The Health of Our Nation

Inner Peace Formula

Natural Dietary Supplements

Get Instant Access

As a nation we have made significant progress in controlling many diseases and reducing mortality rates through public health programs, research, education, health care, and advances in medical technology. Vaccination and food fortification programs have virtually eliminated some of the most devastating diseases, such as polio, typhoid, and rickets, common in previous generations. But chronic diseases associated with aging and longer life expectancies, especially among racial and ethnic groups, have brought new challenges. Americans reporting fair or poor health due to chronic health conditions increases significantly with age.12

In 2004, Americans spent more money on health care than any other country, spending an average of about $6,280 per person.13 While most

Americans have private health insurance, health costs have risen dramatically and the insurance industry has increasingly shifted health care costs onto the consumer, mostly through out-of-pocket expenses. Between 1997 and 2002, consumer out-of-pocket health care expenses increased from 17 to 20 percent. Prescription drug costs represented about 23 percent of total out-of-pocket expenses for those aged 55 to 64. Added to increasing health care costs is the burden of the uninsured. In 2003, 17 percent of Americans under the age of 65 years, in a minority group, or with incomes below or at poverty level were uninsured.14

Dissatisfied with conventional health care and concerned about pharmaceutical side effects, increasing numbers of patients are being drawn to the use of CAM therapies. CAM therapies include health care practices and products that are not usually prescribed by conventional medical practitioners. They include acupuncture, Aruveyda, chiropractic and massage therapies, special diets, and vitamin/mineral/antioxidant and megavitamin therapies. In 1994, 40 percent of the general public reported CAM use and Americans spent between $36 billion to $47 billion on CAM therapies in 1997—mostly out-of-pocket.15 The majority of CAM users are educated, affluent, and were between the ages of 30 and 49. Their expressed dissatisfaction with conventional medicines' ability to treat chronic illness was cited as the main reason they turned to CAM therapies.16

Increases in life expectancy, chronic disease incidence, uninsured and out-of-pocket health care expenses, and a changing attitude toward conventional medicine with a trend toward self-care, finds American consumers more focused on disease prevention and management than ever before. The perceived benefits that antioxidant supplements represent—improved disease management, decreased effects of aging, and lowering of health care expenses—has become very appealing to the average American.

There is no doubt that media attention about the health benefits of dietary antioxidants and CAM therapies influence their use. A survey by the American Dietetic Association (ADA) in 2000 found that most Americans become educated about food, nutrition, and health via media sources. Table 1.1 shows that only 11 percent of Americans learn about nutrition and health from a physician as opposed to 48 percent who learn about it from television.17

But media sources have often lacked a complete scientific understanding and confusion and misinformation often is the result. Sixty-eight percent of respondents in a National Health Council Survey agreed with the statement, "When reporting medical and health news, the media often contradict themselves, so I don't know what to believe." A Rodale Press survey found that most consumers find stories about vitamins, supplements, and nutrition to be the most confusing of all reported health stories. As a result, the International Information Council (IFIC) Foundation and the Harvard School of Public Health convened an advisory group in 2003 to examine health and media communication, issuing guidelines for more responsible health communication practices by the media.18

Table 1.1

Information Sources from which Americans Learn about Food, Nutrition, and Health Topics

Table 1.1

Information Sources from which Americans Learn about Food, Nutrition, and Health Topics

Information Source

Percent (%) of Americans

Television

48%

Magazines

47%

Newspapers

18%

Books

12%

Family/Friends

11%

Doctor

11%

Internet

6%

Radio

5%

Source: Data from American Dietetic Association, "Nutrition and You: Trends 2000: What Do Americans Think, Need, Expect?" Journal of American Dietetic Association 100 no. 6 (2000): 626-627.

Source: Data from American Dietetic Association, "Nutrition and You: Trends 2000: What Do Americans Think, Need, Expect?" Journal of American Dietetic Association 100 no. 6 (2000): 626-627.

But even though Americans often express confusion, dietary supplement use continues to increase. Sales of vitamin A increased by 100 percent, vitamin C by 42 percent, and vitamin E by 178 percent between 1987 and 2000.19 Negative press reports can also affect vitamin use, often with more lasting effects. Sales of vitamin E after 2000 offer a striking illustration. A meta-analysis study published in 200420 found negative health outcomes when large doses of vitamin E supplements were taken. The negative press surrounding this study resulted in an almost 40 percent decline in vitamin E sales, which still have not rebounded to previous levels.21

Attempts to estimate conclusive supplement use in the United States is elusive. Surveys analyzing American eating habits began in 1935, but comprehensive studies of health and nutrition status began with the passage of the National Health Survey Act of 1956. This legislation provided a way to evaluate current trends of illness and disability in the United States on a continuous basis. The survey that resulted from this Act was called the National Health Interview Survey (NHIS) and is still conducted today by the National Center for Health Statistics (NCHS). The United States Department of Agriculture (USDA), NCHS, and the FDA fund the most reliable and scientific surveys. Survey results are analyzed and the information is used to develop public health policies.

Studies about diet and nutrition habits are traditionally retrospective studies—a look back at past food intake by a statistical representation of the population using interviews or questionnaires. This preferred study method is less costly and labor intensive and can be applied to large populations. Accuracy of the data depends on questionnaire design, skill of the interviewer, adequate size and representative population sample, response rate, and accuracy of data collection and analysis. Data collection and survey formats have evolved over time. Food recalls, varying between twenty-four hours and seven days, have been used with questions about supplements and medicines added over time. The most informative nutrition and health surveys are the NHIS, Nationwide Food Consumption Survey (NFCS), the Continuing Survey of Food Intakes by Individuals (CSFII), the National Health Examination Surveys (NHES), The Ten State Survey, and the Health and Nutrition Examination Survey (NHANES). Other studies, such as the Diet and Health Knowledge Survey (DHKS) and Health and Diet Survey, provide information about consumer food awareness, attitudes, practices, and expenditures. In an effort to establish a diet/nutrition link and reduce costs and duplication efforts, the NHES and CSFII were incorporated into the NHANES.

NHANES is one of the most comprehensive and objective national surveys conducted today, studying a representative sample of the U.S. population using direct interview, physical examination, and medical record reviews to analyze health, lifestyle, and diet. All other surveys rely on self-reported information. NHANES surveys were completed between 1971 and 1975 (NHANES I), 1976 and 1980 (NHANES II), and 1982 and 1984 (HHANES-Hispanic population). The 1988 to 1994 NHANES III included more specific questions about dietary supplement use for the first time. Beginning in 1999, the Continuous NHANES was implemented and smaller representative population samples began to be studied annually. Since most individuals tend to under-report what they eat and data is dependent on individual memory, random errors can be significant. Therefore, data collected from the National Eating Trends Survey, directed by the business company NPD Group, is combined periodically into the NHANES to keep the database as accurate as possible.

The Continuous NHANES (1999 to 2000) found about 52 percent of adults took a dietary supplement over the past year. This showed a steady increase in use from 40 percent reported in the NHANES III, 35 percent in the NHANES II, and 23 percent in the NHANES I. Characteristics of reported supplement users, shown in Table 1.2, revealed that the majority were women, over the age of 60, white, educated, physically active, and already practicing healthy lifestyle habits. The most popular supplements consumed were multivitamins/multiminerals (35%) followed by vitamin E (12.7%), vitamin C (12.4%), and calcium (10.4%; 25.5% if taken as an antacid).22 Of the 1900 reported supplements taken by consumers, 47 percent contained at least one antioxidant (see Figure 1.2).23

Other scientific studies, summarized in Figure 1.3, such as the NHIS, CSFII, and the American Dietetic Association (ADA) Nutrition and You Trends: 2000, found similar results.24

In general, the NHANES results have been regarded as a conservative estimate of dietary supplement use in America. Despite safeguards, the general opinion of the IOM is that this data underreports actual intakes and may be preconceived in some cases. But the NHANES still provides a snapshot of nutrient intakes by the U.S. population and provides a way of assessing needs. Other surveys find supplement use is higher than the NHANES reports. The 2002 Health and Diet Survey reported 73 percent of Americans took

Table 1.2

Characteristics and Percent (%) of Antioxidant Dietary Supplement Users

Table 1.2

Characteristics and Percent (%) of Antioxidant Dietary Supplement Users

Characteristic

supplement

MVI/MM

Vt. A

Vt. C

Vt. E

Selenium

Total

52.0%

35.0%

1.3%

12.4%

12.7%

1.1%

Male

46.9%

31.7%

1.2%

12.2%

11.7%

1.1%

Female

56.7%

38.0%

1.5%

12.6%

13.5%

1.0%

Age

20-39

43.3%

30.4%

1.0%

8.9%

4.4%

0.4%

40-59

56.1%

37.8%

1.5%

13.7%

15.3%

1.6%

>60

63.3%

39.8%

1.8%

17.3%

25.3%

1.6%

Non-Hispanic White

58.2%

39.8%

N.D.

14.7%

15.5%

N.D.

Non-Hispanic Black

36.0%

23.0%

N.D.

5.1%

5.4%

N.D.

Mexican American

33.3%

20.5%

N.D.

4.5%

4.9%

N.D.

<High school

34.7%

21.4%

N.D.

5.7%

7.5%

N.D.

education

High school

48.4%

30.5%

N.D.

9.9%

11.2%

N.D.

education

>High school

62.2%

43.9%

N.D.

16.9%

16.0%

N.D.

education

BMI

N.D.

N.D.

<25.0

56.8%

39.5%

13.1%

12.9%

25-30

51.7%

34.3%

13.1%

14.0%

>30.0

46.3%

30.1%

10.8%

10.7%

Exercise

N.D.

N.D.

none

42.5%

26.4%

10.2%

10.2%

moderate

58.9%

40.6%

13.7%

15.3%

vigorous

58.5%

41.3%

14.0%

13.7%

Health

N.D.

N.D.

Excellent

54.9%

38.8%

13.5%

13.2%

Good

49.6%

31.6%

12.2%

12.4%

Fair/poor

46.7%

28.5%

8.7%

11.6%

Cigarette use

N.D.

N.D.

never

52.2%

36.0%

12.8%

13.9%

former

61.2%

41.6%

14.8%

16.7%

current

43.0%

26.6%

9.2%

6.3%

Beer/wine/spirits

N.D.

N.D.

Never

47-53%

31-34%

10-12%

11-14%

1-4 times/mth

52-59%

35-40%

12-16%

12-16%

> 5 times/mth

50-72%

36-51%

14-23%

11-24%

MVI = multivitamin; MM = multimineral;N.D. = No data

Source: Adapted from Kathy Radimer, et al., "Dietary Supplement Use by US Adults: Data from the National Health and Nutrition Examination Survey, 1999-2000," American Journal of Epidemiology 160 (2004): 339-349.

MVI = multivitamin; MM = multimineral;N.D. = No data

Source: Adapted from Kathy Radimer, et al., "Dietary Supplement Use by US Adults: Data from the National Health and Nutrition Examination Survey, 1999-2000," American Journal of Epidemiology 160 (2004): 339-349.

supplements. Of those acknowledged supplement users, 85 percent took a multivitamin/multimineral, 77 percent took a single ingredient vitamin, and 42 percent took other supplements.25 Food marketing, consumer magazines, and Internet quick polls estimate use to be even higher. A Prevention Magazine survey in 2001 found 85 percent of adults queried reported taking a daily dietary supplement over the past year.26 Although much smaller sample sizes

Figure 1.2

Number of Supplements Containing Antioxidants (NHANES 1999-2000)

800 700

E 500 3

800 700

E 500 3

Flavonoids Isoflavones Vitamin E Vitamin C Beta-carotene Selenium

Supplement

Flavonoids Isoflavones Vitamin E Vitamin C Beta-carotene Selenium

Supplement

Figure 1.3

Percent of Americans Using Dietary Supplements

Figure 1.3

Percent of Americans Using Dietary Supplements

1 1985-2000 1970-1980

Study

1 1985-2000 1970-1980

Study

Series1

and self-reporting methods were used for these surveys, they shed some insight into consumer attitude and behavior regarding dietary supplements.

Many Americans assume dietary supplements are closely regulated by the government. Because of this belief, nearly two-thirds of consumers believe supplements are safe to take.27 Between 50 percent and 72 percent taking daily supplements did so to treat or prevent illness, to feel better, or to live longer. Fifty-three percent of those taking functional foods/nutraceuticals believe they offer benefits drugs do not and 56 percent felt they were comparable to drugs but with fewer side effects. Ninety-five percent were satisfied with the supplements they took. Not surprisingly, only 33 percent took them on the advice of their physician.28

A recent Health and Wellness Trend Report by the National Marketing Institute (NMI) found consumers associate antioxidant supplements with cancer prevention (32%), immune function (23%), and heart health (17%). Adults with medical conditions were more likely to take a dietary supplement. Nearly 81 percent of breast cancer survivors, with a high risk for recurrence, reported taking regular supplements and men with coronary artery disease, hypercholes-terolemia, and hypertension were more likely to take vitamin E supplements as well.29 Even more alarming is that most regular supplement and functional food/nutraceutical users, particularly those taking prescription medications, never tell their physician they are taking them because they believe the doctor knows little about them or may be biased against their use. Many supplement users have indicated they would continue to take supplements even if scientific studies proved them to be ineffective.30

Was this article helpful?

0 0
Your Heart and Nutrition

Your Heart and Nutrition

Prevention is better than a cure. Learn how to cherish your heart by taking the necessary means to keep it pumping healthily and steadily through your life.

Get My Free Ebook


Post a comment