Of course, you eat a balanced diet. That's why you're sure you get all the nutrients you need.
Just yesterday, for example, you had—oh, well, you skipped breakfast because you were in a hurry, then grabbed a fast-food lunch. For dinner—who has the energy to make dinner?—you zapped a frozen entrée and rewarded yourself with a cappuccino-mix coffee and mini chocolate chip cookies.
Like many of us, you probably have days when you eat more healthfully—having a salad with your meals and fresh fruit for snacks or dessert. But how regularly does your daily menu include the 1-1/2 cups of fruit, 2 to 2-1/2 cups of vegetables, 3 cups of fat-free or lowfat milk, 3 ounces of whole-grain foods and 5 ounces of meat or beans that the U.S. Department of Agriculture recommends for most women? (In April 2005, these guidelines replaced the old food pyramid requirements. Some new guidelines were released in 2010. To see the food pyramid and dietary recommendations, click here.)
Our eating habits, aging, even how much sunlight we get, all affect how well we meet our bodies' daily nutrient needs. As a result, many women are deficient in one or more important micronutrients, such as vitamins A, B6, B12, C, D, E, folate (folic acid) and calcium. Having lower levels of these means greater risk for cardiovascular and other chronic diseases, certain cancers, bone fractures, and more.
Getting the right balance
In middle age and beyond, it's important to give your body the vitamins and minerals that support good health. The best way to do that is by eating a balanced diet, with a variety of foods, minimal alcohol, and plenty of fruits, vegetables and fiber, says Marian Neuhouser, Ph.D., R.D., a nutritional epidemiologist and cancer prevention expert at the Fred Hutchinson Cancer Research Center in Seattle.
Yet that ideal is rarely achieved. "Almost all Americans are deficient in fruit and vegetable intake," Dr. Neuhouser says.
Indeed, research shows that most of us don't get all the vitamins we need through diet alone. Taking a daily multivitamin helps close that gap. "Even if you don't remember to take it every day, if you take it most days of the week, it's still a good investment in your health," says nutritionist Jo-Anne M. Rizzotto, M.Ed., R.D., L.D.N., C.D.E., Joslin Diabetes Center, Boston.
Change happens
As we age, our bodies may have difficulty absorbing and using certain nutrients that occur naturally in foods. However, very little is known about which individuals may be at nutritional risk from these changes. Because vitamin B12 absorption and utilization may be particularly problematic for some older individuals, the Institute of Medicine has recommended that everyone over age 50 get their daily requirement by consuming foods specially fortified with vitamin B12, such as some cereals, or by taking the crystalline form of vitamin B-12 supplement, notes Dr. Neuhouser.
Similarly, levels of vitamin D—which the skin produces from ultraviolet light—often drop with age. This could be due to limited sun exposure, the skin's declining ability to make the vitamin, as well as low intake of foods containing vitamin D. "Increasing sun exposure and ensuring adequate vitamin D, whether by food or supplements, will optimize vitamin D status," Dr. Neuhouser says.
Calcium also shows an age-related decline in postmenopausal women, in addition to the drop that occurs at menopause.
What you're not getting—or getting too much of—could hurt you
There's reason to be concerned about your vitamin and mineral intake. Here's a brief run-down on some key micronutrients:
| • | Vitamin A—helps immune function, but a high intake (3,000 or more mcg. daily) may lead to hip fractures. |
| • | Vitamin B6— may help manage depression and anxiety; in combination with folate, may reduce heart disease risk. |
| • | Vitamin B12—deficiency of B12 and folate may lead to development of Alzheimer's disease; reduced B12 may cause anemias, neuropsychiatric disorders, and lower bone mineral density; combined with folate, reduces coronary heart disease. |
| • | Vitamin C—potent antioxidant needed for body function, helps counteract some effects of smoking, but its role in lowering the risk of chronic disease is still unknown. Recent studies have shown that it is not effective in preventing the common cold in most people but may help ward off colds in people exposed to brief periods of severe physical exercise and/or extreme cold weather. Its effectiveness in reducing the duration or severity of cold symptoms remains under study. |
| • | Vitamin D—deficiency may lead to osteoporosis, rheumatoid arthritis, multiple sclerosis, cancers and more; protects against fractures and falls; boosts absorption of calcium for protection against osteoporosis. |
| • | Vitamin E—inhibits cancer cell growth, may reduce risks of other chronic diseases; controls cholesterol; despite high hopes, does not slow progression to Alzheimer's disease. |
| • | Folate—low levels may increase risk for vascular disease, cancer and cognitive decline, while too much may mask B12 deficiency (so take multivitamin supplement that contains both); may reduce breast cancer risk in women who are moderate drinkers |
| • | Calcium—vital for preventing osteoporosis, low intake may also contribute to risk of stroke in middle-aged women. |
What's in your multivitamin?
The shelves of discount stores and drug chains are crammed with a dizzying number of multivitamin offerings. Your vitamin needs as a woman at midlife or later are different than for adolescents or men.
Rizzotto advises choosing multivitamins especially formulated for women over 50. Such supplements usually meet women's needs during all stages of menopause. Be sure to compare the vitamin amounts shown on the supplement label with these Dietary Reference Intake (DRI) recommendations from the IOM*:
| Women, 19-50 | Women, 51-70 | Women, > 70 | |
| Vitamin A | 700 mcg | 700 mcg | 700 mcg |
| Vitamin B6 | 1.3 mg | 1.5 mg | 1.5 mg |
| Vitamin B12 | 2.4 mcg | 2.4 mcg** | 2.4 mcg** |
| Vitamin C | 75 mg | 75 mg | 75 mg |
| Vitamin D*** | 15 mcg (600 IU) | 15 mcg (600 IU) | 20 mcg (800 IU) |
| Vitamin E | 15 mg | 15 mg | 15 mg |
| Folate (folic acid) | 400 mcg | 400 mcg | 400 mcg |
| Calcium | 1,000 mg | 1,200 mg | 1,200 mg |
| Iron | 18 mg | 8 mg | 8 mg |
*The above amounts represent 100 percent of the daily value of each nutrient. Use this amount to compare with the daily value information on a supplement label.
**Due to age-related modest decreases in the ability to use the B12 from natural sources, fortified foods or supplements can help to meet the recommendation.
***In the absence of adequate exposure to sunlight.
Tips on vitamin supplements
| • | Read the label carefully. All vitamin formulations are not the same. |
| • | Make sure you understand what the "serving size" is. Some vitamin labels show a nutrient list for a "serving size" of two tablets or capsules. It's easy to mistakenly think that list shows the vitamin amounts in one tablet. |
| • | Check the expiration date. Make sure you'll use the contents before you reach that date. |
| • | Store supplements in a cool, dry place—not the bathroom. |
| • | As with all medication, keep supplements away from children, in a locked or secure location. |
| • | Supplements lose strength quickly in hot, humid climates. Air conditioning helps protect them. |
| • | Your body can only absorb about 500 mg of calcium at a time, Rizzotto says, so take it in separate doses, at different times, to get your full daily. requirement. Avoid taking with iron-containing foods or supplements. She advises taking one dose at bedtime, when you're not eating anything that would interfere with absorption. |
| • | More than 100 percent of a vitamin's daily DRI is not necessarily better. Avoid the dangers that megadoses may cause by consulting the recommended tolerable upper intake levels contained in the Dietary Reference Intakes Table. |
