Transcript X - The Nutrition Investigator

A CONSENSUS ON WHAT SUPPLEMENTS TO TAKE
ABSTRACT
Han Lai and Alfred B. Ordman*
Biochemistry Program, Beloit College, Beloit, WI 53511
At the American Aging Association meeting in 1994, a consensus conference was held to consider how
much vitamin C and E should be consumed to reduce the risk for chronic disease. At an NIH
symposium on multivitamins in 2006, the value of supplements remained a controversial issue. To
help an individual decide whether or not to take supplements, we surveyed three groups to determine
whether there is a practical consensus on which supplements to consume. The groups included people
who 1) attended the Linus Pauling Institute Conference on nutrition, 2) received my newsletter
summary of the latest nutrition research from distinguished peer-reviewed journals, or 3) participated
in a double-blind trial Ordman conducted on weight loss. We have analyzed responses by age, group,
and education. Approximately two-thirds of respondents took multivitamins, additional individual
vitamins, and other supplements like fish oil. Responses showed a wide range of specific choices.
PART 1 - MULTI USE choices
MULTIVITAMINMULTIVITAMIN/MINERAL
B-COMPLEX
OTHER COMPLEX
PART 2 - INDIVIDUAL VITAMINS AND MINERALS
choices
VITAMIN C (include question 2)
VITAMIN D (include question 3)
VITAMIN E (include question 4)
CALCIUM (include question 5)
OTHER (include question 6)
PART 3- OTHER SUPPLEMENTS choices
FISH OIL
SAMe (include question 2)
ASPIRIN (include question 3)
MELATONIN (include question 4)
LIPOIC ACID (include question 5)
N-ACETYL CARNITINE (include question 6)
D AND E COMBINED IN JUVENON (include question 7)
BRANCHED CHAIN AMINO ACIDS - BCAAs (include
question 8)
OTHER (include question 9)
In recent years the American Society of Nutrition has noted the need for members to inform the public
about what is understood about nutrition, particularly recent research discoveries. Every two years the
Linus Pauling Institute (LPI) holds a nutrition symposium to gather and inform researchers, nutritional
and medical professionals, and the public about developments in nutrition. I began an email
newsletter, Nutrition Investigator (NutInv) (Ordman, 2009a), which summarizes and links to peerreviewed articles in the Society's publications: the Journal of Nutrition (J Nutr) and the American
Journal of Clinical Nutrition (AJCN). My basic hypothesis is that efforts like mine and those of the
LPI make a difference in what nutritional supplements people consume.
From the most recent National Health and Nutrition Examination Survey (NHANES), Table 1 shows
what supplements the average person in the US took during 1999-2000 (Picciano and McGuire, 2009).
Table 1: NHANES 1999-2000 type of supplement consumed by adults over 20 yrs of age
Men
4 7%
3 0%
1 0%
1 1%
3%
1 3%
3%
Women
5 8%
3 7%
1 2%
1 1%
1 1%
2 0%
4%
Table 5. People taking a daily multivitamin/mineral supplement
The goal of our study was to determine what supplements people take, and whether more education
and information affect those decisions. The expectation was that those with more education and
information would be more likely to take supplements frequently reported to be beneficial in AJCN
and J Nutr since 2000. The original hypotheses made prior to collecting the results are shown in
Table 2.
Table 2: Hypotheses of what nutritional choices people make in 2009
METHOD
The Beloit survey of supplement use was developed to evaluate the hypotheses. Questions in the
survey are summarized in Table 3. The Beloit College IRB approved the survey. Three groups were
invited to respond. Group 1 (NutInv, n=306) had received NutInv for an average of 2 years. Group
2 (LPI, n=158) were participants in the LPI Symposium in 2007 (Ordman, 2009b). Group 3
(ClinTrial, n=29) were volunteers in an obesity study conducted in 2006 (Ordman, 2008). Answers
were collected and hypotheses evaluated using ANOVA.
RESULTS
A response rate of 29% was achieved (Table 4), compared to a rate of 5% normally
obtained in Beloit College surveys. The number of people taking multivitamin/mineral
supplements has nearly doubled since 2000 (Table 5). Hypotheses were evaluated, and
the responses are presented in Tables 6 to 13. The data, though informative, was
insufficient to achieve significant confirmation of hypotheses. Responses will be used to
design a future survey.
Table 4: Response rate to survey inquiries
LPI
Nut Inv
ClinTrial
Inquiries
Sent
158
306
29
Responses
received
33
97
13
Age
%
1840
15
28
31
Education
%
4055
36
25
46
%
over
55
36
37
8
No
response
12
10
15
%
college
91
49
54
%MD
2 1 .2
4 .9
0
Group
Lpi
Nutinv
clintrial
NHANES 2000
Respondents
33
97
13
National survey
%PhD
52
13
15
M
F
F
youn g Over youn g
50
80
79
70
50
40
60
35
20
32
22
46
Aerobic
27
62
40
60
41
33
36
41
38
flexibility
18
50
40
60
47
33
43
37
38
walking
64
50
60
40
59
33
61
41
46
Male
young
Female
over 50
Female
young
None
M
over
50
9%
12
20
20
Nut
Inv
Male
over
50
0%
1-4
5-9
10+
27%
45%
18%
38
38
12
40
40
0
60
20
0
35%
41%
24%
LPI
45%
3%
NutInv
46%
8%
Cli nTrial
69%
400-999
1000 to
1999
2000+
Twice
daily
15%
15%
18%
15%
31%
50
28
22
45
39
16
100%
0%
0%
Table 14. Revised Hypotheses
Evaluation
Revised
Hypothesis
Rationale for revision
Table 10. Hypothesis E. Most people over 50 in the LPI and
Nutrition Investigator groups take aspirin regularly
A
True
The majority in all groups exercise
regularly.
n/a
LPI
B
True
As people get older, they take
more supplements.
n/a
Do not t ake aspirin
Do take aspirin
NutInv
61%
39%
56%
44%
ClinTr ial
50%
50%
Table 11. Hypothesis F. People in the Nutrition Investigator
group and the LPI group are more likely to take vitamin C
ClinTr ial
Male
young
Female
over 50
Female
young
33
4
35
23%
60
7
0
39
50
7
82
4
6
62%
8%
8%
Table 8. Hypothesis C. Most people in LPI group and in Nutrition
Investigator take vitamin D, 1000 IUs or more
Vitami n D
none
200-399
However, it is remarkable how similar the supplement choices of LPI and NutInv respondents are. Although LPI
participants have more education and professional involvement related to nutrition than the NutInv group, the periodic
presentation of peer-reviewed nutrition information to NutInv via an email newsletter may have led to informed
selections.
Hypothesis
People 50 or older
taking aspirin
Table 7. Hypothesis B. As people get older, they take more supplements;
This will be true for each of the three groups, and for all taken together
LPI
ClinTr ial
%
taking
62
8
8
23
8
0
8
0
0
0
Many preliminary conclusions shown in Table 13 were unexpected. For instance, vitamin D received substantial
attention at the LPI and in NutInv. A typical recent article states that people not getting enough sunshine would benefit
from 2,000 IU daily (Smith et al, 2009). The importance of obtaining 1 to 2 g of fish oil daily as an anti-inflammatory
nutrient particularly involved in heart and brain health has also been reported frequently (Harris, 2008). Yet vitamin D
and fish oil were taken by only about 50% of LPI and NutInv respondents.
none
Some but less than 2000
2000+
69
27
NutInv
%
taking
50
6
15
8
8
7
2
1
6
12
DISCUSSION
ClinTr ial
Strength
Total
taken
Fish oil
SAMe
Baby aspirin
Adult aspirin
Melatonin
Lipoic acid
N-acetyl-carnitine
Juvenon
Branched chain ami no acids
Chondroitin/glucosami ne
LPI
%
taking
55
12
9
15
21
24
12
9
0
21
vitamin D
Table 6. Hypothesis A. The majority in LPI group exercises regularly
LPI
NutInv
M
M
F
F
M
Over youn g Over youn g Over
50
50
50
Regularly 82
100
80
80
88
PART 4 - EXERCISE
DO YOU MAKE A DELIBERATE EFFORT TO
EXERCISE?
WHICH OF THE FOLLOWING TYPES OF EXERCISE
DO YOU DO
PURPOSELY?
GENERAL, STRENGTH, AEROBIC, FLEXIBILITY,
BALANCE
PART 5 - PERSONAL INFORMATION FOR
ANALYSIS
MALE OR FEMALE
AGE ______ YEARS
WEIGHT _____ POUNDS OR ______KG
GROUP
EDUCATION
Table 9. Hypothesis D. Most people over 60 in LPI group and
in Nutrition Investigator take 2000 IU vitamin D daily
People 60 or older taki ng
LPI
NutInv ClinTrial
% using a daily multi
61%
70%
54%
34%
Exercise
Hypothesis A. The majority in LPI group exercises regularly. See Table 6.
Hypothesis B. As people get older, they take more supplements. This will be true for each of the
three groups. See Table 7.
Hypothesis C. Most people in LPI and NutInv take 1000 IUs or more of vitamin D. See Table 8.
Hypothesis D. Most people over 60 in LPI and NutInv take take 2000 IU of vitamin D daily. See
Table 9.
Hypothesis E. Most people over 50 in LPI and NutInv take aspirin regularly. See Table 10.
Hypothesis F. People in LPI and NutInv are more likely to take vitamin C. See Table 11.
Hypothesis G. People in LPI and NutInv are more likely to take vitamin E. See Table 12.
Hypothesis H. Fish oil, S-adenosylmethionine (SAMe), and melatonin will be taken by some people.
See Table 13.
Group
Supplement
Table 3: Survey Questions
INTRODUCTION
Supplement taken
Any
Multivitami n/ multimineral
Vitamin E
Vitamin C
Calcium
Ant acid calcium
B-complex
Table 13. Hypothesis H. Other supplements taken will include fish oil, SAMe, melatonin, and aspirin.
Vitamin C
None
60 to 500
LPI NutInv Cli nTrial
45% 41%
63%
26% 23%
39%
500 to 999 mg 19%
1000 to 1999
6%
2000+
10%
Twice daily
10%
24%
8%
5%
8%
8%
8%
Table 12. Hypothesis G. People in the Nutrition Investigator
group and the LPI group are more likely to take vitamin E
Vitamin E
None
5 to 200 IU
200-399
400-500
2000 or more
Twice daily
LPI NutInv Cli nTrial
45% 45%
18% 31%
100%
6%
3%
24% 20%
3%
3%
0%
0%
C
D
False
In 2008
After the 2009 LPI conference,
more people attending LPI 2009 or
receiving NutInv will be taking
2,000 IU of vitamin D daily
False In After the 2009 LPI conference,
2008
more people over 50 attending LPI
2009 or receiving NutInv will be
taking 2,000 IU of vitamin D daily
The 2009 LPI Award resulted
in a speech by Dr. Michael
Holick on the substantial
benefits of taking daily 2,000
IU of vitamin D
The 2009 LPI Award resulted
in a speech on the substantial
benefits of taking daily 2,000
IU of vitamin D
E
To be
determined
After the 2009 LPI
conference, the
number of people
taking aspirin will
not change.
Aspirin was not mentioned at the
LPI conference
F
To be
determined
After the 2009 LPI
conference, the
number of people
taking vitamin C
will increase.
A speech by Dr. Jeffrey Blumberg
emphasized the benefits of vitamin
C and E, and the misleading media
coverage of hazards of antioxidants
G
To be
determined
After the 2009 LPI
conference, the
number of people
taking vitamin E
will increase.
A speech by Dr. emphasized the
benefits of vitamin C and E, and the
misleading media coverage of
hazards of antioxidants
H
To be
determined
After the 2009 LPI
conference, the
number of people
taking vitamin K
supplements will
increase.
The 2009 LPI conference
emphasized the recently discovered
benefits of taking 360 to 500 mcg
viamin K daily
CONCLUSION
ASN regularly reports the need to disseminate accurate information about nutrition to the public. Neither a
professional symposium like the one held by the LPI nor the peer-reviewed research information distributed
through NutInv has contributed to a majority of participants making identical choices. Even with access to the
same results, people’s choices of what supplements to take vary tremendously.
REFERENCES
Harris, WS, n–3 Fatty acids and health: DaVinci's code, AJCN 88: 595-596 (2008)
Ordman, AB, Pilot Study for an age and gender-based nutrient signaling system for weight control, AGE 30(2):
201-8 (2008)
Ordman, AB, http://www.beloit.edu/nutrition/ln/N409litnotes.htm, Nutrition Investigator (2009a)
Ordman, AB, http://www.beloit.edu/nutrition/ln/zold/ln07maylpi.htm, Linus Pauling Institute Meeting
Summary (2009b)
Picciano, MF and McGuire MK, Use of dietary supplements by pregnant and lactating women in North
America, AJCN 89: 663S - 667S (2009)
Smith, SM, Gardner, KK, Locke, J and Zwart, SR, Vitamin D supplementation during Antarctic winter, AJCN
89, 1092-1098 (2009)
ACKNOWLEDGEMENTS
21%
6%
11%
9%
0%
Beloit College for use of Survey Monkey
Jennifer Stitt of Beloit College Institutional Research and Planning for technical construction of SurveyMonkey questionnaire
Beloit College Institutional Review Board for project approval