One study, conducted by Information Resources Inc. and published in the Journal of the American Medical Association, found that well in excess of $2 billion was spent on supplements and vitamins in the United States in 2006.
"Pills are easy," said Golda Ewalt, a registered dietitian at OSF Saint Francis Medical Center in Peoria, Ill. "We live in a society where we want a quick fix. We want it now. Give me a pill and make me better."
Physicians and dietitians recommend meeting all nutritional needs through diet. They temper those expectations with the reality that today's fast-paced world doesn't always make way for three square meals.
"If you ate a balanced diet, you would not need any supplemental vitamins," said Pat Cole, clinical nutrition manager at Proctor Hospital in Peoria. "That's going to be the official stand of a dietitian.
"However, realistically, the way Americans eat, we don't always choose the right things - fruits, vegetables, grains, dairy foods and those kinds of things."
TALK TO YOUR DOCTOR
Grocery store aisles of pills can be overwhelming. Physicians and dietitians warn of rampant misinformation on the Internet. They recommend consulting with a professional before trying anything more than a multivitamin. Yet, even medical experts admit their opinions sometimes vary widely.
"That's a big controversy," said Dr. Jill Carnahan of Methodist Medical Group at Peartree in Peoria. "If we all ate perfectly with whole foods, and the soil had plenty of nutrients, we shouldn't need supplemental vitamins. But in the standard American diet, we're very depleted in nutrient-rich foods. People are typically eating processed, boxed foods that have very, very little nutrients and high calories. They get full before they get the nutrients they need.
"The second thing is, our soil has been over-farmed and depleted of nutrients. Unless it's small-farm, organic food, a lot of the soils have really been depleted. Even our produce and fresh foods don't have the vitamin content that they did 100 years ago. Because of all that, I think supplementation is a good idea."
UNREGULATED
Because supplements are neither food nor drugs, they are not regulated by the FDA.
The Dietary Supplement Health and Education Act of 1984 prohibits supplements from claiming they treat, diagnose, prevent or cure a disease. Generalized claims are allowed.
Dr. Stephen Hippler, an internist at the OSF St. Francis Center for Health, recommends simple steps, such as the daily use of aspirin for those at risk of heart attack or stroke. But he views the claims of supplements with skepticism.
"I think people cling to the notion that because they're promoted as 'natural,' they're safe and will work," Hippler said. "Yet, some of the most deadly and potent agents are also natural, like botulism toxins. Just because something is natural doesn't mean it's safe. In our society, we've equated natural with safe. That's not accurate, and it's potentially a dangerous assumption."
WIDELY ACCEPTED
Some usage is widely accepted, such as calcium pills for those at risk of osteoporosis.
Omega-3 fats, available from many fish and in pill form, are believed to aid heart patients.
There are some indications chromium picolinate improves glucose control.
"It all depends on your sources," said Dr. Jeffrey Barra, who has a family practice at Proctor's Lake of the Woods Medical Center in Dunlap, Ill.
"The American Diabetic Association I would consider a pretty good source, and they endorsed (chromium picolinate). Like anything, you've got to be sure you're monitoring your blood glucose while you're taking this stuff."
Other people, such as heavy smokers or drinkers or those on dialysis, also can suffer depletions of certain vitamins and minerals. Medication also can cause depletions.
OVERDOSING
So can supplement overuse.
"I don't have a problem with taking a multivitamin, but if someone starts taking a lot of individual vitamins, it may upset the balance," Cole said. "If your body gets too much of something, it can deplete something else. And you could potentially be wasting your money."
Supplements also can interact adversely with medicine.
"People sometimes don't consider vitamins and supplements as medication," Ewalt said. "It's very important to make sure that the physician knows exactly which vitamins and supplements they're taking - especially if they're going for surgery. Some supplements thin the blood, which would not be good if that was in their system when they had surgery."
ANTIOXIDANTS
Antioxidants are the new rage, available in drinks such as green tea or via extract sold in pill form. But dietitians stress other sources of antioxidants.
"You can get plenty of antioxidants through fruits and vegetables - specifically, colorful fruits and vegetables," said Ashley Simper, a St. Francis dietitian. "If green tea is something you like, more power to you. We're, of course, going to promote getting your vitamins and minerals and antioxidants through food."
Carnahan emphasizes education and moderation. She recommends only familiar, proven brands.
"I think supplementation is good, but it can be harmful if it's the wrong ones," she said. "It's definitely a two-edged sword. I have patients come in with a list of 30 things they're taking. That could be doing a lot more harm than good."
