A CONSENSUS ON WHAT SUPPLEMENTS TO TAKEHan Lai and Alfred B. Ordman*

Biochemistry Program, Beloit College, Beloit, WI 53511

ABSTRACTAt 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.

INTRODUCTION

CONCLUSIONASN 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

DISCUSSION

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 peer-reviewed 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

Supplement taken Men Women Any 47% 58% Multivitamin/ multimineral 30% 37% Vitamin E 10% 12% Vitamin C 11% 11% Calcium 3% 11% Antacid calcium 13% 20% B-complex 3% 4%

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

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.

METHODThe 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.

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)

ACKNOWLEDGEMENTSBeloit College for use of Survey MonkeyJennifer Stitt of Beloit College Institutional Research and Planning for technical construction of SurveyMonkey questionnaireBeloit College Institutional Review Board for project approval

Table 3: Survey Questions

PART 1 - MULTI USE choices MULTIVITAMINMULTIVITAMIN/MINERAL B-COMPLEX OTHER COMPLEXPART 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)

Table 4: Response rate to survey inquiries

Table 6. Hypothesis A. The majority in LPI group exercises regularlyExercise LPI NutInv ClinTrial M M F F M M F F Over

50 young Over

50 young Over

50 young Over

50 young

Regularly 82

100

80

80

88

80

79

70

69

Strength 27

50

40

60

35

20

32

22

46

Aerob ic 27

62

40

60

41

33

36

41

38

flexibility 18

50

40

60

47

33

43

37

38

wa lking 64

50

60

40

59

33

61

41

46

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 Tota l taken

LPI Nut Inv

ClinTrial

M over 50

Male young

Female over 50

Female young

Male over 50

Male young

Female over 50

Female young

None 9% 12 20 20 0% 33 4 35 23%

1-4 27% 38 40 60 35% 60 39 82 62% 5-9 45% 38 40 20 41% 7 50 4 8% 10+ 18% 12 0 0 24% 0 7 6 8%

Age Education Group Inquiries

Sent Responses received %

18-40

% 40-55

% over 55

No response

% college

%MD %PhD

LPI 158 3 3 1 5 3 6 3 6 1 2 9 1 2 1 .2 5 2

Nut Inv 306 9 7 2 8 2 5 3 7 1 0 4 9 4 .9 1 3

ClinTrial 29 1 3 3 1 4 6 8 1 5 5 4 0 1 5

Table 8. Hypothesis C. Most people in LPI group and in Nutrition Investigator take vitamin D, 1000 IUs or moreVitamin D LPI NutInv ClinTrial none 45% 46% 69% 200-399 3% 8%

400-999 15% 18% 31% 1000 to 1999

15% 15%

2000+ 21% 11% Twice daily

6% 9% 0%

Table 9. Hypothesis D. Most people over 60 in LPI group and in Nutrition Investigator take 2000 IU vitamin D dailyPeople 60 or older taking vitamin D

LPI NutInv ClinTrial

none 50 45 100% Some but less than 2000 28 39 0% 2000+ 22 16 0%

Table 10. Hypothesis E. Most people over 50 in the LPI and Nutrition Investigator groups take aspirin regularly

People 50 or older taking aspirin

LPI

NutInv

ClinTrial

Do not take aspirin 61% 56% 50% Do take aspirin 39% 44% 50%

Table 11. Hypothesis F. People in the Nutrition Investigator group and the LPI group are more likely to take vitamin C Vitamin C LPI NutInv ClinTrial None 45% 41% 63% 60 to 500 26% 23% 39%

500 to 999 mg 19% 24% 8% 1000 to 1999 6% 8% 2000+ 10% 5% Twice daily 10% 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 LPI NutInv ClinTrial None 45% 45% 5 to 200 IU 18% 31% 100% 200-399 6% 3% 400-500 24% 20% 2000 or more 3% Twice daily 3% 0% 0%

Table 13. Hypothesis H. Other supplements taken will include fish oil, SAMe, melatonin, and aspirin.Supplement LPI

% taking

NutInv %

taking

ClinTrial %

taking Fish oil 55 50 62 SAMe 12 6 8 Baby aspirin 9 15 8 Adult aspirin 15 8 23 Melatonin 21 8 8 Lipoic acid 24 7 0 N-acetyl-carnitine 12 2 8 Juvenon 9 1 0 Branched chain amino acids 0 6 0 Chondroitin/glucosamine 21 12 0

Table 14. Revised Hypotheses

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.

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, BALANCEPART 5 - PERSONAL INFORMATION FOR ANALYSIS MALE OR FEMALE AGE ______ YEARS WEIGHT _____ POUNDS OR ______KG GROUP EDUCATION

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.

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.

Table 5. People taking a daily multivitamin/mineral supplement Group Respondents % using a daily multi Lpi 33 61% Nutinv 97 70% clintrial 13 54% NHANES 2000 National survey 34%

Hypo-thesis

Eval-uation

Revised Hypothesis

Rationale for revision

A True The majority in all groups exercise regularly.

n/a

B True As people get older, they take more supplements.

n/a

C FalseIn 2008

After the 2009 LPI conference, more people 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

D False In 2008

After the 2009 LPI conference, 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 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