BRAIN-HEALTHY EATING PLAN

Are there dietary eating plans that are both heart- and brain-healthy?

Recent research strongly suggests that dietary changes -- in particular, the adoption of a Mediterranean-style eating plan -- can help prevent the onset or else slow the rate of cognitive decline. The Mediterranean diet consists of foods traditionally consumed by people living along the coast of the Mediterranean Sea.

Over the past decade, a number of studies have linked the Mediterranean diet with a reduced risk of cardiovascular disease, diabetes and hypertension. For example, an important Spanish study on the Mediterranean diet, published in the New England Journal of Medicine, found a 30 percent reduction in heart attacks, strokes and cardiovascular deaths in high-risk people who consumed the Mediterranean diet, compared with those eating a "low-fat diet." That's similar to the risk reduction seen with statin drugs.

Not surprisingly, foods that are good for your heart are also good for your brain. A study published in the Annals of Neurology reported that among 2,258 participants (average age 76), those who closely followed the Mediterranean diet had a 40 percent lower risk of Alzheimer's disease than those with the least adherence after four years. Partial observation of the Mediterranean diet proved to have benefits, too, reducing the risk by 15 percent.

The Mediterranean diet may also keep those who have mild cognitive impairment (MCI) from progressing to Alzheimer's disease. A recent study published in the Archives of Neurology reported that among people with MCI, the risk of developing Alzheimer's over a four-year period was 48 percent lower for those who adhered strictly to a Mediterranean diet. Those who adhered moderately to the diet had a 45 percent lower risk.

The Mediterranean diet is characterized by:

•  smaller portion sizes than a Western diet.

•  a focus on fresh rather than processed foods.

•  a high intake of plant-based foods, such as vegetables, fruits, legumes and whole grain.

•  moderate amounts of nuts, olive oil and fish, which are high in healthy monounsaturated and omega-3 fats.

•  moderate consumption of wine, typically with meals.

•  regular consumption of skinless poultry and low-fat dairy in smaller portions.

•  infrequent consumption of meat, which is high in saturated fats, and sweets.

(Source:  John Hopkins Health Alert, 23 June 2014)

REPORT SHOWS UNDER NUTRITION AS A MAJOR PROBLEM AMONG PEOPLE WITH DEMENTIA

A new report, released on 11 February 2014, highlights that under nutrition is a major problem among people with dementia, and stresses the importance of recognizing nutrition as a potential key factor in the well being of people with dementia.

Research reviewed in the report finds that 20-45% of those with dementia in the community experience clinically significant weight loss over one year.

Alzheimer’s Disease International (ADI) and Compass Group commissioned a team of researchers, led by Professor Martin Prince from the King’s College London Global Observatory for Ageing and Dementia Care, to produce the report ‘Nutrition and dementia: a review of available research’.

The report reviews existing research on dietary factors across the life course that might increase or decrease the risk of developing dementia in later life. While obesity in mid-life may be a risk factor for developing dementia in late life, weight loss tends to become a more significant issue in the decade leading up to the clinical onset of the disease and accelerates thereafter.

The report also details actions that could improve the nutrition of people with dementia through diet and external factors such as modifying the meal time environment, and supporting and training carers. Given the evidence for effective interventions, there is much untapped potential to improve the food intake and nutritional status of people with dementia.

Professor Prince, from King’s College London, says: “For older people, under nutrition is arguably a greater health concern than obesity, and it is particularly common among people with dementia. This is a neglected area of research with important implications for quality of life, health and functioning. While weight loss in dementia is very common and can be an intrinsic part of the disease, it could be avoided and we should be doing more to tackle the problem.”

Marc Wortmann, Executive Director, ADI, says: “I am very pleased that ADI and Compass Group commissioned this report. We believe that a focus on diet, nutrition and well being is a positive approach to supporting people with dementia and carers of this devastating disease. The report also shows we need more research into the potential role of nutrition in reducing the risk of developing dementia.”

The Report recommends that:

·      The adoption of nutritional standards of care for people with dementia should be considered throughout the health and social care sectors. These could include regular monitoring of weight, as well as assessments of diet and feeding behaviors, and the need for feeding assistance.

·      Family and professional carers should be trained and supported to understand and meet the challenges involved in maintaining adequate nutrition for people with dementia.

·      Evidence-based advice should be provided to inform consumer choices regarding the balance of risks and benefits associated with the use of nutritional supplements claimed to protect cognition in late life, before or after the onset of dementia.

·      More research should be conducted into the effective components of a diet that might prevent dementia and the progression of mild cognitive impairment.

(Source:  ADI, News Release, 11 February 2014)

Think Twice About Giving Elders Nutritional Drinks or Shakes

"My elderly mother isn't eating and she has lost a lot of weight.  Should I give her a nutrition supplement drink to replace the meals she should be eating?"

Under-nutrition due to lack of eating is a common problem among elderly people. It is also dangerous. Under-nutrition and extreme thinness can lead to higher mortality rates, according to a study published in the American Journal of Clinical Nutrition. It is a problem that can't be ignored.

Geriatricians (specialists in treating the elderly) take weight loss among the elderly very seriously and caregivers should, too. However, some caregivers feel that feeding their parent a nutrition supplement drink, such as Boost, in lieu of meals ensures the elderly loved one is getting the nutrition they need. This isn't the case, according to Dr. Amy Ehrlich, Associate Professor of Clinical Medicine and Interim Division Head of Montefiore Medical Center's Geriatrics Division.

"Just giving them a can of Ensure for dinner isn't enough," she says. "It is always better to try to use regular food to maintain a person's weight." If a caregiver wants to use nutrition drinks, they should be used between meals, as a snack or supplement to add calories to the senior's diet – not as a meal replacement.

Work with a doctor to determine elder's nutrition needs

Weight loss is a marker of frailty. However, it is not a normal part of aging. Dr. Ehrlich stresses that it is critical to find out what is causing the senior's loss of interest in food. A doctor should conduct a detailed medical evaluation to determine the cause of loss in appetite and weight loss. "There are a variety of treatable conditions that could be the culprit: ulcers, thyroid disease, dementia, depression, even ill-fitting dentures. All are treatable, so rather than immediately turning to a supplement, work with your doctor to address the cause of the problem," Dr Ehrlich says.

If a caregiver does decide a nutrition drink is right for their elderly loved one, a doctor should still be consulted to determine the type of supplement to use. For example, diabetics must choose a low-sugar product.

Frail elderly have different nutrition requirements

There is a misperception that frail elderly people should adhere to the same low-fat, low-calorie diet that is recommended for the general population. However, Dr. Ehrlich says that for frail elderly who have substantial weight loss, the opposite is true. "I'll see a 94-year-old person who is losing weight and he is restricting everything, eating a low-calorie, low-fat diet. It would be better to eat a bowl of ice cream, for the caloric intake!"

Elders who have experienced weight loss should eat what they like. And don't be afraid to incorporate eggs, cheese, peanut butter…even ice cream into the diet.

There is no need for low-fat milk or cheese.

Elders often can't (or don't want to) eat three large meals a day. Rather, encourage them to have smaller, more frequent meals, including snacks, even before bed.

Nutrition drinks and supplements can interact with medications

Supplements, including nutrition drinks, can cause dangerous drug interactions in the same way prescription medications do.

If an elder is taking prescription and over-the-counter drugs and supplements, the drugs may conflict and, basically, go to war against each other, while also damaging otherwise functioning body organs and systems. Check with your doctor to avoid interactions. "I encourage my patients to bring in all their medications, supplements and vitamins, so I can check for possible interactions. I call it the 'brown bag visit," Dr. Ehrlich says. As an example, vitamin supplements may negatively interact with blood thinners like Coumadin. 

The bottom line is that nutrition drinks are not a magic fix for lack of eating or under-nutrition. These products are not bad when used as a dietary aid and supplement to regular meals. However, they should not be used as a meal replacement for elders – especially those who are frail or thin.

(Source:  Agingcare.com - Dr. Amy Ehrlich MD is Geriatrics Fellowship Program Director for Montefiore Medical Center's Geriatrics Division in New York and an Associate Professor of Clinical Medicine. She is board certified in Geriatric Medicine and Internal Medicine.)

(POSTED 16 FEBRUARY 2014)