Nutritional fads come and go. But one fad which seems to have elevated to a gold-standard of credibility has been the so-called "Mediterranean Diet". The Mediterranean diet recommends eating lots of plant-based foods mainly fruits, vegetables, and legumes and foods infused with monounsaturated fat such as olive oil. This popular diet acquired high acclaim in the US as a nutritional best-practice in preventing heart disease after a five-year study by a group of Spanish nutrition scientists caused the New England Journal of Medicine, NEJM, to publish its conclusions suggesting that the Mediterranean diet can decrease risk of heart attack and strokes. The study concluded: prolonged exposure to the Mediterranean diet produced a substantial reduction in risk of major heart disease among high-risk people.
Recently, a statistical sleuth named John Carlisle exposed many flaws in the study namely its claim to have assigned people randomly to the study and other anomalies. Carlisle’s analysis refuted the study’s findings thus discrediting it, causing the NEJM in the summer of 2018, to retract the original publication. This turn of events has re-ignited the debate on what is optimal diet for seniors in later life and whether nutrition can have a positive impact on the health and wellness of very old adults? Ironically, much the Mediterranean diet compares agreeably to nutritional best-practice recommendations of public health organizations and other accredited bodies but without all the feigned notoriety. Yet, to deliver nutritional best-practices in later stages of life requires that special accommodation be made to address health-status changes.
Function and Diet in Late Life
The diet of persons over age 80 are complicated by altered nutritional demands and eating mechanics. As we reach older ages, appetite and food consumption declines, as does energy expenditure. Resting metabolism is slowed, taste and smell diminish and things like dentures, swallowing difficulties, and digestion issues may develop. Adding to functional impairment is medication side-effects, diseases like cancer depression, anxiety, food aversion, and dementia all of which may contribute to altered nutrition status. Seniors in later life have more risk of malnutrition or more accurately “undernutrition” and associated issues like falls, loss of energy, mobility, loss of muscle mass and confusion.
Two studies of aging and health, the Baltimore longitudinal Study of Aging and Newcastle 85+ both confirmed that very old adults have high risks of macronutrient malnutrition deficiencies (ex: low protein intake) and micronutrient deficiencies (ex: vitamin D, calcium, and magnesium) These and other studies revealed that very old adults may require higher protein intake of greater than 1 gram per kilogram of body weight per day. The studies recommend dietary patterns characterized by higher intakes of fruits, vegetables, nuts, dairy, fish, and whole grains. Although nutritional requirements of the very old are poorly understood there is wide agreement that optimal nutrition practiced later in life can lead to improved health and function, particularly in boosting energy levels and in building strength.
Tufts University, with support by the AARP, introduced an updated version of MyPlate for Older Adults, in 2016, which adopts most of the 2015-2020 Dietary Guidelines for Americans from the U.S. Department of Health and Human Services and the U.S. Department of Agriculture. MyPlate recommends that seniors consume:
50% fruits and vegetables 25% grains many of which are whole, and 25% protein-rich foods-nuts, fish, lean meats, and low-fat dairy.
However, because many seniors at older ages have complicated medical issues, they should be referred to nutritional specialists or their medical teams for nutritional advice. Nevertheless, Wellness-4 Later Life, the cutting-edged wellness program conceived by Everbrook Senior, embraces the general nutritional guidelines of MyPlate for Older Adults, except further modifies it to better suit the unique needs of seniors in a later stage of life.
Wellness and Nutrition in Later Life
Maintaining good nutritional status in later life is critical to aging well. Because nutrient needs are often neglected in later life through forces related to the aging process, the most optimal diet is one that supports health, level of energy, and function, but individualized to accommodate unique health issues. Wellness-4 later Life adopts evidenced-based nutritional practices that are known to improve wellness, health, and function particularly if good nutrition habits are supplemented by a physical activity regimen. The Wellness-4 Later Life nutritional plan for seniors over age 80 has the following components:
- High Nutrient-Dense Foods: Seniors eat less and the National Institute of Health recommends the consumption particularly by older adults of “nutrient-dense foods” that is a food that provides a high amount of nutrients but have relatively few calories”. The U S Department of Agriculture refers to a quality diet as having a higher level of micronutrients and macronutrients per calorie, while limiting the levels of toxic substances such as trans-fats, sodium, and refined sugars. Fruits and vegetables in a wide rainbow of colors, whole grain breads, oatmeal, brown rice, cheese, milk, and lean proteins are all nutrient-dense foods recommended for older adults.
- Specific Nutrient-Dense foods Suited for later Life: USDA dietary Guidelines identifies vegetables as excellent sources of six nutrients; fiber; potassium; magnesium, and vitamins A, C, and K. Vegetables, especially white potatoes, provide significant levels of key nutrients of concern, such as magnesium, potassium, vitamins, and dietary fiber. Tomato juices and tomato soups, dark green leafy and non-leafy vegetables, deep yellow vegetables, including sweet potatoes all contain high nutrient density. In addition, oatmeal is a carbohydrate and protein-rich source that provides calories, nutrients such as manganese phosphorous, copper, selenium and iron, and therefore good energy. Oatmeal is a low glycemic meal, full of soluble fiber, which helps one feel fuller longer and contains beta-glucan which produces high viscosity conducive to good digestion. Eggs have a high nutrient density because they have a high number of nutrients in proportion to calorie count. One egg has 13 essential vitamins and minerals in varying amounts high-quality protein, and anti-oxidants, all for 70 calories. Skim milk is nutrient-dense. Beans and peas are nutrient-dense and provide good sources of protein, dietary fiber, folate, potassium, iron and zinc. Avocado is a nutrient-dense food that provides nearly 20 vitamins and minerals and is nearly the only fruit which contains heart-healthy non-saturated fat-good fat. Bacon is nutrient-dense food as it contains essential vitamins and minerals, specifically, calcium, iron, magnesium, phosphorous, potassium, zinc, vitamin B-12, niacin, and saturated fats-these can be reduced through cooking technique. Bacon consumption results in increased high-density lipoprotein levels. Other foods which have high-density include blueberries, blackberries, mangos and other fruits.
- Nutrient Deficiencies in Later Life: With few exceptions, mineral intake declines with age. Only vitamins A, C and carotene are known to remain constant or increase with age. Vitamin B-12, B-6, and calcium are deficient in most older seniors as is Vitamin D, E K, potassium, and fiber. Foods enriched in some or all of the minerals known to be deficient in advanced age should be introduced into the diets of older adults. Senior Unfriendly foods and spices includes sugar, salt, and trans fats. High energy foods such as cereals and breads, are loaded with empty calories and should be moderated.
- Modifying Food Consistency improves nutritional status in Later Life: Seniors may develop food aversions when the mechanical act of eating becomes a challenge. Food texture influences food consumption patterns of very old adults. Certain foods are inherently senior-friendly being soft-textured while other foods can be modified to ease chewing or swallowing mechanics. Cutting fresh fruits, steaming vegetables, mashing vegetables, softens the texture of foods to ease chewing and swallowing. Whereas, many meats are course, stringy and difficult to chew and swallow. Foods non-senior-friendly but which are nutrient-dense should be mechanically altered so seniors are enticed to eat them. Dice and shred beef, use skinless chickens, coarsely chop corn, pure carrots, undercook bacon, avoid dried fruits, getable like cauliflower.
- Preparing Popular, Senior-Friendly Meals from Nutrient-Dense Foods: Seniors eat what is tasty but also easier to eat. Offering a filet mignon with full-skin potato and corn may present well but is very senior-unfriendly and could go partially uneaten. Whereas, meatloaf with bread crumbs replaced with oatmeal, lined with herbs and spices, peppers and onions, actually contains a well-balanced array of nutrient-dense foods, essential minerals, and is a senior-friendly nutritious meal easy to eat. Other senior-friendly meals containing optimal consistency and nutrition include cooked oatmeal infused with finely chopped walnuts, cinnamon, skim milk, and fresh or frozen fruits: Quiche prepared with a mix of chopped meats and vegetables, crepes, cauliflower crusted pizza with nutritious toppings, homemade soups infused with super vegetables like kale or spinach, low in sodium, stuffed peppers infused with rice, beans, and soft meats. Sheppard’s pie and whole-grain bread sandwiches including peanut butter and banana but not processed meats.
- Supplement Nutritious Meals with Comfort-Foods to Indulge for pleasure and social interaction. It is recommended that seniors adhere to medical advice but if permitted, moderate consumption of desserts which has sugar may not cause poor health unless abused but does lift spirits, is pleasurable, and may actually induce better overall eating habits, particularly among seniors who are at risk of malnutrition. Portion control is the most optimal way to protect the sanctity of the overall nutritional plan. Soft desserts like custards, puddings, parfaits, and other fresh fruit-based desserts are optimal. Nutrient-dense dessert ingredients include fresh-fruits, Greek yogurt, skim milk, dark-chocolate, honey, and flax-seed.
- Eat Well in Later Life: Seniors in Later Life should form habits which puts good foods first, that is, high nutrient-dense foods which crowd-out high-energy foods high in calorie but low in nutrients. Remove bread and butter from the serving table, replace salt with spices, have multiple servings daily including protein-infused smoothies or fresh-fruit snacks; eat a healthy breakfast, hydrate often eat in accordance with a nutritional plan like MyPlate, and engage in a physical activity program.
