Andy Thomas discusses how nutritional supplements is fast becoming the consumer’s first choice for ‘drug free’ treatment…

Community pharmacists are readily accessible healthcare providers and medicine experts in the community setting and their counsel is often sought by patients and consumers on a number of subjects including the use of dietary supplements.

Their role in the sale of and advice regarding natural health and drug alternatives has never been more relevant. The recent National Health Service (NHS) Interim People Plan calls for the NHS to put all staff front and centre of the way it operates and identifies pharmacists as a critical part of multidisciplinary teams, providing care across a wide range of increasingly complex patient needs.

Despite existing demand to counsel patients on a vast range of medicines, more and more consumers are looking to their pharmacist to support and enhance their knowledge regarding the relevance of a growing range of supplementary nutrients now available.

Nutritional supplementation is increasingly becoming 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 vast and growing depository of information on the internet is certainly fuelling this, but as much of this is brand derived content, information, it can often be generic with a ‘one size fits all’ marketing message.

When ‘independent’ reviews on supplements are posted, a personal agenda can skew the dialogue and provide a level of consumer apprehension which is equally unhelpful. Balanced, realistic and personalized 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, leaving us to rely on the health service to treat and cure as necessary.

As our NHS has become visibly over-stretched we begin to realise what the rest of the world has known for centuries – good health is based primarily upon sensible diet and regular exercise, and both are within our control. Dietary supplementation is here to stay.

More and more global consumer groups are merging their homecare and healthcare divisions as families understand that good health can start within the home and not the doctor’s surgery.

Andrew Thomas

This may be 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 are known to interfere with the patients nutritional status and this should absolutely be communicated when prescriptions are given or dispensed. For example, indigestion, heartburn and Gastroesophageal reflux disease (GERD) may benefit from a proton pump inhibitors (PPI), who’s main action is a pronounced and long lasting reduction of stomach acid production.

It’s interesting to note that the NHS website suggests that some believe PPIs are wrongly prescribed in up to two thirds of cases. The result of dramatically reducing stomach acid is the reduced efficiency of nutrient absorption.

Many key nutrients, particularly those which are water soluble and not stored by the body, 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 asthmatic symptoms.

Ironically, some asthmatic drugs such as inhaled corticosteroids (which work continuously to reduce swelling of the airways) can cause a further loss of magnesium, inevitably making symptoms worse.

Magnesium

Magnesium supplementation is beneficial in the treatment of moderate to severe asthma owing to its broncho-dilating and anti-inflammatory effects. It also assists, in conjunction with vitamin D, in the solubilisation of calcium encouraging calcium from settling in (and stiffening) soft tissue.

Magnesium is an encouraging additional therapy, particularly for paediatric patients who do not respond to conventional treatment in acute severe exacerbations.

Diabetics will often be prescribed the drug Metformin, the first-line medication for the treatment of type 2 diabetes, particularly in people who are overweight. However, studies suggest around 30 per cent of people who take Metformin on a regular basis have some evidence of decreased B12 absorption as it can affect the absorption of this vitamin in the ileum of the small intestine.

Vitamin B12 plays a number of important roles including keeping blood cells and the nervous system in good shape. Overweight customers may well be taking appetite suppressants, also known as diet pills, to trigger hormonal responses which interrupt the brain’s signals and tell the body it feels hungry and that it’s time to eat.

There are also products that are high in fibre, which bulk up in the stomach and give the impression of feeling full. Overweight customers who are prescribed or recommended appetite suppressants as part of a weight-loss programme will be reducing calorific intake but may also be reducing nutritional intake. Rather than a healthy dietary change, the less food that is processed will simply mean a lower nutrient representation.

A good multivitamin will ensure under-represented nutrients aren’t completely overlooked. Most people with Crohn’s disease need to take steroids such as prednisolone from time to time.

A patient may be also advised to take an immunosuppressant to reduce the activity of their immune system. Common types include azathioprine and methotrexate. 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. The recent surge veganism has inevitably led to consumers making significant dietary changes without fully understanding the mid to long term nutritional and health implications.

A primarily plant-based diet may possibly have a severe underrepresentation of iron, iodine, vitamin B12 and vitamin D.

Vitamin D

Individuals who are housebound or convalescing will not be exposed to direct sunlight as much as normal and will begin to dramatically decline in vitamin D levels. The vast majority of the vitamin D our bodies need for optimal health comes from our skin’s unprotected exposure to sunlight.

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 vitamins, minerals and supplements.

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 the winter months, but little data is available on relative efficacy of preparations, rates of uptake, or whether serum status may influence uptake.

We do know, however, that the a one-size-fits-all approach to D3 serum supplementation is ineffective and although infants and children will benefit from 400iu daily, an adult requires between 1000iu to 3000iu daily as a maintenance dose. There has been much development in our knowledge of differing availabilities of active forms and the potential value of alternative delivery mechanisms.

It is essential that the brands you recommend can demonstrate their absorption testing – one thing the VMS industry needs to improve on. With an estimation that one in three of your customers is struggling 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 nutritional supplements.

Data on efficacy remains sparse but is growing 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 is the founder and CEO at BetterYou)

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