June 17, 2019
Physical skills like keeping our mouths closed while food is inside, to help us chew and swallow, can become difficult when we are poorly. As dementia develops, for example, the brain is often unable to activate the body’s natural swallowing reflex (known as dysphagia), which can cause choking. A lack of saliva can also mean that it’s more difficult to chew and swallow food. If you are caring for someone, look out for signs of swallowing issues, such as coughing or grimacing when eating, spitting out, or keeping it in the mouth for longer than usual. A few simple tweaks can really help.
- Find alternatives to liquidised meals. Rather than simply pureeing meals, which can make a person feel disempowered and dispirited, try to find ‘softer by coincidence’ alternatives. Try a cheese soufflé, a delicious, simple chicken soup with a celeriac and potato purée served in a ramekin alongside, or an appetising shepherd’s pie served in a small ramekin instead of struggling with the classic Sunday roast.
- Slow-roasting meat such as lamb in a good stock alongside root vegetables until they all melt in the mouth and become less challenging to swallow can be delicious for everyone to eat.
- Serve a pâté or savoury mousse with a soft crumpet instead of toast to make a great lunch. Labneh cheese is wonderful and easy to swallow. Check out my easy Labneh recipe.
- Make wonderful mashed potatoes with a finely grated mature cheddar or parmesan, or some crème fraîche and very finely chopped herbs such as dill or parsley, to make them that bit tastier and more likely to titillate jaded taste buds.
- Find naturally soft to eat and easy to swallow puddings such as panna cotta, lemon pudding and trifle (which is delicious made with both the classic berries or something like stewed quince or pear). With cakes, think a lemon drizzle or moist ginger cake instead of a flapjack or a rich fruit cake, which often contains nuts and more challenging ingredients. Even a slice of classic Victoria sponge made with loose buttercream can work well. Or try a small steamed lemon pudding, or a bowl of bread and butter pudding if the dried fruits have been cooked so they are really soft. See my Orange Bread Pudding recipe.
- Use smaller utensils (for example, cake forks and knives) to encourage smaller mouthfuls.
- Thicken liquids as some people find thin fluids trickier to swallow. This goes against what we think would be the case, but as the dysphagia progresses it’s the thicker consistencies which are much easier to swallow. In which case, soups, milk with melted chocolate in to thicken and provide a good flavour, or a smoothie given body with ingredients like avocado, ground nuts, banana or a dollop of nut butter can be a good way to ensure they have enough fluids. Italian-style soups which have soaked bread in them, such as ribollita, can be gorgeous and much easier to swallow than a thin consommé. If you have a thinner soup and want to thicken it, then adding some mashed potato, cream or Greek-style yoghurt is another idea.
- Don’t be afraid of using spices and more intense flavours such as garlic, a little chilli, fresh ginger, cardamom, even a little wine (if allowed) in sauces. They not only stimulate the taste buds, but they can activate the brain’s response and encourage swallowing. You can, for instance, stew fruits such as apricots in cardamom and a little orange – delicious not only from the spice, but also because stewing the fruit (and the same applies to other soft stone fruits like peaches, plums, nectarines, greengages, etc) will really intensify the flavours.
- Present dishes such as purées with love and care. Instead of a plate with dollops on, ramekins or even a soup served in a little espresso cup can feel and look far more appetising. Remember, we eat with our eyes so the way food looks has an enormous impact on how tempted we feel to eat it.
For more information on a nourishing healthy diet, see Nutrition Basics.