Guidelines for meeting the Nutritional Needs of People with Huntington Disease
Karen Keast
Manager of Dietetics and Food Service, Lottie Stewart Hospital, Sydney

From Gateway, Australian Huntington's Disease Association (NSW) Inc, Sept/Oct 2001

1O STEPS TO GOOD NUTRITlON

1. Eat Frequent Meals and Snacks
AS WELL as breakfast, lunch and dinner include morning tea, afternoon tea and supper.
HAVE double serves of meals and desserts.

2. Ensure All Food is Soft and Moist
AVOID foods which are hard and brittle and more difficult to swallow such as chips, corn chips, nuts, hard lollies etc.
ADD extra gravy and sauces to savoury foods and custard and creams to sweet foods.

3. Make Every Mouthful Count
CHOOSE nutritious energy dense food and drinks, eg milk or fruit juice rather than tea, coffee or clear soup; eg cake and cream rather than a plain biscuit.

4. Enrich the Food You Eat
ADD foods rich in protein and energy to those you already eat and drink, eg add cream to fruit and margarine or sour cream to vegetables.

5. Try to Include a Protein Food with Each Meal
SUCH AS meat, chicken, fish, egg, cheese, milk, custard or legumes.

6. Have Ready-to-Eat High Energy Snacks Handy
eg Yoghurts, fruche, cream cake, fruit and custard

7. Supplement Your Diet
USE fortified drinks such as high protein milk or Sustagen to boost your energy intake.

8. Enjoy Your Meals and Eat a Variety of Foods
VARY your meals so eating does not become a chore.

9. Maintain a Calm and Relaxing Environment for Meals
MINIMISE all distractions, ie turn the TV and radio off.
ALWAYS sit upright for meals and for at least a half-hour after meals.

ALLOW plenty of time for meals.
EAT slowly.
AVOID eating and drinking at the same time.

10. Monitor Your Weight CONTACT your doctor or dietitian if you are concerned.

NUTRITIONAL SUPPLEMENTS
WHAT ARE THEY?
Supplements are special food products or powders that can be used as part of, or in addition to, your daily food intake. They can add extra energy, protein, vitamins and minerals.

WHY SHOULD I USE THEM?
Supplements are helpful for people who:
Have lost weight
Have difficulty in maintaining their weight
Have a poor appetite
Are not eating enough food

WHEN COULD I USE THEM?
Between meals
As part of a meal
Any time you want to eat or drink

SUGGESTED SUPPLEMENTS FOR YOUR USE
High Protein Milk Recipe
1000ml (1 litre) full cream milk and 1 cup skim milk powder or
150ml (small glass) full cream milk and 2 tablespoons skim milk powder
Add milk powder to milk and whisk until dissolved
HIGH PROTEIN MILK CAN BE USED WHENEVER YOU NORMALLY USE MILK

Compiled by the Dietitians Association of Australia NSW Gerontology Special Interest Group

ENRICHING WITH PROTEIN AND ENERGY
Breakfast Cereals
Use high protein milk or Sustagen
Make porridge on milk or Sustagen rather than water
Add sugar or honey

Toast, Bread, Muffins, Crumpets
Spread margarine or butter thickly
Use smooth peanut butter, marmalade, jam, honey
Use avocado or mayonnaise

Sandwiches
Spread margarine or butter thickly
Add an extra slice of meat or cheese
Add mayonnaise, relish, creamed cheese,avocado

Vegetables
Add margarine, butter, oil, cheese, sour cream, white sauce
Add milk powder or cream to mashed vegetables

Fruits
Add custard, ice cream, gelato, cream, yoghurt
Add sugar, glucose syrup or honey
Add to milk drinks

Soups and Sauces
Add milk powder, cream, sour cream, eggs, grated cheese
Use cream soups instead of broths and consommes
Make soup on milk rather than water

Savoury Dishes
Add grated cheese, milk powder, margarine, butter, oil, cream, eggs, mayonnaise, salad dressing

Milk Puddings and Desserts
Add extra milk powder, eggs, sugar
Add cream, ice-cream, custard, yoghurt
Add flavoured toppings, honey, glucose syrup

Drinks
Encourage milk and juice based drinks in preference to water, tea or coffee
Use high protein milk for milk drinks
Add honey, malt, glucose syrup, flavoured toppings
Add Cocoa, flavoured drink powder, ice-cream, fruit
Use commercial supplements

Acknowledgements to: Dietitians Association of Australia NSW Gerontology Special Interest Group

QUICK SIMPLE MEAL SUGGESTIONS
Snack Suggestions
Breakfast cereal with evaporated or high protein milk and canned fruit and top with cream.
Canned spaghetti, baked beans, creamed corn on buttered toast with cheese.
Canned salmon, tuna or sardines mixed with mayonnaise on buttered bread .
Canned cream soups made on evaporated milk or with added cream. Serve with buttered toast, bread or a bread roll.
Eggs -boiled, poached or fried, served with buttered toast and top with cheese.
Scrambled egg made with extra milk or cheese, served on buttered toast or bread.
Omelette, eg cheese and ham, served with buttered toast or bread.
French toast (bread and margarine, soaked in egg then fried).
Potatoes -baked or microwaved until soft and filled with sour cream, cheese, mashed baked beans or minced meat
Pasta cooked with cream sauces
Wholemeal sandwiches with fillings of choice include meat, chicken, canned fish, cheese, baked beans, smooth peanut butter or egg.

SUGGESTIONS FOR SANDWICH FILLINGS
Choose wholemeal bread and spread liberally with margarine. Remove crusts if required.
Grated cheese and pickles.
Grated cheese and vegemite.
Salmon or tuna with mayonnaise.
Smoked salmon with creamed cheese.
Tuna and creamed corn.
Mashed sardines and tomato sauce.
Curried egg with mayonnaise.
Mashed avocado with lemon juice, pepper and sour cream.
Shaved ham and cream cheese.
Shaved chicken, grated cheese and mashed avocado.
Shaved chicken, camembert cheese and cranberry sauce.
Shaved roast beef and mustard.
Mashed baked beans and grated cheese.
Smooth peanut butter with honey, jam or mashed banana.
Smooth peanut butter and cream cheese.
Hommus.
Canned spaghetti, mashed baked beans or creamed corn with grated cheese buttered toast with cheese.

SIMPLE NOURISHING SNACKS IDEAS
AIM FOR SIX MEALS AND SNACKS EACH DAY KEEP A READY SUPPLY OF SNACKS AVAILABLE

Snack Suggestions
Sandwiches with plenty of margarine and soft fillings
Pikelets with jam, cream and margarine
Yoghurt with soft fruit
Icecream with topping
Soft cake with cream, custard and icecream
Desserts such as cheesecake (remove the crust), mousse, custard, fruche and creme caramel
A bowl of cereal topped with cream or yoghurt
Milkshakes made with high protein milk, cream, icecream and fruit (ask for recipes)
Cream soup instead of tea and coffee
Hot chocolate or coffee made on milk
Cream dips with fingers of wholemeal bread

MAKE EVERYTHING YOU EAT COUNT THAT IS, DON'T FILL UP ON CUPS OF TEA, COFFEE OR WATER INSTEAD OF EATING YOUR MEALS AND SNACKS

SUGGESTIONS FOR DESSERTS

Ice-cream served with soft fruit or flavourings.
Custard and soft fruit (fresh, stewed or canned).
Milk jelly and fruit
Baked custard
Jelly made on high protein milk or evaporated milk.
Prepacked refrigerated desserts such as creme caramel, fruche, creamy rice, yoghurt, mousse,
custard.
Canned creamy rice and canned puddings.
Frozen desserts such as cheesecake without crust,
Vitari, Fruita, and frozen yoghurt.
Cakes such as banana, sponge, cream, jam
rollettes and chocolate cakes with added cream,
ice-cream or custard.
Fruit yoghurt .
Instant puddings.
Add extra egg to pancake batter, cook and serve with maple syrup, butter, jam or desired topping.
Add custard, ice-cream and cream to desserts as desired.

SAMPLE HIGH ENERGY MEAL PLAN FOR A SOFT DIET
Breakfast
Glass of Sustagen
Large Bowl Rolled oats with High Protein Milk, Sugar and Cream
Mashed Baked Beans and Cheese on Buttered Toast or Bread
Stewed Apple with Yoghurt
Glass of orange Juice

Morning Tea
Mashed Banana with Custard and Cream
Glass Sustagen or High Protein Milk

Lunch
Large Serve Lamb Casserole
Large Serve Soft Cooked Potato, Pumpkin and Beans with Margarine or Sour Cream
Baked Custard with Stewed Peaches Topped with Cream
Glass of Sustagen or High Protein Milk

Afternoon Tea
Fruit Yoghurt
Glass Sustagen or High Protein Milk

Dinner
Cream Soup made on High Protein Milk or Cream
Wholemeal Sandwiches (no crusts) with Soft Fillings (eg shaved chicken, avocado and mayonnaise) and liberally spread with Margarine
Strawberry Mousse topped with Cream

Supper
Soft Cake with Thick Custard and Cream
Glass Sustagen or High Protein Milk

SAMPLE HIGH ENERGY MEAL PLAN FOR A MINCED DIET
Breakfast
Orange Juice
Four Weetbix with High Protein Milk, Sugar and Cream
Soft Poached Egg with Extra Margarine
Soft Bread (no crust) and liberally spread with Margarine
Soft Stewed Cut-up Apple with Yoghurt
Glass of Sustagen or High Protein Milk

Morning Tea
Soft Stewed Pears (cut up) with Custard and Cream
Glass Sustagen or High Protein Milk

Lunch
Large Serve Shepherd's Pie
Two scoops Mashed Pumpkin and Pureed Beans
with Extra Margarine and Milk Powder
Baked Custard with Soft Cut-up Peaches topped with Cream
Glass of Sustagen or High Protein Milk

Afternoon Tea
Fruit Yoghurt
Glass Sustagen or High Protein Milk

Dinner
Smooth Cream Soup made with High Protein Milk or Cream
Two Wholemeal Sandwiches (no crusts) with Soft Fillings (eg egg and mayonnaise) and liberally
spread with Margarine
Strawberry Mousse topped with Cream
Glass Sustagen or High Protein Milk

Supper
Mashed Ripe Banana and Ice Cream
Glass Sustagen or High Protein Milk

SAMPLE HIGH ENERGY MEAL PLAN FOR A PUREE DIET
Breakfast
Orange Juice
Large Bowl Pureed Rolled oats with High Protein Milk, Sugar and Cream
Pureed Baked Beans and Sour Cream
Vanilla Yoghurt
Glass of Sustagen or High Protein Milk

Morning Tea
Pureed Pears with Custard and Cream
Glass Sustagen or High Protein Milk

Lunch
Large Serve Pureed Roast Lamb with Gravy and Mint Sauce
Two scoops Mashed Potato, Pureed Pumpkin and Pureed Beans with Extra Margarine and Milk Powder
Baked Custard and Pureed Peaches topped with Cream
Glass of Sustagen or High Protein Milk

Afternoon Tea
Fruche
Glass Sustagen or High Protein Milk

Dinner
Pureed Fish with White Sauce with extra Margarine and Milk Powder
Mashed Potato, Puree Carrots and Puree Zucchini with Extra Margarine, Milk Power and Cream Strawberry Mousse topped Cream
Glass Sustagen or High Protein Milk

Supper
Pureed Apricots with Thick Custard and Cream
Glass Sustagen or High Protein Milk

>From Gateway, Australian Huntington's Disease Association (NSW) Inc, Sept/Oct 2001