Under the counter: the vitamin shelf war

It began the way so many conflicts begin: with the best of intentions and a misunderstanding.

The man was in his mid-fifties, wore a fleece jacket and had the energy of someone who has just seen something on Instagram.

“I need omega-3, vitamin D3, magnesium malate — not oxide, that’s important — and CoQ10. Ideally liposomal CoQ10, that’s more bioavailable.”

He paused briefly. “And astaxanthin.”

I breathed in. I breathed out. I wondered whether “That’s an interesting approach, let’s put it in context for a moment” counts as professional or condescending. I opted for the middle way.

“You’ve done your research,” I said. It was true. The problem was that he had done a great deal of research. Exclusively on YouTube, where someone with 800,000 subscribers had explained why everyone over 50 should take 23 food supplements a day.

“Are you currently taking any medication?”

“Marcoumar.”

A short pause.

“Omega-3 in high doses has an additive effect on blood coagulation,” I said, with the calm of a person who is inwardly thinking “OH NO”.

He looked at me. I looked at him. The vitamin shelf behind me hummed quietly.

“But the guy in the video said…”

“The guy in the video,” I said kindly, “doesn’t prescribe Marcoumar.”

What followed was a ten-minute conversation that I would describe as one of my most productive of the year. We agreed on vitamin D3 (with the dose adjusted to his most recent lab value), magnesium (ordinary oxide — he would not notice), and a letter to his GP regarding the other items on his list.

He also bought cough sweets.

On his way out he turned round once more: “And the astaxanthin?”

“Next time,” I said.

That was a lie. But sometimes the best thing a pharmacist can do is keep the conversation open.