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I-Can't-Chew CookbookDelicious Soft-Diet Recipes for People with Chewing, Swallowing and Dry-Mouth Disorders
By J. Randy Wilson
Hunter House Inc., PublishersCopyright © 2003 J. Randy Wilson
All right reserved.
Chapter OneThe Science of Nutrition Today
by Linda Yoakam, M.S., R.D., L.D.
Nutrition is an ever-growing science of how the body uses food. Experts in nutrition are continually learning more about the foods we eat. Not only how foods serve to maintain basic health, but also how these same foods can enhance health. Even for those restricted to a soft-foods diet it's possible-and equally necessary-to follow a health-promoting diet. Although it may require careful planning to do so, a soft-foods diet can include adequate amounts of all the vital nutrients and can adhere to generally accepted guidelines for healthful eating.
Experts in the science of nutrition have grouped nutrients into six classes. The three classes of nutrients that provide energy (calories) are the most abundant, were the first to be identified, and are the most well known of the nutrients; they are carbohydrates, proteins, and fats. In the twentieth century, particularly from the 1940s to 1960s, another class of nutrients was discovered: the vitamins. Vitamins are organic compounds necessary for life. They do not provide calories and are used by the body only in small amounts. There are fifteen known vitamins. Ten of them are described in the next chapter, "More Nutritional Information." The other five are easily obtained in a normal diet; deficiencies in them are rare or unknown. During the 1900s, research also occurred into the importance and roles of various minerals. There are thirteen essential minerals. The six major minerals in terms of amounts needed are described in the next chapter. And finally, but most importantly, there is the nutrient water. All six of these classes of nutrients are required to sustain and nurture life.
Basic Nutritional Guidelines
As the science of nutrition expanded to identify these essential nutrients, research continued in the area of how much of each nutrient is needed. Guidelines were first written for minimum intakes to prevent deficiency diseases. But intakes recommended for the prevention of disease were not thought to be enough to meet all of the body's needs, so in 1943, the RDAs (Recommended Dietary Allowances, written by the Food and Nutrition Board of the National Research Council) were established to maintain the health of a population group. The RDAs continued to be reviewed and rewritten as new research was made available; they were last rewritten and released in 1989. Now, for the twenty-first century, the guidelines come from the National Academy of Sciences' Institute of Medicine and are called the Dietary Reference Intakes (DRIs). The DRIs are designed to meet the needs of individuals who are healthy and free of specific diseases or conditions that may alter their daily nutritional requirements. There are DRIs for all classes of nutrients, except water; different amounts are given for different age and sex categories. DRIs for healthy adult women and men are included in the next chapter.
All of this is a lot to remember for any individual deciding what to eat at any particular meal. No single food provides all the needed nutrients. The variety of nutrients required by the body needs to come from a variety of foods. To help in the selection of a healthy variety of foods, several guides have been developed. The USDA Food Guide Pyramid is the current recommended guideline for Americans.
The pyramid divides foods into six groups, based on the types of nutrients they contain. These groups are listed below (recommended serving sizes of the various foods are included in parentheses):
Bread group-Includes breads (1 slice), ready-to-eat cereals (1 ounce), cooked cereals (1/2 cup), cooked rice or pasta (1/2 cup). These foods are rich in B vitamins, iron, fiber, and complex carbohydrates. Six to eleven servings per day are recommended. These foods form the base, or foundation, of the pyramid, because they should form the base, or foundation, of a healthy daily diet.
Vegetable group-Includes all cooked or chopped raw vegetables (1/2 cup), and raw leafy vegetables (1 cup). Vegetables are good sources of many vitamins and minerals, particularly vitamin A, vitamin C, folate, and dietary fiber. Three to five servings daily are recommended.
Fruit group-Includes all fresh (1 piece), frozen or canned fruits (1/2 cup), and fruit juices (1/2 cup). Like vegetables, fruits are good sources of a variety of vitamins and minerals, as well as fiber. Two to four servings per day are recommended. Fruits, with vegetables, form the second layer of a good diet.
Milk, yogurt, and cheese group-Includes milk or yogurt (8 fluid ounces), and hard or soft cheeses (1 or 1 1/2 ounces). Foods in this group provide protein, calcium, riboflavin, vitamin D, and other minerals. Two to three servings daily are recommended.
Meat, poultry, fish, dry beans, eggs, and nuts group-Two to three servings daily are recommended of these protein-rich foods that also provide zinc, iron, and other nutrients. One serving is two to three ounces, much less than what is consumed in the typical American diet. That is why this group makes up a much smaller portion of the pyramid.
Fats, oils, and sweets group-This group includes cooking oils, salad dressings, margarine or butter, desserts, candy, and other sweets. Foods from this group should be used sparingly as they contribute to illnesses such as heart disease, cancer, tooth decay, and obesity.
The science of nutrition continues to expand. The DRIs and the Food Guide Pyramid were not enough. The U.S. Department of Agriculture and the U.S. Department of Health and Human Services produced the Dietary Guidelines for Americans to promote the use of nutrition to prevent diseases. The Dietary Guidelines are revised every five years, and were last issued in 2000. The current guidelines were written to help people find ways to enjoy food while at the same time taking action to promote good health. They are built around three basic messages, with several specific suggestions contained within each of those three fundamentals:
A-Aim for fitness:
* Aim for a healthy weight. * Be physically active each day.
B-Build a healthy base:
* Let the pyramid guide your food choices. * Choose a variety of grains daily, especially whole grains. * Keep food safe to eat.
* Choose a diet that is low in saturated fat and cholesterol and moderate in total fat. * Choose beverages and foods to moderate your intake of sugars. * Choose and prepare foods with less salt. * If you drink alcoholic beverages, do so in moderation.
Today, research is also occurring in the areas of phytonutrients and probiotics. The term phytonutrients refers to organic compounds in foods (just like vitamins) that are not essential (unlike vitamins, which are essential), but are thought to be good for health. Examples of phytonutrients include isoflavones (estrogen-like compounds contained in soy foods) and carotenoids (which give color to fruits and vegetables, and may protect against heart disease, some cancers, and macular degeneration). Much further research in this area needs to be undertaken, but studies so far are promising. For now, consumption of phytonutrient-rich foods such as fruits, vegetables, grains, and tea would be prudent.
The term probiotics refers to the beneficial or "good" bacteria naturally occurring in foods. A possibility exists that these may help prevent or treat such bacterial illnesses as vaginal yeast infections and diarrhea. Initial studies have shown mixed results, but nutrition is an evolving science.
Chewing Difficulties May Mean Different Nutritional Needs
The basic health principles established in the DRIs, the Food Guide Pyramid, the U.S. Dietary Guidelines, and the new areas of phytonutrients and probiotics are applicable regardless of one's ability to chew food. However, all these guidelines were written to apply to essentially healthy individuals and to prevent the sorts of "lifestyle-related" illnesses that are the most common causes of death and chronic poor health in the United States-conditions such as obesity, heart disease, stroke, diabetes, and certain types of cancer. Chewing or swallowing difficulties can develop with oral surgery, worn or poor-fitting dentures, cancers and their therapies, temporomandibular joint syndrome (TMJS), or as a result of stroke, multiple sclerosis, Parkinson's disease, Alzheimer's disease, and a host of other illnesses. An individual suffering from one of these conditions may have nutritional needs that differ somewhat from the goals of the guidelines outlined above. A cancer patient undergoing chemotherapy, for example, may need to focus more than the average person on boosting calories and protein intake. General suggestions for how to modify cooking and eating habits to accommodate difficulties chewing and swallowing-including pointers for boosting calories, protein, and fiber-are provided in Chapter 3, "Tips for Getting the Most Out of Meals." If you are restricted in your ability to chew, consult with your doctor or a dietician or nutritionist about your particular dietary needs. Do you need to concentrate on eating as much food as you can? Or, like most Americans, do you need to be careful to avoid exceeding a healthy caloric intake? A diet that does not require chewing can be just as healthy as one that does require chewing. Whatever your specific nutritional needs, this book aims to help you achieve a healthy diet.
Chapter TwoMore Nutritional Information
Body Mass Index (BMI)
The body mass index (BMI) is a measurement of weight as it compares to height. Instead of height/weight tables, BMI is the measurement now used by most nutritionists, medical researchers, and government agencies to determine whether an individual's weight is appropriate for his or her height.
Use the following steps to calculate your BMI:
* Divide your weight in pounds by your height in inches (e.g., 140 ÷ 65 = 2.154)
* Divide that number again by your height in inches (2.154 ÷ 65 = 0.0331)
* Multiply that number by 703 (0.0331 x 703 = 23.27)
* Locate your results below:
18.5 to 24.9-healthy weight
25 to 29.9-overweight
30 to 39.9-obese
(Children and pregnant women have different BMI guidelines.)
The drawback with BMI is that it fails to take into account one's body composition-that is, the ratio of muscle to fat. For that reason, a professional athlete may register a BMI above 25, not because he or she needs to lose weight but rather because his or her body composition has an unusually high percentage of muscle. Nevertheless, in terms of health, BMI is a useful guide for most adults.
Recommendations for calories were revised with the Fall 2002 publication of the DRIs. These are for people of normal weight; they are not designed for use with a weight-loss program. The caloric recommendations given below are based multiple factors, including age, sex, weight, and, new to this edition, activity level. There are four levels of physical activity in the new guidelines: Sedentary, or about the same as resting; Low Activity, or only using about 10 percent more calories over resting; Active, or using slightly under 25 percent more calories than resting; and Very Active, or using almost 50 percent more calories than resting. Increasing one's activity or exercise level to meet the Active calorie level improves cardiovascular and overall health and allows for plenty of healthy food choices. The recommended calorie intakes for Active people are listed below:
1-3 years 992 cal 4-8 years 1,642 cal 9-13 years 2,071 cal 14-18 years 2,368 cal >19-years 2,403 cal (subtract 7 cal per day for each year above 19)
1-3 years 1,046 cal 4-8 years 1,742 cal 9-13 years 2,279 cal 14-18 years 3,152 cal >19-years 3,069 cal (subtract 10 cal/day for each year above 19)
Chapter ThreeTips for Getting the Most Out of Meals
Dealing with Problems Swallowing and/or Chewing
by Debra Mestas, R.D.
When swallowing or chewing is made difficult because of dental or medical problems, it is easy to get into a habit of limiting food selections. An inadequate diet often occurs in these situations. To maintain adequate nutrition under such circumstances, consider the following recommendations:
* Cut or grind food into appropriate-size pieces, and put them into a cream sauce or mix them with other foods, as in a casserole
* Make rich soups of creamed or blended meats and vegetables, or of dried beans, peas, lentils, or soybeans
* Add eggs and cheese to increase protein
* Use mashed or puréed fruits and vegetables or their juices
* Cook hot cereals in milk instead of water
* Use gelatins, ice creams, puddings, custards, and milk shakes
To Boost Protein
* Add dry skim-milk powder to regular milk, sauces, gravies, and puddings. Add extra ice cream to shakes, and half-and-half or evaporated milk to instant cocoa, soups, or puddings
* Add grated cheese to casseroles, vegetables, sauces. Blended cottage cheese makes a great dip
* Add finely chopped eggs to sauces, casseroles, and meat salads. Prepare beverages and desserts that use eggs, such as eggnogs or angel food cake
* Add chopped or puréed meats to soups and casseroles
To Boost Calories
* Melt margarine or butter onto hot toast, cereals, vegetables, rice, or eggs
* Use sour cream on potatoes, meats, or fruits
* Use cream cheese on bread and fruit
* Use mayonnaise instead of salad dressings
* Put peanut butter on apples, bananas, celery, carrots, and breads
* Top puddings, pies, hot chocolate, gelatin, and fruit with whipped cream
* Use honey, candies, and jelly, but only as a supplement to nutritious foods
To Boost Fiber
* Use whole-grain breads and cereals
* Use unpeeled apples and potatoes
* Eat oranges and grapefruit and their unstrained juices
* Add sunflower, sesame, poppy, or pumpkin seeds to salads, breads, and other foods
* Make soups with dried beans, peas, lentils, or soybeans
* Add dates, raisins, figs, or dried apricots to hot cereals, cakes, and muffins
* Make carrot or cabbage slaw with pineapple and raisins
* Add broccoli, cauliflower, and corn to soups and casseroles
* Top sandwiches and salads with alfalfa or bean sprouts
* Eat more sliced tomatoes, and use more tomatoes in sauces and soups
* Snack on popcorn
* Add fresh parsley to salads
Enhancing the Dining Experience
Besides following specially adapted recipes, there are ways to increase mealtime enjoyment despite the restrictions imposed by a soft-food diet. The following are some pointers to consider:
Pay attention to atmosphere: A table set attractively with candles, flowers, or a decorative centerpiece can make any meal more enjoyable. So can dining with friends, playing background music at mealtime, and varying the place in your house where you eat.
Make up your own recipes: Try ice cream or sherbet mixed with ginger ale or your favorite carbonated beverage. Create your own version of a milk shake, frozen yogurt, or eggnog.
Eat a number of small meals during the day.
Vary the color of foods served: Arrange the food attractively on the plate. Add garnishes, such as an orange wedge, a slice of tomato, a sprig of parsley, or a sprinkling of chopped cilantro.
Purée foods in a blender or food processor: If you like soup, for example, heat it and then blend it. Food tastes better if it is cooked before it is blended, and it is also easier to blend warm food. Beware, however, of the fact that hot food expands suddenly when blended. To avoid a mini-explosion when you turn on the blender, blend food that's warm rather than hot, and blend only small amounts at a time. Cut meat into small pieces and add gravy prior to blending.
Serve soft foods: Try mashed potatoes, yogurt, scrambled eggs, poached eggs, egg custards, milk shakes, puddings, gelatins, creamy cereals, and ice cream.
Try tilting your head back or moving it forward to make swallowing easier.
Rinse your mouth regularly: Doing so will remove debris, stimulate your gums, lubricate your mouth, and put a fresh taste in your mouth.
Don't ignore your food cravings: If you're hankering after a favorite food that cannot be puréed, satisfy your desire by simply placing a small piece of the food in your mouth. That way, you still get to savor the flavor.
Excerpted from I-Can't-Chew Cookbook by J. Randy Wilson Copyright © 2003 by J. Randy Wilson. Excerpted by permission.
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