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Home > MSAA Publications > The Motivator > The Motivator: Fall 2007 > Health and Wellness
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Tips for Preparing Food – When You or Someone You Know Has Chewing or Swallowing Problems

Written by Shelley Peterman Schwarz

General Tips to Aid Swallowing

  • Give yourself plenty of time to eat a meal. Don't rush or push yourself to eat as fast as other people.
  • If you eat something very cold or sour, like lemon or lime sorbet, before you begin to eat, this may help improve saliva production for people with dry mouth; it may also reduce any swelling and stimulate the muscles necessary for swallowing. Another strategy is to suck on a few crushed ice cubes about 20 minutes before mealtime.
  • Drink frequently while eating.
  • If possible, sit in an upright position with both feet on the floor while eating. This allows natural body functions and gravity to help you swallow. Staying upright for 30 minutes following a meal helps you to digest your food. Avoid reclining or lying down when eating.
  • Limit any noise or distractions when you eat.
  • Lowering your chin so it is pointed down as you chew and prepare to swallow, helps to keep food from getting into your throat before you are ready.
  • When the time comes to swallow, lifting your chin and moving your head forward may be helpful. Gently touching or massaging the throat if necessary may also aid swallowing.
  • Take smaller, bite-sized portions, chew deliberately and completely, before swallowing and taking another bite. If helpful, you can use a teaspoon to remind yourself to eat smaller quantities.
  • Avoid foods that could pose a choking hazard, such as peanuts, seeds, popcorn, cookies, uncooked carrots and apples, etc.

You're Not Alone

In my late 20s, five years before I was diagnosed with MS, I had the mumps and was sicker than I had ever been before. The worst part was that I was unable to swallow anything, including water. This was scary, painful, and I've never forgotten the sensation of being unable to swallow.

Today, more than 40 million people in the United States have chewing, swallowing, or dry mouth disorders; some of them also have MS. Although I've never had severe swallowing problems again, I have had times when I've needed to choose foods that were "softer and easier to swallow." In addition, I've been dealing with severe dry mouth for more than 20 years as a result of the medication I take for depression.

Today, however, you can find ways to make chewing and swallowing easier. An important strategy is to adapt how we prepare our foods, and to do so in a way that they're not tasteless, shapeless, or similar to pureed baby food.

Please note that many of the items listed include ingredients such as milk, cream, yogurt, and cheese. Some individuals with MS limit their intake of dairy products, and those who do may need to adapt certain recipes to fit their individual dietary requirements.

Tasty and Nutritious Food Preparation

Except for a few rare exceptions, most people are able to enjoy and swallow foods with some texture. Be creative when thinking about food. With a little ingenuity, almost any regular meal can be transformed into a tasty and easy-to-swallow dish. To follow are some helpful ideas to enhance flavor and improve the nutritional value of the foods you eat.

Serve soft foods: Try mashed potatoes (sweet potatoes for more nutrients), yogurt, cream cheese, scrambled or poached eggs, creamy cereals, apple or berry sauces, gelatins, puddings, custards, milk shakes, ice cream, sherbet, sorbet, or gelato.

Cook and blend: Cook cereals such as Cream of Wheat®, Farina®, and oatmeal. To change the flavor, add spices such as cinnamon, or small pieces of apple or dried fruit when cooking. To enjoy sauced fruit, such as applesauce, mix with apricot puree, berries, or cinnamon for variety. Put harder-to-eat cooked meat and vegetables in a blender with broth or gravy; then stir them into soups and sauces. Foods with a skin left on – like peas, oranges, apples, and grapes – may be more difficult to swallow.

Cut or grind food: Use ground meats, finely diced vegetables, and fruits to add color, flavor, and nutrients to your diet. Turn any variety of fruits into refreshing shakes and smoothies; just blend with ice, juice, milk, or ice cream. Add soy or whey protein and ground flaxseed for more nutritional value.

Enjoy soups of blended meats and vegetables. Squash soup is wonderful. Even broccoli, cauliflower, and corn can be finely chopped or blended into soups or gravies.

Another idea is to make easy-to-eat casseroles with rice, risotto, or cut spaghetti. Be creative with sauces; the same rice and meat dish can become Mexican with tomatoes, beans, and chili; Asian with pineapple and green peppers; or Italian with tomato sauce or a creamy risotto style sauce with finely chopped vegetables like asparagus.

Maximize nutrients and fiber with whole foods: Use juices with pulp when possible. Spice up a basic cake or muffin recipe with shredded carrots, crushed pineapple, or small pieces of dried fruit. Berries or dried fruit, simmered in fruit juice, becomes syrup when poured over pancakes. These may also be used as a flavor enhancer for cereal, fish, or vegetables.

General Tips for Dry Mouth


Dry mouth (also known as "xerostomia"), is a condition that is caused by a lack of saliva, brought on by medical conditions and/or medications. Dry mouth can make chewing, eating, swallowing, and even talking difficult. It also increases the risk for tooth decay because saliva flushes the mouth of germs and food particles. Consult your physician and dentist if you have persistent dry mouth. Here are some general tips to help if you have dry mouth:
  • Brush your teeth four times a day with fluoride toothpaste. Since you may not have enough saliva to flush out food particles that produce bacteria, the fluoride can assist in keeping the bacteria in check.
  • Floss daily.
  • Rinse your mouth several times a day.
  • Avoid mouthwashes with alcohol.
  • Ask your pharmacist about over-the-counter products for dry mouth.
  • Make your own solution using ½ teaspoon salt and ½ teaspoon baking soda in 1 cup of warm water.
  • Drink sips of water throughout the day.
  • Chew sugarless gum or suck on sugarless candies to help increase saliva flow.
  • Use a cool mist humidifier, especially at night.
  • Keep a glass of water on the nightstand in case you wake up during the night with a dry mouth.

Increase protein by adding eggs, cheese, or milk to recipes: Chop cooked eggs finely and add to sauces and casseroles. Prepare egg-rich beverages such as eggnog, or desserts like angel food cake, which can be broken into small pieces and served with a cream or fruit sauce – it will almost melt in your mouth!

You may also add grated cheese to casseroles, vegetables, and sauces. Cooking hot cereal in milk or soy milk instead of water will increase protein as well. To vary the flavor, you can try chocolate milk in hot cereal.

Blend yogurt or cottage cheese with a few herbs to make a great dip or a sauce for cooked foods. If you are allergic to milk products, try adding non-dairy (soy or rice) protein powder, available from health food stores, to gravies, sauces, hot cereals, soups, smoothies, and more.

Use sauces and liquids to aid swallowing: Adding condiments such as ketchup, mustard, marinades, oil, and vinegar, not only increases the flavor, but also adds "slipperiness" to foods. Mix meat, vegetables, and rice or bite-sized pasta, with gravy or sauce to allow foods to slide down more easily as well.

You may also put liquids into dry or sticky foods. For example, many of us already use milk in cereal, but you may also try something like yogurt with fruit compote on pancakes. By adding liquids, the consistency becomes looser and this may help with swallowing.

Review of the I-Can't-Chew Cookbook

A unique resource for flavorful soft-diet recipes is the I-Can't-Chew Cookbook, by J. Randy Wilson (Hunter House Publishing). This is not just a liquid or blender recipe book; it contains more than 200 mouth-watering, soft foods. It includes casseroles, quiches, soups, and ethnic recipes. Readers will also find main dishes using crab, salmon, chicken, and other meats, plus fresh vegetables that are chopped, not pureed.

Don't forget the dessert! This cookbook features 32 cakes, pies, puddings, mousses, custards, and iced desserts to delight your palate. This is real food for real people – even when entertaining. Many vegetarian recipes, or recipes that may be easily adapted for a vegetarian, have been included as well.

The book also contains a section on good nutrition, written by a dietician. Each recipe has a complete nutritional analysis, so you can monitor fat content, sodium, fiber, protein, and calories. Two sample recipes from the book appear on the following page. The I-Can't-Chew Cookbook may be borrowed through MSAA's Lending Library (MSAA book # 222). Please see page 48 for ordering information. The book may also be purchased; please see the following details.

This article includes excerpts and information from the I-Can't-Chew Cookbook: Delicious Soft-Diet Recipes for People with Chewing, Swallowing and Dry-Mouth Disorders, copyright 2003 by J. Randy Wilson. To order online, readers may visit www.hunterhouse.com, or contact Hunter House at (800) 266-5592.

Sample Recipes:

Turkey & Broccoli Tetrazinni
Baked Chilies Rellenos

Readers may also be interested in the following titles:

1. MS and Your Feelings by Allison Shadday
2. Living Beyond MS: A Women's Guide by Judith Lynn Nichols
3. Women Living with Multiple Sclerosis by Judith Lynn Nichols
4. The Anti-Inflammation Diet and Recipe Book by Jessica K. Black, ND

To view a full list of Hunter House publications, a full catalog may be downloaded from their website at www.hunterhouse.com.

Please note: Anyone experiencing chewing difficulties, swallowing problems, or dry mouth, should consult a medical professional before making any changes to his or her diet or routine. The information in this column is meant to assist those who would benefit from a softer or less-dry diet. This may not be helpful for all individuals with MS or for all those with swallowing problems.

Readers should consult their physician about appropriate food consistencies for their individual needs and follow any directions closely. Readers are also advised to check with their doctor about specific dietary recommendations and/or restrictions regarding the types of food they include in their recipes.

If an individual has swallowing problems, this carries a higher risk of choking. Family members and care partners should become familiar with the Heimlich Maneuver. Detailed instruction may be found on the Heimlich Institute's website at www.heimlichinstitute.org.

For more information on swallowing dysfunction, please see the Symptom Awareness column in this issue.


RECIPES

Turkey and Broccoli Tetrazzini

3/4 cup reduced-fat mayonnaise
1/3 cup all-purpose flour
2 tablespoons minced onion
1 teaspoon garlic salt
2-1/4 cups fat-free milk
1 cup (4 ounces) shredded reduced-fat Swiss cheese
8 ounces thin spaghetti, cooked, drained, and finely chopped
2 cups finely chopped, cooked turkey breast
1 package (10 ounces) frozen broccoli, thawed, drained, and finely chopped
1/4 cup chopped pimiento
1 can (10-3/4 ounces) reduced-sodium, reduced-fat cream of mushroom soup (condensed)

Blend mayonnaise, flour, minced onion, and garlic salt in a large saucepan. Add milk and cook over medium heat until thick, stirring constantly. Add cheese, stirring over low heat until melted. Stir in remaining ingredients and spoon into a lightly greased, 9 x 13-inch baking dish. Bake uncovered, at 350 degrees until hot and bubbly (about 30 minutes). Makes six servings.

Per Serving: 446.7 calories; 29.5 g protein; 48.2 g carbohydrate; 2.8 g fiber; 14.4 g total fat (3.4 g saturated fat and 57.5 mg cholesterol); 723.9 mg sodium


Baked Chilies Rellenos

1 pound twice-ground lean beef
1/2 cup finely chopped onion
1 teaspoon salt (used as two, half-teaspoons)
1/2 teaspoon black pepper (used as two, quarter-teaspoons)
2 cans (4 ounces each) hot or mild green chilies, finely chopped (each can used separately)
1-1/2 cups (6 ounces) shredded, reduced-fat cheddar cheese
4 eggs, beaten
1-1/2 cups fat-free milk
1/4 cup all-purpose flour
4 dashes hot pepper sauce

Cook ground beef and onion in a large skillet until beef is browned, crumbling beef finely with a fork; drain, and stir in half of the salt and pepper. Spoon one can of green chilies into a 10 x 6-inch baking dish; sprinkle with cheese and top with meat mixture. Spoon second can of green chilies over the meat mixture. Beat eggs, milk, flour, hot pepper sauce, and remaining salt and pepper in bowl until smooth. Pour over mixture in baking dish. Bake, uncovered, at 350 degrees, until topping is set and sharp knife inserted comes out clean, about 45 minutes. Let stand five minutes. Cut into squares and serve. Makes six servings.

Per Serving: 338.3 calories; 29.1 g protein; 10.4 g carbohydrate; 1.7 g fiber; 19.8 g total fat (8.7 saturated fat and 203.8 mg cholesterol); 850.5 mg sodium

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Last Updated on Friday, 14 September 2012 13:25