June 7, 2012

Nutrition Challenges When You're Older or Sick

This was not written for those of us with diabetes; however, there are some aspects that must be considered and people with diabetes need to be extra careful in the manner which they view this. Now I realize that the persons that are quoted are registered dietitians in the Academy of Nutrition and Dietetics, and thus I must say that I at least need to be extra careful to avoid the traps that will be presented.

Having visited several nursing facilities locally, I realize that as we get older, we tend to eat less. Medications can affect our appetite and sometimes our taste. One of the largest problems I see is dental problems. Not only can this make it painful to chew food, but also dental problems may discourage intake of many foods. Ability to swallow some foods is also a problem unless water or other liquids are available to assist in swallowing.

Considering that there are reasons for appetite loss, consider when you are not feeling well or something is bothering you, how do we maintain adequate nutrition. Kathleen Niedert, RD, director of clinical nutrition and dining services for Western Home Communities in Cedar Falls, Iowa, who counsels many seniors on how to deal with loss of appetite says rightly that “no single strategy works for everyone.”

The article lists ten strategies that will fill some of the nutrition gaps. Please realize that this is written for people without diabetes. I will take each strategy and write my understanding as a person with diabetes. I may miss some items, but I will attempt to highlight the important parts.

Give Yourself Permission to Indulge in Favorite Foods
For people with type 2 diabetes, this is unhealthy advice. We need to worry about the nutritional aspect and attempt to eat properly. While we need calories, we need to find someone that can give us better guidance than the advice given as it is a total cop-out on even reasonable dietary advice.

Enjoy Meals With Friends
This advice can be excellent for some people with diabetes, especially if your friends have diabetes, or at least understand your needs. I agree with this because people generally do eat better with family and friends. The socializing can give a positive influence in what we eat and assist us in eating more slowly.

Buy Prepared or Convenience Foods
If you are a person with diabetes, this should be the last consideration for a diabetes friendly meal. I have no objections to the right foods purchased at the grocery store, but as much as possible, avoid convenience foods. Some grocery stores have a cafeteria-style area where some foods are prepared right, but you must be careful to avoid some of the foods with added sugars or I should say hidden sugars in their sauces and gravies.

I realize that many fresh and frozen foods can require a minimum of preparation and microwaves can really be a help. Do not forget that many fresh vegetables will lose nutrients when they sit around for longer than they should after being picked. Therefore, frozen vegetables can sometimes be a more nutritious choice.

Try New Flavors and Foods
This is a difficult one for people with diabetes as so many foods just do not belong on our menus. Occasionally a new food will come along that will fit our needs. At other times, we will need to use our meter to see how a new food reacts in our system.

The dietitians involved in writing this article in WebMD are very transparent and even use the term “comfort foods” to encourage their readers to eat. Those of us with diabetes should understand that we may eat some comfort foods, but in limited quantity and only what our meter allows.

Spice Up Your Meals
If you’re not hungry because food tastes bland, try adding extra spices and other flavors. This is common sense and does make some foods more palatable and some spices do add nutrient value to the meal. A sprinkling of some fruits with certain foods can also add flavor and desirability to some foods. Again, let your meter be your guide.

Add Calories to Foods Wherever You Can
If you are underweight, use creative ways to add calories to dishes, especially when you’re ill. Even if you have diabetes, these tips will work for you, just do not overdo. Switch from skim milk to 2% or even whole milk, for example. Add extra butter to help add flavor to vegetables. Try these tips as they are healthier than the dietitians are willing to admit. Just start using this tip slowly to give your body time to adjust and not all at once. Even being overweight, these tips can assist in losing some weight. Just limit the pastas and whole grains by what your meter says.

Consider Nutrition Drinks and Liquid Meal Replacements
By providing balanced nutrition in an easy-to-consume form, liquid meal replacements can help you make sure you’re getting the nutrients and calories you need. Your doctor or dietitian can discuss options that are appropriate for you. This may be in your best interest if the liquid meal in not loaded with carbohydrates, but contains a reasonable number.

Drink Plenty of Liquids
Dehydration can dampen appetite, so it is important to stay hydrated by drinking plenty of liquids, preferably water, low carbohydrate vegetable juices, and if allowed unsweetened iced tea or hot tea.

Graze on Snacks Throughout the Day
For people with diabetes, if you don’t feel like eating very much when you sit down to regularly scheduled meals, try eating smaller amounts more often throughout the day.
Eating small meals six times per day can actually assist in blood glucose management, but until you try this, you will not know. This technique can assist in keep blood glucose levels lower throughout the day and prevent spikes that often occur at three meals per day.

Get Meals Delivered to Your Home
Most communities have service organizations that provide meals to older people, either delivered at home or served in community senior centers. If you’re not well enough to prepare meals yourself, check with your local social services to find out what options are available. Senior community food programs are open to anyone 60 and older, regardless of income level. If your doctor indicates that you aren’t able to leave the house, you can qualify for meal deliveries. This is good advice and the only caution I would add is when signing up, do not check the diabetes menu.

The reasoning for this is because you will get more carbohydrates than you should or possibly can eat. Most meals are high in processed grains and starches, but the diabetic meals seem to be overloaded with carbohydrates. In my community, this is very true and a couple that receive them are able to spread the meals into five meals and occasionally more to maintain carbohydrate control. Not that they are trying to spread the meals, it is just more food that they normally eat and higher in carbohydrates than they are accustom to or have had for many years. For some reason, the diabetic menu gets you more food than you would otherwise receive – strange what dietitians think.

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