Gels, Foams and Purees: Cookbooks Serve Up Recipes For Those Who Struggle To Swallow

Jill Neimark wrote . . . . . . . . .

In 2007 Diane Wolff, an Asian scholar about to move from California to New York City, got a call from her mother: Dementia had made it hard to take care of herself. Couldn’t Diane move to Florida instead of New York? “My mother was beautiful and headstrong, and even in her old age I thought of her like Scarlett O’Hara,” says Wolff. “She needed me, and I packed up and moved to Florida.”

In 2010, however, her mother’s dementia led to a swallowing disorder called dysphagia. When Wolff tried to source soft foods, or recipes for those with dysphagia, she came up virtually empty handed. “Commercially available pureed foods were horrible. One caregiver compared them to dog food, and I think that was being kind.”

Working with dietitians and speech pathologists, Wolff — who cared for her mother until her death in 2013 — began to develop a suite of techniques and recipes for pureeing delicious, nutritious foods, from pizza to roast chicken. Today she is known as “The Queen of Puree.” With 12 self-published books — including The Essential Puree: The A to Z Guidebook — a blog, and a busy schedule training caregivers and medical professionals, she is helping pioneer a new approach to an increasingly common disorder. The essence: simple, intensely flavorful food that is easy on the throat and packed with good nutrition.

Each year 1 in 25 adults experience a swallowing disorder. Dsyphagia has many causes — ranging from dementia to stroke, surgery and neurological disorders — but no matter the origin, the ability to safely consume foods is essential, according to speech pathologist David Fagen, at Fawcett Memorial Hospital in Port Charlotte, Fla. Some 60,000 dysphagia sufferers die each year, mostly from aspiration pneumonia, which is caused when food or saliva is inhaled into the lungs. Those with dysphagia can also lose interest in eating if foods are too bland or swallowing is too difficult, leading to weight loss and poor nutrition.

Wolff says there are essential tricks to a successful puree. One key is the careful application of flavor through sauces. “When you puree a food,” she explains, “you increase the surface area by a factor of thousands, and you lose flavor. It tastes bland. Sauce becomes the all-important medium to carry flavor. A simple half-cup of sauce can make a puree delicious.”

High-fiber foods will need to be strained after pureeing, and swapping ingredients can be essential. (A polenta pizza crust works well, whereas a traditional wheat flour crust does not). High-speed blenders are best for breaking down the cell walls of fruits and vegetables and liberating the nutrients within. Thickeners such as xanthan gum can be purchased either in gel or powder form; they allow liquids and purees to be thickened according to the patient’s ability to swallow, as determined by a speech language pathologist.

Another tip for caregivers: Before cooking, bring ingredients, such as vegetables and fruits, in to the patient, so they can see and smell them. Present the entire dish before it is pureed, as well. Prepare seasonal foods — the iconic dishes of summer, fall, winter and spring. “Engage all their senses during meal preparation. Just because the form of the food has changed, doesn’t mean eating has to be boring and tasteless,” says Wolff.

Wolff isn’t the only food professional addressing dysphagia. Peter Morgan-Jones is executive chef at the HammondCare Foundation in Australia, which operates facilities for patients with dementia, aged, and palliative care needs. He has published three cookbooks for people who have trouble chewing and swallowing, or even using cutlery; his fourth — coauthored with palliative care specialist Roderick MacLeod of the University of Sydney — is forthcoming in late May. Many of his ingenious recipes draw on molecular gastronomy, utilizing whipping cream canisters to create “molecular foams” soaked in flavor but as light as air, dissolving on the tongue.

“I first tried a foam on my friend’s son, who had been on a feeding tube for eight years,” he explains. Morgan-Jones blended fresh strawberries and ice cream, passed them through a strainer, and added a binding agent. He then frothed the liquid into a foam. “I put the bubble on his tongue and though it was full of fragrance and flavor, it just disappeared without swallowing. His eyes lit up.”

Morgan-Jones utilizes thickening agents, such as agar-agar and xanthan gum, to create gels that can be easily consumed. He offers recipes for finger food, since some individuals suffering from dementia, arthritis or neurological conditions have difficulty using cutlery. His ingenuity extends to beverages: vodka and tonic ice blocks, a jellied mulled-wine ice cube, and a jelled Scotch-on-the-rocks that can be consumed by dipping cotton swabs into the blend, freezing them and then sucking gently. “It’s a new way of having a favorite tipple,” he says.

Morgan-Jones believes the visual impression a food makes is essential: “If you present someone with dementia a bowl of orange mush, they won’t know if it’s pumpkin, carrot, or squash. But if you mold it into the shape of a carrot, or pour a puree of pear into a pear-shaped mold, it will look familiar.”

Using Morgan-Jones’ books, Peter Welfare, a HammondCare chef, created a chicken drumstick satay and a pureed fruit salad for a 51-year-old mother of two with early onset dementia. She was living on ice cream, custard and fruit, and was facing a possible feeding tube because of her difficulty eating. The pureed chicken was molded into the shape of drumsticks; similarly, the pureed fruit was set on yogurt and sculpted to look like the fruits themselves. “It was a smashing success. She ate it all,” reports Welfare.

Individuals with swallowing difficulties are often presented with a difficult choice, says Prudence Ellis, a senior speech pathologist with HammondCare. “They can eat and drink safely but lose the pleasure of food, or they can choose quality of life with delicious meals that may trigger choking or aspiration,” Ellis says.

With cookbooks dedicated to dysphagia, that impossible choice may be changing. Ellis recalls treating a passionate wine lover with dysphagia. “All he wanted for Christmas was a Shiraz, which is a popular wine made from a dark-skinned grape.” By modifying Morgan-Jones’ Scotch cotton swabs, Ellis was able to provide the patient a Christmas drink. “I brought him joy, instead of taking from him something he loved.”

Source: npr

Dinner Rolls with Pumpkin Puree and Pumpkin Pie Spice

Ingredients

2-1/2 teaspoons instant yeast
53 g brown sugar
113 g lukewarm milk
57 g softened butter
2 teaspoons salt
2 teaspoons pumpkin pie spice (or 1-1/4 teaspoons ground cinnamon + 3/8 teaspoon ground cloves + 3/8 teaspoon ground ginger)
2 large eggs
170 g canned pumpkin purée
482 g Unbleached all-purpose flour

Method

  1. Combine all of the dough ingredients in a large bowl, and mix and knead — using your hands, a stand mixer, or a bread machine set on the dough cycle — to make a soft, smooth dough.
  2. Place the dough in a lightly greased bowl, and allow it to rise for 60 to 75 minutes, until it’s puffy though not necessarily doubled in bulk.
  3. Gently deflate the dough, and transfer it to a lightly greased work surface.
  4. Divide the dough into 24 equal pieces. Round each piece into a smooth ball, or shape into knots.
  5. Lightly grease two 9″ round cake pans. Space 12 rolls in each pan. Alternatively, put all 24 rolls in a 9″ x 13″ pan.
  6. Cover the pans, and allow the rolls to rise until they’re crowded against one another and quite puffy, about 1-1/2 to 2 hours.
  7. Towards the end of the rising time, preheat the oven to 350°F.
  8. Uncover the rolls, and bake them for about 20 minutes. Tent lightly with aluminum foil, and bake an additional 5 minutes or so, until the edges of the center bun spring back lightly when you touch it. A digital thermometer inserted into the middle of a center roll should register at least 190°F.
  9. Remove the rolls from the oven, and brush with melted butter, if desired. After a couple of minutes, turn the rolls out of the pan onto a cooling rack.
  10. Serve warm. Store completely cooled rolls, well-wrapped, at room temperature for several days; freeze for longer storage.

Makes 24 rolls.

Source: King Arthur Flour


How to shape into knot:

Watch video at You Tube (0:42 minutes) . . . . . .

In Pictures: Animal Character Dishes

How Often Should You Eat Fish?

Sally Wadyka wrote . . . . . . .

New guidelines from the American Heart Association published today in the journal Circulation cement the importance of eating fish to help protect your heart.

The panel of experts who produced the AHA’s new scientific advisory on fish consumption reviewed the research that has emerged in the decade and a half since the AHA’s last issued recommendations for eating fish in 2002.

“We looked at several more cardiovascular disease-related endpoints [related to seafood consumption], including congestive heart failure, stroke, and hypertension,” says Eric B. Rimm, Sc.D., chair of the AHA’s writing group and professor of epidemiology and nutrition at the Harvard T.H. Chan School of Public Health in Boston. “Also, there is substantially more evidence now pointing to seafood intake and lower risk of coronary heart disease and sudden cardiac death—especially when the seafood replaces less healthy main dishes such as beef or pork.”

In the end, the panel found no reason to change the AHA’s current recommendations for eating fish: Have two servings of nonfried fish—especially fatty fish—per week. A serving is 3½ ounces of cooked fish or ¾ cup of flaked fish.

“The more recent data continues to support the benefits of consuming fish, preferably in place of foods high in saturated fat and low in unsaturated fat,” says Alice H. Lichtenstein, D.Sc., director and senior scientist at the Cardiovascular Nutrition Laboratory at Tufts University and a coauthor of the AHA advisory.

Why Fish Is so Good for You

It’s the omega-3 fatty acids, which are plentiful in many types of seafood, that probably confer most of the heart benefits of eating fish. “Omega-3s are important for cell-to-cell signaling in heart muscle and for cells within the lining of the arteries,” Rimm says. They reduce inflammation, help prevent heart rhythm abnormalities, improve the flexibility of arteries, and help lower cholesterol.

The advisory authors analyzed evidence from a multitude of observational studies and randomized controlled trials, looking at the beneficial effects of omega-3s on cardiovascular health. Some of the key findings include:

  • 50 percent lower risk of sudden cardiac death in those who ate one fatty fish meal a week compared with a diet containing little or no seafood.
  • People who ate one serving of fish a week had a 14 percent lower risk of ischemic stroke (the type caused by a blood clot in the brain) than those who ate little or no fish.
  • Those who consumed seafood four or more times a week had a 22 percent lower risk of coronary heart disease overall vs. those who ate it less than once a month.

Fish vs. Fish Oil Pills

If you don’t like seafood, you may wonder if you can reap the same benefits by simply popping a pill.

The AHA released a scientific advisory on this topic last year, recommending omega-3 supplements to people who’ve had a heart attack or have been diagnosed with heart failure.

But for everyone else, the authors concluded that the current evidence showed no benefit of taking fish oil supplements in preventing heart attack, stroke, or heart failure.

“The benefits of fish are likely due in part to the omega-3 fatty acid content, but may also be due to choosing fish in place of high-saturated fat foods like steak,” Lichtenstein says. “Just taking a supplement isn’t the same as making healthier choices in your diet.”

Is More Fish Better?

It’s possible that going beyond the recommended two servings a week could provide additional health benefits. But hard evidence is lacking. “There just aren’t a lot of studies that included consumption at higher levels,” Rimm says.

Based on the available evidence, the researchers concluded that much of the benefit comes from moving from very little or no fish in the diet to eating fish once or twice a week. “However, if fish is consumed four or more times a week as a substitution for other less healthy foods, then I do think that more is better,” Rimm says.

Choose Low-Mercury Fish

One downside of increasing the amount of fish you eat is potential exposure to mercury, a toxin that can affect brain development in fetuses and young children, and in excess may affect the health of adults as well.

At the same time, though, women of childbearing age (especially those who are pregnant or breastfeeding) and children are encouraged to eat fish to get the omega-3s that support growing brains, and everyone should be eating fish to boost their heart health.

“It’s healthy to eat fish, and you can even eat a lot of fish. You just need to pay attention to which fish are high or low in mercury,” says Jean Halloran, director of food policy initiatives at Consumers Union, the advocacy division of Consumer Reports. “There are acute neurological risks of too much mercury, even for adults—from mental fuzziness to tremors and loss of balance.”

The AHA urges people to choose fatty fish highest in omega-3s for their two servings a week. Its list includes salmon, mackerel, herring, lake trout, sardines, and albacore tuna.

But some of those recommendations are at odds with the Food and Drug Administration’s guidelines for women of childbearing age and children. The FDA lists albacore tuna as a “once a week choice.” And while Atlantic mackerel is low in mercury and okay to eat two or more times a week, King mackerel is a high mercury fish that the FDA recommends avoiding.

The authors of the AHA advisory did not find that mercury had any adverse effects on cardiovascular disease and concluded that the heart-health benefits of eating fish twice a week outweigh any risks, especially if you consume a variety of seafood. Rimm notes, however, that they did not look at pregnant women or children in their review of the research.

Consumer Reports recommends getting your omega-3s from low-mercury fish. Fortunately, some of these are rich sources of omega-3s: Atlantic mackerel, sardines, salmon (including canned), and trout. “Although other low-mercury fish, such as catfish, flatfish and sole, shrimp, and tilapia don’t supply as much omega-3s, they do contain some,” Halloran says.

As for tuna—the most popular type of seafood next to shrimp—Halloran notes that previous Consumer Reports analyses of mercury levels in tuna suggest that pregnant women shouldn’t eat it at all. Everyone else should opt for chunk light, which has one-third of the mercury of albacore and about one-fifth of the mercury in sushi tuna (such as bigeye), and not make tuna the only type of seafood they eat.

Source: Consumer Reports

Exergaming May Help Those at Risk of Alzheimer’s

Older adults with mild cognitive impairment (MCI), often a precursor to Alzheimer’s, showed significant improvement with certain complex thinking and memory skills after exergaming, according to a new study.

The results could encourage seniors, caregivers and health care providers to pursue or prescribe exergames (video games that also require physical exercise) in hopes of slowing the debilitating effects of those with MCI, sometimes a stage between normal brain aging and dementia.

“It’s promising data,” said Cay Anderson-Hanley, associate professor of psychology at Union College and the study’s lead author. “Exergaming is one more thing that could be added to the arsenal of tools to fight back against this cruel disease.”

The study appears in the Frontiers in Aging Neuroscience.

Previously published research by Anderson-Hanley and others found that seniors who exercise using the features of interactive video games experienced greater cognitive health benefits than those who rely on traditional exercise alone.

For the latest study, researchers wanted to target older adults diagnosed with or at risk for MCI. MCI is most common in people over age 55. By age 65, approximately 15 to 20 percent of the population shows signs of MCI, according to the Alzheimer’s Association.

Researchers initially enrolled more than 100 seniors for the study, which was funded through a grant from the National Institute on Aging. Over six months, 14 (evenly split between men and women) persisted with regular exergaming. The average age was 78.

The first group of seven was assigned to pedal along a scenic virtual reality bike path several times a week. The second group was given a more challenging task for the brain: pedal while playing a video game that included chasing dragons and collecting coins.

The special bikes were placed at a number of sites, including hospitals, community centers and independent living centers.

The results were compared against data collected from a separate group of eight seniors who played video games on a laptop but did not pedal, and also a group from the previous research who only rode a traditional stationary bike with no gaming component.

At the end of the randomized clinical trial, participants in both the group that pedaled along a virtual bike path and those that chased dragons and collected coins experienced significantly better executive function, which controls, in part, multi-tasking and decision making.

“Executive function is like the CEO of the brain. It is key to remaining independent in later life,” said Anderson-Hanley. “For example, it allows you to cook two things on the stove at once. It makes sure you don’t forget that you are boiling water while also having something in the oven.”

Benefits for both groups were also seen for verbal memory and physical function, suggesting it may be worth the effort for seniors to incorporate exergaming into a daily exercise regime.

Anderson-Hanley acknowledged that further research with a larger sample size is needed to confirm the team’s findings. One of the challenges faced was getting older adults in the habit of going to the gym or another venue to exergame. The team is working on a way to have seniors stay home and upload a video game to an iPad that can be used with a stationary bike.

In the meantime, the research suggests benefits of exercising while also stimulating the brain with some mental challenge, such as navigating a scenic bike path or interactively playing a video game.

“The goal is to explore even more effective ways to prevent or ameliorate cognitive decline in older adults by tailoring accessibility and level of mental engagement in interactive cognitive and physical exercise,” she said. “The results suggest that the best outcome for brain health may result when we do both: move it and use it.”

Source: Union College


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