognizable brand name bring a lot to the table-not the least being their enthusiastic suppliers, who offer everything from premarket concept development to postmarket support.

But the benefits of branding don’t come without conditions. Hitching your own brand to that of your supplier means entering into a professional and legal relationship that requires extraordinary give and take. “The strength of a successful formulation comes down to the partnership between the branded-ingredient supplier and the supplement marketer,” says Shaheen Majeed, marketing director, Sabinsa (East Windsor, NJ). “A clear understanding of the marketer’s expectations and the deliverables for the ingredient supplier is necessary to walk this tightrope.”

It’s a balancing act more manufacturers are attempting as they turn to the branding advantage in a crowded marketplace. And at the topline level, their expectations run from “finding the best in quality to easing movement in the market and being well noticed among other brands,” Majeed says.

The branded-ingredient supplier, on the other hand, wants “a reasonable margin on the profits from the formulator,” he continues, as well as the visibility that comes from being the marquee player in a commercial supplement. “Ingredients get noticed more widely with more formulations on the market using them,” Majeed says. “An ingredient supplier knows that his brand gains recognition only when he finds the right supplement marketer to carry it forward.”

It’s in narrowing down those candidates that the supplier/manufacturer relationship dynamics really come into play. David Hart, vice president of marketing, Qualitas Health (Jerusalem, Israel), whose algal-source EPA-rich omega-3 oil branded as Almega PL debuted in its first commercial launches late last year, looks for “strong cooperation and collaboration” with formulator and retail partners. Coordinating R&D, marketing, and supply-chain efforts while leveraging distribution channels and marketers’ retail audiences will all help expand the company’s market reach and provides stability for both parties, he says.

But stability is only the start of what supplement makers get from the deal. As the number of moving parts needed to put a product on the shelf multiplies apace, a branded-ingredient supplier can act as a sort of Virgil to its marketer-partner Dantes, guiding the marketer through the various circles of development as they travel toward the daylight of a full-scale launch.

In the absence of such a guide, contemporary supplement makers face a more complex commercialization task than they might be prepared to assume. As Majeed notes, just bringing an ingredient-let alone a finished product-to market is a Herculean feat. “It involves the selection of raw materials, innovation in process development, scientific validation, regulatory guidelines, formulation compatibility, and the creation of an image as an effective nutraceutical.” Determining safety and efficacy while making sure proper doses are practical in finished formulations is another “intellectual challenge” the supplier takes on, he says.

By dispatching all this groundwork before the marketer even enters the scene, a brand-focused supplier makes it easier for a marketer to “establish scientific parameters for a final product,” Majeed says. Simply defining nuts-and-bolts parameters like solubility profiles and optimal storage conditions “saves a huge amount of time for the marketer.”

Mike Bush, senior vice president, Ganeden Biotech Inc. (Mayfield Heights, OH), has probably saved his customer-partners years’ worth of toil. “We’ve literally worked with in excess of 1,000 companies worldwide,” he says. And in doing so, he and his company-known for its spore-forming probiotic Ganeden BC30 (

GBI-30, 6086)-have demonstrated that having a supplier with skin in the game subtracts significant guesswork from the development process.

For example, Bush says, marketers’ R&D staffs aren’t always as familiar with specialized functional ingredients as their suppliers are-and that’s particularly the case when the supplier is dedicated to promoting that specialized ingredient. As Bush puts it, “We’re a probiotic company and a biotechnology company, and that’s all we do.” So when his partners inquire about processing, temperature tolerance, cell viability, and the like, he’s ready with answers that “really cut lots of time off their cycles.”

Such was the case with The Cookie Department (Berkeley, CA), which uses Ganeden’s probiotics in its products. According to CEO Pam Marcus, “Any functional ingredient we use has to be able to take high heat and be baked without breaking down.” After collaborating on several test batches, lab tests, and formulation tweaks, they got the cookies’ probiotic dose just right and “were able to claim that by adding the probiotic, it could support digestive and immune health,” she says.

Giving suppliers this kind of inside peek at formulation details can be off-putting for marketers used to keeping such information under wraps. But when a supplier’s own reputation is inextricable from its brand’s, the marketer can rest assured that the supplier is looking out for the best interests of both parties and will share advice that’s candid, thorough, and honest. Carina Ayden, founder and executive director of EFFi Foods (Los Angeles)-another Ganeden partner-says “there is definitely an adjustment period as you become more trusting and dependent on your supplier, but there’s no mistaking the true value they can be as an asset to your company.” For example, when EFFi needed to find an organic carrier for its probiotic, Ganeden was able to “make that happen for us,” she says, leading her to conclude: “A supplier can make all the difference in the world.”

Even beyond the bench, branded-ingredient suppliers prove their value with marketing support and consumer outreach. Bush says that with some customers, his team is effectively “an extension of their marketing departments, so we’ll make media calls to help promote the products that they’re trying to promote themselves.”

He notes that a fringe benefit he’s seen accrue to his company’s marketer-partners is that working with a well-known branded ingredient like Ganeden’s has “made it much easier for them to get their products on shelves at retail”-where, not coincidentally, he says they sell.

Hart adds that his company’s “focused consumer marketing and outreach” aim to educate and “activate” consumers with programs that communicate the benefits of omega-3 supplements-and of Qualitas’s ingredient. “All of this creates value for the Almega PL brand and builds a win-win relationship with our partners,” he says. “At the end of the day, healthier and happier consumers are important for the retail brands, and we strive to provide them with support in all the areas they require.”

One more area to think about is that of safety and regulatory authorization. While never straightforward, it’s growing more convoluted as marketers set their sights on overseas markets. As Majeed points out, “Different parts of the globe follow different regulatory guidelines, and it would be a time-consuming task for a supplement marketer to get clearances from the various governing bodies. However, with a standardized ingredient supplier having received all the clearances themselves, the marketer is spared this process.”

Todd Johnson, director of marketing, Albion Minerals (Clearfield, UT), is keen to reassure his marketer-partners that Albion’s chelated minerals are made in the USA in cGMP, ISO 9001:2008, kosher, halal, and EFSA-compliant facilities. “Working with branded ingredients can help ensure quality, traceability, and regulatory compliance,” he says. “Formulating with proven branded ingredients helps manufacturers validate their high standards for sourcing and helps reinforce their commitment to quality.”

And how do you validate those high standards and commitment to quality-not to mention the actual functional benefits that a branded ingredient claims to deliver? By testing them. As Johnson says, “While branded ingredients are valuable, it’s essential to ensure that they’re backed by scientific evidence and research.” That’s why his company has collected more than 125 published research papers “pertaining to our properly chelated minerals, their absorption, and their effects on different body functions,” he says.

As Bush points out, “There’s a significant investment to bring these ingredients to market, and as part of that we want to make sure that the consumer understands that not only does this ingredient do what it’s supposed to do; it’s been well researched and studied and sets itself apart from others in the space, as well.”

He notes that it’s important to test the finished products that contain those ingredients. His company ran over 10,000 tests in its labs last year investigating everything from the effects of reformulation to quality of supplements already on shelves. And they’re sticklers about encouraging their partners to use qualified independent labs for their own release testing. “We’ve literally trained outside food labs on how to enumerate Ganeden BC30,” he says, adding that theirs was the first probiotic to get a United States Pharmacopeia monograph: “We actually published our enumeration and identification protocols” so that others could put them to the test.

Ganeden spot tests customers’ products, too, picking up items at stores and bringing them back to the lab to check that the numbers on the labels match the results of analysis. And he insists his customers appreciate it. If Ganeden uncovers a product below spec, it helps the marketer bring it back into line; alternatively, by alerting partners when it finds products

spec, it helps cut both inclusion rates and formulation costs.

Spot testing can also unmask “bad actors,” as Deanne Dolnick, vice president, Next Pharmaceuticals (Salinas, CA), explains. The company supplies a stress-reducing botanical ingredient branded as Relora, and when it found six years ago that a marketer was printing the Relora patent number on the label while including no apparent ingredient in the product itself, “we took this very seriously,” she says, “demanding that the product be taken off the shelves and restitution made.”

The response, she said, was in the interest of protecting consumers, which is a big part of what the brand advantage is about. As Bush says, “Launch one bad product,” and the blowback can be catastrophic. “We certainly don’t want one rogue company to go ruining that for everybody.”

Which, of course, brings us to the marketer’s end of the branded-ingredient bargain. Dolnick says that Next Pharmaceuticals requires its partners to sign a customer agreement establishing dosage requirements that “they 

 adhere to,” she emphasizes. Insisting on this provision “means that the manufacturer or marketer is going to be putting out an efficacious product” to the benefit of all. “We also require that our customers use our logos, trademarks, patent numbers, and so on,” she says, “to ensure that others don’t violate our trademarks and patents.”

Hart believes “we make it easy for customers to cobrand their products.” Qualitas uses a royalty-free trademark licensing agreement that spells out quality standards for any product that bears the Almega PL trademark. “This guarantees that the products including our branding are of the highest quality and enables our retail partners to be on a level playing field,” he says.

And who would argue with that? Apparently, not many supplement marketers. “We rarely get pushback,” Bush says. And if that pushback ever came to shove, he’d rather terminate the engagement than jeopardize the ingredient’s reputation or consumers’ trust.

Perhaps that’s because “the brand image that the ingredient carries speaks for itself,” Majeed points out, “particularly today when consumers have access to so much information right there in the store or on their smartphones.”

As occasional controversies roil the industry, that image assumes even greater gravity. “With the New York state attorney’s unprecedented actions and the resulting deluge of negative media coverage,” Majeed adds, alluding to the investigation of dietary supplements launched by New York Attorney General Eric Schneiderman this year, “now more than ever an emphasis on products with a track record of safety and efficacy is essential.”

Navigating the branded-ingredient partnership

Branded Ingredients for Food, Dietary Supplements: A Two-Way Street

AREDS2 highlighted the importance of lutein and zeaxanthin for AMD, but recent studies also show benefits for younger populations.

Xanthophylls are yellow pigments and one of the two major subgroups in the carotenoid family. Lutein and zeaxanthin are two carotenoids within the xanthophyll family. From a nutritional standpoint, lutein and zeaxanthin are most well-renowned for their eye health benefits because they are the only two carotenoids accumulating in the macula of the retina in humans. These carotenoids form what is referred to as the macular pigment, which serves to filter harmful blue light and provides antioxidant benefits to protect retinal tissue.

 Research studies suggest beneficial effects related to nutritional supplementation with lutein and zeaxanthin, including prevention of macular degeneration, a leading cause of vision loss expected to impact nearly 200 million people globally by the year 2020.

 In fact, this research was the basis for conducting the well-known AREDS2 (Age-Related Eye Disease Study 2) trial.

The original AREDS (Age-Related Eye Disease Study) found that daily supplementation with a combination of antioxidant vitamins and minerals reduced the risk of developing advanced age-related macular degeneration (AMD) by 25%. AREDS2 was conducted as a follow-up study between 2006 and 2012 and included 4,203 individuals aged 50 to 85 at risk for development of advanced AMD.

 The purpose of AREDS2 was to determine if supplementation with the nutrients lutein/zeaxanthin and omega-3 fatty acids yielded additional benefits for AMD prevention beyond the original AREDS formulation. Overall, the results of the study failed to show increased protection from AMD with the added lutein and zeaxanthin as well as omega-3 fatty acids beyond what was found in the original AREDS study. However, the researchers then looked at the data by dividing it into groups based on dietary intake of lutein and zeaxanthin. The groups with the lowest dietary intake of these nutrients showed significant increased protection against progression to advanced AMD from consuming the supplemental lutein and zeaxanthin. Thus it’s possible that those with the lowest dietary intakes of these carotenoids would benefit substantially by supplementing with these nutrients.

A further, and potentially significant, confounding factor pointed out by researchers includes the issue of competitive absorption of carotenoids. As the AREDS formula contains beta-carotene, the authors suggest that administering lutein and zeaxanthin concurrently with the original AREDS supplement (as was the case in AREDS2) could have diluted the protective effect of the latter carotenoids on the basis that significant quantities remained unabsorbed due to competitive absorption with beta-carotene.

Given this confounder, it’s not possible to conclusively say whether the addition of lutein and zeaxanthin to an AREDS-type multinutrient would yield significant additional protection against the progression of macular degeneration. For this, additional long-term studies excluding beta-carotene need to be conducted. However, more recent studies beyond AREDS2 continue to point to the substantial eye health benefits of supplementation with both lutein and zeaxanthin in individuals with macular degeneration as well as in those who are healthy.

Yang-Mu Huang and colleagues from Beijing conducted a randomized, double-blind, placebo-controlled study in 112 individuals aged 50 and older with early AMD to assess changes in retinal function with lutein and zeaxanthin supplementation.

The researchers divided study subjects into four groups, including placebo, 10 mg lutein, 20 mg lutein, and 10 mg of lutein plus 10 mg of zeaxanthin daily. Supplementation commenced for a two-year period, and the researchers assessed measures of retinal sensitivity at baseline, at 48 weeks, and at two years.

Results of the study showed that all groups besides placebo achieved higher macular pigment optical density scores (MPOD). A higher density of macular pigment, composed primarily of lutein and zeaxanthin, is thought to confer better eye protection. Furthermore, retinal sensitivity was significantly enhanced in the groups receiving 10 and 20 mg of lutein daily versus placebo. While the authors clarified that the duration of the current study was too short to determine whether lutein supplementation reduces the progression of AMD, lutein supplementation was clearly shown to enhance parameters of retinal function.

Researchers in the field of carotenoid and eye disease research recently published a study in which they took a different approach to looking at the relationship of lutein and zeaxanthin in preventing AMD. Led by Kristen Meyers of the University of Wisconsin School of Medicine and Public Health,

the group analyzed data from the CAREDS (Carotenoids in Age-Related Eye Disease Study) cohort, which was an ancillary study within the Women’s Health Initiative Observational Study, conducted between 2001 and 2004. The researchers developed a genetic model based on the presence of SNPs (single nucleotide polymorphisms, or variations in DNA occurring where a single nucleotide on a chromosome differs within populations) from 24 candidate genes dealing with carotenoid status, including those related to the binding, metabolism, or transport of macular carotenoids. These gene variants were assessed for their association with AMD. The genetic model was developed to allow for scoring of genetic risk and was found to be able to significantly distinguish between AMD cases and controls. Variants in specified genes were associated with the serum and/or macular status of the carotenoids lutein and zeaxanthin.

Using the genetic model on the CAREDS cohort, the researchers found that those women in the highest quintile of genetic risk score had an odds ratio of 3.1 for having AMD compared to women in the lowest quintile of risk score. According to the researchers, this genetic model significantly adds to the body of evidence indicating a protective role of the macular carotenoids lutein and zeaxanthin against the risk of AMD.

Rong Liu and colleagues from Xi’an Jiaotong University in Xi’an, China, conducted a recently published meta-analysis of randomized controlled trials to evaluate visual performance with lutein and zeaxanthin supplementation in individuals with AMD.

Eight trials involving 1176 individuals with AMD were included in the meta-analysis, with the main outcome measures involving visual acuity, contrast sensitivity, glare recovery time, and subjective perception of visual quality.

Of the eight studies selected, six were conducted in Europe, one in China, and one in the United States. The duration of the studies was between 6 and 36 months, while the dosage of lutein ranged between 6 and 20 mg per day and zeaxanthin between 0 and 10 mg per day. The final analysis found that supplementation with lutein and zeaxanthin resulted in significant improvements in visual acuity and contrast sensitivity in individuals with AMD. The results also showed that the magnitude of benefits increased in a dose-dependent fashion. In addition, the authors noted that the improvement of MPOD levels in study subjects significantly correlated to the improvement of visual acuity and contrast sensitivity, indicating a significant benefit of lutein and zeaxanthin supplementation in those with AMD.

While macular degeneration is a disease often associated with aging eyes, research is also pointing to the ability of lutein and zeaxanthin to enhance visual function in young, healthy individuals. Emily Bovier from the State University of New York, Oswego, (Oswego, NY), and Billy Hammond from the University of Georgia (Athens, GA) recently conducted a randomized placebo-controlled trial to assess the effects of lutein and zeaxanthin on visual processing speed in young healthy adults.

 Individuals aged 18–32 were enrolled in this four-month trial and randomized into three groups: the first group consumed a zeaxanthin supplement (20 mg daily); the second consumed a combination supplement containing 26 mg zeaxanthin, 8 mg lutein, and 190 mg of fatty acids from fish oil; while the third group consumed a placebo. The researchers assessed the subjects for changes in MPOD and a measure of temporal vision known as temporal contrast sensitivity function (tCSF). Increases in MPOD and tCSF were noted in both supplemental groups, while no change was seen in the placebo group. The magnitude of effect was similar in both groups receiving the zeaxanthin and lutein supplements, translating to a nearly 20% increase in MPOD and a corresponding 20% increase in temporal processing speed from baseline levels. These results are significant in that the study highlights the benefits of zeaxanthin and lutein supplementation in a young population that is already at peak function, indicating that the use of xanthophyll carotenoids can further optimize visual function beyond normal levels.

In a second double-blind placebo-controlled study, Billy Hammond and colleagues from the University of Georgia investigated the impact of lutein and zeaxanthin supplementation on recovery from photostress, glare, and chromatic contrast.

 Photostress occurs with intense, short-term exposure to bright light, while chromatic contrast refers to the ability to distinguish colors. Similarly, glare can cause discomfort and disability, leading to a reduction in visual performance. In this year-long study, 150 young, healthy participants were randomized to a supplement consisting of 10 mg lutein and 2 mg zeaxanthin daily, or a placebo. The results of the study showed that the lutein and zeaxanthin supplementation increased MPOD and significantly improved chromatic contrast as well as recovery time from photostress. Glare recovery trended towards improvement, but the changes were not statistically significant. This study provides further evidence for the ability of lutein and zeaxanthin to enhance visual performance in young, healthy subjects.

In an interesting study on Chinese drivers, Yuan Yao and colleagues from Shanghai Jiao-tong University in China conducted a one-year trial to assess the effects of lutein supplementation on visual performance.

In the study, the researchers recruited 120 healthy participants between the ages of 25 and 47 who were employed as drivers with a daily average working time of 10 hours over the previous two years. The randomized, double-blind, placebo-controlled study consisted of drivers supplementing with lutein (20 mg/day) or a placebo and included assessments for visual acuity, MPOD, and visual performance. At the end of the one-year study period, participants in the lutein group had significant increases in MPOD, while no changes in MPOD, were noted with placebo. Additionally, lutein supplementation significantly improved contrast and glare sensitivity, which are particularly important attributes for driving during the day and at night. Furthermore, drivers were asked to complete the National Eye Institute 25-Item Visual Functioning Questionnaire, a validated measure of visual function. Those in the lutein group showed significant improvements in the driving subscale of the standardized questionnaire. The investigators also noted a trend towards enhanced visual acuity in the lutein group; however, the improvements in visual acuity did not reach levels of statistical significance. These results pointed to substantial benefits of lutein for drivers, especially while driving at night or under low-light conditions.

The central role of lutein and zeaxanthin for eye health is abundantly clear from the research. The importance of these xanthophyll carotenoids from a functional and structural point of view in the retina and macula of the eye make them indispensable nutrients for healthy vision. Additional research will ultimately reveal the extent of their ability to prevent the progression of eye diseases like AMD; however, supplementing with these nutrients is a sensible strategy in the elderly at risk for advanced eye diseases as well as in young, healthy individuals looking for an edge to optimize their already healthy vision.

Lutein supplier OmniActive Health Technologies (Morristown, NJ) is one supplier committed to spreading the word that lutein benefits all. The company rang in the second anniversary of its award-winning 

 campaign at the 2015 Natural Products Expo West trade show in Anaheim.

The goal, says Lynda Doyle, OmniActive’s vice president, global marketing, is to raise awareness not only among industryfolk but also among consumers and healthcare providers. “We’re trying to educate about the importance of early and consistent lutein intake over a lifetime-so starting young and continuing on-because if you think about macular degeneration, that doesn’t happen overnight,” she told 

. Instead, AMD is the result of “a constant bombardment of the different stressors of your eye over a lifetime,” including heavy use of computers, tablets, and other electronic devices. The company is now boosting the social media arm of its campaign, ironically and sensibly, to reach those very consumers staring at tablets and smartphone screens daily.

Vishwanathan R et al., “Macular pigment optical density is related to cognitive function in older people,” 

Wong WL et al., “Global prevalence of age-related macular degeneration and disease burden projection for 2020 and 2040: a systematic review and meta-analysis,” 

vol. 2, no. 2 (February 2014): e106–116

Age-Related Eye Disease Study 2 Research Group, “Lutein + zeaxanthin and omega-3 fatty acids for age-related macular degeneration: the Age-Related Eye Disease Study 2 (AREDS2) randomized clinical trial,”

vol. 309, no. 19 (May 15, 2013): 2005–2015

Huang YM et al., “Changes following supplementation with lutein and zeaxanthin in retinal function in eyes with early age-related macular degeneration: a randomised, double-blind, placebo-controlled trial,” 

Meyers KJ et al., “Genetic determinants of macular pigments in women of the Carotenoids in Age-Related Eye Disease Study,” 

Nutritional Outlook Vol. 18 No. 3

Oral Health and the Role of Dietary Supplements

Are Health Food Stores Losing Relevance?

Next Stop: Turmeric Beverages

Dietary Supplement and Natural Product Brand Building: From Lightbulb to Launch

Branded Ingredients for Food, Dietary Supplements: A Two-Way Street

Lutein and Zeaxanthin Benefit Young and Old Alike

Dietary Supplement Packaging: Pouch Power

Probiotics Opening New Doors

Ingredient Spotlight: Salacia oblonga

Mood and Relaxation Dietary Supplements: Hope in a Bottle

Freedom to Operate

NY AG, GNC Reach Agreement. But Is It a Mistake?

Who Is the Dietary Supplement Shopper Today?