Above: Ann Gains, who volunteers to facilitate the Enjoy Eating course.
Debbie Sutton is a dietician at Rowans Hospice Living Well Centre. This Nutrition & Hydration Awareness Week, she talks about how our relationship with food can change when living with a life-limiting illness, how this impacts on life, and what can be done to improve it.
“I run the Enjoy Eating course along with our wonderful volunteer Ann. It is aimed at patients and their carers who find that as a result of their illness, they are not enjoying food in the way they used to. These changes have often led to poor nutrition and unwanted weight loss.
…everything we do tends to involve eating or drinking, so if you’re not enjoying eating, it does have quite an effect…
Clearly, this can impact on your health because if you’re not well nourished you’re much more likely to pick up infections, or you may be more inclined to fall over if you’re not very steady on your feet. I’m also quite concerned with the psychological and the emotional side of it. Food is really social, and everything we do tends to involve eating or drinking, so if you’re not enjoying eating, it does have quite an effect on the rest of your life.
Whether they may be ‘healthy’ options or not, the priority is to prevent weight loss and keep up energy levels to provide the best quality of life we can.
On the course, we avoid phrases like ‘healthy eating’; healthy eating is for healthy people, whereas during illness, priorities may change. Healthy eating is often low calorie, lots of fibre, low fat and so on, because mostly people are concerned with slimming and reducing your risk of developing certain diseases. If you’ve already got a significant illness that probably isn’t your priority, and crunching your way through vast quantities of vegetables or salad, or whatever else, isn’t going to be terribly helpful.
It’s all about finding ways to maximise calorific intake in a nutritionally complete diet, using an often very limited range and quantity of food the person feels able to eat. Whether they may be ‘healthy’ options or not, the priority is to prevent weight loss and keep up energy levels to provide the best quality of life we can.
For example, I may suggest they swap a cup to tea for a glass of milk, and have a nice slice of cake with it. If a slice of cake is something they can enjoy eating, it might be the best thing to introduce to help prevent unwanted weight loss. Plus, you have the nutritional goodness of the eggs and flour in the cake.
…encouraging them to enjoy food again feels like a very worthwhile thing to do.
A lot of advice I give on the course is to help them choose food that’s got as much nutrition in as small a portion as possible, that they can enjoy eating. And actually, giving people permission to choose pastries, dumplings, cakes, biscuits, puddings and so on – things that are nutritious but also happen to be really rather nice – is something I rather enjoy about the course!
Overall, I think when people are heading towards the end of their life they probably want to spend as much time as they can with their friends and their family and make the most of the time they’ve got. So for me, helping them to do this by encouraging them to enjoy food again feels like a very worthwhile thing to do.
These groups are like a light at the end of the end of the tunnel
The course, which is very practical with demonstrations and tasting sessions, has been popular since it began two years ago. Two attendees are Les Cleeve and his wife (and carer) Val.
Val said, “It’s been so useful for me as a carer learning more, and it’s good to be able to taste the recipes. Now we say “you need some fuel tonight” and we stopped referring to it as ‘food’. So this helps open your eyes and see all the options”. Les adds, “Our favourite was the smoothies. Things like this course are really helpful when you have no appetite. It’s also a great chance to talk to people with the same problem; these groups are like a light at the end of the end of the tunnel.”
The following are tips that Debbie has developed in the hope most people could try to help them enjoy food once more, whilst ensuring they are getting the energy and nutrition they need.
- Replace a cup of tea with a glass of milk. Tea is mostly water; of course it is important to keep up a good fluid intake, but milk will help maintain fluid while also being a rich source of protein, calcium and some of the B vitamins we all need.
- If your appetite needs tempting, try some familiar favourites, such as baked beans on toast, egg and chips or fruit crumble and custard. Baked beans on toast with some grated cheese on top is an excellent snack, providing foods from all the different groups that we need – protein and iron from beans, carbs from toast, calcium from cheese and vitamin C from the tomato sauce the beans are coated in.
- If you feel full quickly try to include foods with a high energy content in a small portion. Anything made using pastry is useful and tasty. Try a meat pie, Cornish Pasty or sausage roll. There is plenty of nutritional goodness in anything made using flour, and none of that is taken away when it is used to make pastry.
- If you get tired quickly when you are eating, try meals that are easy to chew and swallow, such as scrambled eggs, macaroni cheese, and a sponge cake, mousse or trifle for dessert.
- A ‘little and often’ approach can often help maintain calories too. As well as breakfast, lunch and dinner, include an ‘elevenses’ biscuit, afternoon tea with cake and a milky drink at bedtime.
- Fruit, vegetables and salad are important but can take a lot of chopping and crunching and you might struggle to achieve your ‘5 a day’. Try ready prepared options, such as fruit salads, dried fruit, smoothies, or a jar of tomato based pasta sauce.
- If you know you are not managing to eat the 5-a-day that is recommended, it may be helpful to take an over-the-counter vitamin supplement.