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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.

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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.

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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.

Planet Medicine: Modalities, Revised Edition: Modalities

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.

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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.

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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.

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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.

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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. Table 3. Calorie density.

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  7. 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.