Food is a word that carries baggage. Think of all the associations when you hear the word food: hunger, diet, money, stress, planning, tradition, illness, etc. From the moment we take our first breath, and our mothers are forced to decide to breast or bottle feed, food loses the simplicity of being just about nutrition. In the toddler stages, food becomes a symbol of control, with battles at the dinner table as parents bribe, yell, demand, or cajole children to “just try one bite”.
As we age, food shifts and inherits meanings tied to family traditions and holidays, religious rituals, and social events. We break bread together and food becomes the vehicle to share these moments.
When we are sick, we are offered soup and juice from our family, the food meant to bring us comfort and healing. When friends are hurting, we bring over food to offer comfort and healing.
Food is used as gifts at holidays, rewards for school, enticements for dates, and celebrations for birthdays and anniversaries.
It is no wonder then, that food, heavy with all its symbols, is a major issue at the end of life.
Our default belief is that food, which has always healed, soothed, strengthened, and comforted us, will again serve this purpose. But at the end of life, it doesn’t.
As the body begins its exit strategy, one of the first changes that occur is in nutrition. The digestive system slows and the stomach shrinks, so appetite diminishes. Food often doesn’t taste good, and the body actually loses the ability to digest all those nutrients sitting in the stomach. As the rest of the body slows, and a person becomes more sedentary, the actual calorie needs lessen as well.
The weight loss that happens is not about actual food input, but the body’s ability to use that nutrition. Thus when we, albeit well meaning, push and force food above the person’s own interest, instead of offering solace, we add nausea, stomach pain, bloating and discomfort.
When someone is in the last months of the dying process, food no longer can bring strength and energy. No matter how many calories someone consumes they will not feel better. In fact, one paradox that can happen is that someone can actually be more tired and weak from eating, because the effort alone uses up whatever energy they had to use.
As the body enters into the last days and weeks, a new problem occurs, as swallowing becomes difficult. This is due to a combination of weakness as the body shuts down and the complexity of the swallow mechanism. Food forced at this point could actually be harmful, with choking and coughing often seen.
If our instincts are to feed for support, how can we approach food at the end of life?
I think of food as any of the other treatments we offer in hospice; as comfort. This means, whatever and whenever someone wants to eat, they should. When they eat, they should do it because they are hungry or have a desire. They should not eat because they feel guilty, or pushed, or to please others. If food can’t bring strength, or make you live longer at the end, shouldn’t it at least bring comfort?
Dr. Amy Clarkson is the medical director for South Wind Hospice.