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December 15, 2010
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In the Caregiver's Words

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If you’re like me, you may have had moments when you’ve looked at the latest clinical information on the health benefits of dark chocolate, and your first response is, “But I don’t like dark chocolate.” What’s a milk chocolate lover to do when dark chocolate gets all the good press, and it seems the only benefit you get from milk chocolate is that it tastes…well…really great! Good news, milk chocolate lovers, new research is pointing to overall health benefits for milk chocolate that include it’s ability to fend off dementia and more. Disclaimer here, when we extend the benefits to milk chocolate, it’s about “minimally-processed milk and powdered varieties” of chocolate. So, read the labels, but be prepared for five health benefits:
1. As with dark chocolate, our milk chocolate intake is part of an overall healthy diet that can reduce the risk of heart disease. Research has shown that adults who even eat a bit less than an ounce of chocolate daily are less likely than those eating no chocolate to develop heart disease. Researchers haven’t pinpointed what the mechanism of action is, but the outcome is real.
2. The antioxidants in chocolate help to defend your blood vessels against plaque buildup by reducing low density lipids – the bad cholesterol. Dark chocolate has an advantage with its greater concentration of stearic and oleic acids, but the less-processed milk chocolate also confers an advantage.
3. Especially if you have high blood pressure or a family history of hypertension, chocolate helps blood vessels to dilate without damaging the vessels, because of the flavonoids all chocolates possess. Improved blood flow means lower blood pressure.
4. Research from Harvard Medical School has found that this blood flow improvement is important to the areas of the brain associated with higher cognition. In other words, chocolate improves mental acuity and memory, but …the good news…you need to consume chocolate daily to optimize the effects.
5. Scientists at the University of Copenhagen found that people consuming chocolate, particularly dark chocolate, had reduced cravings for non-healthy salty or sweet or fatty foods. Who would have thought that chocolate helps promote a healthy diet overall.
Five benefits (and yes, dark chocolate does have an edge over milk chocolate) are a pretty good return on your dietary investment. And you can’t overindulge and expect positive results, but a bit of chocolate-induced happiness has more benefits than just a happy palate. Charlotte Bishop is an Aging Life Care Advisor, Geriatric Care Manager and founder of, certified professionals who are geriatric advocates, resources, counselors and friends to older adults and their families in metropolitan Chicago. She also is the co-author of How Do I Know You? A Caregiver’s Lifesaver for Dealing with Dementia.
There are a lot of tests and exams we all know that are important to catching a condition early on or in some cases even before it appears. We know at what age and how frequently to have a colorectal exam, we know to go to our dentist twice a year, our personal physician once a year and a whole host of other regularly-scheduled tests to maintain our health and well being. And then there are the more subtle indictors… subtle because they progress quite slowly and it may be difficult to discern at what point we really do need to have our vision tested, our hearing assessed or our balance scrutinized by a health care professional.
But how many of us notice when our host’s kitchen doesn’t smell wonderful when we arrive for a dinner party, or when the roses are worth stopping to smell or when it is time to take out the trash…I really mean past the time to get the garbage out of the kitchen? And how many of us give a thought to how important our olfactory sense is for not just enjoying what is in the air all around us, but also a very good leading indicator of our living or dying? In an analysis of more than 20,000 patients in a number of studies - this is called a “meta-analysis” - scientists have found that “olfactory impairment,” or loss of smell, statistically predicts risk of dying. There was a lot of news early on in our COVID-19 pandemic about the loss of smell among those infected by the virus. But that was not predicting mortality; it was a side effect of the infection. The scientists who conducted this meta-analysis across a number of clinical studies found that not only is loss of smell linked to a number of chronic diseases, it’s also a general leading indicator of death, especially among older adults. It is enough of a worry that these scientists have now given this condition a name, “olfactory impairment” (OI). (Of course, they give it a label…) As many as half of individuals age 65 to 80 years have OI, and it is linked to a number of nutritional, neurodegenerative, cardiovascular and immune disorders. This is not to say that loss of smell causes these other life-threatening disorders, but the link is statistically clear. It’s not just about being able to stop and smell the roses; it’s about catching a potentially life-threatening medical condition in the early stages when it can be more productively addressed. If you or an older loved one seem unable to discern an odor that others around can smell, the OI may be nothing to sniff at. Want to read more from the scientists who have been investigating this condition, click here. Charlotte Bishop is a Caregiver Coach, an Aging Life Care Advisor, a Geriatric Care Manager and founder of Creative Care Management, certified professionals who are geriatric advocates, resources, counselors and friends to older adults and their families in metropolitan Chicago. She also is the co-author of How Do I Know You? A Caregiver’s Lifesaver for Dealing with Dementia.
If you are a caregiver to someone with diabetes - Type 1 or Type 2 - then you know that one of the biggest challenges is the fact that food seems to have become the enemy to a diabetic. The difference between Type 1 and Type 2 diabetes is that the former requires insulin to manage blood sugar levels. Type 2 diabetes, the more common of the two, can be managed by diet and/or oral medications. Both require a rethinking of food, however. And if you are caregiver to a diabetic, you may find it most challenging to help your loved one with the food side of the equation, but here are three tips that can make this manageable medical condition also a bearable medical condition.

1.    Don't Manage Diet with No's. Too often it is easy to think of all the foods that a diabetic cannot eat, because they contain sugar. According to professionals who work with diet, they suggest making the whole household's diet healthier. Rethink how you prepare or coordinate meals for everyone so that you are incorporating more complex carbohydrates, more fruits and vegetables along with protein. You should limit, but you do not need to eliminate, foods like cake. Make them special occasion foods, instead of every meal foods.

2.    Portion and Convenience Control. A lot of the excessive intake we all are prone to is because we don't think about proper portions. We make a bag of microwave popcorn, pour it all in a bowl and head for the TV. Instead, we should take a serving dish of the stuff and stop when done. Snack food tends to be high in sugar and salt, so make your own convenience foods. Package in small containers some baby carrots or unsalted nuts or something else that can take the edge off your loved one's hunger until meal time.

3.    Get up and Move. To get a diabetic to exercise, appreciate that they will not respond to a drill sergeant approach. Don't nag. ask them to join you for a walk. Put an exercise bicycle in front of the TV - or a treadmill. Buy a pedometer to record how many steps each day a person logs, and work toward 5,000 steps and then 10,000. Set a time goal of a 30 minute minimum, and have alternatives to walking for the days the weather may be uncooperative like mall-walking. (Many stores open early just for "mall walkers.")

      The way to gauge success long term is by monitoring long term A1C. Blood glucose can swing rather widely based on how recently a person has eaten, but the long term blood sugar measured by A1C should stay as far below 6% as possible. And remember that this is a long term measure just as the changes in diet and physical activity should be long term changes for the better.

            Charlotte Bishop is a Geriatric Care Manager and founder of Creative Case Management, certified professionals who are geriatric advocates, resources, counselors and friends to older adults and their families in metropolitan Chicago. Please email your questions to ccbishop@creativecasemanagement.com.
As our loved ones grow older, we probably are more acutely protective of their health and well-being, especially if we are in the role of caregiver to that loved one. We may even accompany them to a visit with their providers, or make a visit to the hospital is they are hospitalized Which of the following do you think is the greatest threat to your older loved one’s life: 1. heart disease 2. cancer 3. chronic lower respiratory diseases 4. Alzheimer's disease 5. Stroke 6. Ageism If you checked heart disease, the U.S. Census bureau would say you’re right, and the rest of them in order are smaller, but significant risks as well. But ageism takes a largely unseen toll on older adults. In a longitudinal study of a large sample of older adults, those who had a positive perception of aging lived an average of 7.6 years longer than those who did not. Where did they get this impression that could result in an early death? So, what constitutes ageism? One of the answers is in the care they receive from health care providers. If you are a caregiver who has accompanied mom or dad to a doctor’s visit, did you notice: • How much did the doctor maintain eye contact with you versus your love one? • How many times did anyone in the office refer to your older loved one as “dear?” • How thorough was the exam versus what you, yourself may have experienced? • How many additional tests were ordered for your loved one? All of these are signs of ageism. And then there is the cascading of one effect amplifying another. The last one about testing is quantifiable. Medicare is going to pay for the tests, so less thought may be given to ordering tests. In a study in 2018 Yale researchers were able to document that ageism accounted for about $63 billion a year in unnecessary tests in the United States. More tests and they will die younger simply because they are given the impression they are older? Young people don't need tests. Not just feel older, but less viable. Their age becomes a filter through which others view them and consequently treat them differently than folks who don’t have as many birthdays. So, the next time you accompany your older loved one to the medical visit, try these responses to the above: • Doctor, I am just here with mom/dad, please talk with her/him while I listen. • His/Her name is _____ (fill in name)! • Doctor, is it important to also check _____ (missing test or question)? • Doctor, I don’t recall these tests in the past; why are they needed? Charlotte Bishop is a Caregiver Coach, an Aging Life Care Advisor, a Geriatric Care Manager and founder of Creative Care Management, certified professionals who are geriatric advocates, resources, counselors and friends to older adults and their families in metropolitan Chicago. She also is the co-author of How Do I Know You? A Caregiver’s Lifesaver for Dealing with Dementia.
We’ve all heard someone explain…typically referring to that paunch around our middle…that their “metabolism has slowed” from what it was when they were younger. There are changes that accompany everyone’s journey from teens to middle years and beyond, but our metabolic rates aren’t a big part of the change. In fact, the resting metabolic rate (RMR) of humans doesn’t change much from our early years in the mid-20s to as old as our 40s and 50s. Metabolic change really begins to trend slower about age 60 when the cellular metabolic rate begins to trend down about .07 percent a year…it will take about 14 years for the metabolic rate to decline by one percent. But what changes? Well, the human body is constantly at work breaking down muscle as well as building it up, but an older body requires a higher threshold of protein consumption to kick the muscle-building apparatus into gear. This happens at the same time that older adults’ appetites may be waning. The “younger you” could build muscle from a breakfast that included a couple eggs…about 12 grams of protein, but if you are 60 or older your body needs a bigger signal to turn on the muscle-building machinery. In fact, it takes about 25 grams of protein to get things in motion. And breakfast is the best time of day to kick the machinery into motion…for the whole day. The consequence if one doesn’t give the body’s machinery the right protein cues is a consistent decline in muscle mass, as much as 3 to 8 percent decline per decade. The cycle continues also to create more fat instead of muscle if we don’t hit the protein manufacturing threshold. And other ill effects can kick in. Because muscle cells burn more energy than fat cells, a shortage of muscle cells leaves more sugar in the stream which both build more fat and overloads the pancreas as it tries to process the sugar. And you know the rest of that cycle – it’s called type 2 diabetes if carried too far. Talk to your older loved ones about getting more acquainted with where their protein is coming from and in what quantities. A useful bar to set would be about 25 to 30 grams of protein consumed at every meal every day, but especially breakfast. Compliment the protein with colorful fruits and vegetables which will add inflammation-fighting to their diets. Top all this off with fiber, not dessert. The best sources of fiber are in the legume and related families of food. The rest is strength training. I recall a human-interest news story from some time ago in which a WWII vet was talking about his secret – 20 push-ups a day and 10,000 steps. He continued to be in great shape, and a great role model for all who wish to live well in order to age well. Charlotte Bishop is a Caregiver Coach, an Aging Life Care Advisor, a Geriatric Care Manager and founder of Creative Care Management, certified professionals who are geriatric advocates, resources, counselors and friends to older adults and their families in metropolitan Chicago. She also is the co-author of How Do I Know You? A Caregiver’s Lifesaver for Dealing with Dementia.
To answer your first question, Fisetin (pronounced fy-set-in) is a flavonol which is a class of flavonoids found in a number of plants and fruits or vegetables. They are antioxidants, and you may have seen some of the research on the flavonols in chocolate that are thought to help patients with mild cognitive impairment. Some other common sources of flavonols are onions, kale, lettuce, tomato, grapes, berries, tea and red wine. One of the rules of thumb is the greener the leaf, the more of the flavonols the plant will contain. Back to fisetin. Some researchers at the Salk Institute for Biological Studies have published some scientific work based on animal studies that show promise for fisetin's ability to protect the brain's memory from the inexorable degradation of Alzheimer's disease. They have done this in mice, and the scientists think that fisetin has a neuroprotective capability that helps the memories of mice in laboratory tests. The clinical test used three groups of mice. Two groups consisted of what are termed double-transgenic Alzheimer's disease (AD) mice. The third group was the control, and these mice did not have the Alzheimer's transgene. Mice in one of the first two groups were fed fisetin at three months of age until they were nine months old. The other group received no fisetin. Scientists use a water maze as a standard test of mouse learning and memory. The mice without the fisetin did not perform well in the mazes. Those who had been fed the fisetin, however, performed as well as the mice in the control group. Tests were repeated again at 12 months of age, and the results were very much the same with the fisetin mice doing as well as the control mice. Researchers are not prepared to jump immediately into human subject trials, but there is work underway to better understand at the molecular level how fisetin may be working on mouse brains. Ever hopeful, the scientists are also investigating whether fisetin offers any hope of actually reversing the neuro-degradation of AD. What do we take away from this research? Well, animal studies cannot provide a sound rationale for all caregivers to go out and stock up on fisetin rich foods to help an older loved one forestall Alzheimer's progression. But is it a good idea to encourage your older loved one to consume foods rich in antioxidants? probably yes, but as with any dietary, activity or medication change, always consult with your loved one's provider. Charlotte Bishop is a Geriatric Care Manager and founder of Creative Care Management, certified professionals who are geriatric advocates, resources, counselors and friends to older adults and their families in metropolitan Chicago. Please email your questions to info@cr eativecaremanagement.com.

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