Although it may sound like common sense, diet plays a significant role in maintaining your balance later in life. Your health, which can be significantly affected by what you choose to bring into your body, is tied to the ability of your body to stay balanced. Let’s look at how this may affect you below.
Balance Problems Associated with Aging
Before we begin looking at how diet affects your balance, let’s take just a moment to examine a couple of other issues that naturally affect us as we age.
For one, deteriorating eyesight, such as from cataracts, macular degeneration, and loss of peripheral vision can be associated with a reduced amount of light entering the retina. As a result, vision, one of the three main balance systems is negatively affected.
Add to that neuropathy, a condition where patients tell us that they feel unsteady and the sensation in their feet is diminished. This results in a loss of sensation and input from the feet, legs, hips, and trunk. You now have two of the three main balance systems hampered.
With both vision impairment and loss of sensation in the lower extremities, the risk for falling is magnified by as much as 66%.
Compounding the Problem with Nutrition Deficiencies
Poor nutrition has been shown to lead to malaise, muscle weakness, bone loss, and dehydration. This problem only exacerbates, or even magnifies, the risk of falls that are presented by impaired vision and neuropathy.
Studies show that only 30% of older adults, over 60 years of age, eat the recommended dietary foods from the five food groups. And only 5% of individuals in this age group ate a high quality diet.
In a ten-year survey of older adults, the National Health and Nutrition Examination council concluded that “Less than one-third of these older adults were meeting the healthy eating index (HEI) recommendations for meats, dairy, fruits, vegetables, and grains. These foods are good sources of vitamins, minerals, fiber, and other substances that are important for good health. The overall HEI score measures overall diet quality. Additionally, five out of six older adults in this survey had diets that were rated as poor or needed improvement.
Proper fluid intake amounts are also very important as we age, thus avoiding dehydration. In our clinic, several of our older adult patients have been admitted to the hospital for dehydration.
How Do Proper Diet and Fluid Intake Affect Falls?
We know that dehydration can happen relatively quickly; only 1-3 days of low fluid intake can lead to lower than usual blood pressure which can lead to lightheadedness and fainting. If the person takes blood pressure medication to lower their pressure and they are dehydrated, the medication may become even more effective and drop their blood pressure more than normal.
Muscles are primarily made up of protein, water, and extracellular matrix, while proteins are made up of amino acids. In order to provide the building blocks for muscles, the body requires us to eat sufficient amounts of protein from various sources. Amino acids can be linked together in various sequences to fortify the muscles; some of these amino acid sequences are essential to our diet and others are not. Essential amino acids are the ones that our body cannot produce itself and therefore must come from the foods that we eat. A list of the amino acids, with more details for those interested, is found in the chart below titled ‘Protein Sources.’
When we talk about improper diet contributing to falls, we need to recognize that insufficient protein, carbohydrates, fats, vitamins, and minerals in a person’s diet may occur over a longer period of time, such as weeks to months, compared to dehydration, which can contribute to falls in mere days. Muscle mass, metabolism, and function are all affected by diet, as are nerve structures and neurotransmitters in the synaptic cleft. Bones are no different – they require these same components of a balanced diet in order to perform their normal functions and maintain density, which will reduce the risk of fractures if one does fall.
Additionally, studies show other benefits of proper diet and exercise that should not be overlooked, such as a decrease in the chances of developing diabetes mellitus, type II, osteoporosis, some cancers, and obesity .
Eating a Balanced Diet
What nutrients should we include in our diet to promote healthy bones?
Calcium, phosphorus, and vitamin D are some of the key nutrients that should be present in the foods that we consume. The Surgeon General’s report states that “these nutrients need to be monitored the most, because they are the most common ones lacking in our diets, while they make such a significant impact on bone health.” It is also significant that during the last 10-20 years there has been a significant decrease in calcium intake. Researchers suggest that our current lifestyles and food choices are to blame. We eat fewer dairy products and other naturally calcium-rich foods.
In the graph below titled “Median Calcium Intake,” notice the difference in current intake of calcium in women compared to the ideal intake. There is a noticeable discrepancy from the time female children are 9 years old until they are 51+ years. Are you or your loved ones consuming the adequate amount of calcium? It is time to evaluate your diet and identify your strengths and deficiencies. Then you should evaluate the diet of your family members.
Vitamin D is also essential for the absorption and utilization of calcium in the body. It is needed to build strong healthy bones and can be obtained in two different ways. First, sunlight is the main source of vitamin D. A precursor in the skin is converted to active vitamin D when exposed to sunlight. Isn’t that amazing? The second method of getting enough vitamin D is through our diet. Most dairy products are enriched with vitamin D to aid in the absorption of calcium from the digestive tract.
There are a few things that you should know if you are going to get your vitamin D from sunlight: for those who live in parts of the world where sunlight is limited, such as parts of Alaska, supplementation is recommended. If a person goes outside but is covered from head to toe, then the vitamin D precursor will not be activated in that person and again, supplementation is recommended. Research shows that elderly persons need extended exposure to sunlight to get the same effects as their younger counterparts because the skin system does not work as efficiently as before. For the average person, 15 minutes of exposure to sunlight per day is the minimum. Exposure does not mean full body, but arms, face neck, and or legs would be sufficient.
Can you get too much vitamin D? Vitamin D is a fat-soluble vitamin that gets stored in the body. If too much is consumed or produced it can be toxic, like nuclear waste. If you have ever heard of hypercalcemia, kidney failure, or calcification of soft tissues, these conditions have been associated with an overabundance of vitamin D in the system. Hypercalcemia is a rare condition, affecting only 0.1 – 1.0 % of the population, in which there is too much calcium in the blood. The parathyroid gland produces a hormone called PTH which works with vitamin D to regulate how much calcium is present in the blood at one time. Therefore, if there is too much PTH or if there is too much vitamin D in the body, hypercalcemia may occur. In the table below titled “Life-Stages,” it shows the recommended daily amounts. The bottom line is this – be careful about how long you roast in the sun as well as how much vitamin D you consume. Going back to the question posed at the start of this paragraph of whether one can get too much vitamin D, the answer is clearly yes!
What are Some of the Best Sources of Calcium and Vitamin D?
Even though our fast-paced society seeks for the one pill that does it all, the instant gratification without putting any thought or work into it, I believe the best way to accomplish our goal of optimal health and well-being includes a well-balanced diet. It just so happens that the Dietary Guidelines for Americans (USDA 2000) and the Dietary Approaches to Stop Hypertension (DASH Eating Plan – USDHHS 2003) are in agreement that a well-balanced diet will include the foods that contain calcium and vitamin D.
In the table below, you will find a list of foods that have the highest percentage of calcium per serving. Some people may be lactose intolerant, which means that they lack the enzyme lactase in their digestive tracts to break down lactose and, as a result, they suffer from indigestion when consuming dairy products. Research shows that people can slowly build up a small reservoir of lactase in the stomach by drinking small amounts of milk over several days or weeks. Another study shows that many lactose intolerant individuals can mix milk with food and be able to avoid the indigestion. As mentioned above, those individuals who are lactose intolerant or vegetarian and prefer not to consume dairy products can get the necessary calcium from the foods identified in table below. I hope they will be of benefit to the reader in selecting optimal foods for optimal nutrition.
Supplementation
For those who are not able to consume enough calcium and vitamin D through their diet, there are supplements to aid in the acquisition of those nutrients. The report of the Surgeon General suggests using calcium citrate or calcium carbonate for best absorption. Additionally, to ensure better absorption, taking 500-600mg several times throughout the day is suggested.
Beware of side-effects. You may have read about the prescription drugs that were given to fight osteoporosis and osteopenia, called bisphosphonates. Instead of reversing the osteoporosis and osteopenia, they ended up taking bone from the jaw and weakening the support structure for the teeth. It was first discovered several years after the product was introduced on the market by several dentists across the country who at first could not figure out why their patient’s teeth were coming loose, and the x-rays showed significant bone loss for no apparent reason. After comparing the patient’s medical histories, they discovered that all those who suffered from the bone loss were taking the same medication, which was designed to enhance bone formation and prevent bone resorption. If you would like to look up the side-effects of a drug that is on the market, you can go to the following website for information (https://medlineplus.gov). Here is an example if you are interested: Go to the tab “Drugs and supplements,” and select the “F” box for “Fosamax”. Scroll down until you find “Fosamax” and select the underscored word “Alendronate,” and then select the heading “what side-effects can this medication cause.” Here is one of the statements from the website that I mentioned regarding bone loss in the jaw bone. “You should know that Alendronate may cause osteonecrosis of the jaw (ONJ, a serious condition of the jaw bone), especially if you have dental surgery or treatment while you are taking the medication. A dentist should examine your teeth and perform any needed treatments, including cleaning or fixing ill-fitted dentures, before you start to take Alendronate. Be sure to brush your teeth and clean your mouth properly while you are taking Alendronate. Talk to your doctor before having any dental treatments while you are taking this medication.”
This is a public website made available to all as a service of the US National Library of Medicine and the National Institutes of Health. It is not only important to know what to put into our bodies, but what not to put into our bodies.
I am sure that you would agree that it is important to be aware of potential side effects before taking any medication.
Toxins that Affect Bone Health
Very few people that I know would actually ingest or expose themselves or their family members to toxins on purpose, but what if they did not know a product had toxins in it? For example, I have spoken with many senior citizens who started smoking back in the 1940’s when World War II broke out and tobacco companies gave cigarettes to the soldiers for free. Movie stars portrayed smoking as the sophisticated thing to do in the 1920’s, and cigarette sales soared. As we now know, cigarettes have toxic chemicals that can be very addictive as well as damaging to the body. Other toxins came to the forefront several years ago when it was discovered that certain toys being made in China were loaded with toxic lead. Fortunately, it was discovered before too many toys were purchased, as far as we were informed.
We have known for years that smoking is bad for the lungs, blood vessels, and other organs, but recent studies confirm that smoking also affects the bones. Two toxic ingredients in cigarettes are nicotine and cadmium which seem to affect bone cells both directly and indirectly. One of the indirect effects on bone appears to be involved in the absorption of calcium from the intestine, changing the way that vitamin D is processed in the body, and interfering with hormones essential in the homeostasis of healthy bones. If you smoke, please take the necessary steps to stop.
I spoke with a gentleman not long ago who told me that after open heart surgery, he decided to stop smoking and did so; but a year or so later started again. He mentioned the fact that the people he spent time with smoked and he wanted to fit in. In his case, he made the decision to quit, but did not stick with it. I do not mean to imply that desire, willpower, and commitment will make it an easy task, but they do seem to be the common thread in those who are successful at kicking the habit. Have you ever spoken with those who are able to give it up all at once? How are they able to do that? If you smoke and have had a hard time quitting, there are other products and services available to help such as laser therapy, patches, gum, hypnosis, and others. If you smoke, I encourage you to commit to quit, now. If you have attempted to quit before but have not been successful in the past, please recommit yourself to quitting and seek help from your healthcare provider.
The second toxin that we should be aware of is lead. It has been known for many years that certain levels of heavy metals are toxic to the body; however, the worst offender is lead. It became very evident that lead was the cause for many children and adults getting sick during the 1970’s. I remember searching for homes in the late 1980’s with a realtor who advised us to stay away from homes built during or before the 1970’s because the paint used in those homes contained lead. It was discovered that lead was used in the paint which cover the interior and exterior walls, some toys, imported candies, imported cosmetics, pottery and ceramics, drinking water contaminated by lead leaching from lead pipes, solder, brass fixtures, or valves, and consumer products such as tea kettles and vinyl mini-blinds. In California, there were a number of children who showed up in the emergency rooms with complaints of stomach problems, seizures, convulsion, and encephalopathy (which is a disease of the brain), all of which were related to lead exposure. Traditional home health remedies such as Azarcon and Greta, which are used to treat upset stomach or indigestion in the Hispanic community contain lead, as much as 70-90%. Lead has been shown to be stored inside the bones during the remodeling phase, but later as bone passes through the resorption phase the lead is released into the blood stream. Lead seems to be able to bypass the blood brain barrier, which is designed to filter out unwanted toxins around the brain, and then cause damage to the brain.
Below is a statement from the Centers for Disease Control and Prevention regarding Lead:
The most common sources of lead exposure for children are chips and particles of old lead paint. Although children may be directly exposed to lead from paint by swallowing paint chips, they are more commonly exposed by swallowing house dust or soil contaminated by leaded paint. This happens because lead paint chips become ground into tiny bits that become part of the dust and soil in and around homes. This usually occurs when leaded paint becomes old or worn or is subject to constant rubbing (as on doors and windowsills and wells). In addition, lead can be scattered when paint is disturbed during destruction, remodeling, paint removal, or preparation of painted surfaces for repainting.
Lead, which is invisible to the naked eye and has no smell, may be found in other sources. These sources may be the exposure source for as many as 30% of lead-poisoned children in certain areas across the United States.
Additionally, a variety of work and hobby activities and products expose adults to lead. This also can result in lead exposure for their families. Activities that are associated with lead exposure include indoor firing range use, home repairs and remodeling, and pottery making. “Take-home” exposures may result when people whose jobs expose them to lead, wear their work clothes home or wash them with the family laundry. It also may result when they bring scrap or waste material home from work.
If you would like to know more concerning lead, go to the website: www.cdc.gov and type in “lead” in the search box (without the quotation marks).
Other helpful hints include the advice to avoid soft drinks as much as possible. Even though your teenager may show you that it contains phosphorus, which is important in bone health, soft drinks tend to replace drinks that contain calcium and vitamin D.
The table “Median Calcium Intake” (which I provided earlier in this post) shows that females between the ages of 9-18 years have the greatest discrepancy in adequate calcium intake; however, even those 19-71+ are not getting enough calcium. There is strong evidence to show that those who do not have adequate intake of calcium tend to be more susceptible to calcium loss when consuming diets high in sodium, caffeine, or both. These ingredients cause calcium to be excreted in the urine. Therefore, two solutions include increasing calcium intake and decreasing the amount of sodium, caffeine, or both in your diet.
Green leafy vegetables, whole grains, nuts, and dairy products provide many nutrients to our diets, and Magnesium is one of those bone building nutrients found in these types of foods.
Use caution when consuming large amounts of vitamin A if it is present as retinol instead of beta carotene. Beta carotene occurs naturally and is found in many fruits and vegetables, while retinol is manufactured, and large amounts have been shown to have negative effects on bone health.
Final Thoughts
I know that this was a lot to take in, but don’t think that you have to do it all at once, or it could be overwhelming. Take it a step at a time.
Staying healthy does not come easy. It requires planning, execution of the plan, and consistency. There is certainly work involved. Planning requires work. Execution of the plan requires work. Being consistent requires work. All of this can be overwhelming at times. That is why it is so critical that friends and family be involved in the planning, preparing, cooking, shopping, and clean up. How can we get everyone involved? I believe that learning can be fun. I believe that teaching can be fun. Remember that laughter and joy and happiness are included in the goal of optimal well-being. This can be a special time for family members or friends to work together and build strong healthy relationships. Even though we are discussing healthy diet practices, let us always try to include the bone building activities of play, exercise, and work. Together as family and friends, we can become a healthy nation once again.
For now, go ahead and take the first step by taking the balance-killer quiz and find out why you may be at risk of falls.
