When work meets life (and a bit on nutrition support)

It’s funny in life when the things that we deal with as part of our day-to-day jobs cross over with our day-to-day lives.. the estate agent who is asked to price up his wife’s best friend’s house; the banker who is asked by his in-laws to have a gander at their accounts or; the doctor who looks bemused whilst his elderly aunt asks him to stare into the depths of her oral cavity whilst she “ahhhhhhhhh’s”. Strangely, although we get paid money every day to do it with our eyes closed, in these situations where we’re asked by familiar faces to apply our expertise, it often throws us.

And in nutrition as you can probably imagine, this happens a lot. People always want your opinion on the fad diet they read about in last week’s glossy mag, to confirm or deny their various food allergies, or to have a deep and meaningful discussion about how their diet might be affecting their bowel habits... now that really is enough to put anyone off their foie gras.

And I’ve learnt that although my usual reaction has been to fall back on what I’ve been trained to do - immediately pelt them with all the evidence on a given topic, pros and cons, scientific explanation for why it does/doesn’t work - this has no benefit whatsoever. The only consequence is that their attention wavers, they glance around for someone else to talk to and when present, the poor members of my immediate family look down at their laps, frustrated and exasperated by the fact that I’m off on another nutrition-based spiel. Then there's the worst-case-scenario - the so-called friend who asked the question suddenly feels the need to enter into a head-on debate, firmly challenging the argument that I have just put forward to defend said dietary plan that journalist X has it on good faith is followed by Cheryl Cole.

As I say, I’m used to these rejections of my passionate efforts to rid the world of inaccurate information about “healthy eating” and the dietary management of various diseases, however, a few weeks ago the tables turned and for the first time it seemed like the advice I'm able to give was really required.

You only have to consider your own family and friends, take a look around whilst doing the weekly shop or open a newspaper to realise we have a rapidly ageing population - with the fastest growing sub-group actually being the over 100’s. Indeed I’m thrilled to say the last of my own four grandparents reached her 80th this very weekend. Without question, the bulk of my work at the moment and that of many basic grade dietitians is trying with mixed success to help elderly patients in hospital maintain and often ideally gain weight. And this was what I found my family asking me to do for my grandfather, a charming retired QC in his mid-80’s who set the cat amongst the pigeons when he recently presented at our family Easter Lunch with a 5kg weight loss following a bout of community-acquired pneumonia.

I was even asked by my ever critical younger brother to step up to the plate and do something with the skills that day-to-day are my bread and butter. Therefore, continuing on with the theme that I seemed to have developed from last week I thought I’d put together some basic, evidence-based, non-quacky advice about nutritional support, especially as having discussed it with other people it seems there are a lot of people out there who have watched their loved ones steadily drop weight either because of an acute episode of illness or just general old-age. However, please please note, this is very generic information and more individualised help should be sought if there are any other pre-existing conditions to consider. 

As dietitians it is engrained into us throughout our training that where possible food-based dietary interventions should preside over any artificial use of nutrition. Yes there are a whole host of supplements for nutritional support available on the market, both on and off prescription  and these have their place. However, I’m not going to discuss them because to be honest ‘food first’ strategies as they’re known in the world of dietitians really are more pleasant, more palatable, more socially acceptable and let’s face it – more normal for the person trying to gain weight. But if you feel supplements might be the way forward, book in to see your GP to find out if your case is eligible for referral to a dietitian. Otherwise, here there are 9 tricks of the trade (10 seemed boring!) that you can try if you too have an older relative who is, or you feel you yourself might be as the great and wonderful National Institute of Clinical Excellence would put it ‘malnourished or at risk of malnutrition’.

1. Food Fortification
Essentially this involves increasing the amount of nutrition that you are getting from a given food without increasing the volume of the food. This is particularly helpful when a poor appetite is the root of the problem. So avoid over-facingly large portions and instead try adding more sugar, jams, eggs and/or oils to food as appropriate; dairy products such as cream, cheese, milk, evaporated milks, spreads are also really handy. Take mashed potato for example - compare a few pots mashed up with a bit of skimmed or even semi-skimmed milk with the same amount of pots with full-cream milk, a nice dollop of butter, maybe a bit of double cream and a healthy sprinkling of a cheese of your choice on top.

2. Don’t forget protein
Otherwise you’ll just increase fat mass without touching lean muscle mass. This is another reason why dairy products are ideal, although other great protein sources include fish, meat, eggs, beans and pulses.

3. I know it’s a cliché but really do eat ‘little and often’
We’re talking breakfast, mid-morning snack, lunch, mid-afternoon snack, evening meal and ideally a bed-time snack. This can be particularly tricky for older generations as it’s not something that they were brought up to do.

4. Watch out for fibre
Definitely don’t cut it out as it’s known to be great for bowel health - preventing constipation, fighting diverticular disease and possibly even bowel cancer. However, it’s also really satiating and can prevent the consumption of those small, frequent meals. For example, you’re far less likely to snack after a breakfast of all bran or muesli rather than a lower-fibre rice or corn-based cereal. Remember, as with all dietary changes, a compromise can always be to have the foods you usually have every day on alternate days.

5. Have pudding
Any pudding but don’t forget the cream and a little extra sugar, honey or syrup. Puddings come into their own for people who are not used to snacking as you’re tagging a bit onto the end of the meal rather than a whole separate course, then again.. it’d be even better to do both!

6. Try a 10-minute stroll in the fresh air before a meal
This will help efforts to increase muscle mass  and serves as a fantastic appetite stimulant.

7. Food-first nourishing drinks
Often better as snacky-type options rather than at meals when they can be very filling. Choose hot drinks such as cocoa, malted drinks, drinking chocolate as opposed to coffee and tea but if the latter are preferred make sure there’s full-cream milk or cream in their and sugar or honey if possible. Fruit juices and fizzy drinks are also great but won’t give you any protein. Finally, soups (admittedly not really drinks!) can be handy if you add cheese and cream to them.

8. Eat what you like, like what you eat
Is this advice for a person who never had a sweet tooth or someone who loves nothing more than an outrageously sweet Danish pastry? Encourage the foods that fit with a person’s own personal preferences and if at a particular time a particular food is craved.. have it!

9. Overcoming tiredness
Feeling fatigued is many people’s reasons for not eating enough so  accept help when it’s offered, try preparing foods when you have the energy and then storing them, consider the use of meals-on-wheels services and don’t shoot down convenience foods – not to be sniffed at with a few boiled veggies on the side and a handful of cheese on top.

No it’s not an exhaustive summary - that would require at least one half-hour consultation with a dietitian, which unfortunately would take a lot more time out of your day and probably involve waiting weeks for an appointment. However, hopefully it has given you some ideas that might help or dare we say it… some food for thought?

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