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weight loss

Malnutrition in the elderly

Recent research has shown an increase in malnutrition in the elderly. Poor nutritional status and malnutrition in the elderly population are important areas of concern. Malnutrition and unintentional weight loss contribute to progressive decline in health, reduced physical and cognitive functional status, increased utilisation of health care services, premature institutionalisation, and increased mortality.

One in ten adults over the age of 65 are malnourished or at risk of being malnourished , with over 90% of these individuals living independently. Malnutrition is often due to one or more of the following factors: inadequate food intake; food choices that lead to dietary deficiencies; and illness that causes increased nutrient requirements, increased nutrient loss, poor nutrient absorption, or a combination of these factors.

When financial concerns are present, meals are often skipped and food that is purchased may not provide a nutritionally adequate diet. Declines in functional status both physical and cognitive, affect a person’s ability to shop for food and to prepare meals.

Nutritional problems are further compromised by inadequate social support networks and by the resultant social isolation, which commonly leads to apathy about food and therefore decreased intake. Late life can be a time of multiple losses. The older person has experienced change and loss through retirement, disability and death of friends and family as well as change in financial, social, and physical health status. These changes may lead to depression, a well-known cause of anorexia and weight loss. Even transient depressed mood (as with bereavement) can cause clinically significant weight loss.

Dehydration is common among older people and especially older people with dementia. People may not recognise they are thirsty, may forget to drink, may be unable to communicate that they are thirsty, or may refuse to drink because they are worried about incontinence.

Dehydration can cause headaches, confusion, irritability, falls, loss of appetite and constipation which can contribute to urinary tract infections – and these infections in turn can lead to incontinence. Older people who are incontinent need to drink more, not less, in order to encourage the bladder to empty regularly to prevent infection and to exercise the bladder muscles.

How can you help an elderly relative or neighbour?

If you have significant concerns with any sudden weight loss or other symptoms try and see if the individual would see their GP for a health check up.  An online screening tool is available which looks at the individuals weight now and three months ago to determine risk.

  • Having small, nutritious meals more often across the day can help if people have a poor appetite
  • Make sure drinks given between meals offer nutrients as well – for example, milky drinks, fresh fruit juices and smoothies
  • Make available nutritious snacks that the person can eat while moving around, for example some individuals with dementia pace around constantly and have high energy needs. Finger foods can be left out on the route that the older person may take when they wander.
  • It is important to remember that older people need to eat good food whatever their weight, and that overweight people can be under-nourished too, if they don’t get enough nutrients.
  • Ensure they stay hydrated, this can be from drinks such as tea, coffee, water, milk, fruit juice and smoothies and via the food they eat, soups, stews, fruit and vegetables, ice cream and yoghurt.
  • Older people with dementia may choose sweet foods over savoury ones and it has been shown that a craving for sweet foods is part of the clinical syndrome for dementia at some stages. If people eat only sweet foods – for example, if they just eat desserts – they will not get all the nutrients they need. However, it can be useful to add some sweet ingredients to dishes, to encourage people to eat a range of foods – for example, adding sweet apricots to a meat dish, adding fruit to salads and snacks, adding honey to porridge or milky puddings, or adding jam to peanut butter sandwiches, might encourage the person to eat the food and also make a useful contribution to nutrient intake.

If you want a personalised assessment of yours or a relative current diet and a weeks meal plan please contact Susan.

 

 

 

 

 

 

 

 

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Mediterranean diet

Susan has returned from a lovely week in Crete, the original home of the Mediterranean diet, this diet has been researched for many years and has shown many positive effects for health.

For thousands of years Cretans have eaten only what their land produced – which was lots of fruits, vegetables, olives, whole grains and pulses.  Cretans consume a great deal of olive oil, significantly more than any other Mediterranean people and they don’t use any other type of oil. Todays diet can not be exactly replicated since lifestyles have changed since the 1950’s.

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Fat makes up about 35%-40% of daily calories in the Cretan diet. Cretans get their fat from olive oil and olives instead of butter, meat and other oils .

Cretans ate more fruit than any of the other Mediterranean countries and much more than other countries in the study

The average Cretan consumed 9-12 servings of fruits and vegetables each day compared to the current USDA recommendations of about 4.5 servings combined. Wild Greens were popular during the study but are very hard to find now.

The main grains consumed were the whole grains barley and wheat in the form of bread, rolls and rusk. Bread was typically made from all barley or a combination of barley and wheat, rusks from a barley and wheat mixture, Bread was eaten daily (usually with lots of olive oil).

Pulses – Were consumed about 3 times per week

Nuts – Nuts consumed in Crete are most often almonds, hazelnuts, chestnuts and walnuts.

Eggs – While eggs were not a huge part of the Cretan diet, they did consume 2-3 eggs a week. The biggest difference is that the chickens that produced the eggs were all free-range chickens that instead of eating grains like chickens in the US, lived on figs, grasses, insects, worms and purslane. This not only made the chickens healthier, but meant that the eggs are excellent sources of omega-3 fatty acids

Fish and chicken is eaten a few times a week with red meat saved for special occasions.

Food is flavoured with lots of herbs, all vegetables we ate were flavoured with herbs, as with the fish. Meat portions were small, and lots of vegetable were available – The hotel made the tastiest courgette Ive ever tasted, and tomato grown in the sun tastes so different than ones grown in a green house.

Susan was there for only 6 days, having a breakfast of Greek Yoghurt and fruit, followed by a small meat free cooked breakfast. Evening meal always started with a large selection of salad, with some feta cheese. Main meal fish and vegetables and potato cooked in olive oil, since she was on holiday she did try the delicious deserts. Midday snack my sons favourite, frozen greek yoghurt with strawberries and kiwi (highly recommend Andriani’s Homemade Ice and Frozen Yoghurt) and came back 1llb lighter, I never went hungry and felt really nourished. Susan will certainly will be eating this way more at home.

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Supplements

Better You Products

Better You products are popular with many being in a convenient spray form.

Vitamin D

Essential for calcium absorption, maintaining healthy bones and teeth, supporting a healthy immune system and contributing to normal muscle function.  Vitamin D is recommended in the UK for many individuals, during the winter months.

Vitamin B12

Vitamin B12 is a notoriously difficult to absorb through diet alone for many individuals. It is essential to support cognitive function and plays an important role in ensuring healthy red blood cell formation, proven to help reduce tiredness and fatigue.

Vegans often need to supplement B12 if not consuming fortified products.

Magnesium

Very popular with runners to help their muscles after a run and for individuals with restless legs.

 

Note: Information on products does not constitute advice, if you require personal recommendations on products and dosages please make an appointment with Susan.

 

 

 

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The sugar tax

Earlier this year the UK introduced a sugar tax, with the government stating                 ‘The ‘Sugar Tax’ will help to reduce sugar in soft drinks and tackle childhood obesity’  While many companies have reduced their formulas to now be exempt from the tax,  some products are shown as price includes sugar tax, so you would assume that those products in the same store  that don’t have this labelling on are better for you.

One such example is a popular fast food outlet.  One of their frozen drinks has the sugar tax added, it contains Sugar, glucose syrup, dextrose, fructose and lactose.   This drink equates to 37% of an adults daily intake of sugar.   Another drink they sell does not attract the sugar tax since its a frozen fruit smoothie, the sugar is all derived from fruit and lactose in the milk, and whilst this drink has less fat and therefore calories it contains 44% of an adults daily sugar intake.

At the end of the day sugar is sugar, its better for you when taken as a whole fruit since you are then also having the fibre. Over consumption of both glucose and fructose, will lead to weight gain and associated medical conditions.  Sucrose, often referred to as “table sugar”, is composed of one glucose molecule and one fructose molecule joined by chemical bonds. This means equal amounts of glucose and fructose are released into the bloodstream when sucrose is digested.  In Australia  most drinks are sweetened by sucrose from cane sugar, while soft drinks are sweetened with sucrose-rich sugar beet (Europe) or high-fructose corn syrup (US). High-fructose corn syrup is also made up of glucose and fructose, but contains a higher fructose-to-glucose ratio than sucrose.

Do they have different health impacts?

Yes over consumption of fructose has been shown to cause non-alcoholic fatty liver disease, and whilst fruit and vegetables in their natural form contain fructose due to the fibre  when eaten as a whole fruit or vegetable its very difficult to over consume.

High glucose consumption rapidly elevates blood glucose and insulin. This may affect brain function, including mood and fatigue. Because high blood glucose is linked to diabetes, consumption of high-glucose drinks may also raise the risk of diabetes and cardiovascular (heart) disease.

So choosing  a fruit smoothie may not be the best healthy option in terms of sugar.

 

 

 

weight loss

Its not all about the calories

Today the headlines are about reducing calories in processed and takeaway foods, and encouraging people to choose the lower calorie options.

The report also states that women should not consume more than 2000 calories per day, however everyone is not equal and into todays more sedentary life styles, daily calorie requirement are actual lower for the majority of people.  Height and age also effect the calories required, for example Susan burned 2200 calories last Sunday, but that included a 10k run, compared to Thursday where the only exercise was a 2 mile dog walk and she burned 1600 calories, so without the exercise Susan’s daily calorie requirement would be much lower than the average quoted.  It’s not good to get too worried about daily calories but look at it on a weekly basis as quite often it will all balance out and stop any unhealthy relationships with food.

Every person has an individual daily requirement, your basic metabolic rate (BMR) this is the daily calories that your body requires to stay healthy and not lose weight assuming you didn’t leave your bed all day, however these calories should be nutritious and not empty calories.  Your  individual total calorie requirement will then be based on how active you are in the day, the more active the more calories you will require to stay at your current weight, if you are trying to lose weight lower your calorie requirement by 200/300 calories per day.  Apps such as fitbit or my fitness pal, allow you to calculate your BMR and then track your food intake to allow you to have a rough idea (they will not be scientifically accurate) of your calories in compared to your calorie out, tracking food over the course of a week is a good idea, it makes your more mindful of foods that you are eating and looks at the macro nutrients balance as well. The three macronutrients (Carbohydrates, protein and fat) all have their own specific roles and functions in the body, and all supply us with calories or energy. For this reason, the body requires these nutrients in relatively large amounts to grow, develop and continually thrive. Remember macro means large, though many diets the proportion is out we eat far higher carbohydrates and proteins than required and too little fats. Healthy fats are an essential part of our diets, good fats come from nuts and seeds and their oils and oily fish.

If you rely on processed meals, its important to not just go for the lowest calorie option, in the long run this may not be the best for your health.   For example a ham sandwich on white bread is 275 calories, this is processed meat, giving 42% of your daily sodium, 9% of fibre, 33% of your protein, wheres as a wholemeal chicken sandwich with lettuce is 328 calories per serving, however sodium is 6% of daily requirement, fibre 22% of daily requirement, 60% of daily protein, along side having a portion of salad and benefits of B vitamins in the bread a far better choice.

 

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Prescription medication, vitamins, supplements and food.

When you take prescription or over-the-counter (OTC) medications, do you take also a vitamin, mineral, or other dietary supplements? Have you considered whether there is any danger in mixing medications and dietary supplements?  It is  widely highlighted that grapefruit juice affects the way your medicines work, especially if you have high blood pressure or arrhythmia (irregular or abnormal heart beat).  It can effect other drugs a swell,  but the severity of the interaction can be different depending on the person, the drug, and the amount of grapefruit juice you drink.

Many drugs are broken down (metabolized) with the help of a vital enzyme called CYP3A4 in the small intestine. Grapefruit juice can block the action of CYP3A4, so instead of being metabolized, more of the drug enters the blood and stays in the body longer. The result: too much drug in your body.

There is now further research that shows that grapefruit juice can also have the opposite effect.  Fexofenadine an anti-histamine, instead of changing metabolism, grapefruit juice can affect proteins in the body known as drug transporters, which help move a drug into our cells for absorption. As a result, less of the drug enters the blood and the drug may not work as well.  Orange Juice and apple juice also have the same effect with this medication so its important to always read the leaflet that comes with your medication.

St. John’s wort can decrease the effectiveness of birth control pills, leading to breakthrough bleeding and an increased risk of unintended pregnancy. It also interacts with anti – depressants, statins, and many others.

Herbs that decrease blood sugar may interact with anti-diabetes drugs to cause blood sugar to drop too far.

Echinacea a popular supplement at this time of year, but there are many interactions, especially with medications that follow the CYP3A4 pathway since these all have  toxic effects on the liver.

There are lots of reports in news that as well as vitamin D being a common deficiency in the UK this is closely followed by magnesium, however magnesium tablets can interact with blood pressure tablets and antibiotics.

The list is not exhaustive,  before you take any medication either prescribed or over the counter , vitamins, supplement or herbs please check for any interactions.  Please also mention all medication, herbs, supplements and vitamins, to medical staff and your nutritionist.

© 2018 – Susan Monk BSc (Hons) Open,  MFNTP.