May is National Multiple Sclerosis (MS) Awareness Month, as well as National Huntington's Disease (HD) Awareness Month. Being diagnosed with either condition can come with progressive difficulties swallowing, including food, drinks, and medications. While in hospital or continuing care, you may have a healthcare professional suggest changes to diet and drinks to help with swallowing. Sometimes this can add a lot of confusion and you may have no idea how to create meals based on these recommendations. In this article, I will share ways a dietitian can help you with swallowing difficulties.
Dyspha-what?
Dysphagia - it is a term you may hear from a healthcare professional. This is the term used to describe difficulties and discomfort in swallowing. It can affect people of any age with many different conditions, but it afflicts seniors most often. This condition occurs in those with dementia, Parkinson's Disease, MS, ALS, HD, Post Stroke, among others.
You may wonder why this happens. Swallowing is a unique process that involves both the gastrointestinal system and the nervous system. It starts in the mouth with chewing food or holding fluid, then when you are ready to swallow, the tongue pushes the food or fluid to the back of the throat, initiating the swallow. The rest is an entirely involuntary process that must be perfectly coordinated by the brain. This process involves protecting the airway so that you do not inhale food or fluid into your lungs, and instead go into your esophagus and then onto your stomach.
Some symptoms of dysphagia include, but are not limited to:
Coughing/choking
Nausea/vomiting
Sensation of food or medications being stuck in the throat
Breathing that sounds wet
Gurgly vocal quality
Adapting certain food and drink or avoiding them altogether
Weight loss
A Dietitian Can Help You with Diet Changes
Here are some of the terms you will hear in various care settings:
Regular Diet | No alterations to what you eat |
Easy to Chew Diet - foods are soft and moist. Anything that may be hard, crunchy, or chewy would be removed from the diet. This diet would exclude raw vegetables, salads that are not shredded, hard fruits with skins, chewy breads, hard crackers, nuts, bacon, whole sausages, and crispy or fried fish, to name a few |  |
Dysphagia Soft Diet - foods are soft and moist but also need to be diced into pieces no bigger than 1 cm. Some foods may even need to be minced into pieces no bigger than a 1/2 cm. This diet would exclude everything with the Easy to Chew diet but also: whole kernel corn, fruit with seeds, dried fruits, fresh or canned fruits/vegetables that are fibrous or have membranes (ex. pineapple, grapes, tomatoes), dry/loose rice, hard fried eggs, hamburgers/hot dogs in the bun, to name a few |  |
Minced Diet - foods are soft and moist and need to be minced into pieces no bigger than 1/2 cm. Some foods may even need to be pureed/blended. The foods on this diet require very little chewing and there is no water separation.
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Pureed Diet - the food is blended into a smooth texture with no water separation. The thickness of a puree should be similar to that of a pudding or mousse. Some foods are already in a pureed texture, such as Greek yogurt, custards, and puddings. |  |
A Dietitian Can Help You with Fluid Changes
Fluids can be thickened to allow for enhanced safety while swallowing. By thickening fluids, this allows for the drink to travel slower down the back of the throat, allowing the brain a bit more time to initiate safe swallowing, and protection of the airway so that fluids go into the esophagus and not the lungs. Any drink can be thickened, from water to carbonated beverages to alcohol. Typical thickening products are often xanthan gum-based. This is a common thickening agent used in the food industry and is permitted for use by Health Canada(1). Common thickening products you can find include ThickenUp Clear and Simply Thick Easy Mix.
Alberta also has different levels of thickened fluids to provide varying benefits to those with difficulty swallowing:
Regular Thin fluids | No alterations to what you drink. |
Mildly Thick (level-2) fluids - drinks are slightly thickened. They resemble fruit nectar or eggnog. |  |
Moderately Thick (level-3) fluids - drinks are thickened to resemble liquid honey. |  |
Extremely Thick (level-4) fluids - drinks are thickened to be as thick as a pudding. |  |
Dietitians Can Help You Put These Recommendations into Practice
Now that you have a better understanding of what each diet and fluid change means, a Dietitian can help you make meals, snacks, and drinks that will keep your loved one safe.
Was your loved one recommended a minced diet with mildly thick fluids, for example? Do they love eating steak and ice cream? A Dietitian can help you to continue to provide the foods and drinks your loved one has always enjoyed but in a safe way. Through recipe modifications, to how to get the right texture or consistency, Dietitians are here to help you take these recommendations off the paper and into your lifestyle. We are always happy to help!
Where can I get more support with nutrition for my loved one?