So, do people need dietary supplements or not? The short answer in many cases is ‘yes’. Whilst we should obtain the nutrients we need from a healthy diet, many of us don’t. The majority of people in the UK do not eat a healthy diet with significant impact on vitamin, mineral, fibre and omega fatty acid intakes. Despite the high profile 5-a-day campaign since 2003, less than a third of adults aged 19-64 consume the daily minimum.
Not surprisingly, poor diets are reflected in the vitamin and mineral intakes found in the UK National Diet and Nutrition Survey (NDNS) over the past 9 years and DEFRA’s Family Food over the past 20 years which show that there has been a substantial reduction in adults of intakes of riboflavin, folate, vitamin A, vitamin D, iron, calcium, magnesium, iodine, selenium and potassium.
In children and youngsters through their teens, intakes of vitamin A, iron, iodine and zinc, in particular, appear to be falling. Micronutrient intakes of teenagers, especially teenage girls, have been of significant concern throughout the past 20 years with reductions in intakes of iron, vitamin A, folate, calcium, zinc and iodine.
Women of childbearing age and middle years have also shown a reduction in micronutrient status with proportions not achieving the Lower Reference Nutrient Intake (the level at which deficiency is likely) increasing for vitamin A, folate, iron, iodine and calcium. Nine out of ten women of child-bearing age now have such low levels of folate that if they became pregnant, their child would be at increased risk of neural tube defects.
Older people too, are not without issues in terms of micronutrient intake with increases in the proportions of people over 65 failing to achieve the LRNI for vitamin A, iron, calcium, magnesium, potassium, iodine, potassium and zinc over the last decade.
Pharmacists should remind their customers and patients of the need to eat a healthy diet, including 5-a-day, with an explanation of what constitutes one portion (see:www.nhs.uk/live-well/eatwell/5-a-day-portion-sizes). The diet should also contain plenty of wholegrains with moderate quantities of beans and pulses with, dairy or its equivalents and meat and fish if enjoyed.
Some pharmacy customers may also be following popular diets which may put them at further risk of poor intakes of micronutrients. Busy lifestyles, which can lead to skipping meals and consuming takeaways and ready meals together with the sheer confusion that exists about diet and how best to eat, further increases the risk of poor micronutrient intakes.
The findings from the UK’s food and diet surveys suggest a significant micronutrient gap across the population, which may not be set to improve in the short to medium term. A multivitamin and multimineral supplement as well as an omega-3 supplements are wise choices for many pharmacy customers and patients, and the pharmacy team is well placed to make recommendations based on this concerning evidence. Consider customers who may be reducing or avoiding animal foods who would, in particular, benefit from a B12 supplement.
In addition, Public Health England recommends a 10 microgram daily vitamin D supplement for the majority of the population, particularly throughout the winter and spring, a 400 microgram daily folic acid supplement for women during their reproductive years.
The Chief Medical Officer recommends that children aged 6 months to 5 years take a supplement containing vitamins A, C and D.
Consider too that omega-3 intakes fall below recommendations and that an omega-3 supplement can also help to bridge that particular dietary gap. Omega-3 fatty acids are essential for normal brain function and vision and for brain development in infants in children.
In counselling pharmacy customers and patients about the use of supplements, use the 2WHAM approach or similar. Check who will be taking the supplement, in particular, their age, as micronutrient requirements vary and the person should take a supplement appropriate for their age, which will be reflected on the product label.
Check if they are taking any other medication too for any possible interactions (the BNF identifies significant ones), although a multivitamin and multimineral supplement containing the Nutrient Reference Values (NRVs) for each nutrient is unlikely to cause issues with medication apart from those medications such as anticoagulants, which often raise a ‘red flag’ in pharmacy practice.
Public health nutritionist Dr Emma Derbyshire contributed to this article which also appears in the July issue of Pharmacy Business.