Page 49 - Fall2011

Members of the American Dietetic Association expected or encouraged to do this. The Food Guide Pyramid is always
have recently formed the group “Dietitians in adopted as a guide for meals. Because of poor food quality, I find that
Integrative and Functional Medicine,” who rec- vitamins and minerals are inadequate. The meals meet the Recommended
ognize and use these modalities, mostly in the Dietary Allowances only because the foods are synthetically fortified.
private practice arena. Calcium and vitamin D intakes are always inadequate and are rarely
In a nursing home I find most residents do supplemented, which may be the reason for the high incidence of urinary
not want to take medications, complaining that tract infections, falls, weakness and broken bones. I often recognize this
medication makes them feel sick. Many will spit deficiency in the laboratory blood value, a value often overlooked by ev-
them out. The medication continues to be encour- eryone—including the registered dietitian! If calcium is supplemented, it
aged by the nursing staff, and the resident who is most often requested by a family member and is usually in the form of
refuses it is documented in the medical record as the poorly absorbed calcium carbonate and unaccompanied by vitamin D.
“noncompliant.” The medication is encouraged A resident is often admitted on large doses of vitamin D with poor calcium
by a nursing staff who often feel it is making their intake.
resident sick as well, but continue to administer Servings of protein foods are precisely defined and measured at three
it because it is “physician ordered” and it is not to four ounces per serving to control the institution's costs. Increasing a
their responsibility to question orders. resident’s protein amount is allowed if increased protein needs are calcu-
I never encounter a resident or family mem- lated for wound healing in decubitus or skin breakdown.
ber who understands what the medications are Low-cholesterol diets are frequently ordered by the physician and
that they are taking, the reasons they are taking included in the facility's diet manuals, despite the fact that there is no
them, their benefits or possible adverse side ef- research demonstrating the diet's effectiveness. In these cases, physicians
fects. This should all be clearly explained, allow- are protecting themselves in the event a cardiac insult presents and the
ing the resident and/or family member to choose resident was not on this diet, in which case the physician may be deemed
the therapy from an educated vantage point. A liable.
choice should be offered to the resident and/or Saturated fat intake is low. Skim or lowfat milk is used, and skin and
family, meeting them at their comfort level and fats are removed from most meat. Margarine is selected instead of butter
determining a level or age at which they would because it is less expensive. In my opinion, saturated fat intake is so poor
like to discontinue reliance on pharmaceuticals. that it hinders proper absorption of fat-soluble vitamins—another reason
Pharmaceutical use is rarely conducted re- for increased urinary tract infections, weakness and falls.
sponsibly. Identifying the potential side effects Tube feedings are implemented for residents with dysphagia. A
and contraindications as provided by the Nurse's synthetic-type formula such as Ensure or a pharmaceutically sponsored
Guide to Medications or The Physician’s Desk supplement is used. Tube feedings made of whole foods are discouraged
Reference is rare. I frequently identify drugs because of the time required by employees to make them, the increased
prescribed when they are clearly contraindicated risk of fines from the Department of Health for improper preparation and
in a particular disease process such as renal fail- storage, but mostly because genuine food is not paid for by Medicare but
ure, most likely causing the resident distress and these synthetic formulas are. It is quite impossible to implement a whole-
certainly opening the door for potential lawsuits. food tube feeding, unless the family or resident demands it.

INSTITUTIONAL FOOD REAL FOOD FOR RESIDENTS
Nursing homes serve institutional food, A nursing home I recently worked in employed a cook who focused
usually canned or frozen-prepared. Although the on southern-style cooking using fatback, turkey necks, liver and fresh
products may be more expensive than raw food, food! The facility administrator was a “jolly” southern fellow himself and
it saves in employee time (cost) and decreases found the increased cost of serving this type of food to residents entirely
the risk of a fine for improper preparation from appropriate. This facility had little weight loss among residents, fewer
the Department of Health, whose dictates are medications were prescribed, and the overall population appeared much
absurdly stringent and unrealistic. healthier and stronger than in my other facilities.
Dietitians review calories, protein and fat A strong focus on nutrition and whole foods to reduce or eliminate
content of a meal. They determine that the proper the reliance on pharmaceutical medications in nursing home settings is
servings of the food groups as suggested in the imperative. If food intake is poor, or pharmaceutical therapies are depleting
Food Guide Pyramid are served. They do not particular nutrients, they should be supplemented in whole-food form.
review the quality of the food base, nor are they Tube feeding prepared from whole foods should be used, as well as
Wise Traditions FALL 2011 FALL 2011 Wise Traditions 49

82725_WAPF_Txt.indd 49 9/15/11 2:01 PM