My friend Judy asked the other day if I thought her mother should take a vitamin-mineral supplement. This should have been an easy question.
I remembered back to my graduate and undergraduate nutrition work, when the consensus was that if people were eating a healthy diet they didn’t need supplements. However, there have since been some changes to our diets:
• Fewer nutrients in our produce because of processing techniques.
• Faster-growing fruit doesn’t have time to develop nutrients.
• Monoculture farming practices leads to soil-mineral depletion.
• Selective breeding to increase crop yield leads to genetic dilution effect and declines in the content of protein and minerals.
• The average vegetable in today’s supermarket is five to 40 percent lower in minerals than those harvested 50 years ago.
My practice of nutrition therapy promotes the consumption of food as the primary source of nourishment. Foods provide vitamins, minerals, phytochemicals, antioxidants and other compounds beneficial to health. Foods fortified with one or more specific nutrients may be beneficial for nutrients that otherwise might not be consumed in adequate amounts. Fortifying milk with vitamin D, for example, greatly increases vitamin D consumption.
Supplements may be needed when a specific gap is identified and the need can’t be met by a person’s usual food intake. Supplements cannot replace a healthful diet. If a person is already consuming the recommended amount of a nutrient in foods, no additional health benefit will be achieved if they also take the nutrient as a supplement. In some situations, consuming fortified foods may cause intakes to exceed safe levels of nutrients.
Older adults, especially those who spend most of their time at home or in a long-term-care facility and have little or no exposure to sunlight, are at risk for low concentrations of serum vitamin 25-hydroxyvitamin D. Low serum levels are associated with increased risk of bone loss, fractures, and falls as well as decreased muscle strength (which is already an issue for the elderly). Older adults may need as much as 1,000 IUs per day to reach and maintain adequate serum vitamin D levels.
Many elderly, especially those with low incomes or those homebound, are unwilling or unable to eat enough food or the right types of foods to meet recommended intakes of vitamins A, B6, C, D, E, and K, as well as calcium, magnesium, potassium, zinc and fiber. A study that looked at the intake of 348 homebound older adults showed that 27 percent had inadequate intakes of six or more of these nutrients.
However, is there a need for supplements just because there is inadequate intake? The answer depends on the criteria used to define adequacy. Is an adequate intake the amount needed to reduce the risk of chronic disease, or the amount needed to prevent deficiencies? Blatant micronutrient deficiencies such as beriberi and scurvy are very rare these days in the United States.
When it comes to multivitamins, there isn’t a one-size-fits-all solution. If the intake of vitamins and minerals is inadequate, then the intake of protein, calories, essential fatty acids and dietary fiber may also be inadequate and won’t be addressed by a supplement. Minor diet changes can fill needs for nutrients.
The Academy of Nutrition and Dietetics recommends that older adults pay special attention to their intake of calcium, vitamin D, vitamin B12, potassium and fiber. When dietary changes are difficult, a dietary supplement can be a reasonable solution, but each person’s intake needs to be looked at on an individual basis. It isn’t wise to recommend supplements without first assessing food intake.
So Judy, before I can say yes or no, I’ll need to take a look at your mother’s diet.
Georgia Clark-Albert is a registered dietitian nutritionist and certified diabetes educator at Penobscot Community Health Care in Bangor. She provides nutrition consultant services through Mainely Nutrition in Athens. Read her columns and post questions at bangordailynews.com or email her at GeorgiaMaineMSRDCDE@gmail.com.