10 surprising dangers of vitamins and supplements

Don't assume they're safe because they're 'all natural'

Consumer Reports magazine: September 2012
Illustration: Andy Potts
More than half of American adults take vitamins, minerals, herbs, or other nutritional
supplements. Some of those products aren’t especially helpful, readers told us in a
recent survey, but that aside, don’t assume they’re safe because they’re “all natural.”
They may be neither. Here are 10 hazards that we’ve distilled from interviews with
experts, published research, and our own analysis of reports of serious adverse events
submitted to the Food and Drug Administration, which we obtained through a Freedom
of Information Act request. Read and be warned.
1. Supplements are not risk-free
More than 6,300 reports of serious adverse events associated with dietary supplements,
including vitamins and herbs, streamed into the FDA from supplement companies,
consumers, health-care providers, and others between 2007 and mid-April of 2012. The
reports by themselves don’t prove the supplements caused the problems, but the raw
numbers are cause for some concern. Symptoms included signs of heart, kidney, or
liver problems, aches, allergic reactions, fatigue, nausea, pains, and vomiting.
The reports described more than 10,300 serious outcomes (some included more than
one), including 115 deaths and more than 2,100 hospitalizations, 1,000 serious injuries
or illnesses, 900 emergency-room visits, and some 4,000 other important medical
events.
The FDA gets far more reports about serious problems with prescription medication
than about supplements. But there’s a big difference between the two, notes Pieter
Cohen, M.D., an internist at Cambridge Health Alliance in Massachusetts with a special
interest in supplements. “These powerful medications with powerful side effects are
actually saving lives when used appropriately,” he says of prescription drugs. “But when
healthy consumers use supplements, there’s rarely, if ever, a powerful lifesaving effect.”
The FDA suspects most supplement problems never come to its attention, says Daniel
Fabricant, Ph.D., director of the agency’s Division of Dietary Supplement Programs. But
those that do are still useful because they can raise red flags about a developing
problem. For instance, last year the agency noted seven reports of serious health
problems regarding consumers who took Soladek vitamin solution, marketed by Indo
Pharma of the Dominican Republic. When the FDA learned that tested samples
contained vitamins A and D at concentrations many times the recommended daily
allowances, it issued a consumer warning.
Why not simply order a problem product off the market? Current laws make that so
difficult for the FDA that to date it has banned only one ingredient, ephedrine alkaloids.
That effort dragged on for a decade, during which ephedra weight-loss products were
implicated in thousands of adverse events, including deaths.
Type the name of the supplement you’re interested in into the search box at
www.fda.gov to see whether it has been subject to warnings, alerts, or voluntary recalls.
If you suspect you’re having a bad reaction to a supplement, tell your doctor. You can
also report your problem to the FDA at 800-332-1088 or www.fda.gov/medwatch.
2. Some supplements are really prescription drugs
Fabricant has said that dietary supplements spiked with prescription drugs are “the
largest threat” to consumer safety. Since 2008 there have been recalls of more than 400
such products, mostly those marketed for bodybuilding, sexual enhancement, and
weight loss, according to the FDA.
We’ve seen many recalled products that have contained the same or similar active
ingredients as prescription drugs, such as sildenafil (Viagra), tadalafil (Cialis), and
sibutramine (Meridia, a weight-loss drug that was withdrawn from the market in 2010
because of evidence that it increased the risk of heart attacks and strokes). Others
contained synthetic steroids.
Related Topics
Those adulterated products can cause some of the same side effects and interactions
that consumers may have been trying to avoid by choosing supplements over drugs.
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The FDA has received reports of strokes, acute liver injury, kidney failure, pulmonary
embolism (blood clots in the lung), and death associated with drug-tainted supplements.
“A number of the spiked sexual enhancement products claim to work within 20 to 45
minutes,” Fabricant said on the FDA’s website. “When we see a product that makes
claims above and beyond what a dietary supplement might do—above supporting
health—and within a time frame of a few minutes, it tips us off that we might have a
spiked product.”
Slim down with diet and exercise. Build muscles by weight training. And consult a doctor
if you need help in the bedroom, since it could indicate an underlying health problem. If
you suspect you’ve purchased a product that is tainted with undeclared prescription
drugs or steroids, send an e-mail about it to the FDA, at taintedproducts@fda.hhs.gov.
3. You can overdose on vitamins and minerals
Unless your health-care provider tells you that you need more than 100 percent of the
recommended daily intake of a particular nutrient, you probably don’t.
“It doesn’t make sense to me to take huge doses of vitamins and minerals unless
there’s a diagnosed problem, because there is so little evidence that they do good and
sometimes a possibility that they might do harm,” says Marion Nestle, M.P.H., Ph.D., a
professor of nutrition, food studies, and public health at New York University.
Megadoses of the fat-soluble vitamins A, D, E, and K can cause problems, and even
some standard doses may interfere with certain prescription medicine. Some people
may experience adverse effects from too much calcium or iron.
The table below shows the maximum daily intake of key nutrients that the Institute of
Medicine has determined is unlikely to pose a risk of adverse health effects. (The
numbers apply to the general population, not to those who may need supplementation
because of a medical condition.)
It’s surprisingly easy to overdo it. For instance, a 50-something woman who’s worried
about her bones might eat a breakfast of Whole Grain Total cereal, which contains
around 1,000 milligrams of calcium per serving, with a half-cup of skim milk (150
milligrams of calcium), and take a calcium supplement (500 milligrams) on top of her
One-A-Day Menopause Formula multivitamin, which includes 300 milligrams of calcium.
She’d already be coming close to the upper tolerable daily calcium limit of 2,000
milligrams.
Using information from the labels on the supplements and food you routinely consume,
add up your total daily exposure to everything, and then check the related table to see
whether you’re overdoing it. If your doctor says you need more of a specific nutrient
than you can get from food (or sun exposure, in the case of vitamin D), a single-
ingredient pill may be sufficient.
4. You can’t depend on warning labels
Illustration: Andy Potts
For one thing, the FDA doesn’t require them on supplements. There is an exception:
Supplements that contain iron must warn about accidental overdosing and fatal
poisoning in children.
But supplement makers can provide warning labels if they want to. We went shopping to
see what warnings, if any, we would find on labels from 14 varieties of supplements.
After looking at 233 products, all purchased online or in stores in the New York City
metropolitan area in the spring of 2012, we can report that the only thing consistent
about the labels is their lack of consistency.
Good news first: 100 percent of the 15 brands we bought that contained iron had the
required warning.
Of the 233 labels we examined, most included only general warnings, such as those
about not using the product during pregnancy or nursing, or about possible unspecified
drug interactions. But specific warnings were rarer. Forty percent of labels warned
people against taking the supplement if they had a medical condition, but only some
cited an ailment, such as a bleeding disorder; 36 percent warned of possible adverse
reactions; but only 13 percent warned of possible interactions with a specific drug or
type of drug.

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Five of our 20 samples of 5-HTP, a mood and sleep supplement, carried warnings about
a possible interaction with drugs for Parkinson’s disease.
While it’s known that St. John’s wort can reduce the effectiveness of certain prescription
drugs, including birth-control pills and blood thinners such as warfarin (Coumadin), only
two of the 17 samples of it we purchased warned explicitly about those hazards. Ginkgo
biloba can also interfere with blood thinners, but we saw a warning about that possible
interaction on just one bottle of ginkgo.
“Some companies go with an overabundance of caution, and that’s certainly their right
to do that,” says Steve Mister, president and CEO of the Council for Responsible
Nutrition, a leading industry trade group. “Other companies say, you know what, I’m not
going to warn for possible things that I don’t believe are a serious concern to my
consumers.”
Make sure that your doctor or pharmacist knows what supplements and prescription
drugs you are taking or thinking of taking. You can also learn about interactions in our
free “Guide: 100+ Commonly Used Supplements” (funded by a grant from the Airborne
Cy Pres Fund).
5. None are proved to cure major diseases
If you’re surfing the Internet for dietary supplements and find a site that claims its
products can diagnose, cure, mitigate, treat, or prevent a disease, surf right off to
another site. Such claims are off-limits to supplements, according to the FDA. “We’d like
to see those things go away,” Fabricant says. “Those are a direct threat to public
health.” Since 2007, the agency has sent dozens of warning letters to companies telling
them to stop making those types of claims about their supplement products.
Earlier this year, for instance, the FDA sent a warning letter to BioAnue Laboratories of
Rochelle, Ga., when these statements and others were spotted on websites: “Formula
CX will reverse wasting disease,” and “Bovine cartilage stops tumor growth.” (The FDA
said it’s still reviewing the company’s response. The president of BioAnue Laboratories
told us it “complies with all U.S. laws.”)
Over the past decade, the FDA’s regulatory partner, the Federal Trade Commission,
which monitors dietary-supplement advertising, has brought more than 100 legal
challenges to claims about the effectiveness of supplements.
Research supplements at reliable government sites such as the Food and Drug
Administration, the National Institutes of Health’s Office of Dietary Supplements, and the
National Center for Complementary and Alternative Medicine.
6. Buy with caution from botánicas
These stores, which sell traditional medicinal plants and other artifacts for physical and
spiritual healing, are a valued presence in Hispanic neighborhoods in many American
cities. But when Consumer Reports sent a Spanish-speaking reporter on a shopping trip
to several New York-area botánicas in 2011, he came away with incomplete information
and bags of mystery herbs.
Our reporter asked for advice on how to treat type 2 diabetes, high blood pressure, and
impotence, conditions that have effective conventional drug treatments. Healers offered
a variety of instructions and herbs, but none volunteered relevant facts about possible
side effects or the risky interactions that can occur when an herb is taken with a
medication. And when we brought the herbs back to the office and checked the
scientific evidence, we found that conclusive research on efficacy and safety was
lacking for all of them.
Our investigation left us concerned about product quality and identity at the shops. And
experts we consulted suggested that the supply chain used by some of the stores might
not follow the best industry standards.
“These markets should not be singled out, but they also should not be exempt from
meeting the same standards required by other purveyors of herbal and dietary
supplements,” says Tieraona Low Dog, M.D., a clinical associate professor of medicine
at the University of Arizona College of Medicine and fellowship director of the Arizona
Center for Integrative Medicine.
Check with your doctor before taking traditional herbs, and make sure you know what
they are and where they come from. If your culture’s health practices are important to

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you, consider seeking out an integrative physician, such as Low Dog, who combines
conventional medical care with holistic and traditional methods.
7. Heart and cancer protection are not proved
To stay safe, get antioxidants from food, not a pill bottle.
Omega-3 pills and antioxidants are widely thought to reduce the risk of heart disease
and cancer, respectively, and millions of women take calcium to protect their bones. But
recent evidence casts doubt on whether those supplements are as safe or effective as
assumed.
Calcium. The latest blow against calcium supplements was a report by German and
Swiss researchers who followed almost 24,000 adults for an average of 11 years. They
found that regular users of calcium supplements had an 86 percent increased heart-
attack risk compared with those who didn’t use supplements, as reported in the June
2012 issue of the journal Heart. On the other hand, there was a statistically significant
30 percent reduction of heart-attack risk among adults with a moderately high intake of
calcium from food itself.
Why the disparity? The researchers theorized that the supplements may cause quick
spikes in blood calcium levels that have been linked to risky lipid levels, whereas
calcium in food is likely to be absorbed more slowly. Get calcium from dairy products,
green leafy vegetables, and fish with edible bones, such as sardines.
Omega-3 fish oil. The widely held view that fish-oil pills help prevent cardiovascular
disease hit a snag when a study of 12,500 people with diabetes or prediabetes and a
high risk of heart attack or stroke found no difference in the death rate from
cardiovascular disease or other outcomes between those given a 1-gram fish-oil pill
every day and those given a placebo, according to a June 11, 2012, New England
Journal of Medicine online report. But the results may be clouded by the fact that
participants were already taking other heart medication.
Most people can get enough omega-3s by eating fatty fish at least twice a week. The
American Heart Association says that people who have coronary artery disease may
want to talk to their doctor about omega-3 supplementation.
Antioxidants. Far from reducing cancer risk, as a lot of people believe, high doses of
some antioxidant supplements may actually increase it, evidence suggests.
The discouraging news appeared in the May 16, 2012, issue of the Journal of the
National Cancer Institute. Based on current evidence, vitamins C and E haven’t been
found to shield people from cancer; vitamin E, beta-carotene, and vitamin C don’t seem
to protect against getting or dying from cancer; selenium doesn’t prevent prostate
cancer; and there’s no convincing evidence that beta-carotene or vitamin A, C, or E
supplements prevent gastrointestinal cancers. Still worse, the researchers wrote, “Some
clinical trials show that some of these antioxidant nutrients may increase cancer risk.”
And there’s more bad news, from a study of 35,000 men reported in the Oct. 12, 2011,
issue of the Journal of the American Medical Association: Daily vitamin E
supplementation may increase the risk of prostate cancer among healthy men.
The investigators warned that the implications of their findings were worrisome given
that more than half of people 60 or older take supplements containing vitamin E.
Moreover, 23 percent of them take at least 400 IU per day despite a recommended daily
dietary allowance of only 22 IU for adult men.
Lay off the antioxidant supplements and reduce your cancer risk safely by quitting
smoking, avoiding excessive drinking, and eating a healthy diet that includes plenty of
fruit, vegetables, nuts, legumes, and whole grains.
8. Pills can irritate the esophagus

Illustration: Andy Potts

Choking as a serious symptom showed up surprisingly often in the database we
analyzed of problem reports to the FDA in the last five years, with more than 900
mentions. But true cases of choking, in which a pill actually goes down the windpipe
instead of the esophagus, probably happen infrequently, says Joel Blumin, M.D.,
incoming chairman of the Airway and Swallowing Committee of the American Academy

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of Otolaryngology—Head and Neck Surgery. That’s a medical emergency that requires
immediate intervention, such as the Heimlich maneuver.
More typically, Blumin says, pills irritate the esophagus, causing a muscle spasm, or get
physically stuck or slowed. “That sensation feels like choking,” he says, but it isn’t.
Sometimes all you need is a second swallow or extra water to get the pill down.
To get a pill down easily, first take a swig of water to moisten your mouth and throat.
Place the pill on the front of your tongue, take a sip of water, tilt your head back slightly,
and swallow. Then drink the rest of the water to help propel the pill down your
esophagus. People with persistent swallowing problems can switch to liquid or
chewable formulations and should probably seek evaluation by an otolaryngologist.
9. Some ‘natural’ products are anything but
Vitamin pills can be synthetically, and legally, produced in a lab. Synthetic ingredients
are even allowed in multivitamins that bear the Department of Agriculture’s “Organic”
seal. But the FDA has said that synthetic copies of botanicals don’t qualify as dietary-
supplement ingredients at all.
“Vitamins can be synthetic because, by definition, a vitamin doesn’t have to come from
nature,” says Fabricant at the FDA. They just have to perform the biological activity of
vitamins, he added, whereas a “botanical” means that it was alive at some point. In
other words, botanicals and their extracts must come from actual living plants, not a test
tube.
In April 2012, the agency sent warning letters to 10 manufacturers and distributors of
products containing dimethylamylamine (DMAA), often touted as a natural stimulant. It
said the ingredient lacked safety evidence and warned that synthetically produced
DMAA was not a dietary ingredient at all. (The FDA said it is studying the companies’
responses.)
The FDA doesn’t require supplements to go through rigorous testing for safety and
efficacy the way that drugs are tested. If you choose to take vitamins, botanicals, or
other supplements, look for those with the “USP Verified” mark, which means they meet
standards of quality, purity, and potency set by the nonprofit U.S. Pharmacopeia.
10. You may not need supplements at all
If you are already getting the recommended amount of nutrients by eating a variety of
fruit, vegetables, cereals, dairy, and protein, there’s little if any additional benefit from
ingesting nutritional supplements. Here’s our take on five top-selling vitamins, plus
multis:
Vitamin A. Few people in the U.S. are outright deficient in vitamin A. The retinol form—
which comes from animal sources such as eggs, liver, and whole milk—is more readily
absorbed than beta-carotene, but even strict vegetarians can usually meet their needs
by eating five servings a day of produce, including dark green leafy vegetables and
orange and yellow fruit. Too much retinol can cause birth defects and liver
abnormalities, and might harm bones.
B vitamins. Most people get plenty through their diet. Exceptions include vegetarians,
who might need extra B12, which is found in animal-derived foods; the estimated 10 to
30 percent of people over 50 who don’t have enough stomach acid to extract B12 from
food; and women who are pregnant or trying to get pregnant, who should take 400
micrograms a day of extra folic acid to help prevent birth defects.
Vitamin C. There’s some evidence that 200 milligrams or more of vitamin C a day might
improve cold symptoms in smokers and seniors, though it won’t prevent colds. Vitamin
C can enhance iron absorption, so avoid high doses if you have hemochromatosis, a
condition in which the body absorbs and stores too much iron.
Vitamin D. If you get some midday sun exposure during the warmer months and
regularly consume vitamin D-rich foods, such as fatty fish, eggs, and fortified dairy
products, you probably don’t need to take a supplement. People who are middle-aged
or older, are overweight, or have darker skin might need supplements. If you’re unsure
about your vitamin D status, ask your doctor about having a blood test.
Vitamin E. Two analyses have linked as little as 400 IU a day to a small but statistically
significant increase in mortality. Moreover, vitamin E may inhibit blood clotting, so it
shouldn’t be taken with blood thinners.

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Multivitamins. Large clinical trials have repeatedly found that multivitamins don’t
improve the health of the average person. People who might need a multivitamin
include women who are pregnant, breast-feeding, or trying to conceive; dieters
consuming fewer than 1,200 calories a day or cutting out an entire food group (carbs,
for example); and those with medical conditions that affect digestion and food
absorption.
Warnings we like to see
Makers of nutritional supplements have no legal obligation to put warnings about
possible drug interactions on their products, but nothing’s stopping them if they want to.
St. John’s wort is especially prone to drug interactions, and most of the 17 St. John’s
wort product labels we reviewed did contain a general warning or named specific drugs
or drug classes. One of the most complete set of warnings we saw was on a Vitamin
Shoppe bottle. The warning (shown) does a good job of alerting users to the herb’s
important interactions with anti-HIV medication, blood thinners, oral contraceptives,
prescription antidepressants, and transplant drugs.
How much is too much?
What it takes to overdose on vitamins and minerals.
Nutrient Recommended daily intake Safe upper limit
(all sources)
Men Women
Vitamin A 3,000 IU 2,300 IU 10,000 IU
Niacin (B3) 16 mg 14 mg 35 mg
Folate (folic acid) 400 mcg 400 mcg 1,000 mcg
Vitamin C 90 mg 75 mg 2,000 mg
Vitamin D 600 IU ages 19 to 600 IU ages 19 to
70; 800 IU ages 71 70; 800 IU ages 71
and up and up
Vitamin E 22 IU (natural) 22 IU (natural) 1,500 IU (natural)
33 IU (synthetic) 33 IU (synthetic) 1,100 IU (synthetic)
Vitamin K 120 mcg 90 mcg Not established

MINERALS
Calcium 1,000 mg ages 19 to 1,000 mg ages 19 to 2,500 mg through
70; 1,200 mg ages 50; 1,200 mg ages age 50; 2,000 mg
70 and up 51 and up ages 51 and up
Magnesium 420 mg 320 mg 350 mg (from
supplements only)
Potassium 4,700 mg 4,700 mg Not established
Selenium 55 mcg 55 mcg 400 mcg
Zinc 11 mg 8 mg 40 mg
Source: Institute of Medicine and the Office of Dietary Supplements, National Institutes
of Health.
Editor's Note:
A version of this article appeared in the September 2012 issue of Consumer Reports
magazine with the headline "Vitamins & Supplements."

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Dietary Supplements for the Elderly: More is Not Always Better
By National Institute on Aging, National Institutes of Health
Bill's retired and lives alone. Often he's just not hungry or is too tired to fix a whole meal.
Does he need a multi-vitamin or one of those dietary supplements he sees in ads
everywhere? He wonders if they work—will one help his arthritis, or another give him
more energy? And, are they safe?
"Dietary supplements" used to make you think only of vitamins and minerals. But, today
this big business makes and sells many different types of dietary supplements that have
vitamins, minerals, fiber, amino acids, herbs, or hormones in them. Supplements come
in the form of pills, capsules, powders, gel tabs, extracts, or liquids. Sometimes you find
them added to drinks or energy bars. They might be used to add nutrients to your diet or
to prevent health problems. You don't even need a prescription from your doctor to buy
dietary supplements.
Who Needs a Dietary Supplement?
Ads for supplements seem to promise to make you feel better, keep you from getting
sick, or even help you live longer. Often there is little, if any, scientific support for these
claims. In fact, some supplements can hurt you. Others are a waste of money because
they don't give you any health benefits.
So, should you or your elderly parents take a supplement? You might want to talk to a
doctor or a registered dietitian to answer that question. A friend, neighbor, or someone
on a commercial shouldn't be suggesting a supplement for you or an elderly relative.
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Are Supplements Safe?
If you or your senior parent is thinking about taking a supplement, you should remember
that these "over-the-counter" substances are not like the penicillin or blood pressure
medicine a doctor might prescribe. The U.S. Food and Drug Administration (FDA) has to
check prescription drugs to make sure they are safe and do what they promise before
they are sold. The same is true for "over-the-counter drugs" like cold and pain
medicines. It is not the FDA's job to check dietary supplements in the same way. That
means that they are not reviewed by the FDA before being sold. However, it is the
FDA's job to take action against unsafe products on the market. Only if enough people
report problems with a dietary supplement, can the FDA study these possible problems
and take action.
Vitamins and minerals are nutrients found naturally in food. We all need them to stay
healthy. The benefits and side effects of many vitamins and minerals have been studied.
The best way to get vitamins and minerals is through food consumed, not through any
supplements taken. You and your senior mom or dad should try to eat the number of
servings of food recommended by the U.S. Department of Agriculture's Food Guide
Pyramid each day. Pick foods that are lower in fat and added sugars. If you or your
senior parent can't eat enough, then ask a doctor if taking a multivitamin and mineral
supplement is necessary.
Remember, the supplement doesn't need to be a "senior" formula, it shouldn't have
large or "mega-doses" of vitamins and minerals, and generally store or generic brands
are fine.
So how much should be taken? The National Academy of Sciences (NAS) has
developed recommendations for vitamins and minerals. Check the label on the
supplement bottle. It shows the level of vitamins and minerals in a serving compared
with the suggested daily intake.

7
For example, a vitamin A intake of 100% DV (Daily Value) means the supplement is
giving you the full amount of vitamin A you need each day. This is in addition to what
you are getting from your food.
Some people might think that if a little is good, a lot must be better, but that doesn't
necessarily apply to vitamins and minerals. Depending on the supplement, the age of
the person taking it, and their health, taking more than 100% DV could be harmful to
overall health. Also, if the body cannot use the entire supplement taken, you or your
elderly parent has wasted money. Finally, large doses of some vitamins and minerals
can also keep prescription medications from working as they should. People over the
age of 50 might need certain supplements, so talk to your senior parents' doctor before
starting supplements.
Vitamin and Mineral Intake Guidelines for Seniors
 Vitamin B12 — 2.4 mcg (micrograms) of B12 each day. Some foods, such as
cereals, are fortified with this vitamin. But, up to one-third of older people can no
longer absorb natural vitamin B12 from their food. They need this vitamin to keep
their blood and nerves healthy.
 Calcium — 1200 mg (milligrams), but not more than 2500 mg a day. As people
age, they need more of this and vitamin D to keep bones strong. Bone loss can
lead to fractures, mainly of the hip, spine, or wrist, in both older women and men.
 Vitamin D — 400 IU (international units) for people age 51 to 70 and 600 IU for
those over 70, but not more than 2000 IU each day.
 Iron — Men and postmenopausal women need 8 mg of iron a day. Extra iron
may be necessary for women past menopause who are using hormone
replacement therapy. Iron helps keep red blood cells healthy. Postmenopausal
women who use hormone replacement therapy may still experience a monthly
period and they need extra iron to make up for this loss of blood.
 Vitamin B6 — 1.7 mg for men and 1.5 mg for women daily. This vitamin is
needed for forming red blood cells and to keep overall health.
What Are Antioxidants?
You may have heard about the possible benefits of antioxidants, natural substances
found in food. Right now, there is no proof that large doses of antioxidants will prevent
chronic diseases such as heart disease, diabetes, or cataracts. Eating fruits and
vegetables (at least five servings a day) rather than taking a supplement is the best way
for both you and your senior parent to get antioxidants. Vegetable oil and nuts are also
good sources of some antioxidants. Non-dairy calcium sources are especially good for
people who cannot use dairy products.
What About Herbal Supplements?
You may have heard of ginkgo biloba, ginseng, Echinacea, or black cohosh. These are
examples of herbal supplements. They are dietary supplements that come from certain
plants, and since they come from plants, it's easy to think they are safe. Furthermore,
although herbal supplements are not approved as drugs, some are being studied as
possible treatments for illness. However, it's still too soon to tell. Remember some
strong poisons (like hemlock) and some prescription medicines like cancer drugs come
from plants as well, so care should be taken.
When you or your elderly parent use any dietary supplement including herbals for a
health problem, you are using that supplement as a drug. Because the ingredients may
have an effect on the body, they can interfere with medications already being taken.
Some herbal supplements can also cause serious side effects such as high blood
pressure, nausea, diarrhea, constipation, fainting, headaches, seizures, heart attack, or
stroke.
If you are thinking about using dietary supplements for your senior parent, remember:
 Talk to the doctor or a registered dietitian first. Just because something worked
for your neighbor's elderly parent, doesn't mean the same will be true for your
senior mom or dad.
 Use only the supplement the doctor or dietitian decided on—don't buy
combinations with unnecessary added supplements.

8
  If the doctor does not suggest a dietary supplement, but your senior parent
has decided to use one anyway, tell the doctor. Then he or she can keep an eye
on your aging parent's health and adjust their other medications if needed.
 Learn as much as you can about the supplement your senior mom or dad is
thinking about, but be aware of the source of the information. Could the writer or
group profit from the sale of a particular supplement?
 Buy brands you know from companies you, your doctor, your dietitian, or your
pharmacist know are reputable.
 Remember that many of the claims made about supplements are not based on
enough scientific proof. If you have questions about a supplement, contact the
firm or a doctor and ask if it has information on the safety and/or effectiveness of
the ingredients in its product.
Here's what one active older person does: When Pearl was nearing 60, she was
concerned about remaining healthy and active as she aged. She began to exercise.
Now she takes a long, brisk walk 3 or 4 times a week. In bad weather, she joins the mall
walkers. In good weather, she also works in her garden. She had long since stopped
smoking. Pearl tries to follow a healthy diet. She reads the newspaper daily. She's even
learning how to use a computer and keeps in touch with her family by email, as well as
phone calls. She always wears a seatbelt when in a car. Last month, she danced at her
granddaughter's wedding. Pearl is now 84 years old.
Have your elderly parents try following Pearl's example—sticking to a healthy diet,
exercising, keeping their minds active, not smoking, and seeing their doctors regularly.

The National Institute on Aging (NIA), one of the 27 Institutes and Centers of the
National Institute of Health (NIH) leads a broad scientific effort to understand the nature
of aging and to extend the healthy, active years of life. In 1974, Congress granted
authority to form NIA to provide leadership in aging research, training, health information
dissemination, and other programs relevant to aging and older people.
Dietary Supplements = Danger for the Elderly!
Published on Friday, 13 April 2012 16:32 Written by Stanton O. Berg
The AARP Bulletin for April 2012 had a cover page note: “When Natural is
Dangerous - Vitamins and herbs can interfere with your Meds.” The inside article in
the “Your Health” section was headlined: “When Supplements Become Dangerous”.
(Peter Jaret) The size of the problem is outlined with these statements “Millions take
dietary supplements. People assume they are harmless. They’re not, especially for
those over 50.” AARP Public Policy Institute survey of people age 50 and older found
that 59 percent took them daily. Fewer than half said they talked to their doctors about
the pills they took. Because the supplements are often advertised as “Natural” and sold
in health food stores, it implies that they are harmless. (Vitamins, Minerals and Herbs
make up most supplements.)
FDA Regulation is of little value. While they regulate dietary supplements they do not
apply the same rules that are used for medications. The Manufacturers are not required
to obtain approval from the FDA before marketing supplements. While they are required
by law to make sure their supplement products are safe, the FDA only gets involved
when troubles arise. It was pointed out that adverse reactions by the supplements to
prescription drugs go undetected for a long time, even by the doctors.
The reason the elderly are the most often affected is that they tend to take more
prescription drugs then the younger person. This increases the risk of adverse
reactions. They also tend to have more chronic conditions like kidney or liver disease
which may interfere with the body’s ability to process the compounds that make up the
supplements. Alzheimer's is of course a chronic disease as are the other dementia
producing diseases! (A chronic disease is one defined as a disease that is persistent
or of long lasting nature.) Cancer is a chronic disease. I remember just recently when I
visited my Oncologists for follow up on my kidney and prostate cancer and seeing no
one but seniors in the waiting room. Of course there are many with cancer that are of
younger ages, but the seniors are by far the greatest in number!

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FISH OIL: My Personal Experience - This article brought to mind my own recent
experience with “Fish Oil” as a supplement. I have an arthritic condition in my knees
and was looking for pain and discomfort relief. I often joke about my many physical
problems and ailments that require a platoon of doctors to keep me going…one of the
doctors suggested “Fish Oil” and provided me with a bottle marketed under a brand of
“Doctor’s Natural Therapy”. The gelatin capsules contained 1000 mgs of “Marine Fish
Oil.” It was recommended that I start out with 2 a day for the first week and suggested
that in a week time I would note a big improvement in my comfort. No discussion was
had as to my other medications or other ailments. When I returned home and read the
recommendations on the bottle, the suggestion was 1 per day instead of 2 a day. On my
own I decided I would follow the bottle recommendations. I notified my primary care
doctor (Geriatrics and Internal Medicine) who expressed some concern about
increased risk of internal bleeding in connection with the Fish Oil use. I was
already taking 1 aspirin a day. I was cautioned to watch my daily stools for any evidence
of bleeding. A few days later my primary doctor took my blood pressure in a routine
check and found an alarming drop in pressure... Where I normally had a reading of
around 120/60 with BP medications, this had changed to 85/55. I was asked if I had any
light headed or dizzy episodes or fainting…I had not but I was told to immediately
discontinue the “Fish Oil”. In thinking back, I could not help wondering that if I had
followed the original suggestion of doubling the dosage, I might not have awakened
the next morning.
Here is a cautionary list from the AARP article. This is not an exhaustive list but
simply the supplements discussed in the article…there are many others…talk
with your doctor or pharmacist about your specific supplements…
ALOE VERA: “When taken orally in laxative preparations, it may interact with blood
sugar-lowering medicines used to treat diabetes.”
BITTER ORANGE; “It contains chemical that can speed heart rate and increase blood
pressure to dangerous levels.”
GARLIC: “Garlic may seem harmless, but at the high doses found in supplements,
garlic acts as a blood thinner. If you’re on a prescription drug to prevent blood clots,
garlic supplements may make you blood too thin, increasing the risk of excessive
bleeding.”
On a lighter Note: In Gary, IN no one allowed to enter a Theater or Public Vehicle
within 4 hours of eating Garlic!
GINKGO: Linked to adverse interactions with psychiatric medications.
GINSENG: “Can reduce concentrations of the anticoagulant drug Warfarin and can
interact with some antidepressant medications.”
KAVA: “Has been reported to cause liver damage, including hepatitis and liver failure. I
may also impair driving ability.”
LICORICE ROOT: “Can cause high blood pressure and salt and water retention, raising
risk of heart problems.”
MELATONIN: “Can reduce effectiveness of antidepressant, anti-anxiety and blood
pressure meds. It can increase bleeding risk if you’re on blood thinner.”
PSYLLIUM: "Can cause problems by reducing absorption of prescription
medications..."
REUMOFAN: (Aug. 22, 2012) — Consumers should not use Reumofan dietary
supplements because they could cause serious problems such as bleeding,
stroke and death, the U.S. Food and Drug Administration says.
SAINT JOHN’S WORT: “Can reduce the effectiveness of a variety of prescription
medications, including anticoagulants and antidepressants. It also can decrease the
effectiveness of cancer drugs by up to 40 percent.”
VITAMIN C: "In megadoses, can interfer with the effectiveness of cancer drugs."
VITAMIN K: “Essential for health, vitamin k helps in blood coagulation. Taking too much
can block the effect of the medication Warfarin, used to prevent blood clots.”
YOHIMBE: “Added to some erectile dysfunction herbal supplements, can cause
seizures, severe low blood pressure or heart problems…may interact with a variety of
medications.”

10
ZINC: ”Excess zinc can cause nausea, vomiting, loss of appetite, stomach cramps,
diarrhea and headaches. It can interact with a variety of prescription drugs including
antibiotics and hypertension meds.”
The following statement puts a perspective on the problem: “There are 5,300 distinct
dietary supplements, and very few of them have been studied systematically ”,
says Vanessa Grubbs, M.D. and expert in kidney disease at San Francisco General
Hospital. So few dietary supplements have been tested to see how they interact with
prescription drugs that no one really knows exactly which combination are likely to
cause trouble….other dangers are contaminations”…
"Grubbs and her colleagues found that 6.5% of kidney patients were taking a
supplement that contained one or more of 39 herbs considered to be dangerous for
people with kidney problems."
The best recommendation always remains: It you are taking or planning to take a
dietary supplement, discuss it first with your primary doctor and or your pharmacist. The
ending summary in the AARP article says it very well:
“But the best place to start is with your doctor and pharmacist. Make sure they
know if you’re taking a dietary supplement of any kind, including a multivitamin.
And before you start taking any new supplement, no matter how “natural” or
harmless it may seem, talk to your doctor or pharmacist.”
The Dr. "Beers Criteria": Dangerous Drugs for the Elderly!
Published on Monday, 27 February 2012 16:40 Written by Stanton O. Berg
Note: I do not make specific or individual recommendations on treatments nor
drug usage in any specific case. If you find the contents of this page applicable to
your situation or your loved ones situation, make your decision based on a
discussion with your own doctor or a competent doctor in the field of Geriatrics
and Internal Medicine!
The Beers Criteria for identifying Dangerous Drugs for the Elderly was the
product of Dr. Mark Howard Beers (1954-2009) Dr. Beers graduated from Tufts
University and was awarded a degree in Medicine in 1982 from the University of
Vermont College of Medicine. His post graduate work was done at Harvard University
and Mount Sinai Hospital in New York City. In 1987 he was appointed to the University
of California Los Angeles faculty as an assistant professor of Medicine. He also served
at the Rand Corporation as a senior natural scientist from 1989-1992.He died at age 54
in 2009 as a victim of Diabetes complications.
The New York Times on March 9 th, 2009 describes him as an “Expert on Drugs Given
to Elderly.” ”…a geriatrician whose seminal research found that some widely used
prescription drugs led to harmful and unnecessary side effects in the elderly…In the
1980’s Dr. Beers and others investigated the use of mood-altering drugs among
geriatric patients and concluded:
“That psychoactive medications were probably being too freely prescribed.”
Dr. Beers had long been an advocate for:
“Thinking three times before picking up the pen to prescribe psychoactive drugs
to elderly patients.”
”Dr. Beers and his fellow researchers made the medical establishment aware of drugs
with:
“Side effect’s far more destructive than any potential therapeutic benefit”
Wikipedia describes his work: “Beers led a team from Harvard University that studied
850 residents of Boston-area nursing homes, looking at the medications they were
prescribed and their case histories. The research published in the Journal of the
American Medical Association in 1988, found that many had symptoms of mental
confusion and tremors that were caused by antidepressants, antipsychotics and
sedatives that they had been prescribed.”
“Beers Criteria” was established: Using the Harvard research as a foundation, Dr.
Beers prepared a list in 1991 called “Beers Criteria”.” The Beers Criteria (or Beers List)
is a list of specific medications that are generally considered inappropriate when given
to elderly people. For a wide variety of individual reasons, the medications listed tend to

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cause side effects in the elderly due to the physiologic changes of aging. The list was
originally created by Dr. Beers while he was a part of a panel set up for that purpose.
The criteria were created through consensus of a panel of experts (12) by using the
Delphi method. The Criteria were originally published in the Archives of Internal
Medicine in 1991and updated in 2003. The most recent updated was done in 2012”.
The new revised update of 2012 is by the American Geriatrics Society. Click on the
below link for their updated listing and discussions.
An alternative to Beers list has also been created, called the STOPP (Screening Tool
for Older Persons of potentially inappropriate Prescriptions) criteria. The STOPP
Criteria criticizes the Beers List because, when used as a simple checklist, (which is
really what it is and what is should be used for) the Beers List neglects the patient's
medical diagnosis, psychosocial status, and activities of daily living, drug approval (e.g.,
European Agency approved or FDA approved), and causality. This is documented in the
Archives of Internal Medicine June, 2011. The criticisms are simply the considerations
that one would normally expect to be supplied by the care team involved.
Note: In order to undrstand the current and latest research subsequent to the
"Beers Criteria" of 1991 , 2003 and now the update of 2012, it is necessary to refer
to the companion essays on this website that deal with all of the latest and
current studies, trials and findings in the specific areas of Anti-depressants and anti-
psychotic drugs that are subsequent to the Beers work::
See the companion essay on the inappropriate and dangerous use of anti-depression
drugs in the treatment of Alzheimer's and dementia victims: There are no such drugs
approved by the FDA.
See the companion essay on the dangerous use of anti-psychotic drugs on
Alzheimer's and dementia victims...another class of drugs that has no FDA approval for
such usage:
Note: Both my mother Ellen and my Wife June were victims of Alzheimer's and in
addition were victims of improperly prescribed drugs. My mother Ellen was on
antipsychotic drugs with the FDA Black box warnings...she died on 21 October 2007 as
a result of the exact black box warning on the medication she was taking. My inquiries
to her doctor about the drug was pending when she died. My wife June struggled with
this terrible disease for almost 11 years when she gave up the battle and was called to
her Heavenly home on 23 October 2008 - almost exactly one year later then my mother
Ellen's death. During her long struggle with the disease she fell 8 times at the
Alzheimer's faciltiy and became so fearful of walking that she was in a wheel chair for
the remaining 2. 5 years of her life. June was on anti-depressants at the time of her
falls. When I finally determined the cause of the falls, it was too late. I hope that the
above information as well as the information on the other drug essays on this website
will help others to avoid my mistakes and ignorance.
Note: For greater detail on June's life with Alzheimer's and her struggle with the disease
of almost 11 years, please click on the below link for the article found on this website on
the drop down menu on the top blue navigation strip on the "June and Alzheimer's"
label:
"June K. Berg's Journey into Alzheimer's"
June's obituary is found on the same blue navigation strip, under the tab/label "In
Memoriam" on on the drop down menu:
"June K. (Rolstad) Berg - In Memoriam".

Food & Drug Interactions: Taking Your Pills With a Dose of Caution
Last Updated: April 30, 2015
Approximately half of Americans aged 65 and older take five or more medications daily,
and many mix prescription drugs, OTC medications and herbal supplements, according
to a report from the University of Florida College of Nursing.
While anyone who takes both dietary supplements and medicines runs the risk of
experiencing an interaction, changes associated with aging make seniors more

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susceptible, says clinical consultant pharmacist Lawrence Lemchen, who specializes in
geriatrics in Bellevue, Washington.
"I've filled prescriptions for 17 medications [for one elderly person]," says Lemchen.
"When you're combining that many drugs and you add anything else to the mix, the
likelihood increases that you are to cause an interaction of some sort."
In addition to herbal supplements, certain foods can interact poorly with prescription
medications. Other types of non-herbal supplements, such as melatonin and S-
adenosylmethionine, can also interfere with prescription medications, according to the
American Council on Science and Health.
"Basically, a person who has significant medical problems needs to be very careful
when they take any over-the-counter medication or herbal supplement because it
definitely has the potential to interact with prescription medication," says Lemchen. "The
important thing is just to be cautious."
How Do Food & Drug Interactions Happen?
When a drug is taken orally, it usually travels from the stomach to the liver. Here,
specific enzymes then break down and metabolize the drug (or, in other words, process
the chemicals and remove them from your body). Introducing new substances at the
same time can potentially interfere with these enzymes. When this happens, your
medications can be rendered ineffective or their effects can be unintentionally
increased.
"You can potentially saturate the enzyme system so there's not enough enzyme left over
to metabolize your drug. Then you're raising your dose without anyone knowing it,"
explains outpatient pharmacist Howard Crabtree at Harborview Medical Center in
Seattle. "Or there's the opposite scenario in which drugs, herbal products and foods act
as enzyme inducers. Then you get an abundance of enzymes that chew up everything
in their path, causing sub-therapeutic doses of both agents."
Although the Federal Drug Administration (FDA) released a public health advisory in
2000 about the risk of potential drug interactions with St. John's wort, for the most part
its studies have focused almost exclusively on the effects of mixing different prescription
drugs-which means that food and drug interactions caused by dietary and herbal
supplements are not well understood. And while the potential risks of interactions should
certainly not be dismissed, it's worth noting that there is some disagreement as to the
extent to which vitamins and herbal supplements are dangerous.
One 2004 study of conducted by the University of Pittsburgh, for example, found that
94% of food and drug interactions did not have serious consequences-a conclusion that
surprised many health care professionals. A more recent study published in the March
2006 medical journal Geriatric Nursing, however, tracked 58 elderly women, who
reported taking at least one herbal product while using over-the-counter or prescription
medications, and discovered more alarming results. The study detected 136 drug
interactions among the women-41% of which were deemed high risk and 58% moderate
risk. Despite their different findings, researchers in both cases came to a similar
conclusion: because limited information on food and drug interactions exists,
communication between caregivers and patients is essential.
Which Herbs & Foods Can Cause Interactions?
The following are just a few of the foods, herbs, and vitamins that have been known to
cause interactions with prescription medications:
Herbal Supplements
A recent Institute of Medicine Report, sponsored by the FDA, found that Americans
spend close to $16 billion a year on dietary supplements. And while the use of herbal
products among Americans 65 and older has risen dramatically since the late '90s, a
2005 national study found that 49% of elderly patients taking herbal remedies had not
reported their use of supplements to their doctors.
"It can get very confusing, especially for seniors," says Lemchen. "It's already hard to
keep track of as many as nine or ten medications, then you see ads for these herbal
remedies that make all sorts of promises."
Herbal supplements are the most worrisome potential interaction agents, adds
Crabtree, primarily because they are very loosely regulated in the United States. "At

13
least with grapefruit juice, for example, you know what it is and you know what the
concentration is in a given product because it's regulated by FDA," he says. "Herbal
supplements come in any number of dosage forms and concentrations and can vary
from batch to batch. The box right next to another on a shelf could have a totally
different concentration."
In order to minimize potential dosage variations, Lemchen and Crabtree both stress the
importance of buying supplements from reputable brands. There are a variety of herbs
and herbal supplements that can harbor potential risks, but common interaction-causing
culprits include St. John's wort, ginkgo biloba, goldenseal, kava, ephedra, and garlic.
Individuals taking high blood pressure medications, anticoagulants, diabetes
medications, heart medications, monoamine oxidase inhibitors (MAOIs), and drugs that
affect the liver should be particularly cautious when taking these supplements.
Grapefruit Juice
The exact chemical or chemicals in grapefruits that cause interactions are unknown, but
the citrus fruit's pulp, peel, and juice can interfere with your enzymes and essentially
increase the dosage levels of certain drugs. Avoid grapefruit juice if you are taking
certain anti-seizure medications, antidepressants, benzodiazepines, calcium channel
blockers, anti-arrhythmic drugs, pain medications, and impotence drugs, among others.
Vitamin K & Vitamin E
Vitamin K (found in vegetables such as spinach, kale, broccoli, and Brussels sprouts)
and Vitamin E (also in leafy green vegetables, as well as vegetable oils and nuts)
produce blood-clotting substances and can reduce the effectiveness of anticoagulants
such as warfarin (Coumadin®). Because warfarin is highly sensitive to interactions and
changes in diet, adds Lemchen, it is particularly important for individuals taking the
medication to monitor their dietary intake.
Zinc & Echinacea
Vitamins containing zinc and herbal supplements containing Echinacea act as
stimulants for the immune system, which can interfere with drugs such as
corticosteroids or cyclosporine that are meant to suppress the immune system.
Echinacea should also be avoided when taking medications that affect the liver, such as
Arava® or Nizoral®.
When your doctor or pharmacist asks about your medications, remember to include
over-the-counter drugs, herbal supplements, and vitamins in your response. Your
medical providers should warn you about potential food and drug interactions, says
Lemchen, but it's also imperative to keep track of your medications (and their potential
side effects) yourself-especially if you have more than one provider.
Ultimately, Crabtree and Lemchen both stress the importance of being open with your
medical providers, whether it means mentioning new side effects or sharing what you
may suspect is too much information. "Don't leave anything out, even if you think it's
irrelevant," says Crabtree. "Let [your doctor or pharmacist] decide what's relevant and
what isn't."
How to Prevent Senior Malnutrition
Not only do seniors have different nutritional needs than younger adults, they also take
more medication, have higher rates of chronic medical conditions-such as diabetes and
heart disease-and are more likely to live alone; all of which contribute to the rising
numbers of older Americans who are seriously impacted by a deficient diet.
Know the signs and symptoms of senior malnourishment and how to protect your older
loved ones from this preventable state.
Causes of Malnutrition in Seniors
 Lack of interest in cooking
 Living alone and eating for one
 Changing taste buds
 Medication side-effects that supress appetite or create bitter tastes
 Restricted diets such as low sodium or low fat diets
 Preferring to drink alcohol over eating
 Trouble swallowing
 Trouble chewing due to sore gums or poor dental health

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  Limited income to buy nutritious food
 Expensive medications leave little room for food
 Lack of mobility - unable to get to the store
 Depression and dementia
Senior Malnutrition Prevention Checklist
1. Check the refrigerator and observe eating habits
2. Watch for health changes and fluctuation in weight
3. Encourage foods rich in the 5 key vitamins and nutrients
4. Boost hydration with 9 glasses of water a day
5. Ask for help when you need it from sources like A Place for Mom
Top 5 Vitamins and Nutrients for Older Adults
1. Folic Acid 400 mcg per day: Foods rich in Folic Acid: spinach, asparagus,
breakfast cereal, lentils.
2. B-12 2.4 mcg per day: Foods rich in B-12: turkey, salmon, crab, clams, mussels,
chicken, beef, eggs, milk.
3. Vitamin C 75-90 mg per day: Foods rich in Vitamin C: oranges, grapefruit,
strawberries, tomatoes, sweet red pepper, broccoli, potatoes.
4. Vitamin D 600-800 IU per day: Foods rich in Vitamin D: canned salmon, sardines
or mackerel, instant oatmeal, cereal, egg yolk, soy milk, cow's milk or orange
juice fortified with Vitamin D.
5. Essential Fatty Acids (EFA) Foods rich in EFAs: flaxseed oil, canned tuna,
oysters, herring or sardines, salmon, trout, crab.
Ways to Help Seniors Stay Hydrated
Dehydration is one of the top 10 reasons seniors end up in the emergency room. A good
guide for anyone over the age 65 is to drink 9 glasses of fluid a day. Water is best,
but all liquid counts! It's important to watch sugar intake and to discourage drinking
alcohol.
1. Soup - an excellent way to increase fluid and nutrients
2. Coffee with milk
3. Tea - caffeinated or herbal
4. Iced tea - black tea or fruit-flavored herbal teas
5. Popsicles - natural, all fruit are best
6. Juice - 100% juice is best
7. Smoothies - add protein powder, yogurt and vegetables for extra nutrition
8. Coconut water - a good way to get natural electrolytes
9. Milk - chilled soy milk, rice milk, goat or cow's milk. You may also consider
steaming milk and adding a squeeze of chocolate syrup or cinnamon.
Read more about senior nutrition.
Spread the Word: Help Fight Senior Malnutrition
You can embed this infographic on your blog or website.
Elderly Dehydration: Prevention & Treatment
Last Updated: April 21, 2015
Watching for signs of illness in a loved one can be challenging. Some illnesses show up
quite clearly, while others have a more subtle effect on daily living. Dehydration,
depending on the severity, sometimes creates only small telltale signs while having a
big effect on the body, especially in the elderly.
Dehydration occurs when a person loses more water than they take in. Adequate fluid
allows the body to regulate temperature through sweating, maintain blood pressure and
eliminate bodily waste. If severe enough, dehydration can lead to confusion, weakness,
urinary tract infections, pneumonia, bedsores in bed-ridden patients or even death.
Generally speaking, humans can't survive more than four days without water.
Causes of Senior Dehydration
Elderly dehydration is especially common for a number of reasons:
 Medications
It's not uncommon for seniors to be on several medications at any given time.
Some of these may be diuretic, while others may cause patients to sweat more.

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  Decreased Thirst
A person's sense of thirst becomes less acute as they age. In addition, frail
seniors may have a harder time getting up to get a drink when they're thirsty, or
they may rely on caregivers who can't sense that they need fluids.
 Decreased Kidney Function
As we age our bodies lose kidney function and are less able to conserve fluid
(this is progressive from around the age of 50, but becomes more acute and
noticeable over the age of 70).
 Illness
Vomiting and/or diarrhea can quickly cause elderly dehydration.
The Myth of "8 Glasses of Water" a Day
"Everybody has a normal state of body water that relates to their weight. Anything below
that (normal state) is dehydration; everything above it is hyperhydration," Dr. Larry
Kenney, professor of physiology and kinesiology at Penn State University, explains.
That normal level of hydration varies widely from person to person. Contrary to the
mantra that everyone should drink eight glasses of water every day, Kenney says there
is nothing scientific to back that up. "People misinterpreted that to be, it had to be liquid
and it had to be water," he says.
A person's diet can greatly affect hydration levels: fruits (especially watermelon),
vegetables, and soups are mostly water-based. "Day in, day out, a lot of people get their
water from foods, as well as behavioral attitudes towards food," Kenney explains. "For
instance, when we walk by a water fountain, we tend to take a drink, and we tend to
drink when we eat."
Kenney also takes issue with the idea of not drinking caffeinated beverages because
they're dehydrating. He says the amount of caffeine in a cup of coffee or tea is relatively
small, and it's made of mostly water anyway, so it will hydrate you to some degree. The
same holds true for beer, he says, but there is a point at which the diuretic effect of
caffeine and alcohol kicks in, so moderation is always the key.
In general, larger people need to drink more water, as do athletes and those who
perspire heavily, but that may mean more or less than eight glasses a day. "There is no
one-size-fits-all remedy," he says.
Tracking Hydration
Instead, he recommends monitoring body weight to keep track of hydration levels. To
monitor body weight, one should be weighed every morning. If they've lost two pounds
or more from the day before, and especially if they feel thirsty or have a headache,
they're probably dehydrated.
Mild dehydration is defined as losing 2 percent of your body weight. Severe dehydration
occurs with 4 percent or greater body weight loss. Even mild dehydration can affect a
person's health, especially if he already has cardiac or renal problems. "We have
measured in the lab cognitive impairment," he says. "With severe dehydration, it puts a
greater strain on the heart. Think of a pump trying to pump with less fluid. That would be
one of the primary problems."
Kenney says an active 65-year-old who exercises probably doesn't need to weigh
herself every day, but a 75-year-old in a nursing home who has had issues with
dehydration in the past, or has had cardiac issues, should be weighed every day.
But, don't rely on scales that also claim to measure hydration levels and body mass
index. "Their accuracy is very poor; we can't use them even for research purposes,"
Kenney says.
Complicating matters is that signs of dehydration in younger people don't always show
up in the elderly. For example, if a young person was extremely dehydrated, his skin
may be wrinkled or sagging. But, that certainly wouldn't be noticed in most cases of
elderly dehydration.
Perhaps because of that delay in diagnosis, elderly dehydration is a frequent cause of
hospitalization (one of the ten most frequent admitting diagnoses for Medicare
hospitalizations, according to the Health Care Financing Administration), and it can be
life-threatening if severe enough.
Signs of Elderly Dehydration

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Signs of dehydration in seniors may include:
 Confusion
 Difficulty walking
 Dizziness or headaches
 Dry mouth
 Sunken eyes
 Inability to sweat or produce tears
 Rapid heart rate
 Low blood pressure
 Low urine output
 Constipation
If you suspect dehydration in an elderly loved one, you can check for a decrease in skin
turgor by pulling up the skin on the back of the hand for a few seconds; if it does not
return to normal almost immediately, the person is dehydrated.
Preventing Dehydration in Seniors
To help make sure your loved one doesn't suffer from dehydration, make sure he or she
consumes an adequate amount of fluids during the day; eats healthy, water-content
foods such as fruit, vegetables and soups; checks that urine color is light and output
adequate (dark urine or infrequency of urination is a classic sign of dehydration).
Seniors also need to be educated to drink even when they're not thirsty. Keeping a
water bottle next to the bed or their favorite chair could help, especially if they have
mobility issues.
If your loved one is in a nursing home or other care facility, make sure that the staff has
a hydration program in place that includes assisting residents with drinking, offering a
variety of beverages, and providing drinks not only at mealtimes but in between meals.
Also make sure that they monitor residents' weight and assess them if their physical
condition or mental state changes. If dehydration is an issue, and your loved one takes
laxatives or diuretics, speak to his or her doctor about changing medication.
As with most illnesses, prevention is the key. Making sure your loved one stays
hydrated now is much easier than treating him or her for dehydration later.
7 Tips for Avoiding Elderly Heat Stroke & Exhaustion
Last Updated: April 21, 2015
Hot weather is dangerous, and seniors are particularly prone to its threat. Elderly heat
stroke and heat exhaustion are a real problem. In fact, a recent University of Chicago
Medical Center study found that 40% of heat-related fatalities in the U.S. were among
people over 65.
There are several reasons for elderly heat vulnerability. People's ability to notice
changes in their body temperature decreases with age. Many seniors also have
underlying health conditions that make them less able to adapt to heat. Furthermore,
many medicines that seniors take can contribute to dehydration. Fortunately, a few
simple precautions are all that's needed to keep safe.
Here are some guidelines for keeping safe in hot weather:
1. Drink Plenty of Liquids
Dehydration is the root of many heat related health problems. Drink plenty of
water or juice, even if you're not thirsty. But remember to avoid alcoholic or
caffeinated drinks, as they can actually contribute to dehydration.
2. Wear Appropriate Clothes
An old Swedish saying says, "There's no such thing as bad weather, only bad
clothes." When it's hot out, wear light-colored, lightweight, loose-fitting clothes
and a wide-brimmed hat.
3. Stay Indoors During Mid-day Hours
During periods of extreme heat, the best time to run errands or be outdoors is
before 10am or after 6pm, when the temperature tends to be cooler.
4. Take it Easy
Avoid exercise and strenuous activity, particularly outdoors, when it's very hot
out.

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 5. Watch the Heat Index
When there's a lot of moisture in their air (high humidity), the body's ability to cool
itself through sweating is impaired. The heat index factors humidity and
temperature to approximate how the how the weather really feels. The current
heat index can be found on all popular weather websites, and is also usually
announced on local TV and radio weather reports during periods of warm
weather.
6. Seek Air-conditioned Environments
Seniors whose houses aren't air-conditioned should consider finding an air-
conditioned place to spend time during extreme heat.The mall, library or movie
theater are all popular options. During heat waves, many cities also set up
"cooling centers," air-conditioned public places, for seniors and other vulnerable
populations. Seniors without convenient access to any air-conditioned place
might consider a cool bath or shower.
7. Know the Warning Signs of Heat-related Illness
Dizziness, nausea, headache, rapid heartbeat, chest pain, fainting and breathing
problems are all warning signs that help should be sought immediately.
Learn how there's an elderly death risk linked to higher temperatures and get info on
dealing with elderly dehydration.

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