It’s May and that means it’s Older Americans Month!! Unleash the Power of Age (and nutrition)!!

It is May!!  When I think of May I think of the May pole (did anyone else have a May pole when they were kids?) AND Older American’s Month (OAM).  Well, to be honest, I also think about North Carolina strawberries!  Yummy!  This year the theme for OAM is (drum roll, please), Unleash the Power of Age!  What are you doing to unleash your power?  

When I think about the theme the idea of super-heros immediately comes to my mind. Can you tell I’m a parent of a 7 year old?  Ha!  

All joking aside, very soon many states we will have more seniors than they do school aged children.  Those seniors will be (and are) critical to the success of every community!  My hope is that we will continue to see older adults teach younger adults about canning, healthy cooking, freezing, gardening and nutrition.  The younger generation will need older adults to unleash the power of food and nutrition knowledge to keep them healthy.  I also hope that we can work together to take the idea of “farm to school” and apply it to be “farm to nursing home.”  Older adults in nursing homes should have access to better food.  Food that is local and food that is healthy.  It will take all of us to make that a reality!

So, get ready for May and think about how you can unleash your super powers!!  

~Amanda

 

 

GI Virus? What to eat now?

I’ve been fortunate enough to be  in my daughter’s school a lot lately teaching nutrition.  Our lessons have focused on healthy eating, know your food groups, fluid consumption, sugar, eating local and how to try new foods (just to name a few topics).  While I’ve been at her school, I’ve noticed lots of kids are going home with a stomach bug.  I hate stomach bugs (both as a mom and as patient)!!

The GI virus or “throw-up virus” as my daughter calls it can be a real pain to deal with.  Caregivers and parents always ask me lots of questions about keeping hydrated and what liquids and foods to try after the vomiting has stopped.  Here are some helpful tips:

1.  Once the vomiting has stopped, try sucking on ice chips (if over 2-3 yrs old).

2.  Then if tolerated, try 1 teaspoon of a clear liquid (water, apple juice, tea (cold or warm), lemonade, ginger ale, seltzer water or sports drink) every 10 minutes.  (Yep, you read right, every 10 minutes!!).

3.  If tolerated, increase to 1 Tablespoon every 20 minutes.  Keep doubling the amount every hour. (If you are experiencing diarrhea, you may want to try a beverage with some electrolytes added).

4.  Once you’ve been throw-up free for 8 hours, try adding some solid food in small amounts.  I’d recommend foods low in fat and low in insoluble fiber.  Eliminating spicy foods is also a good idea.  Some of the best foods are dry crackers, pretzels, rice, baked potato, dry toast, chicken broth, baked chicken, hard boiled eggs, yogurt, frozen pops (juice type, not the kinds with lots of fruit).

5.  Continue alternating with liquids and solids until you are feeling better.

Amanda

March 13th, 2013: National Registered Dietitian Day!!

Hi Everyone,

I thought I would post a brief post letting you know that tomorrow is National Registered Dietitian Day!!  Yay!!

Congratulations all my fellow Registered Dietitians and future Registered Dietitians!!

Amanda

Sodium Restricted Diets…How low can you go?

There is no denying that most Americans eat far too much sodium.  A diet rich in processed foods is also rich in sodium.  Reducing sodium in your diet (regardless of age, ethnicity or family history) can assist you in lowering your blood pressure.

What exactly does low sodium mean?  I generally consider a diet consisting of ~2400mg/day to be a great goal when aiming for a low sodium target.   That being said, don’t get too excited and totally eliminate all the sodium in your diet.  A recent meta-analysis (1) indicates that going below 1800 mg/day can actually raise your risk of dying.  Of course, that makes sense as our bodies do need some sodium to help manage fluid levels, muscle contractions and nerve function (not to mention improving the taste of our food during aging).

So how much is 2400mg of sodium?  Well, about 1 teaspoon, so not much.  Here are some interesting facts (2) about sodium in the typical American diet:

• 77% of the sodium in our diet comes from processed foods
• 12% is naturally occurring
• 11% is added during cooking or baking

If you are working on meeting a target of 2400mg of sodium in your diet, a great way to get started is to eat more fresh foods (especially fruits and vegetables) and foods that are in season.  These foods usually contain less sodium and are tastier!!

Click here to learn more.  Enjoy!

References:

Salt Image:  Image courtesy of CarlosPorto / FreeDigitalPhotos.net

(1) Heart. 2013 Jan 24.

(2) Fast Facts from the FDA http://www.fda.gov/downloads/Food/ResourcesForYou/Consumers/UCM315471.pdf

Nutrition and Urinary Incontinence

Hi Friends,

I’ve now been asked by four people to comment on foods and fluids and how they relate to urinary incontinence (UI).  For those of you who aren’t familiar with UI, I’d recommend you visit this website.  UI is one of those conditions that most people don’t like to discuss and very rarely bring up with their dietitian….which is too bad.  Foods and fluids play a major role in the management of UI.  Here are just a few tips that may help:

• Drink your water, don’t avoid it.  I find most folks think that drinking less will help them better manage their UI.  Not so.  Staying hydrated and drinking 2 liters of fluid/day seems to help with better management.
• Eat your protein.  I know, I’m back at it talking about protein but less face it…our pelvic floor has lots of muscles and those muscles need protein to fuel them.  Lack of protein in the diet certainly isn’t going to help with muscle integrity.  Read more about protein here.
• Talk with your doctor or dietitian to be sure you aren’t deficient in micronutrients like Magnesium, Calcium, Vitamin B12, Vitamin C and Zinc.  All of these nutrients have a link to UI and doing some investigating into your diet may help you.
• Reduce your caffeine and alcohol intake.  Several studies have suggested that decreasing and/or eliminating caffeine and alcohol is linked to fewer episodes of UI.
• Be careful with sugar sweeteners.  Sweeteners like aspartame have been found to contribute to UI.  If possible, I’d encourage you to find foods that either don’t use these sweeteners or that would use a more natural sweetener (like honey).
• Be careful with foods that could be consider bladder irritants.  Foods that are spicy or acidic (tomatoes, citrus foods, etc.) are notorious for irritation in the bladder and may cause some burning during urination.
• Keep reading about dyes.  This is an area I’m continuing to learn about but there is more and more literature discussing the use of food dyes and its link to UI.  Dyes like Yellow No. 5 have been linked to bladder spasms and irritation.

Amanda

Photo credit: nickwheeleroz / Foter.com / CC BY-NC-SA

3 Deaths in 3 Months

Well, I know it may seem that I’ve fallen off the face of the earth…but, I’m actually still here.  Last semester was a hard one for me.  Our family had three deaths in three months.  Needless to say, it was a time to focus on being together and remembering those whom we had lost.  I didn’t blog much since I was grieving and because I was teaching four courses and trying to keep up with the business of life (parenting, etc.).

It is good to be back on the blog.

In August, we lost Grandma C.  You may remember me talking about her in this post.  She is still the inspiration for this blog and her journey with vascular dementia will forever impact how I care for others.  At her core, she was a true southern lady who taught me a lot about life, food, meal preparation and nutrition.  Oh, how I will miss her!!!  In her final days she suffered another stroke that left her uncommunicative.  We felt her spirit as we sat by her bed as she passed.

We then lost our cat, Eleanor.  Eleanor was our grey tabby and she passed of what seems to have been a brain tumor.  In the end I was syringe feeding her chicken broth and giving her long snuggles.  Our other two four-legged family members (a 15 pound orange tabby and a 61 pound basset hound) also seemed to mourn her passing by staying close in those final days.

Lastly, we lost our Papa.  Papa had battled mesothelioma for 6 months.  He was a fun-loving, spirited man who taught us a lot about family, having a good time and being intentional with our time and talents.

3 deaths in 3 months.  I hope I never have to go through that again.

I will say that I did notice the role nutrition played in each situation.  It was interesting to participate in each “person’s” care. All of them naturally begin to give up food and water.  My Hospice colleagues always remind me that in the end we want people to “eat to satisfaction.”   “Let the patient be your guide.”  Let the patient be your guide.  I love that.  It held true in all three situations.

Although we may want to push, push, push food in the end, we may be doing more harm than good.  It seems that when some people are dying they may want to eat less and less in the final days and at the very end aren’t hungry or thirsty.  They can be truly satisfied with a bite or simple sip.

Well, as we start 2013 I’m going to dedicate my posts to “letting the patient the the guide.” We will be sharing a new smartphone app (and website) with you (that we designed) and we will help you navigate some foods that will better help you live healthy (and happy).

Amanda

Leftovers: A documentary on Food Insecurity

This week, over Twitter, I found out about a new documentary focused on Senior Hunger.  The documentary is titled:  Leftovers and is a film by Seth Hancock.  Here is the trailer:

Seth’s group has done an amazing job bringing to light a topic that is important for all of us to think about.  Many people don’t realize that older adult hunger or food insecurity affect 8.2 million seniors EVERY DAY!  In the nutrition world, we are working hard to figure out ways to bring this number down.  However, as you may imagine, there isn’t one single answer.

I emailed Seth to inquire about a showing of the film here on campus.  I thought it would be a nice way to raise awareness about the subject in the college-age crowd.  I was saddened when Seth wrote back that he was lacking funding to finish the film.  If you are interested in helping Seth, please donate here.

 

Colored Plates: What do Fiestaware and Dementia Have in Common?

Got Fiestaware?  My mom does…she has a whole set of plates and bowls in lots of vibrant, beautiful colors.  Having a meal on a colored plate just seems to make mealtime more fun!

I recently read a great post from The Alzheimer’s Reading Room discussing the use of colored plates in Alzheimer’s patients.  (FYI: The Alzheimer’s Reading Room is a great resource for those with or caregiving for someone with Alzheimer’s.  They have great resources and an active community for you to connect with.  I highly recommend them!!)

The post mentions that colored plates help Alzheimer’s patients see their food more clearly, which as you can imagine, seems to help with intake.   This isn’t a new phenomenom but one we’ve been using in the practice of dietetics for some time.  Colored plates help those with visual impairment see contrast and therefore enhance intake.  Our brains also seem to pick up on the colors and may influence us to eat differently.  In particularly, red plates do seem to increase intake.

So to answer the original question…what do Fiestaware and dementia have in common?  That colorful Fiestaware (or a colored disposable plate) could be an easy trick to helping your loved one with or without dementia eat more!

Have a great weekend!  Sunday is Grandparent’s Day…be sure to honor and/or remember your grandparents!!

——

Resources:

1.  The Alzheimer’s Reading Room:  http://www.alzheimersreadingroom.com/2011/11/thanksgiving-postscript-wont-eat-didnt.html#more

2.  Photo:  Kenan Crawford Hill

Creative ways to swallow crushed medications

If you are helping someone with medication management you may have encountered the need to “hide” their crushed pills in food.  Of course, we aren’t doing this to be deceitful but to help “the medicine go down”…as Mary Poppins would say.  Our goal is to use the food as the delivery method for the crushed medications.

It sounds easy until the person tires of the food or “discovers” the food is the delivery method for medications.  This may sound familiar to those of you who care for adults with dementia.

Here are some of my ideas on foods that can be used to deliver crushed meds:

-Yogurt (get the full-fat, whole milk kind: it works much better)

-pureed fruit (any kind…bananas, apricots, strawberries, mixtures)  We use the Gerber pureed fruits a lot (they are real tasty!!).

-Nutella

-Pimento cheese (delicious on a cracker)

-Any kind of salad (egg, tuna, etc.)

-Ice cream (just scooped)

-Oatmeal

-Grits (or Farina)

-Cheese dip (like pub cheese)

-Any kind of little debbie cake (I know, not what you thought you’d hear the dietitian say…but you can cut a swiss roll (or oatmeal cream pie, etc.) in half, put the meds in the cream and then put back together and serve with a fork). They are soft, easy to chew and have tons of flavor.

-Custard

-Applesauce

-Pudding or Mousse

-Avocados or mild guacamole

-Cottage cheese

-Cream cheese

Of course we aren’t talking a lot of volume for any of these…Enjoy!

References:

Image Location:  nutella-spoon-2.jpg

Adding calories and protein: Oral Supplements or Food First?

I’ve finally decided it is time for me to speak out about the use of oral supplements (Ensure, Boost, etc.).   Oral supplements have been used for decades as a quick solution to adding calories and nutrients to the diet of older adults.  They are easy to consume and aren’t labor intensive.  They have many benefits and when folks are tired and aren’t meeting their calorie needs, many medical professionals jump to recommend them to their patients.

However, over the past few years I’ve begun to question why, during hospital care, we recommend these so quickly.  Why not recommend food first?  Would you rather drink an Ensure or have a fresh fruit and ice cream based milkshake?  How about cheese and crackers?  Or fresh fruit with yogurt?

Too many of us jump to oral supplements as a first line of defense when someone isn’t eating. There are several reasons for this:

1. Cost.   The typical hospital will pay approximately 30-40 cents per can.  You can’t make a real ice cream based milk shake for that little.  So while your in the hospital, it makes sense that this will be given to you as a choice.  The cost on the “outside” isn’t so cheap.  Most consumers will pay $2.00 per 8 fluid ounces.
2. Shelf Stable:  Oral supplements can sit on the shelf of a storeroom and won’t go bad like real food.
3. Disbursement:  It is easier to leave a couple cans of a shelf-stable product next to your bed than it is to leave something that is ice cold that will begin to melt
4. Standardization:  We know exactly what is in every can and we can count those calories and grams of protein so we know exactly what you are consuming.

Of course, all of these make sense and are good reasons….but I’d like to challenge our profession to go back to food first. Would we better serve our patients if we went back to the basics and thought about whole food calorie enhancements (like peanut butter, dried fruits, ice cream, cheese, nuts, fresh fruit, creamed vegetables, etc.)?  Could we save our patient’s money on the “outside” and help them enjoy food again?  Are we missing the social aspects of eating by recommending oral supplements first?  Could we achieve the same goals by discussing meal frequency?  Is this what you would want served to you?  Three times a day?

So, in the meantime, here are some quick, Boost High Protein (240kcals and 15grams of protein) equivalents in “real food.”  Enjoy!

1. 3 whole eggs, hard boiled (232 kcals and 19 grams of protein)
2.  4 Tablespoons of creamy peanut butter and ½ cup of frozen blueberries (228 kcals and 16g of protein)
3. 6 oz of greek yogurt and 1 fresh peach (283 kcals and 12 grams of protein)
4. 2 cups frozen fruit, 1 cup of milk and 3 tablespoons of peanut butter (blended), (524kcals and 28 grams of protein)
5. 1 cup of dry milk (prepared with water) , (240kcals and 24grams of protein)