geriatric nutrition

The core conclusion of geriatric nutrition has never been that "the elderly must eat certain foods and supplement certain nutrients." Rather, there is no universal nutritional standard for the elderly. The premise of all diet and supplement programs must match the individual's age stratification, underlying diseases, and chewing and digestion abilities. Natural diet is always the first choice, and supplements are only used as a supplement when dietary intake is insufficient.

Last week, I was working at a community nutrition consultation office and came across two elderly couples of the same age. They are both 72 years old. My aunt has just been diagnosed with sarcopenia and her feet feel like walking on cotton when she walks. My uncle has been a patient with type 2 diabetes for many years and has high uric acid. They were both together. I watched a health blogger eat natto and drink flaxseed oil. As a result, my aunt's uric acid rose to 480 after two months of eating, and my uncle's fasting blood sugar rose directly from 6.2 to 7.5. They were both confused. Didn't they say that these are "longevity foods" for the elderly? How can you imagine that the same thing, two people with different physiques, have completely opposite problems after eating it.

Interestingly, there are currently two different directions for academic intervention in elderly nutrition, and there is no absolute right or wrong: One is the "calorie restriction school" that has been proposed by European and American academic circles for many years, advocating that after the age of 60, the total caloric intake should be appropriately reduced, the proportion of refined carbohydrates should be controlled, and you can even try 1-2 light meals per week. The purpose of fasting is to reduce metabolic burden and delay cell aging. This idea is really useful for healthy elderly people aged 60-75 who have no underlying diseases and are overweight. I have a few uncles in their early 60s who had high blood pressure. After adjusting their diet to control total calories, their indicators have stabilized, and even the amount of antihypertensive drugs has been reduced.

The other type is the "sufficient supply" group that has been favored by the domestic geriatric medicine department in recent years. Especially for the elderly over 75 years old, or the elderly with chronic wasting diseases such as chronic obstructive pulmonary disease and tumors, it is not recommended to go on a diet deliberately, or even to eat more high-protein, high-calorie foods, giving priority to preserving muscle mass. After all, for the elderly, the risks of falls, fractures, and lung infections caused by sarcopenia are much more harmful than slightly higher blood lipids. I met an 81-year-old man before. He listened to a health class and was told to "eat seven percent full." He lost 12 pounds after being hungry for three months. When he went downstairs to buy groceries, he fell and fractured his femoral neck. He lay down for two months and then left. What a pity.

Many people ask me whether the elderly need to supplement protein powder, calcium, DHA, and various fish oils and krill oils. I usually ask about their daily diet first. Let’s talk about protein powder. In the past, one group said that eating it would increase the burden on the kidneys and was determined not to touch it. The other group said that the elderly are protein deficient and must drink it every day. In fact, they are too absolute: if you can eat 1 whole egg, 300ml of pure milk, and about 2 taels of lean pork/fish, shrimp/chicken every day, then there is no need to supplement with extra protein powder. The amino acid pattern of natural food is much easier to absorb than supplements. ； But if you have bad teeth, can’t chew meat, have diarrhea after drinking milk, or have lost more than 5 pounds for no apparent reason in the past three months, then choose a sugar-free whey protein isolate powder, drink 10-15g a day, and check your kidney function regularly.

Aunt Wang, who lived downstairs before, was afraid of high cholesterol. She didn't dare to eat egg yolks for 12 years and only ate egg whites every day. Later, she started to stagger when she walked. Her serum albumin was only 32g/L, which was almost 10g lower than the normal value. I advised her to eat one whole egg every day, so don't worry. The cholesterol in egg yolks accounts for 70% of the cholesterol synthesized by the human body. The impact of food intake is actually not that big. She tried it for three months with some doubts, and then checked the albumin and it returned to 39g/L. Her blood lipids did not rise. Now she can go out for a walk and can walk two stops.

I usually do assessments for the elderly in the community. I never give them a meal pagoda to carry on their backs first. I just look at two small details: one is to ask them to hold my hand tightly. If the grip is obviously weak and the bowl is a little wobbly when eating and holding it, then add protein first and put everything else later.； The other is to ask if the waistband of your pants has loosened more than two fingers in the past three months. If it has loosened so much without deliberately losing weight, forget about the "light diet" and add the amount of meat, eggs and milk first.

There is another misunderstanding that many people make: they always think that "the elderly should eat soft and light meals". In fact, it differs from person to person. There is no need for the elderly with good teeth to drink porridge and eat boiled vegetables. On the contrary, it will raise blood sugar quickly and lack nutrition. Vegetables and lean meats that are slightly chewy can exercise chewing ability, which is also good for oral health.； The less salt, the better. If you have low blood pressure and are prone to dizziness, there is no need to eat salt-free meals. Normally, 5g of salt per day (about the amount of a beer cap) is enough. If it is too low, it will lead to hyponatremia and general fatigue.

In fact, there are really not so many mysterious rules and regulations in geriatric nutrition, and there is no need to follow Internet celebrities and buy a bunch of "longevity supplements" that cost hundreds of dollars. I have seen old people who lived to be over 98 by eating whole grains and vegetables every day, and I have also seen old people who lived to be over 90 by eating two mouthfuls of braised pork every day. The core is never the "standard answer" of what to eat, but what suits your physical condition. If you are really unsure, go to a community hospital for a free nutrition screening. It will take half an hour to ask you about the diet plan that suits you. It is much better than following the trend blindly.