Should I take vitamin supplements?

Our nutritional needs are complex and while vitamin and mineral supplements may help - they may not. We simply don't have the science yet to confirm or refute the claims made for dietary supplements. The fact that a deficiency of something is harmful does not mean that an excess of it does you good.

Supplements should never be a substitute for a healthy diet but may be helpful for certain people at certain times, for example, those who cannot eat properly for whatever reason, people who omit whole food groups (such as fruit and vegetables or fish) and vitamin D supplements for people who can't get into the sun.

Some scientists recommend one pill that may surprise you - aspirin. There is some evidence that it can help to prevent coronary thrombosis, cancer of the colon and possibly cataract too, though further studies need to be done. The precise dose has not been established - a 0.75 gram tablet once a day is reasonable and even one a week may be enough to gain some benefit. Not everyone can tolerate aspirin, so it's important to check with your doctor, especially if you have gastric problems.

Should I eat bran?

Dietary fibre is an essential part of our diet as it helps food through the gut. Without it we don't just get constipation and haemorrhoids, we are also at risk of varicose veins, diverticular disease and possibly colon cancer. But older people should never add raw bran or bran-rich cereals or products to their diets. They contain phytates which can bind with minerals such as calcium, zinc, iron and copper and reduce their availability in the body. Also, raw bran can simply clog up the gut, making constipation more likely. Dietary fibre is best obtained from wholemeal bread and breakfast cereals, fruit, vegetables and brown rice.

Soluble fibre is a different type of fibre. It plays a key role in how we process glucose and reduces blood cholesterol. It is found in fruit, vegetables, oats and pulses.

Is alcohol good or bad for you?

There are many advantages to being middle-aged and older and one of them is that alcohol is positively good for most of us! Once men have reached 40 and women are past the menopause, alcohol starts to protect the cardiovascular system because it thins the blood.

The health benefits come from drinking small amounts regularly. Modest amounts of alcohol also help to prevent gallstones, prostate problems and cognitive impairment.

All types of alcohol offer these benefits - there is no truth in the notion that red wine is especially beneficial. Nor is it true that alcohol and antibiotics don't mix; only one, rarely used antibiotic (metronidazole) should not be mixed with alcohol.

Of course, if you are teetotal there is no evidence to suggest that you would benefit from starting to drink. If you do drink, alcohol should be taken in moderation, preferably with a meal. People taking prescription medicines or even some over the counter drugs should always check whether the medication is affected by alcohol.

Obviously even moderate levels of alcohol impair the ability to drive safely and can increase the risk of falls. Moderation means a maximum of three to four units a day for men and two to three units for women (one unit is half a pint of average-strength beer, one glass of wine or a standard pub measure of spirits or fortified wines such as sherry. Home measures are often more generous than pub measures of course!) So enjoy it!

How much water is enough?

Water is the part of our daily diet that we all tend to forget about, but insufficient fluid can be serious, leading to constipation and even mental confusion. Many older people are actually slightly dehydrated. One difficulty is that the sensation of thirst declines as we age and thirst can be mistaken for hunger, so we eat when we should drink. We need to drink at least one and half litres of fluid a day (that's around six mugfuls), but we need more if we are not eating properly, for example during illness.

It is almost impossible to drink too much. Fruit juices, squash, milk, tea (in moderation) and herbal teas are all useful alternatives to water. It's important to know that alcohol and caffeine are diuretics, this means that an excess of them will increase the amount of water that we excrete in our urine. However you still take in more liquid than you lose from a cup of tea, coffee or a cola-type soft drink.

Try to drink a variety of drinks to keep your water intake up and remember you can't beat water itself!

Does carrying a bit of extra weight matter?

An astonishing two out of three people over 65 living at home are overweight. Obesity makes the many disorders mentioned in this section more likely, but it also has another damaging effect in later life - it often restricts activity. That in turn means loss of all the benefits of exercise, such as declining strength and cardiovascular health. Obesity also erodes the quality of life because it often leads to 'mechanical' disorders like lower back pain, breathlessness and sleep apnoea.

It's important to avoid weight gain - and it may be a good idea to lose weight - but as we age it needs to be tackled carefully. There is a big risk that restricting calorie intake drastically could affect nutritional health in other ways. The basic rules are: eat three sensible meals a day, drink more water and take some exercise. It's possible to control weight by exercise alone - and still enjoy those puddings! If you need to lose weight, avoid crash diets and get professional advice. Being underweight in later life is not a good idea, either. Not only is there a risk of missing some nutrients but underweight people have a higher risk of osteoporosis.

What is all this talk about a 'new cholesterol'?

Homocysteine is an amino acid found in blood. It is to be thought of as cholesterol and researchers are discovering that too much of it may be a bad thing. It has been reported that high levels of homocysteine can increase our risk of heart disease fivefold. Research into Ageing-funded scientists are also investigating a possible link between high homocysteine levels and Alzheimer's disease.

People with Alzheimer's show signs of abnormal blood clotting and this study is investigating whether high levels of homocysteine may be implicated. Blood clotting in the small blood vessels in the brain could trigger a series of events that lead to the brain damage typical of Alzheimer's patients.

Homocysteine levels tend to rise as we get older but are normally kept under control in the body. The control mechanisms may have a genetic basis, but they are also influenced by three vitamins - vitamins B12, B6 and folate. A deficiency of any of these three vitamins can lead to increased levels of homocysteine. If this study finds a link between Alzheimer's and vitamin B deficiencies, we will have the first real breakthrough in preventing the illness, or limiting its severity.

So, it make sense to keep up our intake of B vitamins to protect our hearts and maybe our minds too. Vitamin B12 comes from meat, eggs, fish, offal and milk; folate from liver, orange juice, dark green vegetables, nuts and wholemeal bread, and vitamin B6 from potatoes, beef, fish, poultry and breakfast cereals, particularly the wholegrain variety. It is not advisable to take high daily doses of folic acid as a supplement however, except under medical advice, as it may mask a deficiency of vitamin B12.