Veganism for the over 60s

Introduction

Good nutrition contributes to our health as we age. This article intends to explore the various areas of interest with regard to advancing years and the nutrient needs of the older vegan.

What is old age?

The older population is the fastest growing section of the population, with the UK having more people aged over 60 than under 16. There are now an estimated 11 million pensioners in the UK (20% of the population). In the UK we generally describe anyone who is over 65 years of age as ‘elderly’.
Ageing is a normal process, involving a range of biological and physiological changes to all parts of the body, but it is also driven by the efficiency of the body to repair itself. The ageing process is malleable. It has been suggested that genes account for about 25% of the determinants of longevity (British Nutrition Foundation 2003), so this leaves around 75% being due to other factors. These factors include lifestyle, chance, the environment, and last but not least, nutrition. We can influence these factors by our lifestyle choices, and as vegans we can build on our already healthy nutritional choices, with our higher intake of complex carbohydrates, fibre, fruit and vegetables, and lower intake of saturated fat, compared with our meat-eating peers. Unfortunately there has been little research concerning the health of elderly vegans, but it is well documented that plant-based diets help to prevent the development of many chronic diseases (Thomas 2007), and could beneficially affect the ageing process.
Energy requirements

The decline in energy requirements as we get older is relatively small, but significant.

As we age it is natural to start eating less – the taste buds in the mouth decrease, there is decreased motor function and muscle tone in the intestine, and all these changes in the gastrointestinal tract work together to cause a reduction in a person’s appetite (Gariballa & Sinclair 1998). Gut microflora also changes, and keeping a gut healthy by eating a diet rich in fruits and vegetables has been shown to protect against both colon cancer and inflammatory bowel diseases.

Lean body tissue (muscle) decreases, and this leads to a fall in basal metabolic rate (the energy expenditure of a person lying at physical and mental rest). Older people also tend to be less active. However, it is still important that enough is eaten to cover energy requirements, maintain a good body weight and to keep active. Vegans tend to be leaner and lighter than meat eaters, which aids mobility and means less pressure on joints. However, weight should be kept at a healthy level because being underweight (a Body Mass Index (BMI) of less than 18.5kg/m2)* can increase the risk of osteoporosis.
So as we get older, it is natural to start eating less, therefore food quality is important to ensure all those essential nutrients are included (see the Vegan Society information sheets for vegan sources of key nutrients). It is also important that older people continue to enjoy their food and keep active in order to maintain mobility and a good appetite (British Nutrition Foundation 2004). Activity helps to retain muscle mass and is important for bone health and mental well-being.

Eyesight

Age-related macular degeneration (AMD) is an eye disease that affects the retina and the central visual field, and which can lead to visual impairment and even blindness. Risk factors include hypertension, smoking and a positive family history of the disease. Cataracts, a degeneration of the lens of the eye, affects approximately 60% of the elderly population. Studies suggest that a high intake of fruits and vegetables is associated with reduced risk of AMD and protection against cataracts. Vegans tend to have excellent intakes of antioxidants which protect against free radical damage. Nutrients and foods particularly recommended include vitamin E (found widely in vegetables, wheat germ, nuts, seeds and grains), and carotenes (found in green leafy vegetables such as spinach, pumpkin, sweet potato, watercress, carrots, and yellow fruits such as papaya, mango, apricots and peaches). Supplementation of long chain omega 3 fatty acids (a vegan form can be found in some algae supplements) may benefit those at risk of AMD (Desmettre et al 2004), but further research is needed.

Osteoporosis and fractures

Osteoporosis is a major health issue for older people, particularly women. This is where bone density reduces and so the risk of fractures increases.

An adequate calcium intake is essential for bone health, irrespective of whether vegan or meat eater (Appleby et al 2007). Food sources include fortified non-dairy milks, tahini, figs, almonds, green leafy vegetables, soya beans and tofu prepared with calcium sulphate.

Like calcium, vitamin K is important for bone health in the regulation of calcium – sources include green leafy vegetables such as broccoli, cabbage and parsley and pumpkin seeds and seaweeds.

Vitamin D keeps blood calcium at optimal levels and stimulates the absorption of calcium from the intestine. Vegan food sources of vitamin D (D2) include fortified breakfast cereals, non-dairy milks and margarines. We get most of our vitamin D from the effect of sunlight on our skin (transformed to pre-vitamin D3). As we get older, we have a reduced efficiency of its synthesis in the skin. If you are over 65 and not having regular exposure to sunlight, a daily supplement of 10mcg is recommended.

Other dietary factors reported to be beneficial to bone health include vitamin B12  and phytoestrogens e.g. isoflavones in soya (British Nutrition Foundation 2003), reducing salt intake and ensuring plenty of fruits and vegetables.

Vitamin and minerals

There is a lack of specific recommendations for older people for many of the micronutrients (vitamins and minerals), although it is known that the ability to digest, absorb, metabolise and excrete nutrients changes with age. An example of this is vitamin B12, where either the output of acid or intrinsic factor by the stomach is reduced, which reduces the availability of this vitamin (absorption is decreased because the intrinsic factor needed for its absorption is thought to decrease with age). Vegans should ensure a reliable, regular source of this vitamin – daily recommendations are 3mcg from fortified foods such as non-dairy milk, breakfast cereal, textured vegetable protein and yeast extract, or a 10mcg supplement.

As we get older we may require less iron, but our iron absorption may not be as efficient. Iron from plants is less well absorbed than from meat, but ascorbic acid (the active form of vitamin C) increases absorption, and vegan diets are generally rich in this vitamin, so that iron deficiency anaemia is uncommon. Nevertheless it is prudent to eat plenty of iron-rich foods to keep up the body's store of iron - pulses (such as peas, beans and lentils), bread, green vegetables, and fortified breakfast cereals. Fruit, especially citrus fruits, green vegetables, peppers, tomatoes and potatoes are all good sources of vitamin C. Add a small glass of fruit juice to a meal. It's a good idea to avoid drinking tea or coffee with iron-rich meals because this might affect how much iron the body absorbs from food.

Folic acid/folate is a B vitamin that is important for good health in older age. Sources include green vegetables, pulses and nuts. Folate status was found to be poor in elderly meat eaters (National Diet & Nutrition Survey 1998) – these people could reduce the risk of stroke, thrombosis and heart disease if they consumed three times the recommended levels of folic acid, research suggested. Vegan diets are rich in folates. These measures – which amount to eating ten to fifteen portions of fruit and vegetables per day – would reduce the level of homocysteine, an amino-acid which can bring on heart disease, say researchers (Rydlewicz et al. 2002). Folic acid supplements are not recommended for elderly people (because folic acid supplements can mask B12 deficiency). Elevated homocysteine levels have been recorded in vegans who do not ensure an adequate intake of vitamin B12.

It has been suggested that elderly people may be at risk of poor conversion of the short chain essential fatty acid (alpha-linolenic acid) found in linseed, hempseed and walnuts, to the long chain omega 3 fatty acids. Therefore a direct source of this fatty acid (found in some blue-green algae) may be beneficial (Davis & Melina 2000). However, there is no direct evidence that this is the case, and more work is needed to clarify and update current UK recommendations.

Fluid intake

Although fluid requirement reduces with old age (from 35ml/kg body weight to 30ml/kg/body weight), our sensitivity to thirst decreases, and it is very easy to become dehydrated. Our skin becomes thinner and so more water is lost via this route. In addition, the kidneys are not able to concentrate urine to the same degree.

The effects of dehydration can be severe. Although vegans tend to have improved bowel regularity, constipation can still be a problem if adequate fluid is not taken. Extra fluid should not be required if the recommended daily intake of 6-8 cups (1.5-2 litres) is taken.  

Summary

•    Ensure a varied vegan diet.

•    Keep active: 30 minutes of daily exercise recommended.

•    Adequate calcium intake is essential for bone health.

•    If you don’t have regular exposure to sunlight, a vitamin D supplement of 10mcg per day is recommended.

•    Take a reliable, regular source of vitamin B12: 3mcg from fortified foods or a 10mcg supplement daily.

•    Drink 6-8 cups (1.5-2 litres) of fluid per day.

Conclusion

Hopefully the above will encourage you to feel positive about continuing your vegan lifestyle well into your twilight years. We can take inspiration from many of the early vegan pioneers - Arthur Ling (founder of Plamil Foods), Eva Batt (author of the first vegan cookbook), Kathleen Jannaway (founder of Movement for Compassionate Living) and Donald Watson (founder of the Vegan Society) to name but a few, who lived fit and healthy lives well into their 80s - Donald Watson continued to walk and climb mountains in his 90s! These early members of the Vegan Society following its formation in 1944 had no experience to draw upon. But they were upheld by their faith and as a result of their courage and steadfastness, well-informed veganism is now established as a fully adequate diet of the 21st century and beyond. They are a testament to a healthy and happy old age, but there are various health issues that need to be focused on as we get older, and being aware of these and making some small dietary changes are important to ensure people continue to enjoy a happy and healthy life.

The Vegan Society is working hard to improve standards of catering for elderly vegans in hospitals and care homes. The Vegan Society produces the booklet "Vegan Catering Guide for Hospitals and Care Homes" which can be downloaded from the leaflets and booklets page, or free paper copies can be requested from the Vegan Society.

* Body mass index (BMI) = weight kg (height m)2

Long chain omega 3 fatty acids can be produced within the body from the short chain omega 3 fatty acids. One teaspoon of flaxseed oil or one and a half tablespoons of rapeseed oil a day can help to achieve the right balance of essential fatty acids and aid conversion.

References

Appleby P., Roddam A., Allen N., Key T. Sponsorship:The EPIC-Oxford study is supported by The Medical Research Council and Cancer Research UK. European Journal of Clinical Nutrition advance online publication, 7 February 2007.

British Nutrition Foundation (2003). Holding Back the Years

Davis B. and Melina V. (2000). Becoming Vegan. The complete guide to adopting a healthy plant-based diet, Book Publishing Company.

Desmettre T., Lecerf J. M. , Souied E. H. (2004). Nutrition and age-related macular degeneration, J Fr Ophtalmol Nov 27 (9Pt 2) 3S38-56.

Gariballa S. E.  and Sinclair A. J. (1998). “Nutrition, ageing and ill health British”,  Journal of Nutrition 80 7-23.

Rydlewicz et al. (2002). “The effect of folic acid supplementation on plasma homocysteine in an elderly population”, Quarterly J. of Medicine 95 (1) 27-35.

National Diet & Nutrition Survey (1998), People Aged 65 years and over. Volume 1: Report of the Diet & Nutrition Survey London, The Stationery Office.

Thomas B. and Bishop J. (2007). “Vegetarianism and Veganism” pp383, Manual of dietetic practice 4th edition, Blackwell Publishing.