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Spring 2011
Boomer Nutrition: Preventive MedicineBy Maura Keller Physicians can play a key role in educating patients on nutrition issues, reminding them that judicious diet choices lead to longer and more healthful lives. The baby boomer generation is redefining the aging process. The perception of men and women in their 50s and 60s has changed, especially when a growing percentage of the population is living for more than a century. This aging demographic is facing myriad lifestyle and health issues including arthritis, heart disease, cancer, and diabetes. Here’s the good news: Consuming more nutrient-rich foods can go a long way toward keeping your boomer patients living longer, healthier lives. A Changing Demographic As Carol Wolin-Riklin, MA, RD, LD, a bariatric nutrition coordinator at the University of Texas Medical School at Houston, explains, baby boomers have entered the era of stratification. “The latest subdivision to arise from the baby boomer group is the ‘golden boomer’,” she says. “The golden boomers are baby boomers that have entered or are entering their retirement years. Boomers are remaining more active later in life and are redefining traditional roles for seniors. This makes them a valuable target for nutritional and diet companies touting the elusive fountain of youth to market their services to.” As Wolin-Riklin explains, boomers intent on thwarting old age may be lured into bogus or alternative neutraceuticals that have no evidence-based research to support the claims made by the manufacturers. Here’s where you come in: As their key healthcare provider, you need to arm yourself with correct information about the nutrition needs of boomers and effectively communicate this information to your patients. So what are the top nutrition issues for boomers? According to Wolin-Riklin, former public health malnutrition issues have been replaced by issues of dysnutrition in the new millennium, which leads to the need for weight management, glycemic control, cardiac health through diet management, and concern for older boomers plagued by high blood pressure and obesity. “Boomers’ nutritional needs are no different than those of the senior generation before them,” Wolin-Riklin says. “It is the negative lifestyle habits—lack of exercise [and consuming] processed foods, fast foods, high carbohydrate snacks and meals—that have caused the rise of metabolic syndrome comorbidities: hypertension, hyperlipidemia, and diabetes.” Influential Factors “Doctors and other healthcare professionals could influence nutrition choices if they spent more time with patients,” says Freeman T. Changamire, MD, ScD, a family medicine physician at Cambridge Health Alliance in Cambridge, Mass., and assistant professor of family medicine at Tufts University. “This would give them more time to focus on nutrition issues. The current primary care visit is only 15 minutes. In this time with a patient, the doctor is supposed to obtain a medical history, do a physical exam, make a diagnosis, order lab tests, prescribe medicines, and counsel a patient. So you can imagine how much time is left to counsel on nutritional issues in a primary care visit. Unfortunately, we spend very little time on this aspect of a patient, which is very important and central to a patient’s health.” “Doctors do have a large influence on their patients’ care,” Wolin-Riklin says. “Nutrition information and education must be provided by doctors and nurses in a very limited time span in the medical office. This is often ineffective. Referral to a registered dietitian who can devote the proper amount of time for an effective and informative transfer of nutrition information can be a more effective management technique.” Or better yet, have a dietitian in the office to spend quality time with patients to discuss diet and exercise strategies. “Model the behavior you want your patients to follow,” says Elizabeth Somer, RD, author of Eat Your Way to Happiness. “Provide incentives for patients who comply with diet and exercise regimens and coordinate services with a nearby gym or health center.” Healthcare providers also need to educate boomers on reading labels to help identify good food choices. This is one of the most helpful educational tidbits doctors and healthcare practitioners can utilize to begin nutrition education. As Dee Sandquist, MS, RD, LD, CDE, a spokesperson for the American Dietetic Association, explains, physicians and other healthcare providers need to work with their patients to make one change at a time. “Let the patient be successful and then add another change instead of trying to have the patient make too many changes at once,” Sandquist says. “Ask patients, ‘What is preventing you from making a change?’ The answer to this question may surprise you. Work with patients to find a strategy that will work for them.” And remember that nutrition needs increase as patients age, yet calorie needs decrease unless they are vigorously active every day. Consequently, the older patients become, the more every bite must count. “Eat junk, you’ll feel like junk. Eat well and your body will repay you a thousandfold,” Somer says. “Also, many medications compromise nutritional status. For example, acid-blocking medications reduce absorption of vitamin B12, increasing the risk for dementialike symptoms. Statins increase the need for coenzyme Q10.” Experts recommend providing boomers with tech-smart techniques to help them monitor their own diet and exercise regimens. Such strategies include online food journals, online support groups for eating disorders, and nutritional information websites displaying caloric content and fat, carbohydrate, and protein percentages for restaurant menus. Susan Kasik-Miller, MS, RD, CNSC, a clinical dietitian at Sacred Heart Hospital in Eau Claire, Wis., recommends physicians tell their boomer patients about the importance of making dietary changes and what benefits such changes will mean to them and their health. “Be very concrete on what diet message you want to convey; do not provide multiple messages at one time,” she says. “Give specific examples of foods that will provide the nutrition [boomers] need. Instead of saying, ‘Eat a low-fat diet,’ tell them, ‘Eat more chicken and fish than beef, and choose lean cuts of beef and pork when you eat them.’” Treat each of your boomer patients with the mindset that proper nutrition is preventive medicine, and reinforce that people who eat healthier live longer lives. To help educate your patients, refer them to websites such as www.eatright.org, www.diabetes.org, www.heart.org, and www.cancer.org. “And remember, daily activity is critical for health and works hand in hand with nutrition,” says Michelle M. Bush, MPH, RD, CHES, a clinical dietitian at Hoag Memorial Hospital Presbyterian in Newport Beach, Calif. “Boomers, like other individuals with hectic lifestyles, may be challenged in making exercise a priority. Compressing all physical activity into one weekend can cause injury and does not provide maximum benefits. However, 30 minutes of daily activity has the ability to increase bone and muscle mass, improve cardiac function, stabilize blood values, and promote weight loss.” Devising Nutrition Strategies While there are benefits for some elders in taking vitamin/mineral supplements, a healthful diet that includes vitamins and other nutrients is the best way for boomers to supply their bodies with essential nutrients. According to Sandquist, boomers need to eat more fruits, vegetables, and whole grains, which can all help reduce the use of over-the-counter laxative products. “Boomers can also reduce [associated] pain by including foods such as cherry juice and healthy fats such as olive oil, canola oil, pumpkin seeds, avocados, and nuts,” Sandquist says. She suggests boomers should typically fill one half of their plates with fruits and vegetables, one quarter with whole grains (think brown rice, whole grain rolls, and quinoa), and one quarter with high-quality protein such as lean beef, pork, turkey, or chicken. Boomers often approach aging seeking to remain vital, sexy, and energetic well into their 80s and beyond. However, as Somer points out, nearly seven of 10 of them are overweight, increasing their risk of heart disease, cancer, diabetes, dementia, hypertension, cataracts, sexual dysfunction, and a host of other age-related ills. “First and foremost, cutting back on calories from processed foods and increasing exercise throughout life are paramount to aging well and staying vital,” Somer says. “Boomers should focus on antioxidant-rich foods such as colorful fruits and vegetables, whole grains, legumes, red wine, green tea, and even a bit of dark chocolate. These foods combined contain almost 1 million phytonutrients, many of which are antioxidants that protect delicate cell membranes from damage associated with aging, from heart disease to dementia.” Physicians should suggest boomers aim for a minimum of nine servings of colorful fruits/vegetables per day, at least three servings of 100% whole grains per day, four servings of legumes per week, and a glass of red wine and bite of 70% cocoa dark chocolate a few times per week, according to Somer. Bush notes that vitamin B12 is linked to improved cognitive function and may reduce dementia, possibly making supplementation beneficial. “Most individuals should be taking a vitamin D supplement and be mindful of adequate vitamin D intake with foods. Guidelines have recently been increased to 600 to 800 IU based on age,” Bush says, adding that “adequate fiber intake is rarely met in the average boomer. Individuals need to consume 25 to 35 g of fiber on a daily basis, [and] adequate fluid intake is important when increasing fiber intake.” Remain vigilant concerning boomers’ need to have blood work completed on a regular basis to monitor cholesterol, blood pressure, blood glucose, and vitamin and mineral levels to maintain overall health. And Somer explains that the omega-3 fat DHA is critical for boosting mood, protecting the brain from age-related memory loss, and lowering heart disease risk, among other functions. “Boomers should aim for no less than two servings of fatty fish such as salmon, mackerel, herring, or sardines a week, incorporate more foods fortified with an algal or vegetarian, contaminate-free DHA, and consider a DHA supplement,” she says. “Boomers need at least 220 mg of DHA a day.” Bone health represents another important nutritional issue boomers face. In particular, osteoporosis is very common among postmenopausal women who fail to get enough exercise, calcium, and vitamin D. “Adequate vitamin D, calcium, and exercise are important for bone health, improving muscle strength and balance, and preventing falls,” says Changamire. “I would recommend vitamin D and calcium supplements for postmenopausal women.” In our society of overconsumption, it’s not surprising that many boomers are facing the harmful effects of obesity. “If people don’t remain vigorously active, they begin to lose about 1% to 2% of their muscle mass by their mid-30s,” Somer says. “That equates to a 5- to 10-lb loss of muscle every decade. As they lose muscle, metabolism slows, weight creeps on, and disease risk escalates. The weaker they get, the less they do. Middle age spread is merely the first step on a continuum that, if not stopped, will end up with the patient using a walker or a wheelchair down the road. All of this is almost completely preventable.” — Maura Keller is a Minneapolis-based writer and editor.
Top Nutrition Myths/Facts to Share With Boomers Myth: A rich chocolate sundae before bedtime is more fattening than the same sundae eaten at lunchtime. Myth: Excess carbohydrates, not fats, cause weight gain. Myth: Older patients no longer need milk. Myth: Avoiding carbohydrate foods will help patients lose weight. Myth: All fats are bad. Myth: To lower cholesterol, it is most important to eliminate high-cholesterol foods. Myth: Eggs and seafood should be eliminated from the diet. — MK
Boomers’ Nutritional Needs • Calorie needs decline with age so eating less, eating fewer calories, and increasing activity are critical. • Meal planning is the best strategy for maintaining a good diet. • Three meals per day are best for a healthful diet; six small meals may be better tolerated. • A meal should include at least three food groups. • Breakfast is the most important meal of the day. • Skipping meals does not save on calories. • Beverages can contribute significant numbers of calories to a patient’s diet. • All food groups need to be included in a healthful diet. • All foods can be part of a good diet, but quantity is an important consideration. — MK
Provider Perspective • Educate boomers on reading nutrition labels to help identify good food choices. • Work with patients to identify individuals’ successful diet strategies. • Suggest tech-smart techniques for boomers to self-monitor, such as online food journals and websites featuring nutrition information. • Encourage boomers to include fruits, vegetables, whole grains, and fish in their diets.
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