Sep 14, 2015

Interviewer: How good nutrition can give you independence and functionality as you get older. We'll examine that next on The Scope.

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Interviewer: As you get older, your nutrition needs change if you want to maintain your independence and functionality. We're talking to Susan Shirer. She's a registered dietitian nutritionist and we're going to talk about if you're a baby boomer, as you get older, how the things you eat can actually make a big difference in your functionality and independence as you age. So how important is nutrition when it comes to functionality and independence as a Boomer?

Susan: Boomers need to really focus in on their nutrition. This is the time when they can impact their aging process and their future independence so it might be the difference between living in your home and having to move to higher level of care later on. So the impact right now is super important.

Interviewer: And from what I understand, the genes can help you so far, but a lot of what determines whether or not you're going to be independent as you get older really is your lifestyle. I mean, that's a big deal.

Susan: Exactly. Lifestyle has more of an impact on your aging process than your genetics. Now, of course, centenarians, that's a different picture. But for the bulk, the masses of older people, it is that lifestyle factor that has to be addressed.

Interviewer: Yeah, it's the choices we make when it comes to food and nutrition. How are your needs different when it comes to nutrition as you age?

Susan: One of the major issues that really ties to functionality in is related to muscle mass, which is related to your protein requirements. As you get older, the turnover of muscle is greater and, therefore, you need more protein.

Interviewer: Really?

Susan: And so I always joke with my older patients and say, "Gosh, did you know you need the same amount of protein as . . ." I come up with some basketball person like Karl Malone or something. But it's really true. You almost double the amount of protein you need after age . . . and this is a little fuzzy, but we'll say 50 than you did when you were younger. So, again, it has to do with that increased turnover. And also it's just hard to maintain the muscle.

Interviewer: What other nutrition needs change as you get older? How does it affect your body?

Susan: So we'll stick with the muscle and we're going it to connect to the bones. They work together and you lose minerals, you lose calcium as you get older, in particular for women but men also. And one of the key factors in maintaining bone health is vitamin D. We think of vitamin D as the sunshine vitamin, but as you get older you can no longer or very minimally synthesize vitamin D from the sun and you become more diet dependent. So we've got to think about what food sources we have to access the vitamin D. There's fatty fish, there are eggs . . .

Interviewer: Great sources of protein as well.

Susan: Yes, exactly. So, again, hand in hand, and there are actually some mushrooms now that are being produced that they have been able to increase their vitamin D content. So there are some foods but not a lot. And milk is fortified with vitamin D only in the US. Yogurt is, although, when it comes to regulations, FDA, USDA, milk is the only food that has to be fortified. The other foods are optional.

So then you have to think about, "Okay. I'm getting x amount for my food. How much more do I need? How am I going to get that?" And for a lot of folks, that's going to be through a supplement. What is a supplement? A supplement is something that supplements your diet and so it's a combination of the two. And that can make a huge impact on maintaining your bone health.

Interviewer: As we get older, of course, we know that falls become a lot more likely and if you're stronger and you got stronger bones, it's less likely, I'd imagine . . .

Susan: Right.

Interviewer: . . . that you would fall. Is that correct?

Susan: Right.

Interviewer: Is that the thinking?

Susan: Right. Because muscle and bone work together and if one is weak then your fall risk is higher. There's research to show that vitamin D is associated with fall risk. And so that is definitely the case. And if you don't have muscle, then you're at high risk for falling too. A fall is extremely important. It's a symptom of something going on, something wrong. And so falls are right at the top of this for us in gerontology. We're always watching, and hearing and asking, "Have you fallen lately?" Because it's an indicator that something's amiss. It could be, again, not enough muscle strength, vitamin D deficiency or a combination of the two.

So there's one other nutrient that I think we should focus in on and that's vitamin B12. As we get older, we have less ability to digest and absorb vitamin B12. It's a type of anemia. It's not what some people talk about pernicious anemia. It's not that. It's called protein-bound B12 deficiency. And why are we worried about B12? Well, B12, as I mentioned, is involved with blood cells and anemia, but it's also involved with cognition. And we want to stay as sharp as long as we possibly can, mentally. So we need to be aware of this. Folks over age 50, the percent of folks that are potentially deficient in B12, it ranges a bit from 15 to 30% of the population. That's a large number and so we need to be watching that.

Now, just because you turn 50 doesn't mean that at 51 you're going to be B12 deficient. You can store B12 and if you had a healthy diet most of your life then you have B12 stored for maybe five, seven years. So it'll take a while. But it's something that you would want to have checked when you go in for your annual physicals and the like and see where you're at and check it because, again, you want the energy and you want the mental acuity.

Interviewer: So we talked about protein, vitamin B12 and vitamin D. For somebody now that is saying to themselves, "All right. I'm ready to start changing my diet so I can be healthier and I can live a more independent life," how much more of these nutrients do they need? So protein, for example, I think you said double.

Susan: Almost, in grams of protein. As a younger adult, you need 0.8 grams of protein per kilogram body weight. When you're older, there are recommendations that start at .2 grams per kilogram body weight, that is of protein, or up to .5, so that's where we're almost doubled. So you have to look at the protein content of your diet.

Now, most Americans eat a fair amount of protein. But, as you get older, protein just doesn't have that . . . you're just not that interested anymore and it's not that tasty. It's expensive, hard to cook. I mean, there's a multitude of factors. And so then it becomes a problem. So you do have to put a little more effort into that. If I might say we think about muscle meat as the protein source of choice, but milk, eggs, beans, they're excellent sources and they can fit in beautifully, and little prep.

Interviewer: And then what about vitamin D?

Susan: Vitamin D, you're going to get probably, at best, about 400 IUs of vitamin D a day. The recommendation, the Dietary Reference Intake for an older adult, it's around 800 IUs a day. So you do have to take a supplement in most cases.

Interviewer: So as you get older, just know that you're going to have to do a vitamin D supplement.

Susan: Yeah, you are. You are. Very much so.

Interviewer: And then B12, same thing? You're going to have to take a supplement?

Susan: You probably are. The amount . . . you can hear different recommendations, but 500 micrograms to 1000 to replace and then maintenance would just be like a part of a multivitamin type thing. But toxicity with B12 is a minimal risk, but you still want to know. In my mind, you want to have a blood test done to see where you stand.

Interviewer: Some very useful information and I didn't realize as the body changes as we get older that the nutritional needs would change so much. Any final thoughts? Anything that you wish I would have asked or anything you feel compelled to say?

Susan: I just think that we need to appreciate the foods that we have, we need to eat fresh, you don't need to take a lot of supplements, although we did mention two. All of this will make a huge difference in how you age. You will be able to maintain, again, your independence and enjoy life. Eat fresh, eat healthy and enjoy.

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