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Who takes dietary supplements, and why?

If you’re a regular reader of this blog, I’ll bet you’re not a regular consumer of vitamins or supplements. I’m in that group. Aside from sporadic vitamin D in winter, I don’t take any vitamins or supplements routinely, nor do I give any to my children. Your reasons may be close to mine: There is little to no evidence suggesting that dietary deficiencies are widespread, nor is there good evidence to suggest that vitamin supplements are beneficial in the absence of deficiency. I don’t have any need for an other supplements, nor am I confident in the scientific evidence for many of them.This position of “no supplements” is a cautious and conservative one, but is based on a consideration of the scientific evidence. I view decisions about healthcare as evaluations of risk and benefit, and then cost if necessary. Given supplementation (with some exceptions) has no demonstrable benefits and, in some cases, a little risk, the odds favour not supplementing in most cases. Add in costs, and it’s even less attractive as a routine health strategy.

Yet a decision not to take vitamins or supplements regularly is becoming a minority position. Supplement use has grown over the past 40 years among Americans, with the National Health and Nutrition Examination Survey (NHANES) showing steadily increasing utilization among younger and older adults:

Source: Council for Responsible Nutrition

Source: Council for Responsible Nutrition

 

Supplement makers promote an image of being small, ethical, and natural — the exact opposite of evil Big Pharma. Yet the numbers show this is big business: a $30 billion (USD, 2011) industry which (as has been noted regularly at this blog) has limited regulatory oversight. The result is a marketplace with products listing exaggerated claims that aren’t supported by credible evidence. Yet industry surveys suggest 85% of Americans are confident in the safety, quality, and effectiveness of these products.

Given the (lack of) good evidence showing benefit, why are consumers so fond of these products that they willingly shed out $30 billion per year for supplements? It’s a question I regularly ask myself when consulting with patients who enquire about supplements as a complement to, or as a substitute for, more conventional treatments. It’s a testament to the marketing of these products that they are (from my own observations) perceived as being safe and effective, in contrast to drug products. The reason that I’m not promoting them, I’m sometimes told, is because I’m not trained in “botanicals” or “herbals,” unlike the friendly neighbourhood naturopath, who routinely recommends a long list of supplements, in contrast with my typical advice to see a medical doctor, or to make basic lifestyle and dietary changes first.

As a pharmacist I have a simple goal with my patients: improve health by improving medication use. I don’t distinguish between drugs, vitamins, and supplements. If they’re being taken for a therapeutic use, they’re fair game. I do this in part by interpreting the scientific evidence to support patient self-care decisions. So as an advocate for science-based medicine, I admit to finding the surging popularity of supplement use a bit frustrating. I’ve seen people spend $100 or more per month on a variety of supplements, most of which are either unproven, or proven ineffective. At the same time, they may reject or defer strategies backed by better evidence. Now $30 billion could likely be used much more effectively for health care if redirected towards the strategies that offer more health “bang for the buck”. So if the goal is to change behaviors, the motivations need to be understood. And I can’t rely on my own biased sample — I need a more systematic analysis.

Happily, consumer patterns and motivations have been studied. Published earlier this month in what used to be called the Archives of Internal Medicine (now called JAMA Internal Medicine) was Why US Adults Use Dietary Supplements by Reagan L. Bailey and colleagues from the Office of Dietary Supplements at the National Institutes of Health. It also relies on the NHANES dataset, a representative survey of US civilians which began collecting specific information on reasons for supplement use in 2007. Data are collected through interviews, and a Dietary Supplement Questionnaire was used to gather detailed information on each participant’s use of vitamins and other supplements. This survey reports the results from 11,956 adults (children, young adults (< 20 years), and all pregnant and lactating women were excluded from analysis). Here’s the snapshot of the participants:

 

  • 49% of adults used a supplement of some kind in the prior 30 days: 54% of women, 43% of men.
  • Supplement use increased with age: 34% aged 20-39, 50% age 40-59, and 67% over age 60
  • Non-Hispanic whites use more supplements (54%) than Non-Hispanic blacks (38%) or Hispanics (33%)
  • Supplement use is greater in “never” (51%) or “former” (59%) smokers compared to current smokers (30-36%)
  • Supplement use is much more common in those with health insurance (53%) than those without  (31%)
  • Supplement use parallels reported exercise, from “low” (43%) to “moderate” (54%) to “high” (56%).
  • Supplement use was higher among those that reported “excellent” or “very good” health (55%) versus “good” (47%) or fair/poor (44%)

So far this is as expected: supplement users tend to be wealthier and healthier than non-users. It’s the “healthy user” effect which shows up throughout epidemiological studies, confounding evaluations of outcomes. That is, we shouldn’t assume supplement use make you healthier, any more than assuming that supplement use makes you wealthier.

Here are the most common reasons for taking supplements:

 

Table 2

 

The most common motivations for taking supplements were to “improve” (45%) or to “maintain” (33%) health, consistently reported between men and women. Bone health is next, with a large gender split between men (11%) and women (36%). Most of the other reasons given are equally common, with significant differences in only a few categories: Men reported more interest in supplements for heart health (18% vs. 13%) while women reported more supplementation for sleep, skin, and hair health, as well as anemia. The frustrating (and fallacious) “to boost immunity” came in at 15%, revealing just how widespread the perception is that our immunity can be “boosted” and that it can be accomplished with supplements. Motivation for site-specific use (vision, heart, bones) increased with age of the user.

The “enhanced energy” rationale for supplements was cited only 11% of the time — less common than I expected.

Knowing the motivations, let’s take a look at the types of supplements comsumed, reported in Table 3. It’s a distribution with a long tail: multivitamins/minerals are tops, with an overall prevalence of 32%. Calcium is next, at 12%, followed by omega-3 supplements/fish oils (10%), then “botanicals” (a category of herbals, probiotics, melatonin, and coenzyme q10) and the individual supplements and other categories.

 

Table 3

 

The authors note that 23% of the supplements reported as being used were recommended by a health professional (not defined), whose top recommendations matched the top supplements reported overall. This suggests that over 75% of supplement decisions are being made without (or despite) the recommendation of a health professional.

Other studies

A related survey, also recently published in JAMA Internal Medicine, Users’ Views of Dietary Supplements, gives additional insight to the NHANES survey on motivations for use of supplements. Blendon and colleagues at the Harvard School of Public Health conducted a telephone survey of 1579 people aged 18 or older. This survey asked specifically about dietary supplements but not vitamins or mineral, and identified 584 supplement users.  38% reported taking any supplement in the past two years, and 13% reported taking a supplement regularly — which appears in the ballpark of the NHANES study, if you pull out vitamins. Fish oil/omega-3 oils were the most common consumed (again, consistent with NHANES) with 24% consuming the product in the past two years. Reasons reported for taking supplements included:

  • “to feel better” (41%)
  • “to improve your overall energy levels” (41%)
  • “to boost your immune system” (36%)
  • “digestive issues” (28%)
  • “lower cholesterol” (21%)

Over 80% reported it was important to have access to supplements. Interestingly, users were asked how government-sponsored efficacy studies would influence their decision to take a supplement. Amazingly, only 25% of users said they would stop using a supplement if it was evaluated to be ineffective. Also interesting: 36% of supplement users had not told their physician about their supplement use, while 31% reported a physician or nurse had recommended their supplement use.

A third study reveals largely consistent information on popularity. From the Military Nutrition Division of the US Army, it’s entitled, Confidence in the efficacy and safety of dietary supplements among United States active duty army personnel, and was published in BMC Complementary and Alternative Medicine in 2012. This was a survey of 990 soldiers in 2006-07 at 11 military bases that focused on motivations, not specific products taken. A dietician or other health professional administered the questionnaire directly and asked for usage of supplements as defined by DSHEA. The sample group was mainly male (87%), white (70%), and young (41% were aged 18-24). Just over half (53%) reported using supplements at least once per week during the prior 6 weeks. Usage was observed to be highest among those older in age, better educated, and holding higher ranks, and reporting good/excellent health.

Here’s the evaluation of efficacy:

Figure 1 BMC

DS=Dietary Supplement

 

Two-thirds (67%) of all participants were somewhat confident or extremely/very confident in the efficacy of supplements, which increased to 86% among users. The majority of non-users (62% were not at all confident in supplement efficacy. Those who reported excellent fitness or dietary habits were much more likely to be very/extremely confident in supplement efficacy.

Here’s the evaluation of safety:

Figure 2 - Safety - BMC

DS=Dietary Supplement

 

The patterns are largely similar. 71% of all respondents were somewhat or extremely/very confident in supplement safety, increasing to 88% among users. Again, the majority of non-users (55%) lacked confidence in the safety of supplements. The same patterns with self-reported excellent fitness/dietary habits and confidence in safety were also observed.

When asked about regulation, few understood the current regulatory structure, with nearly half indicating they didn’t know if there were requirements the supplements work as advertised. Belief that supplements must be safe for consumption was more common among users (38%) than non-users (25%).

On balance, the survey reveals that soldiers that use supplements are confident in their efficacy and safety, and that this confidence is highest among those that believe current regulations require supplements to be both safe and effective.

What does it mean?

Survey on supplement consumption report widespread use, which seems to be based on perceptions that these products are both safe and effective. While supplement use of all kinds is common, it’s multivitamin/minerals that really push the overall consumption rates up. Take that away, and regular usage of other kinds of supplements drops down to just over 10% of the population. When looked at over longer time frames, however, the Harvard survey suggests that 40% do take some form of non-vitamin supplement at least intermittently.

The reasons for taking supplements varies. In the case of multivitamins, it seems to be based around the belief that their consumption will offer meaningful benefits. Yet on balance, there is little evidence to support general supplementation, and in the absence of a deficiency, no evidence multivitamins will boost mood or energy levels. For the most common reasons cited for supplements, expectations are generalized and fairly non-specific. Many may be taking multivitamins as an insurance policy — not a strategy that I’d routinely endorse, given the evidence, but one that is not uncommon. And certainly there is some vitamin and supplement use that is appropriate and evidence-based.

Most of the decision-making around vitamin and supplement use appears to occur without the input of a health professional, raising questions about the rationale for use. And perhaps not surprisingly, few subsequently tell their health professionals about their supplement use. Medical evidence may not be a factor in decisions to take these products. Instead they may be based on perceptions or attitudes that they’re beneficial, perhaps because of confidence in regulations that allow their sale, or the resulting marketing that exaggerates expected benefits. What’s most surprising is that the scientific evidence may not matter at all. It’s said that you can’t reason people out of a decision they didn’t reason themselves into. Perhaps that’s the case with supplements. Certainly it illustrates the need for a more thoughtful (and yes, science-based) approach to promoting health behavior change in individuals. For health professionals interested in improving the safe and appropriate use of vitamins and supplements, and reducing unnecessary or inappropriate use, we need better strategies to promote change.

 References

Bailey R.L. Why US Adults Use Dietary SupplementsWhy US Adults Use Dietary Supplements, JAMA Internal Medicine, 1. DOI:

Blendon R.J. (2013). Users’ Views of Dietary Supplements, JAMA Internal Medicine, 173 (1) 74. DOI:

Carvey C.E., Farina E.K. & Lieberman H.R. (2012). Confidence in the efficacy and safety of dietary supplements among United States active duty army personnel, BMC Complementary and Alternative Medicine, 12 (1) 182. DOI:

 

 

Posted in: Herbs & Supplements, Nutrition, Science and Medicine

Leave a Comment (96) ↓

96 thoughts on “Who takes dietary supplements, and why?

  1. DugganSC says:

    I’ll admit that I’m among the people who takes a regular multi-vitamin. I got into the habit back in college, when my meals were sporadic and often somewhat — I’m grasping for a word to indicate that my dinner was sometimes a sleeve of Saltine crackers, or a can of mixed fruit — non-varied, I suppose. The vitamin was because I was certain I wasn’t getting a sufficient amount of most vitamins and minerals on a daily basis. I tool Calcium as a supplement for a while because my late-onset lactose intolerance meant my dairy consumption dropped sharply, although I now resort to Silk, enriched orange juice, and milk with lactase pills ever since I read the article here about the correlation between Calcium supplements and heart problems. I tried Glucosamine and Vitamin E (or was it D?) or after-workout pains for a while, but results were too mixed to continue. Other than that, my only other sin is Lysine, which I take when I get cold or canker sores. I know that the studies don’t bear out this effect, but if it works as a placebo, I’m willing to spend a few bucks a year to make the occasional sore more bearable (I started ion a semi-medical recommendation from a pharmacist then-girlfriend).

    My wife is a somewhat more medically based case. She has poor uptake of Vitamin D and E, and can’t get much sun with her complexion, so her doctor has her on a supplement pill for that. She’s also taking pre-natal vitamins for the obvious reason (there are other reasons. I have a friend who has some doctor-diagnosed deficiencies which are easiest addressed by pre-natal vitamins). She’s a bit more of a believer in extra supplementation, but is fortunately lazy enough to never get around to it.

  2. Helga435 says:

    I take a daily multi-vitamin as well, partly out of habit but also because it contains folic acid and I am a woman of child bearing years. Folic acid has a demonstrated effect on preventing spina bifida if taken early in pregnancy. While my husband and I are actively trying for another child now, our first child was a “surprise”. Now, I know I can’t say “if I hadn’t been taking folic acid, my daughter would have had spina bifida” but personally, I’m glad I was- just in case.

    I have seen a new study on folic acid in the news lately saying that it may help prevent autism when taken in pregnancy as well. I haven’t read the actual study but I would be interested in an analysis.

  3. tljenson says:

    I guilty as charged, I’d like to think the supplements I’m taking are different in that I research them on all the best science based sites. Take St. John’s Wort, it seems if you look at the evidence that there is a real strong correlation that its getting positive result. I also take Pregnenolone, and while its potentially dangerous there isn’t research one way or the other claiming it does nothing or something. I’ve had positive results, noticeable I suffer from ED and don’t have health insurance to go get all the required test to be put on male hormone replacement treatment. So am taking my chances. I think things like Fish Oil, have positive benefits, and I not talking heart health as I am aware of the recent study showing it’s lack of efficacy.

    I’m also been taking racetrams, which I think I’ll give up while I’ve noticed some effects I don’t think there worth the risks. Actually most of them are drugs that were developed for Alzheimer. No there have been many studies for example on Piracetam regarding effects on dyslexia which I have. A lot of these a drugs, and pass under the radar because of loop holes on what constitutes a supplement.

    I not your usual supplement taker that get’s his stuff from Walmart, I’d like to think I do a little more research. Now I don’t by into most any of the claims the whole Ginkgo, and Echinacea nonsense. I of the opinion that 98% of supplements are probable a waste and a potential risk. I take Alpha Lipoic Acid or ALA some of the studies there look promising while not conclusive. I suppose I take them on the off chance that they do anything. Which I know isn’t an excuse, but I find a lot of skeptic groups target the easy targets, and don’t bother to look into more credible sources for some of these obscure supplements which just haven’t been study enough to say one way or the other about their potential efficacy. I think supplements like Selenium, magnesium, biotin which don’t get absorbed properly do to their condition can be of benefit. are potentially beneficial to diabetics which lack the ability to readily absorb these nutrients efficiently.

    I also worry that some of these potential beneficial supplements don’t get the proper research they may deserve because you can’t patent them and their are no financial intensives to do proper studies. There are exceptions where it’s just smart to take some supplements such as Vitamin B12 if your blood tests come back showing you deficient. So some of them anyway have legitimate uses that aren’t based on bad science.

  4. AlexisT says:

    I wouldn’t make that bet so quickly. It’s probably a minority still, but I doubt my experiences are unique. As a woman of childbearing age, I am pushed to take folic acid (even though I am currently actively avoiding conception) and this seems to be popular advice from doctors. I’ve also had my iron and Vitamin D levels tested, and found to be low. I realize that the latter in particular has some controversy over appropriate levels, but mine were low by any standard. I skip the folic acid for now, but do take Vitamin D and iron.

  5. stanmrak says:

    “As a pharmacist I have a simple goal with my patients: improve health by improving medication use. I don’t distinguish between drugs, vitamins, and supplements.”

    You don’t ‘improve health’ by improving medication use; you’re only treating and improving symptoms, even if you’re using ‘natural’ treatments. Those are not the same concepts!

    Nutrients and supplements are not the same as lab-created drugs; please stop analyzing them as if they were. They don’t occur in isolation, don’t work in isolation, and respond differently in every individual body, and differently in the same body based on the myriad (like, billions) of other synergistic cofactors present when the nutrient is consumed. You can’t isolate the effect of the individual nutrient sufficiently to run a valid study of it, so don’t bother analyzing the studies too much.

    The ‘science’ on nutrition is so contradictory, one can make a case for ANY viewpoint by pulling up thousands of studies that support your beliefs. Of course, it’s just as easy to pull up thousands of contradictory studies as well, just as legitimate.

    People don’t ask their health professionals about supplements because quite often, the patient knows more than the doctor. Of course, the bar is not set too high. Nutrition is not a significant part of a medical school curriculum, more like an afterthought.

  6. mousethatroared says:

    As far as I know folic acid is still recommended for women for whom pregnancy is possible, not sure what % of SBM readers this covers.

    Personally I’m taking a calcium-vitamin D supplement, because sometimes I may not eat enough calcium containing foods and between high spf sunscreen use in the summer and gloomy winters I doubt I get a lot of D.

    So what do I get for winning that bet?

    You may owe the vegans who are regular readers and Elburto something too. ;)

  7. Calli Arcale says:

    stanmrak — find me something, anything, that does work exclusively in isolation with no synergistic effects on anything else. I dare you. Nutrients are *just* like drugs in that respect. Because y’know what? The natural world doesn’t freakin’ care what labels you stick on things, or where a particular molecule came together. Science doesn’t stop working because something is fashionably natural, and honestly, being hard to study is no excuse for giving up and just going off your preferred assumptions, especially if you won’t admit that that’s what you’re doing.

    As far as “improving symptoms” not being relevant to improving health, what on earth do you think a symptom is if not a sign of someone’s health?

    To the original question, of who takes supplements….

    All my family take a multivitamin in the morning. It’s mostly to encourage my eldest to take hers; she has an astoundingly picky palate, so I want to hedge my bets on her nutritional status by supplementing. And we all at some point take a calcium supplement, but as an antacid. ;-) Works great.

  8. lizditz says:

    Back in the 1980s, when I was trying to conceive, I took an OB-recommended prenatal vitamin, which I continued through pregnancy and delivery.

    Like Calli Arcale, throughout my parenting career I took a kids’ multivitamin pour encourager les autres — specifically, vegetable-resistant offspring.

    Latterly, after blood testing, and on the advice of my physician, I’ve been taking vitamin D and vitamin B12. The physician also recommended an Omega 3 supplement, which I also take.

  9. WilliamLawrenceUtridge says:

    You don’t ‘improve health’ by improving medication use; you’re only treating and improving symptoms, even if you’re using ‘natural’ treatments. Those are not the same concepts!

    Giving antibiotics for a bacterial infection treats the cause, not the symptoms. For certain medical conditions you cannot treat the cause, only the symptoms. And the rhetoric that “natural” cures treat the cause rather than the symptoms is just rhetoric – it makes you feel good, but it doesn’t actually help anyone. If you’re talking about lifestyle conditions like type II diabetes and obesity, the standard recommendations are diet and exercise to promote weight loss. If the patient refuses to comply and ends up taking medication, it’s hardly the doctor’s fault, and there is no “natural” alternative.

    Nutrients and supplements are not the same as lab-created drugs; please stop analyzing them as if they were. They don’t occur in isolation, don’t work in isolation, and respond differently in every individual body, and differently in the same body based on the myriad (like, billions) of other synergistic cofactors present when the nutrient is consumed. You can’t isolate the effect of the individual nutrient sufficiently to run a valid study of it, so don’t bother analyzing the studies too much.

    [citation needed]. Or more accurately, your statement holds for every single molecule that enters the body. Nutrients and supplements are like lab-created drugs in that they are chemicals, and are often created in labs. And even if your statement were true, science would investigate, isolate, and ultimately resynthesize data about these compounds to come to a more complete understanding of how they work in the body. Your alternative seems to be “it’s complicated, I give up, but I’ll pretend they’re magic and have no risks”. That’s faith, that’s not science. Nutrients and supplements indeed have risks. Hypervitaminosis A is lethal, as is hypervitaminosis D (ask Gary Null).

    The ‘science’ on nutrition is so contradictory, one can make a case for ANY viewpoint by pulling up thousands of studies that support your beliefs. Of course, it’s just as easy to pull up thousands of contradictory studies as well, just as legitimate.

    And science attempts to address this by analyzing and systematizing the literature, dividing and categorizing results according to quality, method and a host of other factors. True effects should be demonstrable, your reaction of “it’s complicated, I give up” certainly isn’t superior to empirical research. You go ahead and give up, real scientists will keep working and life will improve because of it.

    People don’t ask their health professionals about supplements because quite often, the patient knows more than the doctor. Of course, the bar is not set too high. Nutrition is not a significant part of a medical school curriculum, more like an afterthought.

    That’s a bit of a blatant lie. Doctors may not get a specific course on nutrition, but they learn about the biochemical pathways nutrients take as part of their training both before they get into med school and after. Unless the patient has advanced degrees in biochemistry that focussed on nutrition, it is quite unlikely they know more than a doctor. They may have convinced themselves that their second-hand reading of articles by Gary Null and Joe Mercola about rat and test tube research means they are more informed than their doctors, but that’s not the same thing as knowing where each molecule goes and what it does. Merely because there is no course called “nutrition” doesn’t mean doctors don’t understand anything about vitamin C. Further, doctors base their recommendations on the science analyzed by expert bodies like the FDA, CDC, USDA and UN which are staffed by genuine and highly educated academics and researchers. This is more certain knowledge, based on actual research in humans or, at worst, educated guesses made by people who know more about the specific molecules than nearly anyone else on the planet, than someone who starts their research with the assumption that nature wants us to live happy, healthy lives.

    People probably don’t ask their health professionals about supplements because they probably assume they’re risk-free. For the most part this is probably true – a mutivitamin may be worthless but it’s also unlikely to harm you. Unless it does. Your statements and conclusions are based on your preconceptions, what you want to be true, and what you’ve been told (probably by someone selling vitamins), not on the actual science.

  10. Jeff says:

    Although Scott clearly opposes the use of most supplements, he presents a reasoned discussion of who actually takes supplements and why. Many such posts simply portray consumers as dupes of greedy, predatory supplement companies. The fact is consumers want these products; they have a track record of safety and are sold by a well-regulated industry. Is there any “science-based” reason people should be denied access to their supplement of choice?

    Scott writes, “Supplement makers promote an image of being small, ethical, and natural”. The era of smaller, underfunded supplement companies is coming to an end. Meeting the standards of the FDA’s GMP regulations requires a considerable investment in equipment and personnel:
    http://www.naturalproductsinsider.com/articles/2012/02/the-cost-of-gmp-compliance.aspx

    The FDA is making it clear companies unable to meet those standards won’t long remain in business:
    http://www.nutraingredients-usa.com/Regulation/CA-drug-dietary-supplement-manufacturer-ordered-to-shut-after-nine-failed-cGMP-inspections

  11. Calli Arcale says:

    Jeff — I don’t see it as being about restricting consumer choice so much as about restricting manufacturer’s choice with respect to advertising. ;-) After all, I’m not quite as sanguine as you about the “well-regulated” part; FDA has written some strongly-worded letters, but they really are very limited in their ability to detect and shut down misbehaving manufacturers.

    You can treat your asthma with honey if you want, but I don’t want a honey manufacturer selling it as an asthma cure, because that’s deceptive advertising. And there isn’t enough oversight to ensure they’re even selling what they claim they are. Probiotics have been a particular problem, where many products either don’t contain the species claimed on the bottle, or contain them only in deceased form, which isn’t really useful. Defective and outright fraudulent products are a problem, and the free market does a poor job of detecting them.

    It’s a bit like the ongoing horsemeat scandal in Europe; you can (and should) regulate truth in advertising and basic safety standards without compromising consumer choice.

  12. Jeremy Praay says:

    I’ll bite…

    My mother suggested that I start taking fish oil capsules. My cholesterol was terrible, and even though I was over 40, I had never had it tested. Or if I did, I simply didn’t care. But at some point, it dawns on you that you’re not immortal, or you learn that you’re only immortal for a limited time. ;-)

    Honestly, I was skeptical. I did a bit of Googling, but without knowing what to look for and where to go, I really couldn’t find anything conclusive. So, I did my own scientific test. Double blind? No. Not even blind. Flawed? Absolutely. But that wasn’t the point. I was simply going to show Mom that fish oil tablets were worthless.

    So, I took them for 6 months at 2/day, and got my cholesterol checked. HDL was up quite a bit, LDL was down. Meh, I had also changed my diet a bit. So, that’s probably what’s going on.

    I stopped taking them for 6 months. Checked my cholesterol. HDL was down a little, LDL was up a lot.

    I took the capsules again. After 6 months, I checked my cholesterol again. HDL up (higher than ever), LDL lower than ever.

    I stopped taking the capsules. 6 months later, HDL down again. LDL up again.

    After that, I was convinced. 3 years ago, my HDL was 26, TC at 221. Today it’s 47 and 190, after one year of fish oil. The fish oil alone seemed to shoot HDL up to at least 40. Several months ago, I also began drinking about 2 glasses of orange juice per day, and it shot up to 47, but I also put on 10 lbs, and my LDL was a bit higher. At one point, my TC was 174, but my HDL is 13 points higher now.

    I can’t say that it’s hard science, but I can say that for me, the results were encouraging. As far as the science behind cholesterol and heart disease, I will defer to the experts.

  13. RUN says:

    I take 2000IU vitamin D most days. Its cheap, easy, and seems to be involved in a lot of conditions if not at adequate levels. I take 1000-2000mg DHA, EPA (fish oil) most days. I don’t always eat fish 2-3 times a week, and again seems that a lot of research supports adequate intake. I take a multivitamin with minerals (naturemade womans complete) most days. This is more to help my husband take his. I chose this MVI because it has adequate b vitamins (not that I need b12 now, but I have heard the older we get, we may not be as effecient in making intrinsic factor. I also am not on metformin) also we don’t have a lot of selenium in our soil, so this MVI has some, and it also contains vitamin K which seems to be playing a role in heart health. I eat a lot of dark green veggies, but again, I want to make sure my husband is getting his K. We have not used table salt for a long time now, so this MVI also has a small amount of iodine. I look at taking the supplements to help with my nutrition, not to be the sole source of my nutrition. I still try to eat healthy and exercise since I feel this will have more of an impact on health then just popping a MVI.

  14. PJLandis says:

    I’ve been on a diet and exercise regime, trying to lose weight, and I started taking a multi every other day or so. Not to aid in weight loss, but I’m limiting calories and I thought I might be missing something in my diet. I didn’t really think about it much, but I’m actually probably getting a lot more vitamins and such because I’m eating fruit and vegetables at almost every meal which is a big change. Anyway, just a personal anecdote.

    And I don’t think most people want supplements banned or strictly regulated like drugs. The problem is marketing them as effective treatments, when the evidence is either non-existent or contrary. To me, structure and function claims are inherently misleading. You could sell sugar pills as energy supplements because glucose is essential to cellular energy.

  15. WilliamLawrenceUtridge says:

    Although Scott clearly opposes the use of most supplements, he presents a reasoned discussion of who actually takes supplements and why. Many such posts simply portray consumers as dupes of greedy, predatory supplement companies. The fact is consumers want these products; they have a track record of safety and are sold by a well-regulated industry. Is there any “science-based” reason people should be denied access to their supplement of choice?

    Saying Scott “opposes” use of most supplements is a bit of a straw man. Scott seems to believe in the evidence-based use of supplements, it just so happens that most supplements do not have an evidence base that demonstrates clear benefits. The fact that customers want these supplements in the face of a lack of evidence of benefit provides some support to consumers being dupes quite willing to pay good money for questionable reasons. It’s not limited to the supplement industry, you can buy a convertible for $90,000 when your needs would be met just as easily with a $5,000 used subcompact. Many purchasing decisions are not made for rational reasons, and certainly this applies to most supplement buyers. Demand is never an indication of efficacy.

    It would be nice to have an industry with a track record of safety and regulation, unfortunately I think the DSHEA essentially prevents this (or rather, ensures the industry is self-regulated, which is basically saying “unregulated”). Certainly there is no drive to “deny” people supplements in the current legislation, and modifications to the legislation would likely support only well-founded, explicit claims and more stringent regulation for safety and purity (aka what exists now for drugs). This would drive up the costs of supplements, not make them unavailable, but it would also ensure consumers get what they think they are getting and be more certain that they do what they say on the bottle. Hardly the draconian actions of a state trying to prevent consumers from accessing what they need to stay healthy.

    The era of smaller, underfunded supplement companies is coming to an end. Meeting the standards of the FDA’s GMP regulations requires a considerable investment in equipment and personnel:
    http://www.naturalproductsinsider.com/articles/2012/02/the-cost-of-gmp-compliance.aspx

    …and that’s a bad thing why? Economies of scale would keep many of these costs down, but currently at best all you can say is you are getting cheap products of questionable contents and doubtful efficacy. Right now “health freedom” is asking for the ability to spend a small amount of money to buy a generally worthless product. Changes to regulations would force you to spend more on a product that actually does something (and isn’t made out of lactose and ground up cow bones).

    The FDA is making it clear companies unable to meet those standards won’t long remain in business:

    Again, so what? I would compare it to complaining that the SEC put Bernie Madoff out of business. Smaller business isn’t necessarily better business, it’s often just more expensive business. I’m happy with a regulator willing to shut down a small business because it turns out the contents of their bottles doesn’t match the label on the bottle or is poisonous or is worthless. How is this a bad thing?

    Defective and outright fraudulent products are a problem, and the free market does a poor job of detecting them.

    Indeed, one of the assumptions of models of the free market is that of equal information, and one of the flaws in free markets is unequal information. Regulators are in place to address these failings (in this case by forcing, or really strongly suggesting, companies match content to label; hopefully in the future it will expand to be about matching content to outcome and genuinely ensuring contents are unadulterated, untainted and honestly described).

    As usual, “health freedom” isn’t about freedom, it’s a marketing term for supplement companies’ astroturfing a grass roots movement that leaves them free to sell whatever they want, whenever they want, without restriction. And that’s a good thing how?

  16. Jeff says:

    Calli – I agree there are too many companies making false, misleading claims. But the FDA has strict rules against supplement companies making health claims. The problem seems to be lax enforcement. Sometimes the agency does take strong action:

    http://www.nutraingredients-usa.com/Regulation/FDA-seizes-N.Y.-company-s-products-over-disease-claims

  17. Alia says:

    The only supplements I take from time to time are iron (if my blood test results show that my hemoglobin level is too low) and potassium with magnesium for UTI-related calf cramps. But I do not take them all the time, only on as-needed basis. And over here these are not supplements, they are regulated as pharmaceutical products.

  18. Scott says:

    @ Jeff:

    A reasonable point. However, given how limited the FDA’s resources are, and how ubiquitous explicit health claims by supplement companies are, the most generous possible description of the current situation would still be “effectively unregulated.”

    And THAT assumes the distinction between “health claims” and “structure-function claims” is meaningful. It is not. The only reason to make such a distinction is to allow supplement sellers to advertise with while *wink-wink-nudge-nudge* not technically making drug claims.

  19. Quill says:

    Very interesting post and lots of good data.

    One thing: “Amazingly, only 25% of users said they would stop using a supplement if it was evaluated to be ineffective.”

    This sounds sensational in some way, but how did they word the question(s)? I don’t have access to that study so I can’ t evaluate how accurate that statistic might be.

    1. Scott Gavura says:

      @Quill – the full survey results are supposed to be on the Harvard School of Public Health website, but I received a 404 when I followed the link given.

  20. Ken Hamer says:

    I ingest lots of vitamins every day.

    I get them from my food.

  21. pmoran says:

    One thing: “Amazingly, only 25% of users said they would stop using a supplement if it was evaluated to be ineffective.”

    I believe this. To many users that would merely mean that at that point in time mainstream science was being led to such an opinion concerning some defined benefit or other. Even if that were an entirely honest opinion, uninfluenced by bias, it may change, or other benefits may emerge. As Stanmrak implies, it is difficult to know when the final word is in on many matters, especially for those reliant on lay sources of information and having limited ability to weigh up the evidence personally.

    Mainstream science is also understood to be applying a very strict error-averse approach to the evidence. The public knows that whenever the evidence is less than conclusive it will withhold support, whereas the laity is more inclined to give medical claims the benefit of the doubt whenever there is a chance that they may personally benefit therefrom.

    Finally many users, possibly approaching 50%, will believe that the supplements have already helped them. They may not risk stopping them, even if that belief is somewhat shaken.

    A very different, but very human, medical sub-culture is at work here.

  22. rwk says:

    @Scott,
    After all this, what’s your scientific rational for “sporadic” use of Vitamin D ?
    What are your protocols and how do you scientifically decide the correct dosage?

    1. Scott Gavura says:

      @rwk:
      I am in Canada so cannot rely on skin production of vitamin D in the winter. My primary dietary sources of Vitamin D are milk, eggs, and salmon. Having calculated my average consumption, I need about 2000IU extra per week to average 600IU per day (as per IOM). So I take 1000IU twice weekly.

  23. Janet says:

    Here goes:

    I started Vit D two months ago on doc’s orders when blood work showed levels too low. As far as the rest goes, I’m with Ken Hamer above–I get tons of vitamins every day from the food I eat. I restrict calories by most people’s standards, but I make my food count and it’s mostly veggies and fruit with lots of leafy greens. Other than the Vit D, I seem to be fine (I’m “elderly” according to my children, but manage to x-country ski, shovel snow, grow a big garden and am generally fit). Since I live in Wisconsin and use sunscreen religiously in the summer, I was not that surprised to learn my Vit D levels were low. I take 2000 as instructed. Not sure if its mg or IU.

    I’m tempted to start fish oil as the price of salmon (not to mention the viability of the species) continues to escalate and will discuss it with my Registered Dietician.

    It always amuses me when people who don’t approve of drugs to “treat the symptoms” go around swallowing handfuls of pills every day for no better reason than to “feel better”–for which they have no real evidence. Their blood pressure could be sky high and they wouldn’t even have and symptoms at all.

  24. Angora Rabbit says:

    It was a busy day and I’m only now reading this.

    @Scott, great post and thanks for highlighting these new NHANES findings. About 5yr ago there was an IOM panel that released an analysis of supplement use, and not surprisingly the conclusion was “too much, cut back.”

    It is troubling when all supplements get tossed in the same basket. Table 3 is the really useful part of the papers. Several of these I have no quibble with; I myself take a multivitamin / mineral 2-3x weekly and calcium daily. But I take the one targeted for my age/gender group, read the label to avoid the ULs, and use it as insurance because my meal sizes aren’t as big as they used to be. I also tell folks to buy the Walgreens version since there all only four companies that make the vitamins – might as well buy the cheaper one!

    About half the items on Table 3 I don’t have a problem with as certain age groups are at risk – calcium, folate, B12, VD come to mind. Surprised not to see zinc there. But others are worrisome: B6, VA, potassium, magnesium, protein, VE, VC – these really aren’t necessary for most of the populace and some pose toxicity risk.

  25. Angora Rabbit says:

    The report from the military services is interesting. Some years ago a dietetics student of mine, who was also an NCO, did a nutrition supplement presentation to his charges as a class project. He was alarmed at the quantity of supplements in their lockers and wanted to give them better information. A lot of the supplements focused on “bulking”, energetics and musculature. Some of the supplements were pretty scary. I hadn’t realized the supplement use was so common there; it was an eye-opener for me. I received the impression that these young service men and women were vulnerable to that marketing hype.

  26. Angora Rabbit says:

    @Helga: if folic acid reduced autism risk, then autism rates should have been plummeting since we started fortification in 1998 (US date, dates slightly different for other locales). Folate levels rose significantly thanks to fortification in the North American population since then. Autism rates should’ve dropped in concert with the well-documented drop in NTDs. They didn’t.

    As a colleague liked to say, that dog won’t bark. :)

  27. lilady says:

    @ tanha: The study you linked to was done in Norway, where there is no fortification of food with folic acid. In fact, according to Wikipedia, no country in the EU fortifies food with folic acid. It is “recommended” that women in Norway take folic acid supplements if they intend to get pregnant.

    http://en.wikipedia.org/wiki/Folic_acid

  28. rmgw says:

    I have to thank you for changing my vocabulary: as a vegan I take B12 in tablet form from the Vegan Society of the UK: I now realise that this is not, as I have always said, “supplementing”, it is simply “ingesting”. From now on I will cease speaking of “supplementation”, which is something I would never indulge in: either you’re getting what you need or you aren’t – “spplementation” implies exceeding the adequate amounts of something, which has got to be a waste of time and money. What are all those fish-oil “supplementers” going to do when the fish runs out?

  29. yodeladyhoo says:

    I wish we could get rid of the word “supplements” and come up with some new categories that are more meaningful.

    If a news article says X% of Americans take “drugs” we can pretty much assume they mean things like heroin or cocaine, and that they’re not talking about aspirin or pepto-bismol. If we talk about people using “pesticides” we don’t mean the guy who puts a cup of stale beer in his garden to drown the slugs. But the word “supplement” can mean a multivitamin or any of a zillion other things.

    And “supplement” talk doesn’t acknowledge the wild variation in selection and dosages that various people take. I take one multivitamin and calcium/vitamin D as advised by my doctor. But I know people who take 40, 80, 100 supplements a day. 20,000 IU vitamin D per day, every day, 20 mg of melatonin every night. Blue Green Algae, black cohosh, astragalus, apricot pits, anything with a label written in Chinese characters. I think a lot of the people promoting that kind of supplement use revel in saying “X% of Americans take supplements!” I find that frustrating. We need to acknowledge and measure exotic choices and extreme use.

    A year or so ago there were some news articles about high lead concentrations found in some supplements. The FDA concluded that although some of the drugs tested were of concern, under normal daily use they probably wouldn’t cause a problem. I couldn’t find any information on how they concluded what “normal” would be.

    The Canadians have a public database of adverse drug reaction incidents. (http://www.hc-sc.gc.ca/dhp-mps/medeff/databasdon/index-eng.php) Here’s an example from their database, concerning an 82-year-old woman whose “adverse reactions” were “Fall, Hypercapnia, Polyneuropathy, Respiratory failure.” She was hospitalized, but they don’t give the outcome. Her Report Number is 000137664.

    They list as Suspect medications which may have caused the adverse reactions: ALFALFA, BIOTIN, BLACK CURRANT SEED OIL, BLACK SEED, BONE MEAL, BREWERS YEAST, BROMELAIN, CALCIUM, CALCIUM-MAGNESIUM CAP 1:1 W VITAMIN D, CAYENNE, CHOLINE & INOSITOL, CHROMIUM PICOLINATE, COEQ10, COUNTRY GREENS, CSA (TWINLAB), DANDELION, FENUGREEK, FOLIC ACID, GARLIC, GINKGO BILOBA, GLUCOSAMINE HYDROCHLORIDE (AOR), GLUCOSAMINE SULFATE, GLUTAMINE, GREEN TEA KOMBUCHA (YOGI TEA), KYOLIC GARLIC, LECITHIN, MSM (QUEST), NATRAGARDE, PAPAYA ENZYMES, PYCNOGENOL, RADISH, RESPIRACTIN, SDS TEA – PEPPERMINT, SILICA CALCIUM BIOTIN, TIME RELEASED C SRT 1000MG, TURMERIC & BROMOLIN, VITAMIN A AND D TAB, VITAMIN B COMPLEX, VITAMIN C, VITAMIN E, ZINC

    That’s a lot of stuff! And this is not an extreme example.

  30. elburto says:

    I think the supplement business is one of the finest ways in which entrepreneurs have managed to monetise the concerns of the “worried well”. Not terribly ethical, but clearly very profitable. We have whole chains of shops that sell nothing but supplements, and chemist shops and pharmacies are devoting ever-increasing square footage to goodies for the gullible.

    I have a mother who, like her late mother, is supplement mad. She’s constantly taking this, recommending that, usually thanks to articles in the women’s magazines she reads.

    To see her throwing good money after bad when she has no cash to spare is irritating, but alties do a good job of scaring people into “ensuring heart health” and “boosting the immune system”.

    No supplements for me. I’m prescribed B12 and B9 for my pernicious anaemia. B12 is prescription only here (the injectable form, the only one proven te work against PA). I’m on prescription B6 (pyridoxine), calcium and vit D because the last blood test I had in hospital showed critically low levels of the last two.

    The effect of saturation marketing of supplements is that people think that “vitamin deficiency” can only refer to someone not getting quite enough vit C in their diet, or having brittle hair or bad skin. They think that a daily multivitamin is all anyone needs to have adequate levels, and that health problems related to severe deficiencies of certain vitamins are the fault of the afflicted person for not using multivits or “eating properly”. I’ve even had practice nurses tell me “You’d get adequate B12 if you ate properly”, and had pharmacy assistants enquire if I’m trying to conceive because of my folic acid prescription.

    So many people simply cannot grasp the difference between medically necessary provision of certain vitamins and minerals, and going into Holland and Barrett to buy a bag full of ingredients to make expensive urine.

    To the commenter upthread with erectile issues – do you know for sure that you have low testosterone, or are you guessing? ED can be a sign of diabetes, hypertension, and psychological issues. It can be a mechanical issue (physically unable to become erect) or purely mental.

    Taking an unknown quantity like pregnenolone is risky to begin with, let alone if you don’t know why you’re having problems. Also, trying to boost testosterone “naturally” is pretty pointless. Not only that, but even if you could raise your levels, any excess testosterone aromatises to oestrogen , which would compound your problems.

  31. BillyJoe says:

    My family must be exceptional :)

    Okay, I mean an exception. As far as I know, none of the six members of my family have ever taken a supplement. And neither have we been tested for deficiencies. It’s not something that even enters our mindset. But we live in a sunny clime and eat a wide variety of foods. If that’s not enough insurance, we don’t really care. Well, actually we haven’t even considered whether we care or not. The choice between food and a handful of pills is not an especially hard choice to make.

  32. mousethatroared says:

    “Well, actually we haven’t even considered whether we care or not. The choice between food and a handful of pills is not an especially hard choice to make.”

    Glad that is the case for you all. When I think of omega 3, the choice between fish, (around $9 a pound or higher and coming with government warnings that one must limit types of fish* and numbers of servings per week due to mercury content) and the supplements becomes a more difficult choice.

    Regardless, I’m sure your family is exceptional!

    *Also considering recent information that a good portion of fish in some parts of the country are deceptively labeled.

  33. Jann Bellamy says:

    From the New York Times:

    BUSINESS DAY | February 03, 2012
    Army Studies Workout Supplements After Deaths
    By PETER LATTMAN and NATASHA SINGER
    The military has removed dietary supplements containing the ingredient dimethylamylamine from stores on its bases, though the products are widely available elsewhere in the country.

    http://www.nytimes.com/2012/02/03/business/army-studies-workout-supplements-after-2-deaths.html?emc=eta1&_r=0

    The ingredient suspected of causing these deaths and other health problems is “known as dimethylamylamine or DMAA, advertised to increase energy, concentration and metabolism. The products are best sellers among fitness buffs at stores like GNC and the Vitamin Shoppe, as well as on Web sites like bodybuilding.com.” The manufacturer defended DMAA as “a naturally occurring compound found in an Asian geranium and has been used as food for more than a century.” Critics say DMAA is a stimulant similar to amphetamine and it should be regulated as a drug. DMAA is banned by several sports organizations and is regulated as a drug in Canada, but is considered a dietary supplement under U.S. law.

  34. Janet says:

    @BillyJoe

    None of my family (four children, six grandchildren) take supplements either. My first one is this Vit D ordered by doctor after routine blood tests.

    I wonder if Scott could comment about the idea of a daily multi as “insurance”? It seems to be a popular notion, but my interest piqued when Elburto referred to people’s misconceptions about supplementation. Does skipping veggies x-times per week actually result in deficiencies? Does daily supplementing make a difference?

  35. elburto says:

    Jann – We’ve had a couple of deaths here in the UK due to the same supplement. The popular conception that “natural” = safe contributes to misadventure like this.

    One young woman suffered a fatal reaction the first time she tried it. Apparently the powder she bought from Amazon is still for sale, but the formulation has changed and the geranium extract has been removed.

  36. DoctorLaw says:

    Michael Pollan’s Food Rule #40: Be the kind of person who takes supplements – then skip the supplements.

  37. William B'Livion says:

    I will take Branched Chain Amino Acid supplements when I’m doing a lot of weightlifting (which hasn’t been for many months now), and I’ll go for periods of time (usually, again, when I’m weightlifiting or doing some other sort of muscle building exercise routines) when I “supplement” with whey protein as a drink.

    I’ve tried other stuff in the past and none of it seemed to make a noticeable difference.

    My wife takes either B-6 or B-12 (I can’t remember. Hmmm, maybe I should take it too) on the advice of a GP based on a blood test that showed low levels. She was complaining of memory and attention problems (Well, I was complain about them. She denied it until I presented her with proof that she either wasn’t paying attention to me, or was forgetting).

    Right now I’m not taking anything other than long walks.

  38. Robb says:

    I take an omega 3 supplement (I’m not keen on cooking fish but do sometimes buy canned sockeye salmon) and take vitamin D in winter. I also take a Greens type drink fairly regularly – despite eating salads about every second day and trying to eat as healthy a diet as I reasonably can, I still don’t feel like I get enough servings of vegetables each day.

  39. BillyJoe says:

    Michelle,

    Fish obtained in Australia is considered pretty safe if not eaten to excess (perhaps twice a week). Some fish contain more murcury than other fish and should probably be avoided more than once per week.
    My general rule about all preventive health strategies is that there must be clear evidence of benefit. I don’t see that with supplements in our particular circumstances. There are groups for whom there is evidence of benefit. Pregnant women and those planning pregnancy might consider fe and folate supplements if found to be deficient. Recent immigrants from Sudan (who are as black as the ace of spades) are apparently all deficient in vit D and might consider supplements (that might not apply to those settling in Queensland to our north).

  40. BillyJoe says:

    Janet,

    Four children as well, hey. Alas, no grandchildren here yet. They’re all still living at home in their early twenties, except for our VCE student who is only 16.
    As for “insurance”, I don’t believe in it. Do you believe in god as an insurance policy? :)
    Give me clear evidence of benefit before I will even consider it. Even then, it’s going to take lots of benefit to pursuade me to swallow pills every day instead of food, exercise and sunlight.

  41. tanha says:

    lilady: nice Wikipedia link but I don’t know what your point is. This study would suggest that in a country without folic acid fortification, taking a prenatal vitamin has a positive correlation to reduced autism rate (and therefore an additional benefit beyond just reducing NTDs). It’s an argument for taking a supplement (especially when the vitamin isn’t found at high enough levels in food).

  42. mousethatroared says:

    BillyJoe “Pregnant women and those planning pregnancy might consider fe and folate supplements if found to be deficient.”

    I’ve never heard of testing for folate deficiency. I believe the evidence that a folic acid supplement or fortification (rather than just a standard diet rich in leafy green) prevents a notable percentage of neural tube defects and cleft lip and palate is pretty strong. But many of the articles on this blog seems to prefer to skim by that evidence and focus on the wilder, less beneficial side of supplementation.

    I guess if you don’t have to live with the disability of spinal bifida or the childhood surgeries, therapies and special education requirements of a cleft lip and palate it’s hardly important.

    Because of my connection to international adoption, maybe I see the effects of both more often, so I kinda cringe whenever I see those benefits brushed aside.

    A personal pet peeve, I guess. I should just skip to articles about supplements.

  43. mousethatroared says:

    also BillyJoe “Fish obtained in Australia is considered pretty safe if not eaten to excess (perhaps twice a week). Some fish contain more murcury than other fish and should probably be avoided more than once per week.”

    Yes, there’s a list of fish in the U.S. that are lowest in mercury and those that should be avoided or eaten less often. But you know me, I’m not great at memorizing lists. Basically all I can remember is Wild Alaskan Salmon is okay. Sometimes I remember which canned tuna is okay. For a while I had a list, but sometimes I don’t have the right purse, etc. The dietary recommendation is 2 to 3 serving of fish for Omega 3.

    My interest in Omega 3 is based on research done on Lupus patients which I’ve read, showed a reduction in inflammation markers and reports joint/muscle pain after 6 months of Omega 3 supplements (blinded , compared to placebo).
    http://www.ncbi.nlm.nih.gov/pubmed/17875549

    Even though I do not have Lupus, I have some similar symptoms and test results so, to me the evidence suggests it may be worth a shot. If it helped, and I end up taking 1 or 2 Omega 3 capsules a day instead of sporadic weeks of 4-6 tylenol/aleve daily that would be pretty cool in my book. If it didn’t help, oh well, I would probably go back to weekly fish.

    So, I guess I’m more like pmoran’s portrayal of patients than the young military guys looking to bulk up.

    I would also rather bask in the sun than take vitamin D. Actually, if there were a sun available to bask in right now, I’d do it, regardless of what any doctor told me. :)

  44. mousethatroared says:

    I said “I should just skip to articles about supplements”

    I should just skip THE articles about supplement…some typos are worse than others.

  45. Helga435 says:

    I don’t understand the logic behind NOT taking a daily multi vitamin for women in their childbearing years. Or at the very least a folic acid supplement. Yes, you could get tested for a folate deficiency when you found out you were pregnant but the need for folic acid to prevent NTD is early in pregnancy and in an unplanned pregnancy, you could easily miss the window. I HOPE that my diet is good enough to provide all of the nutrients my body needs but why risk a birth defect when a multi vitamin costs around 8 dollars a month and you can be sure?

    What is the HARM in taking a daily multi vitamin?

  46. lilady says:

    @ tanha:

    “lilady: nice Wikipedia link but I don’t know what your point is. This study would suggest that in a country without folic acid fortification, taking a prenatal vitamin has a positive correlation to reduced autism rate (and therefore an additional benefit beyond just reducing NTDs). It’s an argument for taking a supplement (especially when the vitamin isn’t found at high enough levels in food).”

    I linked to that Wikipedia article, because of your reply to Angora Rabbit when AG made a statement about folic acid fortification in the United States, “…..if folic acid reduced autism risk, then autism rates should have been plummeting since we started fortification in 1998 (US date, dates slightly different for other locales). Folate levels rose significantly thanks to fortification in the North American population since then. Autism rates should’ve dropped in concert with the well-documented drop in NTDs. They didn’t.”

    The Norwegian study, where there is no folic acid fortification of food, that you linked to, is interesting. It is based on women who did…or who didn’t…take folic acid supplements before and during pregnancy. It is not the first study comparing pregnancy outcomes/risk of having a child diagnosed with an ASD for women who took folic acid supplements. The CHARGE group at UC-Davis studied American women who had the benefit of folic acid fortification and who also took folic acid supplements.

    http://www.ncbi.nlm.nih.gov/pubmed/22648721

    According to the NIH-ODS the recommendations from the College of Obstetricians and Gynecologists is for women who contemplate pregnancy to take folic acid supplements.

    http://ods.od.nih.gov/factsheets/Folate-HealthProfessional/

    Note on the ODS fact sheet that people diagnosed with megaloblastic anemia (commonly due to certain prescribed anticonvulsant) are prescribed folic acid supplements. My son who was prescribed Dilantin was prescribed folic acid for treatment of megaloblastic anemia.

    (Here’s hoping that I don’t get stuck in the moderation hopper for two many links…continued below)

  47. emr_rmt says:

    I found this article, and the blog, from a link posted by a professional association’s Facebook page. And I swore to myself that I a) wouldn’t read the comment section, and b) wouldn’t reply. But here I am. Very interesting topic, and interesting to hear such stalwart and steadfast view points that those who do use supplements are just blind sheep – or maybe lemmings is a better analogy.

    While it is true that there is no cure for death, what I think so many people who use supplements are trying to achieve is a better quality of life on the path to death. And as Helga435 stated above me, to hope that your diet is good enough to provide all the nutrients you need but negating the risk costs a small amount of money, why wouldn’t you?

    And as for the case you mentioned, yodeladyhoo, I would hazard a guess that the 82yo female’s polyneuropathy was not caused by any of those supplements, but perhaps by the diabetes mellitus she suffers/ed from – a good part of that list of supplements are used by those trying to combat soaring blood sugar levels. She also must have a history of pulmonary issues, and perhaps they are associated with heart disease. Heart disease which could have been the cause of her hypercapnia and respiratory failure. I am just taking a wild stab in the dark, admittedly, but her list of chosen supplements, while long and varied, would lead me to make these assumptions. The other problem I have with the database in general, is that doseages are often not given. Too little information is provided, in general, to lay the blame solely on a supplement. And then there’s the completely ridiculous: http://webprod3.hc-sc.gc.ca/arquery-rechercheei/report-rapport.do?lang=eng&id=000133699

    I also agree strongly with elburto’s comment, “So many people simply cannot grasp the difference between medically necessary provision of certain vitamins and minerals, and going into Holland and Barrett to buy a bag full of ingredients to make expensive urine.”

    Another topic is supplementation to achieve certain results, in the case of body builders or figure/athletic models. But the general discussion here is on supplement use by the average person, “to improve or maintain health.”

    I watched my mother take her prescribed concoctions every day without fail, and at least three medications she took each day were to combat the side effects of another drug she was also taking. I have no interest in living the rest of my life that way. I also know from my own very biased experiences with supplementation that a combination of Omega-3s and 5-HTP is all I need to keep depression at bay (and do a better job, without any negative side effects, than any medication I tried), and a good quality, broad-spectrum vitamin B keeps my stress levels in check. Probiotics and kefir keep my GI tract moving along nicely, and magnesium makes me sleep like a baby and wake up instantly, while feeling completely well rested. Using myself as a guinea pig and taking a supposed collagen-boosting supplement did, in fact, make my hair and nails grow like crazy, although I’m not sure it did anything for arthritis.

    At the end of the day, I am one of the educated, middle-class, insurance plan-having people who also takes supplements. I used to take them willy-nilly, but after my doctor, Registered Dietician, and one of the top cardiologists in our country failed me, I decided to do something about my situation: I got educated on food and supplements. Perhaps that is the difference that the author should address; that so many people, as elburto pointed out, think that watching Dr Oz then going down to the nearest pharmacy is going to cure their ails. We all own these amazing machines, yet so few of us know how to take care of them, or what to do when something goes awry.

  48. lilady says:

    @ tanha: About the (non) plummeting rates of autism…an interesting article:

    http://www.newscientist.com/article/dn19316-autism-explosion-half-explained-half-still-a-mystery.html?DCMP=OTC-rss&nsref=health

    We in the autism community can point to earlier and more sensitive diagnostic testing for children with mild ASDs, diagnostic substitution at both ends of the autism spectrum (mental retardation with autistic-like behaviors now labeled as ASD and ADD/ADHD now labeled as ASD).

    There also is a broadening of the autism diagnostic criteria in the DSM IV and by school districts, and far less of the stigma formerly associated with labeling a child as autistic.

    Parents who delay pregnancies until they are older has had an impact on ASD prevalence, in addition to every other developmental disability, as does the increase in high order births resulting in premature births and small for gestational age babies.

    IMO, there is a confluence of factors that are bound to skew the results of studies to determine if folic acid supplements have decreased the risk of having a child with an ASD, but on the definite knowledge that folic acid fortification has decreased NTDs rather dramatically, I’d like to see additional studies conducted here in the United States to determine optimum folic acid intake and its impact on ASDs.

  49. BillyJoe says:

    Helga,

    “What is the HARM in taking a daily multi vitamin?”

    I don’t see it as “what’s the harm”. I see it as “what’s the point”. What’s the point in taking something that hasn’t been clearly shown to be of benefit. Otherwise where do you stop? You could end up taking thirty supplements every day. I’m not into pascals wagers.

    There is evidence for folate supplements for women planning to get pregnant, but I think you might find it hard to convince women to take it just in case of an unplanned pregnancy. I could be wrong though.

  50. mousethatroared says:

    BillyJoe – Do you know the percentage of pregnancies that are unintended?

  51. mousethatroared says:

    @BillyJoe, This is somewhat how insurance works. You pay a small amount to prevent a big problem, knowing that you MAY never benefit from that investment. With folate, the people who have benefited, never know that they did, but the evidence is there. It is not some “belief”.

    Of course what people will choose is what they will choose. Some people will deny the need for insurance based on a belief that it’ll never happen to me, or that all insurance policies are just scams. Others might end up making poor decision on which insurance to buy, based on marketing, scams or lack of knowledge.

    What does a consumer need to make good decisions based on their individual needs? Solid evidence and science based information without a bias for or against “insurance policies” is a good place to start IMO.

  52. stanmrak says:

    @WilliamLawrenceUtridge:

    “Giving antibiotics for a bacterial infection treats the cause, not the symptoms.”

    Antiobiotics get your body back to the state of health it was in before becoming infected, at best, but do nothing to improve someone’s health to where they can resist more diseases in the future. Just they opposite, they leave the patient more vulnerable to future illness of all types. Antibiotics destroy essential healthy gut bacteria that are the core of your body’s defense mechanism. Research is indicating that just one round of antibiotics may damage your health permanently if not followed up with probiotic therapy. The list of diseases that are being attributed to poor gut health is almost limitless.

    http://www.greenmedinfo.com/blog/reflection-antibiotics

    “Antibiotics contribute to the killing of many commensal organisms that are important for proper bodily homeostasis, immunity, digestion, metabolism and organ health.  Our bodies are dependent on a rich mixture of micro-organisms both inside and outside. The conventional approach to an imbalance of micro-organisms is to kill the “invader.”  Sometimes this will appear to give temporary success, but most often the trouble will recur if there is no intervention into the whole system.
    Antibiotics can permanently kill off beneficial gut flora, which amongst other things, leads to far worse bacterial infections than the one being “treated” in the first place.  Antibiotics are infamous for creating superbacteria which then turn and potentially bite everyone, including those who don’t use antibiotics.”

    “the rhetoric that “natural” cures treat the cause rather than the symptoms is just rhetoric – it makes you feel good, but it doesn’t actually help anyone.”

    Nowhere do I suggest or recommend using natural cures over drugs to treat symptoms.

    “Merely because there is no course called “nutrition” doesn’t mean doctors don’t understand anything about vitamin C. Further, doctors base their recommendations on the science analyzed by expert bodies like the FDA, CDC, USDA and UN which are staffed by genuine and highly educated academics and researchers.”

    “Expert bodies” that are under the control of the food and pharmaceutical industry and will say and do whatever they’re told. Their job (based on observation of the actions they take, not what they say) is to protect the profits of the industries that pay their bills – not to look out for us.

    Schools of nutrition are also funded by big food corporations who are interested in promoting their own agenda more than they’re interested in more advanced nutritional education. The dean of the school of nutrition at Tufts University recently came out and recommended Froot Loops as a “healthy breakfast” alternative, maybe because Kellogg’s made a nice contribution to her school or she sits on the Board of Directors. Wake up.

    I can’t believe you’re defending doctors’ knowledge of nutrition – and then citing an article by Stephen Barrett as proof of this!

  53. tanha says:

    lilady: thank you for your comments, links and insight. I am interested in seeing more US studies as well.

  54. lilady says:

    @ tanha: I ALWAYS refer to the NIH-ODS because IMO, it gives me a good starting point when I need information about nutrition, “supplements” or “herbals”. The Academy of Dietetics and Nutrition, formerly the American Academy of Dietetics has some great information, as well:

    http://www.eatright.org/Default.aspx

    (I’ll hate myself for replying…but here it comes, anyway): You do know the difference between a self-styled “nutritionist” and a “Registered Dietician”, don’t you? A similar analogy is the comparison of a toothiologist to a dentist…

    http://www.youtube.com/watch?v=uRqB5-egs1s

  55. lilady says:

    @ stanmrak: The YouTube video I linked to, was meant for you. Your link to an article which quoted Dr. Suzanne Humphries, automatically disqualifies you as an expert in human bacterial disease processes and antibiotics.

    “Antibiotics can permanently kill off beneficial gut flora, which amongst other things, leads to far worse bacterial infections than the one being “treated” in the first place. Antibiotics are infamous for creating superbacteria which then turn and potentially bite everyone, including those who don’t use antibiotics. For this reason, Dr Humphries will not prescribe antibiotics and would not recommend them except under dire, truly life-threatening circumstances. Instead, creating a healthy background where infection cannot take hold is the aim. Disease cannot live in healthy terrain. This is a truth that has been demonstrated time and again in plant and animal life. Most doctors are unaware of this problem because it is denied in the conventional medical system. Instead, drugs are prescribed to try to rectify the problems that later occur after a seemingly successful course of antibiotics are completed.”

    Dr. Humphries does not “believe” in vaccines. She states that “vaccines are disease matter” and prescribes Vitamin C in lieu of the early childhood DTaP vaccine series.

    http://scienceblogs.com/insolence/2011/12/19/quoth-dr-suzanne-humphries-vaccines-are/

  56. Narad says:

    Antibiotics can permanently kill off beneficial gut flora, which amongst other things, leads to far worse bacterial infections than the one being “treated” in the first place.

    I suggest you test this out with a cat bite.

  57. pmoran says:

    “What is the HARM in taking a daily multi vitamin?”

    I don’t see it as “what’s the harm”. I see it as “what’s the point”. What’s the point in taking something that hasn’t been clearly shown to be of benefit.

    Perhaps there is no point other than that this is what our basic programming requires of us. It is unnatural for us not to do try to “do something” about any illness or disability, and we also derive pleasure from doing things that we think are good for us — mainly, so long as it does not require sustained effort, as does exercise or dietary discipline.

    There are two reasons for constant tension between these natural instincts and what might look to be more rational, to add to a seeming inconstancy of scientific opinion on some matters.

    1. post hoc ergo propter hoc and placebo responses. These strongly “validate” personal medical choices.

    2. the fact that personal medical decision-making occurs at the level of “this may be worth a try” whereas the mandate of science (as manifested by EBM/SBM) is reflected by your own comment that it is pointless to take something not “clearly shown to be of benefit”.

    Of course, the mainstream HAS to apply much stricter standards of evidence. It has wider responsibilities.

    Probably the main harm from supplements is that they serve to distract from measures that are more certain to help: don’t smoke, drink less, exercise more, and eat better — supplements are even sometimes advertised as making up for the deleterious effects of poor lifestyles.

  58. WilliamLawrenceUtridge says:

    Antiobiotics get your body back to the state of health it was in before becoming infected, at best, but do nothing to improve someone’s health to where they can resist more diseases in the future. Just they opposite, they leave the patient more vulnerable to future illness of all types. Antibiotics destroy essential healthy gut bacteria that are the core of your body’s defense mechanism.You’re right, we should let people die of bacterial infection. If they weren’t healthy enough to fight off the disease in the first place, they deserve to die. Just like the Native Americans. Smallpox killed off 95% of them, presumably because of their diet of processed foods and lack of exercise, not to mention that lack of gut microbes.

    Research is indicating that just one round of antibiotics may damage your health permanently if not followed up with probiotic therapy. The list of diseases that are being attributed to poor gut health is almost limitless.

    Citation needed. I mean a real citation by the way, not one that cites Med Hypotheses apparently seriously, or sells a document for $30 about how great probiotics are, or is based on the assumption that natural products are good and drugs are bad and is hosted by someone who thinks food can treat cancer.

    Nowhere do I suggest or recommend using natural cures over drugs to treat symptoms.

    No, of course you don’t. Never. I’ll certainly grant you prefer negative arguments over positive, but when the CAM approach is intellectually bankrupt, it’s not surprising.

    “Expert bodies” that are under the control of the food and pharmaceutical industry and will say and do whatever they’re told.

    Yes, every single doctor and researcher is controlled by Big Pharma. Not a single one can be trusted – just the guys who run the websites making $30 per article you download. Mainstream medicine has identified and acknowledged the problems of the influence of Big Pharma on doctors and research. CAM is parasitic on this, employing it as a logical fallacy to draw attention from the fact that they offer nothing real medicine can not do better.

    Their job (based on observation of the actions they take, not what they say) is to protect the profits of the industries that pay their bills – not to look out for us.

    The job of most scientists is to conduct research to solve real-world problems. The job of companies (whom often employ said researchers) is to make products that people want to buy. The job of probiotic companies is to make probiotics that people want to buy, and these companies are just as incentivized to distort and exaggerate research as any other company is. You appear to have a rather skewed ideas of what companies do, and a double-standard depending on whether your preconceptions excuse the product in question.

    Schools of nutrition are also funded by big food corporations who are interested in promoting their own agenda more than they’re interested in more advanced nutritional education. The dean of the school of nutrition at Tufts University recently came out and recommended Froot Loops as a “healthy breakfast” alternative, maybe because Kellogg’s made a nice contribution to her school or she sits on the Board of Directors. Wake up.

    The mainstream nutritional advice is:
    - fresh fruits and vegetables
    - some lean meat
    - whole grains
    - reduced sugar

    Citation needed on the Dean of nutrition at Tufts making that claim, ’cause it looks like you’re just makin’ shit up. And I doubt he said “everybody should eat Froot Loops, all day, every day”. I’m guessing it’s more like “the whole grains found in Froot Loops make it a better choice than the previous, highly-refined, simple sugars previously used to make them, as part of a complete breakfast”. Or, “food should be as healthy as possible and people should want to eat it”. Eating a bowl of Froot Loops does not doom one to lifelong ill health (I’m rather proof of that, thanks) nor does having a bowl of Froot Loops for breakfast every day, and no doctor ever recommends a 100% Froot Loop diet – no matter how much you wish that were the case.

    I can’t believe you’re defending doctors’ knowledge of nutrition – and then citing an article by Stephen Barrett as proof of this!

    I can totally believe you’re using shoddy references and unsourced claims to avoid changing your mind.

    Logic and science works by hypothesis, test, theory, retest, conclusion. You’re putting the conclusion first, and you’re not doing science. We had good nutrition in the past, and died in droves. We still have pretty good nutrition (too many macronutrients in large part) and still live considerably longer than our ancestors. Nutrition is important, science recognizes this, but it’s not the entirety of health. Nor is medicine bad because it is made by for-profit companies.

  59. WilliamLawrenceUtridge says:

    Oops, my real point was that the mainstream nutritional advice is:
    - fresh fruits and vegetables
    - some lean meat
    - whole grains
    - reduced simple sugars
    - reduced fat
    - plant fats are better than animal fats

    Plus exercise, no smoking, moderate alcohol. I’m guessing the Dean of the school of nutrition of Tufts University didn’t recommend eating nothing but Froot Loops, and even if he did, he is a single scholar, not the consensus of the medical community. Certainly, if the Dean of the school of nutrition recommended an all-Froot Loops, all the time diet, the rest of the medical community does not agree with him.

  60. lilady says:

    @ WLU: The Dean of Tufts School of Nutrition & Policy actually did make statement about Froot Loops and it wasn’t “recently” (2009)…which was picked up by all the crank “nutritionists” on the internet. That statement was roundly condemned:

    http://www.nytimes.com/2009/09/05/business/05smart.html?pagewanted=all&_r=0

  61. mousethatroared says:

    lilady that link is precious ““You’re rushing around, you’re trying to think about healthy eating for your kids and you have a choice between a doughnut and a cereal,” Dr. Kennedy said, evoking a hypothetical parent in the supermarket. “So Froot Loops is a better choice.”

    I just wonder if donuts get a smart choices label because they are a better breakfast choice for a child than gin.

    Such a help to busy parents rushing around the grocery store.

    Here’s what would actually be helpful. Put the healthy stuff together by the fruits and vegetables. Don’t make me tow the kids past the front loops and the crazy cookie breakfast cereal to get to the mini wheats, whole grain Cheerios and oatmeal.

  62. BillyJoe says:

    Michelle,

    “BillyJoe – Do you know the percentage of pregnancies that are unintended?”

    No idea. Why?
    In context, I suppose you mean uninterested pregnancies that are not terminated and that, therefore, could be affected by folate deficiency. But I’ve already aid that there is evidence to support folate supplementation in women intending to get pregnant. I didn’t say that it shouldn’t be extended to women of child bearing age. All I said is that it might prove difficult to persuade women of childbearing age to take folate supplements until they hav decided to become pregnant.

    “@BillyJoe, This is somewhat how insurance works. You pay a small amount to prevent a big problem, knowing that you MAY never benefit from that investment. With folate, the people who have benefited, never know that they did, but the evidence is there. It is not some “belief”.”

    I think we’re mixing up folate and multivitamins here. I agree with the folate, but not with the multivitamins mentioned by Helga. There is no evidence of benefit with multivitamins.

  63. BillyJoe says:

    …oops, iPad strikes again! That should be “unintended pregnancies” not “uninterested pregnancies” (close though)

  64. BillyJoe says:

    pmoran,

    “It is unnatural for us not to do try to “do something” about any illness or disability, and we also derive pleasure from doing things that we think are good for us — mainly, so long as it does not require sustained effort, as does exercise or dietary discipline.

    There are two reasons for constant tension between these natural instincts and what might look to be more rational, to add to a seeming inconstancy of scientific opinion on some matters.

    1. post hoc ergo propter hoc and placebo responses. These strongly “validate” personal medical choices.

    2. the fact that personal medical decision-making occurs at the level of “this may be worth a try” whereas the mandate of science (as manifested by EBM/SBM) is reflected by your own comment that it is pointless to take something not “clearly shown to be of benefit”.

    Of course, the mainstream HAS to apply much stricter standards of evidence. It has wider responsibilities.
    Probably the main harm from supplements is that they serve to distract from measures that are more certain to help: don’t smoke, drink less, exercise more, and eat better — supplements are even sometimes advertised as making up for the deleterious effects of poor lifestyles.”

    Could not have said it better myself.
    And, yes, the word “clearly” needs to be emphasised.
    But I wonder what Helga – who raised the question – thinks.

  65. Helga435 says:

    I never said that I thought a mulitvitamin should be used in place of a poor lifestyle. I take a multivitamin because it contains folic acid, which to my knowledge has been CLEARLY shown to be of benefit for pregnant women. I also mentioned that taking a single supplement of folic acid would also be acceptable. As I said initially, my first pregnancy was unintended and while I don’t know any statistics on how many pregnancies are unintended, I know I’m not the only one.

    I think there is a real difference between someone who is taking 30 supplement pills a day or in place of medication or a vaccine than someone who takes a multivitamin so that their potentially unplanned spawn don’t end up with a NTD.

  66. Alia says:

    On the other hand – I’m very actively avoiding conception and I’ve been doing this successfully for the last 15 years. I’m not taking any folate supplement – I’ll start taking it the moment I even begin to vaguely wonder about having a child.

  67. mousethatroared says:

    BillyJoe, guess I’m not being clear. I don’t think people should be persuading women to take folic acid (through fortified foods, multivitamin or alone) or not take folic acid. I think they should be given the correct information, recommendations and resources so that they can decide for themselves based on their lifestyle, risk profile, etc. The percentage of pregnancies that are unintended is part of that information. In the U.S. about half of pregnacies are unintended*.

    This is relevant since the benefit of folate appears to have an impact at conception.

    *http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3338192/

  68. mousethatroared says:

    One can either buy a folic acid supplement alone or within a multivitamin. As far as I know, the price is about the same. You still take one pill a day. Why pay the same for folic acid alone when one could have the additional calcium, B, C, D etc included?

    If you have the opportunity to get more for your money and inconvenience, it seems like a good thing. Does someone have evidence that it’s not?

    Really, it all relates to the first line of this article. “If you’re a regular reader of this blog, I’ll bet you’re not a regular consumer of vitamins or supplements.”

    Why is there an assumption that regular readers of this blog have no evidence based needs for a vitamin or supplement, when we know there are a few very good reasons for people to take particular vitamins? Is it that SBM readers wouldn’t take one, even if they have a need? Or maybe it’s that fertile chicks don’t read SBM*? Or maybe it’s that SG did a precise projection of the numbers and reckoned that even with the normal number of deficiencies, applicable women, etc, he would still be ahead on his bet…that seems a bit strange, but it could be true.

    Like Helga435 – I would just feel much happier with an approach that distinguishes more between reasonable supplementation and problematic supplementation.

    Similar to how one would make the same distinction with medication use.

    *I’m joking, I’m joking, I know that’s not it.

  69. santiago says:

    I see the there are two assumptions that should be evidence based:

    1) the micronutrient is required in some minimal amount by body metabolism, inadequacy of the micronutrient causes problems.

    2) the form of micronutrient in the supplement is bioavailable.

    When we speak about vitamins and minerals, i guess that there is enough evidence for the first point. I am not sure about the second point. But otherwise, i do not see that different kind of evidence is needed. It seems to me that it is a naturalistic fallacy to assume without evidence that natural sources of these micronutrients are somewhat better than supplements. If there is no strong evidence for each side, then choosing a mix of sources of micronutrients (e.g. more sunlight or supplements for vit D) is more a lifestyle choice.

  70. mousethatroared said:
    Or maybe it’s that fertile chicks don’t read SBM*
    *I’m joking, I’m joking, I know that’s not it.”

    This is practically begging for a There are no girls on the internet reference. And apparently I’m just the girl to make it!

  71. mousethatroared says:

    Perky Skeptic – HeHe – even when I started working ecommerce in 95, we knew there were girls out there.

  72. BillyJoe says:

    Michelle,

    I will have to admit to ignorance. I did not know that there are multivitamin tabs that contain adequate amounts of folate at the same price as folate on its own. It also surprised me that the price would be the same.

    Helga,

    I was merely asking your opinion, not implying what your views are. It seems you and Michelle and me pretty much agree. I would stil lean towards folate on its own rather than as part of a multivitamin even if the price is the same, just on principle. There is too much hawking of multivitamins for everyone without clear evidence of benefit.

    Santiago,

    I think you are stretching the meaning of the naturalistic fallacy.

  73. mousethatroared says:

    Santiago – I’m no expert, but I believe there is evidence that many vitamins are metabolized better in food (or sunlight) than as supplements. So generally, this is not a naturalist fallacy, when the advise is based on evidence. Of course there are exceptions depending upon individual health conditions and I suppose, individual nutrients.

    I have read advice where the preference for food based nutrients over supplements seems to get very extreme, though, which, perhaps veers into naturalist fallacy territory.

  74. BrewandFerment says:

    How about because sometimes it’s baffling (and a lot of work) to figure out if one is consuming the necessary nutrients. Here’s an example that made me say “how can I possibly accomplish THAT”–the RDA for Potassium.

    The FDA, at http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm181577.htm (as part of a discussion on dietary sodium) states that the recommended intake of potassium for adolescents and adults is 4700 mg/day.

    A typical list of dietary sources such as this one at UMass Med http://www.umassmed.edu/uploadedFiles/SourcesDietaryPotassium.pdf produces a nicely illustrated grouping by type. If I take the most potassium rich items off the vegetable and fruit list, because of course those are less calorie dense than meat and nuts, I get:
    –Baked Potato, 1 large, with skin: 845 mg potassium, 160 calories
    –Cantaloupe, 1/2 medium melon: 680 mg potassium, 60 calories

    So in order to get 4700 mg/day of potassium that’s about 5 large potatoes with a medium one on top to bring it up to the needed total. Only about 900 calories down. Or 3 and a half cantaloupes.

    Of course I wouldn’t restrict my diet to potatoes only for the course of a day, nor melons either. (At the current price of about $2.50/melon imported from somewhere not my hemisphere, that’d be almost $15/day just for self and husband!) Yes, some more of the potassium would come from other items I’d normally eat–but the potassium levels in other foods are less. Like yogurt–one cup, low fat, plain, contains 530 mg, 150 cal. It would mean about 9 cups of yogurt to get the RDA.

    In other words, if I’d have to eat unmanageable quantities of the most potassium rich foods to accomplish the goal, how do I get there with “normal” quantities of lesser potassium content food??

    Or am I totally missing something between RDA and food content?

  75. Chris says:

    BrewandFerment, the title on the first link is “Lowering Salt in Your Diet.” This is important for certain people who have high blood pressure like my step-mother. She had a genetic form of high blood pressure that was controlled by the earliest form of blood pressure, a diuretic. Until that became available members of her family usually had a long painful death in their forties. It happened to her father, and one of brothers. After the introduction of the diuretic blood pressure meds she and her siblings lived into their 80s and 90s.

    When she entered out family when I was eleven years salt was cut from the menu. What was substituted was a potassium chloride substitute. This is mentioned in that article, along with the recommendation for lots of veggies.

    Just keep up the veggies, and the more color the better. That list in the second link was short and limited. This Mayo Clinic site says:

    Because lack of potassium is rare, there is no RDA or RNI for this mineral. However, it is thought that 1600 to 2000 mg (40 to 50 milliequivalents [mEq]) per day for adults is adequate.

    Also, it also says a cup of spinach over 800 mg. Personally, I love the stuff, especially inside a stuffed pizza (see The Great Chicago-Style Pizza Cookbook by Pascale Bruno, Jr, except I use more spinach), or just sauteed with a bit of garlic.

  76. Chris says:

    I did a Google on BrewandFerment, and found an article on beer for those with celiac disease. Over twenty years ago I made the cake-pan size spinach stuffed pizza for someone with celiac after the birth of her daughter. I substituted a half rice flour and cornstarch mixture for the flour. It seemed to work. I actually double the amount of spinach, and add a bit more cheese, plus some salami and black olives. I really stuff that stuffed pizza.

    (the daughter was in marching band with my younger son, she turned out to also have celiac disease plus lactose intolerance, she brought her own food on band trips, as did another mom with the same issues)

  77. PJLandis says:

    See page 40, http://health.gov/dietaryguidelines/dga2010/DietaryGuidelines2010.pdf

    It says Potassium is a source of concern in the American diet, so perhaps that’s a bad example. It also notes that 4,700 is a number designed to be good for everyone and many will need less.

  78. Chris says:

    And it is also tied to high blood pressure, so essentially it seems you are to substitute sodium with potassium. I have an edible garden, most of the fertilizer I use is higher in potassium and phosphorous than nitrogen. Eat veggies.

  79. santiago says:

    mousethatroaredon: I believe there is evidence that many vitamins are metabolized better in food (or sunlight) than as supplements.

    Well, (i am no expert either but AFAIK) that depends on specific vitamin (or mineral), its form and on plenty of other factors (like which other substances are consumed with it). In some cases natural sources are more bioavailable, in other cases there is no difference and in some other cases some natural sources have lower bioavailability due to presence of inhibitory factors (like phytates and tannins for non-heme iron or polyphenols for thiamine).

    Therefore such wide generalisations like ‘vitamins are metabolized better in food than as supplements’ probably could not be backed by evidence.

  80. mousethatroared says:

    Santiago – Well, there you go. ;) I’m in no position to argue the evidence, so I’ll just leave it at that.

  81. DugganSC says:

    ^_^ Honestly, I think half of the trouble here could be solved if we established that the “very few of the readers here take supplements” were clarified for the actual message that most of us here know better than to fall for the idea of “megadoses” that’s getting pushed. Honestly, what’s the harm* with taking a multivitamin from time to time to round out the edges of one’s diet? And folic acid / pre-natal vitamins are well documented for their positive effects in avoiding birth deformities. Sometimes, I feel like people on both sides of debates like this get stuck in a position of having to defend (or attack) the smallest margins just to maintain their cred (I’ve long maintained that half of the issue of the abortion debate is that the involvement of the question of humanity of the unborn child forces people into ridiculous extremes of either attacking genuine contraceptives because you have to take life back to the beginning, or defending things like the partial-birth abortion because if you rule a baby human eight months in, you have to consider why it’s not worthy of life four months earlier). I don’t think the majority of people here, including Dr. Scott, feel anyone who ever takes a vitamin or nutritional supplement is an uneducated idiot. The target is the supplement companies who push the megadoses with the idea that more is better, or the supplements that have no proven health benefit.

    * As a caveat, I actually had to switch my multivitamin a few years back to one without iron because I was starting to develop too-high iron levels, although I’ve since realized that was in part because I was behind on my regular blood donation schedule.

  82. CarolM says:

    Oh great, I’m late…I wouldn’t be taking anything except that two opthamologists insisted I take Omega 3 and some AREDS vitamin formula.
    Who’d have expected this from MDs?

  83. Harriet Hall says:

    I’m a bit disturbed by doctors recommending Omega 3 and AREDS II formulas. The AREDS II trial is in progress and the results are expected later this year. The only data we have are from the first AREDS trial, showing that that mixture of supplements delayed the progression of moderate to severe macular degeneration. There was a question that one of the ingredients might be harmful, so the formula was changed and Omega 3 added for the AREDS II trial. It is generally not good practice to recommend a treatment on the basis of a trial that has not been completed.

  84. BrewandFerment says:

    Chris,

    Yep, the cited article was aimed at lowering salt, but the citation of 4700 mg has been popping up in various locations of assorted trustworthiness. I’ve seen the same number in articles of more general interest than sodium reduction, and the FDA article was just the first reputable site that I found when I was writing my comment.

    So all the RDs on this list: what’s the definitive answer?? (is there one?)

    If it’s substantially less than 4700 mg for people without sodium restriction concerns, are there any other criteria for determining appropriate dosage?

    And if indeed it’s 4700 mg, I’m still at a loss as to accomplishing it. I like spinach well enough, but that puts me back in the original territory of eating ginormous quantities of the most potassium rich foods to meet the criteria. Six whole cups of spinach is about a bag full…cheaper than melons, but still…even three cups a day plus other foods is a lot.

    Actually, I don’t usually bother counting up this stuff very often, it was more about the problem of how to make sense of some of the recommendations and how it fit in with the multivitamin question.

  85. mousethatroared says:

    BrewandFerment – I’m with you. If I really tried to follow RDA recommendations to the letter with food, I might go insane. I already find tracking calories a drag.

    I do think the system where one just shoots for a certain number of servings of a variety of fruits and vegetables, meats, fish, beans and legumes each day (and week) is a lot more user friendly. The government health recommendations seem to want to straddle breaking things down by individual nutrients and offering a simplified healthy food plan. Sometimes I think it confuses the issue for consumers.

    It’s like a Escher print, things look different depending upon your perspective.

  86. elburto says:

    Duggan:

    defending things like the partial-birth abortion

    Can’t defend something that doesn’t even exist. It’s like defending Bigfoot.

    There are several types of procedure to terminate a pregnancy. Medical, suction aspirations, dilation and curettage (D&C), and very very rarely intact dilation and extraction (IDX) or induction.

    PBA was spun out of whole cloth by the religious right. What they succeeded in doing (in the US) was forcing the 2% of women needing a later abortion (in order to stop them being maimed or killed by conditions such as HELLP, or who find out from their 20 week scan that their much wanted baby has illness/deformities incompatible with life) to go through D&C where possible, (which is a procedure that is riskier and more difficult with each week of gestation) or a labour and delivery that could be physically dangerous or emotionally devastating, rather than undergoing IDX under anaesthetic.

    Prior to that there was some element of choice in some cases, now there isn’t.

    Someone in that tiny percentage of women undergoing an abortion past twenty weeks is not doing it for shits and giggles. Your strawman, the person who believes that a foetus at 36wks gestation is disposable and inconsequential, is too ridiculous to even be a caricature. Nobody gets to eight months and says “Oh no, I’m supposed to be a bridesmaid next week!) and trots off to the hospital. A pregnancy that advanced means induction and labour, not ten minutes in stirrups. Trust me, no woman wants to labour to birth a dead baby.

    As this is Science-Based medicine, next time see what science has to say about your choice of rhetoric. Not to mention the sheer wrongheadedness of trying to apply any sort of equivalence to such wildly disparate topics as OTC supplements and reproductive rights.

  87. BrewandFerment says:

    mouse–yeah, even if I did try, there’s the small matter of getting the rest of the family to cooperate…Eldest child at nearly 19 is pretty agreeable to most veggies etc.; husband less so and younger two the least. You’d think they’d get tired of the peas/corn/frozen mixed vegetables/green beans/squash/broccoli (at least they eat broccoli) rotation, and one kid “doesn’t eat potatoes” so that kid gets sweet potatoes instead. Which of course is a better choice nutritionally but then husband won’t eat sweet potatoes. With a microwave, a little bit of catering to assorted tastes isn’t too unmanageable but I draw the line at much more than just nuking the appropriate potato or leftover veggies for the particular persons in the household.

    This link cites Source: Dietary Reference Intakes Tables and Application from Institute of Medicine of the National Academy of Sciences, November 30 2010 at https://www.consumerlab.com/rdas/#Potassium and also uses the 4700 mg/day figure. So seems to me that’s tending to support the higher figure.

    No wonder I just throw up my hands and take a multivitamin (Walmart’s best, equate brand women’s one daily, about $8 for 200 tabs.) Of course it doesn’t actually have potassium–it’s just because I can’t (won’t) possibly do this kind of analysis for every nutrient for which an RDA exists.

    But now that I’ve brought the issue up specifically for Potassium, what’s the word from the science-based studiers of nutrition on this blog? and is it true you can get a lot from coffee? (in which case I might be good already…)

  88. mousethatroared says:

    BrewandFerment – You have my sympathy. I got lucky with my husband, at least, beside the lactose intolerance he’ll eat pretty much anything. In fact, sometimes I have to say “Really, I don’t think you should eat that.” When I see him pulling some forgotten leftover from the fridge. :)

    The kids, though, have been picky lately, suddenly declaring they don’t like foods they’ve never complained about before.

  89. Angora Rabbit says:

    Hi BrewandFerment (love your name!) – resident nutritionist here, yes, the DRIs from IOM are what you want to follow for dietary recommendations if you are in North America. The easy way to obtain potassium is to “eat wet food” especially whole foods. (That is, potassium supplements make you hurl – think Original Gatorade). Potassium is the major monocation inside the cell (sodium is outside). Fruits, veggies, meats are thus pretty good sources in general because they have cells. It’s not surprising that processing tends to remove potassium (and add back sodium).

    We set the DRIs to account for factors like bioavailability, the food matrix, turnover of the particular micronutrient in the body, storage capacity, and chemical identity. Then we look as much as possible (meaning the published data) to set more specific guidelines for sex and life cycle stage. Some data sets are better than others. Because the data are imperfect, and because we aren’t clones, the DRIs have a big “fudge factor” built in.

    How does this work? The EAR (Estimated Average Requirement) meets the need of 50% of the population in a life-stage/sex group (that’s why it’s an average). Then we put in a buffer to meet the needs of 97.5% of healthy people within a life-stage/sex group. This is the RDA or Recommended Daily Allowance. It is usually 20% higher than the EAR. The equation is RDA = EAR + 2SD(EAR).

    Why 97.5% instead of 100%? Because the requirement can be quite different for various illnesses or unique circumstances, and in a public health setting it is unwise and potentially dangerous to fit pharmacologic doses for a small segment to the entire population. An example would be the higher B12 doses for people with gut malabsorption diseases or pernicious anemia.

    What does this mean for you? There’s a built in buffer for your potassium requirement, and all your other requirements. Potassium does get depleted faster than some other nutrients, but one doesn’t become hypokalemic overnight, either. That 4700 mg/day has the buffer built in.

    Btw, any one can visit the IOM website and download the PDF of your favorite nutrient’s guidelines. You can see right there the committee’s thought process, the data they reviewed, and how they ultimately arrived at the numbers. Like real science and medicine, the final results aren’t carved in stone, and they will be revisited as better data arise. But it is a pretty good determination from some fairly knowledgeable people. For a broader background on how the determinations are established, download the first chapter in any of the DRI handbooks; it’s an interesting story!

    PS – since coffee / caffeine is a diuretic, and potassium levels are lost by diuretics, I’m not sure it’s a good source, but I haven’t looked this up in Bowes and Church.

    Does this help? I agree, it can be confusing!

  90. BrewandFerment says:

    Hi AngoraRabbit,

    Wow, thanks for the interesting discussion about how the amount was set! So, alas, it doesn’t sound like I will with much practicality attain the RDA through diet–but the EAR should be doable. Gatorade is just plain nasty no matter what is done with flavors. Ugh. Not worth the calories.

    My understanding about coffee is that habitual drinkers acclimate to regular consumption and so the diuretic effects are pretty well diminished; not sure where I’ve seen that but I’m pretty sure it was an authoritative site. I seem to recall some discussion about the potassium content of the water used to brew coffee being able to contribute to the overall totals as long as you don’t use filtered or softened water; obviously it’s geographically specific.

  91. tjohnson_nb says:

    I have been reading posts here for the last few days and decided to enter the fray. I must say I am kind of shocked at the animosity I perceive here against “alternative health”, for lack of a better term. In particular, the seeming obsession you have for the “gold standard” double blind placebo progressive studies (correct me if I’m wrong) at the exclusion of all other evidence. I have more of a math and physics background and I can’t help imagining what that field would be like if the same kind of animosity from one school of thought was shown to others. I am trying to understand why and the most obvious answer to me seems to be money.

    There is ALOT of money to be made in healthcare – and where there is alot of money you will find alot of people trying to get their piece of it and why not, we all have to eat. It seems to me, unfortunately, that the more money involved the more chance there is of it interfering with the scientific process. There is another issue as well, we have a personal stake in medicine since this is literally a life and death situation. Maybe these factors can account for the disturbing state of affairs.

    I have been sifting through the internet quite a bit for the last 5 years, since I work from home and have the opportunity to do. I use the word ‘sifting’ because that is exactly what I find one needs to do on the internet – it is such a wild and crazy place. One of my main topics has been health, in particular my health but health in general. I have read extensively on many sites and I try to weigh the evidence. So enough of the generalities.

    I take alot of supplements – the main one is Vit C. I take 10-20 gms of C per day, and up to 50 if I feel a cold or flu coming on. I use bowel tolerance as a way of dosing (titration?). I find the theory about mutation resulting in the missing enzyme needed to convert glucose to ascorbic acid fascinating and the evolution of Lp(a) as a a way of patching damaged arteries due to the chronic shortage of AA. This all rings true to me and I am more than willing to take part in this experiment on my health. I read about how various physicians have used IV sodium ascorbate to treat infectious diseases (it seems to have strong anti-viral properties) since the 40′s and I watched a video in NZ where they were about to pull the plug on a guy whose lungs had shut down due to a severe H1N1 infection. His family convinced the hospital to try IV C (50 gms/day) and in 2 days he started to recover dramatically. Then it was discontinued and and at one point the family had to threaten to sue the hospital before they reluctantly gave him only 2 gms a day. In the end they were forced to bring him C and give it to him orally.

    How can this evidence be ignored? No one in their right mind would ignore this. Why does a family have to threaten to sue in order to have a treatment for which there is much evidence as to its effectiveness? If you ask me, it is this kind of situation that has resulted in the alternative medicine movement. I doubt I will ever go to doctor again in my life – I am approaching 60.

    Now why doesn’t someone do a double blind placebo trial for IV C on someone dying in a hospital bed? The only reason I can think of is that there is no money to be made from it. I realize that I am speaking about an entirely different subject than supplements here, ie. using C as a treatment for disease, but I think its tantamount to criminal negligence for doctors to ignore this.

  92. Wellness says:

    Unless they are pregnant/planning a pregnancy within 3 months or have a medical condition, if someone needs to supplement then it is a reflection of the adequacy of the diet. The diet should have variety and be in healthy ratios so a wide variety of nutrients are obtained. Changing the diet is way cheaper and more enjoyable(food is one of life’s pleasures for sure) than popping pills. I’m one of those medical condition people and I have to spend $30 on a supplement a month. I only take one type and I don’t take supplements that have not been medically recommended. Consuming the pill gives me no pleasure and quite frankly, that’s two pairs of high performance running shoes I can’t by. Or it’s not being able to upgrade my health insurance from basic to standard.

    Eating with variety can be cheap and time efficient. It’s just about being creative. When fresh food is not available or too expensive, tinned and frozen vegetables and fruits are still very nutritional. Things like breads and cereals, water, dairy and lean meat (and alternatives) are also really good sources that are transportable. It’s better to consume vitamins and minerals in food than supplements because foods contain multiple micronutrients providing multiple benefit (like multivitamins but cheaper, juicier, crunchier, sweeter and more filling). They also have all the important macronutrients (protein, carbs- and fibre- and essential fats).

    It’s up to you but really, we all have a finite amount of money and time and I would rather spend both on things that are beneficial and/or are enjoyable.

  93. Ian.Bradley says:

    The truth is not many people get the nutrients they need through diet alone. Most people understand this, so a multi-vitamin is a consumer favorite. With so many science-supported benefits of nutraceutical ingredients like omega-3 fatty acids, beta sitosterol and many others, consumers now have a nutritional option for proactive healthcare which in many ways is more appealing to them. To meet this demand, supplement business owners and retailers manufacture a variety of supplements using the latest research on ingredients. My contract manufacturer recently discussed a custom protein powder that would benefit weight loss, immune health and heart health. Who would have thunk it? This new concept of nutrition for proactive healthcare is catching on!

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