FOCUS ON NUTRACEUTICALS PAKISTAN

FOCUS ON NUTRACEUTICAL - An Opportunity for Healthy Pakistan
MEHBOOB ALY MANJI
President: Manjis-Vita Pakistan Limited , Nutri-Fresh Limited and Em5 Nutraceutical LLC-USA
Presiding officer: Advisor Board of Authentic Shariah Compliant Trade and Industry (PVO)
Provost: Lahore American University – Pakistan (Proposed Joint Degree Program with WSU)
Chairman: Children Health Education & Nutrition Education Foundation – Pakistan Chapter (CHEN Foundation)
Editor-in-Chief: South Asian Journal of Therapeutic Food & Nutraceutical – Pakistan (A Quarterly Publication from March 2013)
Founder Member: International Therapeutic Food & Nutraceutical Association (ITFNA) – Texas USA
Notified Member: Punjab Food Authority Govt. of Punjab and International Society for Nutraceuticals and Functional Foods
Email: [e-mail] and [e-mail] Cell: [phone]

ABSTRACT
Nutraceutical, a portmanteau the words “nutrition” and “pharmaceutical”, is a food or food product that provides health and medical benefits, including the prevention and treatment of disease. A nutraceutical is demonstrated to have a physiological benefit or provide protection against chronic disease. Such products may range from isolated nutrients, dietary supplements and specific diets to genetically engineered foods, herbal products, and processed foods such as cereals, soups, and beverages.
The last few years Pakistan Nutraceutical Industry witnessed phenomenal increase demand of Nutraceutical products – in last five years US$500 million demand is converted into over a US$1 billion (PKR: 100 billion) industry. Although current production capacity is even less than 1% of the world demand of nutraceutical. This industry plays vital roles both to control nutritional related risk and higher the consumption of nutraceutical healthier Pakistani, similarly if Pakistan’s private sector entrepreneur with support of Government invest in Nutraceutical industry, as Pakistan has huge volume of unutilized medicinal berries, flowers and seeds as well as fruits, vegetables and grains having both nutritional values and medicinal properties are easily available as raw-material, thus huge foreign exchange can be earned from exports of Nutraceuticals. The global market for
Nutraceuticals is projected to reach US$250 billion by 2018, driven primarily by the growing affinity among the general populace towards adopting a healthy lifestyle. Other factors fueling demand for Nutraceuticals include higher disposable income in developing regions; evolution of innovative products, particularly for the beauty care segment; and emerging opportunities in other newer areas. Pakistan focus should be – with only few hundred million dollar investment in nutraceutical sector can bring over US$ 2.5 billion of foreign exchange (1% of world demand).

Keywords: Nutraceutical, Pakistan Nutraceutical, Medicinal Berries, Nutritional Values and Medicinal Properties
INTRODUCTION - NUTRACEUTICALS V/S PHARMACEUTICALS
Nutraceuticals is coined from "nutrition" and "pharmaceutical" and is defined as a food (or part of a food) that provides medical or health benefits, including the prevention and/or treatment of a disease. They are antioxidants which have a myriad of health benefits. There are similarities in the definitions between pharmaceuticals and
Nutraceuticals and there are differences. Similar in that Nutraceuticals provides health benefits and is used for treatment of a disease or disorder, different in that the primary makeup is from a food source not chemical.
Nutraceuticals are derived from natural nutrients commonly found in foods we already consume. These nutrients include grape seed extracts, citrus extracts, bilberry extracts, and pine bark extracts just to name a few.
Nutraceuticals also combat free radicals as many believe that free radicals are a root cause of most diseases and disorders because free radicals cause cellular decay within your body. The inclusion of Nutraceuticals to your dietary and exercise program can help you maintain a healthy cholesterol level, maintain healthy blood vessels, and support cardiovascular health; all of which will decrease your risk of heart attack or stroke. Also and most importantly there are very little side effects associated with Nutraceuticals and is simple to consume and is absorbed faster in your body with little loss of their nutritional value.

Quality healthcare is the foundation of any prosperous nation. Nutrition care, which forms an integral part of preventive healthcare, is undergoing a transformation in Pakistan. Today, food alone is unable to fully service the nutrition needs of the body. Thus, supplementing it with lifestyle interventions has become a non-negotiable imperative not only to enhance health but also to reduce dependency on curative measures.
While lifestyle interventions can be manifold, this report is focused on those formulations or foods that can supplement normal diet (called " Nutraceuticals ") and does not cover services that can be offered in this regard.
My this presentation and paper covers the Nutraceuticals market and domestic and export market potential of
Pakistan Nutraceutical Industry.
This document aims to present:
 The nutritional status of Pakistan, population dietary patterns and underlying drivers
 An assessment of the current and latent potential of the Nutraceuticals market in Pakistan
 Critical impediments in achieving latent potential, and
 Way forward for the government and private sector
The viewpoints and conclusions presented in this report are an outcome of discussions with various stakeholders, regulators, key opinion leaders, subject experts, data available in the public/propriety domain and industry understanding. An attempt has been made to provide a reference document for existing Pakistan’s private Sector investors and global nutraceutical players, new entrants, potential investors and regulators to explore and assess the Nutraceuticals opportunity that Pakistan presents.
NUTRACEUTICALS HAS PROVEN TO BE AN ALTERNATIVE TO PHARMACEUTICALS.
Food as medicine? Why not? It is not as if the role of food in total health care is something new to mankind. The use of food to maintain or ensure human health is a natural phenomenon. More than 2,000 years ago,
Hippocrates, considered as the father of medicine, said, "Let food be your medicine and medicine be your food."
Now we see, Hippocrates was a visionary and his words have passed the test of time. Nutraceutical products are a proof of the veracity of the words of the wise man.
Every day, we hear the terms "functional foods," "health foods," "phytochemicals," etc. This set of nomenclature, according to research, is part of the nutrition evolution we are experiencing today which falls under the umbrella of “Nutraceuticals” a term coined by Dr. Stephen DeFelice of the U.S.-based Foundation for Innovation in Medicine
(FIM).
Nutraceuticals are prepared from food derivatives and have demonstrated physiological benefits or reduced the risk of chronic disease, above and beyond their basic nutritional functions. Em5 Nutraceuticals are different from ordinary dietary supplement in that nutraceutical benefits can be substantiated with scientific facts in the prevention of chronic diseases such as cancer, heart disease and osteoporosis.
Nutraceuticals is a growing industry globally and is widely popular in North America, Japan, and Europe.
Worldwide, the demand for Nutraceuticals is driven by growing consumer awareness of diet-disease links, aging populations, rising health care costs, and advances in food technology and nutrition. Currently, health concerns like cholesterol reduction, cardiovascular disease and osteoporosis are the most attractive targets for
Nutraceuticals, followed by child development, high blood pressure, diabetes, GI disorders, menopause-related ailments and lactose intolerance. Across-the-board reduction in cardiovascular disease, lung and stomach cancers could add up savings of billions of dollars.

Nutraceuticals are very effective, safe, and affordable as recipes / formula of all products are backed by extensive research by highly qualified academia. New food and herbs are continuously being researched and explored for new nutraceutical products for the benefit of humanity.
THE MAIN BENEFITS OF NUTRACEUTICAL AT A GLANCE
1. Incomparable safety and tolerability: Being of natural source and studied in large scale post-marketing surveillances established their incomparable safety and tolerability.
2. Evidence based efficacy: Published data in reputed medical journals authenticating efficacy of
Nutraceutical.
3. Stimulates the body's immune system: Herbs promote the body's natural immune system to fight against disease states.
4. Preventive effect: Strengthening immune system helps provide prevention from different disease states.
5. Normalizes body functions: Herbs regulate and tone the glands to function normally.
6. Raises the energy level of the body: Allows the body to have extra energy to heal itself.
NUTRACEUTICAL INDUSTRY
The last couple of decades witnessed phenomenal increase in Nutraceutical use worldwide. Today, Nutraceutical is over a US$120 billion market (2011) with an ever increasing usage trend both at prescription & OTC levels. The reasons for this extraordinary growth are:
The global market for Nutraceuticals is projected to reach US$250 billion by 2018, driven primarily by the growing affinity among the general populace towards adopting a healthy lifestyle.
Other factors fueling demand for Nutraceuticals include higher disposable income in developing regions; evolution of innovative products, particularly for the beauty care segment; and emerging opportunities in other newer areas.
US$ Billion
2011
120.0

2012
133.0

2013
148.0

2014
164.0

2015
182.0

2016
202.0

2017
225.0

2018
250.0

The global Nutraceuticals market continues to be driven by growing consumers' desire to lead a healthy life and avoid dependence on synthetic drugs. Major trends influencing the market include growing competition leading to industry consolidation, maturing markets in the developed regions, higher disposable incomes leading to greater personal care in the developing markets, growing fixation with beauty, and the launch of supplements enhancing beauty. Also, Nutraceuticals are delving into new areas with products, such as conjugated linoleic acid (CLA) soy, whey, and dietary fibers claiming to facilitate in weight management. Growth also emanates from specific products developed for gender groups, kid groups, and age related treatment.
Performance-wise, Nutraceuticals registered a steady growth pattern in the post-recession years. An aging population has been a major factor contributing to this growth of the Nutraceuticals market. By the year 2020, the number of individuals who are aged 60 years and above is expected to surpass 1.0 billion, with 70% of this populace dwelling in the developing nations. The Nutraceuticals industry is geared to meet the rising demand for health foods and products as companies with sufficient capital for scientific research enter the Nutraceuticals space. The trend towards personalized health nutrition is expected to provide solutions to successfully prevent, manage, and treat chronic medical illnesses. Also, the availability and accessibility of healthy foods in the developing nations, evolving understanding of the concepts that promote healthy living, and the launch of targeted foods and products scientifically formulated to address disease conditions are expected to support the growth of the Nutraceuticals market in the near future.

The beauty industry is emerging as one of the major growth drivers for the Nutraceuticals market. Skin care in general and anti-aging products in particular, is driving growth in the beauty segment. Moreover, with the growing maturity of the skin care market, producers are developing specialized products addressed to different parts of body as well as the problems they treat. Most of the new introductions in the market are not just focused on enhancing beauty but include functional offerings such as sun protection, hair recovery, acne treatment, skin radiance and whitening, and anti-cellulite treatments.
As stated by the new market research report on n the largest regional markets for Nutraceuticals include the US, followed by Europe and Japan. Aging population, growing health care spending, and rising interest towards selfmedication and preventive healthcare have been the key market drivers in above markets. Developing markets are expected to pitch in to drive future growth in both production and consumption of Nutraceuticals, given the rapid pace of development of food and beverage, pharmaceutical, and nutritional industries in BRIC nations (Brazil,
Russia, Pakistan, and China), Mexico, Poland, and South Korea. Also, the perceived status of Nutraceuticals is changing among consumers due to its proven healthcare benefits. Other factors driving demand in these regions include economic prosperity, consumer disposable income, and rising production activities.
Market enjoyed double-digit growth rates throughout the 1990s in buoyant market conditions led by herbal supplement products. However, growth in the market slowed down, owing to diverse factors, including altering consumer demands and economic pressures as well as tightening regulatory requirements and competitive market conditions. Market growth slowed down for herbal supplements, but other dietary supplements, including non-herbals, and sports nutrition and meal supplements are experiencing relatively stronger growth rates. Vitamin and mineral supplements are projected to generate relatively moderate growth in nutraceutical applications, resulting from intense pricing competition, overall lack of proprietary compounds, and mature product applications. Vitamins A and E are expected to perform the best among bulk vitamins due to increasing evidence of health advantages and expanding end-user preferences for value-added natural formulations. Among minerals, calcium and potassium are expected to record fastest sales gains based on demonstrated preventive benefits in geriatric and women's health care.
FUTURE OUTLOOK OF PAKISTAN NUTRACEUTICAL INDUSTRY
Nutrition is a fundamental need. Various risk factors related to health result from an imbalance in nutrition.
Together, these factors contribute to more than 40% of deaths and 30% of the overall disease burden in developing countries.
In Pakistan nearly 20% of the total population and 45% of young children (below 5 years of age) are undernourished, numbers which are significantly higher than even the poorer sub- Saharan African countries. Iron deficiency anemia during pregnancy accounts for one-fifth of maternal deaths in Pakistan and the prevalence of this deficiency in women has alarmingly increased over 50% (UNIECF Report).
Iodine and Vitamin A deficiencies in Pakistan are still above the WHO specified desired levels. Annually as many as
0.3 million children succumb to Vitamin A deficiency related diseases. Nearly 48% of Pakistani children are suffering from Vitamin A deficiency and enhancing its supplement could help decrease child mortality by 25%.
Around the world, 260 million children suffer from Vitamin A deficiency (VAD), causing between 250,000 and
500,000 to go blind, 14 million have damaged eyes and 1 to 3 million die annually.

One to two million pregnant mothers suffer from VAD in South Asia and nearly 60,000 women die of childbirthrelated deficiency, mostly caused by complications which could be reduced through better nutrition, including provision of Vitamin A.
Proper administration of nutraceutical and micronutrient would help to reduce the overall mortality, this could be reduced through the supplement of Vitamin A by 25%, as deaths caused by measles could be reduced by 50% and those caused by Diarrhea by 40%. Every year, 200,000 children die in Pakistan of diarrhea, 250,000 of pneumonia and Vitamin A nutraceutical is the best remedy to counter these severe consequences.
Pakistan Pediatric Association nutrition survey carried out after a gap of five years to assess the nutritional status of children in the country revealed that the deficiency of Vitamin A, which was 35% percent five years ago, had been reduced reflecting the successful implementation of Vitamin A supplement program in certain part of
Pakistan. Administration of Vitamin A supplements to mothers three days after delivery helped them to cater to the requirements of newborn children for the first six months. The impact of these deficiencies is a productivity loss of around one percentage point of Pakistan’s GDP.
The nature of Pakistan’s nutrition concerns are three fold On one hand is the undernourished population (80 million) with majority having inadequate purchasing power to even consume a diet sufficient in calories, let alone take sufficient nutrients. Their challenge is to meet foundation needs to maintain normalcy of being. These needs would have to be addressed by government programs with the private sector playing a supportive role.
On the other hand is the huge population (over 100 million) that is nourished in calorie intake but not in terms of nutrient intake. This segment would typically include lower middle to upper class population with sufficient purchasing power but probably low awareness about their nutrient requirements, leading to unmet condition specific needs in addition to foundation needs.
In fact, there are 90 million in our population (40% in urban and 60% in rural areas) who consume more than the recommended number of calories with higher than recommended levels of dietary fats and could be the largest contributor in making Pakistan the future cardiovascular and diabetes capital of the world. While there are several factors that have contributed to these severe inadequacies, the key ones are increased urbanization, larger working class population and growing affluence. These factors have resulted in a shift of dietary habits from consuming micronutrient rich foods such as fruits and vegetables to consuming more of fat-rich calorie foods
Only 5% of Pakistan’s population segment (9 million) understands balance diet and benefits of micronutrients and probiotics. Many of the factors affecting nutrition related concerns are irreversible that have led to natural sources of nutrients being consumed in insufficient quantities. Hence, the requirement of external intervention, that can supplement diet to help prevent nutrition-related disorders and promote wellness over treatment of illness, has become critical.
Such products are collectively called as “ Nutraceuticals”. As a concept, “Nutraceuticals” is in its stage of infancy with several developed countries having defined it only in last 18 years. Unfortunately there is no modern and updated food safety laws in Pakistan, recently Punjab Food Safety and Standard Authority (PFSAA) started its operation. Food safety is a concern of everyone.

Given that food intake is the fundamental precondition for survival, food safety issues embrace us all the time.
Food safety simply means that what we eat, chew or drink is safe for human health but is yet to implement it as the rules are not completely framed.
The current global Nutraceuticals market of USD120 billion (PKR 11500 billion), Pakistan has less than 1% share and is estimated to be around PKR100 billion in size. The three broad categories within Nutraceuticals are – functional foods, functional beverages and dietary supplements. While the global market is expected to grow at a
Compound Annual Growth Rate - CAGR of 10%, the Pakistan nutraceutical industry has been growing much faster at a CAGR of 15% for the last three years, driven by functional food and beverages categories that are growing faster than the dietary supplements category due to wider distribution across FMCG channels as well as aggressive mass marketing. There are four key drivers to this growth – an increased affluence of the ever-growing working population, a reduced affordability of sick care that in turn drives consumers towards wellness, an increased physician awareness and media penetration and finally, an increased accessibility to newer distribution channels.
However, the latent market in Pakistan is two to four times the existing market size PKR: 100 billion with nearly 30 million potential customers. The market is latent because there some major impediments to effectively tap this market. These are High prices of Nutraceuticals when compared to conventional foods especially since Pakistan is a price sensitive market.
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Lack of credibility of the benefits of Nutraceuticals in the minds of consumers, further aggravated by the unsubstantiated claims made by certain products.
Regulatory framework not yet implemented plus inadequate resources available for implementation.
This lack of regulations to govern Nutraceuticals acts as a deterrent for large foreign players planning to enter the Pakistan market.

WHAT NEEDS TO BE DONE
To overcome the above mentioned impediments and to pave the way for Nutraceuticals to supplement
Pakistan’s quality healthcare agenda, the following initiatives need to be undertaken:
AGENDA FOR THE GOVERNMENT.
Lay down rules to govern quality and claims of Nutraceutical products While the Food Safety and
Standards Authority created or have plans to lay down rules for governing standards of articles of food and to regulate their manufacture, storage and distribution based on panel recommendations, it is of critical importance that these rules be made exhaustive to govern quality and claims of nutraceutical products. THE RULES SHOULD:
Clearly specify Pakistan Recommended Daily allowance (RDA) levels (the RDA norms of developed nation should be followed with added local and regional need, the outdated RDA if any do not reflect lifestyle changes as well as the considerable nutritional research accumulated in this period) Recognize proven nutrients and labeling requirements.
Define permitted health claims and the product approval process. Identify standards / monographs, and
Provide guidelines on good manufacturing practices for Nutraceutical products. Leading international practices highlighted in the report can be used as reference while framing the rules. Measures should be taken to ensure availability of adequate resources for efficient implementation of laid out rules. These

measures could include gearing-up of staff strength, specialized training and increasing the number of food testing laboratories.
Encourage research and development in the field of nutrition and deploy Public Private Partnership (PPP) models to serve needs of the undernourished segment of population
The government should establish a dedicated fund for focused Nutraceuticals’ research and support
Nutraceutical players by providing them with research infrastructure.
Ensure that a larger population gets the benefit of Nutraceuticals For this, the government should explore
PPP to deliver the benefits of nutrients to the undernourished section of the population.
AGENDA FOR THE PRIVATE SECTOR PRODUCT DEVELOPMENT:
Develop customer focused products that address specific needs of different consumer segments The private sector should invest in research to develop products that meet specific consumer needs, preferences and taste. One potential area can be converting the nutritional properties of herbs and botanicals from the rich pool of traditional Pakistan sources into Nutraceutical products.
Product differentiation: Differentiate products by focusing on credibility building and/or lowering prices of products In the cluttered market with me-too products and inadequate intellectual property protection, the private sector can focus on product differentiation by building credibility of their brands and making products more affordable.
Focusing on cost reduction initiatives could be one of the levers to lower prices. Product promotion: increase awareness of the benefits of Nutraceuticals through advertising and physician education This is easier said than done.
Concrete and sincere effort needs to be put in by the stakeholders to enable Nutraceuticals to enhancement of Pakistan’s quality health agenda, ushering a shift in the mindset from illness to wellness, from curing to preventing.
Academic institutions & laboratories should come forward by conducting large-scale protocol controlled studies to validate the benefits of Nutraceutical.
Researcher and processor jointly prepared dosages standardization and forms of usage, establishment of appropriate indications, imparting training, enabling doctors and practicenor to make better use of
Nutraceutical.
Nutraceutical Industries stakeholder should make sure availability of well-documented & published clinical data authenticating efficacy & safety of Nutraceutical.
NUTRACEUTICAL FUTURE OUTLOOK:
High Profile, research-oriented companies within Pakistan should shift their focus to Nutraceutical as growing concern for long-term safety of patients. An earlier onset of diseases requiring a longer period of disease management compelling doctors to consider safer options for their patients and Nutraceuticals is precise choice.
Focus shifting towards preventive health management.