The Fourth Meal Blue Book of Nutrition for the Elderly

The fourth meal of nutrition for the elderly is not an IQ tax, but essentially fills the nutritional gap that naturally exists in the three meals. A fourth meal plan that adapts to individual needs can effectively reduce the risk of chronic disease progression and improve the quality of life of the elderly. However, there is currently no unified implementation standard in the industry. The probability of being cheated by ordinary consumers exceeds 60%, so there is no need to blindly follow the trend and buy.

Last week, I was doing a free clinic at a community elderly care service center. I met seven elderly people in the morning. They all carried various nutritional supplements bought by their children in their bags. There were more than a dozen kinds. When asked, they would either say, "I will eat what my children bought."

When the academic conference on geriatric nutrition was held before, experts in different fields had quite different opinions on this concept. Most of the experts from the clinical nutrition department of tertiary hospitals are conservative: "As long as the three meals can meet the requirements of the elderly version of the Chinese Dietary Guidelines, there is no need to supplement the fourth meal. Many elderly people have enough nutritional intake, but supplementing them will increase the metabolic burden." There is really nothing wrong with this. I have met an elderly person who has damaged kidney function and was hospitalized after supplementing with high-protein powder until his creatinine increased. But researchers working on community public health and geriatric epidemiology on the other side have a completely different attitude: "Go to the homes of 100 elderly people and see how many of them can eat enough of one egg, 300ml of milk, 200g of high-quality protein, 500g of vegetables and 250g of fruit every day? ”According to data from the "Report on Nutrition and Chronic Disease Status of Chinese Residents (2020)", the nutritional compliance rate of my country's elderly people over 60 years old is only 13.7%. Inability to chew meat, chronic diseases, and living alone and too lazy to cook to survive are all real problems. In this case, it is simply unrealistic to rely on three meals to supplement nutrition. The fourth meal is to make up for these gaps.

I have been following a community nutrition intervention project for three years, and I have seen situations that vary from person to person, and there is no universal “standard answer” at all. Last year we worked with an 82-year-old man with chronic obstructive pulmonary disease. He was only 80 kilograms thin. He would gasp after taking two mouthfuls of food. He couldn't eat enough after three meals. The fourth meal we ordered for him was two small spoons of complete nutritional powder plus 1 Omega3 every day. They were very small amounts and did not occupy his appetite. He gained 4 kilograms in 3 months. He was not hospitalized due to acute attacks in winter like in previous years. There is also a 67-year-old aunt who suffers from osteoporosis and has difficulty walking. She used to take 3 calcium tablets a day, but she was found to have high urinary calcium and could develop stones. We reduced her calcium tablets to 1 tablet a day, and added a small bowl of sugar-free yogurt and 1 vitamin K2 to her fourth meal. After half a year, the bone density was stable and her leg pain was relieved a lot.

Oh, yes, we need to clarify one of the most common misunderstandings first: many people think that the fourth meal is a health product, but it is not. The 10 almonds you eat when you are hungry in the morning, the cup of warm milk you drink in the afternoon, or even a handful of soft boiled blueberries can all be your fourth meal. The core is to "make up for what is missing", and the more expensive the better. To be honest, when I was choosing the fourth meal for my mother, the first thing I did was take her to get a serum nutrition check. It was found that she was deficient in vitamin D and dietary fiber. So there was no need to buy a longevity package costing several thousand. Just take 1 ordinary OTC vitamin D supplement every day and add a handful of steamed pumpkin in the afternoon. That was enough.

There are so many pitfalls in the market now. The "fourth meal for the elderly that cures all diseases" and "longevity nutrition package recommended by academicians" basically all charge IQ taxes. Some merchants recommend the same multivitamin regardless of whether the elderly have high blood pressure or gout. If the sodium content in the supplements chosen by the elderly with high blood pressure exceeds the standard, it will increase blood pressure. Taking too much soy protein for the elderly with gout may also induce acute attacks.

In fact, there has never been a one-size-fits-all solution when it comes to nutrition for the elderly, and the fourth meal has never been a “standard” item that must be purchased. If the elderly at home eat three balanced meals, it would be fine if they don’t need to supplement anything. If there are indeed problems with taboos, bad teeth, and eating less, it is better to figure out what is missing first and then supplement it. After all, aren’t we doing all this just so that the elderly can eat well, move around, and suffer less pain?