Real Food VS. Oral Nutritional Supplements

Michael Pollan is a journalist who, in doing some investigative journalism work about our food supply and the way we Americans eat, has written some very good books. In fact, Pollan is recognized as a foremost authority in the conversation about real food and what he calls “food-like” food. The latter he defines as processed and pre-prepared foods.

I wish Michael had been with me at a conference session (Aging in America) that I attended last week. Two national organizations focusing on aging cosponsored their national conference here in San Francisco so I took advantage of what I had judged to be worthwhile sessions. This one was entitled something about the role of malnutrition in older adults in loss of independence.

Without going into their entire presentation, I present this brief summary: A fine doctor (internist, geriatrician, certified medical director at two teaching nursing homes, and researcher) presented data showing how older adults are at risk for malnutrition and all the ills that can result from malnutrition.

Then two registered dietitians (RD) took over the rest of the session. In the interests of full disclosure, they both stated that they were consultants for Nestle Nutrition Institute. (Oooohhhhh!) I hate it when I get caught in a corporate “paid programming” session especially when it happens at a conference that advertises itself as a professional conference.

Now the first purpose of any corporation that intends to stay in existence is to make money. Good capitalistic principle. Not an evil concept when the reach for profit is kept in its place.

So these RDs showed us many charts with all the good results reflecting the benefits for a person who is malnourished or is at risk for being malnourished when s/he is provided oral nutritional supplements (ONS). I don’t question their results.

This is what I questioned at the session: Are there studies that reflect that when real food is provided to elders (Meals on Wheels, Senior Centers, PACE Centers, retirement settings and nursing homes) that the need for ONSs decreases? Are there studies that indicate that when residents of nursing homes are allowed to come to the dining room (or kitchen in a household nursing home) for meals when they are ready to eat, that the need for ONSs decreases? Believe it or not, not even the doctor was aware of any such studies.

I also had to explain what I meant by “real food.” When food is prepared for any of the congregate settings mentioned above, the typical approach is to buy foods from an institutional food service. The food is already seasoned (high in sodium) and cooked. All that is required of the staff is to open and heat. Even the cakes and other desserts are all pre-cooked and just have to be thawed and served. By and large that is what elders who do not live at home, or who live at home and can no longer prepare their meals, are subject too.

In fact the studies I asked about have been done. And in every study, the need for ONSs decreased; there was less wasted food within the institution and the outcome was an increase of weight for the elders who were malnourished or at risk for being malnourished.

There’s also the whole world of smells when food is “cooked from scratch.” Don’t we all know that experience of the simultaneous sense of aroma from the kitchen and a sense of, “I want to eat!” Let’s not deprive our elders of that experience – the pleasure of eating “real food” and all the healthy benefits it provides.

Michael Pollan summarizes a healthy diet in his book: “In Defense of Food” this way: Eat real food, not too much, mostly plants." I say let’s provide that for our elders!

P.S. I know there are situations in which only ONSs will provide the needed results. But those ONSs should be tried only after there is no response to “real food” provided in an environment of HOME.