The Case for
Nutritional Supplements
In Primary
Prevention
Tim Wood, Ph.D.
Executive Vice
President, R&D
USANA Health
Sciences, Inc.
Executive Summary
The value of nutritional supplements in promoting and
protecting human health is intensely debated. Some argue that supplements
provide a convenient and effective means for supplying the optimal intakes of
essential nutrients that people need for good health. Others argue that
there is no conclusive evidence that supplements provide any true health
benefits at all. The latter argument has been bolstered over the past
several years by a steady stream of negative research reports published in
leading medical journals.
This paper examines the supplement debate and questions
some of the recent evidence suggesting that nutritional supplements are
ineffective and unsafe. It is argued that much of the current controversy
and negativity surrounding nutritional supplements results from inappropriate
use of a pharmaceutical, acute-care model in the clinical evaluation of
nutritional products; products whose real value is in preventing rather than
treating disease. As a result of this mismatch, nutritional supplements
are often tested inappropriately, results of studies are interpreted less than
objectively, and valid but non-clinical evidence of benefit is often discounted
or ignored.
As a case in point, I focus on vitamin E supplements and
their role in preventing heart disease. But the central tenets raised in
this paper pertain to nutritional supplements in general, and to much broader
issues surrounding the field of primary prevention as a whole. We now spend
about $2.0 trillion dollars annually on healthcare in the
In this light, increased emphasis on primary prevention
holds tremendous potential for improving the effectiveness of our healthcare
system. Most Americans have the opportunity to add years of health to
their lives by embracing prudent lifestyle strategies and habits over the
long-term. Clearly, such strategies need to be broad-based, encompassing
diet, nutrition, exercise, stress management, and the avoidance of harmful
habits like smoking. And just as clearly, a program of responsible
supplementation, designed to compliment healthy eating habits and provide the
advanced levels of essential vitamins, minerals and antioxidants required for
lifelong health, can play an important role in this endeavor. The
science, when approached broadly with an open mind, is convincing on this
point.
ABOUT THE AUTHOR
Tim Wood is Executive Vice President of Research and
Development for USANA Health Sciences, Inc. He received his Ph.D. in the
Biological Sciences from
Introduction
The value of nutritional supplements in promoting and
protecting human health is intensely debated. Some argue that supplements
provide a convenient and effective means for supplying, on a daily basis, the optimal
intakes of essential nutrients that people need for good health. Others
argue that there is no conclusive evidence that supplements provide any true
health benefits at all. The latter argument has been bolstered over the
past several years by a steady stream of negative research reports published in
leading medical journals. Several such papers have concluded that
antioxidants and B vitamin supplements are ineffective at reducing the risks of
heart disease and cancer (Lee et al, 2006; Kirsh et al, 2006;Zoungas et al,
2006). Others have reported that calcium and vitamin D supplements
provide at best incomplete protection against osteoporosis (c.f. Jackson et al,
2006). Still others have questioned the safety of nutritional supplements
(c.f. Bjelakovic et al, 2004, Bairati et al, 2005; Miller et al, 2005).
Each time such studies appear, newspaper headlines blare “Supplements
Proven to Be Snake Oil” or “Vitamin E May Be Deadly”.
Morning talk shows feature doctors and alternative practitioners who argue over
the latest findings. Sadly, the public grows more confused about what to
believe concerning the role of nutrition and nutritional supplements in health.
This paper examines the supplement debate and questions
some of the recent evidence suggesting that nutritional supplements are
ineffective and unsafe. I argue that much of the current controversy and
negativity surrounding the benefits of nutritional supplements result from
inappropriate use of a pharmaceutical, acute-care model in the clinical
evaluation of nutritional products - products whose real value is in preventing
rather than treating disease. It is further argued that while the case
against supplements may be evidence-based, the relevance of much of that
evidence is questionable.
Healthcare versus Disease Management
This year, Americans will spend $2 trillion on healthcare
(Borger et al, 2006). This enormous sum represents about $7,000 in
healthcare spending for every man, woman, and child in the
In comparison, only 2% of our healthcare dollars are spent
on primary prevention - measures designed to keep healthy people healthy.
This despite the fact that all of the chronic degenerative diseases listed
above are highly preventable. It is estimated, for example, that 60-70%
of the current cases of heart disease could have been prevented through
improved nutrition, better exercise habits, avoidance of smoking, and the
adoption of other healthy lifestyle habits (Koop, 2002). Similar
statistics apply to the prevention of cancer, stroke, cataracts, osteoporosis,
and macular degeneration (c.f. Michel, 2002; Rosenthal, 2002). Type 2
diabetes is thought to be 90% preventable, largely through improved nutrition
and exercise (Hu et al, 2001).
This lopsided pattern in spending is a clear reflection of
today’s dominant healthcare paradigm; one that focuses on disease
treatment rather than disease prevention. Ours is a reactive as opposed
to proactive healthcare system. We wait for people to develop chronic
illnesses, and then we spend enormous amounts of money treating those
illnesses. The alternative, a focus on primary prevention and an
investment in keeping healthy people healthy, receives lip service, but is
largely ignored in practice. Clearly our healthcare system is less about
caring for health and more about managing disease.
It is also a system of high-tech, acute-care medicine
based on the promise of powerful, fast acting drugs and surgeries that produce
therapeutic results in hours, days or weeks. We spend tens of billions of
dollars every year on medical research in a quest to develop ever more
effective diagnostics, drugs, drug delivery systems, implants, and surgeries
(Meeks, 2002). And we spend billions more on patenting these
technologies. Why? Because our healthcare system is lucrative. It
is no accident that we spend $2 trillion annually on healthcare in the US, that
pharmaceutical companies rank among the most profitable in America, and that
our healthcare costs are rising at near double-digit rates that surpass
inflation and growth in our Gross Domestic Product (Polich, 2005; Borger et al,
2006).
To be sure, acute, treatment-based medicine is useful and
effective in dealing with urgent medical conditions such as trauma, infection,
or incipient heart attacks. However, our almost singular focus on reactive,
acute-care medicine also carries serious limitations, costs and
liabilities. This approach is not particularly effective in dealing with
chronic degenerative diseases like heart disease, cancer and
osteoporosis. After decades of research, we still have no reliable cures
for these diseases. We can treat them and manage them, but we cannot cure
them. Moreover, this approach is expensive, both in dollars spent and in
years of health lost to premature death and disability. Chronic diseases
rob far too many Americans of their health, independence, and quality of life
far too early (Michaud et al, 2001). Finally, acutely acting medicines
and surgeries have many undesirable side effects. Every year,
prescription drugs - taken as prescribed - injure more than 1.5 million
Americans so severely that they require hospitalization. One hundred
thousand others are killed by prescription drugs, making such medicines a
leading cause of death in the
A Vital Role for Primary Prevention
Is there a better way? I would argue that
rebalancing our healthcare system to include a larger emphasis on primary
prevention is an essential step. I would further argue that we can act
now. We know enough today about the principles of primary prevention, and
about the basics of a healthy lifestyle (nutrition, exercise, stress
management, avoidance of smoking, etc) to implement significant improvements
without delay. And I would argue that nutritional supplementation can
play a vital role in this arena.
The research is clear. Diet and nutrition play key
roles in supporting good health (WHO, 2003). It is equally clear that
Americans, as a whole suffer from generally poor nutritional habits (Frazao,
1999). As a nation we are overfed and undernourished. Two thirds of
American adults are overweight or obese (Flegal et al, 2002; Hedley et al,
2004), and high percentages of us are chronically deficient for one or more of
the essential vitamins, minerals and antioxidants (FASEB, 1995).
Some would argue that this problem lies in poor diet
alone; that all we need to do is eat better. Clearly, a healthy well
balanced diet is an absolute foundation for any program of optimal
nutrition. But is a healthy diet enough? Can we obtain
“optimal levels” of the essential vitamins, minerals, and
antioxidants on a routine basis from diet alone? Many, including myself,
argue “no”; that optimal intakes of the essential nutrients,
intakes required to optimize health and minimize the risk of chronic diseases, are
significantly higher than the amounts that can be obtained routinely from food
(and significantly higher than the current RDA’s). In my view,
optimal nutrition is best achieved through a combination of a healthy well
balanced diet plus a responsible program of nutritional supplementation.
In my view, a healthy diet and nutritional supplements are not mutually exclusive. This is not
an “either-or” proposition. It is an “and”
proposition.
Is there substantial scientific evidence to support this
notion? Yes. There are hundreds of scientific studies showing that
regular and responsible use of nutritional supplements can benefit
people’s health both in the short- and long-terms (
Why then, is the role of nutritional supplementation in
healthcare so hotly debated? Clearly, this is a complex issue, but I
believe that much of this debate stems from a fundamental incompatibility
between our current healthcare paradigm (acute, disease-focused medicine) and
the basic tenets of primary prevention. Moreover, current approaches to
medical research, geared largely toward the evaluation of acute, fast-acting
medicines and surgeries, are in most cases inappropriate for the study of
long-term primary preventive measures like nutritional supplementation.
As a result, nutritional supplements are often tested inappropriately, results
of studies are interpreted less than objectively, and valid but non-clinical
evidence of benefit is often discounted or ignored.
Conventional Medicine Looks at Vitamin E:
A Case in Point
These challenges are perhaps most evident in the
scientific literature concerning vitamin E supplements and heart disease.
In the early 1990’s, a large body of scientific evidence pointed to
oxidative stress as a disease process in the onset and progression of atherosclerosis.
This same research suggested in various ways that antioxidants like vitamin E
might be important in preventing this disorder. Numerous epidemiological
(population based) studies, many involving tens of thousands of subjects, concluded
with consistency that people who consumed high amounts of vitamin E through
diet and supplements were at 30-50% lower risk for heart attacks or death due
to heart disease relative to those people who consumed minimal amounts of
vitamin E (Stampfer et al, 1993; Rimm et al, 1993; Losonczy et al, 1996; Kushi
et al, 1996; Meyer et al, 1996). Typically, the levels of vitamin E that
were protective totaled hundreds of International Units per day, many times
higher than the Recommended dietary Allowance (RDA).
A. An Early
Clinical Evaluation
To further test this protective effect, clinical research
on vitamin E supplementation and heart disease was undertaken at several
centers. In January 2000, results from one of the first such studies were
published in the New England Journal of Medicine (Yusuf et al, 2000). The
Heart Outcomes Prevention Evaluation (HOPE) involved over 9,500 subjects 55
years of age or older who were at high risk for cardiovascular events because
they had advanced cardiovascular disease, diabetes, or similar risk
factors. Over half, in fact, had had a previous heart attack. Half
the subjects in the trial were assigned at random to take 400 IU daily of
natural-source vitamin E. The remainder were given placebo capsules.
Average follow-up was 4.5 years, during which time, subjects were monitored for
primary and secondary cardiovascular events such as nonfatal heart attacks,
stroke, angina, and death.
Results of the HOPE study showed that, after 4.5 years,
there were no significant differences in the numbers of heart attacks, strokes,
reports of angina, or deaths due to heart disease between the treatment and
placebo groups. The authors of the paper correctly and appropriately
concluded that “in patients at high
risk [emphasis added] for cardiovascular events, treatment with
vitamin E for 4.5 years has no apparent effect on cardiovascular
outcomes”.
Unfortunately, while the conclusions reached by the
authors were appropriate, much of the editorializing in the medical and popular
press was not. Instead, headlines and sound bites touted the results of
the HOPE study as conclusive proof that vitamin E supplements provided no
benefits for cardiovascular health. Others declared the findings as
“the last nail in the coffin for vitamin E”.
HOPE is only one of several clinical trials to have
evaluated the efficacy of vitamin E in preventing cardiovascular events in
high-risk groups. While two such trials showed significant benefit
(Stephens et al, 1996; Boaz et al, 2000), the majority, like the HOPE study,
produced disappointing results (GISSI-Prevenzione Investigators, 1999;
Collaborative Group of the PPP, 2001). Does this mean that vitamin E is
ineffective as a preventive agent? In answering this question, two
important issues need to be addressed.
First, the standard model for clinical research requires
testing one remedy (one drug) at a time, so that the true, isolated effect of
that drug can be identified and measured. This is good science.
However, it is not necessarily appropriate in the field of preventive
nutrition.
Humans require a full range of some 25-plus essential
vitamins, minerals, and antioxidants, in proper amounts and balances, to
support good health. This is because vitamins and minerals work in teams
to support, for example, robust energy metabolism and protein synthesis.
Similarly, antioxidants work most effectively in groups and networks (Packer
and Obermuller-Jevic, 2002), each playing a unique role in channeling and
quenching the chain-like series of oxidative reactions that can result from a
single oxidative event. As such, high-doses of a single nutrient
represent an incomplete and inappropriate approach to boosting overall
antioxidant protection. This would be analogous to testing the hypothesis
that broccoli has cancer-preventive properties by putting people on an all-
broccoli diet. It’s not likely to work, and it carries the risk of
creating nutrient imbalances, unwanted side effects, and experimental
artifacts.
Second, an important distinction needs to be drawn between
primary and secondary prevention. Primary prevention involves keeping
healthy people healthy. It is about preventing the development of
disorders like heart disease in the first place. Secondary prevention is
about preventing further progression of a disease that people already have
(CDC, 1992). Moreover, because chronic diseases like heart disease and
osteoporosis develop over a lifetime, primary prevention needs to be viewed as
a lifelong (decades long) undertaking. It is not something that is
accomplished over a year or a few years. Within this context, the HOPE
study was clearly a secondary prevention trial. It had nothing to do with
primary prevention. Study subjects were selected because they already had
advanced heart disease. Consequently, attributing the findings of this
study to the general (healthy) public is inappropriate.
Is it possible for something to be an effective primary
preventive agent without being an effective secondary preventive agent? I
believe so. Dentists tell us to floss our teeth to prevent tooth decay
and avoid the need for root canal surgery. If you were to select a group
of people with advanced tooth decay, many who had chronic tooth aches, and
divided them into two groups, telling one to floss regularly and the other to
refrain from flossing, what do you think would happen? Would the flossing
group experience significantly fewer tooth aches, fewer tooth extractions and
fewer root canal surgeries in the short-term? Probably not; the flossing
came too late in the day to change the course of existing disease.
A similar situation may exist with respect to vitamin E
and heart disease. It is very possible that vitamin E, acting as an
antioxidant over the long-term, may help to prevent atherosclerosis.
Epidemiological research certainly supports this notion. However, vitamin
E may be ineffective in preventing the rupture of existing atherosclerotic
plaques (thus triggering a heart attack, stroke, or cardiovascular
death). The HOPE trial and similar clinical studies support this
notion. As such, vitamin E supplementation may be an effective long-term
measure for the primary prevention of heart disease, while being an ineffective
short-term secondary prevention measure or cure (Lewis, 2004). Clearly
this hypothesis deserves attention, and the following study put it to the test.
B. Vitamin E and
the Primary Prevention of Heart Disease
In 2005, the results of a clinical trial on vitamin E supplementation
for primary prevention of heart disease and cancer were published in the
Journal of the American Medical Association (Lee et al, 2005). This
randomized placebo-controlled study involved almost 40,000 women at least 45
years of age who had no history of heart disease or cancer. Half of the
women were assigned to the vitamin E treatment (600 IU natural-source vitamin E
every other day). Half were assigned to placebo. Average follow-up
was just over 10 years. As such, this trial differed from the HOPE study
in that it was a true primary prevention trial. Moreover, it lasted a
full decade, an improvement over HOPE’s 4.5 year duration.
Results of the study indicated that vitamin E had no
effect on cancer incidence or cancer mortality. However, there were
notable benefits for cardiovascular health. Overall, vitamin E use showed
a protective trend toward reducing the risk of total major cardiovascular
events among all women in the study. While individual impacts on heart
attacks and stroke were nil, there was a statistically significant 24%
reduction in cardiovascular deaths among women in the vitamin E group.
And importantly, when the data for women at least 65 years old were examined
separately, there was a significant 26% reduction in major cardiovascular
events, which included a 34% reduction in nonfatal heart attacks and a 49%
reduction in cardiovascular death. These are very significant protective
effects, and they are particularly relevant because women tend to suffer from
heart disease in their senior years following menopause (Mosca et al,
1997). As such, if vitamin E were to have an effect, it would likely be
most pronounced in this age group.
Despite these findings, the conclusions reported in the
abstract of the study were as follows.
“The data
from this large trial indicated that 600 IU of natural-source vitamin E taken
every other day provided no overall benefit for major cardiovascular events or
cancer, did not affect total mortality, and decreased cardiovascular mortality
in healthy women. These data do not support recommending vitamin E
supplementation for cardiovascular disease or cancer prevention among healthy
women.”
This despite the fact that vitamin E supplements reduced
cardiovascular deaths by 24% across all women and by 49% among women 65 years
or older. Why was this benefit largely ignored? Because
cardiovascular death, while measured in the study, was not a specified clinical
parameter – in other words, because the study was not specifically
designed to report on this benefit. So instead the authors concluded
there was “no overall benefit” and that the results of the study
“[did] not support recommending vitamin E supplementation for healthy
women.”
These conclusions appear less than objective, and they beg
the question of bias against nutritional supplements, or primary prevention, or
both in the medical community. Would it not have been more appropriate to
conclude that vitamin E had an apparent primary preventive effect against heart
disease in women, and that the benefits were most significant in senior
women…the group at highest risk for suffering a major cardiovascular
event? I will return to this point later.
C. The Safety of
Vitamin E is Questioned
In January 2005, a research article entitled
“Meta-Analysis: High-Dosage Vitamin E Supplementation May Increase
All-Cause Mortality” was published in the Annals of Internal Medicine, a
respected medical journal (Miller et al, 2005). This study called the
safety of vitamin E supplements into question. It was conducted by
scientists at Johns Hopkins Medical Institutions who pooled the results of 19
clinical trials involving vitamin E supplementation at doses of 16 to 2,000 IU
per day. In total, the 19 trials included almost 136,000 subjects.
In none of the individual trials was a statistically significant increase in
mortality observed from vitamin E supplementation. But when the 19 trials
were examined together, there were weak but apparent trends towards decreased
mortality in subjects taking low doses of vitamin E (< 400 IU/d) and
increased mortality in subjects taking high doses of vitamin E (³ 400
IU/d). The overall conclusion of the statistical analysis was that
high-dose vitamin E may increase the risk of all-cause mortality by about 5%,
and therefore, should be avoided.
Could the results be real? Yes, it is
possible. At high doses, some essential nutrients can produce imbalances
and adverse effects (Hathcock, 1997a). Nevertheless, three important
points argue against the conclusions of this study. First, the toxicology
and safety of vitamin E have been extensively reviewed, and experts agree that
tolerable upper intakes are on the order of 1000 mg per day (about 1500 IU per
day) (Hathcock, 1997b, Food and Nutrition Board, Hathcock et al, 2005).
Second, several large epidemiological studies that identified and followed
groups of people consuming high doses of vitamin E (>400 IU/d) over the
long-term, did not show increased risk of mortality. In fact they
generally showed a reduced risk of dying relative to those people consuming the
least amounts of vitamin E (Stampfer et al, 1993; Rimm et al 1993; Losonczy et
al, 1996; Meyer et al, 1996; Kushi 1999).
Third, while it is possible that high-dose vitamin E could
have adverse effects for certain groups, the Johns Hopkins study did not
provide conclusive evidence of harm. The study suffered from several
important weaknesses. As noted by the authors themselves, all of the
studies included in the meta-analysis were conducted on subjects who were
chronically ill. They included patients with heart disease, cancer,
Alzheimer’s disease, type 2 diabetes, or related disorders. In
short, the subjects were at high risk for dying to begin with. In
addition, many of the studies included in the analysis were small, containing
several hundred as opposed to several thousand subjects. And in fact, the
smaller studies were the ones that typically showed the larger deviations from
normal mortality rates. Given these issues, the authors concluded that
“the generalizability of the findings to healthy adults is
uncertain”.
Moreover, a third and critical weakness of the analysis
was largely overlooked. In all, the authors identified 36 studies
involving vitamin E supplementation that fit the primary criteria for
review. Of these, 19 were included in the final meta-analysis, five were
excluded because mortality data was not available or was insufficiently
reported, and 12 studies were excluded because not enough people died in
them. This latter exclusion is suspect. The authors suggest that
mortality data was available, but close to zero in both the vitamin E and
control treatments. I would argue that this is not a sufficient and
rational reason for excluding the studies from the analysis. And given
the weak nature of the trends as reported in the paper, it is highly likely
that no effect of vitamin E on all-cause mortality would have been seen had the
12 additional studies been included in the meta-analysis. As such, I
believe that the results and conclusions of the study are seriously flawed and
biased. I would be less critical if the title of the paper had been
“High-Dosage Vitamin E Supplementation May Increase All-Cause Mortality
in Very Ill Subjects at High Risk for Dying”; and if the conclusion had been
that high dose vitamin E should be used cautiously by chronically ill people in
that high risk group. But these distinctions were not evident in the
paper or the press.
The Need for a Broader Healthcare
Perspective
Our current approach to healthcare, with its almost
singular focus on reactive acute-care medicine, presents challenges for the
study and implementation of long-term primary preventive healthcare measures,
including nutritional supplementation. As the cases discussed above
illustrate, nutritional supplements are often tested inappropriately, results
of studies are interpreted less than objectively, and valid but non-clinical
evidence of benefit is often ignored or discounted.
Do these studies constitute bad science? Clearly,
some of the methodologies are flawed. The criteria for exclusion of
studies from the Johns Hopkins meta-analysis are questionable, and they likely
biased the results and conclusions of this research. However, the real
challenge is not so much one of poor science as it is one of inappropriate
approach and trial design. The majority of studies on the health benefits
of nutritional supplements have tested supplements as though they were
acute-acting therapeutic agents expected to provide dramatic health benefits
over the short-term in acutely ill people. This is a fundamentally flawed
outlook.
The principal value of nutritional supplementation lies in
primary prevention; that is, in approaches to keeping healthy people
healthy. Importantly, primary prevention is also a lifelong undertaking.
We suffer heart attacks and hip fractures as seniors, but the roots of
heart disease and the beginnings of osteoporosis are evident in childhood and
adolescence. As such, the prevention of these diseases needs to begin in
childhood and progress lifelong. The timeframes of primary prevention are
measured in decades and lifetimes, not in hours, days, months, or years.
Such long timeframes are beyond the purview of acute-care
medicine, in part because they pose significant operational challenges for
clinical research. How does one manage a double blind, placebo-controlled
clinical trial, the gold standard of medical science, over a period of
decades? Epidemiological studies more easily embrace long timeframes, and
as such are useful in studying preventive measures. However, they also
tend to be less well controlled and less precise. This troubles many in
mainstream medicine who then discount or disregard epidemiological science altogether.
Does this constitute tunnel vision? I believe it does. Our
understanding of the link between a balanced diet and long-term health is
largely based on epidemiology. Our understanding of the link between
smoking and lung cancer is largely based on epidemiology. In short, good
epidemiological research constitutes sound science and should not be discounted
or ignored (Kushi, 1999; Potischman and Weed, 1999). It was a mistake in
1964 when the American Medical Association refused to endorse the Surgeon General’s
Report on Smoking (the AMA was the last public health organization to do so),
claiming that the research was inconclusive (Weiner, 1996). And it is a
mistake today to overlook epidemiology in assessing the role of nutritional
supplements in preventive healthcare. In short, advances in primary
prevention will require healthcare scientists to review and give serious
consideration to a broad body of scientific evidence that extends well beyond
the clinical trial paradigm.
It will also require a more open-minded and objective
interpretation of results. The finding that vitamin E supplementation,
over a 10 years period, reduced cardiovascular deaths by 24% in women over 45
years of age, and by 49% in women over 65 years of age (Lee et al, 2005) may
have been disappointing to those steeped in acute care medicine (although I
don’t understand why). But these are significant and positive
findings within the context of primary prevention. In short, vitamin E
worked. Why then did the authors conclude that it “provided no
overall benefit for major cardiovascular events” and refrain from
recommending vitamin E supplementation for the primary prevention of heart
disease? And why did the popular press lead their coverage of this study
with headlines stating “Vitamin E Gets and ‘F’”?
Simply put, the findings did not fit the paradigm.
Poor reporting and bias in the press is easy to
understand. Most journalists are not trained scientists, statisticians,
or healthcare professionals. As such, they are not qualified to interpret
medical studies objectively and competently. Moreover, Job One at major
news organizations involves selling more newspapers and capturing more viewers,
and they accomplish this by crafting controversial headlines and scary sound
bites. If you want the masses to listen, frighten them.
Unfortunately, the delivery of objective and complete information appears to be
a distant Job Two.
This is an unfortunate situation, in that many Americans
rely on the popular press for their health information. As such, the
sensational and controversial coverage given to nutrition news has generated
confusion, doubt, and skepticism in the public’s mind, turning many
against the diet and health message (Patterson et al, 2001).
Why would medical professionals have a negative bias
against nutritional supplements? Several reasons come to mind. Most
doctors receive no more than a few hours of nutritional training during their
medical education. They know little about nutrition and the important
role it plays in human health. Second, many express concerns that their
patients might use supplements as an excuse to eat poorly. This concern
has proved to be unfounded. Surveys show that supplement users tend to be
health-conscious and to follow generally healthy habits. Third, many
doctors have a low opinion of the nutritional supplement industry - and
rightfully so. Too many supplement companies sell substandard products
that fail to meet pharmaceutical standards for potency, purity, and efficacy.
Too many companies fail to pay sufficient attention to safety. And too
many companies make false and outrageous health claims for their
products. Clearly this industry needs an overhaul to win the respect and
confidence of doctors and the general public. But just as clearly, there
are very reputable supplement companies in business today; companies that have
adopted pharmaceutical standards for product quality, safety and efficacy;
company’s that deserve the public’s trust.
These issues aside, I believe that the most significant
barrier to the open consideration of supplement use in mainstream healthcare is
the closed mind. Primary prevention, the focus of keeping healthy people
healthy, lies outside the acute-care paradigm, and so it is ignored. Some
in the mainstream pay lip service to prevention, but few base their practices
or research careers on it. And sadly, because primary prevention is
“alien”, it is often derided as “ineffective”,
“too slow”, “unreliable”, “clinically
unproven”, and “only partially effective”.
Unfortunately, these attitudes carry over to nutritional
supplements. As tools of primary prevention, nutritional supplements also
lie outside the acute care paradigm. When they are evaluated within that
paradigm for short-term treatment / curative benefits, one or two nutrients at
a time, on chronically ill people, they often fail. These failures, in
turn, are judged as evidence that supplements have no benefit whatsoever.
Clearly it’s time to challenge these notions and
views. Change may begin at the grass roots level, as rising healthcare
costs threaten to close the doors of access to good medical care. Today,
too many Americans literally can’t afford to get sick. Our
alternative is primary prevention. We can choose to take charge of our health
by adopting prudent lifestyle strategies and habits for staying healthy
long-term. Nutritional supplementation can play an important role in this
endeavor. The science, when approached broadly with an open mind, is
convincing on this point. As components of healthy living,
nutritional supplements can help people add years of health to their lives.
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