Should Food be Pretty?

Speaker1:
[0:16] I'm Emily.

Speaker0:
[0:16] And this is Eva.

Speaker1:
[0:18] And you're listening to Speech Talk.

Speaker0:
[0:20] We're your research book club so you can do evidence-based practice in practice.

Speaker1:
[0:24] Let's start talking.

Speaker0:
[0:26] Yeah. This week's question is, how gross is puree food?

Speaker1:
[0:31] Literally so gross.

Speaker0:
[0:32] So gross. I've heard it referred to as dog food, multiple expletives like in a row that I don't feel comfortable saying to the microphone. And And I think all those complaints are super valid because when like gray, unidentified slop shows up in front of you, it's hard to just work up an appetite. So we're oftentimes as speech therapists, I think, conflicted between weight loss and dysphagia considerations. I've had a bunch of patients who are just tanking in their weights and they're more cognitively aware and they do not want to eat puree.

Speaker0:
[1:10] It's becoming a problem. So this week, we wanted to look at if there's any research that asks whether or not food presentation can improve patient PO intake.

Speaker1:
[1:20] So we found... This article, The Impact of a Molded Puree Diet on Taste, Appearance, Recognizability, and Overall Liking Among Patients in an Acute Hospital by Lam, Fu, and Guo. And they examined whether puree presentation affects that preference.

Speaker0:
[1:38] Yeah, so the study basically compared patients' preferences for, as the research title suggests, taste, appearance, and overall liking. for molded puree, where they used a maize starch thickener, to unmolded purees, where there was a potato starch thickener. And interestingly, prior to eating, the participants were asked to identify, is this a meat or a vegetable dish?

Speaker1:
[2:03] It's always a fun game to play. Is it meat? Is it vegetable? The participants were much better at identifying the molded food dishes than the unmolded food dishes, unsurprisingly. And overall, the molded puree was favored across all measures. They liked the appearance, the taste, and they overall liked it better.

Speaker0:
[2:24] Yeah. And sometimes when the rating for taste and appearance were in conflict, at the end of the day, taste was a stronger influencer, but that still was in the camp of maize starch molded puree. And even though the unmolded puree sometimes people said like the potato starch was not as noticeable.

Speaker0:
[2:48] At the end of the day, did not win out over carrots that looked like carrots.

Speaker1:
[2:53] We also found some interesting things in this article. Like apparently more than half of hospital patients and not just the ones on modified diets, they don't eat a full meal. I thought that was super, because that's always one of my goals is that you'll eat at least half of your meals.

Speaker0:
[3:09] And I also thought that was really good because, particularly for older people who are like light on breakfast or light on dinner. They're just like, I want to roll in a coffee or I just have a light salad for dinner. Um, people are like, Oh my God, they're, they're not eating their full meals. Like, can you make them eat more? And I'm like, no, um, I don't force feed. I'm not like, Oh, this is so important. Just like shove the eggs and bacon down their throat. So, um, I think it's important to maintain that idea that like, Just because they're not eating full meals does not mean there is necessarily an eating problem, and it may be very normal. Apparently, most people don't eat full hospital meals.

Speaker1:
[3:53] We don't know their whole situation, but if part of their issue was food intake due to advanced dementia, and they're now eating because they can recognize their food, then yeah, they're going to be happier in all of the things, all of the things now that they can eat something that's recognizable.

Speaker0:
[4:12] Oh my God. Speaking of research opportunities, please tell us if you start doing research on whether or not molded foods is more compatible with dementia patients, because that would be some groundbreaking research. Please do it.

Speaker1:
[4:25] Right. Back to the article. So people reported being able to taste the thickeners using the modified diets. Again, that was one of the influencers we talked about.

Speaker0:
[4:34] Oh, and on that, I was talking to a PT friend of mine, and she said that, Some of her colleagues, when they were doing their hospital rotation, were all forced to drink thin, mildly thick, and honey-thick liquids just for an empathy activity. and nobody wanted to drink thickened liquids because it tastes funny, the texture is funny. And I thought that was so great because, you know, it's one of those things where like, oh, it's a thickener. It's supposed to just blend in with the beverage or the solids. And that is straight up not the case.

Speaker1:
[5:12] No, not at all. Eva, do you remember when we did that for class?

Speaker0:
[5:15] Oh, yeah. We had to do it that jank way where we boiled flour and water.

Speaker1:
[5:21] No, and I had to call off the teacher too, like, because they didn't put it in the instructions. And I was like, does anybody know that raw flour has E. coli? So if you have not pre-cooked your flour, like, don't do that. Don't just much flour. She was mad that I said that. I didn't want anyone to get sick. No one had clarified. Instructions are important. Okay, so back to the article. Patients reported that not being able to recognize their food contributes to not being able to complete the meals. Again, if you don't know what it is, why would you even want to try it?

Speaker0:
[5:54] Yeah. The number of times I've had people who are like, Just trying to get it down for the sake of a therapy session. And then after a few bites, they're just like, I can't do this. And it just breaks my heart because I don't want them to have to. I'm like, yeah, I know. But you know how when you eat regular food and you go, oh, it's just till we get past that. I know. So it's already good.

Speaker1:
[6:21] And then we start doing the 200 exercises.

Speaker0:
[6:24] Yeah, right, exactly. Now you should be really motivated for your oral motor exercises. Yeah, they never are, but whatever. Anyways, as we've said for like the fifth time, back to the article.

Speaker0:
[6:36] The research, unfortunately, was not longitudinal. So we couldn't track whether or not there was weight gain seen in these patients. So unfortunately, our original question of does food presentation, can it impact weight gain is not answered. But I think there are some things we can generalize, which is that it certainly improves quality of life and we can promote it on those terms. And I think it logically follows that if people are not repulsed by their food, they may eat it more, which would lead to higher caloric intake. Would it lead to significant weight gain? We don't know, but I can't wait for there to be more research conducted in this area to see if it can.

Speaker1:
[7:23] So, are you guys doing your own research? We could try it out in your sniff kitchens. No, we can ask our kitchens if they'll try. No one says they will, but we can try. We can give them, we can, we can beg and we can plead and we can say, look, it might help. try with your patient one at a time and say, look, they are eating more of this. Maybe we can try it on a larger scale. Test and retest.

Speaker0:
[7:50] Let's crowdsource research. I'm all about it. Let's leave our jobs and just start doing large crowdsourced research. That's the future for us.

Speaker1:
[7:58] Without doctorate degrees.

Speaker0:
[8:00] Yeah, exactly. Exactly.

Speaker1:
[8:02] Just for funsies.

Speaker0:
[8:03] But you're totally reasonable in that you can do things in your own facility.

Speaker0:
[8:09] Maybe you can't get molded foods but you can always ask if there's ways to make it more palatable like instead of just kind of slopping the potatoes see if it can be scooped into like a circle or if it's like a soup consistency putting it in a soup bowl so that it feels like you're eating soup as to like as opposed to you know scooping dribbly bits of bread off of your plate yeah.

Speaker1:
[8:36] That's gave me like such like a gross visual a dribbly bit

Speaker0:
[8:41] I have read the menus and it is not pretty like it not just menus but like how the food is prepared for, Dysphagia mechanical, which is like our site's texture for essentially ground food and for puree, the amount of milk you're supposed to add into bread before you puree it, it's just weird. It's just weird. Nobody eats bread that way.

Speaker1:
[9:05] No, just saying. But some practical tips. Let's just try and know the menu. Like if you are dropping off a tray to your dysphagia patient, make sure you know what it is. bring around a menu with you if you need to or check it before you go about your day just so you can confidently tell them. And I am literally so guilty of this. They'll be like, what is this messy? Girl, I don't know.

Speaker0:
[9:31] Ditto. I should really be better about that. I used to when I worked at a site where the weekly meals were posted in people's rooms, I would like go over and read it to them and we would go through it together. But yeah, when we drop it off a tray and they're poking at it with a spoon. They're like, what is the gray thing? And I'm like, ooh, great question. Mystery meat.

Speaker1:
[9:54] I'll call it a mystery meat. It's something. We'll figure it out.

Speaker0:
[10:00] But why don't you take three bites using all the swallow strategies that we've been training and see if you can guess.

Speaker1:
[10:07] That seems like a great strategy too. And then they'll actually do that. Effortful swallows. Get it down. No gagging. So gross. So gross. It is literally so gross that I've never, I've never willingly tried anything that's been brought on any of my puree patients' trays. I have never asked, hey, can I get a bite?

Speaker0:
[10:30] Yeah, what I can tell you is that if it's green, it's probably a vegetable. That's about as close as I get.

Speaker1:
[10:38] Likely, yeah. The other stuff, it's like either bread or meat. I don't know. They're both the same color, like a weird brown. So normally meat's like a little bit more grainy.

Speaker0:
[10:50] Yeah. Ooh, that textural description, like grainy puree is not what you want to be hearing for your tray.

Speaker1:
[10:57] No.

Speaker0:
[10:58] And today we're serving grainy gray substances with lots of slippery unidentified liquid in the middle.

Speaker1:
[11:08] Like literally only Lumiere can give me gray stuff and I'd find it delicious. Is it that French candlestick? Yeah.

Speaker0:
[11:18] For Beauty and the Beast? Yeah. Well, he's French. We'd probably be like some really fancy gravy. That makes sense. If Lumiere is bringing you puree, it's the right kind of puree.

Speaker1:
[11:28] And then when we have a chance, we want to make sure we're training our caregivers and our patients on how to carry this through going home, if they're going home. And we want to remind them that it's worth it to do those things, right?

Speaker1:
[11:42] Investing in a dysphagia cookbook. So if they're not cooks or they need a break, we can send them a link to those pre-molded foods from Hormel Food Labs Thick and Easy, not sponsored yet, or suggest different types of food that lend themselves well to puree, like curries or lentils or thickened soups, anything that really just already comes mushy or is very easy to get mushy without feeling gross about it.

Speaker0:
[12:12] That's another ask I've tried to do at sites, which is and has not been successful. Tell us if this is successful at your site, which is trying to just process different foods for our people who are on pureed diets. And that like puree eggs is gross, but like cream of wheat is not, I mean, it's bland, but it's not straight up repulsive, you know, uh, blended bacon also repulsive. So just trying to see if your kitchen, even though it is more work and doesn't fit on the line, the cook line as easily, maybe for their lunches, they get soups that are like sweet potato soup, which is very easily blended and doesn't look like you just threw a sandwich in a blender.

Speaker1:
[13:02] I think that's such a good thing, too, because when you think about all the foods that can be pureed, but we just stick to... the things that are easy, right? Like powdered eggs and powdered mashed potatoes when the people on the regular diet have a sweet potato that day. And everything in the middle of the sweet potato is acceptable or can be made easily acceptable on the pureed diet or kind of just like skipping that step. So just digressing to the sadness that is significant. I got that one into a bent.

Speaker0:
[13:36] Oh, yeah. Yeah, yeah, yeah. All the powdered ingredients can be a little overwhelming. But yeah, I think kind of going back to our original question about the impact of food presentation on whether or not people are eating and engaging with food. I think also for food recognizability, and we're trying to get people to engage in eating tests, as always for our cognitively impaired patients, putting them in front of something they can recognize just feels like a more easily stimulable task at a visual level. And obviously, if you have a cognitive patient who is only stimulable by touching a spoon to their mouths, then don't know that it really makes a difference. But when people are able to recognize what's in front of them, we know that that triggers familiar memories and kind of the habits of eating. That's why finger food is so great.

Speaker1:
[14:36] I believe that Hormel Food Labs, seriously, not sponsored, but should be. They have bread for sandwiches, right?

Speaker0:
[14:48] They have all kinds of things. A serious... Unfortunately, unsponsored plug is that Hormel Food Labs really seems to be the only people that I have reliably found are just like tackling easily accessible dysphagia stuff. So if you haven't poked around their website to see what's available, again, even if you're just recommending for things at home for patients and their families, you should really take a look because it's pretty incredible. I found a mech, I can't remember if it was mech soft or if it was like puree molded waffles, but it was like a modified diet waffle that was pre-packaged kind of like an Eggo waffle. And I was like, pop one of those things in the microwave or in the toaster, however it's supposed to be prepared. And like, boom, breakfast, you know, that's fantastic.

Speaker1:
[15:37] Right and it looks so much better i i have so often like mixed that that bread mixture and it's so thick and it's so gummy and it's still like not like there's no way that this is supposed to be like our itsy perfect puree like it's smooth but it's sticky like that's and then i'm adding syrup in it to make it palatable and butter and so much butter yeah and

Speaker0:
[16:03] We all know that butter and syrup is so good for our multitude of patients with diabetes. Like unfortunately, so much of the way to make our food palatable is butter and sugar. And it's also like, one of those things when my patients have diabetes, I'm like, I'm so, I just also want you to eat. So it's the sugar calorie trade-off. I hope your insulin's okay.

Speaker1:
[16:29] I literally do that. I'll go to someone and I'll be like, halfway giving them like a thing of muffins. I'm like, you're not diabetic, are you? And then I'll just go to the nurse later. Like, you might want to check them in a little bit.

Speaker0:
[16:43] Can you go do the finger stick, please?

Speaker1:
[16:46] Just double check that we're not doing anything.

Speaker0:
[16:48] See if they're trending up or trending down. them. Oh man, do when I see that and like the finger stick, I'm like, ouch, like the mouth that you must get, like just used to having fingers constantly stabbed. I don't, my heart goes out to just diabetes patients. So sorry.

Speaker1:
[17:06] I know. I really do feel bad for people with diabetes because that is, I mean, they're like the toughest mofos I've ever seen. Like you'll like stab them in the finger and they're just like continuing on the conversation. I'd be like mid-tier, like, what did you say? Like, I'd be like trying to catch my breath, but yeah, tough ones.

Speaker0:
[17:24] And peanut butter. I love peanut butter. That one's probably harder for folks to clear orally if they have like weak oral mechanisms, but it's a great source of protein and is easily blended into things. So even if it's not like just having a peanut butter snack, it can definitely increase protein and caloric intake for other, you know, more puree-y things.

Speaker1:
[17:46] With the aside, yeah, you definitely have to thin it down because... The more you know peanut butter is regular texture because it's sticky.

Speaker0:
[17:55] Oh, snap. Wow. I just learned something.

Speaker1:
[18:00] Depending on the scale that you use, Etsy says it's regular. NDD says it's mechanical or level three. My building says if you're not allergic to it, you can eat whatever you want.

Speaker0:
[18:16] You know, having allergies be the baseline is probably a good, you know, general precaution.

Speaker1:
[18:23] Starting point.

Speaker0:
[18:24] We're working on that. Good starting point. There we go. All right. And there you have it. Some of our favorite periods. Let's have pumpkin pie. I want pumpkin pie now.

Speaker1:
[18:32] Oh, no. Sweet potato.

Speaker0:
[18:33] All right. Wow. Okay.

Speaker1:
[18:36] So along with educating our patients and families, like we also have to educate the caregivers, right? Right. So caregivers, including our aides in our kitchen. But what happens if our patients are going home hospice? So a lot of times we do have hospice evals, especially if someone's going home and you want your patient to be as safe as they possibly can. Right. They're going home to live out the last of their life, but enjoyably. Nobody wants to bring Papa home and then have him choke on a carrot. so that

Speaker0:
[19:13] Wasn't the goal of.

Speaker1:
[19:14] Hospice that's the goal of hospice easy transitions and food and life yeah right quick aside I once heard a hospice nurse requesting to downgrade a patient's diet to puree to more easily shovel food into their mouth to maintain weight every day Wild. Wild. That's a solution. I don't know.

Speaker0:
[19:43] Or I'll be like, well, can't you just put them on puree because it takes so long to feed them dysphagia mechanical? Like, brutal. Brutal. I think you should eat the puree food here.

Speaker1:
[19:56] Yeah.

Speaker0:
[19:57] Yeah.

Speaker1:
[19:58] Yeah. They don't want to eat the regular food there. They certainly won't eat the puree.

Speaker0:
[20:02] So, in addition to educating our kitchen staff and nursing, making sure that other at-home caretakers or if you have hospice in the building, that they're aware of some of these puree options and making things more palatable, whether it's the molded foods, making molded foods, or, you know, just choosing things that are puree appropriate, but more palatable at face value.

Speaker1:
[20:30] Right. And like our hospice patients, like likely they are going to be more confused than other people. So if intake is a concern, then having that molded food, just being able to recognize that food might really improve that patient's intake that they could possibly, I don't know, maybe graduate from a hospice.

Speaker0:
[20:51] We'd love to see it. Let's go out there, people, and test our many and ever-growing hypotheses.

Speaker0:
[20:58] But and also, you know what, just in terms of presentation, I wish we could see some garnishes. Just like you'd have to take it off because garnish is like not technically pure appropriate, but put a little like parsley on there and then take it off, you know, just like a cute little topping.

Speaker1:
[21:15] I see in some of those dysphagia cookbooks are like on the Hormel website. They have like all these really beautiful pictures. I think when we first did this article, Eva, you had mentioned someone creating a flower with all the molded foods. it's just like making the molded foods that we do have like into like almost art itself, like having fun with the food, creating, making it into something beautiful, beautiful enough to eat.

Speaker0:
[21:46] Yeah. Pretty things. Oh, dang. There's a poem about that somewhere. I'm going to have to look that up and send it to you.

Speaker1:
[21:54] Pretty things?

Speaker0:
[21:55] Yeah. Lastly, let's, let's talk about our favorite purees. We're just telling people like, oh, they're just like more appropriate purees to eat than, you know, as our favorite example, blended chicken. So what are they? What's your favorite puree, Emily?

Speaker1:
[22:11] I am a sweet stuff person. So I like creme brulee. I like pie filling. I like sweet potatoes. And I say that that's like sweet because the main reason I like sweet potatoes is the butter and the brown sugar.

Speaker0:
[22:32] I was like, yeah, obviously that's sweet. If you're not putting sugar in your sweet potatoes, what are you doing?

Speaker1:
[22:37] What are you doing? You need to reevaluate your sweet potatoes. Eva, what about you? What's your favorite?

Speaker0:
[22:42] Okay. On the sweets thing, ice creams. um i'm a i'm a sucker for like a a good like a dark chocolate or a coffee ice cream um i would say that things that are like a really okay it's like puree adjacent you really just have to like immersion blend it for a hot second but like kind of like a doll like indian food doll soup um or egg drop soup is really good congee is really good i do like a kind of savory, porridge-y pudding.

Speaker1:
[23:17] It's like rice

Speaker0:
[23:18] Porridge made with a broth. It's super flavorful because it's with broth. It's got some more protein than some of our other porridges. So yeah, I would say that also kind of more of a sweet breakfast, but porridge with peanut butter, cinnamon, and a little bit of maple syrup or honey can really do it for me on a winter morning.

Speaker1:
[23:43] That sounds good. You just sound like you eat very well. I need to come to dinner at Eva's house. You have the good restaurants.

Speaker0:
[23:55] Well, my current pregnancy breakfast is like four eggs and two pieces of toast every morning, which is just making a crazy dent in our egg bill, you know, because Josie eats too. And so we're going through a half a dozen eggs every morning. it's a lot yeah.

Speaker1:
[24:14] Good going that is a lot of eggs yeah man you need

Speaker0:
[24:17] Protein for days now.

Speaker1:
[24:19] You got to invest in a chicken

Speaker0:
[24:20] And low-key this is how i end up running a small homestead, oh but on the purees uh and you know things are it's not like a liquidy puree but like soft cheeses oh like a goat cheese yeah and i know normally you would eat that on a cracker or whatnot, I will straight up eat goat cheese with a spoon because I'm an animal. Also, we did make something.

Speaker1:
[24:50] Oh, we did?

Speaker0:
[24:51] Yeah, we did. It is essentially a brief outline, not about the research, but for some resources on molded foods. I know we've talked a lot about formal food labs, but there's just some references to like dysphagia, cookbooks, different types of foods and other things that are good for sending home. Again, unfortunately not as accessible for our long-term care people, but for those who are lucky enough to leave the double doors still kicking, that they can go home and go back to food that is both safety appropriate for them and is palatable.

Speaker1:
[25:35] Yeah. Well, everybody, I hope you enjoyed this podcast.

Speaker0:
[25:39] We talked it. We got all of our feelings about puree foods out there on the table, so to speak. We got it out there on the tray and we wrapped it. Sorry, that was a bad joke.

Speaker1:
[25:48] No, I liked it. It was good.

Speaker0:
[25:51] I appreciate it.

Speaker1:
[25:52] I'll send you home with it.

Speaker0:
[25:53] Enjoy. Take a look through that reference sheet. And until next time.

Speaker1:
[25:57] Thanks for listening. You've been listening to Speech Talk.

Speaker0:
[26:02] Thank you, everyone, for coming to listen to our research book club. Until next time, keep learning and leading with research.

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Speaker0:
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Speaker1:
[26:34] If you want even more speech talk content, check out our website at speech talk pod.com where you can find all of our resources we made for you copies of articles covered and Eva's blog, following these topics and more where your hosts,

Speaker0:
[26:47] Eva Johnson and Emily Brady.

Speaker1:
[26:49] Our editor and engineer is Andrew Sims.

Speaker0:
[26:52] Our music is by Omar Benzvi.

Speaker1:
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Speaker1:
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