The recent NHS Interim People Plan calls for the NHS to put all staff front and centre of the way it operates and identifies pharmacists as critical, providing care across a wide range of increasingly complex patient needs. More and more patients are looking to their pharmacist to support and enhance their knowledge regarding the growing range of supplementary nutrients now available.
Nutritional supplementation is increasingly the consumer’s first choice for ‘drug-free’ treatment or natural prevention that provides a true sense of taking control – which the prescription process often denies them.
The growing depository of information on the internet is certainly fuelling this, but with much of this content brand-derived, it can often be generic, with a ‘one size fits all’ message. Balanced, realistic and personalised supplementary advice is what is required, and the independent credibility of the pharmacist provides the perfect source.
Historically, the immense benefits provided by the NHS have instilled a general abdication of our personal health control, relying on the health service to treat and cure as necessary. Yet as our Health Service becomes visibly overstretched, we begin to realise what much of the world has known for centuries… good health is based primarily upon sensible diet and regular exercise – and both are in our control.
Dietary supplementation is here to stay. More and more global consumer groups are merging their home care and healthcare divisions as families understand that good health can start within the home and not the doctor’s surgery.
This maybe stating the obvious, but dietary supplements provide an excellent source of revenue for the pharmacist and we are not talking about an ‘either or’ choice, but complementary purchase. A vast array of medications is known to interfere with the patient’s nutritional status, and this should absolutely be communicated when prescriptions are given or dispensed.
Here are a few examples:
Indigestion, heartburn and GERD may benefit from a PPI, whose main action is a pronounced and long-lasting reduction of stomach acid production. The result of dramatically reducing stomach acid is the reduced efficiency of nutrient absorption and many key nutrients may become under-optimised. PPI’s are most commonly associated with low magnesium levels which may contribute to poor sleep, low energy and muscle stiffness.
Many people suffering with asthma and other bronchial diseases already have low levels of magnesium due to the body requiring higher levels to cope with symptoms. Ironically, some asthmatic drugs, such as inhaled corticosteroids can cause a further loss of magnesium, inevitably making symptoms worse. Magnesium supplementation is beneficial in the treatment of moderate-to-severe asthma owing to its broncho-dilating and anti-inflammatory effects.
Type 2 diabetes
Diabetics will often be prescribed the drug Metformin, the fi rst-line medication for the treatment of type 2 diabetes, particularly in people who are overweight. However, studies suggest around 30% of people who take Metformin on a regular basis have some evidence of decreased B12 absorption, as it can affect the absorption of vitamin B12 in the ileum of the small intestine.
Patients with Crohn’s disease may be advised to take an immuno-suppressant to reduce the activity of their immune system. Corticosteroids have been widely reported to increase the body’s loss of magnesium and patients should be recommended to supplement with magnesium if on a course for more than two weeks. The result of a lower immune system will be an increased susceptibility to disease, including coughs and colds so they would also benefit from vitamins D and C.
Individuals who are housebound or convalescing may not be exposed to direct sunlight as much as normal and will begin to dramatically decline in vitamin D levels. Sub-optimal levels will result in symptoms such as aching bones and joints and more frequent incidences of coughs and colds.
In fact, vitamin D is an excellent example of how medical knowledge of nutrition is relatively outdated compared to that of the world of VMS.
Vitamin D sales have now overtaken sales of vitamin C as the biggest individual vitamin supplement purchased in the UK, yet much of what we now know about its benefits – and more importantly about optimal serum requirements – comes from research within the past 20 years.
We know it is critical for skeletal health and is increasingly associated with other pathologies encompassing gastrointestinal, immunological and psychological effects. Supplementation is now universally advocated over winter months, but little data is available on relative efficacy of preparations, rates of uptake, or whether serum status may influence uptake.
With an estimation that 1 in 3 of your customers struggle to take tablets (or would rather not take more) there has been considerable interest recently in the use of oral sprays for the delivery of nutrient supplements, and, as Dr Fred Pender, Lead Dietitian for Weight Loss, Spire Hospitals, states; “The evidence that oral spray vitamin D is more rapidly integrated into blood is strong, as opposed to being sequestered in fat mass and doing little good. In addition, our patients are usually on a polypharmacy of drugs; the oral spray avoids adding to this”.
Andrew Thomas, founder and managing director of BetterYou, contributed to this article which also appears in the July issue of Pharmacy Business.