Are One-A-Days the Way to Go as We Get Older?
According to the National Center for Health Statistics, 70% of Americans over the age of 60 take at least one supplement and 29% take four or more. As busy practitioners have we lost sight of the needs of aging adults and just recommend a one-a-day to cover all our nutritional bases or is it the lack of knowledge on the part of the consumer buying the one-a-day thinking that a multivitamin surely will take the place of hot cooked meals, or, is it a combination of both?
The overuse of multivitamins indiscriminately in the elderly may not harm, may help, but also may become a problem. The problems are that many seniors are on multiple medications and the nutrients in a multivitamin may cause a drug-nutrient interaction, nutrients may be present in excess of recommended amounts or may contain other compounds not needed. Those taking coumadin are to be consistent in vitamin K intake but may be inconsistent taking their vitamin K containing multis. Or, the multivitamin may contain Ginkgo Biloba, an herb which may interact with blood pressure medications causing pressure to drop. The multi may contain more than the recommended amount of nutrients throwing off lab tests or, in the case of vitamin A, being stored up to toxic levels over time.
Surely, if a multivitamin is purchased it should carry a seal of approval, not contain more than the recommended daily levels of nutrients and be appropriate for age at a minimum.
So, what nutrients are of greatest concern as we grow older?
We are especially interested that as we grow older that we get adequate calories since the tendency is to cook fewer meals, grab something quick, and for many, income is an issue. Malnutrition in the elderly is becoming more predominant just as obesity can be an issue (as well as a form of malnutrition). Achieving caloric balance in the different phases of ageing can be a struggle for many due to multiple factors such as immobility, arthritis, lack of transportation or declining mental status.
Protein needs which are set at .8g/kg when younger may rise to 1.2 g/kg after age 50 to prevent some of the decline in muscle mass with the normal ageing process. Losing even 10% of muscle mass negatively affects the immune system.
It is well known that fiber is too low in our population in general and it further declines as we get older. The median intake of fiber is 13.6 grams per day when it should be closer to 25 grams per day. In fact, recent studies show an increase of 4.3 healthspan years for every 10 g fiber/1000 calories.
While we are discussing fiber, it seems like a good time to talk about fluids which tend to run low in our older diets. Why? One reason is that we lose some of our thirst sensations that would normally remind us to drink. It is especially important to drink 8 glasses of fluid per day when increasing fiber to avoid constipation and to avoid dehydration.
What about vitamins or minerals?
Vitamin D is typically low in ageing as it tends to be in the general population. As we age the skin becomes less elastic and its ability to absorb the vitamin D producing rays is impaired. The less vitamin D in our system the less calcium is absorbed and the weaker our bones can become. It is important to get 800-1000 IUs per day from either vitamin D fortified cereals/milk/seafood or a supplement.
Calcium is also often low due to an age-related decline in the lactase enzyme with a subsequent inability to break down lactose. Drinking milk or consuming dairy, both high in the milk sugar, lactose, begins to cause gas, diarrhea or bloating resulting in a decrease in consumption. This can be prevented by drinking milk treated with the lactase enzyme called Lactaid or taking a digestive enzyme prior to eating dairy. One should try to get their calcium needs met through diet if possible since calcium supplementation may cause kidney stones, arterial deposits or drug interactions. Vitamin D will also help increase the absorption of the calcium eaten. A calcium intake of 800 mg/day is generally adequate.
Vitamin B12, found in meats and mostly animal products, also tends to run low in our “tea and toast” dieters. In addition, the absorption of B12 decreases in the ageing process. Since a low level of B12 may cause anemia and eventually nerve damage or even dementia, identification of a deficiency and treatment of any low levels should be implemented promptly.
Folic Acid is a nutrient of concern for some and will cause similar anemia problems as does B12 deficiency. Treatment with folate may mask vitamin B12 deficiencies. Tomato juice, green vegetables, fortified grains (cereals, breads) are good sources of this nutrient.
Potassium tends to run low in our older population primarily due to lack of fruits and vegetables. Potassium is important in regulating blood pressure and is not commonly found in multivitamins.
Are there nutrients to limit more as we age?
Sodium guidelines are to reduce sodium to less than 2300 mg until age 50 when we are to limit sodium to 1500 mg/day. Be sure to read labels as sodium is in many processed and snack foods. Just one teaspoon of salt contains 2,000 mg of pure sodium, so put down the salt shaker. Salt, or sodium, can cause a rise in blood pressure and or/water retention. High blood pressure is a concern when we age and especially since the guidelines have been lowered to 130/80 as the cut-off for diagnosing hypertension.
We can see that taking a multivitamin does not address calories, protein fiber or water. It doesn’t limit sodium or increase potassium. Multivitamins do not contain enough calcium for one day and calcium frequently interacts with other minerals in a multi. Remember, calcium really should be obtained from food anyway. Nutrients that can be met with a vitamin include B12, Vitamin D, folic acid.
Overall, improving one’s dietary intake seems to be the best choice as we grow older if we are to support optimum healthspan. If dietary needs cannot be met by diet, the diet should be assessed and supplemented with the nutrients that are missing taking care not to over-supplement past the recommended dietary daily intakes recommendations (check the RDI on the label).
Supplemental nutrients need to be taken separately from medications, sometimes by many hours. So, being familiar with potential drug-nutrient interactions are also key to maintaining optimal healthspan. Make supplements your ally, not your saboteur.
Will taking a multi-vitamin hurt you? Probably not. But first, take a look at how you can improve your nutritional intake or have a Dietitian help you. You deserve to feel the best you can feel as you get older, don't you?
See blog 6/6 on The Art of Aromatherapy at: