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Solving the Mystery of the Multivitamin Part IV

This article is the fourth in the series that began with “Solving the Mystery of the Multivitamin.” The focus now shifts to reasons for taking a multivitamin/mineral as we enter the second half of life and, more importantly, the overall approach to nutrition that should inform any anti-aging program. Readers will discover that some, but not all of the gender-specific nutritionaln needs covered in earlier articles become less meaningful in later life. As individuals approach 60, overall physiology changes in ways that tend to lead to a convergence of nutritional requirements.

Aside from the general issue of the benefits of supplementation addressed first below, there are three separate, yet linked areas of physiology that might be considered crucial to protect as we age. These are (1) the insulin system and the prevention of the Metabolic Syndrome, (2) the health of the mitochondria and (3) the functioning of the neurological system. As aspects of metabolism that control most of the rest of what transpires in the body, these three areas must be treated as fundamental.

Secondary issues as we age would include cardiovascular factors, eye health and joint health. The reason these should be considered “secondary” is they usually reflect the downstream impact of the above fundamental factors. For instance, poor blood glucose regulation, high insulin levels and inflammation are factors that lead to serum lipids dysregulation and not the other way around.

Do Seniors Still Need Supplemental Multivitamins?
Some would argue that multivitamin/mineral supplements provide no benefits in later life and that the focus should be purely on condition-specific nutrition. Research does not back this point of view. In a just released study that ran for 10 years, it was discovered that older individuals who were well fed and ate otherwise adequate diets still may be deficient in essential nutrients. In a group of 34 men and 44 women aged 70–75 and in good health, 50 percent were deficient in vitamin B2 and vitamin A. Interestingly, 44 percent of men and 60 percent of women already were deficient in vitamin B1 at the start of the study. In this Mediterranean region filled with fresh fruits and vegetables, a small percentage of those being tracked even developed a deficiency of vitamin C. As the authors conclude, “Multivitamin supplementation may be necessary, even in healthy individuals, to ensure an adequate micronutrient intake in the elderly.”

Benefits may extend beyond merely preventing deficiencies. According to a mouse study from Canada, a mix of vitamins, minerals and herbals may delay the major aspects of the aging process and extend lifespan by as much as 10 percent. This finding in animals did not come as a great surprise in that it already had been shown that multivitamin use is associated with longer telomere length among women, telomere length being a possible marker of biological aging (longer is better). Bruce Ames, long associated with the University of California at Berkeley, is famous, among other things for the triage theory, which posits that modest micronutrient deficiencies (common in much of the population) accelerate molecular aging, including DNA damage, mitochondrial decay and the negative effects of an age-related decline in membrane fluidity. Sometimes a little bit of nutritional insurance is all that it takes.

The Iron and Salt Debates
Few issues are as contentious in nutrition as the roles of iron and salt in the diet. In earlier articles, it was pointed out that men typically do not need supplemental iron unless they are engaged in extremely challenging physical activities, such as running marathons. Women, because of their monthly cycles before menopause, are in the opposite camp. After menopause, there is no clear answer and it may be best simply to include iron status among the parameters tested in regular check-ups.

Salt, as in sodium chloride, is entirely too common in Western diets. Some individuals are salt-sensitive and develop high blood pressure in response to salt, although it is more difficult to pin down why than one might expect. For most of the rest of us, the answer is not so much as to reduce salt intake, although that no doubt is a good idea, but rather by consuming more potassium-rich foods, which includes lightly cooked deep green and leafy vegetables.

Feeding Your Aging Metabolism
As noted above, it is clear that a multivitamin/mineral supplement is good insurance against deficiencies that can crop up as we age even with relatively good diets. To deliver this “insurance,” the amounts of established nutrients need not be high—close to suggested daily intake levels should prove sufficient. In contrast, addressing special issues associated with aging may require different nutrients with different levels of intake.

Essential in response to the needs of the aging metabolism are (a) an integrated insulin support product, meaning such nutrients as chromium, alpha-lipoic acid and so forth, (b) mitochondrial protectors, such as the combination of Lcarnitine with alpha-lipoic acid and/or coenzyme Q10, and (c) substrates for the production of neurotransmitters and items that maintain neural cell membrane fluidity, such as phosphatidylserine, choline and associated factors.

In Western nations, it is assumed that with age the body’s insulin system will naturally respond less well in the control of blood sugar levels. There is evidence this is not true of all dietary patterns, but certainly under American conditions, a decline in glucose control and aging seem to go hand-in-hand. Diabetes, like obesity, is a condition that is reaching epidemic proportions in the United States. Estimates vary, but approximately 17 million people in the United States currently are diagnosed with diabetes. This represents roughly 6.2 percent of the U.S. population. Unfortunately, the word “epidemic” may not exaggerate the magnitude of the change taking place. In 1960, only 2.6 percent of adults aged 45 years and older had been diagnosed with diabetes, whereas by 1990 this figure had risen to 7.0 percent. By 2000 this picture had again worsened dramatically. In 2001, one expert group concluded that the overall rate of diabetes had reached 7.3 percent (at least 10 percent if estimated undiagnosed cases were included) and rates by age groups were as follows:

40–49 5.8%
50–59 10.9%
60–69 14.5%
>70 14.9%

Medical authorities are beginning to view the eventual outcome represented by these trends with alarm, yet there is no reason to relegate such concern to the future. Some 35 million Americans—20 percent of middle-aged adults and 35 percent of the elderly—exhibit some degree of abnormal glucose tolerance. The corollary is usually the Metabolic Syndrome (Syndrome X), which includes such health hazards as obesity, dysregulated serum blood lipids, high blood pressure and other dangers.

Blood Sugar and Insulin Metabolism
To support blood sugar and insulin metabolism as we age, various nutrients are important. Chromium is the best known of these and is important for maintaining the proper response of cell receptors to insulin. Deficiencies in vitamin B6 are commonly found in those with blood sugar problems, especially in men who have developed diabetes and thus B6 should be well-represented. Alpha-Lipoic acid facilitates reduction of blood glucose and supports general metabolism by its effects on energy production. Bitter melon, fenugreek and eucalyptus are a few of the herbal extracts proven to have glucose regulating properties. Magnesium is involved in the metabolism of glucose and production of energy in the form of ATP. A formula for those at mid-life and later should contain one or more nutrients that address blood sugar and insulin balance.

Mitochondrial Metabolism
To prevent mitochondrial decline, both in the brain and in other tissues, L-carnitine is important because it activates and rejuvenates the mitochondrial membranes. Acetyl-L-carnitine (ALS) is the acetylated form of the amino acid L-carnitine and is the version with a particular for neural tissues. As an antioxidant, ALC can protect brain neurons from the damage caused by superoxide radicals. ALC is involved in many other aspects of neuronal metabolism and structurally resembles the neurotransmitter acetylcholine. It supports energy production through its effects upon the metabolism of fatty acids by the mitochondria. Memory loss in aging is associated with brain mitochondrial decay and ALC helps to prevent such decay and even partially rejuvenate aging mitochondria. Research strongly suggests concurrent use with alpha-lipoic acid in large part because fatty acid oxidation can generate free radicals and lipoic acid is especially useful in scavenging such radicals in the mitochondria. In the heart and muscle tissues generally, it is propionyl-L-carnitine, available as glycine propionyl-L-carnitine (GPLC), that is preferred. Coenzyme Q10 and ubiquinol are also useful in conjunction with L-carnitine. Other nutrients associated with mitochondrial health and even the creation of new mitochondria are biotin, a specific proprietary item known as PrimaVie® shilajit, and the olive-derived compound hydroxytyrosol.

Neurotransmitter and Nerve Health
Nerve signals depend on neurotransmitters and the health of the neural membranes. Useful here are CDP choline (cytidine 5’-diphoscholine, also known as Citicoline), phosphatidylserine, alpha-lipoic acid, acetyl-L-carnitine, L-glutamine and taurine to enhance brain metabolism and antioxidant protection. Citicoline (CDP-choline) is a naturally occurring, water-soluble biological compound that is an essential intermediate for the synthesis of phosphatidylcholine, a major constituent of the gray matter of brain tissue (30 percent). Citicoline promotes brain metabolism by enhancing the synthesis of acetylcholine and restoring phospholipid content in the brain. PS (phosphatidylserine) supports the brain’s physiological processing of stress and promotes neuronal communication by its effect on cell membrane fluidity. The antioxidants alpha-lipoic acid, acetyl-L-carnitine, and taurine provide protection for the neurons from damage caused by certain free radicals. Acetyl-L-carnitine, alpha-lipoic acid and L-glutamine also support energy utilization by their effects on fatty acid metabolism, oxidative decarboxylation and gluconeogenesis. Taurine further aids in osmoregulation (maintenance of proper concentrations of ions) inside the cell. More recently, it has been discovered that some of the bluish pigments found especially in fruit such as bilberries, blueberries, black currants and other dark berries can be protective of the brain and memory. Anthocyanins and, especially, the compound known as pterostilbene are particularly protective. Pterostilbene activates sirtuin 1 (Sirt1), protects brain dopaminergic functions and supports memory.

The Second Line of Defense
Many topics usually treated as primary health issues actually are secondary to the three elements just covered. They are secondary because their causes lie with the fundamental changes in insulin, mitochondrial and neurological metabolism as we age. Secondary issues as we age include cardiovascular factors, eye health and joint health. The reason these should be considered “secondary” is, again, that they often reflect the downstream impact of other factors. For instance, poor blood glucose regulation, high insulin levels and inflammation are factors that lead to serum lipids dysregulation and not the other way around.

For cardiovascular health, items that reduce excessive platelet aggregation and improve HDL levels can be very important. Lcarnitine can be quite useful here. Coenzyme Q10 and ubiquinol are also useful. The phytonutrients described in previous articles should be considered. For instance, recent studies have shown that both resveratrol and other grape-derived nutrients (anthcyanidins, proanthocyanidins, etc.) can protect insulin metabolism and endothelial function. Pterostilbene, which is a “methylated” resveratrol, exhibits similar cardiovascular and blood sugarrelated benefits. Beneficial amounts of one or more of these latter ingredients can be included in a multivitamin.

For the eyes, an appropriate intake of lutein and zeazanthin has been shown to be protective against age-related macular degeneration and other eye conditions. Very recent evidence shows that these nutrients reduce inflammatory processes in the eye. Also protective of eye health is the nutrient astaxanthin. Finally, as we grow older, our rate of joint repair declines. Providing the basic building blocks for the production of cartilage is a good practice for preventing the development of cartilage damage. Here glucosamine and chondroitin remain important, as does methylsulfonylmethane (MSM). Unfortunately, these are high-volume nutrients difficult to include in multivitamin formulas. In contrast, beneficial joint nutrients that can easily be included are boron and hyaluronic acid.

Concluding Thoughts
Multivitamin/mineral supplements for those above the half-century mark serve two purposes. First, they offer insurance against inadvertent vitamin and mineral deficiencies that even those who eat well and wisely still may experience. Second, they can address specific shifts in our physiology that take place with age, whether these shifts effect blood glucose/insulin regulation, mitochondrial function or nerve health. Careful formulations often include a range of low-volume nutrients that pack a big benefits punch. Read the list of ingredients carefully and take advantage of these special nutrients.

Dallas Clouatre, PhD

Dallas Clouatre, Ph.D. earned his A.B. from Stanford and his Ph.D. from the University of California at Berkeley. A Fellow of the American College of Nutrition, he is a prominent industry consultant in the US, Europe, and Asia, and is a sought-after speaker and spokesperson. He is the author of numerous books. Recent publications include "Tocotrienols in Vitamin E: Hype or Science?" and "Vitamin E – Natural vs. Synthetic" in Tocotrienols: Vitamin E Beyond Tocopherols (2008), "Grape Seed Extract" in the Encyclopedia Of Dietary Supplements (2005), "Kava Kava: Examining New Reports of Toxicity" in Toxicology Letters (2004) and Anti-Fat Nutrients (4th edition).