Usage patterns, health, and nutritional status of long-term multiple dietary supplement users: a cross-sectional study.
rs1...@yahoo.com
Usage patterns, health, and nutritional status of long-term multiple
dietary supplement users: a cross-sectional study.
Block G, Jensen CD, Norkus EP, Dalvi TB, Wong LG, McManus JF, Hudes
ML.
ABSTRACT: BACKGROUND: Dietary supplement use in the United States is
prevalent and represents an important source of nutrition. However,
little is known about individuals who routinely consume multiple
dietary supplements. This study describes the dietary supplement usage
patterns, health, and nutritional status of long-term multiple dietary
supplement users, and where possible makes comparisons to non-users
and multivitamin/mineral supplement users. METHODS: Using a cross-
sectional study design, information was obtained by online
questionnaires and physical examination (fasting blood, blood
pressure, body weight) from a convenience sample of long-term users of
multiple dietary supplements manufactured by Shaklee Corporation
(Multiple Supp users, n=278). Data for non-users (No Supp users,
n=602) and multivitamin/mineral supplement users (Single Supp users,
n=176) were obtained from the National Health and Nutrition
Examination Survey (NHANES) 2001-2002 and NHANES III 1988-1994.
Logistic regression methods were used to estimate odds ratios with 95%
confidence intervals. RESULTS: Dietary supplements consumed on a daily
basis by more than 50% of Multiple Supp users included a multivitamin/
mineral, B-complex, vitamin C, carotenoids, vitamin E, calcium with
vitamin D, omega-3 fatty acids, flavonoids, lecithin, alfalfa,
coenzyme Q10 with resveratrol, glucosamine, and a herbal immune
supplement. The majority of women also consumed gamma linolenic acid
and a probiotic supplement, whereas men also consumed zinc, garlic,
saw palmetto, and a soy protein supplement. Serum nutrient
concentrations generally increased with increasing dietary supplement
use. After adjustment for age, gender, income, education and body mass
index, greater degree of supplement use was associated with more
favorable concentrations of serum homocysteine, C-reactive protein,
high-density lipoprotein cholesterol, and triglycerides, as well as
lower risk of prevalent elevated blood pressure and diabetes.
CONCLUSIONS: This group of long-term multiple dietary supplement users
consumed a broad array of vitamin/mineral, herbal, and condition-
specific dietary supplements on a daily basis. They were more likely
to have optimal concentrations of chronic disease-related biomarkers,
and less likely to have suboptimal blood nutrient concentrations,
elevated blood pressure, and diabetes compared to non-users and
multivitamin/mineral users. These findings should be confirmed by
studying the dietary supplement usage patterns, health, and
nutritional status of other groups of heavy users of dietary
supplements.
PMID: 17958896 [PubMed - as supplied by publisher]
Olafur Pall Olafsson
Hi RS,
I was just about to post that study, but see that you beat me to it:-)
BTW the full text article is free through pubmed for those interested:
http://www.nutritionj.com/content/pdf/1475-2891-6-30.pdf
Thomas Carter
>
> - Show quoted text -
Hi,
Below I repost the abstract, some excerpts from the full text and my
comments.
Thomas
rs1...@yahoo.com View profile
More options Oct 26, 6:28 pm
Newsgroups: sci.life-extension
From: "rs10...@yahoo.com" <rs10...@yahoo.com>
Date: Fri, 26 Oct 2007 16:28:28 -0700
Local: Fri, Oct 26 2007 6:28 pm
Subject: Usage patterns, health, and nutritional status of long-term
multiple dietary supplement users: a cross-sectional study.
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[from the full text]..........
In NHANES 1999-2000, approximately 47% of dietary supplement
users reported taking only one type of supplement (most commonly a
multivitamin/mineral) [4]. Only 3 individuals out of over 11,000
surveyed reported taking
20 or more different supplements in the past 30 days...
individuals who had been consumers of dietary supplements for >20
years from a dietary
supplement manufacturer and distributor (Shaklee Corporation,
Pleasanton, CA)...
A subset of 300 individuals who completed the questionnaires and were
free of cancer,
other than non-melanoma skin cancer, [I see no reason for
disqualification of those with cancer unless it was to mask the fact
that the supplement users had an equal or greater frequency than the
NHANES control group. If true this could indicate a carcinogenic
propensity, or that they were surviving longer with their cancer.]
Physical examinations were conducted during a national meeting of
Shaklee product
consumers held in Chicago, Illinois in August 2005. [Apparently these
were not typical supplement users, but only those free and willing to
travel, and many may have in fact been employees, or distributors of
the Shaklee products, suggesting they could have falsely reported the
duration and fealty of their usage. Also that some with known disease
history may not have volunteered in order to manufacture a more
favorable outcome.]
Elevated blood pressure was defined as >80 mmHg for diastolic and/or
>120 mmHg for
systolic blood pressure [13]. Suboptimal and elevated nutrient and
biomarker
concentrations were defined as: <317 nmol/L RBC ~folate [14,15]; <37.5
nmol/L and
>600 nmol/L for serum 25-hydroxy~vitamin D [16-19]; >9 µmol/L for serum ~homocysteine
[20]; >3.0 mg/L for serum ~CRP [21]; 200 mg/dL for serum total
cholesterol [22]; <40
mg/dL for serum high-density lipoprotein (~HDL)-cholesterol for men
and <50 mg/dL for
women [22]; 130 mg/dL for serum low-density lipoprotein (LDL)-
cholesterol [22]; <5 for
the ratio of total cholesterol to HDL-cholesterol [22]; 150 mg/dL for
serum ~triglycerides
[22]; and <0.4 mg/dL and >1.0 mg/dL for ascorbic acid [23,24]...
There was a decrease in concentrations of biomarkers associated with
disease risk as
supplement use increased (Table 4). Across the three user groups
there was a
decrease in serum CRP and the ratio of total cholesterol to HDL-
cholesterol, and an
increase in HDL-cholesterol concentration. Serum homocysteine and
triglycerides were
lower in the Multiple Supp users than in the other two groups.
Finally, serum total
cholesterol was significantly lower in the Multiple Supp group,
whereas LDL-cholesterol
concentrations did not vary significantly by supplement use...
the risk among Multiple Supp users could not be estimated because of
the absence of any
persons with elevated values of CRP...[This may have been because those
who were sick did not want to travel.]
Health status and disease prevalence
Prevalence of self-reported disease was low in each user group and
most risk estimates
did not reach statistical significance (Table 6). An exception was the
reduced risk of
diabetes in Multiple Supp users (OR=0.27; 95% CI: 0.12-0.59). Risk of
coronary heart
disease was also lower in this group (OR=0.48; 95% CI: 0.22-1.09), but
was only
marginally statistically significant. For self-assessed health
status, Multiple Supp users,
but not Single Supp users, were less likely to report their health as
'good, fair, or poor'
versus 'excellent or very good' (OR = 0.26; 95% CI: 0.17-0.41)
compared to the No
Supp users group (Table 6).
Full text at http://www.nutritionj.com/content/pdf/1475-2891-6-30.pdf
XXXX
This hugely disappointing, groundbreaking study is the only one of its
kind ever done. Or at least the only one published. LEF and several
other supplement companies have for a long time been in positon to
publish such a paper, and have declined to do so. One might guess they
have good reason not to. This would be especially true of LEF, who has
spent millions on less definitive studies.
The full text did report an almost significant .48 OR for heart
disease, and .41 for heart attacks. This is the only good news. They
disqualified those with cancer, probably meaning previous cancer as
well. This strongly suggests they saw more, or at least as much cancer
in their active group, which would be consistent with other evidence
that the supplements they took are beneficial for the cardiovascular
system, but not for cancer. Most telling there was no mention of
mortality. Had it been reduced, even to a nonsignificanat amount, it
would have been included.
The failure to adjust for things like smoking, moderate alcohol
intake, and exercising indicates the .48 OR for heart disease, and the
cancer rates could be much worse in reality. There were few strokes,
but the stroke rate was actually a bit worse.
The cohort took lecithin, garlic, and glucosamine which were
identified as substances related to a 40% reduction in mortality in
the Beaver Dam Study. (only the men were reported as taking garlic.)
The apparent very moderate health benefit seen here casts doubt on
that report, and virtually crushes any hopes of seeing an additive
benefit for taking all three. Altho not reported, I would guess that
quite a few were taking the very popular Ginkgo biloba as well,
casting doubt on very favorable reports of its efficacy.
Seven of the thirteen supplements listed in the abstract have been
associated with decreased mortality in reputable human reports. If
this report is taken at face value, we must conclude there is little
credibility for the favorable reports of the seven supplements, and
virtually no chance for substantial additive effects between them.
A few more reports like this will have me tossing out everything but
my vitamin C, which appears to do a better job all by itself. And some
selenium because C reduces its absorption, and of course my B
vitamins, and my Ginkgo, and my,, Oh well let's just see what the
future brings. Que sera, sera.
On the positive (hopeful) side. This was a very flawed study. There
were questions and confounders both ways. The cohort may not have
been truthful. Many were probably associated with Shaklee. They knew
when the blood test was to be taken, and would have been sure to take
their pills a few days before. If more had a history of cancer, does
that mean more caught cancer, or more were surviving it. Dead men were
not included. Same for heart disease, most especially since fish oil
prevents sudden death from it, not so much the disease itself. Many
supplements are blood thinners, which allow people to survive more
severe atherosclerosis. The heart disease protection was .48
( 95% CI: 0.22-1.09) The bottom value was .22, a 78% reduction.
Chance works both ways, remember.
Notice that the NHANES multi users had worse values in some ways than
the non supplementers. This underscores the fact that vitamin user
cohorts, may be rich in people who have had previous, cancer, heart
attacks, etc. I've known several sickly people who would have never
been taking supplements were it not for medical problems. The NHANES
group that took multi pills had a 1.7 OR for heart attacks and angina
for instance vs the NHANES non supplementers. These diseases, and risk
factors for them, clearly cause supplementation, not vice versa.
Human nature would tend to indicate that some of those taking a wide
variety of supplements were similarly motivated, perhaps even a
higher percentage would have been. Almost half of the cohort did not
control their cholesterol well, this is one of the most important
measurable parameters, and quite easy to control. Maybe they are not
as savy or dedicated as one would think.
The Shaklee web site appears professional, but is very poorly done. I
was unable to find ingredients for their premier offering, a four pill
multi called "vitality" or something like that. Nor did I find a
product listing with a quick try. I did find a phone number, and the
order taker read the list of ingredients to me. It was rather
woeful. If the active group relied heavily on it, I'm not at all
surprised by the disappointing results. They claimed to have taken
much more, of course. When I asked him if he was in the recent trial,
he first denied knowledge of it, then said he wasn't in it, then got
very defensive when I asked him if other Shaklee associates were. I
still don't have the knack for asking hard questions in an easy way.
Shaklee now has data in hand to do a prospective study, if we don't
see at least one in the next five years or so I would think their
group will have not fared very well.
$To read in 2013
Thomas
XXXX