Many hospitals and senior care facilities give supplemental nutrition drinks to their patients or residents. These drinks typically provide up to 250 to 300 or more calories per serving, 14 grams of protein, and up to 20 grams of sugar. They come in many flavors and styles, and their primary function is to assist in weight gain. Or, more radically, stop weight loss.
When my mom was first moved to her memory care facility, she lost a lot of weight. She was anxious and disoriented. She always wanted to go “home.” She paced the floors and constantly asked for my father.
Eight months on, the occupational therapist tells me that Mom is relatively calm and participates in many of the activities. The other day when I arrived for my visit, she had covered the tables in the main area with tablecloths and set out menus and napkins to create a coffee house atmosphere. Mom animatedly talked to her table mates (including a Spanish speaker whose favorite word seems to be “puta.”) Her “coffee?” A daily drink of Ensure.
“The danger is that people see a lot of minerals and vitamins and think more is better,” says geriatrician Dr. Suzanne Salamon, an instructor at Harvard Medical School. “If you use the drinks as meal substitutes that might be okay. It's not okay to eat a full meal and then drink a supplement, unless the goal is to gain weight or stop weight loss. It's too many calories.”
Mom is served breakfast, lunch and dinner, plus a morning and an afternoon snack. I have been present when she eats lunch and dinner, lunch being the biggest meal of the day. It is difficult to get her to eat, and so frustrating. Often, she moves around the food on her plate rather than place it in her mouth, all the while keeping up a dialogue of word salad. I touch her lips and say, “this is your mouth.” “I don’t have a mouth,” she tells me. When I offer to feed her, she bats my hand away and says, “no.” I try placing food on her spoon and giving it to her to hold, but she forgets what to do with it. That’s all they’re provided with—a big spoon. It’s sometimes hard to cut food with a spoon. The staff steps in to remove chicken from the bone or cut the fish into manageable pieces, and—when we’re not there—they try to feed her. She has been known to eat her soup, even drinking it straight from the bowl. Once in a while, if she's left to her own devices, Mom does eat her lunch all by herself. That’s a good day. Thankfully, she is never forced to eat.
Despite the fact that she eats only a fraction of her meal, Mom is gaining weight.
“Oral liquid nutrition supplements can be a distraction from more healthful foods,” says Dr. Paul Mulhausen, chief medical officer for Telligen, a health management company based in Iowa. Part of the issue is the ingredients used to make the high-calorie, meal replacement drinks. For example, a bottle of Ensure Plus vanilla has 13 grams of protein, no fibre and 20 grams of sugar. A bottle of Boost has similar nutritional value.
Just to compare, the average bowl of cereal contains about 10 grams of sugar.
“Ten grams of sugar in your morning bowl of cereal may not sound like a lot. It’s about three teaspoonfuls that add only 40 calories to the meal and an amount that is about the average sugar content for cereals in the United States,” states Livestrong.com. “Unfortunately that amount of sugar represents a large portion of the serving and a significant percentage of the maximum amount of sugar you should eat each day.”
That’s a lot of empty sugary calories.
I am wondering if Mom needs a daily nutritional supplement. Would her appetite increase if she didn’t drink the Ensure? Would her caloric and vitamin intake be sufficient without it given the difficulty with which she eats? Does it matter that she’s gained several kilos (1 kilo = 2.2 lbs)? She’s not going to get any more exercise, unfortunately, as she’s become very sedentary. Which means that without a change to her diet, there will be no weight loss. Does she need to lose weight?
I have asked to speak to the head nurse about these questions, to ascertain whether it may be prudent to cut back on Mom’s nutritional supplement, or maybe stop it all together. I’m not sure how he will respond, but he has shown that he is a good listener. The staff is attentive to the needs of and the concerns of families. Ultimately, I know that Mom is in good hands in her facility.
If you want to create a balanced dinner that provides protein and nutrients plus a healthy dose of fat, you can’t go wrong with this chicken and cashew dish. There are many steps in the preparation process, but the end result is worth it. So, here goes….
This dish was so popular on Shabbat that my son requested the leftovers to take home. How could I refuse such a sweet request?
500 gr / 1 lb chicken breast, cut in 1” pieces
2 Tbsp potato starch
4 Tbsp olive oil, divided
2 cups broccoli florets (small pieces)
1 red pepper, chopped
1 cup unsalted cashews
3-4 cloves garlic, minced
1 Tbsp fresh ginger, minced
3-4 chives, chopped
Salt and pepper to taste
Sesame seeds, for serving
3 ½ Tbsp apricot / hoisin / sweet & sour sauce
1 ½ Tbsp soy sauce
1 ½ Tbsp rice vinegar
1 Tbsp silan (date honey)
½ tsp sesame oil
6 Tbsp water
Coat chicken pieces in potato starch. Heat half the oil in large pan then place pieces individually in the pan and sauté on both sides until cooked through, approximately 5 minutes. Repeat until all pieces are cooked. Remove to cooling dish. Mix sauce ingredients. Using remaining oil, sauté ginger and garlic, then add vegetables. Cook until broccoli turns bright green then add chicken back into pan. Mix together and pour on sauce. Cook another few minutes. Meanwhile, fry cashews in a separate pan on high heat, literally tossing the nuts until they brown. (You do not need to add oil to the pan.) Add nuts to chicken and vegetables, then remove pan from heat. Mix thoroughly. Serve on a bed of rice.