Should You Take Vitamins After 50? An Ultimate Guide to Vitamins and Supplements for Older Adults with Dr. Eric Tam
So many of my patients come to me with questions about supplements, particularly in the form of vitamins and minerals. I love that because it shows my patients are thinking about their health and are trying to become as healthy as possible. As doctors though, we may feel uncomfortable recommending supplements, either due to fear of adverse effects, or possibly even due to the lack of knowledge of them.
I have always been in favor of getting vitamins and minerals we need in the form of healthy whole foods. However, I realized that when it comes to supplements, it's also important to personalize it to each of our patients.
More than half of adults in the U.S. population use dietary supplements, primarily in the form of multivitamins, with or without minerals. So if you're taking supplements, you're certainly not alone. The bigger goal is making sure it is safe and right for you.
Let's debunk the general purpose of specific vitamins, their recommended amounts, their food sources, as well as their potential adverse side effects.
Water Soluble Vitamins: The B Vitamins and Vitamin C
First, we're going to break down vitamins into two categories: water soluble and fat soluble. This matters because water soluble vitamins can be excreted in urine, preventing dangerous levels to accumulate in your body. So, let's run through our water soluble vitamins.
Vitamin B1 - Thiamine
What does vitamin B1 do?
Vitamin B1, also known as thiamine, is essential for carbohydrate and fatty acid metabolism.
What are signs of vitamin B1 deficiency?
Chronic deficiency can lead to a rare disease called beriberi, which results in cardiovascular or nervous system impairments. These include heart failure or loss of sensation in your limbs, just to name a few. In developed countries, this disease is seen in people with severe alcohol use.
What is the recommended intake of vitamin B1 for adults?
The Recommended Dietary Allowance (RDA) for adult men is 1.2 mg per day, and 1.1 mg per day for adult women. There has been no Tolerable Upper Intake Level (UL), or maximum daily dose, identified.
What is the risk of taking too much vitamin B1?
Adverse effects from overdose include irritability, insomnia, elevated heart rate, and generalized weakness.
What foods are a good dietary source of vitamin B1?
Yogurt
Fish
Lentils
Whole grains
Vitamin B2 - Riboflavin
What does vitamin B2 do?
Vitamin B2, also known as Riboflavin, is also essential for carbohydrate and lipid metabolism. It's commonly promoted for migraines or eye health.
What are signs of vitamin B2 deficiency?
Deficiency can result in skin irritation, such as dermatitis or inflammation of the mouth or tongue.
What is the recommended intake of vitamin B2 for adults?
The Recommended Dietary Allowance (RDA) for adult men is 1.3 mg daily, and 1.1 mg daily for adult women. There has been no Tolerable Upper Intake Level (UL), or maximum daily dose, identified.
What is the risk of taking too much vitamin B2?
High doses appear to be free of adverse effects, apart from the occasional abdominal pain or diarrhea.
What foods are a good dietary source of vitamin B2?
Leafy green vegetables
Dairy
Organ meats
Poultry
Vitamin B3 - Niacin
What does vitamin B3 do?
Vitamin B3, also known as niacin, has a broader effect since it plays a role in many chemical reactions within our bodies. It's commonly promoted for lowering cholesterol and improving circulation.
What are signs of vitamin B3 deficiency?
Deficiencies cause the "four d's" of a disease called pellagra. The "four d's" include dermatitis, diarrhea, dementia, and in extreme cases, even death.
What is the recommended intake of vitamin B3 for adults?
The Recommended Dietary Allowance (RDA) of niacin is for adult men is 16 mg mg daily, and 14 mg daily for adult women. The Tolerable Upper Intake Level(UL), or maximum daily dose, for adults is 35 mg.
What is the risk of taking too much vitamin B3?
Adverse reactions include flushing, nausea, and high doses can even cause liver toxicity.
What foods are a good dietary source of vitamin B3?
Nuts
Seeds
Legumes
Brown rice
Meats
Vitamin B5 - Pantothenic Acid
What does vitamin B5 do?
Vitamin B5, also known as pantothenic acid, is involved in the metabolism of fatty acids, cholesterol, steroids, and the chemical reactions of proteins.
What are signs of vitamin B5 deficiency?
Experimentally induced deficiency causes depression, muscle cramping, gait instability, and the burning of the feet.
What is the recommended intake of vitamin B5 for adults?
The Recommended Dietary Allowance (RDA) of pantothenic acid is for adult men and women is 6 mg mg daily. There has been no Tolerable Upper Intake Level(UL), or maximum daily dose, identified.
What is the risk of taking too much vitamin B5?
There are no known adverse effects, but really no indication for its use either.
What foods are a good dietary source of vitamin B5?
Eggs
Mushrooms
Avocados
Vitamin B6 - Pyridoxine
What does vitamin B6 do?
Vitamin B6 is also known as pyridoxine. Its active form is a cofactor, or "helping molecule" during biochemical reactions. Vitamin B6 is used particularly for many metabolism reactions, including amino acid metabolism. It is commonly promoted for preventing vascular disease and improving brain function
What are signs of vitamin B6 deficiency?
Deficiency causes depression, irritability, and later convulsions and coma. It is indicated for sideroblastic anaemia, homocystinuria and prevention of isoniazid (which is a drug to treat tuberculosis) induced peripheral neuropathy.
What is the recommended intake of vitamin B6?
The Recommended Dietary Allowance (RDA) for adult men and women is 5 mg daily. A Tolerable Upper Intake Level (UL), or maximum daily dose, has not been identified.
What is the risk of taking too much vitamin B6?
Adverse effects may include a higher risk of lung cancer, particularly in smokers.
What foods are a good dietary source of vitamin B6?
Bananas
Salmon
Chickpeas.
Vitamin B7 - Biotin
What does vitamin B7 do?
Vitamin B7 is also known as biotin. It is important in the production of lipids, steroids, and the breakdown of amino acids. Biotin is commonly promoted for skin and nail health, cognitive health, and even balancing blood sugar.
Could I be deficient in vitamin B7?
Biotin is produced by the bacteria in our gut, so chances of deficiency is really low.
What is the recommended intake of vitamin B7 for adults?
There is no RDA established for biotin.
What is the risk of taking too much vitamin B7?
There are no major adverse reactions, but it is found that higher doses may altered thyroid function tests. So for those that have thyroid issues, this is important to keep in mind.
What foods are a good dietary source of vitamin B7?
Red meat
Legumes
Brown rice
Vitamin B9 - Folate
What does vitamin B9 do?
Vitamin B9, also known as folate, plays a role in the metabolism of nucleic acid as an amino acid.
What are signs of vitamin B9 deficiency?
Deficiency results in macrocytic anemia. Deficiency in pregnant woman can lead to birth defects.
What is the recommended intake of vitamin B9 for adults?
Folate's Recommended Dietary Allowance (RDA) is listed as micrograms (mcg) of dietary folate equivalents (DFE). It's recommended that adult men and women consume 400 mcg DFE, and at least 600 mcg DFE for those who regularly drink alcohol. The Tolerable Upper Intake Level (UL) is 1,000 mcg a day for adult men and women.
What is the risk of taking too much vitamin B9?
In those with genetic risks, excess folate supplementation may contribute to a higher risk of colon cancer.
What foods are a good dietary source of vitamin B9?
Dark leafy vegetables
Peanuts
Seafood.
Vitamin B12 - Cobalamin
What does vitamin B12 do?
Vitamin B12, also known as cobalamin, is essential for red blood cell production in the maintenance of our central nervous system.
What are signs of vitamin B12 deficiency?
Deficiency can result in anemia and issues with the spinal cord.
What is the recommended intake of vitamin B12 for adults?
The RDA for adult men and women is 2.4 micrograms (mcg) daily. A Tolerable Upper Intake Level (UL), or maximum daily dose, has not been identified.
What is the risk of taking too much vitamin B12?
Large doses of vitamin B12 used for non clinical reasons are reported to cause nausea, vomiting, hypertension, a slower heart rate, and even anaphylaxis.
What foods are a good dietary source of vitamin B12?
Salmon
Eggs
Spinach
Vitamin C - Ascorbic Acid
What does vitamin C do?
Vitamin C, also known as ascorbic acid, has many functions, including the synthesis of collagen, some neurotransmitters, and the production of steroids. It is commonly promoted to boost immune system, lower hypertension, and promote wound healing.
What are signs of vitamin C deficiency?
Not getting enough vitamin C leads to scurvy, a disease quite rare in developed countries, but consisting of symptoms of bleeding gums, poor wound healing, and defective bone development.
What is the recommended intake of vitamin C for adults?
The RDA for adult men is 90 mg daily and 75 mg for adult women. The UL for adults is 2000 mg daily.
What is the risk of taking too much vitamin C?
Adverse effects of such high doses of vitamin C include stomach discomfort, kidney stones, and diarrhea.
What foods are a good dietary source of vitamin C?
Citrus fruits
Bell peppers
Potatoes
Fat Soluble Vitamins: K, A, D, E
Fat Soluble vitamins are absorbed through fat in the diet and do not dissolve in water. Unlike water soluble vitamins, they can be stored and accumulate in our bodies. As a result, there's a concern for toxicity with these vitamins and excess supplementation.
Vitamin K
What does vitamin K do?
Vitamin K’s use is to maintain our ability to prevent bleeding, but it also plays a role in bone mineralization. It's commonly promoted for bone health on social media. But really, there's been no such clinical proven benefit.
What are signs of vitamin K deficiency?
It's rare to be deficient in vitamin K since it is primarily produced by our gut bacteria.
What is the recommended intake of vitamin K for adults?
There is not enough evidence to support a Recommended Dietary Allowance, although “adequate intakes” (AI), or recommended amounts for adequate nutrition, are set at 120 micrograms (mcg) daily for adult men and 90 mcg for adult women.
What is the risk of taking too much vitamin K?
High doses are generally non toxic, but it can affect medications such as Warfarin, which is a common blood thinner medication to treat a variety of medical conditions.
What foods are a good dietary source of vitamin K?
Avocados
Kale
Eggs
Vitamin A
What does vitamin A do?
Vitamin A is required to maintain the integrity of the lining of our blood vessels, our organs, our skin, as well as even maintaining eye health. It also has antioxidant properties and plays a large role in the development of organs during pregnancy.
What are signs of vitamin A deficiency?
Despite its its importance in the body, there are really no indications for supplementation here.
What is the recommended intake of vitamin A for adults?
The Recommended Dietary Allowance for adult men 19 is 900 mcg and 700 mcg RAE for adult women. The Tolerable Upper Intake Level of vitamin A from retinol is 3,000 micrograms of preformed vitamin A.
What is the risk of taking too much vitamin A?
This vitamin in particular is concerning when consumed at high levels, and can cause increased pressure in our brains, inflammation of our skin, nausea, vomiting, blurry vision, and even convulsions. So in addition, chronic use in the form of medication to treat acne can cause birth defects. Therefore, contraception is needed for at least a year after the use of this drug. Vitamin A supplementation may be linked with increased incidences of lung cancer.
What foods are a good dietary source of vitamin A?
Carrots
Tomatoes
Red bell peppers.
Vitamin D
What does vitamin D do?
Vitamin D's main role is increasing intestinal absorption of calcium, phosphate, and magnesium. We get adequate vitamin D through sun exposure, but it's obviously dependent on where you live or what your lifestyle is.
What are signs of vitamin D deficiency?
Deficiency leads to impaired bone mineralization and bone damage.
Should older adults be taking a vitamin D supplement as fall risk prevention?
There is no indication for supplementation unless you have a clinical deficiency that is determined by bloodwork. Previous studies may have shown that it can potentially reduce the risk of falls. A follow up systemic studies really show there's no difference in those that take supplements and those that do not.
In addition, large research studies have shown that there is no added benefit when compared to placebo for reducing bone fracture risk. However, if you're experiencing a known diagnosis of osteoporosis, this is a situation where vitamin D and calcium supplementation may be warranted and worth a discussion with your primary care provider.
What is the recommended intake of vitamin D for adults?
The RDA for adults is 600 IU (15 mcg) daily and 800 IU (20 mcg) daily for adults over 70 years old. The UL established for adult men and women is 4,000 IU (100 mcg).
What is the risk of taking too much vitamin D?
Too much vitamin D is really quite rare, but it can lead to excess calcium of the body, which can cause damage to our soft tissues and organs.
What foods are a good dietary source of vitamin D?
Dairy
Salmon
Eggs
Vitamin E
What does vitamin E do?
It is the most natural, abundant antioxidant.
What are signs of vitamin E deficiency?
Clinical deficiency has never been described by normal individuals, even on a low diet of this vitamin.
What is the recommended intake of vitamin E for adults?
The RDA for vitamin E for adults is 15 mg daily. The UL for vitamin E is 1,000 mg daily for supplemental vitamin E.
What is the risk of taking too much vitamin E?
At present, large review studies show that there is a dose related to an increase in mortality. As such, vitamin E supplementation should be avoided.
Vitamin E also has blood thinning effects, and has been shown to cause increased risk of bleeding events and patients receiving Warfarin which is a common blood thinning medication.
What foods are a good dietary source of vitamin E?
Sunflower seeds
Almonds
Peanuts
Specific Dietary Supplements and Vitamins
We're going to get specific with some common supplements and break down if they're actually effective in what they're marketed to do, or if they're simply just not worth your money. My goal as a doctor is never to tell you to not take something that you feel benefits you. Instead, my goal is just to make sure it's safe.
Omega-3s
What are omega-3s?
Omega-3 fatty acids are polyunsaturated fatty acids and are considered "good fats." They are also known as your fish supplements.
It is important to note that not all omega-3 supplements are equal. You want to make sure it contains both types of omega-3 fatty acids to maximize its benefits. This will be noted on the bottle by mentioning both DHA and EPA. DHA stands for docosahexaenoic acid, which is best known for its ant-inflammatory effects. EPA stands for eicosapentaenoic acid, which is tied to brain health.
Are they safe?
The answer is yes, they are well tolerated, even if taken for the long term.
If you do happen experienced side effects, they're usually mild and can include headaches, stomach upset, and heartburn just to name a few.
What is the recommended intake of omega-3s for adults?
The Dietary Guidelines for America recommends 450 to 500 milligrams of omega-3 fatty acids per day. Those who have heart disease should consume up to 1000 milligrams per day, preferably from fatty fish.
Does omega-3 supplementation support brain health in older adults? Let's first talk about cognitive decline as you age. What we know from scientific research is that poor nutritional status of omega-3 is associated with increased risk of cognitive decline and developing Alzheimer's disease. Further support for omega-3s benefiting brain health is that studies show additional servings of fish per week resulted in decreased risk for dementia and cognitive decline.
However, the effects of omega-3 supplements alone fall short. Many large studies have found no effects of omega-3 supplements on benefiting dementia, quality of life, mental health, mood or cognitive function.
Aren't omega-3s good for heart health?
Big research studies indicates that omega-3 supplements don't reduce the risk of heart disease. However, there are associations with people who eat seafood one to four times a week and having decreased risk for heart issues.
What impacts do omega-3s have on cholesterol and lipid panels?
As we know, triglycerides are a type of fat found in our blood. Omega-3 supplementation does have a role to play here. High doses of omega-3 fatty acids can help reduce triglyceride levels and are sometimes prescribed by clinicians when a patient has substantially elevated levels of triglycerides.
What are food sources of omega-3 fatty acids?
Fish and seafood
Chia seeds and flax seeds
Walnuts
So, should I take an omega-3 supplement?
An omega-3 supplementation simply does not yield the same results from when we get it from healthy seafoods. Studies have shown the benefits of seafood in our diet on heart health on cognitive health that simply cannot be achieved in supplementation.
My takeaway here is that the magic still lies in our nutrition through whole foods. In fact, a simple serving of salmon can provide substantially more high quality omega-3s than most supplements can in a week. To those that are currently taking omega-3 fatty acid supplements and are feeling like it is helpful to you, I say continue what works for you since it is generally safe. However, I would encourage you to et a serving or to a seafood to your weekly meal to really get the benefits of omega-3s.
Instaflex Joint Supplement
What is Instaflex?
I know quite a few of our Mighty Family takes this specific supplement. Let's dive into some of the ingredients in Instaflex to better understand what they do:
Glucosamine: This is essentially a specific type of sugar produced by our bodies naturally that is needed for building joint cartilage. In theory, you would expect an ingredient for joint cartilage to be beneficial and those suffering from joint disease, but the research studies are inconsistent. Some studies say glucosamine can benefit knee function and pain in those suffering from knee arthritis, while others show really no benefit at all. It's unclear why these results are so inconsistent. But there are many factors such as dosing and frequency just to name a few. However, the more important thing is that it is safe to take.
Willow bark extract: Willow bark extract contains salicin, a compound similar to the predominant ingredient in Aspirin, salicylic acid. The dosing in Instaflex is thought to contain the amount of 1/4 of an Aspirin. This is thought to contribute anti-inflammatory properties and pain relief.
Boswellia serrata extract: This is an herb that has been shown in studies to improve pain and function. But, the improvements were so small that it was hard to determine if it was clinically significant. It is thought to have anti-inflammatory properties, but it's really more commonly used as an incense in religious and cultural ceremonies. Ultimately, its medicinal use is still yet to be fully researched.
Does Instaflex work?
A research study compared 50 patients taking three capsules of Instaflex daily for eight weeks to 50 patients who took placebo. The results show that even as soon as four weeks, those taking Instaflex have less joint pain, more ability to do their daily activities of living, less stiffness, but really no difference in their ability to perform a six minute walk test. In addition, those that took Instaflex suffered no bad reactions.
I have to admit that the benefits are apparent, but it's also a very small research study of only 50 people. My other issue with this study is that the conflict of interest is there and that it was funded by the very company that owns Instaflex. Therefore, we must be cautious when interpreting these results and being truly convinced of its benefits.
Should I take Instaflex or other joint support dietary supplements?
Common ingredients in joint supplements are generally safe, but their efficacy is generally inconclusive. Evidence from studies conducted on Instaflex have shown improvement in joint pain and function when compared to placebo.
With that said, there are limitations to study. Because of these limitations, I am yet to be a believer on achieving good results from Instaflex. However, if it works for your body, keep doing what you're doing. Joint pain and Osteoarthritis are definitely tough conditions to manage effectively.
Immuneti - Immunity Support
The last type of supplement that I want to go over is a supplement marketed for boosting your immune system called Immuneti. I wanted to go over this one in particular because it contains a lot of the ingredients most immune supplements contain, but also because a few of our Mighty Family takes it.
Is Immuneti proven to actually reduce symptoms and duration of the common cold and flu like it's marketed?
Unlike Instaflex, there are no research studies on its efficacy. Rather, on its website, it just cites research articles of various ingredients it contains and its health impact. Ultimately, I'm not convinced at all that it can reduce cold and flu symptoms, or its duration, as even the ingredients it contains has inconsistent results in doing so in the medical literature.
In terms of its ingredients. I do think it has valid substances that do have benefits on heart health, immune system support, and improving inflammation just to name a few. However, the dosage of each ingredient may not be where it needs to be to actually make a difference. For example, its dosing of vitamin D, vitamin C, elderberry akinesia are all on the lower end.
What are the ingredients and what do they do?
Let's jump into some of these ingredients so we can better understand what we're actually putting into our bodies.
Echinacea Purpurea- This is one of the most commonly used herbal supplements and is often marketed to help with the common cold and flu. Unfortunately, the scientific data here is very inconsistent. Some research studies have shown it can reduce the risk of developing a cold as well as the duration of one, while other studies show that it has no benefits. Most recommended dose is usually 300-400 milligram 3 times daily, yet Immuneti only contains 200 milligrams, which led me to my comment earlier about how a lot of its ingredients are under-dosed
Elderberry- Elderberry is often marketed for be able to treat the cold or the flu. Like echinacea, its clinical benefits are also inconsistent in the medical literature. Of note, the dosage used in scientific studies to test its benefits are actually much higher than what is contained in this supplement as well.
Should I take an immunity supplement?
All in all, immune supplements do have some good ingredients such as echinacea, elderberries, zinc, and vitamin C that do play a role in our immune system. However, there are so many factors, like dosing and formulations, where the research and its efficacy is still very inconsistent.
Overall, the supplement is safe. So if you're someone that has been taking it and has benefited from it, feel free to continue.
Mighty Take Home Messages
We covered a lot of ground. We talked about water soluble vitamins, fat soluble vitamins, omega-3s, joint supplements, and immune health supplements. Here are some Mighty take home messages:
In a generally healthy community population, it is extremely rare to be deficient in these water soluble vitamins. As you can see, they're all found in foods we commonly eat. Therefore, supplementation is rarely necessary.
There are many things these vitamins are heavily promoted for to favor sales. However, supplementation is really only necessary if there is a clinical need, such as preparing for pregnancy with folate, or treating anemia that is due to B12 deficiency, just to name a few.
Too much supplementation can lead to adverse effects, so they are not 100% harmless. Therefore I do recommend checking with your doctors prior to starting a supplement because what may be right for one person may not be right for another.
It's important to remember that fat soluble vitamins can accumulate in our bodies compared to water soluble vitamins. As a result, there's a concern for toxicity with these vitamins and excess supplementation.
Created in 1984, the U.S. Preventive Services Task Force is an independent, volunteer panel of national experts in prevention and evidence-based medicine. Primary care doctors tend to follow these guidelines to make preventative medicine recommendations. And based on their recommendations, there is not enough information to suggest there is a benefit to warrant vitamin and mineral supplementation to the general population.
Everyone is different. I know many members have found supplements that work for them. My goal is to never tell you that I know your body better than you do. My goal as a doctor is just to make sure everything you're putting into your body is safe. The goal of this blog post is to hopefully take some pressure off of you in feeling like you're missing out on some magical pill. The magical pill is in our healthy whole foods, and that message will always be true. I recommend healthy diets consisting of fruits and vegetables, fish, nuts and seeds, and other whole foods. Do you need some healthy meal inspiration? Check out our Mighty Health recipe library for free!
For those that are not part of the Mighty Family just yet, check us out at MightyHealth.com for more and to match with your very own health coach! We are always hosting free events to support you on your health journey. We are striving everyday to be the modern, holistic home for healthy living.