Nutrition and the Elderly
This is ultimately for us -- we will grow old, and need this information. But it is also for those of us who have an elderly parent living with us, or nearby who can benefit from the information below -- in today's NY TImes...
August 21, 2001
Nutrition a Key to Better Health for Elderly
By JANE E. BRODY
More Personal Health Columns
ttention, people over 65. Is your brain slowing down, your memory failing, your resistance to infection taking a nose dive? This is not an advertisement for a secret anti-aging formula, but a call to improve your nutrition.
Too many older people may be accepting a cognitive and immunological decline as a normal part of aging, when it may reflect a deficiency in essential nutrients like vitamins and minerals. A simple one-a-day type supplement may be all that is needed to slow or even stem that decline, recent studies show.
Surveys have shown that up to 40 percent of elderly people who live independently in affluent countries consume insufficient amounts of one or more essential nutrients or have deficient levels of these nutrients in their blood.
The reasons for these deficiencies include a limited income, difficulty getting to stores, chronic illnesses or medications that interfere with nutrients, problems with chewing or digesting, and poor appetite. Inactivity or illness can depress the appetite, as can a loss of taste; older people who eat alone or who are depressed can also lose interest in food.
Nutrient deficiencies appear to increase with age. A new study by Teresa A. Marshall and her colleagues at the University of Iowa looked at over 400 Iowans 79 and older living independently in rural areas and found that 80 percent reported consuming inadequate amounts of four or more nutrients. In findings important to disease prevention, 75 percent of those people consumed too little folate, a B vitamin that helps prevent heart disease and stroke. And 83 percent did not get enough vitamin D and 63 percent got too little calcium, both essential to preserving bone and preventing osteoporosis and fractures.
Other nutrients commonly in short supply were vitamin E, magnesium, vitamin B6, vitamin C and zinc. Nutrient deficiencies were especially prominent among participants who relied on a limited number of foods.
In a report in the journal Nutrition last month, the authors recommended that older people be encouraged to increase the variety of foods they eat, especially nutrient-rich fruits, vegetables and whole grains, and to take daily nutritional supplements.
"Supplement use allowed a small number of subjects to have adequate nutrient intakes," the authors wrote. "However, a substantial number of subjects who might have benefited from supplement use did not consume them."
In the newest report on better nutrition among the elderly, Dr. Ranjit Kumar Chandra, a pediatrician and immunologist at Memorial University of Newfoundland, demonstrated that a nutrient supplement with modest amounts of 18 vitamins, minerals and trace elements could improve cognitive function in apparently healthy people over 65. The study involved 86 people who were living independently and randomly assigned to take either the 18-nutrient supplement or a dummy pill for a year. The participants and the researcher did not know who was taking what until the study was finished.
As described in Dr. Chandra's report in Nutrition this month, those who took the supplement showed significant improvement in short-term memory, problem-solving ability, abstract thinking and attention. Even the participants who started out with adequate nutrition got some mental benefits from the daily nutrient supplement, although the greatest improvements occurred in people whose blood contained deficient amounts of one or more nutrients, Dr. Chandra said. No change occurred in long-term memory, which has long been known to be relatively immune to aging's effects.
Dr. Chandra said the cognitive benefits from improved nutrition could significantly improve the lives of the elderly. They would be better able to perform the activities of daily living and would presumably discover more joy. He emphasized that megadoses of nutrients were not necessary or desirable because high doses of certain nutrients could have serious negative effects. The supplement he suggests contains the recommended daily amounts or less of most vitamins and minerals and somewhat larger amounts of beta carotene and vitamin E.
How might nutrients improve brain function? One possibility is that taking a modest nutrient supplement daily can improve immune function. "An enhanced immune response in those receiving the nutrition supplement may be instrumental in preserving the anatomy and function of neurons and their appendages," he wrote in the new report.
Dr. Chandra suggested that by improving immunity, the supplement may prevent the accumulation of beta-amyloid, neurofibrillary tangles and other harmful deposits associated with serious neuronal damage and neuropsychiatric disorders like Alzheimer's disease. But it remains to be shown whether a nutrient supplement can delay or prevent the onset of dementia.
In a report nearly a decade ago, Dr. Chandra showed that the same supplement resulted in a significant improvement in standard immunological tests, including the number of natural killer cells and helper T-cells, the production of interleukin 2, and the antibody response to the influenza vaccine.
He also found that the supplement could restore a lagging immune response in six months, and sometimes as soon as three months. No improvement was found in those who took a dummy pill.
To be sure of the supplement's benefits, the researchers checked on the participants every two weeks to determine whether they had experienced an infectious illness or needed antibiotics. Infection-related illness occurred an average of 23 days in the year among those taking the supplement, while those taking the dummy pill averaged 48 days of infectious illness.
Dr. Chandra said that while it was most desirable to consume a nutritionally adequate diet, he was struck by the cost-effectiveness and simplicity of a nutritional supplement to prevent or delay illness and functional decline in the elderly. Based on his findings, he has calculated that for every dollar spent on such a nutrient supplement, $28 would be saved in health care costs.
The precise amounts of the nutrients in the supplement used in Dr. Chandra's studies were determined by how much of each nutrient had shown a maximum benefit to the immune system in his studies.
For comparison with the vitamin supplements sold to older adults, here are the contents of Dr. Chandra's supplement: 400 retinol equivalents (1,333 International Units) of vitamin A, 16 milligrams of beta carotene, 2.2 milligrams of thiamine, 1.5 milligrams of riboflavin, 16 milligrams of niacin, 3 milligrams of vitamin B6, 400 micrograms of folate, 4 micrograms of vitamin B12, 80 milligrams of vitamin C, 4 micrograms (160 I.U.'s) of vitamin D, 44 milligrams (44 I.U.'s) of vitamin E, 16 milligrams of iron, 14 milligrams of zinc, 1.4 milligrams of copper, 20 milligrams of selenium, 0.2 milligrams of iodine, 200 milligrams of calcium and 100 milligrams of magnesium.