For millennia, people have known about the curative effects of citrus fruit. Yet, it wasn’t until the 20th century that the active ingredient – vitamin C – was discovered and marketed to the world. Hitting the shelves in 1934, vitamin C became the first mass-produced synthetic vitamin in history, opening a door to what would become a multi-billion-dollar industry.

Since that first vitamin C tablet, the dietary supplement or nutraceutical industry has come a long way. Currently worth more than $385 billion worldwide, it’s expected to reach $585 billion in just five years. And, with more than 40 per cent of Australian adults regularly using dietary supplements to enhance and improve their diets, it’s an industry well worth understanding.

So, what exactly are nutraceuticals and why are they so popular?

Dr Evangeline Mantzioris

“Nutraceuticals are food extracts or derivatives – such as vitamins, herbs, amino acids, minerals and enzymes – that are said to exhibit a range of therapeutic health benefits,” says UniSA nutrition and food sciences expert, Dr Evangeline Mantzioris.

“Nutraceuticals claim to help any number of health conditions. There’s fish oil for inflammation, folate for pregnancy health, calcium for stronger bones, and our old friend vitamin C for tissue repair … the list goes on.

"One of the most appealing features of nutraceutical is that, unlike pharmaeuticals, they don’t require a prescription, making them easily available, accessible and affordable.”

There’s no doubt that consumer demand for nutraceuticals is on the up. But it’s the rise of chronic diseases, including preventable lifestyle-related conditions such as type 2 diabetes and cardiovascular disease, that’s really driving demand, especially as health professionals shift from treatment plans to prevention strategies.

“Initial management strategies for lifestyle diseases and associated risk factors, such as obesity and high blood pressure, typically include a combination of increased physical activity and dietary changes,” Dr Mantzioris says.

“Here, nutraceuticals provide attractive alternatives for people looking to negate the potential risks of disease, to enhance their diet, or to try to ameliorate their symptoms.

“Add to this an environment where the population is ageing, and the current crackdown on prescription medicines to address growing concerns about antimicrobial resistance, and it’s easy to see how nutraceuticals are well and truly cemented into our contemporary narrative.”

Australians spend more on complementary medicines and nutraceuticals than on prescription medicines but the nutraceuticals market remains largely unregulated.

Dr Desmond Williams

In Australia, nutraceuticals are listed as “complementary medicines” under the Therapeutic Goods Act (TGA), where regulation is focused on the safety of the ingredients and the consistency of the manufacturing processes. But there are loopholes, as pharmacist and UniSA researcher, Dr Desmond Williams, points out.

“There’s a number of complexities surrounding the regulation of nutraceuticals, both in Australia and overseas,” Dr Williams says.

“In Australia, complementary medicines are classified as either high or low risk.

“Higher risk products undergo a thorough examination, but lower risk medicines are processed differently. Here, the regulator relies on the manufacturer to certify that they have used pre-approved ingredients and that the product meets good manufacturing practice standards.

“In this instance, the products do not need to be stringently checked or evaluated before being accepted to the Australian Register of Therapeutic Goods and, unless proven otherwise, are assumed to be safe. So, there is a lot of trust involved, and this can create opportunities for misconduct, either intentionally, or by unintentional contamination.

“When we add in the international market, there are far more risks, especially for those sold online. Regulations differ dramatically across countries, and when they are sold over the internet, it is not possible to guarantee exactly what the end-user will be consuming.

“Online products may seem legitimate, but they are not regulated by the TGA, so there are greater risks for their safety and effectiveness.”

The industry is often accused of marketing hype and insufficient clinical testing. And a keen strategy to engage consumers is the use of celebrity endorsements. Actors Nicole Kidman and Liam Hemsworth, as well as former cricket captain Ricky Ponting, have lent their names and fame to the Swisse nutraceutical brand, while Jackie Chan and former Chinese tennis star Li Na have supported another big player in the market, Blackmores.

Dr Robert van der Veen

UniSA Adjunct Senior Research Fellow Dr Robert van der Veen says health brands fare well when recommended by celebrities.

“Celebrities can be effective brand ambassadors because of their physical attractiveness and expertise or success,” Dr van der Veen says.

“A famous, unique and attractive face can cut through advertising clutter, generating more attention and brand recall. And, because celebrities are generally healthy and good-looking, their testimonials can be incredibly powerful for a health brand.

"Consumers respond well to celebrities because they associate the celebrity’s values with the product, buying it in the hope that the same attributes might transfer to them.

“Celebrities also like working with health brands, such as Swisse or Blackmores, because they also need to manage their image, and being associated with a healthy product, shows that they too are health-conscious.

“When it works, it works very well, with both the celebrity and the health brand benefitting from the association.”

Marketing nutraceuticals is one thing but delivering on their promises is another. In a recent UniSA review of the efficacy of some of the most commonly available nutraceuticals to manage chronic diseases, such as obesity, hyperglycaemia (a precursor for diabetes), high blood pressure, high cholesterol and inflammation, only a handful showed reliable health benefits.

Dr Mantzioris says the use of nutraceuticals to manage and prevent chronic disease is an emerging area of research, and while there are a lot of claims in the market, many of these are not clinically substantiated.

“In our study, we reviewed the most commonly used nutraceuticals claiming to treat the most prevalent health conditions, and found that the most consistent outcomes related to reductions in cholesterol levels, in blood pressure, and improvements in the control of blood glucose levels,” she says. “We also saw that disease activity was reduced in rheumatoid arthritis and osteoarthritis.

“Interestingly, despite all the hype, none of the tested nutraceuticals had any significant impact for weight loss.

“Of course, there are other nutraceuticals that are vital for people’s health – folate pre-pregnancy, or iron tablets to treat anaemia, for example – but these are often prescribed or recommended by your doctor, who for a variety of reasons, should also be aware of what you’re taking to supplement your health.”

Dr Mantzioris says the most overlooked factor affecting people’s health is a healthy diet.

“So many people look for a quick fix these days – ‘I feel tired, I might need a supplement’, ‘I want my nails to grow stronger, what can I take?’ – but what they forget is that many of these issues can be improved by a healthy, balanced diet,” Dr Mantzioris says.

“Nutraceuticals are perceived to be natural – their core ingredients come from nature – so it’s easy to see why so many people think they’re beneficial. But there’s certainly a blur about what people consider natural.

"Take sugar for example, it's a natural product extracted from a plant, yet we know we shouldn’t really consume it – just because something is natural does not necessarily mean it is healthy.

“Rather than reaching for a pill, more people should invest in a diet filled with whole foods – vegetables and fruits, cereals, lean meats, fish, eggs, nuts and seeds, as well as dairy foods – as recommended by the Australian Guide to Healthy Eating. This will provide them with enough of the nutrients essential for good health.

“Nutraceuticals certainly have a place, but there is still a lot we need to learn about them.

“Perhaps Hippocrates said it best: ‘Let food be thy medicine and medicine be thy food’. After all, when we’re talking about ways to improve our health, which would you prefer: a whole orange which contains fibre and a whole range of other nutrients with multiple benefits or a simple orange pill? I know which choice I’m making.”

FIND OUT MORE | Alliance for Research in Exercise, Nutrition and Activity (ARENA)