Dietetics - Upper Gastrointestinal Pureed Diet

This leaflet is designed to give you dietary information and helpful tips on foods to eat that are both pureed and nourishing.

This leaflet is aimed towards patients who have had Upper GI surgery and is not recommended for use for those who have been given texture modified recommendations by the Speech and Language therapy team. If you do have swallowing difficulties and need support, please speak to your Dietitian or Doctor who can refer you onto the Speech and Language therapy team.

You have been given this leaflet as you have been advised to follow a puree/’sloppy diet. Some types of cancer, medical conditions and treatment or surgery can make swallowing difficult and uncomfortable. If this is the case, pureeing or blending your foods may be recommended.

If you have a poor appetite or have lost weight without trying to, it is particularly important that your food is as varied and as nourishing as possible.

This leaflet can be used as a guide to help you adapt foods in your diet, making them the correct consistency and as nourishing as possible.

Main principles

A puree consistency can be achieved by blending everyday foods using a hand blender or food processor. If you do not have one, cook foods for longer until they are very soft. They can then be mashed until smooth or pushed through a sieve.

• Prepare and cook foods as usual. Ensure you remove any skin, bones, fat or gristle before blending
• Extra fluids can be added to foods to make them easier to blend. Water will dilute the nutritional content of the meal so opt for nourishing fluids such as milk or plant-based alternatives, cream, gravy, crème fraiche or white/cheese sauce
• Add extra energy to pureed foods by adding butter, cream, cheese, mascarpone or smooth nut butters – More information of food fortification is on page 5
• Pureed food shouldn’t have to be bland – Add extra flavour to foods using Worcestershire sauce, lemon juice, ketchup or smooth mustards
• Pureed food may go cold quickly. Use insulated plates or a food flask to keep it hot before it is served
• Pureed foods will look more appetising if the components are not mixed and presented separately. Use an ice-cream scoop or food moulds to help improve presentation
• It is easier to blend large portions rather than individual portions. These can be stored in the freezer and reheated as required
• Avoid baby food as they do not contain enough nourishment for adults
• Ready-made pureed meals, snacks and desserts are available from food delivery companies – Contact details follow:

Wiltshire Farm Foods
Tel: 0800 077 3100
www.wiltshirefarmfoods.com

Oakhouse Foods
Tel: 0333 370 6700
www.oakhousefoods.co.uk

Simply Food Solutions (Simply Puree)
Tel: 0191 456 0456
www.simplyfoodsolutions.co.uk

Boosting your intake

Eating little and often is the best way to increase your calorie intake.

• Aim to have 3 small meals and 3 snacks per day
• Avoid going for long periods without eating
• Try to eat or drink something nourishing every 2-3 hours
• Make the most of ‘good days’ or times during the day when you feel more like eating

Food fortification

Food fortification is a way of adding extra calories and protein to your food without having to eat bigger meals or using nutritional supplements. Here are some ideas for boosting the nutritional content of your pureed meals and snacks:

• Add butter, margarine, mayonnaise, grated cheese or pesto to puree meals
• Add your favourite grated cheese or cream to soup and sauces for extra energy, protein and flavour
• Add cream, ice cream, crème fraiche, custard, honey or caramel sauce to puddings or puree fruit
• Add jam, syrup, cream or condensed, evaporated or fortified milk to porridge, yoghurt or puddings
• Try ‘full fat’ and ‘thick and creamy’ yoghurts and avoid those labelled ‘low fat’ or ‘diet’
• Aim to have a pint of full-fat or fortified milk every day. Use this in drinks, soups, sauces and puddings
• Make coffee and hot chocolate with fortified milk, rather than hot water, or have a glass of fortified milk

For plant-based options:

• Add coconut cream to soups, sauces, smoothies and desserts
• Add cheese, mayonnaise, olive oil or coconut oil when cooking puree meals
• Add nut butters to blended smoothies, desserts and milkshakes
• Use dairy alternative butter, margarine or pesto with puree vegetables and meals

Fortify your milk

Add 4 tablespoons of dried skimmed milk powder to 1 pint (600ml) of full-fat milk to increase protein content and calcium intake. This fortified milk can be used in place of ordinary milk.

For a plant-based alternative, mix 2 scoops of protein powder (equal to approximately 60g of powder) with1 pint of your favourite plant-based milk.

TOP TIP – Fortified milk will stay in date for the same time as your milk. Always check the expiry date!

What if I have a small appetite?

There are many reasons for a low appetite, including illness, pain, anxiety, tiredness and some medications. The following ideas may help to improve your appetite:

• Allow plenty of time for meals
• Try to make food look attractive. Serve on a small plate and use food moulds to separate your food
• Do not over-face yourself with an overloaded plate. You can always have a second helping or pudding if you are still hungry
• Having a drink with your meal can fill you up. Have drinks about half an hour before and/or after a meal instead of with your meal
• Try drinking high-calorie, high protein drinks in between meals for extra nourishment. Fortified milk, milkshakes and other milky drinks are all good choices
• If you prefer cold options, opt for foods like smooth hummus, mashed avocado, yoghurt with honey/smooth nut butter or taramasalata
• Be positive about what you can manage – every mouthful matters
• Choose your favourite foods and flavours to help stimulate your appetite
• Have family or friends cook for you if you find it difficult to prepare your own meals
• Fresh air and walking can make you feel hungry. Try taking a small walk before a meal to increase your appetite

Meal suggestions

All the meals below can be pureed/blended to achieve a suitable consistency. You can also try adding extra sauces to meals to make them a smoother texture.

Breakfast

• Porridge or instant hot cereal (e.g. Ready Brek), blend as required. Make up using fortified, full-fat milk. Add sugar, honey, jam or syrup
• Weetabix soaked in fortified, full-fat milk
• Stewed apple (or fruit of choice) with sugar, cream or evaporated milk
• Banana, mashed with fortified or full-fat milk, cream or evaporated milk
• Thick and creamy yoghurts
• Milk pudding with jam
• Mashed avocado with puree baked or scrambled eggs

For plant-based options:

• Use plant-based alternative milks and yoghurts
• Add yoghurt, smooth nut butters and/or oats to blended fruit smoothies

Lighter and main meals

• Soup – puree as required. These can be quick and nutritious meals whether they are tinned, packet or homemade. Choose ‘cream of’ varieties and add milk, cream or grated cheese
• Meat, poultry, tofu and lentils/pulses – All can be pureed, and extra sauce or gravy can be added
  -    Vary flavours by adding tomato puree or ketchup, chutney, pesto, harissa, smooth nut butters, coconut cream or curry flavours
  -    Add different sauces to vary the flavours – try white, parsley, cheese, korma, Thai curry and sweet and sour sauces
• Pasta and rice - Ensure they are well cooked and soft before pureeing. Add plenty of sauce as needed
  -Try bolognese, lasagne, macaroni cheese, risotto or curry
• Baked or scrambled eggs can be pureed. Cheese can be added for extra nourishment
• Potatoes can be mashed or pureed if they are too lumpy. Instant mashed potato is a useful alternative. Add cream, fortified milk or grated cheese (or plant-based varieties) for extra calories
• Fruit and vegetables blend well and contain essential vitamins and minerals. Cook fresh, canned or frozen fruit and vegetables until they are soft, and then blend
  -    Try mashing carrots, turnips, parsnips and butternut squash
  -    Avocado can be mashed and made more nourishing by adding oil, mayonnaise and/or soured cream

Puddings

• Homemade, canned or individual tubs of puddings such as custard and semolina are suitable. Puddings such as rice pudding, sago and tapioca may need blending
• Try Angel Delight, blancmange, mousse, crème caramel, ice cream and smooth yoghurt
• Fresh, frozen and tinned fruit can be pureed easily
• Fortify your puddings and desserts by adding cream, ice cream, evaporated milk, fortified milk, jam or honey
• Suitable plant-based alternatives include plant-based ice cream, custard and soya yoghurts

Snacks and Nourishing drinks

If your appetite is poor or you are losing weight it is important to try and take snacks and nourishing drinks in between meals. Here are some pureed nourishing snacks you could try throughout the day.

• Glasses of full-fat, fortified milk or plant-based milk
• Thick and creamy yoghurts, fromage frais or plant-based yoghurts
• Home-made or readymade fruit smoothies or milkshakes
• Smooth fresh fruit juices
• Individual mousses, custard or rice pudding pots (puree if needed)
• Jelly and ice cream or plant-based ice cream
• Smooth nut butter
• Soft cheese, hummus or mashed avocado
• Stewed fruit e.g. banana or pear with cream or custard or plant-based alternatives

Contact details:

Upper GI Dietetic Team – 0161 206 4255