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Fun Food for Dysphagia: How to cook for people with difficulty swallowing

dysphagia appropriate fruit caviar
August 16, 2018
Lily Moran

Among some of today’s most challenging diseases are those that make it difficult or impossible to chew or swallow food. It’s a complicating condition called dysphagia that usually requires that all foods are consumed as liquids or purees. And…as you can imagine, taste and presentation are typically an after-thought at best.

Thankfully, health-focused foodies are putting “delicious and healthy!” back into the lives of folks suffering with dysphagia.

Who gets chewing and swallowing problems?

Scores of thousands of people suffer a swallowing disorder every year—1 in 25 adults. Some 60,000 of them die.

Dysphagia comes as a symptom or side effect of many diseases and conditions—dementia or stroke, surgery or neurological disorders, strep throat, a throat injury, radiation, or tonsillitis.

When we understand what a complex process feeding ourselves is, we have to admire our wonderfully capable bodies. Here’s a quick step-by-step review of how a healthy body behaves:

  1. We chew
  2. Salivary enzymes kick in and begin breaking the food down
  3. Our cheek muscles tighten
  4. Our tongue presses against the roof of our mouth
  5. Together, they move food to the back of the mouth
  6. Our soft palate closes the nasal airway to prevent food from backing into it
  7. Our airway into the lungs is closed
  8. Our esophagus relaxes, allowing food and liquid to enter
  9. Our esophagus then contracts and sweeps the food into the stomach

What could go wrong?

There are lots of opportunities for bad outcomes here. A blockage or a malfunction anywhere in the body or in the nervous system controlling chewing or swallowing can result in dysphagia.

Whatever the cause, for many of dysphagia’s most compromised, at-risk, patients, mealtime becomes a bland, boring, diet of baby food and baby-food-like ingredients—pureed to pablum, with an ever-present side of worry about choking. Pureeing meat and veggies together in a blender?  Together?  Some necessary nutrients, sure, but … ick, no?

Plaudits, to be sure, to the many food workers who at least try to make that stuff out of healthy ingredients, with proper levels of carbs, protein, vitamins, fats, minerals, and all of our other essential nutrients.

But caveats to those who might be tempted to try Big Food’s pre-bottled or pre-canned offerings. Read the labels, and you’ll find too much salt or sugar, too much artificial flavoring, too few real nutrients.  Those are not the solution, they’re a major part of the problem

It doesn’t have to be that way.

How to eat

Before we go into what to eat, here are some tried and true practices to make what you eat less frustrating—and safer.  Every patient is different, of course, but these techniques often help a great deal.  My thanks to the doctors of Jackson Siegelman Gastroenterology for collecting and sharing them.

  1. Maintain an upright position (as near 90 degrees as possible) whenever eating or drinking, except when using suggestion 6 below.
  2. Take small bites—only 1/2 to 1 teaspoon at a time.
  3. Eat slowly. It may also help to eat only one food at a time.
  4. Avoid talking while eating.
  5. When one side of the mouth is weak, place food into the stronger side of the mouth. At the end of the meal, check the inside of the cheek for any food that may have been pocketed.
  6. Try turning the head down, tucking the chin to the chest, and bending the body forward when swallowing. This often provides greater swallowing ease and helps prevent food from entering the airway.
  7. Do not mix solid foods and liquids in the same mouthful and do not “wash foods down” with liquids, unless you have been instructed to do so by the therapist.
  8. Eat in a relaxed atmosphere, with no distractions.
  9. After every meal, sit upright for 30–45 minutes to give your food time to pass out of risk zones.

What to eat

The problem here isn’t the ingredients. Most people with dysphagia can eat anything they want.

The problem is the texture and the lack of visual appeal.  Our gastroenterologists describe five levels of tolerable food textures, depending on the severity of dysphagia.

Level Food Texture
1 Totally pureed, no solids
2 Minced solids ⅛-inch, the size of a sesame seed
3 Ground/diced into ¼-inch pieces similar in size to rice
4 Chopped into ½-inch pieces, similar in size to uncooked elbow macaroni or croutons
5 Soft, moist, regularly textured foods

 But even though we can prepare just about any food to sustain dysphagia patients with minimal risk, imagine again the same-same boredom, and the unmet yearning to sink your teeth into just one bite of a loaded bacon cheeseburger.

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But wait…there is a solution.

What is molecular cuisine?

It’s a hard question to answer, and I’m not sure it’s the best term to describe what are really just new ways to prepare food, using tools, techniques, and ingredients we’d ordinarily associate with laboratories.

Here are some commonly used techniques—that are surprisingly simple.

Spherification transforms liquids into little spheres about half the size of a Tic-Tac mint. They give a delightful and delicious “pop” on contact with the tongue. The technique is as simple as creating or buying a calcium chloride solution, mixing it with water and pouring your choice of liquid though a funnel into the solution.

Gelification is a way to create a solid structure that turns a liquid into varying degrees of solidity, from custard-like to elastic and stretchy, like gummy bears and other candies.

Emulsification creates a third, usually thicker liquid when a small amount of one liquid is mixed with a larger amount.  When you shake up vinegar and oil for salad dressing, you’re making an emulsion.

So originating—amidst great chef-vs-chef arguments—in Michelin-starred restaurants around the world, the techniques have crossed over into the world of institutional dining.

Chefs are building a world of new ways to make familiar or visually boring bland foods exciting. Even wine and cocktails can be transformed. One chef creates vodka and tonic ice blocks, a jellied mulled-wine ice cube, and a jellied Scotch on the rocks. Let those melt in your mouth … what a treat! You can get similar results by simply making good old popsicles from fruit juice.

And not to be overlooked is a focus on appearance, making the food look different and beautiful.  Proponents of this cuisine in the institutional setting advise showing diners the uncooked ingredients—a steak, for example—that will return in a different, exotic form after preparation.  This puts diners’ senses, scent memories, and their positive expectations into gear, making the meal tastier before it even arrives.

Many chefs, from amateur to professional, use cookie cutters and other molds to give shape to what they’re making and serving. Binding and thickening agents like agar, carrageenan, and xanthium do the trick.

An Aussie chef, for example, was working with a patient with early onset dementia, living on ice cream, custard, and fruit.  Not healthy, but nothing else appealed. It looked like a feeding tube would be her next step into a sad future.

The chef pureed chicken with satay sauce, and molded it into the shape of a drumstick.  He added a pureed fruit salad set on yogurt and sculpted to look like the fruits themselves. His patient got her appetite back.

Remember, the best food is the best medicine

Some of these techniques and ingredients are obviously more complicated than just pureeing everything at once. But they don’t have to be. Most of the necessary ingredients are commonly available, and many web sites will give you, the diner or the caregiver, loads of help. If you simply do a quick online search for recipes for dysphagia, there are countless options offering creative, healthy options that are both tasty and visually appealing…most of them very easy to prepare.

Just remember, anything that keeps people eating well is good medicine. So how about some big chef-style hats off to these sympathetic, imaginative men and women.  And a huge thank you for making life so much more pleasant for so many.


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