March 2012 Issue

Optimize Whole-Body Nutrition for Healthful Aging — Experts Say a Nutrient-Dense Diet Plus Physical Activity Will Help Clients Stay Younger Longer
By Lindsey Getz
Today’s Dietitian
Vol. 14 No. 3 P. 32

Maintaining healthful eating habits becomes increasingly important as clients from the baby boom generation continue to age. This puts even greater emphasis on your role as dietitians to educate them about the foods they should be eating for optimal health and wellness.

“Eating right and staying fit are important no matter what your patient’s age, but as we get older our bodies do have special needs,” says Vandana Sheth, RD, CDE, a nutrition educator and a spokesperson for the Academy of Nutrition and Dietetics (the Academy).

As clients age, many will become deficient in calcium, vitamin D, and vitamin B12, so it will be important for RDs to recommend these clients get their blood levels tested so they can begin eating the right foods to boost their intake of these nutrients. Potassium-rich foods such as bananas, apricots, carrots, mushrooms, and sweet potatoes as well as heart-healthy omega-3 fats found in salmon, albacore tuna, walnuts, and flaxseed also are needed as clients grow older, Sheth says. “Each nutrient plays a key role in different systems, but overall it’s important that older adults are eating a healthful and balanced diet with some variety.”

What’s more, as people get older, energy needs decrease. This makes it more challenging for them to achieve proper nutrition because they should be eating fewer calories. “It’s important that the calories coming in are more nutrient dense so that all of the nutrients are being obtained in a smaller number of calories,” Sheth says.

With these facts in mind, Today’s Dietitian spoke to several RDs about the key areas of health to pay attention to as clients age and how diet can play a vital role.

Heart Health
Because heart disease is the leading cause of death in the United States, many Americans already are clued in to the importance of eating a heart-healthy diet but that doesn’t mean they’re following through. As adults age, some education on which fats to include in the diet and which ones to limit is important. “Get to know your fats,” Sheth says. “Remind clients to avoid saturated and trans fats and to instead opt for omega-3 fatty foods like salmon, flaxseed, or walnuts.”

Advise clients to avoid products such as butter, lard, and shortening when cooking. Suggest they switch to olive or canola oil—or a margarine that’s at least free of trans fats. Clients also should be advised to switch to low- or fat-free foods and to incorporate more fruits and vegetables into their diet.

Sharp Vision
Eye health is a big concern for aging adults. Even the normal aging process can bring on changes that impact eyesight. On top of that, the chance of developing eye conditions and diseases such as cataracts and age-related macular degeneration (AMD) increases with age. Fortunately, scientists have established a link between good nutrition and eye health. It’s believed that some age-related eye diseases may be slowed or even prevented with the right nutrients. Still, eye health doesn’t always get much attention. “The primary focus tends to be on heart disease when it comes to aging and that’s certainly important,” says Joan Salge Blake, MS, RD, LDN, a nutrition educator, clinical associate professor at Boston University, and spokesperson for the Academy. “But eye health is something to think about. Once you lose your vision, it affects your entire lifestyle.”

According to the Centers for Disease Control and Prevention, approximately 2 million people suffer from AMD, which is the leading cause of blindness, and another 7 million boomers are at risk. Educate your clients about the facts as well as the foods they can incorporate into their diet. “Omega-3 fatty acids can help protect against the inflammation [associated with AMD] that can damage eyes, so people should incorporate two fatty fish meals on a weekly basis,” Blake says. “We also know that lutein and zeaxanthin are wonderful for eye health. They can potentially reduce the risk of both cataracts and AMD. Foods that contain these two carotenoids include spinach, kale, collards, broccoli, and orange juice.”

Bones and Muscles
Aging means losing muscle mass. On average, adults lose 2% of muscle mass per year after the age of 50, which decreases basal energy metabolism. So the body burns fewer calories while at rest. For older adults to avoid weight gain, it’s important for them to reduce their caloric intake or engage in regular physical activity that includes aerobic and weight-bearing exercise. And since adults need more protein as they age, it’s important they eat lower-fat protein sources such as beans, low-fat dairy, and leaner cuts of meat.

“Even if the person’s weight stays the same, their muscle mass often deteriorates and their fat mass increases, which means a lower metabolic rate,” says Terri McNeany, MS, RD, CD, clinical nutrition manager at St Vincent Frankfort Hospital in Indiana. “Maintaining muscle mass is important for overall health. It even contributes to the immune system, which is protein based.”

Adults also lose bone density as they get older, so calcium and vitamin D are obviously vital. “But a lot of older adults find calcium harder to get because many experience lactose intolerance as they age,” McNeany says. “Older adults that are avoiding dairy need to look at fortified sources of soymilk or fortified juices and spread their intake throughout the day. It’s best to get no more than 400 mg at once so that it’s fully absorbed. [So] spread it out throughout the day.”

While the sun is the most potent source of vitamin D, it’s also a cause of skin cancer. “Nowadays, with more people being conscious of wearing sunscreen, it’s become increasingly important that they get their vitamin D from their diet,” Blake says. “Many of today’s products are fortified with vitamin D and people need to pay attention to that and buy products like orange juice that are fortified with both calcium and vitamin D.”

Healthy Skin
Because skin doesn’t produce or retain moisture as well when it ages, dry and itchy skin tends to become a common problem among older adults. Simply staying better hydrated can make a difference, says Dee Sandquist, MS, RD, LD, CDE, of Sandquist Consulting who’s a spokesperson for the Academy. “It’s really important to drink plenty of water,” she adds. “You can count other fluids toward hydration but it’s always best to opt for water.”

Beta-carotene can help boost skin health by keeping it vibrant and helping reduce damage, Sheth says. “An easy way to get more beta-carotene is through vegetables like sweet potatoes, carrots, and spinach,” she says.

Vitamin A is also important, Sandquist adds, and clients should look for low-fat dairy products. Antioxidants found in berries like blueberries and strawberries may benefit the appearance of skin as well as foods containing fatty acids such as salmon, walnuts, and flaxseed.

Cognitive Health
Maintaining mental health is of great concern for those aged 50 and older and another area in which nutrition can play a vital role. “It’s common to become forgetful as we age, so it’s important to incorporate fruits and vegetables rich in flavonoids in the diet, as there’s evidence they can aid memory,” Sheth says. “This would include apples, which are rich in quercetin. Berries, which are a rich source of antioxidants, also are believed to help prevent the breakdown of brain cells.”

Research on the power of antioxidants continues to grow, and Sandquist says she encourages clients to include plenty of berries in their diet. To maximize nutritional benefits, she says clients should aim to eat all types and colors of berries—red, blue, and purple. Of course the impact of blueberries on memory has been studied, and research has shown their flavonoids may help improve not only memory but also learning and general cognitive function. “One of my favorite ways to eat them is to mix them into plain yogurt,” Sandquist says. “But you also can toss berries on cereal or just eat them plain. They’re now available year-round in the freezer section.”

Good Digestion
During the natural aging process, the muscles that help move food through the digestive tract weaken along with other lost muscle mass, McNeany says. This can slow down the passage of food through the intestines and ultimately lead to constipation, which is quite common among older adults. Getting adequate amounts of fiber and staying hydrated are the two biggest combatants in fighting constipation and hard stools.

“Older adults often know they should eat their oatmeal for their cholesterol, but choosing bran cereals, whole grains, and lots of fruits and vegetables with the peel still on are really important in getting lots of fiber into the diet and preventing constipation,” McNeany says. “And get moving. [Clients should] try to avoid being sedentary so [they’re] able to keep the muscles in the GI tract active.”

“When you’re eating fewer calories it’s even more important that each calorie is fiber rich since constipation is a common concern as people age,” Blake says. “Americans should be getting a minimum of 4 cups of fruits and vegetables a day, and many aren’t coming close to that,” she adds. “One hundred percent [fruit] juices are wonderful, but [clients] need to be careful they’re also eating plenty of whole pieces of fruit. I also recommend a high-fiber cereal in the morning for a great kick-start to the system.”

Pain-Free Joints
When it comes to joint health, antioxidants can help reduce the damage associated with inflammation. Clients should eat “a diet that provides a lot of vitamin A, C, and selenium,” Sheth says. “Plant foods and some nuts and seeds are a good source of selenium, while vitamins A and C are found in fruits and vegetables.” Ideally, dietitians should suggest clients eat yellow and orange fruits and vegetables that contain anti-inflammatory properties, such as grapefruit, oranges, papaya, and berries.”

Research has shown that foods rich in omega-3 fatty acids also can help reduce joint swelling and inflammation, Sheth says. So have clients look for foods like walnuts, cold-water fish, flaxseed, and fish oil supplements, all of which are rich in omega-3 fatty acids.

Mouth and Sensory Changes
While we tend to focus on the impact of nutrition on major organs, it’s important to pay attention to the fact many older adults experience changes in the mouth that make getting proper nutrition challenging. Physical changes such as lost or decaying teeth or ill-fitting dentures can make eating problematic, McNeany says. “It can be particularly hard to get the fiber and protein you need when chewing meat is difficult,” she adds. “Suggest your clients choose softer sources of protein like cottage cheese or eggs. Instead of a thicker cut of meat, they can go for ground meat or meatloaf. And keeping the mouth moist by drinking in between bites also can make food easier to chew.”

Besides physical problems with chewing, older adults may develop sensory issues. Food texture suddenly may become a concern, and they may have increased trouble swallowing, particularly if there’s a loss of muscle function from a stroke or a disease such as multiple sclerosis. Modifying food texture by chopping or puréeing is a solution. It’s also common for older adults to experience changes in taste. “I’ve seen many older adults lose [their] sense of taste and suddenly develop a sweet tooth,” McNeany says. “I try to encourage naturally sweet foods like fruit instead of candy. Eating colder foods also can be more tolerable, and you can taste more flavor. Hot foods tend to give off more odors. Colder foods like sandwiches or dairy products may be better tolerated.”

In addition, it’s not uncommon for the sense of thirst to diminish with age, so dehydration becomes a real concern for older adults. “I often find many of my older patients aren’t taking in enough fluids,” McNeany says. “An easy way for patients to think about how much they should be drinking is taking in half of their body weight in water each day. That definitely takes some conscious effort. I recommend a refillable water jug marked in ounces or keeping track of the number of water bottles you drank by numbering the tops. That’s something I do myself. Sometimes it helps to have something visual.”

Balanced Diet
While each system of the body has its own importance, it all comes back to a diet that’s nutritionally balanced and full of fruits, vegetables, and whole grains. “It’s really the total diet,” Sandquist says. “Many of these areas overlap and that’s because it goes back to just eating a basic healthful diet. Supplements should be a last resort. People should try to get all of their nutrients from whole foods. In the end, healthful eating is a win-win. People who eat a healthful diet feel better and have more energy, even as they grow older.”

— Lindsey Getz is a freelance writer based in Royersford, Pennsylvania.


The Wonder of Berries
Research has shown that berries can have a major impact on the diseases of aging, and it’s not just the exotic variety. In a study published in Pharmaceutical Research, researchers found that even the more readily available and affordable berries such as blueberries, strawberries, and red raspberries—along with the more exotic and expensive varieties, including açaí and wolfberries—may prevent cancer about as well as the previously studied black raspberries. In another study, published in the Journal of Agricultural and Food Chemistry, it was found that drinking blueberry juice can improve memory. Researchers such as Amy Howell, PhD, an associate research scientist at the Marucci Center for Blueberry and Cranberry Research at Rutgers University in New Jersey, have been studying the powers of berries for years. Today’s Dietitian (TD) recently caught up with Howell to find out about some of her research on cranberries.

TD: We’ve been used to encouraging people to eat whole fruit, but your research seems to indicate that other forms of cranberries are just as good. Is there really no difference?

Howell: It’s almost impossible to get consumers to eat cranberries. They are very tart. But we found that the active compounds in cranberries called proanthocyanidins (PACs) survive the cooking process, so even relishes and sauces will have the benefits of a whole cranberry. The same goes for dried cranberries and, of course, cranberry juice.

PACs have been widely studied and are thought to be responsible for inducing a bacterial antiadhesion effect, preventing bacterial colonization and subsequent infection and disease not only in the urinary tract but also in the stomach and oral cavity. And the benefits don’t stop there. Emerging research suggests that cranberries may play a positive role in heart disease and cancer prevention.

TD: How many glasses of cranberry juice do you recommend to get the benefits?

Howell: I’d say one glass a day, but if you’re starting a cranberry regimen to prevent UTIs (urinary tract infections) or are serious about some of the other benefits, you might want to drink two glasses. I’d recommend one in the morning and one before bed because research has shown the effects of cranberries can wear off in about 10 to 12 hours.

TD: Can you explain how it works?

Howell: The proanthocyanidins in cranberries bind to the bacteria that cause a urinary tract infection and prevent it from adhering to the bladder wall. Because the cranberries remove rather than kill the bacteria, there’s less chance of it becoming resistant. While UTI prevention is a well-known benefit of cranberries, there’s also research being done that points toward disease prevention. For instance, cardiovascular disease is influenced by a number of processes, including oxidative stress and inflammation. Cranberries are very high in both antioxidants and anti-inflammatory compounds including PACs, anthocyanins, and flavonol glycosides.

— LG