Aged to Perfection

Rickelle Richards, PhD, MPH, RDBYU Wellness Seminar

July 17, 2008

Seminar Overview

• Healthy nutrition habits with aging, including specific nutrients of concern.

• Exercise recommendations with aging.• Specific health concerns: osteoporosis, arthritis, and

maintaining healthy quality of life.

3 Guiding Principles for Healthy Eating:

Balance

Variety

Moderation

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=

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• Eating enough but not too much• Eating foods in different groups• Promotes wider array of nutrient intake

Balance

• Eating many different kinds of foods in each food group

• Promotes wider array of nutrient intake

Variety

• Moderation ≠ Elimination

• All foods can fit into your diet

• Can even have “too much of a good thing”

Moderation

How much should I eat?

• Individualized plan

• Based on:– Age– Gender– Physical activity level– Optional: Height/weight

Grains:Make ½ Whole Grains

What are whole grains?o Include entire grain kernel (bran, germ, endosperm)

Examples:o Whole-wheat flour o Bulgur (cracked wheat)o Oatmealo Whole cornmeal o Brown rice

Grains:Whole Grains & Food Labels

How can I know if it’s whole grain?

Be sure to check the “Ingredients” list – Look for the words “whole grain” or “whole wheat”

Example: 100-Calorie Snack Mix vs. Woven Wheats Crackers

What about “refined grains”?

Milled = Outer layer (bran & germ) removedo Loss of nutrients (fiber, iron, B-vitamins)o Enriched Grains

Examples:o White flour o White breado White rice

Grains:Why eat them?

Health Benefits (esp. Whole Grains)o Decreased risk of heart diseaseo Prevents constipationo May help with weight mgmt

Grains:How much?

1 oz equivalent =

3 cups popped 5 crackers

½ cup cooked rice 1 slice bread 1 cup cereal

2 ½ oz roll/bun

1- 8" tortilla

Vegetables

Variety is key! Try varying your colors Forms = Fresh, Frozen, Canned, Dried, Juice

o Canned may have higher sodium or sugar content

Health Benefitso Reduce risk of heart disease, stroke, diabetes, &

certain cancers o May help to lower calorie intake (wt loss)

Fruits &

Vegetables: How much?

½ cup equivalent =

Fruits &

1 small apple

1 large (8") banana

¼ cup raisins

½ cup strawberries

½ cup juice

1 cup spinach (raw)

½ cup carrots

½ medium baked potato

½ cup tomatoes

½ cup green beans

Milk: Get Your Calcium-Rich Foods

Fluid milk & milk products (e.g., cheese, yogurt)o Note: cream cheese, cream, butter not in milk group (lacking calcium)

Try using fat-free or low-fat options

Health Benefits Builds & maintains bone Helps prevent osteoporosis

Milk: How much?

1 cup equivalent =

1 cup (8 fl oz) low-fat or fat-free milk

1/3 cup shredded cheese

1 cup (8 fl oz) yogurt

½ cup frozen yogurt 2 cups cottage cheese

Meat & Beans:Go Lean with Protein

Meat, poultry, fish, dry beans or peas, eggs, nuts, and seeds

Try lean or low-fat options

Health Benefitso High in iron, zinc, magnesium, B-vitamins, vit E o Building blocks for bone, cartilage, muscle, skin, & bloodo Energy production o Antioxidant

Meat & Beans:How much?

1 oz equivalent = 1 oz meat, chicken, or fish

(picture = 5 oz steak) (picture = 3 oz chicken) (picture = 8 oz salmon)

½ ounce nuts ¼ cup cooked beans

Oils—Know Your Fats:Liquids vs. Solids

LIQUIDS Liquid at room temperature Examples: canola oil, corn oil, olive oil, soybean oil, sunflower oil

SOLIDS Solid at room temperature Found in meat products Examples: Butter, chicken/beef/pork fat, stick margarine*, shortening*

*Made from hydrogenated oils

Discretionary Calories

• Allowance for “extras” after “essentials” met• What counts as “extras”?

– Added sugars– Solid Fats (e.g., butter, margarine)

– Additional foods

Calorie “Budget”

“Essentials” = 1600 calories

“Extras” = 200 calories

Water

• Majority (50-70%) of body weight • ↓ability to sense thirst with aging• Drink even when not thirsty• Water (Rec. = ~8 cups) + Foods

How can I increase my water intake??

• Drink glass of water with every meal.• Carry filled water bottle with you & drink it! • Put a cup next to bathroom & kitchen sinks – drink when

take meds or brush teeth.• To limit frequency of urination at night, drink most fluids

during day & less at night.• Add freshly squeezed lemon or lime in water.• Start small… make goal today to increase by 1 cup &

gradually increase over time.

Some easy tips…

Physical Activity

• At least 30 minutes moderate or vigorous PA most days.• What counts as moderate PA??

– Walking briskly (about 3 ½ miles per hour) – Hiking – Gardening/yard work – Dancing – Golf (walking and carrying clubs) – Bicycling (less than 10 miles per hour) – Weight training (general light workout)

Note: Before starting new exercise program, be sure to talk to your health care provider.

Physical Activity

• What counts as vigorous PA??– Running/jogging (5 miles per hour) – Bicycling (more than 10 miles per hour) – Swimming (freestyle laps) – Aerobics – Walking very fast (4 ½ miles per hour) – Heavy yard work, such as chopping wood – Weight lifting (vigorous effort)

– Basketball (competitive)

Note: Before starting new exercise program, be sure to talk to your health care provider.

Nutrients of Concern with Aging

– ↓ ability to make vitamin D

– ↓ sun exposure

– Drug-nutrient interactions (barbiturates, cholestyramine, Dilantin, laxatives) -- ↓ vit D

Sunlight

Vitamin D

Vitamin D

• Main role – helps keep calcium at the right levels in our blood & for strong bones

• Too little vitamin D -- > “Soft Bones” (osteomalacia)– Helps prevent osteoporosis– Helps prevent painful joints & muscles

Why should I care about Vitamin D??

Recommendation: Some sun exposure + eat in foods (fortified milk, salmon, shrimp).

– Inadequate dietary intake– Reduced calcium absorption– Recommendations = 1200 mg (1 c. milk = ~ 300 mg)

Calcium

…why should I care about Calcium??

– Calcium needed to prevent bone loss – Can protect against high blood pressure

– Abundantly used in body – Needed for strong bones– Involved in nerve activity

Magnesium

– Inadequate dietary intake– Impaired absorption in body from GI disorders & diabetes

…why should I care about Magnesium??

(cooked)*Caution: Mg-based antacids & laxatives may lead to too much magnesium.

Health Concerns with Aging…

What is osteoporosis?

                            

Vertebral

Hip

Wrist

“Porous bone”

Osteoporosis: Effects of Menopause

Sizer & Whitney, 2008

Accelerated Bone Loss•Inadequate intake•Inadequate Ca absorption•Excess Ca excretion

3-5 yrs > loss

Osteoporosis: Prevalence

• 10 million older adults (80% female)

0

5

10

15

20

White Asian Black Hispanic

Men Women

% of > 50 y.o. individuals

http://www.nof.org/osteoporosis/diseasefacts.htm

Osteoporosis-related Fractures

• 2005: 2 million fractures– 297,000 = hip fractures– 547,000 = vertebral fractures– 397,000 = wrist fractures– 675,000 = fractures at other sites

• Projection for 2025 = 3 million fractures

“A woman’s risk of hip fracture is equal to her combined risk of breast, uterine and ovarian cancer.”

--National Osteoporosis Foundation

(http://www.nof.org/osteoporosis/diseasefacts.htm)

http://www.nof.org/osteoporosis/Risk_Factor_Card.pdf

Osteoporosis: Cost

• Economics– 2005 = $19 billion (osteoporosis-related fractures)– 2025 projection = $23.5 billion

• Quality of Life– Limited mobility (6 m, only 15% can walk across room w/o

assistance) + impaired activities of daily living– 1 in 5 ambulatory before require long-term care afterward– ~ 24% die 1 yr post-fracture

Osteoporosis: Prevention

• Adequate Ca (1200 mg/d) – To improve Ca intake + absorption

• Drink milk + supplements at meal• Ca & antacids taken at different times• Adequate Vitamins C, D, B6, & K

• Physical activity

What is Arthritis?

• Pain, aching, stiffness, & swelling in or around the joints • Osteoarthritis (“wear and tear”) is most common• Most common cause of disability (in U.S.)

Risk Factors (Osteoarthritis)…– Increasing age– Obesity– Injury or overuse– Genetics/Family History– Muscle weakness– Other conditions/types of arthritis

How can I manage osteoarthritis besides using meds?

• Moderate physical activity– ↓ pain & stiffness– ↓ fatigue– Strengthen muscles + bones– ↑ flexibility + stamina– ↑ sense of well-being

• Weight control– ↓ stress on joints (esp. hips, knees, back, & feet)

• Reduce daily stresses – balance between work & leisure activities/rest

• Use good body mechanics

Today’s take-home message…

Balance

Variety

Moderation

Questions/Comments??