Ready For Innovation: The Dysphagia Diet
Monday, June 24th, 2019
For seniors worried about choking, mealtime becomes both terrifying and a source of embarrassment. As a solution, CP Kelco can recommend several, nature-based ingredients to help bring back the social experience of eating by adding taste, colour and appropriate texture.
Asia’s population is rapidly ageing. According to a UN Report on World Population Ageing, the number of older persons in the region will double by 2050. The country with the highest proportion of elderly citizens is Japan. 33 percent of the population is over age 60 now. By 2050, it will grow to 42 percent. As such, the country has become an innovator in how it caters to the needs of this new 100-trillion yen “silver market”—from placing reading glasses on bank counters to slowing down escalators. The same care is also being applied to what seniors eat because choking has become a great concern.
We tend to view swallowing as a simple reflex; however, it requires the use of 26 muscles and six nerves to complete the process. Disease and age can deteriorate these “eating muscles” so that swallowing becomes increasingly difficult. The medical term for this is dysphagia. While it can happen to anyone, especially after a brain injury, it’s estimated that up to 22 percent of individuals over age 50 and most individuals by age 80 will experience some degree of dysphagia, according to the National Foundation of Swallowing Disorders.
For seniors worried about choking, mealtime becomes both terrifying and a source of embarrassment. They learn to adapt by eating slower and taking smaller portions. As their condition worsens, it can lead to malnutrition, weight loss, dehydration, aspiration pneumonia and even death.
Doctors prescribe a diet of thickened liquid drinks and pureed food to alleviate dysphagia. However, to quote the Washington Post (February 25, 2018): “The treatment for aspiration is to spoil the experience of eating.” They cite an experiment at the University of California at San Francisco (the thickened liquid challenge) where hospice teams challenged themselves to drink their patients’ thickened liquids for 12 hours. Few made it through and all had a hard time finishing the product. (Note: poor taste and bloating are some of the problems of using starch as a thickener.)
Without any universal guidance, each country—and even each facility—has been concocting its own version of a dysphagia diet. To remedy this, a volunteer group of professionals from numerous countries came together to form the International Dysphagia Diet Standardisation Initiative (IDDSI). They arrived at a standardised way of naming and describing texture-modified foods and thickened. These standards will bring clarity and global alignment to food and beverage manufacturers, as well as every senior living community and hospital worldwide. In the APAC region (specifically China and Japan) IDDSI frameworks have been established as a pathway for implementation.
Creating Food That Brings Pleasure
In Asian culture, where meals are prepared with great artistry, top chefs at restaurants and even nursing home staff use thickeners to reshape food into visually pleasing yet easily digestible dishes. Through their actions, the Japanese model how we should treat the older generation with great respect. The goal of their cuisine is not just to ensure safety but to give joy. After all, purée that looks like baby food isn’t exactly gourmet. And now, with the new IDDSI standards as a guide, it is easier for food manufacturers to create more pleasurable meals, too. This is the inspiration behind the new engay line for seniors. It features elegantly prepared foods puréed and reformed with a gelling agent. For example, salmon retains its shape, complete with “grill marks” and glaze on top. Besides looking and tasting like the real thing, it can deliver more of what older adults need to stay healthy—more protein, calcium, collagen, omega-3 and other vitamins and minerals.
As one of the early solution providers for the dysphagia market, CP Kelco can recommend several, nature-based ingredients to help bring back the social experience of eating by adding taste, colour and appropriate texture. KELCOGEL Gellan Gum is a soluble dietary fibre produced by fermentation that enables the preparation of soft-gel fish, soups, meats, vegetables and desserts. The recently developed KELCOGEL DGA Gellan Gum gives reconstituted foods a soft gel texture but has a reduced setting temperature, allowing more open time for ease of preparation.
GENU Pectin, which is extracted from citrus peel, is another superior stabiliser. It protects proteins and other nutrients during manufacturing and can often support organic label claims. GENUGEL Carrageenan is derived from red seaweed and can be used to reconstitute a broad variety of foods into a cohesive, easy-to-swallow form. For beverages, KELTROL T Xanthan Gum has been used in dysphagia thickening powder for more than a decade in Japan and is optimised for use in hot, cold and acidic beverages with a consistent, gel-like viscosity and no off-taste.
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