Does anyone have experience with sourcing food for a "mechanical" soft diet?

I agree with the oatmeal. If he has been a fan before it is a more normal type of food and it can be enhanced in so many ways, I stir ground flax seed into our oatmeal and have made up a selection of low sugar freezer jams to be used in place of the traditional brown sugar.

I've never used flax seeds just the flax seed oil. It comes in bottles and I store it in the refrigerator. If he wants a farmer's diet, check out Glory Foods. Glory offers canned collards, yams, peas and beans, and even has a lower salt product line. Oatmeal is great because you can make a big batch and divide it into portions that will last a few days in the refrigerator and a few months in freezer. Try adding minced apples, pears, banana and stone fruits when in season into the oatmeal while it's cooking.

Don't restrict things just because the experts say so, everyone is different and the swallowing ability may even change day to day. Experiment with a bite or two of ice cream and see how it goes. My mom's ability to eat has improved over the last year so she can handle things like egg salad or tuna sandwiches. The interesting thing is she loves her crunchy snacks and has no trouble with them at all... small crackers, dry cereals like cheerios or shreddies, every now and then even a peanut or two. Meat is her number one choking hazard, even ground meat unless it is mixed with lots of sauce/gravy. She also has trouble with things like cakes, muffins and plain breads because they are neither moist nor dry and form a bolus that is hard to get down.

CWillie, I heartily support your suggestion of experimenting with frozen foods myself! To be very thorough, perhaps I should start with ice cream, Dairy Queens, sherbet, then work to the puddings.

Actually, I've done a bit more research; yogurt and puddings are fine in their purchased state, as long as they're not left out and become warm and begin to liquify. I haven't found anything though that addresses a better way to deal with the frozen delicacies. I've thought of home made popsicles with thickening - that's a possibility but I also want to be careful with experiments if I can't find medical literature addressing those specific foods.

But given that the frozen products are almost a necessity with the heat wave we're having, I'll still keep checking.

I'm thinking that a thickened milk shake might work, drunk only to the point that the ice cream starts to melt. I've frozen them and chipped away at the ice cream periodically, but I'm not sure that's a solution.

I've even thought about frozen Gatorade or Pedialyte, Boost or Ensure.

Given the importance of DQs and ice cream though, I'll keep working ...and experimenting on myself.


NY DIL, thanks to you as well for the suggestions. I had forgotten about mashed foods that are canned. My father is basically a meat and potatoes person and doesn't like anything like hummus or that's not basically a home grown farmer's good food diet - that's how he was raised when he grew up on a farm. But I recall seeing some frozen, mashed vegetables that could be added to his diet. I'll spend more time in the frozen vegetable aisle the next time I go to the store.

The research I did yesterday supported my suspicion that all seeds are out, including seeds in strawberries and raspberries. That's unfortunate; I was looking for some good fresh fruit and thought they would be easy to swallow.

Have you ever pureed flax seeds and added them to foods? That might be an option.

I haven't explored the baby food options yet; the pureed level is a more restricted stage, although applesauce is recommended. Not having even visited the baby food aisle in decades, I suspect I'll be in for a surprise.

Sometimes I feel as though this diet is opening so many new possibilities and I need to gradually examine and either accept or reject them all. I try to keep remembering Job's "The Journey is the Reward" slogan - with the destination being a wider variety of safer foods while working toward and transitioning back to a regular diet. At that point though, the reward for Dad might be a big slab of babyback ribs!

My next step is to explore what organic thickeners might exist. I recall a discussion on an organic gardening forum sometime ago on what the gardeners used to thicken fruit to make jam, something other than Certo or the commercial thickeners.

Thanks again to you both for your suggestions. This is a learning experience, that's for sure, but I'm glad that at least he can still eat solid foods.

Food companies have foods in cans and frozen that will help. For example, there is cooked chicken in cans that you can shred or mince up. Frozen vegetables like creamed spinach or mashed potatoes,mashed sweet potatoes, mashed turnips, etc. You can puree canned soups like lentil, black bean, or chicken noodle and use it as a side dish. Hummus comes in a lot of varieties now as does guacamole. Check out your grocery store's deli section for chicken salad that is smooth. Smoothies are a great idea, and you can add in flax seed oil for extra nutrients if not contraindicated. You can use the baby food (which now comes in a wide variety of flavors and textures) as a snack or as part of a meal. That's the only way my MIL would accept things like fruit.

I know they say the problem with ice cream and jello is that in your mouth it liquefies and can be a choking hazard. What about freezing pudding or yogurt cups? You could have an interesting time experimenting on yourself ;)

CWillie, Google's regional filtering is actually interesting, if not sometimes amusing. Sometimes when I search for contractors in my zip code, I get hits for ones in Detroit. Every time I search something at Home Depot or Lowes or other stores, Google chooses ones which it determines are near me. Regardless of how many times I reset to choose MY store, Google overrides and defaults to its selection.

Anyhow...I think you're right that hot meals are available in the larger areas, such as our metropolitan area. I'm guessing if I lived in the more peaceful, quiet, more smogfree farming area of Michigan, there wouldn't be any MOW available for my father.


Back to the issue of adapting to a level 2 dysphagia diet...we are managing to find substitutes and ways of dealing with the foods Dad likes. It's not as overwhelming as it seemed initially, but it is limiting. I'm still working on a substitute for Dairy Queens though.

I haven't checked with our speech therapist on these issues, but I'm thinking of some substitutions that might work:

Vitamin C along with iron foods for maximum iron absorption: fresh fruits such as apples and oranges are out, but now there are raspberries, blackberries and strawberries. If the tiny seeds aren't a problem, these would be good accompaniments. I think blueberries wouldn't be acceptable because of the skin.

But, best of all....pumpkin! We both love pumpkin, it's got C and A, and it's delicious. Years ago I switched from pumpkin pies to just pumpkin pudding - same recipe minus the crust.

Now, if only I can get my pumpkins planted...the garden got put on hold when Dad went to the hospital last time. I may try elevating the pumpkins for maximum sun exposure (and maybe away from the raccoons).

I'm also just updating this post as I find other solutions, in the event that someone else might be dealing now or in the future with a similar issue.

Re: the frozen meals on wheels. Google does sort of filter regionally, (I say sort of because when I do a search for a product I usually end up with results for the UK and USA) so I never found anything comparable where you are GA. I did get results from services all across Canada though, I think it is our way to cope with a spread out population that can be impossible to service with hot meals, those are only available in larger towns and cities.

Thanks for the update, GA!

First, a very big, grateful, thanks to everyone who responded. The suggestions are very helpful, so I'm copying each and every post to save and add to my dysphagia file. I do want to comment on just a few issues though.

Second, pureed foods aren't required at his stage, so that's an easy aspect to eliminate before even having had to consider it.

Third, some of the foods allowed and disallowed are surprising: White bread but not whole wheat or artisan (too much texture, good things we normally would like such as grains, flax, etc.), ice cream (uh, oh, no Dairy Queens either!), milk shakes (another disappointment), oatmeals but not with fruit, and corn and peas. I guess it's the very thin skins on these 2 veggies.

I'm going to inquire about using Thik-It in milk shakes, ice cream or sherbet and cut the portions to about 1/2 cup, which could be eaten before it melts and becomes too liquid.

Fourth, I do have a Level 2 dysphagia diet guideline now, so that's our temporary manual.

Fifth, I did check out the sources of prepared meals suggested, both here and in PMs. There seems to be a good selection, but...see Sixth point.

Sixth, we've figured out a way to reinstitute Meals on Wheels, which is great not only b/c I won't have the added food prep time (other caregiving issues have arisen), but because it provides a social source for Dad. Even if it's just a few minutes "meet and greet", it provides a nice break in his day.

And our local MOW apparently works with some local schools; periodically there are handwritten/drawn cards from youngsters offering support, providing a little bit about their life, but generally overall, very cheering.

Ground meats such as hamburger are permitted; chicken can be cut up; breads will not be eaten, as they're off the current diet. There might be a few meals that won't provide much since the ingredients aren't on the current diet, but that's a small portion of what Dad will be getting.

CWillie, I wasn't aware of being able to purchase frozen MOW; I'm going to inquire about that, or perhaps just order extra meals for the weekend and freeze them.

There will be some loss of food, such as the fresh vegetable salads, but overall the diets can be adapted.

Seventh, the Speech Language Therapist (SLP) has provided a list of exercises to be done daily, a few of which are those which Dad did over a decade ago when he had a more severe form of dysphagia after prolonged intubation and reliance on a trach.

One thing I would caution against if anyone does have a parent or loved one who's given these exercises. DON'T do the exercises yourself. Initially I suggested doing them along with Dad, but the then SLP specifically told me not to. These exercises are not for people with normal swallowing functions and could actually harm the vocal chords.

So, I don't get to grunt and groan like a caveman (apologies to the Neanderthals and early humans) along with my father to provide moral support.

Eighth, thanks to some private messages as well as the posted ones, I was given information on a delivery service for special diet meals. They seems to be varied, and I'm keeping that as backup information in case anything changes.


I still have some research to do, but at least the change isn't as drastic as I anticipated.

Perhaps the hardest part is to remember to tuck the chin when swallowing, and accepting the potential loss of treats as hotter weather becomes more prevalent - I don't think anyone can deny the relief provided by a nice cool dish of ice cream, sherbet, or a trip to the Dairy Queen for some really luscious temptations.

Thanks again to everyone who took the time to respond; your suggestions have all been helpful, and as noted above, I'm saving and studying all of them to see how I can integrate them into the new menu.

And as for now, there are some other nonfood issues that have developed, so it's on to the next challenge (of which I frankly have had enough).

Thanks to everyone - your answers and suggestions have been very, very helpful. I plan to spend more time addressing specific issues and suggestions in a few days but wanted to express my gratitude to each of you for the time your spent providing assistance, whether it's here or through a PM.

I met the speech therapist on Friday, got yet another list of acceptable and unacceptable foods, and have started making adaptations. I'm trying to get some of these implemented in the next few days to provide a supply of tolerable foods - it will be a change but it's a challenge, and actually not as difficult as I thought - somewhat time consuming, but doable.

Back in a day or so....

Beware of blanket declarations; "OBrien, it puzzles me that hot meals on wheels programs appear to be so universally available in the USA yet they don't seem to offer therapeutic diets or the option of frozen meals for those in hard to service areas"
A few years ago I had lunch with friends at a senior center. The same center prepared and delivered MOW. Some of which were frozen for recipients to store. Even around MA there is a huge difference , so I am told, between service areas. Senior centers and AAAgencies are places to ask what is available.

Cwillie, i think the answer is budget cuts...im in n.j. and it seens whenever they want to tighten the spending its always a program for the elderly. SS, medicare whatever ,they strike at our aging population which certainly contains me,!!!

Have you tried Moms Meals out of Iowa? I referred a few clients to them and they seem to like them. They make pureed meals, ship them frozen - look at this link:

I want to add, although I cook and modify mom's food most of the time it is sure nice to have a nutritious, modified frozen meal tucked away for those days when the thought of cooking is too much.

OBrien, it puzzles me that hot meals on wheels programs appear to be so universally available in the USA yet they don't seem to offer therapeutic diets or the option of frozen meals for those in hard to service areas. I have found manufacturers in the States so their food trays must be distributed somehow, I think your best bet is to contact service providers in your region and ask about an agency that distributes them locally.

Meals on wheels is a blessing however the sodium content is very high,so I had to discontinue use. My 98 yr old mother w/ Alzheimer's had fluid and swelling in legs. So I now puree all veggies and do soups. Alot more work for me ,so I'll be checking in to see if anyone finds a co. With low sodium, nutritional meals to supplement with.

grind up the meat after it has been cooked... Bought a little Proctor Silex 72507 Food Chopper that does a about a cup+ of stuff and is a handy counter top tool for grinding.

It does not take long to grind up the meat after it has been cooked. Put a little gravy on the meat after grinding it to keep it moist. I had to stop feed my husband thing like corn or peas. Also you can use food that can be mashed easy

Jill Corleone, RDN, LD lists: Foods allowed on a mechanical soft diet for dysphagia include bread, hot cereal, ready-to-eat cereal soaked in milk, canned fruit, soft cooked vegetables, juice, scrambled eggs, ground meat, cooked beans, cooked peas, cottage cheese, yogurt without fruit, custards, puddings, cream soups and noodles.

For several years since I inherited the job of chief-cook-and-dishwasher I have been preparing meals for my ADW. I now cook using a microwave oven and a counter top electric steamer. The diet is based on fish, sea scollops, chicken, vegies and tofu with a hearty base of Chinese eggplant in garlic sauce.I guess 90% of our meals are steamed. This permits food to be from mush to tender. The best thing is the microwave and steamer shut themselves off and eliminate stove top concerns.

Try throwing the meals-on-wheels into the steamer and cook and cook and cook...and cook

My blender is my best friend. Instead of meat, I use protein powders (not soy) in my mother's juice. She can eat really mashed up eggs and tuna fish salad.

I'm sure I have seen frozen meal suppliers in the States but I have been searching for you and coming up blank. Here we thankfully have the option to buy frozen meals-on-wheels dinners, many of which are modified for special diets.
Do you need fully pureed or is minced and moist still possible? I expect you will be able to tweak the diet a little as you go. I wouldn't worry too much about the protein issue, most North Americans are used to consuming way more than we need. As the others have said, cream type soups, smoothies, custards and yogurt are all naturally pureed and can be packed with protein, fruits or veggies. Silken tofu blends up really nicely with fresh or frozen fruits, protein powders can be added to smoothies, and of course there is dairy and the various nutritional supplement drinks.
If he needs a total puree then frankly I would stay away from meat completely unless it is whizzed into a flavourful gravy-like sauce.

The speech therapist will give you lists and booklets and all kinds of detailed material. Until he or she is on board, "creamed" (blended) soups and smoothies/milkshakes will get you through, at least until the weekend when you can cook.

It is true that a mechanical soft Dysphagic diet will effect every aspect of a meal. Not every patient can handle that psychologically.

GardenArtist, oh my gosh, I know I would be totally lost if I had to do what you are now doing.

From my limited brain on cooking, I wonder if cream soups would help. Like split pea if the peas were blended down enough. I might even buy baby food, especially the meat, and add mash potatoes to the menu. Bob Evans makes a tasty mash potato and also mash sweet potato, easy to heat up.

If cereal was soggy enough, like corn flakes or rice krispy, would your Dad be able to eat that? Oatmeal, cream of wheat?

Oh and just as a bye the bye - while dad couldn't eat bread or much in the way of cake he could eat whipped chocolate fools or that sort of think (he hated yogurt with a vengeance) but he lost the taste for anything that was pure chocolate because all he could taste was the fat in it. he could however eat english biscuits - your cookies?????? and he could eat crackers for some reason but that may well NOT BE THE CASE FOR YOU

Dad stopped eating bread and rolls to be fair he couldn't manage them at all UNLESS it was dunked into soup. I imagine gravy is the same but it wont taste like bread any more. he could however eat a bread and butter pudding as long as I gave it a quick whisk. Line a tin with bread and butter add a layer of sugar and sultanas, then another layer of bread and butter and then a layer of sugar and sultanas finish with a layer of bread and butter - whisk up a couple of eggs (more for a big tine) with milk add some nutmeg, cinnamon or vanilla pour it over and bake it - Now normally I would bake it till the top was a little crispy but when I did it for Dad I adjusted the recipe to use blended sultanas (which I had soaked in tea to plump them and cooked it soft and then a quick whisk just broke the bread up sufficiently for him but you might want to judge that one for yourself - it may be a step too far

I batch did it GA and froze it all it small pots then I could pick and choose what he had. Things that blended and froze really well and were colourful. Carrots, Rutabaga and carrots (with a knob of butter!), Squash, pumpkin, peas, Cabbage doesn't, cauliflower does especially if you do it in a cheese sauce but you have to be careful defrosting it, mash potato and sweet potato obviously freeze well, broccoli I found a bit hit and miss, instead of tomatoes I used pasta. creamed leeks work and freeze well


If you are worried at all about nutrients an ensure will git a boost.

Dad lost a lot of his taste for anything in the end so I tried to give him stuff that was pretty instead. He didn't want to eat it initially but once he realised that the taste was the same (and you have to pick your battle here - I did it with sausage and onion and mash and a sort of dahl type pureed baked beans he realised he wasn't losing flavour and all was well with the world again.

As for desserts (oddly enough that never seemed a difficulty at all)
He loved eton mess - meringues crushed into cream with ice cream and pureed red fruit (I used strawberries but change to raspberries because dad preferred them)
Banana which I mashed with sugar and poured custard (HOT OR COLD) over
tapioca or semolina or ground rice pudding with a dollop of jelly in it
He adored peaches and I pureed those and gave him them with condensed milk
so easy to do dessert so much more difficult to do mains.

Easiest mains to get every nutrient under the sun in? SOUP

I could give dad a full meal using a soup maker. Just chuck everything in turn it on and 20 minutes later a blended soup. If Mum ever realises what she has when she has soup she wouldn't eat it believe you me. Kale, broccoli all the greens she hates plus some meats she wouldn't otherwise eat
Pea and ham is her favourite for sure but she like lentils too and all soups freeze well.

I think I would take the blender to Dads and use it there rather than do the double journey then bring it home with me. The one thing you are going to need is a lot of those teeny tiny pots with lids that are freezable and microwavable. I literally used to cook of say 1 whole rutabaga and 6 or 7 carrots mash it all up in the blender with butter and pepper and no sodium salt and put about a tablespoon or two into each pot - boy did I run out of pots quickly the first time I did the cook off!

Phoenix, you've given me an idea. Perhaps I could still use Meals on Wheels; I'll be going to Dad's every few days anyway; I could just take a few meals home, blend them up and bring them back. (There's no blender at Dad's and he would have no use for one otherwise; I don't think he could use one with his limited hand function anyway - [woodworking accident] .)

Thanks for the helpful information. I would have thought that scrambled eggs would be easy to eat, so I'm noting that they're not. Same with fish; the rehab center gave him a tuna fish sandwich the day before he left. I know the bones could be a real problem as well. It's good to know about fish as I would have been stocking up on fish.

I haven't tried pureeing beef; I'm hoping to get some cooking time this weekend and can try it. Frank question: pureed foods sometimes look, well, like baby food or mush. Did your father have any objection to eating it after it was pureed, i.e., was it unappetizing?

How did you handle breads and rolls? I was thinking of pouring gravy over the rolls, kind of a southern biscuit and gravy style.

Sausages are a good suggestion; they add enough flavor that the meal wouldn't seem bland. I like sausage and so does Dad - good for us both!

It must have taken some time to puree everything individually. Wow! That's a lot of work!

Thanks for taking the time to respond; I really appreciate it. I know that in a day or so when the issue is worked out I'll look back and wonder why it was such a complicated issue, but right now the speech pathologist had told me that literally everything Dad eats has to change. That's a big step.

dysphagia