Nutr J. 2007 Oct 24;6(1):30 [Epub ahead of print] Usage patterns, health, and nutritional status of long-term multiple dietary supplement users: a cross-sectional study. Block G, Jensen CD, Norkus EP, Dalvi TB, Wong LG, McManus JF, Hudes ML. ABSTRACT: BACKGROUND: Dietary supplement use in the United States is prevalent and represents an important source of nutrition. However, little is known about individuals who routinely consume multiple dietary supplements. This study describes the dietary supplement usage patterns, health, and nutritional status of long-term multiple dietary supplement users, and where possible makes comparisons to non-users and multivitamin/mineral supplement users. METHODS: Using a cross- sectional study design, information was obtained by online questionnaires and physical examination (fasting blood, blood pressure, body weight) from a convenience sample of long-term users of multiple dietary supplements manufactured by Shaklee Corporation (Multiple Supp users, n=278). Data for non-users (No Supp users, n=602) and multivitamin/mineral supplement users (Single Supp users, n=176) were obtained from the National Health and Nutrition Examination Survey (NHANES) 2001-2002 and NHANES III 1988-1994. Logistic regression methods were used to estimate odds ratios with 95% confidence intervals. RESULTS: Dietary supplements consumed on a daily basis by more than 50% of Multiple Supp users included a multivitamin/ mineral, B-complex, vitamin C, carotenoids, vitamin E, calcium with vitamin D, omega-3 fatty acids, flavonoids, lecithin, alfalfa, coenzyme Q10 with resveratrol, glucosamine, and a herbal immune supplement. The majority of women also consumed gamma linolenic acid and a probiotic supplement, whereas men also consumed zinc, garlic, saw palmetto, and a soy protein supplement. Serum nutrient concentrations generally increased with increasing dietary supplement use. After adjustment for age, gender, income, education and body mass index, greater degree of supplement use was associated with more favorable concentrations of serum homocysteine, C-reactive protein, high-density lipoprotein cholesterol, and triglycerides, as well as lower risk of prevalent elevated blood pressure and diabetes. CONCLUSIONS: This group of long-term multiple dietary supplement users consumed a broad array of vitamin/mineral, herbal, and condition- specific dietary supplements on a daily basis. They were more likely to have optimal concentrations of chronic disease-related biomarkers, and less likely to have suboptimal blood nutrient concentrations, elevated blood pressure, and diabetes compared to non-users and multivitamin/mineral users. These findings should be confirmed by studying the dietary supplement usage patterns, health, and nutritional status of other groups of heavy users of dietary supplements. PMID: 17958896 [PubMed - as supplied by publisher]

Usage patterns, health, and nutritional status of long-term multiple dietary supplement users: a cross-sectional study. Block G, Jensen CD, Norkus EP, Dalvi TB, Wong LG, McManus JF, Hudes ML. ABSTRACT: BACKGROUND: Dietary supplement use in the United States is prevalent and represents an important source of nutrition. However, little is known about individuals who routinely consume multiple dietary supplements. This study describes the dietary supplement usage patterns, health, and nutritional status of long-term multiple dietary supplement users, and where possible makes comparisons to non-users and multivitamin/mineral supplement users. METHODS: Using a cross- sectional study design, information was obtained by online questionnaires and physical examination (fasting blood, blood pressure, body weight) from a convenience sample of long-term users of multiple dietary supplements manufactured by Shaklee Corporation (Multiple Supp users, n=278). Data for non-users (No Supp users, n=602) and multivitamin/mineral supplement users (Single Supp users, n=176) were obtained from the National Health and Nutrition Examination Survey (NHANES) 2001-2002 and NHANES III 1988-1994. Logistic regression methods were used to estimate odds ratios with 95% confidence intervals. RESULTS: Dietary supplements consumed on a daily basis by more than 50% of Multiple Supp users included a multivitamin/ mineral, B-complex, vitamin C, carotenoids, vitamin E, calcium with vitamin D, omega-3 fatty acids, flavonoids, lecithin, alfalfa, coenzyme Q10 with resveratrol, glucosamine, and a herbal immune supplement. The majority of women also consumed gamma linolenic acid and a probiotic supplement, whereas men also consumed zinc, garlic, saw palmetto, and a soy protein supplement. Serum nutrient concentrations generally increased with increasing dietary supplement use. After adjustment for age, gender, income, education and body mass index, greater degree of supplement use was associated with more favorable concentrations of serum homocysteine, C-reactive protein, high-density lipoprotein cholesterol, and triglycerides, as well as lower risk of prevalent elevated blood pressure and diabetes. CONCLUSIONS: This group of long-term multiple dietary supplement users consumed a broad array of vitamin/mineral, herbal, and condition- specific dietary supplements on a daily basis. They were more likely to have optimal concentrations of chronic disease-related biomarkers, and less likely to have suboptimal blood nutrient concentrations, elevated blood pressure, and diabetes compared to non-users and multivitamin/mineral users. These findings should be confirmed by studying the dietary supplement usage patterns, health, and nutritional status of other groups of heavy users of dietary supplements. PMID: 17958896 [PubMed - as supplied by publisher] Hi RS, I was just about to post that study, but see that you beat me to it BTW the full text article is free through pubmed for those interested: http://www.nutritionj.com/content/pdf/1475-2891-6-30.pdf

600 nmol/L for serum 25-hydroxy~vitamin D [16-19]; 9 µmol/L for serum ~homocysteine [20]; 3.0 mg/L for serum ~CRP [21];  200 mg/dL for serum total cholesterol [22]; <40 mg/dL for serum high-density lipoprotein (~HDL)-cholesterol for men and <50 mg/dL for women [22];  130 mg/dL for serum low-density lipoprotein (LDL)- cholesterol [22]; <5 for the ratio of total cholesterol to HDL-cholesterol [22];  150 mg/dL for serum ~triglycerides [22]; and <0.4 mg/dL and 1.0 mg/dL for ascorbic acid [23,24]... There was a decrease in concentrations of biomarkers associated with disease risk as supplement use increased (Table 4).  Across the three user groups there was a decrease in serum CRP and the ratio of total cholesterol to HDL- cholesterol, and an increase in HDL-cholesterol concentration.  Serum homocysteine and triglycerides were lower in the Multiple Supp users than in the other two groups. Finally, serum total cholesterol was significantly lower in the Multiple Supp group, whereas LDL-cholesterol concentrations did not vary significantly by supplement use... the risk among Multiple Supp users could not be estimated because of the absence of any persons with elevated values of CRP...[This may have been because those who were sick did not want to travel.] Health status and disease prevalence Prevalence of self-reported disease was low in each user group and most risk estimates did
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