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Study: Why do we supplement?

Posted on: February 6, 2013   by  John Cannell MD


Ever had a hard time trying to get a friend or two to supplement with vitamin D? New research published in JAMA Internal Medicine reveals underlying reasons why some people choose to supplement, perhaps giving you a little insight on some strategies to make your efforts more successful.

The study, led by Dr Regan Bailey of the Office of Dietary Supplements, surveyed people enrolled in the NHANES cohort over the years 2007 and 2008. After excluding those younger than 20, lactating or pregnant women, they collected information from nearly 12,000 people.

Let’s fly through the results:

  • 49% of people reported taking supplements within the past 30 days of the survey. Women were more likely to supplement (54%) than men (43%). People over 60 and Caucasians were most likely to take supplements. Those who had health-insurance were also more likely to supplement, as well as people who reported to be in good health. And those who drank one or more alcoholic beverage per day were more likely to supplement.
  • People that were either underweight or overweight were less likely to take supplements.

Of the people who took supplements, why did they choose to supplement? (They could choose multiple reasons.)

  • 45% reported to “improve overall health.”
  • 33% reported to “maintain health.”
  • 25% reported for “bone health.” This was a significantly higher reason for women (36%) than men (11%).
  • 22% reported to “supplement the diet.”
  • 20% reported to “prevent health problems.”
  • 15% reported for “heart health, lower cholesterol.” This was a significantly higher reason for men (17%) than women (13%).
  • 15% also reported to “boost immunity, fight colds.”

What kinds of supplements are people taking?

  • 32% of people reported taking a multivitamin-mineral.
  • 12% reported taking calcium (19% of women, 5% men).
  • 10% took fish oil or some kind of omega-3.
  • 5% took vitamin D, making it the 7th most popular product. Why did people take vitamin D? The most common reason was for “bone health,” and thus more women reported taking vitamin D (7%) than men (3%).

These data give some guidance to public health professionals and health care providers to develop strategies to ensure people get the supplements they most need. While research may be inadequate for the use of some supplements, it may be ample for the use of others.

In the case for vitamin D, most here on the blog would contend that there is ample need for supplementation, especially when considering you cannot get adequate amounts from your diet, and very few people get enough sun/UV exposure to synthesize enough vitamin D. Even the most conservative of doctors would suggest a vitamin D supplement upon a vitamin D blood draw reading deficient.

Thus the question begs, how do we approach recommending vitamin D supplementation? The past few years, I have seen a heavy focus on the “prevention message” for vitamin D. Is this the wrong strategy? Here, only 20% of reported supplement users took vitamins to prevent health problems.

Should the focus be shifted to “vitamin D for bone health” when engaging with women?  Should we focus on a general message of “improve your general health” rather than “prevent health problems”?

Should we encourage the manufacturing and formulation of combined calcium and vitamin D supplements? If an astounding 12% of people take calcium supplements, should vitamin D not ride that coattail? If 10% take fish oil for heart health, should vitamin D not also ride the omega-3 coattail and be combined with it as well?

While vitamin D awareness has made leaps the past 10 years, these data show there is still much more awareness to be spread. Since vitamin D cannot be obtained from the diet, it is not implausible that one day it is the most used supplement. The question arises, how can we shrink that gap, that time from now until then?

Members, what do you think?


Bailey RL et al. Why US Adults Use Dietary Supplements. JAMA, 2013

15 Responses to Study: Why do we supplement?

  1. Ian

    Should the focus be shifted to “vitamin D for bone health” when engaging with women? Should we focus on a general message of “improve your general health” rather than “prevent health problems”?

    I think there is far too much calcium taken without consideration of Vitamin D. I know several people who take in excess of 1500mg calcium daily, some at the recommendation of their doctor.
    I tell them, “if you take 3000-5000IU vitamin D daily you will not need so much calcium and so avoid the damaging effects of excessive calcium, such as cardiovascular disease risk”. Some have listened and changed.

    However Is still think that vitamin D is a major preventative in cancers, neurological and immune system diseases. Particularly pre-natal. Are obstetricians recommending it more?

    It would be interesting to know which medical specialties are recommending vitamin D supplementation more and by how much compared to 10 years ago.

    “Even the most conservative of doctors would suggest a vitamin D supplement upon a vitamin D blood draw reading deficient.” – Not in New Zealand they don’t, won’t even test for it.

  2. Brant Cebulla

    If the intention was to actually deliver vitamin D in a bone health calcium-vitamin D supplement, and not calcium, you could formulate it as such. ie, 2000 IU vitamin D and 200 mg of calcium per capsule.

    Also, as a general comment, one important note I’d like to include is that this is data for the United States. I think in other countries, you’d find very different reasons and people with different backgrounds supplementing.

  3. mbuck

    First, I have never been a ‘vitamin’ type of guy believing that I get everything I need from foods. Also, I’ve always believed that I get plenty of sunshine from morning and late afternoon sun.

    But I have also altered any belief in the face of new facts that causes me to toss out the old belief and bring in the new.

    The first sentence above represents the state of things until recently. I serendipitously happened on an paper on D3 while looking into a tangentially related topic. I read it, and came to the tentative conclusion it was all nonsense, and proceeded to look up a couple references mentioned. This lead me to Holick, Garland, Cannell, Vieth, and others.

    I perceived that these researchers were genuine and altered my tentative conclusion to, “Hm.. could it be? Let’s find out.” I still didn’t have personal data, but I did have the willingness to find out.

    The experiment.

    So I bought some Carlson’s 1000 IU / drop and began the experiment, taking 5000 IU/d for 5 days and increasing to 10,000 IU after that. That’s the only supplement I took.

    After a month, I had some personal data. Musculoskeletal improvement and increase in strength and range of motion, general feeling of well-being, sounder, more restful sleep, decrease in pain walking, much milder and shorter flu symptoms, faster healing of day-to-day cuts and burns.

    Then, I ordered four ZRT tests, and sent one back, with results at 50 ng/ml.

    Now I had data from personal experience and scientific analysis.

    So this was the process I went through to bring me to today. I’ve added co-factors as necessary and a B complex once a week. I get most co-factors from foods. I avoid vitamin A as preformed retinol but eat several servings of fruit, colorful vegetables, almond butter, raw and roasted pumpkin seeds. I also eat chicken, beef every other week, sea foods, yogurts and coffee.

    Since I’ve been feeling so much better and more alert, I have had to cut back on the amount of grounds used in coffee by half. I still drink 4 – 5 cups/day, but at half strength from previous days. Cravings for sweets has also been cut by even more than half; a couple cookies satisfies me as much as 6 – 10 would before.

    I have been singing the praises of D3 to eveyone who will stand still long enough to listen, beginning with family and friends who are familiar with my joint problems.

    Regarding your question of adding supplements to D3, I’d say, yes. I also have the D3Plus from BioTech. It’s great because it has all the co-factors. But each capsule only contains 1666 IU, and because I resist taking 6 a day, it would be nice if 10,000 IU caps with co-factors could be made.

    Keep up the good work VitaminDCouncil.

  4. Rita and Misty

    Dear Brant,

    Thank you for an excellent article on this subject. I always enjoy reading your posts.

    However, I think we may have to consider a different tact regarding resolution of this pandemic.

    Firstly, I think we in the Vitamin D community need to call D by what it really is…a Pro-hormone…

    For this deficiency to be taken seriously by researchers, physicians and patients, we need to recognize D as the essential pro-hormone that it is…and not just “another vitamin.”

    To call it a vitamin is a gross inaccuracy…IMO, vitamins are nutrients easily supplied via food sources.

    This is not the case with D.

    Secondly, to quote one of my favorite researchers, Dr. Reinhold Vieth: “I believe we should pay as much attention to vitamin D as we do to cholesterol.” http://www.magazine.utoronto.ca/leading-edge/reinhold-vieth-interview-vitamin-d-cancer-prevention/

    In other words, the 25(OH)D test needs to be included in the routine blood panel requested by our physicians at our annual physicals. And we need to monitor and treat both insufficiency and deficiency.

    Just doing these 2 simple things will dramatically change our society’s views of Pro-hormone D.

    And FINALLY,

    It may just take litigation to put an end to the main stream medical community’s resistance to test and reat patients with Pro-hormone D.

    This is not as radical an idea as you may think:

    To quote another one of my favorite Vitamin D doctors: “Vitamin D has a long history in the courts going all the way back to the height of WWII when manufacturers of over-the-counter vitamin D to prevent rickets were putting such a small amount in the tablets that it would not prevent rickets. The combined lawsuits were settled when the intellectual property rights of D3 became public domain.” http://pandemicsurvivor.com/category/uncategorized/

    Perhaps it will take a group of brazen individuals who are simply sick and tired of being sick at the hands of their incompetent physicians.

    I’m game…are you?

    I thank you for allowing me to express my opinions here. And I hope that we (all) will see this needless pandemic END in our lifetimes.

    To sunnier days,

    Rita Celone Umile

  5. mbuck

    Some more thoughts on how to motivate people. I know Dr. Cannell has a book on this topic.

    The sports angle should be played way up, better performance, faster reflexes, better stamina, faster healing times, etc.

    Wasn’t there some data of a 30% increase of testosterone in men supplementing with D3?? That ought to motivate at least half of the population. Heck, women might be motivated too, for their men who may have grown a bit lackadaisical in romance. Come to think of it, Valentine’s Day is just around the corner, what better gift…

  6. Rita and Misty


    I can share with you that Vitamin D is indeed very helpful for the natural increase of testosterone in a woman’s body…as is correcting Iodine and DHEA deficiencies. From my own experience, these work much better (at least in my body), that the utilization of even bio-identical testosterone cream, which for me was way too strong.

    Men obviously need testosterone for vitality; many who are not in the heath care profession are surprised that women do too (actually, I have spoken to some doctors at my HMO who disagree with me on this point, and this is simply one more reason that I am wary of many physicians).

    At @mbuck, you speak as a true man regarding the necessity of testosterone for sexual drive; however, adequate testosterone levels also improve mood, motivation, and creative energy.

    So, women—those partnered and those not—do something nice for YOURSELF, regardless of whether you have a man in your life, and assure that your testosterone levels are adequate. Consider it a Valentine’s Day gift to yourself !

    Best regards,

  7. mbuck

    @Rita Yes, women do have testosterone in their bodies. An old flame of mine was mildly deficient in thyroid hormone and her lab workup had a slight excess of testosterone. Her doc told her to get some progesterone cream and rub it into her belly and where the skin is thin. He kept up to date in his field (some 15 yrs ago?) and suggested we look up Dr. John Lee on the net.

    An old male friend also uses the cream but don’t recall what for.

    So, yes, guys and gals, listen to Rita and gift yourselves..and each other.


  8. Rita and Misty

    @mbuck…been there and done that with the progesterone cream…and I admire the work of Dr. John Lee…but it didn’t do a darn thing for me…

    Raising my 25(OH)D levels to 74 ng/ml (and now higher) was just what I needed…


  9. lsmiley

    My rheumatologist routinely orders Vit D levels as part of my ongoing scleroderma treatment. I found that keeping levels above 50 significantly decreases my pain, which is very important since I am allergic to most pain meds. She was very knowlegdable about Vit D’s role in rhuemy diseases. I also found that 4000 IU even during the summer in Southern Arizona was not enough to keep my Vit D levels above 50 and I am outside quite a bit but nowhere near what I used to be. So I am aiming for 6000 IU a day throughout the year, increasing to 10,000 for a week when I have been exposed to the flu/cold etc… Seems to be working.

  10. [email protected]

    Good! the VDC-readers knows that vitamin D3 is a pro-hormon. We know that vitamin D3 is essential. We also knows that vitamin D should be D3, not D2. All the co-factors , or most of them are up on the table (K2, A, Mg, Ca, B, I guess selenium and zink should be together etc.) The connection between testosterone and vitamin D is known and recognized.

    What do I miss? Rita almost touched it! The connection with cholesterol. Without cholesterol no steroid-hormones. That is a fact. Do we know what happens with our hormones when somebody is taking statins? Impotency is a wellknown side-affect, also memory problems, there are so many side-affects from statins that I could keep writing for hours … What happens with the 25(OH)D-levels in a person taking Lipitor, or Zocord etc, or, by the way Orlistat!

    Could it be that every person taking statins will have problems with the steroid-hormones? Especially the sex-hormones and of course the stress-hormonesthe immune-system … What happens with the body´s ability to make vitamin D3 or to take up a vitamin D3-supplement? How come that we, – the physicians pretend that cholesterol is not body-made, we have to admit that we cannot increase the blood-cholesterol with eating eggs, and that cholesterol is essential!

    VDC – Let´s talk about the connection between vitamin D3 and cholesterol!

    So, if we want to discuss vitamin D3 and/or testosterone, we have to admit that without cholesterol, no steroids at all. This is a debate a missed since you started VDC.

  11. [email protected]

    Many doctors test for liver enzyme elevations after several months of Statin use. It would be a revelation if doctors tested for hormone levels before and after commencing Statin use since cholesterol is the building block for our steroidal hormones. Why take any Statins if they are going to impair our hormone levels, especially vitamin D. The same with Co-enzyme Q-10. Statins deplete this vital molecular sparkplug. Why are we brainwashed to believe lowering cholesterol is a good thing? Research indicates we live longer with an elevated cholesterol level, most likely because we are keeping our vital hormones at a healthful level. Women should never take these drugs. Check out the Norway Hunt-2 cholesterol study. A revelation! Patrick Moore, N.D.

  12. [email protected]

    This may be premature because I haven’t read the other comments: here’s my approach: I lost the love of my life to metastatic prostate cancer. That meant I lost a friend, a mentor, and a lover. I’ve told every male doctor that I seen the same thing: do you want to be able to have sex for the rest of your life? To satisfy your wife, girlfriend, significant other or lover? Then protect your prostate. It’s the biggest littlest organ in your life; it affects the totality of your brain and your gonads. TAKE D3 NOW. DON’T WALK — RUN! AND PROTECT YOUR MALE CHILDREN AS WELL! Now, if I’m successful about getting men’s attention then I’ve just helped all the women who love them and still want to make love to them, as well as the male babies and children. This may seem brash and visceral, but it makes the point. So men, if you love your prostate, then protect it! This is the anti-dote to prescription Viagra and Cialis. It’s less costly and way better for you because it has no adverse side effects and only GOOD SIDE EFFECTS.

  13. [email protected]

    The best reasons to supplement with vitamin D3 are a 50% reduction in cancers of many types and a substantial reduction in coronary heart disease. Refer to Creighton University School of Medicine study: 1179 post-menopausal women taking 1100 IU of vitamin D3 plus 1400 mg calcium for 4 years with 60% reduction in cancer risk. Many researchers suggest the optimum blood level to be >50 ng/mL. In our case, it requires 5,000 IU of D3 for months to attain 50 ng/mL. With D3 at 4 to 6 c/gelcap, D3 is cheap insurance.

  14. glen2240

    Years ago before the present ability to measure D3 I was the vitamin D analyst for the FDA (the bio-asaay). We received a D = Calcium product which was devoid of any D activity. The company was sent a letter about it and they insisted it should be OK and even sent a new bottle which, indeed, did contain the labeled amount BUT upon reanalysis over a couple pf weeks I could not find the vitamin D. I mixed up a batch of the cod liver oil standard with calcium carbonate and/or calcium phosphate and ran it over several weeks time. To be sure, the vitamin disappeared. We informed the company of my results and I suggested that they could use a relatively new product which was a spray dried mixture of the vitamin in gelatin which was stable.
    My point in writing this is the comment in Brant Cebulla’s note of Feb 6,’13 that was suggesting the mixture of D and Ca. My experience was back in the late 60’s or early 70’s and it was not published or shared with anyone else so I wonder if it might still be true or if companies that prepare the D/Ca products us some protection for the vitamin.

    • Brant Cebulla

      @glen2240, interesting insight. I’m unaware if they prepare it now to “protect” vitamin D. Consumer Lab checks about 20+ calcium-vitamin D supplements every other year and they always contain the amounts they advertise.

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