The end of winter is when energy levels can plummet following a run of colds and viruses

Some 46 per cent of Britons take a daily vitamin supplement, according to Mintel’s latest report on the category. Sales last year rose by two per cent to £414 million. Demographically positioned vitamins were the main driving force behind growth, says Mintel, reflecting consumer demand for targeted solutions. Sales of women’s supplements account for the largest share of the sector at 55 per cent, and one-third of women say they started taking supplements due to a recommendation from a health practitioner.

Vitamin D has driven growth of the market, with penetration up by four per cent last year. As we reach the end of a long winter, chances are your customers will have had plenty of coughs, colds, flu and gastro bugs to contend with, perhaps along with winter tiredness, or SAD, as a result of the shorter days and lack of sunlight resulting in an increase in melatonin production and a decrease in serotonin levels, leaving many with low immunity and a lack of energy. Most adults suffer at least four colds each year, most often during winter, and pharmacy staff can offer advice on boosting immunity and flagging energy levels in time for the spring.

Vitamins and nutrients

“Infections put a strain on the immune system, so it’s important to build this up again,” says Rick Miller, British Dietetic Association spokesperson and a clinical and sports dietician. The right diet is the best way to achieve this, he says.

“A diet rich in protein is essential, and dairy is an important source to include. Dairy products contain alpha-lactalbumin, which boosts immune health by helping to produce the amino acid cysteine, which is used to make glutathione, a powerful antioxidant.”

It is also important to include carbohydrates. “But choose low to moderate glycaemic index foods, such as wholegrains, not cakes or biscuits,” says Mr Miller. “Fibre encourages the growth of good bacteria in the gut, protecting membranes of the gut wall.” Fats are also important to include – omega 3, 6 and 9 are best, and good sources include nuts, seeds, oily fish and olive oil.

Dr Carrie Ruxton, dietician and spokesperson for the Health Supplements Information Service, advises: “Nutrients proven to support normal energy release include B vitamins, calcium and magnesium as well as iron. Those proven to support normal immune function include vitamins A, C, D, zinc, folate, B12 and selenium. A daily multivitamin supplement is a cost-effective and simple method to boost intake of these. There is also good evidence that fish oils support immune function, having an anti-inflammatory effect.”

Mr Miller says the most important micronutrients to include are vitamins D, E and A. “These are essential for white blood cells, which fight off infection. Vitamins C is also important as it helps normalise white blood cell activity, which boosts immunity post-infection.” Zinc is an important nutrient to include. “Zinc can be found in meat, cheese, shellfish, nuts and seeds, wholegrain cereals and breads,” advises Dr Rosalind Miller, nutrition scientist at the British Nutrition Foundation.

Pharmacist Lila Thakerar, of Shaftesbury Pharmacy in Harrow, says: “My first advice to customers who’ve had a run of viruses is to try to eat a more balanced diet and lead a healthy lifestyle. A good multivitamin can be useful and a high-potency vitamin B supplement will boost energy levels and strengthen immunity.” Herbal supplement echinacea can also be popular with customers, despite cold prevention trials with the herb only pointing “in the direction of small preventive effects,” according to a Cochrane systematic review. “It’s become really popular with our customers,” says Ms Thakerar. “It can be used both during a cold/cough/flu and after an acute virus to rebuild vitality and immunity. We can never order enough of it as it sells so fast.”

Alphega Pharmacy member Ranjit Mann, at Ringwood Pharmacy, says: “For those looking to boost their health, we’ve noticed a move away from traditional tonics towards multivitamins, especially those marketed for the immune system. I have also found alternative products in this category have become more popular.”

The role of vitamin D

New guidance from Public Health England recommends everyone over age one should have 10mcg of vitamin D every day. The main source is sunlight, which is difficult to get enough of in winter and for those who work indoors. A lack of vitamin D is linked with poor musculo-skeletal health, and there have been studies also linking it with low energy levels.

“Vitamin D can help to increase tryptophan levels, which in turn boost serotonin levels, making you feel better,” says Mr Miller. “People who suffer with SAD often have low vitamin D levels.”

Dr Rosalind Miller says: “From October to March, everyone should consider taking a daily supplement of 10mcg vitamin D. Around one in five people in the UK has low vitamin D levels. People from minority ethnic groups might not get enough sunlight in summer, so they should consider a supplement all year round.”

Dr Ruxton says vitamin D can help to keep the immune system healthy. “Studies show that vitamin D can modulate the innate and adaptive immune responses through effects on B cells, T cells and antigen presenting cells. Deficiency in vitamin D is associated with increased autoimmunity as well as increased susceptibility to infection.” Fultium Daily-D3 10mcg vitamin D supplement was launched last year to help meet the new vitamin D recommendations. Previously a prescription-only product, the new OTC supplement offers pharmaceutical-grade vitamin D, available in capsule or drop format.

Survey results from Vega Vitamins found that 79 per cent of UK adults don’t take a vitamin D supplement, despite 47 per cent expressing concern that they are deficient, and only 20 per cent of people have heard about the government’s latest recommendations regarding vitamin D.

Iron deficiency and fatigue

“A lack of iron can be a reason for tiredness, and you should suggest your customer has a blood test to check iron levels,” says Mr Miller. “The test should check stored iron as well as circulating levels,” he recommends. He adds: “Iron helps to make red blood cells, which carry oxygen around the body, which reduces tiredness. Most people should get the iron they need from their diet, but women who lose a lot of blood during menstruation are at higher risk of anaemia.”

“Pharmacists can use dietary questionnaires to determine if patients are eating enough iron. Red meat is most important, but also beans, pulses, leafy greens and fortified breakfast cereals,” proposes Dr Ruxton. “A general supplement containing iron (14mg) can be recommended for suspected low iron status.”

Lifestyle tips for immunity and vitality

The following lifestyle advice may be useful to pass on to customers:

  • “Regular exercise will improve your energy levels and keep your immune system healthy,” says Mr Miller. “It also helps improve gut bacteria health.”
  • “Getting plenty of sleep helps regenerate your body and improves your mood.”
  • “Stress can have a big impact on immunity,” comments Ms Barnes. “Take time out eachb day to unwind and try not to plan in too much. Stretching exercises, yoga and mindfulness all help to relax the body and mind.”
  • “Smoking and alcohol are detrimental to immune function,” says Dr Ruxton. “Pharmacists should caution against binge drinking and continue with anti-smoking messages.”
  • Cutting out caffeine can help fight fatigue, according to the Royal College of Psychiatrists. Recommend cutting it out for a month to see if they feel less tired.
  • Drink more water. Even mild dehydration can affect energy levels.
  • Remind people to wash their hands regularly, to reduce the spread of infection.

Probiotic potential

Probiotics may be able to increase the number of beneficial bacteria in the gut. “There’s good evidence that taking some specific strains of probiotics (eg Lactobacillus rhamosus or Saccharomyces boulardii) while taking antibiotics can prevent antibiotic-associated diarrhoea and may also help reduce Clostridium difficile infection,” suggests Dr Miller. “Multi-strain live bacteria supplements help to balance the immune system,” adds Protexin nutritional advisor Claire Barnes. “They help keep the epithelial lining and mucosal layer intact, helping to block out toxins and viruses while improving the absorption of nutrients.” “The microflora balance can be compromised during the winter months if it’s busy fighting off bugs,” says Natalie Lamb, also a nutritional advisor for Protexin. “An effective solution to topping up levels is to take a good multi-strain probiotic. It can shorten cold episodes and one study found it can increase vitamin D levels by more than 25 per cent.”

Category advice

Making the most of the vitamins, minerals and supplements category allows customers to have plenty of choice and a well-trained pharmacy team to ask for advice.

“Make sure there’s plenty of information for customers to read and site these products in the GSL area so they can browse,” suggests Ms Thakerar. “Be aware of new products that are around and be able to talk to your customers about these,” she says. “Reps will come and train your staff if you ask them to. Dummy packs and posters are good ways of promoting new products to customers,” she adds.

“This can be a daunting area on which to advise, so making sure my team are confident and knowledgeable on the products we stock is important,” comments Mr Mann.

“The newer cold prevention sprays are becoming quite established in the marketplace,” he says. “As these are lines with which customers will be less familiar, they provide the opportunity to open up a conversation with the customer when they ask for advice or as an additional item. Another good product to recommend is an antibacterial hand rub or wipes.”

“Make sure all your team is aware of trends and current advice and regularly check there is sufficient stock,” says Mr Mann. “These items are often purchased as a reaction to family or colleagues coming down with virus symptoms, so are needed straightaway. If the item isn’t available, customers may go elsewhere.”

 

COMMENT

Shaheen Bhatia, P&S Chemist, Ilford “This category is probably more important than ever; with funding cuts, it’s important for pharmacy teams to link up sales whenever they can. A lot of our younger customers ask about supplements. People don’t want to take time off work because of illness, so are keen to try something to help boost their immune system. We have a good chance to talk about this, and lifestyle factors that can affect immunity, when promoting the flu vaccination or when somebody does come in with a cold or flu. Of the supplement brands we stock, Redoxon and HealthAid are quite popular, and are not too highly priced, which is important in our area where people don’t have too much disposable income.”

Ali Hashemian, Avicenna Pharmacy, Swindon “Although people with a balanced diet don’t usually need to take supplements, not everyone has a perfect diet. Patients may say they feel very tired and run down. If people are very deficient in a particular nutrient there is a larger conversation that needs to be had, but for someone who is borderline, OTC supplements are usually enough. Many people in this country are vitamin D deficient, because there’s just not enough sun. There are a lot of misconceptions, for example I had a patient say ‘I’m fine, I’m getting sun exposure while driving’, not realising that the benefit of the sun is being blocked by the car window. A good rule of thumb is 10 minutes of sun on the hands, feet and face each day.”

Mithun Makwana, Avicenna Pharmacy, Bristol “Part of being a healthy living pharmacy is offering healthy eating advice. For most people, as long as they eat healthily and have a varied, balanced diet, there is no real need for multivitamins, but sometimes patients come in and feel a bit tired and they might need a bit of a boost. If the patient is happy to take a general multivitamin, that might pick them up a bit. Vitamin D is a big thing now and GPs are prescribing that a lot more. Obviously we have a lack of sunshine in this country so most people are going to have some kind of insufficiency. The advice is to get sun in the summer months, because the vitamin D we make from this will be stored, but we still lack vitamin D in general. People who have a prescription for vitamin D will have very low levels.”

 

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