The term ‘Dysphagia’ is used to describe people who have problems with the process of eating, drinking and/or swallowing. This may affect people with conditions such as Stroke, dementia, cerebral palsy and motor neurone disease. Speech and Language Therapists have an important role in managing dysphagia.
My challenge was to eat only pureed food for a week. This was to gain a better understanding of what it’s like to live with this diet and help raise awareness of some of the issues which many people with dysphagia have to face in their daily lives. A pureed diet includes food which is smooth and moist in texture and does not need chewing. This diet may be prescribed to people with chewing and/or swallowing difficulties to make eating easier and reduce the risk of food going down the wrong way and risking problems such as chest infections.
I started the challenge feeling enthusiastic and well prepared, having bought lots of fresh fruit and veg to make into smoothies and soups. This was going to be a healthy week! The day started off well enough, with a bowl of porridge. I anticipated that snacking would be the biggest hurdle for me as I normally get quite hungry during the day and snack on fruit and biscuits. This time I had to prepare all of my snacks and meals in advance. I’d made a beetroot, pear and ginger smoothie. It tasted ok but somehow it just didn’t cut it when I had my usual mid-morning hunger pangs! I snacked on a yoghurt and ate my shop-bought soup for lunch but was still so hungry! I was missing carbs and protein so felt pretty unsatisfied. In my desperation, I even tried some baby food (veggie lasagne), but at only 75 calories, it just wasn’t sufficient for a healthy adult diet. However, we had our puree dinner party to look forward to this evening. The group had a meal of gazpacho soup starter, blended pasta and spicy tomato sauce, mashed potato and mushy peas, followed by indulgent dark chocolate mousse. I wolfed this down and didn’t even mind the sticky textures. I really think the spicy and tasty flavours helped make a meal of unappealing texture and appearance much more palatable though.
I was determined not to go hungry so prepared a carb-tastic smoothie snack (banana, strawberries, readybrek, ground almonds, yoghurt and milk) and made sure I was equipped with an avocado to snack on. I had leftover gazpacho soup for my lunch. The smoothie was a vast improvement and kept my hunger at bay all morning. However, the soup wasn’t quite substantial enough (lacking carbs and protein again). I had a long day and got home late. I realised I had very few options for a puree-friendly meal and, while my boyfriend tucked into battered fish and chips, I ended up making up another smoothie before bed. I was realising that many ordinary foods which I take for granted (bread, meat, chips etc.) are simply off limits for people on a puree diet.
I prepared the same smoothie snack again, and was getting used to the routine of blending everything in the morning. I also made lots of hearty chicken, sweetcorn and potato soup, determined to cram in carbs and protein today. However, I had trouble finishing my hot soup on such a sunny day, and somehow it felt like harder work consuming all of my calories in liquid/puree form-I was missing the instant satisfaction of tucking into solid food and I had to get through more liquid to feel full.
I decided to join some friends for food and drinks in the evening. I was a bit nervous about the prospect of eating out but I love going to restaurants and feel that having a modified diet should not stop anybody from being able to enjoy eating out. For many, a pureed or soft diet is the reality for the rest of their lives. I had every intention of having a frank discussion with the waiter/waitress about the challenge and why we were doing it to raise awareness. But when it came to it, I couldn’t quite muster the confidence. I apologetically explained to the waiter that I would require my meal to be blended without giving a reason. Many people with eating difficulties may not wish to disclose their difficulties to strangers every time they eat out. Fortunately the waiter did not ask any questions and assured me that this shouldn’t be a problem. I was somewhat limited to a few puree-able options on the menu, but in the end my tagine was brought to me by the manager so he could personally check that it was suitable for me, and it was delicious too. I felt so grateful for the acommodating service, and left feeling like I’d been an inconvenience.
In my attempt to minimise preparation time and not waste food, I’ve found myself preparing my pureed meals in large quantities and having the same meals day in day out. I had more porridge and smoothie in the morning and leftover chicken and sweetcorn soup for my lunch. I didn’t really enjoy my smooth chicken soup (I prefer chunky soups), but ate what I could. For my dinner I made a pureed bolognaise with cheesy mash which was a more of a normal option. I felt priveleged that I have the freedom to choose my meals carefully and tailor the diet around my own tastes. For many people who are elderly, unwell or physically disabled (which is often the case for people with swallowing difficulties), they are limited to hospital food options and may not be able to recognise what is in their meals, as it may not resemble the ingredients once blended into puree form. Unappetising food can cause serious risks of malnutrition resulting in lack of energy and concentration. This can have a knock-on effect on physical recovery and ability to participate fully in therapy/rehabilitation exercises (e.g. Physiotherapy) which may be important for reducing dependence and disability following conditions such as stroke.
By the final day I was getting a bit fed up of of having to prepare everything in advance and having to anticipate when hunger might strike and pack accordingly for the day. I’ve experienced hunger pangs much more than I expected and have frequently been left feeling unsatisfied after a meal or snack.
Today I had porridge for breakfast again and made my usual smoothie snack (which was becoming a bit boring now-I should really be a bit more imaginative!). I was feeling too lazy to prepare my lunch in advance so I took my chances and hoped I could find something suitable. In the end, the only puree friendly option was soup again! I opted for a lentil soup, which in all honesty probably wasn’t strictly puree as the lentils were still a bit lumpy. But this was the best option available, apart from a few runny options which I doubted would fill me up. This throws up some serious questions about difficulties people may face if they are physically less able to prepare meals in advance. All week I’ve been constantly thinking about and worrying whether I’m going to have enough food to stave off the hunger and whether I’ll be able to find suitable options if I need to buy food on the go. It seems that while I have these specific food requirements, food is dominating my thoughts constantly! After only a few days, I’m already craving textured food. This evening I had a hankering for crispy fish and chips, and even contemplated how I could make it puree friendly. In the end I settled for leftover shepherds pie and felt extremely lucky that I am only on this diet for a few days. I can look forward to eating ANYTHING I choose after the challenge, which is not the case for many people.
I have mixed feelings of guilt that I can return to my normal diet tomorrow while for many this is a permanent reality, and pride that I managed to complete the challenge for a fantastic cause. We’ve raised over £1,000 for the Stroke Association!
Thank you to everybody who donated!
- There are very limited options available for snacking and eating on the go. So a puree diet requires lots of planning an preparation to make sure you don’t go hungry. This may be problematic for many people with swallowing problems, who may also have coexisting physical disabilities are be dependent on others to help with shopping and meal preparation. Additionally, having pureed meals prepared by somebody else can cause problems if the person does not know what it is they are eating, and thus food is even less appealing. If food is not appetising, this can cause problems for achieving sufficient nutrition, concentration and energy levels. This is especially important for those who are recovering from illness or engaging in therapies to reduce their disability.
- Imagination and variation, as well as incorporating interesting and strong flavours can help make visually unappealing and textureless foods more palatable. This is achievable if you are able-bodied, independent and have the time and freedom to choose and tailor your meals to personal taste. This is unlikely to be the case for hospital patients who are limited to a small selection of pureed meals on the hospital menu. As Venetia mentioned previously, celebrity chef James Martin has has worked tremendously hard to improve hospital food, but there is still a long way to go.
- Attempting to consume sufficient calories and feel satisfied from a meal is more difficult when it is being consumed in liquid/puree form. I felt that I needed to drink/spoon in more quantity to feel satisfied. This may be particularly difficult for someone who finds eating already very effortful or fatiguing (due to being elderly, unwell, or having eating difficulties).
- Restaurant staff are largely very helpful, the major barrier to enjoying eating out being feelings of embarrassment and feeling ‘different’ or like an ‘awkward customer’.
There are very good reasons why Speech and Language Therapists (SLT) may advise people with dysphagia to opt for a modified diet. In the interests of safety, this can reduce the risk of health problems associated with dysphagia (e.g. choking, respiratory problems, chest infection), but this challenge has increased my awareness of the need to consider balancing risk with quality of life and nutritional intake.
Love Fi x