Contrary to some health professionals pre-21st century thinking the jury is NOT out on whether nearly everyone should be taking a basic multi-vitamin/mineral supplement. The answer is yes, you should. In addition I review a research piece describing nutritional considerations for the aging athlete. Good stuff!
Say “Yes” to a Multi-Vitamin/Mineral
The fact that a person does not have scurvy or anemia doesn’t mean she/he is getting enough vitamin C or B12, respectively. Said another way the absence of overt-disease symptoms doesn’t mean you’ve got your vitamin and mineral bases covered.
According to a recent MedPage Today article 69% of their readers believe vitamin levels should be checked annually.
“I cannot remember how many patients have been rescued from dementia and psychosis by B12, especially when I have a geriatric focus,” said one doctor, who also touted vitamin D, calcium, fish oil, and thyroid testing. “Everybody deserves a look about once a year.”
I believe the trend is shifting toward more open-mindedness about patients using a basic, multi-vitamin/mineral in the medical community. Until only recently, however, dietitians and medical doctors continued to spew the dogma of decades that everyone can get all the vitamins and minerals they need through their regular food intake.
According to an article authored by Harvard Nutrition Chair Walter Willett, published in N Engl J Med, Vol. 345, No. 25 (yes, that’s the New England Journal of Medicine) at least 30 percent of the U.S. population takes a multi-vitamin. And he concludes …
“Given the greater likelihood of benefit than harm, and considering the low cost, we conclude that a daily multivitamin that does not exceed the RDA of its component vitamins makes sense for most adults…”
“Substantial data suggest that higher intakes of folic acid, vitamin B6, vitamin B12, and vitamin D will benefit many people, and a multivitamin will ensure an adequate intake of other vitamins for which the evidence of benefit is indirect. A multivitamin is especially important for women who might become pregnant; for persons who regularly consume one or two alcoholic drinks per day; for the elderly, who tend to absorb vitamin B12 poorly and are often deficient in vitamin D; for vegans, who require supplemental vitamin B12; and for poor urban residents, who may be unable to afford adequate intakes of fruit and vegetables.”
In a follow up article published in N Engl J Med, Vol. 346, No. 24 Willett and his co-author Meir J. Stampfer, M.D., DR.P.H. responded to criticism from colleagues about their recommendation for vitamin supplementation with this …
“During a period of uncertainty, which is common in medical practice, we believe that a reasonable approach is to use all available evidence to weigh the likelihood of benefit against the likelihood of harm, while also considering the cost. Simply invoking the lack of data from randomized trials is insufficient, given that even advice to avoid smoking, control weight, and exercise regularly would not meet the criterion of proof of benefit from randomized trials.”
Journals such as the New England Journal of Medicine and educators like Willett are so incredibly, globally influential they bear a great duty and responsibility to get it right.
I remember sitting in a room of 800 people at a conference some years back when Willett got up in front of the room and slammed the media and his medical cohorts for distorting the hazards of eating whole eggs. Remember that? Remember when eggs were terrible for us? Willett essentially showed, in slide after slide, evidence piece after evidence piece, that what the media had latched onto was simply untrue. It was at that moment the tide began to shift with both the media and medical communities backing off the “eggs are evil” position. That’s how powerful people like Willett are. That one dissenting voice holds so much respected authority I have no doubt he shifted the tide from that one presentation.
The NEJM articles I’m referencing here in this blog post were from 2001 and 2002. And I can say that I believe it’s been since about that time that the medical community began to back down from their guttural, knee-jerk response of “You can get everything you need from food.” Sure, we “can.” But do we? No, we don’t.
Even so? There are still factions of the health and fitness and medical communities living pre-21st century and still touting “Get everything you need from food – you can!” While I agree that supplements should always be just that–a supplement to a healthy nutrition plan–I do not understand those who are fearful of recommending a basic multi-vitamin/mineral to their clients and patients.
Disease causes death. Medications save lives but also cause thousands of deaths each year. Surgeries save lives but also cause thousands of deaths each year. To those who are fearful of recommending a basic multi-vitamin/mineral where are the deaths? I really don’t get it…not in 2011.
To conclude I simply concur with Willett and like-minded colleagues who say the cost and risk to benefit ratio for taking a basic multi-vitamin/mineral is worth it unless there is a true, medically-based contraindication that is determined between the patient and his or her medical doctor. For everyone else? TAKE A MULTI-VITAMIN/MINERAL everyday or most days of the week.
Nutritional Considerations in the Aging Athlete
First, what’s an “aging” athlete? The research varies but for the purposes of saving any argument researchers consider anyone over 40 to be “aging.”
Because of something called sarcopenia, the “natural” age-related decline of muscle, aging men and women who want to function optimally in their everyday lives, have to become more aware of it and know what to do about it. Nutrition is a big component in battling sarcopenia and other issues the aging athlete faces.
In my review here today I looked at a paper by Mark Tarnopolsky MD, PhD, FRCPC, Department of Pediatrics and Medicine, McMaster University, Canada(1). To ensure I don’t forget let me just say this now… UNLESS YOU STRENGTH TRAIN TO KEEP OR INCREASE STRENGTH YOU ARE GOING TO LOSE MUSCLE AS YOU AGE. Running won’t protect you. Cycling won’t protect you. Ellipticalling (word?) won’t protect you. Strength training, if done properly, will protect you from sarcopenia IF you feed the body what it needs nutritionally to support the process.
“…muscle weakness can compromise both sports performance and activities of daily living. Sarcopenia is estimated to affect up to 30% of adults over the age of 70 years. Health care costs attributed to sarcopenia amount to tens of billions of dollars per year.”
Older adults don’t absorb and retain amino acids (think protein) as well as younger adults. But if older adults take in enough protein this difference can be minimized or eliminated.
Another thing to consider is whether older adults even have the ability to add new muscle. The answer is an UNequivocal – YES!
“In response to short term weight training, there is a similar increase in myosin heavy chain and mixed muscle protein synthetic rates (;150%, respectively) in older and younger adults.”
After a workout what macronutrients seem to be best for increasing protein synthesis? Protein alone? Carbs alone? Or a combination of protein and carbs? The answer is pretty clear and consistent for the aging or young adult.
“…older adults retain the ability to stimulate muscle and myofibrillar protein synthesis following a bout of resistance exercise, and this effect is enhanced with carbohydrate and protein nutrition to a greater extent than carbohydrate alone.”
So how much protein per day is optimal for the aging athlete who cares about eliminating sarcopenia and being functionally active?
“…when older adults consume sub-optimal levels of protein (0.5 g/kg/d), rather than an adequate amount (1.2 g/kg/d), there are alterations in mRNA transcript abundance that is directionally supportive of adverse metabolic, functional and structural components that would favor sarcopenia.”
So for an aging 175-pound person 40 grams of protein per day is too little and 100 grams of protein per day may be adequate.
What about the type of protein to consume? What’s ideal?
“…their sources of protein should include those with high biological value (eg, egg white, milk, beef, fish).”
Should older athletes supplement? For the most part protein supplements are only needed if the requirements are not being met with food alone. If that is the case then yes, older athletes will benefit much like younger athletes from supplementation (think whey and egg white protein).
I personally do take five grams (a teaspoon) of creatine monohydrate on most days of the week most of the year. I find I perform better when I do and have for more than a decade now. The research does seem to indicate that older athletes can benefit from taking five grams of creatine monohydrate per day as well. I recommend a simple, micronized creatine. Optimum Nutrition is the brand I currently use. I mix mine in my hot oatmeal, a cup of coffee or any liquid that I can stir it in and drink within a few minutes.
“…three large, randomized, double-blind studies have found that creatine supplementation (;5 g/d for 3–6 months) enhances the resistance exercise training induced gains in fat-free mass and strength in older men and women.”
In conclusion there is lots of good news for older adults who get off the couch and engage in both endurance and strength training. The body does respond VERY favorably regardless of age. You can get back muscle lost! It’s never too late to start. Adequate macro- and micro-nutrients are required to get the full benefit from your training so make sure you’re getting adequate protein from quality sources and take a multi-vitamin/mineral each day as well. You may even want to give creatine monohydrate a try if your strength-training sessions are really intense. If you are solely an endurance athlete creatine monohydrate is likely less or no benefit to you.
1. Clin J Sport Med Volume 18, Number 6, November 2008