Dysphagia – avoiding malnutrition

At the request of a speech and language therapist friend of mine (www.voxaux.com), a summary of nutrition issues affecting people who need to eat pureed or blended foods.  Firstly, I should point out that this information cannot replace specific advice and support from a registered dietitian.

A small amount of background for those reading this who are not speech and language therapists to start.  Swallowing is a very complex process involving facial muscles, lips, tongue, jaw and the nervous system – the swallow reflex is triggered when food or fluid hits the back of the mouth.  This reflex closes the airway allowing the food or drink to pass safely into the gut without the risk of choking or particles of food getting into the lungs.

There are many medical conditions that can affect swallowing – stroke, neurological conditions such as multiple sclerosis and Parkinson’s disease.  Some older people can have problems swallowing some foods.  Dysphagia is the term used for any problems with swallowing food or drink.  When the swallowing is not functioning properly then there is an increased risk of choking and of pneumonia.

Now starts the more nutrition related information.  People with dysphagia require foods of a particular consistency – this varies between individuals depending on the severity of the problem.  There is now a set of standardised national descriptors available for texture modification of food.  These were published in 2010.

There are some high risk foods that should be avoided where there are problems with swallowing:

Stringy, fibrous foods– e.g. pineapple, runner beans, celery, lettuce

Vegetable and fruit skins including beans– e.g. broad, baked, soya, black- eye beans and peas, grapes

Mixed consistency foods – e.g. mince in gravy, soups with lumps, cereals that don’t blend with milk

Crunchy or crumbly foods – e.g. toast, flaky pastry, dry biscuits, crisps or bread crumbs, pie crusts, crumble

Hard foods – e.g. boiled and chewy sweets, nuts and seeds

Husks – e.g. sweetcorn and granary bread.

Dysphagia is associated with malnutrition and there are a number of reasons why this is so.  Liquidised and blended food can be very unappetising – much of our enjoyment of food is the way it looks and how it feels in our mouths.  This is particularly true when the constituent parts are not separate and are indistinguishable in appearance and taste from each other.  In people where there is confusion or cognitive impairment of any kind this can be alarming or confusing.  People with dysphagia can find eating tiring or stressful, especially if they have had an experience of choking.  Some may also have reduced sense of taste and smell, this will also lead to reduced appetite.  These things can result in people suffering with dysphagia not eating very well.

In addition to these problems, often when foods are blended, especially when water is added to get an appropriate consistency, there is a reduction in nutrient density of the food.  It is therefore really important to monitor dysphagia sufferers to ensure that they are maintaining their weight, are properly hydrated and are not suffering any signs of anaemia.  The MUST tool can be very useful to assess risk of malnutrition.

There are manufactured foods on the market which attempt to address these problems to make eating more appealing for sufferers.  Apetito is an example of a company that produces dysphagic meals and these can be sourced in the community via Wiltshire Farm Foods.

In addition, dietitians can advise on the use of powders that can be used to increase the nutrient density of pureed foods and other techniques to help maintain the quality and taste.  There are also sip feeds and supplements suited to dysphagic patients to ensure that they receive sufficient energy and protein.

If you or someone you know is having problems swallowing food then you should bring it to the attention of your GP.  A speech and language therapist can assess the problem and then a dietitian can advise you specifically on how to prepare foods so that you can swallow them safely and comfortably whilst ensuring adequate nutrition.  They may also prescribe specialist products.

I hope this summary is helpful

2 Comments Add yours

  1. Heidi de Quincey says:

    What a useful and accessible blog- I have bookmarked it and hope to refer my clients to it too.
    Thank you.

    Heidi de Quincey
    Speech and Language Therapist

    1. Thanks for such positive feedback – I am so pleased you found it useful. I always welcome any suggestions – hoping to make more regular posts.


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