Nutrition Essentials | Using Diet To Age Gracefully with Ronan Factora, MD

Podcast Transcript

John Horton:

Hello, and welcome to another episode of Nutrition Essentials, a side project of our long-running Health Essentials Podcast. I'm John Horton, your co-host, with registered dietitian Julia Zumpano.

Julia Zumpano:

Hi, John. I'm really excited about today's topic, longevity. It's such a hot topic, and nutrition plays such a great role.

John Horton:

Julia, in the game of life, it seems like the goal is to play for as long as possible. And it seems like proper nutrition can serve as a sort of cheat code to keep you going as you age. We basically get a dietary power boost, right?

Julia Zumpano:

Absolutely. Nutrition plays a huge role on how you feel day-to-day and how long you live your life. So that's why we asked Dr. Ronan Factora to join us today. He's with the Cleveland Clinic Center for Geriatric Medicine.

John Horton:

Well, let's see what he has to say about what we should put on our plates to live a longer life.

Welcome to the podcast, Dr. Factora. We are so glad you were able to join us today.

Dr. Ronan Factora:

It's a pleasure to be here. Thanks for inviting me.

John Horton:

Well, Dr. Factora, to get things rolling, I'd like to talk a little bit about what you do here at Cleveland Clinic as a geriatrician. And I know when we were talking earlier, you said one of your primary roles is basically to help people just stay where they are as they age, stay home and avoid having to go into some sort of assisted care facility.

Dr. Ronan Factora:

Right. So I'm a geriatrician. I've been here for 22 some years. So by “geriatrics,” I mean that I take care of people over the age of 65 traditionally — the average age in my clinic is actually 85.

John Horton:

Wow.

Dr. Ronan Factora:

And I focus on making sure that people age well. So we're focused on things like cognitive issues, falls, mobility, unexplained weight loss, concerns about medications. The whole purpose is to really preserve function and independence, as you had mentioned before. And kind of related to that, making sure a person ages well, stays at home as long as possible, they keep out of the nursing home, and try to minimize the impact that a person's medical problems may have on their ability to live independently.

John Horton:

Yeah. And we're going to dive in today as to how nutrition can play just a huge role in that. And to get started, let's talk about kinds of nutrition and muscle mass. Because I know retaining strength and just being able to do everyday tasks around your house is just so key.

Dr. Ronan Factora:

Right, right. So if you want to be independent, you have to be able to move. Now, there are things that do occur with normal aging that you should expect. So as people do get older, muscles tend to shrink over time. And this process is called sarcopenia; it could be doing any number of factors. It could be related to aging, it could be related to chronic inflammation, it could be related to the medical problems that a person has. So that shrinking does occur ... shrinking does occur over time.

The other thing to keep in mind is that sometimes, the quality of the muscles — and not just the size — also declines over time. So especially in people who are not very mobile or spend a lot of time sitting down, fat can actually infiltrate the muscles. And so they don't work as well. So as a person ages, you're kind of combating two different things: shrinking muscles and reduction in muscle quality. So trying to implement interventions to help to keep that from happening or stave off those changes, that's an important part of getting older.

Julia Zumpano:

Dr. Factora, I saw a quote that for every year after 30, you're losing between 1 to 2% of your muscle. And then, as you age, as you continue to age over 70, you're actually losing 3% of muscle per year. Is that accurate?

Dr. Ronan Factora:

That sounds correct. So this is something that occurs very slowly over time. You won't even notice these changes over a year or two. But once you get to certain thresholds when you're older, 50s, 60s, 70s, you're going to notice that you're not quite as strong as before. You get tired more easily, and those may reflect these muscle changes.

Julia Zumpano:

Well, that number sounds so low, but when it accumulates, it really plays such a significant role if you're not aware of those changes to your body and not taking actions to reduce that loss.

Dr. Ronan Factora:

Absolutely. I mean, if you can actually expect that these things are going to occur, then it's important for you to take steps to help to prevent that from happening or minimize that effect over time.

John Horton:

All right. Well, let's get into what you can do because that is the big reason why we're here today. So Dr. Factora, what is the key thing you need to get in your diet to kind of fight some of this muscle loss?

Dr. Ronan Factora:

Well, one of the biggest things that happens as people get older is that they really are not eating as much protein as they should be. You need protein, and those amino acids are the building blocks to allow your body to repair kind of the usual wear and tear that occurs daily from regular use. And we're not just talking about muscles, but also your skin, your gut, all your tissues.

But I think you feel it a lot more in your muscle mass if you're not consuming that protein. So as a process of that wear and tear, if you're not getting that protein, then your body actually breaks down the protein stores that you currently have in order for it to repair that wear and tear. So it's contingent on a person as they get older to make sure they're eating enough of that protein.

Julia Zumpano:

I completely agree. And most people, when they think of protein, they're thinking of straight meat. And you can get protein from so many different sources from the diet. And we know that a varied source of protein can provide maximized nutrient intake. So you can get as much nutrition possible from things like beans, nuts, seeds, eggs, dairy products, plant-based protein, like tofu. So there's so many great options to get in protein. So it doesn't have to be just one-sided.

Oftentimes, as we see the aging population, their taste for foods may change. They may not have the desire to eat so much meat or what we consider more higher protein-rich foods. So we do have to be very open-minded on different means to increase that intake of protein without just focusing on one food group.

Dr. Ronan Factora:

I think that's an important point. People's tastes vary. So what one person likes to eat, another person may not like to eat. So knowing where the protein comes from, whether it's going to be from meats — and different types of meat, not just red meat, but you can get it from chicken, you can get it from fish. Vegetables for people who don't like to eat meat, so beans, nuts, seeds, everything that you mentioned, that's all worthwhile.

And then, the preparing that food in such a way that a person wants to eat it, that's important. Because, as you mentioned, that sense of taste does change over time. And that's another change, that sense of smell and that sense of taste does decline with aging as well. So people who are older may not feel that the same foods that they've eaten for a long time taste quite the same as they remember when they were younger. And so you have to adjust the flavors so that they want to eat and eat enough to maintain their nutritional status.

Julia Zumpano:

I see that all the time with my patients. I may have an elderly patient with their children or their spouse and really struggling to try to get them to consume the foods that they used to like to eat. So it's a family affair. I mean, we all need to be on board to help support the patient's needs.

Dr. Ronan Factora:

I agree. It's hard to be a cook for yourself and cook different things. So if you have family members that can prepare meals for you, it's good to have an open mind to try something different and try to get those nutrients through other foods. And if you have family members that can help prepare meals for you, eventually, you're going to find something that you like. That's the main thing.

Julia Zumpano:

The best part of meeting with a dietitian or a healthcare provider that can help you through that journey.

Dr. Ronan Factora:

That's right. It's always resource that's available.

John Horton:

Now, protein, as we see when we're at the store, is just a huge fad right now. I mean, just about everything you see has some giant thing on it that it's packed with 20 grams of protein or something like that. As you get older, I mean, should you be looking at a target that you want to hit for protein per day? Or is it just a matter of picking out some of these whole foods that we've been talking about?

Dr. Ronan Factora:

Yeah, that's a really difficult question. I think that there are certain standards in terms of how much protein that a person who should be able to consume during the daytime. But like I said, as before, diets actually vary.

One of the biggest things for my patients as they get older is that they end up losing weight unintentionally. So the first goal is to maintain that weight, preserve your muscle, preserve those stores. Because when you do lose weight as you get older, invariably, you end up losing more muscle than fat. You get to keep the fat, but you lose the muscle. So you want to make sure that at least the weight is stable.

But then, beyond that, you're right, you have to find a way to get a balanced diet. So it's not just about the calories; you have to get the good foods that you eat. And there's a lot of resources that are available for people to look at to see how much protein you need to get. And depending upon the food that you get, there may be different concentrations of protein. So there's different amounts of protein in meat, in chicken, in beans and nuts. So having that guidance helps to allow you to get the protein needed for a well-balanced diet. But you have to also make sure that you're eating enough, and then all the other nutrients are there as well.

Julia Zumpano:

I agree. Oftentimes, when I counsel patients, I ask them what's best for them. So sometimes, logging and tracking protein can be daunting. For someone who's just struggling to get in enough calories or struggling with taste changes or maybe even memory changes. So I just try to infiltrate protein within their current diet or in their day.

So educating on ways we can just sneak in protein and build in protein into the current consumption and meals that they're already having seems to be a more successful approach than counting grams of protein. Mind you, counting grams of protein for those who are willing to do so, can work very well, too, because then we're making sure we're meeting all of our protein needs. So it can go either way. But I think it's just really important to be mindful that a protein source is being consumed every time you're eating.

John Horton:

Julia, just to run through, then, some things that people might want to look for … as you're going to try to get these protein-rich things in your diet, what are some just easy wins for people just to make sure you're getting it?

Julia Zumpano:

Sure. So quick and easy, kind of running through a day, a breakfast would be cottage cheese or Greek yogurt. And if dairy's not very compatible with your diet, we could try some eggs or some turkey sausage. Then we go to lunch-

John Horton:

…that all sounds good. I got to be honest.

Julia Zumpano:

…yeah. Wonderful. Easy, quick choices. I like quick and easy. Everyone's busy, and a lot of people, as you age, your desire to cook and prepare meals and spend hours in the kitchen declines significantly.

So for lunchtime — I'm a huge leftovers proponent for lunch — I usually encourage my patients to make extra food at dinner, double the recipe and have leftovers for lunch. We know we then have a balanced meal if we're eating a balanced meal for dinner. And then, with dinner, it can be any form of meat protein. So a lean piece of meat, which, it can be poultry or can be lean red meats, pork or beef. It can be any kind of seafood. It could be about a cup or a fist-size of beans. It can be tofu or eggs again. Nuts and seeds can be infiltrated as snacks. And then, even protein shakes can play a great role, especially to help support meeting those protein needs.

John Horton:

What about diets? Because I know everybody likes to go online and you can look these things up and kind of get a whole eating plan together. Are there a few that kind of stand out as being very protein-rich?

Julia Zumpano:

There are. There are a couple that stand out specifically for the benefits of longevity and living the best life you can as long as you can possibly. And the Mediterranean diet, no surprise, is one big one. The MIND diet, which is a combination of the Mediterranean and the DASH. And then, the DASH diet as well. And the DASH diet is a dietary approach to stop hypertension.

All three diets are essentially very similar. There are a couple differences in the amounts and frequency of certain food groups. But in general, all three diets encourage whole grains, legumes, fruits, vegetables, nuts, seeds on a daily basis. Leafy greens, fish, on a regular basis, about three times a week, lean poultry on a regular basis. And minimizing processed foods, things like red meats, sugary foods, commercial baked goods, things like that.

John Horton:

Yeah, I got to be honest, that all sounds really good. I could live on that right now. And actually, I'm probably getting to the age where I got to start thinking of that anyway, because I'm almost in the target audience you guys are talking about.

Julia Zumpano:

John, you should be living on that right now, as we all should be.

John Horton:

So Dr. Factora, we've kind of run through a lot of the importance here of proper nutrition to really kind of help maintain strength and muscle mass and all that. When you see patients, how critical is it that you kind of link them with a registered dietitian or really kind of counsel them on nutrition?

Dr. Ronan Factora:

So nutrition comes into play for a lot of my patients if they're losing weight, if they're worried about muscle weakness. And even with regard to cognition, which we can talk about in a little bit, a lot of people still may not be familiar with what foods are actually good for them and what foods kind of come into these ... the MIND diet and the DASH diet are kind of important diets that people may have heard, but are not completely aware of.

So having a dietitian available that I can use as a resource for people who require that guidance, it's extremely useful to help to fill in that health literacy gap for people who are just not aware of what these good foods are, where can they get them from, which foods to avoid as well. And I guess, the key thing about these diets is that, when you heard Julia talk, they're all balanced.

Now, aside from eliminating the ultra-processed foods, there's a whole wide variety of different foods there. Plants, seeds, nuts, fruits, meat, of course. It's not just one thing that's going to allow you to have good nutrition. You have to have a balance of all these things. So fat diets, in consideration, if you're trying to just adhere to one particular type of food, it may be that you're missing a lot of nutrients that are really beneficial for your health overall. So finding that balance is important.

Information is available for you if you want to look online, but the resources are also there. And you can just ask your primary care physician or me, and I can direct you to where you need to go to get that guidance necessary from a registered dietitian. To help you make sure that the diet that you're consuming on a regular basis optimizes your physical health and also your cognition.

Julia Zumpano:

Dr. Factora, thank you so much for your support and nutrition. And one thing I want to add is that when you meet with a dietitian, you get an individualized plan. And I think getting information online is phenomenal, and that's definitely a great place to start. But if you're struggling to incorporate some of these foods, if you're struggling to meet your targets or you're just finding that some of these foods don't jive with your family or your taste buds, that's where a dietitian can really help. So we can really individualize that plan and make a personalized longevity plan for you.

John Horton:

And I think we need to emphasize here also that, obviously, nutrition is important for maintaining strength, but so is activity. So you're not just going to have a well-balanced meal and that's going to maintain all your muscles. It's also critically important that you get out, you move around, you stay active as you get older. I take it that's one of the things you are always telling people, Dr. Factora.

Dr. Ronan Factora:

Right, yeah, John, that is absolutely correct. I mean, good diet is important, but you cannot separate diet from exercise. In order for you to actually preserve your mobility and preserve your muscles, you have to be active.

So making sure that you get those sources of protein into your diet and incorporating them into a day, a routine where you're moving more. Even walking on a regular basis, on top of an exercise program that incorporates resistance training and weight training. And then, avoiding the sitting, which is bad for you, that type of active daily routine is what you need on top of a well-balanced diet that has enough protein to maintain your muscle mass. That will help you stave off these changes that we were talking about earlier, that sarcopenia that you want to fight off. You have to be active and you have to have a good diet. They have to be done together.

Julia Zumpano:

I couldn't agree more. The need for protein is so important and essential. But if you're exercising, if you're moving your muscles, you're going to see so much of an improvement in your increased muscle mass. And then, coupling that with a high-protein, well-balanced diet, you're only going to see benefits head to toe. Like you mentioned, protein doesn't only support your muscles, but it supports your joints and your tissues and your skin. And all of that plays a huge role on even how active we are.

John Horton:

Now, Julia, you just mentioned going head-to-head here. And I feel like we've been focused kind of on the body so far, the muscles and being strong, and how diet can help with that.

Now, let's talk a little bit about how your diet can affect your cognition as you age, and memory and things like that — which are all worries as folks get older. We hear all the time about dementia and Alzheimer's and things like that. Dr. Factora, how does diet play a role in just keeping people mentally sharp?

Dr. Ronan Factora:

So there are a number of different interventions that I recommend for people who want to reduce risk of developing dementia and keep their minds sharp. And diet is one of those key things that people can have control over to help to support their brain health.

So there are a couple diets that are all, already been studied that can help preserve brain health. And Julia mentioned the MIND diet and the Mediterranean diet are a portion of that.

So those are all diets that have high amounts of antioxidants. They have good cholesterol, good fat to help to promote brain health overall. And they also avoid certain types of food that are more pro-inflammatory, like the red meats. So those types of diets are really well studied and are best to actually take in to promote your brain health. And in doing that, you provide your body with the nutrients necessary to support your brain, the cells in your brain overall.

But then, the other factors that are related to the advancement of dementia and diseases, Alzheimer's disease, they also reduce things like free radicals, they reduce inflammation that are all studied and found to be linked to neurodegenerative processes. So if you have a diet that incorporates all of these good things for your brain health, that's really what you want to adhere to, to help to minimize your risk of dementia as much as you can by incorporating a good diet.

Julia Zumpano:

Absolutely. Two components you want to keep in mind when you think of brain health and longevity. One would be antioxidants. So antioxidants are compounds that protect our cells from damage. Damage from things like free radicals, which could be from the environment, pollution, processed foods, et cetera. So we want to protect those cells. I always tell my patients, it's like putting a blanket over your cells. You're giving them a barrier or protection.

Antioxidants are found in the foods we've already discussed. They're found in fruits, vegetables, whole grains, nuts, seeds. Those are foods that are abundant in antioxidants, specifically things like citrus fruits and berries and green tea and black coffee. Those are packed with antioxidants.

And then, the other is omega-3 fatty acids. Omega-3s are a huge supporter for brain health. They help support mental clarity, they help decrease inflammation, they help decrease blood triglycerides. So there's so many benefits to omega-3s, and those are found in fatty fish predominantly. If you're not a fan of fatty fish, I would recommend plant-based sources such as chia seeds, ground flax seeds, walnuts, or hemp seeds. So anyone can get in omega-3s from a plant or a seafood source. So those are the two main things we really want to focus on.

John Horton:

Now, we threw out a term there a little bit ago, “oxidative stress.” And I feel like that's something that's said all the time. But I always feel like that's one of those things where people don't exactly know what it is, other than that it's bad. So Dr. Factora, if you could kind of describe a little bit as to what oxidative stress is and kind of what it can do to your mind that may have some bad consequences.

Dr. Ronan Factora:

Right. So in normal bodily function, the body produces all kinds of forms of energy and particles in cellular function. Sometimes, those byproducts can actually come out in free radical form. For these free radicals actually can do damage to intracellular components like your DNA. And that damage can cause long-lasting effects for the cells that you're in.

So antioxidants help to scoop up those substances that can do the damage. And if that's in your food, that's an easy way to actually help to reduce the damage that can occur just from kind of daily routine activities, and even as a process of maybe some disease processes or maybe some other foods that actually lead to oxidative stress. Having those foods helps to buffer the effect of those free radicals in your cells over time. So that's the reason why those foods are so important.

John Horton:

And it sounds like those free radicals are sort of like little rioters in your body that are just causing all sorts of mayhem, right?

Dr. Ronan Factora:

That's correct. Yeah. And again, you won't notice the difference right away. It's a cumulative effect over time that this damage has on your cells. And just like we had mentioned earlier, these diets are good. But the longer that you incorporate those diets into your lifestyle, the more beneficial the effect that you'll get from it. Because these processes are going on all the time. As we've mentioned before with sarcopenia and the changes in aging, this is over a period of years that you notice these changes.

So if you can start early as these changes are taking place, you can change the pathway that your body is on so that you can preserve more of the good cells, prevent more of this damage. And that's why incorporating these dietary changes and exercise as early as you can will yield the best benefits for you down the line.

Now, is it ever too late to do this? No, I don't think so. OK. So I think that everyone whose goal is to preserve their functional independence should incorporate these changes. But again, the younger you are, the earlier you implement these changes, the better off you're going to be because the benefits are going to be taking place much further upstream.

John Horton:

So basically, today is a good day to start, no matter what age you are.

Julia Zumpano:

Well, the other benefits, too-

John Horton:

…that's correct.

Julia Zumpano:

...is that antioxidants support the reduction of other chronic diseases, right? So we're talking about longevity and aging. But all those well-known chronic diseases, like diabetes and heart disease and cancer, we also can reduce our risk of those by following this type of healthy eating plan and exercise.

Dr. Ronan Factora:

That's correct. I think that when … we kind of lost focus, we're thinking about aging, that people have a lot of these chronic illnesses as well. And if you have this one intervention that can impact so many aspects of your life beyond just aging, I think that's a lot of evidence to say, "This is a good choice for you. You really should consider doing this because it can have positive benefits on your health in so many different ways."

John Horton:

Yeah. I feel like that's the whole point of this podcast, since we started it on day one, is just this notion that what you eat every single day has just a dramatic effect on your life. And it has to do with aging, has to do with fighting off disease and just staying as healthy as you possibly can.

Julia Zumpano:

And as Dr. Factora said, cumulative is the key. It's a cumulative effect. So that's very important. I try to instill that in my patients, start now and start slow and continue to build. Don't feel like you need to change this right away, immediately. But just start to incorporate as soon as possible and build upon that.

John Horton:

Now, we've been talking food. And as we all know, though, everybody likes shortcuts. And that's where you often hear folks look or talk about taking supplements. Hey, if we need to get all these great vitamins and minerals in, you could go shop for all these different veggies and fruits and meats and all that. Or you could just take a handy pill. Where do supplements fit into this overall notion of getting the right nutrition into age well?

Dr. Ronan Factora:

So that's a great question. And I have a lot of patients who do take these supplements. Now, the key thing about supplements is that you have to approach them the way that they leave themselves. They are supplements. So when you eat, whatever you eat, if you find that you're not getting the nutritional value from your food for whatever reason because of your dietary preferences or food access or whatever, then these supplements can fill in the gaps, B vitamins, your vitamin A, single, multiple vitamins can fill in those gaps.

But these are not substitutes for regular food. I think that you have to keep in mind that having a well-balanced diet is going to be more beneficial to you than taking anything over the counter as a supplement.

So the other thing to keep in mind is that the supplements that you get, and they extract all the important vitamins that people feel, this is what you need for normal living and normal life. But there are a lot of other micronutrients that are not extracted from foods that actually amplify the beneficial effects of these vitamins. And you won't get that over the counter. They can only be obtained by eating the whole foods themselves.

So rather than getting an extract from garlic or walnut oil, if you get the walnuts and you eat those, that's better. If you have the garlic, that's better. And if you're getting an extract from vegetables or fruits, something like dehydrated beets, that's fine, but it's probably better for you to actually eat the foods. Don't bother with getting the supplements if you can get the food yourself, and that's actually going to be more beneficial for you than just buying stuff that's going to be in the pharmacy aisle.

Julia Zumpano:

Dr. Factora, I think you make a great point. A lot of nutrients work together. They work synergistically. So if you're just taking iron and you're not taking vitamin C, you're actually not increasing its absorption. So when you eat a balanced diet and you consume these in food form, you're actually more likely to combine the foods that need to be combined together to increase absorption.

The other point that I want to make is that supplements are not well-regulated. There's regulation, they're just not well regulated. So it's a business. So supplements are there to sell you something and they make money off of you. So their goal is not to make you healthy, their goal is to make money. So you want to just be mindful of that.

Now, I am a proponent of certain supplements. Again, like Dr. Factora said, when you're not meeting your dietary needs, then we may need to supplement. Omega-3 is one that I would recommend supplementing if you're not able to meet it through your diet with multiple attempts. But you want to be sure that any supplement you take is third-party tested and you want to do your research when it comes to supplements. Understand why you're taking it, how much you need to be taking it, make sure it's not contraindicated with any medications or health concerns or medical history. So you just want to be very diligent when you consider taking supplements.

Dr. Ronan Factora:

Yeah. And there's one more point that you made, Julia, is that you have to make sure that you get the correct amount. It's not unusual for you to get too much of these vitamins. If you don't actually look at what you're taking and count things up, you can have excessive amounts of some of these vitamins.

And even though we talk about vitamins as being necessary for your overall health, too much of that can really be harmful. So too much vitamin A can lead to osteoporosis, too much vitamin D can lead to kidney stones. And so you have to make sure that you know what you're putting in your mouth. And make sure that you're not taking too much because even though we like vitamins and we think vitamins are important, those can still have problems, cause problems for your health if you take too much of them.

Julia Zumpano:

Absolutely.

John Horton:

And to go back on something we were talking about earlier, I know calorie intake is important as you age also. And you kind of emphasized that a little bit ago, Dr. Factora. And I guess a key point is, if you're taking supplements and doing that in lieu of having some of these healthy foods, you're not getting the calorie intake. And that can also have, then, some consequences if you're just light on that at mealtime.

Dr. Ronan Factora:

That's right. So there's no calories from supplements. When you have to eat regular food, the supplements just fill in the nutritional gaps for when the food that you eat is lacking in those nutrients. But you have to make sure that you're getting enough calories, particularly if you're older, enough to maintain your weight. I mean, you can track calories if you want, but when I actually, I'm seeing patients, the biggest marker for whether or not a person is getting enough to eat is a person's weight.

If you're able to maintain your weight and stay within a five-pound weight range, you're probably getting enough calories. If you're losing weight, you want to try to avoid that when you're older because again, you're risking losing muscle.

Julia Zumpano:

Absolutely.

Dr. Ronan Factora:

And there's no advantage to gaining weight when you're older because you're probably going to end up getting mostly fat. So staying within a five-pound range is good. And use the foods that you eat as the marker for whether or not you're getting enough calories.

John Horton:

Yeah. Julia, the other day, you said something to me, and it really resonated. And we always worry so much about how many calories you're taking in. And you told me, if you're eating good quality food, for the most part, you don't have to worry about calories. You're not going to have problems if you eat too much broccoli.

Julia Zumpano:

Absolutely. If we're eating these core, healthy, nutrient-dense foods, calories shouldn't be an issue. And I don't really like to focus on calories, to be honest. And as I mentioned to you, John, in my younger years as a dietitian, I was very calorie-focused and making sure I was calculating the appropriate needs for everyone and protein, et cetera.

And now, I really just like to look at the diet and scan it and see, well, how can I enhance this person's nutrition? How can I infiltrate foods that will support their body, increase their muscle mass, help combat their oxidative stress that they're going through every day? What can I do to infiltrate that into this person's day?

And that is really the goal of what I do when I see patients. If I see that they're not consuming enough calories, that's certainly a red flag. But those actions that I take are going to be to increase good-quality calories for them. Or if I see they're consuming too many calories that are not providing them nutrition, which I like to call empty calories, then I try to replace those empty calories with nutrient-dense foods that they're in agreement with. So it's all about where you're getting the calories from, not specifically the calories themselves.

John Horton:

Well, and I often feel like we end up talking about diet when we really want to talk about eating plans. And just how you eat, when you eat. And specifically, with when. Julia, I know you are always a big proponent of some forms of intermittent fasting. And I guess, specifically, kind of time-restricted eating. Can you kind of outline how that may be a benefit to people as they age as far as making sure they get the right nutrients, maintain their weight, getting the calories they need, all of that?

Julia Zumpano:

Sure. So we know that there is actually good data that shows that intermittent fasting or time-restricted eating, which is a form of intermittent fasting. So intermittent fasting is when you take periods of time that you're not eating. It's a fasted state. There's various different kinds. The type that I recommend the most because of the clinical data to support its use and the least amount of side effects and the most flexible, is called time-restricted eating.

And there's been good data to support good mental cognition and decreasing inflammation, decreasing oxidative stress, helping maintain weight, decreasing levels of insulin, which can negatively impact your health, like lead to increased fat storage if you have too much insulin floating around. So it helps decrease triglycerides. Some studies even show benefits with LDL and blood pressure. So a lot of great benefits. But you just have to do it properly and screen each patient appropriately.

But time-restricted eating is when you eat within a certain window. And we start with maybe a 12-hour window. Most people can manage a 12-hour window. You might start breakfast at 7:00 or 8:00, you're done by 7:00 or 8:00 pm. You're eating in a 12-hour window, you're fasting for 12 hours overnight. And that's a really great place to start. It also helps pair your eating habits with your circadian rhythm, which is your wake-sleep cycle. So it actually helps support that wake-sleep cycle, helps you get a good amount of rest and tells your body, "OK, we're going to stop eating. It's time to slow down and get the body prepared to go to sleep."

And then, when you wake up, you're telling yourself, "OK, I'm up. Now, I'm feeding you. It's time to start moving. It's time to get moving." Your brain needs to move, your muscles need to move, your body needs to move. So as we go from that 12-hour window, you can continue to decrease the eating window and increase the fasting window. So what I usually recommend is anywhere from an 8- to 12-hour eating window and a 12- to 16-hour fasting window.

John Horton:

As you age, though, I know there are some concerns with going too far with intermittent fasting. Dr. Factora, can you go over some of the things people should watch for or kind of be wary of?

Dr. Ronan Factora:

Right. Yeah. I think that intermittent fasting for certain individuals can be very beneficial in terms of helping promote your overall health and healing. But you have to make sure that those choices are individualized and your doctor is aware. And there are some conditions where intermittent fasting may actually produce harm. So individuals who might have diabetes, and they're taking medications, that kind of presume that you're eating on a regular basis, that could potentially have a downside or danger if your sugars are going to drop below where they're supposed to be, reduce hypoglycemia.

So as mentioned earlier, I think that you have to have a discussion with your healthcare provider about your plan to do intermittent fasting, what the goals of this are going to be for you, and whether or not it is something that is a good idea for you, giving your overall health and medical problems you have and the medications you're taking. I think that it's good to have a discussion with your doctor about this.

Julia Zumpano:

Absolutely.

Dr. Ronan Factora:

And it really shows your interest in maintaining your health. You just want to make sure it is a good choice.

Julia Zumpano:

And I think people can get caught up into fasting too long. I think that's another concern is going too long in that fasted window, where then you can have side effects like lowering blood pressure, lowering blood sugar — fasting decreases your appetite. So some people may be eating only one meal a day and then definitely not being able to meet all their nutrient needs in that sense. So there's definitely negative effects of fasting if not done well and supervised by a health practitioner.

Dr. Ronan Factora:

That's right.

John Horton:

Julia, you just mentioned how medications may affect appetite. I want to kind of spend a moment on a big medication that's in the news right now, which are GLP-1s. And people are using those more and more to kind of drop weight and things like that. And I know you said you see a lot of people coming in and they kind of have some nutritional issues with that. How do GLP-1s, or how might they fit in with somebody who's aging and trying just to keep everything ... just to stay healthy?

Julia Zumpano:

So GLP-1s are a good option if you're looking to lose weight. But as Dr. Factora mentioned, we really want to avoid weight loss as you age. There's not good data that supports losing weight as healthy. Now, if you're very overweight and your physician feels that it's a good fit for you, that's a good option. But you want to be mindful because these medications decrease your appetite. And oftentimes, they make you feel nauseous or make you have different side effects. So, therefore, the food choices you're making also tend to be less nutrient-dense. So more types of high-carb foods, crackers, bread, et cetera, because they seem to settle that stomach a little bit. So it's very important if you are considering a GLP-1 medication to really consider all the risks and benefits.

John Horton:

We've covered a lot of ground here today. And it seems like, overall, the main focus is, as you age, you kind of need to develop a nutrition-lifestyle and kind of just build it into your day-to-day activities. Dr. Factora, can you talk about how eating a certain way and putting a focus on good foods and cooking your meals and all that, how that can also help just the overall aging process?

Dr. Ronan Factora:

So establishing that routine of a good diet can be challenging. So making sure that you have access to the right foods, that you plan what you're going to eat during the week, that you have that meal plan. So getting the food is important from a dietary sample. But then, the planning part of setting up your meals, cooking, doing the work to go ahead and get those groceries. I mean, there's a lot of activity associated with planning and maintaining good nutrition. And it requires good mobility, it requires access.

And being active like that and making sure you take care of your own health has those secondary benefits of keeping you busy, keeping you stimulated, keeping you thinking about what you're eating, whether or not you're eating enough. And so there's an impact of just the planning on your cognition in terms of positive impacts here; on your mobility, in terms of positive impacts there. So there's a lot of other secondary reasons why making sure that you have a good diet can impact you beyond the diet itself. Just trying to go through the process of incorporating that into your weekly and daily routine already provides benefits.

John Horton:

Just learning new recipes. I mean, you kind of keep your mind engaged and do all that. Those are all things we talk about as being so beneficial as you get older.

Dr. Ronan Factora:

That's correct.

Julia Zumpano:

One thing I want to add to that is the benefit of preparing a meal and then sharing it with someone. So I also think, when you think of the Mediterranean diet or even just any studies that show positive outcomes from a longevity perspective, talk a lot about community. So I think when you think about eating, when I think about eating, I think about sharing that with someone. That's the benefit and the joy of eating. That's what I love about it, that you're sharing a meal with someone. And it also can enhance your cognition. It just overall leads to better mental health and longevity … is if you're planning these meals with someone else, if you have that ability. Whether it's a community center or church or family, friends, whatever community you have, it can also offset some of the task of cooking. You can take turns cooking meals and sharing them together. But I think that's something really important to note, too.

John Horton:

Yeah. Getting out and just being social is such a critical part of aging well. And you hear all the time worries about people getting a little too, almost, reclusive. You're not out, and you need that contact. And that can come, I think you said, by sharing meals, by going to the store. It seems like there's just a lot of benefits to it.

Dr. Ronan Factora:

Yeah, that's right. So the socialization, it helps to offset loneliness. It provides cognitive stimulation. It's going to be very helpful to help to prevent depression. So I agree with Julia. If you could find a way to make eating a communal activity, then that's just another benefit for kind of planning your meals.

John Horton:

Well, anybody who's older who wants to cook dinner, I am available to come over and have it. So I just want to throw that out there right now. You can start sending me the invitations through email.

Julia Zumpano:

I'll be there right with you, John.

John Horton:

So like I said, we've touched on a lot of things today. So as we wind things down, Dr. Factora and Julia, if there were one thing you want to make sure somebody takes away from this podcast, what would it be? And Dr. Factora, why don't you lead us off here?

Dr. Ronan Factora:

Sure. I mean, I think that the most important thing is that you have to have a balanced diet. But then, a corollary to that is that diet has to be accompanied by mobility and exercise. You can't separate the two. So the key thing is to, when you're thinking about your overall health and aging well, diet and exercise, diet and mobility, that is going to be how you're going to focus on trying to maintain your overall health.

Julia Zumpano:

My quick takeaway point would be food is medicine. I truly believe that from the bottom of my heart, that when you make a change, every little step, every little change you make toward the positive direction of improving the food choices you make that will support your body in so many different ways, will lead to so many cumulative benefits and health outcomes.

John Horton:

Yeah. And I know we've been kind of focused on as you're aging and things like that. And I feel like the one thing everybody should take away from this is, we are all aging. Whether we consider ourselves older or not is something different. But every day, you get a little bit older. And as you both pointed out, the sooner you start making these healthy changes, the better off you will be as you get into more of those twilight years.

So again, I want to ... Dr. Factora, thank you so much for coming in. You really just brought a lot out that I think can help people just live the best life as they age. And hopefully, as we said at the start, stay in their house and just really live life to the fullest.

Dr. Ronan Factora:

It was a pleasure. It was great talking about this. I think it's very important.

Julia Zumpano:

Thank you so much for joining us. Wonderful discussion.

John Horton:

So Julia, that was just a fabulous discussion. And I have to say, it really opened my eyes as to how every time I sit down for a meal, I'm making a little bit of a decision as to how I'm going to live later on in life.

Julia Zumpano:

I couldn't agree more. I mean, food is medicine, as I mentioned. I grew up with two older parents and two grandparents that were my support system. And as I watched them age and, unfortunately, die young, I made note that that's not the way I want to end. So everything that I put in my mouth, I think about how this is going to affect me later in life, every move I make, it really does make an impact. So you have the power to change your outcome.

John Horton:

Yeah. And it's those little things, and I know that was one of the points that we really made there. It's small changes that you can make just every day, just something minor that you do, but it can have huge effects as you go through time and if you keep doing these positive things.

Julia Zumpano:

Yes, small and cumulative. So continue to build off those small changes and continue to add and build and keep them going as long as possible, for sure. And then, you'll reap exponential benefits.

John Horton:

Yeah. Well, we definitely gave people a lot to build on today.

So if you liked what you heard, please hit the subscribe button and leave a comment to share your thoughts. And until next time, eat well.

Speaker 3:

Thank you for listening to Health Essentials, brought to you by Cleveland Clinic and Cleveland Clinic Children's. To make sure you never miss an episode, subscribe wherever you get your podcasts or visit clevelandclinic.org/hepodcast. This podcast is for informational purposes only and is not intended to replace the advice of your own physician.