At The Window with Dementia Podcast S1E
Laura Banner

Laura Banner

Family Nurse Practitioner, Dementia Trainer & Advocate,
Keynote Speaker (Available for speaking engagements on Dementia)

Nutrition and Hydration

Today I want to talk about nutrition and hydration.

This is a topic that is frequently brought up by family members; they’re concerned because their loved ones seem to have developed an insatiable appetite for sweets. Regardless of whether or not they ever cared for sweets in the past, now it seems as though, that’s all they have an interest in.

So, what we know is that part of the process of dementia, or rather the pathophysiology, the changes that occur within the body. When someone is developing dementia is that there is a change in their taste buds sensitivity. The taste buds that are preserved the longest are salt and sweet, so other types of flavors sours and bland foods, they lose that sense of taste.

And so they might as well be eating cardboard. I don’t mean to be so blunt about it, but in fact, if you can’t taste something, you’re just going through the motions. We also know that their sense of smell tends to be altered, and part of the eating experience is the ability to smell food, so if your sense of smell, has declined, as well as your sense of taste. Do you think that they would want to go ahead and have what they used to like a burger, a steak, maybe some chicken?

Probably not, it doesn’t seem to be so affected in the early stages, but certainly, as the disease progresses, it will become very apparent that they have minimal interest in the things that they once enjoyed. They want dessert, and of course, you don’t want to deny them, but at the same time, you want to do everything within your power to keep them as healthy as possible. And we know that a nutritious diet is truly the best way to keep someone healthy.

However, unfortunately, we know that with dementia, we can’t stop progression, and we can’t reverse it. We need to manage the disease, and we also want to make the journey as comfortable as we can, for the loved one that is suffering from this awful, awful disease. So, how do you find balance?

Well, certainly, negotiation is a good route to first start with. But what happens when you’re no longer able to negotiate with your loved one, you can’t say, “if you go ahead and you have this, the unhealthy part of the meal, then you can have your dessert.” Where do you go from there? Well, the first thing that I would tell you is this: be aware that there is a concept called diabetes type three, and what this theory entails is basically that there is a state of diabetes within the central nervous system, and regardless of whether or not someone has diabetes, the way that we think of a type one or type two check your blood sugar, diabetes Type three is about the effect of increased sugar on the brain, and what diabetes type three proposes and I have to say I actually agree with this theory is that the more carb intake, the more brain fog that results, and that makes sense to me. So think about a meal that is high in carbs, or maybe you know if you’ve really indulged in some cake or some type of sweet that you enjoy, afterward, you have that sense of bloat, you have that abdominal fullness.

Well, something sort of similar happens in the brain, you have some inflammation that results in this brain fog. Well, imagine that brain fog superimposed on someone who’s already having some cognitive issues,
and then, as that sugar starts to normalize or drop, then you feel fatigued, only to be followed by the next meal that’s high in sugar.

So again, sugar levels rise brain fog ensues, and you get the routine, up and down, up and down, and it can be disorienting, it can cause mood instability, and really it is not doing what you can do to optimize brain function by having these extreme fluctuations.

So what I like to tell people is try to focus on protein, now I’m
making some assumptions, I’m making the assumption that someone doesn’t have kidney disease where they have to limit their protein intake, they don’t have any special dietary restrictions for other reasons.
So, assuming that none of that exists. Protein tends to normalize blood sugar instead of these highs and lows like carbs will cause, proteins normalize blood sugar, and it allows this constant steady-state and the brain does better in that type of environment.

So that still leaves you with the big question of how do you convince your loved one that sugar is not good?

Well, good luck. I really do not think you are going to ultimately win that battle. So, moderation. So, what I would say is this: Try to find foods that are interesting to them, when taste is not the driving force, and perhaps they’ve gotten to the stage where they don’t recognize the sense of hunger or satiety, and so they’re always just hungry, or they’re not even hungry, one of the two extremes, seems like it’s never middle of the road.

But what I propose is this: try to offer frequent snacks that have texture to them, for example, imagine having a spoonful of mashed potatoes. Now, if you can’t taste those mash mashed potatoes, it’s not very exciting, not a lot of drama to have that second spoonful of mashed potatoes, right?

But what if it was ground beef or ground turkey, or something that had some texture, well, maybe you can’t taste it, the way you used to, but you still have a different experience, and that experience of texture, maybe enough to make you want to have a second bite, it’s something to try.

Do not always deny what we know about ourselves is if you constantly deny yourself something, it just makes the desire for that so much greater.

Limit the portion size, maybe they don’t get the bowl of ice cream, after every dinner, Maybe you alternate, maybe you try a fruit after dinner, Or maybe you try something that’s a little bit lower in sugar.

They’re pretty smart though; they’re gonna know if you’re giving them something that sugar-free because it’s not going to fulfill the need that they have. So moderation, They’re just completely resistant to eating all they want is something sweet.

Try the nutritional drinks; you’re going to get a lot of dense calories in a small amount of liquid, Ensure is really good, Glucerna if you’re diabetic, be careful because they can cause some GI issues, but they come in different flavors, and perhaps, your loved one will love them, or at least like them enough that they’re willing to have them.

Calories are important; what you need to understand about calories is that calories translate to energy. So yes, you want to try to go ahead and have a balanced diet that’s really important. But when they won’t eat the nutritious meal, give them calories; they need the calories because if they don’t have the calories, they’ll become lethargic; nothing’s going to work properly. The brain is incredibly demanding; it needs to have nutrients.
If it doesn’t have glucose, if it doesn’t have water, it’s not going to function the way that it needs to, the way that it should, the way that it can.

Which leads us into water, you know, water is an interesting beverage, you either love it or you don’t. we can try to mask it by adding fruits into it to infuse some flavor or maybe splash of orange juice into it to change the coloration and maybe make it just slightly sweet, little different than water, but here’s the problem, especially with women, and we know that
women tend to have Alzheimer’s, at least at a much higher rate of occurrence than men.

Women tend to have a weaker bladder than men, perhaps they had children when they were younger, and that weakened their bladder, or maybe it’s just age-related because as the estrogen drops, the bladder tone drops as well and we need to go to the bathroom more often, and our bladder tone is not what it used to be so when we need to go, we need to go.

Urinary urgency is not something that’s rare; it is quite common among almost all women as age advances, and among a lot of men as well.

So keep this in mind, we’re asking people who may or may not enjoy the taste of water to go ahead and consume water; when they know instinctually that the more water they drink, the more frequent they’re going to need to go to the restroom, and they don’t have the bladder tone that they used to, so the time it’s going to take to get to the bathroom, is probably going to be longer than the time that they have before they lose complete control over their bladder. And there’s your incontinence.

So, how do we get around this? Well, of course, there are adult briefs, and that is certainly a very good option, but a lot of people are resistant to it early on, and I understand that, so, what do you do?

Well, keep this in mind, the water that’s in tea or in coffee doesn’t count as water because actually, in those two beverages, it’s more of a diuretic,
so you’re losing more water. Soda, well, we know that that doesn’t count,
it will certainly, meet the sweet need, but it does not meet the need for hydration.

So what you need to do is you need to constantly be pushing water, and when I say push water, what I mean is encouraged them to drink it, what I find is you have a better chance of them drinking more water if you use a straw, perhaps you can find a cup that they enjoy using.

I think just by saying, “You need to have eight glasses of water a day” right away, that’s just going to seem too much, and they’re not going to do it. I think I might have a hard time doing it that way as well.

So why do we need water? Why is water important?

Water is important because it flushes out the toxins from your system, when the toxins build up, it makes you more confused. It creates a situation called encephalopathy; basically, what that means is the toxins built up in your system. It’s causing you confusion. You’re not clearing them.

Water is the key to clearing your kidneys and all the waste that is caused by everyday activities and metabolism.

If you go ahead and you pinch your skin, on your hand is an easy place to do it, and then you release that pinch, and the skin remains lifted; we call it tenting, that is a down and dirty way to check if someone’s dehydrated.

So people ask me all the time, how do I know if they’re getting enough water? Another way to tell besides the tenting test, is by the color of their urine, in the morning, we know that urine is naturally dark yellow some variation of a rich yellow color, by early afternoon, it should be clear, or pretty close to clear, and if it’s not, they’re dehydrated. They still have not gotten enough water to clear those toxins.

So let’s just say for a moment that they’ve decided they’re not going to drink the water, they’re going to drink their coffee, they’re going to drink their soda, they’re not going to drink the water. What’s the problem, right. It’s a perfect setup for infection. The number one infection that it leads to is a urinary tract infection or a kidney infection. And oftentimes, you don’t get those usual signs that there’s some type of infection the signs that we get when we’re younger, the lower abdominal cramping, the burning with urination, the only evidence of infection may be, increased confusion or what we like to say is altered mental status.

Would you be surprised to know that when someone 50 or older goes to the ER and the presenting complaint is confusion, the first thing they check, aside from vitals, is urine. They want to see if there’s a urinary tract infection. It is that common; Left untreated, you can be looking at something far more serious this than just a urinary tract infection, that infection can migrate to the kidneys, it can get into the blood, they can become what we call uroseptic, they can end up in the intensive care unit.

As a matter of fact, that’s exactly where my uncle is right now; he resides in a nursing home he has Lewy body dementia. He requires a level of care that is beyond what our family is able to provide at home, and because he was not aware that he had an infection, he wasn’t running a fever. Seemed like himself apparently to the staff, the infection was present for as best we can tell, at least several days. By the time he got into the hospital, which is where he’s at now. He had a urinary tract infection that became a kidney infection that then gone into his bloodstream, so he’s septic now and that sepsis has created some heart damage, and now he’s in heart failure. I don’t know how this is going to turn out.
But any way you look at it, it’s not going to be good. Because if he survives it, we know that he’s going to have a new normal because every time there is some type of infection, there is a cognitive decline, and there’s a new baseline that is created, or, he may not make it out of the hospital, that’s a conversation my family’s having right now.

I don’t want your loved one to be in that situation. It is something that is so easily avoided by getting enough hydration with water, be creative. Maybe a glass of water for a bowl of ice cream, I don’t know, you’re gonna have to find out what works for you and your loved one.

But nutrition and hydration are the keys to having a slow progression, at least, to the best of our ability to control, because every time that your loved one becomes infected, Again, it precipitates a decline that didn’t need to be.

So, good luck everybody, I know it’s not an easy task. You do what you can do; you negotiate when you can. Sometimes you give in, but sometimes you need to toe the line. At the end of the day, calories are a priority, and water is a must.

I wish you all well; please check out my Instagram page for more information about nutrition and hydration, you can find me at compassionate_education on my website at compassionate education.com

Feel free to go ahead and send me a message on either platform if you have a question or if you have a particular topic about dementia that you’d like me to address.

I hope you’re enjoying the podcast, and please check back again soon. 

This is a weekly series, and we will see you next week.

Thanks a lot

Bye-bye.

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