The original Food Guide Pyramid for Older Adults, published by Tufts University researchers in 1999, is widely used as an illustration in textbooks and manuals, featured in newsletters for older Americans and in informational material prepared by the Departments of Elder Affairs in numerous states. Now, almost 10 years later, the pyramid has a new look. The updated Modified MyPyramid for Older Adults, published in the January 2008 issue of the Journal of Nutrition, focuses on the special dietary needs of those over 70.
The recent update was in response to changes made in the federal government’s Food Guide Pyramid for the general public. A new web site (www.MyPyramid.gov) lets individuals key in their age, gender and physical activity so that they can get a personalized recommendation on their daily calorie level, based on the 2005 Dietary Guidelines for Americans. Tufts researchers were concerned about computer use among older adults and the adaptability of MyPyramid to print form. Thus, the Modified MyPyramid for Older Adults is available as a graphic print-out for general guidance or as a supplement to the MyPyramid computer-based program. It has icons representing physical activity, fluid needs and foods in the following categories:
- Whole, enriched and fortified grains and cereals such as brown rice and 100 percent whole wheat bread
- Brightly colored vegetables such as carrots and broccoli
- Deep colored fruit such as berries and melon
- Low- and non-fat dairy products such as yogurt and low lactose milk
- Dry beans and nuts, fish, poultry, lean meat and eggs
- Liquid vegetable oils and soft spreads low in saturated and trans fat
- Fluid intake
- Physical activity such as walking, house work and yard work
Adults over the age of 70 have unique dietary needs. This is because older adults’ calorie needs usually decline as activity levels decline and lean body mass decreases (due to sarcopenia), causing a decrease in metabolic rate. There are also other notable changes due to the effects of aging on the nutritional health of older adults (discussed below). So, while many may need fewer calories to maintain weight, they still need the same (or even higher) levels of nutrients to maintain health. Thus, it becomes even more important for older adults to choose wisely from a variety of nutrient dense foods, like fruits, vegetables, low fat dairy and high fiber whole grains.
Tufts researchers created the new version of the food pyramid with more pictures and visual reminders to emphasize the importance of choosing foods rich in nutrients such calcium, fiber, and vitamins B-12 and D. The revamped design also emphasizes the importance of exercise. At the base of the pyramid are illustrations showing physical activities such as walking, swimming, and yard work that many older adults can perform.
The new pyramid also shows pre-packaged illustrations of fruit and vegetables, giving many examples of frozen fruits and vegetables, pre washed or ready to use and canned or dried fruit, which might be better options for older adults. These choices are more convenient if bought in single serving sizes (or in a package type that allows for a single serving to be used and the package resealed.) Frozen fruits and vegetables also have a longer shelf life than fresh, minimizing waste and therefore cost. They are also just as nutritious as fresh.
Additionally, the Modified MyPyramid for Older Adults stresses the importance of consuming fluids by having a row of glasses as its foundation. And a final, integral part of the Modified MyPyramid for Older Adults is a flag at the top suggesting that older adults may need certain supplemental nutrients. The flag serves as a reminder that some people may need to discuss this potential need with their health care providers. However, Tufts researchers continue to emphasize that the majority, if not all, of nutrients an older adult consumes should come from food rather than supplements.
Older adults have more health concerns than persons of any other age group, so it is hard to predict nutritional problems based only on chronological age. Let’s look at how aging affects body systems specific to nutritional health and it will become obvious why older adults need a pyramid all their own.
Taste and Smell
Sensitivity to taste and smell often decreases with age beginning at about age 60. Food often requires stronger seasonings which can be a problem for people who need to cut back on salt and simple sugar intake. Although there are plenty of other ways to spice up the taste of food, salt and sugar tend to be the most frequently used—and abused. People often need suggestions on how to use new and different flavor enhancers. Sharing recipes that introduce new spices is one means of exposing clients to a completely new realm of taste.
About 30 percent or more of older people in the US have lost all their teeth often due to gum disease. Replacement dentures enable some to chew normally, but many older adults have problems with their dentures. For some unknown reason, this seems to affect a larger number of men than women. When people have problems chewing, nutrient dense snacks can help alleviate nutritional inadequacies. Sometimes just allowing extra time for chewing and swallowing encourages more eating.
Older adults often partially lose their sense of thirst which results in inadequate fluid intake. Because of this, they are more likely than younger people to become dehydrated. In addition, 25 percent of the fluid in our diets comes from food. If older adults are not eating enough food, they increase the risk of dehydration even more. Consequently, it is very important for older people to consume adequate amounts of fluid. You should monitor your client’s intake during exercise. About six to eight cups daily is a good goal; better yet is the newest recommendation of half ounce of water per pound of body weight. The approximate fluid recommendation is the same for younger adults with activity and is estimated at 1 ml/kcal expended. One cup is about 250 ml, so every 250 calories expended equals the need for about 1 cup of extra water. Because diuretic use is quite common in older adults, there is an even greater chance that a senior will become dehydrated. Watch carefully if your clients are taking diuretics; they will already have a lower fluid volume as a result of the drug.
Some important signs of dehydration are fatigue, confusion, dry lips, sunken eyes, increased body temperature, decreased blood pressure, constipation, decreased urine output and nausea.
The main intestinal problem for older people is constipation. To keep the intestinal tract performing efficiently, older people generally need to consume more dietary fiber than they did in their youth. Regular consumption of nuts, fruits, vegetables, beans, and whole grains usually provides enough fiber. If fiber intake increases, however, water intake also needs to increase to help accommodate this greater bulk. Because medications can cause constipation, a physician should be consulted if this condition persists. Mineral oil is sometimes taken as a laxative, but it should always be taken with caution. It binds fat-soluble vitamins (A, D, E, K) and limits their absorption, so it should not be taken with meals.
Lactase production slows with age; so older people tend to become more lactose intolerant. Most can still eat moderate amounts of cheese and yogurt, though, so adequate calcium intake is still possible. In addition, stomach acid production slows as people age which can cause poor absorption of vitamin B12. Vitamin B12 deficiency can then lead to pernicious anemia, a condition characterized by abnormally large and immature red blood cells that cannot transport and deliver oxygen efficiently. This results in lack of endurance and rapid onset of fatigue during exertion. Lastly, less stomach acid, along with the use of aspirin and antacids, can interfere with iron levels. Again, this can impact endurance and other body processes that rely on proper levels of iron in the blood.
Liver, Gallbladder and Pancreas
The aging liver tends to function less efficiently. When there is a history of significant alcohol consumption, fat buildup in the liver accounts for some of this decline. Alcohol abuse is a problem among a small but significant group of older adults who might be chronic alcoholics or who might have developed alcoholism later in life while dealing with loneliness and depression caused by retirement or the loss of a spouse. When liver function deteriorates significantly, there is an added possibility for vitamin A toxicity. Elderly people, in general, should not supplement with vitamin A.
The gallbladder also functions less efficiently with age. Gallstones can develop and block bile secretion causing it to pool and back up into the liver instead. Gallstones also interfere with fat digestion by restricting the release of bile into the small intestine.
Although the digestive function of the pancreas declines with age, the pancreas has a large reserve capacity. With advancing age, the pancreas begins to produce less insulin. Insulin is necessary to remove glucose from the blood, so one of the major signs of a failing pancreas is high blood glucose. This is different from what happens in obese people. Although blood glucose levels in obese individuals also rise, the cause is not normally a lack of insulin production. Instead, blood glucose remains elevated after a meal because target cells become insulin resistant, so the insulin that is present cannot do its job.
As kidney function deteriorates with age, the ability of the kidneys to excrete the products of protein breakdown significantly decreases. Although an increased protein intake of 1g/ kg of healthy body weight has been recommended for physically active older adults, this recommendation does not apply to people whose decreased kidney function causes urea to accumulate in the blood. Urea is a main by-product of protein metabolism that is formed in the liver and excreted by the kidneys. Another problem with aging is that kidney stones often develop. Surprisingly, coffee, tea, and wine consumption might decrease the chance of kidney stones, while orange and grapefruit juice consumption have been shown to increase the risk.
The immune system operates less efficiently with age. Consuming adequate protein, an array of vitamins (especially vitamins E and B6) and zinc helps maximize the health of the immune system. Recurrent sicknesses and poor wound healing are warning signs of a diet that is deficient, especially in protein and zinc. Eating too little food or too few animal proteins is usually the cause. Older people often eliminate meat from their diet because it is too hard to chew. Balanced nutrient supplements help ensure adequate vitamin and mineral intake.
Lung efficiency declines somewhat with age, but what does this have to do with nutrition? The decrease in lung efficiency contributes to a general downward spiral in overall body function. More specifically, breathing difficulties limit physical activity and endurance and frequently discourage eating. These changes eventually cancel other efforts to maintain overall health.
Hearing and Vision
Impairments in both hearing and vision indirectly affect a person’s ability to maintain a balanced and healthy diet. Elderly people sometimes avoid social situations involving food and shopping for groceries simply because they can not hear well. Furthermore, degenerating eyesight can affect people’s abilities to get to the grocery store, locate the foods they need, read label contents, and prepare foods at home. Macular degeneration is the usual cause of degenerating eyesight in the elderly. On a positive note, regular consumption of foods rich in carotenoids, in particular dark green, leafy vegetables such as kale, collard greens, spinach, Swiss chard, mustard greens, and romaine lettuce, might decrease the risk of developing this problem. Vitamin C also plays a part in preventing cataracts in the eyes and is just one more reason to eat fruits and vegetables.
Decrease in Lean Tissue
The loss of lean muscle tissue with age leads to a lower metabolism, decreased muscle strength, and reduced energy needs. Even if the person does not lose weight, a larger percentage of the body is in the form of fat as lean mass is lost. Older adults benefit from physical activity (especially strength training) because it stimulates food intake, raises energy expenditure, and maintains or increases muscle mass. By eating more, seniors increase their chances of consuming adequate amounts of nutrients.
Consuming sufficient amounts of vitamin B6, folate, and vitamin B12 is important to avoid elevated blood homocysteine levels, which is an additional independent risk factor for heart disease. Much controversy surrounds the treatment for elevated LDL in adults over the age of 70 to 75. If these people consume extremely restrictive diets limited in saturated fat and energy that lead to inadequate total weight, or if their diets lack variety, they might become undernourished. This can be a worse predicament for them than having high LDL.
Blood pressure tends to increase with advancing age. This becomes problematic because hypertension is heavily implicated in both stroke and heart attack in older adults. Blood pressure can be lowered in many people by severe sodium restriction, but this is a difficult diet to follow. Minerals such as calcium, potassium, and magnesium also deserve attention when it comes to hypertension. When people consume at least 1000 mg of calcium per day, they often register slightly lower blood pressures, especially systolic blood pressure, as compared to those who consume one-third to one-half that much. Potassium supplementation in the range of 4g/day (about 2g above typical needs) has also been shown to moderately decrease blood pressure. Finally, some studies indicate that magnesium is capable of lowering blood pressure at intakes equal to twice the RDA. Suggesting an adequate calcium level to clients (1200 milligrams a day) is a safe recommendation. Defer any other nutritional recommendations to the experts. One final point: Excess alcohol intake is responsible for about 10 percent of all cases of hypertension. A prudent intake is one drink per day with a meal or none at all.
Like everything else it seems, bone density also decreases with age. For older adults in general, calcium intake should increase to 1200 mg/day. Maintaining adequate vitamin D at 10 to 15 ug/day (15 ug/day for adults 70+) is a first step in preserving the health of bone.
Many older people suffer from hidden osteomalacia, a condition primarily caused by inadequate sun exposure which leads to decreased vitamin D synthesis in the skin. Ten to fifteen minutes of sun exposure at least two times per week to the face, arms, hands, or back without sunscreen is usually sufficient to provide adequate vitamin D. When they can't get regular sun exposure, older people need a dietary (e.g. milk) or supplemental source of vitamin D. Again, alcohol consumption should be in moderation, if at all.
Medications and Nutrient Needs
Medications and old age often go hand-in-hand. Medications can improve health and quality of life, but some of them also affect nutrient needs at any age. Two-thirds of older adults take at least one prescription drug, while one quarter of the elderly population regularly takes multiple prescription drugs. Many drugs affect appetite or absorption of nutrients, so if they are taken over the long term, malnutrition can result. Unfortunately, this is true for many elderly people; they often continue taking prescription drugs for long periods of time before any improvements are noted. These seniors should definitely work with their physicians and pharmacists to coordinate all medications taken. Pharmacists in particular can advise when to take drugs (with or between meals) for greatest effectiveness and the fewest number of side effects.
Drug-related nutritional problems include: (1) increased need for certain minerals or fat soluble vitamins when drugs leach them out of the body prior to absorption; (2) changes in appetite caused by antidepressant agents or certain antibiotics; and (3) blood loss from long-term use of aspirin or aspirin-like medications which strain iron reserves and can lead to anemia. People who take one or more medications for more than just a few weeks should closely watch their diets, eat nutrient-dense foods, and possibly take nutrient supplements to counteract effects of certain medications. As a personal trainer, you should not advise elderly clients on supplements; instead, refer them to their health care provider. A professional who specializes in nutrient and drug interactions should supervise because some supplements can interfere with the function of certain medications, while some medications interfere with the absorption of nutrients. For example, vitamin K can reduce the activity of oral coagulants. In addition, certain types of diuretics leach potassium out of the body.
Be aware of the fact that many people think herbal supplements and vitamins are not harmful because they are “natural.” Every year, people poison themselves using minerals, vitamins, and other supplements even though their intent was to maximize health. Your clients need to be advised that just like aspirin or any other medication (prescription or not), vitamins, minerals, and herbs need to be used with caution. There is the danger of overdose and toxicity or interaction with medications. The fat soluble vitamins A, D, E and K are examples of “natural” substances that can easily build up in the body when taken in excess. Unlike the water soluble vitamins, fat solubles are not filtered out by the kidneys. Instead, excessive amounts are stored in fat cells throughout the body and in the liver. Excessive mineral intake can also lead to toxicity, especially with the trace minerals such as iron and copper. Trace minerals are needed at very low levels, so they can become toxic at doses not much above typical needs. Another issue is that many minerals have similar molecular weights and charges. For example, magnesium, calcium, iron, and copper all have similar size and the same electrical charge, and this causes these minerals to compete with each other for absorption. As a result, taking too much of one can cause a deficiency in another.
Vitamins Could Slash Billions Off Senior Healthcare Costs
Results of a study reported in 2003 suggested that giving seniors a daily multivitamin could save the nation several billion dollars in healthcare costs. Outcomes showed that vitamins can improve overall health which translated into fewer drugs and less hospital care. Researchers looked at a number of studies that examined the effects of vitamin supplementation on five diseases – coronary artery disease, diabetes, osteoporosis, prostate cancer, and colorectal cancer. While estimates suggest it would cost $2.3 billion to provide seniors with a daily multivitamin over a five-year period, this cost could easily pay for itself. The report estimated that if all seniors took a daily multivitamin, the costs associated with avoidable hospitalization for heart attacks alone would drop by approximately $2.4 billion. Meanwhile, it is thought that another $1.6 billion in costs would be saved as a result of improved immune functioning and a reduction in the relative risk of coronary artery disease.
In conclusion, the modified MyPyramid for Older Adults addresses the unique needs of the aging adult, taking into consideration changing nutrient needs, fluid consumption and physical activity. Much can be done to prevent heart attack and stroke, diabetes, some types of cancer and osteoporosis just by eating a balanced diet and maintaining a healthy weight as adults age.
- Lichtenstein AH, Rasmussen H, Yu WW, Epstein SR, Russell RM. Modified MyPyramid for Older Adults. J Nutr. 138:78-82; 2008.
- Petersen TJ. SrFit: The Personal Trainer’s Resource for Senior Fitness. The American Academy of Health and Fitness, 2004.
- Wardlaw, Gordon. Perspectives in Nutrition. New York: McGraw-Hill, 1999.