Friday, October 13, 2017

Why Eating Right can Help you Heal

How your body processes and converts food into nutrition

Annually the U.S Department of Agriculture and the U.S. Department of Health and Human Services produce Dietary Guidelines for Americans, which offers advice to promote health and to reduce the risk of chronic diseases through diet and physical activity. One of the basic messages of the Dietary Guidelines is that nutrient needs should be met primarily through consuming foods. In certain cases, fortified foods and dietary supplements may be necessary to provide one or more nutrients that otherwise might be consumed in less than recommended amounts.  Foods that provide an array of nutrients and other compounds, within calorie needs, that have beneficial effects on health. This is of particular importance for the older adult with set food habits, who with aging, tends to reduce the amount of calories consumed. Older adults require a high quality diet with nutrient-dense foods and beverages. This translates into food choices with sufficient calories and concentrated nutrients. All vegetables, fruits, whole grains, fat-free or low-fat milk and milk products, seafood, lean meats and poultry, eggs, beans and peas (legumes), and nuts and seeds that are prepared without added solid fats, sugars, starches, and sodium are nutrient-dense.  We are often feeding smaller appetites that require additional nutrients due to the physiological changes of aging that can impair nutrient absorption and utilization.

Important Nutrient Needs for Older Adults

Protein—Protein is the foundation upon which every living organism is built. The body does not store amino acids (the building blocks of proteins), so an adequate daily intake of protein is needed to supply your body with all the 20 major amino acids.  Adequate intake of dietary protein is extremely important for tissue repair and healing, especially in the older adult.  Illness, surgery, and inadequate food intake can result in protein energy malnutrition that can impair immune function, increase susceptibility to infections, slow wound healing and increase skin breakdown. 

New evidence indicates that eating peanuts and certain tree nuts (i.e., walnuts, almonds, and pistachios), which are high in protein, reduces risk factors for cardiovascular disease when consumed as part of a diet that is nutritionally adequate and within calorie needs. Because nuts and seeds are also high in calories, they should be eaten in small portions and used to replace other protein foods.  They are so energy dense and tasty that it can be easy to eat excessive amounts. Choose unsalted nuts and seeds to help reduce sodium intake. 

In 2003, FDA allowed the first qualified health claim for nuts, suggesting that scientific evidence supports that eating 1.5 ounces per day of most nuts as part of a diet low in saturated fats and cholesterol may reduce the risk for heart disease.  Clinical trials with tree nuts have reported favorable reduction in cholesterol levels, particularly the bad LDL cholesterol that elevates heart disease risk. This effect has been demonstrated consistently in different population groups using different study designs and methods.

Carbohydrates and Fiber — Sufficient carbohydrates are needed to protect protein from being used as an energy source, however it is recommended that carbohydrate intake is limited to whole-grain high fiber unprocessed foods.  The refining of whole grains involves a process that results in the loss of vitamins, minerals, and dietary fiber.  There are three types of carbohydrates - sugar, starch and fiber. Both sugar and starch are turned into sugar and since the body lacks the enzymes needed to digest fiber, it is the only carbohydrate that doesn’t convert to sugar.  

By limiting your daily intake of low fiber highly refined carbohydrates, you also limit your sugar intake.  About 78 million Americans—35 percent of the U.S. adult population over age 18 —have pre-diabetes, which means that blood glucose (sugar) levels are higher than normal, but not high enough to be called diabetes. Carbohydrates in the form of fiber can be found in a variety of fruits, vegetables, and whole grain foods.  Avoid highly refined grains, as these also can be high in solid fats and added sugars (e.g., cookies and cakes).  

Calcium — As people age, a decrease in calcium absorption occurs. When the body does not get enough calcium per day, it draws calcium from your bones.  Bone loss also occurs as part of the normal aging process, particularly in postmenopausal women due to decreased amounts of estrogen.  The elderly population is especially susceptible to osteoporosis (bone loss) and bone fractures. One out of every two women and one in four men over age 50 will have an osteoporosis-related fracture in their lifetime. Many factors increase the risk of developing osteoporosis, including being female, thin, inactive, or of advanced age; smoking cigarettes; drinking excessive amounts of alcohol; and having a family history of osteoporosis. Supplementation with calcium plus vitamin D has been shown to be effective in reducing fractures and falls (which can cause fractures) in institutionalized older adults. Some good sources of calcium include yogurt, milk, cheese, firm tofu, canned salmon with bones, spinach, and rhubarb. 

Vitamin D Vitamin D is generally referred to as ‘the sunshine vitamin’ as it is created by our bodies with sun exposure.  However, recent findings of low Vitamin D levels in many patients lead some to believe that despite getting at least 20 minutes of sunshine daily and adequate intake of foods high in Vitamin D, a daily supplementation is necessary to reach optimum levels.  Additionally, if your body doesn’t have sufficient precursors in your skin to convert to Vitamin D, no amount of sunshine will help and supplementation will be required.  Recent research has shown a possible link between Vitamin D supplementation and lowered risk of dementia, heart failure, diabetic neuropathy, and even cancer.  Adequate vitamin D also can help reduce the risk of bone fractures, especially when taken with calcium supplementation.  Some sources of Vitamin D are vitamin D milk, egg yolk, salmon, tuna fish, and sardines. You can ask for a simple blood test from your healthcare provider to determine your risk for Vitamin D deficiency.

Water Aging adults are more susceptible to dehydration due to inadequate daily intake of fluids. The ability to sense ‘thirst’ is reduced and can significantly decrease optimum fluid intake to cause dehydration.  By the time one senses they are thirsty, the body is already dehydrated to a slight degree so that sensing a feeling of thirstiness is actually a symptom of dehydration.  Because our bodies need water to function normally, when you’re dehydrated you may feel tired, have trouble concentrating or wind up eating more than usual since our bodies often misinterpret thirst as hunger.  Beverages that contain caffeine or alcohol can be dehydrating, so be sure you drink plenty of water to offset your coffee or alcohol consumption.  A minimum of 1500 cc’s / day is recommended for most adults, but there can be lesser requirements for some patients with certain medical conditions (like kidney disease). Be sure to consult your healthcare professional for the amount of fluid you are allowed to consume daily.

A new Portrait of Dementia - Brush to Canvas

Evolve at Rye Alzheimer’s residents are creating new portraits of dementia. For many who suffer from Alzheimer’s disease and related dementias, while their short-term memories may be fleeting, their long-term memories are still often intact.  Evolve’s activity director Lori Wiswell believes that reaching those long term memories is often a matter of channeling their attention to target familiar images that we all hold onto during our lives.  There is a palpable sense of enthusiasm bubbling from Lori “Here at Evolve at Rye we offer a therapeutic, multi-faceted interdisciplinary approach to activities and social and leisure programming,”  “Our goal is to provide specialized stimulation to create structure and support in meeting the physical, psychosocial, cognitive and spiritual needs of each resident, in this case it’s through the imagery of art therapy.”  Every week art therapy imagery comes to life. The artwork of the Evolve at Rye residents are on display at the community rooms for everyone to enjoy.  “We focus on the resident’s wellness and the holistic needs, rather than the losses that the disease causes,” explains Lori.  By focusing and building upon remaining abilities, projects such as these can build the confidence of the residents, rather than reminding them of what they may be losing.  All program components are designed to provide “failure-free” stimulation according to the cognitive ability of each resident.  The intimate homey environment offers unique structure for early and later stage residents separately which enables staff to individualize programming for each resident.  “Our programming is designed to provide stimulation within each resident’s capabilities that is confidence building and success oriented,” concluded Lori. 

Friday, September 15, 2017

Dementia is not always Alzheimer's disease

Dementia is a neurological disorder that affects your ability to think, speak, reason, remember and move. While Alzheimer's disease is the most common cause of dementia, many other conditions also cause these symptoms. Some of these disorders get worse with time and cannot be cured. Other types can be treated and reversed.
The three most common forms of dementia are Alzheimer's disease, vascular dementia and Lewy body dementia. Sometimes, a person can have more than one of these problems at the same time. You can have dementia without having Alzheimer's disease but everyone with Alzheimer's disease will have dementia.
Alzheimer's disease involves a loss of nerve cells in the areas of the brain vital to memory and other mental functions. This loss is associated with the development of abnormal clumps and tangles of protein in brain cells. The first sign of Alzheimer's disease is usually forgetfulness. As the disease progresses, it affects language, reasoning and understanding. Eventually, people with Alzheimer's lose the ability to care for themselves. The precise cause of Alzheimer's disease is unknown, but risk increases with age. Ten percent of the population over the age of 65 has Alzheimer's, while nearly half of the population over 85 has the disease.
Another common form of dementia, vascular dementia occurs when arteries feeding the brain become narrowed or blocked. The onset of symptoms usually is abrupt, frequently occurring after a stroke. However, some forms of vascular dementia progress slowly, making them difficult to distinguish from Alzheimer's disease. Some people have Alzheimer's and vascular dementia at the same time. Vascular dementia often causes problems with thinking, language, walking, bladder control and vision. Preventing additional strokes by treating underlying diseases, such as high blood pressure, may halt the progression of vascular dementia.
Lewy body dementia: Has Alzheimer's-like and Parkinson's-like features. In this form of dementia, abnormal round structures - Lewy bodies - develop within cells of the midbrain, beneath the cerebral hemispheres. Lewy body dementia shares characteristics with both Alzheimer's disease and Parkinson's disease. Like Alzheimer's disease, it causes confusion and impaired memory and judgment. And it often produces two distinctive physical signs typical of Parkinson's disease - a shuffling gait and flexed posture. Lewy body dementia can also cause hallucinations.
Lewy bodies contain a protein associated with Parkinson's disease, and Lewy bodies often are found in the brains of people who have Parkinson's disease or Alzheimer's disease. This suggests that the three ailments are related, or that Lewy body dementia and Alzheimer's or Parkinson's disease sometimes co-exist in the same person. Some people with Lewy body dementia have experienced dramatic improvements in symptoms when treated with Alzheimer's or Parkinson's medications.
Several less common brain disorders also can result in dementia.
    Frontotemporal dementia. Because it affects the lobes of the brain that are responsible for judgment and social behavior, frontotemporal dementia can result in impolite and socially inappropriate behavior. Symptoms of this form of dementia usually appear between the ages of 40 and 65. The disease seems to run in families.
    Huntington's disease. Symptoms of this hereditary disorder typically begin between the ages of 30 and 50, starting with mild personality changes. As the disorder progresses, a person with Huntington's develops involuntary jerky movements, muscle weakness and clumsiness. Dementia commonly develops in the later stages of the disease.
    Parkinson's disease. People with Parkinson's disease may experience stiffness of limbs, shaking at rest (tremor), speech impairment and a shuffling gait. Some people with Parkinson's develop dementia late in the disease.
    Creutzfeldt-Jakob disease. This extremely rare and fatal brain disorder belongs to a family of human and animal diseases known as the transmissible spongiform encephalopathies. A new variety of Creutzfeldt-Jakob disease has emerged - particularly in Great Britain. It's believed to be linked to the human consumption of beef from cattle with mad cow disease (bovine spongiform encephalopathy).
Many other conditions, some reversible, can cause dementia or dementia-like symptoms.
    Reactions to medications. Some medications have side effects that mimic the symptoms of dementia. A single medicine may trigger such a reaction in an older person or in someone whose liver fails to eliminate the drug properly. Interactions among two or more drugs may lead to reversible symptoms of dementia as well.
    Metabolic abnormalities. Decreased thyroid function (hypothyroidism) can result in apathy, depression or dementia. Hypoglycemia, a condition in which there isn't enough sugar in the bloodstream, can cause confusion or personality changes. Pernicious anemia - an impaired ability to absorb vitamin B-12 - also can cause personality changes.
    Nutritional deficiencies. Chronic alcoholism can result in deficiencies of thiamin (vitamin B-1), which can seriously impair mental abilities. Severe deficiency of vitamin B-6 may lead to pellagra, a neurological illness with features of dementia. Dehydration also can cause confusion that may resemble dementia.
    Emotional problems. The confusion, apathy and forgetfulness associated with depression are sometimes mistaken for dementia, particularly in older individuals.
    Infections. Meningitis and encephalitis, which are infections of the brain or the membrane that covers it, can cause confusion, memory loss or sudden dementia. Untreated syphilis can damage the brain and cause dementia. People in the advanced stages of AIDS also may develop a form of dementia.
Seek evaluation and treatment

Dementia isn't always due to Alzheimer's. Before you conclude that a loved one's memory loss and confusion stem from an irreversible disease process, get a thorough medical evaluation. Even if the evaluation uncovers no underlying condition that, with treatment, can reverse dementia, options may be available for easing its symptoms. Knowing the likely cause of dementia, however, is the essential first step toward managing it.