Dysphagia Snacks or Dysphagia Snacking?1 Jun 2021
The evidence shows that an increased opportunity for snacks can support people with dysphagia in maintaining a healthy bodyweight. We are asked, regularly, for dysphagia snack ideas from patients, caterers and registered clinicians. There are so many options for dysphagia snacks, you can really do anything, yet our preconceived definition of a ‘snack’ can make it difficult to find suitable examples for dysphagia diets.
To understand how we can do more to provide suitable dysphagia snacks let’s take look at what an established view of a snack is first.
What’s a snack?
Search for ‘snack’ on the internet and commercial brands and products leap at you, as I’m sure you would expect them to. Asking people what their favourite snack is, usually results in the naming of products they like to snack on: crisps, chocolate, cakes… In some cases it’s a natural item, an apple, a banana, or some dried cranberries.
Quick, accessible and with little preparation
So when we think of dysphagia snacks, what are we thinking of?
A snack is not a meal. A snack is eaten between meals. A snack, therefore, shouldn’t take much time to prepare, it must be, pretty much, instant gratification, which is why snacks comprise either pre-made commercial products or something natural that can be eaten without the need for preparation.
For snack food to be available, at our beck-and-call, it must be easily stored and maintain optimum freshness. So again, for ambient storage, it is clear why fresh and dried fruit; along with pre-made commercial products that are made and packaged to ensure long shelf lives.
Salt, sugar and fat
Let us leave natural snacks, for the time being, and look at commercially made sweet and savoury snacks. The requirement for long shelf lives, instant gratification from flavours and textures almost always requires higher than normal levels of salt, sugar and fat.
Now for the general population these elements of dietary intake are quite rightly regulated and society understands the issues related to the overconsumption of foods high in salt, sugar and fat. In 1972, snacks of this type became widely known as junk food, a term coined by nutrition advocate Michael Jacobson, for the reason that these foods provide empty calories and significant related health issues.
However, in health and social care settings, where there are many profound medical and social conditions that impact negatively on body weight, the use of snacks is successfully used to reduce undernutrition and the terrible effects of malnutrition. The use of energy dense snacks is, quite rightly, endorsed and recommended by dietitians, and other registered clinicians that work closely with patients in this area.
The profound effects that dysphagia has on people that develop the conditions causes a massive impact on their ability to eat and drink sufficient quantities to stay healthy. It is therefore sensible, and in fact, evidence shows, that the availability and consumption of snacks leads to a marked improvement in the body weight of people with dysphagia.
Looking at some of the research suggests that either the provision of 5 or 6 energy dense snacks a day alongside regular meals; or 6-10 small energy dense meals a day can have a great effect on the nutritional status of people suffering with dysphagia.
The quest for dysphagia snacks that look like regular snacks is problematic. This thinking leads to the requirement of suitable items being from a group of established foods regarded as snacks; they must be stored easily and instantly accessible; and they should require no preparation to be consumed.
If you search the web for ‘dysphagia snacks’ you can now find lists of ‘suitable’ snacks for the IDDSI Levels. Not only is this approach incredibly limiting and demoralizing; the items listed are not designed to be subjected to the IDDSI Testing Methods.
Snacks or snacking?
I have to admit, I am trying to cut down on my snacking behaviour! However, my snacking, doesn’t manifest itself with the grabbing of a packet of crisps, peanuts or mini-sausage rolls (the odd bit of chocolate maybe)… It is ‘leftovers’ snacking from the fridge: a slither of leftover beef on a small piece of bread, a slice of cheese with a small dollop of chutney, or a teeny-tiny piece of the cheesecake we had yesterday.
These are not commercially marketed snacks, however they could certainly be described as snacks as they are being eaten as snacks… my waistline would definitely describe them as snacks!
Now we’ve made salt and vinegar crisps at IDDSI Level 4 – Pureed, and we could give you a recipe for versions at IDDSI Levels 5 – Minced and Moist and 6 – Soft and Bite Sized. Peanuts, pretzels,, Turkish Delight, you name it… It is all achievable. But you will have to make it, and it might take a little time to do this. This requirement erodes it’s status as a snack; as well as increasing the workload of caterers and carers.
Dysphagia snacking, on the other hand, could meet all the needs of dietetic recommendations, without any extra burden. You just have to make more of the original dish, suitable for the IDDSI Levels, so the ‘leftovers’ can be available on another occasion as a snack.
Many of our residents love to have a small portion of yesterday’s PU4 chocolate orange mousse puree at mid-afternoon; or a MM5 ham hock sausage makes a delicious Scotch egg when combined with suitable egg mayonnaise.
With this approach you have the availability of quick and accessible options that require little or no preparation – the definition of a snack!
There is clearly a need to be able to offer a varied choice of nutrient dense snacks for dysphagia diets, and we should aim to include some of the classic snacks people enjoy that are available in regular diets. Throughout June, Dysphagia Awareness Month, we will be posting a number of dysphagia snack ideas and recipes that we hope will give you the inspiration to create delicious snacking opportunities for everyone!