Eating well on a pureed diet (IDDSI level 4)

Contact Dietitian …………………………………

Tel No: 01223 216655

A pureed diet is essentially a ‘normal’ diet made into a smooth consistency. Your Dietitian or Speech and Language Therapist will recommend this either to avoid the risk or aspiration (food “going down the wrong way”) or to make eating easier. Taking the wrong sorts of food or drinks may lead to choking, chest infections or pneumonia. Please check with your Dietitian or Speech and Language Therapist if you are unsure.

Foods must be of a smooth, even consistency without lumps and hold shape on a spoon. Many everyday foods can be easily altered to form a smooth texture using a blender, liquidiser or food processor. The food should not require chewing.

How to puree your food:

• Foods should be prepared and cooked as usual before putting in a liquidiser, blender, food processor or using a blender stick (remove any skin, fat, bone or gristle).
• Puree small amounts at a time to prevent lumps from forming.
• Adding stock, gravy, sauces, cream or condensed soup can make foods easier to puree. The sauce should not separate from the pureed food, and should be included when the food is pureed.
• Any sauces added to foods (e.g. custards, gravy) should be at the thickness your Speech and Language therapist has recommended (if relevant), or the same thickness as the pureed food.
• If the food is to be served hot, reheat thoroughly in a pan or microwave, and check that it holds the same consistency after heating.
• Some foods such as stringy meats, fruit with pips and seeds and some soups may need straining, even after pureeing.
• Tough skins, and larger seeds and pips should be removed before the food is pureed.
• If you need to thicken foods, you can use corn flour or thickening agents, such as Resource Thicken-up.
• If you experience difficulty in swallowing pureed food, try sieving it as well.
• The food should not be “sticky” as this can cause swallowing difficulties.

How to make meals more enjoyable:

• Try to make puree food more appetising by serving the meat and vegetables separately on the plate, including different coloured vegetables e.g. carrots and broccoli. You can also try piping, using food moulds, or ice cream scoops to separate the different foods and to make the appearance more appetising.
• Include a variety of foods in your diet.
• If the food looks different to normal, please tell the person eating it what it is before they eat it. This can help to make the food more appetising.
• Add extra flavours to food by using grated cheese (added before blending), soft cheese, hummus, pesto, powdered spices, smooth mustard, stock cubes, Marmite, Bovril, tomato purée, lemon juice, chilli powder, curry paste/powder, Worcester sauce, brown sauce or ketchup.
• When food is pureed it loses a little of its flavour, so it is best to taste and season after it has been pureed. A small amount of pepper can be used to improve flavour.
• Some foods lose colour when pureed. Adding Bovril, Marmite, tomato puree or tomato sauce can help to improve the appearance.
• If you eat slowly only put small quantities of food on the plate and keep the rest hot for second helpings. Using a smaller plate may help.
• Eat in a quiet, relaxed atmosphere. Do not rush your meals and make sure you are sitting upright in a comfortable position. Your Speech and Language Therapist can give you more advice about techniques to assist safe swallowing if required.

Menu ideas for meals and snacks

Breakfast

• Porridge/Ready Brek
• Weetabix (ensure it is well soaked in milk)
• Smooth, or Greek yoghurt, plain, flavoured or with honey
• Pureed stewed fruit with yoghurt/cream
• Pureed baked beans, mushrooms and tinned tomatoes
• Pureed scrambled egg with cheese and butter and pureed avocado
• Pureed smoked haddock with plenty of butter/cream or milk

Meat, poultry, fish, and vegetarian dishes

• Pureed cooked meat, non-meat alternatives or tofu with plenty of sauce/gravy
• Pureed casserole/stew with plenty of gravy and beans/pulses
• Pureed mince (or vegetarian/vegan mince) and potato with gravy, such as cottage pie/shepherd’s pie
• Pureed sausages (with skins removed) with gravy or in a tomato sauce
• Pureed fish in lots of sauce
• Pureed curry and rice puree with plenty of sauce
• Pureed chilli and rice puree with sauce
• Pureed cheese and potato pie
• Pureed scrambled eggs with puree baked beans, mushrooms and tinned tomatoes
• Savoury egg custard- ensure the top is soft and not crusted or hard
• Pureed pasta with cheese or tomato sauce for example macaroni, lasagne, ravioli or Bolognese
• Pureed risotto
• Pureed thick soups
• Pureed dahl, made with lentils or chickpeas

Potatoes and Vegetables

• Smooth pureed potatoes (add cheese, butter, cream, oil, milk, thick smooth gravy, cream cheese or soft cheese)
• Pureed carrot, swede, butternut squash (add cheese, butter, extra thick double cream or thick smooth gravy)
• Pureed broccoli or cauliflower cheese
• Pureed Ratatouille
• Blended avocado
• Pureed mushrooms with peeled tomatoes or baked beans
• Pureed beans, peas, broccoli, parsnips, cauliflower or leeks with gravy or cheese sauce

Desserts

• Crème caramel
• Milk jelly/blancmange
• Angel Delight/Instant whip
• Pureed rice pudding
• Pureed fruit with yoghurt, cream, evaporated milk or custard
• Mousse
• Custard
• Egg custard without the pastry
• Fruit fools
• Jelly (not suitable for people who need thickened fluids)
• Thick and creamy yoghurts, fromage frais

Snacks

• Smooth pâté (if not too sticky)
• Pureed tinned spaghetti
• Pureed egg mayonnaise
• Pureed tinned tuna/tinned salmon with salad cream, mayonnaise or cheese sauce
• Savoury mousse, e.g. salmon mousse
• Processed cheese triangles, cheese spread or cream cheese
• Smooth dips, such as taramasalata, hummus
• Individual desserts, for example, crème caramel, thick and creamy yoghurts, fromage frais, custard pot, mousse, fruit fool, pannacotta (no bits), egg custard (without the pastry)
• Blended banana or other soft fruit/stewed fruit with milk, custard, cream or ice cream
• Softened biscuits, cakes or suitable sandwiches (see soaking solution section)

Ensuring adequate nutrition

It is important that your pureed diet is nutritionally balanced in order to prevent weight loss. Because it is necessary to add some liquid to foods to puree them, they can be less nutritious. Swallowing difficulties can mean that you eat less, or slower, which can also reduce the amount of nutrition you are getting.

Practical hints

• Eat a variety of foods as you would normally
• Regular fluids are important. Remember large amounts of fluid at any one time can ‘fill you up’ quickly. It is better to distribute it more evenly throughout the day such as three liquid meals and nutritious drinks in between. These may need to be thickened so follow the advice from the Speech and Language Therapist
• Use thick smooth gravy/stock/soup, milk, extra thick double cream, coconut milk, tomato juice or fruit juice to puree meals to the consistency you need, rather than water, as they are more nourishing
• You may also find it useful to refer to the diet sheet ‘High energy and protein diet’ for fortification tips
• Try adding dried milk powder (four tablespoons to one pint of full cream milk) to make fortified milk and use throughout the day in drinks, sauces and puddings

Soaking solutions

Soaking solutions can be used to alter the consistency of normal foods such as cakes, crackers, cereal, potatoes, sandwiches and biscuits. Foods are soaked with thickened fluids (thickened milk, water, fruit juice or stock) so that they become very soft like puree foods. Thickened fluids are made using prescription fluid thickeners such as Resource ThickenUp Clear. See your GP for a prescription.

Soaking solutions make foods safer and easier to eat, however they have the appearance of normal foods so can look more appealing.

Remember:

Soaking solutions only work with cereals, biscuits and cakes that have no pieces in them such as fruit, nuts and chocolate pieces.

Sandwiches must have puree fillings, such as cream cheese or cheese spread, and the crusts removed before the soaking solution is added.

Ingredients:

• Plain biscuits – such as a rich tea biscuit (no nuts, chocolate chips or dried fruit allowed)
• 100ml milk or juice
• 1 scoop of Resource® Thicken up® Clear

Instructions:

• Place 1 scoop of Resource® Thicken up® Clear into a clean, dry glass
• Add the milk or juice and stir with a spoon until completely dissolved
• Place the biscuit into the solution for 1 minute then remove and place on a small side plate
• Place in the refrigerator for 2 hours until soft
• After 24 hours, throw away any softened items that have not been used

Puree moulds:

Moulds can be used to shape puree food so it looks more like its normal state, and is therefore more appealing to eat. The moulds should be used with thick purees as they hold their shape better.

Some companies which supply thickeners will also supply moulds free of charge. Moulds can be bought from shops and online. Alternatively, ice cream scoops can be used.

Examples of recipe ideas for a purée Diet

All these recipes must be pureed to a thick consistency.

Pea, Spinach and Mint Soup (serves 4)

• 1 onion peeled & roughly chopped
• 2oz (60g) butter
• 1 large potato, peeled and diced
• 1 clove garlic chopped
• 1 can of chick peas, drained
• 2 carrots scrubbed and diced
• 1 pint (600mls) vegetable or chicken stock
• 1 bag spinach washed
• 6oz (175g) frozen peas
• 2tsp fresh mint/1tsp dried mint or to taste
• 2tbsp olive oil
• Squeeze of lemon juice
• Salt and pepper to taste

1. In a large pan, cook the onion in the butter until soft but not browned.
2. Add the potatoes, garlic, carrots, chickpeas and stock, and simmer until they are soft (approx. 15-20mins).
3. When potatoes are almost cooked, add the spinach and peas. Simmer for a couple of minutes.
4. Mix mint and olive oil and lemon juice in a bowl, and add to soup.
5. Allow the soup to cool (to prevent scalding) before liquidising and season with salt and pepper.

Savoury Mince (serves 2)

• 2 teaspoons (10g) Marmite
• 2 dessertspoons (20mls) boiling water
• 4 dessertspoons (40mls) cold water
• 2 dessertspoons (20g) dried milk powder or oat milk powder
• 8oz (240g) finely minced beef / plant based mince
• 2 glasses (350mls) tomato juice

1. Dissolve Marmite in boiling water in bowl.
2. Add cold water.
3. Sprinkle in dried milk powder and whisk into the liquid.
4. Mix beef and tomato juice together and add to water and milk powder.
5. Cook over moderate heat for 15 minutes, stirring well, purée to finish.

Chicken Mousse (serves 2)

• 15g (½ oz) butter/margarine
• 15g (½ oz) flour
• 150mls (¼ pint) milk
• 120g (4oz) chopped cooked chicken (no bone /gristle/skin)
• Small bay leaf
• ½ onion, chopped
• Pinch of nutmeg
• 5g (½ dessert spoon) powdered gelatine
• ½ eating apple (peeled and chopped)
• ½ tablespoon tomato ketchup
• 1½ tablespoon mayonnaise

1. Melt butter in saucepan.
2. Stir in flour and cook gently for three minutes.
3. Gradually add milk, stirring continuously.
4. Add nutmeg and bay leaf, simmer for 10 minutes.
5. Remove bay leaf.
6. Place milk, chopped apple, onion, chicken, ketchup and mayonnaise in blender, blending into a smooth puree.
7. Dissolve gelatine in two tablespoons of warm water and add to mixture.
8. Place in dish and chill until set.

Vegetables au Gratin (serves 2)

• 240 - 360g (½ -¾ lb) vegetables (such as cauliflower, broccoli, carrots, squash, onions, leeks)
• 150mls (¼ pint) cheese sauce
• 45g (1½oz) cheese

1. Boil vegetables, drain when cooked and place into blender.
2. Blend into a smooth puree and place in pie dish.
3. Add cheese sauce, mixing well with vegetable puree.
4. Sprinkle remaining grated cheese on top and brown under a hot grill.

Fish/tofu Mornay (serves 2)

• 240g (7oz) cooked white fish/tofu
• 15g (½ oz) butter
• 15g (½ oz) flour
• 150mls (¼ pint) milk
• 30-45g (1-1½ oz) grated cheese
• ½ small tin chopped tomatoes (sieved to remove skin and seeds)
• ¼ tablespoon prepared smooth mustard

1. Remove skin and bones from fish and puree or puree tofu.
2. Preheat oven to 200oC/400oF/Gas Mark 6.
3. Melt butter with flour, cook gently for three minutes.
4. Gradually add milk to flour mix and bring to boil.
5. Season and add most of the cheese and mustard.
6. Simmer until cheese has melted, stirring occasionally.
7. Place fish/tofu in ovenproof dish and add chopped tomatoes.
8. Pour sauce over fish/tofu and sprinkle remaining cheese on top (again blend /puree at this point).
9. Bake in oven for approximately 30 minutes.

Fruit Mousse (serves 2)

• ½ packet jelly
• ½ small tin of evaporated milk
• ½ small tin fruit in syrup

1. Dissolve jelly in ¼ pint of boiling water.
2. Make up to ½ pint with fruit, syrup and cold water.
3. Liquidise fruit and add to jelly.
4. Leave in cool place, until just beginning to set.
5. Whisk until fluffy, add milk, whisking continuously.
6. Pour into dish and allow to set.

Please note - Jelly doesn’t set if mixed with kiwis or pineapple

Butter bean dip (serves 2)

• 1 tin butter beans, drained
• 2 tbsp olive or vegetable oil
• 2 tpsp lemon juice
• ½ tsp garlic puree

1. Add the drained butter beans, oil, lemon juice and garlic puree to a blender and blend until completely smooth.
2. If too thick, add a little more lemon juice and/or oil and blend again. Repeat until a thick puree consistency is achieved.

Meal Delivery Services:

These companies can deliver puréed meals to your home:

• Appetito (opens in a new tab): 01225 569462
• Oakhouse Foods: (opens in a new tab) 0333 370 6700
• Simply Puree: (opens in a new tab) 0191 456 0456
• Wiltshire Farm Foods: (opens in a new tab) 0800 077 3100

Meals on Wheels:

Cambridge and surrounding areas:

CAMMS Meals on Wheels: (opens in a new tab) 01223 314288

Suffolk:

Aspect Living Suffolk: (opens in a new tab) 01473 749927

Hertfordshire:

Hertfordshire Independent Living Service: (opens in a new tab) 03302 000103

Norfolk:

Please visit Meals on wheels providers (opens in a new tab) or call 0344 800 8020 to find an approved provider in your area.

For other areas, you can search for your nearest meals on wheels service using the following website (opens in a new tab).

Useful recipe books:

Royal Marsden Cancer Cookbook: Nutritious recipes for during and after cancer treatment, to share with friends and family, by Clare Shaw PhD RD.

ISBN 9780857832320

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