We hear so much about macronutrients like protein, carbs, and fat when it comes to midlife health. Yet micronutrients play perhaps an even greater role as we age.
In another post, I detail foods that help us meet needs for certain vitamins and minerals. But supplementation is important too, but there’s so much confusion out there.
Multivitamins have been around for a long time. And I used to be unsure whether taking them was right for me.
But in midlife, I no longer feel that way and I’m going to explain why. But first, it’s important to understand what the multivitamins provide and don’t provide.
What you get with a multivitamin
First, a multivitamin with minerals is usually one (or two) pills with a majority of vitamins and minerals at 100% or more Daily Value (DV).
Yet it’s impossible to get every vitamin and mineral in a single pill. What it can provide at higher than DV levels are important B vitamins like B12, B6, and folic acid.
This is important because the absorption of B vitamins like B12 and B6 declines with age. In fact, government guidelines recommend people over 50 consume supplements or fortified food with vitamin B12.
That’s because we need strong stomach acid to cleave B12 from food, a process that becomes less efficient with age. As people age, they are also more likely be taking medications like metformin and proton pump inhibitors, which interfere with vitamin B12 absorption.
To see if multivitamins help people over 51, researchers analyzed National Health and Nutrition Examination Survey data.
Those who took multivitamins at least every other day had better nutrient biomarker status of folate, iodine, selenium, and vitamins B6, B12, and D compared to non-users.
The one vitamin that exceeded the tolerable upper limit was folic acid. Vitamin B6 deficiency was common in the non-users, and this increased at older ages.
In short: a multivitamin helps close the gap on certain nutrients and is a smart way to get B vitamins.
What you don’t get with a multivitamin
It’d be nice to take one pill and be done. But multivitamins typically don’t contain more than 1000 IU vitamin D and contain very little calcium and magnesium.
Some (like Ritual vitamins for >50) contain omega-3 fatty acids like DHA but the amounts are low.
It simply is not possible to design a multivitamin to meet every woman’s need. There are times we need to take more than the recommended amount of certain nutrients, and this will be different for everyone.
Also, there’s poor absorption of iron in multivitamins. Because nutrients like calcium interfere with absorption, it’s always better to take iron separately along with some vitamin C if your iron is low or you need a maintenance dose. Read more about why it’s so important to get your iron tested.
In short: if you only take a multivitamin, you may fall short on key nutrients like omega-3 fatty acids, magnesium, vitamin D, calcium, and iron (especially with heavy periods).
Are there health outcomes?
As for health outcomes associated with taking multivitamins, the evidence is mixed. Yet this can be a tough thing to measure, as most RCTs are not very long.
What I think matters most is making sure you are meeting your nutrient needs, using lab testing to make decisions as much as you can.
The most intriguing aspect of the research on multivitamins (especially B vitamins) is cognitive function. According to a 2020 meta-analysis in Nutrients:
Our meta-analyses indicated that B vitamin supplementation for 3 months or longer may be beneficial to the cognitive function of middle-aged or older people even when they do not have an apparent B vitamin-deficiency
There’s also new data from the Cocoa Supplement and Multivitamin Outcomes Study (Cosmos) Mind RCT trial including 2,262 adults 65 and older without dementia. It showed taking a multivitamin (Centrum Silver) for three years was associated with a 60% decline in cognitive aging.
This gets to one of the main reasons I recommend multivitamins with minerals to midlife women.
Multivitamins address the homocysteine problem
Although the age group of the aforementioned study is older, the thinking is the higher B vitamins (vitamin B12, B6 and folic acid) in a vitamin like Centrum Silver helps to reduce homocysteine, which is linked to cognitive decline.
Homocysteine is a sulfur-containing amino acid and its blood levels can be raised due to lower intake and/or absorption of B vitamins, which are cofactors in its metabolism.
And get this: researchers have known for years that homocysteine inches up as women go through the menopause transition.
According to a study out of China, homocysteine (>10) increased as women moved across the menopause transition.
In the study, 43% had high homocysteine (hcy) pre-menopause, 26% in perimenopause and 45% post menopause. Those are high numbers!
This is a problem because high homocysteine has been linked to endothelial (cells that line blood vessels) dysfunction, the precursor to cardiovascular disease, the number one killer in women. According to a 2019 review:
These data suggest that declines in estradiol across stages of the menopause transition may lead to elevations in Hcy and cysteine that may contribute to endothelial dysfunction in postmenopausal women
And as I’ve already alluded to, homocysteine plays a key role in brain health. An international consensus statement on the subject came out in 2020 (see below).
Why aren’t doctors doing anything about homocysteine
Homocysteine was a hot topic over two decades ago.
Yet randomized control studies were disappointing. Giving folic acid with or without vitamin B12 and B6, which reduced homocysteine, didn’t decrease cardiac events in those with active disease or at risk.
My problem with this is not only did most of the participants already have chronic disease, most were older than 60.
And that could very well mean that they have been living with high homocysteine for 20 or more years. Quite frankly, the damage could be done.
In fact, the ability of the body to regenerate the endothelium decreases with age. So, it would make sense to me to work on preventing or catching a high homocysteine in midlife, when it’s first likely to jump.
Additionally, as pointed out in this review, researchers only gave one or a few vitamins known to lower homocysteine and not the entire range known to be involved.
That’s another reason I like a multivitamin. It has the range of B vitamins involved, and not just super-high levels of a few.
So, what is the answer?
All midlife women should consider taking multivitamins that supply higher levels of B vitamins, including B12 and B6. For instance, a multi like Centrum Silver or One a Day 50. I think those brands need a makeover because you don’t have to be 50 or silver. And if you have any health conditions, check with your doctor.
I eventually switched to this one that fit the bill perfectly. It’s also good for people with the C677T polymorphism of the MTHFR gene who have trouble metabolizing folic acid.
But I opt to take mine every other day because of my nutrient-rich diet and good lab numbers. I’ve had my homocysteine tested once and plan to get it again at my physical and will see how my numbers are trending.
I’m not a big fan of high-dose b-vitamin complex because the research isn’t clear on the benefits/risks of such high levels for non-deficient people. Yet, even if we don’t know the exact amount of B vitamins needed, research suggests we need higher levels than the RDA as we age.
Of course, I take other micronutrients in addition to the multivitamin, but that’s a topic for another post.
Any questions related to multivitamins??