Chapter 9

Elder Care Canada - Nutrition for Elders

Definition:

"People should take nutritional supplements" ... "Nutritional supplements just create expensive urine".   We've all heard both of these statements before. As with any other issue, they are two sides to every story.   Some people believe taking vitamins just creates expensive urine while others believe that taking excessive amounts of vitamins and nutritional supplements can cure almost anything.  We are not taking either course .  What we are going to try and show in this chapter is that taking quality nutritional supplements can be beneficial to Elders (as well as anyone else!!)   We are not going to make any health claims (although we will make references to different studies) and we would suggest that anyone who has any concerns consult their personal doctor or physician.

Dr. Kevin P. High of Wake Forest University School of Medicine in Winston-Salem, North Carolina conducted an extensive review of studies on nutritional interventions for older adults. His findings are published in the December 2002 issue of the journal Clinical Infectious Diseases.  Based on his review, adults over the age of 65 can benefit from a daily multivitamin and mineral supplement, as well as additional supplements to bring their daily intake of zinc to 20 milligrams (mg), selenium to 100 micrograms and vitamin E to 200 mg.  "Available evidence suggests these supplements are likely to enhance immune function and may boost vaccine responses in healthy older adults, and reduce the risk of infectious illness in both healthy and frail elders," he said.

Discussion:

The following information was found at the Health Information Center at the Cleveland Clinic (ranked one of the top 3 hospitals in the United States by U.S News and World Report 2006).

In general, people who are more likely to need a supplement are:

• Elderly people who
  a. do not eat as much as they should be eating;
  b. have limited exposure to the sun;
  c. may be lactose intolerant;
  d. have a limited ability to absorb and utilize Vitamin B-12 due to a change in their gastric secretions.
• Strict vegetarians who do not eat poultry, eggs, or dairy products may not eat enough foods rich in vitamin B-12.
• People of any age who are lactose intolerant or who do not like milk or dairy products.
• Chronically ill individuals who take medications regularly, or follow a restrictive diet, or are recovering from surgery or trauma.
• People with alcoholism who usually have trouble absorbing the B-complex vitamins.
• Smokers who may need more vitamin C because smoking interferes with the absorption of vitamin C.
• Chronic meal skippers or those who don’t eat a variety of foods and therefore limit the amount of nutrients they receive from food.
• Post-menopausal women who generally need more calcium and vitamin D.

Many health experts agree that seniors, as a group, are at a much higher risk of suffering nutritional deficiencies.  There are several reasons why this happens. First, seniors tend to be less active than younger folks and, therefore, do not eat as much. However, less food means less nutrients, like crucial vitamins and minerals. Some seniors also have difficulty in chewing and digesting food.   Also, seniors tend to also take prescription medications in higher proportion to younger people. Some of these drugs can lead to nutrient deficiencies indirectly due to their side effects, such as loss of appetite.

Vitamins for seniors are crucial because our body's cells do not regenerate themselves as efficiently as we age. Without proper cell regeneration, our bodies are much more prone to diseases and illnesses. This often can become a vicious cycle because chronic diseases themselves can affect the body's vitamin and mineral levels.

The above reasons are not exhaustive, but are just some of the most prominent reasons vitamins for seniors should be a priority for the elderly.  The bottomline? More and more experts believe taking vitamins and supplements can be a big benefit for many of the elderly in todays society.

OK, we've seen that everyone (Seniors included!!) can benefit from the proper intake of Vitamins.  But what exactly do these vitamins do?  We've included a few vitamins and minerals here that you've probably heard of and what they are good for.  For a detailed description of these and many other nutrients, click here!

Water-Soluble Vitamins - Be sure to get adequate amounts of the B vitamins, including folate, and vitamin C every day. During digestion, these vitamins are absorbed into the blood and transported around the body. The body uses them quickly, however, and excretes -- rather than stores -- what it doesn't need.

• Vitamin B-1 - Other names: Thiamine and thiamin.  Converts glucose to energy; essential for normal functioning of the heart, brain, nervous system and muscles.
• Vitamin B-2 - Other names: Riboflavin.  Promotes healthy development; helps produce skin and red blood cells; helps convert glucose to energy. A diet rich in vitamin B-2 may help ward off or slow the progression of cataracts and may help prevent migraine headaches.
• Vitamin B-3 - Other names: Niacin, nicotinic acid and nicotinamide. Helps with producing energy from food (sugars and fats); keeps skin, nerves and digestive system healthy.   Studies link diets rich in vitamin B-3 with a decreased risk of Alzheimer's disease.
• Vitamin B-6 - Other names: Pyridoxine, pyridoxal, pyridoxamine and pyridoxine hydrochloride.  Needed in more than 100 chemical reactions in the body and for forming amino acids, red blood cells and antibodies; important for nerve and brain function and energy production. An Arthritis Foundation-funded study showed that low blood levels of vitamin B-6 decreased as the activity, severity and pain of RA increased. Researchers suggest that inflammation may decrease the level of vitamin B-6.
• Vitamin B-12 - Other names: Cobalamin, cyanocobalamin and methylcobalamin.  Helps make red blood cells, nerve cells and genetic material; converts folate to its active form. Maintaining a healthy level of vitamins B-12, B-6 and folic acid may protect bones by keeping blood levels of the amino acid homocysteine from elevating. High homocysteine levels affect the heart and the skeleton. Experts think the substance may wreak havoc with the chemical bonds in bones.
• Vitamin C - Other names: Ascorbic acid, L-ascorbic acid and calcium ascorbate. Builds and maintains collagen and connective tissue; enhances iron and folic acid absorption; acts as an antioxidant; aids wound healing.  In a recent study of vitamin C consumption and arthritis, people whose diets contained the least amount of the vitamin were three times more likely to be diagnosed with arthritis than those who ate the most fruits and vegetables rich in vitamin C.
• Folate - Other names: Folic acid and folacin. Promotes healthy cell growth and reproduction, formation of DNA; regulates homocysteine levels.  A double-blind study published in the Journal of the American Medical Association report stroke patients who took folate and vitamin B-12 had lower risk of hip fracture compared to those taking placebo.

Fat-Soluble Vitamins - Fat cells absorb vitamins A, D, E and K and store them in your fat tissue and liver. Getting enough of these vitamins is important, but make sure your diet and supplements don't exceed recommendations. Excesses of these vitamins are stored, rather than excreted, so you can have too much in your system, which can cause negative effects.

• Vitamin A - Other names: Beta-carotene, retinal, retinol and retinoic acid. Vitamin A palmitate and vitamin A acetate are retinol forms. "Retinoids" collectively refers to different forms of vitamin A.  Researchers found that high levels of vitamin A from retinol (not beta-carotene) significantly increased bone fractures among men, confirming research showing that high levels of vitamin A from retinol raised the risk of hip fractures in women.
• Vitamin D - Other names: Cholecalciferol, calciferol, ergocalciferol, dihydroxyvitamin D-2 or D-3.  Builds and maintains strong teeth and bones; protects against osteoporosis; aids in calcium absorption; helps utilize phosphorus. Both calcium and phosphorus are important for bone mineralization.In a study of 221 people with knee osteoarthritis (OA), those who increased their daily vitamin D intake gained muscle strength and improved physical function. A study shows daily supplements increase calcium absorption by 65%.
• Vitamin E - Other names: Alpha-tocopherol, gamma-tocopherol, tocopherol acetate and tocopherol succinate. Acts as a scavenger, cleaning up free radicals; also aids in the formation of red blood cells, reproduction and growth.
• Vitamin K - Other names: Phylloquinone (K-1), menaquinone (K-2), menadione (K-3) and dihydrophylloquinone.  Aids blood clotting and activates osteocalcin, a protein that builds and strengthens bones.  A study of more than 72,000 women found a link between low dietary vitamin K intake and an increased risk of hip fracture.

Minerals - The salt of the Earth is what minerals are, literally. Minerals are found naturally in the soil and become part of the fruits, vegetables and other plant foods you eat. Your body needs minerals but if you eat plenty of fruits, vegetable greens and grains, you likely get enough. If your diet falls short, supplements can make sure you're covered.

• Calcium - Other names: Calcium carbonate, calcium lactate, calcium citrate, calcium gluconate and calcium citrate malate. Builds and maintains strong teeth and bones; regulates muscle contractions; transmits nerve impulses and monitors cell permeability. Calcium needs phosphorus and vitamin D present to be effective.  Inflammatory arthritis accelerates bone loss, so getting the optimum intake of calcium daily is critical.  A review of five studies shows the combination of calcium and vitamin D supplements significantly prevented bone loss in people taking corticosteroids. In another study of 65 people with RA, those who took calcium (1,000 mg) and vitamin D (500 IU) supplements not only reversed steroid-induced bone loss but also gained bone mass.
• Chromium - Helps body use insulin, protein, fat and carbohydrates.
• Copper - Other names: Cupric oxide, copper gluconate, copper sulfate and copper citrate.  Helps build red blood cells, transport iron and make connective tissue; keeps immune system, nerves and blood vessels healthy; and removes free radicals.
• Fluoride - Necessary for strong bones and teeth (especially tooth enamel).
• Iron - Other names: Ferrous fumarate, ferrous gluconate and ferrous sulfate.   Necessary for hemoglobin, the protein in red blood cells that carries oxygen to all cells. Men and postmenopausal women should take multivitamins or other supplements with little or no iron.
• Magnesium - Other names: Magnesium chloride, gluconate, oxide, citrate (supplement forms); magnesium hydroxide (antacid) and magnesium sulfate (Epsom salt).  Needed for more than 300 biochemical reactions in the body. Maintains muscle and nerve function, keeps heart rhythm regular, strengthens teeth and bones.
• Phosphorus - Strengthens teeth and bones; also involved in energy production.
• Selenium - Other names: Sodium selenite (inorganic, supplement form) and selenomethionine (organic form found in food).  Works with vitamins C and E as an antioxidant; essential for proper function of immune system and thyroid gland.   Supplementation of 200 mcg daily may lower the risk of prostate cancer in men.
• Zinc - Other names: Zinc gluconate and zinc acetate.  Involved in wound healing, cell reproduction and tissue growth, sexual maturation, and taste and smell; also associated with more than 100 enzymatic reactions in the body.  Zinc may protect against age-related macular degeneration.
  

Resources For Resolution:

MedLine Plus - Complete guide to Drugs, Nutrtional Supplements and health news ... click here.