There is a critical shift happening. We are moving from managing disease to managing health. Consumers are motivated to be healthy more than ever. COVID-19 has taught us a lot about minimizing our risk, and focusing on wellness and prevention in our lives. Anita and John dig into what this shift means to the consumer healthcare industry and specifically the dietary supplements category.
- Episode Transcript
Anita Brikman: Hey, everybody. Thanks for tuning into the Consumer Healthcare Product Association's podcast. I'm your host, Anita Brikman. Settle back, tune in and hopefully learn something new as we chat. Today, we're going to be talking about trends and insights in the consumer wellness and dietary supplements category, a huge category that has gotten a lot of attention, especially during COVID-19. Joining me now is CHPA'S Dr. John Troup. He's our new vice president of scientific affairs and dietary supplements. Pretty fancy title, John.
John Troup: Hi, Anita. So great to be here with you today.
Anita Brikman: You joined us literally as the pandemic was happening. I mean, what was that like? Where did you move from to Washington, DC as all of this was happening around the world?
John Troup: Yeah. Like everybody else, I think it was such a surreal time and maybe still is a surreal time, although I think we've all gotten at least used to this new normal. But at the time I don't think anybody expected that eight months later, we'd still be watching what we do and where we go and what we touch and who we talk to. So, it was an adaptation at first, but I think that what's been most amazing to me in looking, at least, backwards in the last eight months is the behavioral changes that have been created across society, particularly as related to what we think about and how we want to manage our own health.
Anita Brikman: It really has been a time, I believe, a call to action to pay closer attention to what we can personally do to stay healthy, get healthy after an illness, et cetera, as opposed to always thinking that, "I have got to get a doctor's advice before I go down this path." There seems to be a lot of interest and curiosity and empowerment going on.
John Troup: Yeah. I think that that's really the case and it's more true today than ever before, right? I think that America for the last 20 years, really, maybe even longer, has been on this trajectory of compromised health. The incidents and prevalence of chronic health issues has been at an all-time high. And if there's a positive side to what COVID-19 did to our consumer behaviors, is that it's increased the awareness and emphasized the importance of preventive healthcare, as well as early stage management. There are things that we can do. There are things that, as consumers, we need to do to try to help make us stronger from a health point of view and more effective in maintaining a positive lifestyle.
Anita Brikman: As a former healthcare journalist, I have covered, for years, the rise in obesity in this country, the incidence of diabetes, type two in young children. I mean, some really scary stuff. And I think what you're saying is we need to take a look and say, "Okay, these preexisting conditions, this isn't just a lifestyle choice anymore. This can have an absolute impact on my health immediately, and if I get COVID-19, can make it worse." We've always talked about the dangers of heart disease, diabetes, carrying extra weight, high blood pressure. All of those kinds of things have been part of the wellness story that I've been telling for years or trying to educate people about. But there seems to be a greater urgency that this is not something that may hurt me down the line, but it could hurt me right now.
John Troup: Yeah, definitely. One of the things that I think has been emphasized during this time is, what is our health system all about? And sadly, our health system has been really focused on trying to manage disease as opposed to managing health. And that's been a critical shift that's taking place, right? So, when people have diabetes and are obese or have complications of cardiovascular diseases, we've been taught as a healthcare system and practice to basically address the symptom and take something to solve that symptom. But what COVID has taught us, is that there are underlying risk factors. And for the first time in the public conversation, this concept of risk, am I at risk of getting the virus and can I do something to minimize that risk? That's what prevention is all about and that's why managing underlying systems to reduce that risk has become so important.
And that's why I think the dietary supplement category has been so important in the changes, in the accelerated growth that we're seeing, in the improved habits and practice of consumers, has been taking place because of this concept of preventive care, self-care and personalized health needs that consumers are really motivated to pursue today.
Anita Brikman: How do dietary supplements help address some of those risk factors?
John Troup: One of the things that's really important for everybody to realize, I think, is that there are so many nutrient gaps that exist in everyone. And a lot of that has been driven by, sadly, poor choices, poor dietary choices, poor food choices, poor lifestyle choices. And so we all have, or many of us at least, have underlying gaps in our nutrient profiles. And so short of just starting to eat better and trying to find more healthy foods to eat, which is really pretty tough to do, dietary supplements helps address those gaps and helps fill those gaps quite quickly. So, in a matter of really six to 12 weeks, it's possible with the appropriate supplementation choices, depending on your own personal profile that you would get when you, in particular, work with your healthcare provider, you'll be able to fill. And so if nothing else, the most important benefit that dietary supplements provides is that ability to fill the gaps, reduce the risk of complications and progressions into compromised health states. And then really make sure that you meet all the nutrient gaps to stay healthy.
Anita Brikman: But how do I know what my gaps are? You said, talking to your doctor. I don't really know. I mean, is this blood work that tells me what my gaps are? Right now I'm just taking more vitamin D and vitamin C for immunity, because I believe it's the right thing to do and I've read a lot in the press about it, but I don't necessarily know that I have a deficiency.
John Troup: Yeah. So, the good news is that there's some general guidelines that we can discuss that every consumer should be aware of. So, it starts with just an awareness of nutrient requirements. And at the same time that COVID has been taking place, the USDA had a Dietary Guidelines Committee to establish new guidelines for 2020 to 2025. And their guidelines have been based off of an analysis of population statistics looking at nutrient intakes and then the nutrient gaps. So, across the board, upwards to 60 to even as high as 80% of the population are experiencing deficiencies in vitamin D, probably some under nutrient intakes in vitamin C, vitamin E, and even other minerals like magnesium. So, right off the bat, the general rule of thumb is, I've got to try to eat foods, first of all, that'll give me those nutrients in particular. The chances are, I'm not.
So, I should look at and consider taking a supplement for vitamin D, vitamin C, magnesium, omega-3 essential fatty acids as an example, and that will strengthen the foundation of health. And that's the first step. You have gaps. Number two is there are things that you can do from a nutrient point of view to strengthen your foundation of health. And just start there, knowing that the third issue is immune response is the critical issue during COVID-19. You have to find ways to strengthen your health foundation and in particular strengthen your immune system response. And so those nutrients will help do that. And then after that, if you are still interested in even a greater degree or depth of personalization, then go see your healthcare provider, then go and consider laboratory diagnostics and dive in deeper to address any more serious gaps that you think you might have.
Anita Brikman: Great advice. So, now we're talking about the public being very concerned about their immunity, about being able to fight off COVID-19, if in fact they get it. How do people know that what they're buying is the real deal? I mean, I think that there is a feeling of lack of trust at times, as far as the way dietary supplements are regulated or the misconception that they're not regulated at all and that it's kind of a wild west. How do people ensure that what they think they're buying, be it online or in the store or wherever, how do they ensure that they are getting what they think they're getting?
John Troup: Right. Well, first of all, the category does have a regulatory framework. It is a regulated category. It's not regulated in the same way that pharmaceuticals are, but it doesn't need to be. At the end of the day, these are food-derived nutrients, macronutrients and micronutrients. So, there is a regulatory framework. It requires very specific standards for good manufacturing processes and quality assurance. And that's the starting point to know where you should look for a product solution that you've identified. And that starts with identifying a well-known brand, making sure that that company and that brand you know of or you can confirm, through their online size, have robust and rigorous quality assurance programs so that when they say something on the label, you know can trust it.
You want to make sure that those brands are reputable, they've been around for a long time, and to try to avoid any brand that tries to sensationalize a claim or benefit. Because if it's sensationalized or sounds too good to be true, guess what? It probably is, or there's not enough science to support what they're saying. So, look for quality. Look for reasonable balance statements of benefit, and always choose a recognized high quality brand from, really, leading consumer healthcare companies.
Anita Brikman: What about the regulatory structure that you talked about? Does it need to be strengthened? I mean, you mentioned you want to try to avoid bad actors, but does the Food and Drug Administration have the resources to go after those bad actors and shut them down? How does that work? And maybe just to take a step back and let our listeners know, what is the framework of how it works? I don't think, if I'm not mistaken, a dietary supplement doesn't have to be FDA approved to go on the market. Is that right?
John Troup: Yeah. There's not a formal pre-market approval process, yet the FDA does have the authority to be able to monitor and to challenge any product that they believe might pose a safety threat in particular to the consumer. But that regulatory framework is defined by what's called a Dietary Supplement Health and Education Act, or DSHEA, people refer to it as DSHEA, that was first established 26 years ago in 1994. It did a great job because the number one objective of establishing that new regulatory framework in the early '90s was to be able to make sure that consumers will always have access to good nutritional products. And it did that. In 1994, there were an estimated 4,000 products that were on the market. A handful of companies. Today, there's an estimated 70,000+ products on the market, and what we're finding out is that consumers have an all-time great access to products than they've ever had before.
John Troup: And that's where the problem comes into play. It's so easy to get into this category as a business interest that in some cases, those companies who may not be as familiar as they ought to be with the regulatory framework and the standards established by DSHEA may inadvertently and advertently, admittedly, in some cases, take shortcuts, and that's the challenge. And so while the last 26 years DSHEA has done everything that it was meant to do, and still has a lot of enforcement capacity, we've identified some gaps in the last five years, and in particular, they've been emphasized in the last eight months because of COVID, that could be improved. And that's really an important consideration. Enforcement oversight can be improved. We know that claims that are being probably overstated need to be a pulled back. And then there are a series of smaller process improvements that could take place that'll help fill some of the gaps and avoid some of the sensationalized placement of products that have been coming to market just in the last eight months.
Anita Brikman: It's really interesting. I can't help but think about CBD. Because some of the claims I've seen, I mean, it's crazy and it's exploded in popularity. And where does CBD fit into all of this and how do people know what it is they're actually buying? I mean, is there a strong enough pathway to bring a CBD product to market so people know that there are some of those same kind of standards we're talking about for other dietary supplements and pharmaceuticals, quite frankly?
John Troup: Yeah. So, that's a really great example, Anita, and it describes a product that has and can have great potential in supporting the health states and foundations of a lot of consumers. But here's the problem, right? Is that currently there is no regulatory pathway for CBD or hemp oil. And in fact, it's not been formally designated as a dietary supplement. Having said that, though, there are 9,000 CBD products on the market that's been estimated. And so how could that happen? And so there's an example of a regulatory gap that exists because you've got an undefined regulatory category for a product, yet there are 9,000 products on the market. How did that happen, right? And so, as part of that, I think there's a lot of misinformation on the use of hemp oil and the active components of hemp oil called cannabidiols, or CBD for short, that not enough scientific support has been put into place by a large number of companies.
So of the 9,000 companies, I could probably count on two hands the number of companies that have followed a very scientifically robust process to demonstrate safety, what the appropriate levels of these phytoactives should be and ensuring that only the normally occurring level of these phytoactives found in hemp oil would be provided and not provided at higher concentrations that may pose a safety risk. And those are all guidelines that have been well-defined by a new dietary ingredient pathway and process by the FDA and that's followed by a number of high quality consumer healthcare companies, but it still needs to be defined formally so that people know that this is the pathway forward. And just because you got a great idea and have a source of hemp oil, it doesn't mean that you can make a product and put it on the market. And that's an example of a category and a product segment that can benefit, frankly, from a more robust regulatory framework.
Anita Brikman: Absolutely. I was thinking back a couple of years ago. I went down to see my mom who lives in a condo in Fort Myers beach and she's older and spends most of her winter down there. And I went for a walk to a flea market that was right next to her condominiums, and I was floored to see CBD products advertised everywhere for pain, for your joints, if you're having anxiety or if you're depressed. I mean, the claims that were out there, it was unbelievable. And I actually walked up to one gentlemen who had all sorts of oils and different products out on his table, and I said, "Oh, I'm just really interested. How do what the concentrations are in these oils?" He's like, "Well, I'm from Oregon. I really know exactly what's in it because I mix it in my bathtub." I was, "What?" And he was serious that he makes large batches of this stuff and I just thought, "Wow, we've got a problem here," and to your point, a major gap where hopefully we can fix some of this before someone gets hurt, right?
John Troup: Yeah. And what you describe is actually the fundamental issue that needs to be addressed and that we hope to be able to address with an update, if you will, of the regulatory guidelines. And so the issue basically is that you just can't launch a product and prey on the emotions and the motivations of consumers today. And that's the FDA's point of view. And I think that's every healthcare professionals point of view, is basically show me the data, show me the support and make sure that it's being produced consistently at a high level of reproducibility and with the actives that you put on the label that I can trust. And so consumers expect that. They expect that that's happening and they deserve no less. But unfortunately guys like the guy you just described making stuff in his bathtub, or when he goes to larger scale and is in his garage, that's a problem.
And so we have to encourage people and help companies that, while the business hurdles can be low and manageable for the entrepreneur, that's fantastic. The safety standards can't be lowered and those safety standards are defined by regulatory frameworks. And that's why it's important for us to be advocates for the highest possible standards to help make sure that consumers, when they make a choice to enter this category, they know that a quality product can always be there for their selection.
Anita Brikman: That's why we're so happy to have you with us at the Consumer Healthcare Products Association, because we are champions of quality so that people across this station and around the world can trust what it is that they're buying and putting into their bodies or on their bodies. What needs to happen as far as modernization of DSHEA? Who needs to be at the table and what are some action steps that could help us get to that place, a more stringent and appropriate regulation to make sure the bad actors are in some way pushed out of the category?
John Troup: For almost two years, CHPA has already been trying to identify what the critical elements are, and we've developed an 11 point agenda that includes about six issues that require legislative change and about five issues or so that require regulatory oversight. And so we'd like to refer it as DSHEA 2.0. And so we've identified what the most important issues are that can be upgraded and then have been working very closely with a number of associations to get their input and to make sure that every association that has an interest in our stakeholders and influencers in the dietary supplement category have a chance to weigh in and help define and make sure that we are clear in the position that we want to take forward so that the draft legislation and updated regulatory frameworks can be prepared, and then take that to the next level.
We have a federal government affairs team that's fantastic, highly effective in what they do, and they'll be able to go and speak with members of Congress and then start talking about, "Can we get a bill introduced?" Now, these things don't happen overnight and they can take a long time, but the association that's led by CHPA are well-organized. They're highly competent. They know what the issues are. And we have very close relationships with the FDA Office for Dietary Supplements. And so we're not doing this in isolation. We're getting good input and working closely with the FDA. We're working closely with the associations. We're working with healthcare systems and professionals to make sure that every stakeholder's insight is being considered to make this next level of legislation as robust and effective as it needs to be and that it can be.
Anita Brikman: That is so heartening to hear, and it makes me be proud of being a part of CHPA as well. And you're right, our federal government affairs folks, our regulatory team, which you work on, John, truly cream of the crop, quite frankly, when it comes to associations and being champions, as I said, of quality, of responsible use of our products, responsible marketing. I think there are certain categories, and correct me if I'm wrong, where there seems to be the most sensational or maybe egregious claims. I've heard that sexual enhancement, muscle building, weight loss, that in those areas, that's where people need to be extra cautious about what the products say they're going to do for you. Is that right?
John Troup: Yeah. Since really the late '40s and 1950s when dietary supplementation started becoming in the consumers attention span, those are the categories that have posed the greatest risk and that have, sadly, had the highest number of unscrupulous commercial entities trying to take advantage and prey on consumer interests and needs. Sadly though, I have to say, and I think we just have to recognize this, that because of COVID-19, another emerging segment within dietary supplement category is at risk that consumers should be aware of, and that's been the immune response category. There are a lot of great products out there, fantastic science that supports very specific nutrients to support a healthy immune response. Yet there are still companies that want to make outlandish claims specific to COVID-19, even when there have been no clinical studies or safety studies on that specific issue to say that.
And that's what we're trying to protect against. We can't let those four categories grow into additional categories and prey on the needs and the interests of consumers. So, we need to respond to companies. We need to respond to legislation and regulation, and that's why CHPA is such an advocate of making sure that this happens so that consumers are well-protected and healthcare practitioners can be competent in making recommendations to consumers and their patients.
Anita Brikman: John, we've spent a lot of time talking about regulation. What about innovation? What do you see coming down the pike when it comes to dietary supplements, especially since there is such a heightened interest among the consumer to practice this self-care that we've been talking about? What do you see as far as innovation in dietary supplements?
John Troup: Yeah, the dietary supplement category is one category that has always been full of innovative opportunities and in launching innovations. And so there are a number of new innovations that we can expect to see, starting first with what I would call simple innovations that are basically delivery reforms. About ten years ago, maybe 15 years ago, we saw an onslaught of new formats in gummy formats that increased the compliance and increased the number of consumers into the space, because there were more convenient forms to take. So, I think over the next several years we'll see other delivery forms that will help improve absorption. We'll see better and extended use of botanicals that have very specific, normally occurring natural actives that have a very specific benefit to health and health outcomes.
We'll see more of that happening. We'll see more blended formulations coming on board. We'll see new ingredients, frankly, that, like CBD as an example, that will make its way into the market, which is another reason why we are advocates for introducing new legislation. Because there's a very clear pathway called the new Dietary Ingredient Notification Process that is absolutely required, and part of our interest in advocating for an upgrade of that is to provide incentive for innovation so that more companies in this space will invest more in safety studies, in clinical studies, and to make sure that those products get to market in a way that has all the substantiation that's needed and the amount of research to support it. We lack in the category, unfortunately, enough clinical research and enough clinical investment, because people have always been afraid in the brand product world of me toos and copycats on their product. But introducing legislation and a regulatory framework that allows for innovation and some type of protection or early to market opportunities, then I think that'll help just continue to make innovation safe and effective.
Anita Brikman: Couldn't agree more, John. All right, last question for you. What are you doing these days to practice self-care? As we continue to try to connect with each other in this virtual world, we're trying to work from home, keep our teams together, but what do you do personally to try to keep yourself in a good head space and body space, for lack of a better word?
John Troup: Yeah, sure. I've been a lifelong advocate of health and wellness. So, as a former competitive athlete, I still work out every day. And in some cases when I get really bored or frustrated, I'll work out twice a day now I have a little bit more time since my commute doesn't exist anymore. It's about a 30-second walk to my desk. So, I got to get outside and getting outside is really important. And so exercise is another part of foundational health. I take omega 3 fatty acids, high concentration DHA in particular. I take a vitamin D, a vitamin C and a multi, just to make sure that I have that foundational support that I think is so important in times like this. And then as we enter now, the winter season, and cough cold flu seasons and other high risk opportunities, I'll start taking echinacea and zinc, as two examples.
And then the most important adjunct to all of this, obviously, is eating as many fruits and vegetables as you can, as a general rule of thumb, and just making sure that your food and dietary choices are important. And by the way, the other thing that I have added in the last eight months is culinary insights. So, I've been taking some cooking classes and I spend a lot of time in the kitchen cooking up great tasting food. It's easy to do. So, I can say that a lot of the culinary chefs out there don't have anything on me anymore. And so…
Anita Brikman: Wow. So humble, John.
John Troup: Well, I'd like to write a book, too. Everybody else is, so I figure I might as well.
Anita Brikman: That's right. Okay.
John Troup: Got to put a pre-plug in there.
Anita Brikman: What kind of an athlete were you, are you? What's in your past?
John Troup: I was a competitive swimmer through college and had a lot of good times with that. Today I hit the weight room and cycling, both stationary and get outdoors and get on the bike paths in Alexandria and the DC area. So, outside and exercise, I shifted the type of exercise but I've never stopped.
Anita Brikman: That's awesome, and that is so inspiring. I got to see some pictures from days gone by at some point, John Troup. Thank you for joining us for our podcast, and thank you all for listening.