healthy

a 'good' diet?

We need a better diet as we get older. Although our calorie requirements decrease slightly because we are less active, our need for nutrients stays the same or may even increase.
Ideally, we should eat smaller servings of nutritionally dense foods, such as:

• Fruit and vegetables

Wholewheat bread and other cereals
Fish and meat (or vegetarian alternatives including pulses)
Milk and dairy foods
It is difficult to be specific about how much to eat because the way we digest, absorb, use and excrete nutrients not only changes as we age, it also varies widely between individuals.

• Eat a varied diet

The foods listed above are the basics and we need some of these food groups every day. It is important to eat a variety of these foods, too. This is not just to spice up our lives - though that's important too - but because older people who have a monotonous diet or who exclude whole food groups are at risk of missing out on key nutrients.

If you know what day of the week it is from what's on the menu, you probably don't have enough variety - and therefore nutrients - in your diet. We really do need to eat as many types of food as possible.

You may also be at risk if you don't eat any (or enough) fruit and vegetables or dairy products. Vegans and vegetarians should continue to be vigilant about their nutrient intake as they get older, too.

Of course, a good diet not only provides the nutrients we need, it also keeps our weight in check - so avoid refined sugar products and highly processed foods. Enjoy cakes, biscuits, sweets, chocolate, cereal bars, sugary drinks, crisps and other nibbles as an occasional treat.

• Prevent ageing by eating more fruit and vegetables

Fruit and vegetables are dubbed the 'anti-ageing remedy' because the antioxidant vitamins and minerals they contain perform a wide range of jobs, not least of which is mopping up the damaging 'free radicals'.
'Free radicals' form when oxygen (a highly reactive element) combines with other molecules. This produces high-energy chemical substances that attack cell membranes, proteins and even DNA, as they seek out something to combine with causing irreversible damage.

Many degenerative diseases that are common in later life are likely to be exacerbated or even caused by free radical damage, including cancer; vascular diseases; degenerative eye diseases; and possibly neuro-degenerative diseases like Parkinson's.

There are other sources of 'oxidative stress', including tobacco smoke and other pollutants, certain drugs and excess alcohol.

• Antioxidants

The crucial antioxidant vitamins (A, C, E) and minerals (zinc, copper, manganese, selenium) in fruit and vegetables can stop free radicals in their tracks. Carotenoid vitamins are particularly powerful antioxidants. These include beta-carotene (found in carrots), lycopene, lutein and zeaxanthine.

We have other antioxidant defences, such as natural enzymes, but scientists have established that we need to consume antioxidants in large, regular doses. That's why the Department of Health and nutritionists advise us to eat five portions of fruit and vegetables every day.

Smokers use antioxidants faster and therefore need an even higher intake. Different fruits and vegetables offer different protection. For example, green leafy vegetables and vitamin C rich fruits and vegetables offer the greatest protection against heart disease.

Eating foods rich in lutein - such as sweetcorn, spinach, courgettes, green peppers, cucumbers, red grapes and kiwis - may protect against cataract and macular degeneration, as may zeaxanthine, which comes from everything orange -peppers, corn, oranges and mangoes.

Lycopene appears to protect against heart disease and prostate cancer, and a particularly rich source is tomatoes - if they are cooked. So you really can tuck into tomato ketchup and tomato sauces knowing they are health foods!

Fruit and vegetables have many other important jobs to do, including lowering our blood pressure, because the potassium they contain increases sodium (salt) excretion. Potassium is found in many fruits and vegetables including bananas, citrus fruits, raisins and other dried fruits, potatoes and avocados.

• Five portions a day

What is five portions anyway? A 'portion' is a term used by nutritionists. It doesn't mean one 'helping', and it isn't always one piece.

The answer to the question, 'How much is it?' depends on the fruit/vegetable in question. For example, one apple equals a portion of fruit but one pineapple is more than one portion!

Use the information below to work out if you're having five portions of fruit and veg a day.

One portion of fruit equals :

• 1 apple, orange or banana

• 1 large slice of melon or pineapple

• 2 small fruits (eg plums, kiwis, satsumas)

• 1 cupful of berries (raspberries, strawberries) or grapes

• 2-3 tablespoonfuls of fresh fruit salad, stewed or canned fruit

• 1 glass (150ml) of fruit juice

One portion of vegetables equals:

• 2 tablespoonfuls of raw, cooked, frozen or canned vegetables

• 1 dessert bowl full of salad

Fresh vegetables and fruit are the 'best buy' nutritionally, but frozen, tinned, and dried produce counts too. Potatoes don't count but are a good source of carbohydrate and fibre (if you eat the skin).

If you can't eat five portions of fruit and vegetables a day, eat what you can - every little helps.
The way to five

Try experimenting with new ways of cooking or combining fruit and vegetables to make eating them more interesting. Boiled vegetables aren't exactly exciting, but stir-frying is quick, tasty and retains the nutrients well. It is surprising how many vegetables can be roasted - try carrots, peppers, courgettes, even cauliflower and broccoli - preferably in olive oil.

Raw vegetables such as grated carrots or courgettes can liven up salads and sandwiches. You can 'disguise' vegetables in casseroles and liquidised soups and the fruit in pies and puddings is still fruit! If all else fails, take a suitable vitamin supplement but remember that pills don't match the real thing and won't provide fibre.

• Nutrients

What do we need to stay healthy? This is not a complete list of all the nutrients we need, but it covers the main ones.

The nutrients we need to stay healthy Nutrient Why do we need it? Where do we get it from?
Protein Vital for repair and maintenance of all the cells in the body, for growth and for other functions such as the immune system. Meat, poultry, fish,eggs, cheese, milk, yoghurt, beans and lentils, nuts, soya and other meat alternatives.
We do not need a lot of protein and too much may be unhealthy. Around (100-150g) a day is enough. Try to eat a mixture of animal and vegetable proteins.
Carbohydrates To provide energy. Some carbohydrates are a rich source of fibre and vital vitamins and minerals. Bread - including rolls, pitta, bread, chapattis - potatoes, breakfast cereals, rice, pasta, noodles, plantains, sweet potatoes. Try to eat wholegrain cereals where possible - eg wholemeal bread and breakfast cereals (but not bran), brown rice. Sugar (table sugar, honey, syrup) is also a carbohydrate but it is not neccessary to our diet and should be eaten in moderation.
Fats An important source of energy, but eat in moderation, especially if you are concerned about weight gain. Fats enable us to absorb the fat-soluble vitamins (A, D and E). Omega-3 fats help prevent blood clots. Butter, margarine, cheese, meat, lard, vegetable oils, oily fish, nuts, seeds.
Try to minimise the animal fats in your diet (eg butter, lard). Choose monounsaturated fats instead (eg olive oil, nuts). Omega-3 oils can reduce the risk of heart disease, so try to eat oily fish at least once a week.
Fibre Helps avoid constipation; also protects against disease such as cancer of the colon. Wholegrain cereals, vegetables, including lentils, fruit and especially beans.

• Vitamins

The vitamins we need to stay healthy.
The vitamins we need to stay healthy Vitamin Why do we need it? Where do we get it from?
Vitamin A For normal cell division, healthy eyesight and mucous membranes, the immune system. Oily fish, butter, cheese, carrots, apricots, green leafy vegetables, mangoes, red peppers.
B vitamins All are needed to release the energy from foods and have other key roles too.

Thiamin (B1) Important in carbohydrate metabolism. Bread and cereal products, potatoes, pork, liver, nuts and pulses.
Riboflavin (B2) To release and support the role of other B vitamins. Milk and milk products, eggs, meat, breakfast cereals.
Folic Acid For cell division and the formation of DNA and proteins in the body; may help to reduce the risk of heart disease. Leafy vegetables, liver, wholegrain cereals, nuts and pulses. Try to eat more foods with this vital vitamin.
Vitamin B6 For protein metabolism. Meat, fish, eggs, soya beans, oats and nuts.
Vitamin B12 For folate metabolism and maintenance of nerve cells. Meat and fish in the diet, also made by bacteria in the gut.
Vitamin C A powerful antioxodant; also needed for healthy gums, teeth, bones and skin, wound healing. Helps iron absorption. Fruit and vegetables, especially citrus fruits and juices, tomatoes, potatoes, green vegetables, kiwi fruits, blackcurrants.
Vitamin D For healthy bones and teeth - calcium cannot be absorbed without it. Sunshine, oily fish (tuna, salmon, sardines, mackerel), fortified margarines.
Vitamin E An antioxidant which may protect against various diseases linked to ageing. Vegetable oils, wheatgerm,nuts, seeds, margarine.

• Minerals and fluid

The minerals and fluid we need to stay healthy Mineral Why do we need it? Where do we get it from?

• Calcium Keeps bones and teeth strong; also vital to blood clotting, muscle function and nerve transmission. Milk and dairy products, green leafy vegetables, soft bones (like those found in sardines).

• Sodium Maintains fluid balance within the body; important for muscle function. Salt.

• Potassium Keeps the heartbeat regular; maintains normal blood pressure; with sodium maintains the fluid and electrolyte balance in cells. Bananas, avocados, fresh and dried fruit, seeds and nuts, potatoes and pulses.

• Zinc Keeps the immune system healthy; involved in the metabolism of proteins, carbohydrates and fats; may be vital to normal healing; also an antioxidant.

• Iron Essential component of blood and vital for energy. Offal, meat including chicken, egg yolk, dark green leafy vegetables.

Selenium An antioxidant Brazil nuts, fish, offal, avacados, lentils.
Fluid Vital for digestion, regulation of body temeperature, elimination of waste products, lubrication of joints and eyes. Water, fruit, juice, tea and coffee (in moderation). Try to take care - it's almost impossible to drink too much.

• Specific nutrients for older people

Omega-3 oils are now known to act on the blood platelets, making blood clots less likely. Omega-3 oils are found mainly in oily fish - sardines, pilchards, salmon, herring, kippers, mackerel, fresh tuna, trout and anchovies. Fish oil supplements do the same job and if you do not eat fish at all they are worth adding to your diet.
A healthy heart and arteries tops this list for obvious reasons. All kinds of nutrients are needed to keep the cardiovascular system in good order (see below), but omega-3 oils deserve a special mention here.

Calcium is essential to keep bones healthy but most of don't consume enough of it. On the other hand, there is not evidence that a high intake helps protect bones.
Calcium is found in milk (semi-skimmed has more than whole milk) and other dairy products, the soft bones in canned fish, bread, pulses, leafy green vegetables, dried fruit, nuts and seeds. A pint of milk a day will supply all the calcium we need - 700mg.

• We need vitamin D to enable our bodies to use the calcium in food.

Vitamin D is mainly sourced from the sun acting on our skin, and not from our diet at all. It is vital for all of us to get (careful) exposure to the sun in the summer months. Those who cannot get out, or keep their skin covered, should consider a vitamin D supplement, especially in the winter (though note that vitamin D is poisonous if taken to excess).
Some margarines are fortified with vitamin D.

Zinc is involved in the metabolism of proteins, carbohydrates and fats. A lack of zinc will affect tissues that need constant renewal and repair such as the skin, the lining of the gut and the immune system.
There is evidence that older people with poor wound healing, and particularly leg ulcers, are not getting sufficient zinc. Lack of zinc is also a factor in dementia. This vital mineral is found in meat and meat products, seafood, milk and dairy products, wholemeal bread, lentils, eggs, nuts, sweetcorn and rice.

• Nutrition FAQ

Should I take vitamin supplements?

Our nutritional needs are complex and while vitamin and mineral supplements may help - they may not. We simply don't have the science yet to confirm or refute the claims made for dietary supplements. The fact that a deficiency of something is harmful does not mean that an excess of it does you good.
Supplements should never be a substitute for a healthy diet but may be helpful for certain people at certain times, for example, those who cannot eat properly for whatever reason, people who omit whole food groups (such as fruit and vegetables or fish) and vitamin D supplements for people who can't get into the sun.

Some scientists recommend one pill that may surprise you - aspirin. There is some evidence that it can help to prevent coronary thrombosis, cancer of the colon and possibly cataract too, though further studies need to be done. The precise dose has not been established - a 0.75 gram tablet once a day is reasonable and even one a week may be enough to gain some benefit. Not everyone can tolerate aspirin, so it's important to check with your doctor, especially if you have gastric problems.

• Should I eat bran?

Dietary fibre is an essential part of our diet as it helps food through the gut. Without it we don't just get constipation and haemorrhoids, we are also at risk of varicose veins, diverticular disease and possibly colon cancer. But older people should never add raw bran or bran-rich cereals or products to their diets. They contain phytates which can bind with minerals such as calcium, zinc, iron and copper and reduce their availability in the body. Also, raw bran can simply clog up the gut, making constipation more likely. Dietary fibre is best obtained from wholemeal bread and breakfast cereals, fruit, vegetables and brown rice.

Soluble fibre is a different type of fibre. It plays a key role in how we process glucose and reduces blood cholesterol. It is found in fruit, vegetables, oats and pulses.

• Is alcohol good or bad for you?

There are many advantages to being middle-aged and older and one of them is that alcohol is positively good for most of us! Once men have reached 40 and women are past the menopause, alcohol starts to protect the cardiovascular system because it thins the blood.

The health benefits come from drinking small amounts regularly. Modest amounts of alcohol also help to prevent gallstones, prostate problems and cognitive impairment.

All types of alcohol offer these benefits - there is no truth in the notion that red wine is especially beneficial. Nor is it true that alcohol and antibiotics don't mix; only one, rarely used antibiotic (metronidazole) should not be mixed with alcohol.

Of course, if you are teetotal there is no evidence to suggest that you would benefit from starting to drink. If you do drink, alcohol should be taken in moderation, preferably with a meal. People taking prescription medicines or even some over the counter drugs should always check whether the medication is affected by alcohol.

Obviously even moderate levels of alcohol impair the ability to drive safely and can increase the risk of falls. Moderation means a maximum of three to four units a day for men and two to three units for women (one unit is half a pint of average-strength beer, one glass of wine or a standard pub measure of spirits or fortified wines such as sherry. Home measures are often more generous than pub measures of course!) So enjoy it!

• How much water is enough?

Water is the part of our daily diet that we all tend to forget about, but insufficient fluid can be serious, leading to constipation and even mental confusion. Many older people are actually slightly dehydrated. One difficulty is that the sensation of thirst declines as we age and thirst can be mistaken for hunger, so we eat when we should drink. We need to drink at least one and half litres of fluid a day (that's around six mugfuls), but we need more if we are not eating properly, for example during illness.

It is almost impossible to drink too much. Fruit juices, squash, milk, tea (in moderation) and herbal teas are all useful alternatives to water. It's important to know that alcohol and caffeine are diuretics, this means that an excess of them will increase the amount of water that we excrete in our urine. However you still take in more liquid than you lose from a cup of tea, coffee or a cola-type soft drink.

Try to drink a variety of drinks to keep your water intake up and remember you can't beat water itself!

• Does carrying a bit of extra weight matter?

An astonishing two out of three people over 65 living at home are overweight. Obesity makes the many disorders mentioned in this section more likely, but it also has another damaging effect in later life - it often restricts activity. That in turn means loss of all the benefits of exercise, such as declining strength and cardiovascular health. Obesity also erodes the quality of life because it often leads to 'mechanical' disorders like lower back pain, breathlessness and sleep apnoea.

It's important to avoid weight gain - and it may be a good idea to lose weight - but as we age it needs to be tackled carefully. There is a big risk that restricting calorie intake drastically could affect nutritional health in other ways. The basic rules are: eat three sensible meals a day, drink more water and take some exercise. It's possible to control weight by exercise alone - and still enjoy those puddings! If you need to lose weight, avoid crash diets and get professional advice. Being underweight in later life is not a good idea, either. Not only is there a risk of missing some nutrients but underweight people have a higher risk of osteoporosis.

• What is all this talk about a 'new cholesterol'?

Homocysteine is an amino acid found in blood. It is to be thought of as cholesterol and researchers are discovering that too much of it may be a bad thing. It has been reported that high levels of homocysteine can increase our risk of heart disease fivefold. Research into Ageing-funded scientists are also investigating a possible link between high homocysteine levels and Alzheimer's disease.

People with Alzheimer's show signs of abnormal blood clotting and this study is investigating whether high levels of homocysteine may be implicated. Blood clotting in the small blood vessels in the brain could trigger a series of events that lead to the brain damage typical of Alzheimer's patients.

Homocysteine levels tend to rise as we get older but are normally kept under control in the body. The control mechanisms may have a genetic basis, but they are also influenced by three vitamins - vitamins B12, B6 and folate. A deficiency of any of these three vitamins can lead to increased levels of homocysteine. If this study finds a link between Alzheimer's and vitamin B deficiencies, we will have the first real breakthrough in preventing the illness, or limiting its severity.

So, it make sense to keep up our intake of B vitamins to protect our hearts and maybe our minds too. Vitamin B12 comes from meat, eggs, fish, offal and milk; folate from liver, orange juice, dark green vegetables, nuts and wholemeal bread, and vitamin B6 from potatoes, beef, fish, poultry and breakfast cereals, particularly the wholegrain variety. It is not advisable to take high daily doses of folic acid as a supplement however, except under medical advice, as it may mask a deficiency of vitamin B12.

• Enjoy your food

No matter how motivated we are to eat sensibly, getting older can put obstacles in our way. Shopping and cooking may be more difficult and, because our taste buds are less sensitive, eating may become a chore rather than a pleasure. Dental problems may compound the situation.
Follow these simple strategies to make sure you continue to enjoy preparing and eating tasty foods.

We don't have to be able to cook well to eat well. A sandwich can become a nutrition-packed meal with the right fillings. Try grilling tomatoes (a rich source of lycopene), or sardines (a great source of omega-3 oils and calcium if you eat the soft bones) and serving them on toast.

If you feel like a traditional meal, try one of the convenience dinners that can be heated in the oven or microwave cooker. These pre-prepared meals can be nutritious (if expensive). Watch out for meals that are high in fats, salt or sugar; there are often healthier options.

It's not just what you eat that matters - the social factors associated with the meal can make a huge difference to its enjoyment. Cooking for one is a challenge at any age and people who have a partner or friends to eat with have a better diet than those who live and eat alone. So, try to eat with your family and friends - at home, in a cafe or lunch club - whenever you can.

• Looking after your teeth

Older people who don't have their own teeth are more likely to be malnourished than those who do. So it pays to hang on to our teeth for as long as we can. Dentists recommend we all avoid too much sugar (it rots teeth), brush regularly and get a regular check-up.

Gum disease is often the cause of lost teeth; so brush your gums gently and see the dentist if they bleed. If you wear dentures, make sure they fit properly. Our jaws will change as we get older so dentures need to be changed from time to time.