However, Parkinson’s doesn’t only affect movement. People living with Parkinson’s can experience a range symptoms such as depression, constipation, and pain that can have a greater impact on their lives. 

Most people diagnosed with Parkinson’s disease are above 50 years old, but younger people can develop it too. In Singapore, there are currently around 8000 people with Parkinson’s disease, and with our ageing population, the numbers are going up. Parkinson’s disease progresses over time and it’s difficult to predict how quickly this happens. For some, it can take more than 15 years for the condition to reach a point where causes major problems. But for others, it may progress more quickly. 

Unfortunately, there is currently no cure for Parkinson’s disease. With treatment and medication, symptoms can be managed, but they become less effective over time. Everyone affected by this disease experiences a different combination of symptoms – so no two people will follow the exact same medication routine. Parkinson’s is also unique in that it can affect someone differently every day. Symptoms that may be noticeable today may not be a problem the next day.

Nutritional Risk Factors 

You may be wondering, why should nutrition should be of special importance in Parkinson’s disease? This is because good nutrition can make a huge impact in the experience of Parkinson’s disease, even if it has no cure.

By paying attention to their diet, your loved one will feel better, prevent nutrition-related problems, and prevent hospitalisation. As we all are aware, hospital stays can be costly, traumatic for both the patient and their families. By following good nutrition practices, your loved one can stay independant for as long as possible. And as a carer, you will be more able to support him/her in living out a meaningful life for their remaining days. 

In the next section, we’ll share some of the nutrition risk factors that someone with Parkinson’s will face. Following that, we’ll teach you how to tackle them:

1. Parkinson’s causes the gut muscles to slow down. This affects the absorption of medications and nutrients from food. It also causes constipation.
2. Parkinson’s affects the mouth and throat muscles, which in turn causes swallowing problems. As a result, many end up with poor appetite, weight loss and ultimately, malnutrition.
3. With poor appetite, other medical issues such as Diabetes and Hypertension can worsen, which in turn makes it difficult to manage their Parkinson’s.
4. One of the most common medications used to control Parkinson’s symptoms- Levodopa, competes with protein for absorption in the body.
5. People with Parkinson’s may have a higher risk of getting dementia and stroke. There is evidence that good nutrition promotes brain health and protects against them.

Things You Can Do

The symptoms of Parkinson’s disease can vary from day to day. There will be times when your loved one can function almost normally and then other times when they will be very dependent. Listed below are some of the common symptoms and ways to support them through diet and nutrition.

• Constipation
  1. People who don’t drink enough fluids or consume enough fiber can be constipated and have hard stools. This causes a lot of abdominal discomfort. Ensure that fluids are offered regularly throughout the day (at least 1.5 to 2 litres a day) Offer good sources of fibre like whole grain breads and cereals, oats, beans, fruits and vegetables, beans, peas and lentils. Add them to their meals and soups.
  2. When swallowing problems start to emerge, eating fibrous foods may no longer be possible. Therefore, it is important to incorporate dietary fibre supplements so as to maintain digestive health.¹ 
  3. The use of laxatives comes with side effects and results in dependence over time. Instead of relying on laxatives, serve Prune and Pear juice. They are natural laxatives and can help with bowel movements.

• Poor Appetite, nausea and vomiting
  1. One of the symptoms in Parkinson’s is a weakened sense of smell and taste. Therefore, strong-tasting food can help to stimulate appetite. Use flavourful oils, vinegar, soy sauce, curry, chilli to amp up the taste.
  2. If they are eating poorly, make sure that water is given after meals rather than before meals. Otherwise, they might feel too full to eat.   
  3. Offer high-energy snacks throughout the day (e.g. puddings, jellies, buns,  agar-agar, ice cream, egg custard, stewed fruit, local desserts like red and green bean soups, pulut hitam, soybean curd, local snacks like soon kueh, ang ku kueh, yam cake, chwee kueh, chee cheong fun or pastries, croissants, potato chips, chocolates, cream cakes, dimsum etc.) ³
  4. Add peanut butter, jam, honey, or chocolate sauce to their morning porridge to bulk up the calories.
  5. Add margarine and oils, mayonnaise, cream, sour cream, full cream dairy products, dried fruits, nuts, honey, jam to their meals. 
  6. It may be easier to start a meal support service that reduces their risk of malnutrition and allow them to remain happily living in their home. ⁴
  7. Consider nutrition supplements if they are losing weight.
  8. For nausea and vomiting, let them have small frequent meals.
  9. Drinking ginger ale may help to reduce nausea. Include protein at every meal ( e.g. pork, lamb, mutton, beef, chicken, turkey, quail, fish, cheese, yoghurt, nuts, legumes such as baked beans, soybean curd, soy milk, red/green beans, eggs and tofu). 
  10. Promote dairy products such as Milk, cheese and yoghurt which are high in calcium and have protein. Avoid low-calorie, low-fat and low-sugar foods. For a person with poor appetite, the goal is to prevent them from losing weight.

• Swallowing difficulties (Dysphagia)
  1. Make food easier to chew and swallow by changing the texture. Foods that are softer and moist are easier to manage. Mince, chop, grate or mash where needed. ⁴
  2. Use a thickener in water, soups, and beverages. Thicker liquids flow more slowly to prevent choking⁵
  3. Consider home-delivered texture modified meals. This takes away the hassle of cooking and texture-modification. With professionally-prepared meals, you can be assured that it complies with the Dysphagia diet guidelines. ⁴

*If swallowing is a concern, speak to a Speech Therapist. A therapist will be able to assess the problem accurately and teach your loved one exercises to prolong the useful life of his swallowing muscles. Even if there are no swallowing difficulties yet, it is very likely that your loved one has begun to experience speech problems e.g. soft voice and mumbling. These changes in speech is damaging to one’s self-esteem and often causes embarrassment, leading to social isolation. Fortunately, there are very effective treatmentsfor speech problems in Parkinson’s Disease, so please get help as early as possible. 

• Problems moving jaw, lips and tongue
  1. Encourage soft foods, like cooked cereals, soft scrambled eggs, gravies, sauces, thick soups, ground/minced meats or soft stews such as slow cooker meals. ⁴
  2. Try mincing their foods.

• Uncontrolled movements
  1. Parkinson’s drugs can make a huge difference in controlling tremors. Observe how long it takes for the drugs to “kick in” and time your meals shortly after. This gives your loved one the best chance of experiencing an enjoyable meal.
  2. Be flexible and make the most of ‘good eating’ times. Some people eat better at certain times of the day when their movement is less likely to bother them, whether this is at breakfast or later in the evening.
  3. Allow them enough time to eat, do not rush them.
  4. If cutlery is difficult to use, having small portions and finger foods helps them to feed independently (sandwiches, cut up fruits, cheese cubes, fish sticks, chicken nuggets,  diced hard boiled egg, soft vegetables like well cooked broccoli, cauliflower, baked pumpkin/ sweet potato, soft local kuehs/cakes etc). Alternatively, consider a feeding robot that can help your loved one to continue feeding himself in a dignified manner.
  5. Encourage eating in a quiet setting.

• Low blood pressure (postural hypotension)
  1. Large meals can lead to low blood pressure, so stick to smaller portions.
  2. Avoid sugary snacks and drinks (chocolates, biscuits, soft drinks).
  3. Salty snacks may help to maintain the blood pressure ( chips, nuts, soups). *
  4. Sometimes, people find that caffeine can help them avoid low blood pressure ( coffee, diet colas). Avoid caffeine at night, as that can interfere with their sleep.
  5. Having a drink of water before they get up from bed can sometimes help.
  6. Avoid alcohol

* Don’t add extra salt to their diet without speaking to their Doctor or a Dietitian first. It helps to keep a diary of what triggers their symptoms and what makes them better or worse. This will help manage the problem.

Levodopa and Protein

We know that dopamine is important for us as it controls our body movements. That’s why many treatments for Parkinson’s are intended to increase dopamine levels in the brain. For a number of years, the medication Levodopa ( which converts to dopamine in the brain) has been used as the gold standard for treating the symptoms of Parkinson’s. 

However, for somepeople, protein in our food interferes with levodopa absorption. This is because Levodopa and protein both need to utilise “carriers” in order to make the journey from our intestines to our brain. The benefits of protein and Levodopa can only be expressed if they successfully reach our brain.

This means that when our bodies are digesting food that contain a lot of protein, all the carriers in our intestines are “occupied”. There are no empty carriers left to transport Levodopa to our brain and it must wait for its turn. This results in delayed absorption of Levodopa. 

 Thus, it’s helpful for your loved one to:

• Take their medication 30 – 60 minutes before they eat a meal. This will allow the medication to be quickly absorbed before protein can interfere.
• Eating a low-protein snack (such as crackers) when they take their Levodopa. This may  reduce the nausea that Levodopa sometimes causes.
• Take a protein redistribution diet. I.e. Eat most of the protein in the evening. This helps the levodopa treatment to be more effective in the daytime, when your loved one is likely to need it more. 

*Everyone’s Parkinson’s symptoms and drug responses are unique.  If you have any questions about your loved one’s medication or protein intake, their Doctor and Dietitian will always be best persons to provide advice. 

Nutrition in Advanced Parkinson’s Disease 

It is common for people in the later stages of Parkinson’s disease to lose a considerable amount of weight as their symptoms become more debilitating. They may also get dementia and no longer recognise the food they are served. They may:

• Need even more help and become totally dependent for nursing care
• Become increasingly frail and become confined to the bed or wheelchair
• Be completely unable to safely chew or swallow
• Lose control of their bladder or bowels
• Difficulty breathing

In the late stages, deciding on your loved one’s care can be emotionally trying. Please also look after your own mental and physical health. Share your problems, ask for help when needed, and make time for yourself.

* Please read Nutrition in Palliative Care brochure for more information on end-of-life care.

Myths and Facts

Parkinson’s disease only affects someone’s movement.

Many symptoms of Parkinson’s are unrelated to movement. Non-motor (“invisible symptoms”) are common, and may affect everyday life more than the more obvious movement difficulties. These may include: impaired sense of smell, sleep disorders, memory, constipation, bladder symptoms, sweating, sexual dysfunction, fatigue, pain (particularly in a limb), tingling, lightheadedness, anxiety and depression.

My mother doesn’t need to inform her doctor what supplements she is taking.

Supplements can interfere with the effectiveness of conventional medications, which is why it’s important to discuss all dietary supplements she is taking with her Doctor. For example, people with Parkinson’s take supplements like vitamin E, omega-3 fatty acids and coenzyme (CoQ10) for their antioxidant properties. However, in addition to the potential benefits, vitamin E and omega-3 fatty acids may increase the risk of bleeding while coenzyme (CoQ10) may increase blood clotting. These are important risks for people to be aware of, particularly anyone who takes a blood thinner such as warfarin or aspirin, or who is at risk for falling.

Apart from taking his medicines that the Doctor prescribed, there is nothing my Father can do to help his disease.

While it’s true that his Parkinson’s cannot be cured, it is not true that he is merely a passive recipient of life’s circumstances.

By adopting a healthy lifestyle and having strong social support network, we can make a big difference in our experience of illness. In times of hardship, the bonds that we build with our friends and family function like an invisible fortress that keeps us strong amidst the attack of physical illness. That’s why it’s so important to retain one’s communication ability in Parkinson’s disease, and sense of independence. 

Appendix

Helpful Products from Health Food Matters

1. Sunfiber Supplement
2. Special Pantry Snacks and Desserts – Ena Charge Fruit Jelly, Ion Support Fruit Jelly, Soft Fruit Cup, Pureed Fruit, Protein Mousse Dessert, Bread Porridge, Okunosu Nutrition Support Egg Custard  
3. Special Pantry Snacks and Desserts – Soft Fruit Cup, Pureed Fruit 
4. Delisoft Range of dishes available in 4 textures – Regular, Chopped, Finely Minced and Blended textures, Sunfiber Supplement
5. Toromi Smile Clear Beverage Thickener, Special Pantry Thickener Cold Mousse Base powder for making pureed fruits and vegetables

About Health Food Matters 

At Health Food Matters, their team of healthcare experts and food technologist develop scrumptious Delisoft Easy Meals which are nutritious and they come in different textures. They also carry a range of snacks and desserts from their Special Pantry to provide an extra boost for those who struggle getting enough nutrition every day.

About Jaga-Me 

At Jaga-Me we believe in making healthcare accessible and available to everyone. We provide personalised and curated care for your loved ones. If you need a trained nurse to do professional medical procedures, a trained medical escort to accompany your loved ones for their medical appointments or a trained nurse to do nursing procedures, you can engage our care services.

If you found this article helpful, we recommend reading Budget 2019: CHAS Enhancements, Long Term Care Support Funds, MediSave top-ups and How Food is Making a Difference in End-of-Life.

Award winning Home Care trusted by health professionals – Jaga-Me

This approach will help them to regain their strength and energy faster, and give them a quicker recovery period, which will last through their rehabilitative treatments. Healthy eating and lifestyle habits will ultimately improve their health and reduce their risk of getting another stroke.

Click here for A Guide To Nutrition For Stroke Survivors Part 1.

Reduce the Risks: What You Can Do to Help 

Malnutrition*

This serious condition occurs when your loved one suffers from a low appetite and food intake with weight loss as their caloric needs cannot be met. Usually dysphagia is a culprit that affects their ability to eat after a stroke. Malnourished people end up with more infections and trips to the hospital, therefore it’s important to ensure that we identify and act early.  

1. Sometimes stroke survivors end up with a weaker sense of smell and taste. Therefore, strong-tasting food can help to stimulate appetite. Use flavourful oils, vinegar, soy sauce, curry, chilli to amp up the taste.
2. Promote protein at every meal ( e.g. pork, lamb, mutton, beef, chicken, turkey, quail, fish, cheese, yoghurt, nuts, legumes such as baked beans, soybean curd, soy milk, red/green beans, eggs and tofu). ¹
3. Promote dairy products such as milk, cheese and yoghurt which are high in calcium and have protein. 
4. Avoid low-calorie, low-fat and low-sugar foods as these are “empty calories”. For a person with poor appetite, the goal is to prevent them from losing weight.
5. If they are eating poorly, make sure that water is given between meals rather than before a meal, so that they do not feel too full to eat.  
6. Offer high-energy snacks throughout the day (e.g. puddings, jellies, buns,  agar-agar, ice cream, egg custard, stewed fruit, local desserts like red and green bean soups, pulut hitam, soybean curd,  local snacks like soon kueh, ang ku kueh, yam cake, chwee kueh, chee cheong fun or pastries, croissants, potato chips, chocolates, cream cakes, dimsum etc.) ²
7. Add peanut butter, jam, honey, or chocolate sauce to their morning porridge to bulk up the calories.
8. Add margarine and oils, mayonnaise, cream, sour cream ,full cream dairy products, dried fruits, nuts, honey, jam to their meals. 
9. It may be easier to start a meal support service that reduces their risk of malnutrition and allow them to remain happily living in their home. ³
10. Consider nutrition supplements if they are losing weight.

*It’s better to get a referral to a Dietitian to assess the problem as they can recommend a meal plan that will help your loved one recover from malnutrition. In doubt, you can reach out to our teleconsultation doctors.

Dehydration

Many stroke patients don’t feel the thirst sensation, by then, they may already be dehydrated, so it’s important to keep offering them fluids ( especially so if they are unable to communicate) regularly to prevent complications.

1. Provide them moist foods, such as stews and foods with sauces.
2. Provide at least 8 to 10 cups of fluids daily. These can include water, milk, juices, soups and other beverages (Try to cut down caffeinated drinks e.g. coffee and cola drinks as they tend to dehydrate the body).
3. Offer hydrating jellies as a form of fluid. These tend to be better tolerated taste wise.⁴
4. Keep their mouth and lips moist by helping them with mouth care.
5. It is common for stroke survivors to end up constipated due to limited mobility or damage in the part of the brain that controls bowels and continence. Ensure they receive plenty of hydrating snacks, fluids and consider a natural fibre supplement if they are having irregular or infrequent bowel movements. ^4,5

Fatigue

A lot of people experience this condition after a stroke due to the immense physical and mental changes they go through. This type of post stroke fatigue doesn’t just go away after rest, it can last for weeks and months and make it harder for someone to recover and delay their rehabilitation, therefore it’s important to speak with their doctor to identify if your loved one is experience fatigue and how you can help to manage it.

1. Give your loved one plenty of time to complete their tasks. Do not rush them. Help them understand that it will take time to get better.
2. Keep a diary of good days and bad days. Make sure they don’t exert themselves too much on days they feel better, otherwise they will end up exhausted later on.
3. Help them with gentle exercises and social activities and take frequent breaks in between such activities.
4. Establish a proper day, mealtime and night time routine.

Chewing and Swallowing problems*

These problems can occur due to the weakening of the tongue or loss of coordination from their tongue movements. Some general recommendations to help your loved one cope are:

1. Choose soft and moist foods that are easy to swallow, such as bread dipped in milk/milo, scrambled eggs, steamed fish, ice cream and yoghurts. 
2. Refrain from sticky foods like glutinous rice.
3. Cold food and drinks are helpful in soothing painful ulcers. 
4. It’s easier to manage food of the same texture, instead of mixing solids and liquids in the same mouthful. E.g. When serving rice/noodles with runny soup, the soup tends to slip down the throat much faster, potentially causing choking. To make it safer and easier to swallow, try thickening the soup so that it’s less runny and coats the rice/noodles properly. This thickened soup helps to moisten the noodles/rice while reducing the risk of liquids slipping down the throat too quickly. 
5. Cut foods into small pieces if chewing is a challenge. 
6. Make food easier to chew and swallow by changing the texture. Mince, chop, grate or mash. In some cases, food may need to be pureed (blended). ³
7. Use a thickener to thicken up liquids to a safe consistency for them. ⁶
8. Consider organising home delivered texture modified meals for your loved one. This way, it takes away the hassle of preparing specific textured meals and you can be assured it complies with the dysphagia diet guidelines. ³

*It’s better to get a referral to a Speech Therapist to assess the problem as they can suggest the safest texture and consistency of foods and fluids.

Limit Sodium in their Diet

It is important to limit food and drinks containing added salt, as excess sodium in the body ( found in salt and salty foods) raises blood pressure and may put your loved one at risk of another stroke. Assure them that as they reduce their salt intake gradually, their taste buds will adjust in a few weeks.

1. Foods such as salted snacks, soups and gravies prepared outside, canned foods, preserved and processed foods such as hot dogs, luncheon meat, stock cubes, seasonings and sauces are high in sodium and should be reduced.
2. When cooking at home, use whole spices, lemon juice or natural seasonings such as shallots, onions, garlic and parsley to spice up the cooking instead of adding table salt.
3. Only add a small amount of salt or sauces after cooking. If necessary, taste the food before salt is added.
4. Avoid giving pickles, sambal belachan, papadum or chutneys with their meals.
5. Minimize the number of times they eat out as most food sold outside is highly salted.
6. When dining out, ask for less gravy, avoid drinking the soup and limit preserved foods such as salted egg and salted fish. Also remember to request for freshly cooked items without salt, MSG or soy sauce.
7. When purchasing foods, choose foods that have the ‘Healthier Choice’ symbol or those labeled ‘Low in Sodium’ or ‘No Added Salt’.
8. Read food labels to compare similar foods per 100g and choose the lower sodium version.

Limit High Saturated Fat and Trans Fat foods

High saturated and trans fat foods can contribute to high cholesterol levels, and we all know that high cholesterol levels increase one’s risk of stroke. Limit:

1. Fatty meats (pork/mutton/beef) and lard
2. Skin and fat on chicken/duck
3. Canned or processed meats (sausage/salami/luncheon meat/burger patty.
4. Deep fried foods (such as fried chicken/meat/fish)
5. Full cream milk and dairy products
6. Coconut milk/oil and coconut products (e.g. kueh and coconut milk based dishes)
7. Foods containing butter, palm/palm kernel oil, ghee
8. Potato chips, pastries, cookies and cakes
9. Margarine and shortenings ( e.g. Crisco, Planta)
10. Shellfish
11. Organ meats ( liver/brain/kidneys/intestines)

Smart Carbohydrate Choices

In general, people with diabetes are more likely to get a stroke than those without. When there is too much sugar in the blood over time with poorly controlled diabetes, clots or fat deposits can occur in the blood vessels in the neck or brain. Over time, these vessels can narrow or become completely blocked, leading to a heart attack or stroke. Therefore, it’s important to choose healthier types of carbohydrates to control blood sugar levels.

1. Have whole grain/brown varieties of bread, rice, noodles, pasta and oatmeal. 
2. Limit refined grains such as white flour, white rice, pastry and sweetened breakfast cereals.
3. Add starchy vegetables (pumpkin, sweet potatoes, corn) and legumes ( beans, lentils, split peas) to your loved ones diet.
4. Encourage more fruits and vegetables (e.g.spinach, kale, chye sim, nai bai,tomato, capsicum, brinjal, bitter gourd, broccoli and cauliflower)to their daily diet.
5. Limit sweetened canned/packet drinks, bubble milk tea, milkshake, flavoured coffee drinks, energy drinks, flavoured milk and cultured milk drinks.
6. Limit canned fruit with syrup, dried fruit coated with sugar/honey/juice concentrates, fruit punch, fruit juice, preserved fruits.

If you found this article helpful, we recommend reading When Memories No Longer Exists: Understanding Dementia and Nutrition in Parkinson’s disease.

About Health Food Matters

At Health Food Matters, their team of healthcare experts and food technologist develop scrumptious Delisoft Easy Meals which are nutritious and they come in different textures. They also carry a range of snacks and desserts from their Special Pantry to provide an extra boost for those who struggle getting enough nutrition every day.

At Jaga-Me, we believe that healthcare should be a social good – it is a basic human need, and should be available to as many people as possible. We aim to deliver the highest quality care through innovation and a commitment to building meaningful relationships.

Save travelling and long wait times at the hospitals. Get specialised medical treatments:
– Urinary Catheterisation
– Complex Wound Care
– Nasogastric (NG) Feeding Tube
– IV Infusion Therapy

Jaga-Me: Your Trusted Medical Home Care Professional

Dysphagia can also occur in the elderly who are otherwise healthy and have no illnesses or diseases. For example, many elderly people experience tooth and muscle loss (in the cheeks and tongue) and that can affect chewing. They can also have reduced saliva flow. Many medications can cause side effects such as dry mouth or reduced cognition. Finally, when someone ages, they can also have reduced nerve function in their mouth which can affect their ability to taste, feel the texture or temperature of the food in their mouth. All these factors can contribute to improper chewing and swallowing response which would normally help push the food down from mouth to their stomach safely.

Consequences of Dysphagia

According to the American Stroke Association, up to 65 percent of stroke patients may experience dysphagia. In long-term care settings such as assisted living residences or nursing homes, more than 60 percent of residents have dysphagia. We tend to take swallowing for granted, but swallowing is a complicated process that uses lots of nerves and muscles. Chewing and swallowing are automatic processes for us and unless something goes wrong, we don’t tend to pay attention to it. However, if we were to cough and choke during mealtimes, this can cause quite an alarm and we have to stop whatever we are doing and concentrate on recovering before continuing our meal. For those with dysphagia, they may not even know that their food or drink is going down the wrong way into their throat and lungs and they be silently aspirating. The effects from untreated dysphagia can be damaging;

• Dehydration,
• Weight loss and Malnutrition
• Anorexia
• Depression and
• Aspiration Pneumonia

Because of these outcomes, your loved one can be at further risk of other complications like constipation, poor wound healing, increased susceptibility to more infections and weakened muscles. They are not only at risk of having caloric, vitamin and mineral deficiencies because of their irregular and decreased intake of food and fluids, but they can also have psychological issues as well due to their dependence on their others for food and different meal types than they are used to. All this can add to increased anxiety and low mood which can affect their intake, leading to weight loss and malnutrition.

By getting a referral to see a Speech Therapist and Dietitian early and paying attention to their diet and swallow function, your loved one will feel better, prevent nutrition-related problems, and prevent hospitalisation. As we all are aware, hospital stays can be costly, traumatic for both the patient and their families. By following good nutrition practices, your loved one can stay independent for as long as possible. And as a carer, you will be more able to support him/her in living out a meaningful life for their remaining days.

Nutrition Goals in Dysphagia

1. To ensure your loved one has an adequate nutrition and hydration status
2. To ensure your loved one is having the correct and safe texture modified diet as advised by their Speech Therapist
3. To maximise their nutritional intake while maintaining safe eating, i.e. to prevent aspiration and choking
4. To ensure that your loved one is supported in eating and drinking as independently as possible

What You Can Do

When difficulty in swallowing becomes a problem due to an illness or disability, then your loved one has to concentrate when they are eating or drinking and anyone helping them also needs to give their full attention.

• Make sure that the correct texture is always being offered to your loved one.
• Ensure that your loved one is positioned properly for feeding.
• Make sure their mouth is clean and clear before meals.
• Offer small bites of food and sips of fluids.
• Make sure the feeding process is not rushed, allow them time to chew and swallow at their own pace.  
• Use a thickener to thicken up liquids to a safe consistency for them. ¹
• Avoid talking throughout the meal, have a slow and relaxed eating experience, avoid distractions.  
• If one side of the mouth is weak, place the spoonful of food in the stronger side.
• Ensure the food remains at a suitable temperature throughout the meal, reheat if necessary so it stays palatable.  
• If possible, allow them to hold the utensil themselves, or place your hand over their hand. This is to help them eat with dignity and maintain independence as much as they are able to.
• Do not offer drinks through a straw unless approved by their Speech Therapist.
• Help them stay upright for at least 30 minutes after eating. This can help reduce the risk for aspiration
• Consider home-delivered texture modified meals. This takes away the hassle of cooking and texture-modification. With professionally-prepared meals, you can be assured that it complies with the Dysphagia diet guidelines and will be attractive enough to enhance the appeal texture modified foods. ²

Avoid

Be careful with these foods and only use if their Speech Therapist says it’s safe.

• Stringy/fibrous foods such as celery, pineapple, melted cheese.
• Food with husks such as sweetcorn.
• Crunchy and crumbly foods such as toast, chips, biscuits, flaky pastry.
• Hard foods such as tough meat, chewy and boiled sweets, nuts, seeds.  
• Vegetable and fruit skins such as beans, peas, potatoes, orange peels, vegetable stalks, grapes.
• Mixed consistency foods such as cereals that do not blend with milk, soups with lumps, chunky peanut butter, yoghurt with added fruit pieces.
• Ice-cream, jelly and whipped cream – melt into thick liquid only.

Additional Considerations for:

Malnutrition

This serious condition occurs when your loved one suffers from a low appetite and food intake with weight loss as their caloric needs cannot be met when they have dysphagia. It’s important to ensure that we identify and act early by getting a referral to a Dietitian. Dietitians can assess the problem and recommend a meal plan that will help your loved one recover from malnutrition.

• Some people with dysphagia and more so, the elderly, have a weaker sense of smell and taste. Therefore, seasoning can help to stimulate appetite. Use flavourful oils, vinegar, soy sauce, curry, chilli to make it tasty if they are able to tolerate them.
• Promote protein at every meal (e.g. pork, lamb, mutton, beef, chicken, turkey, quail, fish, cheese, yoghurt, nuts, and legumes such as baked beans, soybean curd, soy milk, red/green beans, eggs and tofu). ²
• Promote dairy products such as milk, cheese and yoghurt which are high in calcium and have protein.
• Avoid low-calorie, low-fat and low-sugar foods as these are “empty calories”. For a person with poor appetite, the goal is to prevent them from losing weight.
• If they are eating poorly, make sure that water is given between meals rather than before a meal, so that they do not feel too full to eat.  
• Offer high-energy snacks throughout the day which consist of the appropriate and safe texture for your loved one. (E.g. puddings, jellies, thickened custard, stewed pureed fruit, local desserts like red and green bean soups pureed, pulut hitam, soybean curd.)*  ³
• Add butter, jam, honey, or chocolate sauce to their morning porridge to bulk up the calories.*
• Add margarine, butter, oils, mayonnaise, cream, sour cream ,full cream dairy products, honey or jam to their meals.*
• It may be easier to start a meal support service that reduces their risk of malnutrition and allow them to remain happily living in their home. ²
• Consider nutrition supplements if they are losing weight (thickened if necessary).

*Be careful with the consistency of the foods and only use if their Speech Therapist says it’s safe.

Dehydration

Many people with dysphagia don’t feel the thirst sensation, by then, they may already be dehydrated, so it’s important to keep offering them fluids at the appropriate thickness for them ( especially so if they are unable to communicate) regularly to prevent complications.

• Provide them moist foods, such as stews and foods with sauces. (Thickened if necessary).
• Provide at least 8 to 10 cups of thickened fluids daily. These can include water, milk, juices, soups and other beverages (Try to cut down caffeinated drinks e.g. coffee and cola drinks as they tend to dehydrate the body).
• Offer hydrating jellies as a form of fluid. These tend to be better tolerated taste wise. ³
• Keep their mouth and lips moist by helping them with their mouth care.
• It is common for people with dysphagia to end up constipated due to the limited amounts of fibrous foods and fluids they have in a day. Ensure they receive plenty of hydrating snacks, fluids and consider a natural fibre supplement if they are having irregular or infrequent bowel movements. ^3,4

Aspiration Pneumonia

Your loved one can aspirate if the food, saliva or stomach acids is inhaled into their lungs instead of being swallowed into their esophagus and stomach. As a result, it can cause swelling or infection of the lungs. Therefore, it is important for anyone who is caring for your loved one to keep a lookout for signs of aspiration. Call their doctor right away if you observe:

• Their swallowing getting worse
• Unintended weight loss
• Shortness of breath
• Wheezing
• Food comes back up into their mouth
• Vomiting
• High fever
• A wet-sounding voice after eating or drinking

Myths and Facts

1. My mother has dysphagia but doesn’t cough when she eats, so she must ok.

People with dysphagia can be silently aspirating. We are not able to hear when it happens. Keep a look out for the other signs of aspiration and ensure your mother is being regularly followed up by a Speech Therapist. They can help to assess if your mother is taking food and liquids into her lungs.

1. My grandmother has a feeding tube because she cannot swallow well, so she will never be able to eat again.

A feeding tube is a way for someone to get the nutrition they need if they are not eating enough by mouth or if they have dysphagia, however, it is not true that they can never eat again. A feeding tube is reversible and can be a good way to get the nutrition your grandmother needs while her swallowing improves. Regular assessments with her Speech Therapist can determine whether the tube can be removed and she can eat orally again.

We also recommend reading Your Guide to Oral Nutritional Supplements (ONS) and Apps For Diabetics: 5 Aspects To Look Out For.

Helpful Products from Health Food Matters

1. Toromi Smile Clear Beverage Thickener, Cold Mousse Base powder for making pureed fruits and vegetables
2. Delisoft Range of dishes available in 4 textures – Regular, Chopped, Finely Minced and Blended textures
3. Special Pantry Snacks and Desserts – Ena Charge Fruit Jelly, Ion Support Fruit Jelly, Soft Fruit Cup, Pureed Fruit, Protein Mousse Dessert, Bread Porridge, Okunosu Nutrition Support Egg Custard
4. Sunfiber Supplement

At Health Food Matters, their team of healthcare experts and food technologist develop scrumptious Delisoft Easy Meals which are nutritious and they come in different textures. They also carry a range of snacks and desserts from their Special Pantry to provide an extra boost for those who struggle getting enough nutrition every day.

At Jaga-Me, we believe that healthcare should be a social good – it is a basic human need, and should be available to as many people as possible. We aim to deliver the highest quality care through innovation and a commitment to building meaningful relationships.

Save travelling and long wait times at the hospitals. Get specialised medical treatments:
– Urinary Catheterisation
– Complex Wound Care
– Nasogastric (NG) Feeding Tube
– IV Infusion Therapy

Jaga-Me: Your Trusted Medical Home Care Professional

Different parts of the brain control a person’s movements, senses, emotions and intellectual functions. The effects of stroke depend on which part of the brain is damaged and how severe the damage is. Someone disabled from stroke can have minor to severe problems.

• Some people make a speedy recovery and return to their normal lives. 
• Others have disabilities that may improve with time and can be managed. 
• For many, disabilities may last a lifetime. 
• A small number of people will need full time medical care.

 Let’s explore how the loss of function from stroke can affect someone’s day to day life and look at some easy solutions on how to improve nutrition for stroke survivors.

Post Stroke Health Problems

1. Problems chewing and swallowing ( dysphagia)
2. Physically unable to self feed or drink 
3. Communication problems (Unable to verbalise that they need to eat/drink)
4. Cognition problems (memory, attention, perception) ( Do not realise that they need to eat/drink)
5. Visual problems ( Unable to see what they are eating/drinking)
6. Absence of teeth and dentures and poor mouth hygiene 
7. Depression/ anxiety 

In Singapore, deaths from stroke are increasing every year, and those affected by stroke are getting younger. Unfortunately, it’s common for families of stroke patients to lose hope after the incident and assume recovery is impossible. We tend to get caught up in our grief and lose sight of the real possibility of recovery for our loved ones.  

If your loved one is not eating and drinking well after their stroke, they are more likely to be readmitted to the hospital for complications and their recovery will take much longer than expected. They are also likely to have longer hospital stays which increases their cost of their care and emotional burden. Therefore, it’s important to pay attention and make positive changes to what your loved one is eating after their stroke.This approach will help them to regain their strength and energy faster, and give them a quicker recovery period, which will last through their rehabilitative treatments. Healthy eating and lifestyle habits will ultimately improve their health and reduce their risk of getting another stroke.

Post Stroke Goals

Prevent the recurrence of another stroke.

1. Prevent, recognize and manage co-morbid medical conditions such as Diabetes and High Blood Pressure  (Maintain healthy readings for their Blood Sugar, Cholesterol and Blood Fats)
2. Help them be as independent as possible
3. A balanced diet, with adequate protein, calories and good hydration
4. Maximise comfort and well-being

What You Can Do to Help 

Malnutrition*

This serious condition occurs when your loved one suffers from a low appetite and food intake with weight loss as their caloric needs cannot be met. Usually dysphagia is a culprit that affects their ability to eat after a stroke. Malnourished people end up with more infections and trips to the hospital, therefore it’s important to ensure that we identify and act early.  

It’s better to get a referral to a Dietitian to assess the problem as they can recommend a meal   plan that will help your loved one recover from malnutrition.

Dehydration

Many stroke patients don’t feel the thirst sensation, by then, they may already be dehydrated, so it’s important to keep offering them fluids ( especially so if they are unable to communicate) regularly to prevent complications.

Fatigue

A lot of people experience this condition after a stroke due to the immense physical and mental changes they go through. This type of post stroke fatigue doesn’t just go away after rest, it can last for weeks and months and make it harder for someone to recover and delay their rehabilitation, therefore it’s important to speak with their doctor to identify if your loved one is experience fatigue and how you can help to manage it.

Chewing and Swallowing problems*

These problems can occur due to the weakening of the tongue or loss of coordination from their tongue movements. Some general recommendations to help your loved one cope are:*It’s better to get a referral to a Speech Therapist to assess the problem as they can suggest the safest texture and consistency of foods and fluids.

Limit Sodium in their Diet

It is important to limit food and drinks containing added salt, as excess sodium in the body ( found in salt and salty foods) raises blood pressure and may put your loved one at risk of another stroke. Assure them that as they reduce their salt intake gradually, their taste buds will adjust in a few weeks.

Limit High Saturated Fat and Trans Fat foods

High saturated and trans fat foods can contribute to high cholesterol levels, and we all know that high cholesterol levels increase one’s risk of stroke.

Smart Carbohydrate Choices

In general, people with diabetes are more likely to get a stroke than those without. When there is too much sugar in the blood over time with poorly controlled diabetes, clots or fat deposits can occur in the blood vessels in the neck or brain. Over time, these vessels can narrow or become completely blocked, leading to a heart attack or stroke. Therefore, it’s important to choose healthier types of carbohydrates to control blood sugar levels.

Myths and Facts

A stroke is not preventable.

One of the biggest myths surrounding stroke is that people assume a stroke is not preventable. In fact, one of the largest stroke studies called the International Stroke Study showed that 90% of strokes are caused by preventable risk factors such as obesity, high blood pressure and diabetes. Maintaining a healthy weight, keeping active and eating a healthy, varied diet are ways to prevent a stroke from happening.

Stroke only happens to older people.

While it’s true that our risk for stroke goes up as we age, there’s also an increasing number of strokes in younger people currently, so to say that strokes only occur in the elderly is false. There is an increasing number of people under the age of 65 being diagnosed with preventable diseases such as high blood pressure, obesity and diabetes which puts them at a higher risk for stroke.

Stroke survivors have no lives for themselves.

If people learn to recognise the signs of stroke early on and seek treatment fast, we can prevent major complications from occurring. Research is also now finding newer and better treatments to treat stroke and help the brain to recover and repair itself. Although many people live with the effects of stroke for life, with rehabilitation, a good deal will make strong recoveries and go on to lead fulfilling lives. 

Continue on to A Guide To Nutrition For Stroke Survivors Part 2

Helpful Products from Health Food Matters

1. Special Pantry Snacks and Desserts – Protein Mousse Dessert, Bread Pudding, Okunosu Nutrition Support Egg Custard
2. Special Pantry Snacks and Desserts – Ena Charge Fruit Jelly, Ion Support Fruit Jelly, Soft Fruit Cup, Pureed Fruit, Protein Mousse Dessert, Bread Porridge, Okunosu Nutrition Support Egg Custard  
3. Delisoft Range of dishes available in 4 textures – Regular, Chopped, Finely Minced and Blended textures
4. Special Pantry Snacks and Desserts – Ena Charge Fruit Jelly, Ion Support Fruit Jelly
5. Sunfiber Supplement
6. Toromi Smile Clear Beverage Thickener, Special Pantry Thickener Cold Mousse Base powder for making pureed fruits and vegetables

If you found this article helpful, we recommend reading When Memories No Longer Exists: Understanding Dementia and Nutrition in Parkinson’s disease.

About Health Food Matters

At Health Food Matters, their team of healthcare experts and food technologist develop scrumptious Delisoft Easy Meals which are nutritious and they come in different textures. They also carry a range of snacks and desserts from their Special Pantry to provide an extra boost for those who struggle getting enough nutrition every day.

At Jaga-Me, we believe that healthcare should be a social good – it is a basic human need, and should be available to as many people as possible. We aim to deliver the highest quality care through innovation and a commitment to building meaningful relationships.

Save travelling and long wait times at the hospitals. Get specialised medical treatments:
– Urinary Catheterisation
– Complex Wound Care
– Nasogastric (NG) Feeding Tube
– IV Infusion Therapy

Jaga-Me: Your Trusted Medical Home Care Professional