Nutrition for the Elderly

elderly, nutrition

As the age of technology and medicine advance, we are finding more and more people are living longer and an increased lifespan come issues that need to be addressed. One such issue is the increased risk of malnutrition in the elderly. Most elderly have a reduced appetite and other difficulties when it comes to eating and staying healthy. Patients may have medical conditions that require specific dietary prescriptions, but below are some of the general tips on what is important over and above the normal healthy eating guidelines.

Calcium and Vitamin D in the elderly

With this specific population, it is very important that there is a good intake of these two nutrients to help maintain healthy bones. Calcium and vitamin D are found in dairy products (aim for 3 servings a day), dark green leafy vegetables, fortified cereals and tinned fish with soft bones. We always recommend that we try to get the nutrients that we need from our foods. However, if there is any concerns with regards to malabsorption of nutrients or insufficient intake we recommend that you take a calcium supplement that also contains vitamin D.

Fibre

Fibre is the portion of food which slows down your digestion, makes you feel fuller for longer, and helps you control your weight and your blood sugar levels. It has also been shown to decrease your risk of heart disease as well as type 2 diabetes. Good sources of fibre are fruits, vegetables, legumes (beans and lentils), wholegrain breads and whole wheat or high fibre breakfast cereals such as oats, weetbix and bran flakes.

Vitamin B12 and Iron in the elderly

Many older adults do not get enough of these two nutrients. These both have very important functions in our body. Iron is an important element of haemoglobin and is responsible for the transportation of oxygen in the blood. Vitamin B12 has an important role in the production of your red blood cells and DNA as well as helping the nervous system to function properly. Good sources of iron include red meat, liver, poultry, fish as well as lentils, beans and spinach. Try to including a source of vitamin C when eating food high in iron as this improves iron absorption in the digestive system. Good sources of Vitamin B12 are foods like fortified cereals and breads, lean meats, fish, poultry, eggs and some seafood.

Fat sourceshealthy fats

Dietary fats have been linked to increase risk of colon, pancreatic and prostate cancers as well as coronary heart disease and obesity. The intake of dietary fats is important though as they contain fat-soluble vitamins and essential fatty acids that our body cannot make. It is all about the types of fats. The best fats for us to eat are called monounsaturated fats, these can be found in avocado, olives and olive oils, canola oil and nuts. The best oils to cook with are therefore canola oil or avocado oil as olive oil does burn at high temperatures. Dark oily fish contain polyunsaturated fats such as omega 3 and omega 3 has been seen to have positive effects on your heart health. It is important to still limit the amount of fats we have though as fat is very calorie-dense and can cause weight gain if used in large amounts.

Obviously each individual and their complex medical conditions is different and so it is important to seek proper medical advice with regards to your loved ones diet and how to improve their health. Speak to one of our dietitians if you have questions or need more guidance.

Warning: SUGAR!

ice cream, sugar

Who can resist a cup of hot chocolate or a glass of milkshake, or even that chocolate in the shopping isle? World Diabetes Day is celebrated yearly on the 14th November to raise Diabetes awareness. With the prevalence of diabetes increasing dramatically, it is appropriate to discuss one topic… SUGAR!

Sugar is found everywhere around us. Many people think that they avoid it by not adding it to their foods or drinks, however, it is hidden in so many of the foods that we eat on a daily basis. Sugar tax was introduced to decrease intake of sugary beverages, but if you really want that drink, the extra money will not stop you.

What is the hype around sugar?

In this article I am not looking at carbohydrates, which is a bigger group of nutrients, but rather only sugar. It is a carbohydrate that is found naturally in a number of foods from fructose in fruit and honey to lactose in milk. There are two types of sugars: naturally occurring (such as lactose in milk), and added/hidden (found in table sugar, sucrose and all sweetened products). The added sugar is one of the contributors to obesity and therefore this should be limited. According to the World Health Organisation, no more than 5% of total energy intake should be from added sugar. This equates to about 3 teaspoons of sugar for children and 5 teaspoons for adults (MAXIMUM).

Is sugar bad?

Sugar is used as fast releasing energy when exercising. If you are very active, it is helpful in keeping you energised. However, if you are not active it stores as fat. Most sweetened products have very high amounts of sugar added and even if you are active, some of this will be stored as fat. Eating too much of it may also result in sugar spikes and slumps. These may leave you feeling tired, grouchy, may cause you to gain weight and lead to heart disease and diabetes.

Common sugar culprits

  1. Table sugar: whether it is white or brown, sugar is sugar and enters the blood immediately, causing a spike. Therefore, adding sugar to anything is a culprit
  2. Sugary beverages: on average a can contains about 7 teaspoons (this already exceeds the daily sugar allowance!)
  3. Sweets and chocolates, biscuits, cakes, ice cream
  4. ‘Low fat’ products: due to having a lower fat content these products have extra added sugar to help make them more palatable
  5. Breakfast cereals: Chocolate, strawberry, honey cereals all have high amounts of sugar added, however even ‘healthy’ alternatives such as bran flakes and muesli have sugar added. The best choice remains oats.

What about sweeteners?

The use of sweeteners has increased and they are now used in many products and the product is then tagged as ‘sugarless’ even though when you taste it, it is sweeter than if it were a sugar containing product. Sweeteners can either be artificial sweeteners or sugar alcohols. Artificial sweeteners include sucralose, aspartame and stevia, whereas sugar alcohols include xylitol, mannitol and sorbitol. Sweeteners commonly have side effects such as diarrhoea if used in large amounts. Some of them may also have a slight aftertaste that is disliked by many. The use of sweeteners has not been studied enough to confidently say whether or not they are ‘safe’. Certain studies suggest sweeteners may cause cancers. Some studies have even shown that using sweeteners may increase your appetite and therefore increase your risk for obesity. The topic of sweeteners is such a broad topic and therefore I will not go into more detail in this blog (a blog purely on sweeteners will be released shortly).

How to identify added sugar in products

Read the food labels. The ingredients are named in descending order by weight, therefore the higher up the list they are, the higher quantities are in the product. Added sugar can go in various different names, so look out for the following names:
Sucrose, honey, syrup, high-fructose corn syrup, agave nectar, malt syrup, brown sugar, fructose, maple syrup, cane crystals, fruit juice concentrates, molasses, cane sugar, glucose, raw sugar, corn syrup, dextrose, maltose

So what CAN we eat?

It seems like I have ruled out any and all foods that we eat and I can already sense people thinking they will starve. But behold, this is not the case! I believe we are allowed everything in moderation and this includes sugar, but choose wisely, limit your portions and do not consume it every day. Rule of thumb – raw, fresh, unprocessed, self-made foods (and yes, I said self-made and not home made because very often we can buy homemade foods and we still do not know what the cook has put into it).

Tip to remember: Make time to make your own food!!

Iron Deficiency Anaemia

What is iron deficiency anaemia?

Iron deficiency anaemia is the most common type of anaemia. Anaemia occurs when our body does not have enough red blood cells. These red blood cells provide our body tissue with oxygen. Iron helps to make red blood cells. Iron deficiency anaemia happens when we do not have enough iron in our body to do this. If we do not have enough iron, our blood cannot carry oxygen effectively.

Causes of iron deficiency anaemia?

Iron deficiency anaemia is a result of insufficient iron in our body. When we do not have enough iron in our body, we cannot make haemoglobin (part of red blood cells- gives blood its red colour). Haemoglobin also transports oxygenated blood around our bodies. A combination of not consuming enough iron and losing large amounts of iron can lead to iron deficiency. Causes of iron deficiency anaemia include:

  • Blood loss (heavy menstrual cycle, gastrointestinal tract bleeding such as bleeding ulcers)
  • Malabsorption (celiac disease, Gastrointestinal tract surgery)
  • Lack of iron rich foods in your diet
  • Pregnancy (increased iron requirements)
  • Vegetarian diet (if plant sources of iron isn’t eaten regularly)
  • Donating blood frequently (depletion of iron stores).

Symptoms of iron deficiency:

  •  Fatigue
  • Low energy levels
  • High risk of infection
  • Heart palpitations
  • Itchy skin
  • Thinning hair
  • Brittle nails
  • Pale skin
  • Mouth sores

Iron in our diet

A good way to get iron is to include iron rich foods in our daily diets. There are 2 types of iron sources. Animal sources of iron is known as haem iron and plant sources of iron is known as non-haem iron. Animal sources of iron are more easily absorbed. However, vitamin C can enhance the absorption of both animal and plant sources of iron.

Haem iron (animal sources)- beef, lamb, liver, egg, pork, chicken, fish
Non-haem iron (plant sources)- beans, peas, lentils, chickpeas, nuts, seeds, green leafy vegetables such as spinach, cabbage and broccoli

Iron and vitamin C

Vitamin C is a water soluble vitamin. Our bodies do not store large amounts of vitamin C. Excess vitamin C is lost in our urine. Vitamin C increases iron absorption. Aim to include vitamin C rich foods in your diet everyday to increase iron absorption. Vitamin C rich foods include red bell peppers, green bell peppers, strawberries, kiwi fruit, grapefruit, orange, broccoli, tomato and mango.

Iron absorption inhibitors:

  • Calcium – found in dairy products such as milk, Maas, cheese and yoghurt can prevent iron from bring absorbed effectively. Calcium rich foods should be eaten 2 hours before/ after eating iron rich foods.
  • Tannins- found in tea, coffee, cocoa
  • Polyphenols- found in cocoa, coffee and some herbs

The first step to improving iron deficiency anaemia is to aim for a healthy balanced diet rich in iron and vitamin C. A Registered Dietician can help you to get in all the essential nutrients you require daily. Your Doctor may recommend an iron supplement to improve iron deficiency anaemia.

Diet diet diet… can it lead to obesity?

Obesity is worldwide epidemic not only in adults but also in children. Childhood obesity has been increasing in prevalence over the years. Overweight and obesity are major risk factors for a number of chronic diseases, including diabetes, cardiovascular diseases and cancer. In South Africa two thirds of women and a third of men are overweight or obese.

What is a fad diet?

A fad diet is a diet that promises weight loss or other health advantages usually in a short time period. In many cases, the diet is characterized by highly restrictive or unusual food choices. These diets associated with health risk as well.

Over the years many fad diets boast successful weight loss due to the quick fix or miracle results. The problem is maintaining the weight loss once you stop following the fad diet. Therefore, most fad diets result drastic weight loss and once you are off the diet weight gain is experience. This dramatic fluctuation is discourage can aid more weight gain over time.

How to spot a Fad diet?

  • Magical weight loss, without changing your lifestyle.
  • Promise rapid weight loss
  • Magical fat- burning effects of foods.
  • Promotes severe limitation or avoidance of a whole food groups
  • Suggests eating mainly one type of food.
  • Promotes only eating particular combination- based on genetics
  • Liquid meals only
  • Focus on appearance rather than health.

Healthy weight loss

We should aim to lose weight gradually in a health manner. Tips of small changes

  • Have regular meals start with Breakfast
  • Choose lower fat foods – lean meat grilled, use fat/oil sparingly. Low fat milk/dairy
  • Watch your portion size.
  • Fill up with vegetables and fruits.
  • Get active

It you have a question on Fad diet speak to a dietician and doctor to weigh out health risks. The best way to lose weight and keep it off is to make healthier choices, eat a nutritionally balanced and varied diet with appropriate portion size and physically active.

National Nutrition and Obesity Week- Breakfast, the best way to start your day 9-19 October 2018

#StartWithBreakfast

National Nutrition Week (9 – 15 October) and National Obesity Week (15 – 19 October)

The aim of this year’s nutrition week is to encourage citizens of our country to eat regular meals starting with breakfast. Previously, the focus was solely on nutrition, but “obesity” has been added as a component to raise awareness of the importance of preventing obesity.

Read more

The Gestational Diabetes Cycle: what can be done about it?

Gestational diabetes (GDM) is high blood sugar levels in pregnant women who have not had diabetes prior to pregnancy. The cause of GDM is uncertain but it is thought to be due to hormonal changes. The placenta growth may block insulin action resulting in insulin resistance (the body using insulin less effectively). As the body is unable to use insulin as effectively as previously, glucose stays in the blood – hyperglycemia.

The Gestational Diabetes Cycle

GDM is increasing, as prevalence is in more than 20% of pregnancies. The cycle below shows the link between GDM and obesity. Addressing GDM can help prevent the ongoing cycle of diabetes and obesity.

Tried Nutritional Treatment approaches in GDM

One of the most commonly discussed dietary methods in managing GDM is the restriction of carbohydrates. This will obviously lead to a decrease in blood glucose levels as carbohydrates are the macronutrients that most affect blood sugar control. More recently though, this appears to have its own complications. When there is a reduction in carbohydrates there is often an increase in fat intake, which will then cause an increase in free fatty acids once metabolised. These can further increase risk of insulin resistance in the mother. There has also been research done into the types of carbohydrates and the use of low GI carbohydrates to achieve better blood glucose control, unfortunately though the studies that have been done on these theories have serious limitations.

So what now for the nutritional management of GDM?

An article by Yamamoto et al. (2018) was recently published. This is a systematic review that showed that nutritional intervention allowed better outcomes of all GDM complications. These include reduction in maternal post-prandial (before eating) glucose levels, reduced need for medication usage, reduced macrosomia and lower infant birth weight. Yet again there was a limitation, as the participants could not be blinded to the diets- this is a major bias that cannot be overcome in participants that are free-living. Unfortunately though this does not give us a definitive answer as to what diet should be prescribed for GDM patients.

There are currently no specific dietary guidelines to use for the management of GDM but it is highly important that the dietary management of this condition is managed by a team of professionals including a dietitian that can work to individualize the patient diet and manage their condition continuously. We need to move forward to ensure that we able to find the best dietary approach to manage patients with gestational diabetes. If you have any questions contact any of our dieticians to help work out a healthy dietary approach for you.