VMS: Preventing 5 nutrient deficiencies in your community

Josh Edwards gives his expert advice on how community pharmacy teams can help prevent five of the most common nutrient deficiencies among their patients…

In the UK, many people with nonoptimal diets are at risk of nutrient deficiencies, as they receive less than the recommended intakes of several key vitamins and minerals, which can impact overall health.

Dietary supplements can be one method of treating a deficiency. Dietary supplements like vitamins, antioxidants, fiber, and amino acids are sold in pharmacies across the world, and it is estimated that half of UK adults use at least one dietary supplement per day.

Combined with an increased popularity in vegetarian, pescatarian, vegan and flexitarian diets, there’s a chance patients are not consuming enough vital vitamins and minerals.

If you think a patient’s diet may be lacking in some of the important nutrients our bodies need to function properly, the advice below will provide more information about five of the most common nutrient deficiencies, and where to find these nutrients from easily accessible and plant based sources.

1. Omega-3

Essential fatty acids come in two forms; docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), and are both sources of energy and play key roles in the development of cell membrane structures.

They also play a role in protecting against a variety of diseases and regulating blood pressure and inflammation. DHA is an important component of neurons and healthy nervous systems.

Traditionally, seafood, red meat and dairy products have been touted as the main dietary sources of EPA and DHA. Although EPA and DHA can be difficult to source from plant based foods, ALA - the most common fatty acid - is found in plant based foods and can be converted into long chain omega-3s EPA and DHA.

The omega-3 fatty acid ALA is essential and must be consumed from our diet as our bodies cannot build them. Converting ALA into the usable form of EPA and DHA can be an intensive process, so if a diet consists of mostly processed food or a Patient has poor health overall, you may want to recommend an algae oil supplement that already has ALA converted e.g. Omega-3 capsules.

If a patient already has a healthy diet, simply add some walnuts, chia seeds or flaxseed to breakfast each day for a boost of omega-3 fatty acids. The NIH recommends consuming 0.5 and 1.6 g of ALA each day, and for reference, an ounce of dried walnuts provides 2.6 grams of ALA.

2. Vitamin B-12

Vitamin B-12 is an essential nutrient that is integral in the normal functioning of our bodies. It is needed in the nervous system, as well as for cell division and carbon metabolism. Being deficient in this nutrient can leave you feeling weak and numb, and could increase the risk of heart disease, dementia and Alzheimer’s disease.

Additionally, the vitamin has been known to help prevent a type of anaemia called megaloblastic anaemia that leaves people feeling tired and weak. The vitamin is mostly found in animal products, but it isn’t made by animals or plants and is actually synthesised by bacteria found in the intestines, before being stored in the liver. Because vitamin B-12 is stored in the liver, and it can take years before low B-12 consumption becomes a deficiency.

Despite this, people who avoid meat, dairy and other animal products can still find reliable sources of the vitamin from a variety of fortified foods. Vitamin B-12 is added to many plant based alternatives to milk products, vegan spreads, nutritional yeast flakes, yeast extracts and breakfast cereals.

However, these fortified foods must be consumed at least twice a day, with the aim of a daily intake of at least 3 micrograms. Otherwise, it is advised that supplements are taken to ensure the B-12 level is appropriate for your body’s needs.

If supplementing, take either at least 10mcg daily or at least 2000mcg weekly. In addition to oral dietary supplements, vitamin B-12 is available as tablets, lozenges injections and gel sprays e.g. cyanovit-B12 supplements and Better You B12 Boost Oral Spray

3. Vitamin D

People living in the UK are at a greater risk of vitamin-D deficiency due to the inconsistency in sunshine. Both men and women are at risk of vitamin-D deficiency and it can have major health consequences for both genders. If the sun is shining, your skin can make vitamin-D through any exposed skin, but always remember to advise to be safe in the sun by wearing sunscreen.

A good intake of vitamin D is essential for bone health and the nutrient works to maintain normal calcium levels within the body. That is why, even if you consume enough calcium, if your vitamin D levels are low, your body is unlikely to be able to absorb the calcium into your bones where it is vital.

However, a study by The National Diet and Nutrition Survey found that vitamin-D deficiency was found in 14 per cent of men and 15 per cent of women in adults aged 19 to 64 years and was even more prevalent in the younger age groups.

There was also considerable seasonal variation with blood levels being at their lowest in January to March, suggesting winter is the most important time to supplement vitamin-D into your diet.

While the strength of vitamin-D can vary between sources, it can be found in both plant and animal sources. Vitamin-D is crucial to many processes in the body, especially within the immune system. Many people develop autoimmune or inflammatory diseases after years of vitamin-D deficiency.

Taking in sufficient amounts of vitamin-D can be difficult, regardless of diet, with one study finding that 41.6 per cent of Americans to be deficient in vitamin-D. The amount of vitamin-D you need each day depends on your age.

According to the National Institutes of Health, an average daily intake of 400 to 800 IU, or 10 to 20 micrograms, is sufficient for more than 97 per cent of people.

Sources of vitamin-D that are suitable for people on vegan, vegetarian and pescatarian diets include mushrooms, which contain vitamin D-2, while animal products contain vitamin D-3. Other plant based sources of vitamin-D fortified products, including soy milk, cereal and orange juice. It’s important to check the label before buying fortified products to see if vitamin-D is included, as brands that aren’t fortified will contain very little vitamin-D.

4. Vitamin-A

Vitamin-A is an important nutrient for healthy immune function and assists with reproduction, eyesight and skin health. The recommended intake for vitamin-A in adults is 900 μg for men, and 700 μg for women.

Vitamin-A can be found in seafood, meat, liver, dairy and eggs. However plants contain beta-carotene, which can be converted to active Vitamin-A. Incorporating a healthy serving of dark leafy greens and root vegetables is key to meeting vitamin-A intake needs if you do not consume animal products.

Dark leafy greens like spinach, swiss chard, and red leaf lettuce all contain plenty of vitamin-A, allowing you to meet your recommended daily intake with one or two servings alone. Root vegetables, like sweet potatoes and carrots also contain vitamin-A.

Certain fruits also contain healthy amounts of vitamin-A such as mangoes, cantaloupe, and apricots. Alternatively, many of the multivitamin supplements at the pharmacy will contain sufficient quantities of vitamin A or specific Retinol based products such as cytoplan vitamin A capsules.

5. Iodine

Iodine is an essential micronutrient needed for all stages of life, and an iodine deficiency can lead to thyroid dysfunction and impact mental functioning. A healthy adult has about 15–20 mg of iodine, with around 70 per cent – 80 per cent of this stored in the thyroid. While the nutrient is traditionally found in animal products such as meat and dairy, iodine can also be sourced from plants. Seaweed is one of the most popular sources, however the iodine content varies and can sometimes be too high.

A non-seaweed supplement is the most reliable way of meeting your recommended intake of iodine, if you avoid eggs and fish. Another option is to use a plant milk fortified with iodine, by looking for potassium iodide in the list of ingredients.

(Josh Edwards is a senior Pilltime pharmacist.)