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When Does Old Age Begin?

pensiveThe boundary between seniors and old people has shifted over the years. Some people are deemed old because they are grandparents—even at forty-five. Others become old when they retire, regardless of age or circumstance. Despite getting a seniors’ discount at age 50, or 60 or 65, some folks don’t fit the definition because of their mindset, Social Security or not. Now that Social Security eligibility in the United States is headed toward 70 and a whole lot of folks are still working, old age might never be attainable. The physical and mental changes can sneak up on us, though. Wrinkles and liver spots, gray hair (if you have hair), reduced lung capacity and voice changes wrought by loss of elasticity are signs of aging. But the mental changes, namely forgetfulness and full-blown dementia, are the more frightening. Depressed mood is common.

Because “out of sight is out of mind” may be truer than we like to think, grandma and grandpa may be among the forgotten, especially if they live more than a few hours distant from the rest of the family. If still a couple, the septuagenarian or octogenarian pair might fare quite well. But if left alone, by death or incapacitation, faring well might be history. Those over age 75 may not be as helpless as they were a decade ago, but their nutrition status is probably the same—miserable. Were it not for assisted living facilities or equivalent communal arrangements, or for home care organizations, or even for dedicated family, many seniors would be categorically undernourished or malnourished. One reason is being alone at the table. The isolated person waits for hunger to drive him to eat, often being satisfied with a bowl of high-carb-low-protein cereal, a can of super-salty soup, or a questionably prepared frozen something. Being alone, regardless of age, has been likened to smoking fifteen cigarettes a day (Cresswell, 2010).

Geriatrics is not the same as gerontology, the latter being the study of the aging process itself, which looks at the psychological and biological aspects. Geriatrics is a sub-specialty of adult medicine that focuses on the aged, which is a time of life determined more by need than by years. An aged body will show a decline in organ systems, some of which can be blamed for choices made earlier in life, including smoking, sedentary lifestyle and poor dietary habits. It’s possible that these can be overcome by quitting, moving and choosing foods wisely.

Nutrient deficiency is common in the elderly because of several factors:  reduced food intake, lack of variety, medications that cause nutrient depletions, financial insecurity, poor oral condition, loss of gustatory sensation, and other dreadful conditions, among which are an uncaring family and a desolate social life. There are some things a single senior can do to help ensure more wholesome intake. Eating away from the kitchen, as on a porch or patio, might excite appetite. Setting the table with a placemat and flowers to brighten things up can make a difference. Inviting neighbors or sharing cooking time helps to encourage mindful eating. The bottom line is that nutrition is a major determinant in aging well because it promotes health and functionality.

Meals have often added a sense of security and meaning to life. That’s hard to get when alone. A single who is sedentary also has a reduced energy need. If a comparable reduction in energy intake is not made, body fat will increase, partly because of choosing foods that are energy-dense instead of nutrient-dense.  This concern requires closer attention than at any other time of life.

Dehydration is a form of malnutrition that is a major problem among those over eighty. Blunted thirst sensation is partly the cause, but so too are medications, cognitive decline and fear of incontinence. Besides constipation, cognitive decline can worsen and death can result from inadequate hydration.

Without enough protein, frailty, lowered immune function and impaired wound healing are issues to face. The RDA of 0.8 grams of protein per kilogram of body weight still holds true in old age. In fact, a little more protein can help to prevent sarcopenia, the wasting of muscle mass attributed to aging. Up to twice as much is still healthy.

The depression that is known to accompany bereavement causes malnutrition and leads to unfavorable outcomes. Loss of appetite in such a situation is common, but the encouragement to eat by a caring family or empathic social network can stave off negative consequences.  Measurement of depressive symptoms using accepted diagnostic tools indicate that as many as forty percent of seniors fit the category, with a considerable number being malnourished, the two states being reciprocal (Ahmadi, 2013) (Mokhber, 2011).

Maintaining nutrition homeostasis is a challenge in the elderly to begin with. Those who are homebound by choice or by chance don’t realize their dietary needs. Some don’t care. But it’s necessary to provide enough protein to maintain tissue integrity, muscle mass and immune function.  We mistakenly think that old age translates to limited kidney function and that protein will unnecessarily tax kidneys. That’s not always the case, especially if hydration is adequate. Someone needs to be there to lead the parade. Loneliness is a complex response to lack of company or to feelings of being disconnected. It can occur even in a household filled with people. As odd as it may sound, loneliness interferes with good health by increasing susceptibility to viral attacks and by intensifying inflammatory responses to stressors (Jaremka, Aug 2013, Jul 2013). The prospect of eating alone reduces appetite, but the opposite is true. Being with family and friends is the best appetite stimulant for the elderly.

References

Ahmadi SM, Mohammadi MR, Mostafavi SA, Keshavarzi S, Kooshesh SM, Joulaei H, Sarikhani Y, Peimani P, Heydari ST, Lankarani KB.
Dependence of the geriatric depression on nutritional status and anthropometric indices in elderly population.
Iran J Psychiatry. 2013 Jun;8(2):92-6.

Adam Cresswell, Health editor
Isolation as harmful as smoking 15 a day
The Australian. July 29, 2010
http://www.theaustralian.com.au/news/health-science/isolation-as-harmful-as-smoking-15-a-day/story-e6frg8y6-1225898190216#sthash.5x6gP5ky.dpuf

Drewnowski A, Warren-Mears VA.
Does aging change nutrition requirements?
J Nutr Health Aging. 2001;5(2):70-4.

Greeley A.
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Jaremka LM, Fagundes CP, Peng J, Bennett JM, Glaser R, Malarkey WB, Kiecolt-Glaser JK.
Loneliness promotes inflammation during acute stress.
Psychol Sci. 2013 Jul 1;24(7):1089-97.

Johansson L, Sidenvall B, Malmberg B, Christensson L.
Who will become malnourished? A prospective study of factors associated with malnutrition in older persons living at home.
J Nutr Health Aging. 2009 Dec;13(10):855-61.

Johansson Y, Bachrach-Lindström M, Carstensen J, Ek AC.
Malnutrition in a home-living older population: prevalence, incidence and risk factors. A prospective study.
J Clin Nurs. 2009 May;18(9):1354-64.

Mokhber N, Majdi M, Ali-Abadi M, Shakeri M, Kimiagar M, Salek R, Moghaddam PA, Sakhdari A, Azimi-Nezhad M, Ghayour-Mobarhan M, Soluti S.
Association between Malnutrition and Depression in Elderly People in Razavi Khorasan: A Population Based-Study in Iran.
Iran J Public Health. 2011;40(2):67-74.

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Wham CA, Teh RO, Robinson M, Kerse NM.
What is associated with nutrition risk in very old age?
J Nutr Health Aging. 2011 Apr;15(4):247-51.

*These statements have not been evaluated by the FDA.
These products are not intended to treat, diagnose, cure, or prevent any disease.

Do You Want What You Want When You Want It?

cravings2Is it O.K. to talk about addiction in the context of food consumption? Because some people believe that foods high in fats or carbohydrates might be addictive, does it mean that foods should be regarded in the same way as alcohol or cigarettes? Or is there confusion among the terms addiction, craving and eating disorders?

Addiction may be characterized by the compulsion to use a substance, by the uncontrolled consumption of that substance, and by the probability of withdrawal symptoms when access to it is denied or prevented. Binge eaters and those suffering from anorexia or bulimia may display such symptoms, suggesting similarities between the body’s reaction to drug use and compulsive eating. It’s been conjectured that common pathways in the brain are responsible for the pleasures obtained from food intake and drug use. In laboratory studies with rats, for example, it has been demonstrated that repeated, excessive intake of sugar can sensitize brain receptors to dopamine in a manner similar to that of illegal drugs. The dopamine transporter is an important site of action of cocaine and amphetamines, where the reward system gets fired up. So far, every kind of reward studied increases dopamine levels in the brain, all of which are amplified by drugs. Besides the reward system, there are other dopamine systems, including those that concern degenerative conditions such as Parkinson’s disease, and those that deal with chemical messenger activity (Basu, 2000) (Devoino, 1988).

Eating involves more than just the pleasure/reward system. Research has shown neurotransmitter variations to parallel the changes brought about by drugs and the intense desire to eat certain foods (Fallon, 2007). If food cravings are at all significant, it is because they play a role in overeating that may be driven by an increase in serotonin caused by carbohydrate ingestion (Young, 2007).

The criteria for addiction might possibly be met by the morbidly obese, especially if it is realized that even nonpalatable foods become desired and over consumed. In the obese, the number of dopamine receptors appears to be decreased in relation to their body mass indices, leading to overeating in an attempt to turn the reward switch on (Wang, 2001). Not until early in this century was there substantial interest in the functional neuroanatomy of food cravings. Magnetic resonance imaging (MRI) was used to track changes in the brain when thought patterns of test subjects were directed away from a monotonous diet of foods not craved toward a diet of favorite foods. It was discovered that the brain areas involved in drug cravings—the hippocampus, for example—also were stimulated by images of preferred foods, leading researchers to conclude a commonality between food and drug cravings (Pelchat, 2004)  The more intense the mental image, the more intense the desire (Tiggemann, 2005).

Could a nutrient deficiency trigger a food craving? Most of us can tell the difference between a real need for food and the psychological need prompted by the television. Once in a while, a nutrient deficit will cue a craving for a specific food…and it likely won’t go away or be satisfied by a glass of water.

Iron deficiency, often associated with anemia, might induce a condition known as pica, a centuries-old eating disorder satisfied by the ingestion of non-foods, such as dirt. Children, and even pregnant women, in poverty areas have been known to eat the paint from window sills to meet what was at one time an unidentified need. Other serious issues would then surface if the paint contained lead (Kettaneh, 2005). Though most of us would associate menses with iron deficiency as a result of blood flow, pica does not necessarily result. Craving for chocolate, however, does sometimes burgeon, as reported in a 1987 issue of the Journal of the American Dietetic Association (Tomelleri, 987). Giving chocolate the benefit of the doubt, it absolutely does have the fat, sweetness, texture and aroma that make it so appealing to one’s hedonistic side. It has culinary mouth, too, amiably accompanied by copper, magnesium, phosphorus, calcium, sodium and zinc, not to mention the fatty acids akin to the active ingredient in marijuana (Bruinsma, 1999). Admittedly, lots—and we mean lots—of people (of both genders) succumb willingly to the enticement of the chocolate siren, casting discretion to the wind and leaning on her mineral profile as an excuse to indulge.

Few people crave proteins and fats very often. Carbohydrates and sugars steal the show. To control sugar cravings, five minerals have been tagged as instrumental: chromium, magnesium, manganese, zinc and vanadium. Chromium stimulates insulin production and is vital for normal glucose utilization. It also works to metabolize other carbohydrates and fats. Magnesium is plentiful in the food chain, but not in humans, more than eighty percent of whom are deficient. It’s part of more than three hundred enzymes and helps to maintain tissue sensitivity to insulin. Low stores of manganese telegraph as reduced insulin activity and impaired glucose transport. Zinc influences carbohydrate metabolism by increasing insulin response and improving glucose tolerance. It affects basal metabolism rate and improves taste sensitivity. And vanadium mimics the activities of insulin, while inhibiting the storage of excess calories from carbohydrates as fat (Sandstead, 1997).

A study at Louisiana State found that chromium was able to regulate food intake in healthy overweight women who reported carbohydrate cravings (Anton, 2008), which is a common characteristic of those who suffer some forms of depression (Docherty, 2005). The magnesium in chocolate could explain why chocolate may be used as a form of self-medication in nutrient deficiency because, even though cravings may be episodic, they are real (Bruinsma, 1999). Does chocolate, then, satisfy magnesium deficit, or does magnesium satisfy chocolate deficit?

Food cravings are common, frequently for specific foods. Those for carbohydrates are postulated to arise from a physiological need to adjust neurotransmitters. However, sensory factors need to be considered. Whatever the cause might be, nutrient repletion seems to be the answer.

References

Anton SD, Morrison CD, Cefalu WT, Martin CK, Coulon S, Geiselman P, Han H, White CL, Williamson DA.
Effects of chromium picolinate on food intake and satiety.
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Basu S, Dasgupta PS.
Dopamine, a neurotransmitter, influences the immune system.
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What is the role of dopamine in reward: hedonic impact, reward learning, or incentive salience?
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Bourre JM.
The role of nutritional factors on the structure and function of the brain: an update on dietary requirements
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Bourre JM.
Effects of nutrients (in food) on the structure and function of the nervous system: update on dietary requirements for brain. Part 1: micronutrients.
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Bruinsma K, Taren DL
Chocolate: food or drug?
J Am Diet Assoc. 1999 Oct;99(10):1249-56.

Cefalu WT, Wang ZQ, Zhang XH, Baldor LC, Russell JC.
Oral chromium picolinate improves carbohydrate and lipid metabolism and enhances skeletal muscle Glut-4 translocation in obese, hyperinsulinemic (JCR-LA corpulent) rats.
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Devoino L, Alperina E, Idova G.
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Docherty JP, Sack DA, Roffman M, Finch M, Komorowski JR.
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Fallon S, Shearman E, Sershen H, Lajtha A.
Food reward-induced neurotransmitter changes in cognitive brain regions.
Neurochem Res. 2007 Oct;32(10):1772-82. Epub 2007 Aug 25.

Harrison R, Rucklidge JJ, Blampied N.
Use of micronutrients attenuates cannabis and nicotine abuse as evidenced from a reversal design: a case study.
J Psychoactive Drugs. 2013 Apr-Jun;45(2):168-78.

Adrien Kettaneh, MD, Virginie Eclache, MD, Olivier Fain, MD, Christelle Sontag, MD, et al
Pica and food craving in patients with iron-deficiency anemia: A case-control study in France
The American Journal of Medicine (2005) 118, 185-188

Khan Y, Tisman G
Pica in iron deficiency: a case series.
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Pelchat ML, Schaefer S.
Dietary monotony and food cravings in young and elderly adults.
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Pelchat ML, Johnson A, Chan R, Valdez J, Ragland JD.
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Marcia Levin Pelchat
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*These statements have not been evaluated by the FDA.
These products are not intended to treat, diagnose, cure, or prevent any disease.