Proper Nutrition in Older Patient Populations - Episode 4
Simon D. Murray, MD: If I’m a person who needs some advice about nutrition, I really don’t want to hear about weighing food, or grams of fat, or this or that. Can you give me some practical advice on how I should eat to maintain good health?
Jane Schwartz, RDN: First and foremost, I always start with looking at what someone’s general pattern is to begin with. I’m not going to put somebody on some kind of diet or meal plan that’s very unfamiliar to them. It starts with taking out some foods, possibly, depending on what their diet intake is. If there’s a lot of sugar and high fat and a lot of meats, and high-fat dairy, then you’re going to want to reduce some of those foods. But I talk a lot more with people about what they need to bring into their diet to thrive.
I will ask them what their likes are. “What kind of fruits and vegetables do you like? What are you willing to eat? What do you enjoy eating?” Because my job is to help them bring healthy foods in and be happy about it. And so, it’s really about a variety, color of fruits and vegetables. Because when you look at a plate of vibrant colorful fruits and vegetables, that color is plant chemicals. Those are phytochemicals. Those are medicinal. People are on all of these kinds of medications, and we talk about how the different medications can also interfere with vitamin and mineral absorption, right? You need to be getting in all of these plant chemicals that can actually lower blood pressure, lower blood sugar, prevent cancer, help your brain, help your bones, and they’re amazing. I don’t think people recognize the power in those healthy foods. It’s really incredible.
Simon D. Murray, MD: Yes. Jane actually brought in some foods today—natural foods—and we have some pictures that we could show you of foods, which are real foods in a diet, and these are available in grocery stores everywhere.
Jane Schwartz, RDN: Yes. It’s about figuring out how to help these people work that into their everyday diet, because it can feel overwhelming. And 5 servings of fruits and vegetables is a minimum. That’s the bare minimum people should be getting. Even more is better. But how do they do that in a reasonable way?
Simon D. Murray, MD: Yes.
Jane Schwartz, RDN: So we’ve also included a shopping list that we’ll attach to this.
Simon D. Murray, MD: Well, tell me what a serving of fruit is.
Jane Schwartz, RDN: It’s half of a cup. It’s either a small piece or half of a cup. And the same with vegetables, a half cup of diced vegetables.
Simon D. Murray, MD: Cooked or raw?
Jane Schwartz, RDN: Well, half of a cup raw. And then leafy greens would be about a cup. Helping people work those in can be challenging for some, but there are definitely easy ways that you can do it. The other thing is protein. Protein needs are important, but especially for the elderly population. They might have muscle wasting, or they’re recovering from surgery or some kind of illness. So we need to make sure they’re getting enough protein.
Simon D. Murray, MD: How would you recommend they do that?
Jane Schwartz, RDN: That could be anything from lean meats, to fish, to cottage cheese, or a good quality dairy product. Beans are a really good plant-based source of protein. Sometimes I’ll work with a very clean protein powder to help patients add that to foods. You can do things that way.
Simon D. Murray, MD: You’re not talking about whey powder?
Jane Schwartz, RDN: A good quality whey would be OK. Or a pumpkin seed protein, or a collagen protein, or a P [phloem] protein.
Simon D. Murray, MD: Some people are allergic to whey, actually. It causes dermatitis in some people.
Jane Schwartz, RDN: Yes. So there are a lot of different kinds of….
Simon D. Murray, MD: Acne.
Jane Schwartz, RDN: That’s true.
Simon D. Murray, MD: A practical example of how I should eat; what would be a good dinner for me to eat if I were an older person? How much meat should I eat? How much fish should I eat? What serving size would be good?
Jane Schwartz, RDN: Well, 3 ounces is fine. Three ounces is going to give you about 21 grams of protein. And to speak to the needs of protein, someone who is basically in decent health, the average woman who, for instance, weighs 150 pounds would need about 55 grams or 60 grams of protein a day.
The kind of man who’s about 180 pounds would need maybe closer to 70 grams—65 grams or 70 grams. So 3 ounces of meat, chicken, or fish is going to give you about 21 grams of protein. That’s about the size of a deck of cards.
Simon D. Murray, MD: That’s a practical way to look at it.
Jane Schwartz, RDN: Yes, which is good. If you have 3 or 4 ounces of animal protein, that’s 21 grams to 27 grams right there, just in that 1 piece. A piece of salmon or grilled chicken would be good with maybe a baked potato or baked sweet potato. Your plate should also be half vegetables. That’s the new recommendation. I tell people to have your vegetables hog your plate. The new dietary guidelines show the half plate of vegetables. Especially older people are used to, when they were younger and were growing up, meat taking up most of the plate. Then you had a couple stalks of broccoli, and maybe a potato or some mashed potatoes. And so, you are kind of reversing that. You’re increasing the vegetable portion, decreasing the meat, to some extent, and the starch, depending on what the starch is.
Simon D. Murray, MD: Does it matter if I buy frozen vegetables, or fresh vegetables?
Jane Schwartz, RDN: Frozen is actually wonderful as long there’s nothing added to them, like extra salt or sugar, or they’re not sweetened with something. I encourage frozen vegetables because they’re often frozen at the peak of freshness, and it’s much easier for people to keep frozen vegetables around. They’re so easy right now. There are so many options in the supermarket now. You can steam them, and you can microwave them, and it’s wonderful.
Simon D. Murray, MD: I’ve read that. By the time fresh vegetables make their way up from Mexico or from wherever they come from, they’ve already ripened, maybe, and lost some of their nutrients.
Jane Schwartz, RDN: That’s right. Yes.
Simon D. Murray, MD: So fresh vegetables are good.
Jane Schwartz, RDN: And frozen fruit is also fine too. They can get defrosted, or you can throw them into a smoothie, or mix them with cottage cheese or yogurt or something like that. That works too.
Simon D. Murray, MD: I guess canned would be the last choice?
Jane Schwartz, RDN: Canned would be the last choice, yes.
Transcript edited for clarity.