Updated 30 July 2014

Soft diets for stroke patients

It is important to make it as easy as possible for a stroke patient to eat in order to prevent malnutrition and anorexia, writes DietDoc.

There are many problems that stroke patients may experience when part of the digestive tract is affected and they try to eat. Stroke patients are already exposed to a great deal of stress when they realise that they have lost some of their bodily functions, so it is important to make it as easy as possible for them to eat to prevent malnutrition and anorexia.

In general, stroke victims suffer from different degrees of dysphagia which make chewing, swallowing, tasting and even seeing what they are eating, difficult or impossible. The food that is presented to such patients must be made soft enough for the individual patient to be able to chew and swallow it easily. It is also important that the food should taste, smell and look appetising so that the patient’s appetite can be stimulated and he/she can be encouraged to eat to obtain important nutrients to sustain his/her health and life.

Different forms of the soft diet

Stroke patients who are unable to swallow, may need parenteral feeding which entails delivery of nutrients into the blood stream via a drip. Enteral feeding where liquids are supplied via a nasogastric tube is also an option. These two methods of feeding are generally only applied in a hospital or institutional setting.

However for the majority of patients who return home or are cared for in a frail-care facility, a soft or semi-liquid diet can help them to eat the food they require to retain their health.

Soft diets can vary considerably in the degree of processing the food has to undergo to make it easier to chew and swallow. Some patients can eat food that is slightly processed, such as minced meat with mashed potato and finely chopped fruit salad. Other patients may need their food to be liquidised in a food processor to which nutrients and/or liquids have been added.

For example when you make a smoothie for a stroke patient with severe dysphagia, then you can add additional gravy to the minced meat when you liquidise it to make it easier to swallow. Add milk to the mashed potato to not only make it easier to swallow, but to greatly increase the nutritive value and lower its GI (Glycaemic Index).

Tips for preparing soft diets

a) Fruit

Fruits should be peeled and all pips removed. Try if the patient can eat fresh finely chopped fruit and if this should be problem, try using chopped up or mashed canned or boiled fruit. If this still proves too difficult for the patient to swallow, then the fruit can be liquidised with added milk, milk powder, powdered vitamin and mineral supplements, and/or essential fatty acids supplements (flaxseed oil is probably the easiest to use under these circumstances as salmon oil may impart a fishy taste to the fruit mix). Add honey to acid fruit to improve the taste.

Select the fruit combinations you use for their nutritive value, taste and appealing colour. Remember to make smaller quantities of these smoothies because stroke patients may not be able to consume large volumes at a time and storing smoothies (even in the fridge) may lead to discolouration and loss of nutritional value, such as vitamin C.

b) Vegetables

Starchy vegetables (potatoes, butternut, winter squashes, sweet potato) can be peeled, cooked and mashed with a nutritive liquid such as milk. If the patients still finds it difficult to swallow, then it may be necessary to make soups (butternut, potato, tomato, mixed vegetable, mushroom with milk, etc), which can be highly nutritious and also much tastier than eating limply boiled vegies.

Avoid hard and stringy vegetables and keep things simple. Pureed vegetables for babies with a few added herbs can also provide some variety especially at times when you as the person in charge of the patient, have not had time to prepare soups or pureed vegetables (this is a remedy for special occasions, and should not be used constantly).

c) Meat and fish

Prepare meat and fish as usual and shred finely, taking care to remove all gristle, sinews and the skin and bones from fish. Serve finely shredded or minced meat and fish with sufficient gravy to make swallowing easier.

If the patient is unable to swallow minced meat or fish, these protein foods can also be liquidised with some added liquid (gravy, milk, diluted stock). Make sure that the food still tastes good and does not look unappealing.

d) Eggs

Some stroke patients with mild dysphagia are able to eat soft scrambled eggs, but in many cases the nutritive benefits of eggs (high quality protein, iron and B vitamins), may have to be added to other liquidised foods such as the vegetables mentioned above. Take care that the food is not too hot when you mix in the raw egg to prevent the protein from coagulating and forming hard particles which inhibit swallowing.

Make traditional custard with fresh eggs and milk as a treat for your stroke patient to boost his or her nutrient intake and provide variety in the diet.

e) Milk and dairy products

Milk and yoghurt are probably the two most useful foods when it comes to keeping stroke patients with dysphagia healthy and well-fed, because they have such a high nutritive value (protein, calcium, vitamins and other minerals, and probiotics in yoghurt).  Milk can be used on its own as a cold or hot beverage or it can be added to fruit or vegetable smoothies, to soups, scrambled eggs and custard. Yoghurt makes an excellent dessert and is also most useful for helping dysphagia patients to ingest their ground up medications.

Other forms of dairy products such as cottage cheese can also be substituted in smoothies but will need some dilution with additional milk to ensure ease of swallowing.

The use of jelly with custard can make meals for stroke patients more tasty and add to dietary variety. A dessert such as jelly with whipped up with chilled evaporated milk which was popular a few decades ago, can also be used successfully to provide stroke patients with additional taste and nutrients. Use diabetic jelly if the patient tends to gain weight or is also diabetic.

Ice cream made from milk with pureed fruit also falls into this category and frozen yoghurt will appeal to those stroke patients who enjoy eating cold foods. For the patients who dislike cold foods, ice cream should be allowed to warm up to melting point before it is offered.

f) Grains and cereals

While breads and baked grains may be difficult to chew and swallow, porridges can usually be eaten especially if milk is added to dilute the porridge. Barley, rice and other soft cooked grains can be included in soup recipes and pureed or liquidised. Smooth porridges such as Tastee Wheat and Maltabella are suitable for patients with some swallowing ability. Passing porridges through a sieve can also help to remove husks or hard pieces that can prevent the patient from swallowing with ease.

Special porridges such as ProNutro or Future Life may be suitable to boost nutrient intake in stroke patients. Caregivers can experiment with different flavours, but remember to add milk or warm water to such porridges to dilute them.

g) Fats and oils

While stroke patients who are confined to bed or a wheelchair have reduced energy requirements, all patients need to ingest some mono- and/or polyunsaturated fats or oils, especially the so-called essential fatty acids as suggested under point (a) above. One teaspoon of monounsaturated margarine could for example be added to cooked vegetable dishes and monounsaturated oils like olive oil can be used in the preparation of soups and meat or fish dishes.

h) Liquid meal supplements

In some cases stroke patients have such severe dysphagia that they are forced to rely on liquid meal supplements like Ensure, Peptamen or Nutren. The physician and dietitian responsible for a specific stroke patient should council caregivers regarding which liquid meal supplement a patient requires (high or low energy, with or without dietary fibre or lactose or gluten or with chromium to improve glucose tolerance). Some patients find it easier to swallow the liquid meal supplement when it is cold, while others may prefer it lukewarm.

i) Vitamin and mineral supplements

Patients suffering from dysphagia can easily develop deficiencies of a variety of nutrients if they develop anorexia so it is important to ensure that they still receive a balanced diet that contains all the food groups or are using a fully balanced meal supplement.

Ask the doctor and dietitian in charge if the stroke patient you are caring for requires additional vitamin or mineral supplements. Keep in mind that indiscriminate use of high doses of vitamins and minerals can also be harmful (e.g. too much vitamin C can cause kidney stones in susceptible individuals, excess vitamin A can cause hypervitaminosis A, etc), so be guided by your dietitian who will check the patients diet and food intake and determine if certain nutrients are lacking or if the patient is getting an overdose of certain nutrients.

Caring for a stroke patient is often difficult particularly when it comes to food intake, but no matter what problems your loved ones face, they can be overcome with understanding and innovation to meet their special needs.

(Photo of nurse feeding patient from Shutterstock)

Dr Ingrid van Heerden is a registered dietician and holds a doctoral degree in Nutrition and Biochemistry. She believes that "we are what we eat" and offers free nutrition and weight loss advice via her DietDoc service on Read more of her articles.


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