Do Seniors Need a Daily Boost?

Daily multivitamins help keep seniors’ brains sharp, may ward off dementia

September 14, 2022

by John Anderer

WINSTON-SALEM, N.C. — Could the secret to a sharp brain in old age be as simple as taking a daily multivitamin? New joint research from Wake Forest University and Brigham and Women’s Hospital suggests as much. Scientists conclude that multivitamins can improve thinking skills in older individuals and help stave off cognitive decline.

Study authors note that the findings are still preliminary and require further confirmation before any concrete health recommendations can be made. Nonetheless, establishing a new, affordable such as taking a daily multivitamin way to fight cognitive decline and dementia in old age could potentially benefit millions. Today, over 6.5 million Americans are living with Alzheimer’s disease (the most common form of dementia), and a staggering one in three senior citizens pass away with Alzheimer’s or another form of dementia.

“There’s an urgent need for safe and affordable interventions to protect cognition against decline in older adults,” says Dr. Laura D. Baker, a professor of gerontology and geriatric medicine at Wake Forest University School of Medicine and co-principal investigator of the trial, in a statement. Baker worked alongside Dr. Mark Espeland, also a professor of gerontology and geriatric medicine at Wake Forest.

Multivitamins versus cocoa extract

This project, named the COcoa Supplement and Multivitamin Outcomes Study for the Mind (COSMOS-Mind), was funded by the National Institute on Aging of the National Institutes of Health. Participants include 21,442 men and women living all over the United States.

Researchers investigated if taking either a daily cocoa extract supplement or a daily multivitamin-mineral supplement would influence health outcomes and risk profiles in relation to heart disease, stroke, cancer, and other health issues. Why cocoa extract? Prof. Baker explains cocoa extract is rich in compounds known as flavanolsPrior research suggests flavanols may have a positive influence on cognition. Moreover, deficiencies in several essential micronutrients and minerals among older adults may increase the risk for cognitive decline and dementia.

The research team tested the daily intake of a placebo versus a cocoa extract supplement, as well as the daily intake of a multivitamin-mineral versus a placebo. Over 2,200 participants, all aged 65 years and older, were tracked for a period of three years. Additionally, subjects completed memory and cognition tests over the phone at baseline and on an annual basis.

‘First evidence of cognitive benefit in large longer-term study’

“Our study showed that although cocoa extract did not affect cognition, daily multivitamin-mineral supplementation resulted in statistically significant cognitive improvement,” Prof. Baker explains. “This is the first evidence of cognitive benefit in a large longer-term study of multivitamin supplementation in older adults.”

Study authors estimate taking a multivitamin for three years roughly translates to a “60 percent slowing of cognitive decline (about 1.8 years)”. They also note the benefits were especially pronounced among those with significant cardiovascular disease.

“It’s too early to recommend daily multivitamin supplementation to prevent cognitive decline,” Baker concludes. “While these preliminary findings are promising, additional research is needed in a larger and more diverse group of people. Also, we still have work to do to better understand why the multivitamin might benefit cognition in older adults.”

The study is published in Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association.

Eat Right to Fight Disease

The aging process usually does not cause malnutrition in healthy, active adults, but nutritional health can be complicated by physical changes that occur with age, the presence of disease(chronic and acute), economic, psychological and social circumstances. Malnutrition then exacerbates some of these factors, contributing to a downward health spiral from which it is difficult to recover.

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Lifestyle and Longevity

Does chronological age always match biological age? According to a recent study, 1500 elderly women aged 64 to 95 years who sit for more than 10 hours a day have cells that are biologically older by 8 years compared to women who are more active. These women had shorter telomeres which are found on the ends of DNA strands. These structures protect chromosomes from degradation and normally shorten with age but more progressively with unhealthy lifestyles such as obesity or smoking.

Aladdin Shadyab. Lead author. Department of Family Medicine and Public Health at UC San Diego School of Medicine.

The research was partly funded by the National Institute on Aging.

Living in a Blue Zone

Longevity appears to not just be due to diet. Lifestyle in general is so important. No one says we have to eat rice and beans every day as they traditionally did in the Blue Zone of Costa Rica. However, there were other factors like keeping active and being social with friends and family. Why not search for the benefits of the Mediterranean diet, to try a more delicious fare?

A DAY of the life of living in a Blue Zone:: Costa Rica

“Aged 94, Saturnino “Sato” Lopez rises early each day, chops wood and takes long walks in a part of Costa Rica that’s a global oddity: like him, people there tend to live a very long time.

Home for Sato is the Nicoya Peninsula, where 1,010 people aged 90 or older live in a so-called “Blue Zone” — five areas around the world where life expectancy is particularly high.

And these people did not move to the peninsula, located in the northwest of Costa Rica. Rather, they have always lived there.

“At my age, I feel well because the Lord gives me strength to walk at ease. I go out, walk maybe a kilometer (around half a mile), or four kilometers, and I return, no problem,” said Lopez.

His house is in a village called Dulce Nombre — Sweet Name — is a sort of nature refuge.

The village’s wood, concrete and stick-and-mud houses are surrounded by vegetation and cicadas drone non-stop. The Covid-19 pandemic has gone easy on this village.

“During the day if I have to sweep the patio, I sweep. If I have to chop wood, I chop, also. A bit of everything,” said Lopez.

Blue Zones –

In the late 20th century, demographer Michel Poulain and a physician named Gianni Pes used a blue marker to highlight on a map the Barbalia region of Sardinia, Italy, where they found people lived a very long time.

In 2005, an American author and National Geographic fellow named Dan Buettner discovered similar characteristics in Loma Linda, California; Ikaria, Greece; Okinawa, Japan, and Nicoya.

So what is their secret?

“The main food is rice and beans. A bit of meat, fruit, avocado. That is what you eat. They say this is good food,” said Lopez.

His neighbors Clementina Espinoza, 91, and her husband Agustin, 100, follow a similar diet.

Espinoza has outlived six of her 18 children. She walks slowly but steadily, and still tosses corn to her chickens, prepares meals and washes up afterward.

Clementina Espinoza, 91, tends to her garden in Nicoya. She exhibits robust energy in a country where the life expectancy is a mere 80. For the world in general it is 72, the World Health Organization says.

“Out in the countryside, life is quieter,” said Espinoza, insisting that diet is key. “You are more relaxed and there is not so much danger.”

– Having purpose is key –

Having goals is critical to aging well, said Aleyda Obando, who works in the social security administration in Nicoya.

“They thank God for being alive and they make plans, to plant something or go see friends,” said Obando. “It is a combination of factors that makes these people last longer.”

It also helps to have a social support network, exercise, eat healthy food and minimize stress.

“We grew corn, rice, beans, everything. “We grew what we ate,” said Clementina. Now, her daughter Maria looks after her.

Agustin, one of 53 people in the area who are 100 or older, is blind now and suffered a stroke.

– Back in the saddle –

Jose Villegas is another centenarian, who lives in the neighboring village of San Juan de Quebrada Honda, with one of his eight daughters.

He is hoping that when he turns 105 on May 4 he can once again ride a horse — he used to make his living on horseback, herding livestock. But sometimes he has trouble with his legs.

Being 104, he says, “is a big deal because God has given me a lot of life. It was not fantastic but it was not bad, either,” said Villegas, sitting in the house he was born in.

“Now, lifestyles have changed. It is not the same as before. Things used to be healthier, and people loved each other a little bit more,” said Villegas, who became a widower seven years ago and spends his evenings listening to folk music.

Gilbert Brenes, a demographer at the University of Costa Rica, said the Blue Zone’s elderly population may peak in the next 20 or 30 years and then decline.

Younger generations have different diets and suffer more from diseases like obesity and diabetes. And fewer and fewer people grow what they eat.

But Saturnino Lopez, a father of nine, remains active.

“My children say to me, ‘you no longer work. We have to work to support you.’ But I don’t like that, because I know what keeps me going,” he said, referring to physical activity like cutting wood.

“Even if it is just a couple of blows with the machete, that’s enough.”

Weight Loss: The Good News

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The Metabolic syndrome may not be a household phrase, but it should be. It’s been estimated that more than 30% of the U.S. population may have this disorder. It is defined as a cluster of symptoms that include excess fat around the waist, high blood sugar, high blood pressure, low levels of HDL and high triglyceride (blood fat levels). Diagnosis involves having at least three of these conditions.

The good news is that even a small weight loss (at least 10% of your current weight) may have a positive effect on your health.

Cognitive Fitness and Diet

Eat Right to Maintain Cognitive Fitness

Your brain is fed by the same blood vessels that keep your heart pumping – so it makes sense that when they become unhealthy or your blood pressure is too high, the damage can affect both your heart and mind.

So what foods are heart healthy are also brain healthy? Two diets that have gained positive attention are elements of the Mediterranean Diet and the DASH diet have been shown by a plethora of research to help reduce the risk of Alzheimer’s disease and other forms of dementia. It is thought that these two dietary patterns help the brain by keeping blood flowing efficiently and reducing damaging inflammation. Both are low in saturated fat and recommend a diet heavy on plant foods and healthy fats with a low consumption of red meat, sugar, and processed foods.

There are certain components of healthy diets that can be top choices on what makes these diets stand out with healthy benefits:  

Omega-3 fatty Fish Oils and Brain Health

Protecting Brain Structure: Myelin

The BASICS:  Most all cells contain omega3s (EPA, DHA) and omega-6s in their cell membranes. Most nerve signals cannot be conducted without a special sheath called myelin and fatty  acids like EPA and DHA are necessary for cell membrane structure.  Myelin insulates the nerve fibers of nerve cells.

Brain cells are susceptible to damaging neurotoxins. Long-chain omega-3 fats, EPA and DHA are important for brain development, production of hormones and checking inflammation. Research has also shown that they lower blood triglyceride levels resulting in decreasing cardiovascular risks.  A  meta-analysis found that people with the highest consumption of omega-3, EPA and DHA have an association with a 14% risk reduction of death from any cause when compared to people who consume less.  A new area of research has suggested that fish oils as EPA and DHA are involved in brain health. This is important since there is evidence that omega-3s can protect against neurotoxins that damage the nervous system including the brain.

For example:

1300 elderly women underwent MRIs of the brain to assess how much exposure they had to a type of air pollution called PM for three years prior to the MRI.  PM  pollution is known to have neurotoxic effects known to be linked to strokes, cognitive decline, and dementia. The new study was published in the journal, Neurology,

Results showed that “women with higher levels blood levels of fish oils (omega-3s) had significantly greater volumes in the brain areas (hippocampus) associated with cognition, and memory, and white matter which contains nerve fibers that connect brain cells. The results indicated that women with higher levels of omega-3s were protected against the brain-damaging effects of PM exposure”.

Improved Depression Symptoms

A meta-analysis published in Translational Psychiatry, researchers reported that relatively high dose supplements with a high concentration of EPA to DHA significantly improved the symptoms of mild to moderate depression (mood, sleep disturbances, and fatigue) in pregnant and postpartum women. Higher doses need to be given by primary care physicians.

The U.S. diet is sadly abundant in omega-6 fatty acids; however, on the other hand, sadly deficient in omega-3 fats —-but that’s another story.

Omega-3 fats contain antioxidants that help protect our cells from damage including the heart and brain. A study published in the June 2020 issue of Alzheimer’s & Dementia found that people who closely followed a Mediterranean Diet had a lower risk of developing cognitive impairment in the following 10 years, compared with those who did not follow that eating pattern. But people who ate the most fish had both a reduced risk of cognitive impairment and also slower cognitive decline when compared to those who ate less fish.

Plant Oils

Substituting healthy plant oils like olive oil, sesame oil or canola oil for saturated fat such as butter, helps keep your mind healthy. These simple changes help to keep your blood vessels clear of damaging plaques. Extra-virgin olive oil is particularly rich in antioxidants.

Nuts

Nuts are great as snacks since they are rich in fiber and protein.  The least processed are the best choice.

Some nuts like walnuts, pecans, and chestnuts, contain high amounts of antioxidants. Also, walnuts are rich in a type of plant-based omega-3 fats called alpha linolenic acid which helps fight inflammation and cellular damage.

Coffee

While not a part of the Mediterranean or DASH diets, plain coffee can provide a good source of antioxidants. However don’t over do it and hold the sugar and cream – two cups a day of black coffee is probably enough, research says.

Courtesy of Best Foods for Women’s Health, Women’s Health Guide, Harvard Medical School

How to Live the Mediterranean Way

How to Live the Mediterranean Way and How to Feed Your Microbiome.

Each country around the Mediterranean Sea offers a rich bounty of delicious ingredients. Many authors have written about the Mediterranean Diet in terms of the health benefits that have been shown by an exhaustive array of scientific studies on its merits. The diet is now recognized as an “intangible cultural heritage” in Italy by the United Nations Educational, Scientific and Cultural Organization (UNESCO). It is a way of life and a way of eating, which the Italians call “Cucina genuina” or “cuisine of the poor”.  This is the diet of those who work the land and feed themselves using seasonal ingredients grown in their small plots outside the kitchen”.

The following characteristics attempt to describe the “Americanized” version of how to live and eat the Mediterranean way – it is not just a diet but a gift to a healthier lifestyle.”

DIET: Eat food, not too much, mostly plants. (Micheal Pollan). Whole grains, unprocessed foods, fruits, and vegetables

Eat meat in moderation. Limit your saturated fat, sugar and salt intake. Snack on nuts. Reduces inflammatory foods

Practice mindfulness, smaller servings, early light dinners.

Try yogurt, beans, chickpeas (hummus (fermentable foods) like sauerkraut – diversifies microbiome

Maintain a healthy Body Mass Index (BMI) 19.0 – 25.0

Drink plenty of water

EXERCISE:

Take a walk. Enjoy the sunshine.

Stay active. Get gardening.

Exercise improves cognition and stress reduction

BEHAVIORAL, SOCIAL

1-2 Glasses of red wine (daily): Optional (if you don’t drink wine, don’t start) 

Have a purpose in life (a reason to get up in the morning).

Laugh with friends.

Keep your brain active (read, puzzles, learn a language) card games

Focus on family, God, camaraderie, nature

Reduce stress and avoid eating when angry or sad.

Enjoy the secret pleasures and social aspect of foods.  Become more expert at listening to your gut feelings.(mind/body).  

Citations: 

Diane Phillps, The Mediterranean Slow Cooker Cookbook, Chronicle Books, 2012.

Emeran Mayer, MD. The Mind-Gut Connection, Harper Collins, 2016.

Dan Buettner The Blue Zones Challenge, National Geographic, 2021.

Nutrition, Behavior, and Disease

Biological Changes during Aging and Nutritional Consequences

S0URCE JUDITH E. BROWN, NUTRITION NOW, 7TH EDITION, 2013

The combined effects of poor diets, other risky behaviors, and biological aging increase the rates of serious diseases during adulthood. How soon a disease develops largely depends on the intensity of exposure to behavioral risks that contribute to disease development.  These are often referred to as epigenetics (when the DNA is not altered, but environmental factors cause genes to be turned either on or off.) 

What Are Some Nutritional Consequences?

 Lowered stomach acidity may result in decreased absorption of vitamin B12? The consequences of getting less sun exposure may result in less production of vitamin D in the skin.

A person’s need for calories generally declines with age as physical activity, muscle mass, and basal metabolic rate decrease. However, when one chooses to continue their physical activity into their older years can maintain their muscle mass, experience less muscle, and bone pain, and gain less body fat than people who are inactive. 

For the most part, the development of chronic disease in middle-age and older adults can be viewed as a chain that represents the accumulation over time of problems that impair cell functions. Each link that is added to the chain, or each additional insult to cellular function, increases the risk that a chronic disease will develop. The presence of a disease indicates that the chain has gotten too long – that the accumulation of problems is sufficient to interfere with the normal functions of cells and tissues.

Normal cell functions and health promotion are facilitated by healthful dietary lifestyles and other behaviors. For example:

Correcting obesity and stabilizing weight during the adult years tends to lengthen life expectancy.

Dietary intakes that correspond to the Dietary Guidelines for Americans (MyPlate) or following a healthily diet pattern like the Mediterranean Diet is related to a longer life expectancy.

Maintaining adequate calcium, vitamin D, and protein intake and engaging in regular physical activity during the adult years may prevent or postpone the development of osteoporosis and help maintain muscle mass and strength.

Above average intake of vegetables, fruits, and whole grains may delay the development or help prevent a number of types of cancer, heart disease, hypertension, and cataracts. 

The health status of adults is not necessarily ‘FIXED” by age.; it can change for the better or the worst, or not much at all. It’s up to you.

Diet and Inflammation

“Certain foods encourage inflammation and an anti-inflammatory diet avoids these foods. The body makes compounds called prostaglandins (eicosanoids) that can either be pro-inflammatory or anti-inflammatory. Both saturated fat and omega-6 unsaturated fat are building blocks for pro-inflammatory prostaglandins. Omega-6 fat is abundant in ulltraprocessed foods (not a good thing); it can contribute to an excessive inflammatory response.” How to Eat, Mark Bittman and David Katz, MD., page 61.

” Diets high in inflammatory foods were linked with global markers of brain aging and cerebral small vessel disease, on MRI. Bottom line: Smaller brain volume seen with diet-driven inflammation” See study below. “Systemic inflammatory processes in the body, including the brain, can be influenced by diet leading to its important contributory role in brain aging, the researchers observed.”

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