Intervention Series: Mom seems to be losing her cognition - what you can do

Cognitive Interventions

Cognitive interventions must be blended with a perspective allows us to understand a person not only as someone who suffers from illness or unhealthy conditions, but also as someone who inhabits healthy parts and personality that remains even though it seems to be hidden by illness .  For staff and families, engaging the person behind the impairment will allow everyone to feel good about participating with the residents in the activity experience. 

Alternatives for Cognitive Intervention:

A therapeutic, multi-faceted interdisciplinary approach to activities, social and leisure programming provides specialized stimulation to create structure and support in meeting the physical, psychosocial, cognitive and spiritual needs of each participant. This is especially important for people who are confined in a locked unit and unable to freely experience the outside world where most of the rest of us readily access a wide array of activities and stimulation during the course of our everyday lives. The best practices components listed below allows providers to focus on residents' wellness and their holistic needs, rather than the losses the disease causes. The following research-based programming should then be scheduled to align therapeutic activities with common dementia behaviors as they typically occur during the day. This provides stimulation within each resident's capabilities that is failure-free and success oriented, at specific times when they are most likely to respond favourably.

Failure-Free - Activities that encourage participation at any functioning level, from low functioning to high functioning while still building self esteem of the participants. Participants are not at risk in these activities of being singled out or embarrassed. (Recommended frequency = Daily).

Exercise - Seniors with dementia tend to be less careful ambulating than their non-demented counterparts who are constantly aware of and fear the consequences of a fall. Unfortunately seniors suffering from dementia are at a significantly higher risk for falling than the general elderly population. Morning exercises and physical activities at least every two hours throughout the day keep joints limber and reduce the frequency of devastating falls. Elderly people need to support their own weight and/or walk at least every two hours. This helps them to maintain body strength and muscle mass while improving their coordination, circulation and avoid pressure sores. Elderly can also experience dizziness when standing up.  This is caused by blood pooling in their lower extremities (orthostatic hypotension). It is vital to let them stabilize on their feet for a minute after they have been sitting, or lying for an extended period to prevent dizziness and a potential fall. (Recommended frequency = Daily).

Grooming - Residents who are well groomed feel better about appearing in public than those who do not dress appropriately and groom for their day. People with dementia are at risk of remaining in their rooms in bedclothes without grooming are more at risk for isolation and vulnerable to depression. (Recommended frequency = Daily).

 Current Events - It is important to provide residents a window on the world and keep them informed regarding top stories in the news. This connects them to important events outside their senior living community and stimulates them to maintain cognition. (Recommended frequency = Daily).

Reminiscence - This is the act or process of recollecting past experiences or events. Programs such as trivia, finish the phrase, memories that relate to holidays or the current month, or taking them back to "the Good old days" can help to connect them to their past and ease the fears they experience daily in failing to remember people, places and things. (Recommended frequency = Daily).

Long-Term Memory - These are memories that many people hold onto until late in their disease progression.  These are activities that encourage working with familiar life-long tasks of everyday living such as sorting laundry, setting a table, winding yarn, reminding them what they did in their life, by cueing and using memory stations, and encouraging interaction with these familiar items. Programs that cue residents to access their long-term memories can highlight to them what they can still do which builds self-esteem and confidence. (Recommended frequency = Daily).

Short-Term Memory - These are memories in the immediate past present of days or weeks. Normally the first symptom noticed by families. Programs that offer structure, a calendar or written daily agenda, note cards to refer to. Using familiar photos, family albums, pictures of favorite foods or activities recently completed can help build confidence and reduce fear and anxiety. (Recommended frequency = Daily).

Cognitive Stimulation - This is the intervention that offers a range of enjoyable activities providing general stimulation for thinking, concentration and memory, normally in a small social group setting. It is aimed at general enhancement of cognitive and social functioning. These activities include word games, puzzles, music and practical activities like baking or indoor gardening. All activities were designed to stimulate thinking and memory. Improvements for participants following cognitive stimulation show a much higher functional status. (Recommended frequency = Daily).

Psychosocial - Synaptic reserve, neuroplasticity, and perhaps other factors such as neurotransmission, and neurogenesis may be impacted by lifetime intellectual achievement.  The relationship of leisure activities or other forms of intellectual stimulation such as social interactions to diminished risk for dementia suggests several mechanisms including stress reduction and overall cognitive stimulation are at play. Offering stimulation that reaches back to life-long love and work for others, helps to reflect on the past and validate the present. Creating activities surrounding lifetime accomplishments, travel destinations and other bucket list accomplishments gives a sense of life purpose to participants. (Recommended frequency = Weekly).

Eye-Hand Coordination - Exercising the participant's creativity and fine motor skills can help build a sense of accomplishment. The more you build upon remaining abilities the higher the quality of life they will enjoy. (Recommended frequency = Weekly).

Socialization - Humans are social creatures, but as people begin to lose their memory and become aware of their losses, they tend to seek isolation to avoid embarrassment and confrontation. Programs designed to be delivered in small groups will enable each participant to offer what they can without being singled-out. Programs such as a group exercise activity (parachute) or finish the phrase or wheel of fortune all offer a venue for socialization with other residents while allowing them to express themselves within their individual comfort zone. (Recommended frequency = Daily).

Arts and Crafts - These activities can build self confidence and offer a sense of accomplishment. Creating a door hanger or artwork each month is fun and helps to build self-confidence. Higher functioning residents who help lower functioning residents with their art projects feel a sense of pride and contribution. Assisting others helps to overcome their own insecurities. Art therapy also helps to restore brain synapses through eye-hand coordination. (Recommended frequency = Weekly).

Multimedia Interaction - Researchers surveyed people with dementia and reported that travel and engaging with nature and science were most important to them in terms of their quality of life. Surveying families can help identify life-long interests such as travel, nature, sports, ancient history, oceans, cooking or science.  PBS or Nature series programs available to download from the internet and a great commercial-free way for people to access this. Programming exposure to these themes helps participants remain connected with their passions. (Recommended frequency = Daily).

Sing-a-long - Many people with long-term memory remaining will respond well to sing-a-long programs and music therapy where they can participate at will and often surprise themselves with how well they remember popular songs of their younger days. Music bingo, holiday sing-a-longs and other singing games offer a great social and confidence building venue to residents to access past fond memories. (Recommended frequency = Weekly).

Spiritual and Religious - Remaining active spiritually is very important for elderly people who tend to become more religious later in life. A balanced program which offers interdenominational services or even religion specific services can help residents remain connected with their faith. At the heart of our being exists a core set of virtues – gifts that represent the essence of the human spirit and the content of our character. These gifts are universal, not defined or limited by gender, nation, race or religion. They are inherent in the human experience.  Research shows that seniors need to keep in touch with their spiritual self to live life fully. Living virtues provide empowering strategies that inspire the practice of virtues in everyday life through simplicity which support our residents to cultivate their virtues – the gifts of character. (Recommended frequency = Weekly).

Low-Functioning - Sensory stimulation is needed for even the lowest functioning participants to offer distraction and engagement. Programs that offer simple exposure to stimulate participant's sense of touch, taste, smell, site and hearing can provide engagement and reach into the spirit of someone who may be otherwise catatonic. In many cases it is impossible to tell if a participant is responding mentally to these stimuli, but research has shown that many people with advanced dementia are engaged by sensory stimulation even though they may be unable to physically respond to it. Bubble painting, name that smell, feels like, sounds like, tastes like, or edible art like Hello with Jell-o can all bring stimulation and quality to life. (Recommended frequency = Daily).

Sequencing - Sequencing and muscle memory are among the last cognitive skills to erode for a dementia patient. Sorting silverware, folding napkins, word-find, or playing with musical instruments can restore confidence that participants can still access those skills and be successful in manipulating their form and function. (Recommended frequency = Weekly).

Non-verbal Communication - much of what we perceive about each other is not what is said by how it is communicated.  Activities designed to have fun with non-verbal cues can offer both verbal and non-verbal participants a fun and engaging experience. Introduce the topic by talking about body language. Define it for them if needed. Tell the residents that you are going to communicate non-verbally with your face and body and ask them to guess your mood. Use Happy (smiling and joyful) Sad (mouth turned down and sorrowful) Afraid, amorous, hurt, and yes confused!  Have fun with it and ask the residents to show you how they look for each of these emotions. (Recommended frequency = Daily).

Behavior Modification - Many residents with dementia also experience anxiety disorder. This is typically manifested in the afternoons and often referred to as "sundowning." Physicians normally treat this disorder with medications from the Benzodiazapine family. For many residents, these medications, while effective, can leave patients depressed, dispirited and even catatonic. There has been ample research with essential oils and auditory artifacts that have offered evidence to moderate behaviors without chemical intervention. Aromatherapy is the art of using essential oils to benefit ones physical, spiritual and psychological well-being. Aromatherapy can provide sensory stimulation or relaxation, increase self-esteem, and work against a sense of self-isolation. It can provide opportunities to communicate non-verbally, and enhance reminiscence, memory retrieval, and mood stabilization. Binural beats or delta tones are very low frequency auditory processing artifacts, or apparent sounds, the perception of which arises in the brain for specific physical stimuli. Delta tones have been used extensively with people who suffer from insomnia to induce relaxation, meditation, creativity and dissimulate the brain activity. Binural beats reportedly influence the brain in more subtle ways through the entertainment of brain waves and have been claimed to reduce anxiety and provide other health benefits such as control over pain. (Recommended frequency = Daily).

Other therapies - Horticultural therapy is an interaction between people and plants. This process has a powerful benefit that gives someone receiving care the opportunity to become a caregiver themselves, as they nurture their plantings. The benefits to a dementia population are many. Not only the physical benefits of utilizing fine and gross motor skills, but also the emotional benefits of working with plants include the sensory and mental stimulation, decreased anxiety, and improved orientation to reality with the stimulation of long-term memories. Pet therapy is another way seniors can stay connected to their past and is for many an opportunity to be the caregiver that is calming to both resident and pet alike. (Recommended frequency = Monthly).

Entertainment - Everyone loves to be entertained, whether its live music, multi-media or audio tracks. Having paid entertainer perform for the residents, or even an open mike night can bring that musical stimulation many people crave and enjoy right into their community. Often school bands, or dance groups can be arranged to come and perform for the residents which can offer the group experience performing before a live audience. Regardless of the source or reason, seniors love to be entertained, it stimulates so many emotions and offers a significant boost in their quality of life that is always enjoyed with eager anticipation. Where words fail, music speaks, its the sound of life. (Recommended frequency = Monthly).

Saint Louis University Mental Status Examination (SLUMS) - a method of screening for Alzheimer's and other kinds of dementia. It was designed as an alternative screening test to the widely used Mini-Mental State Examination (MMSE). The idea was that the MMSE is not as effective at identifying people with very early Alzheimer's symptoms. Sometimes referred to as Mild Cognitive Impairment (MCI) or mild neurocognitive disorder (MNCD), these symptoms occur as people progress from normal aging to early Alzheimer's.

Conduct your own assessment:

http://www.memorylosstest.com/dl/slums-english.pdf

Intervention Series: Mom seems to be depressed - what you can do

Depression Interventions

In a recent study researchers found that depressive symptoms were more than twice as common among assisted living residents with mild or moderate dementia than among those without dementia.  Depressed residents often do not have positive outcomes and are greater risk of discharge to nursing homes and death. Chronic depression can lead to loss of appetite and weight loss, lethargy, and a host of other premature health complications. Findings of the study document the high prevalence of depressive symptomatology among those with dementia.  About 54% of the depressed and 33% of the non-depressed participants were taking antidepressant medication.[i] Sixty-two of the participants of the study were depressed had no formal mental health treatment.  Depression was more common among participants with severe dementia, behavioral symptoms and those with pain.  The study also found that over half of the depressed participants were undetected by staff.

These results indicate a strong need to properly assess residents for depression. Seeking interventions for those suffering who are undiagnosed and corrective actions for those currently treated for depression who may not be depressed can derail potential problems.  Identifying these at-risk residents and advising attending physicians and family members may help operators to avert unnecessary mental health triggered discharges, while improving the quality of life for each individual.

The Cornell Scale for Depression in Dementia (CSDD) was developed in response to a need in the industry for a diagnostic tool to quantify incidence of depression in elderly populations with dementia[ii].  This simple 19 question tool enables operators to identify at-risk residents who are suffering from depression and are undiagnosed so that they might be treated, and also identify those who may be already prescribed antidepressants who may not in fact be depressed.  This way attending physicians may be offered a nationally recognized diagnostic tool to use to evaluate and prescribe for their patients, rather than relying upon sporadic observations from caregivers and family members.

Alternatives for Depression Intervention:

Treatment for depression depends upon the cause and severity of the depression and, to some extent, on personal preference. In mild or moderate depression, psychotherapy is often the most appropriate treatment. But incapacitating depression may require medication for a limited time along with psychotherapy. In combined treatments, medication can relieve physical symptoms quickly, while psychotherapy enables the patient to learn more effective ways of handling his/her problems.

Personal Measures: mild exercise, music therapy, pet therapy, gardening or other hobbies, social engagement, volunteerism, intergenerational activities, reminiscing with family members or other residents, social interventions to help with isolation and loneliness (group outings, regular visits from volunteers, participation in a support group), humor, maintaining a healthy diet, religious or spiritual groups, continuous engagement in stimulating activities and craft programs.

Medical measures: treatment of underlying medical conditions, counseling, psychotherapy, anti-depressants, hormone replacement therapy, changes in prescription dosages. Antidepressant medication can help some people feel better by controlling certain symptoms. The can be helpful in mobilizing people who suvive the repair of a broken hip, but lose the will to get out of bed. It should be noted that antidepressants can potentially lead to falls as they are sedating and can cause a sudden drop in blood pressure when a person stands up. Also selective serotonin reuptake inhibitors (SSRI) drugs can create dependency and may lead to self-destructive thoughts.

Psychotherapy and Counseling and Measures: Supportive counseling includes religious and peer counseling. It can help ease the pain of loneliness and address the hopelessness of depression. Both peer counseling and pastoral counseling usually are provided without cost. Cognitive Bahavioral Therapy (CBT) helps people distinguish between problems that can and cannot be resolved, and develop better coping skills. Interpersonal psychotherapy can assist in resolving personal or relationship conflicts. Somatic or trauma psychotherapy with a professional can help bring about resolution of traumatic experiences.

 Why it is important to treat: The body often follows the mind and depression substantially increases the likelihood of death from physical illnesses. Depression can increase impairment from a mental disorder and impede its improvement, while psychological treatment frequently improves the treatment success rate for a variety of medical conditions. Untreated depression can interfere with a patient’s ability to follow the necessary treatment regimen or participate in a rehabilitation program. According to a study conducted by the Rand institute, depressed elerly patients use 6 time more prescription medications and spend four times more in total healthcare dollars than their nondepressed counterparts. Seniors who are vulnerable for depression experience more comorbidities and run a higher risk of catastrophic health failure.

The Cornell Scale for Depression in Dementia (CSDD) is a way to screen for symptoms of depression in someone who has dementia. Unlike other scales and screens for depression, the CSDD takes into account additional signs of depression that might not be clearly verbalized by a person. For example, if your loved one or patient has Alzheimer's disease, vascular dementia or other kind of cognitive impairment, he might not consistently be able to accurately express his feelings. The Cornell Scale measures observations and physical signs that could indicate depression. 

Conduct your own assessment: http://primaris.org/sites/default/files/resources/Depression/depression_cornell%20scale%20for%20depression%20final.pdf

[i] Baldini-Gruber, Ann, Zimmerman, Sheryl, Boustani, Malaz, Watson, Lea, Williams, Christianna, Reed, Peter. Characteristics Associated with Depression in Long-Term Care Residents with Dementia. The Gerontologist. Vol. 45, October 2005, Page 50-55.

[ii] Alexopoulos, G.S., Abrams, R.C., Young, R.C., & Shamoian, C.A. Cornell Scale for Depression in Dementia. Biological Psychiatry, 23, 1988, Page 271-284.

Intervention Series: Mom is losing weight - what you can do

Nutritional Interventions

Seniors have a special relationship with food. Each phase of the aging process presents different nutritional challenges. Although good nutrition is not a treatment for memory loss, it does improve quality of life dramatically. Good nutrition helps to combat infections, depression, skin breakdown, pneumonia, confusion, as well as risks for falls and urinary tract infections. Here are some of the changing nutritional needs presented with the three general progressive phases of Alzheimer's Disease.

In phase one, loss and confusion typically fuel depression, which causes changes in appetite. Weight changes may occur. People with AD may anxiously eat nonstop, or they may forget to eat all together. They may forget how to shop for food, or how to prepare a meal. They may forget how to use kitchen equipment, like a microwave or toaster, and become frustrated.

The increased activity, agitation and wandering that is prominent in phase two increases residents' energy needs. Active residents in this phase may require an extra 1600 calories per day just to maintain their body weight. Getting those extra calories may be challenging if the resident loses interest in food. Swallowing difficulties, inability to recognize or distinguish foods, tasting difficulties, shortened attention span, physical changes like tremors or Apraxia and the inability to cope with the stimulation at the meal site all work against a confused resident. 

In phase three, people with AD are usually confined to a wheelchair. Typically, they forget how much food to put in their mouths or how to swallow. Most people in phase three need to be fed. In order to ensure the maximum nutritional intake, caregivers should take their time, offering cues, coaxing and proper positioning. Appropriate food consistency is essential, as there is a risk for choking. Having the main meal midday helps, too, because that is typically when the resident is at his sharpest.

Alternatives for nutritional intervention:

Have foods available at all times.

Include the resident in choices, preparation and clean up.

Encourage hydration at least six times per day.

Have portable/ finger foods available for residents who wander, have limited attention spans, have difficulty using utensils and/or would benefit from six meals per day. (Examples of finger foods: hardboiled eggs, bananas, baby carrots, orange sections, graham crackers with peanut butter, cookies, cheese, chicken nuggets, etc.).

Offer smaller portions of food frequently throughout the day. 

Offer favorite foods, with a preference on nutrients. (If a resident likes both brown and white rice, serve the nutrient-rich brown rice.)

“Bulk Up” snacks with peanut butter, cheese and margarine. Use dry milk in sauces and soups. Add ice cream and chocolate syrup to milkshakes and desserts. Sprinkle sugar over everything (unless a no concentrated sweet diet is needed).

Choose dinnerware for special needs: large handles on mugs and bowls to increase steadiness; plates with a lip to help get food on a spoon or fork; solid colored dishes to highlight food and minimize confusion; contrasting linen colors to make food easy to see.

Move the plate a ¼-turn to compensate for vision problems. Use dark table linens, so spills won’t show up easily. Use aprons, not bibs, at mealtimes if necessary.

Consider a swallowing evaluation for residents who are observed doing the following: pocketing of food, coughing or choking after meals or liquids, frequent throat clearing, drooling, gurgly voice quality, effortful chewing, complaining of pain while swallowing, watery eyes or running nose while eating, reflux, prolongation of meals. Implement diet modifications, positioning and swallowing techniques, and modify food consistencies.

Positioning techniques: keep the resident’s head and upper trunk as upright as possible with head at midline; the head should be slightly forward in relation to the neck and shoulders; the hips and small of the back should be centered at the back of the chair; arms should be resting on the table to facilitate proper shoulder posture; keep residents feet flat; adjust the table height; and have the resident sit close up to the table.

Serving and Food preparation techniques: Talk to the resident, tell her who you are and what you will be doing; speak slowly and clearly, feed slowly while alternating foods; don’t startle the resident with the feeding utensil; feed small amounts of food at a time; alternate sides of the mouth; offer sips of liquid often and tell the resident when you are done to put closure on the activity.

Nutritional strategies: Remove or substantially modify dietary restrictions; encourage the use of flavor enhancers; encourage more frequent small meals; offer liquid nutritional supplements for use between (not with) meals; improve protein intake by adding meat, peanut butter or protein powder; treat depression with antidepressants that do not aggravate nutritional problems; remove or replace medications that may have anorexia-producing side effects.

Staff Interventions: Ensure that residents are equipped with all the necessary sensory aides (dentures, hearing aide, glasses); ensure the resident is seated upright at 90 degrees preferably out of bed in the dining room in a chair (residents eating in the dining room are much less likely to have low intake); remove or minimize unpleasant sights, sounds and smells. 

Pharmacological Nutritional intervention: Megestrol acetate is a synthetic derivative of the female hormone progesterone. It can promote increased appetite and is very tolerated. The medication is designed to increase food intake, BMI, albumin, prealbumin, hemoglobin and lymphocyte count. This will require a physician order.

              

The Mini Nutritional Assessment - The Mini Nutritional Assessment is an effective, easily administered tool designed to identify older adults who have or are at risk for developing malnutrition. It consists of 18 questions and can be completed in about 15 minutes. A short form, containing the first six questions, can be used for screening. 

https://www.mna-elderly.com/forms/mini/mna_mini_english.pdf

Intervention Series: Mom is Falling - what you can do

Ninety percent of the more than 352,000 hip fractures in the U.S. each year are the result of a fall. The remaining 10 percent of the hip fractures occur spontaneously due to low bone density or osteoporosis. Spontaneous fractures can then precipitate the fall. Women have two to three times as many hip fractures as men, and white post menopausal women have a 1 in 7 chance of a hip fracture during their lifetime.  The hip fracture rate increases at age 50, doubling every five to six years. More than one-third of adults ages 65 years and older fall each year.

Alternatives for Falls Intervention:

Physical Measures:  Using a recliner or rocking chairs, seating adaptations such as wedge cushion, lowering bed or removing of bedframe to put mattress on the floor, commode/urinal at bedside, assistive devices such as quad canes and walkers, review of current medications that may destabilize gait and balance (benzodiazapines), call bell within reach, monitor blood sugar and oxygen levels, check for presence of infections (URI or UTI), consider medications for pain relief, anti-tippers for wheelchairs, self -releasing Velcro lap belt, fall mats at bedside, orthostatic BP & P monitoring, place in high visibility areas. Discuss with physician discontinuing or decreasing doses of medications associated with cognition changes, hypnotic or sedative effects (sleeping medications), bradycardia, hypotensive episodes, or sensory changes.

Environmental Measures: anti-rollback device to wheelchair, remove wheelchair foot supports when not in transport, remove visual barriers, cleat pathways, remove clutter that can fall and pose a hazard (magazines are very slippery on the floor), brakes on beds, bed in low position, repositioning for comfort, personal items within reach, assess seating, brake extenders for wheelchair, walker/cane tips in good condition, room closer to nurses station, assess sidrail use, bed/chair tabs alarms, pressure sensor alarm, reminder signs, non-skid strips on floor, remove wheels from overbed tables, consider motion detection night lights to illuminate pathway to bathroom, non-skid socks while in bed, properly fitting footwear and non-skid shoes, clothing that does not interfere or restrict movement, toileting schedule, room monitor, storage pocket for walker/wheelchair.

Psychosocial Measures: Active listening, behavioural strategies, sensory stimulation, increased surveillance, mental health evaluation.

Activity Measures: Structured daily routines, physical exercises, evening exercises, buddy system to monitor, PO/OT screening, music therapy, restorative ambulation, frequent toileting post-opioid pain medication and constipation relief measures.

The Morse Fall Scale (MFS) is a rapid and simple method of assessing a patient’s likelihood of falling. A large majority of nurses (82.9%) rate the scale as “quick and easy to use,” and 54% estimated that it took less than 3 minutes to rate a patient. It consists of six variables that are quick and easy to score, and it has been shown to have predictive validity and interrater reliability. The MFS is used widely in acute care settings, both in the hospital and long term care inpatient settings. Conduct your own falls assessment: http://networkofcare.org/library/Morse%20Fall%20Scale.pdf

Supplements for Older Adults

The human body is a complex network of different systems, all intricate in their design and function. What each system has in common is its need for nourishment, mostly in the form of nutrients, to operate properly.  Antioxidants, vitamins and minerals work synergistically to help the body reach optimal health. Deficiencies in these nutrients can have serious consequences. The immune system, bones, vision, mental clarity, blood pressure, metabolic function and energy are just a few of the health areas influenced by a deficiency in one or more vitamins and minerals. There is no substitute for a healthy, well-balanced diet; however, in today’s fast-paced lifestyles it is important to ensure the body is getting the fuel it needs.

Ideally, consuming foods such as fruits and vegetables can provide antioxidant protection to cells from the damaging free radicals as well as offer other essential vitamins and minerals that help the body perform optimally.  Unfortunately, many foods today are grown in mass quantities in soil that has been nutritionally depleted over many years of use. In a landmark study published in 2004, nutritional data of various vegetables and fruits over a 50-year period were found to have ‘reliable declines’ in protein, calcium, phosphorus, iron, Vitamin B2, and Vitamin C. It was felt this was due to the modern agricultural practices designed to breed new crops that provide larger yields, pest resistance, and climate adaptability.[i]

Combine the nutrient-deficient soil with over-processing and refinement of our foods, then add chemical preservatives and artificial color and flavor enhancers, and there is now a great need to supplement the missing vitamins, minerals, and antioxidants on a daily basis to help combat the inflammation and free radical production that our modern lifestyle generates. [ii]

Because dietary supplements are not FDA regulated as prescription and non-prescription drugs are for standards, safety, and effectiveness, there can be a wide variety of products on the market to choose from.  These can range from poor quality supplements with high amounts of fillers and nonessential ingredients to high quality, isotonic forms that have FDA marketing approval as high quality and easily absorbable. 

Vitamins are divided into two types: fat-soluble and water-soluble. Fat-soluble vitamins (vitamin A, D, E and K) are stored in the fat tissues and liver. They can remain in the body up to six months. When the body requires these, they are transported to the area of requirement within the body with help of special carriers. Water-soluble vitamins (B-vitamins and vitamin C) are not produced nor stored in the body like the fat soluble ones and need to be replenished everyday, whether consumed in our foods or supplementation.

Choosing the right multivitamin supplement is more than just looking at the ingredients. The form in which the supplement is in can make all the difference in the quality of the supplement you are receiving.  A good multivitamin should be easily absorbed and have all of the required daily levels that are essential to maintain good health. 

One multivitamin supplement recommended is ‘isotonic’ which comes as a powdered form to which you add 2 ounces of water to drink.  Isotonic, which means “same pressure,” bears the same chemical resemblance of the body’s blood, plasma and tears. All fluids in the body have a certain concentration, referred to as osmotic pressure (which is isotonic) and allow a consistent maintenance of body tissues. This means that the body has less work to do to in obtaining maximum absorption. The isotonic state of the suspension allows nutrients to pass directly into the small intestine and be rapidly absorbed into the bloodstream. With Isotonix (Nutrametrix) products, little nutritive value is lost, making the absorption of nutrients highly efficient while delivering maximum results.

The Nutrametrix Daily Multivitamin contains all the basic daily dietary needs, and can be with or without iron as recommended by your healthcare professional.  You can then add other Nutrametrix isotonic dietary supplements according to your own personal needs, for instance, for arthritis, allergies and joint pains (antioxidants like OPC-3 and vitamin C), elevated cholesterol (Essential Omega 3 oil with Vitamin E) or nerve conduction/ nerve pain and stress levels (Activated B-complex).  These items can be found online at www.nutrametrix.com/karendoll.  There is a free “Nutri-physical” you can complete online that will help individualize your supplement needs according to your personal needs.  (www.nutrametrix.com/karendoll/nutri-physical).  Before considering any supplemental regimen, be sure to consult your healthcare provider. 

Omega 3 fatty acids have been shown to be effective in fighting inflammation

 in your body as well as in reducing overall cholesterol levels and triglycerides, improving blood flow and blood pressure, and may also help to reduce the occurrence of the more severe outcomes of heart disease. Fatty fish such as salmon, sardines, anchovies and mackerel provide essential omega 3 fatty acids, especially eicosapentaenoic acid (EPA) and docosahexanenoic acid (DHA).   The American Heart Association recommends 1000 mg per day of Omega-3 EPA/DHA for patients with coronary heart disease and 2000 to 4000 mg per day for patients with high triglycerides. For vegetarians or those who have fish allergies, flax seeds or flax seed oil provides an acceptable alternative. 

To achieve this level of supplementation, a high quality Omega-3 oil is recommended daily as you want to know it is tested to be free of fillers and non-essential ingredients, like the Nutrametrix Heart Health Essential Omega-3 with Vitamin E.  NutraMetrix Heart Health Essential Omega III comes from small anchovies and sardines that have a short lifecycle making them an ideal source of fish oil because they are less prone to accumulating environmental toxins that can be found in larger, longer-lived fish.  A good quick way to test any fish oil supplement is to place a capsule in the freezer overnight.  Pure oil will not freeze solid, but those with mostly added fillers will.  If it is firm and inflexible when frozen, it is likely to be more filler ingredients than omega-3 oil.

Another source of inflammation-fighting healthy fats is nuts—particularly almonds, which are rich in fiber, calcium, and vitamin E, and walnuts, which have high amounts of alpha-linolenic acid, a type of omega-3 fat. All nuts, though, are packed with antioxidants, which can help your body fight off and repair the damage caused by inflammation.

Antioxidants are another key supplement necessary for health, especially as we age that will reduce ‘free radical’ formation.  Free radicals are unstable molecules or compounds that react negatively with other molecules creating stress on the body.  This free radical formation is a natural process that occurs daily when the body breaks down certain substances in our environment or food, or comes in contact with pollutants.  Specifically, antioxidants provide the body with a defense against the negative effects of the free radicals, then stabilize and prevent other molecules from turning into unstable free radicals, thereby promoting good health.

Inflammation is part of the body’s immune response; without it, we can't heal. But when it's out of control it can damage the body. Chronic inflammation has been linked to many cardiovascular diseases. Cholesterol gets deposited in the lining of blood vessels and acts as an insult.  Cytokines respond to these insults in the bloodstream, which leads to systemic inflammation. Inflamed blood vessels and growing fatty plaque can cause blockages and blood clots, which then can cause heart attacks.  Foods high in sugar, saturated and trans fats, excess weight, smoking, pollution, chemical preservatives, poor oral health and unhealthy diets in general cause chronic inflammation.   In addition to cardiovascular disease, inflammation is also associated with diseases such as arthritis, autoimmune diseases, allergies, asthma, cancer, and inflammatory bowel diseases.

Three important antioxidants, OPC-3, Vitamin C, and CoQ10, have been found to be beneficial for heart health by reducing inflammation as well as the number of free radicals causing inflammatory damage in our bodies.   Oligomeric proanthocyanidins (OPCs) are bioflavonoids (complex organic plant compounds) found in fruits, vegetables and certain tree barks that provide exceptional nutritional benefits to the human body. Studies have shown OPCs to be up to 20 times more powerful than vitamin C and 50 times more powerful than vitamin E in neutralizing free radicals.  Supplementing with a high quality isotonic OPC, like the Nutrametrix (Isotonix) formulation OPC-3 taken with your daily multivitamin will help fight the free radicals and offer an effective anti-inflammatory.

Vitamin C is an essential water-soluble nutrient that must be replenished on a daily basis. It is important to know that cooking destroys vitamin C activity.  Aside from it’s well known antioxidant properties, vitamin C supports cardiovascular health in a few different ways, i.e. normalizing blood pressure and cholesterol levels, in addition to supporting our immune system and pulmonary health. A lack of vitamin C can cause general fatigue, as it helps moderate healthy iron absorption, transport and storage.  In the typical diet, most vitamin C comes from fresh fruits and vegetables. Peppers, like sweet green and red peppers, hot red and green chili peppers, are especially rich in vitamin C. Other good sources include citrus fruits and juices, brussel sprouts, cauliflower, cabbage, kale, collards, mustard greens, broccoli, spinach and strawberries.

Another powerful antioxidant and vital nutrient to promote energy production within our cells is CoenzymeQ10 (CoQ10).  CoQ10 levels in our body naturally diminish with age, and even faster with poor eating habits, stress or infections.  It is reported that the use of statins (cholesterol-lowering medications) will also reduce the body’s ability to make CoQ10 even further.  It is generally a combination of choosing the right foods containing CoQ10 with additional supplementation daily that will provide the body with the best possible amount of CoQ10 for optimal health.  CoQ10 is naturally found in high levels in organ meats such as liver, kidney, and heart, as well as in beef, sardines, and mackerel. Vegetable sources of CoQ10 include spinach, broccoli, and cauliflower with peanuts and soybeans the best non-animal sources. 

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[i] University of Texas (UT) at Austin’s Department of Chemistry and Biochemistry was published in December 2004 in the Journal of the American College of Nutrition

[ii] See also antioxidants for a definition of free radicals.