Who takes supplements?

Data from the second National Health and Nutrition Examination Survey (NHANES II) suggest that almost 35 per cent of Americans between 18 and 74 years of age take vitamin and mineral supplements regularly. Other surveys put the figure much higher. In 1988, Americans spent approximately $2-2.5 billion on vitamin and mineral supplements. The total amount spent on foods and pill supplements for health benefits was $6 billion. Nutritional supplements are big business and marketing hype often starts where the scientific evidence ends.

Those who use supplements tend to be older, have higher income and higher education levels. However, statistics also show that those with higher nutrient intakes are more likely to take vitamin supplements. This means that, in many cases, supplements are taken most often by those who need them least.

The most popular supplements are multivitamins, vitamin C, vitamin E, B complex, calcium and magnesium. Recent media coverage of the benefits of herbs such as Echinacea, St John’s wort and Ginkgo means that these are also very popular. Women are more likely to use supplements than men, and most people who take them tend to do so because they feel that their food is of poor quality and contains toxic chemicals. Some people see supplements as health insurance and some take them for what they see as their specific benefits; for example, vitamin C for colds.

Who might need supplements?

Many people may benefit from a balanced vitamin and mineral supplement, including those who have irregular eating habits, skip meals, or eat large amounts of processed and refined foods. There are also certain groups of people who are at particular risk of nutrient deficiencies because of other lifestyle, environmental or disease factors. The following are some examples of those at risk.

Older people often have higher nutrient needs than younger ones due to lower dietary intake, reduced absorption and metabolism, and illness. Lack of appetite, loss of taste and smell, and denture problems can all contribute to a poor diet. Older people who eat alone or are depressed may also not eat enough to get all the nutrients you need from food. Those age 65 or older are likely to need to increase intake of several nutrients, particularly vitamin B6, vitamin B12 and vitamin D because of reduced absorption. They may benefit from supplements (See page 454 for more information.) There’s also evidence that a multivitamin may improve immune function and decrease the risk of infections in older people.
Premenopausal women may benefit from iron supplements as their diets are often low in this mineral and iron deficiency anemia is relatively common. However, there is evidence that too much iron can increase the risk of heart disease in those who are susceptible, and certain people should avoid iron supplements (See page 258 for more information.)

Postmenopausal women have high calcium needs (up to 1500 mg per day in those not taking hormone replacement therapy). This amount is not usually found in multivitamin supplements as it is too bulky and separate supplements may be useful (See page 197 for more information.) Higher vitamin D intake is also necessary.

It is worth considering taking extra vitamin C, vitamin E and beta carotene as several studies show that these vitamins in large doses may help protect against aging-related disorders such as cancer, heart disease, diabetes and cataracts. This may be particularly important in those who have a family history of such diseases.

Pregnant women are routinely prescribed folic acid supplements to prevent neural tube defects; and calcium, iron and zinc requirements also substantially increase.

Someone who is chronically ill has higher nutrient needs and may find vitamin and mineral supplements useful, particularly if they are taking long- term medications.

Supplements may also be beneficial for those on weight loss diets. Many people, particularly women, eat low calorie diets which are inadequate in iron, calcium and zinc.

If your diet has limited variety due to intolerance or allergy, you may benefit from a vitamin-mineral supplement.
Diseases of the liver, gallbladder, intestine and pancreas, or digestive tract surgery, may interfere with normal digestion and absorption of nutrients. Anyone with one of these conditions may be advised to supplement with vitamins and minerals.
Strict vegetarians who avoid meat and dairy products must obtain vitamin B12 from supplements. They may also benefit from extra iron, calcium and zinc.

Those who smoke may benefit from vitamin C supplements. Smoking reduces vitamin C levels and causes production of harmful free radicals.

Those who drink a large amount of alcohol may need supplements. Alcohol affects the absorption, metabolism and excretion of vitamins.

Those under physical or emotional stress may also benefit from supplements.