The main things I have found from this week

• Smoothies made with frozen fruit I have really enjoyed. They break up the consistency from other drinks and are refreshing in a morning. They are also really versatile, easy to make and transport. I have also found that when feeling thirsty during this diet really cold drinks such as these smoothies have helped this
• It is possible to eat out or pick up easy pre-made lunches, although important to select those that are easy to break down with a fork or have few components that would make it difficult to reach the desired consistency i.e. potato skins
• Hot chocolate and mocha have been the best hot drinks to thicken over the week. I have also bought these from vending machines between lectures and found that they are easy to thicken
• It is important to have bold flavours or season any food well, as once pureed it can lose some flavour such as adding pesto, henderson’s relish or mustard
• I have found that some meals due to the consistency have been quite heavy, as such light breakfasts or lunches have meant that I haven’t felt too full or lost my appetite such as yoghurt and fruit or the veggie burgers
• I have found that having different components or elements to a meal has made it more palatable and interesting, such as the burger and salsa, or pesto rice and courgettes.
• The modified diet has had little impact upon my ability to socialise. In particular that it is possible to entertain for both a regular and modified diet simultaneously
• I feel that being aware of and as much as possible being able to choose your meals makes food more palatable, as not only do you have an awareness of what the food is, it is something you want to eat
• I have also found that a vegetarian diet has leant itself to this diet; as many of the foods aren’t too dissimilar from what you would expect typically in terms of texture and taste. I have also found that for the most part the food I have cooked was easy to reach the desired consistency and use natural means of thickening the food.
• I also personally feel that wherever possible it is important to use natural means of thickening the food as it makes it most realistic and similar to a regular diet
• It is possible to have alcohol when on a thickened fluid diet, although I would recommend something with a strong flavour to mask the taste of the thickener. It is also advisable to not use fizzy drinks as the thickener can react to this
• I also feel that this diet is easy to make the food in bulk and reheat at a later point, as blending the food to reach the desired consistency can be time consuming
• It is also important to bare in mind that pureed food cools down relatively quickly

I would like on behalf of myself and my coursemates, to thank everyone who has supported our campaign and helped to raise awareness of a difficulty that few know about.

Day Five

Breakfast 

Raspberry, banana and pineapple smoothie

Puree consistency

                     

Ingredients 

• Half a fresh pineapple
• Half a banana
• Frozen raspberries
• Orange juice

Key things to note

• Similar to the other smoothies I have made this week I really enjoyed this smoothie.
• I would recommend sieving any smoothie with berries in as this will remove any possible seeds
• In particular I found the smoothies transportable and on several instances took them into university with me
• The smoothies would also be easy to make in bulk and drink throughout the week, as long as it is kept refrigerated. This would be particularly good if needing to save time. It would also be possible to freeze the smoothie and leave them to defrost overnight so it is still cold in the morning
• The smoothies have also been very versatile, as you can put a wide range of things into them. However I would recommend putting banana or yoghurt into the smoothies as I found that this naturally forms a thick consistency.
• I would also recommend using some form of frozen fruit, as the coolness of this drink makes a contrast to other of drinks. It also clears and soothes your throat in a morning.
• The main thing to bare in mind when making a smoothie is the quantity of juice or liquids added as this will make the consistency too thin, in which case you will need to add thickener.

Lunch 

Veggie burger and salsa

Fork mashable

     

Ingredients 

• Shop bought spinach and courgette burger
• Shop bought salsa

Key things to note

• I bought a pack of vegetarian burgers from the shops, I then cooked one and mashed it with a fork with a small amount of mayonnaise so that I could obtain the correct consistency. I then piped this into a lunchbox.
• I blended some shop bought salsa to a smooth consistency. However it is possible to buy a smooth salsa, that you wouldn’t need to blend providing there are no lumps.
• I really enjoyed this meal and found that it was quick to do. I also found that it was an easy meal to take into lectures with me.
• This would possible to do with a range of vegetarian burgers and other smooth accompaniments. However it is important not buy those that have a breadcrumbs on the outside, as these will affect the consistency.
• It would also be possible to make a thick puree consistency if you blend the burger, however in order to do so you may need to add mayonnaise or something similar to reach the correct consistency can be obtained.

Tea 

Bangers and Mash

Puree consistency

         

Ingredients 

• A potato
• Mustard
• Milk
• Butter
• Leeks
• Mature cheddar
• Yoghurt
• Sweetcorn
• Vegetarian sausages
• Onions
• Cornflour
• Stock
• Marmite
• Black pepper

Key things to note: 

• I initially intended to do both the leeks and sweetcorn as separate vegetables however found that the leeks were difficult to blend and form a smooth consistency. As such I added the sweetcorn, some yoghurt and cheese to the mixture to allow it to blend. This was my favorite component of the meal.
• I added milk and butter to the potatoes to reach a smooth puree consistency. I also added mustard, as I have found adding flavours such as mustard cut through the consistency and made the food more palatable. Unfortunately I also found that the pureed potato cooled down relatively quickly.
• For the sausages I had to add the homemade gravy as I initially found this difficult to blend. Although I really enjoyed the gravy, I struggled with the consistency of the sausages as I found this was so different to what you would typically expect.
• For the gravy, once I had sweated down the onions I then added cornflour. I found that this naturally formed a thick consistency that didn’t detract from the flavour 0f the gravy.
• I also found that due to the consistency of the food that it was difficult to pipe.

Marble cake:

Fork mashable consistency

      

Ingredients

• Flour
• Eggs
• Butter
• Sugar
• Cocoa powder
• Thickener
• 125ml orange Juice

Key things to note: 

• For this we made a cake as normal, once cooked and cooled I cut a 1cm piece of cake. Then made a mixture of 125ml of orange juice and a scoop of thickener, poured over the cake and left overnight. This can also take as little as half an hour to reach a soft consistency. In this instance the cake became fork mashable and needed breaking down with a spoon to reach this consistency. However with more liquid this should reach a softer consistency.
• I really enjoyed this cake, I found that it was really enjoyable and easy to do. It is also a recipe that can be very versatile, you can use this for most cakes and use a range of juices.
• This recipe is also possible to due simultaneously for regular and modified diet requirements.
• This would also be easy to do in advance, through cooking a cake, slicing into portions and soaking the slices as and when you need them.

Day 4

Breakfast

Banana and honey yoghurt

Fork mashable

Ingredients

• Greek/natural yoghurt
• Fork mashed banana
• Honey

Key things to note

• The presentation would have been better if this meal was piped.
• I really enjoyed this meal. I also found that the texture of the banana was nice alongside the yoghurt as it added another dimension to the breakfast
• I took this into lectures and was easy to transport in a lunch box. Although this may not be as viable if left longer as the banana can go brown
• This would also be possible to make to a puree consistency by blending the ingredients together to form a smooth mixture
• I also feel that if chocolate was added this would make a nice pudding

Lunch 

Pepper soup

Puree

             

Ingredients

• A red pepper
• An onion
• Stock
• 50grams of rice
• Balsamic vinegar
• Salt and pepper
• Garlic
• Chilli
• Passata

Key things to note

• I really enjoyed the taste of this soup. The use of the balsamic vinegar made it sweet, added with the chilli made this soup very flavourful
• The rice must be smoothly blended so there are no lumps, I had no difficulty in ensuring that it reached a smooth consistency.
• I also found that the rice naturally formed a thick smooth soup, which didn’t detract from the flavour. However I found that the consistency became quite close and starchy. As an alternative you could easily add potatoes to also naturally make a smooth soup. Another alternative for this would be through adding corn flour to the mix

Tea

Vegetable Lasagne

Pureed consistency

             

Ingredients

• Aubergine
• Courgette
• Carrot
• Onion
• Beans
• Tinned tomatoes
• Garlic
• Harissa paste
• Dried herbs
• Salt and pepper
• Cheddar
• Garlic and Herb Soft Cheese
• Spinach
• Pasta (lasagne sheets and penne pasta)
• Milk
• Butter
• Corn flour

Key things to note 

Today me and my fellow coursemates (Jo and Olivia) made a lasagne for some guests, in which we made a pureed and typical lasagne. In doing this we wanted to illustrate that whilst on a modified diet it doesn’t affect the ability to partake or enjoy a dinner party. We really enjoyed this evening and found that the difference in food had little impact upon socialising. In particular it illustrated that it is possible to prepare a meal in both  a regular format and within the criteria of a modified diet simultaneously.

• Rather than using lasagne sheets blended we used penne pasta, as we felt this would be easier to blend and reach the desired consistency. Another option instead of this it is possible to use polenta.
• Although we had some initial difficulty in blending the pasta, we added butter and milk to loosen up the mixture. This did allow the pureed pasta to reach a relatively smooth mixture. If I was to do this again, I would blend the pasta in smaller portions as this may make the pasta easier to blend.
• The use of the same ingredients meant that meal was easy to prepare. Although there were some additional steps for the pureed diet this had little impact on the timing of the meal, as the regular lasagne required the pasta to spend longer in the oven to cook. As a result between this time difference, we were able to blend the food to reach the desired consistency and then warm in the oven.
• It was really nice to share a meal with others who are on a pureed diet, as it meant you could enjoy the situation and not notice the difference in the food.
• This is one of my favorite meals from the week. I particularly enjoyed the different layers and elements. I also found that due to the different elements this meal carried a lot flavour well.
• This was also an easy meal to do for numerous people. It would also be possible to make earlier on and reheat.

Day 3

Breakfast 

Raspberry and peach smoothie

Puree consistency

Ingredients

• Frozen raspberries
• Tinned peaches
• Yoghurt

Key things to note

• In this smoothie I didn’t add any additional juice, instead used the syrup from the tinned peaches
• I really enjoyed this breakfast, as it was refreshing and the cold cleared your throat in a morning
• In this instance I found a lot of seeds in the smoothie, as such I would highly recommend that the smoothie is sieved before being given to someone on a modified diet.
• I did have to add some thickener to this smoothie, although only one scoop. I found that in this smooth I couldn’t taste the thickener at all. Although if this is a concern honey could be added to add flavour but not impact upon the consistency

Lunch 

Bean Burgers

Fork mashed

         

Ingredients 

• half a leek
• an onion
• half a tin of flageolet beans
• passata
• garlic
• chilli
• henderson’s relish
• Flour

Key things to note 

• I initially intended for this to be puree consistency, however found that the beans wouldn’t blend to a smooth consistency. As such I left it at a fork mashed consistency.
• Whilst baking the burgers they hold their shape, however once removed and placed on a plate they lost their shape. Despite this I really enjoyed them
• In hindsight another technique I may of used is fork mashing the beans on a plate and adding seasoning to them. Then add some flour to bind the mixture. I feel this may of made the thickness more consistent and would of been less time consuming
• I found that this wasn’t too dissimilar from vegetarian burgers I typically eat
• It is important to note that the onion must be sweated down until soft so that they are easy to blend and form a smooth consistency
• I found that the use of henderson’s sauce really helped this meal, as the flavour was prominent throughout.

Tea 

Pesto rice with tomato and garlic courgettes

Thick puree

     

Ingredients

• rice
• pesto
• yoghurt
• courgettes
• garlic
• tomato puree
• passata

Key Things to note

• When blended rice can form quite a starchy consistency and has little flavour, a key way to cut through through the consistency was through adding the pesto
• I had been finding that when blending some of my meals they all became very similar due to the majority of ingredients being blended together. As such i enjoyed that the fact this meal had two separate elements
• I found the courgettes blended easily into a smooth consistency
• I really enjoyed this meal, however found that the rice went cold quite quickly. As a result if I was to redo this meal I would mix the two parts together.
• I have found the key to being on a modified diet is to heavily season the food.

Day Two

Breakfast 

Peach Yoghurt

Soft consistency

Ingredients 

• Greek or natural yoghurt
• Tinned peaches (with no syrup)

Key things to note 

• Including the syrup would of made a thinner consistency, in this instance thickener  may need to be added.
• I made this the night before and found that the peach lost some of it flavour, as such adding syrup and thickener may of compensated for this.
• If on a thick puree diet, thickener may be needed to reach the required consistency.
• Having made this the night before I also found that the peaches made the texture grainy.
• This was an easy breakfast to make that took little time to prepare
• If I was to make this again I would add honey to add flavour and wouldn’t affect the consistency of the meal

Lunch 

Fork Mashed Jacket Potato

We went out to a local potato shop and ordered our lunches. This enabled us to see that some foods can comply with the modified diet requirements. This was particularly useful as we only had a short lunch break, as such need quick and easy food. I had beans and cheese, providing the cheese is melted means that this filling was easy to break down to a forked mashed consistency. I really enjoyed the potato, and found it easy to gain a fork mashed consistency.

               

Key things to note

• The skin needs to be removed as it is too tough to reach a fork mashed consistency.
• Although I really enjoyed this meal, the food did become cold whilst preparing and removing the skin in order to eat
• It was very easy to make prepared food a fork mashed consistency and took little effort

Tea 

Lentil Moussaka

Thick Puree

                  

Ingredients

• Onion
• Garlic
• Thyme
• Mushroom
• Red lentils
• Half a tin of tomatoes
• Aubergine
• Greek Yoghurt
• One egg
• Plain flour
• Mature cheddar
• Mustard
• Salt and pepper

Key things to note

• I initially intended to blend the aubergine separately, however I found it difficult to blend; even when some passata had been added to aid the consistency. As such I blended the aubergines with the rest of the lentil mix. It all blended easily to form a smooth consistency.
• Once blended the mixture formed a thick and smooth consistency, with no thickener required to modify the consistency
• The topping once cooked, formed a thick smooth sauce on top to a similar consistency and thickness as the lentil mix. The main factor which affects this is the quantity of flour added, I added 10-20 grams of flour.
•   A key thing to be made aware of is that whilst cooking the topping forms a skin on the top. This affected the consistency and is important to remove or if on a fork mashable diet broken down. Although difficult to avoid, cooking on a low temperature may reduce the thickness of the skin that forms.

Main thoughts and tips from today

• We tried a gum based thickener rather than starch based thickener today. This left less residue and didn’t leave an after taste. However this thickener must be added prior to the drink being poured, as such if drinking out this is less accessible if on a modified diet.
• I have found that the modified diet had little impact on the ability to eat out
• Some of the meals can feel quite heavy due to the thick consistency, this has however meant that the meals are filling and as such haven’t required any snacks.

Day One

Breakfast

Smoothie – Banana, raspberry and yoghurt

This is to a ‘soft’ consistency.

Ingredients

• Banana
• Frozen Raspberries
• Natural yoghurt
• 100ml Orange Juice

Key things to note:

• Dependent upon the diet recommended this could be modified to meet this consistency. Through reducing the amount of juice, this will make a thicker consistency. Alternatively the raspberries and banana can be blended together to make a thick puree.
• Dependent upon which berries used, it is important to be aware of the seeds as you may wish to sieve the smoothie to remove these to ensure that it reaches a smooth consistency. Although I found few seeds with the raspberries, it is important to be aware of.
• The banana, yoghurt and frozen raspberries naturally produced a thickened consistency, as such no thickener was required in this instance.

Lunch

Leek and Potato Soup

This is to a thick puree consistency.

            

Ingredients

• 1 leek
• 1 potato
• Garlic
• 200ml of vegetable stock
• Salt and pepper
• A splash of milk
• Mustard
• Butter

Key things to note:

• This recipe can be adapted to different consistencies, through reducing the amount of stock you add to this recipe
• Alternatively you can add corn flour at the stage where leeks are sweated down and butter is added, this is a good technique to naturally thicken the soup. Although this may be unpredictable in ensuring that the consistency is what you need. As such you can mix corn flour with milk in a bowl and add to the soup once pureed, this can be a more manageable method to gage consistency
• A soup at its thinnest level must match the consistency of how thick your fluids are.
• I didn’t peel the potatoes, in this instance when potatoes were cooked the skin was soft enough to blend. There were no lumps or skin within the soup, however some this may not be true in all instances. As such it is important if recommended a puree or soft diet that there is no skin within the consistency, peeling the potatoes would remove any risk of this.

Tea

Ratatouille

Thick puree

      

Ingredients

• Half a courgette
• Half an aubergine
• Fresh tomatoes
• Half a chilli
• Salt and pepper
• Thyme
• Tinned tomatoes

Key tips

• When roasted in the oven at a low temperature, skins become soft and are able to blend to a smooth consistency. If this is a concern, you can remove the skins prior to blending. Alternatively, after blending it may be possible to sieve the ratatouille to ensure that it is completely smooth.
• Roasting the tinned tomatoes for 5-10minutes in with the vegetables at the end reduced some of the liquid which ensured that the puree will meet a thick consistency
• To add some protein to this meal it is possible to melt through some grated cheese, this doesn’t affect the consistency of the meal but adds an additional flavour. This would be particularly key to take into consideration if on a fortified diet.

Main thoughts and tips from today 

• Blended food loses some flavour in processing. I was initially unaware of this, as such to compensate for future meals I will try adding more seasoning so that flavours carry through
• I have found that I have had more consistent results in terms of how smooth the puree is with a smoothie blender. As it is more effective at ensuring all parts of the soup are blended.
• I have also found the food can lose its temperature fairly rapidly, as such reheating food just before serving is important as this will ensure heat is maintained for as long possible
• Consistency is difficult to maintain in particular with liquids, a main plan for the rest of this week is to find a consistent and clear measuring tool, that I can you use easily for each drink
• Although I have enjoyed the food, in particular the smoothie. I have found that due to the consistencies it can feel monotonous, however a main thing that break this up is a range of temperatures. The cold smoothie was particularly good for this as it broke up the consistency. Another key is breadth of flavour, although you can’t differentiate within the meal in regards to textures; flavours enable you to break up the food making it more palatable. This is also true for fluids, the thickener does have some flavour as such a strong flavour in drinks will make this more palatable.
• As a group we went to the pub quiz, a key aspect that I felt would be impacted is in terms of my social life. Using thickener brought little attention whilst being out socially and is less obvious than you would think. Although some people did ask and were curious, I found that this was no different to people generally making conversation or being curious.
• A main thing I feel I will learn from this week is how long it can take to cook and prepare the food. A main way in which I will compensate for this is making things in bulk so that theirs is less preparation at other points. I also think cooking more than one meal at a point such as whilst preparing tea I will also prepare lunch for the next day as I can use the oven or hob at the same time reducing the amount of overall cooking time.
• A main thing that I would like to find from this week is in terms of the diet using natural means or techniques of thickening the food to the desired consistency, as this makes the food more realistic or relatable to a typical diet someone will have had prior to a modified diet.

Keys things to know about a modified diet

There are 4 main stages of a modified diet –

1. Soft consistency – this is the thinnest texture of food

• It is a thin puree consistency
• It is blended to a smooth consistency with no lumps, this includes bits of skins or fibres
• No chewing is required
• All foods are to the same consistency and no garnish can be used at this stage
• It can’t be eaten with a fork
• Unable to hold its shape
• It can’t be piped
• It can be poured

2. Puree consistency – this is a thick puree

• It is blended to a smooth consistency with no lumps, this includes bits of skins or fibres
• All food or fluid is as thick as the puree
• It can hold its shape
• It can be piped
• It cannot be poured

3. Pre mashable

• Must be mashed with a fork prior to being served
• Must be of smooth consistency
• Little chewing is required
• Can hold its shape
• no seeds, pips or skins

4. Forkmashable

• Requires some chewing
• Can be mashed with a fork
• Food of soft consistency, with no seeds, pips or skins
• Cannot have a range of thick and thin consistencies together

There are 3 main consistency of liquids

Stage 1

• Can be drunk through a straw
• A thin coat is left in the back of a spoon

Stage 2

• Cannot be drunk through a straw
• A thick coat is left on the back of a spoon

Stage 3

• Can’t be drunk from a cup
• Requires a spoon

Raising Awareness of Dysphagia – Rosa Holden

Why is this here?
This is here to help raise awareness of a difficulty many people have but few know of or can begin to imagine the impact it has on someone’s life. Dysphagia is the medical term for a swallowing difficulty.

Alongside two fellow Third year Speech and Language Therapy students (Joanne White and Olivia Hallam) from De Montfort University, starting the 27th till 31st October 2014 we will be experiencing what someone who has a swallowing difficulty has to go through. In doing so we will be doing 5 days of a modified diet, eating softened food, primarily the consistency of puree and drinking thickened liquids.

A rough guide to a typical swallow

In a typical swallow has 4 main stages:

– The oral preparatory stage – This is where food or drink enters the mouth and chewing begins
– The oral stage – Food is chewed and broken down into a format that can be swallowed. The chewed food (bolus) is then moved to the back of the mouth via the tongue where the swallow is triggered.
– The pharyngeal stage – Food starts to enter the oesophagus, past the wind pipe which is closed off by a flap covering the voice box.
– The oesophageal stage – Through muscle movement and gravity the food moves down the oesophagus and into the stomach

A problem that occurs at any stage during the swallow, can be an indication of dysphagia. Dysphagia can be both acute or chronic difficulty.

Common causes of dysphagia:
– stroke,
– dementia,
– burns to the throat or mouth,
– Brain, throat or mouth cancer,
– a learning disability,
– a brain injury,
– weakness due to an acute or chronic infection
– cerebral palsy

These are just some of the causes that can lead to dysphagia.

A modified diet, involving thickened liquids and softened food, is just one technique a speech and language may suggest in aiding a patient to manage their dysphagia.

Please keep reading to find out about what we will be doing, cooking tips and my experience of eating a softened food diet.

My fellow course mates are also writing blogs to depict their experiences and will be giving tips on how to manage this diet;

http://ohallamdysphagiaawareness.wordpress.com/

http://jowhitesltstudent.blogspot.co.uk/

Also check out our ‘just giving’ page to read about why we are doing this;
https://www.justgiving.com/j-white1

I hope that this will help raise awareness, provide accessible information to those who are interested, supporting someone or themselves have dysphagia.