Further information on supplements for dietitians supporting older adults

Oral nutrition supplements

We usually try a food first approach for 4 weeks and if it isn’t sufficient to address undernutrition then nutrition supplements are considered (1)

Not all of them are suitable for strict vegans because of the inclusion of milk or vitamin D3. Most are suitable for vegetarians though.

There is one ACBS (Advisory Committee on Borderline Substances) approved supplement suitable for vegans, which can be prescribed by health care professionals and that’s Aymes ActaSolve smoothie. This is a powered style supplement that gets mixed with water. It comes in four flavours and as far as we’re aware it’s the only nutritionally complete prescribed product available for strict vegans.

Nutrition supplements – other

Some people buy their own supplements and there are some vegan options on the market but they haven’t gone through the strict regulation process that ACBS approval requires. Many of these options are marketed towards plant-based athletes so while they are good sources of protein they are not the best choice for calories and aren’t nutritionally complete, so it’s worth checking this.

• Huel is a popular option and the Huel website claims that it is a complete source of nutrition, but it’s not been formally reviewed.

Vitamin supplements:

Calcium:

Because it’s difficult to get sufficient calcium via plant foods alone, for those who aren’t including calcium fortified foods daily, it’s a good idea to consider a calcium supplement. A health care professional can provide further advice on this.

B12:

The recommended B12 supplement amount is higher than the 3mcg/day recommendation because you absorb B12 more efficiently in frequent small amounts. So the less frequently you consume it, the more you need.

For older plant-based adults, there may be benefit from taking a B12 supplement in addition to fortified foods, because it has been suggested that fortified foods alone may not be enough to avoid vitamin B12 deficiency in the longer term (2).

Older plant-based adults are recommended to take a supplement of at least 10mcg daily or 2,000mcg weekly. This is more than you often find in regular multivitamins, so if you are getting your B12 from a multivitamin, it’s best to check the dose. Cyanocobalamin is the recommended form of B12 because it’s the most stable.

Omega 3 fatty acids:

There are supplement sources of EPA/DHA made from microalgae, which are suitable for those on a plant-based diet. These are recommended for certain life stages such as pregnancy and breastfeeding. They’ve been shown to raise EPA/DHA levels in vegans who take them (3) but it’s not yet clear whether this benefits the health of older adults (4).

Iodine:

Supplements may be the most reliable source for those on a plant-based diet if they aren’t including iodine-fortified products regularly. Seaweed and kelp supplements are a source of iodine, but they are not recommended because the iodine content is quite variable and there is a risk of excessive iodine intake (5).

Vitamin D:

UK recommendations are that all adults take a daily 10 mcg (400IU) supplement in the autumn and winter months, and all year round for at risk groups, which includes older adults who are seldom outdoors (6).

References

1. Volkert D, Beck AM, Cederholm T, Cruz-Jentoft A, Goisser S, Hooper L, et al. ESPEN Guideline ESPEN guideline on clinical nutrition and hydration in geriatrics. 2018 [cited 2020 Mar 10]; Available from: https://doi.org/10.1016/j.clnu.2018.05.0240261-5614/://doi.org/10.1016/j.clnu.2018.05.024
2. Pawlak R, Lester SE, Babatunde T. The prevalence of cobalamin deficiency among vegetarians assessed by serum vitamin B12: A review of literature. Eur J Clin Nutr. 2014;68(5):541–8.
3. Sarter B, Kelsey KS, Schwartz TA, Harris WS. Blood docosahexaenoic acid and eicosapentaenoic acid in vegans: Associations with age and gender and effects of an algal-derived omega-3 fatty acid supplement. Clin Nutr [Internet]. 2015;34(2):212–8. Available from: http://dx.doi.org/10.1016/j.clnu.2014.03.003
4. Harris WS. Achieving optimal n-3 fatty acid status: The vegetarian’s challenge . . . or not. Am J Clin Nutr. 2014;100(SUPPL. 1):449–52.
5. Bath S. Iodine Supplements [Internet]. The UK Iodine Group. 2019 [cited 2021 Nov 30]. Available from: https://www.ukiodine.org/iodine-supplements/
6. SACN. Vitamin D and Health 2016. Sci Advis Comm Nutr [Internet]. 2016;56–116. Available from: https://www.gov.uk/government/publications/sacn-vitamin-d-and-health-report%0Ahttps://www.gov.uk/government/uploads/system/uploads/attachment_data/file/537616/SACN_Vitamin_D_and_Health_report.pdf