Nutritional medicine for the elderly

Regarding whether it is necessary to take "supplements" and what should be taken for the nutrition of the elderly, the answer is very clear - there is no universal nutritional "magic pill" suitable for all elderly people. All nutritional supplement choices must first correspond to individual dietary gaps, basic diseases and metabolic status. Blindly following the trend of supplementation will put a burden on the body.

Don’t believe it. I met Aunt Zhang at a community nutrition clinic last month. I heard from my sister that protein powder can enhance immunity. I spent more than 3,000 yuan to buy two cans of imported powder. I brewed one cup every morning and evening. After drinking it for less than half a month, my feet became swollen. When I came to the hospital for a check, the creatinine spiked to 160. She already has mild renal insufficiency. Taking too many high-protein supplements means overloading the kidneys, which is not worth the loss.

Speaking of this, some people may want to ask, multivitamins are safe after all, right? There is no harm in eating something delicious for the elderly who have difficulty digesting it? Alas, this is precisely the point of controversy that has been quarreling among the nutrition community for many years. Most scholars in the field of public health support routine supplementation: after all, most elderly people in China have a simple diet, eating a lot of polished rice and white flour, and their intake of eggs, milk, dark green vegetables, and deep-sea fish and shrimp generally does not meet the requirements of the dietary guidelines. Especially for the elderly who live alone, have bad teeth, and struggle to eat well, the benefits of taking low-dose multivitamins to fill the gap far outweigh the risks. However, many doctors in the clinical nutrition department hold a conservative attitude: as long as the elderly can eat independently and eat more than 12 kinds of food every day, there is no need for additional supplements. Especially the fat-soluble vitamins A, D, E, and K cannot be excreted in the urine if they eat too much. Long-term overdose can easily lead to poisoning. Our department had an old man before who took 2 multivitamins a day and added cod liver oil. He overdosed on vitamin A and suffered dizziness and vomiting for half a month before finding the cause.

More common than multivitamins are calcium tablets, which are a standard requirement for the elderly in almost every household, but this is really not something that can only be taken. There used to be a 70-year-old Uncle Li who bought calcium carbonate and took 2 tablets a day. He also drank high-calcium milk and ate calcium milk biscuits every day. He was panicked when kidney stones were found during his last physical examination. He had high blood calcium and did not like to drink water. The calcium he added could not be metabolized, and it all accumulated in the kidneys and turned into stones. Let’s talk about some trivia that many people don’t know: Many elderly people are not deficient in calcium. What they lack is vitamin D, which helps calcium absorption. Spending 20 minutes in the sun every day is more effective than taking two bottles of calcium tablets. If you really want to supplement, it’s best to check 25-hydroxyvitamin D and blood calcium first. Don’t eat blindly with your eyes closed.

In addition to calcium tablets, fish oil has been highly praised in recent years. Many elderly people take it as a blood vessel scavenger. In fact, there are more pitfalls in it. Some guidelines in the cardiovascular field mention that elderly patients with high triglycerides can follow the doctor's advice to take prescription-grade high-purity EPA fish oil, which can help lower blood lipids. However, the Omega-3 content of ordinary health product-grade fish oil is mostly less than 30%, and the rest is all saturated fat and gelatin. It is useless and makes you gain weight easily. Large-scale studies in recent years have shown that for healthy elderly people with no underlying cardiovascular diseases, regular consumption of fish oil cannot prevent myocardial infarction and stroke. If they themselves take anticoagulants such as warfarin, it will increase the risk of bleeding.

I usually do nutritional consultation in the community, and I don’t prescribe supplements to the elderly. I usually ask family members to help me keep a three-day food diary. It doesn’t have to be very precise. I roughly write down how much milk I drink every day, how much meat I eat, whether I eat fish and shrimp, and how much vegetables and fruits I eat. Combined with the recent physical examination report, I can make up for whatever is missing. If there is no shortage, there is no need to spend money.

I met an 82-year-old Mr. Wang at a free clinic a while ago. He lives next to a market. He walks around to buy groceries every morning, eats meat and vegetables at noon, and eats an apple and a cup of yogurt in the afternoon. He has never bought any supplements. His physical examination showed that his blood calcium, vitamin D, and hemoglobin are all within the normal range. He is more energetic than many old people who take a bunch of nutritional pills every day. To be honest, for the elderly, eating well is more effective than any expensive nutritional medicine. If you really feel that your diet cannot keep up, first ask the nutrition department of a regular hospital. Don't listen to the nonsense of health product sales. Spend your money wisely.