What do pharmacy and health food store assistants recommend?
We thought it would be interesting to see what advice pharmacists and health food store assistants provide about vitamin and mineral supplements recommended for pregnancy. We were also interested to see what they’d recommend for morning sickness.
We sent a shadow shopper to pharmacies and health food stores in different parts of Sydney. She told the shop assistant she was about 6-8 weeks pregnant and suffering from morning sickness, and asked if there was anything they could recommend to help relieve nausea. She also asked for advice about what vitamins and minerals she should be taking, and if there are any she should avoid.
Here’s what she was told.
Q: Are there any vitamins that are important?
Folic acid All shops we visited told our shadow shopper it was important to take it, and some correctly told her she should have been taking it already.
Iodine About half the assistants we talked to specifically mentioned iodine.
Other recommendations Vitamin D, fish oil, iron, and calcium were sometimes recommended.
The shops were generally cautious in recommending other complementary medicines for pregnancy and wellbeing – apart from the recommendations for vitamins, minerals, and morning sickness treatments, the only other suggestions were for spirulina and raspberry leaf later in pregnancy.
Q: Are there any vitamins or supplements I should avoid?
Only two of the 15 shops we visited cautioned our shadow shopper about vitamin A.
Other A few health food stores recommended she avoid herbs (including those sometimes included in multivitamins), and to be careful of essential oils, which can be dangerous.
Q: Is a men’s vitamin OK?
If asked, our shopper mentioned she was already taking a vitamin supplement: “It’s my husband’s – I think it’s a men’s one, actually." Men’s supplements are unlikely to contain enough folic acid for pregnancy, and there is also a risk that it may contain vitamin A in retinyl palmitate form, which is not recommended for pregnant women.
Most sales assistants pointed out that a pregnancy one would be better because the men’s one may not contain enough of the right nutrients and might contain things that were unsafe. In particular, they pointed out it may not contain enough folic acid.
Q: I’ve got morning sickness, what can I take?
Morning sickness affects between 50-80% of women in early pregnancy. Advice for treating it includes eating dry foods, having small, frequent snacks, and avoiding food or situations that cause nausea.
Supplements to help relieve nausea and vomiting generally include vitamin B6 and/or ginger. A large review of studies found that these may help relieve the nausea, though not necessarily the vomiting, associated with morning sickness. But the evidence was limited and inconsistent, with some studies finding no effect. Furthermore, large doses of either B6 or ginger can be unsafe. Other supplements commonly used by women for morning sickness relief include peppermint, chamomile, and raspberry leaf, with acupressure and homeopathy among other alternative therapies used, though with little good evidence that they’re effective.
For our shadow shopper, products containing ginger for travel sickness were often recommended, including Blackmores Travel Calm, Blooms Ginger Calm and Nature’s Own Travel Well Ginger. Neither Blackmores nor Nature’s Own provide dosing instructions for pregnancy, nor are there warnings about excessive intake in pregnancy. However, if the maximum dose on the package is followed, it would exceed the presumed safe level of 1-2 grams per day – Blackmores would be about 5.6g, and Nature’s Own 3g. Blooms Ginger Calm states pregnant women should take one tablet up to four times a day – that’s 4g, again exceeding the safe daily limit.
Key Pharmaceuticals’ Travacalm Natural, which was sometimes recommended, contains 500mg of ginger per tablet, with a warning that pregnant women should not take more than 1g per day.
Elevit Morning Sickness Relief and Blackmores Morning Sickness Formula, containing a combination ginger and vitamin B6, were frequently recommended; if taken at the maximum daily dose, intake would add up to 75mg vitamin B6 and 1.2g ginger.
One sales assistant pointed out that if she was taking a multivitamin, our shadow shopper should just take ginger for morning sickness because she wouldn’t need the extra vitamin B6 from the Blackmores Morning Sickness. This is good advice - while most pregnancy multivitamins only contain around 2mg of vitamin B6, some contain higher levels of up to 50mg, thus potentially exceeding the maximum tolerable limit.
Advice on vitamins and minerals was mixed. All shops received full marks for recommending folic acid. However, the results for iodine were not so good, and reflect lower community awareness of iodine deficiency as a public health issue. An education program targeting supplement retailers and consumers could help address this. While pregnancy multivitamins all contain the recommended dose of iodine, not all women want or need to take multis. There are preparations containing only folic acid and iodine, such as Blackmores I-Folic, which costs much less than multivitamin supplements; two shops recommended this.
Very few shop assistants mentioned that high doses of pre-formed vitamin A could be a problem for pregnant women. On the other hand, most shops recommended a pregnancy multivitamin supplement, which all have the safe form of vitamin A.
About half the shops we visited recommended ginger products designed for travel sickness. In the cases where where dosing instructions for pregnant women weren’t provided on the packaging or by the assistant, the products could be potentially unsafe. Another product was potentially unsafe as the recommended maximum dose was too high. Pregnancy-specific morning sickness products are safer, but research hasn’t yet determined if they’re effective. There’s no evidence that homeopathic products and acupressure bracelets work, though they are harmless.
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