Nutrition and Overall Health Status in Elderly Patients

Simon D. Murray, MD: There are certain diseases that are more prevalent in older people, and I’d like to talk to you about your approach to nutrition with certain diseases. Osteoporosis comes to mind. I’ve read some of the things you wrote about osteoporosis and acidity and alkalinity. Tell me about that.

Jane Schwartz, RDN: I think there’s a misunderstanding about how much calcium someone might need. There’s also kind of an abuse of calcium supplements. I’ll sometimes have someone come into the office and they’re on high-dose calcium supplements, and they’re getting calcium in their diet. And then it’s not balanced by magnesium, or maybe they don’t know about their vitamin D levels, or their diet doesn’t include any vegetables. We have to look at the combination of the calcium supplement and what’s in the diet, because we don’t really want to go over 1000 mg or 1200 mg. And also, to educate them that you can only absorb about 500 mg of calcium at any given time.

Simon D. Murray, MD: Yes.

Jane Schwartz, RDN: Sometimes they’re confused. They might be taking all 1200 mg at once and are getting this big overload in their bodies. Or they’re taking it at the same time they’re having cereal, or yogurt, so they’re not getting the calcium, actually all of that absorption, in their body to begin with. Or they may be taking it at the same time as an iron supplement, and that could be interfering. But calcium is not the be-all-end-all of osteoporosis.

Simon D. Murray, MD: No.

Jane Schwartz, RDN: You want to have a certain amount of calcium in the diet, but you also need a good magnesium status, because magnesium helps with calcium absorption and vitamin D absorption. Vitamin D is critical for bone health as well. So there are just more factors that go into it. And then, what they’re also discovering in the research for osteoporosis is that a heavy meat-based diet is not as beneficial for bone health as more plant-based diets. Then you go back to the benefits of all of the plant-based foods. Even though some of them don’t have calcium, per se, in them, they have so many other nutrients that are supportive for the bone, that are also helping prevent bone issues.

Simon D. Murray, MD: Yes. I know that high protein diets, in general, can promote osteoporosis. I also know that calcium taken in excess of what you need can be toxic to one’s cardiovascular health.

Jane Schwartz, RDN: That’s right.

Simon D. Murray, MD: And so, the recommendations have come down…for supplementation of calcium. But I think the best way to get it would be food, of course.

Jane Schwartz, RDN: Yes, ideally it is food.

Simon D. Murray, MD: And the whole thing about dairy has changed, I think, recently. I understand that we have to be careful about where the recommendations come from, but I’ve been reading more and more about the benefits of cheese and about, well of course yogurt, but cheese, and other whole-fat dairy products as being beneficial to people in terms of cardiovascular health and bone health. Have you read anything about a change in attitude about dairy products?

Jane Schwartz, RDN: I think there is a trend toward going away from all of the low-fat products and embracing more whole, natural foods, so then you wouldn’t be removing the fat. I think the debate is still out there, whether that’s going to be more beneficial, because of the whole saturated fat issue, and with heart disease, and blood sugar, and diabetes. I don’t think we know yet. So for whoever I’m working with, it depends on what their whole diet is like. If they’re eating more whole milk dairy, it shouldn’t be a big part of their diet where they’re having cups of this. If it’s a small amount, mixed with some berries and some ground flax seeds, that’s fabulous. It just depends on the overall amount of saturated fat and meat in the diet, in general. So a good, clean, whole milk dairy product with cheese, I think, is fine—in modest amounts.

Simon D. Murray, MD: Yes, low sodium maybe.

Jane Schwartz, RDN: Yes.

Simon D. Murray, MD: Can you tell me about the DASH [Dietary Approaches to Stop Hypertension] diet? The DASH diet is around 20 years old, I think, 15 or 20 years old. There’s evidence-based medicine to suggest that it really does work on hypertension.

Jane Schwartz, RDN: Absolutely.

Simon D. Murray, MD: But it’s not followed by most people, I would say.

Jane Schwartz, RDN: That’s true. So the DASH diet stands for Dietary Approaches to Stop Hypertension, and it was done by the National Institutes of Health, I believe. They did this study, thousands of people were involved. They put these people on a diet of very high amounts of fruits and vegetables. I think it was about 10 servings a day of fruits and vegetables. And then it was whole grains, a couple servings of low-fat dairy, a serving of nuts, a serving of beans a few times a week. And so, their diets were very rich in all of these amazing minerals and vitamins. It was small amounts of animal protein and very low sugar.

What they found without even reducing sodium levels, they were not on a low salt diet, was that blood pressure levels dropped significantly.

Simon D. Murray, MD: Yes.

Jane Schwartz, RDN: And then they put them on slight sodium restriction, and levels went down even a little bit more. But even just with the diet alone, without sodium, they saw results.

Simon D. Murray, MD: That’s interesting. Do you know any people who were able to follow that diet?

Jane Schwartz, RDN: I’ve seen many people who are increasing their fruits and vegetables, in general, and decreasing their sugar, and their blood pressure is absolutely coming down, even without the extreme 10 servings a day, which is challenging to get in but not as challenging as most people think if you know how to do it right.

Transcript edited for clarity.