“To eat is a necessity,” noted Francois de la Rochefoucauld. “To eat intelligently is an art.” The 17th-century French author’s observation may be more relevant than ever in an age marked by fast food, chemical ingredients, stress and lack of knowledge about healthy choices.
People grappling with various concerns — diabetes, weight gain, acid reflux, gall bladder problems, gluten allergies — are often unsure where to turn. Primary care physicians generally have had little or no training in nutrition; most medical schools fail to offer such courses.
“The reality of requiring substantive course work in nutrition for doctors — we’re not there yet,” acknowledges Amy Nickerson, director of the Master of Science in Dietetics Program at the University of Vermont.
Luckily, a wealth of registered, certified dietitians can offer guidance.
As a former head of the nutrition program at the state’s Department of Disabilities, Aging and Independent Living, Nickerson is particularly aware of how seniors are faring. “We do know from studies that older adults don’t eat enough, especially enough fruits, vegetables and dairy, or get enough physical activity,” Nickerson says, adding that strength training and tai chi are excellent ways for people to incorporate movement into their daily routines.
On matters of food, she advocates learning more about essential nourishment to understand the options. For one thing, every Area Agency on Aging in Vermont contracts with a dietitian who might do home visits, phone consultations or nutrition workshops.
These experts can dispense numerous little tips. Nickerson points out the importance of foods with Vitamin B12, for example, which doesn’t absorb well in seniors who need it for cognition. Vitamin D and calcium are crucial for strong bones. “This is a field I’m still able to get fired up about,” she acknowledges.
The same probably can be said of Laura Biron, a dietitian who practices in Stowe and at the Adams Center for Mind and Body in South Burlington. “My focus is people struggling with food because of eating disorders, weight management or digestive issues,” she explains. Input from primary care physicians or specialists is sought because “it’s important to have a medical diagnosis, sometimes even just to rule things out. Of course, I have more time to talk with patients than doctors do during our 60 to 90-minute initial visits.”
Biron looks at “dietary patterns, weight history, a snapshot of the patient’s lifestyle so I can start to put the pieces together.”
One of those pieces tends to be sleep disturbances. “If people are not feeling refreshed, their hormones may be off-balance,” Biron says. “The hormone gherlin is responsible for hunger and it goes up in your system if you’re not getting enough rest. And leptin is another hormone to think about since it signals that we feel satisfied after eating. Sleep apnea, which is common in older folks, may contribute to being overweight.”
Menopause, according to Biron, frequently affects sleep patterns and thereby can lead to consuming more calories. “The cause is not necessarily menopause itself,” she contends.
The basics, in her view, include making sure to fuel the body throughout the day, never skip meals “which may set us up to eat more or larger portions later. Also, we can mistake thirst for hunger. This exacerbates overeating. Plus, medications are likely to increase thirst. So stay well hydrated.”
Reflux is largely related to eating too close to bedtime, Biron says. Otherwise, different people have individual reactions to certain foods. “I do a complete dietary recall with my patients.”
Biron recommends a balanced diet, “with as close to whole foods as possible,” 80 percent of the time, but that it’s OK to indulge in other edibles “just for taste” the other 20 percent.”
In terms of packaged foods, look for a short list of ingredients and avoid things on the list if you don’t know what they are.”
Another way to go is “the plate method,” which involves filling one-half of a platter with non-starchy vegetables and fruits, one-quarter with protein (meat, poultry, seeds, nuts, tofu) and one-quarter with grains or veggies that have starch (peas, corn, winter squash).
Biron admits that the process isn’t always easy. “I tell patients to keep a food log to get an objective, non-judgmental look at what and how much they’ve eaten each day. Over 50, we have ingrained habits that may be hard to change. But taking small, sustainable steps is a great way to start.”
An Alternative Approach
Those seeking an alternative approach might appreciate the ideas espoused by Ann Ramsay, a dietician and registered nurse who offers Chinese acupuncture and medicine, massage and nutritional counseling in Essex Junction. “There is no blanket advice,” she says. “You must eat what’s appropriate for your age, for your level of activity and for your location.”
With this philosophy, the body’s internal mechanisms can become too cold or too hot, requiring procedures and foods that warm or cool. Ramsay cites a patient in her late 20s, an ex-athlete who had cut back on exercise, begun experiencing painful menstrual cycles and gained weight. “The painful periods meant there was cold in her uterus, which is close to the digestive system.”
Over six weeks, the woman apparently improved after starting to exercise more, eat better, drink warming teas like ginger and ingest an herbal formula that the Chinese call “warm the middle burner.”
Ramsay, whose husband is a doctor specializing in palliative care, taught at UVM’s nursing department — her courses included an introduction to Chinese medicine — for ten years. “People may come to me for acupuncture but you can’t leave food out of the health equation. First, I do a dietary assessment and decide how that fits into the entire treatment plan. The advice is specific to their situation: It’s different for 60 or 70-year-olds than for a 20-year-old; the tropics versus Vermont; what type of work they do. All those factors are important. I tell anyone who wants to lose weight that there is acupuncture geared to cravings and addictions.
In working with some elderly patients, she often uses a Japanese abdominal massage technique called ampuku that improves digestion: “It’s the hands-on part of nutritional counseling. Muscles are part of the digestive system in Chinese medicine. If I had my way, every nursing home in Vermont would have at least one massage therapist.”
The gallbladder is a small, pear-shaped organ, just beneath the liver, that aids in the digestion of fat, such as cholesterol. Painful gallstones form when that substance becomes concentrated in the gallbladder.
Among a range of dietary solutions for this condition, beet greens are at the top of the heap in the opinion of Dr. William Warnock, at the Champlain Center for Natural Medicine in Shelburne. Soybeans, wheat germ and apple cider vinegar also qualify as respected treatment possibilities. Lecithin — particularly in granule form — cannot break up an existing gallstone, but has proved effective in preventing the formation of new ones.
Reportedly, one in 33 Americans is allergic to gluten, a protein primarily found in wheat, rye and barley. The resulting Celiac Disease is an immune reaction in the small intestines and an inability to absorb nutrients that can lead to severe vitamin deficiencies. There’s no cure but, in recent years, a plethora of ways to avoid the culprit.
The King Arthur Flour Company in Norwich produces gluten-free bread, pancake, muffin, bread and pizza crust mixes that replace wheat with tapioca and potato. The Alchemist Pub & Brewery in Waterbury concocts gluten-free beer with sorghum instead of barley. The Woodchuck Cidery in Middlebury brews hard cider from apples rather than ingredients with gluten. Against the Grain Gourmet in Brattleboro turns out gluten-free artisan baguettes, rolls, bagels and pizzas. Many grocery stores now offer gluten free food sections including Healthy Living in South Burlington.
“Older people may have limited transportation and more social isolation, see changes in their senses of smell and taste — appetite killers. So eating well can fall by the wayside,” says Robin Edelman, a dietician who is the administrator of the diabetic program at the Vermont Department of Health in Burlington.
She mentions some staggering statistics: “About 50,000 Vermonters of all ages have diabetes, though only 31,000 of them know it. So one-quarter to one-third don’t realize they have this chronic disease. But 130,000 adults in the state have pre-diabetes conditions. Diet and exercise to lose five to ten percent of a person’s current body weight is the best way to prevent or at least delay the onset.”
For diabetes and a host of other “complex chronic diseases,” Edelman urges people to avoid empty calories and pick foods without fat, especially saturated and trans fats, and find a support system to help make behavioral changes that will manage the problem.
Community services are available, she says, adding that Fletcher Allen Health Care maintains The Diet Line (847-3438) at no cost. “You get a recorded message, give your name and phone number, and a dietician will call you back.”
In addition, the health department has a website with an A to Z menu. Under the letter E, click on Eat for Health and see an array of subjects, such as Meals for a Week. Similarly, under D, the Diabetes Prevention and Control Program link contains a bonanza of information.
At an online service of the Vermont Dietetic Association, there’s much food for thought to explore, such as Quick Guide to Healthy Living, Fruits and Vegetables: More Matters, Online Checkups and Watch Your Weight. Contact a Dietician enumerates the state’s many nutritional counselors on a county-by-county basis.
In days of yore, “we never thought we were getting diseases from what was missing in our food,” Edelman suggests. “Nutrition is a relatively new science.”
This article was contributed by Susan Green.