Association of Pharmacy
Technicians UK (APTUK)
The Professional Leadership Body for Pharmacy Technicians

Supplementary benefits for all

More and more people are turning to plant-based diets, but they could be missing out on vital nutrients. Pharmacies can explain how dietary supplements work and advise customers which products will meet their specific health needs.

Increasing numbers of high street food chains are expanding their plant-based offerings and, by early January this year, more than 350,000 people had signed up to the Veganuary website. 

A recent Kantar study commissioned by Veganuary revealed that people who cut out animal products for January 2019 maintained reduced consumption levels until at least July 2019. But healthcare professionals are concerned that many people who cut out all animal foods fail to explore the long-term implications on their nutrient intake.

In October 2019, the Health and Food Supplements Information Service (HSIS) interviewed 1,000 vegetarian and vegan adults across the UK and found that 28 per cent of vegans and 13 per cent of vegetarians had been diagnosed with a nutrient deficiency following a blood test. Despite this, more than six out of 10 people claimed that their plant-based diet provided all of the nutrients they needed.

One in 10 respondents to the HSIS survey had turned to a meat-free diet in the past year and half had been vegan or vegetarian for longer. However, 60 per cent admitted they had done no research before cutting out animal products, and most didn’t take a targeted dietary supplement, as recommended by the NHS and The Vegan Society. 

Paul Chamberlain, Solgar category development and product training director UK & Ireland, says that all vitamins, minerals and other essential nutrients found in meat and dairy need to be replenished in a vegan diet. “A rich, balanced diet is paramount in ensuring a healthy and fully functioning system,” he says. “For those embarking on an entirely plant-based diet, we strongly advise looking at the food groups they will be giving up and where they can alternatively find the nutritional value. Well chosen supplements provide a valuable and simple solution to this issue and are an asset to anybody embarking on Veganuary.”

Vegan dietary needs explained

According to the NHS website, it is possible for vegans to get all essential nutrients from a plant-based diet, as long as they plan their diet properly. “The NHS website states that if a vegan person doesn’t plan their diet well, at the very least, intakes of calcium, iron and vitamin B12 could be critical,” says Dr Emma Derbyshire, HSIS nutritionist. “In particular, vitamin B12 supplements have long been recommended for vegan diets, as these diets contain no animal foods. Vitamin B12 is obtained only from animal foods, although some foods, such as some breakfast cereals, are fortified.”

The NHS website says that while some sources of omega-3 fatty acids are suitable for vegans, these may not have the same benefits as oily fish in reducing the risk of heart disease. “Most vegans will be consuming adequate linoleic acid – the essential omega-6 fat – from pumpkin and sunflower seeds, walnuts and soya spread,” says Clare Thornton-Wood, registered dietitian and British Dietetic Association spokesperson. “However, alpha-linolenic acid, the essential omega-3 fat, is more difficult to obtain and they may want to consider a supplement of 250mg a day for adults from microalgae rather than animal sources.”

Probiotic supplementation is another key area of interest, says Claire Barnes, Protexin technical advisor and qualified nutritional therapist. “Studies have shown differences in the gut microbiome of meat eaters in comparison to vegans and vegetarians,” she says. “Researchers comparing Bifidobacteria levels in vegans, vegetarians and controls found them to be significantly lower in vegan and vegetarian samples than in controls eating a standard omnivorous diet. Another study observed higher Bifidobacteria levels in meat eaters compared to participants who switched to a vegetarian diet for four weeks. Bifidobacterium is known to play a protective role in the human gut barrier by providing a defence against pathogens and diseases.”

In summer 2019, HSIS published a report that looked at how UK dietary intakes have deteriorated in the past 20 years. State Of The Nation: Dietary Trends In The UK 20 Years On revealed that vitamin D intakes have fallen by 22 per cent, folic acid by 10 per cent, iron by 5 per cent and calcium by 10 per cent. “There are worrying declines in intakes of vitamins and minerals across the board,” says Dr Derbyshire. “Worse still, people seem to be ignoring public health advice. Diets are changing as people try to lose weight, cut down on meat and/or fish, including for sustainability reasons, or pursue low-meat, vegan or vegetarian diets. A majority of community pharmacy customers would benefit from a multivitamin and multimineral supplement to bridge this dietary gap. The fact that 80 per cent of people don’t take a vitamin D supplement, which is recommended by Public Health England for all population groups during the autumn and winter months, is a big worry.”

One key concern about self-supplementation is whether consumers could be taking supplements they don’t need because they are already obtaining sufficient levels through their diet. Pharmacy customers who are concerned about their intake of specific nutrients should speak to their GP, as they may be offered a blood test. 

BetterYou recently launched online At-Home Health Checks for vitamin B12 and iron, and updated its vitamin D testing service. The finger-prick blood tests are analysed by a laboratory. On receiving the results, customers are given a personalised supplementation plan, which advises on how to elevate or maintain levels of the relevant nutrient. A complimentary oral spray product is available to customers following receipt of their test results. Those found to be seriously deficient also qualify for a free retest.

According to the Euromonitor report Vitamins In The United Kingdom (October 2019), vitamin D is one of the most commonly bought vitamins in the UK. It is also one of the most commonly prescribed. A December 2019 study published in BMJ Open revealed that prescribing of high dose vitamin D for British children has surged to an all time high and that prescriptions for the bone health vitamin have risen 25-fold over the past 10 years.

Supplementation recommendations by group

There is good evidence that certain dietary supplements may be beneficial for specific groups of people. 

  • Children: from the age of six months to five years, children should take a supplement that contains vitamins A, C and D.
  • Pregnant/breastfeeding women: all women who are planning a pregnancy and for the first three months of pregnancy should take a 400mcg folic acid supplement daily and a 10mcg vitamin D supplement daily throughout pregnancy and while breastfeeding. Pregnant and breastfeeding women can also be advised to take a suitable omega-3 supplement if they don’t eat much oily fish
  • Adults: all adults should consider taking a daily supplement that contains 10mcg vitamin D during autumn and winter. This is particularly important for people who are frail or housebound, are in an institution such as a care home or who usually wear clothes that cover most of their skin when outdoors. A calcium intake of at least 1,000mg/day is recommended for people at an increased risk of a fragility fracture
  • Older people: there are no official recommendations, but increasing numbers of people over 65 are failing to obtain enough vitamin A, iron, calcium, magnesium, potassium, iodine and zinc from their diets, says HSIS nutritionist Dr Emma Derbyshire. The best way to ensure adequate micronutrient intake in this age group is a multivitamin and multimineral supplement

Low vitamin status

According to dietitian Dr Carrie Ruxton, spokesperson for HSIS, between one quarter and a third of people have low vitamin D status. “Rather than relying on high dose vitamin D prescriptions, people could do more to safeguard their vitamin D status by eating oily fish and eggs, which contain vitamin D, and taking an over-the-counter vitamin D supplement or a multivitamin and multimineral that contains 10 mcg vitamin D,” she says.

Frankie Brogan, Pharma Nord UK’s senior nutritionist, says that of all supplements, finding the correct dosage for vitamin D is arguably the most difficult and variable. “Government recommendations currently lie at 400iu vitamin D per day, but other scientific bodies, including the Endocrine Society and the Vitamin D Council, suggest higher doses – up to 5000iu per day,” he says. “Adding to this, experts have also campaigned for official recommendations to specify vitamin D3. Vitamin D supplements can come in either D2 or D3 form. The latter is considered much more effective at raising our vitamin D levels than the former.” 

According to Spatone, iron is another large category in the pharmacy sector, for both men and women. The brand, which recently rolled out new packaging, says that consumers buy iron supplements for a range of reasons, including to help with tiredness and fatigue, to compensate for a lack of iron in their diets, to help maintain regular energy levels and to support their immune systems. In the summer 2019 HSIS survey, 10 times more older women and almost 54 per cent of teenage girls were not meeting the minimum dietary target for iron compared with 10 years ago.

According to Pharma Nord UK, pharmacies remain a key market for the sale of vitamin and mineral supplements (VMS) of all types. The retail market is estimated to be worth £430 million a year in the UK alone, and recent figures show that 31 per cent of all sales are made in pharmacies – the highest percentage of any retailer category, ahead of specialists such as health food stores.

In September 2019, Pharma Nord UK offered pharmacies free access to 20 training modules covering supplements including vitamin D, coenzyme Q10, magnesium, fish oil, omega-7 and vitamin K. Rasmus Henriksen, UK general manager for Pharma Nord UK, says that pharmacies are in a great position to expand their share of the VMS market and to grow the market as a whole. 

“We know that customers value the knowledge and expertise they can get from pharmacies about how supplements work and which products are best suited for their health needs,” says Mr Henriksen. “Market research shows that 65 per cent of UK adults take vitamin and mineral supplements either daily or occasionally and 46 per cent take them every day. Crucially, 32 per cent of female users and 21 per cent of male users started taking supplements due to a recommendation from a health practitioner, and pharmacists were rated as the most trusted source of recommendations.”

Supplementation safety

Clare Thornton-Wood stresses that pharmacy customers may need advice on the safety of supplementation, just as they do with any other medication. Some people may perceive supplements to be harmless. “Take into account any over-the-counter and prescribed medication, including herbal remedies,” she says. “Customers need to be careful taking multivitamin and mineral supplements alongside single supplements, particularly for fat-soluble vitamins such as A and D as these are toxic at high levels. High doses of vitamin C can cause diarrhoea. Think about interaction between medicines such as warfarin and vitamin K. People should never take more than the recommended daily dose. More is not better and it will either end up passed out in urine or build up in the body and become toxic.”

Many people take nutritional supplements to improve specific aspects of their health and lifestyle, rather than to replace nutrients missing from their diets. According to the Salience Supplements & Vitamins Market Insight Report of August 2019, the top UK monthly searches for supplements included hair vitamins, while Euromonitor revealed in October 2019 that brain health was one of the “hottest topics in the UK”.

In October 2019, Wassen reintroduced its Silica-OK: Hair, Skin & Nails food supplement to the market with an improved formula and more nutrients. The company also introduced Efamol Kids Omega 3 DHA Drops and Efamax Ultra Strength Pure Fish Oil with DHA to support brain performance and vision. “These changes are in direct response to our understanding of the food supplements market and reflect ongoing changes in consumer preference,” says Victoria Malcolm, the company’s head of marketing.

Tiana Advanced Formula Memory Oil provides a vegan alternative to memory and brain supplements that contain fish oil. “Two-thirds of the UK population don’t like, or don’t eat enough, oily fish,” says Karen Middleton, Tiana nutritionist. “Therefore, they don’t have enough omega-3 DHA to fully support their memory and overall health. The vegan omega-3 DHA in Tiana Memory Oil contains a nutrient called choline, which plays a vital part in memory improvement and supports vegan diets.”

Protexin, meanwhile, has launched Bio-Kult Mind, which targets both the digestive tract and cognitive function. “Many people notice a decline in memory as they age and, unfortunately, as our age increases so too does our risk of developing dementia,” says Ms Barnes. “Research is showing that our gut bacteria may play an important role in our brain health and cognition by influencing the central nervous system via what is known as the microbiota-gut-brain-axis. Recent studies are indicating that live bacteria supplements could be a useful tool in preventing neurodegeneration.”

Views from the P3pharmacy category panel

Selina Gill, Rowlands Pharmacy, Redditch

“Lots of our customers are aware of the importance of obtaining the correct nutritional support. They look for the best product at an affordable price. With more health-conscious gym goers and vegans, I have seen tangible growth in sales of vitamin B complex. More people seem to be turning to a flexitarian diet, so multivitamins are a huge opportunity. Creating awareness among this customer group and providing tailored advice is key. We have a large display unit that patients are faced with while waiting for prescriptions and this often leads to queries and purchases.”

Marisa Maciborka, Bedminster Pharmacy, Bristol

“More and more people are trying to use ‘non-medicinal’ remedies to help their immunity and general wellbeing. Customers ask about which products will help with hair and nail growth, immunity and stress. Popular supplements include zinc, biotin and liquid iron. When talking to customers about supplements, it is important to note that although they may be GSL, not all are suitable for everyone. Signage and product placement near medicinal remedies could be a good way to improve sales should customers want to learn about deficiencies that may be causing their symptoms.”

 Sarina Mughal, Day Lewis, London SW1

“Most of our pharmacy’s income comes from the VMS sector, so it’s really important for us. Customers at this time of year want supplements to help them feel better, such as immune boosters, vitamin D, multivitamins, manuka honey and vitamin C. We stock a large range and our top sellers include Wild Nutrition, Solgar, Bear Biology and Viridian. Our customers like ethically sourced brands, and we’ve noticed a slight increase in interest in children’s brands recently. Our customers also like vegan, gluten-free, halal and kosher products. It’s important to have a seasonal display and change it regularly.”



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