A New Healthcare Approach?

When Swine Flu infiltrated Mexico earlier this year, newspapers reported that grocery stores quickly sold out of two things: face masks and vitamin supplements. According to the papers, the idea that people took to heart was that early prevention is the best guard against disease. In the May 18 edition of the newspaper La Opinión, a man buying multivitamins after the outbreak was quoted as saying, "The cost of getting sick is not a good cost."

His sentiment captures the feeling of U.S. consumers as well, as more American customers-men and women alike-are trending toward preventive healthcare in the present economy. The numbers prove it. For the three months that ended December 28 of last year, nationwide retail sales of vitamins and supplements totaled nearly $639 million, up almost 10% from the same period in 2007. This includes a nearly 6% increase in sales of herbal supplements alone, according to Information Resources Inc., a Chicago-based market research firm.

"The economy has helped to drive sales of nutritional supplements up this year. As more people lose their jobs and their health insurance, they are turning to nutritional supplements to support their health," says Kerry Watson, natural product specialist for SPINS, an agency that provides natural products sales data to the industry.

A government survey released in December by the U.S. Department of Health and Human Services (Washington, DC) stated that the cost of conventional medicine influenced Americans' decisions to try alternative remedies. Nonvitamin, nonmineral, and natural products, including fish oil and herbal medicines, were the most commonly used alternatives, taken by almost 18% of Americans in 2007, the report said. Among those users, roughly a quarter said they delayed or failed to obtain conventional medical care because of its high cost.

A bad economy naturally encourages people to look for more cost-effective ways to maintain their health, says Judy Blatman, senior vice president of communications for the Council for Responsible Nutrition (CRN; Washington, DC). "The economy will pick up, but until it does, you can't sacrifice your own wellness."

Last August, CRN's consumer survey on dietary supplements questioned consumers about the economy and their supplement usage. The survey found that 51% of supplement users indicated that the slumping economy would likely not cause them to decrease their purchases of supplements. "Of that 51%, 13% went further to say that supplements are 'an essential part of my wellness regimen, and I cannot do without them,'" Blatman continued. "Given the current economic situation, which is even more unsettling than it was last August, it's reassuring to read that consumers are sticking with their dietary supplements."

IN THEIR WORDS: WHY CONSUMERS BUY SUPPLEMENTS

"Prevention is better than a cure," according to a Dutch proverb. With this in mind, I ventured into a very popular vitamin supplement retail store in Culver City, CA, earlier this month and asked two consumers in the aisle about why they purchased supplements.

A 56-year-old community college professor told me that he used to drink a slew of coffee and energy drinks to get him through the day and supplemented this bad habit with bad food to top it off. Earlier this year, however, he made a resolution to stay mindful of his dietary habits.

He talked to his doctor about other ways to boost his energy without caffeine and was told to eat well and take a multivitamin and B vitamins, which are recommended for stress relief. He followed the doctor's advice, and added ginseng to his diet as well.

"I'm not sure if it works as a placebo, but I feel a lot better," he says. "I feel like I have more energy, and I don't have to drink caffeine [beverages] or coffee all day."

Another customer I approached, a 48-year-old homemaker, was told by her doctor that supplementing her diet with 400 mg of riboflavin (found in vitamin B2), a dose higher than mere diet provides, can reduce the pain of migraine headaches and their frequency.

"I haven't stopped having some occasional migraines," she said. "But some days are definitely much better than others."

She continued, "I don't need to have medication when I can help [myself] with something natural. Maybe by taking an active step against [my reoccurring migraines], at least I'm doing something to maybe cure myself."

What Consumers Are Buying
According to the American Botanical Council (ABC; Austin, TX), the top-selling dietary supplements of 2008 were cranberry, soy, garlic, saw palmetto, ginkgo, echinacea, milk thistle, St. John's wort, ginseng, and black cohosh. Collectively, sales of these 10 supplements were over $150 million last year, with all herbal supplements in total bringing in a little under $290 million.

Cranberry, vitamin D, and omega-3 have become popular in a short period of time due to favorable studies that have been widely publicized. "The big supplement trends are directly affected by media attention on scientific research," says Watson.

A series of reviews published in January by the Cochrane Database of Systematic Reviews leaned heavily in cranberries' favor. The study found that cranberry products may prevent recurrent urinary tract infections in women. These studies were then heavily promoted in television advertisements and newspaper and magazine articles. Such information, in addition to other studies on cranberry's health benefits, may have contributed to the steady rise in sales of cranberry supplements.

According to the Cochrane reviews, sales of cranberry (Vaccinium macrocarpon) supplements increased by more than 23% in 2007 from 2006. Sales continued to rise in 2008, making cranberry the top-selling herbal supplement product within the food, drug, and mass-market channel (FDM).

Vitamin D also benefited from positive media attention. Earlier this year, three studies in the Journal of the American Medical Association focused on the importance of vitamin D supplementation. The studies linked low levels of vitamin D in the blood with an increased risk of several diseases, including osteomalacia, which could result in weakened muscles and bones.

"Sales of vitamin D supplements have skyrocketed in both the natural and conventional channels as a result of these studies," Watson continued.

In the botanical supplement market, flaxseed (Linum usitatissimum) and flaxseed oil products were the top-selling supplements. Perhaps also stemming from advertising, consumers' steady interest in sources of omega-3 fatty acids may be the cause behind this supplement's high sales, says Diana Chang, MD, a general practitioner based in Los Angeles.

"The benefits of omega-3 are plastered on everything from baby food to cereal bars as a very cheap and economical way for families to maintain their health," she notes.

Concerns about Supplements
While people who eat lots of nutrient-rich fruits and vegetables have long been known to have lower rates of heart disease and cancer, it has been unclear whether ingesting high doses of those same nutrients in pill form results in a similar benefit. The question is whether consumers believe that supplements can possibly cure diseases such as cancer, arthritis, or heart disease. As Marian Neuhouser, an associate member in cancer prevention at the Fred Hutchinson Cancer Research Center (Seattle), says, "We call them essential nutrients because they are, but there has been a leap into thinking that vitamins and minerals can prevent anything from fatigue to cancer to Alzheimer's."

Some of the science regarding the effectiveness of supplements that came out this year was less than flattering to the industry. A study published in the Archives of Internal Medicine in February tracked eight years of multivitamin supplement use among more than 161,000 older women. Despite earlier findings suggesting that multivitamins might lower the risk for heart disease and certain cancers, the recent study's results did not validate the previous findings.

Last June, a study that tracked almost 15,000 male physicians for a decade reported no differences in cancer or heart disease rates among those who used vitamins E and C compared with those taking a placebo. And in October, a study of 35,000 men dashed hopes that high doses of vitamin E and selenium could lower the risk of prostate cancer.

"I'm puzzled why the public in general ignores the results of well-done trials," said Eric Klein, national study coordinator for the prostate cancer trial and chairman of the Cleveland Clinic's Glickman Urological and Kidney Institute.

The jury is still out on whether what these studies claim is true. Everyone is struggling to make sense of the data, says Andrew Shao, vice president for scientific and regulatory affairs at CRN. However, consumers and researchers need to "redefine our expectations for these nutrients," he says. "They aren't magic bullets."

Consumers Still Buying
While critics of vitamin therapy are wary of the effectiveness of some supplements, the overwhelming majority of consumers seem to feel that vitamins do have a significant effect on general health, as evidenced by high vitamin sales.

Scientists are even beginning to study whether high doses of vitamins in whole-food extracts can replicate the benefits of a vegetable-rich diet. This is a reason that Harvard researchers are planning to study whether taking higher doses of vitamin D in a group of 20,000 men and women this year can lower risk for cancer and other chronic diseases.

"Vitamin D looks really promising," says JoAnn Manson, MD, the chief of preventive medicine at Brigham and Women's Hospital and an investigator on several Harvard vitamin studies.

Because of the vitamin's potential, Manson says that more doctors are now testing for deficiency of vitamin D as a part of regular patient blood work.

In her practice, Chang sees how positive vitamin reports are causing patients to pay more attention to their own vitamin intake. "There are many people now that specifically ask us to look for nutrient deficiencies and who use vitamins to fill the voids," Chang says.

Patients are becoming more aware that their diet might not meet all of their nutrient needs, says Jonathan Prousky, a naturopathic doctor and professor of clinical nutrition at the Canadian College of Naturopathic Medicine in Toronto. He says that while eating health foods, including organic foods, is great, these foods alone might not provide enough of the body's required nutrients. In fact, the diets of the vast majority of North Americans don't meet daily nutritional requirements.

Consumers' interest in dietary supplements is not likely to wane, he says, especially when doctor's visits and prescription drugs are becoming very expensive. "People look for nondrug approaches," he says. "Wouldn't you feel better using naturally occurring substances that are typically found in your body, as opposed to a foreign chemical?"

Alternative medicine has become more mainstream in recent years, says Prousky. He has been a naturopathic doctor for 11 years and says that he remembers when most people used alternative medicine as a last-ditch effort, often after getting a terminal cancer diagnosis.

Today, however, "I see patients who want a healthcare evaluation; somebody to look at their diet and their supplements and suggest what they might add to optimize their health," he says. He says that he also sees patients on prescription drugs for anxiety disorders, schizophrenia, high blood pressure, or high cholesterol who hope to reduce the amount of medication they need. "I think healthcare has to be more collaborative these days," he says.