Learning more about popular dietary supplements could further cement pharmacists’ position in the healthcare industry, helping them gain recognition as healthcare providers.
With the explosive growth of nutraceuticals and their growing popularity among consumers, pharmacists have an opportunity to add to their skills and further cement their position in the healthcare industry as healthcare providers. But they must be a quick study. There are more than 29,000 different nutritional supplements on the market today, according to the FDA.
The U.S. market for nutraceuticals, which was $64.8 billion in 2015, is anticipated to increase at a compound annual growth rate (CAGR) of 5.3% from 2016 to 2024 and reach a value of $102.6 billion, according to Transparency Market Research (TMR). These researchers also anticipate that competition will significantly grow as more competitors make their way into the field.
Nutraceuticals include dietary supplements, functional foods (probiotics and fatty acid-based foods), botanicals/herbals,
vitamins/minerals, amino acids, proteins, and peptides that are derived from natural bioactive compounds. They add health benefits to the basic nutritional value found in foods and are primarily used to promote health and wellness or prevent and treat disease.
While “nutraceuticals” and “dietary supplements” are often used interchangeably, the latter serves as the broader category. Dietary supplements have been marketed to address a large variety of ailments, from insomnia and poor digestion to low energy, joint pain, and immune health.
Seventy-six percent of more than 2,000 U.S. adults surveyed take dietary supplements-up five percentage points over 2016, according to the “2017 CRN Consumer Survey on Dietary Supplements” put out by the Council for Responsible Nutrition (CRN). The survey found that:
Demand for liquid nutraceuticals is higher among consumers than other forms of nutraceuticals-with a 6.10% CAGR by 2024, according to TMR. The company also says functional foods are popular because they tie into health benefits of natural products.
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Adults aged 55 and older report the highest percentage of supplement use at 74%, according to CRN’s 2016 consumer survey. But 70% of adults aged 18 to 34 say they take dietary supplements.
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Baby boomers are looking to optimize foods with dietary supplements, says Andrew Dahl, CEO of ZIVO Bioscience, Inc., a research and development firm. They are also motivated by concerns over increasing costs of prescription drugs and by supplements’ preventive characteristics, says Yvette La-Garde, Chief Operating Officer for VitaMedica, which manufactures and sells a line of dietary supplements.
Mike Smith, MD, Director of Education for supplement supply company Life Extension, says younger consumers are looking for lifestyle and life-specific supplements such as those for heartburn, acid reflux, constipation, pain, and high blood pressure and cholesterol.
Overall, growth of nutritional supplements outpaced total store growth in the last year, with 5.8% year-over-year growth reaching a market total of $16 billion, according to Information Resources Inc. Total store growth was 1.2%, for a total market value of $757 billion, indicating dietary supplement sales grew at about five times the rate of total store sales in the last year.
Pharmacists can play an important role in helping consumers identify safe and effective supplements, says Marvin Moore, PharmD, President/Owner of The Medicine Shoppe in Two Rivers, WI. He advocates for consumers to buy products at pharmacies rather than online.
“As small, independent pharmacies, we spend time answering questions as best we can and do research to determine if products work and are efficacious. We can’t make promises about safety but if we carry a product, we believe in it and can study it,” Marvin Moore says.
He says his customers often read about supplements online and in ads and are curious about them and concerned over their safety. His best sellers are iron, calcium, multivitamins, and vitamin D.
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Steve Moore, PharmD, Owner/Pharmacist, Condo Pharmacy in Plattsburgh, NY, (no relation to Marvin Moore), says dietary supplements comprise half of his total over-the-counter sales. He receives a fair amount of questions about supplements-especially because of his location in the upper Northeast where vitamin D deficiency is common in winter.
“Doctors often send patients to a pharmacist to seek information on the kinds of products available. This is a great role for pharmacists because we are the most accessible medical professionals,” Steve Moore says. “We are comfortable answering questions because we have responsibility for making the right recommendations when some supplements could cause harm.” Two examples: a magnesium supplement taken for sleep or muscle cramps could be risky for someone with a kidney problem, or too much vitamin E could harm those with cardiac issues.
If consumers are using several dietary supplements, pharmacists might need to perform a comprehensive medication review, in the same way they review prescription medications.
Duffy MacKay, ND (Doctor of Naturopathy), says conversations about adverse interactions between drugs and dietary supplements are an ideal opportunity for pharmacists to communicate with consumers. “In this way, pharmacists can participate in both sides of a drugstore; they can play a pivotal role when prescription drugs and dietary supplements are integrated,” says MacKay, who is the Senior Vice President of Scientific and Regulatory Affairs at CRN.
In general, most pharmacists have a baseline knowledge of nutraceuticals and know the most problematic interactions and side effects, according to the NCPA.
“There are some pharmacists who have chosen to learn about nutraceuticals at a very deep level and built a business model around their pharmaceutical and nutraceutical expertise. The average pharmacist, however, might not be as familiar with insights about subpopulations and specific products that are available,” an NCPA spokesperson says.
A 2015 study published in Healthcare examined the views of pharmacists regarding giving dietary advice to patients. It found that they perceive they have a role in the delivery of information about supplements and should recognize the value of referring patients to specialists, such as dieticians, and of accessing appropriate nutrition information.
John Pezzuto, PhD, is concerned that some pharmacists may not know enough about toxicity, interactions with prescription drugs, and possible overdosing, making it difficult for them to recommend nutraceuticals. “Pharmacists also might be too busy to answer questions and may find it difficult to know what to say,” says Pezzuto, who is Professor and Dean of the Arnold and Marie Schwartz College of Pharmacy and Health Sciences at Long Island University in New York.
The Accreditation Council for Pharmacy (ACPE) Education Standards require course work on natural products in all PharmD programs.
ACPE has a curricular expectation that includes coverage of nutraceuticals and dietary supplements. For natural products and alternative and complementary therapies, there should be evidence-based evaluation of the therapeutic value, safety, and regulation of pharmacologically active natural products and dietary supplements. Education should also include information about the cultural practices of practitioners and/or patients and their potential impact on pharmacotherapy. ACPE also has a database of continuing pharmacy education activities on subjects such as herbal medicines and supplements.
“Our students certainly give voice to the need for more complete curricular coverage to meet consumers’ needs,” says Lucinda Maine, CEO and Executive Vice President, American Association of Colleges of Pharmacy.
An authoritive source pharmacists can use for information on dietary supplement products and for verification of their quality is USP, she says. USP sets standards for dietary supplements.
Answering consumers’ questions about nutraceuticals adequately and providing counseling could be a problem for pharmacists in a busy retail environment, acknowledges Dahl. “It could take up too much time and not be worth it to a store,” he says. “In addition, pharmacists are often cautious because they are worried about recommending products and don’t know about potential interactions with drugs a patient might be taking.”
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But, Pezzuto says, pharmacists must find time to address public perceptions of products that claim to be natural. “People think natural equals safe but that’s not always true.”
One solution could be to follow Marvin Moore’s suggestion: Only carry nutraceuticals that you know and trust.