Cookbook Review – Part 1

As a teacher and trainer of the National Dysphagia Diet, I am always looking for ways to help my clients eat better.

My goal is to see people enjoy the foods and beverages that they can eat and drink. I like to stay up-to-date on research and publications, so I decided to take a look at some of the cookbooks that were written specifically for people who are living with swallowing disorders.

First, a disclaimer: I am a passionate cookbook reader and collector! I currently have more than 100 cookbooks in my collection. I subscribe to every food magazine that is currently published and I can’t seem to part with my 20 year collection of the now defunct “Gourmet” magazine. If you called me a “food-wonk”, you would not be far off!

I chose to review the  four best-selling “Dysphagia Cookbooks” on Amazon:

  • “Soft Foods for Easier Eating Cookbook” by Sandra Woodruff, R.D. and Leah Gilbert-Henderson, Ph.D.
  •  “Down Easy: A cookbook for those with swallowing difficulties” by Judy Best
  • “Easy-to-Swallow, Easy-to-Chew Cookbook” by Donna L. Weihofen,, R.D., M.S, JoAnne Robbins, Ph.D., CCC-SLP, and Paula A. Sullivan, M.S., CCC-SLP
  •  “The Dysphagia Cookbook” by Elayne Achilles, Ed.D.

Each is well written and insightful but there are specifics that are unique to each book.

As I read through and tested the recipes in each of these cookbooks I came to realize that each is a “labor of love” for the author. If you purchase one of these books, I encourage you to read the forewords and acknowledgements as you will find something of value in each.

In my next blog, I’ll go into detail on the pros and cons of each book.

If you can’t wait until my next blog post, please contact me at Laura@dysphagiasupplies.com and I’ll email you the full review.

 

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Having Trouble Swallowing? Strategies for Staying Hydrated.

When you have trouble taking foods and liquids by mouth, it can be especially challenging to get enough hydration. People who must consume thickened liquids are often put-off by the flavor and texture of older, starch-based thickeners. New xanthan gum-based thickeners like ThickenUp® Clear taste better, mix easily and don’t continue to thicken upon standing.

Convenience is also an important factor in getting enough to drink. It is easier to just “grab and go” water, juices and other beverages that have been thickened in bulk and kept readily available in the refrigerator. Commercially prepared thickened beverages provide a consistent supply of thickened liquids but can be a bit more expensive than thickening liquids at home.

Individuals who have limited mobility and who have dysphagia are at high risk for dehydration because they must depend on others to meet their need for liquids. Keeping cool thickened beverages within arms-reach is essential but can be a challenge. One solution is to make ice cube with water that has been thickened to the proper consistency with a xanthan gum thickener, like ThickenUp® Clear and then using the ice cubes in drinks kept within easy reach. Do not make ice cubes with starch-thickened water because they brake-down into particles as they melt, causing an unsafe texture. “Regular” ice cubes are dangerous for people on thickened liquids because, as they melt, they thin-out the consistency of the beverage.

Eating foods like soups, smoothies, yogurt and other foods that naturally have a high liquid content can also help to combat dehydration. “Perfectly Safe Popsicles” are also a great way to encourage hydration. If you want the recipe, send me an email: laura@dysphagiasupplies.com.

What are some recommendations you might have for staying hydrated? Please share in the “comment” section of this blog.

As mentioned in a previous blog: dehydration can be exacerbated by the use of diuretics, laxatives, antidepressants, certain antibiotics and other medications. Please consult your Pharmacist about your specific medications if you have questions or concerns.

 Dehydration can be very serious. Severe dehydration can lead to hospitalization.

The key to preventing dehydration is simple: Avoid it. Be aware of what you are drinking and consume more liquids!

Water is an essential element for sustaining life. The human body is composed of more than 60% water.

Without water, we won’t survive for more than a few days.

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Life After Oral Cancer

I recently spoke at a SPOHNC meeting.  SPOHNC is a support group for people with oral, head and/or neck cancer: www.spohnc.org.  I was invited to speak about cooking for someone who is having trouble swallowing and to introduce some food products available for people living with swallowing disorders and to discuss some strategies for modifying foods so that they remain tasty but are safe to swallow.  Properly modified foods can make a big difference in someone’s life.

I thought I was there to share but I found-out that I was really there to receive.

I thought I was there to teach but I really was taught.

I learned that people who are going through treatment for head/neck/throat cancer need support, encouragement and solutions when it comes to dealing with food and eating.

I learned that people could use some guidance on how to manage and modify “regular” food and the social aspects of eating and dining.

I learned that once the body has healed from the surgery and radiation, there is less and less need for pureed/modified foods because the ability to swallow returns.

I learned that when it comes to swallowing: “if you don’t use, it you lose it”.

I learned that it is terrifying to take food and liquid by mouth, especially after radiation. Often, many people just give-up on eating, instead they take nutrition through a PEG tube.

I learned that recovery is possible.

I was struck by the story of one survivor’s seventeen weeks of radiation and subsequent physical manifestations from that amount of radiation. I’ll call her “Terri”. Swallowing liquids and eating has been extremely painful for Terri so she had almost completely stopped eating. But she steeled herself to have a bite of the tomato that I had prepared for safe swallowing. A whole range of emotions crossed her face as her taste buds came alive. Terri hadn’t eaten in months, instead taking her nutrition through a tube. The tears she shed we’re from pain but from relief and joy and pleasure. Seeing someone who hasn’t been able to enjoy food, enjoying something as simple as a tomato brought me pleasure, as well. I’d grown that tomato in my own garden and I was happy to share it.

At that meeting, I was reminded of the human will to live and just how strong and brave so many of us are and need to be. I was humbled…

If you need advice or information about eating, please contact me at: laura@dysphagiasupplies.com

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Eat Safely, Eat Well and Stay on Budget

“So what’s this going to cost me?” is a question I hear a frequently. 

The answer may be surprising.

For less than the cost of a “$5 foot long”, you can have a nutritious pre-made pureed meal that includes: a meat, a fruit or vegetable and a dessert.

Do you hate pre-made food? Do you want to eat your “normal” food? Then the cost of modifying “regular” foods and beverages adds about 10¢ – 20¢ to a portion.

An in-home cooking class and complete care instruction is $125 an hour. Training in your home takes about an hour and a half.

You’ll need a mini food processor. They cost about $40.  I can supply it or you can purchase one yourself.

Many care-givers are overwhelmed and under prepared for managing dysphagia at home. Help and solutions are not expensive…you just need to know where to look. 

I am here to help.

Contact me: laura@dysphagiasupplies.com

 

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Life After Aspiration Pneumonia

To my dad, food was love. Dad was a passionate gardener and loved to bake bread.  He was a child during the Great Depression when food was scarce. Simple things, like a good meal shared with family, mattered to him. As a “daddy’s girl”, I learned to cook because of my affection for him and because I liked eating good food.

When my dad returned home after his first bout of aspiration pneumonia, life at home changed drastically for both Mom and Dad. Like most people with dementia, Dad’s swallowing problems started a few years after his diagnosis. And like many people with dysphagia, the subtle changes went unnoticed until there was a real problem. Once his doctor and speech therapist prescribed a pureed diet and thickened liquids, life at home had to change. Dad’s food had to be pureed for safe swallowing so food particles didn’t get into his lungs. The beverages he drank had to be thickened so liquids didn’t leak into his lungs.

Mom had been preparing food for Dad for 45 years but she needed to make adjustments to her old cooking habits. Like Mom, many of my clients have been cooking for their loved-one for many decades but the “same-old-same-old” needs to be tweaked.

Many people don’t know where to start but I can help!

There are simple cooking techniques for modifying “regular” foods.

There are delicious, pre-made pureed meats, vegetables and fruits that are simple to prepare and are affordable.

There are thickened supplements and desserts that taste delicious.

There are new  instant food thickeners to thicken liquids are clear and tasteless and cost effective.

I offer it all: cooking lessons, equipment, thickeners, premade purees, pre-thickened beverages and desserts.

There are easy, simple and delicious solutions, if you just know where to look.

Please contact me if you need help: laura@dysphagiasupplies.com or 480-266-5622.

 

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Instant Food Thickener Review: the Good, the Bad and the Gloppy

For people living with swallowing disorders, it is unsafe to drink “regular” liquids. Mixing an instant food thickener into beverages is the most common, but unsatisfying, way to make liquids safe for swallowing.

Getting proper hydration is critically important to health, recovery and living. Implementing a care plan for thickened liquids is challenging but possible, even at home.

Starch-based instant food thickeners like ThickIt®, Thick & Easy® and ThickenUp® tend to be the most affordable options but they add a noticeable “starchy” taste to liquids. Starch-based thickeners react differently to different liquids. Liquids high in acid, like juice and coffee, thicken quickly and may continue to thicken as they sit. Starch thickeners also make milk look unappealing because they thicken the water component, separating the milk fat, protein and minerals making the milk look almost curdled. They work great for making a slurry but you can’t thicken carbonated beverages (or wine) with them.

Liquid xanthan gum-based gel thickeners, like SimplyThick®, are a better tasting option for thickening liquids but these gel thickeners don’t mix easily into liquids with a spoon. You need to either shake or whisk it into a liquid or it will not be completely smooth. Xanthan gum-based gel thickeners are about three times more expensive per serving than both starch-based and xanthan gum-based powdered thickeners.

Fortunately, powdered xanthan gum thickeners are becoming more widely available. The first xanthan gum powdered thickener on the market is ThickenUp® Clear. I am so excited about this product! It is a convenient powder and it mixes easily into liquids with just a spoon. Best of all, it has no flavor. When I it mixed into water, I could taste nothing but water. I mixed it into orange juice and milk and the results were smooth and tasted just like orange juice and milk. When I mixed it into hot tea, it thickened more than expected but it was easily remedied by add a little more water or milk. I didn’t try it in a carbonated beverage but I did try it in wine and it was the perfect consistency and added no flavor.

The only downside I see to powdered xanthan gum-based thickeners is that they are slightly more expensive than starch-based thickeners but think they are worth the slightly additional cost.

Like all thickeners, you must allow the both the gel and powdered thickeners to completely disperse and thicken into the liquid before you drink it. Those five minutes can seem like a very long time when you are thirsty so I recommend mixing liquids in bulk and keeping them in the refrigerator. Make sure to mark the container and drink the beverages within 24 hours. Shake or stir the thickened liquid before serving. If, the liquid had become is thicker than you need after it has been refrigerated, add more liquid to make it the proper consistency.

In the meantime, if you are living with a swallowing disorder, you now have better options. If you want to thicken your own beverages you have a choice of thickeners.

The texture of thickened liquids is tough to get over, though you do get used to it. Drinking thickened liquids that have a starchy taste is really tough. Pre-thickened beverages taste better and are convenient.  Drinking a beverage thickened with a “Clear” thickener is a revelation!

 

Happy older man with glass of juice


What is dysphagia and why does it matter?

Dysphagia means having trouble swallowing.

When you think about it, we swallow unconsciously all the time; normally about 500 times per day. Swallowing is one of the most complicated tasks performed by the nervous system. The swallowing mechanism is centered deep in the brain in the cerebral cortex, medulla oblongata and with the cranial nerves.

In the first stage, about fifty pairs of nerves and muscles work together to process the food we put into our mouth, chew it and prepare it for swallowing. Everything we swallow is in the form of a liquid, puree or has been chewed to the right texture.  Once food is chewed it is called a “bolus”.

In the second stage of swallowing, the tongue pushes the food (bolus) or liquid into the back of the mouth which triggers the swallowing response. During this stage, the epiglottis closes and breathing stops which prevents food from entering the trachea (wind pipe) and lungs. Swallowing is one of the only actions that human’s perform during which must stop breathing!

The third stage begins when the epiglottis is closed and the food (bolus) enters the esophagus, the tube that carries food and liquids to the stomach.  The whole process takes about 3 seconds.

When swallowing doesn’t happen correctly, the results can lead to serious problems. People with swallowing disorders are at risk for dehydration and malnutrition. Food or liquid that leaks into the lungs may cause a serious illness called aspiration pneumonia.

Without proper hydration, our bodies cannot survive. Without proper hydration, our bodies cannot process the foods and medicines we consume. Dehydration often leads to mental confusion and depression.

Without proper nutrition, our bodies cannot heal.  Without proper nutrition, we have no energy to handle the tasks at hand. No one can live, let alone thrive without proper nutrition.

Aspiration pneumonia is the leading cause of death for those suffering from dementia.

Dysphagia is common in people who have had a stroke, Parkinson’s disease, head-neck-throat cancer, dementia and other motor neuron diseases.

If you have a concern or questions about swallowing, see your doctor. Your doctor will refer you to a Clinical Speech Language Pathologist for a swallowing test.

The good news is that once diagnosed, dysphagia can be managed and treated.  Management of dysphagia is usually accomplished by modifying foods and beverages to make them safe for swallowing.

There are delicious, premade pureed meats, vegetables and fruits that are simple to prepare and are affordable. There are simple cooking techniques for modifying “regular” foods. There are thickened supplements and desserts that taste delicious. There are new instant food thickeners to thicken liquids are clear and tasteless and cost effective.

If you have questions, need advice or recipes, please contact me:

laura@dysphagiasupplies.com

 

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“Hydration, Hydration, Hydration!”

 


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Water is an essential element for sustaining life. The human body is composed of more than 60% water. Without water, we won’t survive for more than a few days.

Summer’s warm temperatures and increased humidity can cause dehydration more quickly than during other seasons. No matter what time of year, it is important to stay properly hydrated!

10 Warning Signs of Dehydration:

Thirst. If you are feeling thirsty, you are already dehydrated!

  1. Dry Mouth. Some medications can add to the sense of dry mouth, reduce saliva production and exacerbate the problem.
  2. Fatigue. If you feel tired after activity or in the afternoon, you may be dehydrated.
  3. Dizziness. Feeling light-headed or having vertigo is signs of moderate dehydration.
  4. Depression or Irritability. If you are feeling a case of the blues or find yourself snapping at people for no reason, you may be dehydrated. Dehydration can cause unwanted behaviors in people with Dementia.
  5. Dark or Cloudy Urine. If your urine isn’t clear, you are dehydrated. The darker the color of your urine, the more severe your dehydration.
  6. Difficulty going to the bathroom. Constipation is a common symptom of chronic dehydration.
  7. Changes in Skin. Flushed, or slightly red, skin is symptom of acute dehydration. Dry skin can be a symptom of chronic dehydration.
  8. Nausea. Often, if you feel nauseated, you won’t feel like drinking anything BUT it is necessary for treating and preventing dehydration. If you feel nauseated, take small sips of cool, not cold, water.
  9. Rapid Breathing. Rapid breathing is a sign of severe dehydration and is often accompanied by a rapid heartbeat. If you are experiencing rapid breathing and an increased heartbeat, seek medical attention.

If you experience any of the warning signs, drink sips of cool water to avoid nausea and vomiting.

When you have trouble taking foods and liquids by mouth, it can be especially challenging to get enough hydration. People who must consume thickened liquids are often put-off by the flavor and texture of older, starch-based thickeners. New xanthan gum-based food thickeners like ThickenUp® Clear taste better, mix easily and don’t continue to thicken on standing.

Convenience is also important factor in getting enough to drink. It is easier to just “grab and go” water, juices and other beverages that have been thickened in bulk and are kept readily available in the refrigerator. Commercially prepared pre-thickened beverages provide a consistent supply of thickened liquids but can be a bit more expensive than thickening liquids at home.

Individuals who have limited mobility and who have Dysphagia are at high risk for dehydration because they must depend on others to meet their need for liquids. Keeping cool thickened beverages within “arms-reach” is essential but can be a challenge. One solution is to make ice cubes with water that has been thickened to the proper consistency with a xanthan gum thickener like ThickenUp® Clear and then using the ice cubes in drinks in kept within easy reach. You cannot make ice cubes with starch-based thickeners because they break-down into particles as they melt, causing an unsafe texture.

Eating foods like soups, pureed fruits, yogurt, pudding and other foods that have a high liquid content can also combat dehydration.  Another way to get an even more refreshing hydration is to enjoy popsicles made from fruit juices, sweetened drinks or products like Gatorade® or Pedialyte® that have been thickened to the proper consistency with ThickenUp® Clear. Popsicle molds are inexpensive and are available at stores like Target and Wal-Mart.

Dehydration can be exacerbated by the use of diuretics, laxatives, antidepressants, certain antibiotics and other medications. Please consult your Pharmacist about your specific medications if you have questions or concerns.

Dehydration can be very serious. Severe dehydration can lead to hospitalization.

The key to preventing dehydration is simple: avoid it. Be aware of what you are drinking and consume more liquids!

If you want more help and advice, please contact me: Laura@dysphagiasupplies.com