Page 130 - Petelin, Ana. 2021. Ed. Zdravje starostnikov / Health of the Elderly. Proceedings. Koper: University of Primorska Press.
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avje starostnikov | health of the elderly 128 cum perforatum), which can increase metabolism of drugs processed through
the CYP3A4 enzymes, making up 50% of all drugs. Other common potential
drug-nutrient interactions include grapefruit (Citrus × paradisi), pomegran-
ate (Punica granatum), goldenseal (Hydrastis canadensis), and black pepper
(Piper nigrum) due to the inhibition of CYP450. Another common interac-
tion can occur between anticoagulant medications such as warfarin and sup-
plements such as cranberry (Vaccinium oxycoccos), garlic (Allium sativum),
Ginkgo (Ginkgo biloba), coenzyme Q10, and fish oil/omega-3 fatty acids, due
to increased risk of bleeding (Harris et al., 2017).
Secondly, although users tend to be motivated by putative health benefits,
there is no clear evidence that the use of dietary supplements affects age-related
chronic diseases and mortality (Walrand, 2018). While a considerable body of
evidence has been gathered showing a positive impact of consuming some DS,
some studies also reported contradictive results. Marik and Flemmer (2012) re-
viewed 63 randomized controlled trials that evaluated the benefits and safety
of DS such as β-carotene, vitamin A, B6, B12, C, D, E, folic acid, calcium, se-
lenium, omega-3 fatty acids, glucosamine and some herbs (Ginkgo, saw pal-
metto, milk thistle). No benefit was recorded in 45 studies, with ten of these
showing a trend toward harm and two showing a trend toward benefit. Four
studies reported harm, with an increased risk of cancer and cancer deaths in
the Carotene and Retinol Efficacy Trial and the Norwegian Vitamin Trial II
studies, and an increased risk of fractures in the two studies that investigat-
ed high-dose once-yearly vitamin D. The Nutritional Cancer Prevention Study
(selenium supplementation) demonstrated both benefit (less cancer) and harm
(increased risk of type 2 diabetes). The lower risk of cancer with selenium sup-
plementation, however, was not confirmed in the much larger selenium and
Vitamin E Cancer Prevention Trial. Similarly, the Calcium Polyp Prevention
Study demonstrated both a benefit (reduced fractures and reduced polyps) and
harm (increased acute myocardial infarction). A beneficial outcome was re-
ported in only three studies with omega-3 fatty acids and in six studies with vi-
tamin D, which appeared to be dose dependent.
Conclusions
As there are a lot of things that need to be taken into consideration to ensure
safe and reasonable supplementation in older patients, it is recommended that
they seek professional consultation before starting a new supplement regimen.
Supplement recommendations by healthcare practitioners should be tailored
to each individual patient with consideration of quality of diet, use of medi-
cations, and other medical/social factors. Ideally, nutrition screening should
be conducted for every patient by a qualified provider, such as a registered di-
etitian nutritionist, in order to assess nutrient intake and risk of malnutrition.
If supplementation is deemed beneficial, the quality, safety, and efficacy of the
DS should be assessed and the best regimen for the given patient determined.
the CYP3A4 enzymes, making up 50% of all drugs. Other common potential
drug-nutrient interactions include grapefruit (Citrus × paradisi), pomegran-
ate (Punica granatum), goldenseal (Hydrastis canadensis), and black pepper
(Piper nigrum) due to the inhibition of CYP450. Another common interac-
tion can occur between anticoagulant medications such as warfarin and sup-
plements such as cranberry (Vaccinium oxycoccos), garlic (Allium sativum),
Ginkgo (Ginkgo biloba), coenzyme Q10, and fish oil/omega-3 fatty acids, due
to increased risk of bleeding (Harris et al., 2017).
Secondly, although users tend to be motivated by putative health benefits,
there is no clear evidence that the use of dietary supplements affects age-related
chronic diseases and mortality (Walrand, 2018). While a considerable body of
evidence has been gathered showing a positive impact of consuming some DS,
some studies also reported contradictive results. Marik and Flemmer (2012) re-
viewed 63 randomized controlled trials that evaluated the benefits and safety
of DS such as β-carotene, vitamin A, B6, B12, C, D, E, folic acid, calcium, se-
lenium, omega-3 fatty acids, glucosamine and some herbs (Ginkgo, saw pal-
metto, milk thistle). No benefit was recorded in 45 studies, with ten of these
showing a trend toward harm and two showing a trend toward benefit. Four
studies reported harm, with an increased risk of cancer and cancer deaths in
the Carotene and Retinol Efficacy Trial and the Norwegian Vitamin Trial II
studies, and an increased risk of fractures in the two studies that investigat-
ed high-dose once-yearly vitamin D. The Nutritional Cancer Prevention Study
(selenium supplementation) demonstrated both benefit (less cancer) and harm
(increased risk of type 2 diabetes). The lower risk of cancer with selenium sup-
plementation, however, was not confirmed in the much larger selenium and
Vitamin E Cancer Prevention Trial. Similarly, the Calcium Polyp Prevention
Study demonstrated both a benefit (reduced fractures and reduced polyps) and
harm (increased acute myocardial infarction). A beneficial outcome was re-
ported in only three studies with omega-3 fatty acids and in six studies with vi-
tamin D, which appeared to be dose dependent.
Conclusions
As there are a lot of things that need to be taken into consideration to ensure
safe and reasonable supplementation in older patients, it is recommended that
they seek professional consultation before starting a new supplement regimen.
Supplement recommendations by healthcare practitioners should be tailored
to each individual patient with consideration of quality of diet, use of medi-
cations, and other medical/social factors. Ideally, nutrition screening should
be conducted for every patient by a qualified provider, such as a registered di-
etitian nutritionist, in order to assess nutrient intake and risk of malnutrition.
If supplementation is deemed beneficial, the quality, safety, and efficacy of the
DS should be assessed and the best regimen for the given patient determined.
