Illustrated throughout, this is the standard on the history, philosophy, and anthropology of this subject. He is that rarest of writers, one who combines spiritual sensitivity with enormous intellectual understanding and a style of great clarity and elegance. Grossinger has done a masterful job of covering an immense field of information.
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List this Seller's Books. Payment Methods accepted by seller. AbeBooks Bookseller Since: 12 October Plant-sourced foods that are particularly rich in protein include legumes, nuts, seeds, soy foods, whole grains, and leafy green vegetables. They tend to have lower levels of essential amino acids as compared to animal-based foods, but this difference may be an advantage. However, there are more specific guidelines when it comes to the different types of fatty acids, as although they may be isocaloric, they are not isometabolic and hence impart unique influences on health.
Polyunsaturated fatty acids—namely omega-3 and omega-6—are the only essential fats in the diet. Omega-3 fats are found in their shorter chain form as alpha linolenic acid ALA and are used as energy and also converted by the body to the longer chain eicosapentaenoic acid EPA and then docosahexaenoic acid DHA.
As omega-6 fats linoleic acid , are available ubiquitously in the food supply in the seeds of most plants, they are not a nutrient of concern. In fact, Western diets tend to be excessive in omega-6 fats due to their prevalence in processed foods, which are also low in omega-3 fats. Mono-unsaturated fats are not essential, but impart either a neutral or slightly beneficial effect on serum cholesterol levels, depending on which nutrient they are replacing. When swapped for saturated or trans fats or refined carbohydrates, monounsaturated fats may lower low density lipoprotein cholesterol LDL-C and raise high density lipoprotein cholesterol HDL-C cholesterol.
Saturated fats are not essential in the diet and can promote cardiovascular disease. The American Heart Association recommends limiting saturated fat to less than 5 to 6 percent of total calories about 14 g total on a calorie per day diet. Trans fatty acids TFAs are lab-made via hydrogenation and are found in processed, fried, and fast foods. Although they were originally developed to be a healthy alternative to butter and lard, TFAs were found to increase cardiovascular disease risk. Dietary cholesterol is a sterol found only in animal products. Although cholesterol is necessary for the production of hormones, vitamin D, and bile acids, the liver produces adequate quantities of cholesterol and exogenous intake is unnecessary.
Dietary cholesterol's impact on plasma cholesterol is less significant than saturated fat's, and absorption may be highly individualized, but it nonetheless, may have a significant impact on some individuals and impact may only manifest when individual plasma lipid concentrations are low. Phytosterols, another class of fats, are plant-based sterols found in all plant foods especially wheat germ, nuts, seeds, whole grains, legumes, and unrefined plant oils , which are similar to cholesterol.
Phytosterols reduce cholesterol absorption in the gut, thereby optimizing lipid profiles. Together with viscous fibers, soy proteins, and almonds, phytosterols have been found to be as effective as statins in lowering LDL-C. Overall, some dietary fat is necessary to meet the essential fatty acid requirements.
Whole food sources of fat e. Oils provide excess energy more than calories per cup with minimal nutrition including zero fiber. While nearly a century of macronutrient-centric education has created widespread familiarity with these terms, it may also add a layer of complexity and confusion in chasing mythical macronutrient ratios that seem yet unresolved. Organizing food into isoenergetic macronutrient categories may create a false equivalency of non isometabolic food e.
While much of the focus on food centers on the macronutrient content, or energy density, there are many benefits to a whole food, plant-based diet that fall outside of these energy categories. A proper diet should be varied as it is not likely that every micronutrient e. One of the advantages of a fruit- and vegetable-rich diet is the large variety of micronutrient exposure. Beyond the basic vitamin and mineral dietary reference intakes, there are a host of other phytonutrients that may play a significant, but yet not fully understood, role in health.
For example, a class of plant-derived compounds, poly-phenols, offers a wide range of antioxidant and other cellular regulatory properties. Outside of the emerging science of exotic phytonutrients, fruits and vegetables provide an abundant source of vitamins and minerals. While the vast majority of micronutrients on an exclusively plant-based diet are plentiful, a few need particular attention of note, there are many micronutrient dietary needs that may be an issue in an omnivorous diet that should be addressed in the elderly population.
Some micronutrient levels may be optimized by adding more vegetables and fruits to the diet and other may require supplementation. The key to success is centered on appropriate periodic testing and avoiding excessive supplementation as has been seen with vitamins A and E. Cobalamin, commonly referred to as vitamin B12, is the only nutrient not directly available from plants. B12 is synthesized by microorganisms, bacteria, fungi, and algae, but not by animals or plants.
Animal-sourced B12 results from its natural concentration in flesh, organs and byproducts e. Vitamin B12 deficiency poses an adverse threat of potentially irreversible neurological disorders, gastrointestinal problems, and megaloblastic anemia. B12 deficiency, however, is not unique to vegans who do not supplement. In fact, deficiency is prevalent in the elderly population, due to inadequate intake or absorption. The body can store vitamin B12 for approximately three to five years, or even up to ten years, but without repletion or an ability to absorb, deficiency ensues.
Due to this lag time and because serum tests for B12 levels including serum cobalamin, serum methylmalonic acid, and Schilling test can be skewed by other variables, irreversible damage may occur before a deficiency is caught. In a plant-based diet, vitamin B12 can be found in fortified plant milks, cereals, and nutritional yeast. Since absorption varies greatly depending on the dose and the individual, it is recommended to supplement with greater than the Recommended Daily Allowance RDA to ensure adequate intake.
Although vitamin D is considered a fat-soluble vitamin, it is actually a prohormone produced in the skin upon exposure to ultraviolet B UVB sun radiation and then activated by the liver and kidneys. Despite the fact that bodies evolved to absorb vitamin D via the sun, there appears to be a worldwide epidemic of deficiency. In the geriatric population, deficiency has been associated with an increased risk for cognitive impairment, secondary hyperparathyroidism and its resultant osteoporosis, falls, and fracture risks, certain cancers, type 2 diabetes, cardiovascular disease, and autoimmune disease.
Aging significantly decreases the capacity of the skin to produce vitamin D, particularly with limited exposure to UVB rays. Furthermore, vitamin D is not widely available from the food supply. Sources of preformed vitamin D include fish liver oil, oily fish, liver, and in smaller doses, meat and egg yolk. Vitamin D from sunshine and animal sources is in the form of cholecalciferol, or vitamin D3. An additional form called ergocalciferol, or vitamin D2, is found in plant sources, mostly in UVB-irradiated mushrooms. However, there is a more recently discovered plant-derived version of D3 made by lichen.
Dietary supplements may contain either D2 or D3, both of which can be effective at raising blood levels. Some physicians test for serum levels of vitamin D with the hydroxyvitamin D test. As vitamin D is fat-soluble and excess levels can result in toxicity, it is preferable to monitor vitamin D levels in order to avoid deficiency. If patients have suboptimal levels, emphasizing food sources especially fortified plant milks as well as sun therapy may prove effective as a first line of treatment.
Supplementation may be reasonable if levels remain low. Vitamin K is necessary for blood coagulation, cardiovascular health, and bone strength. Although vitamin K1, phylloquinone, is abundantly available in leafy green vegetables, there is increasing evidence that vitamin K2, menaquinone, is also necessary. Produced by microorganisms as well as converted from K1 by intestinal bacteria in small amounts, supplementing with a direct source of K2 may be beneficial. Calcium is the most abundant mineral in the human body, with 99 percent stored in the bones and teeth and the remaining one percent circulating in the blood and tissues.
Calcium is a nutrient of concern for the general population with respect to bone mineral optimization over the lifespan. However, because bone metabolism is multi-factorial and complex, it is important to emphasize ample sources of calcium as well as vitamins K and B12, fluoride, magnesium, phosphorus, and potassium; to maintain serum vitamin D levels; and to ensure regular resistance exercise. To maximize absorption, frequent consumption of calcium sources spread throughout meals is recommended; prioritize low oxalate leafy greens such as bok choy, broccoli, napa cabbage, collard greens, dandelion greens, kale, turnip greens, and watercress; be wary of excessive intakes of sodium, protein, caffeine, and phosphorus as from sodas ; and ensure normal serum vitamin D levels.
Although iron is one of the most abundant metals, iron deficiency remains one of the most common and widespread nutritional deficiencies, with prevalence increasing with age. Plant-sourced iron is non-heme, which is susceptible to compounds that both inhibit e. However, individuals adapt absorption of non-heme iron more effectively than heme iron and are able to adapt to low iron intakes over time.
There is a wide array of iron-rich food choices in the plant kingdom. Leafy greens and legumes are excellent sources of iron and myriad other nutrients, so it is advantageous to include these foods often. Other good choices include soy products, dark chocolate, blackstrap molasses, tahini, pumpkin seeds, sunflower seeds, raisins, prunes, and cashews.
In order to enhance absorption, consume iron-rich foods in combination with foods high in vitamin C- and organic acid-rich foods. This combination improves solubility, thereby facilitating absorption. Examples include a green smoothie with leafy greens iron and fruit vitamin C , salad greens iron with tomatoes vitamin C , or a bean-based chili iron with tomato sauce vitamin C.
Dietary plant sources of iodine, a trace mineral, are unreliable due to varying soil qualities. Available options include iodized salt and sea vegetables. A pre-existing iodine deficiency, a selenium deficiency, or high intake of goitrogens antinutrients found in cruciferous vegetables, soy products, flaxseeds, millet, peanuts, peaches, pears, pine nuts, spinach, sweet potatoes, and strawberries can interfere with iodine absorption. There is no need to avoid goitrogenic foods as long as iodine intake is sufficient. If a patient does not enjoy sea vegetables or is minimizing intake of salt, an iodine supplement may be warranted.
Selenium is an essential trace mineral that plays a role in thyroid hormone regulation, reproduction, and DNA synthesis and also exerts powerful antioxidant, antiviral, and anti-inflammatory effects. Just one ounce approximately 6 to 8 nuts provides percent of the RDA. When accessible, one Brazil nut a day is an ideal way of meeting selenium recommendations.
Zinc supports immune function and wound healing; synthesis of protein and DNA; and growth and development throughout pregnancy, childhood, and adolescence. However, there do not appear to be adverse health consequences of these lower levels, suggesting increased efficiency of absorption with adaptation to long-term vegetarian diets. Advise patients to include legumes, cashews and other nuts, seeds, soy foods, and whole grains.
Preparation methods such as soaking, sprouting, leavening, and fermenting will help improve absorption. Because the supplement industry is not regulated by the FDA, it is buyer beware in the supplement market. Pharmacopeia, act as independent third parties and offer seals of approval after testing products for potency and contaminants.
They do not, however, test for safety or efficacy. A plant-based diet is beneficial throughout the lifespan, and may be particularly useful in the elderly population. Evidence from prospective cohort studies suggests that a diet rich in vegetables, fruits, whole grains, legumes, nuts, seeds, herbs, and spices is associated with a significantly lower risk of cardiovascular disease; the protective effects of these foods are likely mediated through multiple beneficial nutrients.
A plant-based diet can meet energy and satiety needs and is ideal for the elderly population as it involves simple food preparation, easily digested balanced meals, and, if required, may be easily blended into a flavorful and nutritious liquid diet. Making a significant change in diet and lifestyle can be difficult at any age, especially when the new diet may not at first appear equally familiar, convenient and enjoyable to the Western diet.
A survey of human populations in both time and culture, however, reveals that normal has a wide range of what might be considered palatable. Wilbur O. We need to observe our diet and regulate appetite by reason. In doing this we may be greatly aided by the knowledge of what our food contains and how it serves its purpose in nutrition. This brings us back to a critical person in the dietary transformation, the attendant physician. As was clear in the very successful campaign to adjust the social habits surrounding smoking, a highly addictive activity that most physicians practiced at that time, each of us providing nutritional advice must look at our own diet.
Ultimately the dietary change needed in society requires the leadership of all healthcare professionals. A whole food, plant-based diet pattern can be easily achieved and is at least one solution to the tremendous socioeconomic burden that nutritionally-induced, non-communicable chronic diseases places on all of humanity.
National Center for Biotechnology Information , U. Journal List J Geriatr Cardiol v. J Geriatr Cardiol. Julieanna Hever 1 and Raymond J Cronise 2. Author information Article notes Copyright and License information Disclaimer. E-mail: moc. Copyright Institute of Geriatric Cardiology. The work must be attributed back to the original author and commercial use is not permitted without specific permission. This article has been cited by other articles in PMC. Abstract Cardiovascular disease remains the world's leading cause of death. Introduction Today, many early deaths in the United States are preventable and nutrition-related.
Food groups and recommended servings per day. Open in a separate window. Geriatric nutrition Several issues to consider with respect to nutrition in the elderly include altered appetite, caloric, and nutrient needs as well as dentition and dexterity. Box 1. Overweight and underweight. For overweight patients, recommend shifting diet up the Food Triangle Figure 1 to focus on higher fiber leafy greens, starchy vegetables, and legumes and to limit nuts, seeds, and avocado during weight loss period.
For underweight patients, increase nuts, seeds, avocados and eat together with lower fiber starchy vegetables and fruits e. Table 2. Sources of notable nutrients. Nutrient Food sources Protein Legumes beans, lentils, peas, peanuts , nuts, seeds, soy foods tempeh, tofu Omega-3 fats Seeds chia, flax, hemp , leafy green vegetables, microalgae, soybeans and soy foods, walnuts, wheat germ, supplement Fiber Vegetables, fruits especially berries, papayas, pears, dried fruits , avocados, legumes beans, lentils, peas , nuts, seeds, whole grains Calcium Low-oxalate leafy greens bok choy, broccoli, cabbage, collard, dandelion, le, watercress , calcium-set tofu, almonds, almond butter, fortified plant milks, sesame seeds, tahini, figs, blackstrap molasses Iodine Sea vegetables e.
Meeting energy needs Geriatric patients who struggle to consume enough calo-ries should increase their intake of more calorically dense plant-based foods.
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Table 3. Calorie density. Food group Calories per g Non-starchy vegetables e. Nutrient adequacy A common concern when considering any diet, including an entirely plant-based one, is nutrient adequacy. Plant-based macro-nutrition The ideal ratio of intake of macronutrients is highly debated. Figure 1. The Food Triangle. Carbohydrates The Institute of Medicine IOM 's adequate intake AI of carbohydrates  is g per day for everyone except during pregnancy and lactation after the age of one year.
Plant-based micronutrition While much of the focus on food centers on the macronutrient content, or energy density, there are many benefits to a whole food, plant-based diet that fall outside of these energy categories. Vitamin B12 Cobalamin, commonly referred to as vitamin B12, is the only nutrient not directly available from plants.
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Vitamin K Vitamin K is necessary for blood coagulation, cardiovascular health, and bone strength. Calcium Calcium is the most abundant mineral in the human body, with 99 percent stored in the bones and teeth and the remaining one percent circulating in the blood and tissues. Iron Although iron is one of the most abundant metals, iron deficiency remains one of the most common and widespread nutritional deficiencies, with prevalence increasing with age. Iodine Dietary plant sources of iodine, a trace mineral, are unreliable due to varying soil qualities.
Selenium Selenium is an essential trace mineral that plays a role in thyroid hormone regulation, reproduction, and DNA synthesis and also exerts powerful antioxidant, antiviral, and anti-inflammatory effects. Zinc Zinc supports immune function and wound healing; synthesis of protein and DNA; and growth and development throughout pregnancy, childhood, and adolescence.
Note on supplements in general Because the supplement industry is not regulated by the FDA, it is buyer beware in the supplement market. Conclusions A plant-based diet is beneficial throughout the lifespan, and may be particularly useful in the elderly population. References 1. The state of US health, burden of diseases, injuries, and risk factors. Rose G. Sick individuals and sick populations. Int J Epidemiol. Adams F.
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