No wonder seven in ten adults in the UK pop some kind of daily supplement – it feels like a safe, low-cost health insurance policy. While doctors say it’s better to get nutrients from food, it can be a tall order to hit your five-a-day fruit and veg or twice-weekly oily fish targets.
And as we age, our need for nutrients increases, making it more difficult to find them in diet alone. ‘The nutritional requirements of older people are the highest of any demographic, on a par with elite athletes,’ says pharmacist and author Aidan Goggins. ‘There are huge demands on the body from low-grade chronic inflammation, so we need extra nutrients to counter that. Older people often have lower levels of stomach acid, particularly if taking an antacid, which means they have less ability to absorb vitamins from food.’
Buying vitamins and minerals to compensate seems the simple solution, but when cherry picking single-dose supplements we run the risk of wasting our money or causing more harm than good. Here is our line-up of what’s useful and what might not be, but check with your GP first.
What supplements are worth taking?
The ‘sunshine vitamin’ (produced by our bodies when exposed to sunlight) is one of the most common deficiencies in over-65s, with 84% of men and 91% of women not getting enough, according to a study by the British Journal of Nutrition, BJN. Important for strong bones and immunity, it can also significantly lower the risk of autoimmune diseases such as rheumatoid arthritis and thyroid disease.
Our ability to synthesise vitamin D decreases with age; the Government advises 10mcg a day year-round for over-65s (and in autumn/winter for all other adults). Many experts feel this is too conservative and advocate 25-50mcg a day, which is well within safety limits (100mcg is the NHS upper limit).
‘I would suggest 50-75mcg a day for the over-60s, which is a safe but more effective dose,’ says Dr Angela Rai, GP at The London General Practice. Take with a meal containing fat, which acts as a carrier for the vitamin, helping absorbency. Vitamin D3 is better than vitamin D2 for boosting immunity, finds new research by the University of Surrey, while sprays and gummies are proven to be more easily absorbed.
Around one in ten people over 75 has vitamin B12 deficiency, according to the NHS. ‘Our body’s absorption of B12 is less efficient as we age,’ says Dr Rai. ‘On top of this, our B12 levels drop if we’ve been through a stressful event, are on certain medications, or have poor diet. It’s essential for the nervous system and cognitive function. Vitamin B12 or folate deficiency anaemia is common in this age group, causing extreme fatigue, so I suggest 10mcg a day to prevent this.’ B vitamins are water soluble, so if you take too much, it will be excreted in urine.
Folic acid, or vitamin B9, isn’t just for pregnant women, it’s also advisable for anyone aged 65-plus when deficiency is common. ‘It works with vitamin B12 and if you replace one, you have to replace the other,’ says Dr Rai. ‘It’s only found in dark green leafy vegetables, which are often lacking in our diets. Beneficial for neurocognition and nerve function, I look for low folic acid levels if I’m screening for dementia and give supplements accordingly.’ She recommends 400mcg daily for over-65s.
‘women naturally lose around 750mg of calcium a day from their bones as they age, so that loss needs to be compensated’
Bone density loss increases in postmenopausal women, doubling their calcium needs in comparison to other adults, according to the British Dietetic Association (BDA).
‘Women naturally lose around 750mg of calcium a day from their bones as they age, so that loss needs to be compensated,’ says Goggins, author of several books and now nutritionist at Auriens, a later-life residence in London.
While calcium is readily available in food (dairy, bony fish and leafy greens), some at-risk adults need supplements too. The BDA advises an upper limit of 500mg. What you combine your pill with is also important, says Dr Rai. ‘These supplements were commonly prescribed in the past, but caused problems when calcium deposits built up in the kidneys, heart and blood. It’s important to pair it with vitamin D, which works alongside, helping with regulation and absorption.’ It’s also crucial when you take it. Calcium competes against other minerals, preventing their uptake, so have it at a different time. Choose calcium citrate over calcium carbonate as it takes less stomach acid to break down.
One of the biggest mineral deficiencies in mature men, according to a BJN study, with 73% lacking it (and 41% of women), magnesium is needed for bone health as it helps to activate vitamin D. ‘There are different forms of magnesium, but I would advise magnesium bisglycinate because it’s highly absorbable and doesn’t have the laxative effects of magnesium citrate or oxide,’ advises Alex Glover, senior nutritionist at Holland & Barrett. ‘It’s highly involved in our sleep cycle, so taking it in the evening might relax you.’ The recommended daily amount (RDA) is 375mg.
The great multivitamin debate
Experts are divided about the merits of multivitamins. A study published in March by Harvard Medical School in the US and the Karolinska Institute in Sweden followed more than 20,000 men and women in their sixties for five years. The group on multivitamins were found to have almost the same incidence of heart disease, cancer and mortality rates as those on a placebo. However, most health experts we spoke to were sceptical of the study, not least because other research has shown that people who take dietary supplements are more likely to achieve daily recommendations for vitamins and minerals than people who don’t.
If you are taking single supplements alongside a multivit, make sure the combined total of the nutrient doesn’t exceed the RDA.
Is it worth buying a premium brand promising that its vitamins are ‘food-based’ over a budget supplement? Probably, says Goggins. ‘It’s not so much about whether it’s “food-based” or “food-grown”, but about looking at the forms of nutrients used. Take calcium and magnesium – the citrate forms are better absorbed than carbonate or oxide, and gentler on the stomach. With multivitamins, manufacturers don’t usually emphasise absorption, so you need to check the back of the box for the forms used.’ He rates FutureYou supplements, which are easily absorbable, including its Prime Fifty Multi-Nutrient (£10 for 28 tablets).
What supplements are not worth taking?
Cod liver oil
This is the supplement older people are most likely to take, according to the Health and Food Supplements Information Service (HSIS), and no wonder – studies have shown it can reduce inflammation and help arthritic pain. But new analysis by the European Society of Cardiology suggests anyone with heart disease could increase their risk of stroke by taking it because it raised triglyceride (fat) levels in the blood. However, previous studies have found fish oil lowers triglyceride levels, so the jury is out.
If taking, choose fish oil over cod liver oil. ‘It’s much higher in Omega 3 fatty acid as it comes from all parts of the fish, rather than just the liver,’ advises Glover. ‘Make sure the supplement contains the two different types of this fatty acid – 500mg of DHA and 500mg of EPA.’ Even with fish oil, the evidence is still not clear on whether a supplement gives the same benefit as the recommended twice-weekly portions of oily fish.
Iron deficiency is unusual in the over-55s, and supplementing in large doses or over a long time can be dangerous. ‘Iron deficiency isn’t common in women after they’ve stopped menstruating,’ says Dr Rai. The biggest cause of it in older people is bowel cancer and taking supplements can mask low iron levels in a blood test, delaying diagnoses,’ says Dr Rai. It’s not a tablet Goggins would recommend either. ‘It’s a very reactive metal that stores up in the body and effectively rusts your insides, causing joint, liver and heart problems,’ he says.
This is a fat-soluble vitamin, which means if you take too much, it is stored in body fat rather than excreted in urine, which can cause problems, including liver damage. ‘I cannot think of a reason why anyone would need a vitamin A supplement. Deficiency is very rare as it is readily available in our diets,’ says Glover.
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