High Prevalence of Sleep and Anxiety Disorders in China: A Dream for the Functional Beverage Sector

Stress and Anxiety: The Global Epidemic

Anxiety can be best understood as one manifestation of the body's innate stress response system. Anxiety is mediated through a complex neurohormonal cascade with profound psychological effects in which the body's sympathetic response (fight or flight system) is ramped up, releasing amongst other things catecholamines, cortisol, and increasing peripheral insulin resistance and blood pressure. This flight or fight system is well conserved across mammalian species and has been finely honed through millennia of evolution primarily due to its critical role in helping mammals to react and respond to threats.

In a perceived life or death situation, the body's stress response is crucial; however, chronic activation of this system has a devastating impact on mammalian physiology. The prevalence of anxiety disorders has been trending upwards for the last several decades, and the sequelae of this global anxiety epidemic are unfortunately placing an ever-increasing burden on our healthcare systems and manifesting in a worrying upward trajectory in suicide rates, substance abuse, incarcerations, and hospitalizations.

Chronic overactivation of this stress response underpins many psychiatric conditions, particularly conditions where anxiety is the central component of the disease such as GAD, panic disorders, PTSD, etc. While pharmaceutical approaches involving the use of benzos, barbiturates, antipsychotics, SSRIs and more hands-on approaches like cognitive behavior therapy and exposure therapy remain the mainstay medical treatments for anxiety disorders, there is now a major global trend in which the food industry has stepped up to meet the considerable demand for non-medical solutions to this global issue.

Functional Beverages and GABA: A Cool Glass of Calm

GABA beverage-1.png

γ-Aminobutyric acid, short for GABA (hereinafter GABA) is an inhibitory neurotransmitter responsible for modulating the nervous system^[1]. Modulation of GABA receptors is a well understood pharmacological target and accounts for the efficacy of benzodiazepines like Valium (diazepam) and Xanax (alprazolam), barbiturates, and even the recreational effects of alcohol. From a global perspective, the utilization of GABA as a food supplement is nothing new, but its use in functional foods and beverages in China is certainly novel.

New Product Development

In 2014, an article published on Yaozh News called Research and Application of GABA in Food^[2] indicated that sports drinks using GABA as a raw material could aid athletes engaging in high-intensity activities.

In Japan, where stress, mental strain, and lack of sleep are major problems^[3], food products containing GABA have performed extremely well. Data shows that^[4], in 2018, food containing GABA and BCAA (Branched Chain Amino Acid) had a market size of 250 billion yen (about 15.742 billion RMB).

Similarly, the incidence of sleep disorders in China is as high as 38.2%^[5], which exceeds the global average (27%). Based on this situation, some Chinese food companies have also begun to introduce the concept of GABA to consumers. One Beijing company named Goodnight Technology(晚安科技) has developed a product called Good Night Water(晚安水, as shown below), which is designed to help consumers have a deep sleep and improve sleep quality^[6]. Want Want (旺旺), one of the largest beverage manufacturers in China, launched Dream Dream (梦梦水) last year^[7], featuring three functional materials, including GABA. The product is also low in sugar and calories and fat-free.

This year, due to the outbreak of the coronavirus, there has been a spike in anxiety in China. Yangyuan Beverage (养元饮品), manufacturer of the beverage Kamuning(卡慕宁, as shown below) was originally scheduled to go on sale in June, is now available for pre-sale on online platforms. The pre-sale will start from Feb. 25 to Mar. 4. The product is targeted at white-collar workers and students in first-tier and second-tier cities, suffering from anxiety and exhaustion. According to the introduction, this beverage is based on walnut milk, contains GABA, L-theanine (help improve learning and memory ability), zinc, and phospholipid, all of which have strong evidence indicating a role in the amelioration of anxiety, insomnia, and other conditions.

Future Trends

Zhu Danpeng, a dairy industry expert, points out^[4], beverage functionalization is a predictable trend in the future, and some functional raw materials have become very popular in recent years. For example, Coca-Cola introduced cola and sprite containing dietary fiber, Pepsi acquired KeVita, a manufacturer of probiotic drinks and launched a line of probiotics products and Kellogg's introduced cholesterol-lowering foods containing soluble fiber, etc.

However, there is a high degree of homogeneity in the beverage industry. New products with new ingredients emerge, and successful products are immediately copied by other companies. The relatively low technical barriers involved in adding functional ingredients to beverages are the primary cause of this issue. Companies looking to differentiate themselves will need to invest in R&D and the development of patentable proprietary blends. Meanwhile, Qiu Baochang, an expert consultant from the China Consumers' Association^[4], says that the ingredients added in the beverage shall meet relevant standards, and marketing should not overstate product efficacy.

Regulatory References for the Development of Functional Beverages in China

Note ** For the purposes of clarity, we will assume that stakeholders will look to avoid developing functional beverages with labeling claims purporting to alter specific physiological parameters. The use of these labeling claims requires products to obtain specific certification known as “Blue Hat” (health food certification in China). Depending on the active ingredient used and the associated claim used, this certification can require either product registration or product filing. While product filing can be accomplished relatively easily, product registration is extremely demanding.

Also, all the new products mentioned above in the NPD part of this article are still defined as ordinary food; they are not a health food and do not belong to the category of special food.