Nutrition & Exercise: Their Role in Improving Balance & Preventing Falls
Summary of a public talk given at a BC Balance and Dizziness Disorders Society (BADD) North Shore Support Group meeting held at Summerhill PARC in North Vancouver on July 30, 2014.
Speaker: Rob Huppée, RD, CSCS. Rob is a registered dietitian as well as a certified strength and conditioning specialist. He is the Manager of Active Living for Pacific Arbour Retirement Communities (PARC).
Are you getting enough vitamin B12? If not, your balance may be impacted. Vitamin B12 deficiency is common, affecting about 15-20% of the population. Those over 80 are particularly at risk. Vitamin B12 deficiency can be caused by insufficient production of Intrinsic Factor (IF), a protein produced in the stomach. Your body needs IF to absorb vitamin B12. A routine blood test will show if your B12 levels are low. Food sources of vitamin B12 include eggs, meat, poultry, shell fish, milk, and milk products. Low B12 levels may be corrected with an injection.
There’s a very strong correlation between vitamin D deficiency and falling. On sunny days, plenty of vitamin D is synthesized through your skin. On cloudy days in Canada, particularly between October and March, you may need to take vitamin D supplements. The Fraser Health Authority implemented the first protocol in Canada recommending that everyone who is 65 and older living in residential care get 20,000 International Units (IU) of vitamin D per week (about 3,000 IU per day).
Nutrient “Overdose” (Hypervitaminosis)
Don’t take large doses of a single supplement just because you’ve heard that it’s good for you. You could reach a toxic level quite quickly. Our bodies strive for a delicate nutrient balance – just because something is good for you doesn’t mean more is better. For example, one orange (about 0.7 gram of vitamin C) a day normally prevents scurvy. Taking two grams of vitamin C a day is not going to help you. And it’s not true that a large dose of a water-soluble vitamin such as vitamin C will be simply eliminated in urine problem-free — there’s still some negative effect on your body.
Vitamin A is a fat-soluble vitamin that’s particularly toxic. Early polar explorers learned the hard way not to eat too much polar bear liver. It’s so high in vitamin A that just a few ounces can be deadly. Be careful – too much vitamin A can cause dizziness and balance problems.
Protein is a key part of a balanced diet. It’s very effective in preserving muscle mass. Good muscle mass keeps you strong and mobile. Evidence has grown over the last 20 years to indicate that everyone needs more protein than the previously recommended intake of 0.8 gram per kilo of body weight. The current recommendation is 1.15 grams of protein daily per kilo of body weight. If, for example, you weigh 68 kilos (150 pounds) you need 80 grams of protein. This is equivalent to eating an extra chicken breast a day compared with protein consumption under the old guideline.
It’s not difficult to get enough protein through regular food intake. Only about 30 grams is required for protein synthesis, the process that helps build muscles. Most people get enough protein but eat too much of it at dinner. It’s better to balance your protein intake across all three meals. If you usually just have tea and toast in the morning, try adding an egg. If you don’t like eggs, try a piece of cheese or some yoghurt. If you can’t stomach other sources, use protein powder. Whey protein powder is a complete protein, breaks down very quickly, and is well-absorbed by the body. Plants such as brown rice, beans and lentils are incomplete protein sources. Their amino acid profiles – the building blocks of the protein – are missing one or more amino acids to “complete” them and make them available to your body. If you combine beans with rice, however, a complete protein is created.
High Nutrient Density
High nutrient density simply means getting more nutrients for your calorie buck. Eat a wide variety of whole foods to increase nutrient and phytochemical (biologically-active compounds found in plants that affect human health, e.g. antioxidants) density. The phytochemicals found in vegetables and fruits have some anti-tumour properties. They also have anti-inflammatory properties that are protective to the brain. We tend not to eat enough of nutrient-dense foods such as broccoli, kale, and other dark fruits and vegetables. To equal the amount of folic acid in a small serving of broccoli you’d need to eat a family-sized bag of corn chips fortified with folic acid.
Eat nutrient-dense fruits and vegetables either raw or cooked. There’s a wonderful synergy that increases the nutritional content of many of these foods when they’re cooked. You may have heard that the lycopene in tomatoes makes them good for prostate health. However the lycopene content in raw tomatoes is much lower than in cooked tomatoes. If you eat cooked tomatoes, perhaps in spaghetti sauce, the lycopene content increases exponentially.
Distribution of Food and Fluids
Having regular meals at regular times and staying well hydrated seems to help most people with their balance and dizziness issues. Many people with vestibular problems have an imbalance in their inner ear fluid. There’s some evidence that a lower sodium diet can help this problem. But it may be even more important to maintain a consistent level of sodium intake. If your sodium intake is already low, for example, and one day you consume even less, your condition may act up. [Editor’s note: Heath Canada guidelines recommend that people over the age of one year take in between 1000-1500 mg of sodium per day. This is referred to as the Adequate Intake (AI).] The recommendation for maximum daily sodium intake is 2,300 mg – one and a half teaspoons. Prepared foods are some of the biggest hidden sources of sodium. If you eat mainly whole foods you’ll have a better chance of lowering your sodium intake.
Managing sugar intake can have a positive impact on managing balance and dizziness disorders. If you’re diabetic or pre-diabetic it’s particularly important to take in a controlled amount of carbohydrates. Try to keep concentrated sugars low. It’s important to be aware of sources of concentrated sugars. Canadian food labels list naturally-occurring sugars in with added sugars and syrups. The government is now taking steps to highlight added sugars in a separate category on food labels.
Be aware that some people are unable to handle caffeine and alcohol, especially if they have migraine-triggered vertigo. For others, caffeine and alcohol are not a problem.
Dr. Robert N. Butler, Director of the National Institute on Aging, concluded that, “If exercise could be packed in a pill, it would be the single most widely prescribed and beneficial medicine in the nation.” Exercise helps for just about every condition. And especially, walk every day if you can.
Try to do some balance training every day. You don’t need to train for an hour at a time. Balance training can be done anywhere in short spurts. A training effect builds up the more you practice – even just for a few seconds.
Practice balancing throughout the day. If you’re making a cup of tea or waiting for an elevator, stand in tandem (one foot in front of the other) or stand on one leg. Always remember to have something sturdy to hold on to. Tai chi gives your balance a wonderful gentle workout. Community-based programs for older adults such as Steadyfeet® have a strong focus on balance training.
Strength is the weakest link in many people’s physical condition. Older people who do nothing to strengthen their muscles will end up with sarcopenia (muscle loss with aging). Almost half of 80- to 90-year-olds are unable to pick up a ten-pound bag of groceries. Strength training with weights and machines, even in small amounts, leads to significant functional gains.
Once you get stronger, think about moving a little faster to build power. Power is the ability to exert strength quickly. If you currently struggle to get out of a chair, start doing chair squats – this will help you get up more quickly. The benefit of power training is that it teaches your muscles to fire quickly. If your toes get caught in the rug you will be able to act and stay erect rather than simply fall over. Power training is an extremely effective fall prevention tool.
Body composition shifts when you exercise. Muscle is denser than fat. Don’t worry so much about the number on the scale. Focus more on how you feel and how your clothes fit.