I don’t understand why asking people to eat a well-balanced vegetarian diet is considered drastic, while it is medically conservative to cut people open and put them on cholesterol-lowering drugs for the rest of their lives.
Thanks to the baby boomers, the ranks of “senior citizens” are growing rapidly (but don’t call this group old—60 is the new 40). Today, one in eight Americans is over 60, and that proportion is expected to skew older; by 2030, one in five people will be above the age of 65.1
At 65, people have an average life expectancy of 18.8 more years. Men who live to 85 can expect to live 5.7 additional years, and 85-year-old women 6.8 additional years. In fact, in 2001, 48,000 people in the United States were 100 or older; eight years later, their number had risen to more than 64,000.2 Due to a variety of lifestyle factors, vegans may expect to live a few more years than the general population.3 Compared with nonvegetarians, vegetarians have been shown to have somewhat longer telomeres, an indicator of biological aging, showing a slight slowing of the aging process.4
Of every one hundred Americans over age 65, one is vegan; three consume no meat, poultry, or fish; and forty-six eat one or more vegetarian meals per week.5 Many are aware that a plant-based diet is linked with longevity. Some make this dietary choice to reduce their risk of cardiovascular disease, diabetes, hypertension, obesity, and certain types of cancer; others choose it to prevent a recurrence of one of these conditions. Some studies have shown avoiding meat reduces one’s risk of dementia, making a plant-based diet more attractive.
For a few seniors, environmental concerns were the primary inspiration to make a lighter footprint on the planet. For others, ethics, religion, or a wish to avoid harm to animals provided the motivation. Whatever led to their dietary shift—early in life or more recently—a nutritious diet of plant foods has proved to be a wise choice. Studies of older vegetarians, including vegans, indicate that their intakes of many minerals and vitamins are similar to or better than those of nonvegetarians, their body weight is more likely to be in the optimal range, and they’re likely to live longer in good health. (See chapters 1 and 2.)6–8,82
Relative to the needs of young adults, seniors require fewer calories but more calcium, vitamins D and B6, and possibly additional protein. Meanwhile, the recommended intakes for other nutrients remain the same as those of a younger person, with the exception of iron for postmenopausal women, which is reduced. (For more on recommended intakes of vitamins and minerals, see the appendix on pages 446 and 447). Overall, the diets of seniors must have greater nutrient density.
There are two primary reasons behind seniors’ lower calorie requirements: reduced muscle mass and decreased physical activity.
Muscle tissue burns calories; fat tissue doesn’t. Lean body mass (the amount of muscle tissue) tends to shrink with age, while the percentage of body fat typically increases. As a result, at 60, women have an average of 3.5 pounds (1.6 kg) less muscle tissue than they did at 20. Men lose even more, with 7 pounds (3.2 kg) less muscle at age 60. This shift from muscle tissue to fat occurs for a variety of reasons: hormonal changes, a change in basal metabolic rate, and less exercise. Loss of muscle mass and strength (sarcopenia) can set in motion a cascade of consequences, including worsening of diseases, increased disability, malnutrition, and death.2,8–10
The body’s basal metabolic rate decreases by about 1 to 2 percent per decade from age 20 to 40 if body weight is constant, then starts to decline more rapidly. Each following decade, a man expends 100 fewer calories per day and a woman expends 70 fewer calories daily; in many cases, and the decline in total energy expenditure is greater. However, instead of adjusting menus accordingly, many adults gradually gain weight. Women often gain an extra 10 pounds (0.45 kg) around the time of menopause and may lose more muscle mass at this time.9,10 Among American adults over 65, one in three is obese.2
Although some factors can’t be completely controlled, the reduction in activity, conversion from muscle to fat, and accumulation of excess weight in seniors is strongly influenced by lifestyle choices. According to the Academy of Nutrition and Dietetics’ Position Paper on Food and Nutrition for Older Adults, “Older adults who follow a dietary pattern of high-fat dairy products and sweets and desserts have a higher risk of mortality than those that follow a healthy dietary pattern.”2 Using evidence from the National Health and Nutrition Examination Survey (NHANES), vegan diets are suggested by registered dietitians as one way to avoid overweight and obesity and to achieve a body mass index (BMI) within the optimal range (see table 12.1 on page 363).12 Lifestyle choices that support a healthy old age include choosing a protein-rich and nutritious vegan diet, eating a little less each decade, and participating in regular exercise.
Dr. Ruth Heidrich (born 1935), author of Senior Fitness and Lifelong Running, says, “I’m convinced that our lifestyle choices make the difference between thriving and dying.” After a devastating diagnosis of advanced breast cancer (with metastasis to the bones, liver, and one lung) in 1982, she looked at the research and immediately adopted a low-fat vegan diet. Signs of her cancer’s spread reversed and her energy soared. She had been a runner but added Ironman Triathlons; over the next thirty years, she won nine hundred medals and was named “One of the Ten Fittest Women in North America.” She remains cancer-free and continues daily running, biking, swimming—and her plant-based diet.13,14
Regrettably, less than 5 percent of adults participate in thirty minutes of daily physical activity, and this small proportion declines with age. Yet maintaining fitness is as much a key to wellness as avoiding excess calories, and even moderate amounts of exercise are helpful. A Texas study of adults with an average age of 70 showed that participants experienced improved blood flow and muscle-building effects after forty-five minutes on a treadmill.15,16
Regular exercise promotes physical and psychological well-being and better sleep quality. It reduces the risk of disability and vulnerability to a variety of conditions among older adults, including coronary heart disease; type 2 diabetes; metabolic syndrome; stroke; hypertension; colon, breast, endometrial, and lung cancers; overweight; loss of cognitive function; and depression.2,17,18 Regular physical activity can keep the muscles and bones strong, metabolic rate up, and weight in check, and it can also help to prevent falls.
For good health, adults should aim for an hour of physical activity each day. The variety of recommended activities for seniors include weight-bearing exercise that helps maintain bone mass (walking, jogging, dancing, tennis, and hiking); aerobic or endurance activities that keep the heart strong (any of the weight-bearing exercises, plus swimming, aquatics, cycling, and kayaking); strengthening activities to retain muscle tissue (weight lifting, carrying groceries, stair climbing, and gardening); and activities that support flexibility and balance (yoga, tai chi, stretching, and Pilates). Seniors also should work on their balance (such as standing on one foot), which helps to prevent falls and retain cognitive function.16,17,19 (For specific guidelines for seniors adapted from the Physical Activity Guidelines for Americans, see page 429.)16
Some people acquire a new interest in fitness at this stage of life. British vegetarian and centenarian Fauja Singh rediscovered his passion for running at the age of 81 and thereafter took part in marathons every two to three years, running in London, New York, and Toronto. He gained a spot in history by completing the Toronto Waterfront Marathon in 2011 at the age of 100, becoming the oldest person ever to complete the twenty-six-mile run; he completed the course in just over eight hours, less than his nine-hour goal. He also carried the 2012 Olympic torch on part of its route.
Although some expense may be associated with keeping fit, it can be a thrifty choice. A California study reported on 424 older adults who were at risk for mobility disabilities (losing the ability to walk safely and independently). The study participants followed a program that involved 30 minutes of activity on most or all days and included 150 to 210 minutes per week at a gym, as well as at home. The study estimated that the physical activity program (with center-based educational and exercise sessions that lasted 34 to 52 weeks) cost $1,309—but avoided disability-related annual costs of $28,206.20
Research has established that plant protein intake is suitable for building and retaining muscle. A study of 60- to 70-year-old men who engaged in resistance training reported that a soy-rich diet is as effective as a beef-rich diet in improving muscle strength and power. The men were overweight (average BMI just over 28), nonvegetarians, and weighed an average of 197 pounds (89.3 kg). For the study’s purposes, either soy or beef was added to a vegetarian diet; in both cases, the men’s daily protein intake averaged 1.1 grams per kilogram of body weight over twelve weeks. Their program included resistance training, done at a gym three days per week.21,22
Muscle mass increased equally and significantly in both the beef and soy groups. Researchers found no added benefit from components, such as creatine, that are present in meat but not in soy. It was concluded that either soy or beef protein plus exercise interventions can delay muscle loss and increase muscle quantity, tone, and strength.21,22
A study of pre- and postmenopausal Boston women found vegan diets provided essential amino acids and maintained muscle mass as well as lacto-ovo vegetarian (LOV) or nonvegetarian (NV) diets. Average protein intakes on the vegan and LOV diets were 1 gram per kilogram of body weight daily (g/kg/day) compared with 1.3 g/kg/day on the NV diet; nonetheless, muscle mass and intakes of the indispensible amino acids (IAAs) were similar for participants. Researchers concluded that vegan intakes of protein and IAAs were sufficient to maintain muscle mass.24 (For more on vegan protein sources, see chapter 3.)
Although a senior’s recommended dietary allowance (RDA) for protein doesn’t differ from a younger adult’s, many experts suggest a daily protein intake of at least 1 g/kg/day for seniors; some experts suggest 1.1 g/kg/day. This is slightly more than the recommendation for vegan adults of 0.9 g/kg/day (see page 85).2,24–26 Because this recommendation is based on a healthy weight, an overweight person of any age should use his or her healthy body weight to calculate the desired protein intakes (see table 12.1 on page 363).
The Adventist Health Study-2 (AHS-2) included 5,694 vegans; 60 percent were 55 or older, and 63 percent were women. Their average BMI was 24.1, and protein intake was about 72 grams in a diet of about 1,800 calories daily, with protein providing 14 percent of calories.27
To support muscle maintenance, a daily intake of at least 1 gram of protein per kilogram of healthy body weight may be optimal in seniors. For those who want to build muscle, short-term intakes that are somewhat higher can help.24–26
The menus in chapter 14 (pages 439 to 442) easily provide enough protein for most seniors, along with enough iron, zinc, and other nutrients. The 1,600-calorie menu provides 80 grams of protein; for a person whose healthy body weight is 176 pounds (80 kg), this menu provides 1 gram of protein per kilogram of body weight; for a person whose healthy body weight is 160 pounds (72 kg), it provides 1.1 grams of protein per kilogram of body weight. The 2,000- and 2,500-calorie menus provide 76 grams and 97 grams of protein, respectively.
For seniors, vegan diets may offer a special advantage over diets high in meat, poultry, and fish by providing sufficient, but not excessive, protein; consuming too much protein can accelerate the decline in kidney function that some seniors experience.6–8
For senior men, the RDA for iron is 8 mg per day (unchanged from earlier in life). Postmenopausal women, who no longer have monthly menstrual iron losses, have the same RDA for iron as men.28 Iron from plant sources can be less well absorbed than that from meat; however, the high vitamin C intakes that are typical of many vegan diets substantially increase iron absorption.8,12
Due to lower absorption of the nonheme iron present in plant foods, the Institute of Medicine (IOM) suggests that for vegetarians, the RDA should be multiplied by a factor of 1.8, making the recommended intake for iron for vegan seniors 14.4 mg per day. This recommendation remains controversial (see page 187).8,28–31 However, numerous studies show vegetarians (including vegans) have iron intakes that exceed this level. For example, in AHS-2, the vegans’ median iron intake was 20 mg per day.27
In the general population, iron deficiency (as shown by low hemoglobin levels) occurs mainly in the elderly who are hospitalized, institutionalized, or chronically ill; it can be linked with chronic bleeding in the gastrointestinal tract, dental problems, diminished sense of taste and smell, poor appetite, challenges in obtaining food or making meals, or poverty.32 Anemia can result from chronic inflammation, chronic kidney disease, or insufficient dietary iron. Thus, it may be expected that some elderly vegans will similarly be anemic. Complications of anemia in the elderly include greater risk of mortality, cardiovascular disease, cognitive dysfunction, falls, fractures, longer hospitalizations, and reduced bone density.33–35 Anemia is associated with “restless leg syndrome”; this condition can be corrected with iron supplements (and with foods listed below).32
The RDA for zinc is unchanged from earlier in life for seniors of both genders, at 8 mg per day for women and 11 mg per day for men. In the AHS-2 study, the average vegan intake met or exceeded these levels. In the elderly, insufficient zinc can cause poor wound healing, reduced immune function, and dermatitis; it also affects the ability to taste and thus can have a deleterious effect on appetite. Zinc deficiency can result from poor absorption or from use of certain medications. With increased intake of zinc-rich foods, an elderly person may find that the ability to taste returns, dermatitis heals, and other deficiency symptoms improve. Zinc supplements also can help someone who is deficient; however, these supplements can interfere with the absorption of other minerals, so zinc-rich foods should be the first option.32
The same foods that are good protein sources tend to be rich in iron and zinc: oats, whole-grain products, fortified breakfast cereals, legumes (beans, peas, or lentils), fortified vegan meat substitutes, soy foods, seeds (especially pumpkin seeds), and seed butters. Other iron sources include dried apricots and raisins, dark chocolate, and blackstrap molasses. Additional sources of zinc include cashews, pecans, pine nuts, wheat germ, and fresh and sun-dried tomatoes. Cashews can be blended with water and added to soups and sauces; when heated, they thicken, giving a creamy texture. (For more on iron, zinc, and vegan sources of these minerals, see chapter 6.)
Broken bones are a top health hazard for the elderly and often spell an end to independent living. Maintaining strong bones depends on a broad spectrum of nutrients: calcium, vitamin D, and protein are key components. (Weight-bearing exercise also helps the body to retain the calcium in bones.) Adequate calcium is linked with prevention or reduced risk of osteoporosis, colon cancer, hypertension, and other conditions.8,32,36,67 In women, bone loss is particularly high during the perimenopausal stage, although these losses can be lessened with adequate intakes of key nutrients.
For people older than 50, the recommended intake for calcium increases from 1,000 to 1,200 mg per day.37 Some experts suggest it should be further increased to 1,500 mg per day after age 65, because the body’s ability to absorb this mineral declines over the years.32
It can be a challenge for people to meet recommended calcium intakes—let alone the levels advised for seniors—with food alone. Thus, increased use of fortified foods or a supplement can help.68 Numerous studies show calcium supplementation at levels between 500 and 1,200 mg per day is associated with reduced bone loss and less risk of fracture.36
Vegans in the AHS-2 met the RDAs for calcium and vitamin D, on average.27 The German Vegan Study, which examined the diets of 154 vegans aged 21 to 75, reported that their intake of nutrients related to bone health met recommended intakes, except for calcium (which averaged 840 mg) and vitamin D (which averaged 0.65 mcg per day).38 In many studies that were conducted over six decades in the United States, Canada, Finland, France, Great Britain, and New Zealand, reported daily vegan intakes are well below the RDAs, often averaging about 500 mcg of calcium and substantially less than 2 mcg of vitamin D.8 Nonvegetarians also tend to be low in these two nutrients.8 At northern latitudes, these low intakes of vitamin D matter (as does the calcium).
The 1,600-calorie menu on page 439 provides approximately 1,964 mg of calcium (depending on one’s choice of calcium-set tofu) and the 2,000-calorie menu on page 440 provides 1,294 mg of calcium.
To absorb calcium, the body needs vitamin D. In addition to regulating bone mass, this vitamin plays an essential role in immune function and is protective in many other ways. For people age 70 and older, the RDA for vitamin D increases from 15 mcg (600 IU) to 20 mcg (800 IU); however, many experts recommend significantly higher intakes (see page 223.) Various studies have shown that seniors reduce the risk of fractures and falling or increase bone mineral density with daily supplemental intakes in the range of 500 to 1,200 mg of calcium along with 800 to 900 IU (20 to 22.5 mcg) of vitamin D.36,39,40 Serum vitamin D concentrations of at least 75 to 99 nmol/L are suggested for optimal bone health.41
The benefits of adequate vitamin D intake go beyond bone health. For example, daily supplementation with 1,000 IU (25 mcg) of vitamin D along with about 1,000 mg of calcium has been shown to reduce periodontitis and is linked with shallower dental pockets. (Of course, consistent dental care helps too.)42 An Austrian study of 961 female nursing-home residents (whose average age was 83) found 49 percent greater mortality among those with low serum vitamin D levels.43 Low vitamin D levels also may predispose a person to gain excess weight.44
Poor vitamin D status among older people has numerous causes, related to the vitamin’s primary sources: sunlight, supplements, and fortified foods. With age, the skin’s production of vitamin D from sunlight drops, and vitamin D production by the liver and kidney is less efficient.32,36,45 Thus, at age 70, the body has only about 25 percent of the capacity to make vitamin D that it had at age 20.45 Another factor that impacts vitamin D production can be avoidance of sun exposure due to fear of skin cancer.67
Walking and other forms of outdoor exercise have multiple benefits that include bone health and vitamin D production. Despite spending time outdoors, however, people of any age who live at latitudes above 37 degrees north have little or no vitamin D production in winter months. Adequate vitamin D status can result from some combination of thirty minutes of exposure to warm sunshine between 10 a.m. and 3 p.m., vitamin D-fortified nondairy beverages and cereals, and supplements. It may be of value to have vitamin D levels checked at an upcoming physical examination.36,39,45,67
Vitamin K, found in leafy green vegetables, helps to maintain the complex protein-mineral structure of bones.36,46 Adding just 2 tablespoons (30 ml) of kale to a smoothie or having ½ cup (125 ml) of broccoli, 1 cup (250 ml) of romaine lettuce, or 2 cups (500 ml) of chopped cabbage at lunch or supper is beneficial.36,47,48
The RDA for vitamin B12 is 2.4 mcg. However, due to updated research and to seniors’ limited absorption, larger amounts are advised; see pages 217 or 434 for adult options. Some experts suggest that for optimal status, those aged 65 and older should take at least 500 mcg of vitamin B12 per day and that some do best with 1,000 mcg daily.29,49,50,52,83
The body requires vitamin B12 to keep the myelin sheaths around nerves in good repair. Because B12 is needed for a healthy nervous system, symptoms such as confusion, disorientation, and memory loss may be related to a shortage of this vitamin. In cases when a B12 deficiency caused these symptoms, such symptoms reversed when vitamin B12 status was restored, sometimes through B12 injections. Other signs of deficiency are fatigue, depression, irritability, mood swings, restlessness, apathy, insomnia, and perhaps poor hearing.
B12 also is involved in ridding the body of homocysteine, a troublesome byproduct of metabolism that increases the likelihood of a heart attack or stroke, depression, and perhaps dementia. Lack of vitamin B12 is linked with megaloblastic anemia and with damaged DNA strands that increase susceptibility to cancer.52–55 In vegetarians whose vitamin B12 levels are below normal, vitamin B12 supplementation has been shown to improve arterial function and reduce risk of atherosclerosis.55,56
One might imagine that vegan seniors are at greater risk for vitamin B12 deficiency than nonvegetarians. However, vegans may have the advantage when habitual use of supplements or fortified foods provides their B12 source. Non-vegetarians may assume that they’re getting all their required vitamin B12 from meat and other animal products, while in fact many seniors no longer can absorb that form of the vitamin. These people can become B12-deficient, while vegans who are supplementing get plenty of absorbable vitamin B12. Among 80-year-olds in the general population, one in five has been reported to have low B12 status.52–58
In fact, all people over 50 are advised to consume B12 supplements or B12-fortified foods. Because as many as 30 percent of people in this age group may be unable to absorb vitamin B12 from animal products, the IOM states, “it is advisable for those older than 50 years to meet their RDA mainly by consuming foods fortified with vitamin B12 or a vitamin B12-containing supplement.”49
Absorption of this vitamin requires the normal function of the stomach, pancreas, and small intestine. In animal products, vitamin B12 is bound to protein. Hydrochloric acid and the digestive enzyme pepsin (both produced in the lining of a well-functioning stomach) are required to split the complex for later absorption in the intestine. The vitamin then becomes attached to R proteins that carry it to the small intestine, where pancreatic enzymes free the B12 from the R protein, allowing it to bind to intrinsic factor (a glycoprotein) in a form that can attach to receptors in the intestine and be absorbed. With age and possible inflammation (gastritis), secretion of acid and pepsin by cells in the stomach lining may be decreased, and the bound form of vitamin B12 from meats, eggs, dairy, and other animal products isn’t absorbed.52,59 A decrease in gastric acid production can lead to gradual depletion.
The vitamin B12 in supplements and fortified foods isn’t bound to a protein in this way; it can be absorbed in the intestine in the normal manner, with the help of intrinsic factor. Because people typically know little about the state of their stomach lining, those older than 50 should use supplements or fortified foods to obtain vitamin B12, regardless of diet.49
Vegan diets have been shown to reduce the risk of dementia—as long as good vitamin B12 status is maintained (see pages 72 and 436). Lifestyle choices that help to avoid cognitive decline include:
• choosing foods rich in antioxidants and vitamin B6—plenty of fruits and vegetables
• taking a vitamin B12 supplement
• ensuring optimal omega-3 fatty acid status, perhaps with 200 to 300 mg DHA daily or at least twice a week
• continuing to exercise both body and mind
For someone whose vitamin B12 status is marginal, circumstances that can further deplete B12 include intestinal surgery; use of nitrous oxide during surgery; use of laxatives, antacid medications, and alcohol; diminished thyroid function; and deficiencies of iron, calcium, and vitamin B6. Measuring vitamin B12 status is complicated by the lack of a gold-standard assay; ideally tests should be done in combination. Laboratory diagnosis may show low serum vitamin B12 levels or elevated serum methylmalonic acid or homocysteine levels (see page 215).50,55,59
Approximately 2 percent of people over 60 develop an entirely different B12 absorption problem known as pernicious anemia. This is an autoimmune disease characterized by destruction of the gastric mucosa and failure to produce intrinsic factor, the transport glycoprotein that takes vitamin B12 to intestinal receptor sites where the vitamin is absorbed. Pernicious anemia can occur regardless of dietary choice or supplement use; it seems to run in families and to have a genetic component. With time, B12 deficiency symptoms appear and the condition can be fatal.52,55,59
The most common and effective remedy for pernicious anemia is intramuscular injections of the vitamin at regular intervals (such as once a month) for life, bypassing any need for intestinal absorption. Alternatively, a high-dose oral vitamin B12 supplement of 1,000 to 2,000 mcg per day can be taken. These large doses appear sufficient for a lower-efficiency absorption system in the intestine that doesn’t require the presence of intrinsic factor. Vitamin B12 status should then be monitored by a physician.55,60 (For more on vitamin B12 functions and sources, see pages 214 to 222.)
For people older than 50, the RDA for vitamin B6 (pyridoxine) increases from 1.3 mg to 1.7 mg for men and to 1.5 mg for women. Vitamin B6 is involved in the metabolism of amino acids, carbohydrates, and fats and in building hemoglobin.52 The body’s need for this vitamin can be met by including four servings of fruit per day (recommended in The Vegan Plate on page 434); fruit also provides potassium and fiber.
The many vegan sources of vitamin B6 include avocado, chickpeas and other legumes, fortified breakfast cereals, fruits (other than citrus), nutritional yeast, nuts, potatoes, seeds, spinach, and whole grains. (Also see pages 244 to 245 and table 7.3 on page 252.)
Older adults who consume generous amounts of antioxidant-rich plant foods are likely to enjoy better overall health and greater protection against disease than those with lower antioxidant intakes. Antioxidants are linked to a reduced risk of heart disease, various forms of cancer, cataracts, macular degeneration, and even wrinkles.2,61 The antioxidant vitamins A, C, and E and the mineral selenium are powerful protectors against the free radical damage that contributes to these conditions. RDAs for these antioxidants are the same for seniors as for younger adults. The concentration of antioxidants in vegan diets—due largely to increased intake of vegetables, fruits, seeds, and nuts—can provide vegans with a considerable advantage.
For example, by consuming an abundance of carotenoid-rich yellow, orange, red, and green plant foods, vegetarians have a significantly reduced risk of developing cataracts, and vegans have even less.62 It’s advisable to get vitamin A in the form of beta-carotene from colorful plant foods; in contrast, intakes of preformed vitamin A (which has no antioxidant potential) from supplements have been linked with bone and liver problems.32 (For more on antioxidants, see pages 230 to 238.)
Studies show vegan diets to contain abundant antioxidants. Nonvegetarians who changed to a low-fat vegan diet for fourteen or twenty-two weeks significantly improved their intakes of vitamins A and C (and of folate, magnesium, potassium, and fiber).12 Vitamin E intakes also improved but were still a little low; this can be expected if a diet is low in fat, because vitamin E is a fat-soluble vitamin. Including some higher-fat plant foods, such as avocado, seeds, nuts, olives, or fresh-pressed oils, quickly brings vitamin E to recommended levels. For good sources of selenium, see page 200. (For additional sources of these nutrients, see table 6.2 on page 204 and table 7.3 on page 252.)
Other than some allergies, I’ve gotten rid of every one of a half-a-dozen or so chronic conditions, including obesity, fatty liver, high uric acid (gout), heartburn/ulcers/stomach acid, nervous tension, sleeping problems, and rising cholesterol.
JOI ITO, VEGAN VENTURE CAPITALIST, MULTIMILLIONAIRE, AND GLOBAL LEADER FOR TOMORROW (WORLD ECONOMIC FORUM), COMMENTING ON HEALTH CHANGES SINCE HE BECAME VEGAN
Unfortunately, if dental problems develop in the elderly, they may start to shy away from fresh vegetables and fruits. However, soft fruits, cooked vegetables and fruits, and fresh-squeezed or bottled juices can take the place of foods that are more difficult to chew (see page 356). Baked sweet potatoes and winter squash are rich in protective carotenoids (vitamin A), as are fresh or frozen mangoes and papayas. The day’s RDA for vitamin C is available from 1 cup (250 ml) of cooked potato plus ½ cup (125 ml) of cooked broccoli. Antioxidants are well absorbed from blended vegetable soups, either raw or cooked. (For delicious and nutrient-rich soups, sauces, and pâtés based on puréed vegetables, seeds, and nuts, see Becoming Raw by Brenda Davis and Vesanto Melina (Book Publishing Company, 2010) or The Raw Food Revolution Diet by Cherie Soria, Brenda Davis, and Vesanto Melina (Book Publishing Company, 2008).
“Populations of vegetarians living in affluent countries appear to enjoy unusually good health, characterized by low rates of cancer, cardiovascular disease, and total mortality. These important observations have fueled much research and have raised three general questions about vegetarians in relation to nonvegetarians:
1) Are these observations the result of better nondietary lifestyle factors, such as a lower prevalence of smoking and higher levels of physical activity?
2) Are they the result of lower intakes of harmful dietary components, in particular, meat?
3) Are they the result of higher intakes of beneficial dietary components that tend to replace meat in the diet?
Current evidence suggests that the answer to all three questions is ‘yes.’ ”
Walter C. Willett, Department of Nutrition, Harvard School of Public Health, Boston
Because constipation is linked with too little fiber, water, and/or exercise, some older adults find themselves battling irregularity. Plant foods provide dietary fiber; as a result, vegan diets help to maintain regularity. The fiber in legumes, whole grains, vegetables, and fruits keeps waste and toxins moving through the intestine and out. (Although whole grains are most beneficial, some intake of refined grains can help to increase caloric intake for the frail elderly or those with poor appetites.2)
The high fiber intakes of plant-based diets are linked with a reduced risk of diverticular disease63 and colorectal cancer.84,85 A vegan diet has been shown to alter the balance of the bacteria in the gut. Unwanted microorganisms, such as E. coli, are reduced, and microorganisms that reduce inflammation are increased. Such a change has been shown to reduce the risk of type 2 diabetes, hypertension, and rheumatoid arthritis.64–66
Fiber also helps to maintain blood glucose levels and thus sustains energy between meals.2 However, vegans are generally advised to avoid adding wheat bran to foods; the additional fiber is unnecessary and can significantly compromise mineral absorption.
Thirst and dehydration can be a problem for older people, especially those older than 85 or who are institutionalized; also, medications can affect hydration. With age, the sensation of thirst may become less acute. The kidneys become less adept at concentrating urine, trips to the bathroom may become more frequent, and fear of incontinence can lead to decreased fluid intake. Fortunately, many fruits and vegetables contain more than 90 percent water. Seniors also should regularly drink water, fortified nondairy beverages, and herbal teas, with a focus on beverages that are calorie-free or low in added sugars.2
In planning meals and menus for the later years of life, The Vegan Plate (pages 434 to 435) is a useful guide. For many people, minimum servings from each group provide a suitable caloric intake.
For example, seniors often find that three servings from the grains group are sufficient; also, this approach tends to be ideal for those who want to lose weight. There are significant differences in the speeds at which carbohydrates from different foods are absorbed, digested, and enter the bloodstream. Compared with grains, the carbohydrates in legumes are released in a slow and gradual manner, maintaining more even blood glucose levels between meals and making beans, peas, lentils, and soy foods a priority in meal planning.
It’s especially important for older consumers to emphasize legumes and vegetables, because these are so rich in protein and a wide variety of vitamins and minerals. An international study of people aged 70 and older found consumption of legumes to be “the most important dietary predictor of survival in older people of different ethnicities.”69
Various plant foods have other benefits. The isoflavones in soy foods may help keep skin healthy and lessen wrinkles,70 as do antioxidant-rich vegetables and fruits. Fruit is important for its contribution of potassium, vitamin B6, and other nutrients. Nuts, seeds, and their butters provide important minerals, and their fat helps with absorption of protective phytochemicals, minerals, and fat-soluble vitamins. The sample menus in chapter 14 provide adequate intakes of these nutrients at various caloric levels.
Although a highly nutritious diet is needed in the later years, certain factors can work against achieving this goal. In older people, chewing, swallowing, digesting food, and absorbing nutrients may be impaired. Poor oral health, loss of teeth, ill-fitting dentures, and dental problems can make chewing difficult; a dental referral may be advisable. Changes in the stomach and intestinal lining can affect digestion and nutrient absorption.32
At the age of 70, people have just 30 percent of the taste buds that they did as young adults. Sensitivity to taste also can decline due to use of certain medications or due to zinc deficiency (for vegan zinc sources, see pages 191 and table 6.2 on page 204). Unfortunately, the loss of taste may encourage seniors to use excessive amounts of salt to flavor foods; excess sodium can increase the risk of hypertension, and thereby contribute to heart disease, stroke, and kidney disease.2,8 Instead, foods should be flavored with herbs, spices, lemon juice, and other low-sodium seasonings, and seniors should monitor the sodium content in canned, frozen, and ready-to-eat items by checking the labels.
Besides such sensory loss, a reduction in appetite can be related to poor health, diminished cognitive status, or isolation. Some seniors may have enjoyed food preparation when it involved shopping and cooking for a family or partner, but have lost interest in these activities when dining alone. Physical disabilities, loss of mobility, or lack of transportation may make it a challenge to assemble a meal. Poor eyesight can render direction-reading difficult; limited hand strength and coordination makes opening packages difficult.
Other aspects of declining health influence nutritional well-being. Besides affecting taste buds, medications can directly affect nutrient status. For example, proton pump inhibitors prescribed for peptic ulcer disease and gastroesophageal reflux disease (GERD) are linked with infectious complications and deficiencies of calcium and other nutrients.71
A vegan diet is an ally in combatting certain problems. Some elderly people are motivated to switch from meat to tofu because the latter is far easier to chew and swallow. When seasoned or marinated, tofu becomes a welcome part of lunch and dinner menus. Soft or firm tofu is easily incorporated into smoothies for breakfast and snacks, providing a tasty and easily consumed source of protein, iron, zinc, calcium, and numerous other nutrients. If the combination includes mango, orange juice, and strawberries, the smoothie also becomes an excellent source of vitamins A and C.
Quinoa and oatmeal are whole grains that are easy to prepare and swallow. In addition, refined products, such as soft enriched white bread or rolls, couscous, and white rice, may be easier to chew and thus better accepted than some of the coarser whole grains. The use of some refined grains can provide a suitable balance for elderly consumers, because vegan diets provide so much fiber from vegetables, fruits, legumes, and nut and seed butters.
Digestive difficulties, swallowing problems, hypertension, and other disease conditions can require dietary modifications that are beyond the scope of this book; a few resources that can address these difficulties include:
• For those with type 2 diabetes or metabolic syndrome, Defeating Diabetes by Brenda Davis and Tom Barnard, MD (Book Publishing Company, 2003)
• For those with fibromyalgia or rheumatoid arthritis, raw (and gluten-free) vegan diets have proved helpful to some; Becoming Raw by Brenda Davis and Vesanto Melina (Book Publishing Company, 2010)
• For vegan recipes that are SOS-free (free of sugar, oil, and salt) and used effectively for those with type 2 diabetes, hypertension, and rheumatoid arthritis, Bravo: Health-Promoting Meals from the TrueNorth Kitchen by Chef Ramses Bravo of TrueNorth Health Clinic in California (Book Publishing Company, 2012)
• For healthful, delicious, and easy recipes, each with a nutritional analysis, Cooking Vegan by Vesanto Melina and Joseph Forest (Book Publishing Company, 2012)
• For how to veganize recipes and more recipe ideas and health tips, Never Too Late to Go Vegan by Carol Adams, Patti Breitman, and Virginia Messina (The Experiment, 2014)61
In addition, the list that follows includes meal ideas that deliver good nutrition and are affordable, appealing, simple to prepare, and easy to chew.
• Bagel, toast, or soft bread with nut butter (or with sesame tahini plus blackstrap molasses), accompanied by fresh fruit
• Fortified ready-to-eat dry cereal with fortified nondairy milk and fruit or juice
• Fruit smoothie made with tofu, hempseeds, or protein powder
• Hot cereal with fresh, canned, or dried fruit, and fortified nondairy milk
• Nondairy yogurt parfait: yogurt with berries, fresh fruit, and nuts, seeds, or granola sprinkled on top
• Scrambled tofu with sautéed onions, garlic, spinach, mushrooms, bell peppers, or other vegetables, seasoned with nutritional yeast and turmeric, and served with rye bread toast and fruit or juice
• Avocado and tomato sandwich on whole-grain or white bread, served with bean soup
• Baked potato with steamed broccoli and chickpeas, drizzled with Liquid Gold Dressing (page 219) and sprinkled with toasted sunflower or pumpkin seeds (optional)
• Baked yam with black beans and steamed kale
• Baked tofu with barbecue sauce, green salad, and steamed yam
• Canned low-sodium soup with beans, peas, or lentils, with added chopped greens
• Canned low-sodium baked beans or chili served atop a baked sweet potato, accompanied by spinach salad
• Veggie burger with green beans and baked potato wedges or yam fries
• Vegan pizza and green salad
• Tacos or burritos made with soft tortillas, refried beans, avocado, lettuce, salsa, and vegan cheese (optional)
• Hummus, crackers, and raw vegetables
• Flavored rice mix with added vegetables, peas, beans, or edamame
• Soup with a side of raw vegetables and dip
• Marinated three-bean salad, green salad, and soup
• Pasta with prepared sauce and lentils
• Pasta with prepared sauce, greens, and chickpeas
• Peanut butter or nut butter and banana sandwich
• Quinoa with chopped vegetables and lima beans
• Vegetable stir-fry with seasoned or baked tofu over brown rice
• Sandwich of avocado, tomato, and vegan meat substitute on a roll
• For a creamy texture, add cashews to vegetable soups and blend. (Blended cashews thicken when heated.)
• Add cubes of tofu to soups to enhance nutrition; for a creamy texture, blend the tofu into the soup.
• Mix crumbled tofu with vegan mayonnaise and seasonings for a sandwich filling.
• To prevent spoilage, keep bread in the freezer. Remove a slice or two at a time for toast or a sandwich.
• When preparing foods, make enough to provide a foundation for tasty meals for the next few days. For example, bake a variety and larger quantity of root vegetables (potatoes, yams, beets); bake slices of tofu with barbecue sauce, peanut sauce, or another sauce at the same time; or make large batches of hearty soups or stews. Freeze in serving-sized portions.
• Dried beans are economical; soaking them for a few hours and then discarding the soaking water before cooking will reduce flatulence (double soaking will do the job even better). Cook beans in quantity and freeze in serving-sized portions. If using canned beans, buy a low-sodium variety or rinse well to remove some of the sodium.
• Red lentils, a great source of iron, protein, and zinc, take just fifteen to twenty minutes to cook and can be added to tomato sauce, other sauces, and soups.
• Mild curry paste adds a superb blend of flavors to cooked lentils and beans.
• Substitute quinoa for rice or other whole grains in a variety of dishes. It’s higher in protein and minerals than other grains and cooks in only fifteen minutes; rinse the quinoa before cooking.
• Buy ripe soft fruits, such as papayas, peaches, nectarines, mangoes, pears, bananas, melons, kiwifruit, and berries; for convenience, freeze in serving-sized portions.
• Grate harder fruits (such as apples) for salads; also stew or bake such fruits.
• Well-cooked vegetables usually are easier to eat, including soft-cooked squash, yams, sweet potatoes, zucchini, eggplant, and potatoes.
• After removing stems, slice kale into thin strips or chop it in a food processor, then add it to salads.
• Keep canned and frozen fruits and vegetables on hand for snacks, as side dishes, or for use in recipes. Because potential spoilage is reduced, these tend to be an economical choice.
• When ordering Chinese food, such as vegetables, tofu, and rice, purchase enough for leftovers for another meal or two.
• Invest in a good juicer; fresh juices provide easily absorbed nutrients.
• Adapt the 1,600-, 2,000-, and 2,500-calorie menus in chapter 14 (pages 439, 440, and 441) to individual preferences.
Seniors who have the freedom to travel and dine out may foresee challenges in locating vegan options. Yet, thanks to technology, travelers can quickly find excellent vegan fare in Paris, Prague, Portland, Perth, and points beyond. The websites listed in Resources on page 450 can be accessed via the Internet or downloaded apps for mobile phones. They provide articles and reviews, as well as vegetarian or vegan restaurant choices.72
A part from those who live in care facilities, about one older adult in three lives alone. While these seniors have mobility and independence, they have viable choices about preparing food at home and dining at restaurants. However, as mobility declines, the possibilities of gradual isolation and poor nutrition may arise.
In some cases, a lack of funds may be the problem. Fortunately, in the United States, through state and tribal agencies, the Senior Farmers’ Market Nutrition Program provides low-income seniors (over age 60) with coupons that can be exchanged for eligible fruits, vegetables, and fresh herbs at farmers’ markets, roadside stands, and community-supported agriculture programs.73
For an elderly person who has difficulty getting to a store or market, other options exist. Many supermarkets and some natural foods stores offer grocery delivery services, which can include prepared vegan items from the deli. Food-delivery programs, such as Meals on Wheels, tend to have vegetarian but not vegan meal choices; however, menus are based on local demand. If encouraged, local meal providers may be interested in implementing a four-week menu cycle developed by the Vegetarian Resource Group specifically for Meals on Wheels (see Resources on page 449).74
The Older Americans Act directed the US Department of Health and Human Services Administration on Aging to provide funding for nutrition education, as well as home-delivered meals for low-income seniors. The US Department of Agriculture’s Supplemental Nutrition Assistance Program, as well as other programs, also provides options for seniors with limited incomes, and these may include vegan items.2,75,76
Most people prefer to continue living in their own home as long as possible, yet some wish to also enjoy a greater sense of community. In some areas, community meal programs allow older people to meet in a central location to enjoy a meal in the company of others; often, transportation is provided. In other areas, cohousing communities successfully address the problem of isolation while retaining the best aspects of independent living.
Cohousing is a type of collaborative housing in which residents live in their own homes but actively participate in the design and operation of their own neighborhoods. Cohousing communities typically serve optional group meals in a “common house” at least two or three times a week, with small groups of residents taking turns to prepare meals; efforts usually are made to accommodate vegetarians and vegans. One book on this topic is Senior Cohousing: A Community Approach to Independent Living by Chuck Durrett (New Society Publishers, 2009). For more on cohousing, see reference.77
There may come a time when living at home is no longer safe or healthy for an elderly person. For those in search of a suitable care home for a vegan, it’s worth exploring those run by the Seventh-day Adventists, perhaps through a local Seventh-day Adventist church.78 Mainstream facilities are beginning to recognize the need for vegetarian and vegan options. For example, the Goodman Group, a company with senior living, health care, and residential communities throughout the United States, has made the incorporation of plant-based options in all facilities a top priority. The company’s goal is to enable residents to achieve optimal health and well-being, and to fully support residents who elect to use diet and lifestyle choices as therapeutic tools. Also, the Living Well Bistro in Portland, Oregon, offers a model of an entirely vegan hospital restaurant.79
Nursing homes and assisted-living facilities often are willing and able to accommodate a vegan or vegetarian senior, especially if the kitchen staff is provided with practical solutions to the challenge of providing vegan entrées along with their main menu. Examples of protein-rich foods that can be heated for one or a few individuals include marinated tofu; veggie burgers or other vegan meat substitutes (such as veggie chicken, frozen falafel patties, and vegan entrées); or hearty bean, pea, or lentil soups made in quantity and then frozen in individual portions. Staff could also use veggie ground round in pasta sauce, tofu cubes in stir-fries, or chickpeas in curry to replace meat. A resource on quantity cooking for staff at care facilities is Vegan in Volume: Vegan Quantity Recipes for Every Occasion by Nancy Berkoff (Vegetarian Resource Group, 2000).80
For the elderly who suffer from various diseases or chronic conditions, working with a registered dietitian can be helpful. Dietetic associations in the United States, Canada, the United Kingdom, Europe, and Australia list consultant dietitians who are vegetarian and vegan specialists, provide counsel regarding therapeutic nutrition, are knowledgeable about food-related assistance, and can be contacted through the individual association’s website.81 For example, the Academy of Nutrition and Dietetics (AND) has a strong vegetarian dietary practice group with numerous online resources. AND and Dietitians of Canada have websites with links to “Find an RD” (Registered Dietitian); see reference.81
Though this book focuses on nutrition, other lifestyle factors also are keys to achieving and maintaining good health throughout life: the habit of regular exercise, the maintenance of loving relationships (whether of long-term family or of new-found friends), a positive attitude, and a good sense of humor. Belonging to a community that encourages a quality lifestyle can help people achieve and maintain health goals. “Community” no longer means solely one’s immediate surroundings; thanks to the Internet, a quick e-mail can connect people whose lifestyles and ethical values are in line.
Still, face-to-face contact helps to establish stronger relationships. Fortunately, many communities have lively vegetarian associations whose members span the spectrum from newborns to those dancing through the doors in their nineties; those in wheelchairs are most welcome too. Vegetarian associations often are open to new ideas, such as the creation of a seniors’ support or social group. The associations typically host regular potluck dinners, meetings, restaurant ouings/get-togethers, and annual festivals or food fairs. Such events provide opportunities to meet like-minded people, begin new friendships, and offer support as a volunteer. These associations can easily be found via an Internet search, using the name of the town, city, or country, plus the words vegetarian or vegan; local librarians can help seniors with such a search.
For those interested in widening their horizons, larger gatherings are held at national levels and international levels; these events typically feature great food, excellent speakers, and fascinating people. One is Vegetarian Summerfest held in Pennsylvania each July; travelers also can explore the International Vegetarian Union website for vegfests held in different parts of the world (for links to these events, see Resources on page 450).
I truly believe that if we were to adopt a whole-foods, plant-based diet, we could cut hospital costs by 70 to 80 percent.
COLIN CAMPBELL, PROFESSOR EMERITUS OF NUTRITIONAL BIOCHEMISTRY, CORNELL UNIVERSITY, AND AUTHOR OF THE CHINA STUDY
For people who are more comfortable in small groups, Meetups provide an opportunity to get together with others based on shared interests, such as vegan food or animal rights. Internet dating also can be a way to get to know potential partners or friends. A search using the words vegan online dating will quickly turn up numerous vegan-friendly websites, as well as regular websites that include vegans. Dating can be an exciting and heartwarming adventure for the old and wise, ensuring that all the years added by a healthy diet also are happy ones.