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Who Recommends Dietary Supplements?

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Who Recommends Dietary Supplements? Who Recommends Dietary Supplements? Some Prominent Nutrition “Although one could measure blood levels to identify those who would benefi t most from Experts, Some Professional multivitamins, this would be much more expen- Organizations, and Even sive than simply recommending that all adults Government Reports take a supplement (at a typical cost of $20 to $40 per year). Education regarding nutrition is ADVICE FROM DR. WALTER WILLETT AND DR. MEIR STAMPFER OF HARVARD: vitally important, but it has been far less effec- tive than supplementation or the fortifi cation of What vitamins should I be taking, Doctor? food in raising blood folic acid levels.” Dr. Walter Willett and Dr. Meir Stampfer, two promi- “However, a vitamin pill is no substitute for a nent physician-researchers at Harvard Medical School healthful lifestyle or diet, because foods contain and the Harvard School of Public Health, have offered additional important components, such as fi ber the advice excerpted below on the use of nutritional and essential fatty acids. In particular, a vita- supplements. (Willett & Stampfer, 2001) min supplement cannot begin to compensate “Given the greater likelihood of benefi t than for the massive risks associated with smoking, harm, and considering the low cost, we conclude obesity, or inactivity. The cost of a multivitamin that a daily multivitamin that does not exceed supplement is so low—similar to that of about a the RDA of its component vitamins makes sense quarter of a serving of fruit or vegetables—that for most adults...” it is unlikely to displace healthful foods in most persons’ budgets.” “Substantial data suggest that higher intakes RECENT REITERATION OF of folic acid, vitamin B-6 and vitamin D will MULTIVITAMIN ADVICE benefi t many people, and a multivitamin will ensure an adequate intake of other vitamins Drs. Willett and Stampfer recently reiterated their for which the evidence of benefi t is indirect. A multivitamin advice in a joint letter with Dr. Bruce multivitamin is especially important for women Ames and Dr. Joyce McCann, following a National who might become pregnant; for persons who Institutes of Health Conference. (Ames, McCann, regularly consume one or two alcoholic drinks et al., 2007) The conference reviewed the evidence per day; for the elderly, who tend to absorb on multivitamin/mineral (MVM) supplements vitamin B-12 poorly and are often defi cient in and concluded that there was not suffi cient vitamin D; for vegans, who require supplemen- evidence to recommend for or against the use of tal vitamin B-12; and for poor urban residents, MVM supplements for the prevention of chronic who may be unable to afford adequate intakes disease. (NIH State of the Science Conference on of fruit and vegetables.” Multivitamins, 2006) This review, however, was limited to evidence from randomized controlled trials (RCTs) which included only 63 of the 11,261 This chapter is excerpted from The Benefi ts of Nutritional Supplements, Fourth Edition. © Copyright 2012 Council for Responsible Nutrition. 13 available reports. By so limiting the scope of the NIH intakes of a number of vitamins, exposing them to review, much relevant epidemiologic and mechanistic increased disease risk. They emphasized that the cost evidence was omitted from consideration, according to of routinely using a multivitamin is small—about $20 the authors of this letter. Their bottom line: to $30 per year for brand-name products or as little as $10 annually for the large, economy-size container “Of course, everyone would agree that all per- of a store-brand product. (Fairfi eld & Fletcher, 2002; sons should be encouraged to eat a good diet, Fletcher & Fairfi eld, 2002) but we are far from achieving this goal, espe- cially among the poor. In most cases, a simple HEALTH PROFESSIONALS RECOMMEND way to improve micronutrient status is to take DIETARY SUPPLEMENTS an MVM. However, even if one eats an ideal diet The Council for Responsible Nutrition and the CRN and takes an MVM, some vitamins can remain Foundation sponsored numerous surveys of physi- below recommended concentrations in some cians, nurses, and other health professionals from 2007 groups... A signifi cant fraction of Americans to 2009—the “Life...supplemented” Healthcare have micronutrient intakes below the Estimated Professionals (HCP) Impact Studies. (Dickinson, Average Requirement. Why establish values Bonci, et al., 2012; Dickinson, Boyon, et al., 2009; such as the Estimated Average Requirement and Dickinson, Shao, et al., 2011) The surveys were not take simple steps to eliminate defi ciencies? conducted and analyzed by Ipsos Public Affairs. In Because MVMs are cheap, readily available, addition to the published articles reporting results of and nontoxic, why not recommend that people these surveys, the “Life...supplemented” website pro- take an MVM, particularly because much epide- vides summary information. (CRN, 2012) Physicians miologic, biochemical, and other evidence points surveyed included primary care physicians, ob/gyns, to the need for an adequate supply of vitamins cardiologists, dermatologists, and orthopedists. Other and minerals for optimum function on many health professionals surveyed included nurses, nurse levels? At a minimum, taking an MVM is good practitioners, pharmacists, and dietitians. The surveys insurance.” (Ames, McCann, et al., 2007) asked, among other things, whether various healthcare ADVICE FROM TWO OTHER professionals “ever recommend dietary supplements” HARVARD PHYSICIANS to their patients or clients, and the reasons for such recommendations. The following table shows the Dr. Kathleen M. Fairfi eld and Dr. Robert H. Fletcher percentage of each professional group that responded of Harvard Medical School and the Harvard School positively to this question, and the top reasons they of Public Health reviewed the benefi ts of vitamins gave for recommending dietary supplements. in protecting against chronic disease and concluded that a multivitamin would be prudent for virtually all adults. The physicians observed that “a large propor- tion of the general population” has less-than-optimal This chapter is excerpted from The Benefi ts of Nutritional Supplements, Fourth Edition. © Copyright 2012 Council for Responsible Nutrition. 14 PERCENTAGE OF HEALTH PROFESSIONALS WHO “EVER RECOMMEND” DIETARY SUPPLEMENTS TO PATIENTS OR CLIENTS, AND TOP REASONS FOR SUCH RECOMMENDATIONS HEALTH PERCENT WHO “EVER RECOMMEND” TOP REASONS FOR RECOMMENDING PROFESSIONALS DIETARY SUPPLEMENTS TO DIETARY SUPPLEMENTS PATIENTS/CLIENTS Physicians 79% Bone health, overall health/wellness, joint n=900 (primary care, health, heart health, healthy cholesterol ob/gyn, other) Orthopedists 91% Bone health, joint health, musculoskeletal n=300 pain, overall health/wellness Cardiologists 72% Healthy cholesterol, heart health, overall n=300 health/wellness, bone health Dermatologists 66% Skin/hair/nails, overall health/wellness, bone n=300 health, anti-aging Nurses 82% Overall health/wellness, bone health, fl u/ n=277 colds, joint health, immune health, healthy cholesterol Nurse practitioners 96% Bone health, overall health/wellness, fi ll n=300 nutrition gaps, women’s health, joint health Pharmacists 93% Joint health, bone health, fl u/colds, eye n=300 health, lower cholesterol Dietitians 97% Bone health, fi ll nutrition gaps, overall n=300 health/wellness, healthy cholesterol, heart health ADDING A “SUPPLEMENT FLAG” TO FOOD GUIDE PYRAMIDS vegetables, and legumes. “Finally, a fl ag should be placed on the top of the 70+ Food Pyramid indicating Scientists at the USDA Human Nutrition Research that supplements of calcium, vitamin D and vitamin Center on Aging at Tufts University have given careful B-12 are frequently appropriate to promote optimal thought to the nutritional needs of the elderly. Older health.” (Russell, Rasmussen, et al., 1999) people have lower energy needs and tend to eat less. A national survey showed that about 40 percent of peo- In a book about diet and health, Dr. Willett offers a ple over the age of 70 consumed less than two-thirds “Healthy Eating Pyramid” that places more empha- of the recommended energy intake, making it diffi cult sis on whole grains, decreases the emphasis on dairy for them to get recommended amounts of nutrients. products, and relegates refi ned grain products as well Calcium, vitamin D, and vitamin B-12 are of particu- as red meats and butter to the tip of the pyramid, along lar concern for the elderly. The researchers emphasize with sweets and fats—to be consumed “sparingly.” the importance of educating older Americans to select A sidebar accompanies the pyramid, recommending nutrient-dense foods within all the food groups. To as- “multiple vitamins for most.” (Willett, 2001) The cur- sist in nutrition education, these scientists developed a rent website for The Nutrition Source, a publication of modifi ed Food Guide Pyramid for the elderly. It sits on the Harvard School of Public Health, also shows an a base of water, emphasizing the need for at least eight updated “Healthy Eating Pyramid” with a sidebar that glasses of water daily. Symbols are added to encour- recommends: “Daily multivitamin plus extra vitamin age the consumption of more fi ber-rich grains, fruits, D (for most people).” (HSPH, 2012) This chapter is excerpted from The Benefi ts of Nutritional Supplements, Fourth Edition. © Copyright 2012 Council for Responsible Nutrition. 15 • Synthetic folic acid from fortifi ed foods or supplements for women of childbearing age who may become pregnant and for those in the fi rst
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