Those in the biggest camp, the non users, accept the views of Dr Roger Whitehead, director of the Medical Research Council's Dunn Nutrition Centre. The centre advises the Government on the recommended daily allowance for all micronutrients, the term medical experts give to vitamins, minerals and dietary supplements. "Our basic idea is that with a balanced diet there is no need for dietary supplements," says Dr Whitehead. He recognises exceptions to this rule, such as women planning pregnancy, but overall rejects the idea that one can obtain optimum micronutrients for health by taking pills. "This is an incredibly complicated story," he says. "We know we require micronutrients because of what happens when they are absent." But trying to understand the effects of their presence, has left us with more questions than answers.
Before public health recommendations are given on supplements, experts like Dr Whitehead would need clinical trials to prove their safety and effectiveness. Can we achieve through supplements the benefits from eating a diet rich in fruit and vegetables? Can we replicate in capsules the mirror image, alpha beta structure of micronutrients in food, like vitamin E, when we do not yet fully understand how these vitamins interact with the body's receptors to such good effect? Pills bring with them the possibility of overdose and as the recent arguments over B6 demonstrate, more is not necessarily better. And is it the nutrients themselves, or is it the kind of people who choose such a diet, that explains why they do well?
In the other camp are the users, spending pounds 343 million on vitamins, minerals and dietary supplements last year, according to Mintel, the research company. Dietary supplements, such as cod liver oil, garlic and ginseng, take the bulk of sales at 62 per cent, while vitamins and tonics account for 38 per cent of the market. Cod liver oil is the most popular supplement, followed by evening primrose oil and starflower oil and then garlic. The constant stream of product launches has been a major factor in creating interest in the market. "It's a very young market," says Tim Legge, a pharmacist at Boots. Consumer interest can lead product development. "We are still catching up, launching products for which there is already a demand," says Mr Legge.
The tradition of natural remedies from cultures like the Chinese or Amerindian provides the basis for endless new products. Supplements developed in laboratories on the shores of Swiss lakes abound also. To this, manufacturers have added exotic rainforest plants and most recently the promise of natural beauty. The well-being of skin, hair and nails through supplements is a less contentious positioning in medical terms.
Mintel estimates that just less than a third of us have the vitamin bug, taking supplements at least twice a week. Age is an important factor. Around one in five people in their late teens and early twenties take supplements regularly; by the time people reach their late fifties, and age-related disease becomes a reality, this figure doubles. Age also influences why someone takes supplements. Only 7 per cent of teenagers taking supplements cited health benefits as their reason for doing so. Poor diet was more likely to influence their choice. By the time we reach retirement, views have changed and a third of regular users say they take them because of their health benefits.
Irrespective of age, very few people take supplements on doctor's advice. After all, we classify supplements as a food not a drug. But four years ago, 20 per cent of those taking supplements did so on their doctor's advice compared with less than one in 10 today, according to Mintel. Grocery retailers are more enthusiastic about supplements than chemists, according to Mintel. Between 1994 and 1996, shops like Asda and Tesco saw an enormous 41 per cent rise in sales; only CTNs and mail order enjoyed faster growth.
Doctors may no longer be consulted, but advertising and PR have become major influences on the market. Expenditure on advertising has risen by 87 per cent over the past four years and relaxation in the rules governing advertising has meant campaigns can target consumers other than the elderly, the parents of growing children and pregnant or breastfeeding mothers. So Seven Seas, the market leader with 26 per cent of sales, has targeted campaigns for cod liver oil at teenagers, hoping to extend its appeal beyond traditional consumers who use it because of its claims to benefit suppleness as they get older and face arthritis.
Media coverage also has a marked effect on sales. "A product has only to be recommended by Good Housekeeping for its sales to increase," says Mr Legge. He believes media comment has a greater effect on the market than medical advice, something manufacturers are well aware of. All the major companies run extensive PR campaigns aimed at journalists. Faced with adverse publicity, as had been the case recently over B6 and the legality of health claims made on packaging, the industry is quick to organise lobbying in its defence. Seven Seas, by far the biggest player, offers journalists who are writing about supplements free supplies as well as ready-made question and answer sheets and extensive data on the market. This is widely quoted, both by the media and other manufacturers and retailers. This tends to inflate the market, when compared to data from an independent source, such as Mintel. For example, Seven Seas estimates the market will be worth pounds 500m by the year 2001, compared to Mintel's estimate of pounds 436m. In its latest report on the market, Mintel concludes that around 30 per cent of us are regular users of vitamins, compared with the 44 per cent of women, and 33 per cent of men, quoted by Tesco, figures which are based on Seven Seas' estimates.
Small or large, there is little argument that the sector will continue to grow. Long-term lifestyle changes among younger people are already benefiting the market. The growth in snacking and a tendency to skip meals, which is particularly common among younger people, favours sales on the far from proven premise that we can gain the benefits of a balanced diet from pills instead. But Mintel concludes the heaviest users will continue to be women in their forties, fifties and sixties, with plenty of money to spend and a considerable interest in health and diet issues. Dr Whitehead already knows this is the group of people most likely to take supplements; he also knows it is a group with little or no need to take vitamins, minerals or dietary supplements of any kind in the first place.