Working all of your major muscle groups

Be sure that your routines include at least one exercise for each of the following muscle groups. (In Part III, we show you precisely where each muscle is located.)

• Butt or buttocks (glutes)
• Front thighs (quadriceps)
• Rear thighs (hamstrings)
• Calves
• Chest (pecs)
• Back
• Abdominals (abs)
• Shoulders (delts)
• Front of upper arm (biceps)
• Rear of upper arm (triceps)

For general fitness, the preceding muscles should be your highest priorities. If you neglect any of these muscle groups, you’ll have a gap in your strength, and you may set yourself up for injury.

If you avoid training any particular muscle group, you also may end up with a body that looks out of proportion. You don’t need to hit all your muscle groups on the same day — just make sure that you work each group twice a week.

Doing exercises in the right order

In general, work your large muscles before your small muscles. This practice ensures that your larger muscles — such as your butt, back, and chest — are challenged sufficiently. Suppose that you’re performing the dumbbell chest press. This exercise primarily works your chest muscles, but your pecs do require assistance from your shoulders and triceps. If you were to work these smaller muscles first, they’d be too tired to help the chest.

On occasion, however, you may specifically want to target a smaller muscle group, like your shoulders, because they’re lagging behind in development compared to other parts of your body. If that’s the case, you may want to design a program where you do shoulder exercises first one or two days a week for several weeks to build them up. In general, follow the rule of training larger to smaller.

In order to perform your exercises in the right order, you need to understand which exercises work which muscle groups. Many people do their routines in the wrong sequence because they don’t realize the purpose of a particular exercise (the purpose isn’t always obvious). When you pull a bar down to your chest, as in the lat pulldown (see Chapter 11), you may think that you’re doing an arm exercise when, in fact, the exercise primarily strengthens your back. So, make a point to understand which muscles are involved in each move that you do. In addition, studies show that concentrating on the specific muscle that you’re working and visualizing it becoming stronger increases the effectiveness of your training. You definitely want to make sure that you’re focusing on the right muscles to get the best results.

When choosing the sequence of a workout, imagine your body splitting into three zones: upper, middle, and lower. Within each zone, do your exercises in the following order. Feel free to mix exercises from the upper and lower body. It’s a good idea to train your middle body or core stabilizer muscles last as they stabilize your body during all the preceding exercises and help to prevent injury.

Upper body

1. Chest and back (It doesn’t matter which comes first.
2. Shoulders
3. Biceps and triceps (It doesn’t matter which comes first.)
4. Wrists

Middle body

You can perform your abdominal and lower back muscle exercises in any
order you want.

Lower body

1. Butt
2. Thighs
3. Calves and shins (It doesn’t matter which comes first although we prefer
   to work our calves before our shins.)

If you want to continue to increase your strength over time, studies show that trained individuals require multiple-set training of at least three or more. A trained person is someone who’s been lifting consistently for at least three months. In addition to increasing the number of sets, you should also vary your training volume and intensity over time with periodized training as explained later in this chapter. Increases in training should be gradual to avoid injury from overtraining.

However, if your goal is to become as strong as you can or reshape an area of your body, you need to perform more than three sets per muscle group. Some serious weight lifters perform as many as 20. (However, they don’t do 20 sets of the same exercise; they may do 5 sets each of 4 different exercises that work the same muscle.) See Chapter 21 for more guidelines on how many sets to perform if you’re an experienced lifter.

The principle of specificity of training determines how much rest you should take in between sets. Beginners should take all the rest they need because you’re just becoming acquainted with your body and want to avoid injury. New exercisers may take up to twice as long to rest as those who’re more experienced. The National Strength and Conditioning Association recommends that your rest period be based on your training goal. If your goal is to increase endurance and you’re lifting 12 or more reps, your rest period should be up to 30 seconds. If your goal is to increase size, and you’re lifting between 6 to 12 reps, you should rest between 30 to 90 seconds. If your goal is to increase strength and you’re lifting fewer than six reps, you should rest between two to five minutes. People who train for pure strength are going for all-out lifts — a very intense approach. Circuit training, which emphasizes muscular endurance or what is sometimes described as cardio-resistance  involves taking little or no rest between sets.

The American College of Sports Medicine (ACSM) recommends repetitions for different people.

• High intensity: Perform 6 to 12 reps. Higher-intensity training poses a
  greater risk of injury. This approach to training is suitable for athletes
  and experienced exercisers.
• Moderate intensity: Perform 8 to 12 repetitions because this is the ideal
  number to strike a balance between building muscular strength and
  endurance and has a lower risk of injury.
• Low intensity: For older adults, the ACSM recommends doing between
  10 to 15 repetitions, an even lower intensity.

Why does performing 6 reps result in more strength than doing 15 reps? Because the number of reps you perform links to the amount of weight you lift. So when you perform 6 reps, you use a much heavier weight than when you perform 15 reps of the same exercise. Always use a weight that’s heavy enough to make that last repetition a real challenge, if not an outright struggle.

Weight training isn’t an exact science so don’t take these rep numbers too literally. It’s not as if performing six repetitions transforms you into Xena: Warrior Princess, whereas performing ten reps makes you look like Angelina Jolie. Everyone’s body responds a bit differently to weight training. Genetic factors play a significant role in determining the ultimate size that your muscles can develop.

Bodybuilders (who aim for massive size) and powerlifters (who aim to lift the heaviest weight possible) often train by hoisting so much poundage that they can perform only one or two reps. You may not desire to lift hundreds of pounds of weight over your head, so your goals are best served by doing between 6 and 15 repetitions. Doing more than 15 reps is generally not effective for building strength, but can improve muscular endurance.

To focus on increasing muscular endurance, you want to do at least 12 reps or more, but only two to three sets. To increase muscle size, you want to do between 6 to 12 reps, but more sets — anywhere from three to six. To increase muscular strength, you want to do fewer reps, no more than six, and anywhere from two to six sets each

This may make your eyebrow frown and you may be more interested to know about the unnecessary higher consumption of vitamin A. Let’s see few cases. In the year 1913, there was a great rush for new exploration of unknown lands. One sailor was caught up in extremely bad weather. He did not have any thing to eat and lastly, he started killing his escorting husky dogs & ate the meat and liver continuously for few days. The husky dog’s meat is the rich source for vitamin A. One day the sailor saw that his skin had become abnormally thick and skin ulcer started appearing in many places on the skin.

There is custom in Eskimos that they never eat the meat of their sledge bearer husky dogs. The foreign tourists, who do not pay any heed to the verdict, like to eat the delicious meat from those dogs, generally land up with same problem. The liver of the polar bar also contains enriched quantity of vitamin A. It has been regularly reported to the medical fraternity that this food item typically induces a dull and perennial headache with drowsiness. Skin ulcer is the bonus additionally for the regular eater of the liver of   polar bear.  It is known as hyper vitaminosis syndromes of vitamin A.

Let us dig little more. Vitamin A is having a character of inducing fetal malformation if taken indiscriminately at higher dose for longer period. Some pregnant mothers are multiplying this risk in the abundance of high supply of vitamin A. It does not end here, as some newly mothers feed their children with high dose of cod liver oil. Many repots have confirmed that prolonged high dose initiates a chronic poison like state of blood and it likely to result in painful bone, skin ulcers, abnormality in the size of the liver and spleen and melancholy. These findings are clinically confirmed and registered in many pharmacological text books.

Now don’t be scared much. It is not like that vitamin A is a harmful substance of the body, rather, many essentials functions are geared up by this substance. The main beneficial action is related to skin and it helps in forming mucosal layer of the skin. This layer is very delicate and performs many important physiological functions.

The second very important role is associated with eye and deficiency causes much blindness worldwide.  The third one is directly linked to improved immune status of the body and probably it provides a protective role against many cancers. Some forms of vitamin A are used in treating acne with promising result.

So you have received the message. It is better to handle with care.

The results of a 2005 survey published in the Journal of the American Dietetic Association indicated that as the use of nonvitamin, non-mineral supplements (such as herbal and botanical dietary supplements) had increased during the previous 10 years, so had the concomitant use of dietary supplements and over-the-counter and/or prescription drugs. Many of the people who participated in the survey were taking multivitamin pills and were surprised to learn that their multivitamins contained non-vitamin, non-mineral dietary (that is, herbal and other) supplements as well.

Interactions with Drugs

Few studies have specifically examined interactions between drugs and dietary supplements in the general population, and existing reports have found only mild interactions. These articles comprised mainly case reports, estimations based on laboratory experiments (not in humans), and speculation based on pharmacology studies and theoretical risks. Lack of data, however, does not imply lack of danger.

Dietary supplements may alter the activity of conventional drugs. Such interactions may occur in individuals who are particularly sensitive or immunocompromised or for drugs that have a narrow therapeutic window. In addition, response to drug and dietary supplement consumption may change with age and health status. Interactions between drugs and dietary supplements are especially likely in geriatric patients because they use more drugs and often combine prescription and over-the-counter drugs with herbal remedies. People with a chronic illness, specifically those with hepatic or renal impairment, are at higher risk of harmful interactions between drugs and dietary supplements.

Drug concentration or activity in the blood may be increased if a dietary supplement aids the absorption of the drug or if it inhibits enzyme destruction or elimination of the drug. Conversely, drug concentration and/or activity in the blood may be decreased if the dietary supplement binds components of the drug, thus preventing its absorption, or if the dietary supplement stimulates production and/or activity of enzymes that destroy the drug.

Some of the most popular dietary supplements may interact with drugs. A 2004 study at the University of Chicago Medical Center, which was funded by the National Institutes of Health and the Tang Center for Herbal Medicine Research, found that ginseng, which is commonly taken to enhance well-being, reduce fatigue, and improve immune response, decreased the effect of the anticoagulant warfarin. People who consumed warfarin and ginseng had an increased incidence of blood clots and therefore an increased risk of deep vein thrombosis. Because of ethical reasons, this study was done in healthy individuals, but the researchers believed that the results could be applied to those taking warfarin for prevention of deep vein thrombosis.

St. John’s wort, which people commonly take for mild to moderate depression, may alter the effectiveness of drugs prescribed for HIV, heart disease, depression, epileptic seizures, and cancer and may interfere with oral contraceptives. Dietary supplements containing garlic have the potential to increase the risk of bleeding if combined with other drugs that increase bleeding risk, such as aspirin and warfarin.

Dietary Supplements and Potential Interactions

Interactions with Other Dietary Supplements

Although the potential for a dietary supplement to interact with others exists, currently there is not enough evidence to identify those risks. This should not be interpreted as there being no risk, however, only that none has been identified.

Eat these when you’re not on the diet.

Bread: Stick to high fiber types of bread i.e., whole grain, mixed grain, wheat, etc.

Potatoes: Keep the skin on. When eating baked potatoes, try finely chopped onion and garlic instead of sourcream or butter. Cut your potatoes into long wedges and add your favorite seasonings while cooking on medium heat in a non-stick pot. Brown all sides. Delicious!

Soup: Not just our Negative Calorie soup, but other kinds as well. Try including them into your daily meals. Have a bowl before each main dish. You’ll eat less. Add chicken, turkey, or different kinds of fish or seafood – you’ll be amazed!

Rice: Brown is better, but white is okay. Add vegetables or eat alone. Add lean beef, chicken, or fish. Try to include into your daily meals.

Beans: Black beans, pinto, kidney, red, etc. Mix, or eat separately. Try using different varieties of beans with the majority of your meals. Use in burritos with rice. Very high in protein, low in calories.

Buckwheat: Mix it with your rice, pancakes, cereal, etc.

Chicken: Just be sure to remove the skin before eating. Turkey: Same as with Chicken.

Fish: Not just Negative Calorie fish, but others as well. Add these to your daily meals when you’re not on the diet.

Cottage cheese: Dip your vegetables in it or eat it plain.

Pasta: High in carbohydrates. Rich in starch.

Yogurt: Protein and calcium rich. Great for snacks when you’re not on the diet.

Bananas: Have a banana split! Mix them with strawberries.

Peppers: Hot peppers, chili peppers, try them all! They’re hot, they’’re spicy, and they speed up your metabolism!

Health Status

Dietary supplements may act differently in different people. As noted by Christine Lewis-Taylor, former director of the FDA’s Office of Nutritional Products, Labeling, and Dietary Supplements, “one man’s dose can be another man’s poison.” An individual’s genes and health status help to
explain this difference.

Nutritional genomics and metabalomics are growing areas of research that explain the relationship between genetic makeup and nutrition- and metabolism-related outcomes. Certain relationships between nutrients and health outcomes are well characterized. Folate supplementation, for example, is recommended for all women of childbearing age to prevent fetal neural tube defects. By isolating and analyzing the function of the genes responsible for folate metabolism, however, scientists have identified a genetic variation that predisposes some women to give birth to babies with neural tube defects. This knowledge may eventually allow scientists to target folate supplementation to at-risk individuals. Stage of life, medical history, and environmental factors such as diet and exercise can affect how a dietary supplement behaves in the body. Several populations are at increased risk of adverse effects of dietary supplements:

• children,
• people of smaller stature,
• elderly people,
• women who are pregnant or breastfeeding,
• people with immune disorders (for example, HIV or AIDS),
• people with cancer,
• malnourished people,
• people with existing or subclinical liver or kidney disease,
• people with a history of gastrointestinal health conditions (such as Crohn’s disease) or surgery (such as gastric bypass surgery),
• people who are hospitalized,
• transplant recipients,
• surgical patients.

While research has revealed the unique nutritional needs in women of childbearing age (for example, 400 micrograms of folate are recommended to prevent neural tube defects in offspring, and if pregnant, supplemental vitamins are recommended), information on the effects of dietary supplements during pregnancy and breastfeeding are extremely limited. This is largely due to ethical considerations: scientific studies are not conducted during pregnancy and breastfeeding because of potential risks to the women and their babies. Several herbal dietary supplements historically used during pregnancy have been identified as harmful.

Certain dietary supplements may cause adverse effects during surgery, including increased or decreased bleeding. Medical or surgical professionals should be consulted several weeks before any scheduled surgery to determine whether dietary supplements should be discontinued.

Perhaps the most common adverse effects of dietary supplements are gastrointestinal, including constipation, diarrhea, or nausea. Gastrointestinal adverse effects are often present when a dietary supplement is first added to the diet. Over time, these symptoms may decrease or may cause an individual to discontinue use.

Potential Adverse Events Associated with Some Herbal Dietary Supplements during Pregnancy

Dietary Supplements That May Alter Bleeding

Many dietary supplements are metabolized by the liver and/or kidneys and may therefore cause adverse effects in people with overt or subclinical liver or kidney disease. Adverse effects could include worsening of disease complications or presentation of a previously undiagnosed disease. Other dietary supplements may cause adverse effects in other parts of the body; for example, calendula may cause eye irritation, Ginkgo biloba can cause skin to become dry, and St. John’s wort may increase sensitivity to the sun.

Important Definitions

According to the DSHEA, a dietary supplement is a product that

• is intended to supplement the diet;
• contains one or more dietary ingredients (including vitamins, minerals, herbs or other botanicals, amino acids, and other substances) or their constituents;
• is intended to be taken by mouth as a pill, capsule, tablet, or liquid;
• is not represented as a conventional food or as a food replacement;
• is labeled on the container’s front panel as being a dietary supplement;
• includes products such as an approved new drug, certified antibiotic, or licensed biologic that was marketed as a dietary supplement or food before approval, certification, or license (unless waived by the secretary of the Department of Health and Human Services).

The DSHEA presumes that ingredients introduced prior to October 15, 1994, are safe. A new dietary ingredient, on the other hand, is an ingredient not sold in the United States in a dietary supplement prior to that date or one that is part of a dietary supplement introduced on or after October 15, 1994. At least 75 days before marketing a dietary supplement containing a new dietary ingredient, manufacturers must provide the FDA with their basis for deeming the ingredient “reasonably expected to be safe.”

If they meet the criteria above, botanicals may be considered dietary supplements. A botanical is a plant, or part of a plant, that is used for one or more of its specific characteristics, including medicinal properties, flavor, and scent; herbs are a subset of this group, usually the green, leafy portion of the plant. Botanicals are identified by Latin names designating the genus and species of the plant. Many botanicals, however, have numerous common names or are identified only by their genus. For example, the commonly known dietary supplement black cohosh (Cimicifuga racemosa) is also known as baneberry, black snakeroot, bugwort, cohosh bugbane, rich weed, rattle root, solvlys, and squaw root, to name a few. Botanicals can be sold in many forms, including fresh or dried, as liquid or solid extracts, in tablets and capsules, as loose powders, and in tea bags.

The intended use of a consumable product is essentially what determines its classification—and therefore its regulation—as a food, drug, or dietary supplement. Drugs are created to treat, cure, or somehow mitigate a disease or condition. A dietary supplement cannot claim to have these
effects; if such a claim is made by the manufacturer of a dietary supplement, the substance must then be regulated as a drug. However, a manufacturer can claim a supplement is “used for” anything at all, even though it may have no effect.

The list below describes common preparations of botanicals.

Tea
Process – Also known as an infusion, a tea a liquid that can be drunk is made by adding boiling water hot or cold to fresh or dried botanicals and steeping them.
Product – a liquid that can be drunk hot or cold

Decoction
Process – Sometimes botanicals are  more aggressively processed. A decoction is made by simmering botanicals in boiling water for longer periods of time.
Product – a liquid that can be drunk

Tincture
Process – A botanical is soaked in a  solution of alcohol and water to  both concentrate and preserve
botanical substances, and they can be identified by the concentration of botanical substance in the final product.
Product – a liquid that can be drunk (diluted or as a make a tincture. Tinctures concentrate

Extract
A botanical is soaked in a liquid can be consumed as a to extract certain chemicals and the extract is concentrated.
Product – can be consumed as a liquid, in capsules, or as tablets containing the evaporated substance

Labeling

Labels must include the word supplement and identify the product as a dietary supplement. The required information on dietary supplement labels includes the name and quantity of each nutrient and dietary ingredient or, for proprietary blends, the total quantity of all dietary ingredients (except
inert ingredients) in the blend. Since 1997 all supplements must bear a label entitled “Supplement Facts,” which is very similar in format and content to the “Nutrition Facts” label that appears on all food and beverages marketed in the United States. Labels on herbal and botanical products must state which part of the plant the contents come from. Below is  a sample label from a bottle of Ginkgo biloba.

Some dietary supplements are included in official compendia, such as the U.S. Pharmacopoeia, the Homeopathic Pharmacopoeia of the United States, or the National Formulary. If a supplement is included in a compendium, it must correspond with the specifications of that compendium. For dietary supplements not included in official compendia, the label must correctly identify each substance and the amount in the supplement.

Dietary supplement labels must also contain nutritional information, including ingredients present in significant amounts, and first listing those for which the FDA has established %DVs. Labels must also include the quantity per serving for each dietary ingredient and may include the source of the ingredients.

The FDA published the Dietary Supplement Labeling Guide in 2005. This guide was created in response to numerous questions from the dietary supplement industry regarding all legislation relevant to dietary supplement labels.

Health Claims on Dietary Supplement Labels

The use of health claims on food products is regulated by the Nutrition Labeling Education Act of 1990.  Health claims describe the relationship between a specific nutrient and a disease or condition. In order to appear on the food or dietary supplement label, health claims must be evaluated
and preapproved by the FDA based on “significant scientific agreement.” Few such health claims have been authorized by the FDA.

While a dietary supplement can never be claimed to “diagnose, prevent, mitigate, treat, or cure” a specific disease, the DSHEA allows use of specified statements on the labels of dietary supplements. In addition to the approved health claims listed below, dietary supplement labels can contain statements about nutritional support. These statements, known as structure-function claims, may describe how the product affects the structure or function of the body or the overall well-being of the consumer. Before making such statements on a label, however, manufacturers of dietary supplements must prove that the nutritional support statement is truthful and not misleading, and they  must notify the FDA within 30 days of making the statement. When a nutritional support statement appears, the label must also state, “This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.”

Additional Information Given to Consumers

Manufacturers of dietary supplements often seek to promote their product by providing supporting material such as a scientific study or the statement of a medical or nutrition professional. Under certain conditions, this additional material is not considered to be “labeling,” per se, and is therefore not regulated in the same fashion.

If the manufacturer uses a reprinted scientific article, it must be printed in its entirety and must not be accompanied by any added information. Additional publications used in connection with the sale of dietary supplements cannot be misleading, cannot promote a particular manufacturer or brand, must present a balanced view of the available scientific evidence, and must be physically separate from the dietary supplements in the store.

Good Manufacturing Practices

The DSHEA gave the FDA the authority to establish special good manufacturing practices for dietary supplements. In March 2003 the FDA released its “Proposed Rule for Dietary Supplement Current Good Manufacturing Practices,” which addresses important components of dietary supplement manufacture, including design and construction of manufacturing facilities, quality-control procedures, testing of the final product(s) or incoming and in-process materials, management of consumer complaints, and record keeping and filing of compliance with these standards. The basic tenets of the current good manufacturing practices require that dietary supplement manufacturers
use current industry standards in the processing of dietary supplements to avoid contamination (by pesticides, heavy metals, or other impurities) and improper labeling and to ensure that product labels accurately reflect the identity, purity, quality, strength, and composition of dietary supplements. The following are some examples of product quality problems that these rules are meant to address:

• contains more of the active or inactive ingredients than listed on the label;
• contains less active ingredients than listed on the label;
• contains the wrong ingredient(s);
• contains a drug contaminant;
• contains other contaminant(s), such as bacteria, mold, pesticide, or lead;
• package contains foreign material, such as glass;
• improper packaging and/or mislabeled product.

The “Proposed Rule for Dietary Supplement Current Good Manufacturing Practices” was open to public comment for a year before it was to be considered final. After approval, dietary supplement companies would have 36 months to implement the changes necessary to comply with the rule. Until then, dietary supplement manufacturers were to follow good manufacturing practices for foods. During the comment period, however, the FDA received more than 1600 pages from consumers and members of the dietary supplement industry. A final rule therefore has been delayed and is expected in late 2006 (for current information, see http://www.cfsan.fda.gov/~dms/ds-ind.html#GMPS).

Creation of New Government Entities

Appointed in 1995, the Commission on Dietary Supplements directs the labeling of dietary supplements, essentially to determine how to provide scientifically valid information about them. The first commission comprised scientists from various U.S. universities with expertise in dietary supplements, a member of the Council for Responsible Nutrition, a Seton Hall University School of Law professor, a public relations specialist, and a representative from the Herb Research Foundation.

Responsibilities carried out by the Commission on Dietary Supplements are now being performed by the Office of Nutritional Products, Labeling, and Dietary Supplements’ Division of Dietary Supplement Programs, which comprises a regulations and review team, a compliance and enforcement team, and a clinical review team. Led by Dr. Susan Walker, the division creates policies, regulations, and guidance documents to ensure the safe manufacture and labeling of dietary supplements and reviews safety information submitted by dietary supplement manufacturers 75 days before the marketing of a product to ensure that it is reasonably expected to be safe.

The DSHEA also called for the creation of the Office of Dietary Supplements (ODS), which is housed within the National Institutes of Health and is responsible for facilitating research into the role of dietary supplements in disease prevention and health promotion. The mission of ODS is to strengthen knowledge about dietary supplements by evaluating available research and stimulating and supporting more scientific trials, as well as by educating people about the current state of knowledge. As part of their mission, ODS hosted the 2000 National Nutrition Summit and created numerous resources, including Computer Access to Research on Dietary Supplements, International Bibliographic Information on Dietary Supplements, Annual Bibliographies of Significant Advances in Dietary Supplement Research, and Dietary Supplement Ingredient and Labeling databases. The ODS’s 2004–2009 strategic plan comprises five major goals:

1. expanding the evaluation of dietary supplements in reducing the risk for chronic disease;
2. fostering research on dietary supplements for optimal health and performance;
3. enhancing understanding of the basic effects of dietary supplements on biological systems;
4. improving methodologies;
5. expanding outreach and education.

Whether they are in good health, trying to prevent family medical history from repeating itself, or managing a known illness, people want to feel in control of their health. According to the 2001 “Dietary Supplement Barometer Survey,” the top three reasons consumers take dietary supplements are to feel better, prevent sickness, and treat sickness. Dietary supplement users can be further divided into two groups: those who take them for insurance, which includes people who take dietary supplements for prevention and those who take them to treat an existing condition.

• To feel better – 72%
• To prevent sickness – 67%
• To treat sickness – 51%
• To live longer – 50%
• To build strength and muscle – 37%
• For a specific health reason – 36%
• On the advice of a doctor – 30%
• For sports nutrition – 24%
• To lose or manage weight – 12%

Dietary Supplement Use for Prevention

Many people who take dietary supplements are in good health. Sometimes characterized as “the worried well,” this
population tends to consume healthful diets and dietary supplements and to lead healthy, active lives. While there is no evidence that people in this group rely on dietary supplements as a substitute for good dietary habits, they do believe dietary supplements provide something that may be missing from their diets or that could help them to lead longer, healthier lives.

Among people who use dietary supplements for prevention, some have a more specific agenda. Some take dietary supplements to prevent a specific disease or condition, such as a disease that runs in the family or any disease or condition that has caused the individual concern. If a woman’s mother and father died of heart disease, for example, she may use dietary supplements touted to prevent heart disease. However, many health conditions have gained popular attention through the media, and American consumers have responded with heightened awareness. A study by the American Institute for Cancer Research found that 39 percent of people surveyed said they had made changes to their diets to reduce cancer risk, and 68 percent of those reported using dietary supplements. Of the 61 percent of people who had not made changes to their diets, only 36 percent reported using dietary supplements.

Health professionals comprise another large group of dietary supplement users. Doctors, nurses, dietitians, and pharmacists tend to use dietary supplements more frequently than the general public, and they choose dietary supplements according to specific health concerns. One survey of about 4500 female physicians found that half took a multivitamin; those who were at high risk for heart disease were more likely to use antioxidants, and those with a family history of osteoporosis were nearly three times more likely to regularly use a calcium supplement. Among almost 200 cardiologists surveyed in the late 1990s, 44 percent routinely took antioxidants. Within this group, 90 percent took vitamin E, 75 percent took vitamin C, and less than half took beta-carotene. (Unfortunately, this population has not been surveyed since several widely publicized studies linked high intakes of vitamin E and beta-carotene with serious
adverse events.)

Dietary Supplement Use for Treatment

The other group of dietary supplement users takes them to treat or manage a current disease. For instance, chondroitin sulfate is used to treat osteoarthritis; saw palmetto is used to treat an enlarged prostate (benign prostatic hypertrophy); and fish oil is used to treat high blood pressure. Despite extensive medical research, many conditions and diseases still have no cure or limited treatment options; other conditions have inadequate treatments and/or treatments that cause adverse effects. Many consumers believe dietary supplements offer an alternative to conventional medicine. Long clinical trials and protracted drug approval processes, which seem to keep valuable information and treatments from people in need, may engender consumer skepticism of traditional medicine, as do fears about drug dependence, adverse effects, and interactions.

Individuals may feel empowered by the choice and ability to take dietary supplements. For them, dietary supplements represent hope when conventional approaches have failed. To be able to take something to promote healthfulness without the written permission of a doctor or pharmacist can provide a sense of autonomy. In addition, dietary supplements have a “natural” connotation, which elicits less fear than a prescription drug synthesized in a factory (although dietary supplements are also manufactured this way).

Understanding Dietary Supplements, by Jenna Hollenstein.

The focus of nutrition research, in turn, has shifted to the quality of the diet. Many nutrition scientists are examining how the food we eat affects our health. Some foods, such as those high in saturated and trans fats, have negative effects on health, whereas foods such as fruits and vegetables have positive effects. Scientists are also examining individual nutrients and other substances with potential health-promoting properties. Although deficiencies can be avoided by consuming adequate nutrients, it is unclear whether health can be optimized by consuming more than the established adequate nutrient levels.

The idea of “consuming to promote health” has captured many people’s imaginations. No longer focusing on eating to prevent nutrient deficiency, American consumers are especially interested in which specific foods, nutrients, and other substances can improve health and quality of life by ameliorating current health conditions or preventing future ones. Health-seeking individuals purchase food and other items, including dietary supplements, that they believe will make them healthier.

Who Takes Dietary Supplements?

The 2005 “Dietary Supplement Barometer Survey” found that 85 percent of Americans regularly took one or more dietary supplements, which represents a sharp increase from the 59 percent reported in the 2001 survey. The Nutrition Business Journal estimated that sales of vitamins, minerals, multivitamins, herbal and botanical supplements, sports nutrition supplements, and other dietary supplements totaled $20.3 billion in 2004.

Health-related behaviors are driven by many factors, including sex, age, ethnicity, education, income, geography, and lifestyle, and all of those factors influence the likelihood that an individual will take a dietary supplement. Across nearly all age groups, women are more likely than men to use dietary supplements. In American homes, women still tend to make most of the decisions related to food and nutrition. The nurturing behaviors of women help to explain why they are
more likely than men to consume dietary supplements.

Women are also often the main caregivers. Children under 5 years of age, one of the largest age groups to take dietary supplements, tended to get them from their mothers. Evidence suggests that children with special healthcare needs represent a growing population of dietary supplement users. These children are more likely to receive supplements from mothers than from fathers, especially if the mothers are dietary supplement users.

Most people between the ages of 5 and 20 are not consumers of dietary supplements. After age 20, when young adults often begin to take responsibility for their health, more people consume dietary supplements. Women of reproductive age, especially those who are pregnant or planning to become pregnant, are another large group of dietary supplement users.

The “National Maternal and Infant Health Survey” found that 81 percent of pregnant women took a multivitamin supplement, most often on the advice of their obstetrician.

After age 20, dietary supplement use increases with age. This is particularly evident among the elderly. More than half
of all people over the age of 65 take a multivitamin or other dietary supplement regularly. A substantial proportion of this population also uses herbal supplements regularly. Older Americans who take dietary supplements are already healthier than their counterparts who do not take dietary supplements; they are typically leaner and more physically active, smoke and drink less, and eat more fruits and vegetables.

All surveys indicate that dietary supplement use is highest among non-Hispanic whites, whereas African Americans and Mexican Americans are less likely to consume dietary supplements. Although Asian Americans were not included in the
2005 “Dietary Supplement Barometer Survey,” other sources show they are frequent users of dietary supplements. In addition, a language barrier may have prevented surveys from obtaining accurate data from non-English-speaking ethnic groups. In fact, cultural, historic, and anecdotal references suggest that many cultures use nonfood items, including botanical and herbal substances, to treat illness and promote health.

People who use dietary supplements tend to be educated and to have a higher than average annual income. Table 1.1 shows a significant difference between dietary supplement use among adults with less than 8 years of education and those with more than 12 years of education. Likewise, there is a direct relationship between annual income and dietary supplement use  a 20 percent increase in dietary supplement use is evident between those whose annual income is less
than $10,000 and those who make $50,000 or more annually.

According to the 2001 “Dietary Supplement Barometer Survey,” Americans living in the western states have the highest rate of dietary supplement use (47.8 percent). Midwesterners are second (38.0 percent), followed by people living in the Northeast (37.8 percent) and the South (36.2 percent).

Understanding Dietary Supplements, by Jenna Hollenstein.

In this article, I described the trends specific to people who take dietary supplements. I extracted data from several sources, including the 2001 and 2005 “Dietary Supplement Barometer Surveys,” which were conducted by the Natural Marketing Institute and the Dietary Supplement Education Alliance; the “Nutrition, Health, and Wellness Trends Report,” also done by the Natural Marketing Institute; the “Centers for Disease Control and Prevention/National Center for Health Statistics Survey”; the “National Health and Nutrition Examination Surveys”; the Nutrition Business Journal; the Journal of the American Dietetic Association; and the Council for Responsible Nutrition (http://www.crnusa.org). Most of the figures in this article are from the 2001 and 2005 “Dietary Supplement Barometer Surveys.” When specific numbers are provided, however, they represent general trends.