1 diet (eat less) 2 Exercise: Workouts May Help Turn Back Clock 3 falling injuries/fractures 4 NUTRITION 5 food safety + quiz 6 magnesium 7 NUTRITION articles \1 diet (eat less) Eat less, and better, to live to 120? By Daryn Eller (WebMD) - Roy Walford, M.D., prof emeritus of pathology at UCLA, is preparing to eat lunch, and you can hardly blame me for scrutinizing his plate. This is, after all, the man who has long claimed that calorie restriction with optimal nutrition (what he calls the CRON diet) can help people live for 120 years -- possibly even longer. This is also the man who, in an era of rapidly increasing obesity, has made the radical suggestion that people maintain a weight 10 to 25% below their "set points" (the weight to which the body naturally gravitates). So who wouldn't want to see if the man practices what he preaches? Here are some sample menus. Be sure to check with your doctor before trying this or any diet Actually, Walford's lunch surprises me a little. On his plate, prepared by one of the two office assistants at his Venice Beach, California, home, is a meal not mentioned in his new book, "Beyond the 120-Year Diet," an update of his 1986 book, "The 120-Year Diet." It consists of a small slice of gourmet pizza topped with vegetables, grilled squash and a fistful of penne pasta with tomato sauce. Walford assures me this is not his usual midday repast: "I ate out last night and there were leftovers, so I brought them home." But the man is not the ascetic one might assume him to be. In fact, a lot of assumptions about Walford are off the mark. Not your average white-coated lab rat To be sure, Walford, 76, is unconventional. He sports a shaved head and a walrus moustache, and he lives a rather bohemian existence in a boarded-up commercial building just steps away from the Venice boardwalk -- a place where people come to whirl on skateboards, get tattooed and sometimes espouse kooky theories. He has published fiction and poetry, dabbled in performance art and among other expeditions, has trkkked across Africa. Yet Walford has also maintained a distinguished career as a gerontologist for more than 50 years. An adventurer as well as a scientist, he is best known for his two-year stint in Biosphere 2, the utopian greenhouse experiment in self-sustenance conducted in Oracle, Arizona. Because many of its crops failed, the Biosphere inadvertently became a human study in severe calorie restriction -- in fact, the only such study that has been done on humans to date. But Biosphere also took a serious physical toll on Walford. Working six days a week in the fields left him with an injured back that ultimately required surgery. Worse, he suffered nitrous oxide poisoning because the structure's glass enclosure prevented ultraviolet light from penetrating and dissipating the gas, an agricultural byproduct. The resulting nerve damage has made it difficult for Walford to walk. When we meet, he sits somewhat hunched behind his desk the entire time. He appears more frail and diminutive than I expected. The science of calorie restriction The notion that humans may live 50 percent longer if they eat less is extrapolated from work with animals, Walford says. The first research showing that calorie-restricted rats live longer than their regularly fed counterparts was done in 1935 at Cornell University. Subsequent studies over the last 65 years (Walford estimates that there are 2,000 to 3,000 papers on the topic) have produced similar results and have also indicated that animals on calorie-restricted diets have a lower incidence of cancer, arteriosclerosis, and autoimmune disease. Results have been so promising that the National Institute on Aging (NIA) now spends $3 million a year to study caloric restriction, mostly in rats and monkeys, and has funded Walford's work in the past. Walford has been doing pioneering calorie restriction work with animals since the 1960s. He's found that the animals not only live longer, they live better. For instance, his 1987 study in the Journal of Gerontology found that when mice of varying ages were placed on rotating rods to test their muscle strength and coordination, calorie-restricted 31- to 35-month-old mice performed just as well as their 11- to 15-month-old counterparts. Likewise, the older mice did as well on maze tests, indicating that they had no apparent decline in mental function. "People say they don't want to live to 120 because they think they're going to be frail for 40 years," says Walford. "They don't realize that calorie restriction extends the period of viability and good health." Exactly how the CRON diet may extend life is not known, but several theories have been proposed. "One is that animals, when faced with a shortage of food, will rechannel energy from growth and reproduction into maintenance and repair," says Walford. Other theories suggest that the diet may limit cell-damaging free radicals, decrease blood sugar and insulin or prevent the immune system from deteriorating. Walford concedes that we don't know for sure whether what's true for rodents applies to humans, although ongoing studies at the University of Wisconsin and the NIA using monkeys as subjects may give us a better idea. The monkeys, studied for 10 years, have demonstrated a lower rate of diabetes than their regularly fed counterparts. They've also maintained higher than normal levels of the hormone DHEA, which is associated with youth, according to Mark Lane, Ph.D., head of nutritional and molecular physiology in the Laboratory of Neurosciences at the NIA and principal investigator on the study. Again, the closest thing to a human study is Walford's Biosphere experiment. After two years of functional caloric restriction, the inhabitants had declines in blood pressure, blood cholesterol and blood glucose, which Walford says are markers of aging. Lane, however, isn't convinced -- despite his great respect for Walford's work. "The study shows that you can produce positive health changes in people through calorie restriction, but the data I've seen don't show anything about aging." His own guinea pig Walford, who is currently editing a video documentary about Biosphere 2 and doing animal research at UCLA, has himself been adhering to the CRON diet since 1984. Today he carries about 134 pounds on his 5-foot-8-inch frame. "My set point is about 155," he says. "I was a Big Ten wrestling champion at the University of Chicago and I had to train down, so I know it pretty well." To stay underweight, he consumes about 1,600 calories a day, but says he doesn't feel deprived. "You get accustomed to it after a while," he says. "If you hhange your eating habits to include more whole food (beans, rice, vegetables and fruit), then you'll eat less." Walford eats out about once a week, usually at one of the neighborhood's tonier restaurants. At home, on a typical day, breakfast might be a banana-strawberry milkshake or half a cup of millet with wheat germ and fruit. Lunch is a large bowl of fish chowder (made with skim milk) and a whole-grain roll or a sardine sandwich. For dinner once a week, Walford has a mega-salad of his own creation, consisting of an assortment of raw vegetables (lettuce, spinach, peppers, broccoli, sweet potato, onions, cabbage), rice and beans, and dressed with expensive (get the best, he stresses) balsamic vinegar and olive oil. A dinner roll and nonfat yogurt with apricots for dessert round out the meal. The diet is hardly fit for a gourmand, but it's not quite as austere as a monk's menu, either. The 21st century, Walford says, will be the age of the "long-living society." In the near future, there will be advances in modern biology that will extend life spans. "But calorie restriction is the only thing that we can be relatively confident works now. If you want to hang around to take advantage of the newer techniques when they become available, this is what to do now." Poor Appetite and Aging I am 83 and in comparatively good health except for fatigue. For about eight months I have not enjoyed eating foods I formerly anticipated and liked. I eat and have maintained my weight because I know that in order to work, I must "stoke the furnace." Please tell me the reason for my not enjoying eating and what I can do to correct this. Some time ago I was diagnosed with acid reflux and hiatal hernia but have not been troubled for a LONG time. Many thanks for your consideration and help. It is quite common for taste buds to be less sensitive as people age. Medications can also change the taste of your saliva or interfere with salivation resulting in a dry mouth and decreased taste sensation. Some viruses can permanently destroy your senses of smell and taste and strokes may also affect those senses. If you had just lost your appetite, I would reassure you and tell you to wait and see what happens, but since you are also tired and this has been going on for almost a year, I think you should see your physician and get a thorough evaluation. Rebekah Wang-Cheng, MD 11 Oct 2001 Helping Seniors Overcome Obstacles to Eating Well Many older people have trouble eating well for a variety of reasons. Reading food labels for nutritional information is one way to eat well. But sometimes there are problems that interfere with eating well. Problem: Can't chew Do you have trouble chewing? If so, you may have trouble eating foods like meat and fresh fruits and vegetables. What to do: Try other foods. Instead of: fresh fruit Try: fruit juices and soft canned fruits, like applesauce, peaches and pears Instead of: raw vegetables Try: vegetable juices and creamed and mashed, cooked vegetables Instead of: meat Try: ground meat, or other sources of protein, such as eggs, milk, cheese, yogurt, and foods made with milk, like pudding and cream soups Instead of: sliced bread Try: other sources of grains, such as cooked cereals, rice, bread pudding and soft cookies Problem: Upset stomach Stomach problems, like too much gas, may make you stay away from foods you think cause the problem. This means you could be missing out on important nutrients, like vitamins, calcium, fiber and protein. What to do: Try other foods. Instead of: milk Try: milk foods that may not bother you, like cream soups, pudding, yogurt and cheese Instead of: vegetables like cabbage and broccoli Try: vegetable juices and other vegetables, like green beans, carrots and potatoes Instead of: fresh fruit Try: fruit juices and soft canned fruits Problem: Can't shop You may have problems shopping for food. Maybe you can't drive anymore. You may have trouble walking or standing for a long time. What to do: Ask the local food store to bring groceries to your home. Some stores deliver free. Sometimes there is a charge. Ask your church or synagogue for volunteer help. Or sign up for help with a local volunteer center. Ask a family member or neighbor to shop for you. Or pay someone to do it. Some companies let you hire home health workers for a few hours a week. These workers may shop for you, among other things. Look for these companies in the Yellow Pages of the phone book under "Home Health Services." Your county's Dept of Human (or Social) Services may be able to direct you to a free or low-cost home delivery service. Look in the blue pages of your phone book. Problem: Can't cook You may have problems with cooking. It may be hard for you to hold cooking utensils or pots and pans. Or you may have trouble standing for a long time. What to do: Use a microwave oven to cook TV dinners, other frozen foods, and foods made up ahead of time by the grocery store. Take part in group meal programs offered through senior citizen programs. Or, have meals brought to your home. Your county's Department of Human Services may have more information, or call 1-800-677-1116. These meals cost little or no money. Move to a place where someone else will cook, like a family member's home or a home for senior citizens. Problem: No appetite Older people who live alone sometimes feel lonely at mealtimes. Loneliness or depression can make you lose your appetite. Or you may not feel like making meals for just yourself. Maybe your food has no flavor or tastes bad. This could be caused by medicines you are taking. What to do: Eat with family and friends. Take part in group meal programs, offered through senior citizen programs. Ask your doctor if your medicines could be causing appetite or taste problems. If so, ask about changing medicines. Talk to him or her about depression, which is a common problem among seniors. Increase the flavor of food by adding spices and herbs. Problem: Short on money Not having enough money to buy enough food can keep you from eating well. What to do: Buy low-cost foods, like dried beans and peas, rice and pasta. Or buy foods that contain these items, like split-pea soup and canned beans and rice. Use coupons for money off on foods you like. Buy foods on sale. Also buy store-brand foods; they often cost less. Find out if your local church or synagogue offers free or low-cost meals. Take part in low-cost, group meal programs offered through local senior citizen programs. Or, have meals brought to your home. Get food stamps. Call the food stamp office listed under your county government in the blue pages of the telephone book. Problem: Questions about eating well What to do: Look on food labels for "Nutrition Facts," which list vitamins and other nutrients contained in each serving. Food labels of healthier foods also may include statements such as "low fat, "cholesterol-free," or "a good source of fiber." Remember that diets low in saturated fat and cholesterol may reduce the risk of heart disease. Diets low in sodium may help treat high blood pressure (hypertension). Ask your doctor or other health-care worker for more info. Ask the FDA. There may be an FDA office near you. Look for the number in the blue pages of the phone book. You can also contact the FDA through its toll-free number, 1-888-INFO-FDA (1-888-463-6332) or visit its Web site: www.fda.gov. Info provided by the US FDA. 29 Sep 2001 \2 Exercise: Workouts May Help Turn Back Clock Six months of moderate, steadily increasing exercise can undo the effects of 30 years of aging, at least when it comes to aerobic performance, according to a new study published last week in the journal Circulation. The study was a follow-up to one conducted in 1966 that became known as the Dallas Bed Rest and Training Study. Then, a group of 20-year-old men performed physical tests, spent three weeks in bed, and then were put through a six- month program of moderate endurance training. Researchers from the University of Texas Southwestern Medical Center in Dallas examined five of the men in 1996. Only two had continued to exercise regularly; all had gained weight and on average they had doubled their body fat. In many ways, the researchers found, the deterioration was comparable to the deconditioning that had occurred when the men had been confined to bed. The subjects were then enrolled in a fitness program, choosing to walk, jog or work out on a stationary bicycle. Starting slowly, they built up over six months to working out about five hours a week. That training "restored 100 percent of the age-associated decline in aerobic power," the article said, meaning that tests of their cardiovascular output at the end of the 1996 trial were comparable to those at the start of the 1966 trial. "Even an older person who has failed to maintain fitness over time can benefit from an exercise program," said Dr. Benjamin Levine, an author of the study. The 50-year-olds were not, however, able to match the performances that they produced after the earlier round of training. And, the exercise program did not help them lose significant amounts of either weight or body fat. Exercise Can Increase Fitness Levels in Older Americans Never Too Late - It may not be too late to benefit from exercise, even for people in their 60s and older, according to scientists at the National Institute on Aging (NIA) Gerontology Research Center. They found that an aerobic exercise program for sedentary older people improves cardiovascular function regardless of prior physical conditioning. Age is a major risk factor for cardiovascular disease. The numbers of cases of heart disease and stroke rise steeply after age 65, accounting for more than 40% of all deaths among people age 65 to 74, and almost 60% at age 85 and above. Older people have less reserve mechanisms to augment their heart function during physical activities than younger people do, said Edward Lakatta, M.D., Chief of the Laboratory of Cardiovascular Science at the NIA and the study’s principal investigator. But aerobic exercise conditioning can offset normal aging of the heart by making it a better pump, even for those who begin later in life, at age 60 or 70. In other words, points out Lakatta, you don’t lose the ability to get into condition. You can improve your heart’s pump function, which declines with aging. Aerobic Exercise Helps At Any Fitness Level Previous studies have shown that older people can benefit from aerobic exercise, but a novel aspect of the NIA study found that the relative benefits were the same regardless of how fit they were when they started exercising, said Lakatta. For example, at maximum capacity, older athletes’ heart function seems to be closer to that of younger men than to that of older men who do not exercise regularly. But a decline in maximum heart rate with aging is unaffected by conditioning, said Lakatta. With age, the hearts of otherwise healthy sedentary people gradually lessen their ability to increase their heart rate during acute exercise. The National Institute on Aging, part of the National Institutes of Health, leads the federal effort supporting basic, clinical, epidemiological and behavioral research on aging and the special needs of older people. Lift Weights To Boost Aging Metabolism A comprehensive study might allay any lingering debate about why metabolism slows as people age. The findings show that the gradual loss of body cells, especially those high-energy-consuming muscle cells, can help explain why older people burn fewer calories while at rest – which so often leads to creeping weight gain. Some scientists have suggested that changes in hormones, immune function or other factors may depress resting metabolism with aging. But a study published in the Journal of Gerontology: Medical Sciences (Vol. 55A, pp. M757-760) showed a direct association between metabolic rate and cell mass, also known as lean- or fat-free mass. And that means that older people may regain some of their youthful resting metabolic rate and get off the slow boat to obesity by regular muscle-building exercises. Increasing muscle mass would help seniors, according to the researchers. They analyzed measurements of body composition and resting metabolic rate for 131 healthy men and women taken over a five-year period at the Boston center. The subjects ranged in age from 18 to 87, giving the researchers a broad sample for detecting small changes in cell mass across the years. But they found that only 1 of the 6 methods used to measure the subjects' body composition exposed the decline in cell mass occurring with age. That was a high-tech method for measuring the body's total potassium – a mineral found almost entirely inside of cells. Related studies at the center further support an age-related loss of cell mass. Researchers found a definite decline in muscle mass of middle-aged and senior men and women over 10- and 12-year periods when they measured the subjects' leg muscles by computerized tomography – or CAT scan. The shrinkage of muscle tissue explained at least half of the subjects' loss of strength in those muscles. National Institute on Aging 30 Jan 02 Disorders of Esophagus More Common In Older Adults Difficulty swallowing and acid reflux are just two of the conditions related to the esophagus -- the tube that connects the mouth and stomach -- that frequently affect older Americans. Side effects of disease, along with body structures that no longer function properly, often result in esophageal disorders in the elderly. “Older people are particularly susceptible to a number of disorders related to the esophagus,” notes Reza Shaker, MD, chief and professor of Gastroenterology and Hepatology at the Medical College of Wisconsin. Dr. Shaker is also the director of MCW’s Digestive Disease Center. “Aging takes its toll on the delicate functions of the mouth, throat and esophagus during the swallowing process. In addition, older adults are more likely to suffer from disease processes that affect the swallowing apparatus, including the esophagus, pharynx, larynx and their controlling nerves.” Gastroesophageal reflux disease (GERD), also known as acid reflux, is common among the elderly. It is characterized by stomach acid splashing up into the esophagus and causing heartburn, pain or regurgitation. Some older people have a chronic malfunctioning of the airway protective reflexes, which allows food, drink or refluxed material to "go down the wrong pipe." For a variety of reasons, dysphagia (difficulty swallowing) is also common among older people. Stroke, head injury, Parkinson's disease, multiple sclerosis, Alzheimer's disease, post-polio syndrome and the effects of alcoholism are just some of the conditions that can cause difficulty swallowing. Anatomy of Swallowing There are a number of structures essential to proper functioning of the swallowing apparatus. The uvula is the fleshy tissue that hangs down from the back of the mouth above the tongue. At the back of the throat is the pharynx, a muscular cavity covered with membranes. The pharynx leads from the mouth and nasal passages to the larynx and esophagus. The epiglottis is a piece of cartilage in the pharynx that acts as a lid to cover the trachea (windpipe) during swallowing. This ensures that food goes down the esophagus into the stomach and not down the windpipe into the lungs. Below the epiglottis and adjacent to the pharynx is the larynx, which contains the vocal cords and connects to the windpipe. All of these structures, plus the tongue and muscles of the esophagus, along with other anatomical structures that include bones, cartilage, muscles and membranes, must work together efficiently for proper transport of food to the stomach. At the upper and lower ends of the esophagus are muscles called sphincters. The upper esophageal sphincter opens to allow food to enter and helps move food down the esophagus. The lower esophageal sphincter keeps stomach acid from splashing up into the esophagus (refluxing). Acid reflux may be worsened by a hiatal hernia, where part of the stomach bulges through the opening in the diaphragm through which the esophagus passes. Acid reflux can occur at any age and is usually treated with dietary modifications (limited alcohol, caffeine and tobacco use) as well as medications such as proton pump inhibitors, H2 receptor antagonists and antacids. In severe cases, surgery may be necessary. Some older people have a chronic malfunctioning of the pharynx and larynx, which allows food and drink to enter the lungs and cause a form of pneumonia. Furthermore, it can result in malnutrition since the food is not being processed by the digestive tract and nutrients are lost. Dysphagia affects up to 30% of the elderly population in general hospital wards and perhaps twice that in nursing homes. Any part of the swallowing process may be affected by aging or disease and result in dysphagia. In addition to the conditions already mentioned, tumors of the central nervous system that control swallow functions are also an issue. Sometimes tumors of the mouth, throat and esophagus make swallowing difficult. Cancer treatments, such as chemotherapy and radiation, may cause sores in the mouth and throat and make swallowing painful. Treatment will depend on the cause of dysphagia and the structures involved. Treatment may include physical therapy exercises to relearn swallowing processes, surgery to correct malfunctioning anatomy, medication and other therapies. Esophageal Injuries and Infections Injuries to the esophagus, particularly from pills, are fairly common among the elderly. Older people are more likely to be on a variety of medications so the number of pills they take each day increases the risk of “swallowing wrong” or a pill “getting stuck” and causing injury to the esophagus. Large tablets, distorted anatomy, slow movement of the pills through the esophagus, and pills taken while lying down or with little liquid are some risk factors for such injuries. Alendronate, a medication for osteoporosis, has been associated with severe injury of the esophagus. When taking any pill, drink at least eight ounces of liquid and remain upright for 30 minutes. People of advanced age or those who have a compromised immune system, such as those with human immunodeficiency virus (HIV), diabetes or alcoholism, are more prone to infections of the esophagus. This risk may increase if the individual is taking systemic antibiotics or medication to suppress stomach acid. Symptoms and treatments vary from individual to individual. As with other esophageal disorders, an endoscopy, in which a hollow tube containing a tiny camera is inserted down the throat to the stomach, may be performed to diagnose the condition and prescribe treatment. “Understanding the malfunction or malformation of anatomical structures of the esophagus are key to prescribing treatment for any esophageal disorder,” Dr. Shaker says. “Sometimes the cause of an esophageal disorder is local – within the esophagus itself – but other times the cause is related to the brain or the central nervous system. Proper diagnosis is always essential to effective treatment.” Dr. Reza Shaker developed the Shaker Exercise to help people with swallowing difficulties. The Dysphagia Inst at the Med Coll of WI diags and treats people who have swallowing difficulties. Med Coll of WI 23 Jan 02 Physically Active People Have Lower Medical Expenses The benefits of moderate physical activity are well known: lowered risk for heart attack and stroke, reducing weight, and improving mood. Researchers at the Centers for Disease Control and Prevention (CDC) recently documented another major advantage - improving the health of the Nation's health care expenditures. A study described in the Oct 2000 issue (Vol. 28, No. 10) of The Physician and Sportsmedicine by Michael Pratt and colleagues reports that physically active individuals had lower annual direct medical costs than did inactive people. The cost difference was $330 per person, based on 1987 dollars. The potential savings if all inactive American adults became physically active could be $29.2 billion in 1987 dollars, or $76.6 billion in 2000 dollars. This is the first study ever to examine direct med costs assoc with various levels of physical activity by reviewing actual medical expenditures. The CDC researchers analyzed the relationship between physical activity and medical expenditures from the 1987 National Medical Expenditures Survey, the most comprehensive healthcare information source available. They found that Americans 15 years and older who engaged in regular physical activity -- at least 30 minutes of moderate or strenuous physical activity three or more times a week -- had average annual direct medical costs of $1,019 versus costs of $1,349 for those who were inactive. Persons with health conditions that limited regular moderate physical activity were excluded from the study. The study suggests that health care costs can be significantly reduced by encouraging regular physical activity. The level of physical activity measured in this study was even more modest than current Federal guidelines of 30 minutes or more of moderate physical activity five or more days a week, suggesting that following current recommendations could yield even greater cost savings. The researchers found that physically active people had fewer hospital stays and physician visits and used less medication than physically inactive people. The cost savings were consistent for men and women, for those with and without physical limitations, and even for smokers and nonsmokers. The biggest difference in direct medical costs was among women 55 and older, supporting the widely held belief that the potential gain associated with physical activity is especially high for older women. The authors state that "a population-wide strategy might produce cost savings among most adult age groups." "We must make it easier for people to be active," said Dr. Jeffrey Koplan, Director of the Centers for Disease Prevention and Control. "We need to make a serious national effort to promote physical activity and support changes in the environment that get people moving again." Changes that promote physical activity may be as simple as improving the location and appearance of stairwells to encourage walking at work or as complex as the redesign of communities. Some communities have existing infrastructure that supports physical activity, such as sidewalks and bicycle trails, and work-sites, schools, and shopping areas in close proximity to residential areas. In many other areas, such community amenities need to be developed to foster walking and cycling as a regular part of daily activity. Good habits as aerobics, weightlifting, regular long walks, and good nutrition lead to long healthy life. It bolsters brain power, keeps cholesterol, and blood pressure low, reduces the risk of blood clots. Smoking, overweight, and inactivity are the downfall. Researchers have long known that aerobic exercise such as running or cycling can help relieve symptoms of depres- sion. New findings show that even moderate exercise can help brighten your mood. Non-aerobic exercise pgms such as wt trng or walking can have the same mood- elevating effects as aerobic workouts. Consistency seems to be key in treating depression through exercise: sticking to a moderate pgm consistently may be more important than breaking a sweat occasionally. Jogging Exercise. Begin by walking, 2mi in 30min, then use chart below. Go to next step every 2-7 days. Jog only 3-4 times a wk on alt days. 5-10 mins for warm up and cool down. Time Reps Time Step Jog walk jog walk TTl 1 1 1 12 12 24 2 2 1 8 8 24 3 3 1 6 6 24 4 4 1 5 5 25 5 5 1 4 4 24 6 7 1 3 2 23 7 10 1 2 2 22 8 12 1 2 1 25 9 15 1 2 1 31 10 20 - 1 - 20 11 25 - 1 - 25 12 30 - 1 - 30 -- 2 to 2.5 Standing 2.5 to 4 Walking 2 miles an hr Bicycling 5 miles an hour 4 to 5 Walking 3mi/hr Bicycling 6mi/hr Badminton Housework 5 to 6 Walking 4mi/hr Dancing Raking leaves Calisthenics Tennis (doubles) 6 to 7 Bicycling 10mi/hr Skating Shoveling dirt Sex 7 to 8 Walking briskly 5mi/hr Tennis (singles) Shoveling snow Downhill skiing Water-skiing 8 to 10 Jogging 5mi/hr Bicycling 12mi/hr Basketball Mountain-climbing Ditch-digging 10 to 11 Jogging 6mi/hr Cross-country skiing Squash and handball 12 Swimming Jogging at 5 mph is considered a high-intensity activity and can burn at least 500 calories an hour. ProForm manufactures two of the top-10-rated treadmills ranked by a leading a consumer magazine. -- EXERCISE For Blood Vessels, a Fountain of Youth By JOHN O'NEIL VITAL SIGNS Prevention: Extra Benefit From Chickenpox Vaccine Remedies: A Weapon Is Found to Fight Scleroderma Treatments: Getting Aggressive in Sickle Cell Fight Cause and Effect: When School Brings On the Migraines Forum Join a Discussion on Health in the News The idea that exercise keeps the body young is not news, but a new study from the University of Pisa makes the notion more specific: the blood vessels of vigorous older people functioned as well as those of athletes less than half their age. In an article published last week in the journal Circulation, Dr. Stefano Taddei says that one effect of aging is diminishing the efficiency of a mechanism within blood cells that causes nitrous oxide to be released. Nitrous oxide protects against clogging and assists in dilating the vessels when the heart needs more blood. In the study, Dr. Taddei compared the workings of that mechanism in a group whose average age was 63 and one whose average age was 27. Both groups were divided evenly between sedentary people and athletes involved in long-distance running, cycling or triathlons, which combine running, cycling and swimming. Dr.Taddei said he suspected that even moderate regular exercise can confer much of the same benefits. "Aerobic exercise activity five days a week -- rather than intensive training -- might just do the trick," he said. For The Young At Heart-- Exercise Tips For Seniors People are living longer than ever before. Advances in medicine, nutritional awareness, and improved exercise habits have contributed to the rapid growth of the 65+ age group. By the year 2030, there will be more people over age 65 than under age 18!* (*Aging America. Trends and Projections, AARP, l991) In order to make their later years more healthy and productive, many older Americans are adopting a lifestyle promoting total well-being, including eating a healthful diet, engaging in regular exercise, reducing stress, and improving mental health. Fitness For "The Young At Heart" Exercise is no less important for those in their sixties and seventies than it is for people half that age. No matter what your age, the benefits of exercise are the same; increased energy and self-esteem, conditioned heart and lungs, improved muscle tone, and greater function of bones and joints. The effects of certain chronic diseases, such as diabetes, high blood pressure, arthritis, and osteoporosis, can also be reduced by engaging in regular exercise. There are many sports and activities you can choose from in order to achieve your fitness goals. The best choices, however, will be those activities that you truly enjoy. It's much easier to stay with something that's fun to do. Even walking for 30 minutes, 4-5 days a week, will go a long way in keeping you fit! CYCLING PERFORMANCE TIPS Aging and Physical Performance There are two approaches to the relationship of aging and physical performance. Most athletes are concerned with the effects of aging on their own abilities to perform and compete. But for the nonathlete, the question is often whether physical activity can counteract or blunt the aging process itself. From that perspective, the answer is yes it can, and it has been estimated that 30% of all deaths from heart disease, diabetes, and colon cancer are related to inadequate physical activity. One study indicated that no more than 20% (and more likely less than 10%) of adults in the US obtain sufficient regular physical activity to have a measurable impact on their health and fitness levels. Is it safe to exercise as you age? If one uses common sense, the long term health benefits far outweigh any potential cardiac complications. One should avoid the extremes such as exercising above and beyond the level you have trained for, environmental extremes of temperature and humidity, and exercising when not feeling well. But even orthopedic injuries, which might be expected to be more common in the older athlete, do not appear to be increased with activities of moderate intensity and duration. EFFECTS OF AGING ON PHYSIOLOGIC FUNCTION Physiologic and performance measures peak in the late teens and 20s, and then decline with age. However they do not all decline at the same rate, and the rates of deterioration vary according to lifestyle (the old use it or lose it philosophy). Muscular strength Strength levels for men and women are at their peak between the ages of 20 and 30. Without a regular exercise program, there is then a decrease in muscle mass from muscle fiber atrophy hat becomes particularly apparent at age 60 . However, this is a combination of aging effects on the muscle/ nerve unit AND a decrease in daily muscle loading. One study of men between the ages of 60 and 72 years, training with standard muscle resistance exercises, demonstrated an improvement rate equal to young adults. Another group of 70 year olds who had regularly trained from age 50, had a muscle cross sectional area equivalent to a group of 28 year old students. Neural function Reflexes do slow with age, but as with muscular strength, activity minimizes the effects. Active men in their 70s had reaction times equivalent to inactive men in their 20s. Pulmonary function Once again, there is a decrease in lung function with age that can be blunted with regular activity. These studies indicate that a lifetime of regular physical activity may retard the decline in pulmonary function associated with aging. Cardiovascular function aerobic capacity declines twice as fast in sedentary individuals and may even plateau with a regular training program. the maximum heart rate does decline with age cardiac output also falls with age - partially related to heart rate, but also from a decrease in stroke volume But a group of active 45 year olds on a regular endurance exercise program, followed for 10 years were found to have maintained a stable blood pressure, body mass, and VO2 max. during the ten year period. THE BOTTOM LINE Ben Franklin once said that the only constants in this world were death and taxes. The effects of aging on physical performance should probably be added to this list. However numerous studies have demonstrated the dramatic effect a regular exercise program can have on blunting the inevitable changes. And the training effect is so effective that the aging process may be held at bay for up to a decade or more. NUTRITION AND THE OLDER ATHLETE Although there is a trend towards an increased percentage of body fat after age 30, there is good evidence that a resistance training program will minimize the loss of muscle mass, and good eating habits and self awareness will prevent weight gain. There are no special dietary needs for older athletes. However there is less "physiologic forgiveness" or latitude to skip the pre-event carbohydrate meal, and an increased sensitivity to major fluid shifts from sweating and inadequate replacement, but aside from this decreased tolerance for physiologic abuse, the principles of nutrition are exactly the same for all age groups. This includes vitamin, mineral, and electrolyte replacement as well as the use of ergogenic aids such as diet supplements and unusual food products. - Exercise and Everyday Activities: Gardening Golf Walking Jogging Travel Water Choosing Your Physical Therapist {REMEMBER If you experience shortness of breath, dizziness, cold or clammy skin, nausea, or chest pains while exercising, stop exercising immediately and contact your physician.} Cultivate Your Health With Gardening Having a green thumb can be very rewarding when you see the beautiful results of all your hard work. But before you plant that first seed, try some general stretching exercises to prepare yourself for the lifts, bends, pulls, and lunges to come. Getting In Shape Upper body twist: Stand with your hands on your hips. Slowly turn your upper body as far as possible to the left for a count of 5. Turn to the right and hold for a count of 5. Repeat 10 times. Upper body stretch: Stand with your back straight and arms to your sides. Stretch arms straight out in front of you and hold for a count of 5. Return arms to sides. Repeat 10 times. Now, stretch arms straight in back of you until shoulder blades touch. Hold for a count of 5. Return arms to sides. Repeat 10 times. Down To Earth Gardening Tips If you must kneel, stand up and stretch frequently to avoid stiffness. Use knee pads or a pillow to absorb the pressure on your knees. Also, lean on your hands so that your arms absorb some of the shock. Make sure the object-like a sack of mulch-is not too heavy to lie. Test its weight by lining one corner. Roll or push, rather than carry, heavy loads. Pull an object by placing your feet apart, bending your knees, and leaning away from the object. Pull by straightening your legs. Always face the object and keep your back straight. {Gardening equipment should suit your size, build, and physical capabilities. If you have arthritis in your hands, use garden tools with enlarged handles. Long handles on garden tools ease the strain on an arthritic back.} Fit To A Tee You can't beat a good game of golf for low-impact exercise and plenty of fresh air. Golf is an excellent sport for keeping physically fit and mentally alert. Getting in Shape Start exercising a few weeks in advance, about the same time of day you'll be playing golf. Walk 20 to 30 minutes a day, 3-4 times a week. Take a club and begin practicing your grip. Practice your back swing, keeping the club at waist level, and slowly increase to a full swing. Start with one of the shorter clubs, working up to longer, heavier irons. When You Get To The Course When you arrive at the golf course, and before you change into your golf shoes, find a bench and try these exercises for warming up your neck, shoulders, trunk, and legs: Calf and hamstring warm up: Put your left foot on the bench, keeping your knee close to your body. Your right foot remains on the ground. Place your hands under your led knee, holding onto the thigh. Tuck your chin to your chest and curl down slowly. Hold and count to 10. Do not bounce. Come back up slowly, keepin your chin to your chest. For the trunk and upper body: Stand and hold your golf club horizontally with both hands. Raise the club and place it behind your neck. Then, with feet comfortably apart, slowly rotate body to the left, then to the center, then to the right. Do this exercise frequently during your game and again afterwards. Take Steps To Be Fit-Walk! Walking is a great way to achieve overall fitness year-round. It strengthens your cardiovascular system, tones and limbers up your muscles, and burns off unwanted calories. Walking at a brisk pace gives you the same aerobic benefits as jogging! Walking also reduces blood pressure, improves sleeping habits, helps digestion, alleviates constipation, raises metabolism, and helps to reduce loss of bone mass in post-menopausal women. Getting In Shape During the first week, walk 10-15 minutes at a slow pace. Stay on a flat surface-avoid hills and stairs. After a week, maintain the same distance but pick up your pace. Over the next several weeks, build up gradually to a 20- to- 30-minute walk, 3-4 times weekly, at a pace that is brisk but comfortable. You should be able to walk and talk at the same time. Stretch Before And After You Walk Hamstring stretch: Place the heel of your right foot up on a bench. Straighten out your right leg, and keep your left knee (the leg you're standing on) slightly bent. Reach for the toes of your right foot with both hands. Hold stretch for 15-20 seconds, then repeat with other leg. Do this several times, gently at first. Stretch slowly and steadily-don't bounce! Joining The Joggers? If you're thinking about joining the more than 10 million Americans now jogging, be sure your jogging equipment-your cardiopulmonary respiratory system, feet, and legs-is in good working order! Stretch Before And After You Jog Calf and hamstring warm up (see "When You Get To The Course," above). Calf stretch: Stand facing a wall, arm's length away, and place both of your hands against the wall at chest height. Keeping your right foot on the floor, and your right leg slightly bent, move your led foot back behind you, keeping the knee straightened and the heel flat against the floor. When you feel your left calf muscle stretch, hold for a count of 10. Do not bounce. Repeat exercise with other leg. Jogging Tips Use the "talk test" to pace yourself. If you can't talk comfortably while jogging, you're pushing too hard. Alternate between jogging and walking at first. Avoid hard surfaces whenever possible. Dirt paths are better than asphalt, and asphalt is better than concrete. Grassy areas may look inviting but they may hide holes, rocks, and other potential hazards. Your Passport To Good Health Have you been bitten by the travelbug? Wherever you roam, you'll probably walk more, bend more, and twist and turn more. That's why it's important when you plan your travel itinerary to include exercises that will keep you limber while you're on the go. Travel Tips Several weeks before your trip, take a 20- to- 30- minute walk, 3-4 times a week, wearing the shoes you will wear on your trip. Before you climb into a car or board a plane or train, do some stretching exercises to relax the muscles in your neck, shoulders, back, trunk, arms, and legs. Turn your head slowly as far to the left as is comfortable. Then turn your head to the right. Repeat 3 times. Shrug your shoulders. Make circles with one shoulder, then the other. Touch your shoulder blades together and relax. Repeat 3-4 times. When sitting, keep your knees as high as your hips. Place a pillow behind your lower back for support. Also, pump each foot several times, as if working a car accelerator, to bring back circulation to feet and ankles. When traveling by car, wear your seatbelt and keep the headrest lowered to a position that is in the center of the back of your head. In a plane or train, recline the seat to change your position. Exercise, stretch, or walk every hour in the plane, train, or bus aisle. When driving, pull over every hour and get out, stretch, and walk around the car. Water Workouts - Exercising in the water is one of the best ways to improve fitness and overall well-being. In most cases, you don't even have to know how to swim. Because of the body's buoyancy in water, a water exercise program greatly decreases the strain on the joints and other supporting structures of the body. Getting Your Feet Wet - Before you begin a water exercise program, determine if you have any medical problems that may prevent you from participating (or warrant seeing a doctor first). These may include uncontrolled blood pressure, open or not completely healed wounds, uncontrolled seizures, severe osteoporosis, incontinent bowel or bladder, or severely limited breathing capacity. Safety Tips - Before entering the pool, make sure you have identified the depth markings. If you are alone in a pool, make sure someone is nearby in case of an emgcy. Wait 45 min to an hour after eating before exercising. If the water is cool, you may want to walk several laps as a warm up before exercising. If you have diabetes, stub your toes easily, or have difficulty with your feet slipping, you may want to wear an old pair of sneakers or special water shoes while in the water. Getting In Shape - Strengthen legs and buttocks ("rocking horse"): In at least waist-high water, position yourself so that your left foot is about one foot ahead of your right. Lift arms away from your sides to comfortably maintain balance. Raise your left leg, with left knee bent. Push off with your right leg, and land on your left foot. When landing, keep your heel down, and knee slightly bent. Then rock back on the right foot (heel up) while lifting the front knee up. Do several times on one side, then switch legs. The arms can be simultaneously pushing and pulling. {REMEMBER: Stretching exercises should be done both before an activity as a "warm up" and again afterwards as a "cool down " The "cool down" lets your heart rate return to normal and helps your muscles and joints remain flexible.} Choosing Your Physical Therapist - Physical therapists help people prevent injuries, stay physically fit, and overcome disabilities from chronic disease and traumatic injuries. To find a licensed physical therapist, call your local hosp, consult the Yellow Pages of your telephone book, or ask relatives or friends who may have sought the services of a physical therapist in the past. To select a physical therapist, consider asking the following questions. Are you a licensed physical therapist in my state? How much experience do you have treating patients with my condition? Do you have specialized equipment, if needed, to treat my condition? Will you accept Medicare and what are your payment policies? Real Time FITNESS Sharon Christine Riley YOUR WEEKEND LEISURE GUIDE/8 Dec 000 Feeling and looking younger. Altho it can't be stopped, there are ways to reduce the visible effects of getting older No matter how hard we try we cannot stop the inevitable process of ageing _ but to some extent we can defy it. Also, it may appear that with huge investments in surgery and similar extreme actions there is success in combating the process. Although actions such as face lifts, liposuction, etc, meet with what appears to be success, the wheel is still turning. Therefore,the best that we can do to retain our youthful appearance and stateis to attempt to slow down the ageing process.So let's take a look at what we can do to counteract this naturalprogression.WHAT CAUSES THE BODY TO AGE?Firstly, let's look at the process we know as ageing and see whatchanges take place within the body. This will help us understandbetter the various actions we need to take to combat these processes taking place within our body. The simplest yet most practical way to explain the process is to look at the body's makeup in its basic form. Like everything else in the world, the human body is made up of molecules. Molecules are in turn made up from atoms with a nucleus at its centre. Rotating round this nucleus are electrons _ more or less the planets in our solar system. So far so good? OK, along comes the not-so-good molecule in our body's makeup. Would you believe it is the oxygen molecule! The oxygen molecule is stable only when it has two electrons around its nucleus. One or three is bad news. If it has only one electron, it must find a partner to combine with to obtain the extra molecule. Great for the oxygen molecule but disastrous for it's new found friend. A similar action occurs if the oxygen molecule is carrying too many electrons. It will again search for a partner to dump the excess molecule on. This stealing from or dumping on by the oxygen molecule occurs readily due to the highly reactive state of the oxygen molecule when it is out of balance. But this taking from or adding to process of an electron now puts the new found partner out of balance making it unstable. This destabilisation can lead to damage or even destruction of the partner molecule. We see the result of this action almost every day in one form or another. The most common (after ageing!) would probably be rust. Rusting is the result of this very process taking place in a piece of steel. TELL TALE SIGNS The most common sign of ageing in our body is seeing the changes in our skin. Wrinkled and aged skin is normally the result of the outer layers thickening and then collapsing from the action of being exposed to sunlight over long periods of time. This exposure to the sun also causes thinning of the underlying layers giving less support to the outer layers resulting in a rough and wrinkled look. These lower layers also produce the pigmentation that shows up as age spots. Although there are many so-called miracle cure creams available on the market designed to counteract this process, according to the experts there is only one miracle product. It is known as Retin-A and contains tretinion. This product is available through prescription only and is not an across-the-counter type drug or medication. This product is a derivative of Vitamin A and stimulates the growth of new skin. It causes thickening of the inner layer and thinning of the outer layers of skin, thus returning the skin to its normal balance of support. This in turn reduces the wrinkling appearance of the skin as it now has the supportive foundation to prevent the outer layers from collapsing. This thickening process of the lower layers of skin also generates the growth of more blood vessels to feed the skin. The common moisturisers available across the counter merely plump-up the skin and are only superficial with temporary results in most cases. But do not expect complete miracles from any of these types of products you use. You can reduce the fine lines caused by the ageing process through the use of some of these creams but hereditary lines and creases will normally remain. WHAT TO DO? An obvious fix to the action of sun on your skin is to avoid exposing yourself completely. But this is a little impractical. The use of a good quality high block-out sun cream is recommended to help prevent the ageing process in this area. Be aware that the sun's harmful rays penetrate much deeper than the surface of the skin. Although some of us have more melanin in the skin than others (the pigmentation that gives you a sun tan and protects your skin from UV rays) this protection works only up to a certain level. The sun's rays can penetrate deep down into the skin weakening the collagen protein that makes up the structure of the skin's layers. So protection from the outside is still a good idea. The term "you are what you eat" applies here as well. Eating correctly and looking after your body through exercise are integral parts to defeating the ageing process. On the food side of things, antioxidants are considered to be essential in defeating the ageing process. These come in the form of Vitamins A, C and E, Zinc, Selenium and Glutathione. But be careful with the level of Vitamin A in your body. It can already be found in your body and can build up to dangerous levels. Pro-vitamin A, found in vegetables such as broccoli, spinach and carrots, is safe. Fruits such as watermelon, rockmelon, apricots and peaches also contain pro-vitamin A. Vitamin C is important in slowing the ageing processes relative to the eyes. It is found in very high concentrations in the eye lenses as well as helping to prevent muscular degeneration _ the age-related deterioration of the retina. It is thought that maintaining the high levels of vitamin C in the eyes also helps to prevent the build up of cataracts, the formation of oxidants from the proteins that make up the lenses within the eyes. Vitamin E is all important to our immune system. In particular, vitamin E is known for trapping nitrites, a known by-product of tobacco smoke. It helps to isolate them from becoming cancerous nitrosamines and also strengthens cell walls within the oody. Sources of vitamin E are foods such as whole grain bread, sunflower seeds, almonds and vegetable oils. FOOD'S IMPORTANT ROLE The correct food intake can actually become more important in later life. As seen above, certain foods contain the essential vitamins we need to combat the ageing process. Food also builds bone. A natural effect of ageing is the thinning of bone which also becomes more brittle. The antioxidants mentioned previously help to prevent the body from rusting away. Proteins are used to help build, maintain and repair the body's overall structure. The good fats carry essential vitamins and provide long term energy. Carbohydrates provide a source of readily available energy to a body under demand. And never forget the absolute essential role that water plays in our body's overall functioning. It is used throughout our body to carry essential nutrients to all parts of our body. It also has an important function with processes such as digestion, absorption and circulation. It not only allows us to excrete the unwanted by-products from the various functions within our body but also allows us to maintain the correct body temperature. So it can be seen from this information that the key factors in slowing down the ageing process are to avoid excessive exposure to the sun and eat the correct foods. WHAT ABOUT EXERCISE? It is a must to keep the body in tip-top form and functioning normally. It should be a part of normal life's activity, not something to be specifically targeted to slow down the ageing process. The form of exercise you undertake is your own personal choice but should give variety and challenge to prevent boredom as well as target all areas of the body. Being healthy, active and staying young is all about how you feel. If you feel good you will be active, eat properly and look youthful and happy. So as you can see, it is a cycle _ one that you are responsible for maintaining to give you health, happiness and longevity. Question: How useful is walking for your health? Answer: It has been estimated that even a half an hour walk every day can cut the risk of death substantially. Physical activity: defined as the state of being active, or energetic action or movement. PHYSICAL ACTIVITY AND THE USE OF CALORIES can increase the basal metabolic rate, which is the number of calories used by the body when it is at rest. The increase in basal metabolic rate is approx 10%, and possibly lasts for as long as 48 hrs after the completion of activity. Physical activity helps in the utilization of calories. The number of calories used is dependent on the type and intensity of the activity, and on the body weight of the person performing the physical activity. Physical activity assists in reducing the appetite. For the purpose of weight loss , physical activity can reduce body fat and is more beneficial in combination with reduced intake of calories. Physical activity also helps in the maintenance and control of weight. The following are some variables when physical activity and calorie expenditure is considered: Time: The amount of time spent on physical activity affects the amount of calories that will be expended. For example, walking for 45 minutes will burn more calories than walking for 20 minutes. Weight: The body weight of a person doing the physical activity also impacts the amount of calories used. For example, a 250-pound person will expend more energy walking for 30 minutes than a 185-pound person. Pace: The rate at which a person performs the physical activity will also affect the amount of calories used. For example, walking 3 miles per hour will burn more calories than walking 1.5 miles per hour. BASAL METABOLIC RATE - accounts for most of a person's calorie use. A person's basal metabolic rate is based on body functions such as respiration , digestion, heartbeat, and brain function. The age, sex, body weight, and the type of physical activity impact the basal metabolic rate. Basal metabolic rate increases with the amount of muscle tissue a person has, and it reduces with age. Along with use of calories, the basal metabolic rate is increased during physical activity and also after the physical activity. The basal metabolic rate can remain increased 6 to 24 hours after 30 minutes of moderate type of physical activity. For many people the basal metabolic rate can be increased 10% for approximately 48 hours after the activity. For example, after the physical activity, even when a person is sedentary and watching television, their body is using more calories than usual. PHYSICAL ACTIVITY AND APPETITE - at a moderate rate does not increase the appetite. In some situations, the appetite will actually decrease. Research indicates that the decrease in appetite after physical activity is greater in individuals who are obese than in individuals who are at their desirable body weight. PHYSICAL ACTIVITY AND LOSS OF BODY FAT - A person loses 25% of his or her lean body mass and 75% of his or her fat when losing weight through calorie reduction alone. In combination with physical activity, the loss in body fat is 98%. Weight loss that is achieved with a combination of calorie restriction and physical activity is more effective. For maintenance of desirable body weight, a maintenance level of calories along with physical activity is recommended to preserve lean body mass and muscle tone. PRESCRIPTION FOR PHYSICAL ACTIVITY - The recommendations provided by the American College of Sports Medicine for weight loss and maintenance are as follows: Pursue physical activity at least three times a week. Increasing it to four to five times a week is even more beneficial. Spread out the physical activity through the week rather than doing it on three or four consecutive days to decrease the risk of related injuries. Physical activity should be done at 60 to 90% of the maximum heart rate . To calculate the maximum heart rate, use the following formula is used: + Subtract age from 220 (beats per minute) to get the maximum heart rate. Then multiply this figure by the intensity level. For example, a 50-year old woman exercising at 60% maximum would use the following calculation: + 220 - 50 = 170 (maximum heart rate) + 170 X 60% = 102 which is the target heart rate regardless of the type of physical activity he/she selects to do. Physical activity at 60 to 70% of the maximum heart rate can be continued at a safe rate for a long period of time. If an exercise is too strenuous, conversation cannot be carried on during the physical activity (the person is out of breath). According to the American College of Sports Medicine, physical activity of less than 2 times a week at less than 60% of the maximum heart rate, and for less than 10 minutes per day, does not assist in developing and maintaining fitness. If physical activity is discontinued, the fitness benefits are completely lost. Within 2 to 3 weeks the level of fitness is reduced, and within 3 to 8 months it is completely lost, and the person has to restart again. Twenty minutes of continuous aerobic activity 3 days per week is recommended for weight loss. Examples of physical activity that are considered aerobic are: walking, running, jogging, hiking, swimming, bike riding, rowing, cross country skiing, and jumping rope. BENEFITS - Physical activity contributes to health by reducing the heart rate, decreasing the risk for cardiovascular disease, and reducing the amount of bone loss that is associated with age and osteoporosis . Physical activity also helps the body use calories more efficiently, thereby helping in weight loss and maintenance. It can increase basal metabolic rate, reduces appetite, and helps in the reduction of body fat. SIDE EFFECTS - Physical activity should be done at a rate that is appropriate for the person. An evaluation by an exercise physiologist is helpful to avoid injuries that can occur if physical activity is initiated without much consideration given to the type, duration of physical activity, and the physical condition of the person. ------------------------------------------- Walking--gait abnormalities Considerations: The pattern of how a person walks is called the gait. Many different types of gait abnormalities are produced unconsciously. Most, but not all, are due to some physical malfunction. Some gait abnormalities are so characteristic that they have been given descriptive names: propulsive gait (characterized by a stooped, rigid posture, with the head and neck bent forward) scissors gait (characterized by legs flexed slightly at the hips and knees, giving the appearance of crouching, with the knees and thighs hitting or crossing in a scissors-like movement) spastic gait (characterized by a stiff, foot-dragging walk caused by one-sided, long-term, muscle contraction steppage gait (characterized by foot drop where the foot hangs with the toes pointing down, causing the toes to scrape the ground while walking) waddling gait (characterized by a distinctive duck-like walk that may appear in childhood or later in life) Abnormal gait may be caused by disease in many different areas of the body. Typical groupings might consist of: vestibular (the inner ear is responsible for maintaining balance; damage results in vertigo ) central nervous system (diseases of the brain that cause muscular problems resulting in gait disturbance such as multiple sclerosis and cerebral palsy ) spinal cord abnormalities (disease, trauma, degeneration) peripheral nerve diseases (nerves from the spinal cord to the muscles may be damaged by disease or trauma and result in gait abnormalities) degenerative muscle diseases ( muscular dystrophy , myotonic dystrophy , myositis ) skeletal abnormalities and disease arthritis skin conditions ( plantar warts , bunions , ingrown toenails, ulcers ) toxic reactions (alcohol, drugs, toxins ) Common Causes: ABNORMAL GAIT IN GENERAL trauma foot problems (such as a callus, corn, ingrown toenail , wart , pain, skin ulcer , swelling , spasms ) chondromalacia patellae fracture hemophilia immunization (soreness in the leg or buttocks) legs that are different lengths myositis tight or uncomfortable shoes shin splints infection tendinitis torsion of the testis conversion disorder (a psychological disorder) CAUSES OF SPECIFIC GAITS Propulsive gait: carbon monoxide poisoning manganese poisoning Parkinson's disease drugs including phenothiazines, haloperidol, thiothixene, loxapine, metoclopramide, and metyrosine (usually drug effects are temporary) Scissors gait: cerebrovascular accident ( stroke ) cervical spondylosis with myelopathy (a problem with the vertebrae in the neck) liver failure ( hepatic failure) multiple sclerosis pernicious anemia spinal cord trauma spinal cord tumor syphilitic meningomyelitis syringomyelia Spastic gait: brain abscess brain tumor cerebrovascular accident (stroke) head trauma multiple sclerosis Steppage gait: Guillain-Barre syndrome herniated lumbar disk multiple sclerosis peroneal muscle atrophy peroneal nerve trauma poliomyelitis polyneuropathy spinal cord trauma Waddling gait: congenital hip dysplasia muscular dystrophy spinal muscle atrophy Note: There may be other causes of gait abnormalities. This list is not all inclusive, and the causes are not presented in order of likelihood. The causes of this symptom can include unlikely diseases and medications. Furthermore, the causes may vary based on age and gender of the affected person, as well as on the specific characteristics of the symptom such as quality, time course, aggravating factors, relieving factors, and associated complaints. Use the Symptom Analysis option to explore the possible explanations for gait abnormalities, occurring alone or in combination with other problems. Home Care: Treatment of the cause often improves the gait. For example, gait abnormalities from trauma to part of the leg will improve as the leg heals. For an abnormal gait that occurs with conversion disorder , psychiatric counseling as well as comfort and love from family members is strongly recommended. For a propulsive gait: Encourage the person to be as self-reliant and independent as possible. Allow plenty of time for daily activities, especially walking. People with this problem are susceptible to falls because of poor balance and an unconscious effort to always catch up. Provide walking assistance for safety reasons, especially on uneven ground. Consult a physical therapist about exercise therapy and walking retraining. For a scissors gait: Loss of skin sensation is often associated with scissors gait, so skin care should be provided in order to avoid skin breakdown and ulcers . Leg braces and in-shoe splints can help maintain proper foot alignment for standing and walking. A physical therapist can supply these and provide exercise therapy, if appropriate. For a spastic gait: Both active and passive exercises are encouraged. Leg braces and in-shoe splints can help maintain proper foot alignment for standing and walking. A physical therapist can supply these and provide exercise therapy, if appropriate. Use of a cane or a walker is recommended for those with poor balance. For a steppage gait: Adequate rest is encouraged. Fatigue can often cause affected people to stub their toes and fall. Leg braces and in-shoe splints can help maintain proper foot alignment for standing and walking. A physical therapist can supply these and provide exercise therapy, if appropriate. For a waddling gait: Follow the prescribed therapy. Call Your Healthcare Provider If: there is any sign of uncontrollable and unexplained gait abnormalities. What to Expect: The medical history will be obtained and a physical examination performed. Medical history questions documenting the problems with walking in detail may include: time pattern When did this problem with walking begin? Did it occur suddenly or gradually? Has it become worse over time? quality (type of gait disturbance) scissors gait (flexed hips and knees; legs cross each other) steppage gait (foot drop; toes scrape ground) spastic gait (stiff, foot-dragging walk) propulsive gait (stooped, rigid posture; head, neck bent forward) other symptoms Is there pain? If there is pain, is it in the muscles, joints, spine, or other location? Is there a fever ? Is there testicular pain ? Does there appear to be muscle atrophy ( wasting )? Is there any paralysis ? Are there any muscle spasms ? Are there joint deformities ( contractures )? Has there been a recent infection? medications What medications are being taken? injury history Have there been any recent or past leg injuries? If there was a leg injury, what type? Was it a broken bone , dislocation , or burn ? Has the person had any head injuries , especially one that resulted in a coma ? Has the person had any spinal injuries or nerve injuries? illness history Are there any known blood vessel problems? Are there any known Illnesses such as polio , meningitis , myositis , tumors, or stroke ? Have there been any recent infections, including abscesses ? Does the person have hemophilia ? Has the person been exposed to carbon monoxide ? treatments Have there been any recent immunizations? Has there been a recent surgery? Has there been any chemotherapy or radiation therapy ? self and family history Are there any known birth defects, such as spina bifida , myelomeningocele, or hip dysplasia? Is there a history of cerebral palsy or muscular dystrophy ? Has anyone in the family had multiple sclerosis ? Has the affected person had any growth abnormalities? Are the legs different lengths? Is there a known problem with scoliosis ? The physical examination will probably include neurological examination. Diagnostic tests will be determined by the results of the physical examination workup and observation of the gait abnormalities. After seeing your health care provider: You may want to add a diagnosis related to gait abnormality to your personal medical record. \3 falling injuries/fractures National Center for Injury Prevention & Control Falls and Hip Fractures Among Older Adults How serious is the problem? In the US, one of every three adults 65 years old or older falls each year. Falls are the leading cause of injury deaths among people 65 years and older. In 1998, about 9,600 people over the age of 65 died from fall-related injuries. Of all fall deaths, more than 60% involve people who are 75 years or older. Fall-related death rates are higher among men than women and differ by race. White men have the highest death rate, followed by white women, black men and women. What other health outcomes are linked with falls? Among older adults, falls are the most common cause of injuries and hospital admissions for trauma. Falls account for 87% of all fractures for people 65 years and older. They are also the second leading cause of spinal cord and brain injury among older adults. Each year in the US, one person in 20 receives emergency dept treatment because of a fall. Advanced age greatly increases the chance of a hosp admission following a fall. Among older adults, fractures are the most serious health outcomes associated with falls. About 3% of all falls cause fractures. The most common are fractures of the pelvis, hip, femur, vertebrae, humerus, hand, forearm, leg and ankle. Where are people most likely to fall? For adults 65 years old or older, 60% of fatal falls happen at home, 30% occur in public places, and 10% occur in health care institutions. What is the impact of hip fractures? Of all fractures from falls, hip fractures cause the greatest number of deaths and lead to the most severe health problems. In 1996, there were approximately 340,000 hospital admissions for hip fractures in the US. Women sustain 75% – 80% of all hip fractures. People who are 85 years or older are 10-15 times more likely to experience hip fractures than are people between the ages of 60 and 65.9 Most patients with hip fractures are hospitalized for about 2 weeks. Half of all older adults hospitalized for hip fractures cannot return home or live independently after their injuries.9,13 In 1991, Medicare costs for hip fractures were estimated to be $2.9 billion. Because the U.S. population is aging, the problem of hip fractures will likely increase substantially over the next four decades. By the year 2040, the number of hip fractures is expected to exceed 500,000. What factors increase older adults’ risk of falling? Factors that contribute to falls include problems with gait and balance, neurological and musculoskeletal disabilities, psychoactive medication use, dementia, and visual impairment. Environmental hazards such as slippery surfaces, uneven floors, poor lighting, loose rugs, unstable furniture, and objects on floors may also play a role. What can older adults do to reduce their risk of falling? Maintain a regular exercise program. Exercise improves strength, balance, and coordination. Take steps to make living areas safer. Remove tripping hazards and use non-slip mats in the bathtub and on shower floors. Have grab bars put in next to the toilet and in the tub or shower, and have handrails put in on both sides of all stairs. Ask their doctor to review all of their medicines in order to reduce side effects and interactions. Have an eye doctor check their vision each year. Poor vision can increase the risk of falling. The Costs of Fall Injuries Among Older Adults The Problem Falls are a serious public health problem among older adults. In the US, one of every three people 65 years and older falls each year. Older adults are hospitalized for fall-related injuries five times more often than they are for injuries from other causes. Of those who fall, 20-30% suffer moderate to severe injuries that reduce mobility and independence, and increase the risk of premature death. Calculating Cost Estimates The cost of fall-related injuries is usually expressed in terms of direct costs. Direct costs include out-of-pocket expenses and charges paid by insurance companies for the treatment of fall-related injuries. These include costs and fees associated with hospital and nursing home care, physician and other professional services, rehabilitation, community-based services, the use of medical equipment, prescription drugs, local rehabilitation, home modifications, and insurance administration. Direct costs do not account for the long term consequences of these injuries, such as disability, decreased productivity, or quality of life. The Costs of Fall-Related Injuries In 1994, the average direct cost for a fall injury was $1,400 for a person over the age of 65. The total direct cost of all fall injuries for people age 65 and older in 1994 was $20.2 billion. By 2020, the cost of fall injuries is expected to reach $32.4 billion. Fall-related Fractures The most common fall-related injuries are osteoporotic fractures. These are fractures of the hip, spine, or forearm. In the US in 1986, the direct medical costs for osteoporotic fractures were $5.15 billion. By 1989, these costs exceeded $6 billion. Over the next 10 years, total direct medical costs for osteoporotic fractures among postmenopausal women will be more than $45.2 billion. Hip Fractures Of all fall-related fractures, hip fractures are the most serious and lead to the greatest number of health problems and deaths. In the US, hospitalization accounts for 44% of direct health care costs for hip fracture patients. In 1991, Medicare costs for this injury were estimated to be $2.9 billion. Hosp admissions for hip fractures among people over age 65 have steadily increased, from 230,000 admissions in 1988 to 340,000 admissions in 1996. The number of hip fractures is expected to exceed 500,000 by the year 2040. A recent study found that the cost of a hip fracture, including direct medical care, formal nonmedical care, and informal care provided by family and friends, was between $16,300 and $18,700 during the first year following the injury. Assuming 5% inflation and the growing number of hip fractures, the total annual cost of these injuries may reach $240 billion by the year 2040. \4 NUTRITION One food pyramid doesn't fit all. Researchers at Tufts Univ say older consumers have special dietary needs, and last year they redesigned the pyramid for healthy people older than 70. Because dehydration is a chronic problem for many seniors, water forms the foundation for the 70+ Food Guide Pyramid, which has not been adopted by the USDA. The pyramid advises seniors to drink at least eight glasses of fluids a day. "It doesn't necessarily have to be water as long as it's not caffeinated," said Karen Thomas, a registered dietitian at Palmetto Senior Care. "They can have a popsicle, decaf coffee or tea, fruit- flavored water or Jell-O." Compared to the original pyramid, the new one suggests fewer daily portions from most food groups because most healthy people older than 70 need only 1,200 to 1,600 calories a day. That translates into about six servings of grains, three vegetables, two fruits, two servings from the dairy group and about five ounces of meat, said Kay MacInnis, a cardio/pulmonary rehab dietitian with Providence Hosp. To compensate for smaller quantities, the pyramid emphasizes quality by choosing fortified cereal, high-fiber breads and deep-colored fruits and vegetables. At the pinnacle of the pyramid, a pennant signifies the need to take supplements, namely calcium, Vit-D and Vit B-12. In addition to the general recommendations of the food pyramid, seniors need to pay spec att to several nutrients, MacInnis said. They are: - Fiber: Insoluble fiber promotes regularity, which can be a prob for older people. And water-soluble fibers play an important role in controlling cholesterol levels. Sources of fiber, from highest to lowest, are high-fiber grain products (brown rice, popcorn, high-fiber cereals), nuts, legumes (kidney, navy, black and pinto beans), vegetables, fruits (choose whole or dried fruits over juice) and whole-grain bread. It's easy to add beans to recipes. Try drained cooked or canned pinto beans as a filling for tacos or burritos or use beans as a topping for salads. - Protein is essential for maintaining body tissue and helps keep the immune system functioning properly. Protein is found in meat, poultry, fish and eggs; cooked dried beans and peas; soy products, such as tofu; milk, cheese, yogurt, pudding and ice cream; and peanut butter, peanuts, nuts and seeds. "Protein is often a problem because chewing meat can be difficult," MacInnis said. Precut meat to help with chewing or digestion or try these tips. Add fruit, bran cereal or chopped nuts to yogurt. Top a salad with tuna, peanuts or beans. Use low-fat or fat-free milk instead of water to make soup or gravy. Seniors can stretch their grocery budget by keeping meat, poultry and fish portions small, while adding less costly protein sources such as eggs, peanut butter, legumes and dairy products to the diet, MacInnis said. -Calcium keeps teeth and bones strong, but also is vital for muscle contraction and relaxation, blood clotting and making new cells and body tissues. Most older people do not get enough calcium, and diets that are low in calcium are low in Vit-D, which helps calcium function. The skin can synthesize Vit-D if exposed to enough sunlight on a regular basis. Good sources of calcium are dairy products such as low-fat milk, yogurt and cheese, broccoli, cabbage, kale, tofu, sardines and salmon. Milk, some cereals and juices are examples of foods fortified with Vitamin D. Vitamin D also is found in cheese, whole eggs, liver, salmon and fortified margarine. If dairy products are not well- tolerated, drink smaller amounts or drink reduced-lactose milk. Most of those who are lactose-intolerant can build a tolerance of two cups a day, said Trish Vignati, a dietitian with the SE Dairy Assoc. Flavored milks, hard, aged cheeses and cultured yogurt are generally tolerated better. - Vitamin B-12 helps protect nerves and is involved in the formation of red blood cells. It is found in liver, kidney, yogurt, dairy products, fish, clams, oysters, nonfat dry milk, salmon and sardines. It's difficult for older people to break down and absorb B-12, so supplements may be needed, Thomas said. A symptom of B-12 deficiency is memory loss, which may mimic dementia. - Vitamin B-6 plays a role in the immune system, metabolism of food and red blood cell formation. The recommended daily value for vitamin B-6 for older people is substantially higher than for other adults. Vitamin B-6 is found in bananas, whole-wheat bread, chicken, eggs, oatmeal, peanut butter, pork potatoes, brown rice, tuna, shellfish and walnuts. \ 5 food safety why seniors are more at risk for fooborne illness. So he reviewed data from foodborne outbreaks at nursing homes, and compared the immune and digestive systems of seniors and younger individuals as well as evaluating the overall physical well being of seniors. What he found is most interesting. The Immune System and Aging As we age, the ability of our immune system to function at normal levels decreases. The immune system is one of the most important mechanisms for fighting disease and preserving health, so a decrease in the level of disease-fighting cells is a significant factor in the number of infections that may occur. In addition to the normal decrease in the function of the immune system as part of the aging process, undergoing major surgery also affects the body's ability to fight off infections. To counteract the affects of aging on the immune system, long-term regular exercise is important. The Gastrointestinal Tract and Aging As we age, inflammation of the lining of the stomach and a decrease in stomach acid occur. Because the stomach plays an important role in limiting the number of bacteria that enter the small intestine, a decrease or loss of stomach acidity increases the likelihood of infection if a pathogen is ingested with food or water. Also adding to the problem is the slow down of the digestive process, allowing for the rapid growth of pathogens in the gut and the possible formation of toxins. Malnutrition and Aging You maybe wondering what malnutrition has to do with foodborne illness. There is a connection. Malnutrition leads to increased incidence of infections, including those that result from foodborne bacteria. There are many reasons why malnutrition occurs in seniors. There may be a decrease in the pleasure of eating. Medication, digestive disorders, chronic illnesses, physical disabilities or depression may result in a loss of appetite. Good nutrition is an important factor in maintaining a healthy immune system. Symptoms of Foodborne Illness Common symptoms of foodborne illness include diarrhea, abdominal cramping, fever, sometimes blood or pus in the stools, headache, vomiting, and severe exhaustion. However, symptoms will vary according to the type of bacteria and by the amount of contaminants eaten. Symptoms may come on as early as half-hour after eating the contaminated food or they may not develop for several days or weeks. They usually last only a day or two, but in some cases can persist a week to 10 days. For most healthy people, foodborne illnesses are neither long lasting nor life threatening. However, they can be severe in seniors. In Case of Foodborne Illness If you suspect that you or a family member has foodborne illness follow these general guidelines: Preserve the evidence. If a portion of the suspect food is available, wrap it securely, mark "DANGER" and refrigerate it. Save all the packaging materials, such as cans or cartons. Write down the food type, the date, and time consumed, and when the symptoms started. Save any identical unopened products. Seek treatment immediately. Call the local health department if the suspect food was served at a large gathering, from a restaurant or other food service facility, or if it is a commercial product. Call the FDA Consumer Food Information Line at 1 (800-FDA-4010) if you have questions. Let's face it. Seniors have a lifetime of experience shopping, preparing and eating food. Fortunately, Americans enjoy one of the safest most healthful food supplies in the world. But a lot has changed over that lifetime—from the way food is produced and distributed, to the way it is prepared and eaten. What is also changing is your ability to fight-off dangerous bacteria that may invade your body through the food you eat. The good news is that well-known saying "An ounce of prevention is worth a pound of cure" remains true. From the farm to the table, preventing the growth of foodborne bacteria is the key to reducing the millions of illnesses and thousands deaths each year. What is Foodborne Illness? Right now, there may be an invisible enemy ready to strike. He's called BAC (bacteria) and he can make you sick. In fact, even though you can't see BAC—or smell him, or feel him—he and millions more like him may have invaded the food you eat. The illness caused by bacteria or other pathogens on food, often shows itself as flu-like symptoms such as nausea, vomiting, diarrhea, or fever, so many people may not recognize the illness is caused by bacteria or other pathogens on food. Thousands of types of bacteria are naturally present in our environment. Not all bacteria cause disease in humans. For example, some bacteria are used beneficially in making cheese and yogurt. Bacteria that cause disease are called pathogens. When certain pathogens enter the food supply, they can cause foodborne illness. Only a few types cause millions of cases of foodborne illness each year. Most cases of foodborne illness can be prevented. Salmonella Campylobacter jejuni Listeria monocytogenes Escherichia coli O157:H7 A Lifetime of Changes in Food Production It used to be that food was produced close to where people lived. Many people shopped daily, and prepared and ate their food at home. Eating in restaurants was saved for special occasions. Oh how the times have changed. Turning the tables on foodborne illness requires responding to a complex web of trends: new, more virulent, more drug-resistant pathogens are finding their way onto new foods; there are changes in how food is processed; the food we eat today is produced around the world; we're eating more meals outside the home–40 percent of the American food dollar today is spent in restaurants paying others to prepare our meals; there is a growing senior population whose immune systems cannot fight off the harmful bacteria, which makes them more vulnerable to foodborne illness. FOR ANSWERS TO QUESTIONS ABOUT FOOD SAFETY CONTACT: The FDA Food Information and Seafood Hotline, tollfree, at 1-800-FDA-4010. The hotline offers information to consumers in English and Spanish, 24 hours a day, seven days a week. Public affairs specialists are available from noon to 4 p.m., EDT, Monday through Friday, to answer specific questions. The USDA Meat and Poultry Hotline can be reached, tollfree, by calling 1-800-535-4555. This hotline, staffed by home economists and dieticians, will answer questions regarding the safe storage,handling, and preparation of meat and poultry products from 10:00 a.m. to 4:00 p.m., EDT, Monday through Friday. Recorded food safety messages are available at all times. Now You Know Bad Bacteria May Be in Your Good Food Bacteria may be present on products when you purchase them. Plastic-wrapped boneless chicken breasts and ground meat, for example, were once part of live chickens or cattle. Raw meat, poultry, seafood and eggs are not sterile. Neither is produce such as lettuce, tomatoes, sprouts and melons. Foods, including safely cooked, ready-to-eat foods, can become cross-contaminated with bacteria transferred from raw products, meat juices or other contaminated products, or from persons with poor personal hygiene. That's why care must be taken throughout the food production, distribution and consumption chain. Just the Facts Seniors Are at Risk for Foodborne Illness Data on foodborne illnesses collected by the Centers for Disease Control and Prevention clearly show that those who are age 50 and older suffer more severe complications from foodborne illness that do those who are younger. These complications include more hospitalizations and an increased incidence of death. Why? Check out Why Are Seniors At-Risk for Foodborne Illness?" Some of these harmful foodborne bacteria have been making news lately. You may have heard or read about bacteria such as Campylobacter in chicken, E. coli O157:H7 in ground beef, Salmonella enteritidis in eggs, and Vibrio vulnificus in oysters. Illnesses resulting from these bacteria occurred because the consumers either ate the foods raw or undercooked (thorough cooking kills the bacteria) or the foods were not handled in a safe manner. For more information on the safe handling of food, check out What's a Senior to Eat, To Market to Market, and What's Cooking? What's a Senior to Eat? Nutritionists agree that a healthful diet includes a variety of foods. Food choices also can help reduce the risk for chronic diseases, such as heart disease, cancers, diabetes, stroke, and osteoporosis, that are the leading cause of death and disability among Americans. But for seniors, certain foods may pose a significant health hazard because of the level of bacteria present in the product's raw or uncooked state. Seniors should avoid these products: Raw fin fish and shellfish, including oysters, clams, mussels, and scallops. Raw or unpasteurized milk or cheese. Soft cheeses such as feta, Brie, Camembert, blue-veined, and Mexican-style cheese. (Hard cheeses, processed cheeses, cream cheese, cottage cheese, or yogurt need not be avoided.) Raw or lightly cooked egg or egg products including salad dressings, cookie or cake batter, sauces, and beverages such as egg nog. Raw meat or poultry. Raw alfalfa sprouts which have only recently emerged as a recognized source of foodborne illness. Unpasteurized or untreated fruit or vegetable juice. When fruits and vegetables are made into fresh-squeezed juice, harmful bacteria that may be present can become part of the finished product. Most juice in the United States, 98 percent, is pasteurized or otherwise treated to kill harmful bacteria. To help consumers identify unpasteurized or untreated juices, the Food and Drug Administration is requiring a warning label on these products. The label says: WARNING: This product has not been pasteurized and therefore may contain harmful bacteria that can cause serious illness in children, the elderly, and persons with weakened immune systems. Four Simple Steps to Preparing Food Safely at Home Clean: Wash hands and surfaces often Bacteria can spread throughout the kitchen and get onto cutting boards, utensils, sponges and counter tops. Here's how to Fight BAC: Wash your hands with hot soapy water before handling food and after using the bathroom, changing diapers and handling pets. Wash your cutting boards, dishes, utensils and counter tops with hot soapy water after preparing each food item and before you go on to the next food. Use plastic or other non-porous cutting boards. These boards should be run through the dishwasher -- or washed in hot soapy water -- after use. Consider using paper towels to clean up kitchen surfaces. If you use cloth towels, wash them often in the hot cycle of your washing machine. Separate: Don't cross-contaminate Cross-contamination is the scientific word for how bacteria can be spread from one food product to another. This is especially true when handling raw meat, poultry and seafood, so keep these foods and their juices away from ready-to-eat foods. Here's how to Fight BAC: Separate raw meat, poultry and seafood from other foods in your grocery shopping cart and in your refrigerator. If possible, use a different cutting board for raw meat products. Always wash hands, cutting boards, dishes and utensils with hot soapy water after they come in contact with raw meat, poultry and seafood. Never place cooked food on a plate which previously held raw meat, poultry or seafood. Cook: Cook to proper temperatures Food safety experts agree that foods are properly cooked when they are heated for a long enough time and at a high enough temperature to kill the harmful bacteria that cause foodborne illness. The best way to Fight BAC is to: Use a clean thermometer, which measures the internal temperature of cooked foods, to make sure meat, poultry, casseroles and other foods are cooked all the way through. Cook roasts and steaks to at least 145?F. Whole poultry should be cooked to 180?F for doneness. Cook ground beef, where bacteria can spread during processing, to at least 160?F. Information from the Centers for Disease Control and Prevention (CDC) link eating undercooked, pink ground beef with a higher risk of illness. If a thermometer is not available, do not eat ground beef that is still pink inside. Cook eggs until the yolk and white are firm. Don't use recipes in which eggs remain raw or only partially cooked. Fish shoulb be opaque and flake easily with a fork. When cooking in a microwave oven, make sure there are no cold spots in food where bacteria can survive. For best results, cover food, stir and rotate for even cooking. If there is no turntable, rotate the dish by hand once or twice during cooking. Bring sauces, soups and gravy to a boil when reheating. Heat other leftovers thoroughly to 165?F. Chill: Refrigerate promptly Refrigerate foods quickly because cold temperatures keep harmful bacteria from growing and multiplying. So, set your refrigerator no higher than 40?F and the freezer unit at 0?F. Checking these temperatures occasionally with an appliance thermometer. Then, Fight BAC by following these steps: Refrigerate or freeze perishables, prepared food and leftovers within two hours. Never defrost food at room temperature. Thaw food in the refrigerator, under cold running water or in the microwave. Marinate foods in the refrigerator. Divide large amounts of leftovers into small, shallow containers for quick cooling in the refrigerator. Don't pack the refrigerator. Cool air must circulate to keep food safe. Additional Tips--Safe Handling of Fruits and Vegetables Wash hands with warm water and soap for at least 20 seconds before and after handling food, especially fresh whole fruits and vegetables and raw meat, poultry and fish. Clean under fingernails, too. Rinse raw produce in warm water. Don't use soap or other detergents. If necessary--and appropriate--use a small scrub brush to remove surface dirt. Use smooth, durable and nonabsorbent cutting boards that can be cleaned and sanitized easily. Wash cutting boards with hot water, soap and a scrub brush to remove food particles. Then sanitize the boards by putting them through the automatic dishwasher or rinsing them in a solution of 1 teaspoon (5 milliliters) of chlorine bleach to 1 quart (about 1 liter) of water. Always wash boards and knives after cutting raw meat, poultry or seafood and before cutting another food to prevent cross-contamination. Store cut, peeled and broken-apart fruits and vegetables (such as melon balls) at or below 41 degrees Fahrenheit (5 degrees Celsius)--that is, in the refrigerator. Apply the Heat ... and Fight BAC Cooking food to the proper temperature kills harmful bacteria. This includes raw meat, poultry, fish and eggs, as well as foods that are thoroughly cooked upon purchase, but that may become contaminated during storage or handling. Re-heat ready-to-eat foods such as hot dogs, luncheon meats, cold cuts, fermented and dry sausage, and other deli-style meat and poultry products until they are steaming hot. If you cannot re-heat these foods, do not eat them. Thoroughly cook other foods as follows: Raw Food Internal Temperature Ground Products Hamburger 160?F Beef, veal, lamb, pork 160?F Chicken, turkey 165?F Beef, Veal, Lamb Roasts & Steaks medium-rare 145?F medium 160?F well-done 170?F Pork Chops, roast, ribs medium 160?F well-done 170?F Ham, fresh 160?F Sausage, fresh 160?F Poultry Chicken, whole & pieces 180?F Duck 180?F Turkey (unstuffed) 180?F Whole 180?F Breast 170?F Dark meat 180?F Stuffing (cooked separately) 165?F Eggs Fried, poached yolk & white are firm Casseroles 160?F Sauces, custards 160?F This chart has been adapted for home use and is consistent with consumer guidelines from the U.S. Department of Agriculture (USDA) and U.S. Food & Drug Administration (FDA). Home-Based Food-Borne Illness When several members of a household come down with sudden, severe diarrhea and vomiting, intestinal flu is often considered the likely culprit. But food poisoning may be another consideration. A true diagnosis is often never made because the ill people recover without having to see a doctor. Health experts believe this is a common situation in households across the country, and because a doctor is often not seen for this kind of illness, the incidence of food-borne illness is not really known. A task force of the Council for Agricultural Science and Technology, a private organization of food science groups, estimated in 1994 that 6.5 million to 33 million cases of food-borne illness occur in the United States each year. While many reported cases stem from food prepared by commercial or institutional establishments, sporadic cases and small outbreaks in homes are considered to be far more common, according to the April 1995 issue of Food Technology. Cases of home-based food-borne illness may become a bigger problem, some food safety experts say, partly because today's busy family may not be as familiar with food safety issues as more home-focused families of past generations. A 1993 FDA survey found that men respondents tended to be less safe about food practices than women respondents and that respondents younger than 40 tended to be less safe than those over 40. For example, when asked if they believed that cooked food left at room temperature overnight is safe to eat without reheating--a very unsafe practice--12 percent of the men respondents (but only 5 percent of the women respondents) said yes. And, in looking at age differences, the survey found that nearly 40 percent of respondents younger than 40 indicated they did not adequately wash cutting boards, while only 25% of those 60 and over indicated the same. The increased use of convenience foods, which often are preserved with special chemicals and processes, also complicates today's home food safety practices, said Robert Buchanan, Ph.D., lead scientist for FDA's food safety initiative. These foods, such as TV dinners, which are specially preserved, give consumers a false idea that equivalent home-cooked foods are equally safe, he said. To curb the problem, food safety experts recommend food safety education that emphasizes the principles of HACCP (Hazard Analysis Critical Control Point), a new food safety procedure that many food companies are now incorporating into their manufacturing processes. Unlike past practices, HACCP focuses on preventing food-borne hazards, such as microbial contamination, by identifying points at which hazardous materials can be introduced into the food and then monitoring these potential problem areas. (See HACCP: Patrolling for Food Hazards in the January-February 1995 FDA Consumer.) "It's mainly taking a common-sense approach towards food safety in the home," said Buchanan. "Basically, consumers need to make sure they're not defeating the system by contaminating the product." Other Kitchen Contaminants Lead Lead leached from some types of ceramic dinnerware into foods and beverages is often consumers' biggest source of dietary lead, says John Jones, Ph.D., in FDA's Center for Food Safety and Applied Nutrition. (See "Lead Threat Lessens, But Mugs Pose Problem" in the April 1993 FDA Consumer and "An Unwanted Souvenir: Lead in Ceramic Ware" in the December 1989-January 1990 FDA Consumer.) Here are some tips to reduce your exposure: Don't store acidic foods, such as fruit juices, in ceramic containers. Avoid or limit to special occasions the use of antique or collectible housewares for food and beverages. Follow label directions on ornamental ceramic products labeled "Not for Food Use--May Poison Food" or "For Decorative Purposes Only," and don't use these items for preparing or storing food. Also, don't store beverages in lead crystal containers for extended periods. Microwave Packaging High temperature use of some microwave food packaging material may cause packaging components, such as paper, adhesives and polymers, to migrate into food at excessive levels. For that reason, choose only microwave-safe cooking containers. Never use packaging cartons for cooking unless the package directs you to do so. (See "Keeping Up with the Microwave Revolution" in the March 1990 FDA Consumer.) Aluminum According to FDA's Jones, there has been speculation linking aluminum to Alzheimer's disease. The link has never been proved, he said, but if consumers are concerned, they should avoid cooking acidic foods, such as tomato sauce, in aluminum pans. For other uses, well-maintained aluminum pans--as well as stainless steel, copper and iron pots and pans--present no apparent hazards. Insect and Rodent Droppings, and Dirt Avoid storing food in cabinets that are under the sink or have water, drain and heating pipes passing through them. Food stored here can attract insects and rodents through openings that are difficult to seal adequately. Wash the tops of cans with soap and water before opening. http://vm.cfsan.fda.gov/~dms/seniors.html What comes to mind when you think of a clean kitchen? Shiny waxed floors? Gleaming stainless steel sinks? Spotless counters and neatly arranged cupboards? They can help, but a truly "clean" kitchen--that is, one that ensures safe food--relies on more than just looks: It also depends on safe food practices. In the home, food safety concerns revolve around three main functions: food storage, food handling, and cooking. To see how well you're doing in each, take this quiz, and then read on to learn how you can make the meals and snacks from your kitchen the safest possible. Quiz: Choose the answer that best describes the practice in your household, whether or not you are the primary food handler. 1. The temperature of the refrigerator in my home is: a. 50 degrees Fahrenheit (10 degrees Celsius) b. 41 F (5 C) c. I don't know; I've never measured it. 2. The last time we had leftover cooked stew or other food with meat, chicken or fish, the food was: a. cooled to room temperature, then put in the refrigerator b. put in the refrigerator immediately after the food was served c. left at room temperature overnight or longer 3. The last time the kitchen sink drain, disposal and connecting pipe in my home were sanitized was: a. last night b. several weeks ago c. can't remember 4. If a cutting board is used in my home to cut raw meat, poultry or fish and it is going to be used to chop another food, the board is: a. reused as is b. wiped with a damp cloth c. washed with soap and hot water d. washed with soap and hot water and then sanitized 5. The last time we had hamburgers in my home, I ate mine: a. rare b. medium c. well-done 6. The last time there was cookie dough in my home, the dough was: a. made with raw eggs, and I sampled some of it b. store-bought, and I sampled some of it c. not sampled until baked 7. I clean my kitchen counters and other surfaces that come in contact with food with: a. water b. hot water and soap c. hot water and soap, then bleach solution d. hot water and soap, then commercial sanitizing agent 8. When dishes are washed in my home, they are: a. cleaned by an automatic dishwasher and then air-dried b. left to soak in the sink for several hours and then washed with soap in the same water c. washed right away with hot water and soap in the sink and then air-dried d. washed right away with hot water and soap in the sink and immediately towel-dried 9. The last time I handled raw meat, poultry or fish, I cleaned my hands afterwards by: a. wiping them on a towel b. rinsing them under hot, cold or warm tap water c. washing with soap and warm water 10. Meat, poultry and fish products are defrosted in my home by: a. setting them on the counter b. placing them in the refrigerator c. microwaving 11. When I buy fresh seafood, I: a. buy only fish that's refrigerated or well iced b. take it home immediately and put it in the refrigerator c. sometimes buy it straight out of a local fisher's creel 12. I realize people, including myself, should be especially careful about not eating raw seafood, if they have: a. diabetes b. HIV infection c. cancer d. liver disease Answers 1. Refrigerators should stay at 41 F (5 C) or less, so if you chose answer B, give yourself two points. If you didn't, you're not alone. According to Robert Buchanan, Ph.D., food safety initiative lead scientist in the Food and Drug Administration's Center for Food Safety and Applied Nutrition, many people overlook the importance of maintaining an appropriate refrigerator temperature. "According to surveys, in many households, the refrigerator temperature is above 50 degrees (10 C)," he said. His advice: Measure the temperature with a thermometer and, if needed, adjust the refrigerator's temperature control dial. A temperature of 41 F (5 C) or less is important because it slows the growth of most bacteria. The temperature won't kill the bacteria, but it will keep them from multiplying, and the fewer there are, the less likely you are to get sick from them. Freezing at zero F (minus 18 C) or less stops bacterial growth (although it won't kill all bacteria already present). 2. Answer B is the best practice; give yourself two points if you picked it. Hot foods should be refrigerated as soon as possible within two hours after cooking. But don't keep the food if it's been standing out for more than two hours. Don't taste test it, either. Even a small amount of contaminated food can cause illness. Date leftovers so they can be used within a safe time. Generally, they remain safe when refrigerated for three to five days. If in doubt, throw it out, said FDA microbiologist Kelly Bunning, Ph.D., also with FDA's food safety initiative. "It's not worth a food-borne illness for the small amount of food usually involved." 3. If answer A best describes your household's practice, give yourself two points. Give yourself one point if you chose B. According to FDA's John Guzewich epidemiologist on FDA's food safety initiative team, the kitchen sink drain, disposal and connecting pipe are often overlooked, but they should be sanitized periodically by pouring down the sink a solution of 1 teaspoon (5 milliliters) of chlorine bleach in 1 quart (about 1 liter) of water or a solution of commercial kitchen cleaning agent made according to product directions. Food particles get trapped in the drain and disposal and, along with the moistness, create an ideal environment for bacterial growth. 4. If answer D best describes your household's practice, give yourself two points. If you picked A, you're violating an important food safety rule: Never allow raw meat, poultry and fish to come in contact with other foods. Answer B isn't good, either. Improper washing, such as with a damp cloth, will not remove bacteria. And washing only with soap and water may not do the job, either. 5. Give yourself two points if you picked answer C. If you don't have a meat thermometer, there are other ways to determin whether seafood is done: For fish, slip the point of a sharp knife into the flesh and pull aside. The edges should be opaque and the center slightly translucent with flakes beginning to separate. Let the fish stand three to four minutes to finish cooking. For shrimp, lobster and scallops, check color. Shrimp and lobster and scallops, red and the flesh becomes pearly opaque. Scallops turn milky white or opaque and firm. For clams, mussels and oysters, watch for the point at which their shells open. Boil three to five minutes longer. Throw out those that stay closed. When using the microwave, rotate the dish several times to ensure even cooking. Follow recommended standing times. After the standing time is completed, check the seafood in several spots with a meat thermometer to be sure the product has reached the proper temperature. 6. If you answered A, you may be putting yourself at risk for infection with Salmonella enteritidis, a bacterium that can be in shell eggs. Cooking the egg or egg-containing food product to an internal temperature of at least 145 F (63 C) kills the bacteria. So answer C--eating the baked product--will earn you two points. You'll get two points for answer B, also. Foods containing raw eggs, such as homemade ice cream, cake batter, mayonnaise, and eggnog, carry a Salmonella risk, but their commercial counterparts don't. Commercial products are made with pasteurized eggs; that is, eggs that have been heated sufficiently to kill bacteria, and also may contain an acidifying agent that kills the bacteria. Commercial preparations of cookie dough are not a food hazard. If you want to sample homemade dough or batter or eat other foods with raw-egg-containing products, consider substituting pasteurized eggs for raw eggs. Pasteurized eggs are usually sold in the grocer's refrigerated dairy case. Some other tips to ensure egg safety: Buy only refrigerated eggs, and keep them refrigerated until you are ready to cook and serve them. Cook eggs thoroughly until both the yolk and white are firm, not runny, and scramble until there is no visible liquid egg. Cook pasta dishes and stuffings that contain eggs thoroughly. 7. Answers C or D will earn you two points each; answer B, one point. According to FDA's Guzewich, bleach and commercial kitchen cleaning agents are the best sanitizers--provided they're diluted according to product directions. They're the most effective at getting rid of bacteria. Hot water and soap does a good job, too, but may not kill all strains of bacteria. Water may get rid of visible dirt, but not bacteria. Also, be sure to keep dishcloths and sponges clean because, when wet, these materials harbor bacteria and may promote their growth. 8. Answers A and C are worth two points each. There are potential problems with B and D. When you let dishes sit in water for a long time, it "creates a soup," FDA's Buchanan said. "The food left on the dish contributes nutrients for bacteria, so the bacteria will multiply." When washing dishes by hand, he said, it's best to wash them all within two hours. Also, it's best to air-dry them so you don't handle them while they're wet. 9. The only correct practice is answer C. Give yourself two points if you picked it. Wash hands with warm water and soap for at least 20 seconds before and after handling food, especially raw meat, poultry and fish. If you have an infection or cut on your hands, wear rubber or plastic gloves. Wash gloved hands just as often as bare hands because the gloves can pick up bacteria. (However, when washing gloved hands, you don't need to take off your gloves and wash your bare hands, too.) 10. Give yourself two points if you picked B or C. Food safety experts recommend thawing foods in the refrigerator or the microwave oven or putting the package in a water-tight plastic bag submerged in cold water and changing the water every 30 minutes. Gradual defrosting overnight is best because it helps maintain quality. When microwaving, follow package directions. Leave about 2 inches (about 5 centimeters) between the food and the inside surface of the microwave to allow heat to circulate. Smaller items will defrost more evenly than larger pieces of food. Foods defrosted in the microwave oven should be cooked immediately after thawing. Do not thaw meat, poultry and fish products on the counter or in the sink without cold water; bacteria can multiply rapidly at room temperature. Marinate food in the refrigerator, not on the counter. Discard the marinade after use because it contains raw juices, which may harbor bacteria. If you want to use the marinade as a dip or sauce, reserve a portion before adding raw food. 11. A and B are correct. Give yourself two points for either. When buying fresh seafood, buy only from reputable dealers who keep their products refrigerated or properly iced. Be wary, for example, of vendors selling fish out of their creel (canvas bag) or out of the back of their truck. Once you buy the seafood, immediately put it on ice, in the refrigerator or in the freezer. Some other tips for choosing safe seafood: Don't buy cooked seafood, such as shrimp, crabs or smoked fish, if displayed in the same case as raw fish. Cross-contamination can occur. Or, at least, make sure the raw fish is on a level lower than the cooked fish so that the raw fish juices don't flow onto the cooked items and contaminate them. Don't buy frozen seafood if the packages are open, torn or crushed on the edges. Avoid packages that are above the frost line in the store's freezer. If the package cover is transparent, look for signs of frost or ice crystals. This could mean that the fish has either been stored for a long time or thawed and refrozen. Recreational fishers who plan to eat their catch should follow state and local government advisories about fishing areas and eating fish from certain areas. As with meat and poultry, if seafood will be used within two days after purchase, store it in the coldest part of the refrigerator, usually under the freezer compartment or in a special "meat keeper." Avoid packing it in tightly with other items; allow air to circulate freely around the package. Otherwise, wrap the food tightly in moisture-proof freezer paper or foil to protect it from air leaks and store in the freezer. Discard shellfish, such as lobsters, crabs, oysters, clams and mussels, if they die during storage or if their shells crack or break. Live shellfish close up whe the shell is tapped. 12. If you are under treatment for any of these diseases, as well as several others, you should avoid raw seafood. Give yourself two points for knowing one or more of the risky conditions. People with certain diseases and conditions need to be especially careful because their diseases or the medicine they take may put them at risk for serious illness or death from contaminated seafood. These conditions include: liver disease, either from excessive alcohol use, viral hepatitis, or other causes hemochromatosis, an iron disorder, diabetes, stomach problems, including previous stomach surgery and low stomach acid (for example, from antacid use), cancer, immune disorders, including HIV infection, long-term steroid use, as for asthma and arthritis, Older adults also may be at increased risk because they more often have these conditions. People with these diseases or conditions should never eat raw seafood -- only seafood that has been thoroughly cooked. Rating Your Home's Food Practices 24 points: Feel confident about the safety of foods served in your home. 12 to 23 points: Reexamine food safety practices in your home. Some key rules are being violated. 11 points or below: Take steps immediately to correct food handling, storage and cooking techniques used in your home. Current practices are putting you and other members of your household in danger of food-borne illness. \6 magnesium Magnesium Research (1993) Review paper Magnesium and ageing. II. Clinical data: aetiological mechanisms and pathophysiological consequences of magnesium deficit in the elderly Summary: Ageing constitutes a risk factor for magnesium deficit. Primary magnesium deficit originates from two aetiological mechanisms: deficiency and depletion. Primary magnesium deficiency is due to insufficient magnesium intake. Dietary amounts of magnesium are marginal in the whole population whatever the age. Nutritional deficiencies are more pronounced in institutionalized than in free-living ageing groups. Primary magnesium depletion is due to dysregulation of factors controlling magnesium status: intestinal magnesium hypoabsorption, reduced magnesium bone uptake and mobilization, sometimes urinary leakage, hyperadrenoglucocorticism by decreased adaptability to stress, insulin resistance and adrenergic hyporeceptivity. Secondary magnesium deficit in ageing largely results from various pathologies and treatments common to elderly persons, i.e., non-insulin dependent diabetes mellitus and use of hypermagnesuric diuretics. Magnesium deficit may participate in the clinical pattern of ageing, particularly in neuromuscular, cardiovascular and renal symptomatologies. The consequences of hyperadrenoglucocorticism- the simplest marker of which is non-response to the dexamethasone suppression test - may include immunosuppression, muscle atrophy, centralization of fat mass, osteoporosis, hyperglycaemia, hyperlipidaemia, atherosclerosis, and disturbances of mood and mental performance through accelerated hippocampal ageing particularly. It seems very important to point out that magnesium deficit and stress aggravate each other in a true 'pathogenic vicious circle', particularly in the stressful state of ageing. The importance of magnesium deficit in the aetiologies of insulin resistance, and the adrenergic, osseous, oncogenic, immune and oxidant disturbances of ageing is still uncertain. Oral physiological magnesium supplementation (5 mg Mg/kg/d) is the best diagnostic tool for establishing the importance of magnesium deficiency. Too few open and double blind studies on the effects of the treatment of magnesium deficiency and of magnesium depletion in geriatric populations have been done. Further study is necessary to assess the true place of magnesium deficit in the pathophysiology of ageing. Introduction - The importance of magnesium in the pathophysiology of ageing has been evaluated very differently by different investigators. Enthusiasts such as P. Delbet1 have seen in magnesium a sort of panacea which may play the role of elixir vitae in preventing all the hazards of senility. Intellectual functions, sexual potency and skin quality are all stimulated by oral magnesium supplementation alone. On the other hand, various recent general reviews concerning nutrient requirements and electrolytic abnormalities in the elderly2-6 have entirely overlooked certain data concerning magnesium status during ageing! Between these two extremes, it is now possible to find a balance. It seems to be well established that magnesium does not constitute an elixir vitae. Conversely magnesium deficit may play a role in the pathophysiology of ageing7-10. This clinical notion relies on a substantial experimental background, starting with the seminal paper by O. Heroux et al. (1977) which showed that chronic marginal magnesium deficiency reduced lifespan in rats11. Magnesium deficit accelerates ageing through its various effects on the neuromuscular, cardiovascular and endocrine apparatus, kidney and bone, immunity, antistress and anti-oxidant systems7-10,12. The aim of the present review is to analyse successively the aetiological mechanisms of magnesium deficit in ageing, its physiopathological consequences, and lastly, the importance of its treatment in elderly patients. Aetiological mechanisms of magnesium deficit in ageing Both primary and secondary magnesium deficits should be split into magnesium deficiency and magnesium depletion. Magnesium deficiency is due to insufficient magnesium intake; in animal experimentation, it constitutes the relevant model of a magnesium deficient state. It merely requires oral physiological magnesium supplementation. In developed countries, the marginal magnesium intake induces a high prevalence of primary marginal magnesium deficiency in human beings7,13-17. Magnesium depletion is related to a dysregulation of the control mechanisms of magnesium metabolism: either failure of the mechanisms which ensure magnesium homeostasis or intervention of endogenous or iatrogenic factors disturbing magnesium status. Magnesium depletion requires more or less specific correction of its causal dysregulation. Ageing may induce both these types of magnesium deficit, deficiency and depletion even though they both originate from primary or secondary causes. Primary magnesium deficiency of ageing - In developed countries, magnesium intake is marginal throughout the entire pop whatever the age: around 4 mg/kg/day instead of the 6 mg/kg/day recommended to maintain satisfactory balance. The high prevalence of the marginal magnesium deficiency in 15-20% of the pop seems consistent with the estimation of nutrient deficiency using probability analysis. These data are particularly relevant to the health of aged persons. However, the elderly population is extremely hetero- geneous: diseases, handicaps, physical or psychological impairments expose individuals to more severe nutritional deficiencies. Thus marginal magnesium deficiency is observed in elderly people as well as in the gen pop, and in free living ageing groups as well as in institutionalized elderly patients, although more pronounced in the latter, whatever countries are considered, America, Australia or Europe. A positive correlation between energy intake and magnesium intake is always observed. Primary magnesium depletion of ageing--metabolic dysreg- ulations - Magnesium depletion is due to dysregulation of factors controlling magnesium metabolism, either effectors (intestinal absorption, bone storage and urinary excretion) or controls (mainly neurohormonal controls of magnesium status, in particular neuroen- docrine metabolic alterations which intervene during stress reaction and may induce magnesium depletion). In the human, magnesium absorption decreases with age. Around the age of seventy it becomes two-thirds of what it usually is at around the age of thirty. Exchangeable pools of magnesium are reduced in elderly patients. In particular cases, urinary magnesium leakage may be increased, but usually urinary magnesium excretion decreases or remains normal. Hyperadrenoglucocorticism through decreased adaptability to stress - Among the biological bases of ageing, it seems particularly important to highlight the fact that senescence appears to be a condition of decreased adaptability to stress. Selye et al. (1976) suggested in a seminal paper that the cause of age-related phenomena resided in the progressive breakdown of the neuroendocrine system which intervenes under stress: humans are born with a fixed quantity of 'adaptative energy' which is progressively reduced along with repeated exposure to stressing factors. This clinical observation of a decreased adaptability to stress due to ageing relies now on a rich and well-defined animal experimental background. The age-related alterations in brain function particularly concern the hippocampal pyramidal neurones. This part of the limbic system exerts an inhibitory influence on the activity of the hypothalamo-pituitary-adrenal axis. Hippocampal ageing induces a state of hyperglucocorticism. Target cells for glucocorticoids are more highly concentrated in the hippocampus than in any other brain region. Excess corticoid receptor activation mediates neuronal degeneration through an increased influx of calcium into the cells induced by a deleterious increased release of excitatory amino acids - such as kainic acid - associated with a decrease of protective inhibitory amino acids - such as glycine, GABA and taurine. This new hippocampal injury could in turn provoke a new imbalance of the hypothalamo- pituitary-adrenal axis with a 'glucocorticoid cascade' inducing a state of hyperadrenoglucocorticism. The hippocampus is therefore a prime target area for investigation of the events which accompany stress and in particular for the regulation of stress-induced corticosteroid secretion. But the hippocampus is also a basic structure for social life, being involved in mood regulation, control of internal inhibition, memory and learning. Long term potentiation of synaptic transmission in the hippocampus appears as its privileged investigation tool46-61. The differences between normal physiological ageing processes and pathological brain ageing processes may result from ageing-associated susceptibility factors49,50 : genetic predispositions, infections agents, environmental toxins or nutritional disorders. Magnesium deficit could be one of these ageing-assoc susceptibility factors, particularly through: [1] the vicious circle initiated between magnesium and stress [2] the relation between magnesium and neuroplasticity and [3] the links between magnesium and the hippocampus. These links have been observed both in vitro and at pharmacological doses but only once in vivo on a physiological model. Further experimental research is necessary to evaluate the importance of this hypothesis using, for example, either the model of hippocampal ageing accelerated by chronic stress or the kainic acid model47,61 under deficient or high magnesium diet. With this latter experimental model in rats various magnesium salts were used in order to increase the magnesium intake. Their effects were subsequently compared according to their respective anions as had been done previously with the model of androgenic seizures in mice. The best protective effects were obtained with magnesium acetyl taurinate which constitutes a powerful combin- ation of taurine, the most neuroprotective inhibitory amino acid, and of magnesium. This impressive animal experimental background on the alterations in stressor reactions due to ageing show the importance of the clinical markers in the failure of adaptability to stress in elderly patients. Several clinical observations confirm the frequency of hyperadrenoglucocorticism in ageing. Static investiga- tions of glucocorticoid may seem contradictory. Basal plasma concentrations of glucocorticoids, whether measured as 17-hydrocorticosteroids as in the past, or now as immunoreactive cortisol, have been found to show no change with age to be increased in older men or to be increased in the overall aged population44. The highest cortisol values are observed in the stroke subgroup. This is only one third of the paper... but hair is da Conclusion - Ageing constitutes a risk factor for magnesium deficit. Primary magnesium deficit of the elderly originates from two aetiological mechanisms: deficiency and depletion. Primary magnesium deficiency is due to insufficient magnesium intake. Dietary intakes of magnesium are marginal in the whole population at whatever age. Nutritional deficiencies are more pronounced in institutionalized than in free-living ageing groups. Primary magnesium depletion is due to dysregulation of factors controlling magnesium metabolism: intestinal magnesium hypoabsorption, reduced bone magnesium uptake and mobilization, sometimes urinary losses, decreased sensitivity to negative feedback regulation by glucocorticoid-inducing hyperadrenoglucocorticism, insulin resistance and adrenergic hyporeceptivity. Secondary magnesium deficit of ageing depends largely on various pathologies and treatments common to elderly persons: i.e. non insulin-dependent-diabetes mellitus and the use of hypermagnesuric diuretics. Magnesium deficit may participate in the clinical pattern of ageing - neuromuscular, cardiovascular and renal symptomatologies mainly. The consequences of hyperadrenoglucocorticism may concern immunosuppression, muscle atrophy, centralization of the fat mass, osteo- porosis, hyperglycaemia, hyperlipidaemia, arterioscler- osis, and disturbances of mood and mental performance, through accelerated hippocampal ageing particularly. It seems very important to point out that magnesium deficit and stress aggravate each other in a true pathogenic vicious circle, particularly harmful in the stressful state of ageing. The importance of magnesium deficit in the aetiology of insulin resistance, adrenergic, osseous, oncogenic, immune and oxidant disturbances of ageing is still uncertain. Oral physiological magnesium supplementation is the best diagnostic tool for establishing the importance of magnesium deficiency. Too few open and double-blind studies of the effects of treatments of magnesium deficiency and of magnesium depletion in geriatric populations have been done. Further study is necessary to assess the accurate place of magnesium deficit in the pathophysiology of ageing. \ 7 NUTRITION articles The elderly constitute a rapidly expanding segment of the American population. The number of Americans age 60 or over has grown from about 5 million in 1900 to approximately 42 million in 1990--a figure that will more than double by the year 2030 (fig. 1). The proportion of Americans over 60 years of age has also increased, from 6.4 to 18.4 percent of the U. S. population during 1900-90--a share that will expand to almost a quarter of the population by 2030. The elderly account for about 30 percent of all healthcare expenditures in the United States. They also use hospitals at nearly three times the rate of younger persons, average seven to eight medical visits per year, and occupy the majority of nursing residence beds. The maintenance of health and functional independence of older persons is a national priority, as identified in the U.S. Department of Health and Human Services (DHHS) report Healthy People 2000. Poor nutritional status is a primary concern for the elderly. Nutritionally inadequate diets can contribute to or exacerbate chronic and acute diseases, hasten the development of degenerative diseases associated with aging, and delay recovery from illnesses. A number of studies indicate that the diets of many older Americans do not provide the level of nutrients needed to maintain a healthy body. Chronic diseases and poverty are two important influences on the nutritional status of the elderly. Gauges of Dietary Quality for the Elderly Have Limitations Methodologies for assessing nutritional status include anthropometric measurements (for example, weight and height), biochemical analyses (laboratory tests on blood and urine samples), clinical evaluations (examining physical changes in skin, hair, eyes, and mouth), and dietary intake surveys. Evidence on the nutritional status of the elderly has been based largely on the results of nationally representative dietary surveys, such as the U.S. Department of Agriculture's (USDA) Nationwide Food Consumption Surveys (NFCS) and their Continuing Surveys of Food Intakes by Individuals (CSFII) in addition to DHHS's National Health and Nutrition Examination Surveys (NHANES). Dietary assessment methods are intended to provide detailed information on food consumption, but it should be recognized that there can be problems associated with dietary intake assessments. For example, if a dietary study uses a 24-hour recall method (respondents report on the types and amounts of foods consumed the previous 24 hours), there may be a tendency to underreport the consumption of certain foods and, thus, the intake of certain nutritional components. There has been some evidence in the past to show, for example, that respondents have underestimated caloric and fat intake. However, this problem and others associated with the dietary assessment methods can be mini-mized as long as standardized procedures and close interview monitoring are used during data gathering. Dietary studies frequently define an adequate, nutritious diet as one fulfilling the Recommended Dietary Allowances (RDA's) issued by the National Academy of Sciences. RDA's specify the levels of the average intake of nutrients essential for maintaining normal body functioning for a healthy population. Therefore, diets under 100 percent of the RDA's are associated with, but do not necessarily mean, deficiency. The most recent RDA's, published in 1989, provide guidelines for healthy adults age 51 and over. Despite their importance as guidelines for the elderly's nutrient intake, the existing RDA's fail to address some current concerns about the diet and health of the elderly. For example, separate RDA's for subgroups of the older population may be preferable. It is unrealistic to assume that a 60-yearold healthy individual and an 85year-old homebound individual have similar nutritional requirements. However, insufficient data have prevented the establishment of separate RDA's for elderly subgroups. The RDA's do not cover unusual nutrient needs for special conditions, such as metabolic disorders, or the continued use of medicines. Similarly, margins of safety built into the RDA standards do not cover modifications for any additional requirements caused by disease. Many diseases, especially those to which many elderly succumb, have profound impacts on an individual's nutrient requirements. For example, the incidence of chronic diseases, such as diabetes, increases with age. Therefore, the RDA's may have limited use in evaluating diets of the elderly. Some at Higher Nutritional Risk All these caveats notwithstanding, the most recent information from surveys on the dietary status of olde:r Americans gives reason for concern. Severe or life-threatening nutrient deficiencies are rare, although many elderly are at high risk of deficient intakes of some essential nutrients. Calories, calcium, vitamin B-6, magnesium, and zinc are most frequently below the recommendations for the elderly. For example, caloric intakes averaged only 80 percent of the RDA for elderly men and 73 percent for elderly women, according to data from recent CSFII surveys. Although this caloric dietary pattern is somewhat similar to that adults and may be partly due to underreporting, decreased calorie intake with advancing age nevertheless has important implications for the elderly's diet in terms of meeting existing standards for other nutrients. Researchers haw, found that it becomes difficult to ensure diet quality for the elderly when overall calorie intake is low, requiring a careful selection of nutrient-rich foods. Moreover, the risk of nutritional deficiencies is greater among certain subgroups of that population (some examples are shown in table 1). Low-income elderly have a substantially greater risk of deficient calorie, calcium, magnesium, and zinc intakes than do the elderly as a whole. Intakes of energy and calcium have been found to be lower among black and Hispanic elderly, and elderly Hispanic women have relatively low intakes of energy, vitamin E, magnesium, thiamin and iron. The frail elderly (those requiring assistance to carry out daily activities) appear to have a nutrient- poor diet--more deficient in thiamin, riboflavin, vitamin B-6, vitamin C, and all minerals than diets of the elderly population as a whole. Those age 85 years and above are also at greater risk, with lower levels of calorie and vitamin B-6 intake. There is considerable evidence that the elderly population is also at risk of excessive intakes of fat, saturated fat, cholesterol, and sodium. For example, the Dietary Guidelines for Americans recommend that fat be restricted to no more than 30 percent of total calories, and saturated fat intake to be less than 10 percent. National dietary intake surveys over the years show that elderly men and women have been obtaining between 34 and 41 percent of total calories from fat and between 11 and 13 percent of calories from saturated fat. This is similar to the overall dietary pattern for the U.S. population. However, many of the most prevalent nutrition-related problems of the elderly are chronic conditions that benefit from diet therapy. Some of these conditions may be exacerbated by high intakes of fat and saturated fat. The extent to which dietary, personal, and environmental factors influence the nutritional status of the elderly is only partially understood. Social isolation, depression, attitudes, and lifestyles are cited by some researchers as factors affecting the elderly's appetite, eating patterns, energy level, and hence, nutritional status. However, considering all the factors thought to influence the nutritional status of the elderly, chronic diseases and the financial burdens imposed by limited income are among the most important. Chronic Diseases Interfere with Nutritional Health Chronic diseases can have a wide range of negative effects on the nutritional status of the elderly, There are diseases which can affect digestion, absorption, and utilization of nutrients (such as circulatory and musculoskeletal problems); those which interfere with nutrient intake (for example, oral problems, including poor dentition); and those which hinder the absorption of specific nutrients (examples are diabetes and infections). Statistics show that approximately 80 percent of those 65 years of age and over are afflicted with one or more chronic diseases, compared with 40 percent of adults between 18 and 64 years of age. People 65 years of age and over more often suffer from chronic diseases, such as heart disorders, arthritis, bone diseases, and diseases that affect the respiratory and digestive systems (table 2). The Vital and Health Statistics report from the Centers for Disease Control and Prevention indicates that the incidence of these diseases is not confined to just one sex, race, or other demographic stratum within the elderly population. For example, the rate of hypertension in women is nearly twice that in men, and the rate of hypertension in blacks is higher than that of other races. The incidence of coronary heart disease is similar across educational strata, but more prevalent in elderly men than women and more prevalent among whites than other races. Drugs often have a favorable effect on nutritional status by limiting the disease process, enhancing appetite, and correcting underlying metabolic defects. However, there are also examples of adverse drug/nutrition interactions. For instance, antibiotic therapy can produce vitamin deficiency. Chronic use of some medications can produce gastrointestinal abnormalities which affect nutritional status, and prolonged use of over-the-counter relief products, such as laxatives, can result in altered absorption of certain vitamins, diarrhea, weight loss, and fatigue. Poverty Takes a Toll on Nutritional Adequacy Poverty may be one of the most important environmental determinants of inadequate nutrition among the elderly. Poverty alone cannot precipitate a nutritional deficiency, but may affect a person's ability to obtain an adequate diet. Poverty may also reduce a person's ability to obtain the healthcare needed to diagnose, treat, and manage chronic diseases linked to nutrition. Researchers at Cornell University, who have been involved in measuring hunger and food insecurity in the elderly, indicate that low-income elderly are more likely than higher income elderly to report that they don't get enough to eat, that they skip meals because they have no food available, and that they have to make the choice between buying medicine and buying food. According to 1995 estimates by the Bureau of Census, almost 11 percent of Americans over age 65 had incomes below the official Federal poverty levels, compared with, for example, a poverty rate of 8 percent for "middle-aged" Americans (35-54 years of age). The poverty rate was higher for elderly women than for elderly men, and higher among elderly blacks than among other racial groups. Differences were even more pronounced for those 75 years of age and over. The overall poverty rate for this age group was 13 percent, but women in this age bracket had a poverty rate of almost 17 percent, versus 8 percent for men that age (fig. 2). About 33 percent of blacks over age 75 were in poverty, compared with 11 percent for whites and 27 percent for Hispanics (fig. 3). Many elderly live on fixed incomes (such as pensions), while retail food prices continue to rise. As a result, households headed by the elderly spend an average of about 15 percent of their incomes for food, compared with about 12 percent for all U.S. households. Government Efforts for Intervention A variety of food and nutrition programs have been implemented at the Federal, State, and local levels during the past few decades. In particular, two large-scale Federal foodassistance programs have been developed to help ease the income burden for many elderly as well as to enhance their nutritional status. Food Stamp Program's Impact USDA's Food Stamp Program is intended to improve the ability of low-income house]holds to purchase nutritionally adequate diets by supplementing their food expenditures. The program provides food assistance through coupons that are redeemable for food in retail stores or via electronic benefit transfer (similar to debit cards). Recipients must meet certain income, asset, and employment-related requirements. In 1995, the Food Stamp Program served approximately 2 million people ages 60 or over each month-about 7 percent of all food stamp participants. Only 35 percent of elderly Americans who were eligible for food stamps actually applied for and received them in Jaunary 1994, compared with 71 percent of the 38 million people in the United States eligible for benefits. Elderly persons who received food stamps tended to live alone--76 percent of all food stamp households with elderly members were single-person households. The Food Stamp Act of 1977 made several major revisions to the Food Stamp Program, one of the most farreaching was the elimination of the purchase requirement. Prior to the Act, food stamp recipients were required to make a cash payment for their food stamps. The amount of food stamps they received was equal in value to their cash payment, plus an additional amount known as the "bonus." After the Act eliminated this purchase requirement, recipients received only the bonus (with no cash transaction). Several studies in the early 1970's suggested that inability to make the cash payment required under the original Food Stamp Program may have been a major reason why many eligible households headed by the elderly did not participate. Since elimination of the purchase requirement took effect, participation by households headed by an elderly person did increase somewhat, but minimally. USDA's Food and Consumer Service (FCS), which oversees the Food Stamp Program, is initiating an indepth study to better understand the low participation rate of the elderly. There are also special provisions in effect specifically to encourage elderly participation in the Food Stamp Program. For example, a provision has been made for the allowance of higher medical and shelter deductions when determining the size of the food stamp benefits. Elderly participants are subject to less stringent asset and income eligibility requirements. Also, the elderly can now apply for benefits at home or over the phone. The elderly are not subject to the employmentrelated eligibility requirements. And, USDA allows approved, nonprofit foodservice providers to accept food stamps as payment for meals served to the elderly. However, despite these special provisions, elderly persons may be less likely than others to participate because they generally qualify for smaller benefits. The size of the food stamp allotment is based o:n household size, less 30 percent of the elderly's household net income. Because they tend to have higher incomes (relative to non-elderly food stamp participants), their household food stamp allotments are generally smaller than those received by non-elderly participants. These smaller allotments, in turn, may not allow elderly-headed households to purchase more nutritionally adequate diets. Relatively few studies have focused exclusively on evaluating the impacts of the Food Stamp Program on the nutritional status of elderly recipients. In 1990, USDA did an exhaustive review of studies to examine the extent to which the Food Stamp Program enhanced the nutritional status of elderly participants. Generally, these few studies tend to show that food stamp participation has a positive, although small, impact on elderly recipients' nutrient intake. The studies indicate that low-income elderly Food Stamp Program participants spend about $5 to $10 more on food per month than do nonparticipants, and their intake of nutrients is 3 to 6 percent higher for each nutrient. The Elderly Nutrition Program's Impact In 1973, Congress appropriated nearly $100 million to establish the first Federal nutrition intervention program specifically for the Nation's older population--the Elderly Nutrition Program. This program, administered by DHHS's Administration on Aging, provides grants to State agencies to support congregate and home-delivered nutrition services to eligible elderly individuals. Funds to States are awarded according to a formula based on a State's relative share of those age 60 and over. Funds within a State are awarded to area agencies on aging, which contract with local nutrition service providers. USDA provides additional support to the program in the form of commodities or cash in lieu of commodities for each meal served. Persons at least 60 years of age and their spouses (regardless of age) are eligible for congregate-meal benefits. Home-delivered meals are available to the elderly who are homebound due to disability, illness, or geographic isolation. Unlike with the Food Stamp Program, there are no income or asset requirements to participate in this program, although preference for meal benefits is given to those exhibiting the greatest economic or social need. In fiscal 1995, about 123.4 million congregate meals were served to 2.4 million elderly people, and 119 million home-delivered meals were served to 988,738 homebound elderly people. A 1993 amendment to the Act requires that meals served under State-established and operated projects comply with the Dietary Guidelines for Americans. States are also to provide to each participating elderly person a minimum of onethird of the RDA's if the project provided one meal a day, a minimum of two-thirds of the RDA's if the project provided two meals per day, and 100 percent of the RDA's if the project provided three meals a day. Earlier studies had evaluated the impact of the Elderly Nutrition Program on the nutritional status of the elderly, but there were limitations: inadequate measures of dietary intake, self-selected samples of participants, and failure to include eligible nonparticipants as comparison groups. But despite these various shortcomings, most of these earlier studies found that the dietary intake of most nutrients was greater for the elderly participating in the program than for both nonparticipants and former participants. DHHS recently released the results of a long-term, comprehensive, nationwide evaluation of the Elderly Nutrition Program. The results of this comprehensive evaluation indicated that participants in both congregate and home-delivered meal programs had higher daily, intakes of key nutrients than did similar nonparticipants. For example, the average daily intake of calcium (as a percentage of the RDA's) for congregate meal program participants was 93 percent, compared with 75 percent for elderly nonparticipants. Similarly, the average daily intake of calcium for homedelivered meal participants was 91 percent, compared with 73 percent for a comparison group of nonparticipants. Close Attention to the Issue Must Continue Inappropriate food intake, chronic disease, and functional impairment place a substantial number of elderly Americans at nutritional risk. Unrecognized or untreated malnutrition can lead to dsyfuction and disability, reduce the quality of life, increase morbidity, increase the need for healthcare and social services, and lead to institutionalization. Consequently, the growth in the elderly population, particularly in the oldest segment (age 85 and over) has far-reaching implications for public policy. The Food Stamp Program and the Elderly Nutrition Program, in conjunction with non-Federal programs, have sought to enhance the nutritional status of elderly Americans. Both Federal programs have taken active steps to reach more elderly people in recent years. Although evaluation of the effectiveness of these two Federal programs has not always been conclusive, it generally appears that these programs have led to nutritional improvement among the elderly. In view of increasingly tight budgetary constraints being imposed on Federal agencies, it is difficult to anticipate what changes, if any, might be made to the Federal Government's intervention efforts to enhance the elderly's nutritional status. Table 1 Elderly Have Deficient Intakes of Some Essential Nutrients Race, gender, Energy Vitamin Calcium and income (kcal) B[6] (mg) (mg) RDA's for people 51 years and over[1]: Male 2,300 2 800 Female 1,900 1.6 800 Average nutrient intakes for people 60 years and over[2]: Male 1,956 2816 Female 1,471 1.6 666 Non-Hispanic white[2]: Male 1,946 2823 Female 1,454 1.6 675 Non-Hispanic black[2]: Male 1,728 1.6 600 Female 1,404 1.3 502 Hispanic[2]: Male 1,842 1.6 777 Female 1,288 1.3 601 Low incame[3,4]: Male 1,638 1.7 645 Female 1,303 1.4 539 Race, gender, Vitamin E (mg MagnesiumZinc and income alph-Tocopherol) (mg)(mg) RDA's for people 51 years and over[1]: Male 10 350 15 Female 8 280 12 Average nutrient intakes for people 60 years and over[2]: Male 9.3 306 12.1 Female 7.8 2448.9 Non-Hispanic white[2]: Male 9.4 307 12.1 Female 8.0 2448.8 Non-Hispanic black[2]: Male 6.7 236 10.3 Female6.0 211 7.3 Hispanic[2]: Male 7.1 290 11.1 Female 5.9 2088.0 Low income[3,4]: Male 6.7 2399.5 Female6.1 199 7.9 Table 2 Some Chronic Conditions Are More Prevalent Among the Elderly Chronic condition Total population Elderly 65 years affected and over affected Number of people per 1,000 Heart disease 85.8324.9 Cerebrovasular disease11.5 40.7 Arthritis 128.8501.5 Emphysema 7.8 45.5 Diverticulosis8.3 32.5 Bone or cartilage disorder5.9 18.5 Diabetes 29.9 101.2 Source: U.S. Department of Health and Human Services, Vital and Health Statistics, National Center for Health Statistics Series 10, No. 193, Dec. 1995. Nutrition Program, 1993-1995. June 1996. ~~~~~~~~ By Jon R Weimer, (202) 219-0882 The author is an agricultural economist with the Food and Consumer Economics Division, Economic Research Service, USDA. A Key to Better Health for Elderly Attn, people over 65. Is your brain slowing down, your memory failing, your resistance to infection taking a nose dive? This is not an advertisement for a secret anti-aging formula, but a call to improve your nutrition. Too many older people may be accepting a cognitive and immunological decline as a normal part of aging, when it may reflect a deficiency in essential nutrients like vitamins and minerals. A simple one-a-day type supplement may be all that is needed to slow or even stem that decline, recent studies show. Surveys have shown that up to 40 percent of elderly people who live independently in affluent countries consume insufficient amounts of one or more essential nutrients or have deficient levels of these nutrients in their blood. The reasons for these deficiencies include a limited income, difficulty getting to stores, chronic illnesses or medications that interfere with nutrients, problems with chewing or digesting, and poor appetite. Inactivity or illness can depress the appetite, as can a loss of taste; older people who eat alone or who are depressed can also lose interest in food. Nutrient deficiencies appear to increase with age. A new study by Teresa A. Marshall and her colleagues at the University of Iowa looked at over 400 Iowans 79 and older living independently in rural areas and found that 80 percent reported consuming inadequate amounts of four or more nutrients. In findings important to disease prevention, 75 percent of those people consumed too little folate, a B vitamin that helps prevent heart disease and stroke. And 83 percent did not get enough vitamin D and 63 percent got too little calcium, both essential to preserving bone and preventing osteoporosis and fractures. Other nutrients commonly in short supply were vitamin E, magnesium, vitamin B6, vitamin C and zinc. Nutrient deficiencies were especially prominent among participants who relied on a limited number of foods. In a report in the journal Nutrition last month, the authors recommended that older people be encouraged to increase the variety of foods they eat, especially nutrient-rich fruits, vegetables and whole grains, and to take daily nutritional supplements. "Supplement use allowed a small number of subjects to have adequate nutrient intakes," the authors wrote. "However, a substantial number of subjects who might have benefited from supplement use did not consume them." Sharper Minds In the newest report on better nutrition among the elderly, Dr. Ranjit Kumar Chandra, a pediatrician and immunologist at Memorial University of Newfoundland, demonstrated that a nutrient supplement with modest amounts of 18 vitamins, minerals and trace elements could improve cognitive function in apparently healthy people over 65. The study involved 86 people who were living independently and randomly assigned to take either the 18-nutrient supplement or a dummy pill for a year. The participants and the researcher did not know who was taking what until the study was finished. As described in Dr. Chandra's report in Nutrition this month, those who took the supplement showed significant improvement in short-term memory, problem-solving ability, abstract thinking and attention. Even the participants who started out with adequate nutrition got some mental benefits from the daily nutrient supplement, although the greatest improvements occurred in people whose blood contained deficient amounts of one or more nutrients, Dr. Chandra said. No change occurred in long-term memory, which has long been known to be relatively immune to aging's effects. Dr. Chandra said the cognitive benefits from improved nutrition could significantly improve the lives of the elderly. They would be better able to perform the activities of daily living and would presumably discover more joy. He emphasized that megadoses of nutrients were not necessary or desirable because high doses of certain nutrients could have serious negative effects. The supplement he suggests contains the recommended daily amounts or less of most vitamins and minerals and somewhat larger amounts of beta carotene and vitamin E. How might nutrients improve brain function? One possibility is that taking a modest nutrient supplement daily can improve immune function. "An enhanced immune response in those receiving the nutrition supplement may be instrumental in preserving the anatomy and function of neurons and their appendages," he wrote in the new report. Improving Immunity Dr. Chandra suggested that by improving immunity, the supplement may prevent the accumulation of beta-amyloid, neurofibrillary tangles and other harmful deposits associated with serious neuronal damage and neuropsychiatric disorders like Alzheimer's disease. But it remains to be shown whether a nutrient supplement can delay or prevent the onset of dementia. In a report nearly a decade ago, Dr. Chandra showed that the same supplement resulted in a significant improvement in standard immunological tests, including the number of natural killer cells and helper T-cells, the production of interleukin 2, and the antibody response to the influenza vaccine. He also found that the supplement could restore a lagging immune response in six months, and sometimes as soon as three months. No improvement was found in those who took a dummy pill. To be sure of the supplement's benefits, the researchers checked on the participants every two weeks to determine whether they had experienced an infectious illness or needed antibiotics. Infection-related illness occurred an average of 23 days in the year among those taking the supplement, while those taking the dummy pill averaged 48 days of infectious illness. Dr. Chandra said that while it was most desirable to consume a nutritionally adequate diet, he was struck by the cost-effectiveness and simplicity of a nutritional supplement to prevent or delay illness and functional decline in the elderly. Based on his findings, he has calculated that for every dollar spent on such a nutrient supplement, $28 would be saved in health care costs. The precise amounts of the nutrients in the supplement used in Dr. Chandra's studies were determined by how much of each nutrient had shown a maximum benefit to the immune system in his studies. For comparison with the vitamin supplements sold to older adults, here are the contents of Dr. Chandra's supplement: 400 retinol equivalents (1,333 International Units) of vitamin A, 16 milligrams of beta carotene, 2.2 milligrams of thiamine, 1.5 milligrams of riboflavin, 16 milligrams of niacin, 3 milligrams of vitamin B6, 400 micrograms of folate, 4 micrograms of vitamin B12, 80 milligrams of vitamin C, 4 micrograms (160 I.U.'s) of vitamin D, 44 milligrams (44 I.U.'s) of vitamin E, 16 milligrams of iron, 14 milligrams of zinc, 1.4 milligrams of copper, 20 milligrams of selenium, 0.2 milligrams of iodine, 200 milligrams of calcium and 100 milligrams of magnesium. There is no end in sight to our focus on the baby boom generation, even as we approach the 21st cen. Baby boomers will be a key factor in the coming "agequake," when the elderly will comprise a much larger share of the population. In 1980, about one in 10 persons were 65 or older. By 2030, the 65 and older will number one in five. The first "boomers" will reach age 65 in 2011. And more people will be living longer. According to most projections, tomorrow's 85-plus will be a fast growing group as the median age of death in the next century climbs to 84 years. That's 11 years beyond today's median lifespan of 73 years. The needs of an aging population will shape every facet of society in the next century, including nutrition. "We don't have a good handle on nutrient performance for older people," according to Ann W. Sorenson, Ph.D., health science administrator at the National Institute on Aging (NIA). The recently-revised Recom-mended Daily Allowances (RDAs) do not distinguish among older adults of various ages-there is just one set of RDAs for all adults over age 50. According to Sorenson, the Food and Academy of Sciences felt it did not have enough information to go further. Nonetheless, most experts agree that the dietary needs of people in their 50s or 60s are different from people in their 70s and 80s. Speaking at The American Dietetic Association (ADA) Annual Meeting last October, Irwin B. Rosenberg, M.D., director of the USDA Human Nutrition Research Center on Aging at Tufts University, reflected on the coming demographic shift. "The challenge we face is to maintain a higher degree of physiologic performance throughout the life cycle," Rosenberg said, "so that the individuals in our society are more independent, more mobile, more able to take care of themselves. "If we are going to achieve this," Rosenberg said, "then it is going to be extremely important that we look at those kinds of health patterns in which we can intervene. Clearly, diet and nutrition are going to be very important aspects of this approach." Vitamin Requirements of Elderly There are generally recognized changes in dietary needs for the elderly. Many are related to loss of lean body mass and reduced level of activity. Less muscle tissue and lower expenditure of energy result in a need for reduced caloric intake. When eating less food, the elderly must be careful to select nutritious foods so that their diminished intake will provide the nutrients they need. In general, women require fewer calories, yet have nutrient requirements similar to men, and must be especially mindful of their food choices. Normal changes associated with aging result in higher requirements for some nutrients such as vitamin D, which is necessary for proper calcium absorption. The elderly typically get less exposure to the sun and have reduced capacity for skin synthesis of vitamin D, a major source of this nutrient. Reduced intakes as well as lower absorption and metabolism of vitamin D and calcium are among the many factors related to loss of bone mineral. This leads to susceptibility to fractures and related problems, including morbidity and mortality. The elderly also seem to require more vitamin B6, and may be more sensitive to its depletion. Neurolgic and immunologic effects may become apparent, although they are reversible with supplementation. As many as 30 percent of people at age 65 develop atrophic gastritis, the inability to produce stomach acid, according to Rosenberg. This leads to impaired absorption of certain important nutrients, including folic acid, calcium, iron and vitamin B12. He estimated that by the age of 80, up to 40 percent of persons develop atrophic gastritis, which has a significant impact on the bioavailability of some key nutrients. With vitamin A, however, the body's slowdown with age means that less of the nutrient is better, not more. The elderly clear vitamin A from their blood and tissue more slowly, meaning they can be more susceptible to vitamin A toxicity. An over-supply of vitamin A could easily be harmful. Research into vitamins E and C, both antioxidants, may lead to new RDAs for the elderly one day. Vitamin E has shown a positive effect on the immune system in research at the USDA Center. Whether vitamin E stimulates the immune system or prevents its decline is unclear. An increased chance of developing cataracts has been associated with low vitamin C intakes in research at the USDA Center. Vitamin C's antioxidant properties may ward off potential damage by ultraviolet light, but the conclusion cannot yet be drawn. Some data also indicate a correlation between plasma vitamin C levels and the "good kind of cholesterol," HDL cholesterol. Poor nutrition can have stark consequences for the elderly. Aging is generally associated with decline of the immune response, which may be linked with a cumulative, marginal deficiency of trace metals and vitamins, according to Gabriel Fernandes, Ph.D., at the University of Texas. Of particular interest are zinc, B vitamins, iron and other trace metals. Medications for chronic disease can affect drug-nutrient interaction, as well. These and other emerging ideas lead many to call for more definitive research into the nutritional needs of the elderly. Who Is At Risk? Elderly on low, fixed incomes are at greater risk of malnutrition. A lack of skills and knowledge about food preparation is another problem. The loneliness and despair felt by some elderly also contribute to loss of appetite. Somewhat striking is the significance of living arrange- ment, especially for men. Research has found a corre- lation between living alone and a poor quality diet. An NIA-sponsored study of elderly living in the community by Maradee Davis, PhD. UC at SFO, found that men living alone were more often at risk of poor nutrition than men living with a spouse. The researchers speculate that the reasons why solitary older people show poor nutritional habits vary with gender. Men living alone are at particular risk because they are traditionally unaccustomed to planning, shopping and preparing for meals. On the other hand, women may feel unmotivated to prepare meals when there is no one to share them with. Some simple tips developed by the AARP may help the elderly who live alone. AARP suggests inviting a friend over to share a meal or having a standing date with a friend to eat out together weekly. Other tips include buying smaller food packages to reduce repetitious meals of leftovers, and setting the dining table attractively. AARP also recommends joining a nutrition pgm at a comm or senior ctr, or signing up for Meals-On- Wheels for a few days a week, if eligible. Smell and Taste Important For a variety of reasons, the senses of taste and smell decline with age. The loss can result from disease, injury or drug treatments, as well as from normal aging, according to Susan S. Schiffman, PhD at Duke Univ. Without the pleasure of eating, the overall quality of life for older people is greatly reduced. This can increase depression and stress, and lead to poor nutrition. In extreme cases, older people can become anorexic. A taste disorder can also cause poor digestion by altering salivary flow and intestinal motility. Schiffman has used odor and flavor enhancers to compen- sate for chemosensory loss, increase appetite and reverse the effects of anorexia. Odor and flavor enhancers may become an important factor in developing special food products for the elderly. Thirst: Gradual, steady loss of body water is a factor in aging, and older people more easily become dehydrated. This can be a major complicating factor in illness and negatively affects outcome, according to Galen L. Barbour MD, with the VA in Hampton, Virginia. The reasons may be impaired renal concentrating ability, causing excessive water to pass, and impaired sense of thirst. In some studies, thirst-impaired seniors do not seek water, even when water is physically needed and available. Habit also influences water intake, according to Barbour, as some elderly avoid the greater likelihood of urinary incontinence by drinking less water. He and others stress the importance of finding ways to overcome dehydration as a "buffer" in case of illness and as poss protection from the aging process. Finding a way to slow the aging pro- cess is a mythic quest, which has not yet been abandoned entirely. Short of that, nutrition science is concentrating on the special needs of older adults. The food industry is developing products and services of greater value and appeal to older adults. Communities may develop such concepts as targeted nutrition/ exercise ctrs. Government is working to develop better guidelines and pgms for nutrition, perhaps even specialized recommendations for the physically active and the sedentary. The ideas to help us enjoy greater "healthspans" are countless, and their benefits will surely grow with the aging pop. Staying Young Increased physical activity in the elderly has been shown to increase life expectancy even into advanced old age. Many of the "so-called normative changes" assoc with aging are not inevitable, according to William J. Evans, PhD, chief of the Human Physiology Laboratory at the USDA Human Nutrition Research Center. "It's the changes in muscle mass that may be triggering almost all of the other changes," Evans reported during the ADA Annual Meeting. As evidence, he cited research in which active men, subjected to bed rest for 21 days, had drops in aerobic capacity equivalent to 15 years of aging. Other similar studies reflect changes in almost every organ system and the skeleton. "All of these changes with decreased activity reflect almost precisely the kinds of very slow changes we see with advancing age," he said. Further, when athletes aged 45-60 were compared with athletes in their 20s, as well as inactive men in both age groups, researcher found that loss of muscle and increase fat were not age-related. "We can see that the amount of fat they have stored is directly related to the amount of time they spend exercising," Evans said. "Age is not a co-variant at all." His research indicated this probably holds true well past the age of 60. Related research has shown aerobic exercise causes adaptations in skeletal muscle that result in substantial increases in oxidative capacity, glycogen stores, insulin sensitivity and functional capacity in the elderly. Pumping Up at 80-Plus The most dramatic research by Evans has shown successful strength- training with the very frail elderly in nursing homes. The aver age in one pilot study was 90.2 yrs old. Many required assist in their daily tasks and 80% had a history of falling. For eight wks of strength trng, the group lifted weights at 80% of their one-repetition max. By the end, they increased muscle strength by 160% and muscle mass by over 10%. "It's important to note that in this pop, muscle is quite responsive and, in fact, it appears just as responsive to training as muscle of younger people. And the real problem is low expectations," Evans observed. Better Eating For Better Aging From Aug 98 Food Insight.