What is dysphagia? Dysphagia is not a disease in itself, it is a symptom that occurs with certain conditions. Individuals suffering from dysphagia have difficulty swallowing food or drinks. Swallowing is a complex process, we do it partly consciously and partly automatically. The entire process of swallowing begins when food enters the mouth and ends when the food chunk enters the stomach. Dysphagia can occur at different stages of swallowing. Some people have difficulties from the moment food enters the mouth, while for others pushing the food chunk into the esophagus is a problem. Any pathological condition that leads to a disturbance in one or more stages of swallowing (in the mouth, throat or esophagus) is called dysphagia.
- Dysphagia in neuromuscular disorders
- A prompt diagnosis of dysphagia is important
- The treatment of dysphagia
- Dysphagia and nutrition
- Two recipes from Italian cuisine
A swallowing disorder occurs in various conditions, including Parkinson’s disease, Alzheimer’s disease, ALS, tumors in the throat. It can also occur in children with infantile cerebral palsy. In addition, dysphagia may result from a decline in swallowing mechanisms due to age. Almost all people who suffer from a neuromuscular disorder (a disease of the muscles themselves or of the nerves that control the muscles) will sooner or later have to deal with a swallowing disorder.
Dysphagia in neuromuscular disorders
The symptoms of dysphagia are manifold and it is important to detect and treat the disorder as early as possible. In some patients, the beginning of swallowing is especially difficult. Food often remains in the mouth. Patients cough a lot while eating. Food or drink can come back through the nose. Other patients have the feeling of choking on food, liquid or saliva.
The symptoms are not always noticeable. It happens that the meal just takes a little longer or that the person in question starts to avoid tougher foods because they cause more problems. In the worst cases, even swallowing saliva is a problem.
In neuromuscular disorders that mainly involve muscles, the development of dysphagia is not noticeable and in the beginning changes are mainly visible in the oral phase: difficulty in preparing the food, longer meal duration, fatigue during chewing hard food.
A prompt diagnosis of dysphagia is important
Because a swallowing disorder can cause malnutrition, dehydration and aspiration pneumonia, it is very important that the disorder is detected early. Problems with swallowing often result in reduced food intake or at least an imbalance in food intake. Tougher foods such as meat are less well absorbed than softer foods. Often oral medications are not absorbed correctly. Difficulty swallowing liquids (especially in patients with ALS) can lead to dehydration. Poorly functioning swallowing mechanisms can cause aspiration (food or drink enters the airways). In addition, if the patient is already weakened due to malnutrition or dehydration, this aspiration can lead to aspiration pneumonia. The consequences of this can be fatal. Serious complications can be prevented with early diagnosis and correct treatment. To ensure proper treatment, the patient must be monitored by a team of medical experts (neurologist, physiotherapist, speech therapist, nutritionist). If they work together, they can provide appropriate treatment in the areas of care, therapy and rehabilitation.
The treatment of dysphagia
The patient is given guidelines to prevent food or liquids from entering the airways and to prevent dehydration and malnutrition:
- Adjust posture (sitting upright).
- Practicing eating techniques (eating slowly with small bites and sips).
- Choosing food with the right consistency (solid food with a homogeneous, creamy consistency, semi-solid or finely chopped food, semi-liquid or liquid food).
- Do not eat dishes with a heterogeneous consistency such as non-binding soups.
- Chew well.
- Avoid interfering factors while eating so that the patient can concentrate on swallowing.
- Observe good oral hygiene after meals to reduce bacteria in the oral cavity.
These adjustments must always be tailored to the difficulties and personality of each individual patient.
What should certainly not be lost sight of is the preservation of the pleasure of eating and the social aspect of it. The food must retain its original taste, smell and consistency as much as possible. It must be presented in an appetizing manner so that the patient continues to enjoy a meal. A meal is also a moment of togetherness and patients with a swallowing disorder often have the tendency to want to isolate themselves because of their problem. With understanding and help from people around them, they can overcome their embarrassment.
Dysphagia and nutrition
When preparing a meal for patients with dysphagia, 4 factors should be taken into account:
- The consistency of the food: solid, semi-solid or finely chopped, semi-liquid, liquid. The severity of the disorder determines what consistency is needed.
- The cohesion of the food: the food chunk must be compact. Flaky foods such as crackers should be avoided.
- The homogeneity of the food: the food must consist of small particles of the same size.
- The viscosity of the food: the viscosity allows the food chunk to slide easily down the throat and through the esophagus. Using oil, mayonnaise, cream and butter makes the food more spreadable.
In general it can be said that food that requires a lot of chewing is not suitable. Crumbly foods should also be avoided as the patient will easily choke. Suggested products include fruit puree, mashed potatoes, yoghurt, ice cream, thickened soups and bread without crust soaked in milk. Hard foods such as meat can be eaten if mixed after cooking.
Two recipes from Italian cuisine
The recipes are made for 5 portions so that there are enough portions to freeze and use later. The first recipe is intended for patients who require a liquid diet, but by mixing less the dish can be made more solid.
Cooked turkey breast fillet with green sauce
For the meat
- 500 g turkey breast
- 150 g vegetables for stock
- 100 g white beans
- pepper and salt
For the sauce
- 1 dl extra virgin olive oil
- 30 g boiled potatoes
- 30 g green pepper
- 25 g pickles in vinegar
- 25 g stale bread
- 1 tablespoon capers
- 1 anchovy fillet
- 1 teaspoon of vinegar
- a sprig of parsley
- kitchen twine
- freezer dishes
- For the sauce: boil the potatoes, soak the bread in the vinegar and blanch the parsley in boiling water. Then mix all ingredients into a thin paste.
- Add salt and pepper to taste and set the sauce aside in a sauce boat.
- Tie the turkey meat together with kitchen twine, sprinkle with salt and prepare it in the steamer or cook it in vegetable stock.
- Cook the meat for about 30 minutes and let it cool in the cooking pot.
- Boil the white beans in water with fresh herbs, skim them as they boil and add salt when they are half cooked.
- Turn off the heat when they are done and let them cool in the cooking liquid.
- Mix the turkey and beans with a hand blender or in a blender to the desired thickness.
- Adjust the thickness of the mixture by adding more or less cooking liquid.
- Add salt if necessary and divide the mixture into freezer containers per 100 g portions.
- Before serving, warm a portion in a bain-marie or in the microwave and pour the previously prepared sauce over it.
This dish can also be made with other meat such as chicken and veal.
A commonly made and tasty variant of this sauce is obtained by adding a hard-boiled egg and a pinch of mustard. If you like to add garlic to the sauce, take half a clove and remove it after an hour .
Comments and tips
- To preserve the meat’s own taste as much as possible, steaming is better than boiling.
- Beans not only make the dish creamier, they are also a source of high-quality proteins and they do not contain cholesterol. If you prefer to use potatoes or another vegetable, that is also possible.
- This dish is intended for a liquid diet, but by mixing less you can achieve a coarser structure.
- The dish can be stored for up to 48 hours in the refrigerator and for about 2 months in the freezer. Before you close the freezer containers and freeze them, pour a tablespoon of oil into each container to protect the meat from the cold.
Lasagna with meat ‘alla Marchigiana’
- 150 g egg pasta
- 250 g mixture of beef, pork and chicken
- 100 g chicken livers
- half a cup of extra virgin olive oil
- 50 g onions
- 50 g carrots
- 50 g celery
- 500 g tomato passata
- 100 g grated parmesan
- thyme, bay leaf, sage, nutmeg
- 1 dl red wine
For the sauce
- 15 g flour
- 15 g butter
- 125 cl milk
- 125 cl meat stock
- cutting board
- vegetable knife
- wooden spoon
- non-stick pan
- refractory dish
- baking paper
- Make a roux by melting the butter and cooking it together with the flour for a few minutes over low heat.
- Add the milk and stock and stir well to avoid lumps.
- Cook for 3 minutes, add salt, grated parmesan and nutmeg.
- Pour the sauce into a jar and cover with cling film to prevent a skin from forming.
- Fry the meat in a frying pan over high heat without letting it dry out. Then pour over the wine.
- Add the diced vegetables and let the liquid cook out over a low heat. To obtain a more homogeneous mixture, you can mix everything with a hand blender or in a blender.
- Add the passata and herbs.
- Cook the pasta long enough, it should not be too al dente.
- Arrange alternately a layer of pasta, a layer of bolognese sauce and a layer of béchamel sauce in an oven dish, until everything is used up, and sprinkle some more parmesan on top if desired.
- Bake in the oven at 150°. The baking time varies depending on the type of oven (convection oven or not). The dish should not dry out or become hard. That’s why it’s best to cover the dish with baking paper.
How to store/freeze?
Allow the prepared lasagna to cool and then freeze it in individual portions. The portions can be reheated in the oven or in the microwave.
Dysphagia is usually associated with neuromuscular disorders. If dysphagia is treated early and correctly, serious complications can be avoided. It is possible to deal with dysphagia in a positive way. Even with a swallowing disorder, you can enjoy a tasty meal in good company!