8 August 2017Supplement wisdom for older adults

Anyone over the age of 50 has probably figured out this fact of life: you can't eat the way you did at age 25. You don't need that much food anymore. If you keep eating the same level of calories, you gain unwelcome weight. There's less room in your life for empty calorie junk food.

There's a catch: you may need fewer calories, but you still need the same amounts of vitamins and minerals. In some cases, you need more of them. Which means your diet has less and less room for empty calories. At the same time, many people experience changes that impact their food choices: chewing problems, loss of taste, decreased appetite, lack of interest in food preparation. Intake of vitamins and minerals becomes less-than-adequate.

Nutrient needs for older adults have not been thoroughly researched. The assumption has been that age didn't really change nutrient requirements. Now we are learning that this isn't always the case. Absorption and utilization of some nutrients change with age. Medication use can impact nutrient utilization and absorption.

Senior Multiples

Supplements can fill the gap between nutrient needs and actual food intake. One way to cover all your bases is to take a multiple. Ah but which multiple? There are "senior" formulas, 50+ formulas, "silver" formulas, men's formulas, women's formulas, and various combinations of the above. Are they just gimmicks, or are they the right choice?

In fact, there are some key differences between senior formulas and those intended for younger adults. Some the nutrients in question are:

Iron

Men and postmenopausal women have lower iron requirements. Senior formulas generally limit or eliminate iron. This is not a bad thing. You do still get iron from a variety of foods, from meats to fortified grain products. Excess iron can be detrimental to health, so unless you have a specific medical condition that calls for more iron, a low or no-iron formula is appropriate.

Vitamin D

Everyone is now aware of vitamin D's importance, and supplement manufacturers tend to include high doses in senior multiple formulas. It's good for marketing. While this is not necessarily a bad thing, you do need to pay attention. If you've been tested for vitamin D and need to supplement, the amount in a multiple might be sufficient. But if you're also taking vitamin D separately, your daily total might end up being too much.

B12

As we age, our ability to absorb vitamin B12 deteriorates. The absorption process depends on adequate stomach acid, and production of a specialized carrier molecule called Intrinsic Factor (IF). With age, stomach acid decreases, and many people are taking medications that suppress stomach acid. Multiple formulas for seniors typically have large doses of B12, as some small amount can be passively absorbed in the intestines, bypassing the need for stomach acid and IF.

Calcium

The need for calcium for healthy bones is well known. Plenty of older adults are taking separate calcium supplements for that reason. Senior multiples tend to have a bit more calcium than regular multiples. However, it's not physically possible to put a meaningful dose of calcium into one pill, as the pill would be too large to swallow. So while you might see around 200 mg of calcium in a multiple, you won't see 400 mg, or an amount equivalent to a glass of milk. The higher calcium is more about marketing. If you need more calcium, don't rely on your multiple.

Lutein and other carotenoids

Antioxidants and carotenoids for eye health and inflammation are increasingly marketed to older consumers. Many senior multiple formulas now have token amounts of these, emphasis on the word "token". For example, the suggested intake of the carotene combination lutein+zeaxanthin to support eye health is 6 mg/day. A popular brand name senior multiple has 250 micrograms of lutein, which is a mere 0.25 mg. You can get vastly more than that from 1/2 cup of cooked spinach. Nevertheless, the marketing pitch includes a claim that the supplement is good for eye health.

Most other nutrients in senior multiples are in line with standard intake recommendations. Some experts believe older adults need slightly higher daily intakes of some of these, but as yet there is no consensus. And the emphasis is on "slightly". What you do not need are excessively high doses of anything. You don't need a multiple that contains 500% of the recommended intake for several B vitamins or vitamin C. When considering a supplement, keep this in mind: you should be getting plenty of nutrients from the food you eat. A supplement should add to your nutrient intake, not replace it.

What about single nutrient supplements?

If you're taking a multiple, you might not need extra amounts of any other nutrients, except for calcium. On the other hand, some people may not take a multiple, but do take some single nutrients.

Vitamin D is a popular supplement, and as noted above, you might need to take it if your blood level is low. Simply taking vitamin D because you've read about it somewhere is not a good plan. Your blood level might be fine. Most doctors check vitamin D levels as part of routine lab work, especially for older adults, as vitamin D production in skin decreases with age. If you are deficient, your doctor will have suggestions about an appropriate dose. Vitamin D3 (cholecalciferol) is the best absorbed, and should be taken with a meal that has some fat content to enhance absorption.

If you are trying to boost calcium intake for bone health, it may be difficult to achieve an adequate level if you don't consume about 3 servings a day of dairy foods or other high calcium foods such as fortified soy milk, greens and legumes. Calcium supplements are a good alternative. They come in doses that are roughly equivalent to a serving of dairy (300 mg). Your body only absorbs about 500 mg at a time, so taking very large doses higher than that at once time is not advisable. Calcium carbonate is the most common form in supplements, but calcium citrate may be better absorbed.

As mentioned above, B12 can be a problem for older adults due to decreased absorption. Deciding to take a supplement can be tricky. B12 deficiency or inadequacy can mimic other common problems of aging. It can result in cognitive impairment, and some health experts suggest that any older adult with signs of this be tested for B12 status. But cognitive impairment is a complex problem with many potential causes. Nerve damage can also be caused by inadequate B12, but again there are other conditions that contribute to this. Deciding to self-medicate with B12 because you're becoming forgetful might not be very helpful.

Certainly if you've been taking medication for stomach acid you should discuss B12 with your doctor. Blood levels of B12 can be tested, but the best way to assess your status is with a methlymalonic acid (MMA) test. B12 is necessary for metabolism of this substance, and elevated MMA typically indicates a B12 problem.

Single B12 supplements tend to come in very large doses compared to the recommended daily intake. This is because, if absorption is impaired, the only alternative is passive infusion in the intestines. Only a very small amount of any dose can pass through intestinal walls this way, which is why the dose is so large. Some people swear by sublingual tablets of B12, but there is no evidence that they are absorbed any better.

Getting omega-3 fats from food depends on eating very specific foods, like salmon, sardines, flax and walnuts. If you're not a fan, or you only eat those occasionally, you might consider a supplement. Look for formulas that include both EPA and DHA.

There's no evidence at the moment that older adults need more or less omega-3 fats than anyone else. The one exception may be for Dry Eye Syndrome, a common problem for older women. Omega-3 fatty acids can help with dry eye, and some eye doctors now routinely recommend supplements as part of treatment.

Supplements for the eyes

Since the late 20th century, the National Eye Institute has conducted a study of the impact of certain nutrients on eye diseases related to aging. The study ran in 2 parts over many years, during which subjects were given supplement formulas of nutrients with a suspected relation to Age-Related Macular Degeneration:

  • Vitamin E
  • Vitamin C
  • Zinc
  • Beta carotene (part 1)
  • Lutein/zeaxanthin (part 2)
  • Omega-3 fats (part 2)

Copper was also included to counteract effects of high dose zinc. Lutein and zeaxanthin replaced beta carotene in Part 2. The study results showed that the combination formula from Part 2 of the study was helpful, slowing the progression of AMD, although the omega-3 fats did not appear to provide any additional benefit for these particular eye diseases.

The supplement formula that showed the most benefit is recommended by the American Academy of Ophthalmology as an intervention for AMD, although it is not promoted as a cure. This is a high dose formula of a limited number of nutrients:

  • 500 mg vitamin C
  • 400 IU vitamin E
  • 80 mg zinc
  • 10 mg lutein
  • 2 mg zeaxanthin
  • 2 mg copper (to counteract zinc)

If your eye doctor recommends this, you would need to reevaluate any other supplements you take. You would not need to add more C or E or zinc to your daily intake.

Supplements for ....

It's tempting to think a supplement will combat effects of aging, from heart disease to gray hair. Nutrients have been promoted as preventatives and cure-alls for decades. Vitamin C was famously believed to cure heart disease and cancer. Vitamin E same expectations. None of it panned out. Now we have "supplements" that are supposed to fix achy joints or inflammation or a host of annoying age-related changes.

Of course it's a free country and you can buy whatever you want. Just remember, the FDA does not rate or ensure any supplement for effectiveness or safety before they go to market. Health Halo phrases like "supports joint health" are intended to lead you to conclude that a product will eliminate knee pain or back pain. Anecdotal stories and testimonials are not scientific evidence. Buyer Beware. See the FDA's website for more information about how nutritional supplements are regulated in the United States. See the Office of Dietary Supplements for supplement fact sheets.

Take Away Message

We know that aging does change some nutrient requirements. Future research may well yield information that leads to changes in more recommendations. But it's unlikely that these will be drastic increases or decreases. If you're eating a really healthy diet and taking a senior/50+/silver type of multiple, you probably have most of your nutrient bases covered. Remember, these are supplements, not replacements. It's still about the food.

Donna P Feldman MS RDN

is author of "Feed Your Vegetarian Teen", writes about food and nutrition at Radio Nutrition and is co-host of the Walk Talk Nutrition podcast series.

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Disclaimer: Please note that we cannot provide personalized advice and that the information provided does not constitute medical advice. If you are seeking medical advice, please visit a medical professional.

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Nutrients/Other Vitamins & Minerals Other Health Issues/Aging

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