(Notes in red are “SCD specific” revisions.)

Hippocrates, widely considered to be the “father of medicine”, said, “Let your food be your medicine, and your medicine be your food.” His thought process illustrates the importance of being mindful about what we put in to our bodies. Indeed, some eating patterns can lead to ill health while others help to manage or prevent chronic illness.  The educational process for individuals who want to live optimally from a nutrition standpoint generally looks like this:

• Gaining a general understanding of the nutritional needs for your gender and age
• Understanding your needs related to any health conditions (either existing or potential based on risk factors)
• Understanding your body and it’s food intolerances

This article will help give you a general understanding of nutritional needs for older (all) adults and some resources for making your own individual plan.

General Nutritional Needs for Older (All) Adults

There are three major nutrients that your body needs daily to perform normal functioning. They are outlined in the table below:

Nutrient	Uses in the body	Food sources
Protein	It is the body's main structural nutrient. All muscles and tissues are made from protein. The immune system uses protein.	Eggs, meats, fish, (white) beans, dairy products (hard cheese & homemade SCD yogurt only), soy (not SCD legal).
Carbohydrates	This is preferred energy source of the body. (so is protein) Carbohydrates supply fast energy to the muscles for activity.	Grains, pastas, cereals, breads (These 4 are not SCD legal - replace with more fruits, vegetables & nuts), vegetables, fruits. Eat whole sources of carbohydrates vs. sugary and processed foods.
Fats	This is the energy storage nutrient in the body. Fats are also used as a source of energy for low-intensity activity.	Good sources include olive, canola (not SCD legal), peanut and other oils, nuts and fish

In addition to the above basic three-there are a variety of “micro” nutrients including vitamins and minerals that your body needs in order to carry out all of its functions. Among these are vitamin A, B, C, D, E, K and minerals like calcium, magnesium, folic acid and phytonutrients like beta carotene. Many substances in fruits and vegetables are important for their antioxidant effect and are not yet fully understood. If you eat a balanced diet you will likely get all of the micro nutrients you need. While it is important to get as much of our nutrition from whole foods as possible, due to changes that occur with aging (and those with digestive/bowel & absorbtion problems), some older adults may need supplements, which we will discuss later.

Another important aspect to a good nutrition plan is fiber. Fiber is the bulky part of food found in whole grains (not SCD legal – replace with more fruits, veggies & nuts), fruits and vegetables. Fiber helps to move food through the intestines which contributes to proper bowel function and assists in the proper speed of absorption of nutrients. (Soft-cooked fiber foods are required in the beginning of the SCD until the intestines can handle raw fiber.)

One of the most widely accepted authorities on nutrition is the USDA food pyramid known as MyPyramid. Because of concern over older adults ability to gain access to computer based information, Alice H. Lichtenstein, D.Sc, director of the Cardiovascular Nutrition Laboratory at the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University authored the Modified MyPyramid for Older Adults.

Physical activity

This pyramid has at its base physical activity, which is indeed the foundation of a good health plan. The pictures on the pyramid show a variety of activities that can be done to meet the requirement for 30 minutes of moderate activity daily. Research has shown that older adults who are more active have better health.

Fluid intake

Also foundational and depicted in the pyramid is good hydration, represented on the pyramid by several glasses of water. You can fulfill your fluid requirements by drinking any non-caffeinated beverage and eating foods that are high in water such as fruits and soups. Your thirst is not a reliable indicator since it can diminish with age - you may already be dehydrated by the time you are thirsty. Remember to increase fluid intake when you are engaging in exercise.

Above the base of the pyramid, a variety of foods are represented in a vertical fashion to depict the types of foods older (all) adults should consume. The width of the vertical lines indicates the proportion of these food groups. Grains (not SCD legal – replace with more veggies, fruits & nuts), vegetables and fruits should make up the great majority of the diet.

Grains (Omit all grains in order to heal the digestive tract.)

Whole grains should be consumed whenever possible. Part of the difficulty in our current diets is that too much of our food is processed and refined. This processing removes much of the fiber and many of the nutrients in the food. Eating processed foods leads to a rapid absorption of the sugar ingredients in the food, causing a spike in blood sugar and the release of large amounts of insulin. This can have metabolic consequences in the body that can lead to the development of some chronic illnesses. Many whole grain products are available including whole grain breads, pasta, cereal and oats. Avoid the “white” grains as much as possible for better health.

Vegetables and fruit

Vegetables and fruits are a source of carbohydrates (Print the SCD FOOD LIST of foods that do not feed the bacteria). Their main benefits are in the fiber that they provide and the many micronutrients that are found in them. Eat a wide variety of fruits and vegetables in a wide array of colors to get the most benefit. Generally, the deeper and richer the color-deep green, blue, red, orange, purple-the more micronutrients the food contains. Vegetables and/or fruit should take up half of your plate at every meal. Vegetables are healthiest if they are raw, steamed, roasted or boiled and have minimal fat (Fat is not an issue.) added to them. Fruits should be eaten in their whole state (after healing) to get the best benefit.

The correct amount of fruits and vegetables in the diet has been a source of discussion among experts for some time. The Centers for Disease Control (CDC) has a new campaign called “Fruits and Veggies-More Matters”. According to their website an 80 year old female who does 30-60 minutes per day of moderate activity should eat 1.5 cups of fruit and 2.5 cups of vegetables per day. To calculate your requirements based on age, gender and activity level go to www.fruitsandveggiesmatter.gov . In addition to the calculator, this website gives great tips and suggestions for getting the recommended amount of fruits and vegetables in your diet.

Fats

The vertical area for fats on the MyPyramid for older adults is quite narrow. And, the type of fat is very important. Generally, we say there are “good” fats-those that benefit the body and “bad” fats-those that can lead to health concerns. Generally, good fats come from non-animal sources and are not “hydrogenated”. Hydrogenation is a man made process that creates a “trans” fat. Trans fats have been shown to be very detrimental to health and should be avoided. At Brookdale Senior Living, we work very hard to keep trans-fats out of our food.

While “good” fats are essential in the diet, they are very calorie dense and too much can lead to weight gain. Good fats are those that are non-hydrogenated and unsaturated. Sources include olive oil, canola oil (Not SCD legal.), nuts, avocado and some soft spreads (no spreads, only real butter) to keep the diet low in saturated fats-which can lead to arterial disease-minimize fats from animal sources. Omega-3 fats are essential for good health and are found in fatty fish like mackerel, tuna and salmon. Non-animal sources of Omega 3 fats include flax seed meal (Flax is too rough for damaged intestines.) and walnuts. Try to eat fish at least 3 times per week. 

Dairy

Dairy products are an important source of protein and calcium and are fortified with vitamin D. Eat 3-4 servings per day in the form of yogurt, milk or cheese (No milk – just homemade SCD yogurt and hard cheeses allowed.). Choose low fat varieties to minimize saturated fat levels (Fat not an issue unless you’re cutting calories.). 

Protein

Protein is an essential macronutrient that is necessary for tissue repair and cellular regeneration. Choose low fat varieties like chicken (white meat is best), fish and seafood, low fat cuts of beef, soy products (not SCD legal), (white) beans and eggs. Food should be prepared in a healthy fashion where extra fat is not added, examples include baked, broiled, grilled or lightly sautéed. Avoid fried foods if possible. Eat 3-4 small servings of quality protein each day.

Special concerns for older adults

In order to maintain optimal health, we need a balance between calories consumed and calories expended through metabolism and activity. As we get older, activity levels may decrease some and metabolism slows down. There is a correlation between muscle mass and rate of metabolism which is why strength training is very important as we age. In light of these changes, caloric requirements decrease with age while nutritional requirements stay the same or increase slightly. This means that all foods consumed need to be “nutrient dense” and empty calories should be kept to a minimum (I.e., processed foods should be eliminated.).

You may want to discuss the use of supplements with your health care provider. A few you may want to consider are:

• Vitamin B12-as you age your absorption of this vitamin may decrease. In some cases so much so that you will need a monthly injection. Your health care provider will test levels if they suspect this to be a problem for you.
• Calcium-Osteoporosis can occur as we age, for everyone, but much more frequently for post-menopausal women. Supplemental calcium is very often recommended for those in this category. (Need to also increase magnesium in order for the body to absorb calcium properly.) Talk to your health care professional about this.
• Vitamin D-recent findings indicate that a large number of people may be deficient in vitamin D. In one study, falls were reduced by 50% in nursing home residents who took vitamin D supplements. Vitamin D is made by the skin in the presence of sunlight. Be sure to get 15 minutes of unprotected sunlight daily. Talk to your doctor about possible supplements.
• Fish oil-Omega 3 fats are important for heart health. If you do not get them through your diet, discuss the possibility of supplements with your health care provider.
• Multivitamin-most older adults will be safe to take a good multi vitamin tablet. Take a brand that has been formulated for older adults. (Take one that is SCD approved.) Do not take supplemental iron unless your health care provider specifically recommends that for you. (Iron supplements feed the gut bacteria – see Elaine’s Liver Pate’ recipe in BREAKING THE VICIOUS CYCLE to get extra iron, naturally.)
• Herbs-there are many supplemental herbs being sold today with a myriad of health claims behind them. (Elaine does not recommend herbs, as most are not legal and can promote diarrhea.) If you choose to take herbs keep in mind that they are not regulated by the FDA and therefore can not legally make health claims. Some have been studied and those results can be found an a website called Medline Plus through the U.S. National Library of Medicine. Be sure to let your health care provider know about herbs that you take as some can interact with medications.

Food intolerances

As you get older you may find that certain foods cause GI upset or other symptoms that make you uncomfortable. One common food intolerance is lactose-the common sugar found in milk (The lactaid enzyme that digests lactose, milk sugar, is the first to disappear when there is intestinal damage.). Other common intolerances include spicy foods (can usually return to these after healing), coffee, wheat (always illegal) or raw (no raw until healed) fruits and vegetables. If you are having symptoms of gas, bloating or heartburn after eating certain foods, try eliminating those foods to find relief. If you find you must eliminate certain foods, be sure to find a way to replace the nutrients you were getting from that food group. For instance, if you find you don’t tolerate diry products, be sure to take calcium supplements. Consult with your health care provider for any new unexplained symptoms. (It’s best to discontinue all supplements until healed; then return to only SCD approved/legal supplements.)

Dietary concerns in chronic health conditions

Many chronic health conditions have dietary changes as a part of the management regimen. In some cases the changes are very specific as is the case with chronic kidney failure or celiac disease (All digestive/bowel problems). For other conditions, eating according to the MyPyramid plan will help keep the condition in check. It is very important that you obtain instruction on any specific conditions you have been diagnosed with and follow the instructions carefully. For diabetes diets you can visit the website of the American Diabetes Association and for heart disease the website for the American Heart Association. Ask your health care provider for a prescription for a consult with a dietician (Unfortunately, most are not schooled in this information). In some cases this may be covered by Medicare. (Give the SCD a 100% trial and it will save you the cost of the dietician’s fee.)

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