It’s hard to resist the promise of capsules to strengthen your bones, protect your heart, fight cancer and keep your mind sharp. Dietary or nutritional supplements might seem like an easy way to bolster your health. But experts are concerned that seniors are spending money they can’t spare on pills and powders they don’t really need. Find out whether dietary supplements make sense for you, when they could cause harm and how to take them safely.
Food First
They’re called supplements for a reason. Vitamins, mineral supplements and antioxidant and fish oil capsules are meant to fill nutrition gaps in your diet, not serve as the main course. “The overarching question for my patients is, ‘Are you nourishing yourself? Is this food real food?'” says Dr. Roxanne Sukol, medical director of the Wellness Enterprise at Cleveland Clinic. “If you’re eating real food and you’re getting some sunlight and you’re eating lots and lots of vegetables including green leaves — which are like nutritional powerhouses — then the likelihood of your having deficiencies that need to be corrected with supplements goes down. It’s not zero, but it’s better.”
In a perfect world, Sukol says, people eat lots of fruits and vegetables and plenty of beans — not just kidney beans but foods like lentils, edamame and hummus. “If you don’t have access to those kinds of things, then it’s probably beneficial to look at a vitamin as an insurance policy,” she says.
On the Supplement Menu
Here are just some of the supplement choices available on supermarket, pharmacy and health food store shelves, and of course the Internet.
Vitamins: Multivitamin supplements offer a daily dose of key vitamins, such as vitamins A, B3 and B6, D, E and folic acid, sometimes with minerals. While convenient, multivitamins may give you extra nutrients you don’t need. Single-vitamin supplements let you choose from vitamin A, individual B vitamins (such as B6 and B12) and vitamins C, D, E and K. Dosages vary, however, with some pills exceeding recommended dietary allowances.
Minerals: Calcium, magnesium, iron and zinc are popular mineral supplements. Most older adults don’t need extra iron. “Iron should only be taken by women of childbearing age or people who have a documented iron deficiency,” Sukol says. “It’s a simple matter to get your iron levels checked.” Many seniors take calcium supplements for bone health. But ideally, Sukol says, calcium comes from your food.
Fish Oil: Omega-3 is an essential fatty acid believed to help lower blood pressure, improve cholesterol and reduce heart disease. Fish is the best source of omega-3s, but if your diet doesn’t include much fish, you might benefit from an omega-3 fish oil supplement.
Glucosamine: Many seniors turn to glucosamine supplements to treat arthritis symptoms. It’s often combined with chondroitin or other ingredients. With glucosamine, Sukol says, “I recommend a trial in patients with joint pain due to arthritis, with a caveat that they will require blood sugar monitoring, at least initially, to make sure it does not cause [levels] to rise.”
Botanicals/Herbals: Echinacea, Saint John’s wort and Ginkgo biloba are among the many botanical or plant-based supplements. While some evidence suggests Ginkgo improves memory and delays dementia symptoms, it’s unclear how much difference it makes.
While there isn’t a single “nutritional panel” your doctor can order, individual blood tests can address specific concerns. For instance, a lipid profile (which measures blood cholesterol and other fats) could indicate whether you need an omega-3 supplement, while a B12 level or vitamin D testing could pinpoint gaps there.
More isn’t better when it comes to supplements, says Terese Scollard, a registered dietitian at Providence Health and Services in Portland, Oregon. “When we do recommend a multivitamin or mineral supplement, [it’s] usually one with no more than 100 or 115 percent of the recommended dietary allowance,” she says. “And we often recommend a generic store brand that’s not expensive at all.”
Health Risks
Combining medications and supplements that can cause too strong of an effect when mixed, or potentially conflict with each other’s intent, as well as substituting a supplement for a prescribed drug, can be harmful or even life-threatening, the Food and Drug Administration warns. One example: The prescription drug Coumadin, aspirin, Ginkgo and vitamin E supplements all act as blood thinners. Mixing any of these could raise your risk of internal bleeding or stroke.
Vitamin K has the opposite effect — it helps the blood to clot. It’s sometimes used to treat accidental overdose of Coumadin, Sukol explains. But, she adds, for older patients who take Coumadin to thin their blood, using vitamin K as a supplement “doesn’t make a lot of sense.”
Patients are usually asked to stop taking supplement products several weeks before surgery to prevent drug interactions that raise bleeding and other risks during and after. Make sure to tell doctors and nurses about any and all medications (prescription and over-the-counter) and supplements you take well in advance.
Senior Consumers
Scollard is concerned about the “hype and magical thinking” surrounding supplements. “Older people are looking for a lot of supplements related to cognition and avoidance of Alzheimer’s,” she says. “People are desperate. It’s an ‘It won’t hurt you and it might help’ kind of approach.”
She recalls a patient, a woman in her mid-70s, whom she met while screening her for nutritional risk before an upcoming hip replacement surgery. Living on a modest income, this patient “was spending about $200 a month on pills, potions and supplements, and driving an hour away to see her so-called ‘nutritionist,'” Scollard says. With the best intentions of improving her health, she was potentially putting herself at risk. With surgery three weeks away, she was taking a “cocktail” of supplements, some that could suppress blood clotting and others that could promote it.
But another patient in her 70s had a different problem, Scollard says: “She was not eating enough protein, probably not getting enough vitamins and minerals and she was going into surgery.” In her case, Scollard says, starting nutritional supplements made sense.
Lawmakers Eye Supplement Makers
In February, the New York attorney general demanded that four retailers — GNC, Target, Walgreens and Walmart — remove fraudulent herbal supplements from their shelves, spurred by a New York Times article that revealed labeling fraud in the industry. Instead of plants listed on the labels — such as ginseng, Ginkgo, Saint John’s wort and valerian — various products, depending on the retailer, allegedly contained cheap fillers.
In June, Sen. Claire McCaskill, D-Mo., ranking member of the Senate Special Committee on Aging, began an inquiry into dietary supplements marketed to seniors with claims of brain-health benefits such as treating Alzheimer’s disease and dementia and improving memory.
Supplement Tips
You can take supplements safely (and spend less) by keeping these guidelines in mind:
— Consider the source. Find stores that offer a variety of choices — not just their own brands — and knowledgeable staff trained in nutrition. If you’re buying online, check who’s running the website and whether there’s any input from medical professionals.
— Be open with your doctor. “If seniors are considering taking any kind of supplement, they need to be very honest with their physician about what they’re taking,” Scollard says.
— Go over supplements and medications with your pharmacist, who can detect conflicting drugs and potential interactions.
— Look for the USP mark. It verifies the product contains the ingredients as listed on the label, without harmful levels of contaminants such as lead or mercury, and has been made according to the current FDA good manufacturing practices.
— Be wary of fraud and marketing schemes.
— You don’t have to spend more on expensive vitamins in health food stores. Generic brands can work just as well.
— Eat a colorful diet, Sukol advises: “If I only had 10 seconds for nutritional advice, I would tell [seniors] to eat more color – that means fruit and vegetables for the most part.”
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Seniors and Dietary Supplements: When Less Is More originally appeared on usnews.com
Clarification 08/12/15: This article clarifies an earlier version describing the New York attorney general retailer investigation.