Supplements-Module 144
Test yourself with our four scenarios as we reveal which supplements to recommend to very different patients
In this article you will learn:
• What vitamins and minerals are
• How vitamin and mineral requirements vary during certain stages of life
• Which patients may benefit from taking vitamins and minerals.
Download a pdf version of this module here
Download the Test Your Knowledge questions here
Scenario 1 Feeling run down
A young man asks you to recommend a multivitamin. "I am working hard and not eating properly," he admits. "What can I take to make sure I am getting all the vitamins I need?"
First you should gently point out that the best way to get all the nutrients our bodies need is by eating a healthy, balanced diet that should include at least five portions of fruit and vegetables a day.
Vitamins are compounds required by the body in small quantities for normal metabolism, growth and development. Most cannot be produced by the body and so must come from our diet. There are two types. The fat-soluble vitamins are vitamins A, D, E and K. These tend to come from fatty foods and do not need to be eaten every day, as any excess is stored in the liver and fat. This can mean that their levels can build up, causing toxicity. The other vitamins are water soluble. These are not stored in the body so need to be consumed more frequently. Any excess is excreted by the body, so toxicity is not normally a problem. Vitamin B is not a single vitamin but a group of different vitamins that exist in the same foods; they are known by their name (such as folic acid) or number (such as B12).
Minerals are required only in small quantities but are essential for body function. They are found in all major food groups and some are absorbed better than others. They include iron and calcium.
Trace elements are also essential nutrients that your body needs to work properly, but in much smaller amounts than vitamins and minerals.
People who benefit from taking supplements include the elderly, some ethnic minorities and people whose nutritional status may be compromised by lifestyle (such as vegetarians), surgery, disease or long-term drug use.
Many people, like this customer, simply take supplements to promote optimal health or because they feel they do not eat very well and want to get everything they need by taking a daily tablet.
You should recommend
A general multivitamin and mineral tablet that contains 100 per cent of the recommended daily allowance (RDA) of vitamins, plus varying amounts of minerals and trace elements.
Scenario 2 Pregnancy
A woman asks you for some advice in private. She explains that she has recently discovered she is pregnant. "I know I need to take folic acid," she says, "but is there anything else I should take or avoid?"
Folic acid is a B vitamin that is essential during the early stages of pregnancy. A dose of 400mcg a day for the first 12 weeks of pregnancy is recommended to reduce the risk of the baby being born with neural tube defects such as spina bifida.
Folic acid should ideally be taken before conception, but obviously this isn't always possible.
Certain groups of women (such as women with epilepsy or those who have a history of neural tube defects) require a higher dose of folic acid, which they can get on prescription from their GP.
The only other supplement that is recommended during a normal pregnancy is vitamin D, which aids the absorption of calcium in the body. Our main source is from exposure to the sun, but as this is variable and there is not much vitamin D available from our diet, it is recommended that pregnant women take a daily 10mcg supplement. This is also recommended for breastfeeding mothers.
A number of other vitamins and minerals are required during pregnancy, including iron, calcium and vitamin C, to aid healthy growth and development of the baby. There is no need to increase their intake though, as the body adapts to meet these new requirements. Pregnant women should simply be advised to eat a healthy balanced diet. It is not necessary to ‘eat for two'.
You should recommend
A supplement specifically designed for use in pregnancy (not a general multivitamin). There are a number of different brands available to choose from, and they generally all contain folic acid along with a number of other vitamins and minerals thought to be of benefit to the developing baby and the mother. They do not contain vitamin A because it is known to cause problems in the developing baby if it is taken in large amounts.
Scenario 3 Toddlers and infants
A mother would like some advice on what multivitamin to give her four-year-old son. "He is a bit of a fussy eater," she confides. "I'm worried that he isn't getting enough of a balanced diet. Should I be giving him a supplement every day?"
The simple answer to this is yes. The Department of Health recommends that all children between six months and five years take a supplement containing vitamins A, C and D. Some people qualify for this free under the Healthy Start scheme.
Between the age of one and five years children have very high energy and nutrient requirements in relation to their size. They only have small stomachs and often have variable appetites, so it is a common concern among their parents that they are not eating enough.
It is vital that children are offered a healthy balanced diet containing lots of fruit and vegetables. However, pre-school age children suffering deficiencies in iron, calcium and vitamin D are not uncommon.
Iron-rich foods such as green vegetables and liver are not generally that popular with young children so a supplement may be recommended to avoid problems of iron-deficiency such as frequent infections, poor weight gain and developmental delay. Calcium along with vitamin D is vital for the development of healthy teeth and bones.
Vitamin and mineral supplements aimed at school-age children often contain omega-3 nutrients with the claim that they help maintain healthy brain function and probiotics that may help boost immunity. According to NHS Choices, there is "no compelling evidence" omega-3 can boost children's exam performance.
You should recommend
A supplement aimed at children. As a child grows from a baby through to a teenager, their nutritional requirements vary and there are a number of vitamin and mineral supplements aimed at the various different stages of childhood and adolescence.
It is important to make sure the product is right for the child's age.
Scenario 4 Staying healthy in old age
Mrs Thomas, an elderly customer who comes in regularly, would like you to recommend a tonic for her to take as she is feeling run down.
As we age our energy requirements fall but our requirement for certain proteins, vitamins and minerals remains the same. Factors including poverty, poor mental health, difficulty buying or preparing food and problems with teeth can all impact on elderly people's diets. If a healthy balanced diet is not achievable then a number of supplements are available that are specifically aimed at this age group.
As already mentioned, vitamin D aids the absorption of calcium so is important for bone health. The main source is sunlight, but as elderly people tend to have less exposure to the sun it is recommended that people over 65 take a supplement of 10mcg a day. Post-menopausal women may also benefit from taking 800-1,000mg of calcium a day to reduce the risk of bone fractures. Vitamin K is important for bone health but must be recommended with caution as it reduces the effect of anticoagulant drugs, which are taken by many elderly people. Always ask older patients if they are taking any medicines before recommending a product and, if unsure, refer them to the pharmacist.
Certain conditions or medications can lead to an increased requirement for some vitamins and minerals. Iron deficiency is common because its absorption decreases with age. The tannins present in tea are also known to reduce iron absorption. Iron loss from bleeding from ulcers or from the use of aspirin and certain anti-inflammatories could also be a factor; if either of these conditions are suspected the patient should see the pharmacist.
Requirements for vitamin C and some B vitamins increase as absorption decreases with age.
An elderly person's diet also often contains foods such as bran, which affect the availability of minerals in the body.
You should recommend
A supplement aimed at older people. These often contain additional ingredients such as omega-3, gingko biloba and ginseng, which claim to maintain vitality in mind and body, although NHS Choices says evidence is lacking. Antioxidants such as vitamin E are often included. They neutralise free radicals, which are thought to be responsible for ageing and the occurrence of age-related diseases but it is not known whether this benefit can be achieved from a supplement. Glucosamine is often used
to maintain healthy joints.
Key points
• Pregnant women should take 400mcg of folic acid every day for the first 12 weeks of pregnancy and ideally before conception
• Certain drugs can affect absorption of vitamins and vice versa – if in doubt, refer the customer to the pharmacist
• Vitamin and mineral supplements cannot claim to have any medical benefits
• The best source of vitamins and minerals for most people is from a healthy balanced diet
• A supplement of 10mcg of vitamin D should be taken daily by pregnant and breastfeeding women, children aged six months to five years and people over 65 years of age.
Evaluation
• Have a look at the supplements stocked on your shelves. How do they differ and which will you be recommending to your customers?
• Each vitamin and mineral has a different role in our body. The NHS choices website (www.nhs.uk/conditions/vitamins-minerals/Pages/Vitamins-minerals.aspx) provides more information on their individual functions.
