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2017 HCHB_digital

Vitamins and Dietary

Vitamins and Dietary Supplements Vitamins and dietary supplements are intended to provide essential nutrients, such as vitamins, minerals, fatty acids or amino acids, which are missing or not consumed in sufficient quantities in a person’s diet. Dietary intake of these nutrients may be reduced due to poor food intake, sickness, “fad” diets, pregnancy or lactation, or chronic medical, psychological, or physical reasons. Being aware of the recommended dietary intakes (RDI) or upper intake limits of different types of nutrients, according to age and energy expenditure, helps determine what (if any) supplement a person needs to take. Many people take supplements they do not actually need, usually through lack of knowledge, and for this reason it is advisable to seek dietary counselling from a dietitian. This is especially true for people who choose to restrict their diet (eg, vegetarians, vegans) or intolerant of certain food groups (eg, lactose, gluten). Nutrient reference values (NRVs) NRVs refer to the levels of recommended intakes of essential nutrients, such as vitamins and minerals. In 2006, New Zealand and Australia developed joint recommendations for nutrient intakes necessary to keep people healthy and to reduce their risk of chronic disease. A revision of these recommendations TREATMENT OPTIONS Category Examples Comments Calcium Omega-3/omega-6 fatty acid supplements Probiotics Folic acid supplements Iron supplements Vitamin D with or without other supplements Vitamins for Age-Related Macular Degeneration Iodine [GENERAL SALE] eg, calcium (Caltrate, GO Calcium) calcium + vitamin D (Ostelin) calcium + minerals + vitamin D (Caltrate Plus) eg, Bioglan Kids Smart, Eye Q Fish Oil, Eye Q Baby eg, Bioglan Restore Daily Probiotic, Clinicians Antibiotic Support [GENERAL SALE] eg, folic acid (Apo-Folic 0.8) eg, folic acid with iodine, iron and other vitamins and minerals (FabFol Plus) eg, folic acid with iron (Ferrograd F) eg, Fab Iron, Fab Iron Liquid Iron (10mL =10mg elemental iron + B vitamins) [PHARMACY ONLY MEDICINE] eg, Ferrograd (=105mg elemental iron) eg, Ferrograd C (=105mg elemental iron + vitamin C 500mg) eg, vitamin D (Go Healthy D3, Sanderson Premium D3) eg, vitamin D + other vitamins (Mvite, Vitabdeck, Vitadol C eg, Macu-Vision Blackmores* (contains ascorbic acid, cupric oxide, zinc oxide, vitamin E) [PHARMACY ONLY MEDICINE] eg, NeuroTabs (potassium iodate 268mcg [= iodine 150mcg]), Elevit + iodine (potassium iodine 250mcg) Actual recommended daily intake is controversial (ranges from 500–1000mg). Calcium from dietary sources is preferred over supplemental calcium (see Osteoporosis). Supplements taken at too high a dose may cause kidney stones or affect the heart. Omega-3 and omega-6 fatty acids are essential for optimum growth and development, including brain development. Probiotic bacteria aid digestive health and can restore imbalances between beneficial and harmful bacteria, especially following antibiotic therapy (see Probiotics and Prebiotics). Folate is an essential B vitamin and is found naturally in leafy vegetables, citrus fruits, wholemeal bread, yeast, liver and legumes, and is important for cell growth and reproduction. Folic acid is the synthetic form of folate. For more information about use of folic acid during pregnancy see Pregnancy Tests and Supplements. For more information about iron supplements see Iron Deficiency. Be aware that iron is dangerous in overdose and tablets must be taken as directed for the recommended course. Keep all iron products out of reach of children. Fortification of milk and margarine products with vitamin D is voluntary in New Zealand. Vitamin D helps maintain bone strength by regulating the amount of calcium in the blood, and is obtained from the action of sunlight on skin (produces D3 or cholecalciferol) or from a limited range of foods (contain D2 or ergocalciferol), although it is almost impossible to obtain sufficient vitamin D from the diet alone. Since too much vitamin D is toxic, people at risk of vitamin D deficiency should discuss their status with their doctor before taking supplements. The types and quantities of antioxidants included in Macu-Vision are based on the AREDS (Age-Related Eye Disease Study) research. May help protect the macular region of the eye and protect against Age-Related Macular Degeneration (see Eye Conditions). New Zealand’s Ministry of Health recommends healthy pregnant and breastfeeding women take a daily 150mcg iodine-only tablet from confirmation of pregnancy until the discontinuation of breastfeeding in addition to eating iodine-containing foods such as low-fat milk products, eggs, seafood, and commercially prepared bread. Women with pre-existing thyroid disease or with currently high iodine intakes should be referred for further medical advice. Foods eg, Go Superfood, Whole Live Nutrients Several whole-food supplements are now available that can be used to boost diets that are deficient in certain nutrients. Products with an asterisk have a detailed listing in the Vitamins and Dietary Supplements section of OTC Products, starting on page 267. Join us on the path to better health with Blackmores. Blackmores, Auckland. blackmore Page 164 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION is currently under way. NRVs are also used by the Food Safety Authority of New Zealand for guidance on food labelling requirements. A link to the recommendations – known as the Nutrient Reference Values for Australia and New Zealand – is available from the Ministry of Health website at: www.health. govt.nz. The NZ Nutrition Foundation (www.nutritionfoundation.org.nz) also provides summarised information on nutrients, vitamins and minerals. The Nutrient Reference Values document also outlines suggested dietary targets to reduce chronic disease risk. Some of these include: • reducing sodium intakes to less than 2 grams/day (equivalent to less than 5 grams of salt per day) • a dietary fibre intake of 38g/day (men) and 28g/day (women) to reduce cardiovascular disease risk • increasing dietary intake of omega-3 fatty acids (DHA/EPA/DPA) to 610mg/day (men) and 430mg/day (women). Research has shown it is possible to achieve recommended daily intakes (RDIs) of all nutrients by consuming commonly eaten foods, although in Australia and New Zealand, intake of folate (folic acid), calcium and iron for women, as well as iodine and selenium in all people, are generally borderline. Diets should be varied and rich in vegetables and fruits (including some nuts and seeds), wholegrain cereals, reduced-fat dairy foods and lean meats, fish (particularly those rich in omega-3 fats) and poultry as well as small amounts of poly or monounsaturated fats and oils. Probiotics may also be considered to restore the balance of natural bacteria in the gut and help relieve common digestive complaints or maintain good oral health (see Probiotics and Prebiotics). Being physically active allows more flexibility of food choice and this is a key component in maintaining a healthy lifestyle. Although vitamin and mineral supplements are not considered necessary in healthy people eating a wellbalanced varied diet, they may help some people, including: • strict vegetarians who consume no animal foods (may need supplements of vitamin B12, omega-3 fatty acids, iron and zinc) • elderly people, babies of vitamin D deficient mothers, housebound or institutionalised people, people with darker skin or those who cover their skin for religious or cultural reasons may require vitamin D • pregnant and lactating women (folic acid required during early pregnancy, iodine supplementation recommended throughout, iron and calcium supplementation may also be needed; see Pregnancy Tests and Supplements) • older adults with poor nutritional intake, such as those with dementia, or living alone (may benefit from protein-rich supplement drinks or meal replacement powders). People with chronic diseases or premature infants require specialist advice about supplements. • vitamin C can help iron absorption if consumed at the same time • high intakes of iron may interfere with the absorption of zinc (both use the same absorption pathway) • vitamin K contained in some supplements may interact with warfarin. If an interaction is not desirable, taking the nutrients or medication two or three hours apart may be advised (although this would not stop the vitamin K/ warfarin interaction). Eating and Activity Guidelines The Eating and Activity Guidelines developed by the New Zealand Ministry of Health recommend adults: • eat a variety of nutritious foods everyday including plenty of vegetables and fruit; grain foods (mostly wholegrain and high in fibre); some milk and milk products (mostly low and reduced fat); some legumes, nuts, seeds, fish and other seafood; poultry and some red meat (with the fat removed) • choose whole foods that contain unsaturated fat (rather than saturated fat), that are low in sodium, with little or no added sugar, and are mostly unprocessed »» Use salt sparingly and choose iodised salt over uniodised salt. • make plain water their preferred drink • keep alcohol intake low; avoid alcohol if pregnant or when trying to conceive • partake in at least 150 minutes of moderate or 75 minutes of vigorous intensity physical activity spread throughout the week. Do muscle strengthening exercises on at least two days per week. Break up long periods of sitting with regular activity. Initial assessment Supplements can't and shouldn't take the place of a well-balanced diet, so it is important that you encourage people looking for supplements to first improve how they eat (see the information provided above under Eating and Activity Guidelines). Epidemiological studies have shown that use of dietary supplements is not generally associated with an increased life span, in fact associations with higher mortality have been found with certain supplements such as iron. Always refer people currently taking medications, with chronic illnesses, or who are pregnant or breastfeeding to the pharmacist. Also refer if your knowledge of supplements is limited as you may be doing your customer more harm than good by recommending supplements they don't need. Interactions and when to refer Some nutrients can interact with other nutrients, supplements, or medications in either a good or a bad way. Examples include: 5% of Eye Care sales goes to support proudly supported by Always read the label. Use only as directed. If symptoms persist see your healthcare professional. Vitamin supplements should not replace a balanced diet. Blackmores, Auckland. TAPSPP6714 blackmore Page 165

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