#626: Practical Diet Considerations for Healthy Aging - Prof. Charlyn Black

0:00Danny Lennon: Hello and welcome to Sigma Nutrition Radio. This is episode 626 of the podcast. My name is Danny Lennon. You are very welcome to the show. Today we're going to be taking a look at some of the considerations related to the large topic of healthy aging. And in specific, we're going to be thinking about what parts of the aging process are inevitable, what aspects are more modifiable. and then of those modifiable factors how do lifestyle and particularly diet play a role here so while there's general dietary patterns that are going to be useful over the whole life course in order to reduce risk of chronic disease over time we also might have changes in energy requirements the difficulties in trying to consume enough overall nutrition and therefore there might be certain nutrients that might be worth placing some emphasis on and so to discuss this I'm going to be talking to Professor Charlene Black, who is a longtime health services and policy researcher that was based at the University of British Columbia, has done a lot of work in a whole range of areas, not only in health services, policy administration, but also prevention of chronic disease, and then has more recently taken an interest in some of these lifestyle aspects, specifically related to nutrition, and how that ties into healthy aging and some of the considerations that occur over the life course and then think in very practical terms what are some of the things that are worth paying attention to if you are a sigma nutrition premium subscriber you will get your detailed study notes to accompany this episode available at the episode page so that will be linked in the description where you're currently listening right now you'll also get a fully edited transcript of this episode if you're listening on the free public feed of the podcast that are interested in getting more out of your podcast listening and using this as an educational resource to not only get deeper, but also to be able to revise the content more efficiently, then check out what we offer with our premium subscription.

2:02Danny Lennon: In addition to those study notes, you also get premium exclusive episodes every month. You get the ability to ask questions, which we answer in our AMA sessions and more advantages. So check out what that offers. And of course, that is the direct way to support the podcast. So if you are a regular listener of Sigma Nutrition and you do want to do that, then please check that out and thank you in advance. But for now, let's get into this conversation between myself and Professor Charlene Black.

2:42Danny Lennon: Here we are. A very big welcome to the podcast to Professor Charlene Black. Thank you so much for taking the time to come and join me today. Thank you very much for this opportunity. I'm very much looking forward to talking about this, not only because of the importance and interest in this topic right now, but also from some of the perspective you'll be able to bring to it. But before we get into the specifics of our discussion here today, just for people listening, can you give them an idea into your academic background, any of your research interests, what you've been involved in and then maybe how all that feeds into some of your more recent interests and how you're applying that as well well it starts i guess as a very at a very young age i had a really big interest in prevention i started teaching yoga at the age of 16 after watching my mom be able to reverse her arthritis so i was fascinated with that went into medical school hoping to combine yoga medicine but that was the dark ages and there wasn't any scientific evidence.

3:41So I poured straight into medicine, went into teaching roles. And I have this insatiable curiosity to learn more. I started taking courses in what was then called social and preventive medicine. That led to a residency in public health and preventive medicine. And as part of that, a doctor of science at Johns Hopkins University in theory of health policy. So I consider myself more of an accidental academic. I loved medicine, but was able to bring my understanding of medicine to my academic career. I was, I guess, very early on in developing the use of administrative databases to study patterns of health and healthcare using the population-based administrative data.

4:32And so data had always been a big interest to me and how to use data to tell important stories, especially to influence policy, was a major, major interest of mine. So ended up as co-director of a research center in Manitoba, Canada, was recruited to UBC to be a director of a research center at the Center for Health Services and Policy Research at UBC, and have had administrative roles. But teaching really at the graduate level for all of the rest of my career, sometimes medical, but mostly at the graduate level teaching. And I guess more relevant to this is, of course, two courses. One was research methods, really helping PhD students formulate a strong research question.

5:23And then the other is, of course, I recently reframed on addressing the epidemic of chronic disease.

5:31Danny Lennon: And when we think of the concept of prevention and some of the big challenges at a population health level right now. You mentioned chronic disease burden still being at the forefront of that. And really one of the best ways to get to grips with just how much of a problem we're facing is when we look at some of these large population level data sets and also some of the health service data that you would have worked with as well. What is your sense of those connections that you were able to make over time and how that's informed your view of the type of challenges we're facing at a population health level right now, if that makes any type of sense.

6:07Well, I think from a public health perspective, we've seen a shift from the prevalence shifting from infectious diseases to this incredible increase in the burden of chronic diseases, or as the WHO calls them, non-communicable diseases. I mean, they're just anon, but they represent the major causes of morbidity and mortality, especially in developed countries, and have been increasing over time. So, you know, I think I became interested in this. I guess there was a report we did in 2006 in British Columbia looking at patterns of chronic disease and comorbidity that was really revelatory to show just how much of our health care system dollars are spent towards these later impacts.

6:59And as I hope we'll talk about, many of them are preventable, both by focusing on individual approaches, but also thinking about the environments we create and we support that either support us or make it harder for us to make healthy choices.

7:16Danny Lennon: One of the things we're going to discuss throughout some of this conversation relates to maybe a broad topic that we could call healthy aging. But of course, that covers a whole range of things and we might need to distinguish between those. But it seems that one core part of that relates to this prevention, or maybe a bit more accurately, the delaying of some of these chronic disease developments over time. And therefore, the longer we can push that off would signify a healthier degree of healthy aging. But from that broad perspective, when we think of this concept of healthy aging, for you, what does that encompass?

7:52Danny Lennon: What's maybe the best way for us to conceptualize what healthy aging even is? You know, the gerontological literature talks about this in many different ways. It's been talked about as successful aging, that kind of thing. But I think from my perspective and data perspective, we can easily measure lifespan and how lifespans have changed over time. And in general, our lifespans have increased. But I think it's worth thinking about this concept of health span. And how many of those years do we spend in good health, that is, without functional impairments, disabilities. How many of those years do we feel like we're really in good health?

8:32And the data shows that health spans have not kept up with the increases in lifespan. So in fact, that delta, that difference between the lifespan and the health span has actually been increasing. And I think some of the most recent data I've read shows that it's increased to 14 years that most people live in the United States in, you know, in functional decline or with chronic diseases. So what's important to prolong our lives spends, but how do we want to spend those years? And, you know, the evidence suggests that a lot of this is pretty presentable, but it's obviously a very complex area.

9:09Danny Lennon: You mentioned that many of these seem to be modifiable to a large degree, which gives us then the whole impetus to start looking at dietary and lifestyle changes. I I think this is probably important because maybe sometimes with the conversation of some of the health decline that tends to occur, let's say on average with advancing age, people just simply put it down to age. And of course, that is a risk factor. But as you've noted, if most of these are modifiable, then it's not necessarily that they're age driven alone. Can you maybe distinguish that for people of what are some of the types of things that are substantially modifiable that maybe sometimes people just put down to, well, that's just aging, that's the way it is, as opposed to we can really modify this with some of the types of interventions we might discuss?

9:58Yeah, I think you've hit on something really important here, is that, you know, what are the features of aging that happen regardless? And then what are the features of, you know, sometimes that's called primary aging, what are the features that, you know, can be modified. So, you know, if we think of, you know, so we can distinguish between this sense of primary ageing, the things that happen to everyone, even those who, you know, have the best, healthiest lives, and secondary ageing, which is the decline driven by, you know, disease, behavior change, and our environments. So a lot of what we usually call, you know, getting old is actually the second kind that, you know, our environments, our behaviors really make a difference.

10:44So, I mean, some changes do appear to be intrinsic and kind of under the hood. As you know, as you can tell, I'm in my senior years. And, you know, there are things we do notice, like our eyes change. We can't read small print. We, you know, oops, a little creaky going up the stairs. A few more aches and pains. There are things we do notice. But under the hood, physiologically, there are a number of other changes. So maximum heart rate falls, lens of the eye stiffens, cataracts, immune function wanes, you know, things like stomach acid decreases. So there are all sorts of changes that happen regardless.

11:24But in, and, you know, those declines are not as preventable. They're things, if we understand them, we can perhaps make some adjustments to address them, right? Wear eyeglasses, hearing, or hearing declines. hearing aids, things like that. But in other systems, the average decline is far steeper than biology suggests. And muscle is the classic example. So there are classic studies that show that, you know, we start to lose muscle fibers, I think, after our 30s, and especially fast-twitch fibers. But among seniors, much of the loss is about disuse. It's not aging. And there was a JAMA study that showed that frail nursing home residents around age 90 actually made large strength grains after just eight weeks of resistance training.

12:22So even at age 90, it's still possible to get back strength and muscle fibers. And then another really important one is dementia. And this is one that scares many, many people. But a recent Lancet Commission report suggested, estimated that about 45 % of dementia cases are linked to modifiable risk factors such as hypertension, hearing loss, and physical inactivity. So 45 % of dementia is potentially modifiable.

12:50Danny Lennon: That's pretty profound. So that, you know, aging sets the direction, but behavior in our environments kind of determine the slope of decline. And the interventions with the greatest impact and strongest evidence are not exotic ones. They're healthy diet, physical activity, avoiding risky substances, controlling metabolic pressure and metabolic risk, sleep and social connection. They're not pills and supplements. There are things that do require some conscious effort, but and the extent to which our environments make it easier or harder for us to follow that guidance is really an important issue.

13:35Danny Lennon: One of the things that relates to how some of those lifestyle factors, including diet, will influence some of that chronic disease risk, and particularly when we think about healthy aging, maybe one of the traps that we can fall into sometimes is thinking about, well, healthy aging, it means what are the types of things we should be doing in later decades of life? Whereas really, there are a number of examples we can think about where that is predicated on that process starting earlier in life. Probably one of the classic examples I tend to think of is around atherosclerosis, where someone may have events later in life, but really from your 20s were starting to accumulate some of that atherosclerotic plaque burden, and that of course relates to diet.

14:19Danny Lennon: So what do you think is maybe the right way for people to think about that time horizon for how nutrition and lifestyle ties in with healthy aging, and essentially how early in adulthood should we be thinking about some of these behaviors as it relates to, as you mentioned, health span, healthy aging, etc.? I think the evidence shows that many of these changes start very early. They're cumulative in effect. And so often we're going many years with underlying changes that we don't recognize or aren't recognized for standard medical testing. And, you know, sometimes people find out that they have these conditions as they're calling an ambulance late, you know, in their 60s.

15:04There's, I think, remarkable evidence showing that evidence of atherosclerosis starting quite early. And there was a recent article that talked about prevalence. The REACT study published in the New England Journal in August 2026 imaged coronary carotid and leg arteries of 17 ,000 adults in Denmark and Spain who had no cardiovascular disease and over half had silent atherosclerosis. It was already present in about 1 in 13 people aged 18 to 29, in a third of men and a fifth of women in their 30s, and in about 9 and 10 in their 60s. So men are earlier on the trajectory, but women show a steep rise around menopause when estrogen levels decline.

15:50So, you know, we have evidence that these are starting early, and I've seen recent guidance that we should be screening children for cholesterol. I mean, really, some of it is genetic, but we have seen changes in levels at earlier and earlier, the ages of some of these metabolic risk factors. So obviously, the earlier we start with healthy patterns, the better. But the point is that even if you find out you have not only a high level of risk, but an actual condition, there's more and more research that shows that we can actually reverse or at least attenuate the progression of many of these chronic conditions, even if we start later in life.

16:38So the message is it's never too late to start, and that you can make really profound differences in how your later life proceeds and how healthy you feel, how much bigger energy and vitality you have, and how much you can stay away from doctors and medical care.

16:58Danny Lennon: That's such an important point that obviously the earlier we start the better, but at any point of starting there's never a point of ultimately being too late. There's always these things where we can see really profound changes as I'm sure we'll discuss a bit later. There's probably some specific aspects of diet to discuss, but if we first think just of a broad level, you mentioned healthy diet being one of those. So if we think of the types of reductions in chronic disease that we are interested in, the types of things that would support some of the healthy aging we've discussed, what are maybe from a dietary pattern level, some of the things we are most confident on from the evidence that would purport benefits?

17:39Yeah, from my perspective, the most consistent finding is that several named dietary patterns converge on the same core issues. Plenty of vegetables, fruit, whole grains, legumes, nuts, and unsaturated fats. And then avoiding for sure processed meat, which is a carcinogen, sugary drinks, refined grains, and keep your sodium levels manageable. I've recently worked with two nutritionists, and we've just put together a book, Plant Powered Seniors, which talks about some of these. But I think that there are many ways to think about adding more plants. So the message for me is add more plants to your diet.

18:21If I was still in medical care, I'd say however way you can sneak in more plants, the healthier you'll be. Plants have so many things. They can bring a very high quality of protein, fiber, phytonutrients. So the more plants we can bring into our diets and make them enjoyable, delicious. Learning to make a few recipes that help us. A high-quality plant-based diet can improve cardiometabolic health. It can support our microbiome. And, you know, the strongest causal evidence is for the Mediterranean diet, which is very much based on those things. But I think one of the things I'm digging into is, the different ways in which the Mediterranean diet is operationalized.

19:08Because my understanding is that even in Mediterranean areas, their diets are shifting. And so people's understanding of traditional Mediterranean diets is kind of limited. So this is an area I'm digging into is, you know, how do we measure and understand healthier Mediterranean diets? Because from my perspective, these can exist on a spectrum. Nonetheless, that's where I think the strongest causal evidence is, but these have been shown to reduce mortality and morbidity as well. But there are obviously vegetarian and vegan patterns. One of the most important things if you're moving towards a plant-based diet is, you know, the quality of the diet.

19:49So how do you build a really healthy diet is important. And this becomes even more important as we age because there are some changes in our nutritional needs as we age and we have fewer calories to get them in. So nutrition becomes very, very important as we move into our senior years.

20:10Danny Lennon: So there's a couple of things maybe to recap for people. We have this pretty robust evidence on some of those aspects of a dietary pattern that you note, purport, benefit really for all ages and throughout life in terms of healthy overall diet, lower chronic disease risk, those things around higher fiber intakes, more plants generally in the diet. And then we have distinct different types of dietary patterns, whether we're looking at some of these Mediterranean dietary patterns or vegetarian or completely plant exclusive patterns. They have quite a few things in common. There's a whole other rabbit hole we could go down around a Mediterranean diet.

20:45Danny Lennon: And is that one exposure? Because it can be an umbrella term for so many different things. But we have these commonalities that you mentioned from that level. The second thing that you mentioned, maybe we can drill into now is that while we have those clear principles about long-term that really everyone can kind of follow, there are some specific considerations over the life course where some of those nutrient concerns may change and may be things we need to be a bit more present with. You mentioned around overall caloric intake and maybe nutrient needs or nutrients of concern. From that level, over time, what do you think are some of those changes that we need to be aware of?

21:23Danny Lennon: what are some of the most pressing things that happen over time that we might need to pay some attention to? I will say that there are changes that we need to pay attention to regardless of the type of diet we're on, whether it's omnivorous, Mediterranean, vegetarian, vegan. As we move into our senior years, I guess the concept of nutrient density becomes really, really important. And that's, you know, the amount of essential nutrients a food provides relatives to its energy content, You know, vitamins, minerals, phytochemicals, protein per calorie. The concept is intuitive. Some foods deliver a lot of nutrition for their calories, but others very little.

22:02And this matters as we age because there's a mismatch. Energy requirements fall as we head into our 60s, right? We're moving less. Our muscle volume is declining. We're just not spending as much time moving as we did in earlier years for most people. but our requirement for most micronutrients don't fall and for several they actually rise so an older adult has to meet the same or higher nutrient targets from fewer calories which leaves a lot less room for nutrient poor foods and you know as we age it can get harder to cook to get our meals so this is a really really critical issue for aging in health now on top of that The aging physiology makes some nutrients harder to obtain.

22:51I'm going to highlight about five of them that I think are really worth paying attention to. The first is vitamin B12. And this has always been true for people who are following plant-based diets, that they should supplement with B12. But with age, atrophic gastritis and reduced stomach acid affect somewhere between 10 % and 30 % of older adults. And this impairs the release of B12 from food. And that's why the Institute of Medicine recommends that people over 50 get most of their B12 from fortified foods or supplements. And so some medications can also compound the problem. So even omnivores really should pay attention to their B12.

23:31And this comes as a big surprise because it can, I know my brother was diagnosed with a B12 deficiency and he's an omnivore. So the second is vitamin D. And, you know, our aged skin produces far less vitamin D from the same sun exposure. And I think in general, in life, we're getting less sunshine. We're not outdoors as much as we used to. So vitamin D is a really critical issue for people as we age. And the next one is calcium, where the absorption efficiency declines and the recommended intakes rise to about 1 ,200 milligrams per day. I think most people end up getting about 600 from food. So it's useful often to supplement with calcium supplements.

24:15but it's not well absorbed as a big bolus, so it needs to be distributed throughout the day. Fourth is protein. Protein's big news these days, but this is really important for seniors. Older muscle shows anabolic resistance. This means it needs more protein per meal to stimulate synthesis. And some of the stronger gerontologic research recommends 1.0 to 1.2 grams per kilogram of healthy body weight per day, well above, you know, the standard 0.8. But, you know, changes in appetite, seniors can lose appetite, can feel like a lot to eat. Changes in dentition and cost often push intake the other way.

24:57So getting enough protein in healthier forms. I mean, plant-based proteins really do show some advantages over animal protein. And then the last one I'd mention is omega-3s. And I think this is an emerging area, but, you know, especially for cognitive health, it's worth testing your levels. And I'd say, you know, for calcium, vitamin D, and omega-3s, it's worth testing your levels. For omega-3s, we do get some long-chain omega-3s from flax seeds, etc., but our body doesn't convert them to the longer-chain omega-3s, EPA and DHA. Those are being shown increasingly to be important for cardiovascular and brain health.

25:36And then And other gerontological data has shown common shortfalls in magnesium, selenium, thyme, and riboflame. So the practical message is, you know, how do we build diets that can make sure we're getting all of these nutrients? So what we recommend in the book is vegetables, five plus servings per day, fruits, three plus servings, grains, two plus servings, legumes, three plus servings, and nuts and seeds, one or more servings a day. And so, you know, I think if you can think of how you develop your plates and over the day, if you can kind of hit those targets, you'll have a much healthier diet.

26:16And then we also talk about the supplements that we think are important to add on and how to distribute them. So, you know, thinking about how to put this together can feel a little daunting. But, you know, there are ways to make breakfasts have more protein. There are many, many ways to do this. But I think one of the most important things is to find a few things that work for you, that are easy to do, that taste delicious. There are ways to do this that I think are really quite easy once you get, once you understand and get into a ribbons. Some of the best ways are tofu tempeh. And tempeh has the advantage of being a fermented food, which is great for our microbiome.

26:57And these sources, beans, legumes, nuts and seeds even, have come with other benefits compared to red meat, even chicken.

27:06Danny Lennon: Particularly in the context of, as we mentioned earlier, that we're not just looking at this as providing that protein. If we look at this from a chronic disease risk perspective and we look at a number of those different substitution analyses for plant proteins versus animal proteins, we see how they can have impacts there. typically even those sources you mentioned a lot of them come with extra fiber if we're talking about lentils and beans and so on so one other area that many people think about in this context relates to bone health and this also connects to some of the nutrients you mentioned a bit earlier specifically you outlined vitamin d as one that people can bear in mind the role of calcium obviously those have implications for bone health as is physical activity again can you maybe expand on that a bit for some of the things people should be aware of related to bone health, and then what we might be able to do from this nutrition and lifestyle perspective.

28:03So our bones are a living matrix with comings and goings, you know, building and removing tissue all the time. The big issue is that older people are at higher risk of fractures and osteopenia, which is a loss of bone, osteoporosis, which is a diagnosed condition that we treat in medical care. And the risk is that as we age, we lose balance and can fall more easily and can break things more easily if we're deficient. So, I mean, that's why it's important as seniors to really pay attention to our bone health. So I want to just start with that. But vitamin D, there've been three large trials at all that supplementing generally replete adults.

28:47It doesn't reduce fractures, but we can actually do some harm if our vitamin D levels are too high. So we, you know, we need to be very careful in how we supplement with vitamin D. The same is true for calcium, that low calcium can be harmful, but high can also have some risks. I think it's really important, especially for vitamin D to get, if you can, to get your levels tested and to see if you You can find how much supplementation do you need, and is it different in winter than summer, for instance, to adjust your vitamin D. But getting these things, vitamin D, calcium, protein, is also important for bone loss.

29:26It used to be thought that, you know, protein leached calcium from bone, but that hasn't held up. So meta-analyses show neutral to modestly positive effects on bone density, and cohort data link higher intakes with lower hip fracture risk, provided calcium intake is adequate. So these things have to work in concert and are really, really very important. There is some evidence that does show that vegetarians and vegans have lower bone density and may be at higher risk. And this may be due to a bunch of different factors. Not enough of these nutrients as we age, but also these populations tend to be a little lower in weight.

30:07And obviously for our bones, weight-bearing exercise is really, really important. So both for the earlier message we talked about, about protein, movement and resistance training is especially important for our bones and for preventing the risks of bone loss that come with aging. High impact movements are really, really critical. So it's not just nutrition, right? We can eat all the protein we want, but not put on muscle if we sit on the couch. similarly we can you know take in lots of calcium but unless we're doing things to actively maintain

30:44Danny Lennon: our bones and that's a big yeah very much mirrors the picture with healthy muscle function as well that really that stimulus is from activity and they're the nutrition components are maybe just supportive of that just as we're coming to wrap up here professor black before we get a very final question is there anything else that maybe we haven't mentioned that you particularly want to weave into this conversation or let people know about? I mean, I guess my passion is, you know, we've talked about the changes individuals can make. And these can be really, really challenging, right? How do people get correct information?

31:20How do they put it into action? How do they sustain change over time? These are all huge challenges when we focus on individual level education. You know, in the public health area, we talk about this as health promotion. Rah, rah, you can do this. But what I think we really need to start thinking about is how do we build the policies and supportive environments that can help us make these changes? And, you know, I mean, if you just look around our environments and you look at the toxic food environments we live in, you know, fast food, you walk down the street and you see fast, unhealthy food.

32:00You know, our supermarkets have become, you know, largely purveyors of ultra-processed foods. How do we change these environments to actually support, to develop places that make it easier to move, easier to get healthier food? So that can we think about these larger policy changes? So that's, I think, a really, really important feature that I'm very interested in promoting.

32:25Danny Lennon: and certainly that could be and should be a whole conversation in and of itself of things we can do on some of that public health policy perspective and maybe that is certainly for another time but before we get to my final question let people know about some of the scientific dissemination that you have where can they find more information about the work you're doing and anything else that you want to mention to them this area is a recent passion as i have just retired in june so i i do have a LinkedIn profile, but in publishing the book, it's called Plant Hard Seniors. You can find information about it on the website plant-howardseniors.com.

33:04It is an area that fascinates me. And I think I do want to really start focusing on how can we advocate for policy change.

33:12Danny Lennon: I'll link to that in the description box where everyone is listening right now. So you can click through and check that out. With that, Professor Black, that brings me to the final question that I always end the podcast on, which if you wish can be completely disconnected from anything we've discussed today. It's quite a big, broad question. So apologies for putting you on the spot with it, but it's simply, if you could advise people to do one thing each day that might have a positive impact on any area of their life, what might that one thing be? That's challenging. They're tied together. So, you know, I guess I'd say add more plants to your diet, but I'd love to add some additional things pay attention to your circadian weirdo many many other things get some sunlight get outdoors move yeah get involved with other people and keep active thank you so much for giving up your time first of all for walking us through some of your thoughts and perspectives on this area and for sharing this information it's been a real pleasure to talk to you very much it's been a pleasure to talk to you too

34:27Danny Lennon: thanks so much for listening in to today's episode before you go i just wanted to remind you about sigma nutrition premium our subscription for those of you podcast listeners who want to significantly deepen your understanding of nutrition science and become truly confident in your knowledge so what's the idea of this subscription essentially it was created with the goal of allowing you to more deeply understand the material you're hearing on the podcast episodes themselves, to be able to retain more of that after you've finished listening or reading through the notes, and then be able to easily and efficiently revise over that so that in the future you can be able to remember that information, to be able to reuse it, to be able to create your own content or ideas using things that you have learned.

35:14Danny Lennon: And how do we go about this? Well, there's a few different ways, but at the core of the subscription is our detailed study notes that you get to each episode that is full of useful descriptions, background context, diagrams, charts, etc. to allow you to more deeply understand some of the concepts that were mentioned throughout that particular episode, as well as in linking them back to previous episodes. You also get the segments at the end of each episode called our key ideas segment, where I recap certain key ideas. You get episode transcripts. You get then a number of premium-only episodes.

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36:22Danny Lennon: We don't run ads, we don't sell supplements, anything like that. So your support is what allows me to continue to do this. So thank you for that. I hope you do come back for the next episode regardless. And until then, have a great week, stay safe and take care.