One of the easiest ways how to improve the healthy longevity of your patients - The introduction to supplements

Highlights:

• Vitamins from B family levels tend to decrease with age and should be supplemented
• The elderly are often deficient in several minerals (magnesium, zinc, selenium, and chromium)
• Other important supplements are omega-3 fatty acids, coenzyme Q10, or collagen
  
  

Introduction

Three hundred years ago, sailors didn't return from long voyages because of scurvy - vitamin C deficiency. Treated with the lime juice at the time, the dreaded disease can be now cured with a pill available in every pharmacy. Advances in modern medicine can improve many conditions that seemed fatal before.

Your patients would get every crucial mineral, vitamin, and other compound from the food, sun, and other natural sources in an ideal world. Unfortunately, naturally occurring amounts of vitamins and minerals are lower than they used to be - due to agricultural practices and depleting of the soil. Supplementation becomes necessary to maintain health and even more critical for improvements. Supplements are well studied, readily available, easy to use, and can improve many conditions.

Supplements

Let us look at the main vitamins, minerals, and several chosen supplements that benefit health in general and especially in the elderly. Please, meet A, B, C, D, E, K, Calcium, Magnesium, Coenzyme Q10, Omega-3, and in general - orthomolecular medicine that aims to restore and maintain health using the administration of substances that usually are present in the body (1).

Vitamins

Vitamin is a group of different compounds that are necessary for normal cell functioning and development. Haller et al. point out that since older adults engage in less physical activity, therefore their lean body mass and energy requirements decrease. They consume lower quantities of food and thus less of macronutrients and micronutrients - by 30% less by the age of 80 years (2). 

Those levels differ for different vitamins, especially according to their mechanism of reaction in the body. Fat-soluble vitamins and carotenoids accumulate in fat tissue and liver, and their levels increase with age, except for vitamin D. On the contrary, water-soluble vitamin levels tend to decrease, particularly valid for vitamins B6 and B12. The fact whether a vitamin is soluble in water or fat is also crucial for their use - fat-soluble vitamins (A, D, E, and K) should be ingested after a meal containing fat. The same is valid for the intake of vitamins in their natural form, for example, always adding some oil to the carrot salad.

This takes us to vitamin A (retinol), a nutrient essential to vision (protecting the eyes from night blindness and age-related decline), growth, and immunity. It also supports skin and bone health. It is fat-soluble, and its recommended daily amount (RDA) is 700 µg a day for men and 600 µg a day for women until the age of 64. Sources are cheese, eggs, oily fish, and for its precursor beta carotene - yellow, red, and green vegetables and fruits.

Except for vitamin B12 (up to 15% of older Americans do not reach recommended amounts), vitamin B deficiencies are uncommon since, in the United States, it is added to grain products. Vitamin B12 (2) supports cognitive and neurological functions. Since its absorption from food may be problematic, it is recommended to supplement it. It is safe to exceed the RDA for B12 (2.4 µg) (3).

The superstar vitamin C is present in many metabolic functions, the most notorious being immunity and collagen production. Its RDA was raised to 90 mg for men, 75 mg for women, and more for smokers. Higher doses bring more significant benefits, such as lowering blood pressure, immune system boost or reducing the frequency of colds, and lowering the risk of age-related macular degeneration (1). Since this is a water-soluble vitamin, there is no danger of overdosing. You can find it in fruit, spinach.

The body manufactured the sun vitamin D in the skin, the UV-B radiation converting the vitamin D precursor. The populations living in a climate with less sun present are often deficient, such as a third of healthy Americans and a half of American patients. Its benefits range from fracture and fall prevention to lowering blood pressure. The Institute of Medicine recommends adults from 51 to 70 years ingest 600 IU of vitamin D daily, and for those over age 70, even more - 800 IU. Supplements can be taken daily, weekly, or even every third month (3). Vitamin D should be almost always used together with Vitamin K2 (especially MK7 / MK4).

Vitamin E is a fat-soluble antioxidant with an RDA of 15 mg. It protects against heart disease, plays a role in metabolic processes and the immune system. It can be found in vegetable oils, nuts and seeds, and the usual suspect - leafy greens.                          

Intake of vitamin K correlates with bone density. Most people do not need to supplement K1 at all (K1 is present in the chloroplasts of green plants). But the K2 is crucial for our body, and that we cannot synthesize it - as some animals, like cows, do. The good news is the mere 120 g of romaine lettuce covers the RDA for men and women. It is recommended to supplement it in the form of calcium citrate (3).                

Minerals

The elderly are often deficient in several minerals (magnesium, zinc, selenium, and chromium), but iron intake is generally adequate or higher than recommended (4).

Around 75% of American adults do not consume the RDA of calcium (1200 mg of elemental calcium daily for adults over 50 years of age). This mineral not only prevents osteoporosis but also lowers risks for hypertension and colon cancer (3).

Chromium is a trace mineral that can reduce blood sugar and enhance insulin sensitivity in diabetic patients. High doses that are very safe eliminated the need for medication in 90% of type 2 diabetics. It also lowers cholesterol (1). Its deficiency is associated with type 2 diabetes (4).

70% of the US population is magnesium depleted, and its intake in the elderly tends to be lower than the reference nutrient intake (4). Studies suggest that magnesium supplementation may treat depression in the elderly with type 2 diabetes, improve vascular function in elderly diabetics, and affect primary insomnia of the elderly.

Selenium has antioxidant properties, and its content in plants varies according to the selenium content in the soil. Population studies suggest that a lower rate of the disease may be related to higher consumption of selenium (3). Its best natural source is Brazil nuts.

Other compounds

Omega-3 essential fatty acids are found in fish, green leafy vegetables, and some oils that help lower blood pressure, reduce inflammation and the risk of cardiovascular disease. The American Heart Association recommends everybody eat fish bi-weekly (3).

Coenzyme Q10 is an antioxidant produced naturally by the body, and its levels decrease with age and are lowered by statin drugs. It is essential for mitochondrial energy production. It is found naturally in meat, fish, and nuts. Its benefits are: 

• Lower blood pressure
• Improve congestive heart failure
• Protect the brain in Parkinson's, Alzheimer and other degenerative conditions

Supplementing ranges from 100 mg (prevention of high blood pressure) to more than 400 mg daily for patients with heart disease. Doses exceeding 1000 mg may improve neurological conditions (1).    

Curcumin, extracted from Curcuma longa (Turmeric), has beneficial properties: anti-aging, anti-cancer (bladder, brain, breast, colorectal, or cervical), and anti-inflammatory. It also improves neurological conditions and lowers high blood pressure. It may also prevent Alzheimer's disease by suppressing memory decline (5). European Food Safety Authority determined the Allowable Daily Intake to be 0-3 mg per kilogram (0-1.4 mg per pound)

NMN (nicotinamide mononucleotide) is a precursor to NAD+ and restores its levels that decrease with aging. It suppresses age-related weight gain, improves bone density, eyesight, and hearing (in mice models) boosts muscle function and energy. Human clinical trials are underway.

Collagen is a water-soluble protein that constitutes around 30% of all the protein in the human body, from connective tissues to muscles and strengthening the bones. Its benefits are:

• Improvement and strengthening of the skin
• Joint pain relief
• Prevention of the bone loss
• Muscle mass boost
• Heart health improvement (6)

Melatonin is a pineal indole hormone called "the sleep hormone," regulating the circadian rhythm. Furthermore, animal models increase lifespan and survival, inhibit mutagenesis, and affect the expression of many genes related to calcium exchange. All this suggests that it may be used to prevent premature aging and carcinogenesis (7).

EGCG is the major catechin in green tea. Catechins help regulate blood pressure, increase weight loss and also have neuroprotective qualities. 

Genistein is an isoflavone (soy phytoestrogen) and thus can improve women's health during and after menopause and premenstrual syndrome. 

Conclusion

It is safe to presume that everybody, and the elderly especially, is deficient in several vitamins, minerals, and other compounds. Supplementing those essential vitamins, such as C, D, and B12, minerals such magnesium and selenium, and Omega-3 could be recommended to almost everyone.

References

1. Michael Janson, Orthomolecular medicine: the therapeutic use of dietary supplements for anti-aging, This article was previously published in Anti-Aging Medicine, the official journal of the Japanese Academy of Anti-Aging Medicine (JAAM), an international affiliate of the Society for Applied Research in Aging (SARA).
2. Haller, The Vitamin Status and its Adequacy in the Elderly: An International Overview International Journal for Vitamin and Nutrition Research 1999 69:3, 160-168, https://doi.org/10.1024/0300-9831.69.3.160 
3. Robert Skully, MDa,b,c,d,e,*, Aroob Shanaah Saleh, MDa, Aging and the Effects of

Vitamins and Supplements

4. Vaquero MP. Magnesium and trace elements in the elderly: intake, status and recommendations. J Nutr Health Aging. 2002;6(2) 147-153. PMID: 12166371.
5. James A. McCubrey1 at al, Effects of resveratrol, curcumin, berberine and other nutraceuticals on aging, cancer development, cancer stem cells and microRNAs
6. https://www.healthline.com/nutrition/collagen-benefits#5.-Promotes-heart-health
7. Anisimov, V. N., et al. (2006). "Melatonin as antioxidant, geroprotector and anticarcinogen." Biochim Biophys Acta 1757(5-6): 573-589.

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