Difficulties with swallowing will often have a big impact on the amount and type of foods which a person is able to manage. This can place people at higher risk of not eating enough to meet their needs, or ‘malnutrition’.
It is not difficult to see why mealtimes for someone with dysphagia might become a struggle. Previous episodes of choking or food sticking in the throat might make someone feel anxious or fearful of eating in the future. People might feel embarrassed or isolated that they are needing to eat something different from their friends or family. The range of foods available are fewer and they might become bored with this. They might miss previously enjoyed favourite foods. They might be frustrated by the slower pace which they need to adopt to ensure they swallow properly, and that this can make mealtimes lengthy. They might find the appearance of texture-modified foods off-putting, or find negative comments about the food by those serving the meal unhelpful.
It can be a challenge ensuring that texture-modified meals provide all of the nutrients that people need, are interesting, varied, tasty and look appealing. Fibre levels of texture-modified meals can be lower, and this can increase the risk of constipation, which does nothing for someone’s appetite! Where food is being pureed, care should be taken not to over-boil vegetables before pureeing, as this will lead to a further loss of key nutrients in the final meal. Where liquids are added to a puree to achieve the correct consistency, these should be high calorie options such as double cream, mayonnaise, vegetable oil, tomato, white or cheese sauces, greek yogurt or crème-fraiche.
Remember to keep separate foods and flavours apart so that you can present these separately on the plate. Food colourings can be used to improve the look of some foods where they lack natural colour. Foods such as beetroot, blackcurrants or blackberries, cherries, spinach, tomato purée, mango and sweet potato are great for adding more colour to a meal. And if mealtimes are lengthy then ensure food is kept warm, and that any crust or skin that might form on the food is removed before eating.
Because eating with dysphagia can be more challenging we should make sure we monitor somebody’s food and fluid intake carefully in the initial weeks following a diagnosis to ensure they are still getting everything they need. This is particularly important if the person has been advised to change the texture of their foods or fluids. If you are unsure, or you have noticed that the person you support is losing weight, then raise the concern with a healthcare professional for more advice.