Vitamins, Minerals, and Dietary Supplements

Multivitamin/Minerals

A multivitamin/mineral supplement does not have direct health benefits, but it will increase the likelihood of meeting the requirements for most vitamins and minerals. Supplements marketed to older adults are preferred because they are usually higher in Vitamin B12, and lower in Vitamin K and iron, than [Page 576]are other supplements. No more than one tablet should be taken daily.

Calcium and Vitamin D

Calcium and Vitamin D are required for bone health and possibly for prevention and management of many age-related disorders. Older people need 1,200 milligrams (mg) of calcium and 1,000 international units (IU) of Vitamin D daily. Vitamin D-fortified milk is the richest food source, with 300 mg of calcium and 100 IU of Vitamin D per cup. In the United States, milk intake is one to two cups daily (or less for some ethnic groups). Thus, most older people need supplements of these nutrients but should not exceed the upper levels (2,500 mg for calcium and 2,000 IU for Vitamin D).

Vitamin B12

Vitamin B12 is necessary for the brain, other nervous tissue, and red cell development. Approximately 5% to 15% of older people are Vitamin B12 deficient. Digestion of protein-bound Vitamin B12, but not crystalline Vitamin B12, is impaired by atrophic gastritis (affecting up to 30% of older people) and antacids. So, older people should consume crystalline Vitamin B12 from fortified foods or supplements. Although the recommended dietary allowance (RDA) is 2.4 micrograms (mcg), several studies show that at least 12 mcg of crystalline Vitamin B12 daily helps to prevent Vitamin B12 deficiency. Supplements marketed to older adults often contain 12 to 50 mcg—levels considered to be safe. Those diagnosed with Vitamin B12 deficiency need high amounts provided orally (500 to 2,000 mcg per day) or intramuscularly (1,000 mcg per month).

Vitamin E

Vitamin E is an antioxidant with many other cellular functions. The health benefits of the different chemical forms in foods are not entirely known, so consumption of Vitamin E–rich foods such as vegetable oils is recommended. The preferred chemical form in supplements is “d-alpha,” which has the highest affinity for Vitamin E transporters in the body. Average consumption from foods is only approximately half of the RDA. There may be health benefits to consuming 200 to 400 IU, which is far above the RDA and well below the upper level of 1,000 IU. These intakes of Vitamin E maximize blood concentrations and have been associated with improved immune function in some studies. A few studies also have suggested that high intakes may slow the progression of dementia. Physician supervision of high intakes of Vitamin E is prudent because of concerns about increased risk of bleeding.

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