Should Everyone Over Age 75 Take a Multivitamin?
From the Cleveland Clinic Journal of Medicine
Cindy Moore, MS, RD, LD, FADA, Director, Nutrition Therapy, Cleveland Clinic
Q. Should everyone over age 75 take a multivitamin?
A. Although physiological and functional changes that occur with aging can alter nutrient needs, not everyone over age 75 needs to supplement their diet with vitamins. Many healthy, active older adults can obtain the vitamins and minerals they need by consuming a varied and balanced diet.
However, some older adults, specifically homebound elderly, the frail, or those with chronic disease may be at nutritional risk, and could benefit from some form of supplementation. In fact, deficiencies in vitamins and minerals have been found in almost a third of elderly people. This can result from a failure to eat regular balanced meals; from interactions that occur with multiple medication use; or problems with the body's ability to make or use nutrients. What's more, different medications interfere with nutrient absorption. Those taking corticosteroids, anticonvulsants, thyroid hormone, antibiotics, laxatives or diuretics may benefit from some form of supplementation.
Research studies document that as we age, the amount of food we consume declines. Older people consume roughly 1,200 calories a day. Compare this to the 2,000 calories recommended to meet the minimum daily allowances for vitamins and minerals and its plain to see that many older adults are in need of some form of supplementation. In fact, because of the changes that occur with aging, the latest Dietary Reference Intakes (which include Recommended Dietary Allowances or RDAs) now include specific requirements for select nutrients for persons 70 years or older.
Nutrients that tend to be of concern for older persons include the following: the minerals iron, calcium, magnesium and zinc; b-vitamins like B-12 and folate, and vitamin D. Although intake of these nutrients tends to be lower in older adults, supplementation may not be necessary if appropriate foods rich in these nutrients are consumed.
Iron:
There is a pronounced increase in the number of older adults with anemia once the age of 85 is reached. Up to one-third of the anemia seen in older adults can be attributed to either iron deficiency alone, or in combination with a folate or vitamin B-12 deficiency. Foods rich in dietary iron include liver, poultry, beef, legumes (e.g., beans and lentils), nuts, and fortified breads and grains. RDA for ages 70 and older: 8 milligrams daily
Calcium:
Diets rich in calcium are associated with lower blood pressure and reduced risk of osteoporosis and fractures. Like most Americans, older adults tend to consume less than adequate levels of dietary calcium. Good food sources of calcium include milk, yogurt, cheese, and calcium fortified cottage cheese; calcium fortified soy milk, juice, cereals or cereal bars; as well as dark leafy green vegetables, almonds, canned salmon, and calcium-set tofu. RDA for ages 70 and older: 1,200 milligrams daily
Magnesium:
Magnesium helps maintain normal muscle and nerve function, keeps heart rhythm steady, supports a healthy immune system, and keeps bones strong. Magnesium also helps regulate blood sugar levels, promotes normal blood pressure, and is gaining increased interest in the scientific field for it's role in preventing heart disease. Foods rich in magnesium include dark leafy green vegetables, beans, peas, nuts, seeds and whole grains. RDA for ages 70 and older: 320 (women) to 420 (men) milligrams daily
Zinc:
Zinc is believed to enhance immunity and reduce the risk of respiratory infections. It is also thought to help restore impaired senses, such as the ability to taste or smell. Foods rich in zinc include a variety of fortified cereals and whole grains, red meat, and seafood. RDA for ages 70 and older: 8 to 11 milligrams daily
Vitamin B-12:
Vitamin B-12 is commonly low in older adults. This is because absorption of B-12 occurs in the intestines and recent studies suggest that up to a third of adults over age 51 have stomach acid levels too low to absorb this vitamin effectively. Low blood levels of vitamin B-12 are associated with anemia and other blood-cell disorders, neurological disorders, and elevated homocysteine, a risk factor for coronary heart disease. Vitamin B-12 is largely present in animal foods, so vegetarians are at greatest risk for a deficiency. B-12 can also be found in fortified cereals. RDA for ages 70 and older: 2.4 micrograms daily
Folate:
This b-vitamin is most noted for preventing neural tube defects in infants. However, it also plays an important role in the health of older adults. Folate reduces levels of homocysteine, a risk factor for cardiovascular disease and stroke. Research has also linked adequate folate levels to a reduced risk of certain cancers, specifically the breast and colon. Good food sources include dark leafy green vegetables, yellow and orange fruits and vegetables, beans, lentils, nuts, and fortified cereals and grains. RDA for ages 70 and older: 400 micrograms daily
Vitamin D:
This vitamin has received a lot of press recently for it's role in helping maintain bone health, and the possibility that this vitamin plays a larger role in preventing certain autoimmune diseases. Vitamin D is not prevalent in high levels in the diet but can be found in fortified eggs, milk and cereals. Sun exposure alone can provide adequate vitamin D, however, in the northern United States, ultraviolet radiation during winter months is insufficient to minimize the risk for osteoporosis and fractures. What's more, many older adults avoid sun exposure for other health reasons, making a deficiency all the more probable. RDA for ages 70 and older: 15 micrograms, or 600 IU daily
Consuming a variety of foods each day is the best way to ensure an appropriate balance of nutrients necessary for good health. However, many older persons are at a greater risk for nutritional deficiency due to a number of factors just discussed. For that reason, taking a daily multivitamin containing no more than 100% the RDA is a prudent way to ensure the minimum daily value for these nutrients, and can compliment a healthful diet. Taking single vitamin or mineral supplements is highly discouraged, and can inadvertently produce other micronutrient deficiencies. Calcium is the only exception, as levels are well below the RDA in multivitamin preparations. That said, a vitamin pill is still no substitute for a healthful diet and lifestyle, because foods contain additional components, such as fiber and essential fats. Choosing a healthy, varied diet that includes multiple daily servings of fruits, vegetables, whole grains, low-fat dairy products and meats or meat alternatives along with foods fortified with nutrients is the recommended approach to good health in older persons.
For more information on a heart-healthy diet plan, please contact the Preventive Cardiology and Rehabilitation Program at 216.444.9353 (or toll-free at 800.223.2273, extension 49353) and we can schedule a nutrition consultation - or - use our Remote Cardiac Nutrition Counseling Services.
