Trendy Soft Diet Pizza

Preparation of a soft diet pizza base can be challenging. In my publication Super Foods for Small Appetites I created a soft polenta base with purée or soft texture toppings. See illustration.

This works extremely well but can be very filling to eat; and leftovers are not always desirable when the appetite is poor.

Example of Textures B and C – Minced and Moist and Smooth Puréed Diet - Pizza

The very recent trend to chop cauliflower finely, to steam and substitute it for rice (to cut kilojoules from the diet) has led to a recipe in ‘Australian Healthy Food Guide’ (Sept. 2015, page 22) for a Cauliflower Pizza Crust. I tried this with my family, with an overwhelmingly positive result. It occurred to me that it was perfect to adapt it for a soft diet and even a minced and moist diet if the toppings were suitable.

I chose toppings to meet the requirements of a soft diet. The very small orange tomatoes on the topping were roasted with a small sprinkle of salt, and a spray of olive oil until the skin became very soft. This may not be acceptable in some cases and you could easily substitute with skinned roasted capsicum or skinned tomato.

Cauliflower Crust Pizza with Soft Topping

Ingredients                                                            Serves 4

1 cauliflower head (approx. 1 kg trimmed)

2 eggs lightly beaten

1 tsp dried oregano or 2 tsp fresh finely chopped.

90g Parmesan cheese finely grated

20g tomato paste

200g very small tomatoes roasted

1 avocado peeled and stone removed (approx. 200g).

Method

1.     Cut cauliflower into small pieces and finely chop in a food processor.

2.     Transfer to a microwave proof bowl, cover and cook for 8 mins. Leave to cool and drain well squeezing some of the water from the soft mass.

3.     Preheat oven to 200C or 180C if fan forced and line two pizza trays with baking paper in preparation for the prepared crust.

4.     Mix the cauliflower with the eggs, oregano and one third of the Parmesan cheese until a thick cohesive mass is formed.

5.     Press into trays to make 2 round shapes, approx. 22cm round and 3-4mm thick. Spray with olive oil and bake for 15 mins.

6.     Spread with tomato paste, sprinkle with the roasted tomatoes and sliced avocado. Spread the rest of the parmesan on top,

7.     Bake for a short time until cheese has melted.

Example of Texture A: Cauliflower Crust Pizza with soft topping

Nutrition Information per serve: Energy 1384kJ, protein 19g, fat 23.9g, sat fat 7.9g, carbohydrate 7.2g, fibre 6.3g, sodium 436mg.

Alternative toppings for a soft diet include:

• Cooked pumpkin, feta cheese and baby spinach.
• Ham, skinned capsicum and onion cooked until soft plus cheese (parmesan works best, without going tough in the oven).
• Tomato and onion preferably skinned with zucchini cooked until soft with cheese
• Sardines, goats cheese and soft cooked figs or quince.
• Toppings for a minced and moist diet could be cooked and chopped until pieces less than 0.5cm, but would need to be served with a thick sauce. It may be safer to purée any toppings to go onto the cauliflower crust that in itself has a soft cohesive texture easy to break up in the mouth with the tongue.

HAPPY PIZZA MAKING

Breakfast Oats in Modified Texture Die

It seems there are many factors to take into account in our humble porridge breakfast. I understand the importance of the whole grain perspective with low glycaemic index (GI) keeping our insulin levels at bay.

The new steel cut oats (I chose to buy the Uncle Toby product) has the lowest GI so I decided to give it a try. I thought that being cut up would provide a smaller particle at less than 0.5 cm to maybe make it suitable for a minced and moist diet. Well I missed the toasted label and no matter how long I cooked it the particles remained “nutty” true to the advert. The bits would be a nightmare for anyone with dentures and remained around the mouth to maybe cause problems for swallowing accidents later in the day.

Steel Cut Oats illustrating the “nutty” texture

The other consideration of particle size prompted me to try “steel” cutting in my food processor to create smaller pieces of my traditional oats (the next lowest GI option). I had no idea whether this would raise the GI but I guessed it would make it easier to digest. The results were superb! Easy to eat with no lumps lowered cooking time for 2 serves (3 mins in the microwave instead of 4-5), and a cheap product from the local brand of supermarket. (99c for 750g as opposed to over 5 dollars for the steel cut oats).

Now I was on a mission! How could I improve the protein and fibre of my breakfast to meet the nutrition requirements for the elderly of at least 20g of protein and 10g of fibre. This would be a helpful recipe for aged care homes as well as for modified texture diets at home.

I trialled making the porridge with all milk, adding extra skim milk powder and oat bran before cooking and a teaspoon of honey with a heaped tablespoon of Greek Yogurt to serve. The result was very popular, was suitable for Soft and Minced & Moist diets, and almost met the nutrition goal. The mixed meal using milk would lower the GI and addition of oat bran improve fibre and mineral content. The fibre content of the meal can be further increased by addition of fruit as desired.

Breakfast Porridge

Ingredients                                        Serves 2

60g Rolled Oats

20g Oat Bran

330 ml Skim Milk

25g skim milk powder

2tsp honey

60g Greek Yoghurt

Method

1. Process rolled oats in food processor until pieces < 0.5cm.
2. Mix skim milk powder into the milk before adding it to the processed oats and oat bran.
3. Cook in microwave on high for 2 mins, stir and cook again for 1 further minute.
4. Serve with a teaspoon of honey and a heaped tablespoon of yoghurt.

These may need to be mixed in at the table to minimise mixed texture. The yoghurt will also minimise the slightly cohesive nature of the porridge.

Nutrition Information per serve: Energy1260kJ, protein18.6g, fat 4.2g, sat fat 0.8g, carbohydrate 45.7g, sugars 21.8g, fibre 4.0g, calcium 419mg, magnesium 100mg, iron 1.9g, zinc 2.2g.

Breakfast porridge with small particle size oats

Celebrating Dysphagia Month

To celebrate Dysphagia Month I searched for some delicious dessert options.

Time is precious when you are caring for someone who needs special food. As a dietitian I am aware of the need to balance the diet as well as making the food tasty and looking good. When I am testing and presenting new recipes to my own family for comments I become overwhelmed with the efforts of cooking and washing up, thanking my lucky stars for my dishwasher.

In a recent article in DYSPHAGIA CAFÉ called ‘Moving beyond the isolated swallow: Dysphagia in the context of a shared mealtime’, Samantha Shune reflects on the shared mealtime and ageing. The assessments and interventions from the therapist must reflect the multifactorial nature of the process. The therapist needs to know and be part of the education of other members of the group or family. If the family meal table or social group is available for normal socialisation for at least some meals of the day the food is a large part of the pleasure of this. If at least some of the components are presented to share and thought of as delicious then life is good.

Three Variants for the Parfait Dessert for a Holiday Gathering

The time taken to prepare different meals for the various members around the table can become a burden for the carer/cook. This can be solved by preparation of some of the courses like smooth thick soups (see previous blogs) and desserts (see ‘Super Foods for Small Appetites’) for everyone. The family can then pick and choose to suit their appetite at that time, and may be unaware the items are designed to be suitable as smooth purée. Often a small appetite can only manage the soup and dessert. If these are prepared using all the food groups this will often suffice.

A traditional colourful dessert bought at the local ice cream parlour when I was a child used to be called “A Knickerbocker Glory”. The components are presented in layers and consist of jelly, custard, fruit, ice cream, and cream. A more contemporary name is ‘Parfait’. The acceptance within the family and or social group of the safety aspects and consequences of eating the ‘wrong’ food has to be part of the story along with the acceptance of any other sort of diet or preferences where there are restrictions. This should mean that the items and foods available at the table are there for some who choose it. For example the granola, made from oats, nuts, seeds and maple syrup sprinkled on the parfait are not suitable for the person with dysphagia or indeed the very little people in the family.

A Close-up of a Parfait showing the Layers

The recipes I offer here can be part of this sort of presentation and the family can mix and match according to their taste. My family like both vanilla and chocolate custard as part of their chosen layers. Thick custards are available in the supermarket, as are flavoured mousses if time is limited for preparation.

I chose to offer a recipe for a soft fruit jelly, made from fruit juice, gelatine and some tapioca flour to ensure the jelly does not melt too quickly in the mouth; an apple and rhubarb snow; an iced coffee mousse and I suggest plain yoghurt or custard to separate the layers. If a high energy protein supplement is recommended I have included the recipe for RESOURCE^® Fruit Flavoured Jelly. (adapted from “Super Foods for Small Appetites”).

RESOURCE^® Fruit Flavoured Jelly.

Ingredients:

237 ml box of RESOURCE^® Fruit Flavoured Beverage

¼ cup cold water

1 ½ tsp gelatine

1 tbsp tapioca flour

½ tbsp. sugar

Method

1.  Mix the dry ingredients together.
2. Add the water slowly making a paste initially.
3. Heat either over hot water or more directly on a slow heat until the gelatine has dissolved and the tapioca mix has a glassy appearance.
4. Slowly stir in the fruit Drink until well mixed.
5. Refrigerate until set.
6. Serve broken up with a fork.

Nutrition Information per serve (300ml): Energy 1334kJ, protein 12.9g, fat 0, carbohydrate 67g, sugars 40g, fibre 0.1g, sodium 91mg. (Other nutrients important as part of this supplement not shown).

For the purpose of the exercise I made a Soft Cranberry Jelly and a Soft Queen Garnet Plum Jelly, substituting the Nestlé Healthcare Supplement with fruit juice. The family preferred the Queen Garnet Jelly as it had a full bodied sweet taste. Obviously a favourite fruit juice can be used, although I am told pineapple juice will not set. The amount of gelatine may have to be varied to achieve desired soft consistency. The amount made was enough for 4 glasses of the mixed layered dessert.

Nutrition Information per 100g of QG Plum Jelly: Energy 262kJ. Protein 1.9g, fat 0, carbohydrate 13.2g, 10.7g, fibre 0.1g, sodium 8mg.

Apple Rhubarb Snow

Ingredients:                                       Serves 4

2 apples red unpeeled

280g rhubarb chopped

20g sugar

1 cup water

1 egg white

Method

1. Chop apples and rhubarb into small pieces and place in pan with water and sugar.
2. Bring to the boil and simmer until soft, uncovered.
3. Allow to simmer until product is thick.
4. Blend in vitamiser until smooth.
5. Whisk egg white until soft peaks form.
6. Fold into the cooled fruit.
7. Serve in a bowl or use as part of your layered dessert.

Nutrition Information per 100g: Energy 143kJ, protein 0.9g, fat 0.1g, carbohydrate 6.8g, sugars 6.7g, fibre 1.4g.

Apple Rhubarb Snow

Iced Coffee Mousse

Ingredients:                                      Serves 4

1 tbsp instant coffee

1 tbsp hot water

1 ½ cups milk

2 tsp gelatine dry

1 ½ tbsp. water extra

3 tbsp ice cream

Method

1. Combine coffee and hot water. Add milk.
2. Pour mixture into pan and bring to simmer point.
3. Combine gelatine and extra water, add a little of the hot milk from step 2 and stir to dissolve.
4. Place coffee milk, dissolved gelatine, sugar and ice cream in vitamiser and blend until smooth. The idea of this is to create a product with a creamy froth topping.
5. Pour into small glasses or coffee cups and refrigerate to set. Or use as a coffee layer in your layered dessert.

Nutrition Information per 100g: Energy 386kJ, protein 5.0g, fat 4.0g, carbohydrate 9.6g, sugars 9.5g, fibre 0.1g, sodium 45mg.

 

Iced Coffee Mousse

SARCOPENIA AND DIETS OF PEOPLE WITH DYSPHAGIA

Sarcopenia is a syndrome characterised by progressive, generalised loss of skeletal muscle mass and strength, determined by both low muscle mass and low muscle function. In a population with chewing and swallowing problems when malnutrition is a real consequence the risk of sarcopenia becomes even more prevalent.

Current evidence for prevention and treatment of sarcopenia points to a need for maintenance of good nutrition and physical activity throughout life. In older age it is likely that increased protein intake with more emphasis on type and timing of intake may be beneficial both for prevention and treatment of sarcopenia. The dietitians’ skill in translating this into simple and practical food-based advice is essential.

Protein requirements in older adults are deemed to be higher than younger adults partly due to age related changes in protein metabolism. (Bauer et al JAMDA14 (2013) 542-559). To help older people (>65years) maintain and regain lean body mass the recommendation is for the average daily intake to be at least in the range of 1.0 to 1.2g/kg body weight for relatively inactive people with a range of 1.2-1.5g?kg body weight/day for more active or people who have acute or chronic disease. This translates to a requirement of 20-30g of protein 3 times a day. Within this food protein  a higher leucine content which has rapid digestion kinetics is beneficial. See above reference  Bauer 2013.

Eggs and milk are good sources of the essential amino acids required.

With this in mind I have trialled the intervention of using eggs in soups.  The Chinese classic of ‘Steamed Egg Soup with Crabmeat’ gives a soft mousse like egg base with a tasty soup placed on the top before serving. If the soup is of a smooth thick consistency the standards for a Smooth Purée Diet are met.

The possibilities are endless. The steamed egg base is made by mixing one egg with 150mls of quality stock. Obviously beef /chicken /fish or vegetable stock can be used. The mixing is to be slow so that the mixture does not become frothy. It is then poured through a sieve into a heat proof bowl which the soup will be served in. This is steamed for 12-15 mins until the surface is almost firm to touch. Obviously, if more serves are made the timing of the steaming will be longer.

Steamed Egg with Stock

Steamed Egg broken up to show mousse like texture

The tasty soup recipes in previous blogs can be used to add to the bowl. The consistencies, while all suitable for a smooth purée diet, will vary in mouth-feel. This will add to the variety of texture for the person for whom you are caring.

Complete Meals as Soups and Smoothies Blog 3

The first blog in this series gives a meal plan for 6 meals a day as soups and smoothies suggesting that fluid intake can become an easier task without having to constantly use prepared or ready made thickened fluids after every meal. Often these types of commercial fluids are unpopular and expensive. Inadequate fluid intake is common in dysphagic acute stroke and, I am sure, in other medical conditions. An article by Whelan (Inadequate fluid intakes in dysphagic acute stroke. Whelan, K. In: CLINICAL NUTRITION, Vol. 20, No. 5, 2001, p. 423 - 428.) suggests that most of the fluid in dysphagic diets comes from the foods served. I have also seen this in a slow rehabilitation setting with dysphagic diets after motor vehicle accidents, when patients refuse thickened fluids.  Obviously in the rehabilitation setting recovery is a priority and various fluid consistencies and food textures need to be challenged to meet patient goals. Complete meals as soups and smoothies, however, may appeal for the home setting or long term care.

These two thick soups contain parsnip, carrot, swede and turnip. I find these a useful addition to the recipes as they come with lots of flavour and give a creamy smooth texture when puréed. This is particularly useful when blending meat which, even when slow cooked, has a tendency to be fibrous and grainy.

Boeuf Daube Provençale Soup

Ingredients                                        Serves 5

500g boneless lean chuck steak cut into small pieces

2 tsp olive oil

2 cloves garlic

1 cup red wine

1 medium carrot peeled and chopped

1 medium parsnip peeled and chopped

½  large turnip peeled and chopped (or 1 small)

½ large swede peeled and chopped 9or 1 small)

1 can chopped tomato (400g)

1 cup beef broth

1 bay leaf/ dash of cloves/tsp fresh thyme

Mashed Potato to serve

Method

1. Add oil to slow cooker and seal pieces of beef. Add garlic and cook briefly.
2. Add all other ingredients and follow instructions for the slow cooker.
3. Cook until beef is very tender. Remove bay leaf.
4. Place in a high-powered blender adding more beef broth if required to achieve a smooth thick consistency.
5. Serve in a soup bowl with piped mashed potato around the edge. Place in hot oven for 10 minutes to give a golden look. This can be mixed in as the meal is being consumed.

Nutrition Information per serve: Energy 1536 kJ, protein 38g, fat 11.2g sat fat 4.5g, carbohydrate 17.7g, sugars8.3g, fibre 5.6g, sodium 400mg.

 

Boeuf Daube Provençale Soup

Lentil and Vegetable Soup

I have used green split peas instead of lentils with this soup. Split peas and lentils have similar macronutrient composition but can vary in vitamin and mineral content. Cooking times are also similar. I also used the vegetable kohlrabi that is a turnip with a sweeter taste than the classic turnip. However, the slightly bitter tasting turnip can also be used.

Ingredients                                                    Serves 5

1 &1/4 cups lentils

3 &1/2 cups broth (vegetable or chicken)

2 tsp oil

1 small carrot peeled and chopped

1 small parsnip peeled and chopped

1sticks celery chopped

½ swede peeled and chopped

½ Kohlrabi peeled and chopped

1 small onion chopped

1 clove garlic

1 can chopped tomato (400g)

½ tsp mixed herbs

salt to taste

Method

1. Add lentils to the broth and bring to the boil. Skim any surface froth.
2. Add oil to a frying pan and fry onion, garlic and other vegetables except tomato, for 2 mins.
3. Tip vegetable mix into the lentil/broth mix together with the tomato and herbs and simmer for 40mins until all vegetables are tender. Add salt to taste.
4. Blend until smooth even texture is achieved.

An alternative is to blend 1 cup of the lentil soup and add it back to the soup. If the chopped vegetables meet the standard size of <1.5cm for soft diet or <0.5cm for minced and moist diet this thick version of the soup can meet the requirements for texture modified diets. Check with the speech therapist if uncertain of the suitability for an individual.

Lentil and Vegetable Soup

Nutrition Information per serve: Energy 1104kJ, protein 16.7g, fat 4.0g, sat fat 0.7g, carbohydrate 35.3g, sugars 9.3g, fibre 10.3g, sodium 329mg.