By Jane Clarke, Dietician and Founder of Nourish Drinks (www.nourishbyjaneclarke.com)
As carers, it can seem an uphill challenge to provide the people most in need with the nourishment their body craves. It seems so cruel that when someone is at their weakest and most vulnerable – when recover- ing from illness, such as Covid-19, recuperating from a fall, or living with a critical health condition like cancer or dementia – getting the nutrients necessary for convalescence is such a challenge.
You may find that, rather than sipping the vitamin-rich broth or soup you have provided, the individual you are looking after simply wants to eat a biscuit or piece of cake. It seems counterintuitive, but this is the body’s natural response to perceived threat.
When the body is in crisis, or has digestive or other challenges, we instinctively crave the nourishment that is easiest to absorb – and top of the list is sugar. We know how delicious it is but also, because some of it is instantly absorbed through the roof of the mouth, we get an endorphin response soon after eating, which gives us an instant boost.
Doctors worry about losing too much weight when we are ill. These shifts are not always down to the disease itself – sometimes medication and the anxiety around your illness can cause you to lose some of your appetite. The problem is that losing weight while we are undergoing treatment can alter our blood work and disrupt our body’s reaction to the drugs and therapies.
My advice is not to be scared of giving a little sugar to someone who is convalescing. When a person is struggling to eat, some of the usual rules around healthy eating can be relaxed, or simply don’t apply. In fact,you can harness that energy-endorphin response to sugar to help tempt the appetite and help give the person you are caring for the energy, strength and willpower to move forward and get better.
EATING FOR RESILIENCE AND RECOVERY
When we are fighting a virus or infection, coping with cancer treatments or the high metabolic requirements created by tumour cells, or recovering from surgery, our body requires many more calories than usual. Without them, not only do we not have the physical strength to recover, but we run the very real risk of becoming undernourished and increasingly vulnerable to infection.
Low-fat, high-fibre and sugar-free foods simply won’t give our body the fuel it needs to help build strength and endurance. Healthy fats give us energy and help the absorption of certain vitamins; too much fibre fills us up and, when the appetite is already poor, prevents us getting essential nourishment; and sugar provides a source of easily absorbed energy.
This is why energy dense foods, where only a small quantity will sup- ply a huge amount of much-needed calories and nutrition, come into their own. Fortunately, there are lots of delicious, easy ways to tweak he simple foods to super-charge the nourishment they provide.
Don’t be afraid to use fats. They not only provide a great source of calories, but can also make a dish taste far better, which can be just what’s needed when you’re struggling with a jaded appetite. Add the classic butter, cream (single or double), thick, Greek-style, full-fat yoghurt, olive or avocado oil (one of my favourites), or some finely grated hard cheese such as Parmesan to puréed and mashed vegetables. Coconut cream or oil, or a nut butter, are also delicious if you want to use a non-dairy fat.
Serve a thick creamy custard, cream or ice cream with easy to eat stewed fruits, and add a soft, melt-in-your-mouth buttery biscuit on the side.
Make porridge with all milk (instead of water) and stir in some cream when serving. Top with brown sugar or a drizzle of honey. A small bowl of this classic is a great calorie-intense hit of a morning.
Add a good layer of butter or nut butter to toast or crumpets. Not only will make it them taste delicious but they will also be easier to swallow and more enjoyable to eat, and the fat will help to boost the calories.
Enrich favourite meals. Add a swirl of cream or yoghurt to a mug of soup, add some grated cheese to mashed potato, add avocado to a salad, or sip a smoothie or milkshake.
Take the pressure off eating. Large portions can overwhelm someone who is struggling to eat. Try to ease back on portion size, serve foods in small portions, say in ramekins, so that you are more likely to think, ‘I can eat that’. You can always serve them seconds.
HEALTHY EATING FOR THE OLDER GENERATION
The general principles of healthy eating apply at any age, so if someone you are caring for is generally well and has a good appetite, you should encourage them to eat five or more portions of fruits and vegetables a day, have a good balance of carbohydrates, proteins and the healthy omega 3 fats found in foods like nuts, oily fish and avocado, and opt for fresh, unprocessed ingredients over pre-prepared meals that can be high in sugar, salt and saturated fats. But there are a few key factors that can maintain or even improve wellbeing in our later years, and are vital if we face a health challenge and want to recover well.
TOP UP VITAMIN D
Vitamin D is known as the ‘sunshine vitamin’ because we synthesise it in our body when sunlight comes into contact with our skin. Not only does the ability to produce vitamin D this way decrease with age, but people in their later years may spend less time outdoors, exacerbating the problem – especially during the current lockdown and social isolation rules. It can lead to a deficiency in this vital nutrient, which is need- ed to maintain healthy bones and also has an important role in preventing respiratory infections and improving immune response – important factors in your later years, when you may be at greater risk of chest infections, and which could be crucial if you are infected with Covid-19. Older people are also recommended to take a supplement containing 10 micrograms (mcg) of vitamin D daily.
GET YOUR VITAMINS
Some older people in the UK, especially those living in care homes, have been found to have low intakes of micronutrients – so although they get all the calories they need from their food, it doesn’t necessarily give them the vitamins and minerals they need to stay fit and well. I’m a big believer in ordinary, affordable foods that just happen to be nutritional champions – apples, carrots, beetroot, cabbage and tomatoes are packed with vitamins and minerals and will bring valuable goodness to your diet.
KEEP A FOOD DIARY
Weight gain and weight loss can become a problem in the later years. It can be easy to think someone has eaten less than they have, or to miss a meal without noticing. Keeping a food diary for a resident can help you track how often they’re really eating (don’t forget to make a note of snacks). Keep the diary for at least two weeks, then with the information to hand, you can tweak their eating so they feel stronger, fit- ter and more resilient.
Try to make mealtimes ‘occasions’ to look forward to. Spending time at the table together, chatting with fellow residents and carers, can be the highlight of someone’s day – and we tend to eat better when we feel happy and relaxed.