Elderly diabetics can deviate from typical diet to avoid taste fatigue

Islamabad :Elderly diabetics, defined as being over 65 years of age, require a different amount of nutrient recommendations compared to younger adults. This population frequently has barriers to achieving optimal nutritional and glycemic goals due to financial, lifestyle, physiological, and health status changes. Moreover, they might also have other health concerns to deal with, such as constipation, dementia, heart disease, or a poor appetite, which can make their meal planning truly challenging.

Talking to ‘The News’ here on Thursday in connection with World Diabetes Day, Consultant Nutritionist and Head of the Clinical Nutrition Department at Shifa International Hospital (SIH) Dr. Rezzan Khan shared some of the key dietary recommendations for elderly diabetics. While the general nutrition recommendations from the 2018 Pakistan Dietary Guidelines for Better Nutrition for the Elders emphasize the need to keep a healthy weight and eat nutrient-rich foods with an emphasis on fruits, vegetables, whole grains, low fat dairy items, vitamin D sources, seafood, lean meats, poultry, eggs, beans, nuts and seeds consumption, Dr. Rezzan believes it is equally important to reduce the intake of sugar-sweetened beverages and desserts, and limit saturated fats, and refined grain foods. Consuming light meals regularly and adequate daily fluid intake are both necessary.

Prevention the risk of hypoglycemia (low blood sugar) is an important issue, which can be handled with proper timing of medication, meals, and physical activity, and avoiding falls. “Home glucose monitoring or the use of continuous glucose monitor systems can help identify patterns for glucose control. Pre-and post-meal data analysis may indicate a need for meal composition or timing modification. Keeping a food diary updated can reveal causes of hypoglycemia including irregular meal schedules or skipped meals,” Dr. Rezzan advised.

Dr. Rezzan also highlighted that the MIND (Mediterranean Intervention for Neurodegenerative Delay) diet may have a protective effect on cognitive decline. This diet restricts intake of red meat, butter/stick or hard margarine, cheese, pastries, sweets, fried and fast foods and promotes use of leafy green vegetables and berries. “There is no solid evidence of a beneficial effect of supplementing vitamins and minerals to prevent cognitive decline or dementia,” she said in response to a query.

The use of natural probiotics/prebiotics, i.e. good bacteria added yogurt products, homemade yogurt, kefir, or similar active culture dairy products has beneficial effects for the elderly person’s gut health, Dr. Rezzan shared.

Food intake can be negatively impacted by acute illness, lack of food resources, changes in taste, physical abilities, social status, and poor appetite. “The use of diabetes-specific nutritional supplements (liquid preparations and other powder forms) can help replace an occasional meal, boost nutrient intake, improve caloric intake, and prevent hypoglycemia. However, these items can increase food costs substantially. Individuals can make such supplements using dried milk or protein-based powders mixed with other natural food items by blending them,” said Dr. Rezzan, who is also Islamabad Chapter In-charge of the Pakistan Nutrition and Dietetic Society (PNDS).

Responding to a question about taste alterations, Dr. Rezzan said, elderly diabetics should be presented with more than one option to avoid taste fatigue. “Exceptions can be made to a typical diabetes diet; for example, full-fat dairy products might not be on the list of recommended basic foods for elderly diabetics, but occasionally consuming these out-of-list treats might help an elderly patient retain body weight and strength. Along the same lines, a small amount of sugar can help the patient eat more nutritious foods. Individuals affected by tooth loss, improperly fitting dentures, and gum disease may favour semisolids and liquids in their food choices and use liquid meal replacements more often,” she stated.

An important goal of medical nutrition therapy (MNT) is to minimize hypo- and hyperglycemia with individualized goals for the elderly patient. Food and nutrition practitioners, called dietitian nutritionists, can integrate either of these approaches within accepted diabetes MNT guidelines, Dr. Rezzan stated.