MIL Submissions Engine

Source: The Conversation – UK – By Rachel Harding, Research Fellow in Social Sciences, Nottingham Trent University

Ofsted, the schools inspectorate in England, was the subject of a UK parliamentary inquiry after the death by suicide of Ruth Perry, headteacher of Caversham Primary school in Berkshire, in 2023. The coroner’s report had concluded that Perry’s death was “suicide, contributed to by an Ofsted inspection”.

The parliamentary inquiry called for submissions of evidence about Ofsted from members of the public. Our recent research has analysed the 233 published submissions, many of which were from teachers. One submission to the inquiry included an impact statement by a headteacher written in 2022. It read:

The manner in which the inspection was conducted and the lack of integrity from the Lead Inspector has meant that my family have had to support me through suicidal thoughts and through countless occasions of being in floods of tears as soon as I think back to that day.

“It seems incredible that an issue like the conduct of school inspection should be a life-and-death matter, but so indeed it has become,” the submission from her school stated.

Theory of suicide

Sociological theory helps us ask questions and seek radical answers about how societies function, including government policy such as the inspection of schools.

Sociologist Émile Durkheim’s theory of suicide argues that suicide does not only happen because of mental illness, but that it also has a social context. Durkheim examined how the interaction of people and social control, as well as notions of shame, guilt, failing expectations and feeling trapped, might result in someone having suicidal thoughts and feelings.

We found evidence of teachers feeling shame. One submission mentioned “the enormous shame and distress that is felt by those leading and working within the school”.

Teachers also reported feeling trapped:

In my last inspection in November 2019, I lost half a stone in the three days (starting from the phone call) and lost my voice. My family suffered, there were arguments and I slept on the couch. The stress and pressure was all too much. As a school leader, I live in fear and I came into education because I love teaching but now I feel trapped.

The risk of a less than good inspection was “petrifying”. Having to be always ready for an inspection was “intolerable”. The thought of letting colleagues down by making a mistake was “unbearable”.

Teachers wrote about ill health because of Ofsted experiences. These accounts included vomiting, physical collapse, panic attacks, incontinence and suspected stroke with a temporary loss of speech. One wrote that they had a miscarriage the day after a deeply stressful Ofsted inspection.

The government and Ofsted’s response

The Education Committee’s report noted that the committee had heard that “Ofsted has lost trust and credibility among many in the teaching profession.”

However, a number of reports on Ofsted’s practice, including the independent learning review commissioned by Ofsted, fail to acknowledge that teachers can have suicidal thoughts and feelings because of Ofsted.

Ofsted’s developments since the inquiry include introducing report cards for schools. Ofsted says this is fairer, but teachers say it creates more stress. An independent risk assessment warns that “the revised framework does not reduce the pressure on leaders to achieve a desirable outcome. The consequence of not meeting the expected standards of the revised framework will remain high stakes in nature.”

Other developments include changes regarding inspections of provision for children in care and inspection frameworks themselves.

But we do not believe that these changes constitute the “root and branch” review of Ofsted previously called for by education leaders.

Professor Julia Waters, Ruth Perry’s sister, has said that our study “presents the evidence of the terrible human cost posed by Ofsted inspections, evidence that Ofsted and successive governments have still not fully grasped”.

Both Ofsted and the government should review how the inspectorate works. Not to do so runs the risk of school inspections remaining a life-and-death matter.

If you’re struggling with suicidal thoughts, the following services can provide you with support:
In the UK and Ireland – call Samaritans UK at 116 123.
In the US – call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or IMAlive at 1-800-784-2433.
In Australia – call Lifeline Australia at 13 11 14.
In other countries – visit IASP or Suicide.org to find a helpline in your country.

The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.

– ref. ‘A life-and-death matter’: understanding how Ofsted inspections risk suicidal thoughts in teachers – https://theconversation.com/a-life-and-death-matter-understanding-how-ofsted-inspections-risk-suicidal-thoughts-in-teachers-278478

Source: The Conversation – UK – By Katayoun Shahandeh, Lecturer in Museum Studies, SOAS, University of London

Just days before the opening of the 2026 Venice Biennale, organisers announced that Iran would no longer participate.

A short statement posted to the Venice Biennale website on May 4 said: “With regard to the National Participations in the 61st International Art Exhibition…it has been announced that the Islamic Republic of Iran will not participate.” No explanation was given. I believe that silence is itself revealing.

Iran’s withdrawal is less a sudden decision than the result of converging geopolitical and economic pressures that are reshaping both the global art world and Iran’s place within it.

At the most immediate level, the withdrawal reflects the material realities of crisis. With internet access restricted, international flights suspended and communication networks severely disrupted, even the basic logistics of participation – coordinating, shipping and installing artworks – probably became nearly impossible for Iran.

These conditions have been compounded by intensifying economic pressures, including the sharp devaluation of the Iranian rial, which has made international cultural engagement increasingly difficult to sustain.

Such constraints point to a fundamental condition of contemporary art: global exhibitions rely on infrastructures of mobility and communication that are easily destabilised by conflict and sanctions.

The timing is also significant. The decision comes amid renewed military tensions and escalating political rhetoric surrounding Iran’s position in the global order. In such moments, when political discourse edges toward existential threat, the stakes of cultural visibility are heightened. At the same time, sustaining cultural presence becomes more difficult.

Read more:
Middle East conflict looks increasingly like a war nobody can win

More revealing still was the lack of any announced artist, curatorial framework or exhibition concept for Iran’s pavilion, even days before the Biennale’s opening.

Iran’s presence at the Venice Biennale has historically been organised through state institutions, with oversight exercised by the ministry of culture and Islamic guidance since the Iranian revolution (1978-79). As with many national pavilions, this model positions art as a form of cultural diplomacy. But in Iran’s case, it has often produced a disconnect between official representation and contemporary artistic practice.

This gap is significant. The Venice Biennale, often described as the “Olympics of the art world”, remains structured around national pavilions, with each country responsible for presenting its cultural identity on a global stage. Yet, as critics have long argued, it has never been a neutral platform, but a space where art and geopolitics intersect.

More broadly, biennials are deeply embedded in political and institutional contexts, rather than existing outside them. Within this framework, they are often understood as sites of cultural soft power, where nations project influence through artistic production.

National representation in crisis

Iran’s withdrawal must also be understood in relation to the wider turmoil surrounding the 2026 biennale itself. This year’s edition has been marked by extraordinary controversy, including disputes over the involvement of Russia and Israel, calls for boycotts and the resignation of the entire international jury just days before the opening.

These events expose the fragility of the biennale’s longstanding claim to neutrality. Rather than existing outside politics, it has become a site where geopolitical tensions are actively staged and contested.

To exhibit at the biennale is never neutral: it means entering a highly visible arena shaped by competing narratives of legitimacy and power. For the Islamic Republic, this raises a deeper tension. The biennale’s national pavilion model requires countries to present a coherent cultural identity through contemporary art. Yet Iran’s artistic landscape is anything but singular. It is shaped by internal contradictions between state and independent practices, censorship and experimentation and local production and diasporic circulation.

These tensions are difficult to reconcile within a state-managed exhibition framework. The very premise of the pavilion – art as national representation – sits uneasily with a system in which artistic expression is subject to ideological and institutional control.

At the same time, the Biennale embodies forms of global circulation, cultural competition and visibility tied to international art markets that do not always align with the cultural and political ethos of the Islamic Republic. Representation therefore involves negotiating how a nation appears, to whom, and on whose terms.

The current moment makes this tension even more acute. As political rhetoric escalates and the possibility of large-scale destruction is invoked in global discourse, cultural visibility becomes more urgent. Art offers one of the few spaces through which narratives beyond conflict and diplomacy can emerge. Yet for Iranian artists, cultural presence is becoming more fragmented, shaped by diasporic networks, constrained by national borders and limited by economic and infrastructural pressures.

Iranian artists, particularly those working through independent and diasporic networks, have for decades operated beyond the frameworks of state representation, with their work circulating internationally through alternative artistic circuits. Iran’s missing pavilion, then, does not signal the disappearance of Iranian art. Rather, it reveals the precarious conditions through which that art circulates.

Iran’s absence from the Venice Biennale also highlights the limits of the national pavilion model. The system has frequently been criticised for reducing complex artistic practices to simplified national identities, even as contemporary art now operates through transnational networks that exceed the boundaries of the nation-state.

In Venice this year, the missing pavilion reflects an art world shaped as much by political crisis as by artistic production. Iranian art is not absent from the global stage. Yet the conditions under which it circulates and remains visible have become increasingly fragile.

Katayoun Shahandeh works for SOAS University of London.

– ref. What Iran’s absence from the Venice Biennale reveals about art and politics – https://theconversation.com/what-irans-absence-from-the-venice-biennale-reveals-about-art-and-politics-282416

Source: The Conversation – UK – By Ewen Harrison, Professor of Surgery and Data Science, University of Edinburgh

Artificial intelligence can now outperform doctors at diagnosing patients in the emergency department, according to a new study in Science.

The AI was given written notes from real emergency department records from a hospital in Boston, US, and asked to weigh in at different points during the patient’s care. At the earliest stage – triage, when a patient first arrives – the AI identified the correct diagnosis, or something closely related, in 67% of cases.

The two doctors used for comparison managed 50% and 55%. That’s a meaningful gap, especially at the moment when information is scarcest and uncertainty is highest.

This study matters because the field is moving so fast. Earlier research showed that large language models – the technology behind systems like ChatGPT – could pass medical licensing exams. Interesting, but not all that illuminating. Passing an exam is not the same as being useful on a ward.

This new study goes further. It puts AI alongside doctors across several tasks, using genuine clinical text from a real emergency department. That makes it more directly relevant to medical practice than most of what’s come before. It suggests these systems are developing into something that could genuinely help doctors think through a wide range of possible diagnoses, especially in situations where missing a serious condition is the main concern.

There are good reasons, though, not to get carried away.

The AI was working entirely from written text. It never saw the patient, never noticed how breathless or frightened they looked, never examined them, spoke to their family, weighed up the chaos of a busy department, or took any responsibility for what happened next. It was not practising emergency medicine. It was offering a written opinion based on selected information.

There’s also a gap between producing a list of possible diagnoses and actually improving patient outcomes. A longer list might help a doctor think more broadly, but it could equally generate new problems: unnecessary tests, over-treatment, extra workload, or unwarranted confidence in an answer that sounds plausible but turns out to be wrong.

And some of the benchmark cases used in studies like this may have been publicly available when the AI was trained, which doesn’t undermine the emergency department findings, but is another reason to treat headline numbers with some scepticism.

The hard question

So the question isn’t really whether AI can help doctors think through difficult cases. The harder question is how this should be tested and governed in real clinical settings like the NHS.

That question is already urgent. A Royal College of Physicians snapshot found that 16% of UK doctors were using AI tools in clinical practice every day, with another 15% doing so weekly. Doctors are already using these tools in their daily work – before hospitals and health systems have properly worked out how to assess them, train staff to use them safely, spot when they’re causing harm, or decide who is responsible when something goes wrong.

It’s tempting to say that the solution is to keep a human in the loop. But that phrase does very little work on its own. We need to know which human, in which loop, and with what authority. A doctor’s ability to override an AI suggestion is not, by itself, a safety system. Someone still has to decide which tools get used, who can change how they behave, how harms are spotted, and who is responsible when the tool quietly starts failing.

This study represents genuine progress. But it doesn’t, on its own, change how medicine should be practised. The right response is neither to prohibit these systems nor to let them quietly become part of the routine before anyone has thought it through. They should be trialled in real clinical settings, used as a form of second-opinion support rather than a substitute for clinical judgment, and measured against what actually matters to patients: care that is better, safer and faster.

Ewen Harrison receives funding from a number of grant-giving bodies including UKRI, NIHR, HDRUK, and Wellcome Leap. He is a Deputy Editor with NEJM AI.

– ref. AI in the emergency department: promising, powerful but still unproven – https://theconversation.com/ai-in-the-emergency-department-promising-powerful-but-still-unproven-282029

Source: The Conversation – UK – By Pedram Vousoughi, Post Doctoral Researcher in Biological Sciences, University of Limerick

The question sounds simple. The answer, once you examine the actual measurement science behind it, is more interesting than either “yes” or “no”.

The houseplant-as-air-purifier idea can be traced to a 1989 US study, conducted for Nasa as part of research into closed-loop life support systems for space stations. In sealed, controlled chambers, certain plant species reduced concentrations of volatile organic compounds (VOCs). These are chemicals that easily evaporate into the air at room temperature, including some toxic ones like benzene, trichloroethylene and formaldehyde. The science was sound. The problem is the leap from a sealed Nasa chamber to a living room. This distinction matters enormously, and it underpins almost every piece of inflated coverage about houseplants’ purifying abilities that has followed.

Most studies showing that houseplants remove pollutants share a fundamental design feature: small, sealed chambers with artificially high concentrations of pollutants introduced as a single high dose. A plant is placed inside the chamber, concentrations of pollutants are measured over time and a removal rate is calculated. This design works well for comparing plants to each other. It works poorly for predicting what happens in your home.

The critical missing variable is what building scientists call the air exchange rate. This is how quickly outdoor air naturally replaces indoor air through gaps, walls and ventilation systems. In a real building, this constant dilution is already doing the heavy lifting on pollutant concentration. When a 2019 study modelled plant performance against real-world air exchange rates, it found you would need between ten and 1,000 plants per square metre to match what a building’s passive ventilation already achieves.

So the scientifically defensible answer is: houseplants can remove some pollutants, but they are not an effective standalone air-cleaning solution for homes. That does not mean the earlier studies were “wrong”. It means their results were often overextended into everyday settings where the physics of indoor air are very different.

More recent reviews distinguish between potted plants and more engineered plant-based systems. Some botanical biofilters, which force air through plant-root substrates with fans, may have useful air-cleaning potential, but that is a different technology from keeping a few decorative plants on a windowsill.

Another reason the claim is often overstated is that real indoor environments are not static. Pollutants are not usually released once and then left to decline in a sealed space, as happens in many chamber experiments. In homes, emissions may be continuous or intermittent, from cooking, cleaning, furnishings, consumer products, heating and traffic pollution wafting in from outside. Temperature, humidity, the number of people at home and ventilation also change throughout the day. All of these factors affect how pollutants are emitted, diluted or deposited indoors. This makes real exposure conditions far more complex than the controlled conditions under which many plant studies are carried out.

For these reasons, the most credible public health advice remains straightforward.

First, reduce or remove the pollution source. This may involve stopping the use of products that emit fumes, such as aerosol sprays or strong chemical cleaners, and repairing building defects such as damp or leaks that promote mould growth.

Then, improve ventilation and use effective filtration. Ventilation can be improved by, for example, opening windows and doors and using kitchen and bathroom exhaust fans that vent outdoors. You can also increase the supply of outdoor air through combined heating, ventilation and air conditioning systems, which can be great for filtering air.

Portable air cleaners with high-efficiency particulate air (Hepa) filtration can help reduce airborne particles, while ventilation, such as opening windows or using exhaust fans, helps dilute indoor pollutants when outdoor air quality is acceptable. Air cleaners vary in quality, though. For everyday use, look for a model that is the right size for the room and clearly states that it uses a True Hepa filter, which means it is designed to capture at least 99.97% of very small particles.

It is also helpful if the unit has an AHAM Verifide label, which means its clean air delivery rate (CADR) has been independently tested. As a simple guide, the higher the CADR, the faster the cleaner can remove particles from the air, and the packaging will usually say what room size the unit is suitable for. Most air cleaners are designed mainly for particles such as dust, pollen, pet dander and smoke.

If you also want help with gases or odours, such as VOCs, look for a model that includes an activated carbon filter, because Hepa filters alone are mainly for particles. Packaging will usually indicate whether a unit is intended for particles, gases or both, but no air cleaner removes all pollutants.

It is also worth remembering that plants themselves require care. Overwatering and poorly maintained pots can contribute to moisture problems or microbial growth indoors. In that sense, even the benefits of indoor greenery depend on how they are managed.

Does that mean houseplants are useless indoors? Not at all. Even if their direct air-cleaning effect is modest in real homes, plants may still offer benefits. Scientific studies suggest they can improve perceived comfort and psychological wellbeing, and in some cases slightly influence humidity or the indoor microenvironment.

Keep houseplants because you enjoy them, because they make indoor spaces more attractive and calming. They can make homes feel more pleasant, and that is a value in itself. But they should not be presented as a practical solution to serious indoor air problems.

Pedram Vousoughi receives funding from Ireland’s Department of Climate, Energy, and the Environment for funding his current work under the FORESIGHT services contract for national agriculture and land-use modeling. He has also been granted EPS-IRC funding previously.

– ref. Can houseplants really purify the air in your home?
What the science actually says – https://theconversation.com/can-houseplants-really-purify-the-air-in-your-home-what-the-science-actually-says-279690

Source: The Conversation – UK – By Beverley O’Hara, Lecturer in Public Health Nutrition, Leeds Beckett University

For many people interested in health and wellbeing, the idea of ultra-processed food, or UPF, has become more than a technical term in nutrition research. In public debate, it often serves as shorthand for wider concerns about modern, industrially produced food.

Those concerns are not baseless. A large body of research has found associations between high UPF intake and poorer health outcomes. But the evidence is not always easy to interpret. Many studies rely on self-reported diets and struggle to separate the effects of processing from nutrient quality, eating patterns and wider social factors. The evidence points to real problems, but also to the need for more careful use of the term.

In the US, the Food and Drug Administration and the Department of Agriculture began a formal process in 2025 to develop a uniform federal definition of ultra-processed foods, arguing that no single authoritative definition exists for the US food supply. The central question is: what exactly makes a food “ultra-processed”? Is it the ingredients it contains, the way it is made, the extent to which it has been altered from its original structure, or some combination of these?

This helps explain why the topic has become so divisive. Within nutrition research, there is no consensus on how far the UPF category should guide policy or individual dietary advice. Some researchers see it as an important way of identifying harmful patterns in modern diets. Others argue that it is too broad to serve as a sound basis for dietary guidance on its own.

That distinction is important. A category can be useful for tracking population diets while still being too blunt to tell an individual whether a particular product belongs in their shopping basket, especially when it tries to capture ingredients, industrial processes, product formulation, marketing, palatability and dietary patterns within one category.

There are also valid concerns about the role of large food companies in shaping diets and public health. Many highly processed products are designed to be cheap, convenient, heavily marketed and easy to overconsume. But the political and commercial problems of the food system are not identical to the scientific problem of classification.

A better approach would distinguish more clearly between products that are ultra-processed and nutritionally poor, products that are ultra-processed but may still have a useful place in the diet, and minimally processed foods that people are encouraged to eat more of. This might include some fortified foods, high-fibre breads or medical nutrition products, depending on their composition and use.

One way to balance warnings about UPFs is to give more attention to positive dietary guidance. In the EAT-UP framework, I propose the term “unrefined plant foods”, or UPs, to describe plant foods whose natural structure remains largely intact. These include whole fruits, vegetables, beans and grains that have not been heavily broken down or reconstituted.

This is not a replacement for the UPF framework. Its main value may be communicative: it balances advice about what to limit with clearer guidance on what to add. Many dietary guidelines already encourage people to eat more fruit, vegetables, legumes and whole grains. Naming these foods more precisely may help make that advice clearer.

Like any food category, unrefined plant foods would need careful definition. The phrase “largely intact” is not self-explanatory, and different researchers, policymakers and consumers may draw the boundary differently. But the value of the concept lies in shifting part of the public health message from avoidance to addition.

Advice based only on avoidance can easily become confusing or punitive. Evidence that higher intakes of whole plant foods are linked with better health also has limitations, including food diaries, self-reporting, cohort studies and the difficulty of separating diet from wider lifestyle factors. Even so, fruit, vegetables, legumes and whole grains are consistently supported across dietary guidelines, public health research and long-standing evidence on diet quality.

These debates also shape how people understand food in everyday life. Dietary advice should avoid creating unnecessary fear around food. When processing is treated as inherently dangerous, the result can be confusion, guilt and anxiety rather than healthier behaviour. In some cases, highly moralised food messaging may even encourage disordered eating patterns, including an unhealthy fixation on foods perceived to be perfectly pure or healthy.

This is also why language needs care. Phrases such as “real food” are often used to mean foods that are minimally processed or close to their original form. But the phrase can also carry assumptions about what counts as proper eating and who is getting it wrong. Public health messages need to take account of differences in income, time, access and daily constraints.

Read more:
Why stigmatising ultra-processed food could be doing more harm than good

Improving diets requires more than labelling a broad category of foods as harmful. It requires careful consideration of evidence, behaviour and context. The challenge is to produce advice that is scientifically sound, practical to follow and responsive to the real conditions in which people make food choices.

The UPF debate has rightly placed industrial diets and food quality at the centre of public health discussion. The next step is not to abandon the framework, but to improve it: to define categories more clearly, distinguish between different kinds of processing, and combine warnings about harmful products with practical advice about the foods people can eat more of. In practice, that means combining processing-based classifications with evidence about nutrient profile, fibre content, additives, marketing and the role a food plays in the overall diet.

Beverley O’Hara does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

– ref. Ultra-processed food: why the debate needs less fear and more clarity – https://theconversation.com/ultra-processed-food-why-the-debate-needs-less-fear-and-more-clarity-278060

Source: The Conversation – UK – By Gemma Ware, Host, The Conversation Weekly Podcast, The Conversation

As Xi Jinping prepares to host Donald Trump for a delayed summit in Beijing on May 14-15, a lot has changed since the US president’s last visit to China in November 2017. Trump’s first trade war with China began in earnest the following year, ushering in a new era of trade tensions between the world’s two largest economies.

Trump will travel to Beijing in the wake of a US Supreme Court ruling in February that struck down his “Liberation Day” tariffs. The Trump administration responded by imposing a 10% universal tariff on all goods coming into the US, but it’s time limited to 150 days under US law and will expire on July 24. Since the ruling, both China and the US have also launched investigations into each other’s trade practices.

Before the Supreme Court ruling, the effective tariff rate on Chinese goods into the US was 47%. Now, researchers at Yale put the effective tariff rate at between 19-24%. The range reflects different scenarios for what might happen after July, and factors in tariffs on other goods, such as steel, aluminium and copper, not covered by the ruling.

And yet, amid all the tit-for-tat on tariffs, China reported a record trade surplus in 2025 of US$1.2 trillion. How did it manage it?

In this episode of The Conversation Weekly podcast, we speak to economist Jiao Wang at the University of Sussex, about how decisions China took over the past two decades, meant it was able to protect itself from the worst of Trump’s trade wars.

Wang explains that while the direct trade between the US and China fell sharply in 2025, “it was more than compensated by the increase in trade to other part of the world. We already observed this great reallocation in the first trade war, and then in the second trade war, the conclusion is it becomes even more prominent.”

She traces the history of this great reallocation to understand what moves China made to decouple its economy from the west, and the strategy its now pursuing on global trade.

Listen to the interview with Jiao Wang on The Conversation Weekly podcast.

This episode of The Conversation Weekly was written and produced by Mend Mariwany and the executive producer was Gemma Ware. Mixing by Eleanor Brezzi and theme music by Neeta Sarl.

Newsclips in this episode from APArchive, WSBTTV News, Max Media Asia, Al Jazeera English, CNA, BBCNews, CNBC Television, DW News, France 24 English, CNN, Global News and NBC News.

Listen to The Conversation Weekly via any of the apps listed above, download it directly via our RSS feed or find out how else to listen here. A transcript of this episode is available via the Apple Podcasts or Spotify apps.

Jiao Wang does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

– ref. China’s ability to weather Trump’s trade war was two decades in the making – https://theconversation.com/chinas-ability-to-weather-trumps-trade-war-was-two-decades-in-the-making-282199

Source: The Conversation – UK – By Miguel G. Borda, Consultant in Geriatric Medicine, Department of Neurology, Universidad de Navarra

The use of dietary supplements has increased sharply in recent years. Vitamins, minerals and other nutritional products are often marketed as simple ways to boost energy, support immunity, protect brain health or even promote longevity. For many people, taking supplements can feel like a sensible, proactive health habit.

But this perception can be misleading. For people who already have adequate nutrition, many supplements offer little or no measurable benefit. Some are simply an unnecessary expense. Others are not risk-free: high doses of certain vitamins and minerals can cause toxicity, interfere with medications or produce unintended health effects.

Read more:
Vitamin D deficiency is widespread – but overusing supplements can also be dangerous

For older adults, however, the picture is more complicated. The most useful question is not simply whether supplements are “good” or “bad”, but whether someone is actually deficient, what might be causing that deficiency and whether a supplement is the safest way to address it.

Nutritional deficiencies become more common with age. Appetite may decrease, oral health can worsen, chronic illnesses become more common and many older people take medicines that affect how nutrients are absorbed, used or cleared from the body. Oral health problems, including tooth loss, gum disease and poorly fitting dentures, can also make chewing difficult and reduce dietary variety.

Later life is often surrounded by unhelpful food messages: eat less, lose weight, avoid “heavy” meals, stick to soft foods. But these messages can collide with the body’s continuing need for protein, vitamins and minerals. Over time, small meals, soups, toast and tea can become a diet that fills the stomach without meeting nutritional needs.

Read more:
Millions of older people don’t get enough nutrients – how to spot it and what to do about it

This does not mean every older person needs supplements. It means supplementation should be targeted: based on confirmed deficiencies, clear risk factors, medication use or evidence that someone is not getting enough from food.

Vitamin B12 is one of the clearest examples. B12 deficiency becomes more common with age, partly because the stomach may produce less acid, which is needed to release B12 from food. Low B12 can cause anaemia, fatigue, nerve problems, numbness or tingling, and sometimes memory problems or confusion. Certain medicines, including metformin and proton pump inhibitors, can increase the risk further. High-dose oral B12 often works well, although some people need injections.

Folate is also important, especially for red blood cell formation and DNA production. Low folate can raise homocysteine, a blood marker that has been associated with cardiovascular disease and cognitive decline, though this does not prove that folate supplements prevent either. Folate or other B vitamins may help selected groups, such as people with low folate or B12 status, raised homocysteine or mild cognitive impairment. But B12 deficiency should be considered before folate is prescribed on its own, because folate can improve some blood signs of B12 deficiency while nerve damage continues.

Vitamin D is another common concern. Deficiency is more likely in older adults with limited sun exposure, reduced mobility, darker skin, care-home residence or diets low in vitamin D-rich foods. Supplementation may be appropriate when levels are low, sun exposure is limited, or someone has osteoporosis, recurrent falls or high fracture risk. But more is not automatically better. A large trial found that vitamin D supplementation did not significantly reduce fracture risk in generally healthy midlife and older adults who were not selected for deficiency.

Calcium and magnesium matter for bone, muscle and nerve function, but where possible they should come from food. Supplements may be useful when dietary intake is insufficient or osteoporosis is present, but excessive intake should be avoided. Magnesium is often promoted for sleep, but evidence for routine use as an insomnia treatment remains limited.

Multivitamins can be useful for older adults who eat very little or have poor dietary variety, but they should not be treated as nutritional insurance for everyone. In a large study of three US cohorts, daily multivitamin use was not associated with a lower risk of death. Other research is exploring whether multivitamins may affect markers of biological ageing, but it remains unclear whether this translates into better health, independence or lifespan.

One of the most overlooked “supplements” in later life is not a vitamin at all, but protein. Many older adults eat too little protein or avoid protein-rich foods such as meat, fish, eggs, dairy, beans or lentils. Low intake can contribute to sarcopenia, the age-related loss of muscle mass and strength, increasing the risk of falls, frailty and loss of independence. Expert groups commonly recommend around 1.0 to 1.2 grams of protein per kilogram of body weight per day for healthy older adults. Higher intakes are sometimes needed during illness, frailty or recovery, unless someone has been advised to restrict protein because of kidney disease or another condition.

Unsupervised or excessive supplementation can be harmful. High doses of vitamin D or vitamin A can cause toxicity. Iron should not be taken without confirmed deficiency unless advised by a healthcare professional. Some supplements interact with medicines. And evidence reviews have found that some high-dose antioxidant supplements, particularly beta-carotene and vitamin E, may increase mortality risk in some populations.

A sensible approach begins with food, not pills. That means looking at appetite, weight change, chewing or swallowing problems, dietary variety, medical conditions, medication use and whether someone has enough support to shop, cook and eat well. Blood tests may be needed, particularly for vitamin B12, folate, iron and vitamin D.

Read more:
Older adults who follow healthy diets accumulate chronic diseases more slowly – new study

Evidence does not support universal supplementation for all older adults. But targeted use of vitamin D, vitamin B12, folate and, in some cases, a multivitamin or protein supplement can help when deficiencies or low intake are present.

Supplements can have a role in healthy ageing, but they are not a shortcut. The foundations are still balanced nutrition, strength exercise, adequate sleep, social connection and access to good food. The best supplement is the one that answers a real need, not the one with the loudest promise on the label.

Miguel G. Borda receives funding from Nasjonalforeningen for folkehelsen (Norwegian Health Association)

George E. Barreto receives funding from Research Ireland

– ref. Why supplements aren’t a shortcut to healthy ageing – https://theconversation.com/why-supplements-arent-a-shortcut-to-healthy-ageing-277291