Making Every Bite Count | National Foundation of Swallowing Disorders

Written by Laura Michael (Byline below)

When you are having trouble swallowing, getting the proper calories and nutrition for healing and health can be quite a challenge. Making foods that are pleasurable to look at, taste good and are also packed with calories and nutrition are the keys to making every bite count.

According to the American Dietetic Association, a healthy diet should consist of 45 to 65 percent of calories from carbohydrates, 30 to 35 percent from fat and the remaining 10 percent, or so, from protein.

If you are struggling with weight loss, the easiest way to get calories into your diet is to add an extra source of “good” fat. Too much and/or the wrong kind of fat can definitely be detrimental to your overall health. But when you add a teaspoon of an oil rich in Omega-3s and ALA you are not only adding 40 calories but you are also consuming fats that have been shown to reduce LDL cholesterol, blood pressure and triglycerides. The best (and least fishy) sources of Omega-3s are flax seed oil, walnut oil, canola oil and soybean oil. Monounsaturated fats like olive oil, almond oil, sesame seed oil and peanut oil are also heart-healthy options. All oils have 40 calories per teaspoon (or 120 calories per tablespoon), so when you are eating a puree or smoothie, try adding a little extra heart-healthy oil. Products like Benecalorie® from NestleNutrition® are also a great source of concentrated fat calories and protein and are easy to add to almost any liquid or puree.

Since carbohydrates should be 45 to 65 percent of a healthy diet, they make up most of a normal diet. The trick is to add “smart-carbs” to your diet, not just simple sugars. Smart-carbs include all the colorful foods that make your plate attractive. Most cooked vegetables and canned fruits can be easily pureed, just make sure you add a teaspoon (or two) of a heart-healthy fat.

People who have trouble swallowing may also have trouble with the seeds associated with berries and the fiber of leafy green vegetables. But colorful fruits and vegetables are a great source of anti-oxidants, beta-carotene, vitamin C and vitamin E. What are you supposed to do? When you are pureeing fruits, you may want to add a splash of a brightly-colored juice, like Cranberry-Blueberry, and a scoop of food thickener to your puree. Don’t like the color? Try substituting pulp-free orange juice or mango nectar, both of which are rich in antioxidants and vitamins.

Leafy greens make a delicious salad puree when they’ve been whizzed in a food processor with a little chicken stock, instant food thickener and your favorite dressing. Just do not add uncooked carrots or a salad dressing with pickle chunks, like Thousand Island dressing.

Smart-carbs also include whole grain breads and cereals. Unfortunately, the texture that makes whole grains so satisfying also makes them difficult to swallow. Breads, in general, can be tricky to make safe for swallowing. If you are on an NDD Level 1 diet, you will need some instruction on how to prepare breads to make them safe. Instead, consider well-cooked whole grain pasta or noodles that have been pureed to a smooth consistency. Just don’t forget to add extra butter, gravy or a heart-healthy fat!

Protein may be just 10% of your diet, but it is crucial for rebuilding muscle tissue that may have been lost during an illness. Proteins, like meats, can also be difficult to swallow if they are not smoothly pureed. The best tool for pureeing meats is a mini-food processor. To achieve the proper soufflé-like texture, you need to add chicken stock (or the cooking liquid from vegetables) and a scoop of instant food thickener. To make every bite count, add a spoonful of butter (or a heart-healthy fat), gravy or sauce to your puree. Don’t forget beans and legumes! Smooth, pureed, bean or lentil soups are a great way to add vegetables and protein to “healthy eating”. Smooth canned refried beans, either eaten alone or added to pureed meats, are delicious and can add much needed fiber and calories to a meal.

There are a few commercial “extras” that are helpful for adding protein and calories to liquids and purees. Benecalorie® is a convenient nutrient-dense “extra”. One, 1.5 oz. tub has 300 calories and 7 grams of protein. One tub costs about $2.00 but can be added by the spoonful to various foods over the course of the day. Benecalorie® is flavorless but adds richness. Protein supplements like ProPass® and other whey-based proteins are also handy to add to anything you are mixing or pureeing. Whey-based proteins can be a little “gritty” and may add a “milky” texture to foods and liquids.

Other nutrient-dense extras include: sour cream, cream cheese, heavy cream, whipped topping, regular and Greek yogurt, honey, smooth jellies and jams, chocolate syrup, smooth fruit syrups, maple syrup and soft tofu. Consider adding a spoonful of extras to whatever you are eating and drinking throughout the day.

Lastly, don’t forget fiber. When you are eating purees, it can be difficult to get enough fiber for health and comfort. Soluble fiber products like Benefiber® mix completely into liquids and purees, are not “gritty” and do not add volume. If you are having trouble with normal digestion, you may want to consider adding a little soluble fiber supplement to the foods you are mixing or pureeing.

If you have any concerns, please ask your doctor for a referral to a Registered Dietitian, Nutritionist, or to a Speech Language Therapist who specializes in feeding.

Hopefully, making every bite count brings you health, healing and pleasure!

Byline:

This article was submitted by Laura Michael. She has a Bachelor of Science degree in Nutrition from the Ohio State University and was a teaching assistant in the cooking program at the New School, in New York, NY. She trained with Annette Brown, MS, RD, CEC, one of the authors of the National Dysphagia Diet. She has spent more than ten years in teaching hospitals, nursing homes and with rehab staffs training them in how to manage the National Dysphagia Diet for their patients.