18. LIFE STAGES Flashcards

Question

# Key Postpartum Nutrients Key Postpartum Nutrients include: Protein, what is it needed for?

Answer 1

Protein * Needed to replenish reserve. * Needed for breast milk production to support growth: extra 11g / day. Beans, lentils, quinoa, fish, organic eggs.

Answer 2

Iron * ↑blood volume (anaemia is common in pregnancy). * ↓iron = fatigue, altered cognition. Almonds, kale, spinach poultry, sunflower/ pumpkin seeds, algaes.

Answer 3

Zinc * Involved in production of ovarian hormones; has a high trace of mineral concentration in the brain. * ↓ zinc can contribute to PPD. Pumpkin seeds, whole grains, sprouts, egg yolks, oysters, organic liver, seafood

Answer 4

B Vitamins * ATP production (B1, B2, B3, B5) * B2 PPD protection. * Folate  depleted with lactation. * B12  cofactor for DNA production, myelination (nervous system development). Can be depleted by nitrous oxide in labour. Lentils, leafy greens, whole grains, organic eggs, seeds and nuts, liver, avocado, banana, asparagus, beans, legumes, mushrooms, peanuts. | Life stages pg 52

Answer 5

EPA/DHA * Essential for neural and eye development of foetus. * ↑ need postpartum, mother at risk of losing DHA from brain tissue as passed to foetus / breastfed infant. Flaxseeds, hemp seeds, chia seeds, oily fish (salmon, mackerel etc) anchovies, sardines, herring). | Lifestages pg 15

Answer 6

Magnesium * Mg needed to convert ADP to ATP (essential for energy postpartum). * Absorbed by foetus in pregnancy & lactation. * ↓ levels can contribute to PPD. Dark leafy greens; pumpkin seeds, almonds, molasses.

Answer 7

Vitamin C * Co-factor for collagen synthesis (aids in wound healing postpartum). * Increases absorption of non-haem iron. * Depleted in times of stress (adrenals). * Synthesis of thyroxine and adrenal steroid hormones (postpartum thyroiditis). Broccoli, blackcurrant, peppers, pineapple, strawberries, oranges. | Lifestages pg 16

Answer 8

Vitamin D * Diet and lifestyle changes in pregnancy (e.g. lack of dietary intake and avoiding sun exposure / excess sunscreen) can predispose women to low vitamin D levels. * Vitamin D has a role in commensal bacterial colonisation. * Reduces risk of PPD. (Abedi et al., 2018) Sunlight, mushrooms, egg yolk, wild-caught oily fish, sunflower seeds.

Answer 9

Probiotic Foods * Babies receive beneficial bacteria from the mother (from birth and breastfeeding). It is especially important if born by caesarean or if given antibiotics during / after labour. Yoghurt, kefir, miso, kombucha, sauerkraut. | Lifestages pg 17

Answer 10

* Daily nutrient requirements during lactation are higher than during pregnancy. * Breastfeeding benefits are dependent on mother’s nutritional status. * Inadequate maternal nutrition may leave the mother depleted. * Severe energy restriction may hinder milk production. * The postpartum period is not the time to go on a weight loss diet to lose the baby weight! * **Do not skip meals, especially breakfast. Erratic eating triggers the body’s stress response which can affect milk production.** * Eat to satisfaction: oxytocin triggers the milk ejection reflex and also more enzymatic activity in the intestines ( better digestion). Chew food well. * Drink to thirst — no over/under drinking. Filtered water is best. Constant thirst can be a symptom of EFA deficiency. Over-drinking may affect milk supply. * Avoid cold foods and drinks, especially if experiencing low milk supply or if prone to mastitis. * **Focus on whole, fresh, organic produce.** * Well-cooked and energetically neutral foods (e.g. *round grain rice, potato, sweet potato*) are easily digested by both mother and child. * Every woman is different and will require different nutrition according to her constitution  refer back to Energetics lecture. * Include probiotic foods (e.g. *sauerkraut, kimchi, kefir) and prebiotic foods (e.g. asparagus, Jerusalem artichoke, dandelion greens, onions, garlic* (may cause gas in baby) to support the microflora. * Include sources of EPA / DHA: flaxseeds, hemp, oily fish, algae. * Avoid salted, sweetened foods, sugary drinks, cow’s dairy products and microwaved foods.

Answer 11

Avoid alcohol as it easily enters breast milk and significantly diminishes the amount of breast milk consumed by the infant. * It changes the taste of the breast milk. * Even low doses of alcohol are not metabolised efficiently by the infant which suppresses feeding and causes sleepiness. * Alcohol interferes with lactation by inhibiting the hormone oxytocin. * Alcohol consumption also interferes with the ability to look after your baby

Answer 12

* Medicinal drugs: Some medicines are contraindicated with breastfeeding — always check with your GP. **Contraindicated:** anti-cancer drugs, lithium, oral retinoids, amiodarone, codeine, decongestants, aspirin. * Illicit drugs: Are **always harmful ** and can cause irritability, tremors, hallucinations and even death in infants. It can also impact the mother’s ability to care for her baby.

Answer 13

When breast milk does not agree with the baby: * Babies can develop GI symptoms towards any foods in mother’s diet. Investigate and eliminate! * Infants who develop food allergy symptoms may be more comfortable if the mother’s diet excludes the most common offenders: cow’s milk, eggs, fish, peanuts, tree nuts. * Go for a leisurely walk in natural surroundings; this will also help your baby. * Include a daily relaxation practice (e.g. mother and baby yoga or baby massage with sesame / almond oil, according to constitution). | Lifestages pg 31

Answer 14

* China: one month confinement — nourishing warm foods, no visitors, no leaving the house, rest and feeding the baby. * Korea: 21 days — mother sleeps, eats and nurses the baby at this time. Large amounts of hot tea and seaweed soup is given. * India: mother is kept warm for 10–40 days by a fire, she is fed warming rich foods containing almonds and pistachios. * Nepal: new mother spends first 11 days with baby in darkened room, nourishing foods include ghee and caraway soup. | Lifestage pg 18

Answer 15

1. In a medium pot, sauté ½ chopped onion in 2 tablespoons sesame oil until lightly browned. Add 1 chopped garlic clove, 115g of organic beef sirloin OR 1 cup of dried anchovies (omit if vegetarian). Stir and cook until browned. 2. Add 2 litres of broth of your choice, 30g of dried seaweed (dulse / wakame or kelp) which has been rinsed and 6 shiitake mushrooms. Reduce heat and simmer for 40 minutes. 3. Eat warm and store leftovers in fridge for up to three days. | Lifestages pg 20

Answer 16

1. In a medium pot, bring 390g of soaked brown rice with 1 litre of water to a boil over a high heat. You may also use organic vegetable or chicken broth to make it more flavourful. 2. Reduce heat to a simmer and cook until the grains soften and open. Stir often and keep checking and adding water if it’s been absorbed. 3. Serve hot with toppings such as black sesame seed paste / picked vegetables / boiled egg / adzuki beans. 4. Store leftovers in the fridge for up to five days or portion freeze.

Answer 17

- eggs - fish - wheat - cow’s milk - peanuts - tree nuts. | Lifestages pg 31

Answer 18

**Vitamin C** - Co-factor for collagen synthesis (aids in wound healing postpartum). - Increases absorption of non-haem iron - Depleted in times of stress (adrenals). - Synthesis of thyroxine and adrenal steroid hormones (postpartum thyroiditis). **Magnesium** - Mg needed to convert ADP to ATP (essential for energy postpartum). - Absorbed by foetus in pregnancy & lactation. - ↓ levels can contribute to PPD.

Answer 19

Alcohol easily enters breast milk and significantly diminishes the amount of breast milk consumed by the infant. - It changes the taste of the breast milk. - Even low doses of alcohol are not metabolised efficiently by the infant which suppresses feeding and causes sleepiness. - Alcohol interferes with lactation by inhibiting the hormone oxytocin.

Answer 20

- Birth and breast milk play a role in early bacterial colonisation of the GIT (and other areas) of the infant. - Various research confirms that an infant’s bacterial profile is directly related to that of its mother; the role of ‘friendly’ (or commensal) bacteria includes digestive support and immune modulation. - Breast milk and colostrum may contain more than 700 species of bacterial microbiota. - A 2012 study found that milk from overweight mothers has considerably less diversity of species than normal-weight mothers. - Caesarean birth mothers also showed less diversity in their breast milk microflora than in vaginal birth mothers (→stress?).

Answer 21

- Colostrum is high in *secretory IgA, vitamin A and zinc, and also provides bifidus factors*, which favour the growth of the ‘friendly bacterium’ lactobacillus bifidus in an infant’s GIT so that other, harmful bacteria cannot gain a foothold there. - An iron-binding protein in breast milk, *lactoferrin*, prevents bacteria from accessing the iron they can use to grow. It also aids iron absorption and kills some bacteria directly. - The protein *lactadherin* in breast milk fights off the virus that causes most infant diarrhoea (rotavirus). - Several other *growth factors and enzymes* stimulate the development of the digestive tract and protect against infections. - Breastfeeding prevents or delays the occurrence of *atopic dermatitis, cow milk allergy and wheezing* in early childhood when compared to formula-fed infants, according to research. - Breast milk can offer protection against the development of *cardiovascular disease* compared with formula-fed infants (possible links to oxytocin release which causes vasodilation); breast-fed infants have lower blood cholesterol as adults.

Answer 22

- The **calcium** content of breast milk is ideal for infant bone growth. - **Zinc** has also high bioavailability, thanks to the presence of zinc-binding protein. - Breast milk is **low in sodium**, which is a benefit for immature kidneys. - Breast milk contains relatively small amounts of **iron**, but the iron has a high bioavailability. Historically, babies got more iron by delaying cord clamping.

Answer 23

At birth, one third of a baby’s blood is outside its body. By delaying umbilical cord clamping until it stops pulsating, babies can get 30% more iron-rich blood, oxygen, erythrocytes, leukocytes and stem cells. ## Footnote Also possibly reduces the need for Vitamin K injection

Answer 24

It is recommended to breastfeed exclusively for six months and continue up to two years or more. Breastfeeding also provides feelings of love, comfort and protection and can contribute to a toddler’s feeling of self-esteem. Breastfeeding mothers also benefit from being near their child. The physical contact increases oxytocin, which supports bonding, and also has mild anti-inflammatory effects.

Answer 25

Establishing Successful Lactation: * Consider hiring a doula or lactation consultant straight after birth to help start your breastfeeding journey and address any issues. * Familiarise yourself with local breastfeeding support (‘milk spots’) in your area. * Spend the first week postpartum at home with your baby with plenty of skin-to-skin contact. * Feed on demand (especially at night). * Consider pumping one feed in order for the mother to get some rest between feeds.

Answer 26

Protein is needed to replenish the mother's energy reserves. It is needed for breast milk production to support growth: extra 11g / day. Good sources: Beans, lentils, quinoa, fish, organic eggs.

Answer 27

* **Zinc** - Pumpkin seeds, whole grains, sprouts, egg yolks, oysters, organic liver, seafood. * **Magnesium** - Dark leafy greens; pumpkin seeds, almonds, molasses. * **Vitamin D** - Sunlight, mushrooms, egg yolk, wild-caught oily fish, sunflower seeds.

Answer 28

By consuming probiotic foods such as yoghurt, kefir, miso, kombucha or sauerkraut, the mother can help to expose the infant to beneficial bacteria through the breast milk.

Answer 29

Nourishing warm foods that replenishes Spleen Qi and requires minimal effort to digest, is gentle and nourishing.

Answer 30

Although everyone’s constitution is different, pregnancy is generally considered a time of moisture (consider the amniotic fluid). During pregnancy, women can feel more hungry, emotional, lethargic, and congested (all signs of excess moisture). *Avoid:* - Damp-forming food (i.e. dairy, refined sugars, processed foods). - Excess fluids, cold green smoothies, mucilaginous foods (e.g. okra). - Sweet and high water content fruits (e.g. melons, ripe bananas). *Consume:* - Whole grains, legumes and generally lighter, drier, crunchier foods. - Warmth also helps to counteract moisture so foods and drinks taken warm and small amounts of culinary herbs and spices will be balancing (not high amounts during pregnancy and breast feeding).

Answer 31

Since energy requirements during lactation are high, the postpartum period is not the time to go on a weight loss diet to lose the baby weight! This can be attempted later and breastfeeding should enhance weight loss until such time. - Daily nutrient requirements during lactation are higher than during pregnancy and inadequate maternal nutrition may leave the mother depleted. - Breastfeeding benefits are dependent on mother’s nutritional status and severe energy restriction may hinder milk production.

Answer 32

* Do not skip meals: especially breakfast. Erratic eating triggers the body’s stress response which can affect milk production. * Eat to satisfaction: oxytocin triggers the milk ejection reflex and also more enzymatic activity in the intestines (→ better digestion). Chew food well. * Drink to thirst: no over/under drinking. Filtered water is best. Constant thirst can be a symptom of EFA deficiency. Over-drinking may affect milk supply. * Avoid cold foods and drinks: especially if experiencing low milk supply or if prone to mastitis. * Focus on whole, fresh, organic produce. * Well-cooked and energetically neutral foods: e.g. round grain rice, potato, sweet potato, are easily digested by both mother and child. * Include probiotic foods (e.g. sauerkraut, kimchi, kefir) and prebiotic foods (e.g. asparagus, Jerusalem artichoke, dandelion greens, onions, garlic (may cause gas in baby) to support the microflora. * Include sources of EPA / DHA: flaxseeds, hemp, oily fish, algae. ## Footnote Always tailor advice to your client's constitution

Answer 33

* Salted, sweetened foods, sugary drinks, cow’s dairy products and microwaved foods. * Caffeine and other stimulants (chocolate, soft drinks and tea): Caffeine enters breast milk to make the infant irritable and wakeful. Large doses of caffeine interfere with the bioavailability of iron from breast milk and impair the infant’s iron status. * Avoid alcohol as it easily enters breast milk and significantly diminishes the amount of breast milk consumed by the infant. * Eliminate smoking: it reduces milk volume, so smokers may produce too little milk to meet their infant’s energy needs. * Medicinal drugs: Some medicines are contraindicated with breastfeeding — always check with your GP. Contraindicated: anti-cancer drugs, lithium, oral retinoids, amiodarone, codeine, decongestants, aspirin. * Illicit drugs: Are always harmful and can cause irritability, tremors, hallucinations and even death in infants. It can also impact the mother’s ability to care for her baby.

Answer 34

Galactagogues such as fenugreek or fennel seed enhance lactation and can be consumed as tea (2–3 cups/day).

Answer 35

**Modern-day infant formula is the ultimate refined food, composed of highly processed ingredients such as sugar, non-fat dried milk, vegetable oils and a list of synthetic nutrients.** * Infant formula lacks many key substances for development and growth and contains no antibodies for immune protection. * Primarily composed of sugar or lactose, dried skim milk and refined vegetable oil which can include GM components. * Organic formula is made of basically the same ingredients but they are not genetically modified. * Soy-based formula is made of soy protein, sugar and refined oils. * Rocket fuel, phthalates, melamine and high levels of heavy metals have been found in infant formula. * Additives to infant formula, such as iron, DHA, AA and lab-made folic acid are problematic. * Heat damages the protein in formulas forming advanced glycation end products (a bio-marker implicated in ageing and the development of many degenerative diseases), as well as compromising the nutritional value.

Answer 36

Current guidelines recommend not introducing solids until **six months of age**. At this point the gastrointestinal tract and immune system have matured to a level where new foods are more likely to be tolerated. Weaning too early (four months) or too late (> 12 months) may increase the risk of allergies. Breastfeeding whilst weaning (six–12 months) can protect the baby from allergenic foods via antibodies in breastmilk. The baby needs to show signs of being ready: sitting upright, taking an interest in the parents’ food, putting food in their mouth.

Answer 37

Baby-lead weaning: * Lets babies feed themselves finger foods right from the start. * Supports the development of hand-eye co-ordination, chewing skills and dexterity. * Offers babies an opportunity to explore the taste, texture, aroma and colour of a variety of foods. * Encourages self-regulation * Less time-consuming than preparing puréed foods. * Baby is part of the dining experience, although that may encourage the baby to eat foods they are not ready to digest.

Answer 38

* **Concentrated sweets**, baby food desserts have no place in an infant’s diet * Products containing **sugar alcohols** can cause diarrhoea, e.g. glycerol, sorbitol, mannitol, xylitol used as sweeteners as well as in chewing gum. * **Canned vegetables** — contain too much sodium, sugar or preservatives, and are nutritionally inferior to fresh / frozen produce. * **Honey** should never be fed to infants because of the risk of botulism (a rare but serious bacterial infection). * **Soya products** — they are hard to digest and contain compounds with oestrogen-like compounds (‘isoflavones’). * **Cow’s milk** — apart from the side-effects linked to excess protein intake, cow’s milk consumption before 12 months can cause: 1. Iron deficiency anaemia (impairs iron absorption). 1. Deficiency of linoleic acid (low in cow’s milk). 1. Gastrointestinal blood loss (can cause occult blood in infants). 1. Type 1 diabetes (in genetically predisposed infants)

Answer 39

**Disposable nappies:** Most disposable nappies contain a range of chemicals including dioxins, sodium polyacrylate, tributyl-tin, plastics, dyes and fragrances. These can irritate the skin. **What’s the alternative?** * Use natural cloth nappies, wash in fragrance-free, low-chemical detergent. * Dry in the sun — it reduces bacterial growth. * Allow ‘free time’ without a nappy, which may also assist potty training. * Use calendula cream for any skin irritation.

Answer 40

* Lead by example by eating well yourself. * Make mealtimes pleasant: turn off the TV and include the child in conversations (encouraging mindful eating of each meal). * Encourage children to chew food well. * Cook together and grow a garden with your child. * Put food out in serving bowls and let your child help him / herself. * Do not entice or manipulate your child to eat. It entices reluctance and reciprocal control. Don’t bribe with sugary desserts!

Answer 41

* Prepare foods at home using organic whole foods. * Eat away from TV to ensure mindfulness. * Be aware of age-related portions. * Encourage structured mealtimes versus snacking. * Discourage inactivity; encourage regular exercise in a way your child would enjoy, e.g. team sports can improve compliance and build relationships. * Promote adequate sleep.

Answer 42

* Avoid processed foods (ready meals, sugary snacks, soft drinks, crisps). * Cow’s milk inhibits the absorption of iron. * Optimising digestion and gut health: probiotic and prebiotic rich foods, chewing food well. * Deficiency symptoms / signs include: fatigue, listlessness, irritability, loss of appetite, apathy, impaired learning, slow growth rates, pallor, tachycardia, spooning of nails.

Answer 43

Teenagers make many more choices for themselves than they did as children: - They make their own food decisions. - They may be influenced by their peers. - Alcohol consumption may begin here. - They may diet to meet extreme ideals of slimness or athletic ability.

Answer 44

- **Physiological:** Increased appetite due to growth spurts; decreased appetite in case of illicit drug or alcohol use. - **Social:** Strong influence of peers, preoccupation with body size and body image; media and advertising. - **Economical:** More independent and increased money spending; living in food-insecure, temporary housing; fast and convenience foods.

Answer 45

Protein quality is often an issue, with teenagers opting for processed meats and dairy products. Protein insufficiency can occur in teens, e.g. in those on weight-loss diets or on inappropriately planned diets (i.e. junk food).

Answer 46

- **Protein:** Ensure good quality protein intake and sufficient levels to support increased body mass and growth. - **Carbohydrates:** Limit refined carbohydrates which could lead to conditions such as acne. Focus on nutrient-dense foods such as whole grains, sourdough breads, sprouts, fresh fruits and vegetables to support GIT health. - **Fats:** Fat intakes should not exceed 30–35% of total caloric intake and EFAs are important for the production of sex hormones (e.g. testosterone, oestrogen, progesterone) which is crucial during this time. They are also needed for skin, hair and nail health (consider teenage acne). Include healthy fats contained in nuts and seeds, oily fish, avocado, olives and olive oils.

Answer 47

**a) Iron** - Iron requirements increase in adolescence for both males and females as their blood volume increases with growth. - Iron needs increase for females as they start to menstruate, and for males as their lean body mass develops. - For females, iron needs remains high (heavy menstruation and pregnancy) until late adulthood / menopause. Menstruation makes women more susceptible to iron deficiency. -** Include non-haem iron foods such as almonds, apricots, avocado, sunflower, pumpkin seeds as well as vitamin C-rich foods to aid absorption (broccoli, citrus fruits, peppers, rosehips, strawberries, sweet potatoes etc.)** **b) Calcium:** - Adolescence is a crucial time for bone development and the requirement for calcium reaches its peak during these years. - Low calcium diets and physical inactivity compromise the development of peak bone mass (the best protection against osteoporosis). Encourage daily exercise and avoidance of fizzy drinks, caffeine, alcohol, fast food. - Include bone supportive nutrients such as vitamin D and magnesium rich foods (almonds, barley, leafy greens, legumes).

Answer 48

Childhood obesity is associated with: - Eating highly processed and hyperpalatable foods (sugary cereal, ready meals, soft drinks, crisps, high fat and calorie fast food). - Reduced energy expenditure, less time spent outside, TV watching, mindless eating. - Bigger food portions, both at home and in restaurants. - Gut dysbiosis (e.g. antibiotic use in childhood, not being breast-fed).

Answer 49

Avoid: * Damp-forming food (i.e. dairy, **refined sugars, processed foods**). * **Excess fluids**, cold green smoothies, mucilaginous foods (e.g. okra). * **Sweet and high water content fruits** (e.g. melons, ripe bananas).

Answer 50

YES, The newborn baby is also damp (childhood is the moist life stage). An infant needs breastmilk, warmth, comfort and sleep.

Answer 51

* Lowered hormone levels, e.g. sex hormones, growth hormone. * Immunity: dysregulation of innate and adaptive immune function. * Loss of skin integrity due to ↓production of lipids, ↓desquamation. * Decreased bone density and muscle mass. * Heart valves and arteries stiffen (= less flexible). * Decrease in renal function (GFR declines). * Reduced chest wall compliance and alveolar recoil. * Neurological function declines (with neuron atrophy). * GIT: affected by ↓stomach acid, dysphagia and ↓taste sensation ## Footnote Lifestages pg 62

Answer 52

* E.g. **atherosclerosis** is becoming more common in teenagers. * Ageing is normal, **accelerated ageing** is not. * Ageing can be accelerated by: - Lifestyle, poor diet and ↓physical exercise. - Stress and not having a goal in life. - The socioeconomics status. - Diseases and medications. * **Genes** contribute about 30% and **lifestyle** factors 70% to ageing. * Biological age can differ from one’s chronological age.

Answer 53

* When telomere length reaches a critical limit, the cell undergoes senescence and / or apoptosis. Telomere length can, therefore, serve as a biological clock to determine the lifespan of a cell and an organism. * Certain lifestyle factors such as smoking and poor diet can increase the pace of telomere shortening. * Studies show that shorter telomeres are a risk factor for cancer

Answer 54

* I.e. wrinkles, joint stiffness, decreasing physical strength. * Increase: soups, stews and smoothies, sweet and high water content fruit and veg, root vegetables, nut milks, ‘mucilaginous’ okra, chia and linseeds, liquorice, most herbal teas. | Lifestage pg 65

Answer 55

* I.e. digestive power weakens, circulation reduces, we feel colder, declining mobility, exhaustion and withdrawal. * Increase: warm, cooked and mildly spiced food and drinks that increase body temperature, digestive power and circulation (Refer back to your Energetics lecture)

Answer 56

* Fat mass and visceral fat increases. * Lean muscle mass decreases

Answer 57

* The age-related **loss of muscle mass, strength and function **which can significantly impact an older adult’s quality of life by decreasing mobility, increasing the risk of falls and fractures, lowering metabolic rates and increasing the risk of death. * Accelerates with decreased physical activity. Weight-bearing exercises slow its pace (whilst also supporting bone mineral density).

Answer 58

* **Sedentary** lifestyle, lack of exercise, prolonged **bed rest**: muscle disuse causes a large decline in muscle size and strength. * Body composition changes with age. * **Poor nutritional** status (reduced protein and energy intake). * **Hormonal** changes (low testosterone, oestrogen, growth hormone, as well as insulin resistance have anabolic effects on muscle). * **Inflammation** (↑interleukin-6 and CRP). * **Chronic** **diseases** (e.g. cancer, heart failure).

Answer 59

1. Age-related loss of lean muscle mass affects body composition and basic metabolic rate is lowered as physical activity declines. 2. Increase in fat mass increases the risk of cardiovascular disease, diabetes and obesity, which influences energy balance. * Co-morbidities and infection may increase energy requirements, immobility may reduce them. ## Footnote Lifestages pg 68

Answer 60

* Reduced intake of food: changes in taste and smell (sometimes due to **medications, cigarette smoking** or Alzheimer’s), alterations in gastric hormones regulating appetite and motility, depression and bereavement, as well as social isolation. * **Cachexia** (side effect for cancer or COPD). * Stroke / dementia can lead to **dysphagia** (difficulty eating / swallowing). Dysphagia may also lead to aspiration pneumonia (a leading cause of death amongst nursing home residents).

Answer 61

* A poor nutritional status (e.g. high refined sugars, low antioxidant). * Dentures (problems chewing); amalgams (risk of dental infections). * Xerostomia: causing difficulty chewing and swallowing, whilst also impacting the oral microbiome and reducing salivary IgA. This increases the risk of oral thrush, which can reduce taste. ## Footnote Lifestages pg 70

Answer 62

* Loss of muscle mass and strength. * Loss of mucosal integrity  malabsorption. * Impaired immune function. * Psychological impact: apathy / depression.

Answer 63

* **Physiological**: decreased visual acuity, joint problems, hand tremors, hearing problems, anorexia, dementia. * **Social / psychological:** reluctance to go shopping, isolation, depression, fear, bereavement. * **Economical**: isolation, low income. * R**educed appetite**: could be due to increased levels of **cholecystokinin** with ageing, resulting in increased satiation after meals and delayed gastric emptying. These can make acquiring, preparing and eating food more difficult.

Answer 64

* Parietal cell **intrinsic factor** production declines with age. * **Achlorhydria** (reduced stomach acid) can lead to: - ****Poor digestion, absorption and biliary excretion B12**** (low HCl also impairs bile flow and pancreatic function). - Vitamin**Poor digestion, absorption and biliary excretion B12** deficiency (HCl and intrinsic factor are needed). - **SIBO** and other intestinal bacterial infections. - **Iron** deficiency (due to impaired absorption). * Gastric **motility** and gastric emptying can also be impaired. * *To support these clients: avoid drinking with meals, chew well / eat fewer solid foods, eat bitter greens, supplement where appropriate.*

Answer 65

* Decreased arterial wall compliance, **thickening** / **stiffening of arteries**: ↑ systolic blood pressure. * **Decreased maximum heart rate**. * **Increased left ventricular muscle mass** (also due to hypertension): can be a predictor for cardiovascular disease. * Focus client's dietary intake on whole foods, rich in antioxidants. Increase **bitter** **foods** and heart nourishing foods / herbs such as **garlic and rosemary**. Encourage regular aerobic exercise.

Answer 66

Significant changes in structure and function of the kidney occur, including: * Kidney cortex volume decreases. * Number of renal cysts increase with age. * Nephrosclerosis increases with age, with a decline in nephron numbers and the GFR. Decreased renal function may lead to: * Problems with urinary excretion and difficulties regulating sodium concentration in the body. Poor glomerular filtration is reflected by a low GFR on a blood test

Answer 67

* Cognition, steadiness, coordination, gait, sensations and daily living tasks. * Depression in older people is often undiagnosed as symptoms can be confused with other medical illnesses. Loneliness, losses, not having a goal and purpose of life are the foundation of depression and need to dealt with by the Naturopathic Nutritionist. * Deficiency of B vitamins (folate, B12, B6) have been linked to cognitive impairment, and can contribute to raised homocysteine  a risk factor in the pathogenesis for Alzheimer’s.

Answer 68

- A progressive decline in T-lymphocyte function. - A decline in cell mediated immunity. * This increases the risk and severity of infections and cancer incidences amongst the elderly. * Poor nutritional status further exacerbates impaired immune function. Key considerations are: - Protein energy malnutrition = reduced lymphocyte proliferation  increased risk of infection. - Micronutrient deficiencies (A, C, E, Zn, Se, Fe) that ↓ immunity. - Optimise the intake of these nutrients to support immunity.

Answer 69

* Bones: Bone Mineral Density (BMD) gradually declines with increasing age and is a risk factor for osteoporosis (and fractures). BMD decline is accelerated in women following the reduction of oestrogen associated with the menopause. * Cartilage: Decreases its water content, changes to the extracellular matrix structure with collagen fibres cross-linking (making the cartilage stiffer), and a reduced delivery of nutrients to cartilage. Intervertebral discs lose their height  limiting movement. * Regular weight-bearing exercise can support bone density and cartilage health. Also optimise vitamin C status to support cartilage

Answer 70

* NAD+ depletion is associated with the hallmarks of ageing and may underlie a wide range of age-related diseases, such as metabolic disorders, cancer and neurodegenerative diseases. * You can increase NAD+ levels by: - Exercising regularly. - Getting adequate sleep. - Fasting / periodic calorie restriction. - Eating a nourishing diet which includes **avocados, green leafy vegetables, fish, nuts, cremini mushrooms, fermented foods.** NAD+ = Coenzyme Nicotinamide Adenine Ageing: NAD+ Dinucleotide

Answer 71

- Serves as a potent antioxidant, a chemotoxicity reducing agent, and an anti-ageing substance. - Modulates immune defence (e.g. NK cells). - Acts as a tumour surveillance agent. * Optimise melatonin levels by: increasing natural sunlight exposure, having a regular bedtime in a dark room, avoiding artificial light at night and stimulants (e.g. caffeine), eating Montmorency cherries and B6-rich foods for melatonin synthesis.

Answer 72

Encourage clients to consume nutrient dense diets. * Protein: a higher protein intake (1g / kg body weight) can increase bone mineral density and preserve muscle mass. However, high protein diets can pose stress on the kidneys and increase urinary calcium excretion. * Carbohydrates: 50–70% of calories should come from vegetables, fruits, whole grains, legumes; these will provide micronutrients as well as fibre to counteract constipation.

Answer 73

Cooked foods are easier to chew and digest than raw foods: * Focus on soups, stews, well-cooked grains and legumes, small amounts of stewed fruits (high in sugar). * Ensure adequate hydration by including liquid foods / herbal teas

Answer 74

Vitamin B12 * Older adults at risk of deficiency from achlorhydria. * Important for cognition. Egg yolks, salmon, sardines.

Answer 75

Vitamin D * Low levels in elderly due to poor skin synthesis, reduced kidney conversion and less sun exposure (housebound). Sunlight, mushrooms, egg yolk, wild-caught oily fish, fish liver oils.

Answer 76

Vitamin E * An antioxidant that protects against free radical damage, which is linked to accelerated ageing, neurodegenerative diseases and atherosclerosis. Almonds, egg yolk, hazelnuts, sunflowers, wheat germ.

Answer 77

Folate * Important for lowering homocysteine levels, a risk marker for Alzheimer's, atherosclerosis, Parkinson’s. Green leafy vegetables, barley, beans, lentils, sprouts, yeast, organic liver.

Answer 78

Calcium * Decreased absorption in the elderly. Sesame seeds, almonds, broccoli, green leafy veg, sardines, molasses.

Answer 79

Potassium * Positive effect on blood pressure. * Inverse association of potassium and stroke mortality. Nuts (esp. pistachios), all vegetables, avocado, banana, dates, parsley, potato, sunflower seeds.

Answer 80

CoQ10 * An **antioxidant** that protects cells from oxidative damage. * Body production declines with age and with **statin** use (very common in the elderly). * CoQ10 also supports the immune system and facilitates ATP production. * Useful for **cardiovascular** problems such as coronary artery disease, hypertension, angina, atherosclerosis. Spinach, cauliflower, broccoli, avocado, parsley, oranges, strawberries, apples, grapefruit, sesame seeds, pistachios, walnuts, sweet potato, organ meats, oily fish, egg yolk. ## Footnote Lifestage pg84

Answer 81

* Eat a diet high in **plant foods** with some **fish** (two or three meals a week). After age 65–70, if you start losing muscle mass, add more fish and introduce some animal foods such as **eggs, sheep / goats milk yogurt.** * Eat at the table of your ancestors: consume a variety of foods to ensure adequate nutrient intake; choose ones that were common on the table of your grandparents and great-grandparents. * **Restrict your eating to 11–12 hours a day **or less and consume two or three meals a day at most (e.g. breakfast and one other).

Answer 82

Nettle leaf: * A diuretic — relieves fluid retention, blood purifier — flushes out toxins, skin cleanser, nutritive, assists blood glucose balance, anti-inflammatory (arthritis). Dandelion root: * Enhances digestion (bitterness stimulates release of digestive juices to improve breakdown and absorption of nutrients), supports liver detoxification, a gentle laxative, mild diuretic (assists with fluid retention). Promotes peristalsis. Peppermint: * Soothes digestion — relieves griping pain, flatulence and nausea. * Is antimicrobial internally and topically. * Relieves pain and itching topically. Chamomile: * Relieves pain, flatulence and spasm in the digestive tract. It is calming to the nervous system, relieving stress and promotes a restful sleep. * Topically helps with wound healing. ## Footnote Lifestages pg 87