To protect bones, the most important thing to supplement is not calcium, but this! I regret knowing it too late...

After several years of unremitting brainwashing by calcium tablets advertisements, the concept of calcium supplementation has been deeply rooted in the hearts of the people. Among the large number of people who take calcium supplements, middle-aged and elderly people are the group that will never fall behind. Calcium supplementation to prevent fractures is a belief that many middle-aged and elderly people have always adhered to and never wavered in.

However, most middle-aged and elderly friends do not know that the nutrient that really helps prevent falls, fractures, and disability is not calcium, but protein.

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Why do you say that? This is because:

1. The muscles in our body are mainly composed of protein, and the muscle content in the body will decrease with age.

2. When we are young, muscle weight accounts for about 50% of our total body weight. Starting from around the age of 30, our muscle content decreases by an average of 3-8% every 10 years.

Starting from around age 50, our muscle mass decreases by 5-10% every 10 years, which is about 400 grams per year. By the age of 75-80, it will be reduced to only about 25% of the total body weight.

3. As we age, our muscle mass decreases and our body fat percentage increases. The decrease in muscle mass affects our metabolic rate, which means it is easier to gain weight. As muscle mass decreases, the strength of skeletal muscles also decreases.

To combat the loss of muscle mass that comes with age, two things need to be ensured: adequate dietary protein intake + reasonable muscle-building exercises.

If protein intake is insufficient or poorly absorbed, insufficient protein will be effectively "retained", thus affecting muscle synthesis.

We know that muscles are important "organs" that help the body maintain stability and coordination. When the muscle mass is small and the muscle strength is weak, once a bump occurs, it is easy to increase the risk of falling due to insufficient muscle support or poor coordination and balance, which can lead to falls.

If the bone mineral density happens to be insufficient (also known as osteoporosis), the risk of fracture will be very high.

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In other words, no matter how much calcium supplementation is taken, if the elderly have poor protein nutrition and weak muscle mass and strength, their "bone safety" will be on thin ice, just like not wearing a safety helmet at a construction site or riding a motorcycle without a helmet.

Some elderly people with severe muscle attenuation may even be diagnosed with "sarcopenia", a disease that increases the risk of falls, disability, and even death in the elderly.

Data show that the prevalence of sarcopenia in the Chinese community is 8.9%~38.8%, higher in men than in women. The prevalence of sarcopenia in the elderly aged 80 and above can be as high as 67.1%.

Why is this the case? How can we get enough protein? Let’s talk about it in detail today.

01

Leading to protein in the elderly

What are the causes of poor nutritional status?

1. Aging and functional degeneration

As they age, many elderly people have varying degrees of tooth loss, decreased secretion of digestive juices, weakened gastrointestinal motility, and reduced digestion and absorption capacity.

These will lead to insufficient overall food intake and/or insufficient intake of protein-rich foods such as meat, eggs and milk, as well as decreased digestion, absorption and utilization of nutrients.

2. Disease

Chronic diseases such as diabetes, cardiovascular disease, chronic gastritis, heart failure, chronic obstructive pulmonary disease, chronic kidney disease, etc. will make many elderly people afraid to eat or unable to eat protein-rich foods such as meat, eggs, fish and shrimp, and these foods are often the best choice for protein supplementation.

Many elderly people even follow a completely vegetarian diet, thinking that this will help prevent or reduce the incidence of cardiovascular disease, but the intake of soy products in their diet is far from satisfactory...

Moreover, diseases such as diabetes, metabolic syndrome, and thyroid dysfunction can lead to muscle loss. Cognitive impairment, which is common among the elderly, can also lead to insufficient dietary intake, including protein.

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3. Lack of correct nutritional knowledge

Health supplements have always been targeted at the elderly. Many elderly people spend a lot of money on various supplements. Regardless of whether these supplements are regular, reliable and safe, in terms of nutritional content, most of them do not contain protein or the content is very low.

Although some products claim to be rich in xxx protein, it is not difficult to find out from the nutritional information table on the outer packaging that they are really "not up to their name".

In addition, many elderly people still tend to "focus on medical treatment and neglect nutrition", not knowing that prevention is the basis of health. This is also one of the reasons why the elderly do not have enough protein intake.

4. Poor lifestyle

Many elderly people have problems with insufficient physical activity, especially insufficient resistance exercise involving muscle training.

There are also some long-term drinking and/or smoking. Long-term alcohol intake can lead to atrophy of muscle type II fibers, while cigarettes can reduce protein synthesis and accelerate protein degradation.

02

How much protein do older adults need?
How to make up for it?

Unlike young people, the protein synthesis efficiency of the elderly decreases, and they need more protein than young people to synthesize muscle fibers.

Elderly people over 65 years old who do not have sarcopenia require an average of 0.2 grams more protein per kilogram of body weight than young people, that is, 1.0~1.2 grams/kilogram of body weight.

For example, an elderly person weighing 60 kg needs 12 grams more protein per day than a young person, which is equivalent to more than one or two catties of lean meat or more than 300 milliliters of milk.

For elderly people over 65 years old with sarcopenia, the amount of protein they need per kilogram of body weight is 0.2 to 0.3 grams more than that of those without sarcopenia, that is, 1.2 to 1.5 grams per kilogram of body weight.

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Of course, in daily life, as non-professionals, it is impossible for us to use a calculator to add and subtract the protein content of food every day. Therefore, we only need to roughly understand how much "qualified" high-protein food the elders at home need to eat every day.

The sources of protein in our daily diet can be divided into two main categories:

1. Animal foods , including eggs, milk, poultry meat, fish, shrimp, shellfish and crabs, have an overall absorption and utilization rate higher than plant protein, especially eggs and milk, and are therefore classified as "high-quality protein."

2. Plant-based foods mainly come from grains (such as rice, white flour, and cereals) and beans (such as soybeans, tofu, dried tofu, soy milk, miscellaneous beans, etc.).

Among them, the protein from soy foods/foods has the highest absorption and utilization rate among plant proteins, and is also the only high-quality protein among plant proteins. Nuts, vegetables, and fruits also provide a little protein, but the content is not that high and the absorption and utilization rate is very average.

Affected by the physiological and disease factors mentioned above, the intake of animal food by middle-aged and elderly people is often insufficient, which is the main reason for insufficient dietary protein intake among middle-aged and elderly people in our country.

In the "Dietary Guidelines for Chinese Residents (2022)", the following dietary requirements for middle-aged and elderly people over 65 years old require extra attention:

Ensure adequate high-quality protein

Daily food arrangement:

Consume ≥ 12 food items per day;

Breakfast should include ≥1~2 staple foods, 1 egg, and 1 cup of milk;

Lunch and dinner should have ≥2 staple foods, 1~2 meat dishes, 1~2 vegetables, and 1 bean product. How to ensure that the elderly get enough high-quality protein:

Eat plenty of meat , including fish, shrimp, poultry, pork, beef, mutton, etc.;

Drink milk every day . Elderly people with lactose intolerance can consider drinking low-lactose milk or eating yogurt. It is recommended to drink 300 grams of fresh milk or an equivalent amount of dairy products every day;

Eat soybeans and soy products every day . ——"Dietary Guidelines for Chinese Residents (2022)"

For the specific implementation method, you can refer to the following "1234 intake method":

Image source: provided by the author

In addition, additional attention should be paid to:

1. For elderly people who are overweight, they need to increase physical activity and lose weight appropriately, and eat 1 more serving of soy products, or 1 serving of dairy products, or 1 tael of lean meat (fish, shrimp and poultry are preferred) every day on the basis of the above 1234.

2. Conversion relationship of dairy products that provide equal amounts of protein: 100 grams of fresh milk = 100 grams of yogurt = 12.5 grams of milk powder = 10 grams of cheese.

3. The conversion relationship of soy products that provide equal amounts of protein is as follows:

Image source: Internet

In addition to protein, the elderly should also be encouraged to eat more dark vegetables, fruits and beans . The reason is that these foods are rich in antioxidant nutrients such as vitamin C, E, carotenoids, selenium, etc., which can reduce muscle damage caused by oxidative stress.

For the elderly who have many missing teeth or whose food choices, food intake, and nutrient digestion and absorption are affected by diseases such as chronic atrophic gastritis, in addition to processing the food as finely and softly as possible to reduce the burden of chewing and digestion, they can also make up for the lack of dietary intake by taking dietary nutritional supplements.

You can also go to the nutrition department of a large hospital and follow the advice of a nutritionist or clinical nutritionist to make reasonable choices such as special medical purpose formula foods, protein powder, etc. as supplements to three meals.

03

How can older adults increase muscle strength?

sports!

Diet is only half of maintaining muscle, lifestyle including exercise is the other half. Most of our friends over 65 need to adjust their lifestyle.

In addition to quitting smoking and controlling alcohol consumption, you should also reduce sitting for long periods of time and increase various forms of physical activity, including aerobic, resistance, flexibility, and comprehensive functional exercises.

For example, swimming, Tai Chi, yoga, aerobics, running on the spot, Tai Chi soft ball, table tennis, badminton, elastic band exercises, brisk walking that can speed up your breathing rate and make you sweat slightly, and moderate-intensity exercises that cover pushing/pulling/dragging/lifting/pressing movements, such as standing wall push-ups, standing heel raises, stair climbing, lying leg push-ups, seated presses, and hand washing clothes.

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The World Health Organization recommends that people over 65 years old, regardless of whether they have chronic diseases, should engage in at least 150 to 300 minutes of moderate-intensity aerobic exercise per week, or 75 to 150 minutes of high-intensity aerobic exercise, or an equivalent combination of the two intensities.

This should include: moderate or vigorous intensity muscle strength training involving all large muscle groups ≥ 2 days per week, and balance and strength training ≥ 3 days per week to enhance physical function and prevent falls.

Additional health benefits may be achieved if moderate-intensity aerobic physical activity is increased to ≥300 min per week, or vigorous-intensity aerobic physical activity is increased to ≥150 min per week, or an equivalent combination of the two intensities.

Of course, these 30 minutes can be divided and do not have to be done in one go, but it is best that each small exercise lasts for more than 10 minutes. In addition, it is best to have 2 to 3 resistance training sessions per week.

Finally, I want to remind you that many middle-aged friends also have the problem of insufficient muscle and too much fat ...

References:

[1] Janssen, I; Heymsfield, S. B; Wang, ZM & Ross, R. Skeletal muscle mass and distribution in 468 men and women aged 18-88 yr. J. Appl. Physiol. (1985), 89(1):81-8, 2000.

[2] RAKIC S., DOPSAJ, M., et al., Profile and reference values ​​for body fat and skeletal muscle mass percent at females, aged from 18.0 to 69.9, measured by multichannel segmental bioimpedance method: Serbian population study. Int. J. Morphol., 37(4):1286-1293, 2019.

[3] Rita Rastogi Kalyani, Mark Corriere, Luigi Ferrucci. Age-related and disease-related muscle loss: the effect of diabetes, obesity, and other diseases. The Lancet Diabetes & Endocrinology. Volume 2, Issue 10, October 2014, Pages 819-829

[4] Alfonso JCruz Jentoft, Avan ASayer. Sarcopenia. The Lancet. Volume 393, Issue 10191, 29 June–5 July 2019, Pages 2636-2646

[5] Cui Hua, Wang Zhaohui, et al., Expert consensus on the diagnosis and treatment of sarcopenia in the elderly in China (2023). Chinese Journal of Geriatrics, Vol. 42, No. 2, February 2023.

[6] Chinese Nutrition Society, Dietary Guidelines for Chinese Residents (2022)

[7] Fiona C Bull, et al., (2020). World Health Organization 2020 guidelines on physical activity and sedentary behavior. Br J Sports Med, DOI: 10.1136/bjsports-2020-102955

Source: Suiqian's Nutrition Hut

Review: Xue Qingxin, the first batch of nutrition instructors of the National Health Commission, China registered nutritionist

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