Essential Answers for Dysphagia Caregivers

The IDDSI (International Dysphagia Diet Standardisation Initiative) framework is a global system that uses a common language and standardized testing methods to describe food textures and liquid thickness for people with swallowing difficulties (dysphagia). It consists of eight levels (0–7), with levels 0–4 for drinks and levels 3–7 for foods, to ensure safer and more consistent care for individuals of all ages and cultures.

The Speech Language Pathologist prescribes the level of thickness for the individual, based on testing for their swallowing ability. 

Cooking for Dysphagia includes two chapters explaining the IDDSI framework and testing, written by eminent speech language pathologists.

Batch cooking means cooking once and eating six times. It means stocking the freezer with individual servings that can be steam heated for service.

The System includes stocking the pantry, fridge and freezer and using cooking techniques and appliances that render food moist and tender, ideal for the dysphasia kitchen. It also explains  food labelling and storage.

The System means organizing the home kitchen, pantry, fridge and freezer so that a tasty meal is always on hand.

A backup caregiver can heat and serve the meal. The primary caregiver can get a night off.

The mini-food processor (3.5 cups) and a good blender form a basic cooking station in the home kitchen.

Tools may be added as needed or all at once for an instant dysphasia kitchen. The idea is to simplify the creation of beverages, soups, snacks and food.

All great food begins with great ingredients. This system focuses on the best use of foods with the least amount of waste. The system can be incorporated into family meal planning, where the individual and family live together. Recipes that conform to the IDDSI framework are suitable for bringing to a family member who resides in a healthcare facility.

Nutrition is the single most important factor affecting mood, immune health and quality of life. It is an element that is completely under the control of the individual. The focus is on flavor and clean eating. Piping the plate so that the food looks great is important because we eat with our eyes.

Fried food it's not good for the swallow. Cooking for Dysphagia focuses on pan sauté instead of frying, or stir frying instead of deep frying. It is better to have a tweaked version of the dish than not to have the dish at all.

The best cooking techniques for the dysphagia kitchen are steaming, pressure cooking as in an instant pot, and stewing and braising as in a slow cooker. Cooking on an indoor griddle at a low temperature is a good method for making pancakes.

Elementary rules of food chemistry: When you season a four ounce serving of protein, you add enough seasoning for the surface of the protein. When you puree the protein, you increase the surface area geometrically and the seasoning is lost. Cooking for Dysphasia suggests that the sauce is the medium of flavor. It suggests putting the flavor into the sauce.

A simple half cup of sauce assists the texture of the puree and will enhance the flavor.

The stainless steel steamer is a kitchen appliance version of the Chinese three-tiered steamer made out of bamboo. The problem with a bamboo steamer is that they are made of organic material and eventually they have to be replaced. They can harbor bacteria and they can get moldy.

Steaming, as a method of cooking, preserves nutrients and gives a moist, tender texture for puree.

Cooking cruciferous vegetables, a whole head of broccoli or cauliflower, one has enough vegetable to make four to six servings for freezing. Thickened, flavored with light seasonings, The System guarantees that a side dish is always on hand.

Diane says: I invented this for my mother who had a sweet tooth. Banana creaam pie was her favorite. When I make banana cream pie, I puree the shortbread for the crust and add it to a shot glass. Then I add a half cup of homemade vanilla pudding from my own no sugar added recipe. Then I add a pureed ripe banana. Then I add thickened whipped topping. I prefer So Coconut Milk  frozen whipped topping because it does not have transfats like Coolwhip. The result is a dessert in a shot class. One can take a spoon down through the layers, because all the layers are the same thickness and safe for the swallow.

For strawberry shortcake, I use my recipe for pureed fruit sauce--it has been strained through a mesh strainer. My fruit sauce is made from whole berries and stevia as a sweetener. I use the So whipped topping--no transfats. I use pureed shortbread as the crust.

There are no preservatives and additives in these desserts. The sugar content is low. Best of all, I do not have to make a whole pie. I can make one serving at a time.

The System focuses on the healthy eating plate of the Harvard Chan School of Public Health.

The plate is divided as follows: one half fresh veggies, one quarter lean protein and one quarter healthy carbohydrate.

The idea is to increase the amount of phytochemicals contained in  vegetables and spices-- this is where the nutritional healing elements are found. Also, fiber is critical to the functioning of the digestive system.

The focus is on fresh foods, frozen foods or lower sodium canned foods. The closer to nature the better. Processed food lacks nutrients and fiber and contains additives and preservatives.

Cooking for Dysphagia has included the piping technique of Andrew Cullum, a noted chef trainer from the UK. Andy focuses on making the food look like food. He calls it dignity in dining.

The IDDSI framework is international and can be applied to any cuisine in the world. See the IDDSI website for instructions in the world's languages.

The Dysphagia Outreach Project assists those who require resistance.