What do you do when chewing is difficult?
Kathrynne Holden MS, RD (retired)
In some cases, Parkinson’s disease slows the normal swallowing movement of the throat (peristalsis). This leads to choking, or even inhaling food into the lungs. The condition is called dysphagia. It can cause a type of pneumonia, which is a frequent cause of death among people with PD. If swallowing is a problem, or if you have choked, it’s very important to ask your doctor for a referral to a speech therapist. The speech therapist can determine whether you are at risk, and can demonstrate safe swallowing techniques. If needed, s/he may order a special diet of pureed foods and thickened liquids. This article does not apply to the condition of dysphagia, only to the problem of chewing difficulty.
Good digestion begins in the mouth. The mouth performs many necessary tasks. Let’s think about what happens to corn just after we take a bite. The teeth chew the corn, grinding it up into smaller pieces. If not for the teeth, the corn might be too bulky to swallow, and we would choke. Besides that, the stomach would have a hard time with chunks of food — it can digest small pieces much better than large ones.
The teeth and tongue also move the corn around the mouth, and that stimulates the taste buds, which helps us enjoy our food. After the food is chewed, the tongue moves the food to the back of the mouth in position for swallowing.
Next, saliva mixes with the food. Saliva has two important jobs. First, it moistens the food, making it easier to swallow. Second, it contains special enzymes that begin the process of digestion.
Chewing our food is something we take for granted. But when the mouth isn’t working normally, these functions are lost. In the long run, chewing difficulty and/or poor oral health can lead to malnutrition.
For some people Parkinson’s disease causes chewing problems. Nerves that guide the muscles of the jaw and tongue become weaker. It may take an unusually long time just to chew a bite of food. Then the tongue has a difficult time moving food to the back of the mouth in position for swallowing. I’ve known persons who needed three to four hours to finish just one meal. There is hardly enough time in the day to eat the amount of food necessary to maintain a healthful weight and get the minerals, vitamins, fiber and calories needed.
Besides the nerve damage the PD can cause, there are other concerns. Dry mouth, which is common in PD; poor oral hygiene, due to difficulty managing a toothbrush; and sugary foods, can all cause tooth decay and/or tooth loss. Dentists can order bridges or dentures to replace missing teeth. But these don’t always fit well, and may not be as efficient as the natural teeth. Using an electric toothbrush, flossing daily if possible, and regular dental checkups can help prevent tooth loss. If you cannot floss, talk to your dentist about extra cleanings between checkups. Some will negotiate a modest price.
Any of these circumstances can cause chewing problems that affect our mouth and jaw, and the ability to chew food properly. In these cases, people need soft foods that can be easily swallowed. We also need a variety of foods for good health. Nutrition is just as important, perhaps even more so, when it’s hard to eat.
For some conditions, ground meat or flaky, canned fish may be good choices, as they don’t require much chewing. For others, you can puree meats. Cheese and cottage cheese contain high-quality protein, and add texture and flavor to casseroles and other dishes. Shredded cheese mixed with mayonnaise can be a good choice. Eggs can be scrambled, fried, or soft-boiled, or hard-cooked and diced for egg salad. Cooked dried beans are not only high in protein but rich in fiber also. They can be mashed and thinned, or thickened, as needed. And for those who use levodopa and are especially sensitive to protein, plant proteins like beans may not block levodopa absorption as severely as animal proteins. Peanut butter can get stuck in the mouth or throat, but can be blended into smoothies.
Vegetables and fruits
These are important sources of vitamins, minerals, antioxidants, and fiber but can be hard to chew. Cooking and pureeing solves the problem – for example, applesauce or pear sauce. Add a bit of cinnamon for even more health benefits. Bananas can be difficult to move to the back of the mouth for swallowing; but they are very easy to swallow when blended with liquids into a smoothie.
Vegetables such as potatoes, sweet potatoes, winter squashes, turnips, carrots, and peas can be cooked and mashed. You can make a hearty soup of green beans, zucchini, summer squashes, tomatoes, sweet peppers, chopped small and cooked with broth and ground meats.
These have complex carbohydrates and fiber as well as trace minerals and vitamins. Oatmeal and other cooked cereals; bread pudding made with whole-wheat bread; and rice pudding made with brown rice are all good choices – and again, cinnamon adds both flavor and health benefits. Sandwiches may not work well, but sauces, gravies, and cream soups can be poured over whole-grain bread to moisten it and make it easier to chew.
Milk and milk products are rich in protein, calcium and B vitamins. Milk, yogurt, custard, and puddings are all easy to chew. You can add fresh or dry milk to casseroles, cooked cereals, and soups. Note: some people who use levodopa find that milk protein blocks levodopa absorption to a greater extent than other proteins. Others cannot tolerate or are allergic to dairy. If so, consider one of the milk alternatives – almond, soy, or coconut milk; vegan cheeses.
Tips For Chewing Problems
When chewing takes a long time, small, frequent meals and snacks may be better than three large meals a day. It also helps to take small bites.
Because a soft-food diet is more restrictive, it may be advisable to use fortified foods and a multivitamin-mineral supplement.
Here is a recipe for people who need easy-to-chew foods. I like it, because it features salmon, a valuable source of heart-protective fats, as well as excellent protein. The vegetables included make it almost a one-dish meal. The cream sauce mixed with the baked potato makes each bite easier to swallow. Be sure to discard the potato skin, as it is hard to chew.
RECIPE: SALMON VEGETABLE POTATO TOPPER
4 tablespoons (1 oz) finely minced onion
4 tablespoons (1 ½ oz) finely minced bell pepper
2 tablespoons (1 oz) unsalted butter
1 ½ tablespoons (3/4 oz, 45 grams) whole wheat flour
1/4 teaspoon (1 gram) garlic powder
1/8 teaspoon (½ gram) ground thyme
Dash ground marjoram
1 1/2 cups (12 oz, 350 ml) milk or milk alternative
3 oz (90 grams) shredded Cheddar cheese or vegan cheese
1 cup (8 oz, 236 gram) thinly sliced carrots, cooked and drained
8 oz (230 gram) canned salmon, drained
2 baking potatoes, baked
In a medium-size saucepan saute onion and bell pepper in butter about 5 minutes or until vegetables are tender. Combine flour, garlic powder, thyme and marjoram. Stir into onion mixture. Heat and stir 1-2 minutes. Remove from heat. Slowly stir in milk or milk alternative. Return to heat and stir until sauce just comes to a boil and is thickened. Stir in cheese, cooked carrots and salmon and heat through. Split the baked potatoes and fluff the insides with a fork. Discard potato skins. Spoon salmon mixture over potatoes and stir lightly to blend with and moisten the potato.
Now let’s make a one-day menu with variety, flavor, vitamins, minerals, and fiber. We’ll use our feature recipe, and some of the other suggestions we’ve discussed. If the portions are too small, increase as needed.
An Easy-to-chew One-day Menu
6 oz (177 ml) calcium-fortified orange juice
1 cup (.4 pint) oatmeal cooked with 2 tablespoons (29 gram) raisins
4 oz (120 ml) 1% milk or calcium-fortified milk alternative
Coffee or tea
1/2 cup (.2 pint, 120 ml) applesauce
(If needed, you may crush a multivitamin tablet and mix into the applesauce)
1 scrambled egg
1 1/2 cups (236 ml, 8 oz) split pea soup
1 whole-grain rye crisp biscuit/cracker, crumbled and added to soup to soften
1 oz (30 grams) cheese or vegan cheese, grated, added to soup
1 cup (.4 pint) bread pudding or rice pudding (made with milk alternative if needed, and whole-grain bread or brown rice)
6 oz (177 ml) tomato juice
Salmon Vegetable Potato Topper
½ cup mashed turnips or cooked finely chopped spinach
1 cup (240 ml) milk or milk alternative, or coffee or tea as preferred
1 poached pear, chopped
The protein foods include salmon, egg, cheese and split peas. Fish has omega-3 fatty acids that nourish the brain and nervous system, and split peas are rich in fiber. Other proteins could include ground beef, lamb, or poultry.
Fruits include orange/grape/apple juice, well-cooked raisins, applesauce, poached pear. Melon chunks, which can be chopped small or pureed to a slush, also work well. Stewed prunes are a good choice, especially if constipation is a concern.
Vegetables include bell pepper, onion, carrot, turnip, and potato. A cold vegetable soup, such as gazpacho, is another way to increase vegetable servings.
Rice pudding and bread pudding are easy-chew ways to get more fiber daily. Use whole-grain bread and brown rice, if possible. Also, a slice of bread can be chopped and soaked in honey-sweetened milk or milk alternative for a snack.
Other fiber sources include oatmeal, applesauce, pea soup, soaked rye crisps, bread pudding or rice pudding, well-cooked minced vegetables such as onion, bell pepper, turnips, spinach, and carrots.
Although chewing problems require adjustments in cooking and serving foods, it is possible and important to have a varied, healthful, and nourishing daily meal plan. This will help to get the vital nutrients needed, and enough calories to maintain a healthful weight.
As always, be sure to check out Foods That Feed the Brain — Let’s Cook! for more delicious and healthy recipes geared towards those with Parkinson’s Disease!