Although adult dietary requirements for vitamins, minerals and accessory nutrients do not change appreciably as we grow older, our ability to digest and absorb many nutrients is altered by the aging process. In addition, our ability to properly metabolize and utilize nutrients is also affected.

Age-Related Changes in Digestive Function
The loss of teeth can reduce the ability of many people to chew certain foods that contain vital nutrients. Additionally, hypochlorhydria (inadequate hydrochloric acid in the stomach) can reduce the ability of many older people to properly digest proteins. Age-related decreases in the production of digestive enzymes by the salivary glands, stomach and small intestine, as well as lowered production of intrinsic factor (produced by a specific area in the small intestine and essential for absorption of vitamin B12), also negatively effect digestive functions.

Many of these changes can be compensated for with nutritional supplements. Betaine hydrochloride, for example, when taken at meal time will restore normal stomach acidity. Digestive enzymes taken at the same time can augment the body's declining enzyme production. Supplemental B12 can insure the full utilization of the available intrinsic factor, although injections of B12 may be required in some cases.

Metabolic Changes Associated with Aging
One vital factor that affects us all as we age is the inevitable decline of our basal metabolic rate (BMR), the rate at which a resting body consumes energy. For each decade beyond our 20's, our basal metabolic rate declines by about two percent (Fig 1). Consequently, we are probably burning fewer calories than when we were 20 years old (due to reduced activity and declining basal metabolism), yet our needs for other nutrients remain basically the same as those of a 20-year-old. This is one reason why obesity is one of the most prevalent and difficult-to-treat diseases related to aging. Nutritionally this means that in order to avoid becoming overweight as we age, we must either reduce our caloric intake or, conversely, increase our physical activity to consume these extra calories.

Regular exercise is one way we can compensate for the decline in basal metabolic rate. Exercise also contributes to combating another age-related problem, the progressive loss of lean muscle mass. As we lose muscle mass, we tend to put on more fat. Since muscle is more metabolically active than fat, it is obvious that the more lean muscle we can retain and use, the higher our metabolic rate will be. The best way to maintain lean body mass is to include some form of resistance exercise in your program, such as weight training.

The best strategy to ensure we receive optimal levels of critical nutrients is to eat a well-balanced, nutrient-dense diet of foods that are minimally processed, and to supplement with a broad-spectrum multinutrient formula. Also, we must reduce our intake of calories by cutting back on what we eat and/ or maximizing our energy output by increasing our levels of physical activity.

Hypothyroidism
A common but often unrecognized and underdiagnosed cause of age-related decline in metabolic rate is hypothyroidism, both overt and subclinical. Hypothyroidism is characterized by a clinical spectrum that can include a number of the following signs or symptoms: low body temperature, cold intolerance, difficulty losing weight, fatigue, headaches, "female problems" (many women later diagnosed as hypothyroid have already had hysterectomies), acne, dry skin, hair loss or hypertension, to name a few. Treatment with thyroid hormone or thyroid-enhancing nutrients, like ferulic acid or guggulipid, is capable of not only restoring normal levels of thyroid hormone, but also, perhaps, of resensitizing thyroid receptors, restoring normal metabolic rate and alleviating thyroid-related symptoms

Alteration of Regulatory Mechanisms
Our bodies have many regulatory mechanisms designed to maintain levels of some essential nutrients, such as calcium. Unfortunately, the effectiveness of some of these mechanisms also shifts with advancing age. For example, if an adolescent eats little or no calcium for a week, literally starving himself of calcium, the next time he consumes a food with calcium such as milk or ice cream, he will absorb over 90% of the calcium from that food! However, if a 55 year-old follows the same regimen, the amount of calcium absorbed will not increase significantly: it will remain nearly constant. The 55 year old will retain only about 60% of the mineral regardless of his individual needs for calcium at that moment. Since many minerals are necessary for optimal health, a prudent course for anyone who is middle-aged or older would be to supplement with a broad spectrum mineral formula to overcome any age related problems with digestion and absorption.

Diabetes and Insulin Resistance
Another physiologic function affected by aging is the activity of the hormone insulin. For each year we age, our risk of adult onset diabetes increases. In addition, as we mature we are more at risk to develop what is known as "insulin resistance." Although our pancreas continues to secrete insulin, our ability to utilize carbohydrates declines because the insulin receptors on our cells become less responsive to the effects of this hormone.

One essential nutrient known to combat this problem and resensitize insulin receptors is chromium. The Journal of the American Medical Association recently published the results of a study that demonstrated that a lifetime use of refined foods, such as refined sugar and white flour, increases our risk of developing adult onset, or Type II, diabetes. This study can be added to the growing body of evidence that the "Standard American Diet" (SAD) with its reliance on over-processed foods is contributing to the increased development of the chronic diseases of aging.

Most people would benefit by not eating the processed convenience foods they've come to rely upon, as well as by reducing the amount of carbohydrates in their diet. A preferred diet for the aging human should emphasize a broad range of foods high in protein, as well as whole grains (whole wheat and brown rice), fresh fruits, vegetables and fats. Preferred fats include butter, olive oil, coconut oil, flax seeds and MCT oil. Hydrogenated oils and margarine should be avoided!

Free Radicals and Antioxidants
By now, nearly everyone is familiar with the free radical theory of aging. This hypothesis asserts that, although oxygen is necessary for life, just the act of breathing creates unpaired oxyradicals (unpaired oxygen electrons). These unpaired electrons are toxic to cells and have been implicated in the development of cancer, atherosclerosis, diabetes, arthritis and other degenerative diseases related to aging.

The human body employs natural antioxidant systems, many of which use vitamins and minerals as cofactors, to neutralize many of these unpaired electrons. However, several uniquely modern hazards can dramatically increase our needs for antioxidants, including constant stress and exposure to air pollution and pesticide residues.

Some of the most well known and best studied antioxidants include the vitamins C, E, A, beta carotene and the mineral selenium. Additionally, several other antioxidants are now believed to contribute to controlling the effects of free-radicals, including proanthocyanadins, found in Pycnogenol, N-acetyl cysteine (NAC), alpha lipoic acid, and bioflavonoids, to name just a few.

Alpha Lipoic Acid
Alpha lipoic acid is one of the most exciting but least well known antioxidants. I believe this situation will change quickly as the benefits of lipoic acid explode into mainstream awareness. One important defining factor of alpha lipoic acid is that, while most other antioxidants are active in either an aqueous (water) or lipid (fat) environment, lipoic acid is effective in both environments. Additionally, lipoic acid potentiates the effects of other antioxidants, such as vitamins C and E, and a growing body of evidence suggests that supplementing with lipoic acid can increase the chances of surviving a heart attack or stroke by 75%. Lipoic acid has also been beneficial in preventing some of the disabling complications of diabetes like cataracts and peripheral neuropathy. With antioxidant properties of its own and the ability to increase the efficacy of other antioxidants, alpha lipoic acid is a unique nutrient that can benefit everyone regardless of age.

Osteoporosis Prevention
Osteoporosis is a disease for which everyone is at risk. Osteoporosis literally means "porous bone." Peak bone mass is attained between the ages of 25 and 35 and decreases thereafter in both men and women (Fig. 2, page 6). Many people mistakenly believe that bone is static and that once peak mass is attained, the skeletal structure undergoes very little change. In actuality, bone is one of the most dynamic tissues in the body, constantly undergoing remodeling in cycles of resorption (the breaking down of bone), formation and quiescence (resting). Osteoporosis occurs when the amount of bone being resorbed (lost) exceeds the amount of new bone being formed.

Unfortunately, osteoporosis is a silent disease that presents few symptoms. When a problem does appear_usually in the form of a broken hip, wrist or rib_significant disability may have already ensued. Maintaining a healthy skeleton depends upon supplying the body with adequate nutrients_calcium, magnesium, boron and vitamin D, to name a few. Less well known are the bone-building properties of vitamin K and folic acid. In addition, growth hormone, progesterone and low-dose androgenic (testosterone-related) hormones like testosterone, androstenedione or even the anabolic steroid Deca DurabolinÖ, have also been used to restore bone density. Weight-bearing exercise in the presence of these nutrients and hormones is also essential to restore bone density.

Macular Degeneration
Macular degeneration is the leading cause of blindness in the older population in the United States. This age-related disease has traditionally been considered inevitable, but now it appears that this condition may be prevented or delayed by nutritional interventions and lifestyle changes. Recent studies have associated macular degeneration with excess exposure to sunlight over the course of a lifetime, suggesting that we can help preserve our sight by wearing sunglasses that provide protection from both UVA and UVB rays.

In addition, low levels of certain antioxidants and nutrients are associated with a higher risk of developing macular degeneration. Some of the most important of these antioxidants fall under the broad category of arotenoids which are precursors to vitamin A. Beta carotene is the best known of the carotenoids because it was the first of over 600 carotenoids to be chemically isolated.

Another form of carotenoids, the xanthophylls, include lutein and zeaxanthin, two compounds best known for their roles in preventing age-related eye diseases. Xanthophylls are found in dark, leafy green vegetables, which is just more evidence to follow your grandmother's advice to "eat your fruits and vegetables." In addition to eating more fruits and vegetables, supplementation may be a prudent course of action. There are additional nutrients that are associated with preventing age-related eye problems such as taurine, bilberry and the powerful antioxidants of grape seed extract, ginkgo biloba and vitamin C.

Osteoarthritis
One of the most debilitating consequences of aging that affects a huge portion of the population is osteoarthritis. Osteoarthritis, also known as degenerative joint disease, is the degeneration of articular cartilage that especially affects the weight-bearing joints, such as the knees and hips, and results in pain and loss of mobility.

Until recently, osteoarthritis. was considered an almost inevitable consequence of aging that was most certainly progressive and irreversible. This is no longer considered to be the case. Additionally, in the past the treatment options available had been limited to analgesics or non-steroidal anti-inflammatories (NSAIDs) for pain relief. NSAIDs have the well-known ide effect of causing GI distress and the less well-known side effect of actually increasing the destruction of the cartilage in the affected joints!

Two novel nutritional supplements when used alone or in combination have shown promise in their ability to help to regenerate cartilage that has worn away. The most well-studied and effective of these substances is glucosamine, but some new research suggests glucosamine can be even more effective when used in combination with chondroitin sulfate, turmeric (curcumin) and Boswella. This is exciting news for people who suffer from osteoarthritis.

Dementia and Age Associated Memory Impairment (AAMI)
One of the most feared consequences of aging is the possibility that we may succumb to one of the dementing illnesses, such as Alzheimer's. Fortunately, we live in a time when research into this area is progressing at a rapid pace, and nutritional supplements that enhance brain function are becoming increasingly more well-researched and more available.

Phosphatidylserine
One of the newest nutritional supplements to be added to the cognitive enhancing armamentarium is phosphatidylserine (PS). PS is a component of brain cells that is a key ingredient in the functioning of neurotransmitters and cell-to-cell communication at the level of the synapses of the brain. PS has been shown to improve memory, cognitive function, concentration and a host of other age related changes that occur in the brain.

Most clinical studies confirming the effectiveness of PS in improving mental performance in both normal adults and those with dementing illnesses were conducted with a bovine-derived product. Despite phenomenal clinical results in improving memory, PS was not widely used because of high cost. Recently PS has been produced from a soybean base, and is now available at a much more affordable price.

Acetyl-L-Carnitine
The brain, dependent on a constant supply of oxygen, is especially susceptible to increases in free radical production. Research suggests that the age-associated accumulation of mitochondrial deficits caused by oxidative damage is a major contributor to the aging process.

A growing body of research suggests that age-associated deficits in mitochondrial function can be slowed or reversed by acetyl-L-carnitine (ALC), the acetylated ester of the amino acid L-carnitine. ALC is a normal component of the inner mitochondrial membrane and serves as a precursor for acetyl-CoA and the neurotransmitter acetylcholine. ALC also functions as a high-energy mitochondrial substrate to aid in the transport of long chain fatty acids between the cytosol and the mitochondria where they undergo ß-oxidation, a key source of energy for many tissues.

ALC appears to reverse age-associated deficits in cellular function, in part by increasing cellular ATP production while providing acetyl groups to regenerate acetyl-CoA. ALC quickly crosses the blood-brain barrier to help normalize local mitochondrial membrane function and fluidity while enhancing neuronal metabolism, cerebral blood flow and brain neurotransmitters activity. ALC is uniquely able to restore and enhance mitochondrial function, increasing cellular energy output while improving the sensitivity of receptors that trigger and mediate acetylcholine release.

Ginkgo Biloba
Another extensively studied brain nutrient is ginkgo biloba extract (GBE). There is a growing body of evidence, both clinical and pharmacological, that GBE can ameliorate some of the age-related changes that occur in the brain, particularly those related to a decrease in cerebral blood flow. GBE is known to promote vasodilation and improve blood flow in both the capillaries and arteries. Recent evidence also suggests that GBE acts as a potent antioxidant and free radical scavenger in the brain.

Clearly, PS, ALC and GBE can be considered important components of a supplementation program designed to optimize and preserve cognitive functions in the mature and aging adult.

Immune Alterations
Finally, the functioning of our immune system seems to decline with age (Fig 3) resulting in a decreased ability to fight off infectious diseases, including cancer. Moderate doses of vitamin E (200-400 iu) have been shown to improve the immune function of elderly people. In addition, growth hormone stimulation by amino acids (see VRP Nutritional News, Vol. 11, No. 11, Nov. 97) also appears to enhance immunity. Other approaches are to use high doses of fish oil, various immune-stimulating herbs like cat's claw, echinacea, astragalus and lugustrum, or the Reishi and Maitake mushrooms.

Summary
The first step in a total health and fitness plan that I outline to my clients is to start with a diet as described above, regular exercise (even if it's only a walk around the block each day), and a broad-spectrum high-potency multinutrient supplement, usually augmented with supplemental minerals. Next, we try to restore and maintain as many of the biochemical and physiological parameters as we can to those of healthy 25-30 year olds. With modern nutritional and natural hormonal supplementation, this goal is coming closer to a reality each year.

Next, I specifically address any diagnosed illnesses they may have with nutritional therapy designed to ameliorate symptoms and intervene with the underlying disease process. By implementing a comprehensive program of supplementation, we can often alleviate many chronic conditions, and approach one of my goals concerning optimal health to die young (biologically) and healthy as late (chronologically) as possible.

Karen Sadowsky graduated Phi Beta Kappa from Skidmore College in 1974 and earned an MS in Human Nutrition from the University of New Haven. In addition to consulting, Ms. Sadowsky maintains her private practice as a nutritionist.

References
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3. Fekra, S. Are antioxidants and other supplements protective for macular degeneration? Current Opinion in Opthalmology, June 1, 1996
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11. Dean W, Morgenthaler J, Fowkes S. Smart Drugs II, The Next Generation, 1993, pp.75-80
12. Kidd P. Phosphatidylserine (PS), A Remarkable Brain Cell Nutrient, 1995
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14. McGuire J, MD. Rheumatologist and Osteoporosis specialist (Personal communication 12/8/97)
15. Fielding RA. The role of progressive resistance training and nutrition in the preservation of lean body mass in the elderly. J Am Coll Nutr. Dec. 1995, v 14: p. 587-594.

For more information email me at spierce@warpnet.net

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As Of 7/23/98