geriatric nutrition

The core of geriatric nutrition has never been the "uniform light diet, eat more vegetarians and less meat, and the less salt, the healthier" as spread on the Internet. Instead, it takes maintaining the quality of life of the elderly as the core goal and customizes differentiated nutrition plans based on individual physiological status, basic diseases, and dietary preferences. The priority is always "eatable > eating "right"", "muscle preservation > calorie control", "experience priority > rigid standards".

I was particularly impressed by Aunt Zhang, whom I met at a community free clinic last month. She is 72 years old and has been suffering from high blood pressure for three years. She heard from a health regiment that she should "clean her blood vessels with a whole-vegetarian diet." She drank white porridge every morning and evening, stir-fried cabbage and radish at noon, and only dared to eat half an egg. She lost 7 pounds in half a year. She climbed the third floor twice to rest after shopping for groceries last time, and her serum albumin was only 31g/L, which is the critical value of sarcopenia. Her daughter was so scared that she rushed over to ask if something was wrong.

Don’t think this is an exception. Seven out of ten elderly people I interact with have fallen into the “standardized elderly diet” trap. It seems that after the age of 60, everyone’s eating standards have automatically changed to “less salt, less oil, less meat and more vegetables”. Even eating sweet and sour pork ribs will be called “unhealthy” by the younger generation.

Speaking of which, we must mention the current differences between the two schools in the field of elderly nutrition: Public health scholars prefer unified dietary standards, such as daily salt intake not exceeding 5g, oil not exceeding 25g, and red meat not exceeding 500g per week. The core is to reduce the risk of cardiovascular and cerebrovascular diseases.； However, front-line clinical geriatricians and nutritionists are more inclined to moderately "relax" the elderly. For example, an elderly person who has been accustomed to heavy eating for a long time suddenly reduces the salt to 5g. He cannot eat at all. The daily energy intake is not enough, and the risk of muscle loss and immunity decline is much higher than the risk of eating 1g more salt. In this case, the salt can be relaxed to 6-7g, and it is more cost-effective to eat more spinach and edamame with high potassium content to balance the impact of sodium.

Both views are actually correct, but they come from different perspectives. Public health considers the average risk of the group, while clinicians consider the actual quality of life of an individual elderly person. When it comes to specific people, there is never a unified standard answer.

For example, there was an 80-year-old Uncle Li who had been diabetic for 20 years. Before, he strictly controlled sugar and did not dare to touch anything sweet. He even dared to take a few bites of cucumber. Later, he always complained that he felt tired. He was found to be deficient in vitamin B12 and vitamin C, and his gums bleed frequently. When we adjusted the plan for him, we specifically added the requirement of "eating 10 small tomatoes or half a soft peach every afternoon." He has been eating this for more than three months now, and his blood sugar has not fluctuated. Instead, he can walk with more energy. Last time, he went to climb a mountain in the suburbs with his old friend.

Many people don’t know that the rate of muscle loss in the elderly is 3-5 times that of young people. Just like an old sofa that has been used for decades, the filling is already loose. If you don’t replace it, it will collapse quickly. Elderly people over 65 years old actually have a higher protein intake than young people. They need to eat 1.2-1.6g per kilogram of body weight every day. For example, a 120-pound old man needs to eat 72-96g of protein every day, converted into food. , it’s about 1 egg, 1 bag of milk, 2 taels of lean pork or fish and shrimp, plus a piece of tofu, it’s almost enough. Don’t listen to what others say: “Old people have poor digestion and should eat less protein.” If you really can’t stand still, it will be too late to add more.

There is another question that everyone has been debating for a long time: Should we take supplements? There are two opinions now. One is that food supplements are enough, and supplements are IQ taxes. ； The other group says that the elderly have poor absorption and it is more efficient to take supplements directly. My own experience is that it really depends on the person: if an elderly person usually eats well, is not picky about food, and eats fish, meat, eggs, and milk, then there is really no need to take additional supplements. 15 minutes of sunshine every day is better than any imported vitamin D. ； But if the elderly have bad teeth, eat less, or have been diagnosed with low protein, anemia, or osteoporosis, they must take the whey protein powder, iron supplements, and vitamin D they should take. Don’t be reluctant to spend that little money. By the time you are hospitalized, the money spent will be dozens of times more than supplements.

I usually make recipes for the elderly, and I never give them a list of things they can’t eat. Instead, I first ask, “What is your favorite food?” ”For example, if he likes pickles, switch to low-sodium pickles and eat a small plate with porridge at a time. It is better than not letting him eat it and secretly eating a big bowl. ； If you like pastries, buy him soft peach cakes without sucrose. Eat half a piece at a time to satisfy his cravings without raising his blood sugar too much. After all, at this age, it is very important for the elderly to enjoy eating. If eating every day feels like torture, no matter how precise the nutritional ratio is, it will be in vain if they cannot eat.

I have been in this industry for almost 6 years, and I have seen too many elderly people who regard "healthy eating" as a shackle, and I have also seen many examples of people who followed Internet celebrity recipes and ended up in the hospital. In fact, how can there be so many black and white standards in geriatric nutrition? To put it bluntly, it is centered around "making the elderly live comfortably and with quality". There is no best recipe, only the most suitable recipe for him. Being able to eat, sleep and walk is better than any cold indicators.