Nutritional deficiencies in the elderly

Nutritional deficiencies in the elderly are really not as simple as "reluctance to eat" or "cannot afford good food". More than 90% of the problems are the result of the superposition of physiological decline, chronic disease constraints, and old dietary concepts. As long as you find the right personalized adjustment direction, most of them can be replenished by spending a small amount of money without relying on high-priced health products.

Last week, I was doing a nutritional screening at the community health service center and met 68-year-old Aunt Zhang. Her children are out of town all year round and she pays her monthly to buy sea cucumber and bird's nest. As a result, she lost only 82 pounds and her blood albumin was only 32g/L. She was moderately malnourished and could walk without a smile. After asking about it, I found out that she had lost three of her back molars and could not chew lean meat. She was also afraid of high blood sugar levels if she ate too much. She drank half a bowl of porridge at every meal and only ordered pickles. She ate bird's nest once a week in a small bowl. What's the use?

Many people have misunderstandings about the weight of the elderly. They always say that "no money can buy you old age and lose weight." They think that if you lose weight, you will not suffer from hyperlipidemia and diabetes. This is not unreasonable, but it must be measured in a certain way - the risk of hip fracture for elderly people with a BMI lower than 18.5 is 2.3 times that of normal-weight people, and the probability of becoming severe after getting the flu is also nearly 2 times higher. This is the survey data released by the Geriatrics Department of Peking Union Medical College Hospital last year. It is really not alarmist.

Nowadays, two groups of people are quarreling fiercely about how to supplement nutrition for the elderly: one group is the elderly who adhere to traditional concepts. They think that "a simple meal is the most nourishing" and eating too much meat, eggs and milk is a burden.； The other group is the panicked juniors, who think that the more expensive supplements are more useful, and often buy protein powders and imported vitamins worth thousands of yuan. In fact, both of them have gone to extremes. Many elderly people I have met are not reluctant to eat, but simply unable to eat - their sense of taste has deteriorated, and everything they eat tastes tasteless. Even twice the amount of salt in a stir-fry dish tastes bland. Eating too much salt can easily lead to high blood pressure and fall into an endless cycle. ； Some people have removable dentures, which make their gums hurt when they chew. They would rather drink porridge every day than eat hard food.

As for whether to take supplements, there is no complete consensus in the academic circles: The evidence-based nutrition school believes that as long as the daily diet can include 1 egg, 300ml of milk, 2 taels of lean meat, 1 catty of vegetables and half a catty of fruits, there is no need to take additional supplements at all.； But most doctors who work in geriatric clinics don’t think so. The gastric acid secretion of the elderly is less than 60% of that of young people. Even if they eat enough, the absorption efficiency of vitamin B12, vitamin D, and calcium is very low. Most elderly people cannot reach the recommended intake, so it is recommended to supplement them regularly in small doses. My own experience is, don’t just follow the trend and buy it. Go to a community hospital to draw blood and do a simple nutrient screening first, and make up for whatever is missing. I once met a 72-year-old man who bought 12 kinds of supplements after listening to a live broadcast and took them every day. In the end, he was overdosed with vitamin A and suffered from dizziness for half a month. It was just a waste of money.

In fact, many adjustment methods are very simple and don’t cost much at all. For example, if you have bad teeth and can't chew meat, you can chop the lean meat into minced meat and steam it in egg custard, or use a pressure cooker to stew the ribs until they fall off the bones, so you can eat them without straining your teeth. ； If the dish feels tasteless, I use mushroom powder and dried shrimps instead of salt to make it fresher. The sodium intake is reduced but the taste is sufficient. ； If you are afraid of high blood sugar levels when eating fruits, choose low-GI fruits such as strawberries and kiwis. Eat half a piece at a time. If you can’t chew them, just steam them for two minutes. The loss of vitamins will not be as much as you think.

Yesterday, Aunt Zhang came for a check-up. Her weight had increased by almost 6 pounds, and her albumin had returned to the normal range. She was also holding a bag of strawberries she had just bought. She said that she could now eat less than half a bowl of minced pork and steamed eggs every day, which was much more appetizing than the 3,000 yuan a box of sea cucumbers her son bought before. You see, it’s not that complicated. If you find the root of the problem, nutritional supplementation for the elderly is not difficult at all.