Why We Take Nutritional Supplements

I’m pretty confident that you, a reasonably regular reader of these health tips, devote a small portion of your living quarters to nutritional supplements. Your morning ritual of teeth/skin/hair/clothes likely includes some pill-swallowing, an act you regard not necessarily as pleasant, but as necessary, sort of like inserting your contacts or a tampon. Most of these daily efforts are required for you to be classified as a reasonably normal person.

But where did the supplement ritual come from?

That question was asked in a fairly complex survey of almost 12,000 adults in a project undertaken by the National Institutes of Health and Tufts University School of Medicine and published this week in JAMA Internal Medicine. Some of the results confirmed previous studies. For example, we’ve known for years that about half the US population takes supplements regularly and that more women (55%) do so than men (45%).

As we age, decade by decade we take more supplements, perhaps an attempt to keep mortality at arm’s length. We add extra supplements when we develop a chronic condition like osteoporosis, diabetes, heart disease, or cancer.

For this study, when participants were asked why they took supplements the most common reasons cited were to improve overall health (45%), maintain health (33%), for bone health (11% of men and higher for women respondents at 36%), to supplement diet (22%), to prevent health problems (20.4%), and for heart health/to lower cholesterol (15%). Further down the list, but appearing consistently: boost immunity and for enhanced energy, healthy joints, skin health, mental health, and weight loss.

You could probably have written this list yourself, but later the article got more interesting:

• For the most part, nutritional supplement users made decisions without any help from their physicians. Just 23% of products used were based on recommendations from a health care provider.
• Across the board, in all age groups, regular supplement users reported themselves as being in good or excellent health. They generally didn’t smoke, ate a healthful diet, had a healthy weight, exercised regularly, used alcohol moderately, and had health insurance.
• Yet, oddly, despite the results showing nutritional supplement users were healthier than those not taking supplements, positive results in actual clinical trials using specific supplements for specific conditions have been iffy. For example, B-complex to reduce the heart risk factor homocysteine came up zero when it came to heart disease prevention. The antioxidants beta carotene and vitamin E scored zero for heart health as well.

What does this mean? Three scenarios are possible.

Scenario one  You wake up one morning and realize that slowly but steadily you’ve been feeling crummier. You’ve gained weight and you’re tired, grumpy, and suffering one cold after another. You resolve to make amends and choose the fork in life’s road that leads to better health, so you toss your Marlboros, pour out the Jack, quit the junky food, taste your first salad, and even discover your exercise bike buried under a mountain of clothes. Then it occurs to you that most of the healthy people you know take supplements. You ask around, read about vitamins online, and soon you’re in the vitamin-using group. After three months of this you’re feeling pretty damn good and it’s likely you’ll be a supplement user for life.
Conclusion: some people take supplements because it’s part of a healthy lifestyle.

Scenario two  You wake up one morning, realize you’ve slowly been feeling crummier, and mention this to someone who says “Why not try some supplements?” You do and in a few weeks you feel better. “Well,” you think, “Now that I’m spending this good money on vitamins, maybe I’d better eat healthier, exercise more, lose some weight…”
Conclusion: some people take supplements, which spurs them to embark on a healthier lifestyle.

Scenario three  You wake up one morning with some sort of symptom that doesn’t seem to be going away. You really don’t want to go to a doctor (or you go to a doctor and don’t want to take her prescription because you fear side effects). You think you’ll try a supplement and lo! you get better. “Hmm,” you think. “I’ve got to look into this a little more.”
Conclusion: some people take supplements for a specific condition, enjoy the positive results, and then add more supplements as the need arises.

The researchers in the journal article agree that these scenarios occur, but that further research is needed to understand motivations, lifestyle changes, and so forth. In other words, supplement use and how it affects health is much more complex than they originally thought. What was especially interesting to me was the fact that less than 25% of the supplements being taken had been doctor-recommended. In other words, if regular supplement users are healthier, why aren’t the medical profession and health insurance industry at the forefront of recommending supplements to everyone?

The standard reason given by conventional doctors for being brain-dead by choice when it comes to supplements seems always to revert to quoting one study or another where the data “isn’t strong enough” to warrant a universal supplement recommendation. The real reason, however, is that medical students are taught virtually nothing about nutritional supplements during their training. When they finally get out into the real world and start doctoring, the average physician knows less about supplements than most curious patients and far less than a competent health food store clerk.

This is especially ironic given that other studies show more than half of physicians (and 60% of cardiologists) take supplements every day and, with the possible exception of the people they live with and the researchers questioning them, never tell anyone their dirty little secret.

Be well,

David Edelberg, MD