In a generally healthy older adult, which supplements have proven evidence for reducing age‑related disease risk or extending lifespan?

Supplements with Proven Evidence for Healthy Aging

For generally healthy older adults, vitamin D (with calcium), omega-3 fatty acids at specific doses, and creatine have the strongest evidence for reducing age-related disease risk, while vitamin E at 200 IU/day shows proven immune benefits but requires careful consideration of bleeding risks. 1, 2, 3, 4

Tier 1: Strongest Evidence (Guideline-Supported)

Vitamin D + Calcium

• Take 1,200 mg calcium daily plus vitamin D supplementation to prevent bone loss and fractures 5, 6
• This combination has "strong and compelling support for health benefits" when intake is suboptimal 6
• The American Diabetes Association specifically recommends this for older adults 5

Omega-3 Fatty Acids (EPA + DHA)

• Take 850-1,000 mg combined EPA+DHA daily if you have any cardiovascular risk factors 2
• This dose reduces sudden cardiac death by 45% and total mortality by 15% in those with established cardiovascular disease 2
• The protective effect is particularly strong in older adults with hypertension 2
• Do not expect stroke prevention from standard doses (600 mg/day showed no benefit for secondary stroke prevention) 2
• Avoid doses above 4 grams daily due to 25% increased atrial fibrillation risk 2

Vitamin E (with important caveats)

• Consider 200 IU/day specifically for immune function enhancement 1, 3
• This dose reduces mortality by 10% in nursing home residents and improves delayed-type hypersensitivity responses (a predictor of mortality in older adults) 1, 3
• The American Geriatrics Society suggests limiting to ≤200 IU/day for optimal safety 3
• Avoid if taking anticoagulants (warfarin, etc.) due to bleeding risk 3
• Do not exceed 400 IU/day due to increased hemorrhagic stroke risk (RR 1.22) 3

Tier 2: Moderate Evidence (Condition-Specific)

Creatine

• Take approximately 2 g/day for 30 days (or 20 g/day for 5 days loading) to increase muscle mass, strength, and cognitive function 4
• Creatine supplementation increases lean body mass, enhances fatigue resistance, and improves activities of daily living in older adults 4
• Cognitive processing that is impaired due to aging can be improved with creatine supplementation 4
• Creatine is "inexpensive and safe" with both peripheral and central nervous system effects 4

Multivitamin/Mineral Supplement

• Take a daily multivitamin containing B vitamins at recommended daily allowances (16 mg/day niacin for adult males) 5
• The American Diabetes Association recommends this for older adults with reduced energy intake to address multiple micronutrient deficiencies 5
• B vitamins are crucial for energy metabolism, protein metabolism, and neural function—all declining with age 5
• However, note that evidence for health-related efficacy of multivitamins is limited despite common recommendations 6

Protein Supplementation

• Combine dietary protein supplementation with resistance exercise to prevent muscle mass loss 7
• This combination has "a strong effect in preventing age-related muscle mass attenuation and leg strength loss" 7
• Underlying micronutrient deficiencies must first be addressed for protein interventions to succeed 5

Tier 3: Insufficient or Negative Evidence

Antioxidant Vitamins (A, C, E combinations)

• Do not take antioxidant combinations for cardiovascular disease or cancer prevention 6
• Evidence does not support recommendations for vitamins A, C, E, or antioxidant combinations in preventing CVD or cancer 6
• Biogerontological knowledge predicts that "taking antioxidant dietary supplements does not increase lifespan" 1

High-Dose Vitamin E

• Avoid doses >400 IU/day due to increased all-cause mortality (RR 1.04) and prostate cancer risk (1.6 per 1,000 person-years) 3

Critical Pitfalls to Avoid

• Do not assume all supplements are safe simply because they are "natural"—vitamin E increases bleeding risk, high-dose omega-3s increase atrial fibrillation risk 2, 3
• Do not use standard-dose omega-3s (600 mg/day) expecting stroke prevention—this has been disproven 2
• Do not combine vitamin E with anticoagulants without medical supervision 3
• Do not exceed the Tolerable Upper Limit for vitamin E (1,000 mg or ~1,500 IU) 3
• Do not recommend injectable NAD+ or similar unproven anti-aging interventions—they lack regulatory approval and clinical guidelines 5

Dietary Approaches with Strong Evidence

Beyond supplements, adopt a Mediterranean-style diet rich in vegetables, fruits, olive oil, nuts, and fish 1

• This dietary pattern substantially reduces cardiovascular disease risk to a greater extent than standard low-fat diets 1
• The diet provides mithormetic compounds, has a low glycemic index, and contains anti-inflammatory substances 1
• Vegetarian diets are associated with reduced all-cause mortality and provide more plant-based proteins with lower methionine content 1

Consider intermittent fasting (fasting every other day or several days per week with up to 75% calorie reduction) for improved cardiovascular markers 1

• Preliminary studies show improvement in LDL cholesterol and insulin sensitivity 1