Nutrition for females over 50 years

Simple changes to hit key targets

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One of the groups of people I see a lot in my clinic are females over 50 years of age. They typically come and see me because of one or more of the following:

• blood sugar creeping up (prediabetes)

• feeling more tired than usual

• noticing weight gain (especially around the middle)

Most of these women report not having changed their habits much. They tend to do a reasonable amount of fairly gentle exercise like walking, and in general try to follow a healthy diet.

I am nearly always impressed by the nutritional knowledge lots of my patients have, and most of the time, 80% of their diets are spot on. But the one thing I can nearly always guarantee in older female patients: they don’t eat enough protein.

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This is the profile of a fairly typical patient:

Female, aged 63 years, weight: 59kg, height: 1.55m, BMI: 24.6kg/m2, waist circumference: 82cm. Her HbA1c was 41mmol/mol. This isn’t quite diagnostic for prediabetes but this had been flagged by her GP as it was 39mmol/mol on her last pre-pandemic check-up. Her lipid profile and blood pressure were within recommended ranges.

She had been advised by her GP to “lose a few pounds and exercise a bit more” to try and lower her HbA1c. However, the patient said she feels hungry quite a lot, and in any case wasn’t keen on losing too much weight. She wasn’t sure what to do.

This was her 24hr dietary recall:

Breakfast:
Branflakes (30g) with almond milk (125ml) and blueberries (25g). Cup of tea with splash of almond milk.

Lunch:
Pita (75g) with margarine (7g) and hummus (30g), green salad with olive oil (5ml) plus low-fat fruit yogurt.

Snack:
Kitkat (21g) and cup of tea with almond milk.

Dinner
Pasta (150g) with olive oil (15ml), tomato sauce (110ml) and mixed veges.
Handful of olives, crisps and glass of red wine.

Nutritional analysis of the 24h recall:

Energy: 1400kcal

Carbohydrate: 165g (47% of calories)

Fat: 61g (39% of calories)

Saturated fat: 11g (7% of calories)

Protein: 34.1g (10% of calories or 0.6g/kg)

Fibre: 19g

Vitamin B12: 1.7microg (Requirement: (1.5microg/day)

Calcium: 488mg (Requirement: 700-1200mg/day)

Exercise: Monday to Thursday she walks to work in central London which takes her about 15 minutes each way, and likes to go on long walks with her husband on the weekend.

Sleep: tends to have difficulty falling asleep and then wakes up early.

My Assessment:

You can see in general this is pretty good. This lady said she’s not a “health freak” (her words!) and she wants to enjoy her food including chocolate and wine now and again. (Good for her!). She said she’d like to be able to have more energy and feel a bit more like her own self.

So we focussed on three things that I thought were key:

1. She’s not getting enough protein. Older individuals actually have higher protein requirements than younger people, and she’s getting below the recommended amount for most people, let alone the recommendation for older people. The protein should help build some muscle mass (in combination with 3.), may help her feel more full, so help her reduce calories slightly, and should also lower blood glucose).

2. Calcium could do with being higher. The data on the optimum amount of calcium (and indeed other micronutrients) to prevent osteoporosis and whether this could come from food or supplementation isn’t precisely clear. But at less than 500mg this should be higher.

3. Some resistance type exercise might be beneficial for her for many reasons.

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And here (*) is the modified diet plan:

Breakfast:
Branflakes (30g) with soy milk* (125ml) and blueberries (25g).

Lunch: 
Pita (75g) with cottage cheese (60g)*, green salad with olive oil (5ml) plus low-fat fruit yogurt.

Snack: 
Peanuts, raisins and chocolate chips* (30g).
Cup of tea with soy milk. 

Dinner:
Pasta (60g) with soy meatballs* (75g), 60g butter beans*, olive oil (15ml), tomato sauce (110ml) and mixed veges. 
Handful of olives* and glass of red wine

These are the changes we made and why:

• We switched from almond to soy milk for the protein: 0.4g per 100ml to 3.5g per 100ml.

• We switched from the hummus to the cottage cheese for the protein and calcium.

• We switched from a kitkat to peanuts, raisins and chocolate chips so she could enjoy a treat but also get some additional benefits from the dried fruit and nuts (eg, fibre, healthy fats, micro- and phytonutrients).

• The main switch was the evening meal: rather than a carb-heavy meal which used to leave her sluggish, we lowered the carb content, adding in soy mince for the protein and then butter beans for the protein, fibre and other phytochemicals.

• My recommendation was to avoid the crisps in the evening snack - these are nutritionally the worst kind of empty calories (high in salt and refined carbs).

I also said that she may find this new menu - although giving the same amount of calories - too filling and might therefore be able to reduce her intake a bit over time. This is a really gentle way of gradually losing weight.

Here is the nutritional analysis of the revised day’s intake:

Energy: 1395kcal

Carbohydrate: 144g (41% of calories)

Fat: 52g (34% of calories)

Saturated fat: 8.6g (7% of calories)

Protein: 73g (21% of calories or 1.2g/kg)

Fibre: 20g

Vitamin B12: 2.3microg (Requirement: (1.5microg/day)

Calcium: 911mg (Requirement: 700-1200mg/day)

Also note that I also recommended she introduce some resistance-type exercise into her exercise routine, starting with resistance bands and light weights. Resistance exercise has many benefits including increased insulin sensitivity, improved muscle strength, tone, balance and even cognitive benefits. The latter points are particularly critical for us to remain active and independent as we age.

This patient’s vitamin B12 intake was fine but this is important to look at because B12 deficiency is more common in older individuals. If vitamin B12 deficiency is diagnosed, intramuscular injections are usually warranted (because absorption of this vitamin can be impaired). However, maintaining good vitamin B12 status with diet is a sensible approach.

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Anything else?

You might be thinking, hmm, this individual *should* have more fruits and vegetables, less processed food etc. First, that’s not how I run my practice. A patient knows best how they want to live their life, and this patient was very clear she wanted a relaxed approach to health. Second, lots of aspects of diet have much less impact on health markers than people tend to think.

In fact, as we move forward, we’ll be looking more at exercise, and how this lady can get a bit more intensive activity into her daily schedule. This might help her sleep better, and therefore directly and indirectly improve her complaint of feeling tired and sluggish.

It’s also possible that if she sleeps better and feels less tired, she actually won’t feel as hungry. And all of this together will help her stick to her diet goals and lose a bit of weight gradually as she desires.