The two most important items in making food for the person with dysphagia, or swallowing difficulties, are method of cooking and method of puree. This post is a guideline to the best tools for making perfect puree.
In the summer of 2015, I attended the Florida Academy of Nutrition and Dietetics Symposium in Orlando, Florida. I had a booth and I introduced my book to the thousands of students and professionals who gathered for the theme of Nutrition and Aging, and discussed Essential Purée with many dietitians. I met with the brilliant Dr. Dee, a nutritionist who is also a graduate of the Culinary Institute of America. Dr. Dee is a fine chef. I explained to Dr. Dee that I wished to make some food available to the patient with swallowing difficulties and that I believed this could be done with mindful preparation and common sense.
Dr. Dee and I agreed that the home cook could apply the techniques of gourmet food preparation long recognized in the high traditions of cooking in Europe to create smooth purees of any food item, so that it could be incorporated into the diet of the person with swallowing disorders. The secret is in the technique. The technique makes use of classical kitchen tools and also new kitchen appliances that have come on the market in the last few years. If a food is puréed correctly, it should not contain fiber, seeds or skins, or any texture that would make a swallow difficult. Once properly puréed, the food may be thickened or thinned according to individual needs.
This chapter suggests kitchen tools that eliminate problem textures and create a smooth puree. The smooth puree is for ease of swallow. The idea is to prevent the patient from coughing and aspirating food or liquid into the lungs and causing an infection known as bacterial pneumonia. This type of infection is life-threatening and it is difficult to cure.
Note: The most important feature of the National Dysphagia Diet, NDD, at all levels, is texture. The National Dysphagia Diet emphasizes the fact that the diet is not one size fits all. For the purposes of this book, I am speaking now of the Level 4 diet of the NDD. This is the pudding consistency. Patients on the Level 5, Modified Soft Diet, and Level 6 diets, the Soft Diet, may consult their healthcare providers for determining individual guidelines for puréeing to achieve textures allowed in their diets. These are prescribed according to individual medical histories. The following suggestions on creating puree should be cleared with your healthcare provider, the dietitian, the speech language pathologist, the physician.
The Five Tools for Making Perfect Puree
The High Speed Commercial Blender
The Vitamix, the Nutribullet Rx or the NutriNinja are three of the most popular varieties. These have very powerful motors and very sharp, specially engineered blades. They have the capacity of breaking down cell walls of ingredients to achieve a completely smooth consistency. This includes whole grains such as rice and quinoa.
The Pressure Cooker
These have the ability to reduce protein to a smooth moist texture in a shorter amount of cooking time. (When I refer to a pressure cooker, I mean one of the new electric pressure cookers that are computerized and completely safe. I am not referring to the old-fashioned stovetop pressure cookers that are so scary.)
The Potato Ricer
Once a vegetable is pressure cooked, or cooked by any other method that renders it tender, such as steaming, the potato or the hard squash or the soft beet, can be put through the potato ricer and created in small grain like textures that can then be mashed with milk or broth or any other cooking liquid for a smooth puree. The potato ricer is a press that holds a cup of potatoes that have been cooked to tender. The potato goes in the holder, the handle is pressed down, the potato comes out like grains of soft-cooked rice. This produces velvet-y mashed potatoes when combined with butter and milk or cream.
The Food Mill
This is the staple gadget of the French housewife. It is used for eliminating any roughness of texture from any vegetable ingredient or any soup or sauce. You put a small amount of food in the well of the cone shape and you twirl the handle. A blade circulates, forcing the food through a sieve, leaving behind large particles that will not go through the sieve. The milled food has a very smooth texture with no lumps. This produces the most glorious gravies and sauces.
The Mesh Sieve and Silicone Spatula
Put any food item that has been puréed in a food processor or a blender through the mesh sieve with the metal spatula and any and all particles not suitable will be left behind. The sieve can also be lined with cheesecloth. This is especially good for removing the seeds from fruits such as strawberries, raspberries and kiwi. See the Essential Puree shopping guide on the website for pricing and ordering information.