A woman I'll call Beulah came to a Seasons of Grace session last fall carrying a brown paper grocery bag. She set it on the chair beside her and waited until the room had emptied. Then she lifted out fourteen bottles, one at a time, and lined them along the edge of the table. Multivitamin. Two different fish oils. Calcium. Magnesium. Turmeric. A pricey "brain support" formula. CoQ10. A probiotic with twelve strains. Resveratrol. A green powder. Two bottles whose labels she couldn't pronounce. She looked at me and said, "I spend more on these than I do on groceries some months. My daughter thinks I'm being conned. Am I?"
I didn't have a tidy answer for her that afternoon. What I had, after 40 years of sitting with older adults around questions like this one, was a longer answer: most of those bottles were probably doing nothing. A couple might be doing harm. Two or three might be worth keeping, depending on her bloodwork and her diet. The hard part wasn't the science. The hard part was telling Beulah that the industry built on her hope of staying well had, in many cases, sold her something closer to a story than a medicine.
This is the article I wish I had handed her that day.
What the Big Trials Actually Found
Before we talk about any single supplement, sit for a moment with the bigger picture. Over the last 25 years, several large, well-designed trials have tested supplements specifically in older adults. The pattern is not what the bottles on the pharmacy shelf suggest.
The VITAL trial, published in the New England Journal of Medicine in 2018, followed nearly 26,000 adults over five years. Vitamin D at 2,000 IU daily and marine omega-3 at 1 gram daily were tested against placebo. The result: no significant reduction in cancer or major cardiovascular events. The COSMOS trial in 2022 looked at multivitamins in roughly 21,000 adults and found a small signal for cognition but a mixed picture overall. The SELECT trial of vitamin E and selenium for prostate cancer was stopped early when vitamin E appeared to increase risk. HOPE-2 and similar trials of B-vitamin combinations for heart disease showed no benefit.
The lesson I've drawn from 25 years of reading these results alongside my clients is plain. If you are not deficient in something, taking more of it rarely helps and sometimes hurts. The body is not a bank account where extra deposits earn interest. It is closer to a thermostat. Set it where it belongs and leave it alone.
This is why the rest of what I'm going to say is built around a question, not a list: what does your body actually need that it is not getting? That question, answered honestly with your doctor and ideally with bloodwork, is worth more than any "top supplements" article on the internet, including this one.
The Short List of Supplements Worth Considering
There are perhaps six things I find myself talking about most often with older adults. None of these is a guarantee. Each has a real reason to be on the table, and each one deserves a conversation with the person who knows your medical history.
Vitamin B12. Roughly 10 to 30 percent of adults over 65 don't absorb B12 well. The villains are common: atrophic gastritis, long-term use of acid-blocking medicines like omeprazole, and metformin for diabetes. A blood test will tell you where you stand. If your level is low, oral cyanocobalamin at 500 to 1,000 micrograms daily works fine for most people. The sublingual tablets cost more and don't do more. That's marketing, not absorption.
Vitamin D. The story here has softened in the last few years. The Endocrine Society's 2024 update walked back the older blanket recommendation that nearly everyone over 65 should supplement. The current advice is closer to this: test 25-hydroxyvitamin D, and if your level is below about 30 ng/mL, supplement enough to bring it into a healthy range. 800 to 2,000 IU daily is reasonable for documented insufficiency. If your level is normal and your diet includes fortified milk, eggs, or fish, you may not need anything.
Omega-3 fatty acids. The VITAL trial was disappointing for over-the-counter fish oil in the general population. But REDUCE-IT, published the same year, found that prescription icosapent ethyl substantially reduced cardiovascular events in patients with high triglycerides on a statin. Two important things. First, over-the-counter fish oil is not the same molecule as icosapent ethyl. Second, eating fish twice a week — salmon, sardines, mackerel — accomplishes most of what most people need from omega-3s without a capsule.
Magnesium. Mild deficiency is genuinely common in older adults, and it can show up as constipation, leg cramps at night, or restless sleep. Magnesium glycinate or citrate at 200 to 400 mg is cheap, generally well tolerated, and not aggressively marketed (which I take as a small endorsement). It interacts with certain antibiotics and bisphosphonates, so timing matters. Separate doses by a few hours.
Calcium. This one I've grown more cautious about over the years. Calcium from food (yogurt, kale, sardines with bones, fortified plant milks) appears safe and useful. Calcium from a 1,000-mg pill, taken alongside an already adequate diet, has been linked in some analyses to a small increase in cardiovascular events. The 2010 Bolland meta-analysis in the BMJ started that conversation; it isn't fully resolved. My quiet rule of thumb: if you have osteoporosis or clearly inadequate dietary calcium, supplement modestly. Otherwise, eat the yogurt.
Protein and creatine. I add these as a pair because they aren't really supplements — they're the actual intervention. The age-related condition that quietly steals independence is sarcopenia, the loss of muscle. The research has converged on a number: 1.0 to 1.2 grams of protein per kilogram of body weight per day for older adults, ideally spread across meals, paired with resistance training twice a week. Whey or pea protein powder is a fine way to close a gap if your appetite has shrunk. Creatine monohydrate, three to five grams daily, has surprisingly solid evidence for muscle preservation and possibly cognition in older adults — the International Society of Sports Nutrition published a position statement supporting this use in 2017.
The Bottles I'd Quietly Set Aside
This is the harder part of the conversation. There are categories of supplement I now decline to recommend, even when a client brings them in with hope.
Multivitamins. The data are mixed. COSMOS suggested a small cognitive signal; the older Physicians' Health Study II and other trials found little to nothing on major outcomes. For an older adult eating reasonably, a multivitamin is unlikely to harm but unlikely to help much. I no longer push them. If you take one because it gives you peace of mind, fine. Don't expect it to do heavy lifting.
"Brain" supplements. Prevagen is the example I see most often. Its active ingredient is apoaequorin, a protein from a jellyfish. There is no rigorous evidence it improves memory. The Federal Trade Commission and the New York Attorney General both pursued the maker for deceptive marketing. The settlement is public. If a clerk recommends it, ask gently what trial they're thinking of.
NMN, NAD+ precursors, resveratrol. The underlying biology is genuinely interesting and worth following. The clinical evidence in humans is thin. These are areas where researchers are still arguing about effect sizes in mice. Save your money until human data improves.
Megadose probiotics. Specific strains have specific uses — Saccharomyces boulardii for antibiotic-associated diarrhea, for instance. The broad-spectrum 50-billion-CFU products marketed for general health are mostly faith-based purchasing. Yogurt and kefir cost less and may do more.
Coenzyme Q10 for the general population. There is some evidence it helps statin-related muscle aches in a subset of patients. For the general adult who hopes to slow aging, the data are weak. I won't talk anyone out of it if they feel better on it. I won't suggest it cold.
What's in the Bottle May Not Be on the Label
This is the part of the conversation that surprises people most. In the United States, supplements are not tested by the FDA for content or purity before they reach the shelf. Independent testing by groups like ConsumerLab.com routinely finds products that contain less of the active ingredient than the label claims, or more, or in some cases something else entirely. A 2013 study published in BMC Medicine used DNA barcoding to test herbal supplements and found product substitution, contamination, or filler in roughly a third of the bottles examined.
There are two seals worth looking for. USP Verified means the United States Pharmacopeia has tested the product and confirmed it contains what the label says, in the strength claimed, with no harmful contaminants. NSF Certified for Sport does similar work, originally aimed at athletes who can't risk a contaminated product. ConsumerLab.com offers independent testing summaries by subscription. The National Institutes of Health Office of Dietary Supplements (ods.od.nih.gov) is a free, plainspoken resource I send clients to often.
None of these seals guarantees the supplement works. They only guarantee that what's in the bottle matches the label. That's a smaller promise than most people assume they're getting when they pay extra for a brand.
The Conversation Most Pharmacists Wish You'd Have
A man I'll call Otis came to one of my groups a few years back. He was on warfarin for atrial fibrillation. His wife had read that fish oil was good for the heart, and he'd been taking 4,000 mg a day for six months. His most recent INR — the blood test that tells you how thin your blood is — had crept into a dangerous range. The cardiologist hadn't asked. Otis hadn't told.
This is the most important section of this article, and the one most people skip.
Supplements interact with prescription medicines. Sometimes in small ways, sometimes in serious ones. A short list of interactions I see often:
- Warfarin and high-dose vitamin K (or sudden changes in green-leafy intake), vitamin E, fish oil, ginkgo, garlic
- SSRIs and St. John's wort (this combination can trigger serotonin syndrome)
- Statins and red yeast rice (which contains a statin-like compound — you can essentially double-dose accidentally) or grapefruit
- Levothyroxine for thyroid and calcium, iron, or magnesium taken within four hours
- Bisphosphonates for osteoporosis and any mineral supplement within an hour or two
- Metformin and chromium
When you sit down with your doctor for an annual visit, bring the bottles. Not a list. The actual bottles, in a bag. Pharmacists are often even better than physicians at catching interactions. A free "brown bag review" with your pharmacist is one of the most useful 20 minutes you can spend.
What I Said to Beulah
We went through her fourteen bottles together over two sessions. By the end, she had three on the shelf: a vitamin D3 at 1,000 IU because her bloodwork showed insufficiency, a B12 at 500 mcg because she'd been on omeprazole for a decade, and magnesium glycinate at 300 mg because her legs cramped at night and she liked the way it felt.
The other eleven went into a small box. Some she finished slowly, the way you finish a jar of jam you don't love but already paid for. Some she gave away. The brain-support formula she returned to the store. The pharmacist who took it back agreed with her that the savings would be better spent on the salmon she'd started buying twice a week.
I thought, when she told me, of something Dr. Okonkwo said to me in a seminar at Spelman almost fifty years ago. She kept an empty chair in every class, and when a student gave a textbook answer she'd point at the chair and ask, "Would that help the person sitting there?" The textbook answer about supplements is that more is better. The answer that helps the person in the chair is closer to this: the body knows what it needs, the trials have shown us what helps, and the rest is mostly hope wearing a label.
If you are taking a wall full of bottles, you are not foolish. You are hopeful, and hope is not a character flaw. But hope deserves better evidence than the supplement aisle generally provides. Bring the bag. Have the conversation. Keep what helps. Set down what doesn't. Spend the difference on something that feeds you — fish, books, a phone call to someone you love.
You are already doing the work of staying well. The bottles were never going to do it for you.
