Best way to eat for healthy aging

Have you ever wondered: what should I be eating, for better aging?

It’s an important question, since nutrition can be a powerful influence on health. But with all the varied nutrition and healthy diet information out there, it’s easy to end up confused.

In this article, I’m going to explain:

• How I am currently thinking about nutrition for older adults,
• What I recommend most older adults eat (and not eat),
• The importance of eating to support better metabolic health,
• How to determine what is a good diet for YOUR aging body and brain.

I’ll also address nutrition for older adults dealing with frailty and sarcopenia (muscle loss).

This information is also covered in my related YouTube video:

I find it helpful to think of nutrition as a means to achieve certain goals within the body.

Now, eating should also be a pleasure (and that is good for health!), but when it comes to better aging, it’s good to understand nutrition as a powerful mechanism for influencing health.

A healthy nutritious diet is one that achieves the following:

• Keeps glucose, inflammation, and weight in good control
• Keeps you metabolically healthy (more on that below)
• Fosters a healthy diverse microbiome in your gut
• Provides you with a variety of nutrients that your cells (and healthier gut microbiome) need
• Minimizes your consumption of toxins
• Supports healing and repair of cells and organs
• Supports slower cellular aging

Those first two bullets are especially important, because most of the chronic diseases that affect older adults (e.g. heart disease, arthritis, dementia and more) are affected by inflammation and metabolic health. We also now know that the gut microbiome plays critical roles in modulating inflammation and metabolic health.

A good diet should also fit the person’s medical situation. So for instance:

• Someone with high blood pressure may need to pay particular attention to sodium
• Someone with insulin resistance (or even diabetes) may need to be more careful about refined carbohydrates
• Someone who is frail or losing weight may need to focus more on calories and protein than on almost anything else

Now you may be wondering: ok, so what should I eat??

Here’s the thing: Different people respond differently to the same nutritional input.

This is a fact that has been scientifically proven over and over again: you can feed a group of people the exact same meal, and get wildly different responses when it comes to things like blood sugar response and fat metabolism.

This happens because an individual person’s response to food is affected by many factors. These include:

• Genetics (which genes they have) and epigenetics (which genes are turned on)
• Their microbiome, meaning the composition of the bacteria in their gut
• Their body composition, meaning how much fat and muscle they currently have
• Their chronic health conditions
• The type of exercise they’ve been getting
• How their bodies have changed with aging
• Plus many other factors…

This means that there really is no such thing as the perfect or ideal diet for most people. So, for instance, whereas one person may do well eating lots of carbs, another person may do better with fewer carbs.

The key is to figure out what leads to better metabolic health and lower inflammation for each individual.

For this, we know of some general principles that work for most people. But first, what does it mean to have good metabolic health?

Metabolic health refers to how well the body manages blood sugar and fats in the bloodstream, organs, and cells.

When metabolic health is poor, the body is more likely to struggle with:

Metabolic health matters! Poor metabolic health significantly increases the risk of almost every chronic disease, including heart disease, kidney disease, liver disease, Alzheimer’s and other brain diseases, arthritis, and more. It’s also associated with a higher risk of cancer and accelerated cellular aging.

How we measure metabolic health

Metabolic health is usually tracked through five key clinical metrics:

• Fasting blood sugar (ideally 70-99 mg/dL)
• Blood pressure (ideally below 120/80 mmHg)
• HDL cholesterol (ideally above 60mg/dL)
• Fasting triglycerides (ideally below 100mg/dL)
• Waist circumference (ideally below 40 inches for men and 35 inches for women)

If a person is doing poorly in three or more of these metrics, they can be diagnosed with “metabolic syndrome”.

Many people with metabolic syndrome are obese. However, it’s important to know that you can be thin and still metabolically unhealthy; some slim individuals are experiencing high blood pressure, poor glucose control, and/or bad cholesterol numbers.

Poor metabolic health does become increasingly common with age.  Focusing on a more nutritious diet can help improve metabolic health, especially when diet changes are combined with increased exercise.

Your goal should be to figure out what works for YOUR body, to keep glucose, inflammation and weight under good control.

As I explained above, you also will want to foster a diverse microbiome, provide your body with all the varied nutrients it needs for healthy functioning, and minimize toxins.

General healthy nutrition principles for aging

Here are general principles that work for most older adults:

1. More vegetables, greens, fiber, fruits, beans, lentils
   • These support a healthier microbiome (your gut bacteria)
2. Minimize added sugars, fast food, trans fats, and processed food
   • Highly processed food often worsens metabolic health, in part because it tends to contain high amounts of sugar, salt, and/or trans fats
   • Avoiding added sugar is especially important if you have diabetes or tend to run a higher fasting blood glucose
3. Be careful about a high sodium intake
   • This can be important especially if you have high blood pressure or kidney problems
4. Be careful with simple starches (e.g. refined flours, most sweets)
   • This is especially important if your bloodwork suggests problems managing blood sugar
5. Be careful with alcohol
   • Alcohol worsens heart health and seems to be associated with higher cancer risk
   • Current research suggests that consuming a low to moderate amount of alcohol does not confer health benefits (other than being associated with enjoyment and socializing, both of which are good for health). The latest research suggests alcohol is essentially a toxin for the body, with larger quantities increasing the toxicity.
6. Check to see how your body responds to saturated animal fats
   • Some people maintain good levels of cholesterol and triglycerides despite eating animal fats, but others experience worse levels of lipids when they eat a lot of animal fats
7. Some people feel better off dairy, gluten, or other types of food
   • These foods seem to be inflammatory for some people but not others
   • If you notice worsening of joint pains, gut pains, or skin conditions when you consume these foods, consider minimizing them

Particular foods that may be especially nutritious and beneficial for older adults

The following foods have often been associated with better health outcomes in later life:

• Nuts and seeds (especially flaxseed)
• Foods with polyphenols, such as olive oil and berries
• Cocoa and tea (especially green tea)
• Seafood, especially oily fish high in omega-3 fatty acids
• Fermented foods
• Healthy fats (e.g. olive oil, avocado, nuts)
• High-quality protein (1.2-1.5 grams/kg/day, e.g. 0.54-0.68 g/pound of body weight)

But I would still put most of the emphasis on optimizing the overall eating pattern and focusing on less processed foods, rather than trying to make sure you include any particular “superfood”.

The foods above are generally included in the Mediterranean diet, and in other diets that are associated with good health outcomes.

What’s most important when eating for healthier aging

People often want to know exactly what to eat for healthier aging. But I think it’s understanding the right general principles that is most important:

• Minimize “bad” foods that cause inflammation or are otherwise harmful
  • E.g. ultra-processed foods, sugar, alcohol, junk food
• Eat large diverse quantities of vegetables and other minimally-processed plant foods 
  • This will provide fiber and a variety of nutrients, anti-oxidants
• Eat enough protein to support strength training
• Strive to be metabolically healthy

You can also think about minimizing your ingestion of toxins. Along with alcohol, potential toxins to be aware of include pesticides, artificial ingredients, and microplastics.

Unfortunately, metabolic health problems are common and often go unnoticed.

And although excess weight often overlaps with poor metabolic health, a person does not have to be obviously overweight to have unhealthy blood sugar and lipid patterns.

How to check your metabolic health

To better understand your metabolic health, it’s often helpful to review several basic measures with your health provider. These include:

• body weight
• waist size or waist-to-hip ratio
• fasting glucose
• hemoglobin A1C
• blood pressure
• a lipid panel that includes triglycerides and HDL

These tests can provide a useful snapshot of how well the body is handling glucose and fats.

In some cases, people may also find it helpful to use a continuous glucose monitor for a short period of time, especially if they are trying to better understand how particular foods affect their blood sugar.

How to improve metabolic health

If your metabolic health is not where you’d like it to be, one of the most important things to do is exercise.

In particular, strength training is especially valuable, because muscle plays a major role in glucose regulation. Building and maintaining muscle can improve how the body handles blood sugar, and it also supports function, mobility, and independence.

I share more about exercise and aging here: 4 Types of Exercise in Later Life: How to maintain strength, balance, & independence in aging.

By combining diet changes with exercise, it’s often possible to significantly improve metabolic health, even in the very old. The most useful diet changes usually include:

• Reducing ultra-processed foods
• Cutting back on foods that trigger unhealthy blood sugar responses
• Reducing saturated fat intake (if one’s body seems to be sensitive to that)
• Reducing overall calories, especially if one is obese

Medications (such as those for high cholesterol) can also help, but it’s best to use them in conjunction with making diet and exercise changes.

Although many discussions of nutrition focus on obesity and metabolic disease, malnutrition is also a major issue in aging.

Some older adults are not getting enough calories, protein, or nutrients to maintain weight, muscle, and function. This is especially common in people who are:

• very old
• frail
• cognitively impaired
• socially isolated
• financially constrained
• affected by serious illness

Signs of malnutrition can include:

• unintentional weight loss
• eating less than usual
• reduced muscle mass
• reduced body fat
• weakness
• declining function
• a declining blood albumin level

Sometimes fluid retention can make weight loss harder to recognize.

If an older person is losing weight, getting weaker, or eating poorly, this should be brought to the attention of a health provider. You can learn more about what should be done in this article: What to Do About Unintentional Weight Loss.

Let’s now talk about nutrition in the context of frailty.

Some older adults do become frail, and many of those show signs of sarcopenia, which means age-related loss of muscle mass and strength.

Frailty is important to identify, since it’s associated with important problems such as falls, weakness, hospitalizations, and loss of independence.

Common characteristics of a frail person include:

• Weight loss (> 5% in the last year)
• Exhausted by normal activities
• Weakness (decreased grip strength)
• Slow walking speed (>6 sec to walk 15 feet)
• Decreased physical activity

Treating and preventing frailty and sarcopenia

People sometimes want to know what an older person should eat, to prevent or reverse frailty and sarcopenia.

The most important thing is actually exercise, especially strength training.

This has been shown in randomized trials to help reverse frailty, and reduces the chances of it developing in the first place.

Nutrition (including protein supplementation) has also been studied. On its own, it doesn’t seem to be very effective in treating frailty.

However, when combined with strength training, adequate calories and adequate protein intake do help reverse frailty.

Protein intake becomes especially important when an older adult is:

• frail
• losing strength
• trying to rebuild muscle

The standard recommended dietary allowance for protein is 0.8 grams per kilogram of body weight per day. But many experts believe that this is too low for many older adults, especially those with frailty or sarcopenia.

For frail older adults, a target closer to 1.3 grams per kilogram per day is probably more appropriate, assuming there isn’t a medical reason to limit protein, such as certain forms of kidney disease.

It is also often helpful to:

• distribute protein across the day rather than eating most of it at one meal
• consider a protein supplement such as whey protein, if needed

For healthier older adults who are not frail, protein still matters, but I usually would not make it the sole focus. Overall diet quality, physical activity, and regular strength training often matter just as much, or more.

This is another area where many people hope for a simple answer.

Unfortunately, the evidence for supplements is often less impressive than people would like.

Many large studies have failed to show clear major benefits from commonly used vitamins and supplements for outcomes such as:

• cardiovascular disease
• fractures
• cognition

That does not mean supplements are never useful. It does mean they are often marketed more enthusiastically than the science supports.

Furthermore, the manufacturing of supplements is poorly regulated, which makes it even more problematic to rely on them for health purposes.

That said, deficiencies do matter.

Vitamin D and vitamin B12 are two nutrients that are often worth paying attention to in older adults, because low levels are relatively common. Taking a good quality multivitamin can also help prevent deficiencies, and in some studies has been associated with health benefits.

But overall, I would not place supplements at the center of a healthy aging strategy. A high-quality varied diet is a better way to obtain the vitamins and nutrients we need. That, plus enough protein when needed, and regular exercise are usually what’s most important for healthy aging.

I recommend you start with the basics, and then individualize.

First, try to avoid clearly poor nutrition. This means reducing ultra-processed foods, excess sugar, and other foods that are likely to undermine health. 

Next, work towards building a generally healthy pattern of eating, which generally means:

• More vegetables, greens, fiber, fruits, beans, lentils, to support a healthier microbiome (your gut bacteria)
• Minimize added sugars, fast food, trans fats, and processed food
• Be careful about a high sodium intake (especially if you have high blood pressure)
• Be careful with simple starches (e.g. refined flours, most sweets), especially if your bloodwork suggests problems managing blood sugar
• Be careful with alcohol, which worsens heart health and seems to be associated with higher cancer risk
• Check to see how your body responds to saturated animal fats
• Eat adequate amounts of high-quality protein
• Try to include foods associated with better health outcomes
  • These include nuts and seeds, berries, healthy fats such as olive oil and avocados, seafood, and fermented foods

Then step back and ask what is most relevant for your particular situation:

• Are there chronic conditions that should shape the diet?
• Do you seem to develop inflammation in response to certain foods, such as dairy or gluten?
• Are there signs of poor metabolic health?
• Is there weight loss?
• Could malnutrition be present?
• Is frailty or sarcopenia becoming an issue?

Those questions are usually more useful than asking which named diet is best.

In short: there is no one best diet for every older adult.

But with a little experimenting, you can find the diet that enables your body to keep glucose, inflammation, and weight in good control. And this will help you maintain health, strength and function in longer run.