Staying Golden: Targeting Nutrition and Health Tips for Boomers

Transcription

1 Presented at the 2010 Canadian Association of Cardiac Rehabilitation Annual Meeting and Symposium Montreal, Quebec October 23, 2010 Staying Golden: Targeting Nutrition and Health Tips for Boomers Jennifer Sygo, MSc, RD Director of Nutrition, Cleveland Clinic Canada and Nutrition Columnist, National Post Dr. Paul Oh, MD, MSc, FRCPC, FACP Medical Director, Cardiac Rehabilitation and Secondary Prevention Program, Toronto Rehabilitation Institute President, Canadian Association of Cardiac Rehabilitation Nutrition for successful aging Zoomers (boomers with zip) are pushing wellness and prevention to the forefront. Successful aging can dramatically impact quality of life and wellbeing. Dietary habits, specific nutrients, and in some cases, supplements, can play a critical role in successful aging. Interdisciplinary teams are in a unique position to support boomers in their quest to age well. Foods to Focus on for Zoomers Fruits and vegetables (brightly coloured) Oily fish (salmon, sardines, anchovies) Olive oil, avocados, nuts, seeds Wheat bran, whole grains Oat bran, psyllium fibre, ground flaxseed Beans, legumes, viscous fibres Yogurt, lower fat dairy foods The following information provides insight as to how diet can help address various physiological conditions that often develop as people age. A holistic approach to supporting boomers with all the health issues they face offers the best chance to help them age successfully through the years.

2 Musculoskeletal Health Osteoporosis affects 1 in 4 women and 1 in 8 men over the age of 50 in Canada. Osteoporosis increases the risk of falls as people age, but can be prevented. Current clinical practice guidelines recommend a calcium intake of 1200 mg/day for adults with reduced bone density (formerly known as osteopenia) or osteoporosis. 1 Recent research linking calcium supplementation with heart disease, especially in menopausal women, has led Osteoporosis Canada to recommend that calcium needs be met through diet first, and supplementation only used to meet the adequate intake (AI). Osteoporosis Canada now recommends daily vitamin D supplementation of IU/day for adults over 50, or those with known bone loss. A vitamin D intake of 2000 IU/day is also recommended and may also be important for muscles for fall prevention. 2 A protein intake of 1.0 g/ kg body may help prevent sarcopenia (loss of muscle mass associated with aging) in older adults and consuming 25 to 30 g of high quality protein at each meal may help sustain muscle mass during aging. 3 Adequate intakes of magnesium, potassium, vitamin K and vitamin A are also important. Sodium, caffeine (including cola beverages) 4 and alcohol should be limited. Dairy products and calcium rich foods Nuts, seeds, beans and legumes Lean meats, fish with bones Fruit and vegetables (dark green) Vitamin D (minimum 800 IU) Limit salt, caffeine, alcohol, pop Digestive Health Diverticulosis affects about half of people between years; but is usually asymptomatic. Age related changes in the lower gastrointestinal tract may contribute to delayed transit time, decreased stool water content and constipation. 5 A diet rich in fibre (14g/1000 kcal) helps to prevent constipation and manage diverticular disease. 6 Soluble fibre softens stools and insoluble fibre increases fecal bulk. Emerging research indicates that probiotics may also benefit digestive health. Certain probiotic yogurts may help improve digestive health by speeding colonic transit time. 7 Insoluble: Wheat bran, vegetables Soluble: Psyllium fibre, oat bran, fruits, beans, legumes, ground flaxseed Endocrine Health Menopause: Women often experience unwanted weight gain, especially around the abdomen, associated with hormonal changes as they go through menopause. This can lead to a host of increased risk factors for cardiovascular disease and type 2 diabetes. An energy reduced diet

3 and exercise program can help women manage their weight. 8 Another reason to help women manage their weight is that hot flashes may also be related to abdominal weight. Metabolic Syndrome: Weight control can help reverse many of the risk factors associated with the metabolic syndrome. A Mediterranean diet emphasizing monounsaturated fats, whole grains, vegetables and fruit and a decrease in saturated fats can help, as can fibre. 9,10 Soluble fibre helps control blood sugar by slowing carbohydrate absorption and insoluble fibre can help improve insulin sensitivity by altering gut bacteria over time. 10 Soy isoflavones (especially genistein) may help hot flashes. 11,12 Monounsaturated fats Fibre and whole grains Vegetables and fruits Insoluble and soluble fibre Cancer Prevention Colorectal: Among the factors that may increase risk are overweight, high intakes of red meats, particularly processed meats, high temperature cooking and alcohol. 13 Both low and high levels of folic acid may increase risk. 14 Breast: Factors that may increase risk include weight, inactivity, and alcohol intake. Excess folic acid could also be a risk factor. 14,15 There is inconsistent evidence as to whether antioxidants (beta carotene, vitamin C, vitamin E) provide protective benefits. 16 Prostate: Possible risk factors include high intakes of calcium (more than 1500 mg/day), processed meats, milk and dairy products. 11 Dietary intake of antioxidants such as vitamin E, selenium, lycopene and flavonoids may be protective; however, supplementation may not be effective and may increase risk of other conditions, so caution is warranted. 17 Colorectal: Higher fruit and vegetable intakes. 18 Breast: Very low fat diets, vitamin D and soy (particularly in pre menopausal women) may be protective. 19,20 Prostate: Foods, but not supplements, rich in antioxidants such as vitamin E, selenium, lycopene and flavonoids may be protective. Cardiovascular Health Diets high in fruits, vegetables and fibre, and low in saturated and trans fat, sodium and refined carbohydrates are recommended. Diets such as the DASH, OmniHeart and Mediterranean diets have all proven effective. Psyllium fibre reduces total and LDL cholesterol. Foods from the

4 Portfolio Diet: nuts, beans, lentils and soy can also reduce LDL cholesterol. 21 Foods rich in omega 3 fatty acids, especially oily fish, are effective for CVD prevention, especially through the management and control of triglycerides. 22 Vitamin D status is also inversely associated with hypertension, diabetes, metabolic syndrome, stroke, and coronary heart failure, though it is not yet known if the relationship is causal. 23 However, caution is warranted with high dose supplements, especially vitamin E and folic acid. 24 Recent evidence suggests that intake of sugar and refined carbohydrates could also be a risk factor for CVD. 25,26 Fish and/or fish oil supplements MUFA rich foods: olive oil, avocados, nuts Fruits, vegetables Nuts, seeds, soy, beans, lentils Psyllium fibre (cereals, supplements), oats, and other soluble, viscous fibres Neurological and Vascular Health The research on specific nutrients and cognitive decline is generally not conclusive. Results on improvements in cognitive decline, dementia and Alzheimer s disease with omega 3 or fish intake are inconsistent. 27,28 The research to date does not generally support the use of B vitamin supplements for preventing cognitive decline in otherwise healthy individuals. 29 Limited evidence also suggests poor vitamin D status may be related to cognitive decline. 30 Fatty fish, maybe fish oil supplements Fruits (especially berries) Vegetables (especially dark green and orange) References 1. Papaioannou A et al clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: summary. CMAJ, 2010; 10: Hanley DA et al. Vitamin D in adult health and disease: a review and guideline statement from Osteoporosis Canada (summary).cmaj, 2010; 182: Paddon Jones D and Rasmussen BB. Dietary protein recommendations and the prevention of sarcopenia. Curr Opin Clin Nutr Metab Care 2009; 12: Tucker KL et al. Colas, but not other carbonated beverages, are associated with low bone mineral density in older women: The Framingham Osteoporosis Study. Am J Clin Nutr, 2006; 84: McCrea GL et al. Pathophysiology of constipation in the older adult.world J Gastroenterol, 2008; 14: Strate LL et al. Physical activity decreases diverticular complications..am J Gastroenterol, 2009; 104:

5 7. Marteau P et al. Bifidobacterium animalis strain DN shortens the colonic transit time in healthy women: a double blind, randomized, controlled study. Aliment Pharmacol Ther, 2002; 16: Kuller LH et al. Women's Healthy Lifestyle Project: A randomized clinical trial: results at 54 months.circulation, 2001; 103: Giugliano D et al. Are there specific treatments for the metabolic syndrome? Am J Clin Nutr, 2008; 87: Weickert MO et al. Cereal fiber improves whole body insulin sensitivity in overweight and obese women. Diabetes Care, 2006; 29: Faure ED et al. Effects of a standardized soy extract on hot flushes: a multicenter, double blind, randomized, placebo controlled study. Menopause, 2002; 9: Williamson Hughes et al. Isoflavone supplements containing predominantly genistein reduce hot flash symptoms: a critical review of published studies.menopause, 2006; 13: American Institute for Cancer Research. Food, Nutrition, Physical Activity, and the Prevention of Cancer: A Global Perspective, Chapter Kim YI, Does a high folate intake increase the risk of breast cancer? Nutr Rev, 2006; 64: Lin J et al. Plasma folate, vitamin B 6, vitamin B 12, and risk of breast cancer in women. Am J Clin Nutr, 2008; 87: Roswall, N et al, Micronutrient intake and breast cancer characteristics among postmenopausal women. Eur J Cancer Prev, 2010; 19: Lippman SM et al. Effect of selenium and vitamin E on risk of prostate cancer and other cancers: the Selenium and Vitamin E Cancer Prevention Trial (SELECT). JAMA, 2009; 301: Koushik A et al. Fruits, vegetables, and colon cancer risk in a pooled analysis of 14 cohort studies. J Natl Cancer Inst, 2007; 99: Chlebowski RT et al. Dietary fat reduction and breast cancer outcome: interim efficacy results from the Women's Intervention Nutrition Study. J Natl Cancer Inst, 2006; 98: Garland CF et al. Vitamin D and prevention of breast cancer: pooled analysis. J Steroid Biochem Mol Bio, 2007; 103: Kendall, CW et al, A dietary portfolio: maximal reduction of low density lipoprotein cholesterol with diet. Curr Atheroscler Rep, 2004; 6: Kris Etherton, PM et al. Fish consumption, fish oil, omega 3 fatty acids and cardiovascular disease. Circulation, 2002; 106: Michos ED and Melamed ML. Vitamin D and cardiovascular disease risk. Curr Opin Clin Nutr Metab Care, 2008; 11: Bjelakovic, G et al, Mortality in randomized trials of antioxidant supplements for primary and secondary prevention: systematic review and meta analysis. JAMA, 2007; 297: Siri Tarion, PW et al, Saturated fat, carbohydrate, and cardiovascular disease.am J Clin Nutr, 2010; 91: Johnson, RK et al, Dietary sugars intake and cardiovascular health: a scientific statement from the American Heart Association. Circulation, 2009 ; 120: Freund Levi Y et al. Omega 3 fatty acid treatment in 174 patients with mild to moderate Alzheimer disease: OmegAD study: a randomized double blind trial. Arch Neurol, 2006; 63: Lim WS et al. Omega 3 fatty acid for the prevention of dementia.cochrane Database Syst Rev, 2006; 25:CD Aisen PS et al. High dose B vitamin supplementation and cognitive decline in Alzheimer disease: a randomized controlled trial. JAMA, 2008; 300: Oudshoorn C et al. Higher serum vitamin D3 levels are associated with better cognitive test performance in patients with Alzheimer's disease. Dement Geriatr Cogn Disord, 2008; 25: