Better nutrition adds years to your life and life to your years
March 1, 2020
My 95-year old mother lives in an independent living apartment community and no longer cooks for herself. Her walk down the hall to the dining room gives her a little exercise and the other residents who share her table provide companionship and support. With three out of the four at her table very hard of hearing, it isn't always easy to have great conversations, but they manage to keep up with each other's visiting children, health changes and travel plans. And, they help each other order from the menu and most importantly assure that each can reach the food on her plate – sometimes a challenge with shrinking frames, arthritis and poor eyesight.
The last time I visited her, I was a little disappointed in the dining room food. She seemed happy enough with things and she isn't losing weight, but I would have liked to have seen more vegetables, fresh fruit, whole grains and protein on her plate. My hopes were raised when she called to ask if I knew anything about "black rice" and a dessert called "Italian Custard and Berries". Berries with Sabayon crème is a classic light Italian egg custard dessert and black rice is common daily fare in many parts of Asia. Both could add fiber, protein and some beneficial antioxidant compounds. It sounds like their recently hired chef was upping the culinary game.
With the numbers of seniors increasing in the U.S. and worldwide, many experts believe optimizing nutritional health for the prevention and treatment of chronic health problems should be a top priority. Eating nutritious foods is important at all stages of life and should be considered essential, cost-effective medicine for seniors. Eighty-five percent of adults over age 60 have at least one chronic condition such as diabetes, heart disease, arthritis, cognitive decline or frailty – these may all be influenced significantly by what we eat. Because seniors are also vulnerable to undernutrition and deficiencies due to normal aging processes, socioeconomic factors and limitations brought on by aging or chronic disease, improving nutrition status could mean the difference between just living longer or living longer with vitality.
What do we know about the nutrition status of U.S. seniors?
Approximately 16 percent of the elderly population are at risk for hunger and some estimate that between 20% and 50% of community-dwelling adults are in less than optimal nutrition status when admitted to a hospital.
National surveys suggest that older adults may under-consume protein, Omega-3 fats, dietary fiber, vitamin A, calcium, magnesium, potassium, and vitamins B-6, B-12, D and E. These nutrients can mostly be obtained through food but many experts recommend taking supplements of B-12, vitamin D and calcium. These supplements are generally safe, but be sure to consult with a medical provider about what is right for you.
Consider supplements - carefully
As many as 30% of older adults may lack stomach acid required for absorbing the vitamin B12 in food and a national health survey estimates that 3.2% of adults over age 50 have seriously low B12 levels and 20% have a borderline deficiency. Even borderline B12 deficiency can cause nerve and balance problems, difficulty thinking, weakness and fatigue. Supplements do not appear to have any toxicity and a daily supplement of 100 to 400 micrograms can be safely consumed.
Since normal aging changes in seniors make absorption and conversion of vitamin D less efficient, seniors should get their blood levels of vitamin D checked and use a supplement if recommended by their medical practitioner. An estimated 25% to 50% of adults are either deficient or insufficient in vitamin D. Low levels of vitamin D are associated with muscle pain, back pain, loss of strength, falls, poor immune function and cognitive difficulties.
Calcium supplements were recommended for many years (to help keep bones strong) but should only be used after considering how much is obtained in the regular diet as there are concerns about increased cardiovascular disease risk from too much supplemental calcium. If your diet includes milk, yogurt or cheese, figure out how much calcium you are getting and only supplement at a level to that brings the daily total up to 1,200 mg for postmenopausal women and men over 70 years old.
Food as medicine
Improved food intake and nutrition status may be especially helpful for quelling "chronic inflammation". Researchers credit ongoing inflammation with causing much of the disease experienced by seniors - heart disease, type 2 diabetes, arthritis, and cancers.
Without getting into the mechanisms, nutrients that support a healthy immune system (vitamins D, A, C, E, zinc, protein, Omega-3 fats) can be helpful in stopping the cascade of damage from inflammatory compounds. But the effects of plant compounds known as "phytonutrients" are also strongly associated with lower inflammation and may explain why the plant-based Mediterranean diet and the DASH diet (Dietary Approaches to Stop Hypertension) have been the winners in the best diets of the year contest for many years running.
It feels like every other day a new Mediterranean diet benefit is announced with the latest suggesting that seniors who follow a food pattern rich in vegetables, fruit, whole grains, beans, nuts, seeds and olive oil for one year had beneficial changes in their microbiome (the microorganisms in your digestive tract) and this was associated with less frailty and better brain function. Earlier studies have shown associations between Mediterranean food pattern with less heart disease, a greater life expectancy, less autoimmune disease, lower blood pressure, healthier body weight and less depression.
So, what do I want to see on my mother's plate and what should seniors be aiming for?
- Homemade food with only modest additions of salt, sugar and fat.
- A few portions of lean protein daily with fish at least several times per week
- A daily calcium source like Greek yogurt, canned salmon with bones or cooked greens
- Lots and lots of vegetables – make it half of the plate every meal
- Fruit in place of most sweets with berries as often as possible
- Healthy fats like extra virgin olive oil, seal oil, safflower or canola oil
- Whole grains
- Several servings of legumes weekly
- A small portion of nuts or seeds daily
Keep it colorful
"Eating the rainbow" is the way some people describe eating a variety of colorful food. We usually have in mind colorful fruits and vegetables but grains or beans or nuts like black rice, kidney beans or walnuts also contribute important color to the rainbow. And variety within each of the food categories helps to assure that all your nutrient bases are covered.
I usually encourage people to start slow with changes in their diets. Perhaps I shouldn't, but I also promise them that they will feel better as they increase the vegetables and fruits and decrease the sugar and unhealthy fats (I've never had anyone come back and say I had lied). Going Mediterranean in Alaska might be a challenge but even seniors may experience health improvements and not only live longer but add life to their years.
Leslie Shallcross is a registered dietitian and professor at the University of Alaska Fairbanks Institute of Agriculture, Natural Resources and Extension.