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The puree kitchen

I like to think that running a puree kitchen is a fun adventure.  Cooking is creative. Creative activity releases endorphins in the brain and these are the body’s natural feel-good hormones.

Making classic American comfort foods with the emphasis on flavor is the focus of Essential Puree: The A to Z Guidebook. The diet is not boring and tasteless and the patient is happy. The patient’s pleasure in food is important because it promotes well-being in the patient. This is critical to patient and caregiver alike.

Having a good time in the kitchen instead of viewing it as a chore aids with the problem of caregiver burnout. You play some music, you chop your veggies, you make a beautiful puree. The food has flavor. The problem of isolation frequently encountered by caregivers may be eliminated if the caregiver is connecting through the simple process of shopping for food.

I am an author and journalist. In creating Essential Puree, I interviewed healthcare professionals from physicians in many specialties to dietitians and speech pathologists, to aides, caregivers and nurses.

My friend Heidi Pines is a licensed clinic social worker. Heidi has been working in the healthcare sector in Florida for the past twenty years, specializing in geriatric medicine. Heidi says, “The complaint that I hear most often (in visiting facilities in the state of Florida) is that of boring tasteless food.”

We eat with our eyes I engaged my mother’s mind, her sense of smell and her sense of sight.

 

This makes the patients extremely unhappy. They have lost one of life’s greatest pleasures, that of good food. I created the Guidebook for my mother. I took updated healthy versions of our family recipes so that she would have good food in old age, even with swallowing difficulties. It was a labor of love, but it was also a research project.

The problem with pureed food is that it all looks the same.  Many CNAs who care for patients in home healthcare situations and also in healthcare facilities have told me that the patients get discouraged because every meal looks like a bowl of oatmeal. To solve the problem of the patient boredom, I got creative.

The answer was simple. We eat with our eyes I engaged my mother’s mind, her sense of smell and her sense of sight. I used the faculties she had to make up for her difficulty in swallowing.

When I cooked the dish, the smells filled the house.  When the dish was cool enough, I brought it to her so she could see it.  A bowl of pea soup.  A plate of pasta with meatballs.  A piece of fish with mashed potatoes and vegetables.  Barbecued pork and Cole slaw.  Chicken pot pie.

When the puree came, she ate with enthusiasm and pleasure, slowly with swallows of water in between mouthfuls, as directed by her speech pathologist.

When my mother became bedridden, I brought the food to her, either in her green chair in the family room or in her bedroom.

Visualization has been used as a meditation technique in Asian traditions for thousands of years. The image of the food lingers during the meal.

Healing begins in the mind

I encourage food companies that create pureed meals for healthcare facilities to place slide shows of ingredients and dishes online. Caregivers in an institutional setting or a home health care setting could download the images of the ingredients of the food and the dish itself to a smart phone, a tablet, a laptop or a flat screen, for the patient to view as I have described I did with my mother. The image of the meal engages the patient. This may be superior to the current fad of creating food in the shape of the pureed item. Molding a pureed carrot in the shape of a carrot, for example. In some of my research with healthcare professionals, it has been reported to me that patients are less than enthusiastic about extruded and molded veggies and other foods.

The importance of atmosphere

On a recent trip to San Francisco, I had a conversation with Michael Broffman, a well-known practitioner of Traditional Chinese Medicine (TCM). Michael is a fluent speaker of Chinese and has been a practitioner of this form of medicine for decades.

Some of the best medical schools in the country have been working on integrative medicine, combining the best of Western medicine with Chinese medicine, which has a clinical history of several thousand years. This is a real East-West collaboration, to the benefit of the patient. Western medical schools have also been investigating other traditional forms of medicine from Asia, among them the Ayurvedic tradition from India.

According to Michael, TCM recognizes three equally important categories in relation to food. These are:

The science of nutrition, meaning what is in the food should be good for you.

The preparation of food, which includes cooking, plating and serving.

Finally, TCM includes the context in which the meal is eaten. This is the most unusual from a standpoint of the Western tradition.

Photo credit: _StaR_DusT_ / Foter / CC BY
Photo credit: _StaR_DusT_ / Foter / CC BY

Michael said, “One of the teachers I have known and respected for a long time, the Taiwan food specialist Ma Lao-fe, emphasizes the importance of context, from a standpoint of health benefits in a meal.This teacher often stated that context is as important as or more important than food.

“The idea of connecting with family and friends, of having conversation, of the environment and surroundings of the meal is as important or sometimes even more important because these elements of a meal are nourishing too.”

This does not mean that one should be a food snob. Michael quoted the great master of French cuisine, Julia Childs, as saying, “On the road, the atmosphere might be MacDonald’s, because it is road food.”

Michael also recounted his teacher inviting Michael to eat in a variety of locations just to amp up the factor of atmosphere. To a park. To somewhere outdoors. For a couple trying to conceive, to a playground filled with children.

Think of it. The meal is not only what is on the plate. It is the surroundings. We take it in. We eat with our minds and hearts.

This is especially important for the patient with swallowing difficulties. Dysphagia patients really benefit from the practice of creating an environment of health and healing. It does not take much. It is an approach, an attitude.

My mom really appreciated it when I brought in roses from the garden in her favorite color, red, and let her smell the roses before she ate her meal.

 

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Diane Wolff
Diane Wolff is a widely published author and journalist. An expert on China, she has written a number of books on Chinese history and culture. She has lived and worked in Japan. Professor Robert Thurman, widely considered the most eminent scholar of Buddhism in America, wrote the foreward to her last book. She is widely traveled in Asia where she has done independent study in art, architecture, textiles, theater and cuisine. She has worked in the field of cultural diplomacy, being a member of a cultural delegation to the People’s Republic of China under then-mayor of San Francisco, Dianne Feinstein. She worked on arts exchange in music, painting and dance with the sister city of Shanghai and also in Beijing. Essential Puree: The A to Z Guidebook is her first cookbook

8 COMMENTS

  1. Thanks Diane Wolff for this fantastic article!!!!! I have always felt and believed the environment if as conducive to getting a patient to just eat- as much as the “look” and smell of the food put in front of them. If the healthcare profession could prove this as an evidence based fact- our jobs as speech pathologists could be utilized in more than diet modifications and swallow strategies!! I use this approach in homes with families that become the caregivers to their loved ones. I encourage the family at the table, the use of spices that evoke memories from smelling them in the kitchen and identifying the foods when in a puree stage. However in the facilities it becomes a very different task- I just keep telling myself – you have to have the “buy in” from just one staff member in order to feel that your recommendations are acknowledged- respected. At this point in my career (over 22 years in the field) I know that staff are the people we as therapists have to educate- in order to obtain referrals and then treat as a team- staff have to believe in the feeding needs and benefits that environment/smells/presentation of meals will make in the overall health- both mental and physical of our patients.

    • Dear Jessica,

      I salute you for feeling intuitively a way to support the staff and engage the patient, body, speech and mind, holistically. I encourage you to continue to make these suggestions to staff. I know that in my mother’s case, with our CNAs in the home healthcare environment, it made all the difference. I also know that with the SLPs and other healthcare professionals that I interviewed, they felt that this was of tremendous benefit. Plus, it is not difficult, nor is it costly. It is a way of working. That’s what I love about it.

      Please write to me and share any tips you may have from your own experience. I think this is groundbreaking work and I know that the community of professionals dealing with dysphagia are compassionate and caring.

      If you write your address to me at the Essential Puree website, I will send you ten recipe cards, for patients to try Cathie G’s Banana Cream Pie, and then order the Guidebook if they like the recipe. It is delicious and a lot healthier than what you would buy from a commercial bakery.

      Diane Wolff
      EssentialPuree.com

  2. Hello Diane

    Your book is a great idea and I’ll be passing details of it on to speech pathologist’s we work with to pass onto their patients.

    It isn’t just for the recipes it’s for reminding carers to consider the whole picture – the whole eating experience; paying special attention to the atmosphere.

    Now that’s done…there is one more thing to achieve for puree foods. Sound?

    As we chew food, it makes a sound which reverberates in our head. Cereal is different to toast, pasta is different to chips and so on. We know what the sound should be and if we don’t hear/feel it – it has a detrimental effect on our eating experience.

    Puree foods by their form make no noise and I don’t know if it can ever therefore be achieved. If it can that would complete the experience for
    those with dysphagia.

    Mathew

    • Dear Mathew,

      I am very excited by your idea of sound. In fact, as a speech pathologist, I am going to issue a challenge to you. Could you find a library of sounds relating to eating. The different types of eating that you mention, as the crunch of cereal, the crunch of celery, and so on. With the wonders of modern technology, you could post them for your fellow speech pathologists and for caregivers. We could all creatively think of a way to incorporate this, maybe even with animation, a sound track of the enjoyment of food, even with archival film clips. You could call it, “The Sound Track of Food: Never Miss The Beat. Music for Dysphagia.”

      By making it creative and fun, the patient might be able to have a laugh, but know that the condition is supported in love and humor. I love this idea.

      Please stay in touch with me. Please let me know if you are developing this idea. I think as a clinician, you might have a lot of fun with this. You might even enlist the aid of local musicians who would have the knowledge and skill to help you. Somewhere, there is a library of sound clips of eating that could be used, probably without paying for a license. Maybe even the government research bodies, such as the CDC or the National Institute of Health or the Office of the Surgeon General, might be of some assistance. Somewhere, some scientist is working on this.

      Please write in for the ten free recipe cards for patients to try Cathie G’s Banana Cream Pie and order “Essential Puree” if they like the pie. It is one of my signature deconstructed desserts that goes straight to puree. How to Make a Pie Without Making a Pie.

      Diane Wolff
      EssentialPuree.com

      • Morning Rosa

        I’m glad you like the idea. I just wanted to point out I’m not a clinician?

        I own a Company that makes drinks that flow slowly for people with dysphagia http://www.slodrinks.com

        I also consult for a Company that makes puree foods here in the UK.

        Consequently, I have an interest in all things Dysphagia food and drink related and like to share we find with all the Clinicians we are in contact with.

        I’ll therefore pass your challenge on to them and see what they can do.

        In the meantime if you would like to try any of our drinks with your meals – together with Slõ Iced Tea, Juice and Coffee we also do Slõ Wine and Beer – let me know and we’ll send you some.

        Regards

        Mathew

  3. Hello Diane.

    I think exactly the same. Context is very important. Where we are, with wo we are, the sound too… The sound of present. The sound of laughters, family and friends. Eating is communication. Eating is essential to live. Live alone with strange food in a strange place in a heath delicated situation can realy be stressed. We need to take care of our past because the way that we treat them tels something about our future…
    I don’t want to eat puree alone. But if i had to eat that to see my daughter, my son and my husband some more days i would eat. I would eat all if i knew they are there with me… Loneliness is all the problem…
    Diane you need to spread the word… Loneliness keals.

    • Dear Rosa,

      You are so correct in the idea of loneliness. That is the great thing about seeing the dysphagia experience as a connection to the world of food. Because you have to shop for food and prepare food and store food, and each step of the way, you meet people.

      I used to take my mom to the vegetable stand, even in her wheelchair, so you could participate in the selection of the food.

      If we can make the creation of food an event rather than a chore, the families will be there. I designed my book so that the meals could be prepared for a family as well as for the patient who was on the pureed diet. Everyone is eating the same thing. And all of it is really tasty. Of course, any family can add their own recipes, from their own traditions, just follow the guidelines for the proper puree.

      The idea of sharing foor even when a family member needs the pureed form can be taught to an entire family or a community in a healthcare institution. I think it is the approach.

      Plus, in thinking of families, I make suggestions for batch cooking, meaning cooking multiple servings at a time, so you can feed the family, but have a serving for the puree patient in the fridge, and also a couple of servings in the freezer. That way, there is always a delicious meal on hand and the caregivers are not chained to the kitchen. Also, I suggest ways of food preparation for easy cleanup, so that with the proper organization of the puree kitchen, it is fast, easy and smart.

      I would make beef stew for my mom, which she loved, and puree it for her, and I would eat a bowl of beef stew with her. This was true for any family member who stopped by. Come. Join in. Be part of the food.

      We found the way to joy. Eliminate the negative and focus on the positive.

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