Q: My 92-year-old grandmother is recovering from a few different infections and has developed difficulty swallowing. She used to be a meat-and-veggie eater, but now she can eat only soft foods without choking. What are some soft food options?
—Patty B., Augusta, GA
A: The soft food diet is one that includes foods that are easy to chew, swallow, and digest. The need to eat soft or puréed foods is common in the elderly, many of whom develop dysphagia (difficulty chewing or swallowing). This diet is also good for people recovering from oral surgery or surgery to the head, neck, or stomach.
We may not think about it, but swallowing is a surprisingly complex function that involves more than 30 nerves and muscles. Dysphagia can lead to malnutrition and dehydration. It can also increases the risk of choking or developing aspiration pneumonia, an infection that can develop when food goes down the “wrong way” and enters the lungs.
Dysphagia can occur at any age, but seniors are at an increased risk because of normal aging, illnesses, and medications that affect the body’s swallowing mechanism. Estimates suggest that 15–22 percent of people over age 50 have dysphagia. For those in assisted living facilities, the prevalence is even higher: up to 60 percent have feeding difficulties.
Did You Know?
Sauces used to help thin out foods are an important part of the soft food diet. Opt for a simple butter and olive oil sauce, or go all-out with cream sauces, pasta sauces, hollandaise, or bone broth gravy.
How to Tell If You Have Dysphagia
The first step in treatment is to make a proper diagnosis. Symptoms linked to dysphagia include choking when eating, coughing when swallowing, recurrent heartburn, a sensation of food getting stuck in the throat or chest, and regurgitation.
There are several possible dysphagia causes, including stroke, dementia, esophageal disorders, multiple sclerosis, Myasthenia gravis, Parkinson’s disease, and radiation therapy to the neck and head area. Certain medications, such antibiotics, can increase the risk of esophageal infections, leading to swallowing problems. In some patients, no cause is found.
A critical part of treatment is starting on a specialized diet that addresses the body’s basic nutritional needs. Here are some easy-to-swallow foods to try:
Soft Sources of Protein
Protein is the most important nutrient for healing from illness and repairing tissues after surgery. But it is the hardest for people on soft food diets to get in a form they can safely eat.
Minced or Ground Meat
Try small bits of ground or finely minced meat or poultry in a moist form with coconut oil, olive oil, or a sauce. If this type of meat is too hard to swallow, purée it with broth and/or oil to make it softer.
Eggs often work better than meats for many people because they are naturally softer. Good options include minced soft or medium poached eggs, soft scrambled eggs cooked in coconut oil or butter, and puréed soft scrambled eggs with cheese.
As a source of protein for vegetarians, or for variety in the diet, try mashed beans, such as refried beans thinned with vegetable broth. Other options include dips such as hummus or Mexican-style bean dips.
Bone broth is a healing food that’s a rich source of easy-to-digest protein and other nutrients; however, it can be too thin for people with swallowing problems. Try blending it with starchy veggies such as carrots or potatoes. Or whisk tapioca flour into melted butter, then slowly whisk in bone broth to make a gravy.
A wide range of powders can be used to fortify shakes, smoothies, or other foods with extra protein. Try PaleoPro Paleo Protein Powder made from beef protein concentrate and egg protein; collagen-based protein powders, such as Primal Kitchen Collagen Fuel; hemp protein powders, such as Nutiva Organic Hemp Seed Protein; bone broth protein powders, such as Ancient Nutrition Bone Broth Protein; or pea-based protein powders, such as NOW Organic Pea Protein. Experiment and decide which ones you like best.
Greek yogurt and cottage cheese
Super-smooth Greek yogurt is a great source of good-for-your-gut probiotics, and it’s also higher in protein than regular yogurt. Skip the sweetened kind, and buy organic brands such as Straus Family Creamery Organic Greek Yogurt or Maple Hill Organic 100% Grassfed Yogurt. Try mixing yogurt with puréed fruits or mashed bananas for breakfast or as a snack (add a touch of fruit juice or maple syrup for more sweetness, if needed). Or make yogurt-based dips such as tzatziki or French onion dip. Cottage cheese is another soft source of protein. It can be eaten either as-is or puréed to make it smooth.
Greek-style almond yogurt
If dairy products don’t agree with you, give yogurts made from alternative milks a shot. Kite Hill Almond Milk Greek-Style Yogurt, for instance, has 10 grams of protein per servin.
Unflavored grass-fed gelatin, such as Great Lakes Gelatin, is another good source of soft protein. Go to greatlakesgelatin.com for recipes, such as Pumpkin Pudding and Homemade Strawberry Gelatin Cups.
Soft Carbohydrate Options
Natural sources of soft carbs are readily available. Often, it’s just a matter of how you prepare them.
Eat your veggies peeled, cooked, and minced or mashed, such as soft-cooked small zucchini pieces, mashed carrots, mashed butternut squash, mashed cauliflower, and mashed potatoes with organic butter or coconut oil. Boost the flavor with minced roasted garlic or puréed onions that have been sautéed.
Soft, Healthy Fats
Good sources of soft fats are as close as your favorite healthy oils.
MCT stands for medium chain triglycerides, a type of fat usually derived from coconut oil, which is easier to absorb and utilize as a source of energy. Find it in the supplement aisle, and add it to smoothies, or mix into minced meat to up the moisture content.
Organic coconut oil, butter, and olive oil
Many people shy away from including fats in meals, but they shouldn’t. Adding just a little of these provides fat-soluble vitamins (e.g., vitamins A and E) and a desirable mouthfeel. Fats also help the body absorb nutrients from other foods and increase satiety.
Full-fat coconut milk is a great source of calories and MCTs. Use it in smoothies thickened with fruit and protein powder, or in gravies, sauces, or desserts.
Turn Your Smoothie Into a Drinkable Meal
Smoothies can easily become meal replacements for people with or without swallowing difficulties. Here’s how to make the healthiest meal replacement smoothie possible:
Step 1 - Start with a liquid, such as unsweetened nondairy milk, regular milk, fruit or vegetable juice, or low-sugar, high-electrolyte beverages such as coconut water or cactus water.
Step 2 - Add protein and fat to thicken the smoothie and give it staying power. Good sources include unsweetened protein powder, collagen powder, Greek yogurt, or silken tofu.
Step 3 - Add a tablespoon or so of a good fat, such as MCT oil or nut butter, and if desired, vegetables such as spinach.
Step 4 - Add fruit—fresh, canned, or frozen, depending on preference. Frozen fruit lends a thicker consistency to smoothies.
Step 5 - Blend until smooth, and pour into a glass or travel mug. Sip slowly, knowing you’re getting a comprehensive range of nutrients in convenient, drinkable form.
Aslam, Muhammad & Vaezi, Michael. (2013). Dysphagia in the Elderly. Gastroenterology & hepatology. 9. 784-95.
Jackson, Seigelbaum Gastroenterology. (2018, September 24). Dysphagia Diet. Retrieved from: https://www.gicare.com/gi-health-resources/dysphagia-diet/
Newman, Tim. (2017, December 21) What causes difficulty swallowing (dysphagia)? Retrieved from: https://www.medicalnewstoday.com/articles/177473.php