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JAMDA
journal homepage: www.jamda.com
Editorial
Antioxidants
A recent Cochrane Review3,4 reported on the use of antioxidants
for prevention of mortality in 296,707 adults. Overall, antioxidant
supplements had a 22.7% mortality compared with a 10.2% in placebo.
This was not signicant. In 56 trials where there were minimal risks
of bias, antioxidants had a signicant increase in mortality (relative
risk 1.04; 1.01e1.07). The evidence that Vitamin E and beta-carotene
increased mortality was strong. Higher doses of vitamin A also
increased mortality.
A 2007 satirical novel, Boomsday by Christopher Buckley5 suggested that boomers should be given nancial incentives to commit
suicide and thus reduce the burden on younger persons who were
responsible for generating the money to pay for their Social Security.
It would appear that if the data on antioxidants and the increase in
supplement purchases are to be taken at face value, the young need
not worry as Boomercide appears to already be occurring with the
older persons actually putting money back into the economy while
doing it!
The fact that antioxidant supplements fail to extend life is not
surprising. Simply put, free radicals are essential for survival. Free
radicals are essential as part of the bodys defense against infections
and cancer. In addition, free radicals play an important role as
neurotransmitters (eg, nitric oxide) and increasing blood ow (eg,
nitric oxide again) and in modulating a variety of signaling pathways.
The author declares no conicts of interest.
* Address correspondence to John E. Morley, MB, BCh, Division of Geriatric
Medicine, Saint Louis University School of Medicine, 1402 S. Grand Blvd, M238,
St. Louis, MO 63104.
E-mail address: morley@slu.edu (J.E. Morley).
1525-8610/$ - see front matter 2014 - American Medical Directors Association, Inc. All rights reserved.
http://dx.doi.org/10.1016/j.jamda.2014.01.013
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Data supports that calcium and vitamin D will reduce hip fracture.54,55 Data is less solid but does suggest that vitamin D supplement in persons who are truly vitamin D decient may decrease falls
and mortality.56e58 Vitamin D deciency may also play a role in
cognitive function.59 There is no evidence suggesting a need for more
than 1000 IU per day.
Conclusions
Other Vitamins
Data from Europe has consistently suggested that reducing
elevated homocysteine levels with folate may reduce coronary artery
disease, Alzheimers disease, and osteoporosis.35e37 The data from the
United States has in general been negative.38,39 This is explained by
folate supplement of food in the United States. The most common
reason for elevated homocysteine in the United States is renal failure.
Thus, folate deciency is rare in the United States and is mostly due to
drugs such as methotrexate.
Vitamin B12 deciency is due to pernicious anemia, bacterial
overgrowth, and drugs (metformin and proton pump inhibitors).40 It
is a common treatable cause of dementia and should be replaced
when deciency is demonstrated by nding an increase in methylmalonic acid.41
Vitamin D deciency is a common problem in older persons.42e45
The interpretation of vitamin D levels are made difcult by the poor
quality of many assays and the fact that vitamin D binding protein
levels need to be measured if the true bioavailable vitamin D level is
to be determined.46 The Institute of Medicine has suggested that
25(OH) vitamin D levels should be between 20 and 25 ng/dL to return
parathormone to normal ranges.47,48 Others have suggested a higher
range but there is no good data to support this.49 In older persons,
exposure to 30 minutes of sun or ultraviolet light can restore values
to normal.50e53
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