Noting that tastes, likes and dislikes change and diminish appetites of many Lewy Body patients leaves the caregiver in a quandary. What should the goals be to slow the inevitable weight-loss, and how to do it while offering balanced meals?

Over the past many months, I have noticed that my husband enjoys peanut-butter and jelly sandwiches for lunch.  This frequent request varied drastically from his “normal” lunches that mainly consisted of regular fare of deli sandwiches or leftovers.  Worrying that this was not a robust or satisfying meal at the time, I now acknowledge his tastes and provide it but always with milk and fruit on the side and with whole wheat bread. I now call it “balanced”.  Likewise leftover pastas with plenty of cheese and a fruit side suits his taste and also falls into the “balanced” category.

Balanced meals means, to me, providing calories with protein, carbohydrates, and various fruits and vegetables that supply flavonoids for vitamins and micronutrients especially for brain health. A recent article in the New York Times that presents research findings from the journal Neurology, and notes that higher intake of brussels sprouts, strawberries, winter squash, and raw spinach were “most highly associated with better scores on the test of subjective cognition decline”. Flavonoids include beta carotene in carrots, flavone in strawberries, anthocyanin in apples. There are about three dozen flavonoid containing foods.  Blended drinks or soups of these fruits or vegetables if swallowing is an issue would cover basic needs. Many people add yoghurt, milk, whey powder and other protein powders to the mix to cover extra protein or even fat for calories for balancing.     

Chewing and swallowing sometimes prevent solid meat meals.  Getting more “tender” cuts of meat and cutting in small pieces can work for a time to help with this problem. Most of our solid protein now is fish or chicken, but a juicy cheeseburger with avocado, tomato and onion is appreciated. Eventually I suspect that in the future meals will be served pureed for safety in swallowing.    

Changing tastes also brought us to a liking for a nightly dessert. Those dealing with proving meals to diabetics have a real challenge here.  I still will give ice-cream for dessert, but try to balance it with berries. A very popular dessert here is peach/mango melba or banana splits served with chopped walnuts or a little granola on top. Of course, keeping a watchful eye on the AIC blood level is important and substituting sugar free ice-cream or yoghurt is necessary when the level reaches 7.  Half a blueberry muffin with blueberries on the side with probiotic yoghurt and whipped cream is another favorite. A small piece of dark chocolate is a good evening snack since the antioxidants stimulate endorphins that help with stress.      

Another benefit from fruit and vegetable intake is bowel health since constipation is an often reported symptom associated with Lewy Body Dementia. The added roughage from fruit and vegetable can aid regular bowel movements. Luckily, we like stewed prunes as a regularly served fruit, and three servings a week can aid in bowel regularity. This along with good fluid intake helps prevent, thus far, the addition of laxatives on a regular basis. 

Keeping track of fluids is necessary for adequate hydration. An adult’s daily intake should be about 3 to 4 quarts daily. Since older adults have thinner skin that allows for fluid loss through evaporation, and a muted thirst signal that slows down fluid intake, dehydration should be monitored because it can cause increased confusion among this population. 

Thus far, these small meal changes are working and we haven’t needed the commercial supplements available on the market. However, these supplements are readily available in varied flavors and consistency and can be relied upon to provide necessary vitamins, calories and protein. 

Tracking weight on a weekly basis with a scale that mimics the one at your doctor’s office and provides consistent results is helpful. Our old scale just got replaced by a new digital one that matches our physician’s numbers exactly. This way there is no guessing weight numbers and we can develop a plan to augment diet as needed.

Caregiver Elizabeth Vecchione