The geriatric population is the fastest growing segment of our society and is the number one consumer of pharmaceuticals. This population suffers from the greatest number of medical conditions and have the poorest nutritional status.
The geriatric population often suffer from conditions that can be directly linked to the nutritional status of that individual. These include problems such as digestive disorders, cardiovascular disorders, suppressed immune systems, cancer, endocrine imbalances, insomnia, and depression. Each of these conditions has been shown to have a direct correlation to the nutritional status of the patient.
Malnutrition is a fairly common problem within the geriatric population due to low caloric and protein intakes. Such malnutrition is frequently accompanied by corresponding deficiencies in vitamins and mineral levels. Geriatric patients often have a reduced digestive and absorptive capability and often eat less due to diminished senses of taste and smell.
By making effective nutritional recommendations to your geriatric patients you can greatly enhance your already effective Chiropractic treatments. This document reviews some of the common conditions that present to each of us as practitioners, and provides some viable nutritional solutions for each. Such conditions include:
Gastrointestinal complaints are exceedingly common within the geriatric community, manifesting with syndromes such as gastritis, heartburn, ulcers, and constipation. Improving digestive function is fundamental to the treatment of ailments within the geriatric community. As our bodies grow older , there is a corresponding decrease in the production of gastric hydrochloric acid (HCl), intrinsic factor, and digestive enzymes. The decreased levels of these substances results in a decrease in the primary building blocks needed for healing proteins, fats, and complex carbohydrates. This dysfunctional state also affects the bodys ability to absorb essential vitamins and minerals.
Some specific areas that you can focus on in order to reduce digestive dysfunction are:
Constipation is a common problem faced by the geriatric patient and can be related to numerous symptoms such as diverticulitis, hemorrhoids, gas, bloating, headaches, varicose veins, and insomnia. In the majority of cases constipation is a direct result of a lack of fiber and fluids in the patients diet. As we age, our thirst mechanism becomes inexact. Consequently the geriatric patient often goes for long periods of time with out drinking(1). Furthermore the kidneys of the geriatric patient begin to lose their ability to effectively retrieve water before it excreting it in the urine (2). To counteract this problem it is recommended that all adults, regardless of age, drink eight to ten glasses of water per day.
In addition to the increased fluid intake, the fiber intake should be increased to at least 27 to 40 grams per day, preferably in the form of fruit, vegetables, and whole grains(2). Supplementation with phsylum at 2 teaspoons, 2 times per day has been shown to be very effective.
From a pharmaceutical perspective, traditional laxatives only offer only short term relief from constipation. Pharmaceutical laxatives eventually disrupt the normal bacterial flora and can actually cause chronic constipation. Supplementation with Flax oil, at a dosage of 3 Tbs. per day, has been found to be very effective at softening stools without the adverse effects that accompany pharmaceuticals. In cases of chronic constipation , it is important to restore the normal flora by supplementing the diet with acidophilus and bifidus supplements. Typical dosage is 3 times per day, for 4-6 weeks.
Heart burn and indigestion are often the result of incomplete digestion and are commonly treated with Antacids. However, since the geriatric patient already suffers from decreased levels of HCl production, the use of antacids only compounds the problem and further impairs the digestive process. Therefore, it is important to supplement the diet with HCl and digestive enzymes. In addition, the intake of L-glutamine at a dosage of 500-1,000 mg before each meal can help to reestablish intestinal integrity.
Ulcers are a frequent complaint of the geriatric patient. Many ulcers are a result or side-effect of caffeine, alcohol, aspirin or other non-steroidal, anti-inflammatory drugs. All of these substances alter the absorption of nutrients by affecting the integrity of the gastrointestinal tract.
Another effective alternative to pharmaceutical intervention is deglycyrrhizinated licorice or DGL. DGL works by enhancing defensive components that line the stomach and intestinal tract, and increasing the lifespan of intestinal cells by improving the circulation to the intestinal lining. DGL has been shown to be more effective than drugs such as Tagamet, Zantac, or Antacids in the treatment of ulcers(3).
Dr. M.T. Murray author of "Natural Alternatives to over the Counter and Prescription Drugs" recommends a dosage of 760 mg. of DGL, taken two time per day, either between meals or twenty minutes before a meal. Continue at this dosage for eight to sixteen weeks depending on the response.
In addition to DGL supplementation, specific dietary guidelines include:
Whether we are dealing with primary or secondary osteoarthritis, we will find that the geriatric patient experiences a decrease in the abilities of their collagen matrix repair mechanisms to effect healing. With increasing age, our bodys ability to restore and synthesize collagenous structures decreases. Therefore any treatment protocol should be directed at enhancing these healing mechanisms rather than at suppressing them.
The typical pharmaceutical approach to osteoarthritis are through the use of non-steroidal anti-inflammatory drugs (NASID). These drugs do relieve pain and inflammation but often have considerable side-effects including tinnitus, gastrointestinal irritation, and dizziness. At best NASIDs offer symptomatic relief, but can in the long run actually inhibit cartilage repair and accelerate the degeneration of cartilage(17). Several studies have confirmed the fact that NASIDs accelerate this degenerative process(18,19). With this in mind, we must carefully consider the logic of prescribing NASIDs for a condition that already involves a decreased ability in collagen matrix repair.
Nutritional guidelines for osteoarthritis include:
|Achievement of normal weight.||Excess weight increases the stress on weight bearing joints and accelerates the degenerative process.|
|Supplementation with Glucosamine Sulfate.||Glucosamine Sulfate promotes cartilage growth and inhibits cartilage degradation. For acute osteoarthritis, 500 mg of glucosamine sulfate should be taken 4 times per day for the first 5 days, and then dependent on the severity of injury, reduced to a normal dosage of 2 times per day for the next two to six weeks(20).|
|Supplementation with Methione.||Several clinical studies have shown that this sulfur containing amino acid is superior to Ibuprofen and Motrin(17). Dosage is at 250 mg, 4 times per day.|
|Supplementation with Vitamin E.||Vitamin E supplementation has been shown to have significant benefits for patients with osteoarthritis due to its antioxidant and membrane stabilizing action.(21)|
|Supplementation with Vitamin C.||Geriatric patients are often deficient in vitamin C.(22) Vitamin C helps to reduce pain and inflammation and acts as a key component in chondrocyte protein synthesis(23). Recommended dosage is 3 grams per day.|
|Supplementation with multi-vitamins and minerals.||Deficiencies in Vitamins A, B, E Copper, or zinc can cause an acceleration of joint destruction(25).|
Cultures with a high fiber diet have been found to have low levels of obesity(15). In contrast, our western culture typically supports a high fat, high carbohydrate, low fiber diet. Such diets, that are low in fiber but high in fats and refined carbohydrates, are a major factor in obesity.
The average western diet obtains 50-60 percent of its caloric intake from fat, 30 percent from carbohydrates and 20 percent from protein sources. Considering these statistics it becomes obvious that fat intake must be reduced. In addition, exercise must be incorporated as a vital component in any weight loss program. In order to combat obesity in the geriatric patient, you should apply the following guidelines:
Cardiovascular disease is the number one killer in the Western world. The importance of cardiovascular health cannot be over stressed with the geriatric patient. By dealing with cardiovascular health, we are not only addressing heart disease but all the conditions that are typically associated with atherosclerosis and oxygen impairment including hypertension, aneurysms, thrombophlebitis, varicose veins, chronic ischeamia of the kidneys, and peripheral neuropathy.
Many cardiovascular disorders are reversible and sometimes preventable with the correct focus on care. Dr. Dean Ornish M.D. of the San Francisco Preventive Medicine Institute has shown that thousands of patients with heart disease can avoid surgery by reversing their cardiovascular disorders through nutritional changes. Specific areas you can address through nutritional recommendations are hypertension, cholesterol levels, homocysteine levels, and vitamin E levels.
Many physicians consider an increase in blood pressure within an aging patient to be normal simply because it is a common occurrence. However, this is not a physiologically normal or healthy condition. Hypertension, even at low levels, is associated with an increased risk of vascular diseases such as strokes and heart disease. From a nutritional perspective the increase in blood pressure is often a result of diets that contain excessive amounts of salt, sugar, caffeine, animal fat, and alcohol. Typically such diets are also very low in fiber.
As a practitioner it is important to evaluate the patients diet and his or her consumption of these substances. Based on the degree of hypertension, you can then recommend appropriate changes to the diet that either eliminate or regulate these substances. Some important points to focus on while advising your patients include:
|Stress the right diet.||
On November 14/1996, the New York Times reported that the American Heart Associations found that a diet high in fruits and vegetables and low in fat and cholesterol can significantly reduce blood pressure.
Dietary changes can reduce systolic pressure by an average of 11.4 mm and diastolic pressure by an average of 5.5 mm. Such results are as good as or even better than those achieved through pharmaceutical drugs and possess the added benefit of no adverse side-effects (5).
|Increase the intake of potassium rich foods.||
It is essential to maintain the correct balance of sodium and potassium when you are addressing hypertension.
Potassium rich foods include oats, rice, raw leafy vegetables, garlic, onions, broccoli, celery, watermelons, squash, parsley, and cucumber(4).
|Supplement the diet with calcium and magnesium.||
Researchers at McMaster University in Ontario who reviewed 14 studies that were conducted on hypertension between 1966 and 1994 came to the conclusion that there is strong evidence that calcium supplements produce an "important reduction" in systolic and diastolic blood pressure(6).
Recommend dosage is 1200 mg of calcium per day, in a 2 to 1 ratio with magnesium.
Clinical professor Dr. Philip Frost at the University of California has shown that geriatric patients who keeps their total blood cholesterol level below 185 mg/dl have a 23-30% reduction in coronary heart disease (7).
Cholesterol sources can be both exogenous (dietary) and endogenous (primarily hepatic). Your diet accounts for only 25 to 30 % of the total cholesterol in your body. The remaining 70-75% of the cholesterol is produced by your liver.
Diet is the fundamental component of any cholesterol lowering treatment. Some general recommendations are:
|Reduce the total fat content of the patients diet.||It is especially important to reduce fats of animal origin. Patients should eat more vegetables and fruits, use skim milk or 1% fat milk, and choose fish , lean meat or chicken. Many sources of diary (such as cheese) are composed of nearly 30% fat. Eggs should be eaten in moderation along with other sources of animal fat.|
|Increase the intake of dietary fiber.||Research in Finland and the USA has found a direct correlation between fiber intake and cholesterol levels. The American Heart Association recommends 25 to 30 grams of fiber per day in the diet (8). A simple change from white refined flour to whole grains or rye will greatly increase the level of dietary fiber intake.|
25 years ago, Harvard pathologist Dr. Kilmer McCully showed a direct relationship between high homocysteine levels and vascular disease(6). Since then, in 1995, the New England Journal of Medicine confirmed this finding by showing that high homocysteine levels significantly raised the incidence of carotid artery obstruction(7). University of Washington researchers have also concluded that a 5 u.mol/L increase of homocysteine levels results in the same risk of coronary artery disease as a 20 mg/dL rise in cholesterol would(8).
Folic acid breaks down homocysteine and allows it to be removed from the blood stream. University of Washington studies have shown that inadequate levels of Folic acid is the main determining factor of homocysteine imbalance. Their research recommends that individuals ingest at least 400 mcg. of folic acid in their diet per day (9). Some of the best sources of folic acid are beans, green leafy vegetables, and citrus fruits.
Numerous studies have indicated that vitamin E levels are directly related to a reduction in heart disease. (6).
Vitamin E works well because it acts to reduce LDL oxidation, thereby reducing macrophage mediated (inflammatory) damage to endothelial cells. This in turn impedes the production of foam cells and plaque which are a primary cause of atherosclerosis. A recommended dosage for vitamin E supplementation would be 600 iu. per day(3).
The nutritional status of the geriatric patient cannot be over-stated for any treatment protocol. Used in conjunction with Chiropractic adjustments and exercise, effective nutrition can help the geriatric patient recover more rapidly from illness and live a more comfortable and active lifestyle.
Author: Dr. Brian
Coauthor and Editor: Kamali Abelson
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Calgary, Alberta, T3A-2R4
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