- Email: [email protected]
Stopping heart disease with diet
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Stopping Heart Disease with Diet Peggy K. Yen, RD, MPH Cardiovascular disease kills more elderly adults than any other single cause. Just as important, this disease disrupts lifestyle and limits mobility for many older people. Can dietary changes help elders as much as younger people? Reductions in total fat and saturated fat intake are recommended for older adults with high b l o o d cholesterol. Total fat intake should be less than 30% of calories, and saturated fat should be 10% of calories or less. This formula allows about 60 grams of fat and 20 grams of saturated fat for an older man with an average calorie intake. The comparable numbers for the average elderly woman are 44 grams of fat and 14 grams of saturated fat. Eating a low-fat, low-cholesterol diet not only will reduce elders' risk of death and disability from heart disease but also will help prevent chronic 7olest diseases like cancer, high blood pressure, and diabetes. Avoiding drug t r e a t m e n t - - a good possibility with dietary intervention and increased physical activity--saves elders money and the trouble of side effects. Dietary treatment of high blood cholesterol in elders should be tried for at least 6 months before drug therapy is started.
dietary step
helping elders lower
cholesterol. !
Is Low Blood Cholesterol Risky? Physicians and even nurses sometimes drag their feet on encouraging dietary changes to l o w e r blood cholesterol. At one time, research seemed to show that elders with low blood cholesterol were more likely to die. Now, however, deaths once attributed to low blood cholesterol in elderly people clearly are a result of frailty and chronic disease. For example, the mortality rate for malnourished elderly patients with congestive
50
heart failure was 80%, compared with 18% for their nonmalnourished counterparts in a recent study. In such patients, low blood cholesterol is a symptom rather than the cause of poor health.
What Foods and Nutrients Help Lower Blood Cholesterol? Lower fat and cholesterol intake is the most important dietary step in helping elders lower blood cholesterol. Soy foods., fiber, fish oils, and certain vitamins also have some ability to lower cholesterol or fight heart disease. Soy protein substituted for animal protein can lower L D L cholesterol, the "bad" cholesterol, by 9% to 20%, depending on the amount eaten. People who think elders won't tolerate meatless meals can look to the Little Creek Sanitarium in Tennessee, where residents enjoy an entirely vegetarian menu. Soy foods, such as tofu, have the added advantage of being easy to chew and digest. Tofu can substitute for eggs in "egg" salad, soy milk can be used on cereal and in shakes, and soy flour can be substituted for some of the regular flour in recipes. High-fiber cereals, like bran cereal and oatmeal, can help lower blood cholesterol, as well as prevent constipation and possibly colon cancer. Many of these products are fortified with vitamins and minerals so that eating a serving is like taking a vitamin supplement--not a bad idea for elders whose diets are marginal. A cup of bran flakes has about 8 grams of fiber compared with cornflakes, which has only i gram. However, relying on supplements for fiber intake deprives elders of the other nutrients found in fiber-rich foods. Fish consumption long has been related to lower risk of cardiovascular disease. And eating fish is just as good as, if not better than, taking capsules. Sardines and canned salmon, for example, contribute fish oil and calcium. However, fish can be high in sodium, so the other foods at these meals should be low in sodium to keep the total intake reasonable. Vitamin E and folic acid can help prevent heart disease and strokes. Folic acid lowers homocys-
Geriatric Nursing Volume 19, Number 1
teine levels, which increase the risk of heart disease and stroke when too high. Up to 25% of elders may have elevated homocysteine levels. Many elderly people do not eat enough folate-rich fruits and vegetables. The bran cereal mentioned above contributes the recommended amount of 400 mcg in one cup. Other good folate sources are lentils, kidney beans, spinach, and orange juice. In addition to boosting immunity, high vitamin E intake is associated with reduced risk for coronary disease. Most studies have used supplements to increase vitamin E intake because the main food source of vitamin E is vegetable oil and foods made with oil. The Alliance for Aging Research recommends an intake of 100 to 400 IU of vitamin E daily, 10 to 40 times the recommended dietary allowance. Apparently no harm results from vitamin E intake up to 800 mg a day, but most authorities are not ready to recommend vitamin E supplements for heart disease prevention. Fruits and vegetables are good sources of many important substances needed to help prevent heart disease. The national campaign to increase fruit and vegetable consumption, known as "Five A Day For Better Health," might be a little misleading to elders who don't read the fine print. The actual recommendation is five to nine servings a day of fruits and vegetables, a goal most older adults don't reach.
Do All Elders Need Dietary Changes? All elders will benefit from consuming more of the foods mentioned above. Caution older adults that taking supplements in place of food won't turn a bad diet into a good one. Older adults with high blood cholesterol who already have developed heart disease are prime candidates for dietary intervention. Also, caregivers should remember that although low blood cholesterol is desirable in healthy elders as a way of preventing disease, frail elders with low blood cholesterol may be malnourished or may have other debilitating illnesses that would rule out aggressive dietary therapy for heart disease prevention.
PEGGY K. YEN, RD, MPH, is a nutrition consultant with Cardiovascular Health and Nutrition Services, Divisionof Community and Public Health Services, Maryland Department of Health and Mental Hygiene, in Baltimore. Geriatr Nurs 1998;19:50-1. Copyright © 1998 by Mosby, Inc. 0197-4572/98/$5.00 + 0 34/1/89090
in residential N.E. Washington, DC'is a member of the Daughters of Charity National Health System.
Clip and mail this coupon to:
Please send a brochure on the meeting listed below: I / Name: [ Address: [ City: State:. [ ' Zip' Mtg # k! " Contemporary Foru - ~ s y 11900 Silvergate Dr, Dept. 442, Dublin, CA 94568 I_ (51_._0)828-7100, Ext.0 www.cforums.com (Dept.442) .j
Geriatric Nursing Volume 19, Number 1
We seek a team player to become an integral part of this new and busy Practice working with 2 Geriatricians who will value your excellence in: • Patient Care • Patient Advocacy • Customer Service • Patient Teaching • Community Resources for the Elderly Candidates must be licensure eligible in DC; with current CPR certification; and a minimum of 2 years of experience in an Adult Medicine/Internal Medicine outpatient environment with a focus in Geriatrics. Knowledge of OSHA and CLIA regulations required
Please fax resume c/o Ger/NJ to (202)269-7662 with salary history and requirements, We do preemployment drug screening. EOE I I
I
I
II
ill
I
I
I
III
51
O
Stopping Heart Disease with Diet Peggy K. Yen, RD, MPH Cardiovascular disease kills more elderly adults than any other single cause. Just as important, this disease disrupts lifestyle and limits mobility for many older people. Can dietary changes help elders as much as younger people? Reductions in total fat and saturated fat intake are recommended for older adults with high b l o o d cholesterol. Total fat intake should be less than 30% of calories, and saturated fat should be 10% of calories or less. This formula allows about 60 grams of fat and 20 grams of saturated fat for an older man with an average calorie intake. The comparable numbers for the average elderly woman are 44 grams of fat and 14 grams of saturated fat. Eating a low-fat, low-cholesterol diet not only will reduce elders' risk of death and disability from heart disease but also will help prevent chronic 7olest diseases like cancer, high blood pressure, and diabetes. Avoiding drug t r e a t m e n t - - a good possibility with dietary intervention and increased physical activity--saves elders money and the trouble of side effects. Dietary treatment of high blood cholesterol in elders should be tried for at least 6 months before drug therapy is started.
dietary step
helping elders lower
cholesterol. !
Is Low Blood Cholesterol Risky? Physicians and even nurses sometimes drag their feet on encouraging dietary changes to l o w e r blood cholesterol. At one time, research seemed to show that elders with low blood cholesterol were more likely to die. Now, however, deaths once attributed to low blood cholesterol in elderly people clearly are a result of frailty and chronic disease. For example, the mortality rate for malnourished elderly patients with congestive
50
heart failure was 80%, compared with 18% for their nonmalnourished counterparts in a recent study. In such patients, low blood cholesterol is a symptom rather than the cause of poor health.
What Foods and Nutrients Help Lower Blood Cholesterol? Lower fat and cholesterol intake is the most important dietary step in helping elders lower blood cholesterol. Soy foods., fiber, fish oils, and certain vitamins also have some ability to lower cholesterol or fight heart disease. Soy protein substituted for animal protein can lower L D L cholesterol, the "bad" cholesterol, by 9% to 20%, depending on the amount eaten. People who think elders won't tolerate meatless meals can look to the Little Creek Sanitarium in Tennessee, where residents enjoy an entirely vegetarian menu. Soy foods, such as tofu, have the added advantage of being easy to chew and digest. Tofu can substitute for eggs in "egg" salad, soy milk can be used on cereal and in shakes, and soy flour can be substituted for some of the regular flour in recipes. High-fiber cereals, like bran cereal and oatmeal, can help lower blood cholesterol, as well as prevent constipation and possibly colon cancer. Many of these products are fortified with vitamins and minerals so that eating a serving is like taking a vitamin supplement--not a bad idea for elders whose diets are marginal. A cup of bran flakes has about 8 grams of fiber compared with cornflakes, which has only i gram. However, relying on supplements for fiber intake deprives elders of the other nutrients found in fiber-rich foods. Fish consumption long has been related to lower risk of cardiovascular disease. And eating fish is just as good as, if not better than, taking capsules. Sardines and canned salmon, for example, contribute fish oil and calcium. However, fish can be high in sodium, so the other foods at these meals should be low in sodium to keep the total intake reasonable. Vitamin E and folic acid can help prevent heart disease and strokes. Folic acid lowers homocys-
Geriatric Nursing Volume 19, Number 1
teine levels, which increase the risk of heart disease and stroke when too high. Up to 25% of elders may have elevated homocysteine levels. Many elderly people do not eat enough folate-rich fruits and vegetables. The bran cereal mentioned above contributes the recommended amount of 400 mcg in one cup. Other good folate sources are lentils, kidney beans, spinach, and orange juice. In addition to boosting immunity, high vitamin E intake is associated with reduced risk for coronary disease. Most studies have used supplements to increase vitamin E intake because the main food source of vitamin E is vegetable oil and foods made with oil. The Alliance for Aging Research recommends an intake of 100 to 400 IU of vitamin E daily, 10 to 40 times the recommended dietary allowance. Apparently no harm results from vitamin E intake up to 800 mg a day, but most authorities are not ready to recommend vitamin E supplements for heart disease prevention. Fruits and vegetables are good sources of many important substances needed to help prevent heart disease. The national campaign to increase fruit and vegetable consumption, known as "Five A Day For Better Health," might be a little misleading to elders who don't read the fine print. The actual recommendation is five to nine servings a day of fruits and vegetables, a goal most older adults don't reach.
Do All Elders Need Dietary Changes? All elders will benefit from consuming more of the foods mentioned above. Caution older adults that taking supplements in place of food won't turn a bad diet into a good one. Older adults with high blood cholesterol who already have developed heart disease are prime candidates for dietary intervention. Also, caregivers should remember that although low blood cholesterol is desirable in healthy elders as a way of preventing disease, frail elders with low blood cholesterol may be malnourished or may have other debilitating illnesses that would rule out aggressive dietary therapy for heart disease prevention.
PEGGY K. YEN, RD, MPH, is a nutrition consultant with Cardiovascular Health and Nutrition Services, Divisionof Community and Public Health Services, Maryland Department of Health and Mental Hygiene, in Baltimore. Geriatr Nurs 1998;19:50-1. Copyright © 1998 by Mosby, Inc. 0197-4572/98/$5.00 + 0 34/1/89090
in residential N.E. Washington, DC'is a member of the Daughters of Charity National Health System.
Clip and mail this coupon to:
Please send a brochure on the meeting listed below: I / Name: [ Address: [ City: State:. [ ' Zip' Mtg # k! " Contemporary Foru - ~ s y 11900 Silvergate Dr, Dept. 442, Dublin, CA 94568 I_ (51_._0)828-7100, Ext.0 www.cforums.com (Dept.442) .j
Geriatric Nursing Volume 19, Number 1
We seek a team player to become an integral part of this new and busy Practice working with 2 Geriatricians who will value your excellence in: • Patient Care • Patient Advocacy • Customer Service • Patient Teaching • Community Resources for the Elderly Candidates must be licensure eligible in DC; with current CPR certification; and a minimum of 2 years of experience in an Adult Medicine/Internal Medicine outpatient environment with a focus in Geriatrics. Knowledge of OSHA and CLIA regulations required
Please fax resume c/o Ger/NJ to (202)269-7662 with salary history and requirements, We do preemployment drug screening. EOE I I
I
I
II
ill
I
I
I
III
51