 Hey everybody, welcome to Chapter 17, this is Dr. Rose, sorry, life cycle nutrition, adulthood in the later years. So we've gone through pregnancy and lactation, infancy, childhood, early adolescence. So now we're just talking about near the end of life. We're talking about not adulthood, but your typical recommendations, we have your 20s and 30s or 40s are all going to be all the same, but you will see that we talk about how someone becomes elderly and gets older, how that's going to impact the nutritional needs quite a bit. So we're going to focus really more on the later years or the elderly years, more than anything. About 20% or 1 in 5 of Americans are over the age of 65 now, 85 plus is actually the fastest growing population in the United States. So this is clearly a big concern or helping make sure that the growing elderly population, the baby boomer population and beyond, helping them stay really healthy. It's a whole different ball game than it was 100 years ago. The life expectancy in 1900 was 47 and now we're looking at 78, 79, somewhere in that ballpark. So it's amazing what's happened in the last 100, 120 years. In 1907, I know the two leading causes of death were basically pneumonia and diarrheal diseases, tuberculosis, things like that. So one of the main reasons that the life expectancy has shot up so much has been our ability to deal with infectious diseases. So that's where you see a lot of progress there. So the question is like, are we healthier than 100 years ago? Are we healthier than our ancestors? I generally would say no because we're less physically active and we over consume empty calories, et cetera. But we're really good at staying alive and then allow that has to do with infectious disease. So you can live a very long, healthy life and that's the things we're going to talk about here today. All right, let's go ahead and dive in. Do you think being active in later years is related to physical fitness or to nutrition? Is there a relationship between the two? Why or why not? So I mean, I think the answer is yes to both of them. So if you're eating to fuel physical activity, then you're more likely to be active. And if you're physically fit because of exercise and lifestyle factors, then you're going to be able to do those kind of things, right? Keeping your mobility, keeping your strength, taking as much lean mass into your elderly years as possible, the elderly years as possible. These are all really important things. So if you're in too much pain or you're too immobile to be physically fit, to be physically active, then you're going to have a hard time being physically fit. And if you're eating a very poor diet, so you're always tired and malnourished, then that's going to have a big impact as well. So I think the two, and the two feet on each other too, I know that if you eat well, you are more likely to be physically active. If you're physically active, you're more likely to eat well. You know, like personally, I know that I don't want to ruin a good training session by eating a poor diet. And that's why, like if I skip an exercise, let's say I'm hurt and I can't train for a week, I'm more likely to eat poorly that week, just being honest. So I think the two feed into each other. So the answer is yes, in my opinion, so both, both nutrition and physical fitness play critically important roles in being active. When you get old or if you've lost all your muscle mass and you have weak bones, like, yeah, you're not going to want to be active. You're frail and you're going to be concerned about fall risk and those kind of things. So the two absolutely feed into each other. So is there a relationship to the two? Yes, we, I don't know, I just explained why. All right, learning objectives for this chapter, describe the role nutrition plays in longevity, summarize how nutrition interacts with the physical, psychological, economic and social changes involved in aging, lots of stuff going on there. Explain why the needs for some nutrients increase or decrease during aging. Lots of good examples there. You know, just off the top of my head, you've got stomach acid changes will impact iron absorption and we'll talk about B12, that'll be a big one. Explain how nutrition might contribute to or prevent the development of age related problems associated with vision, arthritis, the brain and alcohol use, and instruct an adult on how to shop for groceries and prepare healthy meals for one person on a type budget. Nutrition and longevity. So the aging of the U.S. population, we've talked about that already, but two motivating goals, promoting health and slowing aging, so which the two are interrelated, if you're healthier, if you're healthier then you will age more gracefully, so to speak. So we do have old people, the young people is increasing. We talked about how 20% of the U.S. population is above the age of 65 and how 85 plus is actually the fastest growing age group, you see there. So growing old happens day by day, yeah, that's very true. You look back and you think, you know, I don't have my birthday recently and I don't feel any different than I did yesterday, but I do feel different than I did five years ago and 10 years ago and I can only imagine what my 84th birthday is going to feel like compared to my 44th. Factors influencing life expectancy, we've talked about infectious diseases when you're young, you know, surviving through childhood is a huge, huge part of it. Trauma and injuries, so high risk behaviors. Genetics play a very, very big role and then what we primarily can control then is diet and lifestyle factors. Observation of older adults. Physiological versus chronological aging. So physiological age refers to a person's health status may be different from their chronological age. So this is really clear examples. You know, you see someone that's in their 80s or 90s that still, their mind is still firing away. They can still take care of themselves. They can do a lot of activities of daily living. So you've got a physically and mentally active 90 year old and then you have someone that, you know, like my grandmother, she had rheumatoid arthritis and she was basically disabled in her mid 50s. So when she was in her 60s, you know, she had difficulties that someone might not have in their 90s. So we all know someone that's in their 60s and has sadly already died or have serious health problems. So they have a lower chronological age but a higher physiological age. Their body is aging more rapidly. Then we all know someone that's old so their chronological age is higher but their physiological age is lower. I had patients back, you know, back in the day when I saw patients, I remember I had a patient that was 72 years old and he still logged about 1,000 miles a year on his treadmill. He was extremely healthy, right? He had the physiological age of someone in his 50s. I had a patient that was in their 60s and they would roll her blade into the practice. You know, it was just really, really cool to see these kind of things. But then you have people that are just, I mean, even in the 30s that just can barely function. So that's the difference between your physiological age and your chronological age. Your chronological age is how many days have you been on this earth? Your physiological age is how much has your body aged. So things like extreme stress and poor diet, poor physical activity, all those things will accelerate aging. All right, healthy habits in eating. So what, you know, what healthy older people kind of have these things in common? Eating well balanced meals, nutritious meals, engaging in physical activity daily. You know, not always structured exercise but physical activity, keeping their step counts up and gather your step count and life expectancy are definitely linked together. You know, whether it's a correlation or causation is a whole another question but I'll do a separate video presentation on that on non-exercise activity thermogenesis. It's a talk I've been giving recently and people really like. So I'll throw a video up with that sometime. Not smoking, not using alcohol or using it in moderation which basically means like one drink a day for females and two drinks a day for males. And even then that second drink doesn't seem to be super beneficial. So generally one drink a day. Maintaining a healthy body weight, sleeping regularly and adequately, relieving stress by focusing on a sense of purpose. So a lot, you look at like the blue zones, the parts of the world where people typically live longer. Families usually a huge deal. And elderly people, they still have a purpose and that is their family. They often live with their family. They help care for their family members. You know, they call it like the grandparent effect. So having a sense of purpose is very important. You look at the number of people that, you know, they retire and they kind of lose their purpose which was their career and they age pretty rapidly and they don't do very well. So keeping a sense of purpose is very big deal. Having a community of family and friends who just mentioned that. So support, purpose, diet, exercise, not doing things that are very harmful for your health like smoking. This is the blueprint for living a long, healthy life. Not guaranteeing it, but it's increasing the likelihood that you will have a long, healthy life. Knowledge check ones. You can pause this and try to answer these questions quick. Aging is an inevitable process programmed into our genes. The process can be slowed by adopting healthy lifestyle habits. So aging is inevitable. You know, I have a book behind me. You probably can't see it but I have a book called Ending Aging that's looking at, you know, it's from an Aubrey de Grey who's the head of the Methuselah Foundation that's trying to basically, trying to make a 70 the new 30 and then trying to extend life. It's pretty cool, the stuff they think about. But as for now, aging is an inevitable process. You can slow it but, and some people are going to age at different rates but it is inevitable. Why is that? It's an interesting question. So, you know, from an evolutionary standpoint, your genes are designed to help, you know, you survive long enough to reproduce. Once you reproduce and had your offspring, there's no longer any selection pressure on you. So if you age rapidly and you have, you know, dementia or heart disease and you die in your 50s or if you age really well and live to be 100, there's no selection pressure that chooses those genes that allowed you to live to be 100 years old because the 56 year old that died and the 100 year old that died both had their kids when they were 20 so their genes were already passed on. So there's just, so evolution can't really help us when it comes to aging. So if you're lucky enough to have genes that make you more likely to live to be 100, that's great but you're just not more likely to pass them on than someone that doesn't have them because everyone's had their kids by then. All right, good nutrition aids and maintaining a healthy body and can improve the quality of life. And that's why I think that, you know, eating well and you know, I know plenty of people that live into their 70s and 80s and beyond that don't eat well and don't practice all these habits but the quality of life is the key. And that's why I especially with exercise, I think if you exercise, you may not live that much longer and most the time that you live longer you would have spent exercising but some studies show your quality of life can be 300% higher or more. You know, like being able to physically take care of yourself and having a brain that still functions well in old age is super important. So quality, to me quality over quantity for sure. I don't wanna live to be 120 and feel like 120 year old, right? I wanna live as long as I can where I can take care of myself, take care of my family not be a burden on my family and have a good quality of life. I know like my grandfather, you know the last couple of years of his life he lived to be 93 the last couple of years were really, really rough. I don't know if he would have wanted them or not, you know, to be honest because the quality of life wasn't there. Life expectancy in the United States is currently 79 years. It's a little higher for females and lower for males. But some evidence is starting to come out that that number starting to drop and I've been expecting that for years because you've got, you know our diet and lifestyle changes they've been exceedingly worse Modern medicine is amazing and it's great at keeping us alive but at some point we are going to pay for our diet and lifestyle choices. All right, benefits of physical activity in older adults lot, you know, obviously lots and lots of them but staying strong, staying mobile having the endurance you need to take care of yourself and your activities of daily living I know that's a really low bar for someone that's younger but being able to take care of yourself I mean like I remember you get my grandmother, rheumatoid arthritis you know type 2 diabetes basic caring for yourself making food, using the restroom, et cetera those kind of things became difficult and I always like to say life is sport and we're all gonna be, we're all training right now so I'm 44, I'm training for the elderly Olympics I'm training to be in my 70s and still be able to take care of myself I wanna win the get off the toilet championship I want to lift, I wanna, I wanna I want to win the gold medal for being able to go to the grocery store and buy my groceries and carry my groceries in and put my groceries away I know it's a low bar but you at least wanna meet that you can, you hopefully will exceed that and be that person that rollerblades to the clinic or be that person that logs 1,000 miles in the treadmill but you at least wanna, you wanna, you wanna have that base level of strength and flexibility and mobility and endurance so you can take care of yourself addition, and play with your kids right play with your grandkids, et cetera additional benefits from specific activity types so aerobic activities we just talked about, you know keeping your heart and lungs healthy moderate endurance activities so you can have the stamina needed to do the things you need to do play with, again, playing with your grandkids your great grandkids pushing them on the swing, et cetera strength training, you want lean mass it keeps, it helps control blood sugar it keeps you from, hopefully decreases fall risk, et cetera resistance training for holding on to that muscle that you carried into old age with you and then physical activity is the most powerful predictor of mobility in later years it, once you stop doing something this is from a, this is from a powerlifting legend named Louis Simmons the quote was, once you stop doing something that's when you can't do something so if you stop moving of course you're gonna lose your mobility if you keep moving you're way less likely to lose it alright, exercise guidelines for older adults you see here aerobic activity, be active five minutes, these are minimum, right start easy and progress gradually be active for a minimum of five minutes on most or all days at least five days per week of moderate activity or at least four days per week of vigorous activity if, as the activity gets more vigorous than the amount of time in the number of days you do it goes down because you need more time to recover from it intensity, moderate vigorous or a combination like I just mentioned duration, at least 30 minutes of moderate activity in bouts of at least 10 minutes each or at least 20 minutes of continuous vigorous activity I generally recommend the 10 minute walk after each meal that's three 10 minute moderate activity sessions super easy, almost everyone can do it cautions and comments comments, stop if you are breathing so hard you can't talk or if you are feeling dizziness or chest pain strength training using no weights or weights up to two pounds do one set of eight to 12 repetitions twice a week and that depends on where you're at I sure hope that when I'm older I can lift more than two pounds but and I'm not afraid to have people lift heavier weights than that as long as it's safe controlled environment, et cetera frequency at least two non consecutive days per week non consecutive being important so you can recover from the first session before you have the second one moderate to high intensity 10 to 15 repetitions per exercise and gradually increase the weights eight to 10 exercises involving the major muscle groups so full body routines breathe out as you contract and in as you relax do not hold your breath use smooth steady movements again work with your trainers and therapists and stuff with that kind of things balance, so starting easy hold on to a table or chair with one hand then with one finger so you're just removing your support and making it more difficult two to three days per week at least 20 to 30 minutes incorporate balance techniques with strength exercises that you progress that's why I like Pilates because Pilates is kind of like balance, strength, core work, et cetera yoga would be the same thing flexibility, hold stretches for 10 seconds do each stretch three times that'd be starting slowly at least two days per week preferably on all days that aerobic or strength activities are performed generally stretching is better as part of a cool down than a warm up just so you know moderate intensity stretch your major muscle groups for 10 to 30 seconds repeating each stretch three or four times and then cautions and comments stretch after strength and endurance exercise for 20 minutes three times a week use slow steady movements bend joints slightly so that's a huge deal the whole after instead of before for years stretching was part of warm up routines but you don't see it much anymore because the evidence has shown that it can increase injury and decrease power production so I like to do active warm ups like mobility type active warm ups before training and then just your static stretching it's called after all right manipulation of the diet this is just interesting I guess but manipulation of the diet energy restriction in animals so studies have shown for years that starting with fruit flies and worms and animals live longer and have fewer age related diseases if you restrict their energy so it appears to slow the aging process this is where there are people that do this there's like calorie restriction societies where you consume 70% of normal energy intake but prevent malnutrition so you get all the nutrient needs you need but consume less calories it basically slows your metabolism and increases antioxidant activity increases repair mechanisms like autophagy is one of the big ones but this stuff is not really panned out in humans the way it has other animals and part of it's the bottom line there age of starting energy restriction the reason that animals live longer when you put them on these kinds of diets is it delays puberty it delays maturation and delays the aging process so if you decide in your 40s to start doing this because you want to live longer you're not gonna see anywhere near the same benefits you see in animals that do this for their entire lives so I don't know about this I used to be a bigger fan of it but the other big thing here is if you do this so yeah mechanistic studies show that decreasing protein intake decreasing calorie intake can increase enzymes that might lead to aging or slowing aging increase DNA repair all these things sound great but here's the other problem with this in the real world if you do this you will not have muscle you'll be on a diet your entire life so yes you might live a little longer but I would jokingly say it'll feel like forever because we all know it's like to be on diets but how will you build lean mass how will you maintain lean mass so my concern is that yes you might have some more DNA repair but you're not gonna be strong your bones are gonna be weak you're gonna fall you're gonna break your hip and that's gonna change your life forever so I think that being strong and capable and carrying as much lean mass into your elderly years as possible is critically important so a diet that's higher in protein meets your needs allows you to be stronger yeah you might not have as much DNA repair but you'll be able to move and take care of yourself and hopefully not fall and if you do fall hopefully not break a hip, et cetera, et cetera so make sure you look at the whole puzzle these kind of studies have shown mechanistically how at an enzyme level they might be able to slow the aging process but the last thing I would ever tell someone to do is to go on a diet that causes sarcopenia that causes them to lose muscle and lose muscle function as they get older so be careful with this stuff just my little note and now most people aren't gonna go on a diet for their whole life it would actually work better if you started in childhood at some point but most people don't do this but just keep in mind you'll probably see articles about this and just be cautious when you think about these kind of things I know my opinion has changed over time because I value lean tissue too much difficulty defining energy restriction like where would you need to be time of energy restriction needed to realize health benefits like so you have to do this for one year five year, 10 years, 20 years we don't have done studies in humans over that long period of time so we don't know and that's why again you can maybe double the life expectancy of a fruit fly but when they did studies in primates you didn't see as good a results and the human I would say if you did this just based on what I've seen you might be able to expect it to be to live five or six years longer but you can live that much longer with positive healthy diet healthy activity levels but also have more muscle and these types of things if you do other things so I just don't know I just don't know how I feel about this but all right so a moderate restriction 10% reduction energy intake does have benefits I'm gonna agree with that you don't want too many calories you don't wanna be carrying a bunch of fat around so you want to eat an appropriate amount of food without being too restrictive nutritional adequacy essential to a long and healthy life no matter how many calories you're eating absolutely all right so speaking of body fat versus muscle and those kind of things before we get into the aging process remember when we talked about BMI and those kind of things that being slightly having a BMI that puts you in the slightly overweight category is actually advantageous over being underweight so and I think that's a lot of that's because if you get sick if you have cancer or infectious diseases you need that extra fat you need the extra fuel to deal with those types of things but just something to consider that being carrying a couple extra pounds around is maybe better for you than being a couple pounds underweight but it's hard to tell because is that a cause or effect if someone's underweight is it because they have an underlying disease a gut disease or cancer or something already I don't know all right so stress psychological and physical stressors your body's stress response system we have nervous and hormonal systems and then so there's you know again we talk about you see your differences between men and women women that you know this is way too typical right typical man typical woman there's all sorts of overlap here it's a spectrum but males are more likely to have the fight or flight response women females more likely to have the tend or befriend response they say but again that's those are where stereotypical male stereotypical female but the stress response remember stress is not a bad thing right excessive stress is stress is what your body adapts to so we have what's called the stress recovery adaptation process so stress can be good right the stress of an exam coming up motivates you to study and motivates you to learn that's positive stress exercise is stressful but how your body so stress recover adaptation how your body recovers from the stress from exercise and how your body adapts to the exercise is what makes it good for you so exercise is bad for you while you're doing it how your body recovers from it is what makes it good for you same thing with like eating you know produce right the phytochemicals the antioxidants the nutrients that are in plants like vegetables that make them good for you they're actually mildly toxic so plants so vegetables are bad for you exercise is bad for you I'm saying this as a joke but for real the phytochemicals that are in plants are mildly toxic how your body responds and adapts to them is what is what increases the antioxidant capacity in the body so exercise is bad how your body responds to it makes it good eating plants is bad how your body responds to them makes them good those are examples of stress recover adaptation physiological changes associated with aging body weight the lowest mortality correlates with a slightly higher BMI so like I mentioned carrying a few extra pounds around having a BMI a little bit above 24.9 is better than being underweight older adults who are obese still face serious medical complications at least until the age of 85 so some extra fat is good too much extra fat lots of problems body composition over time a typical person I'm saying typical because it doesn't you can slow this process but a typical person as they get older they have a loss of bone and muscle and they gain body fat and sarcopenia I just mentioned that's the loss of muscle so you see here what's happening in these images someone they might weigh the same amount but they have less lean tissue more body fat and this happens over time now it doesn't happen as fat it doesn't it happens faster than it needs to because if you're eating well and you're physically active and you're strength training you could hold the goal the goal in your 70s and whatnot is to hold on to the muscle you have and not let your body transition this bone and muscle to fat not saying that muscle becomes fat but not getting to where you're losing bone and muscle while you're gaining fat you can slow this process down and maybe completely stop it at least for a while all right immunity and inflammation so the immune system loses function with age that's just like other parts of your body a lot of your immune cells become senescent is the term which means that they just don't function well and they actually just promote inflammation rather than doing their job so those are called that's called immunos senescence inflamaging so that's the inflammation associated with normal typical aging inflammation is critical in supporting your health so that's one thing we talk about inflammation like it's bad inflammation is needed acute short term inflammation like after is part of your immune system so inflammation associated with fighting off an infection is good inflammation associated with a sprained ankle or something is good strength training exercise causes inflammation the inflammation leads to the recovery and the adaptation so inflammation is great when appropriate chronic inflammation just high baseline levels of inflammation is not good that's what interestingly enough they taught, you know, studies show that taking anti-inflammatory drugs like ibuprofen on a regular basis actually decreases the adaptation that occurs from exercise because you're blunting the inflammatory response that your body needs to promote recovery and adaptation but if you're older so if you're inflamed in your 60s then taking ibuprofen will actually promote the increase in lean mass and muscle and I think that's because if your inflammation is normally low then after exercise the spike in inflammation is noticeable and leads to adaptation if your inflammation levels are always high then the spike in inflammation with exercise isn't as noticed so if you lower, so if you take ibuprofen as a 20 year old you're decreasing that inflammatory spike and decreasing the response if you're older and you already have a high baseline of inflammation dropping it with ibuprofen makes the spike that occurs with training exercise more noticeable so it's kind of interesting all right compromised by nutrient deficiencies so again, inflammation nutrient deficiencies will make inflammation worse a diet that's low in nutrients high in inflammatory fats, et cetera is bad improving the immune system response how you do that regular physical activity absolutely strengthens the immune system nutrient rich diet including diet rich in fruits and vegetables so antioxidants, phytochemicals all your vitamins and minerals, et cetera so immune system will cover more in our disease prevention chapter but basically every nutrient plays a role in your immune system but the big ones would be getting enough vitamin A vitamin D iron those types of things GI tract, this is a big one when I think about aging I think about the fact that you're not what you eat you're what you absorb so as you get older if digestion and absorption get impaired then you need more nutrients because the nutrients you are eating are less bioavailable so when I think about someone in their 60s, 70s and 80s versus their 20s, 30s and 40s this is the biggest thing that I think of is as digestion gets worse your food needs to become more nutrient dense because if you're absorbing a smaller percentage of the nutrients you eat then you have to eat more of those nutrients alright, so GI tract changes contribute to poor appetite, early satiety and malnutrition so when you need a more nutrient dense diet you often will lose your appetite so that can be a big issue so you're not gonna want to eat as often you'll get full faster so that's a terrible combination poor digestion with eating less means less nutrients entering your bloodstream one common example that I use this in case studies all the time in anatomy especially nutrition as well is atrophic gastritis so basically it's an inflammatory condition in the stomach called gastritis that leads to a loss of function so the simplest way to look at it is parts of your stomach kind of become a scar rather than functional stomach tissue which means that you're gonna have less stomach acid, less enzymes, et cetera so atrophic gastritis affects absorption of nutrients that are impaired, especially vitamin B12 and that's, I mentioned that at the beginning but that's because one of the things the stomach produces is a compound called intrinsic factor an intrinsic factor is needed for the digestion and absorption of vitamin B12 so the less functional stomach tissue you have the less B12 you will have and that's why if someone has a trophic gastritis and it leads to a B12 deficiency which usually will show up as a B12 deficiency anemia but also can show up as neurological problems they might put you on a B12 supplement but the simplest solution is a B12 injection they skip the gut altogether and they inject the B12 into your body dysphagia, so that means difficulty swallowing so the texture of the diet often requires modification so trouble swallowing, maybe poor dental health maybe having dentures means that you'll need a lot more soft foods and less fibrous foods and foods are difficult to chew all, this occurs very commonly constipation, so the intestinal walls lose their strength, some motility is slowed so you're way more likely to become constipated so the solution for that is increased fiber intake you know like when you get older maybe you start using metamucil because it softens your stool and increases fiber intake finding more soluble fiber in your diet so fiber and then also water you don't want to consume more fiber without more water because it will suck water into your gut and you need the water in the rest of your body as well so fiber, water, and then exercise staying physically active, very important I had lots of elderly patients that were dealing with constipation and then if fiber, water, and exercise are not enough then you speak to your doctor about maybe drugs or things like that, that will help you hormone secretion, diminished appetite leads to lower energy intake and weight loss so again it can be good if you're carrying excess fat around and you want to lose it but if you're losing lean tissue as you get older I really can never say that's a positive tooth loss, difficult and painful chewing which limits food selections less dietary variety, lower intakes of fiber and vitamins if you have trouble chewing food then you're gonna only eat certain types of food because they'll be soft and if it's hurt to chew you're gonna eat less so I know I have dental issues and I have to get an implant here in the back so I'm missing some teeth I don't eat crunchy foods I don't, I just don't so a lot of times with vegetables I'll blend them up into smoothies and things like that I can eat lots of vegetables but I won't eat a piece of celery I actually broke a tooth on a piece of celery one time I don't eat chips I don't eat crunchy foods so I guess you can limit your intake of some of your bad foods too but I know as a 44 year old that my mouth situation already limits my food selections so if I have even more dental problems down the road or I have false teeth or something I know it will impact my dietary choices so less variety so you gotta make sure you're getting your vitamins and your fibers and everything somewhere sensory losses and other physical problems like vision, mobility, hearing, taste and smell all these can impact a dietary intake and physical activity other changes psychological changes I'm gonna take the clock, you're sorry gotta pick up Oliver, he's at camp today psychological changes we have depression which can lead to a loss of appetite and loss of motivation to cook a loss of motivation to eat healthy foods then support and companionship of family and friends makes a big deal someone living alone is definitely gonna be more likely to be depressed economic changes so living arrangements and income I think about if you're barely surviving month to month on your retirement income or something like that or government assistance then it's gonna be hard to buy nutrient rich foods social changes malnutrition is most likely to affect those living alone especially men those with low income and or education so let's say that a man was married lost his wife he's definitely the highest risk category especially if he doesn't have a lot of money and doesn't have to prepare food highest risk category to eat really, really poorly and lose a bunch of weight and be malnourished so living alone male low income lower education level all those put you at risk for malnutrition with aging that's where the food meals on wheels and other programs like that or church related programs why they're so important having someone looking out for you making sure you're getting your nutrition I know my grandmother she her children played a really big role in making sure she had the food that she needed but then also meals on wheels and those kind of programs were a big help as well discussion question one do you know someone who is considered elderly which outward signs of aging do you notice in them can you identify things you can do to help that should be help with some of the changes they experience as they age so you've got to think about that for yourself but let's talk about it says here one area of aging students might identify with our social changes especially in the elderly who live alone students might also easily identify physical changes and psychological changes and should be able to identify ways in which those changes become obvious and what can be done to help the elderly with those changes so maybe losing muscle gaining fat skin hair changes those kind of things but the big ones are activities of daily living how can you help someone stay mobile and active enough to take care of themselves so help give people a help them when possible but don't help somebody so much that you're actually hurting them in the long run energy and nutrient needs of older adults so water so the elderly people may not feel as thirsty and that's a big problem as the thirst mechanism goes away you have to kind of remember to drink water because your body's not reminding you to do so so that's the thirst response is a big issue and so thirst response in dry mouth those can be impacted by in the older years dehydration your total body water does decrease with age sadly that's part of the aging process as our tissues kind of dry out so you see your prevention at least six glasses of water a day they generally recommend eight to 12 but as you get older less total body water which means I guess you need less intake but you know that's at least right that's a minimum I still recommend are you earning every three hours is it pale yellow those recommendations don't change for me but your overall needs might drop a little bit the risk associated with dehydration well you already have less body water so if you're losing body water you're losing if you lose a pound of water weight you lost a larger chunk of you because your total body water is lower and that's why between the lower thirst response and less total body water that's why the elderly are at very high risk for dehydration in ways that middle-aged people are not so the youngest young and the oldest old are at the highest risk of dehydration okay energy and energy nutrients energy needs decline and estimated at 5% per decade so I got a nap floating around here sorry so basically yeah you look at the basal benabolic rate drops somewhere in the neighborhood of 1% to 2% per decade but energy needs go down 5% per decade and that has to do with so it's not just basal metabolic rate dropping activity levels drop and I'll do that neat presentation that whole presentation I was talking about earlier where we talk about what happens to our metabolism so I'll make sure I do a video about that but the newest research done gold standard research using double labeled water has shown that really between your 20s and your 60s your basal metabolic rate doesn't need to drop your energy expenditure drops because you start moving less and because you're moving less then you're gonna lose lean tissue and that's why your metabolic rate drops so if you stay active and you exercise you can't blame aging on your low metabolism until you get into your 70s or above because then your metabolism truly drops your brain uses less energy your liver loses less energy so our energy needs do decline but it not necessarily doesn't have to stay strong, keep your lean tissue, stay active and your metabolism can stay elevated definitely past your 30s and 40s where most of us start to blame our decreased metabolic rate on weight gain so it's in effect not a cause nutrient needs do remain high so make sure you're following all the food patterns the my plates and those kind of things proteins especially important because we need more protein to stimulate protein synthesis in the elderly's and digestion of it goes down so you need more protein you're gonna get less of it from your foods so you must eat plenty of protein as you get older to at least preserve lean mass if not try to build some so look for low calorie sources because if you need less calories but more protein then the protein you eat needs to come from lower calorie sources so leaner pieces of meat or other sources like that liquid nutritional formulas if digestion's a problem then getting things that are basically pre-digested or in a more bioavailable form there's nothing wrong with that if you're not hungry then these are good ways to get more calories so the same things that you would tell someone to do like liquid calories you would say don't do that when you're younger because you might be gaining weight too quickly in this situation you need to get these calories into somebody the best way possible so protein shakes, liquid calories, whatever our reflections so pause and try to answer these energy needs decline with age on average by 5% each decade but again that's not needed you know my metabolic rate has gone up I get my resting energy expenditure tested and my metabolic rate has gone up I don't know in the last couple of years because of strength training my resting energy expenditure has gone up 140 calories a day and it's still climbing so I plan on my metabolic rate as a 45 year old being higher than it was at a 35 year old so these declines are in effect of our loss of activity and function more than anything older adults need fewer calories but have high nutrient requirements for this reason nutrient dense foods are needed protein is important for supporting a healthy immune system it also prevents muscle wasting and optimizes bone mass so you don't want to lose lean tissue muscle or bone sufficient carbohydrate intake protects against protein being used as energy so that's why you know remember carbohydrate sorry it's your nose again carbohydrates are protein sparing because if you're not consuming carbohydrates your body has to turn protein into carbohydrates in a process called gluconeogenesis Alright discussion question two how do basal metabolic rate and physical activity change with age I've just mentioned a lot of that but these are what we see not doesn't need to happen BMR declines one to two percent each decade due to reduced lean body mass and thyroid hormones physical activity tends to decline so yes hormone levels change but we don't have to lose lean body mass which means that our metabolism doesn't have to drop in our 20s, 30s, 40s, and 50s again 70s and 80s you will see your basal metabolic rate will drop things like liver metabolism brain metabolism but physical activity tends to decline so I think the activity decline leads to lean body mass losses not the other way around use it or lose it carbon fiber needs the fiber whole grains fruits legumes which are like beans and peas and stuff and vegetables these foods along with water alleviate constipation remember fiber water exercise are the three pillars of constipation relief fats the polyunsaturated fats provide valuable nutrients because that's where your essential fatty acids are your omega-3 and omega-6 fats are the essential fats and they are polyunsaturated saturated fats raise the risk of atherosclerosis and other degenerative diseases that should be degenerative diseases so remember saturated fat intake should not be more than 10% of your calories so dropping your saturated fat intake from 10% to 7% or 8% you're not going to see a big difference dropping it from 12% to 10% you won't see a big difference but if 20% of your calories are coming from saturated fat and you drop it to 10% you'll see a huge difference in atherosclerosis and cholesterol levels and heart disease risk limiting fats may lead to nutrient deficiencies and weight loss so you do you want to get plenty of fats to make sure it's the right kind vitamins and minerals so which ones do we have to worry about the most for the elderly vitamin B12 I've already mentioned this people with atrophic gastritis are especially vulnerable so you can use fortified foods and supplements but if those aren't working B12 injections work great vitamin D we make less vitamin D as we get older maybe we're outside less often less exposed skin, et cetera so for lots of reasons vitamin D issues can crop up so maybe you need to supplement go to your doctor, get your blood levels tested take a supplement or change your diet enough to go outside more so the levels go up if those things don't work you can actually do in situations where it's needed you can do intramuscular injections of vitamin D as well folate, calcium, iron and zinc all these are just critical nutrients all the time so make sure you're getting plenty of them dietary supplements over 50% of older adults use dietary supplements recommended by many healthcare professionals can provide 100% of daily values thought to be more beneficial than harmful again it's a supplement it supplements a healthy diet it doesn't replace a healthy diet but I like these especially for older adults because if your digestion is impaired then fill up top off the tank with supplements so eat as well as you can and then use supplements to fill in the gaps and I've mentioned before that even really healthy diets could be lacking in potassium, magnesium, iodine those are a few examples there and then if you have underlying GI problems it's only gonna be worse food is the best source of nutrients for everybody supplements are not a sub-stupor food I just said that as well they're called a supplement because they should supplement the healthy foods in your diet nutrition related concerns of older adults vision, so again we won't spend a ton of time here but cataracts it's basically an age-related clouding of the lenses of the eye that the lenses need to be clear for what you're looking at to reach the retina at the back of the eye so cataracts will cloud your vision lead to blindness if not surgically removed risk factors generally high blood sugar is a big one a poor diet and it's caused by oxidative stress so a diet that's higher in antioxidants especially the ones that are really good for your eyes like lutein will hopefully help prevent these problems macular degeneration is the leading cause of vision loss and blindness in the United States anyhow it's vitamin A deficiency in some places so that's another one so here we just see again how the eye works and then you look at the, you have a cataract clouding vision because it's literally blocking what you're looking at from reaching the retina in the back of the eye arthritis this is a big one 50 million Americans are dealing with arthritis pain that's probably an underestimation but you know, just like me and my wife we're both 44 or I'm 44, should be 44 a couple months here you know I have some arthritis in well lots of arthritis in my neck and my wrist and a knee right and these kind of toe she's got it in both thumbs and she's got a knee replaced you know this reality but arthritis so it's an inflammatory condition that osteoarthritis is a deterioration of the cartilage in your joints so a simple way to look at it is cartilage are shock absorbers and they protect you from wear and tear well when that cartilage is worn away now you've got an inflammatory reaction and you've got maybe some more bone-on-bone contact and now you're starting to see the bony changes that's why it's called osteoarthritis connection with being overweight, no doubt I mean just puts more pressure on your joints like I mean the arthritis I've never injured my ankle but I have a little bit of arthritis on an x-ray from an ankle and that's just from carrying more weight around benefits of aerobic activity and strength training if you have arthritis right it can hurt but there's basically the pain of use and the pain of disuse so I found the training yeah I hurt sometimes you know my knee hurts a little bit sometimes when I do a lot of heavy squatting but when I weighed more and when I was really physically inactive my knee hurt too so to me it's like do I have some pain that's associated with me getting stronger or do I have pain associated with me getting weaker either way I'm going to get old either way I'm going to be in pain I'd rather have the pain of use and maximizing what my body can do functionally than the pain of disuse and deterioration so just think about that like old people are going to hurt are you going to hurt because you're moving or are you going to hurt because you're not that's really what it boils down to I used to tell my patients that joints don't wear out they rust out alright rheumatoid arthritis is different it's an autoimmune condition your immune system destroys the bone in the cartilage it's different gout can lead to gaudy arthritis it's actually uric acid will deposit in your joints imagine like microscopic knives little crystallized knives and they can lead to issues but that's caused by diets high in purines which come from meat consumption, alcohol, fructose consumption, et cetera but those are kind of separate we're mainly just talking about osteoarthritis here so what do you do? you take care of yourself protecting your joints as much as possible moving in safe ways moving as much as you can without doing damage these are all things but you work with your a doctor or a trainer on those kind of issues alright so as far as supplements and those kind of things I think the omega-3s the omega-3 fats because they're anti-inflammatory they can play a role again not an advertisement but I like to use this here I use something called turmeric and Boswellia just like an herbal supplement not medical advice but I do think that turmeric is a nice anti-inflammatory ginger I don't know how much these things help but to me I just, you know I hedge my bets but I would say that the most well studied thing would be the omega-3 fats so eating your fatty fish getting some fish oil supplements, et cetera alright the aging brain dementia affects 15% of adults over the age of 70 Alzheimer's now impacts one in eight people over the age of 65 that number is going up really quickly and it's not just because we're aging Alzheimer's is I don't know why but Alzheimer's is becoming more common and it can't be explained away by the fact that we're living longer brain changes due to genetic and environmental factors so some things we can control some things we can influence others we cannot characteristic changes with age loss of neurons and decreased blood supply your brain is going to age but how much is it going to age and how much can you slow the aging process that's the part you can control nutrient deficiencies may be a factor in the loss of memory and cognition so if you're malnourished you're not getting the healthy fats you need, et cetera alcohol use and binge drinking can affect older adults and affect the brain so Alzheimer's specifically the prevalence in the United States I just said one in eight people the third leading cause of death now when you take away cancer and cerebro and cardiovascular disease so it's a neurodegenerative disorder possible causes genetic factors, free radicals oxidative stress, inflammation all these things alright one thing I've seen research out of Stanford showed that the mycroglia basically the immune cells in your brain they become pro-inflammatory they start churning out inflammation in people that are more likely to develop Alzheimer's but we talk about the plaques and the neurofibrillary tangles way too much information for this class but a lot of the causes are unknown we're looking more at the effects at the end so I don't know what the answer is senile plaques and neurofibrillary tangles I just mentioned those like the beta amyloid plaques they're called cardiovascular disease so really basically protecting yourself from cardiovascular disease is probably the best way to protect yourself from Alzheimer's at this point so lowering your cholesterol and your blood pressure and raising your good cholesterol and all these kind of things treatments I think we got a few we'll talk about a couple things there coming up as far as treatments but as nerve cells die the brain shrinks and loses its ability to think, plan, remember and form new memories the fluid filled spaces within the brain grow larger because the brain itself is shrinking so the fluid filled areas grow larger plaques which are called beta amyloid so clumps of beta amyloid protein pieces block cell to cell synapses signals tangles, these neurofibrillary tangles twisted strands of protein destroy the cell transport system as plaques and tangles block essential nutrients from reaching the nerve cells they eventually die so again we've seen those things and we're like how do we control those but it appears those are like the effect not the cause but they are there and that's why Alzheimer's is really diagnosed upon autopsy as nerve cells die the brain shrinks and loses its ability to think, plan, remember and form new memories which we just said oh it's just saying the same thing again sorry about that there was a copy and paste issue with that slide Alzheimer's in the healthy brain so see a healthy brain on the left Alzheimer's brain less functional brain tissue fluid filled spaces are larger and you see the healthy nerves versus nerves that have the placking and the tangles so you can read that if you want discussion question three while there is no cure for Alzheimer's there is treatment do you know of anyone with Alzheimer's and what can be done to help them so you think about that so treatment for Alzheimer's excuse me disease includes providing care to clients support to their families so you know we're just basically making the best of a terrible situation drugs may be used to improve or at least to slow the loss of short-term memory and cognition but they do not cure the disease other drugs may be used to control depression anxiety and behavior problems maintaining appropriate body weight may be the most important nutrition concern for the person with Alzheimer's disease perhaps the best that a caregiver can do nutritionally for a person with Alzheimer's disease is to supervise food planning and meal time so forgetting to eat would lead to malnutrition very quickly food choices and eating habits of older adults we've mentioned quite a few of these already malnutrition and food assistance programs so one in six older adults are malnourished contributing factors again maybe there could be some memory issues loss of hunger loss of thirst don't know how to prep food properly low income all these types of things a diminished quality of life if you're malnourished and not fueling your body properly that kind of goes without saying then remember that 90% of people that are over the age of 65 are taking at least one prescription drug so don't forget about food and drug interactions too alright I think we'll come back to that a little bit diminished quality of life nutrition screening initiative is screening for malnutrition and then we have food assistance programs I mentioned Meals on Wheels earlier the OAA Nutrition Program provides group meals in a social setting so I like that Meals on Wheels is great if people have trouble getting out but meals in a social setting is actually really cool because it's a double whammy alright discussion question four what are the six ways malnutrition limits a person's ability to function and decreases quality of life malnutrition limits a person's ability to function in a variety of ways including impairing muscle function so again if you lose muscle function you lose the ability to take care of yourself and you have concerns about falling and you know those kind of things decreased bone mass muscle and bone go together your body you know if you don't use your bone you lose it compromising immunity that COVID taught us a lot about that about nutrient deficiencies and malnutrition and immunity reducing cognition super important for anyone but especially elderly poor wound healing and slowed recovery so like surgery recovery and those kind of things you know my grandma had a wound that never healed and that's what killed her she was septic and that led to lactic acidosis and she died but it was the poor wound healing the struggle with the wound healing that was that was really what started the whole process and then increasing hospitalization so that's a good list there of reasons not to be malnourished meals for singles remember we said that people living alone especially males that maybe have lost a loved one people in lower socioeconomic status lower education levels they're the highest risk for malnutrition if they live on their own so what should they do challenges in purchasing, storing and preparing food so you've got programs and those kind of things maybe family can help but if you have a limited income foodborne illness risk increases because of leftovers right if you make a big pile of food and live on it for days then the risk of foodborne illness is going to go up being a wise shopper I mean I think this works for families too but buy in bulk and store so can you buy food in bulk and put it into freeze it in individual meals and then cook individual meals using maybe an air fryer or these kind of things so don't make a bunch of food and let it sit around for days separate the food before you prepare it or prepare it and then freeze it and then thaw it and reheat it and those are some good examples okay a lot of good stuff there now the lesson is over you should have learned to describe the role nutrition plays in longevity we hit that really good especially with calories and nutrient density, etc summarize how nutrition interacts with the physical psychological, economic and social changes of all the nature we covered all those and explain why the needs for some nutrients increase or decrease during aging we covered that especially the ones that increase identify how nutrition might contribute to or prevent the development of age related problems associated with vision, arthritis, the brain and alcohol use and instruct an adult on how to shop for groceries and prepare healthy meals for one person on a type budget covered all that one thing I didn't mention that I had on my notes that I wanted to cover we were talking about drugs how most elderly people are on at least one drug and some are on many many drugs I mentioned nutrient and food interactions but one that I just wanted to talk about because you see it all the time on prescriptions and people don't often know why a lot of times drugs will say not to take them with grapefruit juice so what actually happens there? grapefruit juice will actually increase the amount of drug that's in your bloodstream and that's because it blocks an enzyme so grapefruit juice blocks an enzyme called CYP3A4 don't worry about that part of it but cytochrome P4503A4 that's part of your body's detoxification pathway so basically it blocks the ability of your body to remove a drug so the levels will elevate in your bloodstream so that's just interesting but that's why often times you'll see drugs say not to take with grapefruit juice so just an interesting little fact there okay I hope this helps you have a wonderful day be blessed