Luke Huber, ND, focuses on CRN’s scientific affairs and nutrition policy activities that support the appropriate role for dietary supplements and functional food in health promotion and disease prevention. He has over 20 years of experience in the dietary supplement industry leading scientific and technical affairs, research and development, clinical research, and regulatory affairs. Dr. Huber has held senior scientific, R&D, and technical leadership roles at several prominent companies within the dietary supplement industry. Dr. Huber received his doctorate of naturopathic medicine from Bastyr University in Bothell, WA, completed his residency at Cancer Treatment Centers of America in Zion, IL, and earned his MBA with honors from University of Massachusetts at Amherst.
The CRN Foundation is a non-profit 501(c)(3) educational foundation of the Council for Responsible Nutrition (CRN), the leading trade association for the dietary supplement industry. The CRN Foundation provides consumers with information about the responsible use of dietary supplements and provides researchers and healthcare practitioners with education on the proper role of supplements in a healthy lifestyle. www.crnusa.org/CRNfoundation/.
Sheldon Baker is an InnoVision contributing editor. His freelance editorial content can also be found in several lifestyle publications, and as CEO of Baker Dillon Group LLC, he has created numerous brand marketing communications and public relations campaigns for health and wellness organizations. Contact him at Sheldon@NutraInk.com.
Integrative Medicine: A Clinician’s Journal (IMCJ): The CRN Foundation commissioned Frost & Sullivan to do an analysis of the potential health care cost savings that could be realized if specific at-risk populations were to use certain dietary supplements. An extensive literature review of six health categories was conducted and in each health category it was discovered large amounts of money could be saved by people using dietary supplements for their various health issues. Of all the health categories reviewed, what stood out to you most?
Luke Huber, ND: While each of the sections of the Supplements to Savings report demonstrated impressive cost savings and reduced morbidity, the osteoporosis section stood out to me due to the dramatic savings of over $155 billion with simple and affordable supplementation with calcium and vitamin D. Osteoporosis is a condition that significantly impacts the aging population, leading to increased risk of fractures, which, in turn, can result in substantial healthcare costs, reduced quality of life, and increased mortality rates. The use of calcium and vitamin D supplements is a preventive measure that could lead to considerable savings by reducing the incidence of osteoporotic fractures. The economic implications of supplementing at-risk populations with calcium and vitamin D were underscored by the potential for avoiding costly medical treatments and hospitalizations associated with fractures. This section not only sheds light on the direct medical costs saved, but also emphasizes the broader societal benefits, such as helping seniors maintain independence and mobility, which are crucial for quality of life as well as the reduction of long-term care costs. The emphasis on osteoporosis and its prevention through dietary supplements underscores a growing recognition of the condition’s impact on public health and the economy, highlighting a proactive approach to healthcare that focuses on prevention rather than just treatment.
IMCJ: In general, how can supplements aid in nutrient gaps?
Dr. Huber: Dietary supplements play a crucial role in filling nutrient gaps for the majority of the population who do not obtain sufficient micronutrients from their diet alone. Vitamins, minerals, and other important nutrients support overall health by ensuring we receive the necessary nutritional building blocks for proper health. For example, vitamin D supplementation is often necessary as much of the population has limited sun exposure and insufficient levels, while Omega-3 supplements support heart health and many individuals receive very little from their diet. Furthermore, specific supplements like calcium and vitamin D are vital for bone health, and low levels increase the risk for osteoporosis, demonstrating how targeted supplementation can address specific health concerns. By filling nutritional gaps, supplements can aid in maintaining optimal health, preventing deficiencies, and contributing to a balanced diet.
IMCJ: The cost-effectiveness of several dietary supplement ingredients for managing the risk of coronary artery disease outcomes was studied. There are numerous risk factors – five major factors (high blood pressure, cholesterol, diabetes, smoking and diet). Talk about the findings of each supplement category from a dollar standpoint.
Omega 3
Magnesium
Soluble fiber
Vitamin K2
Dr. Huber: The report points to substantial financial benefits associated with the targeted use of Omega-3, magnesium, soluble Fiber, and vitamin K2 supplements in managing and preventing coronary artery disease (CAD) outcomes. These findings demonstrate that dietary supplements can play a significant role in not only improving health outcomes but also in reducing healthcare costs related to CAD.
Omega-3 supplementation demonstrated a considerable financial impact, with projected net cost savings due to reduced healthcare expenditures resulting from avoided CAD-attributed events. The report notes that if the target population fully utilized Omega-3 supplements, significant yearly cost savings could be realized, amounting to billions over the analysis period. This suggests Omega-3’s strong potential for reducing the financial burden of CAD on the healthcare system through the prevention of cardiovascular events. Specifically, the broad use of Omega-3 supplements was projected to result in an average net cost savings of $4.12 billion per year during the period 2022 to 2030.
Magnesium supplementation was also associated with notable cost savings from the perspective of avoided CAD events. The analysis presented in the report suggests that if magnesium supplements were used at preventive levels among the target population, it could lead to a substantial reduction in CAD-related healthcare costs annually. This reflects magnesium’s value in potentially lowering the incidence of CAD events and, consequently, the overall costs associated with CAD management and treatment. More specifically, magnesium supplementation was associated with an average net avoided CAD-attributed hospital utilization expenditures of $2.11 billion per year over the 2022 to 2030 period in the report.
The financial analysis of soluble fiber’s impact on CAD outcomes indicated that soluble fiber supplementation could lead to meaningful healthcare cost savings. By reducing the risk of CAD events through the improvement of cardiovascular risk factors, such as lowering cholesterol levels, soluble fiber supplementation among the target population could significantly decrease the economic burden associated with treating and managing CAD. The report noted the adoption of soluble fiber supplements would lead to an average annual net savings of $1.41 billion from 2022 to 2030.
Vitamin K2 supplementation also showed potential for significant healthcare cost savings by reducing the risk of CAD-related events. Vitamin K2 supplementation was calculated to result in an average net cost savings of $9.48 billion per year throughout the 2022 to 2030 timeframe.
IMCJ: According to the CDC, in the US in 2010, an estimated 10.2 million people aged 50 and over had osteoporosis and about 43.3 million more people had low bone mass. We know it’s the most common bone disease. Women are at significantly greater risk of developing osteoporosis after menopause. Discuss the benefits the study found using calcium and vitamin D to reduce fracture risk.
Dr. Huber: The report details the significant health and financial benefits of using calcium and vitamin D supplements to reduce fracture risk among individuals at risk for osteoporosis. From a health perspective, calcium and vitamin D play crucial roles in bone health. Calcium is fundamental for maintaining the structure and density of bones and teeth, with its absorption and effectiveness enhanced by vitamin D. Vitamin D aids in calcium absorption, building bone mass as well as supporting muscle, nerve, and immune health. Deficiency of these nutrients can lead to decreased bone strength, increasing the risk of fractures.
From a financial standpoint, the use of calcium and vitamin D supplements shows substantial potential savings. The report indicates that if the entire target population utilized these supplements, an average of 361,507 osteoporotic fractures could be avoided per year from 2022 to 2030. This translates to an average annual net savings of $19.92 billion over the period from 2022 to 2030 due to the avoidance of osteoporotic fractures. These figures highlight the significant economic impact that calcium and vitamin D supplementation can have on managing osteoporosis and reducing risks associated with fractures, alongside the public health benefits of reducing fracture risk and supporting overall bone health.
IMCJ: The CDC notes more than 4.2 million people aged 40 and older suffered from low vision or blindness in 2021, an event risk of 2.9% given a total population of over 145 million. In addition, over seven million US adults aged 44 and older had a large amount of retina health issues and are at significant risk of developing AMD in the near future. Between 2022 and 2030, over $950 million in health care costs might be saved. The report shed an interesting light on vision.
Dr. Huber: The report outlined significant health benefits and cost savings related to Age-related Macular Degeneration (AMD) through the use of dietary supplements, specifically focusing on lutein and zeaxanthin. These nutrients are well known for their antioxidant properties and for selectively concentrating in the macula lutea, a key component of the macular pigment essential for protecting the eyes against damage from free radicals. By enhancing the macular pigment, these supplements can significantly slow the rate of visual acuity decline typically associated with AMD, leading to a potential reduction in healthcare costs and morbidity related to this condition.
From a financial perspective, the report detailed that the systematic use of lutein and zeaxanthin supplements could lead to avoided healthcare expenditures attributed to AMD. Specifically, it is estimated that a net average of $107 million per year in healthcare costs could be avoided from 2022 to 2030.
IMCJ: There are huge positive economic implications that reveal B vitamins plus choline could save over a billion dollars over an eight-year period especially when focusing on dementia and neurodegenerative disorders. Three B vitamins, B6, B9, and B12 have been extensively studied for their roles in cognitive health. Early childhood cognitive development disorder from inadequate maternal choline intake is another issue and cost concern. Please describe the health benefits and cost savings described in the report related to cognitive decline and childhood cognitive development disorders.
Dr. Huber: The report outlines the significant health benefits and cost savings associated with addressing cognitive decline and early childhood cognitive development disorders through the supplementation of B vitamins (B6, B9 [folate], and B12) and maternal choline intake, respectively.
For cognitive decline, the report reviews the role of B vitamins (B6, B9, and B12) in maintaining brain health. These vitamins are involved in homocysteine metabolism; elevated levels of homocysteine are associated with an increased risk of cognitive decline, dementia, and Alzheimer’s disease. The report describes how the targeted use of B vitamins could slow the progression of age-related cognitive decline, often a precursor to dementia and Alzheimer’s, by reducing homocysteine levels. This intervention has significant health benefits, potentially delaying or preventing the onset of more severe cognitive impairments.
Financially, supplementation with B vitamins among individuals aged 50 and older at risk for cognitive decline was projected to save a net $12.22 billion per year in healthcare costs related to dementia from 2022 to 2030. These savings are attributed to the reduced need for long-term care and medical interventions for those who might otherwise progress from mild cognitive impairment to more severe forms of dementia.
Regarding early childhood cognitive development disorders resulting from inadequate maternal choline intake, the report highlights the crucial role of choline in fetal brain development. Adequate choline intake during pregnancy is linked to improved cognitive outcomes in offspring, underscoring its importance for early neural development. The health benefits include better memory, faster information processing, and overall cognitive function in children, which can have long-lasting effects on their academic performance and quality of life.
The financial implications of increasing choline intake among pregnant women are also notable. The report calculates that addressing inadequate maternal choline intake could lead to significant cost savings by reducing the prevalence of cognitive development disorders in children. Specifically, it is estimated that these interventions could save a net $373 million per year during the 2022 to 2030 time period reflecting the reduced costs associated with educational and healthcare interventions for affected children.
IMCJ: How about using probiotics to combat irritable bowel syndrome a health issue that can affect people at a young age and as a result affect productivity issues. This is another area where over a billion dollars could be saved from using supplements.
Dr. Huber: The use of probiotics to combat Irritable Bowel Syndrome (IBS) offers both health and financial benefits, as described in the report. From a health perspective, probiotics can significantly alleviate the symptoms of IBS, including abdominal pain, bloating, and irregular bowel movements. By restoring the balance of the gut microbiome, probiotics contribute to improved digestive health and overall well-being for individuals suffering from IBS.
Financially, the report described considerable cost savings associated with the use of probiotics for IBS management. The analysis estimated that if individuals aged 18 and older with IBS utilized probiotics, there would be a potential reduction in direct medical costs and indirect costs related to productivity losses. Specifically, the use of probiotics was estimated to lead to an average net savings of $10.54 billion per year during the 2022 to 2030 time period through avoided healthcare expenditures and labor productivity gains.
These savings stem from fewer doctor visits, reduced need for prescription medications, and a decrease in the number of missed workdays due to IBS symptoms. Consequently, the broader adoption of probiotics among IBS sufferers not only promises to improve the quality of life for millions of Americans but also offers the potential for significant economic benefits by reducing the overall financial burden of IBS on individuals and the healthcare system.
IMCJ: With the significant cost savings and health benefits seen from dietary supplements as laid out in the Supplements to Savings report, do the current government regulations allow for coverage of dietary supplements by FSA/HSA programs?
Dr. Huber: Only three categories of dietary supplements are generally allowed for coverage by FSA (Flexible Spending Accounts) and HSA (Health Savings Account) programs. These are prenatal vitamins, glucosamine, and fiber supplements. Other dietary supplements can be covered by FSA and HSA programs but must be recommended by a licensed healthcare practitioner for a specific medical condition. The dietary supplement(s) recommended must be deemed medically necessary, and a Letter of Medical Necessity (LMN) from the licensed healthcare provider is typically required. The LMN typically describes the dietary supplement that is being recommended and how it is used to treat a diagnosed medical condition. It’s important for individuals considering using their FSA or HSA funds for dietary supplements to review the specific guidelines of their FSA or HSA plan and consult with their plan provider as the coverage for these programs is variable.
IMCJ: Is there proposed legislation to have dietary supplements more broadly covered by FSA/HSA programs?
Dr. Huber: Yes. There is proposed legislation aimed at having dietary supplements more broadly covered by FSA and HSA programs. In 2023, US Reps Darin LaHood (IL-16), Brendan F. Boyle (PA-02), John Curtis (UT-03), and Josh Gottheimer (NJ-05) introduced the Dietary Supplements Access Act. Several additional members of Congress have since been added as co-sponsors. This bill would amend the tax code to classify dietary supplements as qualified medical expenses, thus allowing consumers to use FSAs and HSAs to purchase them. This would be a significant step toward modernizing the availability and coverage of vitamins, minerals, and other supplements. This legislative effort aims to promote Americans’ ability to make personal healthcare decisions and support healthy lifestyles by acknowledging the valuable contribution of dietary supplements to overall health and wellness. As seen from the perspective of the Frost & Sullivan Healthcare Cost Savings data, the enactment of such a law would also lead to significant savings within the overall healthcare system, and most importantly, a healthier nation.