Healthy Eating after 70


From the publishers of the New England Journal of Medicine



The Story

      If you've ever idly scanned the posters in your doctor's waiting room or the fine print on your breakfast cereal box, you've probably seen the Food Guide Pyramid. Each of the stacked blocks in the pyramid represents how many servings of grains, fruits and vegetables, dairy, meats, fats and sweets we should eat each day. Developed by the U.S. government in 1992, the Food Guide Pyramid lays out dietary guidelines for all adults and children over age 2.
      But recent research shows that older Americans tend to eat less than healthy younger adults and so may need to follow different dietary guidelines to meet their nutritional needs. Researchers at Tufts University's USDA Human Nutrition Research Center on Aging have now developed a modified food pyramid for healthy people over 70 that reflects their changing dietary and health patterns. The report appeared in the March Journal of Nutrition.
      The two most striking changes in the over-70 pyramid are the addition of eight glasses of water a day at the base and a flag at the top signaling a need for supplemental doses of calcium, vitamin D and vitamin B12. The pyramid is also narrower overall, reflecting the lower caloric needs of most healthy older adults (1,600 calories or less a day). The emphasis on fluids is important, the researchers say, because the sense of thirst decreases with age, and many seniors can become dehydrated without realizing it. Although nutritionists typically prefer that people get their nutrients from foods rather than pills, the Tufts researchers recommend supplements for calcium and vitamins D and B12 because these are the nutrients most likely to be deficient in older adults.
      If you're over 70, how should you incorporate these new recommendations into your daily life? — The Editors



George Blackburn, M.D.
Associate Editor

      Over the years, there has been much debate about the "right" dietary guidelines for most Americans. But nutrition is not a one-size-fits-all proposition. Everyone has different needs, depending on health status, activity level and metabolism. As people live longer, it becomes increasingly important to focus on maintaining good health into the later decades. Diet is an essential part of healthy aging.
      The modified food pyramid provides a sound nutritional foundation for people 70 and older — the fastest-growing segment of the U.S. population. The skinnier pyramid stresses that most healthy older Americans need to cut down on calories as they become less active in later life. Indeed, research shows that eating fewer calories is associated with an increased life span. Of course, anyone who has a chronic illness, is under a doctor's care or is undernourished already should consult a physician before making any drastic dietary changes.
      The new, narrower pyramid emphasizes the need for older adults to make their food choices count. For many of us, far too much of our diet is made up of low-fiber, nutritionally empty foods, such as bagels and soft drinks, which don't provide enough nutritional punch relative to the calories they contain. People over 70 would do better to eat nutrient-dense foods that are high in fiber, plant-based phytochemicals, antioxidants and all the required vitamins and minerals.
      The modified pyramid also emphasizes the need for fluids — as much as two quarts per day. This level of fluid intake helps keep the kidneys healthy and reduces constipation, a frequent problem in older people. Although it may seem daunting to drink this much liquid every day, you can get your fluids without having to down it all as water. Other liquids, provided they don't act as diuretics (as alcohol and coffee do), count toward the total. These can include vegetable soups, fruit or vegetable juices, and low-fat milk, all of which provide additional nutritional benefits such as phytochemicals, calcium and essential vitamins. If possible, juices should be fresh squeezed to retain nutrients and fiber. Most processed juices and fruit drinks are high in sugar and calories and not much else.
      Fiber is another important piece of the puzzle. It provides numerous health benefits, ranging from lower cholesterol to a reduced risk of heart disease and possibly cancer. High-fiber diets have also been shown to help prevent diverticular disease (the development of pouches in the intestinal wall that can become inflamed), as well as constipation. Yet the over-70 pyramid recommends fewer daily servings of grain products than the standard food pyramid (six instead of six to 11). That's because most older Americans aren't active enough to burn the calories in the higher number of servings. Therefore the breads, cereals, rice and pasta that you do eat should contain high-fiber, whole-grain ingredients such as oat or whole-wheat flour, instead of low-fiber, refined ingredients. Vegetables, fruits and beans (legumes) are also excellent sources of fiber.
      While the modified pyramid recommends three servings of vegetables and two of fruit per day, other research suggests that we should be making these foods an even bigger part of the menu. The DASH (Dietary Approach to Stop Hypertension) study found the greatest health benefits in people who ate up to 10 servings of fruits and vegetables a day. Again, getting some of these servings as liquids, in soups and juices, will not only add variety to your diet but also do double duty by fulfilling some of your fluid needs. The most nutrient-packed choices are those that are deeply colored: dark green, yellow and orange vegetables and yellow, orange or red fruits.
      When selecting from the meat and dairy group, choose lean meat, fish or poultry and low-fat dairy products. Use a variety of spices to reduce the amount of cooking oil, salt and sugar called for in your favorite recipes.
      As for supplements, it's true that many older people have difficulty getting certain nutrients from their diet. So the supplement recommendation in the modified pyramid makes sense. Many older adults find it challenging to get the recommended 1,200 milligrams to 1,400 milligrams per day of calcium (the amount in three 8-ounce glasses of milk), especially if they believe they are lactose intolerant. They may also come up short on vitamin D, either because they don't drink enough vitamin D-fortified milk, or they don't spend enough time in the sun for their bodies to make the vitamin. People who live in northern latitudes, particularly, won't be able to get enough sun exposure in the winter to make sufficient vitamin D. In addition, the body's ability to absorb vitamin B12 from food decreases in many people as they age.
      I believe that most older adults can also benefit from taking supplemental vitamin E, which may provide some protection against heart disease and dementia. But rather than taking a multivitamin pill, which contains many vitamins and minerals you may not need, I recommend taking daily supplements for just these key nutrients: 500 milligrams of calcium, 250 IU of vitamin D, 10 micrograms of vitamin B12 and 100 IU of vitamin E. If you have a particular deficiency — such as anemia, which would require supplemental iron — or think you need more folic acid, you can then add those other specific nutrients.
      By eating a balanced, healthful diet, supplemented with key vitamins and minerals, you'll build a strong foundation for maintaining good health through your 70s and beyond.




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