Food for Thought

A healthy balanced diet provides all the nutrients the body needs in the right amounts to stay fit and well. Eating a nutritious balanced diet and maintaining a healthy body weight is just as important for people with dementia as anyone else.

Eating healthily does not mean that certain foods have to be avoided. Everything in moderation and a little bit of what you fancy is the key to enjoying food and staying fit and well. However, knowing which foods provide which types of nutrients can be helpful in planning a healthy approach to eating and mealtimes.

Food groups

Similar foods are often grouped together into 'food groups'. Listed below are the different food groups and the nutrients they provide. Choosing a variety of foods from each of the main food groups is the best way to ensure a balanced intake of all the different nutrients needed for good health.

Milk and dairy

This group includes milk, cheese, yoghurt and milk alternatives such as soya. These foods are a good source of protein, which is needed to build and repair body tissue. They also provide a rich source of calcium, which is needed for strong bones and teeth.

To help the body absorb calcium from food, Vitamin D is needed. Vitamin D is mainly formed by the action of sunlight on the skin, but can also be found in foods such as oily fish, margarine and eggs. However, for older people who are unable to leave their home, or who spend little time outdoors, a vitamin D supplement may be required. Check with the GP and dietician.

Meat, fish and vegetarian alternatives

This group includes meat, poultry, fish, offal, eggs, nuts, beans, lentils and vegetarian alternatives such as tofu.

These foods are a good source of protein and also provide some of the B group vitamins. As well as keeping the blood and nervous system healthy, B vitamins break down food to release energy. Foods such as meat, fish, offal and eggs, are good sources of vitamin B12. Vitamin B12 is needed for a healthy nervous system and the formation of red blood cells.

Folate and iron are also needed to keep the blood healthy. Liver is a good source of folate. Iron can be found in red meat, oily fish, liver, kidney, beans and lentils. Eating fruit and vegetables that are rich in vitamin C can help with the absorption of iron from food.

Oily fish is a rich source of Omega 3 essential fatty acids which help to keep the heart and nervous system healthy. A number of research studies have focused on the effect of fish oils on brain health and function as interest around the area of nutrition and brain health continues to grow.

Generally, it is recommended that a healthy diet includes at least two portions of oily fish a week (a portion is 140g cooked weight). Oily fish includes salmon, mackerel, herring, kippers and sardines. Omega 3 fatty acids can also be found in linseeds, walnuts and cold-pressed rapeseed oil.

For further guidance see the healthy eating section of the NHS choices website at www.nhs.uk/livewell/goodfood

For people who choose not to eat meat or fish, foods such as pulses (beans, peas and lentils) nuts, eggs, cheese and soya can be eaten instead. A variety of these foods should be eaten to ensure a good range of nutrients.

Some people who avoid all animal sources of foods (ie meat, fish, eggs and dairy foods) may need a vitamin B12 supplement. Check with the GP and dietitian.

Bread, cereals and potatoes

This group includes starchy foods such as bread, pasta, rice, potatoes and cereals. These foods provide energy and are a good source of B group vitamins. Wholegrain varieties such as brown rice and wholewheat pasta are also a good source of fibre.

Most breakfast cereals are fortified with added vitamins and minerals, such as folate, vitamin B12 and iron. Served with milk, they provide a nourishing snack that can be eaten at any time of the day, not just in the morning!

Fruit and vegetables

This group includes all fruit and vegetables, dried fruit and fruit juices. Fruit and vegetables are packed full of fibre and vitamins - in particular, the antioxidant vitamins C, E and beta-carotene. These vitamins help to protect the healthy cells of the body from damage and support the immune system to fight infections.

Beta-carotene is found in yellow and orange fruit and vegetables and in dark green leafy vegetables. Once in the body, it is converted into vitamin A as required. Vitamin A can also be found in foods such as liver, eggs, cheese and butter.

Vitamin E is present in green leafy vegetables, vegetable oils, butter and nuts, and is needed to support the body's immune system.

Vitamin C is needed to keep gums, teeth and skin healthy as well as keeping the immune system strong to help fight infection. Vitamin C also helps the body absorb iron from food. Oranges, strawberries, kiwi fruit, tomatoes and potatoes are good sources of vitamin C. For people who find it difficult to eat or prepare fruit and vegetables, drinking a glass of orange juice every day is a good way to ensure an adequate intake of vitamin C.

Green leafy vegetables, brussel sprouts, oranges and other citrus fruit are good sources of folate, which helps to keep the blood healthy.

A general guide is to try to have five servings of fruit and vegetables a day to ensure a good range of nutrients for health. However, individual dietary needs can vary, and this guide may not be achievable for everyone. For some people with dementia, difficulties chewing or swallowing or a change in taste preferences may dictate what a person is happy to eat and drink. Blending fruits together to make a smoothie may be a much easier way for some people with dementia to eat fruit and vegetables. Every little helps, so encourage and accept what each person can manage.

Fats and sugars

Fats include margarine, butter, ghee and vegetable oils such as sunflower, rapeseed and olive oil.

These foods are concentrated sources of energy (calories). If someone has lost weight, eating these foods liberally can help to regain it. However, to maintain a healthy weight it is advisable to eat these foods in moderation.

Fats and oils also provide some vitamins. Margarine contains vitamins D and E and vegetable oils are a good source of vitamin E.

Sugars include cakes, pastries, biscuits, confectionery and soft and alcoholic drinks. These foods are not nutrient rich and provide mainly energy (calories) from fat and/or sugar. They can be included as part of a healthy balanced diet, but if eaten too frequently they may dampen the appetite for more nutritious foods. They should be eaten in moderation, except in cases where people need to gain weight. In this situation, these foods are an easy way to get extra calories.

Drinks

Drinking enough fluid every day is vital for good health. A low intake of fluid is likely to result in dehydration. Dehydration or poor fluid intake can contribute to constipation, headaches, tiredness and confusion. It can also affect mood and increase irritability.

Actual fluid requirements can vary daily from one individual to the next. A healthy guide is to drink at least six to eight glasses or at least eight cups of fluid a day. Drinks can include water, tea and coffee, fruit juice, milk and other soft drinks.

A note about fibre

Fibre is important to help keep the digestive system healthy and prevent constipation. The risk of constipation is greater for people who are inactive, do not drink enough or eat a low fibre diet. Certain medications can also aggravate the problem.

A good way of preventing constipation is to include foods that are a good source of fibre in the diet - fruit and vegetables, salads, beans, lentils, wholemeal bread or wholegrain breakfast cereals. However, it is best to introduce high fibre foods gradually if the person is not used to eating them. It is important to remain as active as possible to prevent constipation. A daily walk is an excellent start.