Natural Foods Merchandiser

American Top 25: Supplements Climbing the Charts

After 25 years in the business, we at The Natural Foods Merchandiser know that what sells now may be a dog next year, while other products, once hot, stay hot. As we celebrate a year full of ?Top 25s,? here?s our list of fastest-growing supplements, based on sales data from Information Resources Inc. For complete details, look back to the herbal, nonherbal and mineral supplements charts in our June Market Overview issue.

1. Policosanol
Policosanol leads the list with a sales increase of 26,290.9 percent in 2003, though it only accounted for .019 percent of total sales that year. According to User?s Guide to Policosanol and Other Natural Ways to Lower Cholesterol (Basic Health Publications Inc., 2003), policosanol is derived from wax and can help maintain healthy cholesterol levels and reduce other heart-related risks. ?Policosanol has been shown to effectively reduce harmful LDL cholesterol by 25 to 30 percent and increase good HDL cholesterol by 15 to 25 percent. Even better, it prevents LDL cholesterol from becoming oxidized, decreases blood clot formation, promotes circulation and reduces inflammation of the artery walls,? according to User?s Guide. However, Anthony Almada, founder and chief scientific officer of IMAGINutrition, warns that policosanol supplements found in the United States may be imposters of the real thing. ?Policosanol comes from Cuba, and because of the Cuban embargo, true policosanol is not available in the U.S. The supplement that is used here is chemically different than Cuban policosanol and has not been proven to work in any controlled studies,? he says.

2. Bone Meal
Dollar sales of bone meal rose 432.5 percent for the year ending January 2004. A dried, processed powder made from finely ground bones (usually bovine), bone meal?s high calcium and phosphorous content is believed to give it efficacy in promoting the health of human bones and teeth. In the Textbook of Nutritional Medicine (Third Line Press, 2000), Melvyn Werbach and Jeffery Moss describe a Canadian study in which bone meal proved effective for the treatment of children with growing pains. All of the subjects who received bone meal, vitamin A and vitamin D were ?completely relieved? of symptoms, while only 40 percent of the subjects receiving dicalcium phosphate, vitamin A and vitamin D found relief. Because it has been shown to contain lead, naturopathic physicians like Alan Christianson, NMD, based in Scottsdale, Arizona, are ?wary? of using it. Consumers are advised by Michael Murray and Joseph Pizzorno in their Encyclopedia of Natural Medicine (Prima Lifestyles, 1997) to ensure that the lead levels in the bone meal products they ingest do not exceed the ?recommended level of 1 mcg per 800 mg of elemental calcium.?

3. Wheat Germ
IRI reported an 80 percent increase in dollar sales of wheat germ. Wheat germ is essentially the ?embryo? of an unprocessed wheat kernel (wheat berry). Christianson calls wheat germ ?one of the real good superfoods ? [one that] gives a fair dose of vitamin E, some B vitamins, zinc and some minerals.? Wheat germ is believed to improve colon function, nourish the skin, lower cholesterol and boost the immune system. Wheat germ is available in its natural flaked form, as well as in an extracted oil form. In his New Herb Bible (Fireside, 1992), Earl Mindell advises people with dry skin to use soaps containing wheat germ oil to minimize the depletion of the natural, protective oils in the skin. In The Natural Pharmacy (Prima Lifestyles, 1999), Schuyler Lininger Jr., D.C, et al., say that preliminary studies on the octacosanol present in wheat germ oil ?had promising effects on endurance, reaction time, and other measures of exercise capacity.?

4. Lycopene
Lycopene?s sales increased by 56.2 percent in 2003. According to the Natural Health Bible (Prima Lifestyles, 1999), lycopene is found in tomatoes and grapefruits and belongs to the family of chemicals known as carotenoids, which give color to fruits and vegetables. A diet high in lycopene may reduce the risk of prostate cancer as well as other types of cancer. It may also help prevent cataracts and macular degeneration, which are the leading causes of blindness in the United States. Observational studies have found people who eat large amounts of tomatoes have a lower incidence of prostate cancer, and that elders who eat numerous tomatoes have low rates of cancer as well. No double-blind studies have studied lycopene. Almada suggests that lycopene?s allure comes from its association with tomatoes. He also stresses the need for more extensive research about lycopene. ?The studies surrounding lycopene have not tested the supplement itself, but have only observed people who eat tomatoes—their positive results could have come from any nutrient in the tomatoes, not just lycopene,? he says.

5. Essential Fatty Acids
Essential fatty acids had a sales increase of 50.3 percent over 2002 and represented 11.5 percent of supplements? total dollar sales. The two main groups of EFAs are the omega-3 and the omega-6 families, which are both polyunsaturated hormone-like substances and ?have an important effect on immune function, smooth muscle function, platelet aggregation and inflammation,? according to Textbook of Nutritional Medicine. Greenland Eskimos, who eat a diet high in omega-3 fatty acids, have a very low instance of degenerative diseases such as arthritis. A good source of omega-3 fatty acids is cold-water fish, while oils rich in linoleic acid, such as evening primrose oil, provide omega-6. Flaxseed oil is a very popular omega-3 supplement, though Almada says that evidence supporting the effectiveness of flax or other plant-derived omega-3 supplements is lacking when compared to that of fish oil. ?People who eat plant-derived omega-3s may not be getting all the benefits they would from eating the long chain omega-3s found in fish and algae,? he says.

6. Liver
IRI recorded a 42.7 percent increase in dollar sales of liver supplements. Christianson says that liver extracts are ?a decent source of iron and B vitamins that may have some use as an adjunctive treatment for iron deficiency anemia.? In the Encyclopedia of Natural Medicine, Murray and Pizzorno cite one study whose hepatitic subjects saw a reduction in liver enzyme levels following liver extract supplementation. This decrease in enzyme levels, Murray and Pizzorno say, suggest that liver extract is ?effective in treating chronic hepatitis.? Similarly, The Natural Medicines Comprehensive Database (Therapeutic Research Faculty, 2003) notes liver extract?s ability to ?stimulate liver cell proliferation in experimental animals after partial hepatectomy.? Michael DiPalma, N.D., in Nature?s Medicine (Rodale, 1999) advocates liver extract supplementation for anemics, saying that it contains ?all the things that your body needs to rebuild blood.?

7. Lutein
Lutein sales brought in more than $7 million in 2003 and saw a sales increase of 34.8 percent. Like lycopene, lutein belongs to the carotenoid family. ?Recent evidence has found that lutein may play an important role in protecting our eyes and eyesight. It may work in two ways: by acting directly as a natural sun block, and also by neutralizing free radicals that can damage the eye,? according to Natural Health Bible. Leafy green vegetables, like spinach and kale, are the best source of lutein. Observational studies show that people who eat a diet high in lutein are less likely to have eye and vision problems, though no double-blind studies have been performed on pure lutein. ?Evidence is still blurry in terms of what lutein supplements do for preventing macular degeneration because there is no supplement of pure lutein on the market,? Almada says. ?Instead you can find lutein-rich marigold extracts. Like with lycopene, it?s difficult to tell where the benefits come from: lutein, or other nutrients found in marigolds. More studies are needed to prove the benefits of pure lutein.?

8. Green tea
As news of green tea?s versatility spreads, its sales increase—up 32.4 percent between 2002 and 2003, with total sales last year of $2.4 million. Green tea is packed with polyphenols, which give it antioxidant, anticarcinogenic and antibiotic properties. In essence, it?s a wonder drink that can help lessen and prevent cancer, reduce cholesterol, lower blood sugar and prevent the flu. These claims are backed by strong science—the National Library of Medicine lists 1,484 journal articles detailing green tea studies. ?There?s an impressive array of science supporting green tea?s antioxidant effects and its cholesterol-lowering effects, and a growing number of epidemiological evidence supports its ability to prevent certain cancers,? says Mark Blumenthal, executive director of the American Botanical Council. Green tea?s active components include catechin, which has been found in human and animal studies to be effective for treating and reducing gastrointestinal cancers. A 1990 Japanese study linked catechin with a reduction in influenza among study participants. Green tea also contains polysaccharides, which have been found to reduce blood sugar.

9. Black cohosh root
Black cohosh root?s success in treating menopausal symptoms drove a 26.2 increase in sales between 2002 and 2003. Total 2003 sales were $15.7 million. ?Since the Women?s Health Initiative [hormone replacement therapy] study was halted in July 2002 [due to findings about the negative effects of HRT], the obvious interest and demand for black cohosh has skyrocketed. There?s also been a much higher interest among gynecologists,? Blumenthal says. He notes that there are ?a dozen or more clinical studies? detailing black cohosh root?s success in preventing menopausal symptoms, particularly hot flashes, perspiration and mood swings. The Complete German Commission E Monograph (Integrative Medicine Communications, 1998) approves black cohosh root for menopausal symptoms ranging from hot flashes to insomnia, and for premenstrual discomfort. The British Herbal Compendium (British Herbal Medicine Association, 1992) adds rheumatism, rheumatoid arthritis and tinnitus to the list of ailments, and the American Herbal Pharmacopoeia monograph on black cohosh adds epilepsy, depression and anxiety; hypertension; premature labor; cramps during pregnancy; and postpartum pain.

10. Silicea
Silicea had a 22.6 percent sales increase in 2003, though it only accounted for .022 percent of total supplement sales that year. Derived from flint, Silicea is a homeopathic remedy used for the treatment of abscesses, acne, acute arthritis, breast inflammation, ear infection, chronic headaches, knee conditions, mental fatigue, milk intolerance and low self-esteem, among others, according to Homeopathic Remedies, (Avery Publishing Group Inc., 2000). Dana Ullman, author of eight homeopathic books, recommends Silicea to fortify hair and nails. ?Silicea is a homeopathic dose of silica, which helps the body strengthen hair and nails, especially for people who have some susceptibility to weakness in those areas. It is safe and effective when taken in 6c or 12c doses two to four times a day for one or two weeks,? Ullman says.

11. Pau d?arco
This supplement, made from the inner bark of the South American lapacho tree, posted a 22.3 percent increase in sales between 2002 and 2003, but total 2003 sales were only $87,761. Pau d?arco?s claim to fame is cancer prevention. However, Blumenthal says a 1960s National Cancer Institute study found that lapachol, an ingredient in pau d?arco, had anti-tumor activity, but only in dosages so large they were unsafe. ?The jury?s still out as to what pau d?arco?s true benefit is,? Blumenthal says. The National Library of Medicine lists only eight journal articles about pau d?arco as a supplement, and several of those studies are critical of pau d?arco?s cancer-preventing capabilities. A 2001 Brazilian study found pau d?arco had analgesic, anti-inflammatory and diuretic properties when given to mice and rats.

12. Coenzyme Q10
Co-Q10 sold more than $45 million in 2003, and increased its sales by 20.8 percent that year. According to the Natural Health Bible, Co-Q10 is a naturally occurring antioxidant found in every cell of the human body. Its principal uses include treatment of congestive heart failure and other forms of heart disease, high blood pressure, gum disease and nutrient depletion caused by various medications. It has also been used for treatment of AIDS, cancer, obesity and muscular dystrophy. ?Co-Q10 appears to assist the heart during times of stress on the heart muscle, perhaps by helping it use energy more efficiently. ? At least [nine] double blind studies have found that Co-Q10 supplements can improve symptoms [of CHF] and heart function,? according to the Natural Health Bible. Almada believes Co-Q10 plays another important role for individuals lowering their cholesterol through the use of statin drugs. ?Studies have shown that taking statin drugs, which are very effective in lowering cholesterol, also lower Co-Q10 levels in the blood and muscles. One of the side effects of statin drugs is muscle pain, and to combat this, taking a Co-Q10 supplement would be wise,? he says.

13. SAM-e
At No. 13, SAM-e was responsible for 3.94 percent of total supplement sales in 2002 and increased its sales by 20.3 percent over 2002. SAM-e (nonabbreviated name S-adenosylmethionine,) is made up of the amino acid methionine and ATP, the body?s main energy molecule, according to the Natural Health Bible. The body produces SAM-e naturally, but deficiencies in methionine, folic acid or vitamin B12 can cause a reduction in SAM-e levels. As a supplement, SAM-e is used to treat osteo-arthritis, depression, some diseases of the liver and the muscle condition fibromyalgia. ?Double-blind studies suggest that SAM-e is about as effective as standard anti-inflammatory drugs? for the treatment of arthritis, working in the same way that the supplements glucosamine and chondroitin do. Furthermore, notes the Natural Health Bible, ?Several double blind studies have found oral SAM-e to be an effective treatment for depression,? although they were performed on too small a number of participants to provide authoritative evidence. Almada classifies SAM-e as an ?expensive alternative? to glucosamine for arthritis and St. John?s wort for depression. ?SAM-e shows decent effectiveness in studies but is no better than other supplements. It?s popular because of its exotic, unknown name,? he says.

14. Royal Jelly
Royal jelly saw an 18.3 percent increase in dollar sales for the year ending January 2004. Royden Brown, author of the Bee Hive Product Bible (Avery, 1993), touts royal jelly as ?one of nature?s best kept secrets.? A blend of proteins, vitamins, minerals and amino acids, royal jelly may impart health benefits to humans when used in supplements and skin care products. The pantothenic acid present in royal jelly, for example, has been shown to ?increase the life span of white mice,? and, Bee Hive says, its gamma globulin is said to help the body internally ?fight against bacteria, viruses and toxins.? A human trial described by Shawn Talbott in A Guide to Understanding Dietary Supplements (Haworth Press, 2003) demonstrated that hyperlipidemic subjects receiving daily royal jelly supplementation saw a ?significant reduction in total serum lipids (10 percent) and cholesterol (14 percent).? Christianson says, ?[R]oyal jelly may have some efficacy as a general adaptogen for maintaining stress response.?

15. Alpha-Lipoic Acid
With a sales increase of 17 percent over 2002, alpha-lipoic acid has been shown to help treat individuals with AIDS by inhibiting HIV activation, notes the Textbook of Nutritional Medicine. Furthermore, alpha-lipoic acid also increases glutathione levels in the body. Glutathione is an antioxidant that protects against cataracts in the eye; supplementing with alpha-lipoic acid may reduce the risk of cataracts in the elderly. A study done on rats showed that alpha-lipoic acid protected 60 percent of the animals from experimentally induced cataracts. Though alpha-lipoic acid gained popularity through its presence in cosmetics, Almada finds it useful to only a very select population in the United States. ?Lipoic acid, when taken orally, has only been shown to have a significant effect on diabetic individuals with peripheral neuropathy (nerve damage), and they would have to take 600 mgs per day to feel effects. Most products contain no more than 200 mgs,? he says.

16. Potassium
Potassium accounted for almost 3 percent of total sales and increased its sales by 15.4 percent in 2003. ?Potassium is one of the major electrolytes in the body [and] is an essential mineral we get from many common foods ? including bananas, orange juice, potatoes and avocadoes,? reports The Natural Health Bible. It is commonly used to treat high blood pressure and kidney stones. Potassium is also beneficial for balancing sodium levels in the body. Several double-blind studies have proven potassium?s effectiveness in treating high blood pressure, especially for individuals who consume too much salt. According to The Natural Health Bible, potassium supplements also reduced the average number of kidney stones from 1.2 per year to only .1 per year in patients with chronic kidney stones. Almada believes that the current low-carb trend could increase potassium?s popularity. ?The two pleasurable tastes in food are sweet and salty. If you take away carbs, you take away sweetness, so people will be eating a lot of salty foods. The more salt you eat, the more potassium you need to balance that out.?

17. Elderberry
The flowers from the European elder or black elder shrub are becoming popular supplement ingredients—elderberry sales totaled $423,976 in 2003, a 14.6 percent increase from 2002. Blumenthal believes elderberry sales are poised to skyrocket for several reasons: ?There?s an increasing amount of research coming out of Israel and Europe on the immunostimulating and immunomodulating effects of elderberry. It?s also very tasty. You can make a delicious herbal concoction with elderberry syrup.? A 1995 double-blind Israeli study found that 27 children and adults who took elderberry had half the recovery time from B Panama epidemic influenza than those who took placebo. Commission E Monograph and the British Herbal Compendium recommend dried, sifted elderberry flowers for colds and fever.

18. Horny goat weed
Despite its comical name, horny goat weed sales are no laughing matter: They totaled $2.5 million in 2003, up 13.9 percent from 2002. Horny goat weed has been used in China as a male aphrodisiac for more than 2,000 years, after goat herders discovered their charges became randy while eating the weeds. However, there have been few scientific studies on the plant, also known as Epimedium glandiflorum or yin yang huo. ?I don?t know of any clinical trials. I haven?t seen any good research,? Blumenthal says. ?But in a post-Viagra economy, anything goes, even with only a modicum of evidence of its efficacy.?

19. Spirulina
Spirulina, also called blue-green algae, saw a 13.5 percent increase in dollar sales for the year ending January 2004. Rich in carotenoids and nutrients (including all of the essential amino acids), spirulina is gaining support from an increasing number of studies for claims that these microorganisms have antiviral, antimutagenic and cholesterol-lowering properties. In A Guide to Understanding Dietary Supplements, Talbott describes a test-tube study in which Spirulina platensis ?was effective in inhibiting HIV-1 replication and infectivity by up to 50 percent.? Another study showed a ?complete regression of oral cancerous lesions? among 45 percent of its tobacco-chewing subjects who received daily spirulina supplements for one year. Naturopathic physician Christianson says, ?Although spirulina contains a lot of nutrients ? its B12 is not an isomer that is metabolically active in humans.? As such, Christianson counsels his vegan patients ?against relying on it as a source of B12.? Available in tablet and capsule form, spirulina may also be added to food or juice in powder form.

20. Chlorophyll
Dollar sales of chlorophyll rose 12.6 percent for the year ending January 2004. A group of related green pigments found in photosynthetic organisms, chlorophyll is believed to detoxify, heal wounds and combat unpleasant odors. The Alternative Pharmacy (Prentice Hall, 1998) cites a study in which the symptoms associated with a subject?s rheumatoid arthritis were ?significantly lessened? following supplementation with a chlorophyll-containing green drink. The Natural Medicines Comprehensive Database notes that ?derivatives of chlorophyll which have been extracted from silkworm droppings seem to have a cytotoxic effect on certain cancer cells.? Unlike the fat-soluble chlorophyll we get from foods, Christianson explains, liquid chlorophyll concentrates are water soluble. ?This water-soluble form of chlorophyll,? he says, ?is a very effective deodorant for the intestinal tract, but because it is not actually absorbed across the gut lining, it doesn?t actually get in your blood and do things outside of the intestinal tract.?

21. 5-HTP In 2003, 5-hydroxytryptophan increased its sales by 12.4 percent. James South writes in ?5-hydroxytryptophan: The Serotonin Solution,? in Nutritional News, 5-HTP is a breakdown of the amino acid tryptophan, which is found in most protein foods. It is a precursor to serotonin (5-HT) and is used to treat depression, insomnia and fibromyalgia, according to Vitamin Research Products Inc. 5-HTP is not chemically synthesized like other anti-depression drugs but is derived from the seeds of the griffonia plant. A symptom of low serotonin levels is carbohydrate cravings; eating carbohydrates has been shown to increase serotonin production in the body. Once serotonin levels are raised, the cravings subside. Almada predicts that 5-HTP, like potassium, will fit into a low-carb lifestyle. ?When 5-HTP was first introduced, it was hailed as being the natural Prozac and a stimulant-free weight-loss agent,? he says. ?With the popularity of low-carb diets right now, 5-HTP could see a rebirth as a diet aid.?

22. Magnesium
Magnesium increased its sales by 12 percent over 2002 and was responsible for a little more than 4 percent of total supplements sales that year. Magnesium deficiency can cause a number of common ailments, such as milk intolerance, PMS and insomnia, according to Homeopathic Remedies. Magnesium is an essential trace element found in the human body and magnesium supplements are ?used for headaches, as a laxative and for lowering blood pressure,? says Almada. Almada also suggests that magnesium be taken for the same reason calcium is—to strengthen bones. ?The major four ingredients in bone are magnesium, calcium, zinc and phosphorous, but we are a calcium-centric nation. Women don?t buy a multi-mineral supplement, but only a calcium supplement, and are therefore not getting enough magnesium.?

23. Calcium
Dollar sales of calcium rose 9.3 percent for the year ending January 2004. The most abundant mineral in the body, calcium is essential to the health of bone and other body functions, including ?nerve transmission, muscle contraction, glandular secretion, cell membrane permeability, respiration, renal function and blood coagulation,? reports The Natural Medicines Comprehensive Database. Calcium supplementation has proven to prevent osteoporosis, and also has proven efficacy in the treatment of high blood pressure, PMS and pregnancy-related leg cramping. Because reduced levels of estrogen cause a decrease in calcium absorption and retention, calcium supplementation is recommended for ?pregnant and breast-feeding women, adolescent girls and postmenopausal women,? says The New Encyclopedia of Vitamins, Minerals, Supplements, & Herbs (Bookman Press, 1998). The percentage of elemental calcium present in a supplement depends upon its accompanying compound. Because calcium citrate is a ?clean, well-absorbed and readily available form of calcium,? Christianson says, it?s ?probably your best bang for the buck.?

24. Cranberry
This fruit from a bog plant native to North America accounted for $13 million in 2003 sales, up 9.2 percent from 2002. The tiny berry?s popularity stems from its ability to limit adhesion of E. coli bacteria to the cell wall of the urinary tract, thus preventing infections. ?There?s a significant amount of impressive evidence—more than 15 clinical studies—that show without any doubt that drinking 8 ounces of cranberry juice cocktail per day does significantly reduce or prevent urinary tract infections,? Blumenthal says. He also notes a couple of studies that show that freeze-dried cranberry juice in capsule form can be equally effective as a glass of juice, provided the capsules are taken with water. Other studies have found that cranberries are high in antioxidants and flavonoids and can help prevent kidney stones, stomach ulcers, gum disease, arteriosclerosis and cancer.

25. Evening primrose
Evening primrose?s versatility in treating everything from eczema to premenstrual syndrome contributed to a 7.6 percent increase in sales between 2002 and 2003. Total sales for 2003 were $6.5 million. The seeds from this North American wildflower contain up to 25 percent oil, which is enriched with the omega-6 EFAs linoleic acid and gamma linoleic acid. While there?s no question about evening primrose?s nutritional importance, Blumenthal questions its other health claims. ?It?s not one of those herbs that can be pigeonholed in a narrow bandwidth of benefits. But the problem is that the research has been somewhat equivocal to support all those benefits. It?s hard to find one or two really direct benefits that are strongly supported by evidence.? Evening primrose has been claimed to prevent hair loss, eczema, poor wound healing, liver and kidney degeneration, poor immune and reproductive system function, PMS, diabetic-induced nerve injury and breast tenderness. There are a couple studies supporting the latter two functions; however, Blumenthal notes that ?there are no clinical studies strongly supporting evening primrose?s benefits on eczema, and compelling evidence on PMS is equivocal.?

Kristen Lewis is a free-lance writer in Arvada, Colo. Christine Spehar is a free-lance writer in Boulder, Colo. Vicky Uhland is a a free-lance writer in Denver.

Natural Foods Merchandiser volume XXV/number 7/p. 44, 46, 48, 50, 52

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