Lancaster Physician Summer 2019 - 19

SUMMER 2019

Data from the National Health and Nutrition Examination Survey (NHANES 1999 to
2012) illustrates the use of dietary supplements
in the United States:
* Fifty percent of adults, 70 percent of
older adults, and one-third of children are
consuming dietary supplements.
* The most commonly used product is a
multivitamin.
* Supplement use increases with age and
differs by sex, education, race/ethnicity,
family income, physical activity, health
insurance coverage, smoking, and prescription drug use.
* Usage may help with meeting nutrient
recommendations.
* Users tend to be diagnosed with chronic
conditions (e.g. high cholesterol, diabetes).
* Supplements are used mainly to improve or
maintain health, prevent health problems,
and supplement the diet.
NHANES further confirms that Americans
are using dietary supplements beyond their
intended use; potential theories explaining
consumers' motivations for use include:
Insurance policy idea

WHAT DOES THE LITERATURE SAY
ABOUT THE BENEFITS OF DIETARY
SUPPLEMENTS?
Nutritional epidemiology has repeatedly
exhibited an inverse association between various
foods and lower rates of cardiovascular disease
(CVD), cancer, and other major morbidity
and mortality. However, the difference from
food's association to health and that of dietary
supplements has numerous factors to consider.
Is it the food matrix, one or more of its nutrients, patterns of food combinations, or the
function of other confounding non-dietary
factors that contribute to the synergistic effects?
The U.S. Preventive Service Task Force
(USPSTF) 2014 review listed:
* A recommendation against ß-carotene or
vitamin E supplements for the prevention
of cardiovascular disease or cancer.
* A conclusion that the current evidence
is insufficient to assess the balance of
benefits and harms of multivitamins for
the prevention of cardiovascular disease
or cancer.
* A conclusion that the current evidence is
insufficient to assess the balance of benefits
and harms of single- or paired-nutrient
supplements (except ß-carotene and vitamin E) for the prevention of cardiovascular
disease or cancer.

Although Americans have demonstrated
high supplement use, there is a lack of general
agreement on whether individual vitamins
and minerals or their combinations should be
taken as supplements for cardiovascular disease
(CVD) prevention or treatment (Jenkins et
al., 2018).

Jenkins et al., (2018) conducted a literature
review of publications 2012, both before and
including the 2014 U.S. Preventive Service
Task Force (USPSTF) review. The authors
reported finding "generally moderate- or
low-quality evidence for preventive benefits for
folic acid for total cardiovascular disease and
folic acid and B-vitamins for stroke; no effect
for multivitamins, vitamins C, D, ß-carotene,
calcium, and selenium; and increased risk with
antioxidant mixtures and niacin (with a statin)
for all-cause mortality (Jenkins et al., 2018).

What does exist is the standard recommendation of consumption of a balanced diet as
part of a healthy lifestyle. The Canadian Cancer
Society (2018), however, does recommend
that a supplement of 1,000 IU vitamin D to
be taken in fall and winter.

A CLOSER LOOK AT ANTIOXIDANT
SUPPLEMENTS
As we possess a greater understanding of
cellular defense mechanisms, there is a tangible
shift in the literature regarding the use of antioxidants, specifically when promoting their use

Medical self-treatment
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LANCASTER

19

PHYSICIAN

to support cellular defense. With the increase in
clarity and understanding of the mechanisms
of action, a clinician's view must also evolve
with current research and therefore be able to
better assist patients in navigating that waters
of nutrition interventions, particularly when
considering dietary supplementation.
It is well established that in order to maintain
overall cellular health and wellness, oxidation
processes must be in balance (Bouayed &
Bohn, 2010). Terms such as "oxidative stress,"
"free radicals," and "reactive oxygen species/
ROS" can not only confuse patients but also
set the stage for fear and vulnerability for the
marketing of products that promise to correct
those "issues."
Gutteridge & Halliwell (2010) remind
us of how even decades earlier there was the
understanding that "antioxidants would only
significantly influence a disease process if free
radicals or other reactive species caused or
significantly contributed to the progression
of the disease."
Numerous factors such as intense exercise,
emotional stress, depressed mood, poor diet,
and micronutrient deficiencies all serve as
stressors to the body, increasing production
of ROS (Bouayed & Bohn, 2010). However,
that does not mean that all sources of increased
ROS production are inherently bad. While the
research strongly supports that increased free
radical formation is usually a result of tissue
damage by a disease or toxin, in some circumstances reactive oxygen species (ROS) may be
employing a protective role, such as helping
to down-regulate inflammation (Gutteridge &
Halliwell, 2010). Amongst the aforementioned
list, exercise had been shown to have an overall
anti-inflammatory effect, despite its acute
production of ROS (Petersen & Pedersen,
2019). In fact, Ristow et al. (2009) showed
how the use of antioxidant supplementation
had a negative impact on exercise by blocking
the positive effects exercise had on metabolism.
While it is tempting to think that when it
comes to antioxidant supplementation that
"an ounce of prevention is worth a pound of
cure," this is certainly not the case. Antioxidant
supplements do not offer the same health
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