​Iron Deficiency in Women: Can You Be Iron Deficient Without Anemia?

What We Dont Know We Dont Know in Health Care: September 24, 2024 -Oral Care, Monitored Meals, and Aspiration PneumoniaProper oral care is crucial for maintaining optimal health. Keeping the mouth clean not only helps maintain the protective properties of saliva but also reduces bacteria in the mouth which can be a source of infection in aspiration pneumonia. In addition, monitoring meals and assisting with feeding for those at high risk for aspiration is also a necessity. The process of swallowing involves dozens of muscles that start in the mouth and include the pharynx, larynx, and esophagus. These muscles can become weakened with age and from various, often age-related diseases.  The aging population is especially at risk for aspiration pneumonia due to comorbidities, frailty, and conditions that can impair swallowing.  As a result, aspiration pneumonia is one of the leading causes of death from infection in individuals over the age of 65. One study shows that 1 in 10 deaths from pneumonia in elderly nursing home residents may be prevented by improving oral hygiene (Sjogren et al., 2008). Unfortunately, proper oral care and monitoring of meals is often overlooked in the health care setting.  Perhaps the greatest reason for this is the challenge that almost every health facility faces today: adequate staffing. When I started working in acute care as an RN over 20 years ago, nursing assistants (these are the staff generally responsible for proving oral care in an acute care setting) were typically responsible for 5-7 patients. Nurses had 3-5 patients (this was on a step down cardiac unit). Between the nurse and the assistant, we were able to provide oral care at every meal and offer one-on-one assistance to any patient that was at risk for aspiration. This is no longer the case.  RNs oftentimes look after upwards of 8 patients, and there is generally either no nursing assistant on the floor or only 1 for a patient load that can exceed 20.  Consequently, proper oral care is neglected.  I have often seen patients that are aspirating during meals, but do not have adequate staffing on hand to provide them with the supervision and monitoring that they need. This presents a hazardous catch-22: the aging individual needs to eat to maintain nutritional needs yet he/she needs assistance with eating to prevent aspirating pneumonia.   How can this be remedied? If the family is present, they can provide oral care and meal monitoring. If meal monitoring is required for an at-risk individual, its recommended to touch base with the health care team to inquire as to what the specific aspiration precautions are (every individual may have a different need and/or recommendation). A care companion can also be hired to provide the needed care. I hired a companion for my father when he was in a skilled nursing facility. He was not getting his teeth brushed or flossed regularly, and I was seeing a decline in his dentition. Having this extra support provided him with much needed assistance and the care companion had the added benefit of encouraging him to eat more at every meal, something that was a bonus as he was not meeting his nutrient needs. Touching base with staff to request that oral care and meal monitoring be done can also be helpful. Having an advocate to ensure necessary care is getting done can also be very effective in the health care setting.  What is proper oral care and effective meal monitoring?  Proper oral care includes brushing the teeth for at least 1 minute after every meal. It also includes using a soft bristle brush, fluoride toothpaste, flossing daily. A final component of oral care that is often not discussed is denture care. Dentures should be cleaned at least once per day and removed at bedtime. Removing them prior to sleeping can greatly reduce the risk of pneumonia (Iinuma et al. 2014). Effective meal monitoring includes adequate supervision during mealtime for those at risk of aspiration. Such supervision includes ensuring the individual is properly positioned for a meal (head of bed as high as can be tolerated and supine position), takes small bites, eats slowly, swallows a couple times in between each bite, and intermittently takes a sip of liquid to clear the mouth of food particles. The use of straws is generally not recommended for an individual at risk for aspiration as it propels the food to the back of the throat and hence can increase risk. I recall when I was working as a Registered Nurse (RN) in acute care that I was constantly removing straws from the bedside of at risk individuals and often reminding them to eat slowly and swallow at least twice between each bite to ensure food clearance. Individuals at risk for aspiration often require a modified texture diet as it can further prevent the aspiration of food and liquids.   This is a brief summary of the attention to detail needed in addressing oral hygiene and meal monitoring amongst the aging population. Both measures can play a significant role in reducing aspiration pneumonia.  If you would like more information on understanding proper oral care or any other questions that you may have regarding aging life care, please feel free to reach out to me.    Sources:1.      Sjogren P, Nilsson E, Forsell M, Johansson O, Hoogstraate J. 2008. A systematic review of the preventive effect of oral hygiene on pneumonia and respiratory tract infection in elderly people in hospitals and nursing homes: effect estimates and methodological quality of randomized controlled trials. J Am Geriatr Soc. 56:21242130. 2.      Iinuma T, Arai Y, Abe Y, Takayama M, Fukumoto M, Fukui Y, et al. 2014. Denture wearing during sleep doubles the risk of pneumonia in the very elderly. J Dent Res. doi: 10.1177/0022034514552493 3.      F Muller, 2015. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4541086/#   

Since the start of the year, you may have noticed an uptick of fad diets. Maybe its your mom trying a pescatarian regime, or your neighbor raving about his new Mediterranean diet. With so many diet trends buzzing around, it can be hard to separate what works from what doesnt. This is especially true when it comes to heart healthy eating.The American Heart Association released a study comparing diets and their heart healthy potential and organized the results in four tiers. With the help of Kelly Elliot, RD at Intermountain Healths Denver Midtown Clinic - Weight Loss Center, we turned the studys results into easy-to-digest bites. It is important to always be mindful of your diet to reduce risk factors for heart disease, said Kelly. Creating a lifestyle that works for you as an individual that you can follow is what matters, because its what you will stick to!Whether youre a seasoned diet tryer, or just dipping your toes in heart-healthy waters, theres important information for everyone.Tier 4: Paleo Diets and VLDC/Ketogenic DietsStarting from the bottom of the barrel, we meet paleolithic and ketogenic diets. These diets, often hailed for their weight loss potential, may miss the mark when it comes to nourishing our hearts.The paleolithic diet, while rooted in our ancestral past, falls short in meeting heart-healthy guidelines. With its emphasis on meat and fat, and limited intake of fruits, grains, and legumes, it takes a detour off the heart health highway.Similarly, ketogenic diets focus on slashing carbs and loading up on fats. By cutting out essential food groups like fruits and grains, we risk missing key nutrients.These diets don't limit saturated fats, which can raise your LDL, which is the bad cholesterol, said Kelly. One way to modify these diets is to reduce saturated fat by consuming nuts and seeds instead of animal proteins, but this has to be balanced with caloric intake.Kelly also added that because these diets are low in carbohydrates, they could be beneficial for people with diabetes. However, because diabetics are at a higher heart disease risk, their saturated fats should be limited.Tier 3: Very Low-Fat Diets and Low-Carbohydrate DietsTier 3 diets include very low-fat and low-carb options, and present mixed heart health benefits.Both of these diets can potentially help with weight loss without omitting food groups and can help lower risk factors for heart disease, said Kelly.Very low-fat diets, while aiming to reduce overall fat intake, may inadvertently miss the mark on essential fatty acids. Likewise, low-carb diets, with their focus on slashing carbohydrates, could lead to a decrease in fiber-rich foods, which play a vital role in heart health.The drawback is that with low fat diets, they can lead to deficiencies in protein and essential fatty acids and B12, that the body requires for good health, said Kelly. On the other hand, a low carb diet can overemphasize animal-based protein and restrict fiber and increase saturated fat intake.Tier 2: Vegan Diets and Low-Fat DietsVegan and low-fat diets are the heart of Tier 2. These dietary paths offer a bounty of heart-healthy benefits with some caveats.The vegan diet, with its plant-based focus on fruits, vegetables, whole grains, and legumes, embraces the power of plants for heart wellness. However, tread carefully to ensure youre meeting your nutritional needs, particularly for vitamin B12.No animal protein is consumed in vegan diets, so they are very low in saturated fat intake, but the restrictive diet can lead to B12 deficiency, said Kelly. It is recommended to include a B12 supplement and choose plant-based milk alternatives.Meanwhile, the low-fat diet promises reduced cholesterol and a lighter load on our hearts. By emphasizing lean proteins, whole grains, and fruits and vegetables, it is a good heart healthy diet. But its important to avoid overconsumption of less healthy carbohydrates, such as added sugars.People with high cholesterol or high LDL cholesterol can benefit from replacing foods high in saturated fats with foods that have unsaturated fats, said Kelly.Tier 1: DASH-Style, Mediterranean, Pescatarian, and Ovo/Lacto-Vegetarian DietsStarted from the bottom, and now were here with Tier 1s DASH-Style, Mediterranean, pescatarian, and ovo/lacto-vegetarian diets. Its the pinnacle of heart-healthy eating, where the nutrients shine.Well start with the Dietary Approaches to Stop Hypertension, or DASH, diet. By the name alone, you might infer this diets ultra heart healthy nature. It emphasizes 8-10 servings of fruits and vegetables per day, whole grains, plant protein, and low-fat dairy, while limiting sodium.According to Kelly, the DASH diets sodium limitations help cut out highly processed foods, which can help control weight and high blood pressure. This diet provides adequate variety with adequate protein, moderate healthy fats and moderate healthy carbs intake, while minimizing sodium intake, she said.Moving onto the Mediterranean diet, with its emphasis on olive oil, fish, fruits, vegetables, and whole grains. These heart healthy foods make this a great choice for reducing heart disease risk. However, the Mediterranean diet also includes moderate alcohol consumption, which means two or less drinks for men a day, and one or less drinks for women per day.Kelly cautioned against misinterpreting what moderate alcohol consumption is. This does not mean, to have no alcohol for 3-5 days and then have all 3-5 drinks at one time, she said. These drinks should not include added sugar such as margarita mix, juices, and sugary sodas.A pescatarian diet is similar to a vegetarian diet, with the addition of fish, and sometimes includes dairy and eggs. Lacto-ovo vegetarians eat eggs and dairy, but not beef, poultry, fish, or pork. These diets may be lower in saturated fats, especially if whole milk products are not consumed. The biggest challenge with these diets boils down to protein.Kelly explained it simply as there being complete and incomplete proteins. While animal proteins contain all essential amino acids, plant-based proteins are incomplete, and must be combined for full nutritional benefits.The way to do this is to combine a nut or seed or bean with a grain, said Kelly. For example, red beans and brown rice, or nut butter on whole grain bread, will allow you to consume all of the essential amino acids.While these diets might seem daunting, remember youre not alone. A registered dietitian, like Kelly, can be an excellent starting source.Dietitians are full of ideas and strategies to help each individual overcome barriers to create effective behavior changes, said Kelly. Its important to remember that baby steps and small changes lead to big impacts on your health over time!Whether you're sticking to tried-and-true favorites like the DASH plan or exploring new diet horizons, the key is finding what works best for your heart. Remember, it's not about perfection it's about progress. So go ahead, savor those veggies, indulge in some heart-smart protein, and above all, listen to what your body needs. 

Youve heard it before, but since its American Heart Month, well say it again. Heart disease is the leading killer of U.S. adults. The number one cause of death is a frightening number, so heres a new number: 10. Knowing these 10 heart health risk factors, and how to manage them, can save your life.To understand your personalized heart health risk better, check out our online quiz. Or read along and learn the key to a healthy heart from our Intermountain Health caregivers.Maintaining a healthy heart is the cornerstone of overall well-being, as the heart serves as the engine of our body, said Carlos Albrecht, MD, an Intermountain Health cardiologist at St. James Healthcare.1. Family history/geneticsUnderstanding your family's medical history is vital for anticipating health risks. Genetics play a significant role in heart-related issues. After speaking to your primary care provider about your family history, minimize any risks with lifestyle changes.2. SmokingSmoking (including second-hand smoke) deteriorates the cardiovascular system, increasing the likelihood of heart-related issues. This includes traditional cigarettes, e-cigarettes, and vaping nicotine. Your primary care provider can help create a quitting plan.Viet Le, PA-C at Intermountain Medical Center, warned against smokings consequences. Cardiovascular disease and smoking do not mix, he said. It is the highest risk for death and highest risk for cardiovascular events.3. High blood pressureConsider high blood pressure a silent threat with serious consequences. While it often coincides with other risk factors, hypertension is the biggest indicator of heart disease. If your blood pressure is consistently higher than 130/80, consult your primary care doctor.4. Unhealthy dietA diet high in processed and unhealthy foods has direct implications for heart health. Opting for a diet rich in fruits, vegetables, and whole grains supports cardiovascular well-being. Need heart healthy dish ideas? Check out this Intermountain dietitian cookbook.According to Dr. Albrecht, a balanced diet plays a pivotal role in persevering cardiovascular health and reducing the risk of heart disease. "Just as a well-maintained engine ensures the smooth functioning of a vehicle, a healthy heart is crucial for optimal physical performance and longevity, he said.5. High cholesterolCholesterol is a waxy substance produced by the liver, but its also in foods like meat, poultry, and dairy products. Too much cholesterol can block your bloods circulation, so keeping your cholesterol levels low mitigates heart-related complications. Your primary care provider can order a blood test to obtain your cholesterol level, and help you address the results.6. DiabetesDiabetes introduces a layer of complexity to heart health. Unfortunately, diabetes and heart disease risk often coincide. According to the CDC, those with diabetes are twice as likely to have heart disease or a stroke than those without diabetes. Make a plan with your primary care provider to address your diabetes and minimize heart risk with lifestyle changes.7. Physical inactivityInactive lifestyles contribute to a range of heart-related issues, such as obesity and high blood pressure. Incorporating routine exercise is a great way to minimize these heart-related issues, and keep you feeling healthy.Make sure that youre being active, Le said. The American Heart Association says 150 minutes a week of moderate aerobic activity. That sounds like a lot, but you break it down, its 30 minutes, five days a week. And you can even break it down into 10-minute segments.8. ObesityExcess weight puts strain on the heart, impacting its efficiency and longevity. Everyones ideal body weight varies by person, so talk to your primary care provider about your Body Mass Index (BMI). A BMI calculator evaluates if you have an ideal BMI between 18.6 and 24.9.9. Not enough sleepAdequate sleep is a non-negotiable aspect of overall health, including heart health. According to the American Heart Association, adults need 7-9 hours of sleep each night, and children require eight to 16 hours, depending on their age.Enough sleep improves your bodys brain function, immune system, mood and energy, and reduces your risk of chronic disease.10. Too much stressHopefully reading these risk factors hasnt caused stress. Stress can contribute to high blood pressure, among other factors. Managing stress levels helps maintain overall cardiovascular well-being. Your primary care provider can introduce stress-reduction strategies, such as exercise, meditation, and breathing techniques.Maintaining the de-stressors in your life is important. It takes intention. It takes planning, said Le. Give yourself the gift of the present by knowing you can effect change.In the realm of heart health, knowledge is power. Harness this power by understanding your unique risks, regularly visiting your doctor, and taking on heart healthy lifestyle changes. Each choice you make contributes to your cardiovascular well-being.Prioritizing heart health is not just a choice, said Dr. Albrecht. It is a commitment to a vibrant and fulfilling life.