Vitamins & Supplements: What should I Take?

Fall 2010 CSANews Issue 76  |  Posted date : Sep 17, 2010.Back to list

There is probably no area of medicine which has provoked more controversy and differing opinions over the years than the recommendations which doctors offer to their patients concerning vitamins and supplements. For the senior population, most experts would recommend some extra vitamins and minerals, but the specifics often vary. This article attempts to provide some general advice based on the majority consensus from evidence-based research. Always review with your own doctor the appropriate regimen for you to follow based on your own health status, especially if you are being treated for any chronic condition or taking prescribed medications.

In our younger adult lives, most of us never considered taking vitamin or mineral supplements but, as we age, we do need to supplement our diet with certain vitamins and minerals. While it is strongly advocated that we maintain a well-balanced diet, there is much evidence that many do not always follow this advice. In addition, absorption of vitamins is sometimes less efficient and certain diseases and medications can impair the adequacy of dietary sources alone.

The advice regarding which supplements to take and in what dosage changes from year to year with the evidence-based research that provides new insights into how effective these are in improving one's health status or helping to prevent certain medical conditions. This partially explains why there is very little consistency among doctors' prescribing habits for such supplements. In addition, our diets differ in what we consume and one formula does not necessarily fit all. For example, an elderly person who fairly closely follows Canada's Food Guide may need few supplements, such as vitamin D and calcium, whereas if the individual were vegetarian, supplemental vitamin B would likely be recommended.

Just pass by the aisle in your local pharmacy and you will be amazed at the array of different vitamins, minerals, multivitamins and other supplements for sale. If you are in average health and have not been advised by your physician to take them, then most are not for you. The following two vitamins and two minerals are an exception and, if in good health and older than 65, you should be considering these supplements.

USEFUL DIETARY SUPPLEMENTS

Vitamin D

Evidence of the changes that occur from year to year are exemplified by the recent research into vitamin D. In 2007, the Canadian Cancer Society announced a change in their recommendation for vitamin D dosage from 400 I.U. to 1,000 IU for people who are older, have dark skin, do not go outside often or wear clothing that covers most of their skin. The society is quoted as saying "we're recommending 1,000 IU daily because the current evidence suggests that this amount will help reduce cancer risk with the least potential for harm." Studies had shown growing evidence about the link between vitamin D and reduced risk for colorectal, breast and prostate cancers.

The latest issue of the Canadian Medical Association Journal outlines the new vitamin D guidelines from Osteoporosis Canada, which recommends that persons over the age of 50 should be taking supplements of between 800 and 2,000 IU to help reduce the risk of osteoporosis and fractures. For snowbirds who get more year-round exposure to sunlight, a supplementary dose of 1,000 IU daily, year round, would seem reasonable.

Vitamin C

For many years, it was thought that taking vitamin C at the onset of a common cold would shorten the severity and duration of the symptoms. Numerous studies have shown that this one-time use has no effect on the average population, however, there is some evidence to support its daily use in shortening the duration of symptoms. In adults over age 65, there is also evidence that higher vitamin C requirements may be necessary for protection against oxidative damage to cells. Accordingly, many experts now advise older adults who are at a higher risk for chronic disease caused, in part by oxidative damage, such as stroke, heart disease, cataract and certain cancers, should take at least 400 mg. daily. Vitamin C comes in several forms, but there is little evidence that one is any better than another.

Calcium

In addition to vitamin D helping to maintain bone health, supplemental calcium is usually recommended, especially for post-menopausal women. Commonly recommended doses are 1,500 mg. for women and 1,000 mg. for men. If a bone scan reveals established osteoporosis, a prescription drug will probably be advised as well.

Magnesium

The fourth most abundant mineral in the body is magnesium. It plays a role in keeping bones healthy, regulating normal blood sugar levels, promoting normal blood pressure and supporting our immune system. Although plentiful in green vegetables (spinach), peas, beans, whole grains and nuts, there is significant evidence that older adults more commonly demonstrate magnesium deficiency. Lower dietary intake, as well as decreased absorption, might occur and some seniors may be taking prescribed drugs that can interact with magnesium. Magnesium comes in a number of different forms. Since the different forms have different absorption effectiveness, the dosage should indicate the strength of the "elemental magnesium" in the product. Many experts recommend a supplemental dose of 300-350 mg. per day of elemental magnesium for older adults.

Fish Oil

Omega-3 fatty acids - especially DHA and EPA - are found in fish oil. For those of us eating one or two servings a week, our intake is sufficient from dietary sources. Many physicians advise those with diets deficient in this antioxidant to take a fish-oil capsule daily because of possible beneficial effects on cognitive function and to reduce the risk of cardiovascular disease. In addition, there has been recent research indicating a possible role in reducing the risk of ductal breast cancer in women.

OTHER DIETARY SUPPLEMENTS

Multivitamins

It is estimated that more than 50% of seniors are taking a multivitamin with minerals supplement each day, despite the fact that for most, there is very little evidence of any value in these low-dose supplements. Furthermore, the few essential supplements in the formula are in doses that are inadequate, according to recent recommendations. It is true that proper nutrition, maintaining a healthy weight and keeping active are the essentials of good health, but recent studies have shown that there is no evidence that most of us reap any benefit from taking multivitamin supplements. In fact, the largest study ever conducted in post-menopausal women has found "convincing evidence" that multivitamin use has "little or no influence" on the risk of common cancers, cardiovascular disease or dying from any cause. Yet statistics show that more than $100 million is spent by Canadians each year for multivitamins! Persons with certain medical conditions may need such supplements, but the majority of us do not. Remember that many foods are also fortified with vitamins. Read your food labelling and you will be able to determine which foods have vitamins and minerals added.

Vitamin E

For many years, there was a perception that taking vitamin E would help prevent a number of chronic conditions, especially heart attack and stroke. Numerous reputable clinical trials over the years have failed to establish any difference in the incidence, morbidity or mortality of these conditions between participants taking full supplementary doses of vitamin E over the years and those taking none. Similar studies attempting to show a link between vitamin E intake and cancer have also been inconclusive.

It had long been speculated that vitamin E supplements might be beneficial in preventing dementias such as Alzheimer's disease. Nevertheless, a number of very large studies failed to show any difference in the risk of developing or ameliorating dementias.

However, recent research, as reported in the Archives of Neurology, has found that getting more vitamin E from dietary sources, not supplements, offers significant protection from Alzheimer's disease. The study revealed that those on the higher end of dietary vitamin E intake were 26% less likely to develop Alzheimer's disease than those ingesting foods low in vitamin E. In addition, there was no evidence that supplemental vitamin E had any effect on reducing this risk. It has been speculated that since vitamin E comes in eight different forms, the form of vitamin E found in supplements - alphatocopherol - may not be the effective type. Further research is ongoing. Meanwhile, there appears to be value in ingesting adequate amounts of vitamin E, but it should be from dietary sources such as nuts (almonds, hazelnuts, peanuts), seeds, vegetable oils, spinach, broccoli and tomatoes.

The B Vitamins

There are eight common B vitamins that play an important role in cell metabolism. For all but a few (elderly persons with absorption problems or those with certain diseases), our diets are full of the B vitamins. Furthermore, excess amounts are simply excreted in the urine.

Vitamin A

This vitamin is important for vision, reproduction, cell division and bone growth. Present in meats, dairy products and carrots, as well as many other foods, the vitamin is plentiful in most diets and experts do not recommend taking supplements. Over-dosage through supplements can cause serious damage.

Other Vitamins and Minerals

As with vitamin A, there are numerous other vitamins and minerals necessary for good health, but all are obtained through a good diet and supplements are unnecessary.

Coenzme Q10 (CoQ10)

Known to have beneficial effects on heart health, cognitive health and anti-aging, this antioxidant is present in fish, meat and other foods and is also produced by the body to help process energy. It has been established that certain cholesterol-lowering drugs (known as statins) can lower the level of this enzyme in the body. Although scientific proof that supplementation is of any value in the average person is lacking, there are some physicians who believe that it has beneficial effects for persons on statins, and those who suffer from Parkinson's disease or periodontal disease and gingivitis. 

SUMMARY

There is a large number of other over-the-counter "remedies" which some individuals have found useful. Alternative medicine has come a long way in the past few decades, but be cautious about what non-prescribed supplements you consider. Common over-the-counter supplements are advocated to help osteoarthritis, heart health, brain function and anti-aging, in addition to almost every other ailment. Other than some placebo effect, there is little scientific evidence that any supplements are of value, other than helping to support a very lucrative industry. Be sure to always get advice from your physician when considering taking non-prescribed supplements and – most importantly – eat well.