Are Supplements Worth It?

Written by Dr. Steve Chaney on . Posted in Healthy Living, Supplements and Health

A Cost, Benefit Analysis of Supplementation

Author: Dr. Stephen Chaney

 

are supplements worth itAre supplements worth it?  There is no question that supplements add to the family budget. As families juggle their budgets it is natural to wonder whether the supplements they are buying are worth the cost.

It is only natural to ask questions like: “What is the cost, benefit ratio of supplementation?” “Is there any evidence that supplementation today will save us money in health care costs down the road?”

If a recent study is accurate, the answer to that last question may be a resounding yes!

How the Study Was Designed

A number of studies in the past have suggested that supplementation reduces health care costs, but they have suffered from a variety of methodological pitfalls so their conclusions could not be considered definitive.

In a time of skyrocketing health care costs coupled with governments tightening their budgets worldwide, it has become increasingly important for those governments to determine what the most cost effective public health interventions are. Thus, the question of whether supplementation can decrease health care costs has become paramount.

Therefore, an international group of scientists decided to do a systematic review and meta-analysis of the cost effectiveness of supplementation (Elia et al, Clinical Nutrition, doi: 10.1016/j.clnu.2015.07.012). They included only the highest quality previous studies in their analysis. After screening 16,598 published studies they excluded all but 19 in their final evaluation. The studies that they included had the following characteristics.

  • The subjects were supplementing with a commercially available multi-nutrient supplement that also contained protein and calories (i.e. a meal replacement supplement). Subjects consuming disease-specific supplements or immune-enhancing supplements were excluded from the study.
  • Subjects were studied in a wide variety of settings, including both free living individuals in the community and those in care homes
  • In some cases the supplementation was begun while they were in the hospital and continued when they went home. In other cases supplementation was begun while they were at home and continued after admission to the hospital.
  • Subjects were of all ages.

Are Supplements Worth It — The Money?

are supplements worth the moneyFrom a public health perspective the conclusion from this study was clear. Supplementation with a basic meal replacement supplement saves money. It is an effective public health intervention.

  • Overall, supplementation decreased health care costs by 8.1%.
  • For studies lasting less than 3 months, supplementation reduced health care costs by 9.2%. These were most often short-term pre- and/or post-operative supplementation studies. The cost savings ranged from $300-$530 per patient.
  • For studies lasting more than 3 months, supplementation reduced health care costs by 5%. These were mostly long-term community studies.
  • Overall, the costs savings attributable to supplementation were most apparent in short term studies involving a hospital component and in those studies involving younger patients.

The first observation was expected, but the second was a bit of a surprise. The general assumption is that elderly patients are more likely to suffer from malnutrition and benefit from supplementation. These data suggest that suboptimal nutrition may be more prevalent in younger adults than generally anticipated.

The reduction in health care costs was primarily due to:

  • Significant (16.5%) reduction in hospital admissions.
  • Decreased length of stay in the hospital.
  • Decreased infections.
  • Reduced post-operative complications.
  • Reduced falls and functional limitations in the elderly.

Although, it did not factor into the cost analysis, those subjects using the meal replacement supplement reported greater quality of life as well.  Are supplements worth it?  For some, a greater quality of life would help answer that question.

Strengths and Weaknesses of the Study

This was an excellent study, but it does have some important limitations.

  • While the systematic review and meta-analysis was very well done, it is limited by the quality of the studies that were included in the analysis, and most of those studies had one or more limitations. The authors acknowledged the need for future large scale, prospective studies, that are designed specifically to measure the cost effectiveness of supplementation.
  • The authors focused almost entirely on the cost benefit analysis. No information was provided on:
  • The health of these subjects
  • Why they were using a meal replacement supplement
  • Whether they decided to use the meal replacement supplement on their own or whether it was recommended by their doctor.

Thus, it is a bit difficult to extrapolate these data from a public health perspective to an individual perspective – the question of whether supplementation reduces health care costs sufficiently to be cost effective for you and me.

  • This study showed that even a basic meal replacement supplement has a significant effect on reducing health care costs in a variety of settings. However, it provides no information on whether individuals would obtain even greater benefit if they included other supplements in their program.

The Bottom Line

  1. A recent study has shown that even a simple meal replacement supplement can be an effective public health intervention because it significantly reduces health care costs and improves quality of life.
  2. The most significant reductions in health care costs came from:
    • A significant (16.5%) reduction in hospital admissions.
    • Decreased length of stay in the hospital.
    • Decreased infections.
    • Reduced post-operative complications.
    • Reduced falls and functional limitations in the elderly.
  3. The cost savings were most significant when the meal replacement supplement was used just prior to or following hospital admission for a surgical procedure. This argues strongly for a basic program of nutrition supplementation whenever you are preparing for surgery.However, as the saying goes “Stuff happens”. We don’t always know the precise date and time of our next hospital admission. This may be one case where an ounce of prevention is definitely worth a pound of cure.
  4. The study did include some long term studies of free living individuals in the community, but it is difficult to directly extrapolate from this study to the question of how much a basic meal replacement supplement might reduce health care costs for healthy individuals like you and me.However, many of the things we do to improve our health – buy organic, go on a diet program, purchase a gym membership, or go on a supplement program, for example – cost us money. It is studies like this that suggest at least a portion of those costs may be offset by reduced health care costs down the road.
  5. Finally, this study only looked at the cost effectiveness of a basic meal replacement supplement. It does not provide any information on whether addition of other supplements might provide even greater health care savings.There are studies suggesting that a holistic approach to supplementation may reduce disease burden long term (for example; Nutr J. 2007 Oct 24; 6:30). A detailed cost effectiveness analysis has not been performed on those studies, so we cannot say how much money they might save in reduced health care costs over the long term. However, if a holistic program of diet, exercise and supplementation keeps me out of the doctor’s office and out of the hospital, I’m happy.

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

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High Protein Diets and Weight Loss

Posted October 16, 2018 by Dr. Steve Chaney

Do High Protein Diets Reduce Fat And Preserve Muscle?

Author: Dr. Stephen Chaney

Healthy Diet food group, proteins, include meat (chicken or turkAre high protein diets your secret to healthy weight loss? There are lots of diets out there – high fat, low fat, Paleolithic, blood type, exotic juices, magic pills and potions. But recently, high protein diets are getting a lot of press. The word is that they preserve muscle mass and preferentially decrease fat mass.

If high protein diets actually did that, it would be huge because:

  • It’s the fat – not the pounds – that causes most of the health problems.
  • Muscle burns more calories than fat, so preserving muscle mass helps keep your metabolic rate high without dangerous herbs or stimulants – and keeping your metabolic rate high helps prevent both the plateau and yo-yo (weight regain) characteristic of so many diets.
  • When you lose fat and retain muscle you are reshaping your body – and that’s why most people are dieting to begin with.

So let’s look more carefully at the recent study that has been generating all the headlines (Pasiakos et al, The FASEB Journal, 27: 3837-3847, 2013).

The Study Design:

This was a randomized control study with 39 young (21), healthy and fit men and women who were only borderline overweight (BMI = 25). These volunteers were put on a 21 day weight loss program in which calories were reduced by 30% and exercise was increased by 10%. They were divided into 3 groups:

  • One group was assigned a diet containing the RDA for protein (about 14% of calories in this study design).
  • The second group’s diet contained 2X the RDA for protein (28% of calories)
  • The third group’s diet contained 3X the RDA for protein (42% of calories)

In the RDA protein group carbohydrate was 56% of calories, and fat was 30% of calories. In the other two groups the carbohydrate and fat content of the diets was decreased proportionally.

Feet_On_ScaleWhat Did The Study Show?

  • Weight loss (7 pounds in 21 days) was the same on all 3 diets.
  • The high protein (28% and 42%) diets caused almost 2X more fat loss (5 pounds versus 2.8 pounds) than the diet supplying the RDA amount of protein.
  • The high protein (28% and 42%) diets caused 2X less muscle loss (2.1 pounds versus 4.2 pounds) than the diet supplying the RDA amount of protein.
  • In case you didn’t notice, there was no difference in overall results between the 28% (2X the RDA) and 42% (3X the RDA) diets.

Pros And Cons Of The Study:

  • The con is fairly obvious. The participants in this study were all young, healthy and were not seriously overweight. If this were the only study of this type one might seriously question whether the results were applicable to middle aged, overweight coach potatoes. However, there have been several other studies with older, more overweight volunteers that have come to the same conclusion – namely that high protein diets preserve muscle mass and enhance fat loss.
  • The value of this study is that it defines for the first time the upper limit for how much protein is required to preserve muscle mass in a weight loss regimen. 28% of calories is sufficient, and there appear to be no benefit from increasing protein further. I would add the caveat that there are studies suggesting that protein requirements for preserving muscle mass may be greater in adults 50 and older.

The Bottom Line:

1)    Forget the high fat diets, low fat diets, pills and potions. High protein diets (~2X the RDA or 28% of calories) do appear to be the safest, most effective way to preserve muscle mass and enhance fat loss in a weight loss regimen.

2)     That’s not a lot of protein, by the way. The average American consumes almost 2X the RDA for protein on a daily basis. However, it is significantly more protein than the average American consumes when they are trying to lose weight. Salads and carrot sticks are great diet foods, but they don’t contain much protein.

3)     Higher protein intake does not appear to offer any additional benefit – at least in young adults.

4)     Not all high protein diets are created equal. What some people call high protein diets are laden with saturated fats or devoid of carbohydrate. The diet in this study, which is what I recommend, had 43% healthy carbohydrates and 30% healthy fats.

5)    These diets were designed to give 7 pounds of weight loss in 21 days – which is what the experts recommend. There are diets out there promising faster weight loss but they severely restrict calories and/or rely heavily on stimulants, they do not preserve muscle mass, and they often are not safe. In addition they are usually temporary.  I do not recommend them.

6)    This level of protein intake is safe for almost everyone. The major exception would be people with kidney disease, who should always check with their doctor before increasing protein intake. The only other caveat is that protein metabolism creates a lot of nitrogenous waste, so you should drink plenty of water to flush that waste out of your system. But, water is always a good idea.

7)     The high protein diets minimized, but did not completely prevent, muscle loss. Other studies suggest that adding the amino acid leucine to a high protein diet can give 100% retention of muscle mass in a weight loss regimen – but that’s another story for another day.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

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