One of the fastest growing industries in the world is the nutritional supplement — or vitamin, mineral and supplement (VMS) — category. Producing approximately US$32bn in revenue for just nutritional supplements alone in 2012, it is projected to double that by topping $60bn in 2021, according to Nutrition Business Journal.
However, consumption and popularity on a global scale vary in different markets. In the UK, for example, the market is relatively arduous. It is also a very different landscape compared with countries such as Singapore, China, North Korea and Australia, where households spend up to $300 a year on supplements. In North America, the world’s largest VMS market, growth is healthy.
In the UK, only the 'worried well' feel the need to supplement their diet with added nutrients
Typically, when it comes to health in Britain, the UK tends to follow many of the trends implemented in the US; this is not the case, however, when it comes to supplement use. In the UK, only the 'worried well' feel the need to supplement their diet with added nutrients. It appears that no consumer knows the real reason for their personal consumption or stigma, but as a registered dietician, I believe market challenges include the following:
- health professionals do not tend to recommend them
- legislators — at least in the UK — make it almost impossible to make claims about them
- consumers are confused by the lack of validated studies and media translation of available studies, thus questioning whether supplements are needed at all
Aside from market challenges, there is also an abundance of misconceptions across the VMS landscape. While attending health professional conferences and writing for nutrition-based journals, I rarely see any research into the use of supplements being shared or disseminated. As such, any health professional who wants to learn more about supplements has to actively seek out information and research the area themselves. Few have the time or motivation to do this.
To add to the category’s growing misconceptions is consumer mistrust in the way that manufacturers market their products and their claims. Given the lack of global oversight or even regulatory standards from country to country, not all vitamin and mineral supplement manufacturers adhere to the same quality and safety standards. On the one hand, manufacturers and retailers want to use specific health claims to help consumers to select products that meet their needs. On the other hand, an ever-increasing climate of restrictive UK regulation has made it even more difficult for health claims to be made.
The European Food Safety Authority’s Nutrition and Health Claims Regulation (NHCR) has been in force since December 2012 and provides one of the clearest examples of increased stringency regarding VMS health claims. The NHCR’s register of nutrition and health claims currently includes 2,200 evaluated claims, only 248 of which have been authorised. To give an idea of how stringent the EFSA’s process is, only six new claims were approved in 2012, which included three related to DHA and EPA omega fatty acids. The DHA and EPA fatty acid approvals were particularly welcomed, as omega-3 fatty acids continue to be deficient in our UK diet, and these supplements can help to fill those gaps.
Manufacturers must prove the need for supplements; that much is clear
Yet, throughout that year, the agency rejected a host of other claims including all claims relating to probiotics. I found this quite amazing considering that probiotics are regularly given to National Health Services (NHS) patients following surgery and antibiotic treatment. This restriction on claims will no doubt go a long way to relieve health professionals' scepticism, but it doesn’t make the manufacturer’s job any easier. Manufacturers must prove the need for supplements; that much is clear. How that proof is obtained means that the industry needs better quality research that is robust in its methodology. Industry must give clinical proof that diet alone will not fulfill the requirement for individual nutrients.
As a registered dietitian, I know that science tells us that a significant part of our population needs dietary supplements to meet their nutritional requirements and prevent disease. Take vitamin D, for example; some campaigners suggest that all UK citizens should take a daily vitamin D supplement, yet very few people do. Historically, researchers have stated that everyone would produce enough vitamin D in their skin via sunlight and from eating foods that contain high volumes of vitamin D. Now we know that's just not the case; we live too far north to make that guarantee. As a result, children based in the UK are falling short of their vitamin D needs. Unfortunately, Europe is seeing an increasing number of cases of rickets and other signs of vitamin D deficiency in our youngest children.
Nurses, doctors and healthcare professionals are failing to inform parents that their children need to take a daily supplement of vitamin D
In 2006, the UK government recognised the need for action and launched the Healthy Start scheme. Healthy Start includes the provision of free vitamin drops containing vitamin D for children from families receiving welfare benefits. Yet only a minority — as few as 2% — of eligible families take advantage of the offer. Why? I believe that nurses, doctors and healthcare professionals are failing to inform parents that their children need to take a daily supplement of vitamin D. Reasons that support this position include the following:
- the UK health culture just doesn’t lend itself to informing consumers that diet alone does not suffice; unfortunately, daily recommended nutrient levels can’t be obtained through dietary habits and supplements bridge that gap; we are indoctrinated into believing that 'diet is best'
- the UK National Health Service (NHS) should be better known as the National Sickness Service as it only treats people when they are sick; we do not have a strong culture of preventive medicine
- most healthcare professionals work within the framework of the NHS, which legally prevents them from recommending or endorsing specific products or brands to patients
- in my experience, UK health professionals lack the knowledge and confidence in the efficacy of dietary supplements to play significant roles in the prevention and treatment of deficiencies.
Research has also led to greater support for vitamin D supplementation, providing a pragmatic platform for other forms of supplementation in the UK. Geographically, it is understood that the UK does not receive enough direct sunlight to guarantee sufficient vitamin D production for everyone. This was underpinned by population statistics showing that more people living in the UK are from cultural backgrounds where it is traditional to cover the arms and legs with clothing, thus inhibiting vitamin D production from sunlight. Research also demonstrated the increased use of sunblock, which supported the case, and lastly, limited dietary sources of vitamin D (only spreads made from vegetable oil are mandatorily fortified with Vitamin D) convinced many that when it comes to vitamin D, diet is not enough.
At the same time, the industry needs to take some action to build the confidence of UK health professionals. The following issues must be addressed:
- levels of nutrients in supplements are not always regulated; more is not always better and can even be harmful in some cases
- consumers need to be able to clearly identify reputable brands; there needs to be a clear international and industry wide mark of quality
- the sale of single, high dose supplements may need to be restricted or controlled.
As a practising dietitian, I know the challenges involved with eating the perfect diet. Lack of time, lack of cooking skills and lack of money are all very real twenty first century obstacles to eating a balanced diet. My entire career has been dedicated to helping patients and consumers overcome these issues. Unfortunately, this task cannot be accomplished solely by such professionals. Better education and validated research conducted by independent and credible experts are needed to ease the confusion for all individuals across the globe.
In this quest, I came across a new organisation that is bringing independent, common sense advice about the VMS category and optimal nutrition. The Global Nutrition & Health Alliance (GNHA) is an organisation that I believe will be able to bridge that knowledge gap for all consumers. The GNHA is a newly formed group of health and medical experts who focus on educating consumers, healthcare professionals and the media about optimal nutrition, including the use of vitamins, minerals and supplements (VMS) as part of a healthy lifestyle.
The VMS landscape is riddled with inconsistent messages and misconceptions that ultimately confuse healthcare professionals and consumers. Our intention is to stand as a unified global voice that elevates science to demonstrate the value of optimal nutrition and appropriate supplementation, ultimately clearing up such confusion. To accomplish that, we are aiming to collaborate with academia and industry to conduct clinical-based studies, publish peer-reviewed articles, initiate educational campaigns, leverage digital and social media platforms and participate in symposia.
