VITAMIN RECOMMENDATIONS

MICHAEL SLEZAK

Vitamin sales at supermarkets are coming on stronger than a tsunami, and there are signs that pharmacists are starting to catch the wave.

A number of trends show that pharmacists' interest is growing in vitamin supplements, especially multivitamins -- a category they historically have been reluctant to embrace. Consider:

· Pharmacists polled by Supermarket Pharmacy were nearly unanimous in their approval of patients taking multivitamins.

· Increased consumer interest in vitamins has led to a deluge of questions, say supermarket pharmacists. · Supermarkets are encouraging customers to ask questions of pharmacists by displaying vitamins close to the pharmacy and running ads. One such ad by Stop & Shop reads: "Our pharmacists will be happy to answer any questions you might have about vitamins or dietary supplements. Just ask!"

· Pharmacy schools are beginning to offer vitamin courses that go beyond the historical role of vitamins to prevent deficiencies. At the University of Utah, two-thirds of eligible pharmacy students are enrolled in one such course.

· Pharmacists are looking to continuing education courses to bring them up to speed on vitamin studies and trends in usage.

Sales of vitamins and tonics in supermarkets grew 18% to $502 million for the 12 months that ended June 30, 1994, according to Towne-Oller & Associates, New York, a subsidiary of Information Resources Inc., Chicago. Drug stores still lead the category, with $707.8 million in vitamin and tonic sales for the year, an increase of 15%.

Pharmacists who take vitamins themselves are the biggest advocates of their customers taking vitamins.

"I'm very pro-vitamin, and I take quite a few myself. So that influences what I tell my customers," says Ed Derderian, owner of United Pharmacy, located inside Dinuba United Market, Dinuba, Calif.

"I was a big fan of Linus Pauling," says Derderian. (Pauling died last month at age 93.) "I've been taking megadoses of vitamin C for 20 years or so. Every other day I take B-complex. I take lecithin on a regular basis as well as a garlic supplement. I also take a multivitamin daily.

"If I have a cold sore coming on, I use lysine [an amino acid]," says Derderian. "I find that lysine works in about 60% to 70% of the people I recommend it to," he adds.

Derderian also will suggest vitamin C and zinc for patients with postsurgical wounds or burns. "I find that they substantially increase the healing rate and speed tissue repair," he says.

Derderian admits he is "the guinea pig on a lot of this stuff. When I see something I like, I try it out." He says he stays away from fad items, but adds he has been studying herbal supplements lately.

He says he doesn't believe everything he hears about herbal products, but is finding some valid uses for them. After all, says Derderian, "many of the drugs we carry behind the counter were once derivatives of herbs."

Most pharmacists, though, are much more cautious about recommending vitamins, with the exception of multivitamins, which many pharmacists will recommend enthusiastically.

Jim Wright, pharmacy manager at Nugget Market, Woodland, Calif., is a big proponent of multivitamins. "People should take them; I believe that very much so. I take them. I've been practicing pharmacy for over 40 years, and vitamins make me feel better," he says.

Wright scoffs at those who say vitamins are unnecessary if a person has a balanced diet. "People say they don't need vitamins because they're eating well. They aren't really eating a balanced meal usually," he says. "Someone will say, 'I eat lots of salads.' Salads are fine but you need carbohydrates for strength, and proteins, too. Who knows what a balanced diet is for each individual person? Vitamins fill in the blanks in your diet."

Wright says he does not favor the use of single vitamin supplements, explaining that the fat-soluble supplements, vitamins A, D and E, potentially can be harmful in overdose. He adds that excessive doses of water-soluble vitamins, while not harmful, will end up being eliminated by the body. Multivitamins, in comparison, are low-risk and offer all the benefits of the numerous ingredients they contain, he says.

Rohit Patel, pharmacy manager at Gregerson's Pharmacy, inside a Gregerson's Food store in Gadsden, Ala., says he highly recommends multivitamins to customers, including a multivitamin with iron for most women. "I take vitamins myself, and that does influence my opinion," he says. He frequently will recommend a prenatal multivitamin for both men and women.

Jeff Hogrefe, pharmacy manager at Bigg's, Cincinnati, also prefers multivitamins over single supplments, with the exceptions of calcium and also vitamin E, which he says is difficult to get in sufficient amounts in the diet. "I try to stay within a range and keep my advice as conservative as possible," he says.

Melissa Bishop, pharmacist at Rick's Discount Drugs, inside Johnson Giant Foods, Attalla, Ala., says she is comfortable recommending multivitamins, especially national brands having "a strong reputation" that she has taken herself.

"If someone asks for something because they are feeling run down, I will recommend a vitamin," says Bishop. "We have a new women's vitamin here that I've taken myself, so I don't have any problem recommending it. I know it works," she explains.

"If a person has a good diet, eats the proper foods and exercises regularly, there's no need for vitamins," says Phil Thomas, pharmacy manager at Cee Bee's Pharmacy, Carol Stream, Ill. "But how many people actually do that?" he asks. Then he will recommend a multivitamin.

Thomas, however, does not consider himself in need of a multivitamin. "I do not take vitamins," Thomas says with a laugh. "My wife's a good cook."

Jay Drake, pharmacy manager at Intermountain Food Stores, Boise, Idaho, similarly will first inquire about diet before recommending a vitamin. "I recommend vitamins if people don't have decent diets." He also will recommend a multivitamin if people complain of feeling fatigued.

Except for multivitamins, pharmacists generally remain cautious about recommending vitamin supplements. The main reason is the lack of completely unambiguous information on which to base a recommendation. "Proof" that vitamins prevent disease, however, is difficult to come by because their effects are more subtle than, say, drugs.

Then there's the recent conflicting study results concerning use of antioxidant supplements. (See accompanying story.)

"People are familiar with the recent studies [on antioxidants], but they don't understand the results," says Larry Fortune, pharmacist at Toddy's Supermarkets, Greeley, Colo.

Patel says he's getting more questions from customers about various vitamin supplements, especially selenium and beta carotene. Bishop of Rick's Discount Drugs says she sees a lot of people who want advice on herbs. "They ask us to recommend them and we tell them we don't have them, don't know anything about them and can't recommend them," she says.

"Pharmacists are scientists," says Richard Wuest, Pharm.D., professor of pharmacy practice at the University of Cincinnati Medical Center College of Pharmacy, explaining pharmacists' reluctance to recommend vitamins more aggressively. "Everything they're taught is black and white. Vitamins are shades of gray."

Loyd Allen, professor and chairman of the department of medicinal chemistry and pharmaceutics at the University of Oklahoma, agrees. "Pharmacists don't know which information is valid or truthful," he says. "Pharmacists may disagree with some of what is in the press about vitamins, but they hesitate to discount it because information is still coming out.

"Pharmacists may not feel as comfortable talking about vitamins as they do prescription drug products," says Allen, who edited the vitamin section for the American Pharmaceutical Association's Handbook of Nonprescription Drugs. "Vitamins have been available at supermarkets and drug stores for years, but some pharmacists consider them on the periphery of their practice, which is not necessarily true."

David Roll, professor of medicinal chemistry at the University of Utah College of Pharmacy, says pharmacists must evaluate new studies on vitamins in context and learn to interpret studies for themselves.

In addition to conflicting information about vitamins, another reason for pharmacists' ambivalence is that, historically, pharmacy school classes on vitamins were not relevant to current practice.

Until recently, "vitamins were a very dull area" of study, says Roll. "Pharmacy education concerning vitamin supplements was limited to how they prevent deficiency-related diseases like beriberi or pelegra. That stuff really belongs in the history of pharmacy. You hardly ever see those conditions anymore. "Most pharmacists don't know about some of the recent credible studies done on vitamins, and their potential use," says Roll. Vitamins may slow down the processes associated with such conditions as heart disease, cancer, cataracts and osteoporosis, he says.

"We're also seeing more continuing education programs on vitamins," adds Roll.

Pharmacists have every reason to get excited and be informed about vitamins, says Bob Garrison, a pharmacist who is president and founder of Health Media of America, San Diego, a company offering publications and continuing education on vitamin supplements.

Pharmacists don't ask the right questions of patients seeking product recommendations, says Garrison. "Pharmacists should ask if the patient is dieting, if their caloric intake is below 2,400 calories per day, if they've seen a physician to have their iron checked, if they drink dairy," he suggests.

Pharmacists should find it "a pleasure to have additional products to recommend," says Garrison. "There's a lot that can be done [with vitamins]. With no more than a minute amount of additional information, pharmacists can do it," he says.

Incentives may be needed to spur pharmacists, such as giving them the opportunity to participate in continuing education courses on vitamins, Roll suggests.

"It's a win-win situation," he says. "Pharmacists feel better about what they're doing; the public will get the information they want and act on it by making purchases; and store owners will make more money. I can't think of another situation with this kind of payback," he says. "Why give all that business to health stores?"