All Food Is Medicine with Registered Dietitian Meredith Kleinhenz

Summary:

"We need more vitamin joy." In this episode of Hope Floats, registered dietitian Meredith Kleinhenz discusses the nutritional needs of individuals with dementia, emphasizing the importance of understanding changes in eating habits and preferences as the disease progresses. She advocates for a flexible approach to food, encouraging caregivers to prioritize enjoyment and comfort over strict dietary rules. The conversation covers practical strategies for managing weight loss, the significance of familiar foods, and the role of caregivers in supporting nutritional intake. Meredith also addresses end-of-life nutrition considerations and the complexities surrounding feeding tubes, ultimately highlighting the importance of 'vitamin joy' in enhancing quality of life for those with dementia.

Takeaways

• Meredith Kleinhenz is a registered dietitian specializing in gerontological nutrition, to learn more about her work visit www.savvydietitian.com or email her at savvydietitian@outlook.com
• Weight loss in dementia can lead to decreased function and higher fall risk.
• Food should be enjoyable and familiar for individuals with dementia.
• Caregivers should focus on the quality of life rather than strict dietary rules.
• Vitamin joy is essential for enhancing the experience of eating.
• Recognizing signs of malnutrition early can help prevent further complications.
• Social eating environments can improve nutritional intake for elders.
• Fluid intake is crucial, but can be challenging for older adults.
• End-of-life care should focus on comfort rather than forcing food and liquids.
• Oral nutrition supplements can be a useful tool but should be chosen based on individual preferences.

Transcript

Shoshawna Rainwater (00:05)

Welcome to Hope Floats, a podcast for people who are caring for a person with dementia. I'm Shoshawna Rainwater, social worker and dementia consultant based in Portland, Oregon. I'm also the daughter of a person living with dementia.

Rachel Coady (00:20)

And I'm Rachel Coady, a professional certified coach and the daughter and primary caregiver for a person who had dementia.

Shoshawna Rainwater (00:27)

Today we're excited to have registered dietician, Meredith Kleinhenz, as a guest on Hope Floats. Meredith is a registered dietician and board certified specialist in gerontological nutrition. She's cared for older adult patients across the spectrum of living environments from independent and home settings to assisted living, adult care homes, memory care, skilled nursing, and hospital settings. Meredith is passionate about educating elders and their loved ones about the risks of weight loss in advanced age and addressing malnutrition with an all foods can fit approach that emphasizes foods and beverages the elder enjoys most.

As a volunteer leader, Meredith has served in multiple roles on the Oregon Academy of Nutrition and Dietetics Board, including as president, and she was elected Oregon's Outstanding Dietitian of the Year in 2023. Meredith currently works full-time in a hospital setting and also has a small private consulting practice based in Portland, Oregon. Welcome, Meredith.

Meredith Kleinhenz (01:33)

Thank you so much for having me. I'm excited to be here.

Shoshawna Rainwater (01:35)

We're so glad you're here today.

Rachel Coady (01:37)

Thank you so much for joining us. Yeah, it's so great. You know, before we get started on the different things we want to talk about today, I'm just curious, how did you get started in this line of work? Where did this come from for you or how did this begin?

Meredith Kleinhenz (01:50)

This started way back in high school in Health class when we had to keep a food journal for a few days. And it really just piqued my interest about health. And I was a classic teenager in the 90s, eating. But it really struck me, I remember some classmates talking about all the fast food and sodas they were drinking and it stuck with me.  And so this is so very dated also, I went to the library and I looked in the Occupational Outlook Handbook, if you remember those humongous books, and I thought “what can you do with nutrition?” And I sort of stumbled on Dietetics.  

And before I had been thinking of, you know, I was taking German in high school and I was thinking maybe international studies and German. And as soon as my parents heard me talking about something practical, they jumped on it because they didn't like the idea of these nebulous studies. So, really that was it. I looked for programs and I went to one in Missouri, which is where I grew up. And became a dietitian.

Shoshawna Rainwater (03:10)

One of the things that I know to be true about you, Meredith, is your passion and enthusiasm for food. And when you and I were colleagues listeners, Meredith used to bring in amazing, really nutritionally dense and also delicious recipes. I remember something called a Raspberry Fool and I remember you brought in like a rice and bean bake one day and we got to be the recipients of your passion around food. It was a lot of fun.

Meredith Kleinhenz (03:39)

I'm so glad you remember that.

Shoshawna Rainwater (03:41 )

Yeah, yeah, we get to benefit from that. 

Rachel Coady (03:44)

What a teammate (laughs).

Shoshawna Rainwater (03:46)

So Meredith, as we're thinking about the population that our listeners are involved with, so our listeners are people who are caring for or involved with a person who is experiencing dementia. We were wondering if you could help us understand what are some of the expected changes or maybe some different nutritional needs that come with a dementia diagnosis? and then with the progression of dementia?

Meredith Kleinhenz (04:15)

So, in the beginning, there may not really be any changes. In someone who's maybe identified with impaired cognition, they're still able to live on their own. Maybe they have caregiving help a few hours a week or family are checking in regularly. The things to maybe look out for are, are the groceries getting consumed? Or is the fridge piling up with rotting produce or the milk's going bad? And it doesn't look like they're eating the things that maybe you left for them to reheat. Those might be early signs of them forgetting to eat. 

Throughout the dementia progression, I'm concerned about weight loss because weight loss means muscle loss and muscle loss means decreased function, higher fall risk. And if you fall and break something, that really can change your independence and quality of life. And then you superimpose on that impaired cognition and do they have the ability to participate in therapies with physical therapy, occupational therapy to get back to a functional baseline that they had before.  So, I'm always thinking about weight loss in elders. 

As dementia progresses, we can also see changes in ability to chew and swallow. Those are muscles. And also that neurological connection, they might not be remembering how to chew and swallow. So things to look for with that would be if they seem to be holding food in their mouth. We call that “pocketing.” Or they need cueing to swallow or take a bite. Or they might forget how to use utensils. So finger foods can be helpful in the beginning. And as things progress, they may need to be fed by hand by someone else. Or hand over hand feeding, helping them remember that mechanical action.

Shoshawna Rainwater (06:17)

Yeah, when you were noting that in the beginning, sometimes we notice foods being uneaten or weight loss, that was the first sign, I think, for us when my mom was not, she would go out into her yard and she would stay there all day and did not think to break for food. And I don't know if it was because her brain was no longer recognizing signals from her stomach that she was hungry, but I remember seeing her after maybe about four weeks or so, and I turned to my family and I said, “she looks really thin.” And when we weighed her, she was down 11 pounds. 

Meredith Kleinhenz (06:55)

Oh, gosh.

Shoshawna Rainwater (06:55)

Yeah, and it was kind of our first like, “oh, this is a person who unless you really get to meals and bring her food, she's probably not going to pause and do those things on her own anymore.” And that was challenging because she was still in the care of my dad, who had never had to be in the kitchen. My mom was always the person who was very beautifully managing meal preparation and making sure everyone was fed. So that was a big aha.  

And when we talked to my dad about that and said, “have you noticed that she looks thinner and her clothes are looser?” And he said, “well, you know, she likes to go outside and I don't see her all day. And then she comes in and she'll eat ice cream.” Which, you know, that's fine. But also she wasn't eating anything else. 

Rachel Coady (07:37)

That is one food that nobody forgets. 

Meredith Kleinhenz (07:42)

Yeah, it can sneak up on you and then you get a look at someone after a period of time and go, “oh yeah, they look different to me.” 

Shoshawna Rainwater (07:50)

Yeah. The other part that you talked about just now about the chewing and swallowing, that's helpful to remember that our muscles change over time and in the dementia experience. And when we interviewed Dr. Linda De Sitter, and she talked about end-stage dementia, we really talked about that swallowing mechanism and how difficult it can be for people in the more advanced stages of dementia to chew and swallow food safely and to be able to what I think is referred to as protecting one's own airway.

Meredith Kleinhenz (08:20)

Right, the speech pathologist that we had at the program we worked at together would talk about, we don't want the food going down the air pipe, which is into our lungs, right? And so we can do modifications to the texture. If your loved one is living in a facility, they might have diet orders, quote, and they might have diet texture orders. So maybe they have a “mechanical soft”   is what we call it, texture, where things are chopped up. They're softer. You're not going to be getting maybe a salad or raw vegetables on that kind of texture because they're just too hard to chew.  Or maybe you'll be on a puree texture because that takes minimal chewing, right? It's already ready to be swallowed. 

In some cases, the risk of going down that air pipe is high enough that they might recommend thickened liquids. So think of your water, your coffee, juice, milk being thickened with an agent because “thin liquids” as they're called, they go down our food pipe the fastest, right? So that also means that they're easiest to get into the air pipe because they don't go down so quickly. So we slow them down by thickening them.  

And there are some things all of us eat that are a thickened consistency, right? If you think of yogurt, if you think of a milkshake or a smoothie, those are slower. They take longer to go down the food pipe so that those types of foods can be protective when there's chewing, swallowing concerns. 

Shoshawna Rainwater (10:00)

Interesting.

Meredith Kleinhenz (10:01)

And they can be highly nutrient dense, which you want if they're having trouble getting enough volume to maintain their weight.

Shoshawna Rainwater (10:09)

Well, let's talk about that. What about this idea of “good” and “bad” foods? And talk about this idea that you've put forth around food being “medicine” in advanced dementia.

Meredith Kleinhenz (10:22)

I spend a lot of my time talking about and addressing malnutrition in my work and I'm really passionate about that. And malnutrition is an inadequate intake of protein, of calories, maybe micronutrients. And when people aren't eating enough, all foods need to be on the table. And I have a couple of good examples and I appreciated hearing your story Shoshawna about your dad having to sort of step up in the kitchen and not noticing your mom eating enough. 

And I'm thinking of a story of a couple. I did a home visit. They had been married for 50 or 60 years. were living in the home they had bought as newlyweds. And she was suffering from pretty advanced dementia by the time I met her.  I was sitting on the couch talking with him and he looks at me and he says, “is it okay that we eat Dinty Moore beef stew?”

Shoshawna Rainwater  (11:20)

Hmm.

Meredith Kleinhenz (11:22)

And here is a man who's never cooked a meal in his life trying to support his wife and he's asking if it's okay to serve what other people might call an ultra-processed food that no one should eat. And I said, “yes, please,” because it's the context here, right? Look at this man is trying to care for this woman he's loved for decades. And that can of chili or stew is gonna make that easier for him. And it's high calorie, high protein, it's soft, it's familiar. And so yes, please nourish yourself with that and nourish your wife with that. It doesn't mean that it's the right choice for everyone, but for their context, absolutely. 

And I have another story too. This man was maybe in earlier stages of dementia, at least he was living on his own in an apartment. His ex-wife was in the same apartment building in a different place and she would come in and sort of check on him. He had some caregiver help also a few hours a week and his son was really involved–very health-conscious son. So he's enrolling in our program and he's mentioning “dad's losing weight.” Oh, dad's also on dialysis. So his kidneys aren't great. He's getting dialysis three times a week. And there's usually a therapeutic diet restriction around that because of your kidneys not functioning.

And he says, “my dad will go through these phases where he'll only eat certain things.  And it was potatoes and now it's whoppers from Burger King.” And, you know, his son had been trying protein powders, green powders, CBD oil, and nothing was working. And I said, you know, “I'm not telling you to eat Whoppers three times a day, but I am telling you to give your dad whoppers three times a day because that is what he will eat and he is malnourished and he is losing too much weight.” And so giving that permission and license to let go of those food rules; we live in a culture of food rules and moral descriptors of food, good, bad, clean, and whatever the opposite of clean is, so it can be helpful to hear that it's okay. 

Shoshawna Rainwater (13:52)

Yeah.

Rachel Coady (13:53)

Yeah. I remember a lot of times for our mom, food was a moment of pleasure and comfort. It is in our family, right? Like we gather around, we make our favorite recipes. And so as her disease progressed, there were certain foods that were like treats to her and it wasn't, she loved ice cream too. wasn't just ice cream, but she would love a hamburger or a cheeseburger. And, so we were working hard to kind of keep her eating and keep her going. But I think also looking at just like taking down those judgments of what's okay or not okay–

Meredith Kleinhenz (14:27)

Yes.

Rachel Coady (14:27)

… or healthy or not to trade for her feeling excited or enjoying or having pleasure in a situation around a food moment. Also is just like a great way to spend time with her for her to feel safe and good and kind of content. 

Meredith Kleinhenz (14:42)

Absolutely, you know, when our worlds get small–which dementia does to us–or our physical frailty or things change, food becomes a really big component of quality of life. And I've found if I say, “well, that food” whatever it may be that there may be a judgment or hang up about is “high in vitamin joy,” people like that.

Rachel Coady (15:10)

Oh my gosh, I love that!  Vitamin joy food.

Meredith Kleinhenz (15:14)

It's high in vitamin joy, period. And you can't argue. 

Shoshawna Rainwater (15:20)

Well, and it lines up with this framework that we talk about often on this podcast, Meredith, around dementia is really about trying to lean into and find the things that soothe people who are having the experience of a changing brain and reducing the things that distress them. 

Meredith Kleinhenz (15:37)

Yes.

Shoshawna Rainwater (15:38)

And so I love this idea of food being “vitamin joy,” and a real source of comfort.

Meredith Kleinhenz (15:45)

Absolutely, and especially if folks are living in a care facility. I just was so grateful for family members who would go visit their loved ones and who would bring things for them and maybe they brought things for other people too. But shaking up the day, bringing the treat, you're bringing them that feeling and an opportunity for joy that really matters.   And we can let go of strict goals around blood sugar and diabetes. I'm much more interested in avoiding weight loss. So that means liberalizing the diet. That's to the exception of the chewing and swallowing difficulty. It's gotta be within the context of something they're not gonna choke on.

Shoshawna Rainwater (16:36)

Mm-hmm.

Meredith Kleinhenz (16:36)

But letting go of low salt, low fat, low this, low that, because they're much more at risk for not getting enough. I'm more interested in are they having bowel movements? Are they drinking enough fluids? And so we can encourage more fluids by giving them the fluids they like. 

Shoshawna Rainwater (16:56)

Mm.

Meredith Kleinhenz (16:56)

And it doesn't have to just be water. All liquids are fluids. Anything that's melted at room temperature is a liquid.  So popsicle, Jell-O. Now if they're on thickened liquids, those things are thin, so that has to be considered, but most people are not on thickened liquids because those are also not well accepted. So you end up not drinking enough and so there's a conversation around risk and quality of life. 

And so there's different language around it. Some common language is called “nectar thick.” That would be, if you think of like tomato juice, is sort of a nectar thick consistency that we all are sort of familiar with. Then there's “honey thick,” and we can picture honey and how that pours. And then there's pudding thick, and we can picture that. And I like to say that hot fudge is thickened liquid and that's what I will be drinking if I have to drink thickened liquids.

Rachel Coady (17:50)

I was like, what about nacho cheese? Like baseball park, nacho cheese. Where's that in the category? 

Meredith Kleinhenz (17:54)

Mmm.  Maybe if it's not too hot.

Rachel Coady (17:59)

When do you, when do you know, like let's say I'm a caretaker on this journey. When do I know that I need to come and meet with a specialist like you? You know, is it around that significant weight loss moment? H ow do I know if my loved one needs to kind of be reconsidered for textures or thickness of liquids or those kinds of things. How does that happen?

Meredith Kleinhenz (18:21)

I would say if you are noticing unintended weight loss in your loved one, then it would be a good time to talk to the doctor about having a referral to a dietitian because we can talk about strategies and maybe helping let go of that notion of a strict diet at this time. 

With changes to chewing and swallowing, I would say if you're noticing people coughing frequently at meals, if you're seeing watery eyes, runny nose, maybe they have like kind of a wet voice, those are signs that those muscles might be weak and that would be definitely something to bring up with the doctor. 

Speech and language pathologists are experts at evaluating swallows and can do sort of an oral test and watch for signs and symptoms. And there are other more technical evaluations they can do by having the person eat and drink things in front of an x-ray machine. And they can watch actually the functioning of the swallow to see if their airway is protected or if modifications would be needed.

Shoshawna Rainwater (19:32)

So asking for a referral to an SLP, or speech language pathologist,  and dietitian would be a good thing for people to know about?

Meredith Kleinhenz (19:41)

Yeah. Bringing up those symptoms that you're noticing. And if your loved one were to be diagnosed with pneumonia, that maybe the doctor would be thinking about asking about those things. Because if something has gone into the airway and then created a pneumonia that's called an “aspiration pneumonia,”  so because something that was not air went into their lungs and cause an infection.

Shoshawna Rainwater (20:05)

Meredith, what are some of the things that you consider to be best practices?

Meredith Kleinhenz (20:10)

Best practices would be for folks who are forgetting to eat to make frequent offers of food, of liquids, and making it as easy as possible. If they can't remember to take the sandwich out of the fridge that you made for them, if they're living on their own, that might be more difficult. Would a timer work? And it might have to be audible. Or making a phone call to them to check, “hey, can you get that sandwich out? It's lunchtime.” Offering foods of preference, like we talked about, liberalizing diet. What foods do you like in general? This is probably not the time to introduce new exotic foods; we want familiar. 

Having a calm environment around eating. Eating socially with your loved one. Or if they're in a setting that they're in a dining room setup rather than eating in their room if they're in say an assisted-living because that's be similar to living at home alone, right? We eat better in a social setting and if they're forgetting how to physically eat, seeing other people modeling for them because they're eating their own meal, that can be helpful.

Rachel Coady (21:22)

I was just going to add, early in our disease journey, my mom was living independently, but we had support coming in and we were supporting her. And, and I did a lot of the food prep and the grocery shopping. And so, you know, familiar foods and kind of regular food. If she liked something, we got a lot of it. 

And I would try to call her around the time that I knew she ate. And instead of kind of being like, “Hey, have you eaten your soup yet?” Or I would just go on the journey of like, “you know, I was  thinking about how good that soup is and how much we have loved like making it together” or whatever it was and just trying to like butter her up a little bit. 

Meredith Kleinhenz (21:59)

Yeah.

Rachel Coady (21:59)

And then she'd be like, “yeah, you know, I think I'm going to go get some of that soup.” And I'm like, yeah, it's right there on the fridge. I think you kept a bowl of it for yourself.” But like, again, kind of in the earlier parts of the journey where you're noticing the forgetfulness around eating, trying to do it in a way that helped her feel like she hadn't lost that ability, but like, that it was right there. If there was an easy snack, I could food prep it. A lot of times it was like carrots and hummus. “yeah, I think there's some of that in there. I wish I had that. That sounds good.”  But things like that, that just kind of empowered her, but also helped remind her to eat the food. 

One of the questions that we struggled with that I wanted to ask you about is drinking more liquids as we get older also means going to the bathroom more. And our parent was like, “I don't want to drink more.” Like it's annoying to have to get up all night.” So is there any guidance around that or anything in the earlier parts of the journey that you've worked with clients and found success with?

Meredith Kleinhenz (22:59  )

I think that is a universal challenge with aging, regardless. 

Rachel Coady (23:0 4)

Yeah, fair, yeah.

Meredith Kleinhenz (23:07)

I encounter a lot of people who start to restrict. Maybe trying to emphasize high water content foods like lots of fruits and vegetables or making smoothies, favoring things in the morning. It is a challenge.

Rachel Coady (23:24)

Yeah.

Shoshawna Rainwater (23:25)

One of the things that I did when my mom lived with us–this was not my own original idea–I used to try to sneak in extra calories into my mom by asking her to be my taste tester. So going to her as I was, in the process of preparing a meal and saying, “hey, I really need your input on this” and bringing her a very small, like a ramekin with a spoon and saying, “what is this missing? You know this recipe way better than I do. Give me your feedback.” And it was a way to just kind of sneak in extra calories.

Meredith Kleinhenz (23:57)

I love that idea. It's a gorgeous idea. 

Shoshawna Rainwater (24:02)

And she felt helpful. Yeah, it was a way for her to feel like she was contributing something, too.

Meredith Kleinhenz (24:19)

It's inclusive and it also serves the agenda that you want, which is for her to eat more. It's brilliant. 

Rachel Coady (24:16)

Listeners, we’ll compile some food ideas that might be helpful or food suggestions that might be helpful for you to use and put those on our website in the Resources section as well from this conversation today. So I think we've all have some ideas around kind of finger foods and extra calorie foods that are good to keep around the house if there are no restrictions or concerns about the density of food or liquid food.

MUSIC TRANSITION

Shoshawna Rainwater (24:52)

Meredith, can we talk a little bit about this common experience of people losing interest in eating and drinking as they are in the very end-stage of life and how hard that can feel for families? Can you help us understand the experience of the body shutting down and when we may want to stop trying to offer?

Meredith Kleinhenz (25:17)

Going back to that food is love, it's quality of life, and when we see someone not eating, we worry about starvation and their starving to death. And that really isn't the case. As our body slows down, we'd expect all of it to slow down. Our digestive system is going to slow down.  And so our intake should sort of match where our body is. And so one of those other best practices that I had wanted to circle back to was allowing the elder to control the volume of food and liquid that they consume at any one time. And so our job as caregivers is to make those offers and it's their job to tell us by turning their head away or not opening their mouth, for example, how much they wanna take at that moment. 

And so as we approach end-of-life–and this goes for all of us–we end up going into ketosis, which is a metabolic process that maybe people have heard of because the ketogenic diet is very popular, but it ends up, at end-of-life, kind of creating this opioid release and a kind of a sense of euphoria or comfort where they're not feeling hungry or thirsty or that they're lacking in that way. And in fact if we try and force foods or liquids when someone is in that state, we can cause discomfort because their digestive system really isn't prepared to handle those things like it was and so we might see diarrhea, we might see bloating or just nonverbal cues of pain. We might increase their aspiration risk because their muscles are too weak to support the safe swallow of that item and so that can create discomfort. 

And so again, just looking for those cues much like when you have an infant, right? And you're learning, “how do I tell what you need?” Those nonverbal cues, that turning the head away, not opening the mouth, those types of things. And of course, if someone isn't alert enough, not offering them. If their mouth looks dry, maybe having those oral swabs, those little sponges can be helpful to moisten things, but they wouldn't be taking in a lot of liquid for say, for example.

Shoshawna Rainwater (27:51)

Meredith, do you have families in the hospital setting asking about feeding tubes?

Meredith Kleinhenz (27:57)

Yes. And… this is a complicated subject, because again, sometimes the families really just want to give it a try and that's okay. That is a fair thing to want to try. I just recently had this conversation that we can try placing the tube so commonly in the hospital, if someone needs a feeding tube for a short time, for less than six weeks, the tube is often placed from their nose. It goes in through their nose and down through their food pipe, their esophagus, and then into their stomach or in some cases down into their small intestine. So you've got this tube placement that needs to occur. 

And I'm thinking of a particular example I had about a year ago where the person was in there for a gallbladder issue and he was having complications so he wasn't eating enough and he had dementia and the family wanted to place a feeding tube and that made sense in the moment around the short-term acute illness was kind of creating why he wasn't eating well and the background was he had fairly advanced dementia. 

He really had a hard time with the tube placement. They had to do it three or four times. And those times he was yelling; he was sort of making his needs known. And we persisted at the request of the family and eventually the tube was placed and he got used to it. And in his particular case, he wasn't really in a place where he could then recover his oral intake enough to not need the tube.

And finally, his process was continuing where he was progressing to end-of- life. And so eventually they did stop the tube feeding and they removed the tube, which provided some comfort because the tube is something that you can physically feel. 

Shoshawna Rainwater (29:59)

Mm-hmm.

Meredith Kleinhenz (30:00)

I had another recent case where they wanted to try the tube and the placement was successful and he was tolerating the thing fine, but then he pulled it out overnight and the family elected to not try and replace the tube and they said, “hey, that's sort of his vote on how this is and how much he likes it.” 

And so it's very fair to want to try it. And I also just encourage looking for those cues. If someone's not able to really speak their needs about the process themselves or or it hadn't been discussed prior.

Shoshawna Rainwater (30:39)

Yeah, it's a complex topic.

Rachel Coady (30:41)

Yeah, hopefully people know loved ones’ wishes about that, but not everybody does. And so you're kind of in a situation of trying to guess what's what's best. 

Meredith Kleinhenz (30:51)

And what I would say is if the driving idea around placing a feeding tube is inadequate intake and really around the dementia diagnosis and not some acute illness that once it resolves, they'll be all right and they'll be able to pick up where they left off with their eating, it really hasn't been shown to increase quality of life or health outcomes for folks with advanced dementia because the tube is confusing and physically uncomfortable. And we risk those overfeeding like I talked about earlier. 

Rachel Coady (31:31)

At the end of our mom's disease journey, we saw a signal of her not being interested in eating and drinking. And we had talked about as a family and we knew her wishes and we let her tell us and kind of lead us on that journey. And one of the hospice workers that was working with us sat down and said to our family, “you know, before everything became so advanced, the most natural way to die was to kind of stop this eating and drinking because your body responds it’s getting less nutrition and then it slowly kind of stops like a car without fuel.” And that gave us such great comfort because I think we had that thing of like, “is it okay? And should we be trying harder?” 

And so I offer that to the listener.  That gave us a lot of peace and we never had signaled that our mom was uncomfortable or if she asked for water or something, we gave it to her. But I felt like we tried to follow her lead on that. 

MUSIC TRANSITION

Meredith Kleinhenz (32:37)

I feel like I should talk about oral nutrition supplements–you know, nutrition drinks. There's lots of brands out there. If you go to any grocery store there's an aisle full of them and what I like to say is the magic is in what your loved one might like, what you can afford, what's accessible and you don't have to have those.  And they can be a useful tool, right? They're shelf-stable. They can go in a purse. They can go on a walker, in a basket. If your loved one's in a facility, that's something that you can purchase and the medication aid can help dispense to them. And it's a known quantity, right? We know how many calories and how much protein they got by finishing that carton of something. 

So they can be a tool and they're okay to not use and they're okay to use and the best one is the one your loved one likes and that you can afford.

Rachel Coady (33:36)

Yeah, there are so many choices now. I'm always surprised. There are just so many different brands of, yeah, it is the whole aisle, you're right.

Meredith Kleinhenz (33:46)

They're culturally very accepted, right? Because there's the sort of bodybuilder, max protein, low calorie version, which is not actually what I would recommend for someone with dementia. They probably need more calories and protein. So I guess I would say for someone who's had unintentional weight loss–and if they don't have diabetes or blood sugars aren't real concern, I would say calories around 300-350 and then whatever the protein is that comes with that. Whereas something like Premier or Ensure Max P rotein those are very high in protein which is great–30 grams–and they're low in calories and if you're not eating enough you need both calories and protein so those both have less than 200. 

So I'd like to see more of a balance in 300-something calories and then whatever the protein is that follows along with that. So hopefully that might be helpful for listeners who are scratching their heads in that aisle.

Rachel Coady (34:47)

I love the permission of just like the correct answer is “the one that they will drink.” There were some things that we really had to try out. Like “this yogurt works. This one does not;” they can both be strawberry. one is a hit and the other one goes wrong. So, yeah, I think just really finding, it is,  it's not unlike when we're trying to get very young people to eat. It's like, “what's the snack that you'll go for? I need to have on hand?” 

Meredith Kleinhenz (35:12)

Yes. And you know, I am surprised for people who have been dieting their entire life, they can remember that and they might talk about things being too high in calories and not wanting to gain weight. And so if that's the case, of redirecting in the moment may or may not work; maybe pouring that drink into a cup so they don't see the nutrition information.

And I would say maybe not relevant so much with cognitive impairment, but for folks that I've worked with that have been dieting for decades, I say “we're in a different chapter of life here.   And so that worked for your previous chapters and now I need you to eat more. We're in a different chapter.” So again, going back to that permission of liberal diet.

Shoshawna Rainwater (36:06)

Meredith, do you have a simple recipe you wanna offer our listeners?

Meredith Kleinhenz (36:10)

I do, it's really simple. It can be no cook. Just need to have a couple things on hand. And if you don't like pesto, this recipe is not for you. But I've been really enjoying this lately, especially because the weather is heating up. But I take a non-specific amount of pesto, which I will make a little more specific for the show notes.

And you can warm it up or you could just put it in a bowl and then drain a can of and rinse a can of white beans. Navy beans could be cannellini beans. I accidentally did this with pinto beans and that turned out great too. So maybe just the bean that you have available. The bean that you will like or you will eat and mix them together.

And then have some grilled bread or pita or crackers, some sturdy crackers so they can scoop that up. And if you have other things floating about in the vegetable drawer like some radishes or celery or tomato or a little shred of carrot, stirring those in to add some color and also other nutrition. Or if you have a packet of tuna or some leftover chicken, chopping that up, stirring it in. And then maybe needing to add a little bit more pesto because of all that stuff you just added. It's a super yummy, nourishing, very easy recipe to put together and very flavorful. Use the pesto you like.

Rachel Coady (37:45)

(laughs) Use the pesto you'll eat.

Meredith Kleinhenz (37:49)

Yes, because it's a prominent flavor and I've just been really enjoying that weekly recently.

Shoshawna Rainwater (37:54)

That sounds amazing.

Rachel Coady (37:56)

That sounds delicious. Yeah. Yeah. I want to dip like cucumbers into that and eat that. That sounds so good. 

Meredith Kleinhenz (38:03)

I'm just sort of stirring them all into a bowl. I'm not blending it per se. Yeah. I'm going for as easy as possible.

Rachel Coady (38:09)

Okay, cool. That's great. Meredith, you've shared so much information with us here today and we really appreciate it. Where can people find out more about the work you're doing right now?

Meredith Kleinhenz (38:24)

Probably the easiest way to find me would be to go to my website, which is www.savvydietitian.com. There's a couple ways to spell dietitian. I spell it with all T's. So that would be a place to find me. And then my email is there and folks could reach out to me with questions or if they're wanting to work together.

Rachel Coady (38:47)

Listeners, these will all be on our show notes and we'll put resource links on our website as well. Okay, final question that we love to ask when guests come to Hope Floats podcast. What is one hope that you have for our listeners today?

Meredith Kleinhenz (39:02)

I hope that you take home the message of “vitamin joy” and letting go of the guilt about certain foods, that certain foods are good and bad for your loved one and having that permission to bring them a milkshake or the brownie they love or the donut from that shop when you're making that visit because that's gonna brighten their day and that's at the end of the day. My goal is always to try and have a positive interaction with folks and if we can do that with a little bit of food what can be better?  Spreading vitamin joy. We need more of it.

Rachel Coady (39:53)

Yeah, I take that on. That's great.

Shoshawna Rainwater (39:56)

So great.

Rachel Coady (39:58)

Thank you so much.

Meredith Kleinhenz (39:59)

Thank you, delighted to be here.

Shoshawna Rainwater (40:01)

Thank you, Meredith. This has been amazing. So glad you joined us. 

Today we talked about the changes that we might see and expect in our loved ones with dementia as it progresses and how to let go of societal expectations for how eating should look when we are caring for a person who is experiencing dementia. We also learned a lot from Meredith about best practices for eating and drinking and supporting the nutritional needs of a person living with dementia.

Rachel Coady (40:31)

We'll be back after a brief summer break with more episodes of Hope Floats. We appreciate all that you're doing and for listening. Until then, take care.

You can always reach out to us here at Hope Floats with your questions or with topics you'd like us to discuss on the podcast. We're here if you want to share your experiences, and let us know what could help you navigate this journey. We want to support you. 

Shoshawna Rainwater (40:58)

You’ll find us at our website hopefloatspodcast.com.  When you’re there, you can learn more about how to work individually with Rachel or Shoshawna for support with your specific circumstances or situation. That’s also where we’ll share more tools, resources, and libraries that can help people on this journey.

Rachel Coady  (41:16)

Never miss an episode of Hope Floats by following us wherever you listen to your podcasts and join our community at hopefloatspodcast.com.