From The December 1999 issue of Nutrition Science News

A Supplement Plan for Seniors

by Michael Janson, M.D.

The search for the Fountain of Youth is ages old, yet as we move into the next millennium, researchers and customers alike are increasingly interested in gaining some control over the inevitable aging process.

As people get older, physiological changes are unavoidable. They might notice changes in their vision, memory, or sexual function. They might see a subtle loss of strength, their sleeping patterns may change, and digesting food may become more difficult. Visible signs of aging include wrinkles; dry skin with pigment deposits, and loss of elasticity and flexibility; hair loss; and posture deterioration. Aging can also be associated with serious diseases such as arthritis, atherosclerotic heart disease, cancer, diabetes, strokes and even asthma. Other conditions associated with aging are degenerative eye disease and senile dementia.

It’s not all bad, though. Gradual changes are inevitable, but the rate of change is variable. Plus, the development of what are considered the “diseases of aging” may not be as unavoidable as many people think.

In fact, with current knowledge, older customers can design a supplement program to protect them from the age-related decline that typically occurs among people who do not take care of themselves. The following supplements can be added gradually to their plan as they grow older. Start them with a basic comprehensive multivitamin and mineral with enough B complex; basic amounts of vitamin C and E; beta-carotene; trace minerals including chromium, copper, manganese, selenium and zinc; and, if possible, adequate magnesium and calcium, which may need to be taken separately because of their bulk.

Start by suggesting that people older than 40 take 400-800 IU of vitamin E per day, up to 4,000 mg/day vitamin C, 50-100 mg/day Co-Q10, and if they have trouble sleeping, 1-3 mg melatonin at bedtime. It is also a good time to incorporate mixed bioflavonoids (1-2 gm daily), specifically quercetin for the heart, liver and stomach and proanthocyanidins for the brain, kidneys, eyes and blood vessels.

Dietary supplements protect the body from accelerated aging processes in a variety of ways. They enhance metabolic functions that protect against several age-related health problems. They also help detoxify harmful substances produced in the normal course of metabolism. Most of the supplements discussed here have some antioxidant activity, or they recycle antioxidants after they have spent themselves quenching free radicals. Some of the supplements are important cofactors for the activity of antioxidant enzymes. They are arranged in order of importance and availability.

Vitamin E is an antioxidant that enhances immune function and protects against cancer, heart disease, diabetic retinopathy and kidney disease. In 1990, researchers at the Tufts University USDA Human Nutrition Research Laboratory on Aging showed that 800 IU of vitamin E per day enhanced immune function in the elderly. In addition to enhanced cell-mediated immunity, they found vitamin E reduced formation of lipid peroxides, which can damage cell membranes and arterial lining cells and eventually lead to heart disease and diminished cellular function. Vitamin E also restored the levels of interleukins 2 and 6 to those seen in younger people, thereby restoring normal immune function. More recent studies show immune benefit with vitamin E doses as low as 200 IU per day.

Many studies show vitamin E protects against different cancers. A population-based study conducted between 1984 and 1985 showed reduced oral and esophageal cancer in those who regularly supplemented with vitamin E.10 In addition, vitamin E helps prevent the most common cause of death, arteriosclerotic heart disease. A 1989 report said serum levels of vitamin E are a better predictor of heart disease risk than cholesterol. People with the highest blood levels of vitamin E had the lowest risk of heart disease.

More recently, researchers using megadoses of vitamin E have shown reversal of diabetic retinopathy and kidney disease. This was a small eight-month trial with 36 patients. After four months, circulation to the retinal vessels improved in patients who took 1,800 IU vitamin E per day, and the improvement was maintained during the withdrawal period. Retinopathy and nephropathy are but two examples of the accelerated aging process in diabetics that can be slowed down by vitamin E supplements.

Vitamin C, another protective antioxidant, reduces the risk of age-related diseases, including oxidative damage. One sign of this damage is abnormal function of cells lining the arteries, called endothelium. These cells produce nitric oxide, also known as endothelial-derived relaxing factor. In one study, researchers gave patients with coronary artery disease 2,000 mg of vitamin C two hours before testing how well their arteries relaxed. Compared with a placebo group, there was a significant improvement in arterial dilation.

Vitamin C has numerous mechanisms of action that suggest it can help slow the aging process. It also helps prevent cancer and heart disease. Vitamin C enhances wound healing, improves collagen production and stimulates immunity. In a prospective study in Switzerland, vitamin C, independent of other beneficial antioxidants, was associated with reduced heart disease risk. The authors of that study suggest the benefits of antioxidants are likely to be greater when they are all available in adequate amounts because they work together to protect against free radicals.

Carotenoids help retard the aging process as well as treat age-related diseases. As of 1995, a total of 21 carotenoids had been identified in human blood. All of them function as antioxidants. Beta-carotene, probably the best known carotenoid, may enhance immune function when 25,000-50,000 mg is taken daily. It is associated with lower risks of cancer and heart disease. Lycopene, abundant in tomatoes but also available as a supplement, is the most prevalent carotenoid in the serum. People with the highest lycopene levels have the lowest rate of age-related macular degeneration (ARMD). Lycopene helps to prevent prostate cancer and in doses of 15 mg per day may help to slow its progression. Two other carotenoids, lutein and zeaxanthin, are also related to the prevention of ARMD.

Mineral cofactors enable antioxidant enzymes, which are produced in the body and include superoxide dismutase (SOD), catalase, and various peroxidases such as glutathione peroxidase. In the mitochondria, SOD depends on manganese, and in the rest of the cell SOD depends on zinc and copper. Catalase is dependent on iron as a cofactor, but excess iron can actually lead to increased free radical generation. Glutathione peroxidase depends on adequate selenium as well as adequate glutathione, a sulfur-containing amino acid derived from glutamine. A typical selenium dose is 200 mcg per day.

Zinc levels decline with age in both animals and humans. As the thymus gland ages, it shrinks and loses its vigor in a process called involution resulting in decreased cellular immunity. Zinc supplements prevent thymus involution and enhance the activity of the thymic hormone thymulin. In elderly diabetic patients, zinc supplements can restore some deficits of T-cell function and thus enhance immunity. Zinc deficiencies lead to conditions commonly associated with the aging process–immune deficiencies, impaired wound healing and lowered resistance to infection. An adequate dose is 30 mg per day with 2-3 mg copper.

Coenzyme Q10 (Co-Q10) also helps protect against oxidation and age-related diseases. It is essential for energy production in the mitochondria, especially in the heart. It can reduce damage to the heart muscle in ischemic heart disease. Researchers in one study found that 20 mg/kg of Co-Q10 injected into muscle and 10 mg/kg injected into the abdominal cavity increased aerobic energy production and protected enzymes from free radical damage. In an animal study, cell membrane damage was prevented with 10 mg/kg/day oral Co-Q10 when challenged with adriamycin, a chemotherapeutic agent that induces cell membrane damage.

In addition, Co-Q10 can prevent acetaminophen-induced liver damage through peroxidation, adding evidence to its role in free-radical protection.26 Typical preventive doses of Co-Q10 would be 50-100 mg daily, but if someone has signs of age-related disease–particularly cancer, heart disease or immune disorders–the dose may be increased to 100-400 mg daily.

Herbs and flavonoids can help prevent and treat age-related conditions, though it is impossible to thoroughly cover all of them in this review. For example, silymarin, found in the berries of milk thistle (Silybum marianum) protects the liver and helps control blood sugar; St. John’s wort (Hypericum perforatum) treats depression, a common problem in the elderly; while hawthorn berry (Crataegus spp.), garlic (Allium spp.) and proanthocyanidins from grape seeds7 protect the heart and the eyes. Saw palmetto (Serenoa repens) and pygeum (Prurrus africana) help prostate disorders common in men older than 50 Ginkgo (Ginkgo biloba) preserves memory, reduces vertigo, and improves small blood vessel circulation that helps with the functional signs of atherosclerosis. Memory loss is one of the most distressing signs of aging. I recommend 60 mg of standardized ginkgo extract two or three times a day.

Melatonin and DHEA supplements may slow the aging process, as shown in animal studies and strongly suggested by their mechanisms of action. Melatonin, produced by the pineal gland, is a powerful antioxidant hormone that protects the brain, particularly by scavenging the damaging hydroxyl free radical. Melatonin production declines with age, and it is associated with age-related disorders. Melatonin appears valuable against Alzheimer’s disease. It is thought to protect brain cells from the oxidative damage that may lead to brain deterioration. Antioxidants that might protect the brain need to cross the barrier between blood and the brain, and melatonin readily does so, where it protects nerve receptors from oxidative damage. Melatonin enhances many parameters of immune function. Typical doses of melatonin range from 1-6 mg, always taken at bedtime.

Dehydroepiandrosterone (DHEA) is another hormone that declines with age. According to several review articles, supplements appear to help many conditions that are usually age related, including Alzheimer’s disease, diabetes, immune function decline and osteoporosis. Low levels of DHEA are also associated with increased cardiac disease. I recommend 5-100 mg daily, but people taking more than 5 mg/day should have their blood levels monitored.

Customers with specific health problems can customize their plan: higher doses of chromium for diabetics, garlic and Co-Q10 for heart disease, lutein and lycopene for eye disease, and saw palmetto for prostate enlargement.

Many supplements can help prevent or treat the diseases of aging. It is always best to combine them with a healthful diet and other supportive practices. With the proper choices, your customers should have no trouble keeping away from serious health problems. We know enough to empower everyone to control these age-related conditions and be vibrant, productive and fully functional into their golden years.

Michael Janson, M.D., is past president of both the American Preventive Medical Association and the American College for Advancement in Medicine. He is the author of Dr. Janson’s New Vitamin Revolution (Avery, 1999) and All About Saw Palmetto and Prostate Health (Avery, 1999).

Supplement Plan References

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