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If you think of vitamins as the chewable cartoon characters of childhood or overhyped by the supplement industry, you may wonder if they really matter.
The answer: Yes, in a big way.
Humans can’t survive without the 14 vitamins — A, C, D, E, K, choline and B complex — and 15 minerals. Fortunately, our bodies are designed to extract the nutrients we need from the food we eat.
Most people can get all the vitamins and minerals needed from a diet of vegetables, fruit, protein, dairy, healthy oils and whole grains.
But “most people” is not everyone. After age 50 the absorption of some vitamins begins a slow decline. A system that works like a well-oiled machine at 50 may continue to do so or it may be squeaking by at 65 or 75. Along with age, vitamin deficits can also be caused or exacerbated by a number of issues, including:
- Some medications
- Diminished appetite
- Forgetting to eat due to memory loss or depression
- Poor food choices
- Food insecurity
- Too much alcohol
So how can you tell if the person for whom you care has a vitamin deficit?
You can’t. The only way to find a vitamin shortage is a lab test.
The signs of low vitamin levels can be subtle and seem unrelated, or dramatic and still seem unrelated. Serious symptoms — including pain, memory loss and a downturn in cognitive function — may be falsely attributed to normal aging or an already diagnosed illness.
And the consequences of a vitamin deficiency can be serious. For example:
- A vitamin D deficit can cause cognitive impairment and raise the risk of death from cardiovascular disease.
- Too little folate (B9), vitamin B12 and vitamin C can cause vitamin deficiency anemia, a condition that can cause weight loss, muscle weakness, personality changes, unsteady movements, confusion and forgetfulness.
- A severe B12 deficit can mimic dementia.
Sometimes a single change in the body — one that seems unrelated to vitamin levels — can interfere with vitamin absorption and launch a domino effect, triggering symptoms that can lead to a misdiagnosis.
For example: Ten to 30 percent of Americans over age 50 don’t produce enough stomach acid. While that may sound great to heartburn sufferer, stomach acid is key to absorbing vitamin B12, a powerhouse that helps produce red blood cells and DNA, and maintain nerves.
The result: People without enough stomach acid, and the many more who take medication to suppress heartburn, are courting a B12 deficiency, a shortage that can produce a variety of symptoms, including:
- unsteady gait
- brain fog
Take away tips:
- The best way to get vitamins is through food.
- If you suspect your loved one’s vitamin levels are low, talk to the doctor about ordering lab tests.
- Never add supplements without a medical OK.
- Too much of certain vitamins can harm the body or promote a different risk.
- Some supplements interfere with prescribed medications.
- Know the difference. The Recommended Dietary Allowance (RDA) is the average daily intake of nutrients needed to keep 98 percent of healthy people healthy. The Daily Value (DV) is the percentage of necessary vitamins provided in a single serving, based on a 2,000 calorie a day diet. For example, a medium carrot contains 6 percent of the vitamin C you need for a day.
Know your nutrients
Knowing your loved one’s vitamin levels — and understanding what these essentials do — can help you fine-tune meals.
Who, why, where and how much?
Who needs it? Most people in the U.S. get enough vitamin A from food.
Why it’s needed: Studies show vitamin A protects vision, heart, lungs and kidneys, and lowers risk of some cancers. People at high risk for age-related macular degeneration (AMD) are often prescribed specific supplemental vitamins (500 milligrams [mg] vitamin C, 400 international units [IU] of vitamin E, 15 mg beta-carotene, 80 mg zinc as zinc oxide, 2 mg copper as cupric oxide) developed by the National Eye Institute after its Age-Related Eye Disease Study (AREDS). The study found that the AREDS formulation reduced the risk of advanced AMD in people already diagnosed with the condition by about 25 percent over a five-year period.
Where? Vitamin A comes in two forms. Provitamin A carotenoids are plant based and include fruits and colorful vegetables such as squash, pumpkins, red and orange peppers, carrots, cantaloupes, mangoes, sweet potatoes and dark greens such as collard greens, spinach, romaine lettuce and broccoli. Preformed vitamin A is animal-based and is found in in dairy, fish and meat, especially liver. The body needs both.
How much needed daily? Women: 700 micrograms (mcg); men: 900 mcg. 1 cup of cantaloupe provides 108 percent.
Some drugs — including the psoriasis treatment acitretin and the T-cell lymphoma treatment bexarotene — contain synthetic vitamin A, which, taken with a vitamin A supplement, can raise levels to a dangerous point.
There are eight B vitamins: B1 (thiamine), B2 (riboflavin), B3 (niacin), B5 (pantothenic acid), B6 (pyridoxine, pyridoxal, pyridoxamine), B7 (biotin), B9 (folate) and B12 (cobalamin). Some — like B12 — are also sold separately.
From the first B to the last:
Who? Older people; those with HIV/AIDs, alcohol dependence, diabetes; and those who had bariatric surgery may need supplemental thiamine.
Why? Essential for brain, skeletal muscles, heart, liver and kidneys. Supports nervous system, muscle function, digestion, metabolism.
- Thiamine deficiency can cause appetite and weight loss, slow reflexes, tingling hands and feet, confusion, memory loss, muscle weakness.
Where? Found in beef, pork, poultry, brewer’s yeast, beans, brown rice, fortified cereal, milk, nuts, oats, oranges, rice, sunflower seeds, whole grains.
How much? Women: 1.1 mg; men: 1.2 mg, some fortified cereals cover 100 percent of daily need.
Who? Most people who follow a healthy diet get enough B2. Vegetarians, vegans and people who don’t eat dairy may have a shortage.
Why? B2 converts carbohydrates into energy, breaks down fat and protein, protects the heart, muscles and nervous system. Essential for cell growth and function.
- A deficit can cause skin problems; cracked, swollen lips; sores at the corners of lips; hair loss; sore throat; liver problems; nervous system upset.
- Extreme shortage can cause anemia and cataracts.
Where? Found in almonds, eggs, red meat, liver, tuna, low-fat milk, green vegetables, fortified whole grains yeast.
How much? 1Men: 1.3 mg; women: 1.1mg, a ½ cup cooked spinach provides .21 mg.
Who? Niacin deficiency is rare. Sometimes found in people with alcohol addiction.
Why? Niacin supports digestive, gland and liver function, skin and nervous system; helps break down carbohydrates, fats and proteins into energy; and clears harmful chemicals from the liver.
- Deficiency symptoms include fatigue, canker sores, vomiting, depression, poor circulation and indigestion. Severe deficiency can bring on pellagra, which causes digestive problems, inflamed or flaky skin, diarrhea and mental impairment.
Where? B3 is found in meat, eggs, enriched whole grains.
How much? Women: 14 mg; men: 16 mg, a ½ cup of peanuts delivers about 10 mg.
Who? Most people get enough B5 from a healthy diet.
Why? B5 helps convert carbs to energy, helps utilize fats and protein, and helps the nervous system function. Along with the other B complex vitamins, it contributes to healthy skin, hair, eyes and liver.
Where? Find B5 in brewer's yeast, corn, cauliflower, kale, broccoli, tomatoes, avocado, legumes, lentils, egg yolks, beef liver and kidney, turkey, duck, chicken, milk, split peas, peanuts, salmon, soybeans, sweet potatoes, sunflower seeds, lobster and wheat germ.
How much? 5 mg for men and women, 3 ounces of beef liver has 5.6 mg
Who? Older people may metabolize B6 faster than they did when young. Most likely to fall short are people over 65; male smokers; those who cut back on protein, are suffering malnutrition, have had gastric bypass surgery, kidney or renal disease; and those with alcohol dependence.
Why? Supports the brain; makes red blood cells, immune system cells; helps make niacin; controls blood sugar and amino acids; maintains low levels of amino acid homocysteine, which has been linked to clogged arteries.
- B6 deficiencies are uncommon but can be serious. A mild B6 deficiency could be symptom-free. A severe shortage can show up as anemia, depression, confusion.
Where? Poultry, beef, bananas, spinach, potatoes and fortified food are rich in B6.
How much: Men over 50: 1.7 mg; women over 50: 1.5 mg, 1 cup pistachios has 1.38 mg
Who? Biotin deficiency is rare in the U.S., most likely to affect people with alcohol dependence or those who have a genetic disorder called biotinidase deficiency. Some medications can interfere with biotin absorption.
Why? Biotin helps metabolize fatty acids and amino acids.
- A biotin shortage can cause hair loss, rashes, skin infections, brittle nails, pinkeye, high acid levels in urine.
Where? Meat—especially liver and other organ meats, fish, eggs, seeds, nuts, sweet potatoes, spinach, broccoli.
How much? 30mcg. One cooked egg has 13-25mcg.
Folate is found in food. Supplements contain synthetic folic acid.
Who? B9 deficiency is rare in the U.S. but risk is higher for people with alcohol dependence.
Why? B9 helps make genetic material including DNA, needed for cell division.
- Low folate can cause megaloblastic anemia, fatigue, headache, loss of focus, heart palpations and shortness of breath.
Where? B9 is in fruits, asparagus, Brussels sprouts, dark green leafy greens, peas, peanuts, nuts, oranges and enriched products.
How much? 400 mcg for men and women, 1 cup of lentils provides 358 mcg.
Who? People over 50 who do not fully absorb vitamin B12 from food; vegans; vegetarians; and people who take certain drugs, including acid reflux, are more likely to have low levels of B12. The National Institutes of Health recommends that people over 50 eat foods fortified with vitamin B12 or take supplements. Consult a doctor before adding any vitamin.
- B12 helps make DNA, maintain blood and nerve cells. It is required for proper red blood cell formation, neurological function and DNA synthesis.
- A deficit of B12 can cause balance issues, depression, confusion, dementia, poor memory, soreness of the mouth or tongue, and can harm the nervous system.
Where: Found in clams, crab, fish, beef, fortified grains, dairy, eggs. Look for low-fat beef and dairy.
How much? 2.4 mcg for both men and women. One king crab leg delivers more than twice needed amount
Who? Most people do not get the RDA.
Why? Choline, which was declared an essential nutrient in 1998, is often grouped with B vitamins. Choline helps form neurotransmitters and cell membranes and is used by the brain and nervous system. It also helps prevent liver damage, regulates memory and homocysteine concentration in the blood, and aids mood and muscle control.
- Low choline can harm muscle and cause nonalcoholic fatty liver.
Where? The top high-choline foods are sweet potato, beef liver and carrots. Meat, eggs, fish, shellfish, dairy, cantaloupe, Brussels sprouts, cauliflower and peanuts have a worthwhile amount.
How much? Men: 550 mg a day; women: 425 mg a day, 1 cup of chopped eggs provides about 72 percent of the amount needed.
Who? Everyone, especially smokers.
Why? Vitamin C helps convert dopamine, collagen and some hormones; supports wound healing, immune system, calcium absorption; maintains bones, teeth and gums; lets the body absorb iron; and boosts immune system.
Where? Find it in guava, citrus, red and green peppers, strawberries, kiwi, baked potatoes, tomatoes, broccoli, bell peppers, dark leafy greens, berries, oranges, green peas and papayas.
How much? Men: 90 mg; women: 75 mg. Smokers: Add 35 mg, 1 cup of cooked broccoli contains 101 mg.
Who? A vitamin D deficiency is not uncommon.
Why? Muscles need Vitamin D to move; nerves need it to communicate. D maintains calcium and phosphate levels in blood, strengthens immune system, may lower cancer risk and blood sugar levels.
- A D deficit has been associated with cognitive impairment in older people and an increased risk of
death from cardiovascular disease.
- Direct sunshine
- Eggs; oily fish including salmon, tuna, mackerel; sardines; cheese; some mushrooms; egg yolks; and vitamin D-fortified milk and cereals
How much? 600 IU; after age 70: 800 IU for both men and women, 3 ounces of canned salmon has 447 I.U.
Who? Although a serious vitamin E deficiency is rare, most Americans do not get enough vitamin E from food.
Why? Vitamin E is an antioxidant that protects cells from free radicals—unpaired electrons created naturally within the body or are brought in by toxins— that damage cells, DNA and proteins. Vitamn E also supports the immune system and helps keep blood vessels dilated to prevent blood clots. E also helps prevent oxidative agents from damaging the brain, as happens in Alzheimer’s disease.
Where? The best sources are wheat germ, sunflower and safflower oils, sunflower seeds, nuts (especially almonds). Fortified processed foods and green vegetables provide a lesser amount.
How much? 15 mg/ 22.4 I.U. for men and women, 1 tablespoon wheat germ oil provides 100 percent recommended amount.
Who? Older people, because of bone fracture and osteoporosis risk. The Framingham Heart Study found a decreased risk of hip fracture among people who ate 250 micrograms — one cup of broccoli or a large salad — daily.
- People taking anticoagulants, such as warfarin (Coumadin), must consult their cardiologist or physician before eating foods high in K or taking a supplement.
Why? Essential for blood clotting and bone health.
- Signs of deficiency: bruising
Where? Find K in kale, greens, spinach, collard greens, turnip, mustard greens, parsley and broccoli.
How much? Women: 90 mcg; men 19: 120 mcg, 1 cup of raw spinach has 145 mcg.