Difficulty swallowing—or dysphagia—is not uncommon. The condition affects an estimated one in six adults in the United States, according to a survey conducted by Cedars-Sinai Medical Center in Los Angeles. It can occur because of aging, gastroesophageal reflux, cancer of the head or neck, and injury to or irritation of the esophagus. For people with a neurologic condition, the risk is even higher.
For anyone with dysphagia, eating can be challenging. To make meals easier, chef Linda Monastra and Kristin Gustashaw, RDN, of Rush University in Chicago developed these recipes in accordance with the International Dysphagia Diet Standardization Initiative (IDDSI), which assesses levels of dysphagia and recommends food accordingly. The first four recipes are distinct dishes. The second four are one set of ingredients prepared for four different levels of dysphagia per the IDDSI.
Roasted Butternut Squash Soup
IDDSI Level 3: Liquidized
Serves 4
- 1 ½ pound butternut squash
- 1 ½ teaspoon olive oil, divided
- ¼ teaspoon ground cinnamon
- 2 teaspoon curry powder
- 2 cups low-salt vegetable broth
- ½ teaspoon salt
- 1 13.5-ounce can coconut milk
- 1 tablespoon maple syrup
Preheat oven to 400°F.
Cut butternut squash in half lengthwise and scoop out and discard seeds. Pour ¼ teaspoon olive oil on each half and rub onto surface. Sprinkle cinnamon on both halves then place squash face down on baking sheet and roast in oven until soft and easily pierced with a knife, about 30 minutes. Remove from oven and set aside to cool slightly.
Scoop cooked squash into blender and discard squash peel. Add curry powder, vegetable broth, and salt. Blend until smooth. Pour mixture into medium pot. Add coconut milk and maple syrup. Stir to combine. Warm over medium until heated through, about five minutes. Stir occasionally.
Baked Sweet Potato with Black Beans
IDDSI Level 7 (easy to chew) and Level 6 (soft and bite-sized)
Serves 4
- 4 medium sweet potatoes
- 1 tablespoon olive oil
- 2 cloves garlic, minced
- 1 15-ounce can low-salt black beans, drained and rinsed
- 1 teaspoon ground cumin
- 1/8 teaspoon chipotle or chili powder
- ¼ plus 1/8 teaspoon salt
- ¼ teaspoon ground black pepper
- ¼ cup scallion greens, thinly sliced
- 1 tablespoon minced cilantro
- 1 cup diced grape tomatoes
- 1 cup diced avocado
- 2 teaspoon lime juice
Preheat oven to 425°F.
Prick sweet potatoes with fork to allow steam to escape while baking, place on cooking sheet, and bake until tender, about 45 minutes to an hour.
To make black bean topping, heat olive oil in medium skillet. Toss in garlic and cook for one minute, stirring regularly so garlic doesn’t burn. Add black beans, cumin, chili powder, ¼ teaspoon salt, black pepper, scallions, and cilantro. Lower heat to medium and cook until beans and scallions soften, about three to five minutes. Stir occasionally. Remove from heat.
In small bowl, combine tomatoes, 1/8 teaspoon salt, avocado, and lime juice. Stir to combine and set aside.
When sweet potatoes are done, cut them down the middle to open and place one on each plate. Spread bean mixture and tomatoes and avocado evenly on top of each one.
Omelet With Green Herb Sauce
IDDSI Level 5: Minced and moist
Serves 2
- ½ cup roughly chopped parsley leaves
- 1 ½ teaspoon minced chives
- 1 ½ cups arugula
- ¼ cup diced avocado
- 1 ½ teaspoon lemon juice
- ¼ cup plus 1 ½ teaspoon olive oil
- 1/8 teaspoon plus ¼ teaspoon salt
- 1/8 teaspoon plus ¼ teaspoon ground black pepper
- 6 large eggs
To make herb sauce, add parsley, chives, arugula, avocado, lemon juice, ¼ cup olive oil, 1/8 teaspoon salt, and 1/8 teaspoon black pepper to blender or food processor and pulse until mixture is smooth. Set aside.
Crack eggs into small bowl and whisk well until eggs turn pale yellow. Add remaining salt and pepper and whisk until combined. Heat 1 ½ teaspoon olive oil in 10-inch skillet Tilt pan to evenly coat with oil to help prevent sticking.
Pour eggs into pan and spread mixture evenly throughout. When eggs start to set, use spatula to drag cooked edges into center of pan. Tilt pan to let uncooked eggs move to edge. Once bottom of egg mixture is set, but top is still a bit wet, use spatula to fold omelet so edges meet. Allow to cook additional minute then remove from heat.
Cut omelet in half and transfer each to separate plates. Pour herb sauce over each half and serve.
Pureed and Layered Lasagna
IDDSI Level 4: Pureed
Serves 3-6
- 2 cups frozen chopped spinach, thawed and drained
- 8 oz. whole-milk ricotta cheese
- ¼ teaspoon salt
- ½ teaspoon dried basil
- ½ teaspoon dried oregano
- ¼ tsp. garlic powder
- 8 cooked lasagna noodles at room temperature
- 2 tsp. olive oil
- 1 15-ounce can smooth tomato sauce
- ¼ cup finely grated Parmesan cheese
Preheat oven to 350°F.
Squeeze excess liquid from thawed spinach. Add spinach, ricotta cheese, salt, dried basil, dried oregano, and garlic powder to food processor. Pulse until smooth and ingredients are combined. Transfer to small bowl and set aside. Clean food processor to use in next step.
Place cooked lasagna noodles in processor with olive oil and pulse a few times to break up noodles. Add six tablespoons water and blend until noodles are pureed. Continue to add water, one tablespoon at a time, if noodles aren’t fully pureed. Pour in one cup tomato sauce and pulse until just combined.
Divide noodle puree into thirds. Add 1/3 of pureed noodles to an 8” x 5” baking dish or loaf pan, and carefully spread on the bottom using a slightly wet spatula. Add ½ of ricotta mixture and spread on top of noodle puree. Repeat with another layer of noodle puree and then another ricotta layer. Finish with a final layer of noodle puree and top with remaining tomato sauce. Sprinkle Parmesan cheese on top.
Cover dish with foil and bake for 30 minutes. Remove foil and cook additional five minutes. Remove from oven and let sit for five minutes. Cut lasagna into six pieces and serve. Remove any hardened edges to ensure a consistent smooth texture in every bite.
White Bean Tacos – Four Levels
IDDSI Level 7 (easy to chew) and Level 6 (bite-sized)
Makes 4 servings
- ½ cup diced grape tomatoes
- 2 tablespoons finely diced red onion
- 1 teaspoon minced jalapeno pepper, seeds removed
- 1 ripe medium avocado
- 2 teaspoon lime juice
- ½ teaspoon salt, divided
- ¼ cup olive oil
- ½ cup roughly chopped cilantro leaves
- 1 tablespoon fresh oregano leaves
- 1 tablespoon roughly chopped chives
- 1 15.5-ounce can Great Northern beans, drained and rinsed
- ¾ teaspoon smoked paprika
- ¾ teaspoon ground cumin
- ¼ teaspoon garlic powder
- ¼ teaspoon ground black pepper
- ¼ cup low-fat plain Greek yogurt
- 4 6-inch soft corn tortillas
To make salsa, combine tomatoes, red onion, and jalapeno in small bowl. Stir to combine and set aside.
To make guacamole, cut avocado in quarters, remove pit, and place quarters in small bowl. Add lime juice and ¼ teaspoon salt, gently mash together until mixed and set aside.
In blender or food processor combine olive oil, cilantro, oregano, and chives and blend until no large pieces of herbs remain, and oil has been infused with herbs. If herbs stick to sides of blender, turn off and scrape before continuing to blend again. This herb oil is used to cook the beans.
Place medium skillet over high heat. Pour in herb oil and allow it to warm for one minute. Add beans and stir to coat with oil. Stir in smoked paprika, cumin, garlic powder, ground black pepper, and ¼ teaspoon salt. Cook over low heat for five minutes, stirring occasionally. Remove from heat.
Warm tortillas in large clean skillet over medium heat, flipping to warm each side.
To assemble, place warmed corn tortilla on plate, spread ¼ guacamole, top with ¼ of bean mixture and ¼ of tomato salsa. Add one tablespoon yogurt on top. Repeat for remaining tacos.
IDDSI Level 5: Minced and moist
Ingredients as listed above in Level 6/7 recipe plus 1 cup low-salt vegetable broth
Cook beans as above in level 6/7 directions, then add vegetable broth. Bring mixture to boil, then reduce heat to medium-low. Stir occasionally and simmer until beans begin to break down, and liquid has been absorbed, about five to 10 minutes. Mixture will thicken a bit as it cools.
Tear tortillas into pieces, place in blender, and pulse three or four times until crumbled. Add ½ cup water and blend again on high until mixture is combined and sticks together. Scrape down the sides of blender to get uniform mixture. Transfer tortilla mixture to medium bowl. Set aside.
Make guacamole as instructed for Level 6/7 but create a smoother texture by using a whisk or large spoon to quickly stir the mixture until no chunks of avocado remain. Set aside.
To make salsa, put all salsa ingredients in a blender (or food processor) and pulse until no big chunks remain and texture resembles apple sauce. Drain off excess liquid.
To assemble tacos, scoop out ¼-size measuring cup’s worth of tortilla mixture for each plate. Spread mixture into a slightly flattened circle and evenly distribute beans, guacamole, and salsa puree on each tortilla and top with one tablespoon yogurt.
IDDSI Level 4: Pureed
Ingredients as listed above in Level 6/7 recipe plus 1 cup low-salt vegetable broth
Prepare as in Level 5 but put bean mixture in blender and mix until smooth and to a consistency that slides off a spoon easily with very little food left on the spoon. If mixture is too thick, add additional vegetable broth, one tablespoon at a time (up to ¼ cup maximum) until mixture is appropriate consistency.
Make sure tortilla mixture is fully blended, with no chunks, then divide mixture evenly between four medium ramekins. Fill each ramekin with one layer of beans, guacamole puree, and salsa puree, and top with one tablespoon yogurt.
IDDSI Level 3: Liquidized
Ingredients as listed above in Level 6/7 recipe plus 2 cups low-salt vegetable broth and no corn tortillas
Prepare beans, guacamole, and salsa as in Level 4, but puree beans in blender with additional two cups low-salt vegetable broth. Once mixed, add guacamole and tomato salsa and blend again until smooth. If needed, continue to add additional broth, one tablespoon at a time, until desired consistency is reached.
Pour mixture into cup or bowl and serve.
Prepare beans, guacamole and salsa as above in Level 4, but puree the beans in blender with an additional 2 cups low-salt vegetable broth. Mixture should pour nicely off of a spoon without sticking or clumping. Add in guacamole and tomato salsa. Blend again until completely smooth. Add additional broth, one tablespoon at a time until desired consistency is reached. Mixture should be able to be drunk from a cup and easily poured from a spoon when tilted.
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