I love food. One of my favorite spots in Missoula is the Good Food Store. It's packed with local, clean, fresh, real food. It has giant windows that look out at the trees. People gather to work, to talk, to shop, to connect, surrounded by beautiful food and the smells of fresh cooking. It reminds me of how vital food is to being human.
When I look at the options of foods that are available for people with dysphagia, I see a lot of preservatives and sugar and artificial flavors. Look at any ingredients list for a product from healthcare food industries designed for people with unique nutritional needs and you will likely find them packed with artificial flavors, processed oils, preservatives, and unpronounceable ingredients.
Why is it that for the people who need the cleanest food, we are offering the most processed foods? As one woman in the National Foundation of Swallowing Disorder's Dysphagia documentary put it, "It looks like liquid plastic... and you're just drinking it 7 times a day."
I know the reasons for this in healthcare settings: Sanitation, consistency, convenience.
But... we can do better! Especially for patients who find thickened liquids intolerable (trust me, I would be the most annoying patient you ever had if you put me on thickened liquids). There are so many REAL, TASTY, REFRESHING ways to prepare thickened liquids. Sure, we must enter the grey zone... when using fresh fruits and vegetables to make a thickened smoothie, we don't have a black and white set of instructions telling us how to make it exactly nectar thick or exactly honey thick.
But our job is not to teach people how to take powders and mix to a perfect consistency. Our job is to provide education about the risks of aspiration and then come up with creative solutions that are individualized, safe, hydrating, nutritious, and ultimately what will keep aspiration at bay. It's not an exact science and draws on the three pillars of evidence-based practice: published articles, clinical expertise, and patient values and preferences. A handout designed to teach patients how to make these will be included in the July 2018 Therapy Fix.
One of my favorite techniques lately is making thickened popsicles. Simply Thick uses xanthan gum as its main ingredient. Typically derived from corn, xanthan gum is produced when a glucose, sucrose, or lactose is fermented by bacteria. The product is a gummy substance used as a thickener and stabilizer in recipes and packaged foods from salad dressings to ice cream. When rehydrated by liquid, xanthan gum swells to alter the consistency of a product. The great thing about xanthan gum is that this consistency, once reached, is highly stable, even if you freeze it and melt it.
Check out this video for how to make thickened popsicles:
Notes from the video:
- Any ingredients can be added to make the popsicle, and SLP guidance is necessary to determine how best to puree/thicken the ingredients before freezing.
- The best smoothie ingredient options are fresh/frozen fruits and vegetables with low water content and creamy textures, such as bananas, avocados, greens, mangoes, etc. If you do need moisture to get it to blend, stick to oils that are naturally creamy like coconut oil, or yogurts thickened with xanthan gum, which are more stable and less likely to separate into a thin liquid
- These popsicle molds are on Amazon. You can find them here:
Ozera 150 Pack Popsicle Molds Bags, Disposable DIY Ice Pop Mold Bags for Gogurt, Ice Candy, Otter Pops or Freeze Pops. BPA Free and FDA Approved Popsicle Bags Maker - Comes With A Funnel
- If you're looking for re-usable popsicle molds, check out:
Ouddy Silicone Popsicle Molds Durable Ice Pop Molds Popsicle Maker, Assorted Color, Set of 6 with Lids