The choice of dietary supplements is enormous, and customers may be overwhelmed when trying to decide which ones to take. You are ideally placed to answer their questions and offer advice, so it’s important that your knowledge is up-to-date

Poor diet costs the NHS an estimated £5.8 billion a year, according to the Health Supplements Information Service (HSIS). In fact, the organisation estimates that 70,000 premature deaths could be prevented each year if the British public’s diets matched the Government’s nutritional guidelines.

A lack of vital nutrients is linked with an increased risk of certain cancers as well as heart disease, diabetes, osteoporosis and depression. During pregnancy, it can also have serious health implications for the unborn child – many of which last into adulthood.

If everyone ate a balanced diet on a regular basis, most of us wouldn’t need to take supplements regularly. However, significant numbers of people don’t do this. In addition, there are certain times in life when people need to take supplements alongside a healthy diet to meet their nutritional needs. “A healthy, balanced diet should always be promoted as the cornerstone of dietary advice,” says HSIS dietitian Dr Carrie Ruxton. “A supplement is there to help prevent deficiencies due to poor dietary intake or greater requirements at certain times.”

Your customers may find the choice of dietary supplements overwhelming, so they will welcome your advice on which ones are recommended for their needs. The following examples of typical customers with additional dietary requirements will help you respond to customers in real life.

Mum-to-be

Sandra is 35 years old and 10 weeks pregnant with her first baby. She wants to know if there are any dietary supplements she should be taking to protect her baby’s health, as well as her own.

Pregnant women shouldn’t take supplements or change their diet without talking to a healthcare professional first, so Sandra should speak to the pharmacist before she buys any new supplements.

In general though, folic acid is important for the development of a baby’s neural tube, and helps to protect against tube defects such as spina bifida, cleft palate and brain damage. Women should ideally take a 400mcg folic acid tablet daily as soon as they start trying to conceive and until they are 12 weeks pregnant. If Sandra hasn’t already been taking folic acid, it’s not too late for her to start taking it. For customers with an increased risk of having a baby with a neural tube defect (e.g. a previous pregnancy was affected, the woman or her partner were affected, there is a family history of a defect or the woman has diabetes), a higher dose of 5mg daily until 12 weeks should be taken. Women taking antiepileptic medication may also need the higher dose.

Vitamin D is also essential during pregnancy as it regulates calcium and phosphate levels, which will keep Sandra’s bones healthy and also ensure healthy bone development in her baby. A supplement of 10mcg daily is recommended during pregnancy.

Iron deficiency is common among pregnant women and can cause anaemia. Good dietary sources include lean meat, leafy greens, dried fruit and nuts. If iron levels become low, a GP or midwife may prescribe an iron supplement. Vitamin C-rich drinks, such as orange juice, can help the body to absorb iron.

Importantly, vitamin A must be avoided during pregnancy as large amounts can harm the baby. If your customer wants to take a multivitamin, make sure it doesn’t contain vitamin A. There are a range of multivitamins formulated for use specifically during pregnancy, so one of these would be a suitable choice.

According to Mintel, some 63 per cent of people took supplements in the past 12 months

Breastfeeding mum

Cathy, 32, is breastfeeding her three-week-old baby and also has a two-year-old son, so she’s very busy and doesn’t always make time to eat well.

It may be difficult for her, but try to encourage Cathy to make time to eat a healthy, balanced diet. Breastfeeding women need to consume an extra 500 calories a day for milk production and energy requirements – and eating well is important as it affects milk quality. As well as being beneficial to the health of mum and baby, research suggests that a good variety of foods may help the baby get used to different tastes.

A vitamin D supplement of 10mcg daily is recommended for women who are breastfeeding to safeguard their babies’ bone formation, and a multivitamin supplement may be a good way of ensuring Cathy gets all the nutrients she needs during this busy time of her life.

A number of nutrients are recommended during pregnancy

Child under five

Kirsty is about to stop breastfeeding her six-monthold baby. She wants to know if he now needs extra vitamins.

It’s not easy to get babies and young children to consume enough nutritious food containing vitamins A, C and D, so a daily supplement is recommended from the age of six months to five years. Vitamin A is important for immunity, healthy skin and eyes; vitamin C supports immunity and iron absorption, and vitamin D is essential for healthy bones. Children’s vitamin drops are available with the correct dosage of all three vitamins.

Babies who are bottle-fed don’t need vitamin drops until they are having less than 500ml of infant formula milk a day as it is already fortified with vitamins.

Primary school-aged children

John has two children aged six and 10, both of whom are fussy eaters and don’t like fish. He wants to know if he should be giving them extra vitamins.

A daily multivitamin is a good idea if children don’t eat a wide variety of foods on a regular basis, and many studies have shown that eating oily fish, which is rich in omega-3 fatty acids, can support brain development and concentration in children. For children who don’t eat fish, a supplement that contains omega-3 may be suitable.

Another concern could be vitamin D deficiency, which is increasing among children and, in extreme cases, can lead to rickets, a disease that affects bone development. As well as being found in oily fish, eggs and meat, the best source of vitamin D is sunlight, so a supplement can be useful during the winter months, when children get less sun exposure.

Teenagers

Theresa has two teenagers – a son and a daughter, who is a vegetarian. She wants to know whether they could both do with taking extra vitamins.

According to the British Nutrition Foundation (BNF), many teenage girls are consuming low amounts of iron – 46 per less than the LRNI (lower reference nutrient intake). Good vegetarian sources include pulses, leafy greens, wholemeal bread, fortified breakfast cereals, dried fruit, eggs and nuts. A multivitamin supplement with iron may also be useful. For Theresa’s daughter, it is important to ensure that the product is suitable for vegetarians.

There is also evidence of low intakes of other nutrients among teenagers, adds the BNF. This includes vitamin A (14 per cent below the LRNI), riboflavin (21 per cent below), calcium (18 per cent below), magnesium (51 per cent below), potassium (31 per cent below), iodine (21 per cent below), zinc (19 per cent below) and selenium (45 per cent below the LRNI). In addition, some 20 per cent of 11-18 year olds are low in vitamin D. A multivitamin containing these nutrients would therefore be a good idea.

For people who follow vegetarian diets, the main nutrients that are commonly lacking are iron, selenium, vitamin B12 and omega-3 fatty acids. If recommending supplements containing these nutrients, remember to check the labels to make sure they’re suitable for vegetarians.

Busy woman

Serena is 27 and works full-time in a busy office job, so making sure she eats healthy mealsisn’t always her top priority. She asks if you can offer her any advice on supplements that will help her to ensure she isn’t missing out on vital nutrients.

Iron deficiency is common in women, especially if they have heavy periods and don’t eat ironrich foods such as red meat. Other good food sources include pulses, nuts, dried fruit, whole grains, fortified cereals and leafy greens, so Serena should ensure she includes some of these in her diet. If this isn’t possible, she can take a multivitamin that includes iron. Vitamin C aids iron absorption, so suggest she has a glass of vitamin C-rich juice, such as orange juice, with her breakfast too.

Many adults are deficient in vitamin D, especially during the winter months and particularly if their job is indoors like Serena’s. Vitamin D keeps bones healthy and strong, which can reduce the risk of osteoporosis in later life. The current recommendation for adults is a maximum of 25mcg per day.

If Serena was planning or considering a pregnancy, she should also ensure that she takes a daily supplement of 400mcg folic acid.

Menopausal woman

Gill is 52 and going through the menopause. She’s worried about osteoporosis, which runs in her family, and she’s having hot flushes. What supplements can you recommend?

As a result of falling oestrogen levels after the menopause, bone density decreases by two to three per cent during the five to 10 years afterwards. As well as doing weight-bearing exercise, such as walking, it’s important for Gill to increase her calcium and vitamin D intake. Since she is at risk of osteoporosis, her GP may recommend a supplement of calcium with colecalciferol, a form of vitamin D. Adults over 50 need 1,000mg calcium daily.

Some women have also found that phytoestrogens, compounds found in plants which are similar to the human hormone oestrogen, are beneficial when going through the menopause. Good dietary sources include soya, tofu and linseed. Some supplements (e.g. red clover) contain isoflavones, which are converted into phytoestrogens in the body.

Athletic man

Rob, 40, is training for a triathlon and wants to know if there are any nutritional supplements that he can take to keep his energy levels up.

“Regular exercise can deplete some vitamins and minerals, such as B vitamins, vitamin C and magnesium,” says Dr Ruxton. “Athletes dieting to maintain low body weight can be at risk of iron deficiency. However, sports organisations suggest it is better for athletes to take a general multivitamin and mineral supplement instead of picking out single nutrients. This may be because some nutrients work better when in balance – for example, magnesium, calcium and vitamin D.”

Other useful supplements that Rob could consider are glutamine, which can help replenish energy stores, and creatine, which may help to boost performance. Many athletes also consume whey protein shakes to help repair and build muscles after exercise.