It's Nancy Bertolino's job to know what's on the grocery store shelves, but when she shops for herself, she keeps an eye on the calcium content of foods.

Bertolino is a dietitian for Midwestern grocery store chain Hy-Vee, and she's bordering on a full-blown diagnosis of osteoporosis.

"I have all the risk factors -- I'm probably the poster child. Caucasian, not a great milk drinker, low body weight," Bertolino said.

The 51-year-old said she's in the same boat as many of the Baby Boomer clientele she serves in Omaha, Neb. Age has brought on a cavalcade of health problems that are forcing them to change their diets.

In addition to looking for high-calcium foods, Bertolino said she also shops with an eye to her husband's family history of heart disease. While some customers resist Bertolino's dietary suggestions, she said her husband wasn't one of them.

"He's an easy client. He observed his father come out of the OR after quadruple-bypass and it scared him. He's remained vigilant," she said.

The Age Of Consequences

Christine Gerbstadt is a registered dietitian in Altoona, Pa., and a spokeswoman for the American Dietetic Association. She said change is hard on boomers who always thought they had the world on a string.

"Baby boomers grew up in the '60s and drugs had no consequences. Current baby boomers thought they'd get away with everything and do it all. You can't live on the edge all the time. You reach the age of consequences," Gerbstadt said. "The people I see mostly already have (diabetes or heart disease) -- they're not looking down the barrel of it anymore. The candy bars and extra cocktails and steaks every night have caught up."

Osteoporosis, heart disease, high blood pressure and weight gain are boomers' biggest complaints when they consult a dietitian. Women in menopause, especially, are prone to weight gain, but a slowing metabolism is just an expected part of aging.

Loss Of Muscle

"The most significant impact is the loss of muscle mass as we age, " said Rita Frickel, a registered dietitian -- and at 50, a baby boomer herself -- at Creighton University's Medical Center's cardiac unit in Omaha. "At about the age of 40, the average adult loses half a pound of muscle mass per year, and that's what controls the metabolism."

Frickel said that to stay out in front of that weight gain, people over 40 need to remove about 50 calories per day, per year from of their diets. If they don't, and they maintain the same activity rate, they'll put on about 5 pounds a year.

"From personal experience, I used to never have to exercise and I ate what I wanted. After having children, but even more recently, I started to have to exercise 30 minutes a week, and now its 45 minutes," Frickel said.

Gerbstadt emphasizes that Boomers can't just concentrate on the number on the scale. She said plenty of people are overweight at 150 pounds because their body-fat percentage is above 26 percent, so she urges Boomers to keep an eye on their body-mass index, too. Lowering it probably means exercise.

Nutrient Needs

At the same time that boomers need to trim calories from their diets, they need to consume more vitamins and minerals. As cells age, they absorb nutrients less effectively, so dietitians said there's not room in a boomer's diet for junk.

"You see 100-calorie packs -- even though they're only 100 calories, they're not that good for you because they're processed," said Gabrielle Redford, who writes a fitness column for AARP. "If you're consuming them, it may mean you're not consuming some of the things that are loaded with vitamins and minerals."

Frickel said the best approach is to boost the fiber up to 25 to 35 grams per day.

"We have higher nutrient needs -- we need to meet the same needs with fewer calories," Frickel said.

That means more fresh fruits, vegetables and whole grains. They deliver a panoply of nutrients and make you feel full for the fewest calories.

In Ohio, dietitian Shari Baker, of the Ohio Department of Aging, has helped take federal grant money and turn it into coupons that give even low-income seniors a chance to boost their nutrition.

"We get funding and give $50 worth of coupons per participant to go to farm stands to get fresh, locally grown produce," Baker said. "Eating is an art and a science. I provide high-fiber, fresh produce to seniors. It's a program that we have a passion for. It brings them back to their memories. They can share it with their grandkids and remember when they lived at a farm. There's nothing better than being able to eat fresh."

Adding fiber and reducing calories will fight weight gain, high blood pressure and heart disease.

Dietitians said calcium and vitamin D are needed together in the 50s and 60s to help maintain bone density and ward off osteoporosis. Green, leafy vegetables also contain calcium and vitamin D is a fortification of many milk and juice products.

Vitamin B6 is recommended to ward off anemia and help keep blood and cells healthy.

"Food first, but I think it's a good insurance policy to take a good daily multi-vitamin," said Frickel. "We don't absorb as well and we don't know at what age we stop absorption."

Finally, 50 doesn't mean the end of fun food. But, the dietitians agreed, balancing birthday cake and full-fat steaks with low-calorie, high-fiber meals is even more important as we age than ever. Don't be a food fuddy-duddy at a party, but walk the dogs an extra time the next day.