8/31/11

Macronutrient Requirements for Older Adults

Aging affects:
- Body weight decreases (or increases)
- Lean body mass decreases
- Body fat increases

Changes in the body influence nutrient metabolism and the nutrient requirements. Malnutrition is high; especially protein and micronutrient deficencies (vitamins and supplements).


Nutrition needs have to factor in:
- age related biological changes (body changes, illness, etc)
- socioeconomic changes (decrease money, living in nursing home with limited food options, etc)
- decreased food intake (not that hungry, food not appealing)
- sedentary lifestyle
- decrease in energy expenditure (weight gain from lack of exercise)

Nutrition Starting Point: Dietary Reference Intake Guide (DRI)
A fabulous site to utilize is the United States Department of Agriculture


The USDA has links for everyone and all sorts of food and health related topics. To access the DRI Table for people age 51+ please see the following link:


** Please keep in mind that Dietary Reference Intake (DRI) Tables are for HEALTHY people; those with medical conditions may need additional interpretation. **



ENERGY NEEDS
Energy is physical activity and involuntary activity (respiratory/circulation/body functions). Energy is based on resting, physical activity, and food types. Energy comes from:
* Carbohydrates
* Protein
* Fat

Maintaining Weight
Food eaten = energy expelled

To monitor food intake and energy you can use the EER (Estimated Energy Requirement) tool. The US Department of Health and Human Services has an excellent site:


VERY IMPORTANT
Please understand that "...older adults require less energy to MAINTAIN their weight, BUT their nutrient needs STAY THE SAME, and in some cases INCREASE." (Bernstein, 2010, pg 46)






A great indicator is to use the MyPyramid for older adults, it is different than the Food Guide Pyramid for younger adults.



The pyramid provides several options for exercise levels and food intake.






CARBOHYDRATES
So many people want to cut carbs, STOP IT!! Carbs come from starch and fiber (complex carbs) and sugar (simple carbs). Carbohydrates provide energy to the brain and nervous system (incase you didn't know this.....the brain lives on 90% carbs which is why you feel brain-dead when you don't have enough).


Carbs are a VERY IMPORTANT part of the daily diet. Don't believe me? Check out this link and use Google to do some research of your own.


45-65% of daily diet should be carbohydrates

Examples of carbs:
- fruit
- vegetables
- legumes
- grains

See the following link for specifics (I am a huge fan of the Lance Armstrong foundation, they do great research!!):
Dietary fiber is the portion of the plant that we cannot break down (remember that age old saying about Celery being the colon's toothbrush? This is similar). Benefits to fiber:

* Relieves constipation
* Absorbs water, keeping our bodies hydrated longer
* Fiber moves slow through the body, helping the body to absorb nutrients better and manager our sugar intake - this is EXTREMELY BENEFICIAL for people who have Diabetes I or II.
** Appetite suppressant so be careful; people who are already too skinny or have an eating disorder should watch their fiber intake closely.

Recommended Amounts and Food Examples

Women: 50+ Men 50+
14 - 14.4g 17.5 - 18.5g

- Wheat bran
- Whole grain breads
- Cereal
- Vegetables

FATS
Fat is very important in the diet; without fat - fat soluble vitamins are not absorbed (Vitamins, A, D, E, K). Fat regulates the body's temperature (keeping you warm or cooling you off), fat acts as an insulator for your internal organs (reduces bruising and damaging), and fat is a hormone regulator. Our body's need fat in order to survive. When people talk about Good cholesterol vs Bad cholesterol here is what they are talking about.....

Good cholesterol makes hormones, retains vitamin D, and makes bile to help with digestion.

Types:
Saturated fat: 8-10% daily
(animal fat: butter, cheese, fatty meats)
Polyunsaturated fat 10% daily
(nuts and seeds)
Monounsaturated fat 10-15% daily
(oils: olive & canola)




ESSENTIAL FATTY ACIDS
How many people have seen this at the store.....? I know it's the milk I drink because I think it tastes better - well, that wonderful label (DHA-Omega 3) is beneficial to neurogrowth (brain development and maintenance), cardiovascular benefits, arthritis prevention and cancer fighting properties.

Essential fatty acids include Omega 6 and Omega 3 which come from FAT. Omega 6 comes from nuts and seeds and is the structure of your cells.

Dietary Recommendations:
Men 50+ Women 50+
14g 11g

Omega 3 also comes from nuts and seeds as well as fish and dairy products.
Dietary Recommendations:
Men 50+ Women 50+
.6 - 1.2 % .6 - 1.2%

PROTEINS
Average adults eat more than enough protein; however, as we age our appetites decrease and we start to eat less and less food. There are not many studies out; however, the few studies that are out recommend a higher intake of protein as we age.

Recommendations:
- 25-30g at EACH meal

Men 50+ Women 50+
56g+/daily 46g +/ daily

Protein combined with weight lifting and exercise has been shown to curb the loss of lean muscle and has even show to help add more lean muscle onto the body. It is recommended to eat protein from animal sources and not supplementation as eating from the source provides better nutrients:
Iron, B12, amino acids, and more nutrients are in meat than supplements.

WATER RECOMMENDATIONS
Water is such a vital part of health. As we get older our thirst mechanism stops, our body stops sweating, and our kidneys are not able to hold onto as much water as before (hence the frequent bathroom trips as we age).

Recommendations:
Men 50+ Women 50+
3.7L/day 2.7L/day

We lose fluid through the following avenues:
- Skin
- lungs
- kidneys
- GI tract
- Medications can dehydrate us as well

Water imbalance occurs:
- mental problems
- physical problems (can not get cup to mouth, shaky hands, etc)
- anorexia
- incontinence management (drinking less to pee less)
- hospitalizations
- severe weather changes
- stress

Indicators of dehydration:
- cracked lips - rapid weight loss
- sunken/dry eyes - need help drinking from cup
- trouble swallowing - confusion
- headache/dizzy - lethargy
- muscle weakness - falls

Nutrition is such a huge part of how we live, feel, and sustain our quality of life. Please remember to be empathetic towards others as you may not understand what they are going through. Thank you again for your time!

All information in this post is taken from the following school text book:
Bernstein, M & Schmidt-Luggen, A. "Nutrition for the Older Adult," 2010 by Jones and Bartlett Publishers, LLC

Nutrition Age 65+ Physiologic Changes

"The body’s a temple
That’s what we’re told
I treated this one like an old honky tonk
Greasy cheeseburgers
And cheap cigarettes
One day they’ll get me if they ain’t got me yet"
- Kenny Chesney


Aging....a topic we all try and avoid. From creams, to diets, to magic potions, and surgery. No matter what we do, we will age and many of us already have friends, family members, and loved ones who are undergoing those magnificent changes. Below are two categories that help us understand the concerns and ways to curb deteriorating health.

Concerns:
1. Body Changes
2. Attitude Shifts
3. Nutritional Changes
4. Independent Changes

Preventative Measures:
1. Exercise
2. Nutrition
3. Problem Solving - Brain Activity
4. Sleep
5. Lab Testing


BODY CHANGES
Sagging, shrinking, and libido disappearance! To quote my mother..."bust out the duct tape!" Can you imagine waking up, still feeling like you're 18 but then looking in the mirror and saying...."excuse me, who the heck are you, where did my perky figure go, my 6 pack abs, and my rippling muscles?" Instead the image that you see is a wrinkling, hair thinning, soft body in front of you that you don't recognize anymore. Age....we love it!

In all seriousness though...Here are some hard facts....
Skin, Hair, Nails
Thin, wrinkle, lose elasticity. Bruise easier, tear, vitamin D becomes harder to absorb. Liver spots, discoloration, flaky and scaly skin. (you still with me? LOL)
Graying/whitening, thinning, gaining hair in the nose, ears, and getting Groucho Marx eye brows, and....CHIN HAIR!
Brittle, thickening, dry, fungus in toes.

Wow - so far we're doing great! Anyone else as excited as I am to get older? Sweet...lets continue.... :) You have a whole new appreciation for your grandparents now don't you! Remember...they all looked like us at one point in time!

Vision and Hearing
Cataracts/Macular Degeneration, hearing loss and feeling like you are isolated from everything. Take a minute to sit down and picture what it's like not to hear, not to be able to see. Watching movies, having a conversation, and reading take on a whole new meaning. Would you start to feel isolated? Would you be bored? Irritated? Many people face this every day!

Nose and Mouth
Smell and taste decrease drastically! Good bye favorite foods...wait...what do we eat now? What do I like? Most people do not eat enough food when they get older because they are not hungry; appetite diminishes and a large part of that is not being able to smell or taste food. You all know how this feels - think back to when you have a cold and you can't taste or smell anything...how hungry are you then? Are you excited to eat? No, I didn't think so. Another thing affecting older people is that our drinking mechanism is all messed up. We don't know when we are thirsty and as a result, several people are dehydrated which lead to more problems.

Lungs and Heart
Lungs shrink by 25%, our ribs calcify which prevents them from moving when we take a deep breath, and we can not expel all the air we inhale which leads to the "barrel chested" look we see so many older people having. And our lungs dry out which lead to infection. The heart does not pump as strong as it used to and recouperating from exercise is hard if we haven't been active our whole lives.

Stomach and GI Tract
Our stomachs have a hard time producing enough acid to break our food down (we are not producing enough saliva) and our abdominal muscles are saggy. Hernias are very normal in elderly because of the loss of muscle (see, exercise is key!). Our intestinal tracts are not so great at absorbing the nutrients that it used to, so supplements and healthy food choices are very important!

Kidneys
Kidneys help get all the toxins out of our bodies, but they slow down. When elderly people are taking medication for their ailments, they are killing their kidneys. Kidneys have a very hard time digesting and removing the medication that is ingested. This can lead to medication buildup and other serious illnesses.

Skeletal/Muscle Changes
Spinal column compacts and our arches in our feet collapse - most people lose between 2 and 4 inches! So, we are no shorter, weaker, hairier people .... awesome. You're happy you took this journey with me aren't you!? :) Bone health is very important when we get older. Our tendons stop being elastic and get hard and rigid, our muscle mass deteriorates, and our bones start compacting on one another. Exercise, vitamin D and calcium supplements, and proper nutrition can help curb all of this!

Neurologic Changes....see "Attitude Shifts"

ATTITUDE SHIFTS
Remember being a teenager and your hormones going crazy! Acting out, having attitude, facial hair, boobs, etc...well...similar things happen when you get older. Menopause for women...yay! :) (feel the sarcasm?) Picture this...hot/cold flashes, irritation, confusion, seeing your body change (not for the better like puberty), and realizing that you are getting older! Seriously - how many people are more depresse at this point of the blog than when you started and felt young and invincible? yeah...I thought so.. :) ) Many of the neurologic changes our bodies are going through are due to our bodies not absorbing vitamins and minerals the way it used to.
Touch, sensitivity, depth perception all change. Walking, up and down gaze, and our achilles tendon falter. Decrease amounts of water result in delirium too!

NUTRITIONAL CHANGES
As we age, our tastes change. Our smell and taste diminish and those foods we loved once upon a time are not tasting good to us. Trying to find new foods or changing eating habits is frustrating. Many people become allergic to dairy products (very common). Also, those nuts, grains, and seeds we loved so much actually deplete the calcium in our bodies.

INDEPENDENT CHANGES
Bone and muscle deteriorate over time, pain sets in, mobility is difficult, and small muscle groups stop working long before your larger muscles (i.e. hands & hand function). Libido disappears (yikes!)

Walking, driving, hearing become difficult. Forgetting things and coping with change become even harder as we age. Imagine your friends or family members telling you that you have to move into an apartment full of other people your age because you are no longer fit to live on your own. How easy would you go? You still feel fine mentally, you just are a little tired, you forget stuff once in a while, and you just don't want to cook lately. (Remember....this is what we do to our grandparents all the time!)

THERE IS GOOD NEWS!!! WE CAN AGE GRACEFULLY AND WITH MINIMUM PROBLEMS!!!!!

Exercise
I can not over emphasize exercise enough! Endorphin's, socializing, muscle maintenance, and keeping body fat low are all beneficial in staying young and healthy. The following nutrition is for people age 65+

Nutrition
Water: at least 30ml per kg of body weight per day

Vitamin D: (400-800 iu/daily) - fish oil, fatty fish, egg yolk, fortified milk

B12: most get adequate amount from meat, fish, and dairy; however, low levels can lead to depression and serious illness

Fats, folic acid, carbohydrates, Iron, lactose

Calcium: (post-menopausal women 1,200 mg per day) (make sure take with Vit D

Vitamin K: helps with blood clotting; people with Crohns, Celiac, Sprue, Ulcerative Colitis, and prolonged use of antibiotics can be depleted in Vitamin K. Vitamin K is linked to bone health.

Side note: Vitamin E and A counteract K - vitamin E makes you bleed more.

Food sources of Vitamin K
Kale, spinach, turnip greens, broccoli, romaine, cabbage, asparagus, okra, black eyed peas, blackberries, soy bean oil, blue berries, green beans, artichokes, cauliflower, green fresh tomatoes.

**All these get harder for the body to absorb. Deficiencies lead to body breakdown and mental impairment.**

Problem Solving - Brain Activity
Dimentia and delusions are a persistent problem as we age; playing bridge, working on puzzles, learning new material, playing musical instruments, and keeping a social network of friends are all ways that you can curb mental diminishings.

Sleep
As we age, sleeping becomes more difficult. Remember to stay on a routine, avoid caffeine after 11a and if you can't sleep after being in bed for 20 minutes, get up and exhaust yourself and try again.
Sleep deprivation causes irritability, mental, and physical breakdowns.

Lab Testing
Many medications and vitamin supplements affect lab results. Test malfunctions with:
- Penicillin G, levodopa, morphine, nalidiric acid, isoniazid. Isoniazid leads to false positives in urine glucose (may say you have diabetes when you don't).

SUMMARY

Many of us are great at not airing out our issues, we want people to understand that we are fine, healthy, and never felt better. As we age, our bodies change and we are fighting with the mental feeling of feeling young, but seeing our bodies change and being able to do little about it; leading to frustration and depression. Empathy, compassion, and not feeling sorry for our loved ones is something that they all appreciate.

Exercise, eat right, see a nutritionist for food ideas and alternative health ideas besides taking medication right away. Be empathetic towards others and remember that you may not always understand or be aware of the challenges each person is going through. May we all age gracefully and in good health....or at least rational enough to drive our family members crazy :) :) :)

All information in this post is taken from the following school text book:

Bernstein, M & Schmidt-Luggen, A. "Nutrition for the Older Adult," 2010 by Jones and Bartlett Publishers, LLC