Vitamins: The Good, the Bad, and the Ugly

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Dr. John Morley is considered a leading researcher and educator on nutritional issues in older adults. In an April 2014 editorial in the Journal of the American Medical Directors Association, Dr. Morley states “The data that a diet rich in fruits and vegetables is associated with increased longevity and improved quality of life, is overwhelming…this has been translated into the concept that instead of eating a healthy diet, a quick fix is to take a multivitamin or other supplements”.

For instance, antioxidant supplementation including Vitamin E, beta-carotene, and higher doses of Vitamin A have been shown to actually increase mortality. A study of Vitamin E in mild cognitive impairment failed to show any benefit.

Conversely, whole foods such as broccoli and other cruciferous foods have been shown to decrease cancer risk in persons with certain genetic variants.  Foods high in polyphenols such as olive oil and red wine have been shown in several studies to reduce the odds of first heart attack, death, and the chances of developing Alzheimer’s disease. However, studies of supplements containing these same polyphenols failed to produce the same benefits.

Exceptions may include Vitamin D supplementation for persons with osteoporosis to prevent falls and fractures and Vitamin B-12 supplementation for person with low B-12 blood levels. Vitamin B-12 absorption can be inhibited by drugs such as omeprazole and metformin and can lead to painful neuropathies and dementia-like symptoms.

But what about older adults who do not eat well (less than 1000 calories per day) and become malnourished? There is some data to suggest that vitamin deficiency in these persons may increase delirium and cognitive impairment.  However, foods such as fruit drinks, appear to be a better choice than vitamin supplements, particularly as liquid caloric supplements between meals increases food intake.