Low Levels of Dietary Vitamins Linked to Frailty in Older Adults

Researchers from The Irish Longitudinal Study on Ageing (TILDA) at Trinity College have shown in the largest study to date that lower levels of specific dietary vitamins and antioxidants are associated with frailty. Their findings have been published in the Journal of American Medical Directors Association.

Frailty is a common chronic syndrome which affects up to 25% of adults over 65 years and over half of adults over 80. Frailty is characterised by an overall decline in physical function and a loss of ability to bounce back after experiencing a stressful event such as infection, a fall or surgery. It is associated with poor health, disability and death. The TILDA study examined the association of vitamin B12, folate, vitamin D, lutein and zeaxanthin levels with frailty.

The B vitamins (B12 and folate) are important for several cellular processes throughout the body including DNA repair and energy metabolism. Vitamin D is essential for bone metabolism, muscle strength and mood. Lutein and zeaxanthin have antioxidant and anti-inflammatory properties important in eye health and brain health. Low levels of all of these vitamins and antioxidants is common among Irish adults.

In this new research lower levels of lutein, zeaxanthin, and vitamin D were consistently associated with not only frailty but also earlier stages of ‘pre-frailty’ (a subclinical precursor of frailty). Low levels of B vitamins were associated with pre-frailty. Furthermore, the accumulation of micronutrient insufficiencies – having low levels of more than one micronutrient – was progressively associated with severity stages of frailty.

This data raises the question of the role of dietary supplementation and contributes to the ongoing policy discussions regarding fortification.

Lead author of the study and Senior Research Fellow at TILDA, Dr Aisling O’Halloran said:

“We have presented evidence in the largest study to date that lower levels of specific vitamins and antioxidants – and having low levels of more than one micronutrient – is consistently and progressively associated with the most commonly used methods for measuring frailty. Our data suggest that low micronutrient status may act as an easily modified marker and intervention target for frailty among adults aged 50 years and over”.

Principal Investigator of TILDA, Professor Rose-Anne Kenny said:

“Frailty occurs when a number of systems in the body lose reserve capacity and therefore the ability to ‘bounce back’ after even trivial illnesses. It is an important and challenging state; commonly associated with ageing but also common in patients of any age who have major surgery, cancer treatments and severe infections. The hall mark of frailty is muscle weakness. If it is recognised in its early stages, it can be reversed. However, the longer it is present, the more difficult is it to ‘bounce back’ and generalised weakness and fatigue become progressively worse. This research suggests new potential treatments for a common and important condition.”

Co-author of the study Dr Eamon Laird said: “Again we see that micronutrients (including vitamin D) are associated with better health outcomes in older adults. However we still lack a food fortification policy in Ireland and whilst this continues, we miss the opportunity of a cost-effective strategy to prevent and intervene in the progression of these conditions. As of yet there is no sign that the government or the FSAI (Food Safety Authority Ireland) intend to advise or implement on such a strategy”.

Source : The University of Dublin


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Video: Vitamins and Supplements – Magic Pills?

As many as three out of four Canadians use natural health products. From herbal remedies to minerals, vitamins and other supplements, it’s a billion dollar industry that includes everyone from Big Pharma to Mom and Pop operations. They’re products packed with promises, but what’s actually in the bottle? Could we be taking too much? And could they actually be harmful to your health?

Watch video at You Tube (42:24 minutes) . . . .

There’s Not Much Science-based Evidence That Vitamins Do Any Good to Your Health

Faye Flam wrote . . . . . . . .

Proponents of science-based medicine are fond of saying that there’s a name for alternative treatments that pass scientific tests: medicine. But what they don’t mention are those parts of long-established medicine that get demoted to “alternative” status — or should be.

For years, doctors pestered me — and apparently many other people — to take a daily multivitamin and a calcium supplement. There was nothing wrong with me; doctors said it was a kind of insurance. The calcium was to protect against fractures, and the multivitamin … well, the doctors were never too clear on that, but they were adamant.

And now, Kaiser Health News is reporting that most older Americans are “hooked” on vitamins. The story, which ran in the New York Times, detailed a litany of scientific studies showing vitamin supplements either failed to deliver benefits or caused harm. Experts quoted in the story presented all this as if consumers were buying into some egregious form of pseudoscientific quackery — as if this were never part of established medicine.

Paul Offit, a pediatrician at the Children’s Hospital of Philadelphia, included vitamins alongside homeopathy and “energy healing” in his book on quack medicine, “Do You Believe in Magic?”. He notes that indeed, the medical establishment did once assume everyone should take vitamins, and universally recommending them has been a hard habit for the doctors to break.

The benefit of supplemental vitamins for healthy people was, he said, based more on assumptions than data, as are many other common practices in medicine. And even as 21st-century medicine advances at lightning speed, with precision genetic testing, immunotherapy and robotic surgeries, it can slow to a crawl in discarding outdated practices. Doctors were slow to stop pushing low-fat diets, Offit said, and are still reluctant to acknowledge data pointing to the downsides of the standard mass screenings for prostate and breast cancers. The notion that people should take antibiotics long after they feel better was never based on testing, he said. That’s now being called into question.

Unlike many forms of alternative medicine, vitamins can have real benefits for some people. It was a giant leap for public health when scientists discovered that foods contained essential trace compounds — named vitamins in 1912. For the first time, doctors understood why people got sick from an unbalanced diet even if they consumed enough calories to keep from starving. There’s no doubt early sailors and explorers living on nothing but hardtack would have done much better with a few bottles of One-A-Day in the hold.

Now many foods are already fortified with vitamins, and it’s rare for people without unusual health conditions to have vitamin deficiencies, even if they eat a less-than-perfect diet. But somewhere around the 1980s, doctors became soured on food as a source of nutrition. We were told it was unsafe to eat fat of any kind, or anything with salt. We were supposed to avoid shrimp, shellfish, nuts, eggs and cheese. Vegetables were still on the list of acceptable foods, but they were pretty grim fare when cooked with no oil, butter or salt.

And then there was the demonization of calories, which are a measure of energy — of how much food is in food. While calorie counts can be useful in protecting us from massive portions of low-quality food, some experts have said the whole obsession with calorie counting is premised on the notion that food is bad. Vitamins, meanwhile, are for the most part calorie-free and fat-free, and doctors assumed they couldn’t be harmful.

Gradually, scientific studies started to show that food was not nearly as dangerous as thought, and that vitamin and mineral supplements could do harm. There was data showing that calcium supplements did not decrease the risk of fracture and might increase the risk of kidney stones. A large-population study found that less than 3 percent of subjects were deemed deficient in iron, but around 13 percent had levels that were dangerously high.

In other studies, vitamin A supplements increased the risk of death among lung cancer patients, and vitamin E increased deaths among people with prostate cancer. These were doses higher than what’s in multivitamins, but low enough that scientists assumed they were safe. Here’s one of the doctors quoted in the recent Kaiser Health News piece:

“Vitamins are not inert,” said Dr. Eric Klein, a prostate cancer expert at the Cleveland Clinic who led the vitamin E study. “They are biologically active agents. We have to think of them in the same way as drugs.”

Considering that larger doses of certain vitamins can cause harm, isn’t the safest course of action to eat some spinach and avoid the pills? Back in 2008, physician Harriet Hall posed the same question regarding her own use of vitamins in a post for the blog Science-Based Medicine. She wrote that she considered her past use of multivitamins “irrational,” and that she continues to take calcium and vitamin D to address a problem, but has dropped the daily multivitamins. She told me she still agrees with what she wrote back then:

There are two philosophies: to take everything that is suggested just in case, or to wait for scientific validation before taking anything. Based on long experience, I consider the latter course more reasonable. I can’t begin to tell you how many times I’ve heard strong recommendations for something that was later shown to be useless or harmful.

Perhaps the enthusiasm for vitamins was also a product of that techno-optimism that was such a part of 20th-century culture. We were in the space age, and soon food would be replaced with technologically superior substances. But food is back in vogue, and finally, doctors are recommending people get their vitamins by eating it. If doctors are now concerned that too many people are hooked on vitamin pills, they might want to admit they were wrong.

Source : Bloomberg


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Vitamin Deficiency in Later Life

One in two persons aged 65 and above has suboptimal levels of vitamin D in the blood. This is the conclusion of an investigation conducted by researchers at the Helmholtz Zentrum München, as part of the population-based KORA-Age study in the region of Augsburg. Moreover, as the authors of the study report in the peer-reviewed journal ‘Nutrients’, one in four older adults has suboptimal vitamin B12 levels.

Since more than 30 years, the KORA Cooperative Health Research platform has been examining the health of thousands of people living in the greater Augsburg area in Southern Germany. The aim of the study is to understand the impact of environmental factors, lifestyle factors and genes on health. “In this context, we were also interested in examining the micronutrient status of older adults, including vitamins” explains study leader Dr. Barbara Thorand of the Institute of Epidemiology (EPI), Helmholtz Zentrum München. “So far, in Germany, research data on this topic has been relatively thin on the ground.”

Overall, the scientists examined blood samples of 1,079 older adults, aged 65 to 93 years from the KORA study*. Their analysis focused on levels of four micronutrients: vitamin D, folate, vitamin B12 and iron.

“The results are very clear,” explains first author Romy Conzade. “Fifty-two percent of the examined older adults had vitamin D levels below 50 nmol/L and thus had a suboptimal vitamin D status.” The scientists also observed shortages with regard to some of the other micronutrients. Notably, twenty-seven percent of older adults had vitamin B12 levels below the cut-off. Moreover, in eleven percent of older adults, iron levels were too low, and almost nine percent did not have enough folate in their blood.

EPI director Professor Annette Peters puts the data into context: “By means of blood analyses, the current study has confirmed the critical results of the last German National Nutrition Survey (NVS II)**, which revealed an insufficient intake of micronutrients from foods. This is a highly relevant issue, particularly in light of our growing aging population.”

Are dietary supplements the way forward?

The majority of older adults with suboptimal vitamin levels had in common that they were very old, physically inactive or frail. Special attention should, therefore, be paid to these groups with a higher risk for micronutrient deficiencies, explain the researchers.

“Our study also shows that regular intake of vitamin-containing supplements goes along with improved levels of the respective vitamins,” says Barbara Thorand. “However, vitamin-containing supplements are not a universal remedy, and particularly older people should watch out for maintaining a healthy and nutritious diet.”

In this context, the authors say their next objective is to continue investigating the metabolic pathways that link supplement intake, micronutrient status and disease states.

Source: German Research Center for Environmental Health

Dairy Products a Good Dietary Source of Some Types of Vitamin K

Vitamin K, with its multiple forms, is among the lesser known nutrients. Now, new research from scientists at the Jean Mayer USDA Human Nutrition Research Center on Aging (USDA HNRCA) at Tufts University sheds new light on the vitamin and its significant presence in some dairy products available in the United States.

In the study, published June 1 in Current Developments in Nutrition, researchers quantified the activity of two natural forms of vitamin K in dairy products of various fat contents and found that common U.S. dairy items, including milks, yogurts and cheeses, contain appreciable amounts of multiple forms of vitamin K. Vitamin concentrations varied by fat content.

Vitamin K, which helps the blood to clot, is most commonly thought to come from leafy greens such as spinach, kale and broccoli. In fact, dietary sources of vitamin K are found in two natural forms: phylloquinone (PK, or vitamin K1), which is widely distributed through plant-based foods, and menaquinones (MK, or vitamin K2), which appear to be primarily in animal products and fermented foods. Almost all MK forms are also produced by bacteria in the human gut. Not much is known about MK amounts in U.S. dairy products.

“Dairy foods contain minute amounts of PK, the best known of the vitamin K forms, and so dairy is not commonly considered a rich dietary source for this nutrient. However, when it comes to MK forms, we found that dairy items already found in many peoples’ refrigerators are indeed a good dietary source for vitamin K,” said Xueyan Fu, Ph.D., first and corresponding author and scientist in the Vitamin K Laboratory at the USDA HNRCA.

Guidelines for adequate vitamin K intake are based only on PK intake without consideration for other forms of vitamin K. MK differ from PK in structure in that they are compounds with different numbers of isoprenoid units in the side chain, designated as MK4 through MK13. Which forms of MK are present reflects which bacteria might be in the dairy products. Lactic acid bacteria, for example, are widely used in dairy and fermented foods.

To understand the presence of MK and PK in dairy products, the researchers used 50 nationally collected dairy samples provided by the USDA Nutrient Data Laboratory and 148 dairy samples purchased in 2016 from Boston area retail outlets. The products were divided into categories based on dairy types and fat content: milks, yogurts, Greek yogurts, kefirs, creams, processed cheeses, fresh cheeses, blue cheeses, soft cheeses, semi-soft cheeses, and hard cheeses. The effect of fat content on total vitamin K in all forms was compared using a two-sample T-test. The vitamin K content of cream products, for which the researchers had a smaller sample size, was analyzed using a general linear model, with heavy cream as the reference group.

Among the findings:

  • All full-fat dairy products contained appreciable amounts of MK, primarily in the forms of MK9, MK10 and MK11. Combined, these three forms of MK accounted for approximately 90 percent of total vitamin K present in the foods tested.
  • In cheeses, the total vitamin K content varied by type, with soft cheese having the highest concentration, followed by blue cheese, semi-soft cheese, and hard cheese. All of the cheeses contained MK9, MK10 and MK11, and modest amounts of PK, MK4, MK7, MK8 and MK12. Little MK5, MK6 or MK13 was measured in the majority of cheeses.
  • In milk, the vitamin K concentrations varied by fat content; both total vitamin K and individual MK concentrations in full-fat milk were significantly higher than in 2 percent milk. PK was only detected in full-fat milk. Only MK9-11 were detected in milk.
  • In yogurts, full-fat regular and Greek yogurts exhibited similar vitamin K concentrations as in full-fat milk; neither MK nor PK were detected in fat-free yogurt.

“Estimated intakes of PK and MK in dairy-producing countries in Western Europe suggest that between 10 and 25 percent of total vitamin K intake are provided by MK, and primarily from dairy sources. Additionally, observational data from Europe suggest that MK from dairy products have a stronger association with heart health benefits compared with PK intakes. This data from other countries highlights the need to analyze MK in commonly consumed foods in the U.S.,” said Sarah L. Booth, Ph.D., last author on the study. Booth is senior scientist and director of the Vitamin K Laboratory at the USDA HNRCA, interim director of the USDA HNRCA, and professor at the Friedman School of Nutrition Science and Policy at Tufts University.

Additional research is needed to determine the role of microbes used in production of dairy products, and their impact on MK content. The researchers also say there is a need to determine the relative bioavailability of all MK forms given their abundance in the U.S. diet.

The researchers acknowledge limitations of the study, including the reliance on food labels for fat content instead of direct measurement of fat content. Additionally, whereas the dairy product samples obtained from the USDA Nutrient Data Laboratory were geographically representative of the U.S. diet, those purchased in the Boston region were not. However, items purchased locally were selected from retail outlets with national representation.

Source: Tufts University


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