by Jeanette Beebe, AARP, July 21, 2021
When it comes to vitamins and minerals, there's no need to take multiple pills.
Taking a dietary supplement or two (or five) every day isn't exactly uncommon. About 70 percent of adults age 60 and older reported taking at least one supplement in the last month — be it a multivitamin or a chocolate-flavored calcium chew. And about 30 percent took at least four, research shows.
But what's really worth taking? And what should be left on the grocery store shelf?
"In most cases, it is person-specific,” says Lingtak-Neander Chan, associate chair of the department of pharmacy and a faculty member in the nutritional sciences program at the University of Washington in Seattle. The decision, he says, should be based on “underlying health conditions, diet, access to food and other individual factors.”
The majority of older adults can get the nutrients they need from foods in a varied, healthy diet. That said, if you're worried you're missing the nutritional mark — your doctor can test you for a deficiency — calcium, vitamin D and vitamin B12 are three supplements worth considering, Chan says.
That's right, only three. But they're mighty important.
As we age, our bodies typically don't absorb vitamins and minerals as well as they used to. The poster child for this is calcium, and a deficiency can lead to bone fractures and, eventually, falls. If you don't get enough calcium from dairy, leafy greens and other calcium-rich foods (and women over 50 and men over 70 often don't, according to the National Institutes of Health, or NIH), your body sources it from your bones, making them weaker. A lack of consistent, weight-bearing exercise can make this worse.
Post-menopausal women are especially at risk for weak bones. According to the National Osteoporosis Foundation, 1 in 2 women over 50 will break a bone due to the bone-weakening disease osteoporosis; for men, it's up to 1 in 4. A woman's chance of fracturing a hip is about the same as her risk of developing breast, uterine and ovarian cancer combined. But a hip fracture is more likely to be fatal for men. So it's not just women who should mind their calcium intake.
How much calcium do you need? Here's what the NIH's Office of Dietary Supplements says:
1,200 milligrams (mg) calcium per day for women age 51 and older
1,000 mg calcium per day for men age 51 to 70
1,200 mg calcium per day for men age 71 and older
When it comes to supplements, calcium can be found in multivitamin pills and chews; there are also supplements that contain only calcium or that pair it with one other nutrient, like vitamin D.
If you opt for calcium carbonate (which is more affordable than calcium citrate, the other form found in supplements), you should probably take it with food. If you also take a supplement that contains iron, you should take it at least four hours apart from your calcium pill, Chan says. Make sure to check with your doctor about whether any medications you're on interact with calcium supplements (e.g., bisphosphonates, to treat osteoporosis; the thyroid hormone levothyroxine; and tetracycline-class antibiotics) or if there are any side effects (constipation, for example) that are cause for concern.
This part is important: A bigger dose isn't better. And taking more than what's recommended won't make your bones even stronger. In fact, “a mega amount” of calcium can cause harm, Chan says.
Some studies suggest that taking a supplement with an excessive amount of calcium can be dangerous for middle-age and older adults, with negative effects on the kidney, heart and prostate, though more research is needed to better understand the potential links.
Because of this, you should try to get as much calcium as you can from healthy foods — dairy, broccoli, kale, salmon, sardines and various calcium-fortified grains — and take a calcium supplement only if your doctor says you're not getting enough from your diet.
Calcium works best when it's taken alongside vitamin D, which assists in its absorption from the gut. Vitamin D, like calcium, is crucial for bone health. It also supports the immune and nervous systems and may even benefit the heart.
A vitamin D deficiency is often the result of two things that are becoming more common among Americans: obesity and not enough exposure to sunlight. (Sorry, sunlight through a window doesn't count.) Safe sun exposure is key, of course, because too much can cause skin cancer.
Even if you're getting enough sunshine, it might not do the trick, because the aging process interferes with the skin's ability to make vitamin D. Having darker skin does, too. People with Crohn's disease and celiac disease are also more likely to have a vitamin D deficiency.
Here's how much vitamin D you need, according to the NIH:
15 micrograms (mcg) / 600 international units (IU) per day for adults 19 to 70 years old
20 mcg / 800 IU per day for 71-year-olds and older
One word of advice: If you take a vitamin D supplement, take it with food for optimal absorption, ideally with a meal or snack that contains a bit of fat.
Be sure to talk to your doctor about whether vitamin D2 or D3 is more appropriate for you. (D2 is plant-based and more often prescribed by health care providers; D3 is animal-derived and more common over the counter, experts from the Cleveland Clinic explain.) And don't forget to ask whether vitamin D might affect medications you're currently taking. Some cholesterol-lowering statins like atorvastatin (brand name Lipitor) may not work as well if you take vitamin D supplements. Similarly, the weight-loss drug orlistat can reduce the amount of vitamin D your body absorbs from food and supplements, according to the NIH.
Your health care provider can also advise you on how much vitamin D to take. Some reports published in the last 10 years have advocated supplementing with up to 2,000 IU of vitamin D daily. “But more recent clinical trials suggested that amount of intake does not show benefits (no harms either), so it may not be the best generic approach for everybody,” Chan says.
Still, excessive doses — the daily upper limit for adults is 100 mcg/ 4,000 IU — can do terrible things to the body: vomiting, confusion, dehydration, muscle weakness and more. Extremely high levels of vitamin D can lead to kidney failure and death.
Remember how aging makes it harder for the body to use calcium? And to make vitamin D?
When it comes to vitamin B12, older adults are also at a disadvantage. That's because aging impacts the body's ability to absorb this essential nutrient, which plays an important role in regulating blood, nerve and genetic health, according to the NIH.
Older adults who are vegetarian or vegan, who take the antidiabetic medication metformin or who take gastric acid inhibitors to treat certain digestion problems are even more likely to be B12-deficient. And just like with vitamin D, people with Crohn's or celiac disease are also more likely to have a B12 deficiency.
If you do have a vitamin B12 deficiency — and it's estimated that up to 43 percent of older adults do — you will be more likely to develop anemia. A B12 deficiency can also lead to neuropathy or nerve damage (which may feel like tingling or numbness in your hands or feet), balance issues, depression, confusion, poor memory and even dementia.
So how much do you need? The NIH recommends that adults get, on average, 2.4 mcg per day of vitamin B12. When it comes to food, you can get what you need from fish, meat, poultry, eggs, milk, clams and beef liver, as well as from some fortified cereals. Many multivitamin supplements also contain this key nutrient, or you can take it on its own.
And there's no need to worry if your supplement contains a higher dose than what's recommended. Unlike calcium and vitamin D, “vitamin B12 has not been shown to cause any harm, even at high doses,” the NIH maintains. Just be sure to talk to your doctor about any medications you are on that could interact with a vitamin B12 supplement.
Trade that pill for food
Or, if you must, have both
One of the best ways to get all of your essential vitamins and minerals is the old-fashioned way: through a healthy, balanced diet (proteins, veggies, fiber and fluids).
Here's where you can find calcium, vitamin D and vitamin B12:
Calcium: tofu, broccoli, collard greens, kale and various dairy products
Vitamin D: yogurt, milk, fatty fish, beef liver, mushrooms
Vitamin B12: poultry, meat, clams, dairy, eggs
Calcium, vitamin D and vitamin B12 — that's the very short list of vitamins and minerals older adults may want to consider taking. Many other dietary supplements lack robust data to support their regular use, and in fact, you might want to steer clear of a few altogether.
• Vitamin E: A vitamin E deficiency is rare in most healthy people, according to the NIH, even if your diet is short on the recommended daily amount (15 mg for adults). And while vitamin E that is naturally present in food causes no harm and does not need to be limited, getting too much from a supplement can be dangerous.
For example, high doses of vitamin E in supplement form can increase bleeding risks, especially in adults on blood thinners. Research has also linked vitamin E supplementation to an increased risk of prostate cancer in men. For these reasons, “routine supplementation of vitamin E should be avoided,” Chan advises.
• Vitamin C: Despite popular belief, there's no solid data to show that loading up on vitamin C will prevent or cure the common cold. It's a myth. And taking too much vitamin C can cause diarrhea, nausea and stomach cramps. Instead, opt for citrus fruits and vegetables to get the recommended amount needed to support your overall health.
• Folic Acid: For most people, there is no need to take this B vitamin, since many foods, such as cereals, are fortified with folate. “Folic acid deficiency is rare in the United States ... its routine use in aging has not been supported by research,” Chan says. (One exception is during pregnancy.)