There are approximately forty medical reasons for the condition of dysphagia (or swallowing difficulties) that call for the patient to begin eating a regimen of pureed food. I have detailed the conditions in Essential Puree.
The CDC says that one million people a year are diagnosed with the condition. According to the CDC, 15 million people in America have a swallowing disorder. That is a lot of people. There are many medical specialists who treat these patients.
Most swallowing disorders come about through neurological disorders related to aging: Alzheimer’s, dementia, Parkinson’s, stroke. some are related to disease; and some are related to accidents: motorcycle, automobile, boating, sports and industrial accidents. Some are related to paralysis and disability. Some are related to digestive disorders. Some are temporary and some are permanent. These condition are not related to age, but may occur at any time of life. It is tragic to think of losing one of life’s greatest pleasures, the pleasure of good eating.
In my mom’s case, dementia related to age was the cause of her swallowing difficulty.
War injuries are of many kinds and are often overlooked. I had a letter from a young serviceman returning from a war zone. He had been shot in the neck and could not eat solid food. He ordered a copy of Essential Puree: The A to Z Guidebook and he began making the recipes and feeling better from nutritional healing, he was happier.
The designer in the print shop who created my letterhead told me that her stepson had been in a motorcycle accident and needed to eat pureed foods. She bought a copy of Essential Puree for him, hot off the presses.
The maitre d’ at a restaurant where I attended an alumnae event told me that his sister needed the book because she was in chemo for cancer treatment.
These are people who need puree because of illness. But there is the health and fitness crowd who desire pureed foods by choice rather than necessity. These people who are trying to improve their health by losing weight, detoxing and cleansing or just plain trying to control their food in a fast food world.
The manager of my whole foods store recommended the cookbook to someone who had gastric bypass surgery as a means of getting control of obesity. He used the cookbook to get him through the post-op period.
This same manager told me that many people with digestive issues seem to have an easier time with pureed foods.
Take note: Healthy people may have a reason for wanting pureed food.
The very talented guy who did physical therapy for my mother had extensive oral surgery. He couldn’t eat solid food. He had a copy of the Guidebook and he made pureed meals. He was grateful because he had originally been drinking fruit juices and he was starving.
My banker saw a copy of the book and told me he wanted to lose weight. He wanted to escape the fast food and vending machines at his bank, a branch in the suburbs. He liked the fact that the calorie and nutrition count per serving were provided. He was watching his food intake. He was heating up the meals in the microwave in the bank’s break room. He told me proudly that he had lost ten pounds.
A friend of mine had a plastic surgery procedure, a facelift, and could not eat solid food for a week. She got the Guidebook; she made the pureed food and drank it through a straw. It got her through the post-op period.
Another friend of mine is a mother with children in grade school. She is always on the run. She thinks of the Essential Pureeblended meal as a smoothie of rocket fuel. She can take it with her and sip it in the car. It beats the fast food joints. She can even take it to the gym, so she has a protein supply after a workout. She thinks this is better than downing a protein sports shake that solves the protein problem but is unsatisfying to her.
An investment banker friend of mine is always taking a plane to some far corner of the world. He grew tired of eating airplane food, airport meals, and take-out food from delis.
This man had been eating in five-star restaurants all over the world and was familiar with the pureed vegetables that top chefs had been serving as side dishes. He liked the puree.
He thought he could bring pureed food in a portable container and he found out about the airline regulations: three 3 oz. containers were allowed by TSA regulations. He brought the food in the approved containers in a zip-lock bag.
The covered containers had good seals and did not open in his briefcase or his carry-on. For the road warrior in him, the pureed meal was a salvation.
The new routine saved him mental energy—he did not have to think about getting food in airports. It was also a time-saver. He knew the food was high quality, scrumptious and had the virtue of being clean eating. He had control of his food.
In other words, perfectly healthy people might choose to eat pureed foods for reasons of convenience, health, and fitness.
We are honored to be featured in a 5-page spread in the January issue of Harbor Style Magazine.
In it, Diane talks about why she developed a line of cookbooks, and how to create a pie crust puree that is safe for the swallow, and tastes just like a pie crust. Here’s a short excerpt:
Who’s Says You Can’t Puree Pie Crust?
Diane Wolff, the Queen of Puree through circumstance, if not birthright, says you can. Wolff can puree anything. Want a nice piece of pie that goes down easy? She’ll bake it crust to topping. She’ll puree it and serve it layered in a lovely carafe. And it will taste good.
Wolff, a Port Charlotte woman with rapid-fire speech and hands that keep time, has written the book on pureeing food – everything from a steak to a banana cream pie. In fact, she’s written several. Thyey cover the spectrum of a subject that was bland until she put the prism to it.
“You’re going further than a bowl of mush,” she said.
She has gone much further, in fact. Through necessity, Wolff created a line of cookbooks for caregivers of those with a condition called dysphagia, or diffculty swallowing. The disorder affects eating, drinking, taking oral medications and brushing teeth.
Here is the big secret of Essential Puree: The single most important ingredient for a great puree is the sauce.
Nothing glorifies a holiday meal more than a tasty gravy. It is an excellent medium for puree.
This recipe is flexible. You can use it with or without pan juices from a roasted bird. You can make your own stock or buy store bought. This one is mushroom and thyme based. The secret ingredient is the rich taste of a good lower sodium soy sauce.
The dysphagia patient will never be bored with the food when the puree is made with a homemade gravy. The homemade gravy makes the taste buds sing. Also, most store-bought gravies are very high in sodium in order to achieve flavor. At home, you use the artistry of the kitchen instead of an overload of salt.
Yield: Single recipe yields two one-half cup servings of gravy.
1 cup mushrooms, preferably Baby Bella, Oyster, Chanterelle, Maitake or Morel. If you have nothing else, white button mushrooms will do.
4 tablespoons oil, can be extra virgin olive oil, coconut oil, walnut or canola oil
1 teaspoon fresh thyme, minced
2 tablespoons Wondraflour, from the supermarket
1 cup simmering water or warmed lower sodium broth of your choice
Pan juices from roast turkey, chicken, pork. If you have roasted any of these, especially if you have roasted a turkey with vegetables in the bottom of the pan, such as carrots, onions and celery, with broth and herbs.
2 shots of lower sodium soy sauce (optional)
Mince a handful of baby portobellos or any combination of mushrooms
A cup of mushrooms is the correct amount for a cup of broth. Double the recipe for more gravy for a crowd. If your healthcare provider permits it, you can use half broth and half white wine.
Cut off the nubby end of the stem and wipe the mushroom clean with a damp paper towel. Slice the mushrooms into medium slices. You may remove the stems and chop them in the warmed liquid, creating a more intense flavor, a mushroom stock.
Saute mushrooms in 1 tablespoon olive oil.
Add 1 tsp. minced fresh thyme from the herb garden. Alternatively, a pinch of dried thyme will work.
Mushrooms will soak up the oil. Add the second tablespoon of oil if the pan gets dry. If you’ve added more oil and the pan continues to get dry, use a tablespoon of broth, one at a time. This will impart flavor to the mushrooms.
(The choice for Essential Puree is always lower sodium broth when using store bought broth. Not every cook has time to make the broth at home, although it is well worth while to put this on your cook’s schedule.)
Remove mushrooms from pan with any juices and reserve in a bowl. Season with salt and pepper.
In the sauté pan, add two tablespoons oil and two tablespoons Wondraflour and brown the flour.
This is your roux, the classic thickening agent. When roux has browned, about a minute and a half, slowly add one cup simmering water. Whisking is a good idea. Stir or whisk as you go, careful to keep the gravy free of lumps.
Add mushrooms back to gravy. Cook for about six minutes on a slow simmer, whisking or stirring, to allow gravy to thicken and cook out the raw flour taste. This finishes the cooking of the mushrooms.
Add broth and continue stirring. The liquid will thicken in the pan. It will bubble. At this moment, add a secret ingredient. Add a shot or two of lower sodium soy sauce for color and flavor. The gravy will be done. It will be homemade and delicious. You can always add a tablespoon of minced fresh parsley to a finished gravy for color.
For the Puree
For four ounces of protein, use about a quarter cup of gravy adding more if needed. I recommend using a quarter cup of mashed potato, mashed sweet potato or stuffing, along with the protein and gravy, to get a smooth puree. You adjust the amount of the carb and gravy to achieve your desired thickness, according to your level of the National Dysphagia Diet.
Note: Dried mushrooms such as porcini will work. Follow the directions for rehydrating on the package. Save the rehydrating liquid and use it in the gravy.
Note: I use Wondraflour because it is light and contains rye flour and gives a good quality gravy. Also, it has less tendency to lump. Use any flour you like, including pastry unbleached whole wheat flour. A finer flour eliminates the bran.
Note: If you are gluten free, use rice flour or even coconut flour. Both of these are very light and will whisk in nicely without lumps. If you wish, you may even use a sieve to sieve the flour into the warm oil, to make sure there are no lumps. This is, however, an extra step.
I wanted to create a recipe that tasted like the classic Latin comfort food, but was safe for the dysphagia diet.
The great secret to puree in the Essential Puree Guidebook is that the sauce is the medium of flavor. This dish has a flavorful sauce. I intentionally added a little more liquid than was necessary to create a flavorful sauce for the puree. As I say to the purists in all the cuisines represented on the Essential Puree blog posts on this website, it is better to have a tweaked version of the dish for the dysphagia patient than not to have the dish at all. This is as close to the Cuban recipe as I can get.
This is how I adapted the classic dish to puree: Instead of using a whole chicken cut up into pieces, I used boneless and skinless breasts. One could use boneless and skinless thigh meat or a combination of the two. Also, it is difficult to puree chicken skin, so it has been eliminated from this dish. This shortened the cooking time. I cubed the chicken and used the classic technique of Chinese cooking, the stir-fry.
I used an electric wok. You can use a good skillet with good heat conduction on the bottom. The pieces of chicken cooked faster and remained tender, and, as an added bonus, they were also the perfect size to place in the blender or food processor for puree. Annatto, found in the spice aisle of the supermarket, is traditional to color the dish. One can use saffron, although saffron is more expensive. Annatto is generally used in the Americas.
I have found that many ingredients in dishes prepared in the dysphagia kitchen are best prepared separately, and then combined for maximum flavor. The reason for this is insuring that the texture is correct. You have to make allowances in the cooking process in order to have a smooth texture, in the final product, with no issues for the swallow.
I cooked the rice in an electric pressure cooker before adding it to the chicken and sofrito for the final 10 or 15 minutes of cooking. When using an electric pressure cooker for rice, follow the instructions for the rice. Cuban recipes call for Valencia rice, but this is a white rice colored with saffron or annatto. I use brown basmati rice because it has a softer outer coating on the rice grain but is a whole grain. The choice is up to the cook.
The other cooking method for making tender rice that is safe for the swallow is in the mini rice cooker or regular rice cooker. Either of these tools helps in creating a tender whole grain rice. Fluff with a fork. Taste. Make sure your rice is very tender, without a fibrous husk.
Note: Every family has its own version of this dish. Please tweak the ingredients to suit your family tradition. The sofrito is the flavor base for the Cuban kitchen and other cuisines of the Americas as well. Various cuisines of the Americas add different ingredients to this dish, such as olives or capers. There is no reason you cannot get clearance from your healthcare provider to include regional or national variations of the sofrito and the dish.
Because I cubed the chicken, I did not need as long of a cooking time as for the traditional preparation. By cubing the chicken and pressure-cooking the rice, the two components can finish at the same time. The tender rice finishes in the sauce and absorbs the flavor. This technique insures the correct texture for the safe swallow.
I did use a cup of white wine, but broth could be substituted if the individual is restricted from alcohol. I used lower sodium vegetable broth on the day I tested this in my kitchen, but chicken broth is traditional. I used red pepper bruschetta topping packed in olive oil, a tablespoon or two. This added richness to the dish to make up for the flavor lost in eliminating the skin. Usually one uses jarred pimentos. Again, the choice is up to the cook. Tweak to suit your palate.
If the person with swallowing disorders lives in a family setting at home, and your household makes this dish for the family in the traditional way, for the puree, simply remove the meat from a piece of chicken in the desired portion for the loved one. Puree it in a good blender or food processor until it is smooth. Add sauce or broth to achieve the desired consistency. Add rice and veggies. That’s the secret to the puree.
Prep Time: 15 mins – Cook Time: 30 minutes – Total Time: 45 minutes
3 skinless and boneless chicken breasts, about 2 pounds, cut into one-inch cubes.
6 ounces of Valencia or basmati rice (the amount of the cup for the mini rice cooker)
Sliced red pimientos for garnish, or ½ jar of red pepper bruschetta topping from diLallo or some other similar purveyor
1 cup frozen green peas (Petit Pois) for garnish
1 tsp dried oregano
1 tsp ground cumin
½ tsp white pepper
1 Tbsp red wine vinegar
Sofrito and Broth:
2 Tbsp olive oil
1 small onion, finely chopped
1 small red bell pepper, cored, seeded and finely chopped
3 cloves garlic, minced
1 small tomato, seeded and diced
2 cups broth, vegetable or chicken
1 cup dry white wine
½ tsp annatto seeds, or ¼ tsp saffron threads
1 Tbsp tomato paste
Salt and white pepper, to taste
6 ounces of Valencia or basmati rice (the amount of the cup for the mini rice cooker) or 1 cup for an electric pressure cooker
Sliced red pimientos for puree Or ½ jar of red pepper bruschetta topping from diLallo or any similar purveyor
1 cup frozen green peas (Petit Pois) for garnish and puree
First marinate the chicken: Combine oregano, cumin, white pepper and vinegar in a large stainless steel bowl. Add the chicken and stir into the marinade. Place in the refrigerator for 30 minutes.
Rice Prep: Wash the rice until the water runs clear. Place the rice and double the amount of water plus double the amount of water and a pinch of salt in the electric pressure cooker. Use the timing recommended by the manufacturer for your type of rice. I use forty to forty-five minutes for brown basmati rice. The time is shorter for white rice. When the timer dings, allow the pressure to come down or vent to bring down the pressure. Fluff with a fork. Allow rice to stand while you prepare the chicken part of the dish. I stress the softening of the rice to allow for a smooth puree with no harsh parts of the rice grain left in the food. To me this is preferable to using cream of rice recommended by some experts. The whole grain contains more nutrients and fiber, both good for the patient if the swallow is safe.
Prepare the dish: Heat the oil in a large electric wok on high. Sear the chicken, stir-frying, about five minutes. Transfer the chicken to a plate, leaving behind any oil and fat.
For the sofrito: Add the onion, bell pepper and garlic to the oil in the casserole, cook over medium heat until soft, but do not brown, 3 minutes. Add the tomato, and cook for one more minute. Return the chicken to the casserole with the sofrito, and cook for about 2 more minutes.
Add the rice. Add the water, wine, saffron, tomato paste and salt and pepper. When the rice and chicken boil, reduce the heat, cover and simmer for 15 minutes. Five minutes before the dish is done, add the frozen peas. Turn off the heat and allow the dish to cool.
For the Puree
When the arroz con pollo has cooled, place a cup of the dish, with extra sauce, in the bowl of a mini food processor or the pitcher of a blender. Pulse a few times to get it broken down. Then puree until the mixture is smooth. Place in a dish and serve. This dish has a nice color.
Purees of Winteris a collection of recipes of comfort foods for winter, for the person with dysphagia, or a swallowing disorder.
It is also a guide to new techniques for cooking the comfort foods of winter. As such, it is an original for the dysphagia kitchen.
This is the time of the year when the weather is cold if you live up north. Even if you live in warmer climates, the days are shorter. One spends more time indoors.
We here at Essential Puree believe in eating seasonally, using the fresh produce available in the markets. We celebrate the seasonal ingredients of root vegetables and whole grains and legumes, peas for pea soup, lentils for lentil soup, and kasha for the classic cooked buckwheat. Substituting frozen vegetables means that good ingredients are always on hand, and allows for variety.
The slow cooker is the featured cooking method of winter. Purees of Winter introduces the electric wok for making hot pot or shabu-shabu. This is a traditional technique—the idea is that the loved one can make the dish to suit the individual taste.
A dish made in the slow cooker is nourishing to the soul. The smells of the dish fill the house and the person with the swallowing disorder engages senses that are critical to the enjoyment of the meal. Soups and stews may be made in batches of six servings in the slow cooker, so the extra servings may be frozen. A warming meal or snack is always on hand.
The volume also presents a few recipes using the rice cooker, sometimes called the multi-cooker. This volume includes a recipe for an iconic dessert, a rice pudding made in the rice cooker. This is an easy version of a dessert that may be created to suit individual taste.
This eBook contains recipes for quickie soups using the blender with a heat function.
These kitchen appliances are inexpensive and worth the investment for the dysphagia kitchen. They simplify the cooking task with a minimum of cleanup. Food is Medicine. Food is Love. That’s the Essential Puree system.
Kitchen Hack: How To Batch Cook And Freeze | Fall Cooking | Whole Foods Market - YouTube
Here at the Essential Puree Kitchen, we believe in saving time and money for the busy caregiver. We don’t think you want to be chained to the kitchen. So plan for a cooking day on the weekend, when you have time and make servings of the favorite dishes of the loved for the freezer, so a good meal is always on hand. This can also provide a quick meal for the caregiver or for a family member.
For Instructions on How to Cook Once and Eat Four Times, pick your favorite recipe from the Essential Puree Guidebook. It could be a soup or a stew that makes four to six servings. Or even a side or an entrée. Follow the instructions in the video for cooling, packing, labelling and freezing.
To serve, microwave on 50% power for two minutes, until the food comes away from the bag. Add to a microwave safe plate, cover with paper towel or plastic wrap and heat for 30 seconds on high. Or until food is 160 degrees.
Another technique is to thaw in the fridge for two hours or on the countertop for an hour, place in microwave safe serving dish, cover with paper towel or plastic wrap and pop in the microwave on 50% power for a minute.
Today we launched our crowdfunding campaign to raise the needed funds to produce the Essential Puree Desserts on a larger scale and offer them to thousands of people on a puree diet and to healthcare facilities.
Our next step is finalizing the recipes for commercial production. We are ready to produce them, get them in the freezer and make them available for home delivery. This is an expensive step in the process and we need your help to get there.
With your help, we can bring the fun and flavor back to the dysphagia diet! We like to emphasize that we feature good nutrition. Our desserts have the best and the highest quality ingredients. Did we also mention they’re delicious?
Our desserts are the only ones like them on the market. We stuck to the classics, and want them to be a source of pleasure for those with swallowing disorders.
Please donate as much or as little as you like. Every dollar helps us accomplish our mission. The sooner, the better.
Contributors will receive perks at various levels for donating and supporting us: free desserts, a free copy of the Essential Puree Guidebook with a selection of great family recipes, free copies of our entire library of eBooks, AND, at certain contribution levels, we will donate Essential Puree desserts to local healthcare facilities with your name listed as the donor.
We are proud to be on the caregiver list for a number of healthcare facilities here in Florida.
You can feel good knowing that you are contributing to a great cause and helping thousands of people.
With summer coming up, and the outdoor holidays that include celebration, we thought we would pass along information on how to thicken alcoholic beverages.
Hydration is important for the dysphagia patient, so it is important to have the ability to thicken many types of beverages. There is an art to thickening liquids, including fruit juices, milk, coffee and tea, sodas and other carbonated beverages and alcoholic beverages. Don’t be shocked. Not every dysphagia patient is alcohol-restricted. One company has thought this need for hydration through and has created an excellent line of products for every type of beverage. It is called Slõ Drinks. They have a special line for beer, wine and bar drinks. If you are cleared for the consumption of alcoholic beverages, the product is sold on their website.
I interviewed the founder of the company, Mathew Done. He explained the reason why there are different products for different drinks. Food science, dear readers, is important and it takes time. “A drink’s fat, sugar, temperature and pH levels affect a thickener’s ability to thicken. . . As a result my company has different thickeners for different drinks. I think we are the only manufacturer to think this way, which is why it took 10 years to perfect our products!”
As Mathew explained, “It is essential to first make sure the thickener works in a drink and then calculate the amount required to make it a specific consistency.” Different thickeners for different liquids. That is why the full product line took ten years to develop.
Slõ Drinks thickeners are available in nectar and honey consistencies. The company also provides instructions for pudding consistency. You use less liquid rather than more thickener to get to the correct consistency for each individual. The Slõ Drinks website is an informative resource. If you click on their YouTube link, you will find a How To video, with Mathew himself demonstrating how to use his company’s products.
As I have written elsewhere on the Essential Puree website, ALL LIQUIDS must be thickened for the dysphagia patient. This includes oral rinses and liquid medicines, such as cough medicines. It is easy to overlook liquids such as mouthwash and liquid medicines, but it is absolutely necessary. The consequences may be dire, as I found out in taking care of my mom. The aides and me were not thickening her oral rinse. As a result, she kept getting bronchitis and her doctor was puzzled at the recurrence and why it would not clear it up. We did not want the bronchitis to turn into pneumonia that would require hospitalization. We went over the household routine to discover the cause. One of the aides realized that we were not thickening the oral rinse. We told the doctor. We changed the routine and started thickening her oral rinse and her cough medicine. Once we did this, the problem came to an end.
Another innovation: Slõ Drinks makes a line of thickeners custom-tailored for taking medication, such as flu medication in hot or cold liquid. They have a second formula for pain medication and vitamins.
Note: As I write in the Essential Puree Guidebook, at the suggestion of one of my mother’s physicians, I bought liquid vitamins and collated minerals and added them to her thickened drinks. That’s another way to go.
(Slõ Drinks also has a tasty line of thickeners for Milkshakes!)
The blue graphic to the left gives you an idea of how to balance a meal.
Fruits, Veggies, Grains, Proteins and Dairy. If you notice, the veggie portion of the plate is bigger than all the others. The fruit portion is a little smaller. Grains are a bigger proportion of the late than proteins.
This system replaced the Food Pyramid about four years ago. It is easy and it is handy. Know thy proportions.
If you don’t serve all the food groups at one meal, you can add them in snacks or desserts. Just make sure to touch all the bases. An easy way to get all the right nutrients. A visual reminder. A no-brainer.