The VMS category is thriving, as consumers try to do all they can to protect their health during the pandemic

Vitamins, minerals and dietary supplements designed to help people cope with stress, support energy production and look after their joints have become increasingly popular during the past year. And with the public keen to protect themselves from Covid-19, immune boosting ingredients have seen a huge surge in demand. One of the most popular – and closely examined – has been vitamin D. Research into its protective effects continues.

A white paper produced by scientific experts for Thornton & Ross (Seeing the light: does vitamin D have a role against Covid-19?) looked at the antimicrobial and anti-inflammatory effect of the nutrient as a possible protector against acute respiratory illness. “There is evidence from other critical illness that suggests vitamin D preparations can reduce the risk of death,” says the paper. “Patients with severe Covid-19 might benefit from vitamin D preparations as part of clinical trials to determine whether it has a role to play in reducing risk of death in Covid-19.”

The Scientific Advisory Committee on Nutrition rapid review on using vitamin D supplements to prevent acute respiratory tract infections found a modest protective effect of vitamin D supplementation (daily dose 10-25mcg). And although the NICE Covid-19 Rapid Guideline: Vitamin D (NG 187) review found insufficient evidence for its use in preventing Covid-19, it agreed that low vitamin D status is associated with more severe outcomes. “It is not possible to confirm causality because many of the risk factors for severe Covid-19 outcomes are the same as the risk factors for low vitamin D status,” says the guideline.

Further investigation

Dr Michele Sadler, scientific adviser at the Health Food Manufacturer’s Association, says: “More research is needed before any conclusions can be drawn about vitamin D supplementation. Some research suggests a link, but it is not clear that taking vitamin D offers any specific benefit over and above its role in supporting the immune system. However, in the current situation, it makes sense to ensure a good dietary intake of all the nutrients important for the immune system.”

Mike Wakeman, founder and clinical pharmacist at Vitmedics, says: “A recent report from the Royal Society suggested people admitted to hospital with Covid-19 should have their vitamin D status checked and/or supplemented and consideration should be given to testing high dose calcifediol in the RECOVERY [Randomised Evaluation of Covid-19 Therapy] trial... There seems nothing to lose and potentially much to gain.”

Clinical nutritionist Suzie Sawyer says: “Pharmacy staff need to recommend vitamin D supplementation, which will help optimise immune health – vital as we live through Covid- 19. One recent review found a positive association between vitamin D deficiency and severity of Covid-19. It therefore makes real sense to ensure vitamin D levels are adequate and this is only possible through supplementation, especially during winter months.”

Bridging gaps

Although it is found naturally in foods such as oily fish, red meat, eggs and mushrooms, around 80-90 per cent of our vitamin D requirements are obtained via sun exposure.

However, the National Diet & Nutrition Survey found that around a fifth of UK adults have low vitamin D levels (below 25nmol/l), and during winter this rises to about 30-40 per cent.

Dr Nisa Aslam from the Health & Food Supplements Information Service (HSIS) says: “It remains important for pharmacy staff to advise customers to take a vitamin D supplement for overall health, immune health and muscle and bone health.”

Registered dietician and British Dietetic Association spokesperson Susan Short echoes NICE recommendations when she says: “All adults and children over the age of one should consider taking a daily supplement of 10mcg of vitamin D, especially during autumn and winter.”

Vitamin C and Covid

Results from more than 100 studies have shown that vitamin C may help prevent, treat and reduce severity of symptoms in patients with Covid-19. Evidence has been published in the journal Nutrients and presented to NICE for review. The research included a randomised controlled trial which showed vitamin C could cut the fatality rate of critically ill patients by 68 per cent.

Co-author professor David Smith, emeritus professor of pharmacology at the University of Oxford, says: “Vitamin C is, we believe, important in two areas: first, a person’s vitamin C status will influence their susceptibility to suffering harm from Covid, which can be reduced by oral pre-treatment; second, during hospitalisation, there is evidence that the course of the disease can be influenced by intravenous administration of high-dose vitamin C.”

The authors of the report have launched a campaign – VitaminC4Covid – to highlight the nutrient’s importance.

All adults and children over the age of one should consider taking a daily supplement of 10mcg of vitamin D, especially during autumn and winter

Other immunity nutrients

Aside from D and C, vitamins A and E are important for a robust immune system, along with zinc and omega-3 fatty acids, says dietician Dr Carrie Ruxton on behalf of HSIS.

A study in BMJ Nutrition looked at the association between vitamin intake and respiratory complaints in adults from the UK National Diet & Nutrition Survey. It looked at vitamins A, E, C and D from diet and supplements and the prevalence of respiratory complaints. It found intake of vitamins A and E from diet and supplements, and vitamin D from supplements, were linked with a lower prevalence of respiratory complaints.

“This new study reports that people who supplement have a lower chance of experiencing respiratory complaints,” says Dr Ruxton. “This shows that supplements are an important tool in our armoury to stay healthy all year round.”

Other important market sectors

A 2019 report from the charity Versus Arthritis found that musculoskeletal conditions such as arthritis and back pain affected some 18.8 million people in the UK in 2017, accounting for more than 22 per cent of our total burden of ill health.

While supplements won’t alleviate all the risk factors for these conditions (obesity being a main one), they can help. Consultant rheumatologist Dr Rod Hughes says: “Pharmacists can play a pivotal role in steering people with joint pain towards a prevention programme, promoting lifestyle and diet changes, including recommendation of clinically proven joint specific supplements, such as the galactolipid GOPO. A prevention programme can help to reduce the number of people using long-term analgesics, with resulting side-effects.” Current food trends are also creating a role for supplements.

People choosing vegan and vegetarian diets are predicted to make up a quarter of the British population by 2025, with flexitarians accounting for half of UK consumers, says HSIS.

A plant-based diet can have health benefits. However, if not well planned, it can lead to nutrient deficiencies, especially of vitamins B12 and D, iron, zinc, selenium, iodine and omega-3 fatty acids. According to an HSIS report, a quarter of people on plant-based diets have been diagnosed with a nutrient deficiency at some stage – mostly iron or vitamin D – and eight out of 10 vegans and vegetarians rely on ready meals. HSIS says 62 per cent of people switching to a plant-based diet did not research the nutritional health impact first and around half take no dietary supplements.

A prevention programme can help to reduce the number of people using long-term analgesics