Nutrition Tips for Aging Well
As you get older, food may not seem like a top priority when it comes to your immediate health needs, but it should. Aging significantly alters your body in many ways. Some of the common concerns include loss of muscle, nutrient deficiencies, blunted or loss of senses, decreased energy or fatigue, reduced appetite, poor digestion, chewing or swallowing challenges, and bowel and urine dysfunction. Building a smart strategy for nutrition care and having a good routine in place can help to improve and maintain your body’s functioning as you age. Proper nutrition can further help to lower disease risk and the onset of acute illnesses. Below are some key nutrition considerations that you may want to start including as part of your daily routine.
Think Quality Over Quantity
More may not necessarily be better when it comes to diet. Rather, the highlight should be on nutritional quality. Older adults may need fewer calories to maintain a healthy weight because there may be reduced energy expenditure (less movement and exercise). Older adults also tend to carry less muscle mass. However, needing fewer calories does not necessarily mean needing fewer nutrients. Below, we focus on some key dietary elements that are important to keep up with while you age:
This vitamin is responsible for a variety of functions including red blood cell formation, cellular metabolism, nerve and cognitive functioning, and bone health to name a few. The challenge with B12 is that this vitamin cannot be made by the human body, therefore sources must come from food or supplements. As you get older, vitamin B12 may be even harder to obtain for a variety of reasons. Food intake generally declines, which means there may be less B12 coming from your diet, and your stomach acid production starts to lessen. Stomach acid is a key piece to helping you absorb vitamin B12 from the foods you eat. Sometimes, certain medical conditions or the use of B12-depleting medications can also alter your vitamin B12 status. For instance, some corticosteroids, anti-inflammatories, antibiotics, anti-diabetic, anti-convulsant, cardiovascular, cholesterol-lowering, gout and ulcer medications may impair your ability to maximize your B12 levels. If you are concerned, have your family doctor and pharmacist review your medications.
Vitamin B12 deficiency is often overlooked or improperly diagnosed. The following are some common symptoms associated with vitamin B12 deficiency:
- Fatigue/ lethargy/ weakness
- Pale or yellow skin
- Migraine headaches
- Depression/ mental conditions (psychosis, mood disorders)
- Gastrointestinal issues (diarrhea, nausea, constipation, bloating, gas)
- Poor concentration / cognitive impairment (difficulty thinking and reasoning, memory loss)
- Swollen or inflamed mouth/ tongue
- Numbness, tingling or “pins and needles” in the hands and feet
- Poor coordination/ balance
- Visual disturbances
- Muscle cramps or weakness
Normally, a blood test will let you know if you have vitamin B12 insufficiency or a deficiency at play. Treatment may include B12 intramuscular injections, supplements, and dietary advice to increase B12-rich sources of food. Generally, a mild vitamin B12 deficiency can be corrected with a standard multivitamin. For prevention, try to include a variety of meats (all types), eggs, seafood (fish, clams, crabs), milk products (milk, yogurt, cheese) or non-dairy fortified products, B12-fortified grain products (cereals, breads), fortified nutritional yeast (good for vegans), and soy products (good for vegans). Aim for 2.4 mcg daily for men and women.
Iron is a mineral that plays a vital role in blood production. Nearly 70% of your body’s iron is found in two areas of your body; first in hemoglobin, which is in your red blood cells, and the other is stored in myoglobin, which is found in your muscle cells. Iron, just like vitamin B12, can help reduce feelings of tiredness or exhaustion. It also helps the muscles in your body store oxygen (and remove carbon dioxide). Blood loss is one of the most common causes of iron deficiency amongst the elderly, but inadequate dietary intake and impaired absorption are also major factors. Other medical reasons may include the interference of certain medications on iron uptake, your body not producing enough red blood cells, or your body is destroying red blood cells.
Iron deficiency is one of the most common and widespread nutritional disorders worldwide, according to the World Health Organization. Amongst the elderly, iron deficiency and iron-deficiency anemia are almost always due to chronic gastrointestinal diseases, which can lead to long-term iron losses because of impaired absorption. Often, they are caused by chronic upper an d lower gastrointestinal blood losses, and this may be due to esophagitis, gastritis, peptic ulcer, colon cancer or pre-malignant polyps, inflammatory bowel disease, or angiodysplasia. Frequent use of medications like proton pump inhibitors (PPI) for the treatment of heartburn/ acid-related disorders may also interfere with absorption as stomach acid is need for iron uptake. In relation to nutrition, calcium and phytates/ phytic acid (the stored form of phosphorus) found in foods can also interfere with absorption of iron. Often it is recommended that you space your intake of iron rich foods/ supplements from calcium-rich foods/ supplements and moderate your intake of phytates/ phytic acid-rich foods (beans, seeds, nuts, and grains).
For treatment of low iron, an iron-rich diet and, or the use of prescribed iron pills may be recommended. Should you be placed on iron pills, monitor your gastrointestinal symptoms as some iron medications may cause stomach problems like heartburn, nausea, diarrhea, constipation, or cramps. If you are actively increasing your dietary iron intake, do not forget about vitamin C (i.e., adding an orange, kiwi, having some lemon/ lemon juice, grapefruit, bell peppers, berries, tomatoes, broccoli, cabbage). Vitamin C helps improve iron absorption from plant-based foods containing non-heme iron. The other type of iron (heme iron) is mainly found in animal-based foods like meats (beef, pork, veal), seafood (halibut, haddock, perch, tuna, salmon, clams, oysters, mussels), and poultry (chicken, turkey). Generally, heme iron is better absorbed by your body.
Dietary approaches are always recommended for seniors to help with meeting other nutritional goals that may include protein and caloric restoration. The recommended iron for seniors is 8 mg daily for both men and women (post-menopausal). To ensure that your iron levels are adequate, a blood test can be done.
Eating a diet rich in iron like those found in animal meats, beans, lentils, iron-fortified cereals, dark leafy green vegetables, and dried fruits is a wonderful way to start building iron into your diet.
Magnesium is an essential mineral that helps to support muscle and nerve function, brain function, mood, healthy immunity, bone strength, normal and steady heartbeat, as well as energy production. Approximately 60% of the magnesium in your body is found in bones. It is involved in assisting over 300 enzymatic reactions in the body.
Chronically low levels of magnesium may increase your risk for high blood pressure, depression, heart disease, migraines, type II diabetes, and osteoporosis. Low levels of magnesium may further be impacted by poor diet, malabsorption, alcohol abuse, uncontrolled diabetes, hypercalcemia (when you have too much calcium in the blood), or the use of magnesium-depleting medications (i.e., diuretics, proton pump inhibitors, and antibiotics). The following may indicate signs of magnesium deficiency:
- Weakness, fatigue, lethargy
- Poor appetite
- Numbness or tingling skin
- Muscle cramps
- Abnormal heart rhythm/ rate
- Personality changes
A standard blood test will help to determine whether your magnesium levels are within range. Severe magnesium deficiency is often treated with oral magnesium salts, or an intravenous or intramuscular injection may be used if oral therapy cannot be tolerated.
The daily dietary recommendation for magnesium is 420 mg for elderly men and 320 mg for elderly women. Choose magnesium-rich food sources from a variety of foods including spinach, broccoli, potatoes, legumes (beans, peas, lentils), whole grains (breads, cereals, pasta), dairy products (milk, yogurt), fortified soy beverages, seeds (pumpkin, sunflower, sesame), nuts, and soy-products (tofu).
Calcium is a key player in helping you build and maintain strong bones. It is one of the most abundant minerals found in your body and nearly all of it is stored in your bones and in your teeth. However, outside of these areas, your body also needs calcium to support muscle movement and proper nerve communication between your brain and each part of your body. Among other roles, calcium is also responsible for the release of hormones and helps blood vessels move blood throughout your body.
Too little calcium may increase your risk for osteoporosis, frequent falls, and fractures. Research as found that as early as the age of 30, bones slowly start to lose calcium. Between the ages of 25 to 50, bone density remains relatively stable. This means that the rate of bone formation and bone breakdown (resorption) is the same. However, after the age of 50, bone breakdown speeds up and overtakes bone formation. This is particularly true for women after menopause. For elderly women, the risk for osteoporosis and osteopenia (low bone density that is not yet classified as osteoporosis level) is higher since female bones are smaller and less dense compared to male bones. Once estrogen hormone levels fall after menopause, the risk increases further.
Some medical condition may also exacerbate calcium loss – overactive thyroid (hyperthyroid) or parathyroid glands, cancer, chronic lung disease, endometriosis, vitamin D deficiency, and long-term use of steroid medications like prednisone. Other risk factors that may threaten bone health include:
- Low dietary intake of calcium, vitamin D, potassium, or protein
- Excess alcohol intake
- Eating disorders or disordered eating patterns
- Low estrogen levels (women) or testosterone (men)
- Lack of physical activity (weight bearing exercises)
For prevention, both women and men should aim for an average of 1,000 mg to 1,200 mg of calcium daily. Choose calcium-rich foods like dairy products (milk, yogurt, cheese, soy), greens (broccoli, kale, bok choy), canned fish (sardines/ salmon with bones), and calcium-fortified beverages (almond milk, cashew milk, coconut milk) or calcium-fortified food products. If you are on dialysis, consider talking to your doctor and dietitian about your individualized calcium needs. Calcium supplementation may be a consideration if you cannot meet your requirements from food but before you start, speak with your dietitian. You may be recommended to take extra vitamin D to support its absorption.
Popularly known as the “sunshine vitamin,” vitamin D is a vital nutrient that supports healthy aging. It supports calcium and phosphorus absorption and retention, and research also suggests that it plays a role in reducing cancer cell growth. Among other roles, it has been found to enhance cardiovascular health, improve neuromuscular function, while helping to control infections and reduce inflammation. Research has also pointed to its involvement in mood regulation and in the prevention of depression.
Seniors are more likely to run into issues of vitamin D deficiency due to poor intake, low sunlight exposure, and reduced synthesis of vitamin D in the skin. Among other conditions, those with digestive concerns that impact fat absorption like celiac disease or inflammatory bowel disease are at further risk for D deficiency. Poor function of the parathyroid, liver or kidney can also reduce one’s ability to generate the active form of vitamin D3, which can result in deficiency as well. Symptoms of vitamin D deficiency may include muscle pain and weakness, and this in turn may increase one’s risk for bone fractures from falls.
Exposure to the sun’s rays on our skin helps us to make vitamin D, but the challenge is that we normally do not get as much sun as we need to produce adequate levels. Along with aging, our skin’s ability to make vitamin D decreases. Natural food sources of vitamin D are also scarce, which means supplementation should be considered. Those over 50 years of age should aim for approximately 800 IU to 2,000 IU daily. A better option is to pick vitamin D3 (cholecalciferol) as it has been found in some research that it increases and sustains blood concentrations of the vitamin longer compared to vitamin D2 (ergocalciferol or pre-vitamin D). Build up additional sources of vitamin D from cod liver oil, salmon, swordfish, tuna fish, orange juice (fortified with vitamin D), sardines, margarine, egg yolks, fortified cereals, and dairy and plant-based milks fortified with vitamin D.
Regular blood tests can help to determine whether you are meeting adequate levels.
Adequate intake of protein is essential for seniors in helping to maintain lean muscle mass function and strength, and to prevent weight decline. Sarcopenia, the progressive and generalized loss of muscle mass and strength, is a common concern amongst the aging population as it has been found to correlate with physical disability, poor quality of life, and increased risk for death. The maintenance of adequate protein is key to preventing these issues.
Protein further supports:
- Collagen (providing strength and structure to tissues)
- Growth, maintenance and repair of skin, hair, and nails
- Hemoglobin (helps to transport oxygen to the entire body via red blood cells)
- Hormone functions
- Enzyme activity involved in metabolism and key chemical reactions
- Antibodies that play a role in your immune defense
General recommendations for protein are between 0.8-1.2 grams per kilogram of weight. Needs may be more if you have malnutrition or have an acute or chronic disease. It is best to consult a dietitian for further guidance and individualized targets.
With dietary approaches to reaching protein requirements, it is best to opt for foods. Complete proteins are best as they contain all the essential amino acids (building blocks of protein) to support the building of muscle protein. Examples of complete proteins include meat (beef, pork, lamb), poultry (chicken, turkey), fish, eggs, dairy (milk, cheese, yogurt). Among plant-based options for complete protein, quinoa and soy are recommended. Incomplete proteins, mostly from plant-based sources, are low in one or more essential amino acids so if you are considering these options, make sure to include a variety.
Another important element to include for maintenance is dietary fiber and it comes in two forms, soluble and insoluble. Typically, you need a combination of the two types to support good health. Generally, males over 50 years of age require an average of 30 g of fiber daily, and females over 50 need 21 g daily. Fiber has many functional benefits including keeping you regular, reduces your risk for high cholesterol, heart disease, and type II diabetes. You can easily boost your fiber intake from foods like vegetables, fruits, whole grains, plant proteins like legumes, and nuts and seeds. Choose fiber enriched products when available. Don’t forget to stay hydrated too as you increase your dietary fiber. Connect with your registered dietitian to learn what each type of fiber does for you.
Poor dentition, swallowing difficulties, reduced physical and cognitive functioning, limited finances, and self-dietary restriction are all factors that can challenge nutritional intake amongst seniors. Resolving these concerns and making proper accommodations like diet texture modifications, building good eating strategies, engaging in visual and verbal cueing, considering socio-cultural factors to cuisine, activating community supports, and providing education to seniors and their caregivers are essential to helping seniors reach their nutrition goals. Use of support products like oral nutrition supplements, protein powders, and vitamin and mineral supplements can go a long way to helping seniors obtain a nutrient-rich, high-quality diet to support health and longevity.
About the Author:
Rosanna Lee is a geriatric dietitian specializing in the areas of chronic disease prevention and management. She works primarily with the elderly at the Centre for Seniors and Neuro Rehabilitation at Peel Memorial Centre (William Osler Health System). Rosanna works closely with seniors that are part of the Memory, Parkinson’s, Falls and Frailty, Osteoporosis, Continence, Behavioural and Psychological Symptoms of Dementia (BPSD), Neurological Rehabilitation, and Geriatric Outreach clinics. Follow her on LinkedIn, Facebook, or Instagram. If you would like to be in touch, send her an email at firstname.lastname@example.org.
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These resources were made possible due to an unrestricted educational grant from Ensure.