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TCVM Geriatric Food Therapy ROGER CLEMMONS, DV, PHD, CVA, CVFT, ACVIM (NEUROLOGY) GAINESVILLE, FL [email protected] What is aging? “ At age 50 years old, the liver starts to decline, the lobe of the liver starts to become thinning and eyes start unclearness. At age 60 years old, the heart Qi starts to decline causing worry and sadness, Qi and blood is sluggish and weakness causing favor in lying down. At age 70 years old, the spleen Qi is deficient and the skin desiccates and withers. At age 80 years old, the lung Qi debilitates, the corporeal soul (po) is gone causing error during talk. At age 90 years old, the kidney Qi parches, all other four zang organs and channels are exhausted” Huang The Di Nei Jing Yellow Emperor’s Classic of Internal Medicine TCVM Geriatric Medicine & Aging Jing Deficiency Zang‐fu organ function declines with age Kidney is ruler of prenatal essence SP/ST is the origin of post‐heaven Qi Generalized Qi Deficiency Blood Qi stagnation/stasis TCVM Geriatric Medicine & Aging Combination of excess and deficiency Deficiency: mostly Qi deficiency, then Yin Yang Excess: mostly stagnation and phlegm Zang‐Fu Qi activities Heart: ability to circulate blood Lung: respiratory actions to inhale/exhale Kidney: ability to pull air down from lung, reproductive ability, bone growth and metabolism control of sphincters (urinary/fecal) Yang ability to warm the body as it declines (late stage) What age is considered old? Small/Medium breeds: dogs 7‐10 years and older Large to Giant Breeds: 5‐7 years and older Cats:7‐10 years and older Chronic illness or Jing deficiency can make animals age before their time Signs of illness or disease may be subtle or just energetic disharmony prior to clinical symptoms Multiple disharmonies or imbalances can occur at the same time TCVM Geriatric Medicine & Aging Qi Deficiency: LU, HT, SP, Kid General weakness Exercise intolerance Decreased appetite, anorexia Muscle atrophy Loose stool or too frequent defecation/ urination Urinary or fecal incontinence Dyspnea Tongue: Pulse: pale, wet, thick weak, thin TCVM Geriatric Medicine & Aging Yin Deficiency: LU, HT, LIV, KID Panting Cool seeking Thirsty Dry signs: eyes, mouth, skin, fur, nails Small/ fine flake dander Mental anguish (Heart Yin) Leads to Yang deficiency when fluid is consumed Tongue: red, may have coating Pulse: thin, wiry, or choppy TCVM Geriatric Medicine & Aging Ya ng Deficiency: Generalized Warm seeking Cold back Lethargy Food stagnation/ Edema Tongue: Pulses: stasis pale, wet deep, weak (R<L) TCVM Geriatric Medicine & Aging Stagnation Sleep more, less active Difficulty getting up, painful Anxious, confused, unaware Vomiting or constipation Tongue: Pulse: dark, purple fast, wiry TCVM Geriatric Medicine & Aging Blood Deficiency: SP, LIV, Kid Chronic stagnation, Qi deficiency, Yin deficiency Dull, dry fur coat with thick flake dander Pale and dry pads and nails Anxiety, depression, insomnia, poor memory Muscle tremors Tongue: Pulse: pale, dry, thin deep, weak (L<R), choppy TCVM Geriatric Medicine & Aging Phlegm Substantial Secondary excess pathogen in the lungs Mass, growth, nodules Non‐substantial Physical‐ lymphadenopathy, arthritis, joint deformity In Channels‐ numbness, tingling, dysfunction In Heart‐ anxiety, depression, crazy in the mind mansion In GB/ KID‐ stones (Kidney, Bladder) Tongue: Pulse: thick, greasy, white coating (thin or thick) slippery TCVM Geriatric Medicine & Aging Vital birth energy and fluid Lowered metabolic rate Less are used up activity Less energy requirement (up to 20%) Increased stagnation in joints Intestinal transit time decreased Difficult to extract the same nutrients or energetics from food Weak digestion, may not be able to handle whole grains Lowered excretion of nutrients Decreased organ reserves Decreased body mass Decreased ability to regulate blood sugar Takes longer for postprandial glucose to be metabolized Receptor abnormality decreases insulin response Decreased ability to metabolize carbohydrates Geriatric Food Requirements Higher Protein Compensates loss of lean body mass Decrease protein turnover rates Decreased Fat Enhanced Antioxidants Helps maintain body weight Supports declining immune systems Omega-3-Fatty Acids Helps with joint and kidney function Goals of Treatment Increase the QUALITY OF LIFE Slow Disease Onset or Progression Warm the middle burner Nourish Kidney Essence Prevent too much Qi or Blood consumption Help the body breakdown, digest, assimilate, disperse and use as many vital nutrients as possible For the Mind, Body and Soul Goals of Treatment Feed moderate amounts of food, often Nutrient extraction Glucose assimilation Prevent Stomach Qi Feed stagnation easily digestible food Well cooked‐ middle Jiao cannot heat Food preparation‐ finely chopped Sprouts of grains, grasses, legumes and Soups, stews, congee Digestive enzymes & probiotics Feed nutrient rich foods Feed warming foods Organic‐ greater nutrient Non‐processed foods Energetics Temperature composition seeds Goals of Treatment Avoid pro‐inflammatory foods Nightshades: bell pepper, eggplant, white potato Goiterogentc: cruciferous‐ raw: broccoli, kale, cabbage, canned food Feed turnip, radish, horseradish, rutabaga, anti‐inflammatory foods/supplements Alternate lower meat diet‐ lower Lower saturated fats‐ lower PG PG Increase omega‐3 FA‐ lower PG/leukotrienes Increase Vitamin C Cold water fish, mackerel, trout, salmon, tuna Also generates collagen Cantaloupe, strawberries, Supplements MSM, peppers, cranberry to help alleviate arthritis pain SAM‐e, alfalfa, dandelion, turmeric, white willow bark Goals of Treatment Treat imbalance or disharmonies as early Older animals take longer to heal or recover Use as possible ½ to 2/3 dose of herbs for longer time (maybe for life) Avoid very strong herbs or Too bitter: Coptis (Huang Lian) Too cold: Gypsum (Shi Gao) Bitter‐cold herbs cause Yang‐Qi damage Hot‐pungent herbs consume Yin use them for short periods of time Too hot: Aconite (Fu Zi) Too pungent: Ephedra (Ma Huang) Select Tonic herbs or mild regulating herbs Tonic: Codonoposis (Dang Shen), Angelica (Dang Gui) Movers & shakers of Qi: Citrus (Chen Pi) Moving Blood to resolve stagnation: Ligusticum (Chuan Xiong) Transform phlegm: Fritillaria (Chuan Bei Mu) Don’t forget about tui‐na, acupressure, acupuncture and daily EXERCISE!!!!! Qi Tonics Energetics: Neutral to warm Meat: beef, chicken, duck, goose, lamb, quail, eggs, catfish, carp, eel, herring, trout Grain/Legumes: brown rice, coix, glutinous rice (caution with digestion), millet, lentils, soy bean, string bean Vegetables/Fruit: peas, potato, sweet potato, yam, shiitake, cherry, date, lychee, fig Nuts: chestnut, coconut, peanut, walnut Other: molasses Qi/Yang Tonics Energetics: warming or hot Meat/oil: chicken, liver (esp. chicken, lamb), kidney (esp. lamb), mutton, venison, beef, shrimp, catfish, anchovy, trout, olive oil Grains/Legumes: oats, white rice, corn, quinoa, broad bean Vegetables/Fruit: carrot, squash, winter squash, pumpkin, ginger, garlic, pepper, apricot, citrus, peach, plum Nuts: walnut Other: brown sugar, rice vinegar, cinnamon, cloves Avoid: cold food‐ cereal grasses (wheat grass, barley grass), seaweed Blood/Qi/Yin Tonics Neutral foods: Meat: pork, eggs, goose, duck, catfish, salmon, sardine, tripe, quail Grains/Legumes: corn, sweet rice, soy bean, string bean Vegetables/Fruit: yam, sweet potato, white potato, grapes Other: green tea Blood Tonics Energetics: Tonify SP to help digestion and absorption of nutrients to make more blood Digestive enzymes, probiotics Chicken, duck, goat, rabbit, carp, eel, aduki, rice, winter squash, carrot, turnip black bean, peas, sweet potato, nutmeg Tonify KID Blood/ Jing Dark foods with salty flavor (not too much) Blood Tonics Generalized Meat/ Dairy: beef, bone marrow, liver, duck, goat, goose, salmon, sardine, eggs, milk (goat/ sheep) Grain/Legume: amaranth, barley, coix, rice, wheat germ/ grass, aduki bean, black bean, soybean, tempeh Vegetables/ Fruit: reishi, shiitake, alfalfa sprout, artichoke, spinach, sweet potato, chard, kale, watercress, apricot, avocado, fig, date Other: sesame/ sunflower seed, parsley, microalgae, bee pollen, miso, molasses Stagnation Focus: Improve Qi/Blood Flow Meat: chicken, lamb, venison, shrimp, crab Vegetables/Fruits: carrot, radish, watercress, mustard greens, hawthorn berry, citrus inc peel, Other: vinegar, ginger, garlic, turmeric, clove, dill, coriander, chestnut Phlegm • Focus: Strengthen spleen, drain damp, transform phlegm • Strengthen Spleen: beef, salmon, tuna, millet, oats, rice, sweet potato, pumpkin, apple, cherry, dates & jujube, winter squash, ginger • Drain Damp: barley, rye, mung bean, soy bean, alfalfa, celery, radish, mushroom, lemon, garlic, horseradish, mustard green • Transform Phlegm: Clam, oyster, apple, pear, citrus and peel, seaweed, garlic, thyme, pepper, peppermint, almond • Avoid: thick, damp, sticky food: dairy, fat, raw, too yin, alcohol Treatment of CCD Selegiline 0.5-1 AM FDA mg/kg QD approved Up 69% improved vrs 52% placebo Westlab Pharmacy 1-800-4WESTLA [email protected] Vitamin E (& other antioxidants) to 50 mg/kg Ginko biloba 1-2 mg/kg BID extract Acetylcysteine 5-25 mg/kg BID St John’s wort 2-4 mg/kg