The perfect puree day

AdvocacyCoffee BreakLaura MichaelJune 4, 2014

Getting proper nutrition can be difficult when you have trouble swallowing

The inability to eat the right foods safely can lead to malnutrition. Maintaining proper nutritional intake is a key to overall good health and a high quality of life¹. The National Dysphagia Diet² defined the standard of what pureed food is, but offers little information on how to incorporate pureed foods into an active lifestyle.

The Challenge: Is it possible to eat healthy and well on a puree diet without using your blender or food processor? Can you still eat out? Yes! Let’s answer that challenge by offering breakfast, lunch, and dinner options for those on a modified diet.

Breakfast

Pre-made smoothies, available in the freezer case at most grocery stores, are a good option. Custom-made smoothies can be found at Whole Foods®, Einstein Bros.®, McDonalds®, Starbucks® or any juice bar. Smoothies that contain kale, beet or carrot juice add an important dose of phyto-nutrients. Don’t want a smoothie? Yogurt and Kafir are full of protein. If you want something warm, try a bowl of creamy wheat cereal or creamy oat bran cereal into which you’ve swirled smooth peanut butter and strawberry syrup. Smuckers® makes an entire line of smooth blueberry, mixed berry and strawberry syrups. 

Lunch

Whether you are eating at home or packing a lunch, a creamy pre-made soup and a homemade “safe” sandwich is a classic combination. Traditional sandwiches are not an option. Bread can be dangerous and difficult to swallow, but a modified “safe” sandwich can be attractive and delicious. One of my favorite safe sandwiches is an open face Mediterranean. Start with ¼ cup of tomato juice (or vegetable stock), add one scoop of instant food thickener and stir until thick. Place half of the thickened juice/stock on a plate or in the bottom of a plastic sandwich container. Top with a slice of smooth bread, like oat bran bread, crust removed. Spread the remaining thickened juice over the bread. Place dollops of pre-made hummus over the bread and smooth to the edges. Drizzle with olive oil. Cover and refrigerate at least 30 minutes then eat it with a fork. Smooth creamy soups are available right off the shelf at most grocery stores. If you have been prescribed thickened liquids, it may be necessary to thicken some creamy soups to the correct consistency with an instant food thickener. Safety first!

Dinner (eating out)

When eating out, most restaurants will be happy to accommodate reasonable requests. Let your server (or the manager) know that you have a medical condition that may require simple modifications to your food. Being humble and gracious will go a long way! If you have brought your own pre-thickened water, let them know. Ask your server for menu suggestions. Consider making a meal from appetizers like salmon mousse or side dishes like cheese grits. Don’t be afraid to ask your favorite restaurant to use their blender or food processor to modify your meal, within reason. Most restaurants want your return business and good word-of-mouth. When a restaurant is accommodating to you, be sure leave them a positive review on the Internet.

Many restaurants have creamy soups on their menus: split pea, tomato and potato are usually safe options. If you are afraid that the soup may not be smooth enough, ask them to use their blender or food processor to make it safe.

• At an Italian restaurant, order creamy polenta that has been swirled with pesto or Alfredo sauce.
• At a steakhouse or other American restaurant, order a stuffed baked potato or an order of mashed potatoes with butter, sour cream and a smooth-melting cheese. Leave off the chives or green onions and make sure you potatoes are smooth. Grits are delicious eaten the same way. Restaurants like Cracker Barrel® and Outback Steak House® have a roasted sweet potato on the menu which you can make into a meal with the addition of butter and honey.
• In a Mexican restaurant, order smooth guacamole and smooth refried beans with chile con queso which you will eat with a fork. Unfortunately, chips and salsa are unsafe for those on a puree diet. If you are on thickened liquids, ask the bartender to blend your Margarita to the correct consistency by using the packet of ThickenUp® Clear instant food thickener that you’ve brought with you.

Dinner (eating in)

Eating well at home can be easy, even on a pureed diet. Grocery stores carry many “regular” foods that are smooth and ready to eat or to heat and serve. The best options are often in the refrigerated, dairy and freezer sections of the store. Look in the refrigerated section for hummus, guacamole, Greek yogurt dips, cheese spreads and flavored cream cheeses. Add these to the mashed potatoes that you find in the freezer section. The freezer section is also where you’ll find Stouffer’s® spinach souffle and Tabachnik® butternut squash souffle. The pasta aisle has smooth pesto, Alfredo sauce or cheese sauce that can be mixed into smooth soups for a change of pace.

Hungry for desert?

Choose crème brulee (without fruit), panna cotta, salted caramel pudding or chocolate mousse. Cream pies are fine, too, just don’t eat the crust. Avoid chunky textured puddings like rice pudding and tapioca pudding. Whether eating out or at home, avoid any dessert that could leave a puddle of thin sauce on the plate, especially if you cannot tolerate mixed textures.

When you have the right strategies, some imagination and a little help, it is possible to eat well without using your blender or food processor!

References

1. ¹Cichero, Julie AY, Nutrition Journal. 2013, 12:54
2. ²Clayton J, editor. The National Dysphagia Diet: Standardization for Optimal Care. American Dietetic Association; 2002.

Links of Interest

1. “Cooking for Someone with Swallowing Problems” is $44.95 (includes shipping & handling). Visit her website: www.dysphagiasolutions.com

AboutLaura Michael

Laura Michael has a degree in Nutrition from the Ohio State University and over a decade of experience working in the healthcare food industry. She is the owner of Dysphagia Supplies Direct and Dysphagia Solutions where she offers hands-on training and education (with CEUs) for patients and healthcare professionals. She is the author of the training manual and cookbook: “Cooking for Someone with Swallowing Problems”. Laura is on the executive board of the National Foundation of Swallowing Disorders.