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 Nutritional Medicine: Nutritional Programs for the Elderly 
  • Common Deficiencies in the Elderly
  • Important Factors to Good Health for the Elderly
  • Dietary Nutrient Program for the Elderly

    This program is designed primarily for people over age 65, an age group that continues to increase in numbers in our society. An important point I would like to state early is that we need to care for ourselves in our younger years so that we can stay healthy in our older ones. Also, our society needs to learn to better care for our elders and to incorporate them into a meaningful life to keep them feeling useful and youthful.

    Being old or aging is as much a state of mind involving how we live and our attitude toward life as it is a physical condition. Of course, our genetics are also important. Some people become old in their 50s and 60s, while others only really start to age (or degenerate) a year or two before they die in their 80s or 90s. Psychologically, even some young people are old. They are limited and resist change and lose the positive energy and love of life. Youth, like age, is really a state of mind.

    With regard to nutritional status, elderly people are sometimes even more difficult to nourish than teenagers. Many are resentful or rebellious and eat an unbalanced diet consisting of a limited number of foods. Malnutrition is fairly common in the elderly, with low calorie and protein intakes, as well as many deficiencies of important vitamins and minerals. Many elders eat less because of such reasons as apathy, diminished sense of taste and smell, poor teeth, low income, or inability to obtain or prepare foods, and they further have reduced digestion and absorption, which makes their intake needs even higher than usual. The government RDAs become relatively meaningless for the elderly; they simply need more nutrients!

    Many old-age problems, such as insomnia, anorexia, fatigue, depression, diminishing eyesight and hearing, fragile bones, and fractures, are a result of poor diets and nutritional deficiencies. This can also lead to a weakened immune system and more infections. The thymus gland, which produces the important T lymphocytes that mediate the cellular immune system and help to regulate antibody formation, tends to diminish in activity with aging—especially with a low vitality diet, living under stress, and possible emotional factors, such as loss of friends and relatives, anxieties of aging and loneliness, and depression—thus leading to problems of weakened resistance, infections, and sometimes cancer. Tissue weakness due to lack of cellular support can lead to decreased skin protection and increased aging of the skin. Free-radical formation and a reduction of neurotransmitter chemicals, such as acetylcholine, gamma-aminobutyric acid (GABA), glycine, L-glutamine, norepinephrine, and serotonin, caused by deficiencies of amino acids and the B vitamins including inositol and choline—all may contribute to aging, internally and externally, mentally and physically. (This is discussed further in the Anti-Aging Program.)

    Most elderly people have reduced production of gastric hydrochloric acid, which minimizes the breakdown of complex carbohydrates, fats, and proteins. The general function of the other digestive organs, such as the pancreas, which produces digestive enzymes, is also reduced. Often the digestive lining does not function as it once did, and absorption of nutrients, particularly minerals, decreases.

    Common Deficiences in the Elderly

    Calories Potassium Vitamin B1
    ProteinZincVitamin B2
    FiberChromiumVitamin B6
    FluidsIronVitamin B12
    CalciumCopperFolic acid
    MagnesiumVitamin AVitamin C

    Many elderly people simply do not obtain enough calories. Calorie count can be easily increased with more food, but it is important that it be more nutrient-rich food, so that the important vitamins and minerals are also provided. Less protein may be needed for tissue production, but because of poorer assimilation, as much protein as usual is needed. Amino acid intake is necessary to build cells, for energy, and for tissue repair.

    Fiber, in foods and as a supplement, is very important to colon health and function. It reduces the incidence of colon cancer and possibly other types of cancer, as well as pulling some chemical toxins from the body. Eating more fresh fiber foods, such as vegetables and whole grains, offers many other benefits as well. Extra bran (insoluble fiber) or psyllium (soluble fiber) will help bowel function when natural-fiber foods are not eaten in sufficient quantities. Constipation, a common problem in the elderly, can be reduced and eliminated with adequate fiber and water.

    Fluid intake by older people may also be low. Drinking enough clean water is crucial to good internal organ function for clearing impurities and for waste elimination. It also keeps the skin healthier and prevents dehydration, which may lead to all kinds of problems.

    A number of common vitamin and mineral deficiencies occur in the elderly, mainly from not consuming enough fresh, nutrient-rich foods. Vitamin A is commonly low, and this can lead to poor vision, dry skin, and weakened immunity. Thiamine and riboflavin (B1 and B2) may not be adequate in the diet because of low intake of whole grains, and this may affect the skin and energy level. Pyridoxine (B6) is often low, especially with avoidance of whole foods and with eating refined flour products. Folic acid may be deficient because of avoidance of leafy greens, and vitamin B12 may be inadequate because of both low intake and poor absorption. Folic acid and vitamin B12 are important for building blood cells and for energy. Supplemental B12, even through injections, is often helpful for enhancing energy levels in the elderly. Vitamin C intake may also be inadequate, because of avoidance of citrus fruits and fresh, raw vegetables; this deficiency may lead to poor tissue health, healing abilities, and disease resistance.

    The diets of the elderly population are often deficient in many minerals. In fact, deficiencies of minerals and hydrochloric acid (HCl)—needed for adequate absorption of most minerals, such as iron, calcium, and zinc—are very common. This inadequacy of digestion by limited production of HCl (and digestive enzymes) may well in fact be one of the most common health factors affecting the elderly, though it may be less obvious than some more externalized problems. Vitamin B12 absorption may also be low because of weak intrinsic factor, which is produced by the same parietal cells that produce hydrochloric acid. Calcium intake is one of the biggest concerns. Calcium deficiency is more common in women than in men. Low-calcium foods, lack of exercise, low hydrochloric acid, and poor digestion lessen calcium availability. Antacids, especially those containing aluminum, are best avoided because of their interference with calcium absorption and the possibility of aluminum toxicity, which has been implicated in Alzheimer’s disease and other types of senility. Avoiding both aluminum cookware and the storage or heating of foods in aluminum foil are also good ideas. Imbalances among calcium, phosphorus, and magnesium and possibly low levels of vitamin D also affect calcium bone metabolism. Magnesium in the diet (whole grains, nuts, seeds) may also be low, while phosphorus intake is often normal or elevated, and excess phosphorus may allow even more bone loss when calcium is deficient. Occasionally, older people with arthritis avoid calcium with the support of their doctors. However, there is no reason for that. With arthritis, calcium is being lost from the bones and may precipitate in the joints, but this is a result of the mineral imbalance. Calcium is needed in balance with phosphorus, magnesium, boron, and vitamin D.

    Decreased absorption and limitations in the diet may affect the levels of most of the minerals as well. Iron may be low, but fortunately there is less need for it in the elderly. If anemia is present, check for iron levels as well as B12, folic acid, copper, and protein. Iron-rich foods such as meat, even liver, may be used occasionally for their good protein and other nutrient contents. Copper, important to many energy and enzyme systems, can be obtained from whole grains, nuts, seeds, and many vegetables, and is very high in oysters. Zinc, which is necessary for immune function, acid-base balance, tissue healing, and the prevention of aging, is also often inadequate in the diet. Low immune function due to zinc deficiency is frequently a factor in infections, cancer, and cardiovascular problems. Zinc is present in many of the same foods as copper.

    One of the most commonly deficient minerals is chromium, which is sparse in the soil and foods, and often poorly absorbed. Chromium is important to the proper use of blood sugar, functioning in glucose tolerance factor (GTF) to support the function of insulin. Supplemental chromium is often helpful, and brewer’s yeast, if tolerated, is one of the better foods for supplying this mineral.

    Potassium may also be deficient, because of low intake of vegetables and higher intake of salt. Sodium, chloride, and potassium are the body electrolytes that help balance acid-base chemistry and fluid movement. With weakened kidney function, which is not uncommon in the elderly, electrolyte imbalances occur. Adding potassium in food and supplements and diminishing salt intake will help restore the balance.

    Many medicines may interfere with mineral absorption and function. Antacids may bind calcium, as mentioned earlier, as well as other minerals, such as zinc or magnesium. Many diuretic drugs stimulate the kidneys to clear more potassium, lessening body stores. When these drugs are prescribed by a physician, this is often carefully watched, and potassium may then be supplemented. But the diuretics, which are commonly used by the elderly, also increase clearance of zinc, magnesium, and other minerals, and these are not always replaced, so that deficiencies of these minerals can result. Antibiotics can reduce colon flora, a source for the production of B vitamins and vitamin K. This can limit many intestinal functions in any age group. Laxatives can also cause loss of nutrients, and mineral oil, used more frequently years ago, can bind the fat-soluble vitamins A, D, E, and K.

    Dietary factors that should be monitored include excessive consumption of simple sugars and total fats. Intake of sugar, refined foods, and other nonnutrient calories should be minimized. High intakes of sugar will increase blood fats, which will speed up aging and atherosclerosis. Dietary fat is also best kept at a minimum. Lower levels of stomach acid and reduced production of digestive enzymes make fat harder to process. There are more nutritious foods than the fatty foods, though some dairy products, if tolerated, may be helpful. Low-fat or nonfat milk is probably better than whole, unless we are trying to gain weight.

    Prevention of aging is very important. There are many aspects to this; the psychological ones are the most significant. The time to prevent growing old is between the ages of 40 and 60, when a good, well-balanced diet high in vitamins, minerals, and other basic nutrients, and low in fats and refined foods is crucial. Of course, this type of supportive nutrition does not become less important in the senior years. How we lived yesterday affects us today, and what we do today will influence our future. Our whole attitude toward life and how we live our days is really what we are looking at here. The way we feed ourselves is an outcome of our self-image, knowledge, conditioning, education, self-love, and desire to live and be healthy.

  • (Excerpted from Staying Healthy with Nutrition ISBN: 1587611791)
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     About The Author
    Elson Haas MDElson M. Haas, MD is founder & Director of the Preventive Medical Center of Marin (since 1984), an Integrated Health Care Facility in San Rafael, CA and author of many books on Health and Nutrition, including ...more
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