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Aging Gracefully and the 
Importance of Geriatric Nutrition

by Bonnie Minsky MA, MPH, LDN, CNS


Aging is part of living. Every human has the choice of aging healthfully or living with sickness and poor quality of life. In the coming years, human aging will be one of the biggest challenges faced by industrialized countries. Because the average life expectancy is continuously increasing, we may be faced with spending more years in poor health.

Nutrition has a major role in protecting health and slowing disease progression. Paradigms that promote the nutritional components of healthy aging are needed to increase the age of chronic degenerative disease onset and to maintain healthy, functional lives for as long as possible. At this time, there is a tremendous disconnect between nutrition and how it is implemented into healthcare. In a recent interview with Dr. Jeffrey Blumberg, PhD, FACN, at the Jean Mayer USDA Human Nutrition Research Center on Aging, he stated that while we have the knowledge to prevent degenerative disease, we are still geared principally toward repair and recovery as opposed to health promotion and disease prevention.

While it is widely agreed upon that micronutrients play a large role in promoting health and preventing disease, meeting the nutritional needs of elderly persons, whether they are or are not living in institutionalized settings, is a great challenge. There are no nutrient intake standards at present for the elderly demographic. The World Health Organization says there is an urgent need to create nutrient guidelines, which competent national authorities can use to address the nutritional needs of their growing elderly populations.

Micronutrient deficiencies are common in elderly people due to a number of factors such as reduced food intake, lack of variety in the foods they eat, medications that deplete nutrients and create side effects, the price of foods rich in micronutrients, and the deplorable food choices available in the institutional setting. Additionally, the elderly often suffer from “anorexia of aging,” because the hormones leptin and ghrelin increase as you age, leading to prolonged satiety and suppressed hunger, which can lead to calorie deficit and malnutrition.

Signs of declining nutritional status are notable changes in weight and hydration status, loss of muscle mass, performance of activities of daily living, and poor oral health status. Medications should be closely monitored and flagged for the potential of creating nutrient deficiency. If laboratory measures can be performed at regular intervals (i.e., monthly), a CBC and Chem Screen are the most reliable measurements for micronutrient deficiencies and for macronutrient deficiency (i.e., measured by blood protein and serum albumin). According to Dr. Blumberg, there is an epidemic of vitamin D deficiency among older people that simply cannot be met by food or synthesis in the skin produced by ultraviolet light. For this reason, testing for low serum 25-hydroxyvitamin D concentration may be warranted due to an association with a greater risk of future nursing home admission, according to a study in the September issue of American Journal of Clinical Nutrition.

PREVENTION OF MALNUTRITION

It is necessary to eat foods that are nutrient dense. Maintaining nutritional homeostasis may be challenging, especially with an institutionalized elderly person. Immobility, either in bed or in a chair, contributes to negative nitrogen balance. Increased protein demands are associated with the requirements for healing surgical wounds, pressure ulcers, or bone fractures and for producing immune bodies when fighting infections. It is also important to provide enough dietary protein to maintain tissue integrity, muscle mass, and immune function. There is an erroneous assumption by many health care practitioners that elderly people cannot tolerate large amounts of dietary protein because of their renal function. In the absence of overt renal disease, most elderly people can tolerate high levels of dietary protein if they are adequately hydrated.

Consume the following “Superfoods” as much as possible. Superfoods are functional foods that provide health benefits far beyond their provision of macro and micronutrients.

•Quinoa
•Cruciferous Vegetables
•Pomegranates or Pomegranate Juice Concentrate
•Dried Beans & Peas
•Avocados
•Onion (allium family)

•Wild Pacific Salmon
•Nuts & Seeds (or nut butters if chewing is difficult)
•Tea
•Sea Vegetables

Achieving adequate fluid consumption in older adults is sometimes difficult, because with advancing age, thirst sensitivity decreases and voluntary fluid intake is impaired. It is important to maintain adequate hydration because water serves several purposes, including the maintenance of body temperature, a diluent for medications, and as a solvent for nutrients, waste products, and electrolytes.

People over the age of 60 have much less of the “friendly” bacteria in their gut, making them more susceptible to gastrointestinal infections and bowel conditions such as irritable bowel syndrome. Supplementing with products that contain healthy bacteria such as lactobacillus acidophilus and bifidobacterium are helpful.

IMPROVED AGING AND OUTCOMES FOR ELDERLY BY REDUCING INFLAMMATION

Aging is associated with chronic, low-grade inflammatory activity. Systemic chronic inflammation has found to be related to mortality risk from all causes in older persons. Age-related diseases such as Alzheimer disease, atherosclerosis, diabetes, sarcopenia (loss of skeletal muscle mass), and osteoporosis are initiated or worsened by systemic inflammation, which suggests the critical importance of “putting out the fire.” The best laboratory determinants of chronic inflammation are C-reactive protein (CRP) and WBC (white blood cell count). Genetic determinants for predisposition or specific chronic inflammatory pathways are interleukin (IL) cytokines and tumor necrosis factor {alpha} (TNF- {alpha}).

One of the major causes of systemic inflammation is the “standard American diet” (SAD). To reduce degenerative disease and chronic pain, specific food triggers must be eliminated, such as conventional red meat, saturated fat from lard and meat fats, fried foods, trans fats, soft drinks, artificial sugar substitutes, and most importantly, sugar (both from heavily processed sources, such as candy, and from naturally occurring sources such as fruit juice). Sugar is one of the most serious causes of inflammation, rapid aging, and weight gain. When sugar and foods that quickly convert to sugar are consumed, blood sugar rises, creating an insulin release and free radicals that oxidize fats.  When oxidized, the fats form plaque deposits in our your arteries, leading to disease. Insulin release also increases stored body fat and release of pro-inflammatory chemicals causing cell damage and accelerated aging.

For a short-term, two-week elimination, we use an Action Plan called The Pain Relief Diet that removes all food triggers and infuses antiinflammatory foods complete with a menu and recipes. For the long-term, an antiinflammatory diet with a 60/40 alkaline to acid ratio is suggested.

COMMON CHRONIC DISEASES CAUSED BY INFLAMMATION

OSTEOPOROSIS

Osteoporosis and associated fractures are a major cause of illness, disability and death, and are a huge medical expense. Osteoporosis is an inflammatory disease with a primary cause of excess acid. To keep homeostasis, our bodies will pull alkaline calcium out of our bones to neutralize the acid, creating bone loss.

Current pharmacologic approaches focus on inhibiting bone resorption in those with osteoporosis but do little to improve bone mass. To ease the future burden of osteoporosis, focusing on prevention will be key, and this includes antiinflammatory dietary interventions to stimulate bone formation.

Key nutrients for maintaining healthy bone:

calcium (optimally absorbed)
magnesium (non-laxative source)
boron
vitamin D (deficiency is common in older persons)
flavanoids
adequate protein

Be aware of the “bone robbers”:

medications (especially long-term use of steroids, thyroid meds, and proton pump inhibitors)
smoking/excess alcohol consumption
malabsorption (especially low levels of B-12)
sedentary lifestyle
•inflammatory food triggers

DIABETES

It is key to balance every meal with 50% of calories from complex carbohydrates, 30% from lean protein, and 20% from healthy fats. Ingestion of protein with carbohydrates increases muscle protein synthesis in elderly men, according to a recent study in the September issue of American Journal of Clinical Nutrition. Fruits and vegetables are ideal complex carbohydrates because they turn into sugar very slowly and because they have more water, are less dense in carbohydrates. Grains have virtually no water and are dense in carbohydrates.
                                                                       

Soluble fibers delay glucose absorption when eaten in sufficient quantities. Consuming 20-35 grams daily is suggested. If you cannot consume enough fiber from dietary sources, guar gum (such as Benefiber), methylcellulose (such as Citrucel), and plant sterols (such as Basikol) are the safest and least allergenic recommendations.

It is also important to choose your carbohydrates with low glycemic index and low glycemic load . Low Glycemic Index is the amount of sugar in a food (100 is the highest, 0 is the lowest) and Low Glycemic Load is how fast food turns into glucose. The faster food turns into glucose, the worse it is for blood sugar balance.

Micronutrients for blood sugar balance:

•Alpha Lipoic Acid – improves insulin sensitivity
•Magnesium – most important because, without it, glucose cannot be efficiently transported into cell membranes; the role of magnesium in maintaining muscle integrity and function in older persons is significant as well.
•Chromium – reduces high blood sugar
•EPA/DHA Fish Oil – reduces inflammation (from salmon, cod liver, or a mixture of herring, anchovy, and sardine)
•Zinc – prevents insulin mediated free radical damage

CARDIOVASCULAR DISEASE

10 Dietary Tips to Improve Heart Health

•Use olive oil, avocado, and/or grapeseed oil exclusively
•Eat whole, unrefined grains (esp. oatmeal, quinoa, brown rice, and wild rice)
•Eat wild caught fish often (esp. sardines and salmon)
•Eat raw/dry roasted nuts/seeds (esp. pecans, walnuts, almonds, flaxseed, sunflower seeds)

•Drink tea and coffee in moderation (Swiss water-processed decaf if caffeine is not tolerated)
•Eat more fruits and vegetables (esp. blueberries, dark greens, and avocado)
•Eat more fiber (esp. flaxseed, oat bran, dried beans, and high fiber veggies)
•Restrict saturated fats (i.e. bacon, lard, sausage, high fat cheese)
•Avoid trans fats (label of all processed foods should read zero trans fats)
•EAT LESS AND SLOWLY!

Nutrients for Heart Health

•Co-Enzyme Q10 (CoQ10) – a nutritional cofactor for all aspects of heart health (and suggested if on statin medication)
•EPA/DHA Fish Oil – helps reduce inflammation and prevent excess coagulation (must discuss with physician if on blood thinning meds)
•Magnesium – important for all aspects of heart health (especially heart rhythm and prevents heart failure).

CANCER

Try to avoid the following as much as possible:

•Pesticides (eat certified organic)
•Artificial Colors/Flavors
•Nitrates/Nitrites
•Heavy Saturated Fats and Trans Fats
•High sugar foods

•Fried foods
•Grilled foods that have not been marinated
•Bovine Growth Hormone (BGH) in dairy products
•Artificial Sweeteners (sucralose, aspartame, saccharin)

Key nutrients:

•Vitamin C

•Vitamin E
•CoQ10
•Magnesium
•Vitamin D
•EPA/DHA Fish Oil
•Alpha Lipoic Acid

NEUROLOGICAL DISEASE
The most financially and emotionally devastating of all aging diseases is memory loss and other neurological disorders such as Parkinson’s. Families have trouble coping because the disorders can only be managed, not cured or reversed. Sufficient
omega 3 fatty acid and vitamin D intake may slow cognitive decline, but prevention is paramount.

According to recent research presented at the 10th International Conference of Alzheimer's Disease and Related Disorders, risk factors for Alzheimer's are integrally linked to diet and physical activity. Additionally, a new study presented by Finnish researchers showed that high intake of saturated fat, especially from milk products at midlife, was associated with poorer cognitive function and memory, while high intake of polyunsaturated fatty acids and fish consumption correlated with better overall cognitive function.

According to the American Journal of Clinical Nutrition, high concentrations of homocysteine and low concentrations of B-12 and folic acid are frequently observed in subjects with dementia, and can predict cognitive decline. 

BEYOND DIET AND NUTRIENTS

Of course, men and women do not live by food and nutrients alone, so I conclude with my…

RECIPE FOR HAPPINESS


-2 heaping cups of patience
-1 heart full of love
-1 head full of understanding
-dash of laughter

Sprinkle generously with kindness. Add plenty of faith and mix well. Spread over a period of a lifetime. Serve to everyone you meet.

Disclaimer: This column is for information only and no part of its contents should be construed as medical advice or diagnosis. It is always a good idea to consult your doctor before making any dietary and nutrient changes.

Licensed Dietitian Nutritionist Bonnie Minsky, Public Health Educator, Certified Nutrition Specialist, and Certified Menopause Educator, spoke at the 25th Annual National Conference of Gerontological Nurse Practitioners on “Building Health Through Nutrition.” Bonnie is President and Wellness Director of Nutritional Concepts Inc., in Northbrook, IL, established in 1985.

© 2006 Nutritional Concepts, Inc.

 

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