Food & Drink
Information & Advice
Colophon Authors Maaike Nieuwkamp-Bosma, speech therapist Jeanne van Dommelen, dietitian Mariska van Maanen, occupational therapist The authors are attached to the Atlant Huntington Expertise Centre, part of Atlant Care Group in Apeldoorn. The aim of the Huntington Expertise Centre is to provide expertise, information, advice and support to clients, carers and care professionals. This is a publication of Atlant Huntington Expertise Centre. Atlant Care Group; Apeldoorn 2012. www.huntingtonexpertisecentrumatlant.nl
Introduction People suffering from Huntington’s disease often struggle with
Huntington’s disease. They confront patients daily at every
weight loss. It is still not entirely clear how that weight loss is
mealtime. Eating becomes more of a trial than a pleasure.
caused. Chewing and swallowing problems play a role, as do involuntary movements. Metabolic changes are also likely to
An adequate diet is essential, as it helps to maintain health
be related.
and prevent malnutrition. To support patients in the problems stated here, this brochure provides advice and suggests
Huntington’s disease is characterised by motoric, psycho-
possible measures they might find helpful. The three distinct
logical and cognitive changes. In addition to involuntary
disciplines of speech therapy, dietetics and occupational
movements, mental regression, behavioral and character
therapy form the basis of this approach.
changes, Huntington’s disease also causes speech, chewing and swallowing problems. Many patients also struggle with weight loss. Such issues are the most difficult aspects of
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Weight loss • What is energy?
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Energy-enriched products
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• Carbohydrate powder
• What is the effect of weight loss?
• Nutritional supplements
• What is a healthy body weight?
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• A few preparation tips
in powder form
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nutritional drinks • Energy-enriched bars
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Chewing and swallowing problems
Nutrition for swallowing problems
• The normal swallowing
• Thickening fluids
process 15 • Common swallowing problems 16 • Focus points for swallowing problems
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• Energy-enriched
• Nutrition tips against weight loss
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• Changing the consistency of solid food
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•N utrition tips for 17
• How do you react to choking? 18 • Helpful tips if someone is choking 19
swallowing problems
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• Tips to help with eating and drinking
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Sitting position and eating & drinking aids
Oral hygiene
• Sitting position while eating and drinking
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• Aids for drinking
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• Aids for eating
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Other focus points
Contact details
• Changes in appetite
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• Too little dietary fibre
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• Regurgitation of food
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• Influence of medicines
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Cause of weight loss Everyone suffering Huntington’s disease loses weight at some point. For some this begins at an early stage of the disease, in others it occurs later. The many involuntary movements associated with the disease are a major cause of weight loss. These movements demand a great deal of energy and complicate the action of raising food and drink to the mouth. Problems with eating and drinking and obtaining an adequate diet lead to weight loss and worsening of a patient’s condition.
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Involuntary movements are not the only cause of weight loss. It can also be caused by chewing and swallowing problems due to loss of control over muscles in the mouth and throat. What is more, experts suspect that Huntington’s disease involves metabolic changes that cause weight loss, despite patients having a healthy appetite.
What is energy?
Using as much energy as a top sportsman
We obtain energy from food. The human body could be compared with an engine that requires fuel (gasoline, electricity) to work. Your body also requires fuel (energy) to function properly: to walk or think, but also to maintain body temperature and pump the heart muscle, and so on. Body weight is all about balance. If you absorb less energy (fuel) than your body requires, you lose weight. And vice versa: those who digest more energy than their body requires put on weight. Experts think that many Huntington’s patients require extra fuel to enable their body to function because their ‘engine’ runs at higher revs. Not everyone with the disease struggles with this, but a large group does. Many people with Huntington’s disease use as much energy as a top sportsman.
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What is the effect of weight loss? In the beginning, a few pounds more or less make little difference to the body. Most people have sufficient reserves of energy (fuel) in the body in the form of a layer of fat. But when these reserves are gone, the body has less fuel available than it requires. This makes you feel tired and drained, decreasing your motivation to face daily life. Resistance levels decline and you get ill more easily. And once you are ill, healing takes longer and you run a greater risk of complications. That is why it is essential that you always have sufficient reserves. In other words: a healthy body weight is crucial.
What is a healthy body weight? Whether or not your body weight is ‘healthy’ depends on your age and height. A handy aid for assessing this is the Body Mass Index (BMI). This value indicates whether your body weight is within the healthy zone, or is too high or too low. You can easily determine your own BMI using the adjacent figure. Use a ruler to connect your height in the left column with your weight in the central column. The ruler indicates your BMI in the right column, giving you an idea of whether or not you enjoy a healthy body weight. Though it is not often encountered with Huntington’s disease, Source: P. Deurenberg, Wageningen University
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it is possible that you may have an excessive BMI. Do you
need to take action? The answer to that is, mostly, no. You
A few preparation tips:
will observe that you gradually lose weight over the course of your illness and that you will in fact benefit from these reserves. Only when you experience problems from being
• Add a lump of butter to vegetables and potatoes or pastas.
overweight (e.g. high blood pressure, high cholesterol, diabetes, difficulty in moving) should you consult your doctor about taking any necessary measures. The doctor will refer
• Use plenty of oil or liquid margarine for stew, pasta and rice dishes.
you to a dietitian who, together with you, will review how you can lose excess weight responsibly.
• Use crème fraiche or a dash of cream in soups or sauces. • Add cream to yoghurt, custard or porridge or to enrich
Dietary tips for weight loss patients
your coffee.
• Try eating when rested, taking a nap before mealtimes if necessary. • Try and get as much exercise as possible, preferably outdoors. • Try to create a comfortable atmosphere at mealtimes.
Try to create a comfortable atmosphere at mealtimes
• Ensure regular bowel movements. • Eat food you like and ensure adequate variation. • Sour products promote appetite: for example, a glass of fruit juice or a piece of fruit.
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Choose these
Full-fat dairy products (milk, custard, yoghurt, quark), crème fraiche, (aerosol) cream, full-fat chocolate dairy drink, ice cream, fruit-flavoured dairy drink.
(Diet)margarine with at least 70% fat.
Fatter meat types, such as mixed mince, fresh sausage, streaky beef or pork, hamburgers, lamb, chicken with skin, breaded meat.
Fatty fish, such as herring, mackerel, eel, salmon, trout. Sauteed or fried fish (fillets), fish fingers.
Full-fat Gouda cheese or 48+ cheese, full-fat cheese spread, Brie, Camembert, Boursin, feta, cream cheese.
(Instant) potato puree, sauteed or fried potatoes, french fries.
Sugar-sweetened soft drinks, fruit juices (with no added sugar), mixed fruit juice, coffee with milk and sugar, tea with sugar.
Cake, luxury cookies, cake, battenberg, almond cake, chocolate, bonbons.
Cream sauce, prepacked sauce prepared with milk instead of water, ‘white’ barbecue sauces, ‘real’ mayonnaise, salad dressing 40%, vegetables in cream sauce.
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buttermilk or other drinks without added sugar, low-fat yoghurt drink, water ice or sorbet. Diet low-fat margarine or low-fat spreads.
Lean beef or pork chops, tenderloin of pork, beef steak, tartar, chicken breast.
Stewed white fish, such as cod, whiting, haddock, pollack.
20+ or 30+ cheese, low-fat cheese spread, cottage cheese.
Boiled potatoes, boiled rice or pasta.
Artificially sweetend soft drinks and yoghurt drinks, (mineral) water, tea and black coffee without sugar.
Sweets, liquorice, biscuits.
rather than these
Semi or fully skimmed dairy products, artificially sweetened chocolate dairy drink,
Tomato ketchup, ‘red’ barbecue sauces, low-fat salad dressing and low-fat mayonnaise.
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Energy-enriched products Still not managing to get enough energy and maintain your weight with these dietary tips? Then special dietary products could be the answer. We have listed a few options below.
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Carbohydrate powder
fruit purees. And each sort is also available in different
This powder consists of dextrin-maltose but does not taste
flavours.
sweet. It contains as many calories as sugar, but because it does not taste as sweet, it is easily added to sweetened and
Although these products are expensive, they may be covered
unsweetened drinks. It can also be added to soup, mashed
by health insurers. Dietitians can help guide you through
potato, sauces, boiled leafy vegetables, etc. It is available at
this maze of products. They can determine whether or not
drug stores or pharmacists and in some supermarkets. In the
you really need them, ascertain if you are entitled to reim-
Netherlands, it is not subsidised by health insurers.
bursement and complete the necessary claim forms. In the Netherlands, these products are available from pharmacists
There are various brands:
or from so-called medical services companies. The latter
Fantomalt®
Nutricia
supply the products directly to your home at no extra cost
Polycose®
Abbott
and can also supply a sample pack so you can decide in the
Resource dextrin-maltose®
Nestlé
comfort of your own home which brand, type and taste you prefer.
Nutritional supplements in powder form
Energy-enriched bars
These powdered products contain not only extra energy, but
These are soft bars covered in a layer of chocolate that deliver
also provide extra protein, vitamins and carbohydrates. There
lots of energy in a compact volume. They are subsidised by
are various brands on sale that vary in their composition. In
health insurers under certain circumstances.
the Netherlands, they are not subsidised by health insurers. A dietitian can advise you on the most suitable product.
Energy-enriched nutritional drinks These drinks contain high energy levels in small volumes. They also contain extra protein, vitamins and minerals. There are various brands (Nutricia, Abbott, Nestlé, Fresenius Kabi). Each brand has an extensive range, such as dairy-based or fruit-based drinks, energy enriched creams, energy-enriched
Compact volume with lots of energy 13
Chewing and swallowing problems Swallowing is a complex combination of all sorts of muscle movements. Huntington’s disease means the chewing and swallowing muscles no longer work together properly, causing various swallowing problems. There is all sorts of advice that can help you swallow better. Additionally, there are options for coaching and treatment to ensure you swallow safer and for longer. Please consult your speech therapist for this.
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The normal swallowing process Swallowing occurs in four phases. In the first phase, the food
does not exit the mouth. Fluids are collected and held against
or drink is taken into the mouth by taking a bite or a swig.
the pallet. Solids are chewed and mixed with saliva until a
Tensioning lip and cheek muscles ensure the food or drink
bolus is formed.
Phase 1
Phase 2
Phase 3
Phase 4
The tongue pushes the
The soft pallet rises, so
Then the epiglottis seals
Once the bolus is in the
bolus to the pharynx.
no food returns through
the trachea.
esophagus, the esophagus
The swallow reflex is
the nose.
activated. From that
The muscles in the throat
The esophagus inlet opens
using peristaltic move-
moment on, swallowing is
tense together and push
and receives the bolus.
ments – contractions of
involuntary.
the bolus downwards to
pushes it to the stomach
the esophagus wall.
the esophagus.
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Common swallowing problems
•Y ou take multiple bites or gulps in a row.
Swallowing problems caused by Huntington’s disease cannot be cured; they only get worse as the disease runs its course.
• You cannot swallow fully.
Your speech therapist helps you train your chewing and swallowing muscles by practicing certain swallowing techniques.
• Food or drink stays in the mouth too long before you swallow. • You take in too much air when eating or drinking. This
The most common swallowing problems: • Your body is constantly moving, making it difficult to eat or drink.
usually results in excessive burping after mealtimes. • During chewing, you breath in bits of food, with a risk of solid obstructing your trachea.
•T he food does not collect in the right place in the mouth.
• Food gets caught in your throat.
• You are not able to bite food properly.
• You begin to retch when food enters your mouth.
• The lips do not close, so food and drink can run out of
• You choke.
the mouth. • Chewing is more difficult. Sometimes swallowing problems are difficult to identify. It • The tongue fails to pass food to the back of the mouth.
is important to always take symptoms not directly related to swallowing problems seriously, such as reduced food intake,
• You have the urge to take large bites or gulps.
rejection of foods, change of tastes, severe weight loss, coughing or throwing up a lot.
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Focus points for swallowing problems •S wallowing problems can be life threatening. It is therefore essential that there is always someone present when you eat or drink. •T o concentrate properly, it is crucial that you eat in a quiet, yet comfortable room. •S ome people like to have music on when eating, but others find it too distracting. We advise against watching television while eating, as it diverts too
Eating with a spoon is much easier than with a fork.
much attention from the eating process. •E ating with a spoon is easier than with a knife and/or fork. Eating with the hands is also an option. • If you have the urge to take excessively large bites or many bites in a row, then we recommend using a smaller spoon and putting less food on your plate. • If you spill your drink, then try only filling your glass or beaker half full.
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How do you react to choking? Choking is a serious problem with Huntington’s disease.
anxious and cannot get enough air, that you grab your throat
Choking occurs when food or drink enter the trachea, instead
or that your face turns blue. At this point you need help.
of in the esophagus. Possible causes include eating fast, insufficient chewing, distractions or eating and talking at the same time. Repeated choking can lead to lung infections. In most cases, choking ends in a coughing fit. Coughing is a protective reflex that ensures that food or drink is ejected upwards from the trachea into the throat. But sometimes the coughing reflex fails, despite choking. This is called ‘silent choking’. However, in such cases, there are other signals that indicate choking, namely: the face turns red or blue, watery eyes, gurgling voice, shortness of breath, chest pain and sweating. If you choke with fluids, it is very important to cough heartily. A weak cough will have no effect. Bend you body forward a little and have a cough strongly a few times. The power of the cough will free the airways. A strong cough is also important if you are choking with solids. Sometimes the food stays in the trachea and coughing fails to have the desired result. You then notice that breathing and talking become difficult or impossible, that you get
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Strong coughing is very important with choking.
Helpful tips if someone is choking If coughing strongly fails to stop the choking, you need help. • If the food fragment is at the back of the throat, then it can be removed by hand. Using your fingers, push the chin downwards to open the mouth as far as possible. Remove loose dentures if necessary. Using your middle finger and forefinger, try to remove the fragment from the throat.
Only apply the Heimlich Maneuver in extreme circumstances.
• Get the person to bend forward while sitting or standing, with the head towards the knees. The upper body can also be laid on a table. Warn them what you are about to do. With a flat palm, slap them between the shoulder blades. It is crucial to hold them firmly so they do not fall forwards. • Only resort to the Heimlich Maneuver if the above fails to work (see illustration). Stand behind the person choking. Wrap your arms around their waist and clench your fist. Grab the clenched hand with your other hand. Place the fist above the navel in the middle of the stomach. Now use both hands to give a powerful slanting jerk upwards. This pushes the food fragment upwards. Repeat this movement if necessary. The Heimlich Maneuver can also be applied from the front, equally placing the hands above the navel. Prevent the choker from falling backwards by placing the (wheel)chair against a wall.
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Dietary tips for swallowing problems When chewing or swallowing gets harder, there are various possibilities to limit problems. There are practical dietary tips than can be applied. What’s more, certain types of food are better avoided. The consistency of solid and liquid food is crucial. In other words, the texture of the food and drink. There is a distinction in drinks between more viscous fluids (such as yoghurt or custard) and less viscous fluids (such as water, coffee or tea). In terms of food, suggestions include soft food (such as well-cooked vegetables) and ground or finely chopped food. It is possible to modify the consistency of food and drink. Review with your speech therapist the most suitable consistency of drink and solid food for you.
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Thickening drinks Low viscosity drinks, such as water, coffee and tea, move
starch or flour are less suitable because they cannot be used
rapidly through the mouth towards the throat. Adequate
in cold drinks. What is more, they affect the flavour and it is
control over these ‘fast’ fluids is essential. Huntington’s
difficult to attain the required thickness.
disease involves loss of control over the muscles, including the tongue. This means choking on low viscosity drinks is often an issue. Thickening these drinks reduces the risk of choking. Thickening the fluid delays its intake, giving more time for all the muscles ‘to prepare’ for swallowing. Ask your speech therapist which thickness is best for you.
Choking on low viscosity drinks is common
Drinks can be thickened using thickener. Thickeners are tasteless powders that can be dissolved in both hot and cold drinks without preheating. Check the packaging for the proper dose for the required thickness. Thicken the fluid with a whisk to prevent the thickener from becoming lumpy. Thickener can be purchased at the pharmacist’s but is not subsidised by health insurers. Brands include: Nutilis Clear® (Nutricia), Multithick® (Abbott), Resource-thicken up clear® (Nestlé). Note: Nutriton® (Nutricia) is used to thicken baby food and is not suitable, as the food only thickens once in the stomach. Binding agents like corn
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Changing the consistency of solid food It is also possible to modify the consistency of solid food. The consistency most suitable for you depends on the type and degree of your swallowing problems. We have summarised
Mash potatoes and vegetables where necessary
some common consistencies for you. Your speech therapist and dietitian can advise further. Soft food Eat food without seeds or hard or tough pieces, and bread without (hard) crusts, seeds, grains and suchlike. Finely chop or mash potatoes, meat and vegetables, but avoid hard-fried meat. Dunk hard cookies (without nuts and suchlike) briefly in your coffee or tea.
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Ground food When eating sandwiches, use crustless bread with spreadable topping (cheese spread, jam, smooth peanut butter and suchlike). For hot meals, use ground meat, potato puree, ground vegetables. Do not mix the various foodstuffs! Use a liquidizer, hand blender or old-fashioned food mill to grind food. Food mills do not require electricity. Mixed food The food has a very fine, almost smooth, texture. Instead of bread, eat smooth porridge-like dishes (e.g. custard or butter-
Crustless bread with spreadable toppings
milk and wheat porridge), yoghurt, quark. Mix the elements separately for hot meals: add as much fluid (broth, milk) as necessary to create a smooth pulp. Do not mix the various foodstuffs. Liquid food Further thin mixed food with liquid to achieve the required consistency for a spoon or for drinking. The various elements of the meal can be mixed together if required. Food which has a modified consistency, especially a mix of liquid food, contains more moisture and fewer calories, increasing the risk of weight loss. The preparation tips on page 9 might be helpful.
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Make the food smooth with, for instance, gravy or sauce
Dietary tips for swallowing problems People with swallowing problems need to concentrate harder and remain more alert. Below are a number of practical tips for limiting swallowing problems. • Eat smaller portions more often during the day to reduce fatigue and increase calorie intake. • Make the food as smooth as possible using gravy or sauces, applesauce, ketchup or mayonnaise.
Food to avoid: • Go for soft meat (e.g. mince, fresh skinless sausage, soft boiled beef, chicken breast) and soft vegetables
•D ry and grainy food, such as rice, couscous and rusks.
(e.g. well-cooked vegetables, skinless and seedless tomatoes), as they are easier to chew.
• Hard, coarse and small products, such as peanuts and cocktail snacks.
• During hot meals, use cold applesauce, (thickened) iced water and/or mineral water. Cold and sour food/
• Hot and spicy food.
drink is good at stimulating the swallowing reflex. Carbonated drinks can also stimulate swallowing. • If you have difficulty chewing and swallowing bread,
• Unfilleted fish and unboned meat. • Food with two different consistencies. Examples
try removing the crusts, cutting the sandwich into
include: soup with meat balls (thin fluid and solid food)
small pieces and using spreadable toppings, such as
and yoghurt with fruit (thick fluid and solid food).
cheese spread or jam. You might also try moistening
It is difficult to chew and control fluids in the mouth
the bread with milk or tea.
at the same time. Make sure you have only one consistency in your mouth. So do not eat and drink at the same time.
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Tips to help with eating and drinking
• It is better not to talk during the meal. Talking and
If you need help eating and drinking, you might find
eating at the same time is unwise, as it affects the
the following tips useful.
concentration and increases the risk of choking.
• Sit opposite one another at the same level.
• Your helper can provide you with swallowing guidance where necessary. Say for instance: ‘Close your lips
• Use a small spoon and take small bites and gulps. Preferably use a transparent glass so you can better
together tightly’, ‘Chew thoroughly’, ‘Keep swallowing’. Demonstrate if necessary.
gauge the amount you are drinking. • Eating is best done at a gentle pace. Healthy people swallow twice for each bite or gulp they take, so someone with swallowing problems must do at least the same. • Only take a new bite or gulp when your mouth is empty. Be alert to food residues that can remain in the mouth. Your helper can draw your attention to any food residues in your mouth, asking you to swallow again if necessary. • Place the spoon on your tongue and press gently. This encourages the swallow reflex.
It is better not to talk during the meal.
• Make sure the food is taken off the spoon. • Only remove the spoon once the lips have closed. Avoid running the spoon along the teeth when removing it from the mouth.
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Sitting position feeding and drinking aids A proper posture is essential when eating and drinking. There are recommendations and aids to encourage a proper posture, providing greater stability when seated.
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Sitting position while eating and drinking Huntington’s disease patients struggle to find and maintain a
sideways movement. When using a wheelchair you might
proper posture. Due to the involuntary movements, it is not
want to tip the wheelchair back slightly while eating. This
always possible to sit quietly at table during mealtimes. It
posture is more relaxed, providing you with greater support
is therefore essential that the body is well supported while
from the backrest. However, it is important not to move your
eating. Such support often helps to reduce involuntary move-
head too far back, as this increases the risk of choking.
ment somewhat. The chair you sit on must allow your feet to rest properly on the floor. This means they are resting comfortably on the floor, on a footrest or the foot supports on a wheelchair. Sometimes a stable, heavier chair is more comfortable than
Make sure you have adequate support
a normal dining chair, as it is more likely to stay in position with excessive involuntary movements. Eating at table is preferable. The height of the table relative to the chair is also important. It is crucial that the lower arms are resting comfortably on the table and that your elbows are supported by the table when eating, increasing the degree of bodily support. It is also important to push the chair close to the table during the meal. You must sit up straight when eating and drinking, with your head bent slightly forward (with your chin towards your chest). Sufficient stability is essential. Further support can be attained by placing a cushion behind your back or head. If required, you could also place cushions at your sides to limit
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An adapted chair or wheelchair can help facilitate a proper
A modified chair support a proper posture
posture. One chair that is specially designed for people with Huntington’s disease is the Doge Basic chair. This chair is made of sturdy material and has a strong subframe, making it very resistant to forces exerted on it by involuntary movement. Standard adapted wheelchairs do not always support a proper posture. For somebody dependent on a wheelchair, a custommade seating orthosis is often a good solution. A seating orthosis is an individually tailored wheelchair seat that follows the body’s contours, thus providing optimum support. An occupational therapist or physiotherapist can provide advice on a wheelchair or adapted chair. Be sure to position the (wheel)chair properly. If you are sitting in a wheelchair, it must be braked while you are eating and drinking. Ensure sufficient room around you so your helper can provide rapid assistance if you start choking. After eating, it is advisable to sit up straight for fifteen to thirty minutes.
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Aids for drinking Sometimes it is no longer possible to drink safely from a
The following beakers are useful for locomotor problems:
normal cup. A modified cup could be the solution. There are many modified cups available, but they are not all suitable
• A heavy cup with a large handle.
for each individual situation. For advice and coaching in purchasing the right aids, please consult your occupational therapist. A modified cup can be used for either locomotor or swal-
• A cup with two handles (e.g. a Handy Cup or the Caring Cup). • An unbreakable cup.
lowing problems or a combination of the two. Locomotor problems can make it difficult to lift the cup to the mouth
• A cup with a spout.
and properly dose the drink in the mouth. Spilling can also be an annoying result of locomotor problems.
• A cup with a lid and straw. • The Tremor Cup, which has a fan-shaped insert
A cup with two handles is easier to grip
that delays the movement of the fluid.
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The following cups are suitable for swallowing problems:
The Handy Cup
The Thermosana Cup
The Handy Cup has
This has a large handle, making
been designed so that
it much easier to hold.
swallowing can be
The shape means you do not tilt
achieved without having
your head back when drinking.
to tilt your head back.
The Heidi Cup
The Novo Cup
This cup helps to dose
This cup is suitable if you
fluids and promotes proper
drink while lying down.
lip closure.
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Aids for eating Eating can also cause problems. Involuntary movement can make it difficult to put a knife or fork to your mouth. It also makes it difficult to scoop up food from a plate without spilling food.
Knives and forks with thick handles are easier to hold
The following aids are available: • Knives and forks with thick handles are easier to hold. With better grip on the handle, you are better able to control the knife or fork. • There are also weighted knives and forks that mitigate the tremors in your arms and hands. • To facilitate scooping up your food, use a deeper plate or a plate with a raised rim. • If eating is difficult, you require more time for meals. To keep food warm, try using an insulating plate. • An antislip placemat helps to prevent the beaker or plate from sliding around.
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Oral hygiene Teeth are necessary for chewing and swallowing, but also for talking. Keeping your mouth clean is therefore essential, especially if you have swallowing problems as these can cause fur build-up on your tongue.
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Swallowing problems can also result in food residues remaining in your mouth, either on your tongue or in your cheeks. Bacteria in your mouth or on your tongue can enter the lungs when choking, increasing the risk of lung infections. So after every meal check that your mouth is empty and clean your teeth and
Aids for oral hygiene
tongue. Oral hygiene aids include (electric) toothbrushes, toothpaste, toothpicks, dental floss and/or tongue scrapers. Always ask your dentist or dental hygienist which aids are best for you. Also get your teeth checked regularly by a dentist and/or dental hygienist. Thorough oral hygiene ensures your teeth stay in good condition.
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Other key points Finally, below are a number of key points associated with eating and swallowing problems.
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Changes in appetite Your appetite can decline due to a fear of choking, embarrassment at spillage, fatigue or simple irritation at the difficulties you experience at mealtimes. It can even get so bad that you refuse to eat. It is therefore essential that you make yourself aware of these signals and that you receive assistance from a doctor, dietitian or an occupational or speech therapist.
Your appetite can change for fear of choking
Too little dietary fibre Ground or mixed-consistency food usually contains less dietary fibre than a normal diet. This can lead to constipation. If you suffer from this, then consult your doctor or dietitian for help with this problem.
Regurgitation of food Sometimes, small bits of food can return from your stomach into your mouth. This can be very upsetting. The precise cause of this is not known, but involuntary muscle spasms probably play a part, as does eating too fast. Ask your doctor or dietitian for advice on mitigating this annoying problem.
Or due to embarrassment at spilling food and drink
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Influence of medicines Medicines used to suppress the symptoms of Huntington’s disease can also have a negative impact on eating. They can affect talking and swallowing reflexes, and reduce or even (undesirably) increase your appetite. It is known that some medication generates too much saliva in the mouth, and other medication a shortage of saliva (resulting in the feeling of having a dry mouth). Furthermore, certain medicines make you feel drowsy or fatigued, or affect your concentration. Discuss with your doctor whether your medication can be adjusted. Medicines can be supplied in a modified form, either preground or as a liquid. Ask your pharmacist for advice. It can also help to take your medicines with water, applesauce or yoghurt.
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Medicines can affect your eating patterns
Atlant Care Group ‘Eating & Drinking, information and advice’ is published by Atlant Huntington Expertise Centre, part of Atlant Care Group.
The best possible care
Contact details Atlant Huntington Expertise Centre
Atlant Care Group comprises five residential care centres and three nursing homes in and around Apeldoorn. Residents at
Postal address:
these locations are given the best possible care. Furthermore,
Postbus 10, NL-7300 AA Apeldoorn
we provide special care facilities at two sites for clients with Huntington’s disease and Korsakoff’s Syndrome (Topcare).
Visiting address:
We also recently opened a centre for clients with co-occur-
Heemhof Care Home, Beatrijsgaarde 5,
ring disorders.
NL-7329 BK Apeldoorn
Clients feel very much at home Each of Atlant’s locations has a unique character and style, so
Telephone: +31 (0)55 506 7429
residents feel very much at home with us. If someone finds they can no longer live alone safely, we provide them with a residential care centre near their current dwelling or resi-
E-mail:
[email protected]
Internet:
www.huntingtonexpertisecentrumatlant.nl
dential area. As far as possible, we aim to help them run their lives in their own familiar way. We like to say: ‘A genuine home from home’.
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Edition September 2012
www.huntingtonexpertisecentrumatlant.nl
