Despite their growing popularity, there remains a great deal of public confusion about when dietary supplements are recommended or useful

The VMS sector is currently undergoing sustained growth, driven both by an increasing awareness of the need to be healthy and significant advertising activity.

A growing interest in veganism and vegetarianism also means customers are increasingly thinking about taking supplements to counter potential deficiencies in such diets. As a result, there has been an explosion of product ranges and competing brands, creating challenges for pharmacies when deciding which products to stock. Here we review the main sub-sectors of the category.

Multivitamins

Multivitamins can be recommended for providing a wide range of micronutrients to people consuming a poor diet. Recent research from the Health and Food Supplements Information Service (HSIS) reveals that three in 10 people worry that their diet might not be providing all the nutrients they need for their health and wellbeing. It also found that:

• Fewer than one in five adults eat enough fruit and vegetables
• Nearly four in 10 eat ready meals or takeaways at least once a week
• Most people (80 per cent) are unaware that the Government recommends supplements for some groups and advises that everyone takes a vitamin D supplement for half of the year
• Four in 10 adults don’t take dietary advice from anyone, not even their doctor, while one in 10 follows the advice of celebrities and social media bloggers (this doubles to one in five in the 18-24-year age group).

“Sourcing optimal amounts of nutrients from the diet alone is a challenge and most people in the HSIS survey had not considered food supplements, which are an effective way to top up vitamin, mineral and omega-3 intakes,” says dietician Dr Carrie Ruxton. 

Customers should be asked about their diet and lifestyle to assess whether they could benefit from a supplement, says Clare Thornton-Wood, specialist paediatric dietician, Great Ormond Street Hospital for Children. For instance, it is important to find out if the customer is pregnant, how old they are, what diet they eat and whether they have any allergies. The aim should be to recommend a healthy diet with a balance of fruit and vegetables, protein foods, starchy carbohydrates, milk and dairy foods or plant-based alternatives. Then it is important to ask about all supplements being taken by customers. 

“For instance, if they are taking a general multivitamin and mineral supplement plus a fish oil supplement or calcium and vitamin D combined, they could easily exceed the recommended daily intake for fat soluble vitamins such as vitamin A and D. And cold and flu remedies often contain large doses of vitamin C, so if these are taken alongside other supplements containing vitamin C, then they could experience effects like loose stools.”

Customers who have been ill will benefit from a multivitamin supplement for a short while to replenish their nutrient stores, she says. Another group that may struggle to get enough nutrients in their diets are vegans and vegetarians. A general supplement can be useful or individual supplements such as vitamin B12, omega 3 and iodine can be recommended.

Vitamin D 

Vitamin D helps to regulate the amount of calcium and phosphate in the body – the nutrients that keep bones, teeth and muscles healthy. A lack of vitamin D can lead to bone deformities such as rickets in children and osteomalacia in adults, osteoporosis and muscle weakness. 

Vitamin D is made in the skin by the action of sunlight and this is the main source of the vitamin for most people. “A healthy, balanced diet and short bursts of sunshine will mean most people get all the vitamin D they need in spring and summer,” says Dr Louis Levy, head of nutrition science at Public Health England (PHE). “However, everyone will need to consider taking a supplement in the autumn and winter if they don’t eat enough foods that naturally contain vitamin D or are fortified with it.”

In addition, PHE advises that the following groups should take a daily supplement:

• All babies from birth to one year old
• All children aged one to four years old
• People who have little exposure to the sun (e.g. people who are frail or housebound, who live in a care home or who usually wear clothes that cover most of their skin when they are outdoors).   

Fish oils

Cod liver oil and other fish liver oils are rich sources of vitamins A and D and the omega-3 essential fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). 

EPA and DHA are found in every cell membrane in the body and are helpful in reducing triglyceride levels in the blood, maintaining a healthy heart, supporting brain function, reducing blood pressure and maintaining eye health. 

Fish oils inhibit the production of inflammatory chemicals in the body and are widely used in the management of inflammatory joint conditions.  

Probiotics

Probiotics such as acidophilus and bifidus can help improve digestion. Once in the gut they work by multiplying and restoring the balance of the normal bacterial population of the intestine, especially if it has been disrupted by illness.

According to nhs.uk, there is some evidence that probiotics help prevent diarrhoea when taking antibiotics and may ease some symptoms of irritable bowel syndrome – but there is little evidence to support many of the other health claims made about them. For example, there is no evidence to suggest that probiotics can help in eczema. 

CoQ10

Coenzyme Q10 (CoQ10), an antioxidant produced naturally by the body, is used by cells for growth and maintenance. Levels of CoQ10 in the body decrease with age. Scientists have linked low levels of CoQ10 with various medical conditions, including heart disease and cancer. Supplements produce few side-effects but there is limited research to support suggested health benefits.

Supplements for specific groups

For the majority of the population, vitamin and mineral supplements are unnecessary as people obtain all the nutrients they need from their food, says Clare Thornton-Wood. “However, there are groups of the population who should be taking some supplements at various stages. These include pregnant women, children and babies, people with restrictive diets unable to meet their full nutritional requirements via food (for instance, people not eating dairy and not replacing this with other dietary sources of calcium), vegans and, in some cases, also vegetarians.”

Pregnancy

All women thinking of having a baby should take a folic acid supplement, as should any pregnant woman up to week 12 of the pregnancy to help prevent neural tube defects such as spina bifida. Pregnant women should also be advised to take a vitamin D supplement.

Digestive health 

Numerous supplements can be recommended for digestive health including: 

• Peppermint oil in tea or as an enteric-coated capsule. Peppermint soothes the digestive tract, helps relieve nausea and sweetens breath. Peppermint oil may be effective in irritable bowel syndrome (IBS)
• Ginger has been used for thousands of years as a treatment for digestive problems ranging from mild indigestion and flatulence to nausea, vomiting, travel sickness, morning sickness in pregnancy and vertigo  
• Chamomile is widely used to promote general relaxation and to help calm the digestive system. 

Joint health

Glucosamine has an anti-inflammatory action and is commonly used for relieving the pain and other symptoms associated with osteoarthritis and other joint disorders. A 2005 Cochrane review of 20 randomised controlled trials demonstrated the effectiveness of glucosamine in the reduction of pain and improvement of joint function in osteoarthritis and also demonstrated its safety.

Remember: when selecting any product, check that it complies with food supplement regulations and labelling requirements to ensure consumer protection.