Features

Supplementary benefits for teens?

03 October 2018

As a rise in the use of supplements among children – especially teens – is observed in the US, journalist Helen Bird looks at whether it’s a trend we’re likely to see in the UK and how you can help to address it.

Supplements Getty Images

How much do children and young people understand about the virtues of a balanced diet? Far less than they need to, it seems.

A study by US researchers found that, since 2003, the use of alternative medicines such as herbal products and so-called nutraceuticals (such as energy drinks) has doubled among children, driven by a rise in 13- to 18-year-olds taking omega-3 fatty acids and melatonin. In addition, they found that supplement use among adolescents varied by gender – with vitamin B products and folic acid popular among teenage girls, and boys favouring omega-3 and bodybuilding supplements (Qato et al, 2018).

According to public health advice (NHS Choices, 2011), the only groups that should use supplements are those at risk of deficiencies: pregnant and breastfeeding women; women trying to conceive and in the first 12 weeks of pregnancy; people aged 65 and over; people with darker skin and those who are not exposed to much sun; children aged six months to five years; and people with a medical condition whose GP has recommended specific supplements.

‘If you fall outside of these groups and buy vitamin pills, then the chances are that you will be spending your money on surplus amounts of vitamins you’ve already gained through your diet,’ the report continues (NHS Choices, 2011).

So what is behind the upward trend – the influence of parents, external pressures or both? Although there is little data on supplement use among UK children, the prospect that it might be on the rise closer to home should be considered, says Alana MacDonald, specialist child and adolescent mental health service dietitian and member of the British Dietetic Association. ‘It’s possible that rates are increasing among young people [in the UK] due to an increasing awareness of nutrition and a focus on vitamins and minerals,’ explains Alana. ‘It is possible this has been spurred by healthy eating movements, which are very popular on social media. Young people may have a misconception that they need to take certain nutrients in a supplement form for their health.’

 

Highlighting a deficiency?

Unless children are deficient in nutrients for a particular reason, such as a medical condition or they have a specific dietary requirement, they should not need additional supplements. Professor Mary Fewtrell, nutrition lead at the Royal College of Paediatric and Child Health, explains: ‘Generally, otherwise healthy young people should ideally get nutrients from their diet – and in many cases, the nutrients are absorbed better from “real food”.’

However, evidence suggests that many young people are not getting the nutrients they need through food intake. The latest National diet and nutrition survey showed that 96% of children aged 11 to 18 years in Northern Ireland did not meet the five-a-day recommendation for fruit and vegetables. And for the UK as a whole, low intake of some vitamins and minerals was seen in the 11 to 18 age group in particular (Public Health England, 2018).

There is also the rising number of children being brought up with a vegan diet to consider, for whom supplementation of vitamin B12 is considered essential, among other nutrients, (see Raising vegan children with care? in the May 2018 issue of Community Practitioner). However, groups that are not deficient in the vitamin will receive little to no value from taking it, Alana suggests. ‘B vitamins are water-soluble, meaning anything that is not used in the body will be excreted in urine, [so] where it’s not required, it mostly results in you having an expensive pee,’ she adds.

Nonetheless, the trends in supplement use observed by the US study do not appear to tally with dietary deficiencies. Indeed, the researchers note that vitamin B products and folic acid, which were popular with teenage girls, are marketed as ‘having benefits against depression’ while omega-3 fatty acids, promoted for their ‘cognitive benefits’, were most widely taken by teenage boys, alongside bodybuilding supplements, which suggests there are wider influences at play.

Supplements Table

Parental power

Looking at the likelihood of a rise in supplement use among UK children and teens as opposed to their US counterparts, it might be easy to dismiss melatonin because of the difference in availability (it’s prescribed in the UK).

Just last year, experts warned that too many children were being given the hormone for sleep problems – and suggested that parents were often pushing for the prescriptions. Dr Neil Stanley told The Guardian that, unless a child has a diagnosed condition ‘such as autism’, which is proven to be helped by melatonin, ‘there is no medical rationale for a child to be given it’. But for non-autistic children, he added, ‘it is a fashionable treatment for parents wanting “perfect” children’ (Marsh, 2017).

In addition, claims of boosted intelligence can lure parents to omega-3 supplements, according to the NHS Choices report (2011), which states: ‘A substantial proportion of fish oils are sold with the promise of aiding or improving mental ability, making them attractive to parents hoping to boost their child’s performance at school.’

External factors

The role of social media in adjusting the attitudes of children and young people is undeniable. Although research into its influence on health behaviours is in its infancy, one review of public health campaigns using social media to target eating behaviours and physical inactivity showed nine out of 10 were successful in improving those aspects (Maher et al, 2014).

Anna Howard-Price, a school nurse for more than 20 years who now provides training and education around child health, agrees the marketing of supplements can be powerful. ‘We see advertising saying if you want to feel good, take this medication…’ she says. ‘Only the other day I saw: “Are you tired of being tired? Take folic acid,” and I thought: you don’t really need it if you’re not deficient in it. But that’s the way they’re being sold to teenagers, and they are very body-image conscious.’

And worryingly, a 2017 US study found that health food store employees in America frequently recommended creatine and testosterone boosters to 15-year-old school athletes (Herriman et al, 2017).

‘Bodybuilding supplements are not something that I would recommend or condone in any way,’ says Alana. ‘A healthy, balanced diet, with an appropriate proportion of macronutrients and micronutrients, is sufficient to support healthy growth, development and athletic ability.’

Identify and educate

Renaissance physician Paracelsus noted: ‘All substances are poisons. There is none which is not a poison – the right dose differentiates a poison from a remedy.’ And indeed the principle includes dietary supplements, however natural they are purported to be.

For example, too much vitamin D over a long period (for one- to 10-year-olds, no more than 50µg a day should be taken) can cause calcium to build up in the body, weaken the bones and damage the kidneys and heart (NHS, 2017). And vitamin A can be ‘very harmful to the body if taken in high doses over long timeframes’, says Alana. It doesn’t help when ‘the nutritional labels are very confusing because different units are used to inform dosage,’ she adds.

Supplements with active ingredients beside vitamins and minerals that are on an approved ingredients list may have unwanted ‘biological effects on the body’, some ‘even dangerous’ (NHS Choices, 2011). An example is ginkgo biloba. It’s also important to remember that supplements are regulated in different ways depending on the type of product (NHS Choices, 2011), and internet purchases may not all meet UK standards (BDA, 2016).  

However, Anna points out that unless a child presents with symptoms consistent with the side effects of a particular supplement, school nurses are unlikely to pick up on excessive or problematic use. Therefore, the solution appears to lie in educating children, parents and professionals more widely about the benefits of a balanced diet versus the risks of taking supplements that haven’t been medically recommended. Indeed, with nutraceuticals such as energy drinks, which rising numbers of children are reported to be consuming (EFSA, 2013), some schools have imposed a total ban.

Alana says: ‘My advice would be to support the use of general multivitamin and mineral supplements, but any specific or targeted supplementation should be advised by a dietitian to ensure the correct dosage.’

Professor Fewtrell suggests healthcare professionals draw upon the information provided by the NHS Choices (2011) report, adding that practitioners also ‘need to recognise situations where specific nutrients may be required, such as vitamin D’.

But surely an equally important message to pass on to impressionable teenagers is to ask questions. ‘It’s about educating children and young people to respect their own bodies and not to look at things at face value,’ says Anna. ‘Be inquisitive – don’t just do it because somebody says, not even if it’s in a magazine. Make your own mind up.’


What are teens lacking?

Iron

Iron requirements increase during adolescence to help with growth and muscle development. After menstruation begins, girls need more iron than boys to replace menstrual losses. The reference nutrient intake for girls (11 to 18 years old) is 14.8mg of iron each day, while for boys of the same age the figure is 11.3mg of iron daily. Girls who have particularly heavy menstrual losses may require larger amounts.

Calcium

The rapid increase in bone mass in young people means that they require more calcium during their teenage years and if this is not provided, future bone health may be compromised. At ages 11 to 18 years, the reference nutrient intake for boys is 1000mg per day and for girls the figure is 800mg per day.


More information about supplements


References

BDA. (2016) Supplements. See: https://www.bda.uk.com/foodfacts/supplements.pdf (accessed 17 September 2018).

British Nutrition Foundation. (2016) Nutrition Requirements: Reference Nutrient Intake for vitamins and minerals for 0-18 years. See: https://www.nutrition.org.uk/attachments/article/234/Nutrition%20Requirements_Revised%20Oct%202016.pdf (accessed 9 September).

Department for Work and Pensions. (2018) Households below average income: 1994/95 to 2016/17. See: https://www.gov.uk/government/statistics/households-below-average-income-199495-to-201617 (accessed 9 September 2018).

European Food Safety Authority. (2013) Gathering consumption data on specific consumer groups of energy drinks. See: https://efsa.onlinelibrary.wiley.com/doi/10.2903/sp.efsa.2013.EN-394 (accessed 9 September 2018).

Herriman M, Fletcher L, Tchaconas A, Adesman A, Milanaik R. (2017) Dietary supplements and young teens: misinformation and access provided by retailers. Pediatrics, 139(2). See: http://pediatrics.aappublications.org/content/139/2/e20161257 (accessed 9 September 2018).

Maher CA, Lewis LK, Ferrar K, Marshall S, De Bourdeaudhuij I, Vandelanotte C. (2014) Are health behaviour change interventions that use online social networks effective? A systematic review. Journal of Medical Internet Research, 16(2). See: http://www.jmir.org/2014/2/e40/ (accessed 9 September 2018).

Marsh S. (2017) Too many children being prescribed melatonin to aid sleep, experts warn. The Guardian, 29 May. See: https://www.theguardian.com/lifeandstyle/2017/may/29/melatonin-prescribed-children-fashionable-treatment-sleep-experts-warn (accessed 9 September 2018).

NHS. (2017) Vitamin D: vitamins and minerals. See: https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-d/ (accessed 12 September 2018).

NHS Choices. (2011) Supplements: who needs them? A Behind the Headlines report. See: https://www.nhs.uk/news/2011/05May/Documents/BtH_supplements.pdf (accessed 9 September 2018).

Public Health England, Food Standards Agency. (2018) National Diet and Nutrition Survey: results from years 7 and 8 (combined) of the rolling programme (2014/2015 to 2015/2016). See: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/699241/NDNS_results_years_7_and_8.pdf (accessed 9 September 2018).

Qato DM, Caleb Alexander G, Guadamuz JS et al. (2018) Prevalence of dietary supplement use in US children and adolescents, 2003-2014. JAMA Pediatrics, 172(8): 780-2. See: https://jamanetwork.com/journals/jamapediatrics/article-abstract/2685282 (accessed 9 September 2018).

 

Image Credit | Getty

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