Food & Fitness After 50: Dietary Supplement Q&A

frequently-asked-questions

In June of this year I developed a webinar for Today’s Dietitian titled, “Dietary Supplement Use in Older Adults: Help, Hype, or Hope?” (Click here to access the webinar.) The webinar ended with a robust Q&A. Time ran out before we could get to all of the questions and some of them were tough to answer. In my teaching days I told students to seek out experts when they didn’t know the answer to a question, so I turned to an expert in dietary supplements to help me. Dr. Anthony Thomas is the Director of Scientific Affairs for Jarrow Formulas and he jumped in to answer your questions. I’ve tapped Dr. Thomas in the past when you asked about probiotic supplements…click here for a link to that post.

Question: The number 1 question involved supplement ingredients. Many people believe that all supplement ingredients are manufactured in China and they expressed concerns over quality issues with Chinese ingredients.

“Ingredients for use in dietary supplement manufacturing are sourced from all over the world, including China,” explains Dr. Thomas. “Quality ingredients are quality ingredients regardless of their country of origin and in fact a number of companies headquartered in other countries have manufacturing set up in the U.S., too.”

thOne suggestion that I routine make when asked about supplements is to look for a quality brand, like Jarrow Formulas (disclosure, I have no connection to Jarrow Formulas, but I do use some of their products because I recognize quality supplements.). A quality brand often uses third-party verification or endorsement. That means that a brand contracts with a third-party certifying agency to test their products. One of the most well-known is USP which stands for United States Pharmacopia. When you see the USP symbol on a supplement it tells you that the supplement:

  • Contains what the ingredient label says it contains and, in the amount, listed
  • Doesn’t contain contaminants
  • Will dissolve or break down in the body and get absorbed into the blood stream in a specific time frame
  • Has been made with good manufacturing processes (GMPs) as outlined by the Food & Drug Administration.

NSF-Certified-for-sport-blue-and-orange-196x300Another well-known third-party entity that evaluates supplements is NSF. The NSF certification also helps consumers know they are getting a quality supplement.  When I worked with athletes at the university, we looked for NSF certified supplements because they test supplements to ensure that they do not contain substances banned by their sport governing body.

Question: What is the difference between a supplement called a nutraceutical vs. nootropic?

Dr. Thomas defines it this way, “a supplement called a nutraceutical is more-or-less a fancy term (not a legal term) for dietary components or dietary supplement ingredients with purported health benefits beyond nutritive value.  Nootropics are a subset of ingredients that positively influence cognitive function(s).”

Question: Is there a B12 supplement source for vegans? What form of B12 is best absorbed in older adults?

Vitamin-B12“All forms of B12 used in dietary supplements are suitable for vegans since they are synthesized chemically. Look for one that says suitable for vegans because some capsules are made with gelatin. Jarrow Formulas makes a chewable form that is appropriate for vegans,” says Dr. Thomas. “Thus, the concern about vitamin B12 deficiency in vegans is easily overcome.”

As for the “best” form of B12, Dr. Thomas explains, “despite the marketing hype, there is not good evidence of differences in absorption between different forms of the vitamin. There is limited evidence suggests that methyl-B12 may be better retained by the body and reduced elimination in the urine compared to cyanocobalamin.  Methyl-B12 seems to be the preferred form by consumers, but that is likely due in large part to marketing rather than research demonstrated superiority. Some suggest that methyl-B12 is not suitable for all the body’s needs as if it cannot be converted to right form, but this is incorrect.” The bottom line is that some marketing might make it appear that there is a “best” form but all forms are used by the body.

 Question: How do you know if supplements of omega 3s are not rancid?

Fish-Oil“Unfortunately, smell is not always indicative of oxidative degradation.  If the product is stored away from heat and light exposure, it should be fine, although I often just keep my bottles in the fridge,” says Dr. Thomas. “Soft gels are usually formulated with antioxidant ingredients to protect against oxidation.”  As with other supplements, buy supplements from a reputable brand with a long-standing reputation of quality. That is my recommendation, as well as Dr. Thomas’ recommendation. He adds, “of course this recommendation may seem self-serving given the company I work for.  However, there is increasingly more direct consumer brands primarily available online as they can contract the manufacturing of the supplement and just put their label on the product but it may or may not have all the other quality control measures in place to ensure safety, potency, and quality.  We see more problems with products from such companies, not all or most, and it is often guilt by association for the entire industry. In fact, Jarrow L. Rogovin, the man who started Jarrow Formulas in 1977, relied on contract manufacturers but after so many issues over the years, he eventually invested in the development of our own manufacturing nearly 20 years ago.

Thanks to Dr. Thomas for helping me answer your questions on dietary supplements. Keep the questions coming!

Dr. Christine Rosenbloom is a registered dietitian nutritionist and a nutrition professor emerita at Georgia State University in Atlanta. Along with Dr. Bob Murray, she is the author of Food & Fitness After 50.

Copyright © 2019 [Christine Rosenbloom]. All Rights Reserved

 

 

Food & Fitness After 50: The Scoop on Collagen

Bob bike 2
Dr. Bob enjoying his just desserts after a long bike ride

Survey data from the Council for Responsible Nutrition (a trade association for dietary supplements) shows that 78% of adults over the age of 55 take supplements. Reasons for supplement use include overall wellness and healthy aging. It is no surprise that people are asking about one of the hottest supplements…collagen. I reached out to my friend and co-author of Food & Fitness After 50 to ask him some of your top questions about collagen. Dr. Bob Murray is an exercise physiologist and is passionate about exercise and health. He consults with many companies on hydration, protein, and supplement use in active populations, including older adults.

Let’s start with the basics. What is collagen and are there different types of collagen in the body?

Collagen-structure.800x345-wWe can think of collagen as the glue that holds us together. Collagen is the name for a large family of proteins found in the body.  In fact, there are so many types of collagen proteins that collagen turns out to be the most abundant protein in the body. Collagen proteins make up connective tissues throughout the body.  The term “connective tissues,” makes many people immediately think of tendons, ligaments, and cartilage, three good examples of connective tissues.  Muscles, skin, and bones also contain large amounts of connective tissues and therefore large amounts of the collagen proteins that intertwine to give those tissues the structure, strength, and elasticity required for the many different roles required of connective tissues. It should be obvious that the connective tissue in bone has a different role to play compared to the connective tissue in muscles or skin. That’s why so many different kinds of collagen proteins are needed throughout our bodies.

When I was younger, I remember my friends dissolving Knox gelatin in water and drinking it to strengthen their nails. Is gelatin the same as collagen?

The connective tissues of cows, pigs, and chickens are the primary source of gelatin produced for human consumption.  As a result, gelatin is rich in collagen proteins.

Is collagen a complete protein, that is one that contains all the essential amino acids needed by the body?

Collagen is an incomplete protein and is low in the amino acids that are associated with building muscle mass and strength.  However, collagen proteins are high in two amino acids—glycine and proline—that appear important in stimulating the growth of connective tissues in physically active people.

There are many claims for collagen supplements…from preventing wrinkles and strengthening skin to improving joint flexibility and strengthening muscles and bone. Is there any good human evidence that collagen supplements will help with any of those body systems?

The best way to sum up the current state of affairs is that the benefit claims for consuming collagen are long on theory and short on evidence.  That’s not to say that there isn’t some evidence suggesting benefits to skin, joints and muscles, but that evidence has yet to reach the levels of quality and quantity required to draw comfortable conclusions about the magnitude and reproducibility of the benefits associated with consuming collagen proteins on a regular basis.

It is well known and accepted that protein is needed for muscle protein synthesis, is collagen any better than simply getting more protein from whey protein or other protein-rich sources?

iStock Older man lifting weights smallMaybe, but much more research is needed to either confirm or deny that consuming collagen benefits muscle mass and strength beyond what we know occurs by increasing dietary protein intake. There are a growing number of studies that report benefits to muscle strength, joint pain, and repair of connective tissue, but there are a greater number of studies that report no benefits.  The unsatisfying answer to your question is that we’re going to have to wait and see what future research has to say,

Do you think older adults need to use collagen as a supplement?

Collagen production does naturally decline with age and there are studies that report benefits of collagen consumption in older adults.  Maybe the best news is that there is little to no risk of trying collagen supplements, aside from the possibility of spending money on something that does not work.

There are so many forms of collagen being sold…hydrolyzed, peptides, raw, undenatured and found in various forms from liquids, powders, tablets, chews and even gummies….if someone wanted to take collagen what is the form and dose that is currently recommended?

The current research indicates that the effective dose seems to be 15-20 grams of collagen per day, along with 200-250 mg of vitamin C to aid in collagen synthesis. The body seems to respond best to the presence of collagen peptides—short chains of a few amino acids—and most forms of dietary collagen contain such peptides. Look for products containing hydrolyzed collagen or collagen peptides on the label.

1800ss_getty_rf_vitamin_cI’m glad that Dr. Bob mentioned vitamin C and its role in collagen production. Vitamin C is most frequently thought of a nutrient that helps our immune system, especially fighting the dreaded winter cold, but it has a fascinating history (well, fascinating to most dietitians!). At the end of the 15th century, a disease called scurvy was the major cause of disability and death of sailors undergoing long sea voyages. Without access to fruits or vegetables, sailors developed bleeding gums, lost their teeth, had poor wound healing, and frequently old wounds would open up (called dehiscence). All because they were deficient in vitamin C and its important role in collagen production. Collagen helps anchor teeth in our gums and jawbone, as well as helping to keep skin healthy and elastic. It wasn’t until the 1930s that a Hungarian scientist, Dr. Albert-Szent-Gyorgyi, discovered and isolated ascorbic acid (a contraction of anti-scorbutic), better known as vitamin C.

Dr. Christine Rosenbloom is a registered dietitian nutritionist and a nutrition professor emerita at Georgia State University in Atlanta. Along with Dr. Bob Murray, she is the author of Food & Fitness After 50.

Copyright © 2019 [Christine Rosenbloom]. All Rights Reserved

Food & Fitness After 50: Good Bones

A recent article in the Washington Post caught my attention because it related to an issue that older adults frequently ask about….how to protect their bones as they age.

Hip-Fracture-Surgery-Infection-640x444According to the study published in JAMA vitamin D supplements showed no effect on reducing hip fractures where as vitamin D plus calcium had about a 16% reduction in the risk of breaking a hip. Hip fracture is one of the most serious threats to health as we age. Here’s a few facts from the Centers for Disease Control and Prevention.

  • Each year over 300,000 older people—those 65 and older—are hospitalized for hip fractures.
  • More than 95% of hip fractures are caused by falling, usually by falling sideways.
  • Women experience three-quarters of all hip fractures.
    • Women fall more often than men.
    • Women more often have osteoporosis, a disease that weakens bones and makes them more likely to break.

Dietary Supplement Use for Bone Health

A recent survey from the Council on Responsible Medicine, a leading trade association for dietary supplements, shows that among consumers over 55 years of age who take dietary supplements, 31% cite bone health as a reason for supplementation. For younger age groups, bone health is not mentioned as a reason for supplementation. That is too bad because the time to build bone is when we are young! Peak bone mass is achieved somewhere around the age of 30 or 35 so waiting until you are 60 to start worrying about bone health is a bit too late. It’s like getting concerned about your cholesterol level after you’ve had a heart attack. (Side note to my older readers…encourage your grandchildren and great grandchildren to get plenty of bone building nutrients now!)

boneMass35Anthony Thomas, Director of Scientific Affairs for Jarrow Formulas puts it this way, “Maximizing peak bone mass is important when we are young to protect against age-related bone loss.  A 10% increase in peak bone mass is estimated to reduce the risk of osteoporotic fracture later in life by 50%, so early life deserves more attention to ensure sufficient nutrient intake and status to support bone health across the lifespan.”

It Takes More Than Calcium and Vitamin D to Make a Healthy Bone

natto
Natto

While the media focuses on calcium and vitamin D, Dr. Thomas reminds us that bone is more than those two nutrients. Healthy bones need the minerals magnesium, potassium, copper, manganese, silicon, boron, and zinc. Two underappreciated vitamins are also key, vitamins C and K. Vitamin C is needed to produce collagen, the most abundant protein in the body and building block of bone. Vitamin K helps calcium get deposited into bones. There are two forms of vitamin K, referred to as K1 and K2. K1 is most well-known for its role in blood clotting. But the K2 form promotes bone building. It is hard to get sufficient K2 from foods. Dr. Thomas points out that “vitamin K2 is from bacterial origin, so it is found in fermented foods in which bacteria are used as starter cultures in cheeses and sauerkraut.  The best dietary source of vitamin K2 in the form of MK-7 is the traditional Japanese dish natto, cooked soybeans fermented by the bacteria Bacillus subtilis subspecies natto, that while popular in Japan, is not much appreciated in the U.S.“ The best way to get this form of the vitamin is with supplements sold as MK-7.

“Based on emerging research, the supplemental doses used in research is a daily dose of vitamin K2 as MK-7 is 45 micrograms upwards of 360 micrograms is recommended,” adds Dr. Thomas.

Fall Protection

While foods and supplementation can help provide nutrients for healthy bones, don’t forget the ABCs (agility, balance, and coordination) as keys to help preventing falls. We’ve written about this before (click here for the post), but it pays to work on your balance with activities like yoga, Tai Chi, or simple exercises such as balancing on one foot when you brush your teeth. When it comes to balance, we can use it….or, we can lose it!

Check out this video from Silver Sneakers for easy exercises to improve your balance

For more information on foods and supplements for bone health and tips to improve your agility, balance, and coordination, see Food & Fitness After 50, available at Amazon and other booksellers.

Copyright © 2019 [Christine Rosenbloom]. All Rights Reserved.

Food & Fitness After 50: Want a killer physique?

“Some supplements work for some people some of the time. Many supplements don’t work for anybody any of the time.”  

Dr. Ron Maughan, Emeritus Professor of Sports and Exercise Nutrition, Loughborough, United Kingdom

body building supplementsIn my last post, I discussed the basics of dietary supplements with a focus on multivitamin-minerals. This week, let’s talk about muscle building and weight loss supplements. Bottom line up front: there are some sports supplements that can help active adults train harder and recover faster, but most of what you read about, like the headline, “want a killer physique?” won’t happen without hard work in the weight room and a stringent diet to reduce body fat. A supplement by itself, despite wild claims, will not give you a killer physique. Sorry. And, weight loss supplements are not much better.

Headlines can be persuasive!

So, what can we say about muscle-building and weight loss supplements. First, here are few more headline grabbing claims:

  • “Drop body fat in a single dose”
  • “Boost muscle growth by 600%”
  • “Incinerates excess fat”
  • “Produces immediate results in energy, size, strength, pumps, performance, mental focus, and training intensity.”

The downside of weight loss supplements

Between 5-20% of supplements (mostly muscle-building and weight loss supplements) contain prohibited substances: for athletes, that could mean a positive drug test and banishment from sport. For older active adults, it could mean physical harm. For example, a  weight loss supplement called SmartLipo 365  was found to contain unlabeled sibutramine and phenoltphathein. Sibutramine is an appetite suppressant that was taken off the US market in 2010 and phenoltphathein is not approved for dietary use due to concerns of causing cancer.

Many of the supplements for weight loss contain harmful substances when taken in high doses; case in point, 25% of emergency room visits for adverse effects from dietary supplements are from weight loss supplements, with cardiac symptoms being the primary complaint. Not too surprising when many of these supplements contain stimulants. Don’t be fooled by so called “natural, herbal” stimulants like guarana, kola nut, or green tea extract. A stimulant is a stimulant. Consumer Reports identified 15 supplement ingredients to always avoid. It’s worth taking a look at the list and stay away from supplements containing any on the list.

One popular weight loss supplement that has it’s 15 minutes of fame on a popular doctor’s television show is garcinia cambogia. It is a small fruit that is traditionally used as flavor enhancer in cooking. It contains a substance called hydroxycitric acid that has been touted as a weight loss miracle.  However, in a 12-week study  on overweight men and women the researchers concluded, “garcinia cambogia failed to produce significant weight loss and fat mass loss beyond that observed with placebo.”

What does work?

For active athletes, a few supplements have stood the test of time (and research), including caffeine, B-alanine, beetroot juice, and creatine. Here’s a quick overview of what types of athletes might benefit, the effective dose, and the expected result.

Caffeine: Most of us know that caffeine can help keep us alert and ward off fatigue. Caffeine’s main effect is on the central nervous system. It is an adenosine receptor antagonist. Adenosine induces sleep and fatigue, so blocking thee ffects of adenosine with caffeine promotes a more alert state. The response to caffeine is highly variable (some of you can’t fall asleep if you have even a tiny amount of caffeine in the evening, while others can drink a pot of coffee and have no trouble sleeping). A small dose of caffeine can be effective for sports performance; just 2 to 3 milligrams per kilogram of body weight; for a 154-pound person, that is a dose of 140 to 210 milligrams of caffeine or the amount found in a small to medium cup of coffee. More certainly isn’t better!

B-alanine: This amino acid can buffer lactic acid and shows promise in athletes performing high intensity exercise (sprints). Some research shows it might also help endurance athletes who need to sprint hard to the finish line. This is not needed by recreational athletes. Effective dose is about 3-6 grams/day.

Beetroot Juice: Beets are naturally high in nitrate and it might increase skeletal muscle efficiency by lowering oxygen demand. It is used by endurance athletes who run or cycle. To be clear, nitrate is not carcinogenic, but nitrite can combine with amino acids from foods to form nitrosamines, which may be cancer-causing. In research studies, a dose of about 4 mg/kg/body weight has been used. My advice, eat beets!

Creatine: It is used a source of muscle energy and is in short supply during high intensity exercise, like sprinting or weight lifting . Supplemental creatine is usually taken as a powder mixed with water or juice, 3 to 5 grams/day. It can increase muscle stores of creatine by 10 to 30% and, when combined with exercise, can increase muscle cell volume. Researchers describe the benefits of supplemental creatine as, “small increases in lean body mass with repeated, high-intensity duration (less than 30 seconds) exercise.” For most healthy, active older adults, creatine supplementation isn’t necessary.

For more information on dietary supplements, check out Food & Fitness After 50.

 

 

 

 

Supplements: Help or Hype or Hope?

This post is a summary of information from a talk I gave at the Bell Family Branch YMCA in Hartwell, GA on April 12th and 30th, 2018.

Broccoli and pillsAre you among the 76% of Americans who take dietary supplements?  And, if you are  in the 55+ population, are you one of the 80% who take supplements? The most popular supplements are multi-vitamins, vitamin D, vitamin C, calcium, and B-complex.

This post will cover multi-vitamins and minerals; next week we’ll cover muscle-building and weight loss supplements.

How much do you really know about the supplements you are taking? Dietary supplements are a profitable business with a $40 billion annual market. Supplements are regulated by the Food & Drug Administration, but not as well as many people would like them to be. In 1996, the Dietary Supplement Health & Education Act put supplements in a new category, unlike  food additives or drugs, supplements do not undergo testing to make sure they are

  • pure
  • safe
  • or that they work before coming to market

More people are more worried about artificial sweeteners, which undergo rigorous safety testing, than dietary supplements, which are lacking in safety testing.

What is a supplement?

Dietary supplements include thousands of products that fall into these categories:

  • Vitamins: such as vitamin D or C
  • Minerals: like calcium or magnesium
  • Herbs or botanicals: such as St. John’s Wort or echinacea
  • Amino acids: like branched chain amino acids or arginine
  • Dietary substances: like glucosamime or curcumin
  • Concentrates or extracts: such as green tea extract or resveratrol

Decoding a supplement label

All supplements must have a supplements facts panel, similar to a nutrition facts panel found on food packages. And, supplement makers can make claims called structure-function claims: things like, “supports heart health,” “supports bone health,” or “supports muscle health. “But they can’t say “prevents heart attack,” “treats low bone density,” or “will make your muscles grow like Arnold Schwarzenegger’s.”  Any time there is a health claim you will find this statement (usually in small print):

“This statement has not been evaluated by the Food & Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.”

Interesting, because many of us take supplements to treat, cure, or prevent disease!

Beware of testimonials

The promotional materials for supplements can make all sorts of outrageous claims. As showcased in this article from Center for Science in the Public Interest, testimonials abound and many use identical testimonials to make your think that real people are praising the value of the supplements, when in fact they are paid advertisements.

Multivitamin mineral supplements

Since multis are the most popular dietary supplement, let’s look at what you need to know.

First, look for an age-appropriate supplement: adults over 50 have somewhat different nutrient needs than younger adults. “Silver” vitamins or vitamins for “50+ for her” or “50+ for him” are formulated to meet your needs. Multivitamin-mineral supplements are safe, relatively cheap, and can fill gaps in your nutrient intakes. But, they may also be unnecessary. (Supplement users have healthier habits that those who don’t take supplements: they tend to eat better, get more exercise, and more likely to be non-smokers.) And, multis don’t provide everything you need. For example, no multi provides all of the calcium you need.

Some things to consider fall into my “don’t” list:

  • Older adults should not take a pre-natal vitamin, unless they are pregnant. Pre-natal vitamins are formulated to support the health of the baby and mother. They contain higher amounts of many nutrients, including iron, that are not needed in large amounts as we age.
  • Avoid adult gummies or chewables: they don’t measure up to pill or capsule forms and many contain far less than the recommended levels of nutrients and may be lacking trace minerals such as zinc, magnesium, or chromium.
  • Don’t fall for special “immunity,” “muscle function,” “heart health,” “energy,” or even “healthy appearance” claims. These are more expensive and just not necessary.

Resources for more information on vitamin and minerals

My “go to” source for learning about vitamin and mineral supplements, updated research, as well as food sources, is the Office of Dietary Supplements at the National Institutes of Health. On this site, you will find a wealth of information on individual nutrients: here is a link to the consumer information on vitamin D, to show you an example.

And, in our book, Food & Fitness After 50, we provide more information on supplements that might be helpful in specific disease conditions.

Look for next week’s post on muscle building and weight loss supplement!

Chris Rosenbloom, along with co-author, Bob Murray, talk about supplements and much more in Food & Fitness After 50.

 

 

Citicoline and Brain Health

My husband is concerned about his brain. He exercises, is lean, and eats right, but increasingly he says he has a hard time remembering the right word or clearly articulating his thoughts. So, when I attended a lecture by Drs. Deborah Yurgelun-Todd and Perry Renshaw from The Brain Institute of the University of Utah on the brain health benefits of the dietary supplement, CognizinÒ citicoline, I was intrigued. (The session was sponsored by Kyowa Hakko, USA (http://kyowa-usa.com/), a global manufacturer of compounds used in dietary supplements and CognizinÒ brand citicoline).

After the conference I did some research by starting with Natural Medicines and then doing a literature search through Pub Med (http://www.ncbi.nlm.nih.gov/pubmed) to learn more about citicoline. I also contacted Dr. Yurgelun-Todd about her research on citicoline, as she has been studying it for over a decade. I found that citicoline was originally used as a treatment for individuals who had a stroke.  It is estimated that 2 million brain cells die every minute after a stroke so early treatment is essential to preserve the brain and maintain normal function. In a recent review of citicoline used in stroke patients, it was found that citicoline was safe to use and had beneficial effects on recovery, especially in older patients (>70 yrs) who had no other treatments. One study found that when citicoline was given to stroke patients within 3 hours, they were more likely to have complete recovery compared to those who got a placebo. Not all studies find such great results, but overall the evidence of a positive improvement in brain function after a stroke is well founded.

Food is not a good source of citicoline; only a small amount is found in organ meats. When citicoline is taken orally (in a pill) it is broken down into a B-vitamin, choline, and cytidine which is further metabolized into a compound called uridine. Both choline and uridine can cross the blood brain barrier and once in the brain, they can be converted back to citicoline, sometimes referred to as CDP-choline. Within the brain citicoline has several actions. First, it helps stimulate the production of cell membranes. Second, citicoline increases the production of the neurotransmitters which have been shown to increase attention, focus and memory.

Research on citicoline for other disorders where cognitive abilities are affected is scant, but promising. Researchers can’t yet say that citicoline will improve memory or cognition in individuals with Alzheimer’s disease, Bipolar disorder, Parkinson’s disease or traumatic brain injury, but stay tuned as more research is conducted in these areas.
I asked Dr. Yurgelun-Todd what she would say about healthy 50+ adults taking citicoline and she said that there is some good evidence to support the use of the supplement on improved focus and sustained attention. Her studies have used doses ranging from 250-4000 mg/day but she says a dose of 250-500 mg/day is effective and well-tolerated.

What about my husband? He has been taking citicoline for a couple of months (250 mg twice a day) and notices an improvement in word finding and clarity in conversations. He said he sometimes had to “think in pictures” when telling a story, but now he thinks he has better mental clarity. Of course, this is anecdotal. As for his memory, well, he still leaves the house without his wallet and phone and can’t find the milk in the refrigerator, but he feels it has helped him and that is a good thing.