Fight the one-two punch of inflammation and aging - Inflammaging!

healthy eating healthy living meditation morning practice real food resilience sleep sugarfree Aug 29, 2021

Imagine yourself 10 or 20 years from today. How do you feel? Is your life happier, healthier and more fulfilling than ever? What personal goals have you reached? How many lives have you touched? Perhaps you’ve been able to spend more time with friends and family? Maybe you’ve finally been able to take that trip of a lifetime, be it an arctic cruise, wildlife safari or some other adventure? Or possibly you’ve downsized from your family home in the city and moved to a smaller community with a less stressful lifestyle?

Building up to and achieving your personal long-term goals is supported by your day-by-day, step-by-step actions, including the things you do for your health. In fact, without your health, how many of these would be possible? We all get chronologically older at the same rate: one year, every year, but the rate at which our bodies actually age depends to a large extent on the healthy habits we practice each day. If you’re concerned, know that life’s journey doesn’t have to be filled with aches, and pains, and medications. I’m here to show you daily habits and strategies that you can adopt NOW to increase the chances that your journey will not only be longer but also healthier!

The reality is that for many people, physical abilities change with age. Some of us may need to start wearing glasses to read. We may feel more aches and pains while losing energy and strength. We may even wonder if our memory isn’t as good as it used to be. 

You probably know that your risks for many health concerns like falls, fractures, frailty, heart disease, type 2 diabetes, and dementia increase as you get older. And you’ve likely wondered why this happens and if there is anything you can do to slow down or even stave off this seemingly inevitable process. 

The good news! Yes, there are a lot of things you can do!

Let’s talk about the process of inflammaging (inflammation + aging) PLUS what you can start doing more of right now to slow it down and keep it as low as possible for as long as possible.

What is inflammaging?

The term “inflammaging” was coined in 2007 by a group of Italian researchers led by Claudio Franceschi at the University of Bologna. As they describe it, “a large part of the aging phenotype . . . is explained by an imbalance between inflammatory and anti-inflammatory networks, which results in the low grade chronic pro-inflammatory status.”[1]

Aging is a complex process that occurs within all of our cells as we get older and involves inflammation.[1,2] This means that aging and inflammation go hand-in-hand, increasing together over time. 

There are two kinds of inflammation: acute and chronic.

Acute inflammation is part of the natural healing process whereby our immune systems respond to infections or injuries by sending white blood cells to help out.[3] This beneficial inflammation helps your body fight the cold virus or heal that sprain or cut. Acute inflammation is usually intense, located in the area where it’s needed, and subsides once the infection or injury is dealt with. It looks and feels like the temporary heat, redness, swelling, and/or pain of when you stub your toe. When the healing is complete, the inflammatory response stops but continues to be “on call” for the next infection or injury. Inflammatory responses (ones like these that speed up the healing process) are strongest when we’re young and decrease as we age.[4] 

Acute inflammation as described above is not the kind associated with chronic disease risk and aging. The inflammaging type of inflammation is the longer-term, lower-level, insidious kind of inflammation known as chronic inflammation (the “dangerous” kind). When you experience chronic inflammation, your immune system doesn’t stop, but rather keeps fighting indefinitely. This longer-term inflammatory response can end up negatively affecting healthy tissues and cells.[3]

Health effects of inflammaging

When the balance tips toward higher levels of chronic inflammation with age, so do the increased risks for falls, fractures, frailty, heart disease, type 2 diabetes, and dementia.[5] As time goes on, our cells accumulate small bits of damage that can make us more susceptible to these health concerns.[2] 

One thing that impacts inflammaging is another natural age-related process called sarcopenia—loss of muscle. Sarcopenia impacts millions of older adults.[6] Starting at 40 years of age, we all tend to lose about one percent of our muscle mass and strength every year due to declines in hormone levels, lack of physical activity, and less-than-ideal nutrition.[6] That’s why it’s important to build your muscle strength and mass as a younger adult and stay physically active throughout your life.[7]  Keep reading for tips and strategies to help you reduce sarcopenia (hint - yes, it does involve moving your body!).

Falls, fractures, and frailty

Having muscles that allow us to keep doing everything we want to is extremely important to healthy aging. Whether we want to continue competing in our favourite sports or dancing and enjoying life without worrying about falls, fractures, or needing help, we must maintain our muscles’ strength and ability. To do this, we need to continue to use our muscles so they remain strong and healthy. Chronic inflammation compromises aging muscles and is thought to be one of several contributors to sarcopenia.[7] 

One way inflammation is thought to negatively affect our muscles is by reducing their ability to retain protein (muscle protein balance).[8] For our muscles to stay strong, they need both protein and movement (particularly resistance exercises, like lifting weights, doing push ups and sit ups, squats and lunges). So, when our muscles can no longer effectively retain protein, their ability to do what they’ve always done can be reduced. 

Inflammaging and sarcopenia, along with malnutrition, can result in frailty.[9] Frailty includes symptoms like unintentional weight loss, exhaustion, weakness, slow walking speed, and can worsen low levels of physical activity. Frailty is a predictor of decreased mobility, cognitive decline, lower quality of life, falls, hospital and nursing home admissions, many chronic diseases, and overall mortality.[9]

You can preserve your muscle mass by eating enough protein and keeping physically active.

Obesity can worsen inflammation

Adipose (fat) tissue is closely tied to inflammation: the more we have, the more inflammation we tend to have. There are a few reasons for this. One reason is that adipose tissue actively produces hormones and other substances that increase chronic inflammation.[6] 

Another reason is that obesity often goes hand-in-hand with low muscle mass and sarcopenia. Having less muscle mass decreases the ability to use calories from foods and drinks because muscles burn a lot of calories. When there is less muscle, this can reduce the number of calories burned, increasing the amount of calories that need to be stored. These calories are stored as fat, which is part of the [vicious circle/cycle] that promotes more inflammation.[6] 

Whatever size body you have, actively trying to maintain and grow muscle mass can decrease your risk for obesity, which in turn decreases inflammation.

Heart disease

Inflammaging increases risks for many aspects of heart disease, such as atherosclerosis, high blood pressure, and high cholesterol. A recent study from Harvard University published in the Journal of the American College of Cardiology found a connection between eating inflammatory foods (processed meats, refined grains, sugar-sweetened beverages, etc.) and risk of heart disease.[5,10] The authors say, “Reducing the inflammatory potential of the diet may potentially provide an effective strategy for CVD [cardiovascular disease] prevention.”

You can maintain your heart health by eating nutritious foods that don’t fan the flames of inflammation. In other words, Just Eat Real Food!  This includes more vegetables - all colours of the rainbow, along with whole grains, clean proteins and healthy fats.

Insulin resistance and type 2 diabetes

Increased inflammaging and sarcopenia are also associated with insulin resistance, which leads to type 2 diabetes. That’s because muscle tissue is responsive to insulin (the opposite of being resistant) and helps remove excess sugar from the blood. This means that the more muscle we have, the less risk we have for becoming resistant to insulin.[6]

We can reduce our risk of diabetes with a healthy lifestyle that promotes muscle tissue and reduces blood sugar spikes as you’ll see below.

Dementia (Alzheimer’s disease, etc.)

Both inflammation and aging are two factors that underlie risk for dementias like Alzheimer’s disease. Other risk factors include heart disease and diabetes (which are also linked to inflammaging).[11] Research shows that changes such as the buildup of compounds called beta-amyloid and tau start occurring in the brain years before any symptoms of dementia appear.[11] 

Researchers have found these brain changes in adults may be triggered by inflammaging, and inflammaging may even play a central role.[12] In addition to inflammaging, lack of enough quality sleep is also associated with increased risks for dementias.[13] While it’s unclear whether it’s these brain changes that affect sleep or vice versa, we can still try to prioritize sleep as part of a healthy lifestyle.

Independence and quality of life

Inflammaging and sarcopenia can threaten our independence and quality of life.[8,14] When our muscles become smaller and weaker over time, we can experience loss of strength and balance. The longer sarcopenia goes unchecked, the more it can result in frailty, falls, and disability. These can sometimes result in institutionalization, hospitalization, and even death.[6]

By working on your balance and muscle strength, you can keep your independence and quality of life for as long as possible.

Fighting inflammaging

It’s never too late to boost your health and wellness with anti-inflammaging strategies and tips! Getting better sleep, having an active lifestyle, and following a more nutritious eating style can benefit everyone, regardless of how old you are. Recent studies show that healthy lifestyles can slow down or even reverse the process of inflammaging.[4] 

You don’t need to start sleeping like a baby, eating like an Olympic athlete, or training for a marathon to stave off inflammaging and sarcopenia. (Unless you want to!) Making small steps starting today will help get you on the path to a healthy and physically strong future—no matter your age.

Here are my top recommendations:

Getting better sleep

Getting an adequate amount of quality sleep is very beneficial for both physical and mental health. A healthy amount of sleep is needed so your brain can process and remember things. Inadequate sleep is linked to depression, migraines, high blood pressure, increased susceptibility to infections, and even blood [sugar/glucose] issues.[15]

Adults of all ages need 7-9 hours of sleep each night.[16] (Yes, all ages!) If you’re struggling to get enough quality sleep, here are a few tips to try:

  • Follow a regular sleep schedule by going to bed and waking up at the same time.
  • If you enjoy caffeine (like coffee or black/green tea), limit it later in the day as its stimulant effects can last for several hours. Ideally, caffeine can be cut out about 6 hours before you plan to go to sleep, so if you want to go to sleep at 10:00 p.m., try to drink your last cup by 4:00 p.m. and then switch to caffeine-free drinks.
  • Regular exercise during the day can help you sleep better at night. (Try to finish exercising at least 3 hours before you go to bed.)
  • If you wake up in the middle of the night with heartburn or have to use the bathroom, limit your food and liquid intake before bed.
  • Limit your screen time before bed as the light can stimulate your brain.
  • Create a relaxing evening routine to help you wind down for the night.[16]

For more on supportive sleep strategies, read my articles here.

Exercise is anti-inflammatory

Research shows that exercise has significant anti-inflammatory effects. A recent review of 23 studies published in the journal Experimental Gerontology concluded that exercise was linked to lower levels of inflammation.[17] Another study in the Journal of Applied Physiology looked at how well exercise can delay the onset of inflammaging.[8] The researchers found that older men who maintained an aerobic exercise regimen had lower levels of inflammation and better chances of delaying, or even preventing, inflammaging altogether.

Beyond being anti-inflammatory, physical activity has many additional health benefits. For example, it helps to reduce risk of high blood pressure (linked to heart disease and stroke), diabetes, and depression.[18] Exercise also helps to reduce falls and maintain independence, and studies suggest it may help benefit the brain by delaying or slowing the onset of cognitive decline and dementia as we age.[18]

Exercise strategies you can start today

There are four kinds of exercise recommended for adults to improve physical function and prevent (and even treat) fraily:[19]

  • Resistance (strength) training
  • Aerobic (endurance) activity
  • Balance
  • Flexibility

If you’re new to exercise (or getting back into the habit), start from where you are now (making sure you’re cleared by your doctor) and go for small improvements over time.

There are a few things to keep in mind when starting or increasing your physical activity. First, listen to your body. Be sure to slow down or stop if you experience pain, dizziness, or other concerns.[20] Also, be sure to drink fluids before you start feeling thirsty, and follow instructions for proper form when learning new moves or using equipment.[20]

1 - Resistance (strength) training

Resistance, or strength, training can improve your muscle strength, walking speed, and physical performance.[9,19] Resistance exercises are particularly effective to slow down the process of sarcopenia by keeping your muscles strong.[6] 

“Though all types of physical activity offer benefits, resistance training is presently the most effective intervention to elicit improvements in muscle mass, strength, and function in older adults.” ~ Strasser et al. 2021[7]

Resistance exercises are those where you are pushing or pulling, often against gravity. These are commonly shown as lifting weights or stretching a resistance band, but can also be done without any equipment​​—for example, doing push ups, sit ups, lunges, or squats that use nothing but your own body weight to resist gravity.[20] 

2 - Aerobic (endurance) activity

Aerobic or endurance activities are ones that increase your heart rate and improve the health of your heart and lungs.[20] For that reason they’re also known as “cardio” exercise. Brisk walking, yard work, dancing, swimming, and biking all count as cardio. (It’s not just running!)[20]

One way to get more aerobic activity into your day is to take daily walks - and this is a great way to start your day. Even just 10, 20, or 30 minutes can make a difference. Even if you don’t already go for regular walks, if there is no physical reason why you cannot, then go ahead and start enjoying them. If you already walk, you can increase them by 10 or more minutes, or try going farther or finishing your regular route at a faster pace. You can also use these daily walks as opportunities to get some fresh air. While many people like to walk while listening to music or podcasts, I enjoy the “music” of nature, as this can be very meditative, and can also be a time to let my mind wander and be creative - some of my best ideas have come to me while on my morning walk!  And walking with a friend is also a valuable way to deepen connection with others - something we all need more of.

There are so many options when it comes to aerobic exercise, that there’s bound to be one that’s just right for you. For example you could join a fitness centre or group program in your community. There may be opportunities right in your neighbourhood to join a class or sports team. Or maybe you can enjoy recreational swim time at your local pool.

3 - Balance exercise

Improving your balance helps prevent falls. As you now know, falls can become more serious with inflammaging because they can lead to hospitalization, institutionalization, and loss of independence.

Examples of balance exercises include balancing on one foot or Tai Chi.[20] If you need support, be sure to hold on to a steady chair, countertop, table, or other sturdy piece of furniture. And of course yoga classes often include balance postures, on one foot, and sometimes even on your two hands!

4 - Flexibility exercise

Stretching can help maintain or improve flexibility so doing everyday things like bending over to tie your shoes, reaching the top shelf, or picking up dog poop, are easier. Stretching can even improve performance in other physical activities like your golf swing or tennis serve.[21] 

You can add some stretches after your resistance or aerobic workouts, but be sure to stretch muscles after they’ve been warmed up a bit, as experts no longer recommend stretching “cold” muscles.[20,21] 

Interested in trying out some gentle yoga for strength, balance and flexibility?  Check out my weekly classes “Take A Deep Breath In” and join today.  Your first class is FREE!

Nutrition strategies you can start today

Enjoying more nutrient-rich, anti-inflammatory foods is another key strategy when it comes to fighting the process of inflammaging. Here are my six top tips.

1 - Eat enough protein

Protein is one of the main macronutrients everyone needs to get enough of every day.[6] Protein does more than just keep your skin, hair, and nails healthy. Sufficient protein is necessary for healthy muscles and bones, and the proper functioning of your immune and digestive systems. Protein is also necessary for effective wound healing, blood clotting, and maintaining the correct balance of fluids in the body.[22]

Regardless of your age, the official daily protein recommendations for adults are 0.8 grams of protein per kilogram you weigh.[23] For a 150-lb (68-kg) adult, that comes to 54 grams of protein per day, and for a 200-lb (90 kg) adult, that’s 72 grams of protein per day.

Both the revised Canada Food Guide and the U.S.-based Harvard’s Healthy Eating Plate recommend that one-quarter of your plate be protein-based foods.[24,25] Good sources include eggs; lean meats and poultry; nuts and seeds; fish and shellfish; lower-fat dairy; and beans, peas, and lentils. 

2 - Enjoy your fruits and vegetables

People who eat lots of fruits and vegetables tend to have lower levels of inflammation because these foods contain fibre, vitamins, minerals, and many health-promoting phytochemicals.[14] 

One anti-inflammaging vitamin found in fruits and vegetables is folate (vitamin B9). When levels of folate get too low, your risk for heart disease, stroke, depression, and impaired memory increases. Some of the best sources of folate are spinach, asparagus, and Brussels sprouts.[26] 

An easy way to get a bit more fruits and veggies is to add some to your current meals. Berries and leafy greens (e.g., spinach, kale, etc.) have been studied for their anti-inflammatory properties.[11] You can try adding berries to your yogurt, cereal, or smoothie, or add some spinach to your sandwich. You can also try adding a side of broccoli (or any vegetable) to your dinners to help you eat more of these anti-inflammatory plants. 

PRO TIP: You don’t have to splurge for fresh produce every time—check out the frozen food section in your grocery store and see what they have.

3 - Snacks can fight inflammation, too

Of course, you can enjoy an apple, banana, or cucumber as a snack, but you can also enjoy non-fruit or vegetable anti-inflammatory snacks, like a small handful of nuts (preferably raw and unsalted). Nuts provide you with fibre, protein, vitamins, minerals, and healthy fats.[14] 

4 - Switch to healthier fats

Olive oil is a healthier fat that’s associated with lower blood pressure and cholesterol levels, as well as a lower risk of heart disease.[11,14] Olive oil is high in monounsaturated fat (MUFA), especially oleic acid, and also contains vitamin E and polyphenols that may contribute to its anti-inflammatory and antioxidant properties.[11]

Try substituting olive oil for saturated and animal fats (like margarine, butter, mayonnaise, and dairy fat).[11]

Other sources of healthier fats like omega-3s are flax, chia, walnuts, and seafood.[27] In fact, eating fish may be one of the strongest dietary factors that influence higher cognitive function and may slow cognitive decline.[11] Fish like salmon, tuna, trout, mackerel, or sardines contain healthy omega-3 fats that are anti-inflammatory.[14] 

Have you seen my article “What The Fat?”  It’s part of the Resilience Bundle download, which you can access here.

5 - Have your grains whole

Whole grains are those that haven’t had some of the more nutritious parts removed (like the bran and germ). They’re often a browner colour and chewier than processed grains, think of whole-wheat bread or brown rice. What makes whole grains healthier is that they contain more fibre and many of the vitamins that are naturally found in minimally-processed grains. One of the vitamins commonly found in whole grains is the anti-inflammatory vitamin E.

Some whole grains to try include whole wheat, brown or wild rice, or quinoa. 

6 - Limit these pro-inflammatory foods

There are several foods associated with higher levels of inflammation in the body. These include red and processed meats, refined carbohydrates (i.e., processed grains such as white flour), and sugar-sweetened beverages.[10,14] Regularly consuming these increases inflammation and inflammation-related diseases such as heart disease. Try to save these for an occasional treat if you eat them at all.

Summary of anti-inflammaging strategies

Inflammaging (inflammation + aging) is linked with sarcopenia, heart disease, diabetes, and dementia, but it’s a risk you can mitigate.

By taking some simple actions every day, you can fight the inflammaging process and lead a healthier, more energetic life as you get older. You can maintain your independence and physical abilities, and prevent  chronic diseases. 

It’s not always easy, but by starting to make small changes to improve your sleep, becoming a bit more physically active, and eating more nutritious foods every day, you can make an impact on inflammaging and sarcopenia before it can make an impact on you.

If you haven’t done so already, make sure you join my email list and get both the Resilience Bundle and weekly articles related to the topics of resilience, natural nutrition, and healthy lifestyles.

References

1 - Franceschi, C., Capri, M., Monti, D., Giunta, S., Olivieri, F., Sevini, F., Panourgia, M. P., Invidia, L., Celani, L., Scurti, M., Cevenini, E., Castellani, G. C., & Salvioli, S. (2007). Inflammaging and anti-inflammaging: a systemic perspective on aging and longevity emerged from studies in humans. Mechanisms of ageing and development, 128(1), 92–105. https://doi.org/10.1016/j.mad.2006.11.016

2 - Huynh, Hahn. (2018, August). What is the relationship between aging, nutrition, and inflammaging? University of British Columbia Department of Pathology and Laboratory Medicine Magazine. https://file.pathology.ubc.ca/Newsletter_web_Summer2018/What_%20is_the_Relationship_between_AGING.html

3 - Harvard Health Publishing. (2020, April 1). Understanding acute and chronic inflammation. https://www.health.harvard.edu/staying-healthy/understanding-acute-and-chronic-inflammation

4 - Cannon, R. and Cooper, O. (2020, September 17). Inflammaging: The Side Effect of Age You Haven’t Heard of.

https://www.research.colostate.edu/healthyagingcenter/2020/09/17/inflammaging-the-side-effect-of-age-you-havent-heard-of/

5 - Li, J., Lee, D. H., Hu, J., Tabung, F. K., Li, Y., Bhupathiraju, S. N., Rimm, E. B., Rexrode, K. M., Manson, J. E., Willett, W. C., Giovannucci, E. L., & Hu, F. B. (2020). Dietary Inflammatory Potential and Risk of Cardiovascular Disease Among Men and Women in the U.S. Journal of the American College of Cardiology, 76(19), 2181–2193. https://doi.org/10.1016/j.jacc.2020.09.535

https://pubmed.ncbi.nlm.nih.gov/33153576/

6 - Santilli, V., Bernetti, A., Mangone, M., & Paoloni, M. (2014). Clinical definition of sarcopenia. Clinical cases in mineral and bone metabolism : the official journal of the Italian Society of Osteoporosis, Mineral Metabolism, and Skeletal Diseases, 11(3), 177–180.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4269139/

7 - Strasser, B., Wolters, M., Weyh, C., Krüger, K., & Ticinesi, A. (2021). The Effects of Lifestyle and Diet on Gut Microbiota Composition, Inflammation and Muscle Performance in Our Aging Society. Nutrients, 13(6), 2045. https://doi.org/10.3390/nu13062045

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8232643/

8 - Lavin, K. M., Perkins, R. K., Jemiolo, B., Raue, U., Trappe, S. W., & Trappe, T. A. (2020). Effects of aging and lifelong aerobic exercise on basal and exercise-induced inflammation. Journal of applied physiology (Bethesda, Md. : 1985), 128(1), 87–99.

https://journals.physiology.org/doi/full/10.1152/japplphysiol.00495.2019

9 - Haider, S., Grabovac, I., & Dorner, T. E. (2019). Effects of physical activity interventions in frail and prefrail community-dwelling people on frailty status, muscle strength, physical performance and muscle mass-a narrative review. Wiener klinische Wochenschrift, 131(11-12), 244–254. https://doi.org/10.1007/s00508-019-1484-7

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6570667/

10 - Tabung, F. K., Smith-Warner, S. A., Chavarro, J. E., Fung, T. T., Hu, F. B., Willett, W. C., & Giovannucci, E. L. (2017). An Empirical Dietary Inflammatory Pattern Score Enhances Prediction of Circulating Inflammatory Biomarkers in Adults. The Journal of nutrition, 147(8), 1567–1577. https://doi.org/10.3945/jn.117.248377

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5525108/

11 - National Institute on Aging. (2019, November 27). What do we know about diet and prevention of Alzheimer's disease? https://www.nia.nih.gov/health/what-do-we-know-about-diet-and-prevention-alzheimers-disease

12 - Więckowska-Gacek, A., Mietelska-Porowska, A., Wydrych, M., & Wojda, U. (2021). Western diet as a trigger of Alzheimer's disease: From metabolic syndrome and systemic inflammation to neuroinflammation and neurodegeneration. Ageing research reviews, 70, 101397. Advance online publication. https://doi.org/10.1016/j.arr.2021.101397

13 - National Institute on Aging. (2019, September 12). Poor sleep in middle age linked to late-life Alzheimer's-related brain changes. https://www.nia.nih.gov/news/poor-sleep-middle-age-linked-late-life-alzheimers-related-brain-changes

14 - Bilodeau, K. (2021, May 11). 5 inflammation-fighting food swaps. https://www.health.harvard.edu/blog/5-inflammation-fighting-food-swaps-2021051022570

15 - Johns Hopkins Medicine. (n.d.). The Science of Sleep: Understanding What Happens When You Sleep.

https://www.hopkinsmedicine.org/health/wellness-and-prevention/the-science-of-sleep-understanding-what-happens-when-you-sleep

16 - National Institute on Aging. (2020, November 3). A Good Night's Sleep. https://www.nia.nih.gov/health/good-nights-sleep

17 - Bautmans, I., Salimans, L., Njemini, R., Beyer, I., Lieten, S., & Liberman, K. (2021). The effects of exercise interventions on the inflammatory profile of older adults: A systematic review of the recent literature. Experimental gerontology, 146, 111236. https://doi.org/10.1016/j.exger.2021.111236

https://pubmed.ncbi.nlm.nih.gov/33453323/

18 - National Institute on Aging. (2018, September 24). Preventing Alzheimer's Disease: What Do We Know? https://www.nia.nih.gov/health/preventing-alzheimers-disease-what-do-we-know

19 - Jadczak, A. D., Makwana, N., Luscombe-Marsh, N., Visvanathan, R., & Schultz, T. J. (2018). Effectiveness of exercise interventions on physical function in community-dwelling frail older people: an umbrella review of systematic reviews. JBI database of systematic reviews and implementation reports, 16(3), 752–775. https://doi.org/10.11124/JBISRIR-2017-003551

https://pubmed.ncbi.nlm.nih.gov/29521871/

20 - National Institute on Aging. (2021, January 29). Four Types of Exercise Can Improve Your Health and Physical Ability. https://www.nia.nih.gov/health/four-types-exercise-can-improve-your-health-and-physical-ability

21 - Harvard Health Publishing. (2015, April 16). Benefits of flexibility exercises. https://www.health.harvard.edu/staying-healthy/benefits-of-flexibility-exercises

22 - Brazier, Y. (2020, December 10). How much protein does a person need? Medical News Today. https://www.medicalnewstoday.com/articles/196279

23 - Health Canada. (2006, June 29). Reference Values for Macronutrients. Dietary Reference Intakes. https://www.canada.ca/en/health-canada/services/food-nutrition/healthy-eating/dietary-reference-intakes/tables/reference-values-macronutrients-dietary-reference-intakes-tables-2005.html

24 - Health Canada. (2020, October 14). Eat Protein Foods. Canada’s Food Guide.

https://food-guide.canada.ca/en/healthy-eating-recommendations/make-it-a-habit-to-eat-vegetables-fruit-whole-grains-and-protein-foods/eat-protein-foods/

25 -  Harvard T. H. Chan School of Public Health. (n.d.). Healthy Eating Plate. The Nutrition Source. https://www.hsph.harvard.edu/nutritionsource/healthy-eating-plate/

26 - Office of Dietary Supplements. (2021, March 29). Folate. 

https://ods.od.nih.gov/factsheets/Folate-HealthProfessional/

27 - National Institutes of Health Office of Dietary Supplements.(2021, March 26). Omega-3 Fatty Acids. https://ods.od.nih.gov/factsheets/Omega3FattyAcids-HealthProfessional/



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