Ageing

It will happen to the majority of us one day!! 

Aging brings with it a raft of challenges both for the aging person themselves and for the practitioners of natural medicine who treat them.

Multivitamin and Mineral Prevents Infection in Older Population

Those of you who are regular television viewers will have noticed the increasing incidence of advertising of pharmaceutical drugs viewers to ask their doctor for/about the medication.  At this time of year advertising noticeably includes the Flu vaccination.  This drug was previously marketed to the over 60’s and to “at risk” under 60’s with chronic illnesses such as asthma.  The current advertising has extended the indications to target “well people” in occupations with a high exposure to the general public such as, schoolteachers, nurses, bus driver’s etc. 

With this type of aggressive marketing of pharmaceuticals it is important that we provide another option by making our older clients aware of ‘natural infection prevention’ through use of herbal or nutritional medicines.  The following study comes from the Nutrition Care Bulletin, volume ll, Issue 5 and can be found on their website at www.nutritioncare.com.au 

In a study of 130 community dwelling adults who were between 45 and 65 years of age or over, 80 subjects (66% female) received placebo, while 78 subjects (77% female) received a multivitamin/mineral supplement daily for 1 year.

The multivitamin/mineral supplement contained vitamin A at 4,000 IU, beta-carotene at 1,000 IU, vitamin B12 at 4.5mg, vitamin B2 at 3.4mg, vitamin B3 at 20mg, vitamin B6 at 6mg, vitamin B12 at 30mcg,  vitamin c at 120mg, vitamin D at 400IU, vitamin E at 60 IU, vitamin K at 20mcg, biotin at 0.03mg, pantothenic acid at 15mg, folic acid at 400mcg, calcium at 120mg, magnesium at 100mg, manganese at 4mg, copper at 2mg, iron at 16mg, zinc at 22.5mg, iodine at 150mcg, selenium at 105mcg, and chromium at 180 mcg.

More of the subjects receiving placebo reported an infectious illness over the 1-year study compared with those receiving the multivitamin/mineral supplements (73% vs 43% respectively).  Infection-related absenteeism was greater in the placebo group than in the treatment group at 57% vs 21% respectively.  In the 51% diabetic participants, it was found that 93% of the diabetic subjects who received placebo reported infection compared with 17% of those receiving the supplements.[i]

Malnutrition in older people

Over the years studies have indicated that malnutrition is a significant issue in the elderly population with estimates ranging from 20% in independently living older people to over 60% for those in long-term care.  A 2001 audit of patients in Middlemore hospitals rehabilitation wards found that almost 25% of patients were malnourished with a further 44% being at-risk of malnutrition.[ii]

Causes of malnutrition in older people

A range of psychological, physiological and social factors influence the occurrence of malnutrition in older people:  These include:

q       Loss of appetite, this may be due to reduced senses of taste or smell, sub optimal liver function, depression, grief, general fatigue, impact of medications on appetite.

q       Dental problems, decreased salivary gland activity and difficulties with swallowing can act as a disincentive to consuming adequate quantities of food or choosing a poorer quality of food that is more easily digested.  Think of the images of older people who may have nothing more than a slice of white bread toasted with jam on it or a wine biscuit and a cup of sweetened tea for their breakfast.

q       Sluggish digestive processes resulting in reduced nutrient absorption and constipation.

q       Decreased hydrochloric acid production by the parietal cells of the stomach  leading to achlorhydria and hypochlorydria.  Numerous studies have shown that acid secretory ability decreases with age, with over 50% of those over 60 having either hypochlorydria or achlorhydria.

q       Depression is a major factor contributing to loss of appetite and weight loss.  Many elders are socially isolated or suffering the loss of a life partner and may lose interest in food preparation and eating in general.

q       Other chronic health conditions such as dementia, arthritis, COPD can interfere with the ability to perform normal self care tasks such as feeding oneself well.

q       Nutritional status can be impacted by pharmaceutical medications and poly-pharmacy in particular.  Drug side effects can include loss of appetite, dry mouth, nausea, vomiting, diarrhoea and constipation.  Dehydration which is common in older people may affect the pharmacokinetics of a medication and affect the metabolism, excretion and toxicity with potential adverse impact on nutrient status.

Sequelae of malnutrition in the elderly

Poor immune function – a study of 72 home bound elderly women provided blood for comprehensive evaluation of iron status and cell-mediated and innate immunity. [iii] Results showed that in iron-deficient women T cell proliferation was only 40-50% of that in iron-sufficient women.  Phagocytosis did not differ significantly but respiratory burst was 28% less. 

The researchers concluded that iron deficiency is associated with impairments in cell-mediated and innate immunity and may render older adults more vulnerable to infections.  Zinc supplementation should also be considered in the elderly both directly for its immune stimulating effects as well as for its anti-viral properties.  Additionally zinc is an important factor in the formation of hydrochloric acid for release by the parietal cells of the stomach.

Loss of lean body mass and muscle strength increasing the likelihood of falls and fractures

Osteoporosis is a significant problem in the elderly, particularly post menopausal women.  Common practice in general medicine is the prophylactic prescribing of a calcium supplement, often in the form of calcium carbonate.  Unfortunately the absorption of calcium depends somewhat on its ionization in the intestines, this ionization is problematic with the carbonate form as it must first be solubilized and ionized by stomach acid.  Thus patients with insufficient stomach acid output can only absorb about 4% of a carbonate oral dose whereas someone with normal stomach acid typically absorbs about 22%.[iv]  So those at risk of osteoporosis and suffering from low stomach acid need a form of calcium already in a soluble and ionized state, like calcium citrate, lactate or gluconate.  Even with reduced stomach acidity calcium citrate is absorbed at about 45% compared to the 4% for carbonate.

Low magnesium levels and associated health problems.  Magnesium deficiency usually results from either reduced absorption or increased excretion.  High calcium intake (many elders take calcium tablets without any magnesium content) alcohol, surgery, diuretics, liver and kidney disease all impact on magnesium status.  Magnesium deficiency is thought to be common in the elderly population but often goes unnoticed as blood tests are usually taken for serum magnesium levels whereas the bulk of magnesium storage occurs within cells.  A low magnesium level in the serum reflects end-stage deficiency and a more sensitive test of magnesium status is the level of magnesium within the red blood cell (erythrocyte magnesium level)

Poor wound healing, leg ulcers, pressure sores.  Malnutrition is associated with skin anergy and with immobility because of mental apathy and muscle wasting.  Severe malnutrition, impaired oral intake and the risk of pressure ulcer formation appear to be interrelated.

Nervous system problems such as those associated with pernicious anaemia resulting from poor dietary intake or inadequate secretion of intrinsic factor.  A vitamin B12 deficiency is quite common in the elderly and is a major cause of depression in this age group.  As a methyl donor B12 plays a role in homocysteine metabolism, homocysteine is a factor in the progression of both atherosclerosis and osteoporosis.  Elevated homocysteine levels are thought to interfere with collagen cross-linking leading to a defective bone matrix.

Nutritional products for the elderly

The Nutrition Care range of products holds several gems for correction and prevention of poor nutritional status in the elderly including:

Formula SF88 – with the SF standing for ‘Stress Formula’ – this one a day tablet is an excellent source of B vitamins, minerals, amino acids and trace elements (including low dose lithium) as well as Betaine hydrochloride to help with absorption. 

Lithium (Li), the lightest of the alkali metals, occurs in numerous other minerals and was named after the Greek lithos, stone, because of its presence, in trace amounts, in virtually all rocks. Mobilized by weathering processes, lithium is transported into soils, from which it is taken up by plants and enters the food chain.

Lithium is found in variable amounts in foods, primary sources are grains and vegetables which may contribute from 66% to more than 90% of the total Li intake. In some areas, the drinking water also provides significant amounts of the element (up to 100mg/L are found in some natural mineral waters).  In general more lithium is taken up by plants from acidic than alkaline soils.  Since soil acidity also increases the solubility of the heavier metallic elements, plant Li levels are directly and significantly correlated with those of iron, nickel, cobalt, manganese and copper. 

In studies conducted from the 1970’s to 1990’s animals maintained on low-lithium rations were shown to exhibit higher mortalities as well as reproductive and behavioural abnormalities.  In humans defined lithium deficiency diseases have not been characterized, but low lithium intakes from water supplies were associated with increased rates of suicide, homicides and arrest rates for drug use and other crimes. 

Lithium appears to play an especially important role during the early fetal development as evidenced by the high lithium contents of the embryo during the early gestational period.  

Lithium Supplementation Studies

In a placedbo-controlled study with former drug users (mostly heroin and methamphetamines) 24 subjects were randomly divided into two groups, one receiving 400mcg of lithium daily the other placebo for four weeks.  All subjects completed weekly self-administered mood test questionnaires. In the Li group, the total (positive) mood test scores increased steadily during the four weeks of supplementation and specifically in the subcategories reflecting happiness, friendliness and energy.  In the placebo group, the combined mood scores showed no consistent changes; the happiness scores actually declined.[v]  

The mood elevating action of supplemental Li may be related to the increase monoamine oxidase activity, which is depressed in Li deficiency. Li has been shown to enhance folate and B12 transport into L1210 cells, the transport of these factors is inhibited in Li deficiency.  Since vitamin B12 and folate also affect mood-associated parameters, the stimulation of the transport of these vitamins into brain cells by Li may be a mechanism of the antidepressive, mood-elevating and anti-aggressive actions of Li at nutritional dosage levels.  The joint administration of Li with vitamin B12 and folate may prove more effective than Li or the vitamins alone.

 Schrauzer [vi]suggests a provisional RDA for a 70 kg adult of 1000mcg daily (Formula SF88 contains lithium carbonate 750mcg per tablet)

Indications in the elderly include:

·        Elevated homocysteine levels

·        Inadequate diet and anorexia

·        Anxiety, depression, apathy

·        Raynaud’s syndrome

·        Confusional states

·        Immunodeficiency

·        Manic-depression

·        Alcoholism

B12 Sublingual tablets – these 1000mcg dissolvable tablets are a convenient and effective form of vitamin B12 supplementation which rapidly raises serum cobalamin levels.  It is a common practice to inject vitamin B12, and there is a misconception that oral supplementation is ineffective.  The truth is that even in the absence of intrinsic factor, administration of the appropriate dose results in effective elevations of serum B12.   [vii]

Main indications:

·        Hyperhomocysteinemia

·        Supplementation of vegetarian diets

·        Malabsorption syndromes

Minoporph tablets – this 1 a day, broad spectrum mineral supplement also contains haematoporphyrin (catalyst to the anti-ageing effects of vitamins A, E and certain enzymes in the body).  Along with Betaine Hydrochoride, Glutamic acid and vitamin D3 all included to specifically enhance the bioavailability of the individual minerals.

Main indications:

·        Malabsorption

·        Mineral deficiencies

·        Thyroid dysfunction

·        Brittle nails, poor hair quality

·        Osteoporosis