Reference: Briony Thomas (2007) Manual Of Dietetic Practice (4th ed.) Blackwell Publishing. Department Of Health (2001) National Health Service Recipe Book. HMSO p26. British Dietetic Association and Royal College of Speech and Language Therapist (2011). Dysphagia Diet Food Texture Nutrition and Dietetic Service Descriptors. Gateshead Health NHS Foundation Trust Nutrition and Dietetic Service Queen Elizabeth Hospital Sheriff Hill Eating well Gateshead Tyne and Wear on a fork mashable diet NE9 6SX (previously known as soft options of normal diet) Tel: (0191) 445 2074 Your dietitian is: ………………………………………………………… Speech and Language Department Hancock Building Queen Elizabeth Hospital Sherriff Hill Gateshead Tyne and Wear NE9 6SX Tel: (0191) 445 2599 Your speech and language therapist is………………………………… Updated June 2011 Review date: June 2013 12 You have been advised to try the soft option because you have difficulty with swallowing and eating. Suggested meal plan Fork mashable diet Breakfast Food should be broken up with the flat edge of a fork. It requires some chewing, but normal muscle strength and teeth are not necessary. Mid Morning Snack How can I make my food softer? There are a variety of ways to make your foods softer and easier to manage, including: Lunch Adding sauces gravy, stock, white/cheese sauce, milk or cream (examples include fish in butter or parsley sauce, cauliflower cheese, mince in gravy) Mashing potatoes, vegetables and soft fruits Mid Afternoon Snack Mincing cooked meat and poultry Foods to avoid These food items should be avoided to prevent choking: Tea Stringy fibrous textures such as pineapple, runner beans, celery and lettuce. Vegetable and fruit skins such as broad beans, grapes and tomatoes. Supper Mixed consistency foods eg cereals that do not blend with milk like muesli, mince with thin gravy, minestrone soup. Crunchy or crumbly foods such as toast, pie crusts, dry biscuits, crumbles and crisps. Biscuits, boiled or chewy sweets and toffees, nuts and seeds. Notes Food with husks, such as peas, beans, wholegrain cereals and breads. 2 11 How can I make sure that I’m getting enough to eat? Ideas for extra flavour (savoury) If you have unintentionally lost weight or you are not able to eat Herbs and spices. your usual amount of food: Smooth mustard. Avoid low calorie, low sugar or low fat foods unless otherwise advised. Smooth chutney. Choose full fat products where possible including full cream milk, full fat yoghurts, butter or margarine instead of low fat Bottled sauces: Tomato spread. Worcestershire Eat regular meals with nourishing snacks in between (see light Brown/BBQ meal/pudding ideas). Salad Cream Mayonnaise What if my appetite is very poor? Ideas for extra flavour and calories (sweet) If you have a small appetite and cannot manage large portions, there are a many ways that foods can be enriched to make them White, chocolate or fruit sauce/puree. as nourishing as possible, using normal everyday foods. For example: Syrup, treacle, honey. Milk Adding four tablespoons of dried milk powder to one Jam, lemon curd. pint of milk (full cream if possible). Keep this in the fridge and use in drinks, on cereals and in puddings, Cream, condensed milk, evaporated milk, crème-fraiche, sauces, custard or other desserts. custard, ice cream. Cream Add to potatoes, porridge, cereal, milk puddings, milky Yoghurt, fromage-frais. drinks, soups or sauces. Fats Add margarine or butter to vegetables, potatoes, rice or pasta. Cheese Grate into soups, omelette, scrambled egg and mashed potatoes, on to mashed baked beans/tinned spaghetti and vegetables, or even add to main dishes like Bolognaise. Sugar Add to drinks, cereals and use in puddings. 10 3 Weight loss Useful store-cupboard ingredients Weigh yourself regularly. Your weight will give you some idea as to whether you are eating enough. If you do not feel like cooking or have difficulty preparing meals, there are many convenient alternatives available. You If you are losing weight, ask your GP to refer you to a dietitian. may however need to alter the texture of some of these in order to make them easier to eat by blending or sieving or Constipation pureeing. Constipation can become a problem if on a modified diet. To Tins Stew avoid this try the following: Minced beef Curry Drink at least six to eight cups of fluid each day such as water, Bolognese tea, coffee, milk, fruit juice or squash. Spaghetti Pasta shapes Include vegetables, pulses (beans, peas, lentils) in soups and Macaroni cheese casseroles. Tinned vegetables Include stewed, tinned or fresh fruit daily. Frozen Meals Hot-pots Fish pies Try prunes or prune juice one to two times daily. Fish/pasta in sauce Frozen vegetables Helpful hints Packets Pasta in sauce Boil in the bag meals Ensure that all foods are well cooked. Instant mashed potato Moisten foods with sauces and gravies. Check all foods for bones and skin. Chew foods well before swallowing. Take small sips of drinks with meals if this helps. Allow plenty of time to eat your meals. 4 9 Breakfast ideas Fluids Porridge, wheat biscuits or instant oat cereal made with milk It is important to make sure you drink enough fluid each day to or cream. Add sugar, honey or syrup to taste. keep you well hydrated. Scrambled, poached, boiled eggs. Six to eight glasses is the recommended amount. Omelette with cheese and tinned tomatoes. Sausages without skins. In order to ensure you receive as much nourishment as possible from your drinks if your appetite is poor, Try some of Soft bread (no grains or crusts) well covered with tinned the following: spaghetti or baked beans with grated cheese. Soft bread (as above) with jelly type jam (avoiding seeded j Tea, coffee, drinking chocolate, Ovaltine, Horlicks made am), shred less marmalade, chocolate spread, honey or with milk. lemon curd. Cooked eggs well covered with tinned spaghetti or baked Milkshakes with ice cream or fruit added (blended until beans with grated cheese. smooth using a food processor, liquidiser or hand blender). Yoghurt or fromage-frais with stewed or soft fruit (eg mashed Cup-A-Soup made with milk or cream. bananas or stewed apple). Pancakes with butter/margarine and syrup/jelly type jam or Fruit juice or full sugar squash. soft/stewed fruit and yoghurt/cream/evaporated milk. Complan and Build-Up drinks are useful between meals if appetite is particularly poor. These can be bought from most Light meal ideas chemists and some supermarkets, and come in a range of savoury and sweet flavours. Packet/Condensed soups made with milk or tinned soups (avoiding those with croutons or hard lumps). Scrambled/boiled eggs and soft grain less bread (no crusts). It is very important to remember to thicken your drinks if Poached egg or cheese omelette with baked beans/tinned you have been advised to do so by your speech and tomatoes or mashed potatoes. language therapist. Tinned pasta (eg ravioli, spaghetti Bolognese) or well cooked pasta in sauce sprinkled with grated cheese (for extra calories). Cauliflower cheese/macaroni cheese. Creamed potatoes with grated cheese and baked beans. 8 5 Soft bread sandwiches without the crusts with the following Fish pie (with mashed potato topping) or fish in sauce (eg filling: cheese, parsley or butter) with vegetables. Remember to check for bones. - Cream cheese. - Potted meat/fish paste. Ready made meals such as ravioli, macaroni cheese, - Hummus. spaghetti bolognese or other pasta dishes made with plenty of - Tuna mayonnaise. sauce (avoiding those with crispy toppings). - Well mashed egg and mayonnaise. - Smooth peanut butter ands seedless jam. Corned beef hash/sausages without skins, mushy peas and - Mashed banana (with honey/syrup/jam for extra flavour and mashed potato. calories). Well cooked meat and vegetables in sauce (eg Ragu, Dolmio, Jacket potato (without skin) with butter/margarine and the Chicken Tonight, condensed soup, Uncle Bens - taking care to following fillings: avoid those with crunchy vegetables) with either mashed potatoes, well cooked rice or pasta. - Grated cheese or cheeses sauce. - Butter and margarine. Pudding and dessert ideas - Condensed soups. - Baked beans/tinned spaghetti. If you cannot manage a pudding straight after your main course, - Tuna mayonnaise. try waiting an hour or so, and have a pudding as a snack between - bolognaise. meals. Suitable suggestions for puddings and snacks include: Wheat biscuits or porridge with the following toppings: Milk puddings (eg rice pudding, sago, semolina, custard). - Mashed banana. Sponge puddings, soft plain cake or pancakes with stewed fruit or sauce and cream/evaporated milk/custard/ice cream. - Pureed fruits. - Jam, honey, syrup, chocolate sauce. Trifle or other individual ready made desserts. - Grounded almonds and honey. Jelly made with milk or evaporated milk and served with ice Main meal ideas cream, custard and/or cream, like a trifle. Cottage or shepherds pie and well cooked soft vegetables. Instant desserts, whips, or blancmange. Fruit fool, smooth fruit yoghurt, fromage-frais or mousse. Mincemeat in gravy with mashed or creamed potato and mashed vegetables. Soft fruit chopped into small pieces ( apricots, pear bananas) or stewed apple or drained tinned fruit with evaporated milk, Casserole, stew, or curry (ensuring any meat is tender and cream, ice cream, custard, crème-fraiche or yoghurt. broken into pieces and that vegetables are well cooked and soft). Ice cream, sorbet, frozen yoghurt, banana split. 6 7 .