Ready to Serve! “46 Food Recipes that Help to Train Swallowing” from Chula’s Faculty of Allied Health Sciences – A Collection of Recipes for Both Sweet and Savory Dishes for the Aged who Have Trouble Chewing and Swallowing Their Food

A lecturer from the Faculty of Allied Health Sciences, Chulalongkorn University has worked with the Thai Dietetic Association to research and develop innovative food and beverages for the aged and patients who have difficulty chewing and swallowing their food.  A total of 46 nutritious recipes for swallowing training are based on the IDDSI (The International Dysphagia Diet Standardization) so that the elderly can enjoy nutritious meals and stay healthy.

Our food might taste good and endowed with nutritional value but if a patient cannot swallow their food or have difficulty swallowing their food then they are meaningless.  This often happens to many elderly persons who lose their appetite for food which might be the result of their difficulty in chewing and swallowing food.  With a better understanding and proper preparation of the dishes served to the elderly, they should be able to resume their appetite and enjoy better physical health and well-being.  

“Once you get older and are plagued by oral health and hygiene problems along with other physical conditions that affect the ability to chew and swallow food you can lose your appetite and this eventually leads to malnutrition and other health problems,” Varanya Techasukthavorn of the Department of Nutrition and Dietetics, Faculty of Allied Health Sciences, Chulalongkorn University explained the problem that has been increasing and is now becoming an increasingly crucial subject in a full-fledged aging society such as Thailand.                                   

“There are also patients suffering from brain and neurological conditions, strokes or cancer in the head and neck with side effects caused by the treatment such as stomatitis that causes mouth sores which means they can only eat very soft, mashed food.” 

For this reason, Varanya and her research team have worked with the Thai Dietetic Association to develop a food and beverage innovation concentrating on the aged and those with the problem of difficulty in chewing and swallowing along with instruments to test how appropriate the food or beverage was and a “46 Menus to Train Swallowing According to International Standards (IDDSI) – Thailand’s first cookbook for caregiving of the elderly and those with difficulty swallowing. 

“We hope that this research will help make it easier for the elderly and other patients to eat their food and be ensured of adequate nutritional value and improve their appetite.”  The head of the research team explained the objectives of her research.

How difficulties in chewing and swallowing food can be dangerous

Varanya also mentioned the ill effects on health for those with difficulties chewing and swallowing their food saying that “if food isn’t properly swallowed, it can get into the windpipes instead of the esophagus, and can damage the lungs or even lead to death in some instances.”                                        

There can also be long-lasting effects for example “in the case of old people, when swallowing becomes increasingly difficult they lose the desire to eat and loss of appetite can eventually lead to malnutrition, weight loss and ultimately their overall health and well-being.”

How to assess chewing and swallowing problems

Assessment of chewing and swallowing problems is the job of a professional most of whom follow the two main guidelines:  

  1. Bedside Swallowing Assessment is a basic method that uses food and drinks to test how a patient swallows and whether they experience choking.   
  2. Videofluoroscopic Swallow Study; VFSS is the best standard practice used to assess difficult swallowing where the patient is tested by swallowing food that is mixed with Barium, an opaque substance, to observe the movement of food and drinks with different levels of viscosity before it enters the esophagus.                                          

Other than this, assessments can be taken by way of a simple questionnaire called EAT-10 in the more basic cases with questions such as whether one experiences pain repeatedly after consuming food or drink, etc.

Innovative devices to test food and drinks for those faced with difficulties chewing or swallowing

Aside from testing chewing and swallowing capabilities for the aged and sick persons there is another way to help those faced with such conditions which is to prepare food that is suited for them.  For this reason, the National Metal and Materials Technology Center of the National Science and Technology Development (NSTDA) led by Dr. Chaiwut Gamonpilas, and the Thai Dietetic Association of Thailand have worked together on the Research Project for the Development of Testing Devices for IDDSI. 

According to one of the members of this research project, this innovation is very important.  “For those faced with difficulties swallowing even plain water can sometimes be impossible for them.  So, preparing food with very fine texture and drinks with high viscosity can help reduce the risks they face and delay the time needed for swallowing to ensure safer consumption.”   

The “Fork Pressure Test” is the first test developed to determine whether or not the texture of certain foods meets the International Dysphagia Diet Standardisation Initiative (IDDSI).  A fork is pressed into the food item to find whether the texture is soft enough for the person to chew or swallow.    

There is also the Syringe flow test which is classified according to the drinks with the least.  Some of the methods for testing include the Flow Test.

46 recipes for food that train swallowing” – what to prepare for the elderly

From the research and development of tests for food and drink appropriate for those with problems chewing and swallowing, the Thai Dietetic Association has developed this recipe book that compiles food and drink specifically for such needs.                                                    

As the editor and chairperson of the sub-committee for the development of standards of food used to train people to swallow Varanya tells us that “food that trains people to swallow is a rather new concept in Thailand.  The standards for this type of food did not exist before and this is the first recipe book that compiles all the recipes that comply with IDDSI standards.”

 “All the recipes here are derived from the concepts and suggestions compiled from medical practitioners and patients who have told us what it is they would like to have.  The Top 5 in the survey are Palo Egg Stew, Hainanese Chicken Rice, Stir-fry with basil, Tom Yum soup with shrimps and stir-fry pumpkin with eggs,” Varanya said.                                                                                                                                  

“Once we came up with the meals from the survey, we then developed the foods with the kind of texture and viscosity suitable for the elderly and computed the nutritional value to get the food and drinks with high energy and protein.  The food should also have an appealing appearance similar to what they eat in everyday life to boost the patient’s appetite.”

The recipes have been tested with patients in many hospitals both in Bangkok and other provinces.

Frozen products for those with problems swallowing

In the future, this research will be expanded to include semi-processed high-protein foods and desserts like orange or strawberry-scented puddings that make it easier for the elderly to swallow nutritious foods.

To download the 46 recipes for IDDSI standard foods access  
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