Tea and toast syndrome

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Tea and toast syndrome is a form of malnutrition commonly experienced by elderly people who are unable to prepare meals and tend to themselves. Their diets often dwindle to tea and toast resulting in a deficiency of vitamins and other nutrients.[1] The syndrome often manifests itself as hyponatremia, a low concentration of the electrolyte sodium in the bloodstream, due to the lack of salt in the diet.


The syndrome often occurs once children have moved away, and a partner has died or is dying. An elderly person with nobody left to cook for, or without the skills to cook, will revert to a diet of simple foods such as bread, cheese and crackers, and canned foods. These simple diets with poor protein and salt content often lead to decreased solute and increased water intake. Patients with poor kidney function, or low glomerular filtration rate, are at even higher risk of hyponatremia due to increased water retention.[2] According to the New York Times, as many as 60% of seniors living at home are either malnourished or at risk of becoming malnourished. In addition to the problems lack of nutrients will cause, this state also means that the complications of other illnesses, even the common cold, can be much more severe.[3][4]

Factors that lead to the syndrome include social isolation, psychological issues such as depression, illness, and physical limitations. Though less of a factor than psychological issues, the increased number of medications often taken by elderly people can also affect eating habits. These medications may suppress appetite, make food taste different, or affect how nutrients are absorbed, making it even less likely seniors will get the required nutrients. 8% of seniors suffer from hyponatremia, although it is unclear how much of that is due to "tea and toast" diets. [5] Medications, such as thiazides and antidepressants, may exacerbate symptoms of hyponatremia. [6]


Typical laboratory findings for tea and toast syndrome include a low serum osmolality (hypotonicity) with a normal urine osmolality since antidiuretic hormone levels are normal. A common laboratory finding for the tea and toast phenomenon is manifestation as hyponatremia. This laboratory finding is not commonly symptomatic when paired with other abnormal electrolyte findings seen in the elderly such as hyperglycemia. [7] Other laboratory tests to identify the cause of hyponatremia as being due to low solute intake include identifying a patient's protein intake through measures of urine urea content and through a history of their regular dietary intake. [8] Upon determination of the cause of hyponatremia as being due to low dietary intake, effective treatment measures can be taken on an individual patient basis.


Treatment of tea and toast syndrome is centered primarily around resolving hyponatremia. Treatment choice depends on the type of hyponatremia.[2]

Traditional treatment for hyponatremia depends on the volume load in the person. For those who are euvolumic (normal body volume load), fluid intake should be restricted. In those that are hypovolemic (low body volume load), give isotonic saline. In those that are hypervolemic (high body volume load), diuresis should be induced.[9] Elderly patients may present in any of these volume states. However, "tea and toast" syndrome patients typically present euvolemic hyponatremia since their hyponatremia is caused by low solute intake. It is critical that these patients receive proper nutrition that is higher in protein and electrolyte intake. [10]

The Health and Medicine Division of the National Academies of Science, Engineering, and Medicine recommends that older adults improve their diet by consuming more fish, low-fat dairy products, and whole grains (such as fortified breakfast cereals). Older adults can also improve their diet by snacking on nuts and legumes as well as ensuring that they include fruit and vegetables at the center of their diet.[11]

See also[edit]


  1. ^ "Senior Citizens Suffer From 'Tea and Toast Syndrome'". prnewswire.com. 28 February 2011. Retrieved 28 September 2015.
  2. ^ a b Filippatos, Theodosios D; Makri, Andromachi; Elisaf, Moses S; Liamis, George (November 2017). "Hyponatremia in the elderly: challenges and solutions". Clinical Interventions in Aging. 12: 1957–1965. doi:10.2147/CIA.S138535. PMC 5694198. PMID 29180859.
  3. ^ https://www.nytimes.com/2005/04/12/job%20market/health/health-tea-and-toast-and-a-danger-that-can-be-hard-to.html
  4. ^ Anderson, Olwen (25 December 2010). "Avoiding the 'tea & toast' syndrome as you age". Retrieved 28 September 2015.
  5. ^ Myer, Cara (2003). "The Tea and Toast Syndrome: Psychosocial Aspects of Congregate Dining". Generations. 28 (3).
  6. ^ Filippatos, Theodosios D; Makri, Andromachi; Elisaf, Moses S; Liamis, George (November 2017). "Hyponatremia in the elderly: challenges and solutions". Clinical Interventions in Aging. 12: 1957–1965. doi:10.2147/CIA.S138535. PMC 5694198. PMID 29180859.
  7. ^ Liamis, George; Elisaf, Moses S.; Makri, Andromachi; Filippatos, Theodosios D. (2017-11-14). "Hyponatremia in the elderly: challenges and solutions". Clinical Interventions in Aging. Retrieved 2019-08-05.
  8. ^ Yu, Alan S. L.; Jain, Nishank; Budhiraja, Pooja; McGreal, Kerri (2016). "Current Challenges in the Evaluation and Management of Hyponatremia". Kidney Diseases. 2 (2): 56–63. doi:10.1159/000446267. ISSN 2296-9381. PMC 4947691. PMID 27536693.
  9. ^ Braun, Michael M.; Barstow, Craig H.; Pyzocha, Natasha J. (2015-03-01). "Diagnosis and management of sodium disorders: hyponatremia and hypernatremia". American Family Physician. 91 (5): 299–307. ISSN 1532-0650. PMID 25822386.
  10. ^ Verbalis, Joseph G.; Goldsmith, Steven R.; Greenberg, Arthur; Korzelius, Cynthia; Schrier, Robert W.; Sterns, Richard H.; Thompson, Christopher J. (October 2013). "Diagnosis, Evaluation, and Treatment of Hyponatremia: Expert Panel Recommendations". The American Journal of Medicine. 126 (10): S1–S42. doi:10.1016/j.amjmed.2013.07.006. PMID 24074529.
  11. ^ Food and Nutrition Board; Health and Medicine Division; National Academies of Sciences, Engineering, and Medicine. (13 July 2016). Meeting the dietary needs of older adults : exploring the impact of the physical, social, and cultural environment : workshop summary. Washington (DC): National Academies Press (US). ISBN 978-0-309-44227-5.CS1 maint: multiple names: authors list (link)