What Multivitamins do Health Professionals Choose?
Nutrition is confusing. It is frustrating too because we really don’t know our nutrient status unless we get a blood test. The most recent National Health and Nutrition Examination Survey (1999-2006) using blood lab tests reports that the prevalence of nutrient deficiencies hasn’t changed for vitamin B6, iron, vitamin D, vitamin C, vitamin B12, vitamin A, vitamin E and folate. Without this information, how does one know if they should be using dietary supplements? To answer this question, let’s examine the practices of health professionals.
Rautianien and colleagues examined multivitamin use in middle-aged men participating in the Physicians’ Health Study. Based on self-reported information, the 18,040 males were categorized as: 1) no supplement use, 2) use of multivitamins only, 3) use of multivitamins with other individual vitamin/mineral supplements, and 4) use of other supplements only. 36% of the physicians reported using multivitamin supplements. Like many Americans, many physicians were hypertensive (42%) and hypercholesterolemic (445). Despite their knowledge of medicine and health, these physicians ate ~5 servings of fruit and vegetables and <2 servings of whle grains daily, less than half of the number of servings of fruit, vegetables, and whole grains recommended by the DASH diet to control blood pressure or the American Heart Association for heart health. Their nutrient shortfalls must have been significant because Figure 1 shows the greatest change in health score was seen in those using 3 or more supplements simultaneously.
According to results from the Nurses’ Health Study and Health Professionals Follow-up Study, multivitamin supplement use increased from 43% in 1986 to 74% in 2006 (Kim et al, 2013). This is the period that the Physicians’ Health Study was conducted. After multivitamins, Kim and colleagues found the most common supplements used by health professionals in 2006 were calcium (65%), vitamin D (32%), vitamin C (28%), and vitamin E (20%). Usage was pretty stable between 2002 and 2006 except for vitamin D (which increased from 25%) and vitamin E (which decreased from 44%).
National surveys find that people using dietary supplements have higher vitamin intakes from foods than non-users. Supplement users are less likely to have inadequate vitamin intakes (Bailey et al, 2012). In other words, people who don’t use dietary supplements would benefit the most by changing that habit (or their diet) because they are more likely to have suboptimal nutrient status. Age, sec, and race/ethnicity significantly affect vitamin status but supplement use and smoking are the most significant influencers (Pfeiffer et al, 2013). To reiterate, people not taking supplements need them the most. According to today’s main citation, the best chances of obtaining a 3-unit increase in health score is by using a multivitamin and at least 4 other dietary supplements.
Ideally, we should be making healthy choices to obtain all the nutrients needed from the foods we eat. But too often, we fail. If you were to follow the most common practices of health professionals, the ‘other 4 dietary supplements’ of choice are calcium, vitamin D, vitamin C and vitamin E.
Rautiainen S, Wang L, Gaziano JM, Sesso HD. Who uses multivitamins? A cross-sectional study in the Physicians’ Health Study. 2013 Eur J Nutr doi:10.1007/s00394-013-0608-5
Bailey RL, Fulgoni VL, Keast DR, Dwyer JT. Examination of vitamin intakes among US adults by dietary supplement use. 2012 J Acad Nutr Diet doi: 10.1016/j.jand.2012.01.026
Kim HJ, Giovannucci E, Rosner B, Willett WC, Cho E. Longitudinal and secular trends in dietary supplement use: Nurses’ Health Study and Health Professionals Follow-up Study, 1988-2006. 2013 J Acad Nutr Diet doi:10.1016.j.jand.2013.07.039
Pfeiffer CM, Sternberg MR, Schleicher RL, Rybak ME. Dietary supplement use and smoking are important correlates of biomarkers of water-soluble vitamin status after adjusting for socioedemographic and lifestyle variables in a representative sample of US adults. 2013 J Nutr doi:10.3945/jn.112.173021