The Wellness Connection with Fiona Kane

Episode 75 Greater attention needs to be paid to malnutrition in the sick and elderly

• Fiona Kane • Season 1 • Episode 75

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As many as half of all patients admitted to hospital and other healthcare facilities are malnourished and this can have dire consequences. This is the conclusion of a review article by researchers from Uppsala University and the University of Gothenburg published in the New England Journal of Medicine.

In this episode I discuss how we often fail to recognise and understand malnutrition in the west and how this has a huge affect on older people.

Article here: https://www.sciencedaily.com/releases/2024/07/240712124111.htm

Learn more about booking a nutrition consultation with Fiona: https://informedhealth.com.au/

Learn more about Fiona's speaking and media services: https://fionakane.com.au/

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The Beat of Nature

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Fiona Kane:

Hello and welcome to the Wellness Connection Podcast with Fiona Kane. I'm your host, Fiona Kane, and today I was actually inspired by a science article that I read today in Science Daily and it's talking about the nutrition of the sick and the elderly, and it's based on a study that was done at Uppsala University and it said that as many as half of all patients admitted to hospital and other healthcare facilities are malnourished. This has serious consequences for the individual in terms of unnecessary suffering, poor quality of life and mortality. Providing nutrients can alleviate these problems, but not enough attention is paid to this knowledge. According to these researchers and it's true they're saying here that as many as half of all patients admitted to the hospital and other healthcare facilities are malnourished, and this does have serious consequences. So this has been published in the New England Journal of Medicine and said that far too few patients are diagnosed with malnutrition. Under diagnosis and under treatment of the condition remains a problem, and I think this study might have been done in Sweden, so they said it's in Sweden, but it's also worldwide and what a difference it could make if people would consider nutrition.

Fiona Kane:

It's always surprising to me the amount of people who dismiss nutrition and don't understand its value and we understood it when and maybe people don't remember this stuff, but there's know there's a lot of things that we've found out over the years, for example that you know, scurvy is what the severe vitamin C deficiency that sailors were getting, because they weren't eating any fresh nutrients with vitamin C in it, right, any fresh fruits or vegetables. They were kind of just living on the kind of meat products and all dried things that they were eating, that the sailors were eating, and many of them came down with scurvy and they realised that this is a vitamin C deficiency. So now we know to have vitamin C-containing foods, right, and they've got things like rickets, which is a severe vitamin D deficiency, and that sort of causes, these sort of bow-legged, deficient and disabled kind of legs, and there's all of these different nutrition deficiencies. And the other one is vitamin A that can cause blindness. And actually there was a situation in Australia I can't remember now it must have been about five years ago of a young man he might have been a teenager or young, fairly young though who went blind in one eye and he was starting to go blind in the other eye and they realized it was a vitamin A deficiency, right. So they're looking for some weird and wonderful disease and it's simply a vitamin A deficiency.

Fiona Kane:

And I see it all the time when people come into my clinic. They come into my clinic or my online practice and I see them and they look malnourished. They look and they say, oh, I'm fatigued and their skin started to go break out or having skin issues. And you can just tell by looking at their pallor, by looking at their eyes, by just looking at people. You can see people that are just nutrient deplete. They just don't have the nutrients, and so it is really really common and with these people, often I put them on a sort of a powdered sort of mineral supplement and that boosts them straight away and you do see the same thing. So when you do spend time in whether it be in aged care or in hospitals and things like that, you'll often see.

Fiona Kane:

So by the time people arrive in hospital or in whatever care place they've been in, they have probably gone through a lengthy time where they are not feeling well enough or don't have enough energy to eat well, especially if they're living alone and they've got to prepare their own food but possibly they haven't been eating well. They haven't been eating any kind of a balanced diet and maybe whatever other health issue they have has been either preventing absorption of nutrients or it's been making it harder for them to eat certain foods, and so they start to limit their diet because different foods might make them sick or might make them feel sick or might be hard to eat. And then you find what's happening is people are reducing the nutrition, reducing the foods available in their diet, and slowly, bit by bit, they remove all of the nutrition and they're not having the nutrition they need to be having. And by the time they get into hospital they're often so deplete that, honestly, as soon as they get on a drip and they give them some nutrition, they pop right back up and even just fluids. Some of these people, even just getting fluid is really beneficial. So, yes, it never ceases to amaze me that this isn't thought of more often.

Fiona Kane:

And to just get a good look at someone's nutrition, the way I see it is, it's kind of I think it was Occam's razor that said look for the most obvious first. And the most obvious is you know, for a human being, is you know? When you think of a health of a human being, it's like okay. Is this person getting outside and getting the sunshine? Is this person moving their body? Is this person getting enough sleep? Is this person managing their stress? This person isn't sort of addicted to any drugs or alcohol or anything like that, and you know, and is this person getting the nutrition? And so it's like eating the right foods, but it's also absorbing those nutrients. So it's kind of looking at all of those things. And also the other thing that we've talked about a lot in regards to health, and we see it lot in regards to health is people just having connection and meaning in their life. So it's healthy relationships or healthy connection to community. We know all of those things make a really big difference in people's health outcomes.

Fiona Kane:

And when we look at, the problem is when we look at health and when someone goes to a hospital or doctors or whatever, I understand there's only so many resources but they're all looking for really, really specific things. So they're all looking to diagnose all different various diseases and sometimes that's what's going on. But sometimes the underlying thing is actually nutrition deficiency and if you actually have that person sort of eating well and if you have that person sleeping well and all of the things, and that's the other thing too, is people don't understand nutrition's involvement in all of those other things. So you need protein and you need certain B vitamins and magnesium to make things like serotonin and melatonin and serotonin makes you, is the thing that's sort of good for your mood, makes you feel happy, but melatonin is your sleep hormone. And you need proteins so that you can make the hydrochloric acid. And you need salt as well. You need proteins and salt and different nutrients, essentially to make the hydrochloric acid and other enzymes and things that you use, to absorb and use nutrients from your diet. You need fiber to feed the microbiome and to feed those good gut bugs, because they make some nutrients and they're involved in making things like vitamin K and B vitamins and things like that. There's so many.

Fiona Kane:

It's an intricate system. Your body is an intricate system and there's all these different things going on and there's a whole kind of ecosystem and balance going on, and so if you start having nutrition deficiencies, then things stop working well. So then you're not replicating your cells in a healthy way and then you're not making the energy in your cells properly way, and then you're not making the energy in your cells properly and then you're not sleeping properly and then you're feeling stressed or you're feeling sad or you're feeling wired, and because you're feeling tired or wired or whatever, then you start kind of wanting to eat sugar or caffeine and things to give you to pick up, because you feel terrible and you're more likely to not eat a balanced diet when you're not feeling well and you're feeling tired and you're kind of just wanting to grab the easy thing off the shelf and the easy kind of quick boost of energy that you're going to get from the caffeine or the carbs or whatever it is. And so then you end up with more deficiencies. Um, the issue, too, with a lot of people once we get to that sort of what's called polypharmacy stage. So people once they go on a lot of medications, which is not unusual for people and when they get older they end up on a lot of medications um, or often do it like, especially in the western world. Excuse me, I'll just have some water. I've been doing a lot of podcasting today, losing my voice With people when they go on polypharmacy.

Fiona Kane:

That just adds another layer of issues, because the medication while I'm not saying anything specific about you shouldn't take medications or anything like that, not at all. Talk to your doctor about your medications. This is not saying that, but what happens with medications is most medications have certain side effects and many of them will affect your nutrient levels in your body. So many of them affect things like magnesium or they might affect certain B vitamins. Especially things like folate, and B12 are often low because of certain medications. We know the cholesterol medications will reduce things like your magnesium, but they'll also reduce your coenzyme Q10, which is an important nutrient for energy and heart health. So there's all of these medications and then actually medications for reflux and anyone who's trying to calm down that kind of reflux and burning and those sorts of symptoms. The medications they use for that proton pump inhibitors actually reduce your ability to digest your food even more. So you're on that medication and then now you can't absorb your nutrients properly, you can't digest your nutrients properly.

Fiona Kane:

So what happens is we start having health issues and, layer upon layer, the next thing, next thing and because it's often like a pill for every ill, which is our modern way of treating health conditions, unfortunately, instead of kind of going, oh okay, you got really low in energy, what's going on? I'm looking at all the factors that affect someone's energy or their mood or whatever it is. It's like oh okay, here's a medication for your mood or here's a medication for your cholesterol or whatever it is. And again, I'm not saying there's never reasons to take these medications not at all and I know individual situations are much more complex and there's much more going on. So this is by no means me picking on anyone being on a medication that needs to be on a medication for whatever reason. I'm just talking about a general population thing where people are being nutrient deficient and a lot of people are on medications that they don't really need to be on, or they're being treated with a medication that could be treated with food or with some magnesium for a while and then with food or something to help them digest better. If you're a very, very stressed person, if you're stressed all the time and in that fight or flight mode that I've talked about a lot on this podcast, then you're not making digestive enzymes and you can't digest your food properly. Therefore, you can't use the nutrients right, and so someone's having a lot of stress.

Fiona Kane:

They often give them medications for different things around anxiety and depression, and I understand the reasoning behind that, but they often don't then address the underlying issues, which could be that there's already deficiencies to start with, which is why they have their depression. I had a client once many years ago who had been suffering from depression. This person, when they told me their diet, they were only eating I think it was toast, it was bread and two things. It was like bread and oh, I can't remember. It was like two things. It was like bread and coffee. I can't remember now, but essentially this person was having no protein in their diet, right? So they've been on these medications for depression for many years, but no one ever looked to see if they were getting the nutrients they needed to make the neurotransmitters in your brain.

Fiona Kane:

So we forget that the whole you are what you eat thing is actually quite true and a lot of the things that we need to stay well, whether it's to make energy, whether it's to sort of replicate and make new cells, whether it's to make new bone cells or make new eye cells or make new muscle cells or whatever it is, or whether it's enzymes or it's neurotransmitters like serotonin, melatonin, dopamine and all the different neurotransmitters we forget that our body makes them up. My body is like a massive factory and constantly making all of these different things all of the time, and the ability of your body to make them will be dependent on how well your body's functioning, but also will be dependent on the available ingredients to make them. So you actually need to be eating the foods that have the ingredients, and not just eating the foods but absorbing the nutrients from the foods so your body can make all of these things. And many of our symptoms just come from the fact that we're not getting enough nutrition, and then you start feeling tired, or you start feeling depressed, or you don't have the right nutrients to make your digestive enzymes, and so then you start getting reflux and then you get treated with something like a PPI, a proton pump inhibitor, that's going to reduce your ability to absorb nutrients even more.

Fiona Kane:

So you can kind of see that what happens is people will often start having issues because of their lifestyle or because of their nutrition. They'll be treated with some other thing a drug or some other thing but that drug will then go on to cause more nutrition deficiency and more issues. So then they get put on another medication to counter the fact that that medication's caused this problem, or that medication's maybe not caused, but the medication might have compounded things and made things worse. So what happens is when you get to that polypharmacy situation and people are on six, seven, eight medications they literally are on medications to counteract the problem from the other medication and everything's kind of countering everything else and they end up with the really lower nutrients and uh, and you know there's a really big issue and the when people do end up in like I've seen it before and I saw it when my mom was really ill that uh, when they they don't really spend much time looking at someone's diet and helping them overcome challenges around their diet. So what happens is people often end up, for a whole bunch of reasons, they end up on a really really narrow diet where they're not eating much nutrition at all, maybe not absorbing it at all or anything in their nutrition, and maybe they're not absorbing it, and then they end up really deplete in nutrition. And then they end up in hospital and often they're not really looking at that. They might accidentally come across it just for the fact that they put someone on a drip and there's a bit of sodium and the person starts to pick up a bit and so that helps with the nutrition a bit in that way, but they don't go in and they're not looking at that. When people go into emergency or into the doctors or whatever, unfortunately, more often than not're not not looking for the nutrition, uh, the nutrition factor in it, or they're discounting that or the importance of that, and that, you know, makes a really, really big difference. So, um, so I believe that article, uh that I read that study based on what I've seen myself, and I think that we need to understand that you really are what you eat and it is really important to consider your nutrition. And if you are working with people who are older or people who are not, well, it's important to consider nutrition as part of how you treat that person.

Fiona Kane:

I remember years ago, dr Rangan Chatterjee he had a tv show on bbc or something like that. I think it might have been called doctor in the house and it's quite interesting because he said that he had people coming into his uh gp practice all of the time and he realized he was like he was only getting a, he's only getting a snapshot of what was going on for them and and you know, and and that's the truth too is you don't get to spend much time with patients and these's only getting a snapshot of what was going on for them. And that's the truth, too, is you don't get to spend much time with patients and these doctors only get a few minutes with their patients, and so they can only deal with what walks on the door and what the patient says. And he said that he just realized he was just missing a whole. He was just missing so much by not knowing what was going on in their lives and by not knowing what was really happening and what was getting in the way of them making healthy decisions. Was it financial, or was it lack of education, or was it just bad habits, or was it some other issue going on? And so what he started doing is he started going and staying with his patients and live in their house, for I can't remember if it was like a week or a few days. He'd go and live with them, and what a difference it made, because he did get to see these things. He got to see that what's getting in the way of someone doing exercise and what's getting in the way of them eating in a healthy diet what's, what are the foods that they've got in their cupboard? Are they? Do they have a really stressful lifestyle? Do they have a lot of support or not really? You know, he's looking at all of those things and he was able to help them much more, because there's so many things. Human beings have, so many things that affect us and it really is important to look at that.

Fiona Kane:

Core nutrition Is someone just getting their nutrients? Are they eating the right food and are they absorbing those nutrients? And then the other things I've already talked about. I've talked about so many times on this podcast, but it's important Is someone sleeping well? Is someone moving their body? Are they connected to other people in community? Do they have some sort of meaning in life, support, relationships, community, and are they I think I already said the exercise and are they managing their stress? All of these different things and the other thing, too, that I didn't mention is just even just things like a healthy environment. Does that person have a whole lot of moulds in their home or a lot of dust or something else that's affecting their health, or something to do with the water or what they're breathing in or whatever it is?

Fiona Kane:

There's so many things that affect our health and unfortunately the medical model is kind of you don't get to spend much time with people, with patients, and they very rarely think of nutrition. Or if they do, it's very narrow that. They might think about things like iron and they do think about things like vitamin D now, but they don't think of all of the other nutrition. And well, much of it, a lot of it. And the other thing too is the thing with nutrition is the way nutrition works, is nutrients work together. So you might be low in magnesium, but you need vitamin D and magnesium together for certain functions to happen. So there's a lot of nutrients where one nutrient alone won't do the job, but when you combine that nutrient with another one, that's how the job is done. So the tricky thing too, even in regards to science and when they do studies on different nutrients, is they can say that this supplement or that supplement doesn't work. And look, there's a lot of supplements out there that don't do anything. There are a lot that do do something, but the issue is that it's on its own it doesn't work because it works in conjunction with something else, like I've always talked about with food and with nutrition, is these things?

Fiona Kane:

It's about a synergy. It's about a synergy of a whole group of nutrients that come together to do a certain thing, or a whole group of things that come together to do a certain thing. You're managing your stress, so your body's in rest and digest mode, and then you're eating a healthy meal and you're able to digest and absorb it. You're moving your body so you're able to maintain your muscle and your blood sugar levels and manage your mood with exercise as well as the nutrition you know you've got good relationships. All of these things. They come together and it's a synergy with all of them. So it is important to look at all of it. But yeah, it really really is important.

Fiona Kane:

If you are working with people who are ill, coming into hospitals or in nursing homes and things like that, it is really important to get back to basics and with those people. If nothing else, if all you could do is get those people to be drinking broths, bone broths, chicken noodle soup or chicken broth, vegetable broths, but ideally something with meat in it some of the time, so bone or chicken, that kind of animal protein broths, but with loads of veggies as well, if you can make even just getting people to eat things like that, to sort of snack on bone broths, to snack on a bit of egg. Even if someone has a bit of a difficulty with eating certain things, you can mash up some egg or mash up a bit of egg and avocado together. Great nutrition. It's really, really important to get nutrients into these people and unfortunately, when they do go into hospital environments and things like that, it's often kind of like jam on toast. Again, there's no protein in that, there's no nutrition, whereas they could be having a lovely broth so if it was a beautiful soup or stew or broth of some sort with all the nutrients. So, like I said, eggs or some and they don't get when they're in hospital. They don't get good fats like olive oil and avocado and those sorts of things, but in my experience they don't get a lot of that sort of thing in Australia. It's just like they get cereals, they get jam on toast and just really kind of ordinary foods.

Fiona Kane:

So anyway, I think we do need to consider nutrition a lot more. We need to understand how it is affecting our health and I see it all the time with my clients that when we change their diet, sometimes we need to top them up with some supplements first, but ultimately, when we change their diet, manage their stress and ensure that their digestive system is working well and they're absorbing their nutrients. It makes all the difference. So please consider this, especially with your older patients, family members, friends, whoever it is in your life that nutrition really matters and it makes a really big difference in your mood, energy and your overall health, and we need to make sure that as people get older, in particular, where it gets a bit harder to digest, as you get older and sometimes people sometimes people lose interest in food, that sort of thing it's harder to keep those nutrient levels up. We have to remember that nutrition really really matters, and I think it was.

Fiona Kane:

Was it Hippocrates that said let food be thy medicine? He's a father of modern medicine. He let food be thy medicine and medicine be thy food. And there's a lot you can do medicinally with nutrition, and so it's really important to consider how important nutrition is, especially as we age, and it's not just what we eat, but it's how we eat and whether or not we can absorb that food well. So all of those things need to be considered together. Anyway, I hope you found that useful. That's the latest thing I've sort of found in the news today and please like, subscribe and share and, if you're on Rumble or YouTube, you can comment or tell me what you think and I'll talk to you all again soon. Thanks, bye.

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