Nutrition and dementia
Eating a nutritious, balanced diet is vital for your health. It helps keep your body strong, which means you’re better able to:
- fight off illness and prevent injury
- manage other health conditions, like type 2 diabetes, high cholesterol and high blood pressure
- reduce health complications, like falls and infections.
If you live with dementia, you might have different food and nutrition needs, because your appetite, weight, physical activity and abilities have changed. You might:
- lose your appetite or forget to eat
- feel hungrier than usual, or have a hunger that can’t be satisfied
- forget how to chew and swallow, or find your mouth is dry
- lose or put on a lot of weight
- experience changes in taste, such as craving sweet or salty foods, or unusual flavour combinations.
If this occurs, your doctor or a dietician can provide you with nutritional advice that’s specific to your needs, including any supplements.
What to eat
We recommend choosing a variety of foods from the following food groups:
- vegetables in a variety of colours, like leafy greens, sweet potato and cauliflower
- legumes and beans, like lentils and chickpeas
- fruit
- grains, but choose mostly wholegrain and/or high-fibre cereals
- poultry, fish and lean meats
- eggs
- tofu
- nuts and seeds, like almonds, pumpkin seeds or sunflower seeds
- milk, yoghurt, cheese and dairy-free alternatives (mostly reduced fat)
- “good fats”, such as olive oil, avocado and oily fish.
While you might enjoy something sweet and salty as a treat, try to limit or remove food and drinks that contain saturated or trans fats, and added salt or sugars. These include:
- butter and cream
- full-fat dairy products
- fatty and processed meats
- palm oil and coconut oil
- biscuits, cakes and pastries
- deep-fried foods.
What to drink
Water is the best option for drinks. Increase your daily water intake by carrying a water bottle with you or pouring a glass of water with each meal. You can also stay hydrated by eating fruit with a high water content, such as watermelon.
Alcohol can make memory problems worse and can affect your sleep. It’s also nutrient-poor and can lead to weight gain, so it’s best to avoid it. If you do drink, try not to drink on an empty stomach.
For more on food and dementia, see our Eating page.
Dementia Expert Webinar: Nutrition and Dementia
In this webinar, Dietitian Emma Butler describes how you can maintain adequate food and fluid intake, with simple practical tips to implement on a daily basis.
Transcript
[Beginning of recorded material]
Emma: Hello and welcome. My name is Emma Butler, and I've been at Dementia Australia for the last 20 months working as a Dementia Support Specialist. Prior to coming to Dementia Australia, I was an accredited practising dietitian for around 25 years. I worked in a variety of settings, from hospitals to community health, private practice, and aged care. I have many years experience working with people living with dementia, their carers and family. My passion and goal as a dietitian has always been to provide easy and practical tips to help clients and carers improve their health outcomes. I hope after today's webinar; you are able to implement some of these positive changes. So, we'll move on through to our first slide. I'd like to begin by acknowledging the traditional owners of the land on which we meet today. Today, I'm coming to you from the lands of the Awabakal and Worimi people, and I pay my respects to Elders past, present, and to our shared futures. This session outline for today, there's so many topics that come to mind when we think about nutrition. For today's webinar, I've tried to highlight the nutrition issues most relevant to dementia. The outline today will include the following:
• How dementia can impact nutrition intake.
• Nutrition issues that we do see and present with dementia.
• Unintentional weight loss.
• How we can work on improving appetite and preventing weight loss.
• We'll talk a little on nutrition supplements.
• We'll also talk on fluid intake, stimulating the senses and how we can make mealtimes enjoyable.
So, as you can see, there is a lot of information to cover but hopefully after listening today, you'll have a little bit more awareness and understanding of some of the nutrition concerns that may occur for a person living with dementia. Dementia may impact regions of the brain involved in appetite regulation and eating behaviour. Memory loss can affect food related behaviours, such as buying food at the supermarket and remembering to eat and drink. A person living with dementia may experience a loss of ability to plan and carry out food preparation. The ability to follow recipes or using cooking equipment and utensils may be impacted, therefore, meal preparation can become daunting. A person living with dementia may have reduced concentration and experience a reduced attention span, which again, may impact on the person's ability to sit still for a length of time to eat. And of course, we know that they can become, may become easily distracted at mealtimes. A person living with dementia may develop a lack of interest, which can result in reduced motivation to eat and drink, ultimately, affecting a person's food intake. A person living with dementia may experience changes in movement, or even increased movement, such as walking, which can result in increased energy expenditure. Awareness of these possible changes can identify nutrition concerns early and promote early intervention.
So, just moving on to some of those issues that we've just touched on in the last slide. During the early stages of dementia, a person will generally have the ability to continue to eat and drink normally. As dementia progresses, additional supports and strategies may be required to maintain optimal nutrition. The nutrition goals should focus on maintaining a variety of healthy food choices and adequate food and fluid intake. Weight loss is a prominent clinical feature of dementia and continued weight loss can impact on cognitive capacity and physical capacity. And of course, we know that nutrition intervention is essential to help us minimise and prevent weight loss. Don't be afraid to seek support from a dietitian or a GP, friend or family member if food and nutrition is becoming impacted. Remember, early intervention is important. Unintended weight loss can impact progression of dementia and increase the risk of infections, delayed wound healing, falls and malnutrition. Keep a check on weight or any signs of weight loss. Keep a check on appetite. Any changes in appetite can be picked up and early strategies can be implemented. Not all people will experience weight loss. Some people may gain weight. However, weight loss is more common.
So how do we spot signs of weight loss? A couple of take-home points just to have as an option to keep a check on things like poor appetite, clothes, rings, jewellery or dentures may become loose. A person may feel more tired or have a lack of energy. There may be a reduced physical performance. There's a greater risk of falls. There may more signs of constipation or changes in a person's bowel movements. Altered mood and changes in behaviour, poor concentration, and poor wound healing. So how can we help prevent weight loss? A couple of strategies in the next few slides. We've got eating small meals, frequently throughout the day. This could mean three small meals and two or three snacks throughout the day. Don't always rely on appetite. Try to eat by the clock and maybe try every two to three hours to have something to eat or drink, the protein part of your meal first. Chicken and meat, always first, so that we don't feel too full.
Food-first approach. This is a great concept. It's a way of always remembering we can achieve extra protein and energy at home by fortifying the foods that we naturally eat throughout the day. So, this could look like making milkshakes and fruit smoothies. We could add ice cream, yoghurt, milk powder, and of course, fruit. We can add cream. We can use a neutral powder. We can add this to porridge, to soups, to desserts, and to custards. When we have a sandwich, make sure we're adding a protein filling at on all occasions. This can be tuna, chicken or some leftover cold meats. We can add cheese, mayonnaise and avocado again just to bulk up the protein and calories. Adding cream, butter and cheese is a great way to add and boost the calories into mashed potato and mashed vegetables. So, if we've done all of that with the food-first approach, it's a great first option. However, if we do see that appetite remains poor and weight loss has become evident or has continued, a supplement may be needed to boost the energy between meals.
Nutrition supplements definitely have a place, when needed and you can always talk to Doctor, Geriatrician or a Dietitian regarding nutrition supplements. There's a large variety. You can go to the supermarket and of course the Chemist. Some of the ranges include powdered supplements. So, you may have heard of words such as 'Sustagen Hospital Formula', 'Ensure', 'Advital'. Or, sometimes even you can just think of full cream milk powder, which you can get from the supermarket as an ideal addition into the homemade milkshakes that we just spoke of. Ready to drink supplements. They can include the Sustagen Tetra packs. You can get the high protein versions. There's great Tetra packs in the ‘Up and Go’, with a variety of flavours. Other examples are 'Resource', 'Fortisip', and they can be really useful and convenient, especially when someone is travelling or they have a long day trip planned. And it's a great thing to have as a backup when you need something to drink. And of course, add in that extra protein and calorie component. And lastly, the last dot here, is mentioning a supplement called 'Souvenaid'. So, this is a product from the company 'Nutricia', and it is a formulated nutrition supplement that is designed to support memory and cognitive function in early Alzheimer's disease. Please talk to your GP, Dietitian, or Geriatrician to determine if this is a suitable option for you.
And what about fluid intake? Adequate fluid intake or a decrease in fluid intake can lead to dehydration. As we get older, our sense of thirst, naturally diminishes. Dehydration makes people more tired and cranky. It can bring on stiff joints, headaches, nausea and cramps and can result in incontinence, constipation, increased risk of falls, poor oral intake, and low blood pressure. So how can we spot signs of dehydration? A person may present with dry skin. The membranes of their nose and eyes may become very dry. They may be more confused or lethargic. They may experience dizziness and urine can be dark in colour with a strong odour. Also, frequent UTIs, which is urinary tract infections, can also be a sign of a poor fluid intake. Tips to increase fluid intake. So, let's think of some easy ways we can make sure we're all getting enough fluid each day. Chilled drinks might stimulate someone's appetite. Certainly, try not to have too much fluid before a meal, but definitely lots of chilled drinks so that we can stimulate appetite. Try smoothies, milkshakes, and ice blocks. This also offers protein, calories, along with the fluid content. Incorporate foods with high water content such as watermelon and soup. Always have a glass of water readily available when at home and carry a water bottle when out. Prompt and encourage regular drink breaks and just as a reminder, trying to aim for six to eight glasses of fluid, each day.
Okay, so we are going to move on to our senses. As we age, the number of taste buds reduce, and less saliva is produced while eating. A person living with dementia may experience a reduction in the ability to taste, smell, and see foods. As the brain starts to change, a liking of sweet foods can become more dominant factor for food choices. Sensitivity to sour, bitter, and salty taste can be reduced, whereas sensitivity to and enjoyment of sweet foods can increase. So, some of the strategies that may help combat these sensory changes includes:
• Using aromas, herbs, and spices to evoke and stimulate our appetite.
• Using strong flavours to enhance dishes such as spices, herbs, cheese, soy sauce, et cetera.
• Make food look appealing with different colours, shapes and textures.
• And switch between foods. Switch between different foods. Taste buds and senses can become saturated quickly, making it unappealing to taste the same foods frequently.
• Try to satisfy any sweet cravings with foods that have some nutritional value, such as milks, milkshakes, fruit, and yoghurt.
I'll tie it all up with the last couple of slides that brings on some of the good strategies that can make mealtimes enjoyable. So that's always some couple of good words to remember, making mealtimes enjoyable. So, some things to consider is to have a variety of pre-prepared meals available, which can be served at any time of the day. Prepare meals in bulk and freeze leftovers. Flexible with food preferences. It is possible the person living with dementia may suddenly develop certain food preferences or reject foods he or she may have liked in the past. Allow plenty of time to eat, making mealtimes sociable. Enjoy meals with family and friends. Eating socially can help a person living with dementia to eat more, eat better choices, and eat more regularly. Making mealtimes pleasurable and free from distractions and loud noises, such as the TV. Still on that same topic of making mealtimes enjoyable. We've touched on the idea that mini-meals can be really manageable and less daunting than large quantities of food. Leave healthy snacks and fluid on the table. Grazing throughout the day is absolutely okay. Finger food is ideal as a snack or as a light meal. This can be chopped up fruit, bite-sized sandwiches, chicken tenders, fish bites, and many other things that we can use in that bite-sized, finger food style with meals and snacks at any time in the day. Something like breakfast cereal, or a bowl of porridge can be a great, quick, easy option for a meal to eat at dinner or at any time that someone needs a quick, easy option. All of the information discussed in the webinar today has been sourced from highly reputable organisations and research bodies. For further reading, you can always look to Dietitians Australia and their website is on the page here. Nutrition Education online, they have some fabulous materials that can be very helpful for some tips and resources. Ageing and Dementia Research Center. National Institute on Ageing. Alzheimer's Association. Health Direct and Nutricia, which has information regarding Souvenaid. For any further information or support, please reach out to the National Dementia Helpline on 1800 100 500, that's available 24 hours a day, seven days a week. Thank you for listening.
[END OF RECORDED MATERIAL]
Dementia Expert Webinar: The Mediterranean Diet
In this webinar, dietitian Emma Butler will describe how you can incorporate aspects of the Mediterranean diet into your daily food habits.
Transcript
[Beginning of recorded material]
Emma: Hello and welcome to the Dementia Australia Webinar on the Mediterranean Diet. My name is Emma Butler, and I've been at Dementia Australia for the last 18 months working as a Dementia Support Specialist. Prior to coming to Dementia Australia, I was an accredited practising dietitian for 25 years. I worked in a variety of settings from hospitals to community health, private practice, and aged care and I've many years’ experience working in aged care and particularly working with people living with dementia, their carers, and also their family. My passion and goal as a dietitian has always been to provide lots of practical tips, and tricks, to support people implementing healthy eating guidelines. I'd like to begin by acknowledging the traditional owners of the land on which we meet today. Today, I'm coming to you from the lands of the Awabakal and Worimi people, and I pay my respects to Elders past and present, and to our shared futures.
This webinar is focused on the Mediterranean diet and it's likely you've opened this webinar as you have an interest in learning more about the Mediterranean diet. So, throughout the session, we'll be discussing:
• What is the Mediterranean diet?
• The health benefits of the Mediterranean diet.
• How you can incorporate this into your daily activities and food habits.
And of course, lastly, giving some practical examples of what your meals and snacks could look like on a daily meal pattern. So, what is the Mediterranean diet? The Mediterranean diet refers to eating food that is traditionally eaten by people living around the Mediterranean such as Greece, Italy, and Spain. It's the traditional diet originating in the olive growing areas of this region. It is regarded as one of the world's healthiest dietary patterns and has long been considered the 'benchmark' of a healthy diet. It's even recognised by the World Health Organisation as a healthy and sustainable dietary pattern. It is this style of eating, began back in the 1960s, after observations that people in this Mediterranean region were healthier and had a lower risk of chronic conditions. It's a style of eating, rather than a single fixed diet and it values eating with family and friends, and enjoyment at mealtimes. So, it's really not one fit for all, but a person can look at the Mediterranean diet as a guide to help make positive choices for eating healthier.
So, what are the foods that are included in the Mediterranean diet? So, this slide highlights all of the good food choices that can sit under a Mediterranean style diet. It includes an abundance of fruits and vegetables, extra virgin olive oil, used throughout our food and preparation. Whole grain breads and cereals, legumes, which can include chickpeas, kidney beans, and lentils, to name just a few. Nuts and seeds, fish and seafood, herbs, spices, onion, and garlic. And as you can see from that list, the foods on this highlight an abundance of those whole foods and includes very few processed foods. Another way of looking at the Mediterranean diet which I find really helpful and really useful is this pyramid style. So, this was developed back in 2009, and it's a picture representing how the Mediterranean diet can look. Basically, looking at the base of the pyramid, which is the foods that we eat the most, and then you can see at the top of the pyramid are the foods to eat in smaller amounts or less often. The bottom section also highlights that people can be getting enjoyment from food and also incorporates physical activity. It's important to note that dairy foods such as the yoghurt, milk, and cheese and lean proteins such as eggs, are also eaten in the Mediterranean diet and they sit in the middle, in the moderate amounts. So now that we've got a little more of an understanding of all the things that the Mediterranean diet might look like in terms of the foods that we can utilize. Why do we like to talk about the Mediterranean diet?
So, I want to highlight some of the health benefits. As I said earlier, it is a very well researched diet and almost all of this research concludes favourable health benefits. Several scientific studies have reviewed and concluded there is convincing or highly suggestive health benefits in relation to longevity, cardiovascular or heart disease, Type 2 diabetes, fatty liver disease, chronic kidney disease, depression and anxiety, and some cancers. In regard to cognitive function, a scientific review which has collated over 32 studies from unique cohorts, has concluded that the majority of studies have shown that the Mediterranean diet is associated with improved cognitive function, a decreased risk of cognitive impairment, and a decreased risk of dementia or Alzheimer's disease. It's important to note, that the health benefits of the Mediterranean diet, may also be linked to broader socio-cultural factors such as a relaxed pace of life and sociable mealtimes. Supporting the well-documented links between increased social contact and reduced risk of cognitive decline. So that's a great take home message.
So, why do we think the Mediterranean diet is so healthy? It's actually not fully understood. What is the actual part or parts of the Mediterranean diet that may explain its many health benefits? But we do know, it's likely the combination of healthy foods rather than a single standout food. And likely, the foods it does not include, such as the sugary foods and the highly processed foods. And of course, we do know that the Mediterranean diet is promoting a good balance of healthy fats, which we know is then good for promoting good cardiovascular health. It's high in whole fresh foods, it has lower levels of highly processed and refined foods. It's high in fibre. This is a great example of a healthy diet to help fill us up, without providing excess calories and it's high in antioxidants which can help reduce inflammation in the body. So, lots of ticks for the diet to keep us nice and healthy.
Now putting it all into practice. And I've tried to keep some really good examples of just a couple of ways we can incorporate it into our eating pattern. So, let's imagine that we might start to utilise more fresh fruit and vegetables every day. We might like to replace a meal each week with a legume-based meal, such as some chickpeas in some soups or some lentils into some casseroles, and beans into some kidney bean mixes and mince dishes. We could maybe swap some unhealthy fats for some extra virgin olive oil in our cooking and in dressing salads. We could start to eat a little more oily fish such as salmon or tuna, and aiming for something like twice a week is seen to be beneficial. We can try to share meals with family and friends more often, and of course, we can eat meals without distractions. Some really good breakfast ideas which I always like to reinforce, examples such as muesli with natural yoghurts, fruits and nuts. Porridge, which is a great staple and quite economical breakfast choice. It can be made with milk or water and adding some extra berries and seeds. Whole grain toast is always a great option with some avocado, feta cheese and tomato and some whole grain toast with baked beans or poached eggs is another great breakfast example. Moving on to lunch. There're so many good things we can incorporate in our lunch ideas that can be really simple and it's nice to think 'salad bowls.' So, into salad bowls, we can be adding lots of colour, with green leafy vegetables, spinach, lettuce, and so on. Adding canned fish, can be salmon or tuna, even with a variety of flavours from the salmon and tuna range. We can incorporate the beans at this time and add in our chickpeas or other examples of beans there, and we can use the olive oil in the dressings with the lemon and herbs. Bring back whole grain breads because they're easy to add additions such as hummus, salad greens, tomato. There's that avocado again, and grilled chicken. And another one I like to always think about is adding to our soups, lots of veggies, lentils, beans and tomato and of course, those things can be made in bulk and then we can always be having those as quick easy lunches moving forward.
Okay, so some nice dinner options, might include the salmon that we've mentioned before. Bringing in brown rice, steamed vegetables, and again, lots of colour and making sure we've got all of those vegetable options with the green leafy options. Stir-fries with chicken or beef are always great. And again, adding in the vegetables with a rice base. Homemade pizzas, they can be, again with a variety of toppings, vegetables, mushrooms, eggplant, tomato, garlic and olives. And again, incorporating the tuna with things like pasta bake and again, using tomato, spinach and feta cheese as needed. Then finally, we've got some really good snack ideas. Nuts are a great one for snacks, easy to take with us if we're out for the day, to work or have at home. Always thinking fruit. And of course, we can have the fresh options, dried or canned. Hummus dip is readily available in the supermarkets, and we can always add some sticks, such as carrot sticks and whole grain crackers to those. Avocado and tomatoes, another great one to have as a snack on your little whole grain crackers and bringing in natural yoghurts and berries for a sweet taste, of course, is a good one. And the boiled egg is always a great way to fill us up in between meals.
So, in summary, hopefully you've been able to take home the idea that there's many health benefits, including the lower risk of heart disease, cancer, dementia and diabetes with the added benefit of improved mental health and longevity. Hopefully you've been able to take home that there's a great way to incorporate lots of fruits and vegetables and whole grain, whole grains and legumes. Aiming to eat oily fish twice a week, including healthy fats such as olive oil and nuts daily. Making mealtimes enjoyable with family and friends and hopefully that's just a few practical tips so you can introduce aspects of the Mediterranean diet. And maybe you are already following a lot of these types of food options, and hopefully it's given you some reassurance and reassured you that it is a healthy option and it is providing a great benefit to your long-term health and longevity.
And lastly, I think we have the last slide to recognise all of the information that I've been able to collate today is from a variety of sources. Particularly, Dietitians Australia, a great resource I utilize from the nutrition education materials online, along with healthdirect.gov.au. A couple of the review articles that I referred to are mentioned at the end here, and the Mediterranean resources there's a website for the two of those. The old way is the pyramid that we spoke of in one of the slides earlier. So, thank you for listening. Always remember that you can talk to your doctor and you can always ask to see a dietitian if you do think you would benefit from a more individualised plan and hopefully that would be of assistance. For any further information or support, please reach out to the National Dementia Helpline on 1800 100 500. That's available 24 hours a day, seven days a week. Thank you for listening.
[END OF RECORDED MATERIAL]
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