A Guide to Soft and Liquidised Food for Head and Neck Cancer Patients

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1 A Guide to Soft and Liquidised Food for Head and Neck Cancer Patients Nutrition & Dietetic Service Excellent care with compassion

2 Introduction Chewing and swallowing problems can occur at different times during your illness and treatment. After head and neck surgery or during radiotherapy you may need to have a soft or blended diet. This leaflet will help you to choose foods of a more suitable texture and suggest ways to help keep you well nourished. A Soft Diet If you are able to manage normal foods but need softer textures this section will give you some ideas of foods which may help. Soft foods should be easier to chew, have no bits, be moist and can be mashed easily with a fork. The following information gives you ideas on easy soft meals, snacks and drinks. Try to have 5-6 small meals or snacks everyday. Below each section there are ideas on how to add extra nourishment into your meals and snacks. This is particularly helpful if you have lost weight or have a poor appetite. If your mouth or throat is sore it may be better to avoid foods which are very hot or very cold. Also salty or spicy foods, fruit and fruit juices may hurt. Meal Ideas For A Soft And Nourishing Diet Soft Breakfast Meals Porridge or instant oat cereals made with milk or cream and add sugar or honey to taste. Rice Krispies, Weetabix, Bran Flakes, add sugar or honey to taste and try with hot milk to soften. Thick and creamy yoghurt or fromage frais (no nuts or seeds). Baked beans or tinned spaghetti on toast without crusts. Boiled or scrambled egg or omelette (make sure the egg is cooked through). 2

3 Fruit juice avoid if your mouth is sore. Soft fruit such as banana, if tolerated, with yoghurt or cream. NB: you will need to avoid live yoghurt if on chemotherapy treatment Adding Extra Nourishment These ideas will help to increase the calorie content of your meals without increasing the bulk of your food: Use full fat milk or cream with cereals. Use full fat margarine or butter on bread. Try adding seedless jam, seedless marmalade, lemon curd or honey to bread without crusts. Try adding grated cheese to beans or eggs. Use fortified full cream milk. You can make this up by adding 1-4 tablespoons of dried skimmed milk powder to 1 pint of full cream milk. Soft Meals Soft sandwiches (no crusts) or soft jacket potatoes (no skin) with egg mayonnaise, tuna or salmon with mayonnaise, cream cheese, cheese spread, meat or fish paste, pate or mashed banana. Soups (creamed varieties) homemade, tinned or packet e.g. chicken, mushroom, pea, lentil. If packet soups are used try making them up with milk or add a sprinkle of grated cheese. Omelette try adding grated cheese. Soft scrambled, poached or boiled egg. Corned beef hash. Tinned dishes e.g. ravioli, macaroni cheese, beans, spaghetti, sardines and pilchards with sauce. Serve with bread or toast (no crusts). Fish in sauce homemade, frozen or packet. 3

4 Mashed potato with added cheese / chopped boiled egg, this can be served with gravy, beans or spaghetti. Adding Extra Nourishment Use full fat margarine or butter on bread. Add a tablespoon of milk powder or cream or some grated cheese into soup. Use full fat margarine in sandwiches, also use salad creams or mayonnaise. Try grating cheese over pasta dishes, hot pot, savoury mince, cauliflower cheese, skinless sausage, cottage pie, onion gravy and mashed potato, dahl and other pulse dishes. Soft Puddings Try to include a pudding after both meals. If you feel full, leave pudding for an in-between meals snack. Milky pudding e.g. rice, semolina, sago, tapioca. Fruit and custard e.g. stewed apple, pear, rhubarb, mashed banana. Thick and creamy yoghurt (no seeds / nuts). Mousses (avoid sugar free options). Soft fruit e.g. tinned peaches and double cream. Soft sponge and custard. Crème caramel. Blancmange or milk jelly. Fruit fool (stewed fruit with whipped cream) Fromage frais (full fat). Instant desserts e.g. angel delight or instant whip. Trifle. Ice cream or sorbet. 4

5 Adding Extra Nourishment Try making jelly with milk. Add jam, syrup, lemon curd or ice cream to milk based puddings. Add cream into custard, milk puddings, or ice cream. Drinks Spread your drinks out throughout the day. Try to avoid drinking large amounts just before meals, although sips of fluid with meals may help with swallowing. Ideas for drinks include: Full fat milk and milkshakes. Yoghurt drinks. Fruit juices e.g. orange, grapefruit (avoid if your mouth is sore). Pop or squash. Water (still or fizzy). Tea / milky coffee / Bovril or Oxo type drink. Malted drinks e.g. Ovaltine, Horlicks. Try to drink milk or yoghurt based drinks more often than tea or coffee. These provide more nourishment for you. Adding Extra Nourishment Try fortifying your milk by adding 1-4 tablespoons of skimmed milk powder to one pint of milk. Use this in your drinks, puddings, cereals, sauces, soups etc. Aim to make drinks such as coffee or malted drinks with milk rather than water. Make milkshakes using full cream milk, single cream and ice cream. Make sure all fizzy or squash drinks are not diet or low in sugar. 5

6 A nourishing blended or liquidised diet If you need a very smooth lump free consistency you will need to use one of the following methods: - Hand blender. Jug liquidiser. Food processor. It is often possible to buy hand blenders quite cheaply and these can be useful for blending small, single portions of food. Foods should be prepared and cooked as usual before blending. Adding stock, gravy, soup, milk or single cream makes them easier to liquidise. It is better to use one of the above to help obtain the correct consistency rather than water, as they will provide you with additional nourishment. Look at the savoury and sweet sauce ideas that follow: - Sauce Ideas Savoury Sweet Dried packet sauces made up with milk e.g. white sauce. Cook in sauces, creamy rather than tomato based. Undiluted condensed soups e.g. onion, celery, mushroom. Gravy or cheese granules. Fortified full fat milk (see recipe). Evaporated or condensed milk. Cream. Full fat or Greek style yoghurts. Custard. Egg custard. 6

7 Making meals more attractive and palatable Always blend meat and fish items separately from vegetables and potatoes. Serve foods of different colours at the same meal, such as brightly coloured vegetables like carrots with white fish and potatoes. Bowls may be better than plates for serving liquidised food unless you have plates with divided sections. Using a rich gravy, stock or sauce can help improve flavours. Experiment with different herbs but avoid spices, garlic and ginger if you are undergoing radiotherapy to the mouth or your mouth is sore. (see page 9 for other tips about diet during radiotherapy) Meal ideas Breakfast Strained smooth porridge or instant hot cereals made with full cream milk or cream. Wheat biscuit cereal such as Weetabix served with plenty of hot milk. Blended fruit e.g. mashed banana with milk or cream or sweetened stewed apple (with care if mouth is sore). Strained thick and creamy yoghurt or Greek yoghurt with honey or syrup, or try full fat fromage frais. Ways to add extra calories and protein Add fortified full cream milk to cereals (see recipe). Use cream or condensed milk with fruits. Add sugar to cereals or mashed fruit. Try adding honey, syrup or jam into yoghurts. 7

8 Light meals Soup blended or strained. Pasta dishes e.g. ravioli, macaroni cheese and bolognaise. Blend well and add extra sauce such as cheese sauce, cream or tinned tomatoes unless your mouth is sore. Thicken if required. Poached or scrambled eggs liquidised well. Fish blended with cheese or white sauce. Ways to add extra calories and protein Make up packet soups with milk instead of water. Add grated cheese to egg and pasta dishes. Main meal ideas Minced meat and gravy chicken, turkey, beef, lamb or pork. Remove skin, bone and gristle. Blend well with stock or white sauce when cooked. Meat dishes corned beef hash, cottage or shepherd s pie, hot pot, bolognaise sauce, casseroles. Remember to remove gristle and fat before cooking. Add extra stock, soup or gravy to blend. Pasta dishes lasagne, ravioli, spaghetti bolognaise, macaroni cheese. Blend with the sauce when cooked. Try cream or cheese based sauces. Fish dishes fisherman s pie, boil in the bag fish with sauce. Vegetarian/cheese dishes cauliflower cheese, cheese and mashed potatoes, cheese pudding, lentil bake, cheesy potato bake. Bought ready meals can be liquidised after cooking. You may need to add extra sauce or gravy. Gravy or sauce granules can be quickly made up and added after cooking. Ways to add extra calories and protein Add cream to stews and casseroles. 8

9 Try adding grated cheese into savoury dishes. Add full fat spread or butter to blended potatoes or vegetables for extra taste and calories. Hints and tips during radiotherapy During radiotherapy and for a few weeks afterwards it is best to avoid any foods which may irritate the lining of the mouth and worsen pain. This could be spices, vinegar, garlic, chilli, ginger and also fruit juices, strong or mature cheeses, tomatoes and tomato based sauces. After treatment when your mouth starts to feel better the above foods may be re-introduced carefully and may help to trigger your taste buds. If you find hot or cold foods difficult to manage, allow them to reach room temperature. Try the puddings and drink ideas on pages 5-6. If you are under the care of a speech and language therapist follow their advice regarding the consistency of food you require. Try to eat regular snacks or meals and include foods from each of the following groups each day: - Fruit and vegetables Starchy foods cereals, pasta, rice, potatoes Dairy foods Protein foods meat, fish, chicken or pulses If you are struggling to achieve this your dietitian will give you further advice on how to supplement your intake. 9

10 Are you constipated? A pureed diet can be low in fibre and lead to constipation. Try to include wholegrain cereals (see breakfast meal ideas). Make sure you are drinking enough. Aim for 6-8 cups of fluid each day. Discuss with your doctor or specialist nurse as they can prescribe medications to help keep your bowels regular. Do you have a dry mouth? If you have a dry mouth, and are able to take oral fluids try taking frequent sips of drinks (thicken if required). If allowed by your speech and language therapist you may find it helpful to try sucking ice cubes or ice lollies made up with lemonade or nutritional supplement drinks. However, sometimes the symptoms of radiotherapy could make this painful. If you are having problems with your saliva your doctor or specialist nurse can prescribe artificial saliva preparations available as a gel, spray or lozenges. Suitable high calorie drinks Nourishing drinks can be taken in between meals to help boost your intake. Ask your dietitian about the drinks available on prescription or you may like to try the recipes below. Fortified milk 1 pint or 600ml full cream milk 4 tablespoons milk powder Put the powder into a jug. Add the liquid milk gradually, stirring all the time until all the powder has dissolved. Store in the fridge. Use this in place of ordinary milk on cereals, in tea and coffee or in cooking. 10

11 Honey cup 200mls full fat milk 2 heaped tablespoons milk powder 2 teaspoons honey Warm the milk add the milk powder. Put the honey into a cup. Pour the warm milk into the cup, stirring well. Yoghurt flip 150ml full fat milk 1 heaped tablespoon milk powder 1 carton 150g creamy fruit yoghurt Whisk all ingredients together in a tall glass. Serve chilled. Fortified malted drink 150ml full fat milk 1 heaped tablespoon milk powder 3 teaspoons malted milk drink powder 2 tablespoons cream Gently heat the milk then pour onto the dry ingredients and stir well finally adding the cream. 11

Patient name: NHS Number: Dietitian: Telephone No: 01772 522467 Sources of further information www.lancsteachinghospitals.nhs.uk www.patient.co.uk www.bofas.org.

12 Patient name: NHS Number: Dietitian: Telephone No: Sources of further information Lancashire Teaching Hospitals NHS Foundation Trust is not responsible for the content of external internet sites. Please ask if you would like help in understanding this information. This information can be made available in large print and in other languages. Lancashire Teaching Hospitals is a smoke-free site On 31 May 2017 Lancashire Teaching Hospitals became a smoke-free organisation. From that date smoking is not permitted anywhere on any of our premises, either inside or outside the buildings. Our staff will ask you about your smoking status when you come to hospital and will offer you support and advice about stopping smoking including Nicotine Replacement Therapy to help manage your symptoms of withdrawal. If you want to stop smoking you can also contact the Quit Squad Freephone Department: : Integrated Nutrition and Communication Service Division: Surgery Production date: November 2016 Review date: November 2018 Excellent care with compassion

Helpful tips for people following a Soft Diet

Helpful tips for people following a Soft Diet Why do I need a soft diet? Due to the treatment you are having, you may find softer foods easier to manage if your mouth or throat is sore. This leaflet is