Bio: Risa Latinka is a senior studying Dietetics and Global Health at the University of Arizona. She is a lacto-ovo-vegetarian and enjoys trying new recipes when not studying, working, volunteering or watching Netflix. She’s interested in community nutrition and international nutrition. She aspires to get an MPH and become a RD.
Supplement Use in the United States
In 2014, $5.7 billion was spent on multivitamin and mineral (MVM) supplements in the United States. Many MVMs contain most or all of the micronutrients (vitamins and minerals) in adequate amounts that help the consumer meet the Dietary Reference Intakes (DRIs) and are specially formulated for different life stages because our nutritional needs change as we get older.1
According to an analysis of National Health and Nutrition Examination Survey (NHANES) data, 33% of the American population aged 1 year and older took an MVM in a given month. Further analysis shows MVM use is more common among women and their children; the elderly; those with higher education levels, higher incomes, healthier lifestyles, and lower body-mass indexes; and residents of the western United States. MVM use is lowest among smokers, African Americans, Hispanics, and Native Americans.1
The 2015-2020 Dietary Guidelines for Americans emphasizes that foods should be the primary provider of our nutritional needs and that “fortified foods and dietary supplements may be useful in providing nutrients may be useful in providing one or more nutrients that otherwise may be consumed in less-than recommended amounts.”2 The logic behind this statement is that fruits and vegetables contain phytonutrients which have beneficial effects such as reducing the risk of developing cardiovascular disease or certain types of cancer. Phytonutrients found in supplements may not be as effective as their whole food counterparts.
Which, if any, Americans should be consuming a MVM daily? There are some factors that need to be taken into consideration. If you consume an adequate diet that is well balanced in all of the food groups, then chances are you don’t need a daily MVM. Unfortunately, the American diet is low in vegetables, fruits, and dairy products which are good sources of many micronutrients.2
One of the most well-known, supplement-taking population is expecting mothers. Most Americans know the importance of taking prenatal vitamins due to the increased needs of the mother and baby. Another group that can benefit from taking an MVM is the elderly population. People in this age group commonly suffer from difficulties eating and swallowing, decreased appetites, and dementia which all affect their nutrition status. In both situations, a MVM can be taken to fill in the gaps and meet the DRIs.
Clinical Uses of Supplements in Disease States
In recent years, there has been a lot of research involving supplements and their effects on many different diseases. In all of the literature that I have read, the conclusion is that more research needs to be done to ensure the safety and efficacy of using supplements as primary treatment. A typical MVM contains adequate amounts of folic acid, iron, vitamin B12, and vitamin D that can help prevent anemias, neural tube defects, and bone disease.3 In addition to these disorders and diseases, there are other clinical uses of supplements.
Hypertriglyceridemia, or elevated triglyceride levels, affects 33% of the American population and is associated with an increased risk of developing cardiovascular disease and acute pancreatitis.4 There are many medications that are currently being used to treat hypertriglyceridemia and two medications include high doses of micronutrients. Niacin, or vitamin B3, lowered triglycerides levels by 20%, increased HDL by 16%, and decreased LDL by 12%. Niacin has also been shown to reduce the rates of cardiovascular events and improve coronary atherosclerosis.4 The second type of drug is the consumption of around 4g of long-chain omega-3 fatty acids. These medications, on average, lowered triglyceride levels by 25-34% and increased HDL levels by 1-3%. In addition, LDL levels were increased by 5-11%.4 It should be noted that these medications are prescribed by a physician and taking the same dosage of over the counter supplements is not recommended.
Many gastrointestinal (GI) disorders require supplementation due to malabsorption, maldigestion, and/or diarrhea. Gastritis, or inflammation of the stomach, requires a vitamin B12 supplement due to the lack of intrinsic factor which is involved in the absorption of B12.5 General malabsorption and increased losses in patients with Celiac disease or irritable bowel syndrome should also take a daily MVM to ensure that all DRIs are met. When some GI disorders damage sections of the GI tract, those sections have to be removed and their removal may cause micronutrient deficiencies. For ileal resections, fat soluble vitamins, calcium, magnesium, and zinc should be supplemented. For ileostomies, vitamin C and folate should be supplemented due to low fruit and vegetable intake. For colectomies, vitamin B12 should be supplemented.5
Drug and Nutrient Interactions
Certain drugs can also cause nutrient deficiencies even if the person is consuming a well-balanced diet that is providing adequate levels of all micronutrients. For this specific population, supplementation is often recommended to ensure adequate levels are consumed while taking the medication. Thiazide diuretics which are used to treat high blood pressure and edema may cause deficiencies in magnesium, potassium, sodium, and zinc.6 For patients with asthma or other airway diseases inhalers are often prescribed which may cause deficiencies in calcium, magnesium, phosphate, and potassium.6 Metformin is popular drug to treat type 2 Diabetes and may cause deficiencies in folic acid and vitamin B12.6 These are just three examples of how drugs may cause nutritional deficiencies, but the list is much more extensivethan this. It is extremely important that professionals are aware of these interactions and inform their patients to avoid the consequences of nutrient deficiencies.
Nutrient deficiencies are common in the United States due to the lack of fruits and vegetables in our diet. Eating a well-balanced diet would be the preferred method to eliminate the deficiencies, but picky eaters and those who may not have access to fresh produce may benefit from a daily MVM. In addition, people with certain diseases or taking certain medication should also consider supplementation. Dietary supplements do have a place in medical care today.
1. Office of Dietary Supplements. Multivitamin/mineral supplements. Office of Dietary Supplements website. Last updated July 8, 2015. Available at: https://ods.od.nih.gov/factsheets/mvms-healthprofessional/. Accessed February 12, 2016.
2. U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015 – 2020 Dietary Guidelines for Americans. 8th Edition. December 2015. Available at http://health.gov/dietaryguidelines/2015/guidelines/. Accessed February 12, 2016.
3. Ward, E. Addressing nutritional gaps with multivitamin and mineral supplements. Nutrition Journal Nutr J. 2014;13(1):72.
4. Ito MK. Long-chain omega-3 fatty acids, fibrates and niacin as therapeutic options in the treatment of hypertriglyceridemia: a review of the literature.Atherosclerosis. 2015;242:647-656.
5. Mahan, LK, Escott-Stump, S, Raymond, JL, Krause, MV. Krause's food & the nutrition care process. St. Louis, MO: Elsevier/Saunders; 2012.
6. Moss M. Drugs as anti-nutrients. Journal of Nutritional and Environmental Medicine. 2007;16:149-166.