I spent 3 days on a modified texture diet; day 1 was soft and bite-sized, day 2 was minced and moist with High Energy (HE) and High Protein (HP) and day 3 was pureed with HE.
When creating my meal plan, I tried to create meals that were similar to what I often normally eat as I thought this would make it less of a “change” and easier to stick with. I tried to include a wide variety of the 5 food groups, fibre and fluid each day, but found this difficult on the second and third day as I was trying to make each meal as energy dense as possible without having to physically consume extra food, so I found vegetables, grains and low energy food groups hard to include on these days.
Prior to commencing this task, I was confident it would only have a small impact on my day-to-day life and I thought having to prepare the food was my only challenge. I assumed day 1 would mostly resemble my regular meals and be easy to adjust to, but I assumed the following 2 days would be a bit more challenging.
I found day 1 quite achievable as my breakfast and lunch was a close replication of my usual meals and it still had texture which I found enjoyable to eat. Day 2 and 3 were both HE days where I added things like cream and honey to increase the energy density of meals and snacks. This was easy to add on paper, but when it came to actually consuming some of the meals, it was quite sickly and filling. Although I was consuming similar flavours to what I normally eat, I noticed the look and texture decreased my desire to eat the meals.
By the end of day 2, I was craving more dry and solid foods and didn’t really feel like any of the meals I had planned for myself. I also struggled to eat all my meals within my usual 8am-6pm window, because I was full for longer periods of time between meals during the day and I often felt sick after eating which reduced my appetite for the following meals.
I think it helped having my HE HP meals kept the same size and physically eating the same amount, because I didn’t actually notice the extra calories I was consuming. I found the dairy based smoothies, oats and milk drinks were sickening after consuming a lot at once, but adding cream to soups and hot pots was a good option as I could hardly notice.
I think if the diet is very carefully planned, taking into consideration the five food groups, fluid and fibre, theoretically I don’t think there would be any negative nutritional implications of the diet. However, the compliance may be the main issue. After analysing my diet, I was quite happy that I met my fibre, fruit, vegetable, meat and dairy intake quite comfortably over the three days, Stewart (2015), but I fell short in the grains on day 2 and 3. I found it difficult to add grains as the diet became more pureed, cream and sugar seemed like a more energy dense option rather than pureed grains which would physically add more food and be more filling. My weight also stayed relatively stable during the three days, refer to table 1 below.
I underestimated the difficulty of this task even with having the luxury of choosing particular days and preparing foods ahead of time which was helpful, I did not realise how much actually consuming the meals would also be a hurdle. I was surprised how much the texture and fullness from previous meals reduce my desire to eat and how uncomfortable I felt consuming large quantities in one setting.
In conclusion, I found this task extremely beneficial to both my learning and my future practice, it will allow me to be able to put myself in my patients’ shoes and be more willing to negotiate changes and adjustments to their modified texture diet when necessary.
In future practice, if possible, I would try to make the modified texture meals resemble the patients regular eating habits as I felt this worked well in my experience. I would reduce my reliance on dairy-based products and find HE, HP alternatives to offer the patient for both main meals and snacks to prevent the feeling of ‘sickness’ and a decreased appetite. I would also recommend planning 6 smaller meals throughout the day rather than 3 large meals to increase appetite towards eating. Lastly, I will be mindful to include more grains by creating modified texture risottos or cream-based pasta dishes to add extra calories with cream at the same time.
Overall, I enjoyed this experience and despite my challenges, I would still recommend a modified texture diet for those who require it as nutrition is such an important part of any recovery.
Here are the meals I chose and the energy of each meal:
Level 6 – Soft and Bite-sized
BF – Oats with milk, berries, banana
MT- Full milk coffee
L- Creamy tuna pasta and vegetables
AT- Cup of tea with 2 chocolate biscuits dunked
Di- Shepards pie
De- Chocolate pudding + cream
Level 5 – Mince & moist with high energy and high protein (add 2100kJ onto energy requirements and calculate protein at 1.2-1.5g/kg)
BF- Overnight oats with milk, berries, peanut butter and honey
MT- Cup of tea with 2 chocolate biscuits dunked
L- Shepards pie with cheese
AT- Smoothie with banana, nut butter, protein powder, milk
Di- Sweet potato and chicken soup
De- Chocolate pudding and cream
Level 4 – Pureed with is high energy (add 2100kJ onto energy requirements)
BF- Smoothie with banana, oats, protein powder, nut butter, milk and chia seeds
MT- Creamy yogurt with honey
L- Pureed slow-cooked beef stew
AT- Full milk hot chocolate
Di- Pumpkin and lentil soup pureed
De- Chocolate pudding and cream pureed