Cut out the sugar and breathe easier

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Tuesday January 22 8:56 AM ET Dietitians Help With Care of Elderly By LAURAN NEERGAARD, AP Medical Writer WASHINGTON (AP) - The 60-year-old lung disease patient gasped for breath after certain meals. The culprit: High-calorie meals loaded with sugar. Healthy people just breathe a little faster to excrete the carbon dioxide that 's produced by eating sugar. But lungs damaged by chronic obstructive pulmonary disease - one of the nation's top killers - can't handle both the extra work and the new pounds. It's one of numerous little-known diet tips that can make a big difference in easing chronic diseases that plague older Americans. But too few doctors have the time or training to deal with nutrition choices that are making their elderly patients sicker - or even realize how medications can sabotage a senior's already precarious diet. Now they're getting help: Dietitians have joined one of the largest primary-care physician groups to provide the first at-a-glance doctors' nutrition guide for the most common killers of elderly Americans. Better nutrition isn't a cure, cautions Dr. Albert Barrocas, a New Orleans surgeon and nutrition professor who offered the sugar-lung disease example. But the hope is that the new nutrition guide - linked to more comprehensive nutrition science at an Internet site - and some easy-to-use consumer advice will ease seniors' suffering, maybe enough that some can cut back on prescription pills. It comes at a time of increased interest in nutrition therapy. This month, Medicare began paying for registered dietitians to help treat more than 7 million seniors with diabetes or kidney disease, illnesses considered among the most influenced by diet. Some 85 percent of seniors have at least one chronic disease that can benefit from nutritional interventions. Yet the societal, economic and physical changes of aging leave them at particular risk of malnutrition. A spouse dies and the survivor lacks the will or know-how to cook healthy meals. Arthritis, heart disease or other ailments makes cooking a physical challenge. Alzheimer's make patients forget to eat. And medications can sap appetite or make eating unpleasant. Antibiotics, for example, can leave your mouth feeling like ``aluminum foil with fungus on it,'' says University of Tennessee dietitian Jane White. Indeed, while being overweight is a big risk for numerous illnesses like heart disease and diabetes, many seniors can have the opposite problem - being too thin to battle an illness. ``If you're elderly, I'd rather have you 10 percent overweight than 10 percent underweight,'' Barrocas says. The new Nutrition Screening Initiative, sponsored by the American Dietetic Association and the American Academy of Family Physicians (news - web sites), provides thousands of doctors a guide to nutrition concerns regarding eight chronic diseases: cancer, chronic obstructive pulmonary disease, congestive heart failure, coronary heart disease, dementia, diabetes, high blood pressure and osteoporosis. A Web site - www.aafp.org/nsi - links to more comprehensive information and provides a quick test for consumers to check their own nutrition risks. Everyone's heard the ``eat less fat'' mantra for heart disease. But the campaign's tips include less well known advice for doctors and consumers: -Monitor low weight. While 120 pounds may be nice for a 30-something who's 5-foot-4, that may be dangerously skinny for a 65-year-old. And losing 10 pounds in six months without trying is a danger signal. For example, seniors' sudden weight loss can be an early sign of dementia. -Some common drugs, such as digoxin for heart failure, are among the worst appetite-killers. -Seniors often lose their taste for meats, yet protein builds muscles and helps the body recover from illness. Remember other protein-rich foods like beans, peanut butter and eggs. -The sweet tooth that often accompanies age isn't necessarily bad. If you're trying to fatten up an Alzheimer's patient who loves doughnuts, provide them - all calories count to postpone tube-feeding as long as possible, Barrocas advises. Try bite-size finger foods; they forget how to use a fork. -Make sure hypertension patients consume enough calcium, a natural way to lower blood pressure. All patients at risk for heart failure should lower salt intake. -Get adequate fluids, six to eight 8-ounce glasses a day of water, juice, milk, tea, coffee. -Many experts recommend vitamin B12 supplements for seniors; absorption lessens with age. -Customize patients' dietary advice. Many kidney disease sufferers need a low-protein diet, for instance, but some have a form of illness that actually requires a little more protein. White says seniors need to know there are easy ways to get healthy foods. Buy pre-washed and cut bags of fresh vegetables and fruits. Try salad bars, single-serving frozen vegetables, or low-sodium frozen entrees. Some Meals on Wheels branches offer to sell the hot meals to seniors who can afford food but find it hard to fix. - EDITOR'S NOTE - n Neergaard covers health and medicine for The Associated Press in Washington.