Whether you are a seasoned kitchen goddess or a kitchen goddess in training like myself, you will find that when it comes to Parkinson’s disease all bets are off! Undoubtedly, you have found yourself countless times like myself feeling “on” or “full of energy” one moment only to realize that at that crucial moment when lunch or dinner time arrives and family is depending on you for sustenance you have completely worn off! Or you were so busy getting over the side effects of the medications that by time you settled into feeling “normal” meal time had fast approached and you forgot to defrost the meat!
Or perhaps you are the care-partner and you find yourself spending all morning caring for your loved one; taking to doctor, talking to medical staff, tending to their personal needs that you do not have time to plan a meal but they must eat to not only to stay healthy and nourished but also to ward off medication side effects.
Now, imagine that the doctor has informed you that you must change your or your loved ones diet to a Dysphagic one because you or your loved one has progressed to the point were swallowing is compromised!
You ask yourself; what now? I am already at wits end…I don’t even know what is a Dysphagic diet or how to follow one….first of all Dysphagia means to have difficulty swallowing which can result in chocking, aspiration, dehydration and malnutrition.
Signs include drooling, chocking, pocketing (holding food in cheeks), gagging, slow swallowing (taking-longer than 2- 10 sec to swallow). This all occurs as a result of increase stiffness and rigidity in the chewing and swallowing muscles as Parkinson’s disease progresses.
According to NDD (National Dysphagic Diet)- there are 4 categories into which Dysphagic diet is classified- individuals must be able to consume soft, moist food which can be formed into bolus easily (either because they have enough saliva and strength of chewing muscles to do on their own or be provided to them in this form!).
NDD 1 ( dysphagia puréed ) all foods must be purred and thickened to a pudding like consistency – must be lump free and little or no chewing required. – patients are end stage PD typically have very stiff and weak muscles!
NDD2 ( Dysphagia mechanical altered ) all foods soft, moist and easily chewed…meats are ground and served with gravy and sauce. Cooked breakfast cereals and pancakes. Moistened with syrup. Tuna and egg salad in is category. Some chewing required. Patients are having severe fluctuations typically and have unpredictable wearing “off”.
NDD3 ( Dysphagia advanced) most food consistency allowed except no dry, sticky, hard or crunchy . Food must be moist and bite size. Meats must be tender and cereals moist. Lettuce can be served if shredded. Patients are mid stage PD are just slow or fatigue easily so take a lot longer to eat!
NDD4 regular diet – no restrictions.
When to initiate dysphagic diet?
At the first sign of drooling or gagging with medications ( solids ) ask ask doctor for evaluation with speech therapist (ST) and start the Lee Silverman program – not only will this help strengthen your voice but will also strengthen your chewing and swallowing muscles only down side that in order to be effective you must commit a month of your time almost daily! I guarantee this will be very beneficial especially if you continue to reinforce and do exercises at home and go back to program every few years as disease advances. Sometimes ( more often than not) this has to be done in conjunction with medication adjustment – the goal is to prevent aspiration, pneumonia and hospitalization!!! If you or a loved one are already experiencing difficulty with swallowing liquids as well, aside from thickening the liquids with honey or fiber you and your doctor may need to consider alternative treatments like feeding tube temporarily while meds are adjusted and ST program is completed to prevent airway and malnutrition!
As with any PD symptoms, it is of the utmost importance to have a team approach involving physician, nutritionist, speech therapist, and caregiver (sometimes it may involve evaluation by other specialist like GI or ENT to rule out obstructions in the esophagus or reflux disease which can cause swallowing difficulties. It is not entirely uncommon for a Parkinson patient who has a lot GI dysfunction like nausea and vomiting due to meds to develop gastritis and reflux especially if severe these can cause marked trouble with swallowing even burning vocal cords!
Many PD patients who have trouble swallowing often have diminished appetites – to prevent malnutrition it is the job of the caregiver to enhance food flavoring and appearance with things like attractive divided dishes.
Also to prevent aspiration and decrease fatigue, it is recommended that small bites be taken each time, chewing multiple times before swallowing with all diets in PD. Also take frequent sips of water/liquids to wash down food.
Patients who have restrictions to thin liquids should also avoid Jello, ice-cream, and Popsicles because these melt quickly in the mouth and cause chocking! A company called RESOURCE has several products that are thickened like coffee, water, dairies, and juices…this is just one of many…vendors! You may also use honey to thickened liquids or replace with nectar juices!
To all Parkinson’s patients, independent of stage of disease or swallowing status, I suggest you invest on a crock pot ….particularly if you are the one in charge of meal preparation. This simple act will not only save you time in your busy schedule but will help decrease your fatigue by having one less thing to worry about each day! IT will allow you to look like a pro with little effort! Plus, you can make as much or as little as you want to store for later. This will also serve to enhance your marriage! For, in my experience nothing makes a man happier than coming home to a hot meal!
Furthermore, you can attend to the care of your loved one if you are the care giver while food cooks or you can take those 5 minutes of rest which I mentioned in a prior blog as being crucial in keeping fatigue down and at same time vital for building inner and outer beauty. But, the best thing about owning a crock pots is you can make any type of meal including soups, vegetables, dips, desserts, appetizers, meats and casseroles…and these can be adjusted for all types of swallowing diets! Once you prepare food in the pot you can then Puree the food separately if need be……How to Purée food-
most solid foods can be puréed as long as excess fiber, fat, pits, and bones are removed and use lots of broth. Peppers, tomatoes and beans can also be puréed. Pureed Meat will taste better if tomato sauce is added to the blend instead of water. If you drizzle puréed vegetables on top of puréed meat, this will also enhance flavor. condiments like ketchup, mustard, mayonnaise, sour cream, sorbets, blended grits, cooked oatmeal, cooked cereal or brown sugar can be used for taste.
Oranges and apples can be peeled prior to placing in food processor.
Still feeling overwhelmed and not sure you can do this? If you are like me and just not creative enough or inventive to think of Recipes other than a pot roast in a crock pot…I suggest you also invest in another great recipe book ( <$20.00) that will serve you well as it has me for years! This book is called: "Anybody can cook in a crock pot" by Debbie Thornton…..Who actually is well acquainted with Parkinson's since she was a caregiver to one of her parents ( I believe her father had PD for years).
Rule # 5 :Always start with desserts which is the antidote of stressed (stressed spelled backwards!) – best if it contains dark chocolate -your brain will doubly appreciate it since is full of dopamine and flavonoids which protect your brain because of their anti-oxidant properties! 🙂
My easiest recipe is Chuck Roast
1 4-5 pound boneless chuck roast
1 onion, chopped
1 garlic clove crushed
3-4 small red russet potatoes
2 carrots chopped
2 celery sticks chopped
1/2 teaspoon salt
1/2 teaspoon pepper
1/2 cup water
1/2 tablespoon whole black peppercorns
1 can 8oz tomato sauce
1 tablespoon of bay leaves
1/2 teaspoon celery salt
Place roast, onion, potatoes, celery, carrots in crock pot -place crock pot liner first for easy cleaning and storing if you have left overs.
Pour other ingredients on top.
Cook on Low for 10 hours or High for 5 hours.
Remove roast and shred serve with extra juice (au jus); purée potatoes and carrots with milk and butter and add extra salt to taste if need NDD3,2
If NDD1 once shredded blend and add juice, water and celery;
Also blend potatoes and carrots; may want to put some mixture of potatoes and carrots on top of meat to make it more flavorful…
Dr. M. De Leon is a retired movement disorder specialist,
PPAC member and research advocate for PDF; Texas state assistant director for PAN (Parkinson’s Action Network).
You can learn more about her work at http://www.facebook.com/defeatparkinsons101
you can also learn more about Parkinson’s disease at http://www.pdf.org or at http://www.wemove.org