Complete Meal Soups and Smoothies

One way to approach a dysphagia diet is to plan for 6 smaller meals a day that, in total, meet the daily requirements for adequate energy, protein, carbohydrate, and at least 1500mls water.
Traditional soups made with a few extra ingredients can contribute.  They make complete meals an easier task when designing modified texture diets. The following soup recipes are designed to provide approximately 900-1300kJ at mealtimes with at least 17-25g protein and enough vegetable to meet healthy eating plans. Breakfast and in-between meals could be a fruit smoothie with cereal and nuts providing extra calories to meet energy requirements. See meal plan below.

Example Meal Plan Using Smoothies as Complete Meals

(Recipes from “Super Foods for Small Appetites” (SFSA). Other recipes will be added to this blog over the next few weeks.

Breakfast: Quinoa Porridge with cinnamon, berries (SFSA) and half a mashed banana providing 1000kJ, 10g protein, 5g fat, 30g carbohydrate, 10g fibre.

   OR

High Energy Breakfast: Oats express using a tetrapak of Dairy Farmers flavoured Oats Express with extra oats (SFSA) with half a mashed banana providing 1500kJ, 16g protein, 4g fat, 55g carbohydrate 10g fibre.

Morning Tea: Green Smoothie (SFSA) made with a green vegetable, rockmelon etc. plus added sweet potato for extra thickening if required providing 6-700kJ, 5.6g protein, 0.6g fat, 30g carbohydrate, 6g fibre.

Lunch: Split Pea & Ham, Lentil & Vegetable, or Minestrone Soup (recipes to follow) providing 1100kJ, 20g protein, 6.5g fat, 30g carbohydrate, 6g fibre.

   OR

High Energy Lunch: Soup as above with approx. 20g  Sustagen (or similar) whisked in before serving. This will add 300kJ and 5g protein.

Afternoon Tea: Chocolate and Chia Seed Smoothie (SFSA) providing 800kJ, 11.6g protein, 7.5g fat, 25g carbohydrate, 8.5g fibre. OR  Tropical Quinoa Smoothie. (SFSA)

Dinner: Meat or Fish based soup eg Scotch Broth (see below), Beef Daube Soup, Cream of Chicken Soup (SFSA), Fish Bisque. These will provide 1000-1200 kJ, 20g protein, 30g carbohydrate, variable fat and fibre content depending on recipe.

Supper: Fruit Flavoured Beverage jelly. (SFSA). This can be made with a clear fruit supplement OR a favourite cordial or fruit juice. Tapioca provides the stability for thickening the jelly so melting in the mouth before a swallow is avoided.             

If a fruit flavoured supplement is used for extra nutrition up to 1500kJ would be available as well as an extra 13g protein.

 My experience with blending colours leads to my recommendation to include green leafy vegetables in the fruit smoothies that have become extremely popular with the provision of powerful blenders on the market. The Internet has lots of examples but I recommend the book “Super Foods For Small Appetites” available as download or printed format from www.familyconcernpublishing.com.au. This book has a section on ‘Smoothies’ giving examples of general and specific ways of creating smooth thick textures for easier swallowing with appropriate nutrition information.

My first recipe is a traditional Scotch broth with lamb and barley. If cooked in a Slow Cooker the lamb falls off the bones easily and the barley is soft. The meat, vegetables and barley provide small pieces that float in a tasty broth. This constitutes a mixed texture and can be a challenge for those with chewing and swallowing problems   where the thin broth may cause coughing. Blending the soup will create a thick consistency that is easier to manage in the mouth.

Scotch Broth

Ingredients                                                                Serves 5

500g lamb neck chops trimmed

150g carrots

1 medium onion

2 leeks

3 sticks celery

¾ cup pearl barley

1.5 litres hot water

1 beef stock cube

salt & pepper to taste.

2 tbsp chopped parsley

Method

1. Peel carrots and onions and trim leeks.  Chop into small pieces.

2. Sear lamb chops and onions in slow cooker.

3. Add washed barley, water, vegetables and stock cube.

4. Slow cook for at least 3 hours.

5. Remove lamb chops, separate meat from bones and chop into small pieces.

6. Season with salt and pepper. Add chopped meat and parsley.

7. Blend the soup until smooth thick consistency is achieved.

Nutrition Information per serve: Energy 1126 kJ, protein 20.6g, fat 6.5g, sat fat 3.2g, carbohydrate 29.7g, sugars 7.5g, fibre 5.8g, sodium 519mg.

Scotch Broth as a Smooth Purée showing a 'figure of 8' motif to demonstrate extremely thick consistency

Christmas Fare

Turkey Crust Pizza

Ingredients                                                    Serves 4-6

500g turkey mince

2 tsp. cornflour

30g dry breadcrumbs

1 egg white lightly beaten

6 drops Tabasco sauce

1 tbsp. water or wine

1 tsp. olive oil

Pizza Sauce

10ml olive oil

50g onion sliced

120g red capsicum chopped

70g mushrooms chopped

400g tomato purée

1 clove crushed garlic

1 tbsp. red wine vinegar

1 tbsp. fresh basil chopped

1 tsp. sugar

30g parmesan cheese grated

Method

To prepare the Sauce:

1. Fry the onion, capsicum, mushrooms and garlic in oil until soft (5 mins).
2. Add tomato purée and vinegar and sugar and simmer for 20mins. Add basil.
3. Blend in vitamiser until smooth, thick consistency is achieved.

To prepare the Pizza Base:

1. Blend the turkey mince in a food processor with cornflour until a paste like texture is achieved. Remove any tendon lumps. If a soft or minced and moist texture is suitable the mixing can be light.
2. Add the breadcrumbs, egg-white, salt, pepper and sugar, Tabasco sauce, water or wine. Process in the machine with enough of the pizza sauce (approx. ½ cup) to create a thick spreadable mixture. Again only light mixing is needed for a soft or minced moist texture.
3. Spread the turkey mix over the base of an oiled pizza tin or plate (23-25cm diameter).
4.  Pour the rest of the sauce over the turkey mix leaving an edge to resemble a pizza crust. Sprinkle with the cheese.
5.  Cook in a moderate oven for 15mins.
6. Serve in wedges with extra sauce if required.

Nutrition information per serve: Energy 1150kJ, protein 25g, fat 13.5, sat fat 4.1g, carbohydrate 11.6g, sugars 6.8g, fibre 2.7g, sodium 730mg.

A shortcut for this dish would be to use commercial smooth pizza sauce and chicken mince can be used in place of turkey mince. If cooked turkey or chicken were used a moist thigh fillet would be the better choice. Favourite pizza toppings can be adapted to suit. The pizza freezes well.

Turkey base Pizza for Modified Texture Diets

Salads served with the pizza need to be suitable for the texture recommended for the individual with dysphagia. See my previous blog for soft salads. Smooth purée salads for Christmas fare can be adapted from vegetable smoothies with the consistency corrected with addition of thickeners such as Resource^® ThickenUp Clear from Nestlé Nutrition, or Precise THICK-N Instant from Trisco Foods. Commercial vegetable juice tetrapaks can be used for convenience. The thickener will provide fibre (see section on fibre in “Super Foods for Small Appetites”)

http://www.familyconcernpublishing.com.au/products-page/products/super-foods-for-small-appetites-home-based-modified-texture-diets-2/

Beetroot & Apple Gel; Carrot & Pineapple Gel;
Kale & Avocado Smoothie.

Christmas Pudding

A smooth melt in the mouth plum pudding for a Christmas Treat

Ingredients                                                    Serves 4-6

3 tbsp. sago

½ cup water

1 cup milk

60g butter or margarine

1/3 cup brown sugar

½ tsp. vanilla essence

½ tsp. mixed spice

1 cup fresh breadcrumbs

1 tbsp. extra milk

1 tsp. bicarbonate of soda

1 egg (slightly beaten)

1 cup sultanas

1 tbsp. sherry (optional)

Method

1. Place water and sago in a bowl and let soak overnight.
2. Barely cover the sultanas with water in a saucepan, bring to the boil and simmer until approximately 1 tablespoon of water is left. Add the sherry and simmer for 1 minute more. Cool.
3. Blend sultanas and sago in vitamiser until smooth.
4. Heat the milk in a saucepan, add butter, sugar, vanilla, spice and the sago/sultana mix. Stir until butter is melted.
5. Dissolve the bicarbonate of soda in the extra milk and add to the mix along with the breadcrumbs. Mix in the egg  and stir well.
6. Pour into a lined and greased pudding basin, cover and steam for 2 hours.
7.  Turn out onto a serving dish and serve with custard or cream.

Nutrition information per serve: Energy 1140kJ, protein 5g, fat 9.0g, sat fat 1.8g, carbohydrate 42.5g, sugars 29.4g, fibre 1.6g, sodium 470mg.

Sago Plum Pudding

If you found these recipes useful, and want to find out more about novel recipes for Dysphagia Diets, try one my books - either A Kitchen Manual for Preparation of Modified Texture Diets (2nd Edition) or Super Foods for Small Appetites - Home Based Modified Texture Diets

Sticky Rice as Finger Food

One of the challenges I have encountered in my work with texture modified diets is simple cooked rice, the staple cereal food for millions of people. Unless eaten as a thick rice pudding it tends to separate in the mouth and requires multiple chews to enable safe swallowing. My successful efforts so far have been with a Congee rice, a traditional easy to eat and swallow meal from Chinese cuisine and a fish kedgeree (smoked fish, rice and egg in a white sauce) that originated in India.

Imagine my surprise when I had a visit from a friend from Thailand who described rice eaten by small children from the age of 1 year called sticky or glutinous rice.

My understanding is that toddlers of one year tend to eat meals that can be cut into pieces <0.5cm and served in a thick sauce i.e. minced and moist texture.

Cooked sticky rice is soft and moist, easily forming a ball, lumps can be broken up in the mouth with the tongue, as opposed to needing the teeth and the lumps in the food are soft within a cohesive consistency product.
Sticky rice is available in Australia as part of the SUNRICE^® range and the cooking instructions on the packet are easy to follow. I will not pretend that the product is as good as the traditional steamer version with bamboo that imparts a particular flavour, but it is good enough.

The traditional Thai way is to serve it for the child to eat with their fingers and wrap small pieces of meat around a portion to pick up. Obviously for a minced and moist standard the meat/fish would need to be very soft and cut very thinly.

As a finger food I believe it would be a useful addition to a nursing home menu particularly for an Asian population who love their rice. Finger bowls would be used under supervision for any finger food version.

The chemistry of the rice is such that it digests easily, being an amylose chain that starts digestion in the mouth and is completed in the small intestine. It has a high glycaemic index if served alone but as part of a meal of meat and vegetables this would be lowered.

Finger Food Sticky Rice with Shaved Ham or Smoked Salmon

If you found these recipes useful, and want to find out more about novel recipes for Dysphagia Diets, try one my books - either A Kitchen Manual for Preparation of Modified Texture Diets (2nd Edition) or Super Foods for Small Appetites - Home Based Modified Texture Diets

Soaking Cakes as a Way to Modify the Texture and Create a Moist Easy to Swallow Product.

We are familiar with the jelly cake made as part of a modified texture trifle or served as a cake soaked in jelly and set overnight.

In a small environment experienced staff or carers will often use cream or ice cream with a fruit sauce or topping to mix with a soft cake to make it easy to chew and swallow particularly when a birthday comes around.

The traditional soaked cake is known as a savarin and is a yeast cake soaked in syrup with rum or kirsch added. There are many versions of this inevitably delicious item, but they take time to ‘prove’ etc. being a yeast cake. The following recipe is a semolina cake that seems to absorb syrup well, making a moist if grainy texture. Serving it with an additional fruit sauce and yogurt or cream ensures an easy to chew and swallow desert or afternoon tea treat.

Soaked Semolina Cake with Blueberry Sauce

Ingredients                                                    Serves 16

125g reduced fat table spread

¾ cup caster sugar

2 tsp. vanilla extract

2 large eggs

1cup low fat plain yogurt (plus extra for table serving if desired)

1 .5 cups fine semolina

½ cup almond meal

1 tsp. baking powder

½ tsp. bicarbonate of soda

Syrup

¼ cup lemon juice

1.5 cups water

¾ cup caster sugar

Blueberry Sauce

1 can blueberries (415g)

Method

1. Preheat oven to 150C. Grease and line a 20x20cm cake tin.
2. Place table spread, ¾ cup sugar and vanilla essence in a bowl and beat with an electric mixer until pale and creamy. Add eggs one at a time beating well after each addition.
3. Fold in yoghurt, semolina, almond meal, baking powder and bicarbonate of soda. Mix until combined.
4. Spread mixture into the prepared tin, smooth surface and bake for 25 mins until a skewer inserted into the cake comes out clean.
5. Place sugar, water and lemon juice into small saucepan. Bring to the boil, stirring to dissolve the sugar. Simmer for 10 mins to make a syrup.
6. Spoon the syrup over the hot cake and leave it in the tin to cool.
7. Place the drained blueberries in a blender with about 60mls of the syrup from the tin and blend until smooth. The product should be fairly thick.

Nutrition Information: Energy 880kJ, 4.9g protein, 6.7g fat, 1.1g sat fat, 32.8g carbohydrate, 22.6g sugars, 1.4g fibre, 144mg sodium.

Soaked Semolina Cake with blueberry sauce and yoghurt

This product is suitable for a soft, and minced and moist diet. Smooth puréed diet will require further blending of the cooked product with the sauce.

Smooth puréed Semolina Cake with blueberry sauce, topped with yoghurt

If you found these recipes useful, and want to find out more about novel recipes for Dysphagia Diets, try one my books - either A Kitchen Manual for Preparation of Modified Texture Diets (2nd Edition) or Super Foods for Small Appetites - Home Based Modified Texture Diets