THICK PUREED DIET ADVICE (TEXTURE C)

LEICESTERSHIRE NUTRITION & DIETETIC SERVICE ADULT SPEECH AND LANGUAGE THERAPY SERVICE THICK PUREED DIET ADVICE (TEXTURE C) Name Dietitian Tel:.. Speech and Language Therapist. Tel: Hospital / Clinic. Date.. Pureed Diet Advice June 2016

MAIN POINTS 1. You will need to liquidise and sieve or blend your food 2. It needs to be smooth 3. You should try to have lots of different foods in your diet 4. Some foods don t puree well ( see page 3) INTRODUCTION If you are having difficulty with chewing or swallowing your food, or coughing during or after eating, you may need a pureed diet. It is important that you keep eating lots of different types of food to make sure you get all the vitamins and minerals that your body needs to stay healthy. This advice leaflet will give you ideas on what to eat to keep your meals a smooth consistency, as well as advice on how to get the most out of your meal times. Many people find it difficult to keep their weight steady while eating a pureed diet. This information sheet will give you ideas on how to make your meals as nourishing as possible, to stop you losing weight and help you gain weight if you need to. WHAT IS A PUREED DIET? A pureed diet consists of foods which are very soft and moist that has been pureed in a liquidiser or food processor and passed through a sieve, to leave a single consistency with no lumps or bits. The mixture should be soft and moist enough to just about drop off a spoon. Mix in extra thick sauce, e.g. cheese sauce, or gravy to make the right consistency. Each food should be pureed separately to maintain different flavours. It should hold its shape on a plate. Any sauce / gravy should be the same thickness as the food. 2

FOODS TO AVOID / TAKE CARE WITH Most foods will be fine to use once they have been put through a liquidiser and sieved. However the following is a list of foods that do not puree well. 1. Bread 2. Peas, green beans, baked beans, kidney beans, sweet corn. These will all need to be sieved after puréeing as the skins do not liquidise down well. 3. Very dry foods e.g. hard cheese, meat without sauce or gravy, biscuits 4. Raw vegetables such as celery and salad Ice cream and jelly may NOT be recommended if you are also having thickened fluids check with your Speech and Language Therapist. PRACTICAL TIPS We all have to eat and for most of us it is an enjoyable experience, often involving family and friends. Eating a pureed diet will mean a change from your normal routine, but by following these ideas you can still enjoy your food. 1. Have a wide range of foods. This will provide you with lots of different nutrients to keep you healthy and also stop you getting bored. 2. Make the food look appetising. Purée each food separately so it keeps its own colour and flavour. 3. Once you have pureed hot food, warm it up again in a pan or microwave, as pureeing will make it cooler. It will also warm up cold foods so if you are making milkshakes etc, chill the food or drink in the fridge before serving. 4. Mix with a fork before serving to make sure liquid is not separating out and to achieve one texture. 3

5. Eat in a quiet relaxed atmosphere and take your time. 6. Make sure you swallow each mouthful before you take the next mouthful. If you feel that some food is still at the back of your throat, swallow again before continuing to eat. 7. If you are eating out, let the restaurant know beforehand that you need a special diet and what your requirements are. Most places will be happy to cater for you. If you know you take longer to eat think about ordering a main course and ask for that while everyone else is eating their starter. You may then be ready for dessert at the same time as everyone else. 8. If possible, weigh yourself once a week. If you are losing weight or your appetite is poor, please make sure you are following the ideas on page 7. Your Dietitian or Speech and Language Therapist will be happy to help you, so please give them a ring if you are worried or have any questions about your diet. PREPARING AND SERVING YOUR FOOD Equipment you will need All food needs to be sieved but some may not require pureeing or processing beforehand e.g. thick, smooth soup. A hand blender can be used for small quantities of food; otherwise a food processor or liquidiser would be useful. Presentation Make your meals look appealing by using foods that are different colours. Foods that are light in colour, such as chicken or fish, are better served with brightly coloured vegetables such as carrots or broccoli. 4

Thickening foods Once you have pureed your food you may need to thicken it, if this has been recommended by the Speech and Language Therapist. You can use things such as mashed potato (must be really smooth, no lumps), cornflour, custard powder, ground rice, jelly crystals / gelatine, grated cheese, instant sauce, tomato juice or gravy granules, as well as the thickening agent you may be using for your drinks (if recommended by your Speech and Language Therapist). Flavours Herbs, spices or lemon juice can help improve the flavour of foods. Tips You may find it easier to prepare food in bulk then store in your freezer. Make sure that the food is defrosted thoroughly at room temperature before reheating. BALANCED DIET You should try to have foods from each different food group everyday: Protein foods: try to have one of these twice per day pureed meat or fish in sauce pureed beans, lentils or pulses cheese in sauce Starchy foods: have a food from this group at least 3 times per day Ready Brek, instant porridge e.g. Oat so Simple or Weetabix with warm milk mashed potato (no lumps) or pasta, rice with a sauce (jacket / baked potato (no skin) is a better texture i.e. easier to swallow than boiled & mashed potato for patients with a tumour in the oesophagus as less tacky). ground rice pudding, semolina or custard 5

Vegetables: which will cook until soft and can be pureed, e.g. carrots turnips cauliflower broccoli parsnip swede Fruit: try to have 2 portions of fruit a day which can be stewed or tinned and pureed e.g. mango apple (without the skin) tinned peaches or pears or fruit which can be pureed and sieved if necessary or put in a drink e.g. banana or strawberry milkshake. Dairy products: try to have the equivalent of at least 1 pint of milk per day 1 smooth yogurt (no bits) = ⅓ of a pint 30g/1oz cheese = ⅓ of a pint Use full cream varieties and wherever possible make custard, semolina or ground rice with full cream milk. Fatty & sugary foods: add more of these foods if you need to gain weight e.g. butter, oil, cream, margarine, grated cheese, sugar, honey or syrup. Make sure you puree and sieve everything you need to. 6

PROBLEMS YOU MAY HAVE Poor appetite/weight loss If you have a small appetite or find that you are losing weight you should make your foods more nourishing. There are some ideas below on how to do this: Useful tips: 1. Try to have small meals/snacks often i.e. 6-8 per day. 2(a). If you are not able to manage a full meal try instead to have a milkshake, soup or pudding to which you have added e.g. Complan. (These are available from the chemist or supermarket.) 2(b). If you are struggling to cook or shop on a regular basis, make use of convenience foods which require very little preparation (see store cupboard ideas on page 17). 3. Take only sips of drinks with a meal, as these can be quite filling. Remember to have additional drinks between meals /snacks. 4. Extra nourishment can be added to your food in different ways, e.g. use full cream milk to make milk puddings, milky drinks and sauces add 2-4 tablespoons of milk powder (e.g. Marvel ) to 1 pint of full cream milk. Use this in hot drinks, puddings, mashed potato (no lumps) and sauces add grated cheese to vegetables, potato, soups and sauces add extra butter / margarine /oil to sauces, potatoes, vegetables and pasta use double cream in soups, sauces, potatoes and puddings, e.g. custard add extra sugar, syrup, jam or honey into puddings, drinks or cereals ensure meals are pureed with nourishing fluids e.g. gravy or sauces, not just water 7

5. If you continue to lose weight then please ring your Dietitian for some more advice. Note: Remember to thicken all drinks and foods if advised by a Speech & Language Therapist. BREAKFAST PUREED MEAL IDEAS Ready Brek, porridge or Weetabix (well soaked and sieved) with full cream milk and sugar Pureed fruit and full fat smooth yogurt BETWEEN MEAL SNACKS Milky drink such as Ovaltine, Horlicks or Complan Nb. may need to be thickened, check with your Speech & Language Therapist Pureed stewed fruit Full fat smooth yogurt, custard pot or soft pudding (see pudding list on next page) SNACK AND MAIN MEAL IDEAS Cream of tomato soup (smooth, no bits) Other smooth soups that have been pureed or sieved Note: soups need to be of a thick consistency or thickened, if necessary, as per the Speech and Language Therapist s recommendations Hard-boiled egg, mashed and mixed with salad cream / mayonnaise to a soft, moist paste Smooth pâté Cauliflower / broccoli cheese, well cooked and pureed 8

Cream cheese mixed with tomato puree Minced meat, cooked with root vegetables (no onion, tomato skins or peas), pureed and sieved Sieved tinned fish mixed with mayonnaise (e.g. tuna, salmon) Boil-in-bag fish with sauce which has been sieved and blended The above could be served with creamed or instant mashed potatoes (no lumps) well cooked pureed pasta well cooked rice pureed with sauce or with your main dish e.g. curry And pureed soft vegetables with butter, gravy or sauce For more ideas, see recipe ideas at end of leaflet PUDDINGS Yogurt, smooth with no bits Fromage frais, smooth with no bits Mousse with no nuts e.g. chocolate Blancmange Instant Whip Stewed or tinned fruit which has been pureed and sieved Mashed banana, mixed with cream, evaporated milk or custard Custard (thick) Sponge pudding with pureed fruit, mashed well with custard Crème caramel Ground rice pudding, smooth and not runny Fruit smoothies (these may need sieving) Milkshakes Make all desserts where applicable, with full cream milk 9

SUGGESTED MEAL PLAN Breakfast Instant porridge or Ready Brek made with full cream milk and sugar. Mid-morning Milky drink such as Ovaltine, Horlicks or Complan. Midday meal Pureed mince and gravy, mashed potatoes, pureed vegetables, custard or smooth yogurt. Mid-afternoon Pureed stewed fruit and thick cream or custard. Evening Meal Pureed cauliflower cheese, mashed potatoes, mousse. Bedtime Smooth yogurt, custard, fromage frais or milky drink. PUREE FOOD DIETARY ADVICE MAIN MEALS IDEAS Cauliflower Cheese 4 servings 500g (1lb) cauliflower 1½ dessert spoons (1½ x 10 ml spoon) corn flour 450 ml (¾ pt) milk 120g (4oz) grated cheese 30g (1oz) butter Salt and pepper to taste 1. Remove leaves from cauliflower. Divide into florets and boil in salted water until tender. 10

2. Mix the corn flour with a little of the milk in a large jug. Pour the remainder of the milk into a saucepan. 3. Boil the milk; remove from the heat and pour, stirring all the time, into the blended corn flour. 4. Return the milk and corn flour to the pan and simmer for 3-4 minutes, stirring continuously, until thickened. 5. Remove from heat and stir in the cheese and butter. 6. Drain the water from the cauliflower. Place the florets and cheese in the liquidiser until smooth. 7. Divide into 4 servings. 8. Serve 1 portion and freeze the remaining portions, when cooled, for use later. Macaroni Cheese 1 serving Small tin (210g / 7 oz) pasta in cheese sauce e.g. macaroni 1 dessert spoon (1 x 10ml sp) corn flour 1. Place contents of the tin into the liquidiser with corn flour. 2. Liquidise until completely smooth then heat gently in a saucepan until thickened, stirring constantly, and serve. You may require slightly more or less corn flour depending upon the make of pasta cheese. Cod Mornay 2 servings * 90g / 3oz poached fish, without bones * 150-210ml (5-7 fl oz) ordinary savoury sauce e.g. standard white or cheese 60g / 2oz mashed potato per portion * suitable alternative frozen fish in sauce 1. Liquidise together. Divide into 2 equal portions. Add all the mashed potato to one portion and serve. 2. Freeze the remaining portion for use later. 11

Mediterranean Minced Beef 8 servings 250g / 8oz minced beef 30g /1oz margarine 30g /1oz flour 300ml /1½pt water or beef stock 1 dessert spoon (1 x 10ml spoon) tomato puree ¼ - ½ x 5ml spoon / ¼ - ½ tsp (1 x 5ml) mild chilli powder Salt and pepper to taste 60g / 2oz mashed potato 1. Fry the minced beef in the margarine in a deep pan until brown. 2. Add flour and stir well until mixed in. 3. Slowly add water or stock, stirring continuously. 4. Add tomato puree, chilli powder and seasoning. 5. Bring to the boil, reduce heat and simmer for 15-20 minutes, stirring occasionally. 6. Remove from heat, transfer to a food processor and process until smooth. 7. Take 45g (1½oz) portion of liquidised minced beef and mix with 60g (2oz) mashed potato and serve with pureed vegetables. [NB: You can increase the quantities of each depending on your appetite e.g. 90g (3oz) pureed beef with 120g (4oz) potato]. 8. Divide the rest of the meat mixture into equal portions and cool completely before freezing for use later. Minted Lamb As Mediterranean Minced Beef but using lamb instead of beef and replacing the tomato puree and chilli powder with 1-2 x 10ml spoon / 1-2 dessert spoon of mint jelly at stage 4. Pork with Apple 1-2 servings (As Mediterranean Minced Beef) Omit the tomato puree and chilli powder. Instead add ½ stock cube, crumbled into the meat mixture at stage 4. 1. Follow to stage 6. 12

2. Then take 90g / 3oz cooked minced pork, liquidised 2 x 5ml spoon / 2 tsps. apple sauce 90-150 ml / 3-5 fl oz gravy 90g / 3oz mashed potato 3. Mix all ingredients until smooth. 4. Serve with pureed vegetables. Pureed Vegetables 1 serving 60g / 2oz cooked vegetables e.g. carrots, swede, cabbage (either fresh or frozen) 30-60g / 1-2 oz mashed potato or made-up instant potato 1. Take cooked vegetables and liquidise with a little stock or water, if necessary, until smooth paste like consistency is reached. 2. Sieve if necessary and mix with mashed potato to ensure a smooth thick consistency. Note: Peas, sweet corn and beans (e.g. broad, butter, red kidney) must be sieved after liquidising as skins can make the food difficult to swallow. SOUPS Spicy Tomato Soup Fry some chopped onion in a little oil with garlic paste, salt, chilli powder and ½ teaspoon of sugar. Add either tinned tomato soup or a tin of chopped tomatoes with desired amount of water and boil vigorously to reduce. Mash the tomatoes and liquidise before serving. Add cream if you need the energy. Potato & Tomato Soup 1 serving 60g / 2oz made up instant potato 60ml / 2 fl oz cream of tomato soup Knob of butter, salt and pepper to taste. 1. Make up the instant potato following the instructions on the packet. 2. Blend by hand or in a liquidiser until smooth. 13

3. Heat the soup and butter in a saucepan until it begins to boil. Remove from heat. 4. Mix potato and soup together to a smooth consistency. Add salt and pepper to taste and serve. Note: Any remaining cream of tomato soup from the tin can be frozen in 60ml / 2fl oz portions for use later, if desired. Tinned Soup 1 serving 120ml / 4fl oz of your favourite tinned soup 15g / ½ oz corn flour 1. Liquidise soup and sieve to remove any lumps. 2. Blend corn flour in a little water until smooth and stir into the soup. Heat through until thickened, stirring constantly and serve. DESSERTS Rice Pudding Add spice such as nutmeg to tinned rice pudding and liquidise. Stewed Fruit e.g. Stew apples/rhubarb/mango and liquidise. Serve with thick custard, extra thick double cream. Apple Dessert 1-2 servings 200ml / 1/3 pint apple puree 2 teaspoon / 2 x 5ml spoons of caster sugar 2 rounded teaspoons / 2 x 5 ml spoons corn flour, mixed in a little water to a paste. Heat puree until just bubbling, add sugar and cornflour and stir rapidly until thickened. Serve hot or cold. 14

Banana Whip 2 servings 2 bananas 2 tablespoons / 2 x 15ml spoons natural yogurt 60g / 2oz cottage cheese 1 tsp / 1 x 5ml spoon honey 1 tsp / 1 x 5ml spoon lemon juice 1. Peel and roughly chop the bananas. 2. Place the bananas, yogurt, cottage cheese, honey and lemon juice in the liquidiser. Liquidise until smooth. 3. Divide into 2 servings, serve one and refrigerate the second serving for up to 24 hours. DO NOT FREEZE. Note: Try fromage frais in place of the yogurt. Sweeten to taste with sugar. Apricot Dessert 1-2 servings 454g tin of apricots in syrup 3 rounded teaspoons / 3x 5ml spoons corn flour, mixed in a little water to a paste. 1. Drain the syrup from the fruit. 2. Liquidise the fruit with 60ml / 2fl oz of the fruit syrup and sieve, if necessary, to make a smooth puree. 3. Heat the apricot puree until just bubbling, add corn flour and stir rapidly until thickened. Serve hot or cold. Fruit Bake 3-4 servings 500g / 1lb cooking apples, peeled, cored and sliced. 30g / 1oz dates, stoned and chopped 30g / 1oz caster sugar 3x15 ml spoons of water / 3 tablespoons 30g / 1oz suet 60g / 2 oz fresh wholemeal breadcrumbs 30g / 1oz soft brown sugar 300ml / ½ pint custard. 15

1. Grease an oven proof dish. 2. Layer apples, dates and caster sugar in dish and add the water. 3. Mix together the suet, breadcrumbs, brown sugar and sprinkle on top of the fruit. 4. Bake at 180ºC, 350ºF or Gas mark 4 for 30-40 minutes until golden brown. 5. Liquidise hot fruit bake with custard. 6. Divide into 3-4 portions. Serve one and refrigerate the rest. NOT SUITABLE FOR FREEZING. Note: You can use other tinned fruit, such as peaches or pears in this recipe. Tinned Milk Pudding 2-3 servings N.B. Tinned semolina milk pudding may be eaten cold without thickening or liquidising. 210g / 7oz tinned milk pudding (e.g. rice, tapioca, sago, macaroni) 1 dessertspoon / 1 x 10ml spoon cornflour 1 dessertspoon / 1 x 10ml spoon original or flavoured Complan powder. 1. Liquid the milk pudding with the cornflour and the Complan powder. 2. Gently heat in a saucepan until thickened, stirring constantly. 3. Divide into 2-3 equal portions. Freeze into 2-3 equal portions. Note: You may need slightly more or slightly less cornflour depending on the make of the milk pudding. Consider adding spice such as nutmeg to tinned rice pudding for added flavour. Custard 4-6 servings 100g / 3½ oz custard powder 60g / 2oz granulated sugar 600ml / 1pt milk 16

1. Blend the custard powder and sugar with a little cold milk until smooth. 2. Heat the remaining milk and when nearly boiling stir into the custard powder mixture. Return to saucepan and heat through until thickened, stirring constantly. Use by itself as a custard or mixed with liquidised and sieved fruit of your choice to make fruit fools. You could also use tinned or packet custard. Note: If necessary add milk powder, cheese, cream, butter, syrup, sugar into recipes see page 7. STORE CUPBOARD IDEAS Suitable convenience foods to keep in your store cupboard are: tinned mince meat, corned beef tinned fish tinned or packet soup (without bits) tinned cream/evaporated milk Ready Brek /porridge oats custard/instant whip/milk puddings tinned fruit (to make milkshakes) instant mashed potato pasta/pasta sauces tinned vegetables gravy granules milk powder Build Up Complan Note: The above ideas can also act as a suitable alternative to some of the items listed in the recipes section and can save on preparation and cooking time. Make sure that you puree and sieve anything that you need to. 17

WEIGHT CHART Some people find it useful to write down their weight. If you would like to keep a record of your weight you can do that here. There is no need to weigh yourself more than once a week. Try to weigh yourself on the same scales at the same time of day each week. Date Weight Developed and Produced by Nutrition and Dietetic Service, University Hospitals of Leicester NHS Trust Updated by Leicestershire Nutrition and Dietetic Service and Adult Speech and Language Therapy Service Crown Copyright Nutrition and Dietetic Service, University Hospitals of Leicester NHS Trust June 2016 LNDS079 Access our website on www.lnds.nhs.uk 18