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"I jumped on board with IDDSI because I’ve always believed it would reduce errors in the food served to people."

John Holahan

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  • Writer's pictureJohn Holahan

Writing a Modern-Day Dysphagia Cookbook

This is the story of an unexpected journey that ended with me leading my team in writing and publishing a cookbook.


I became an advocate for the International Dysphagia Diet Standardisation Initiative (IDDSI) the first time I saw it presented – back in 2015. Since then, I have taken many actions to support the cause, including developing and hosting IDDSI training webinars, co-founding the US IDDSI Reference Group, being the first to distribute the IDDSI Funnel and being the first product to label packaging with IDDSI terminology.

IDDSI Hall of Appreciation Member John Holahan of SimplyThick

As a result of these volunteer efforts, I was named as an inaugural IDDSI Hall of Appreciation member.


However, even with this enthusiasm and even as we were re-working our recipes to incorporate IDDSI standards and testing methods, I still had no plans to write a cookbook. Let alone the first cookbook focused on home users that teaches how to make food at home into IDDSI-compliant dishes.


The final piece of inspiration for Modern Dysphagia Cooking came from my personal experience of trying to make a "soft, no chew diet" at home for my daughter following a delicate wisdom tooth extraction. I found a complete lack of concrete instructions on what to do for a home cook and absolutely no instructions on how to modify family favorites to meet these special dietary requirements.


It became clear that there was a HUGE gap in the adoption of IDDSI in the US. Although IDDSI has many awesome resources for professionally trained and institutional cooks, there were no available materials that really showed people at home how to adapt their family favorites to meet the requirements of the IDDSI Framework and Testing Methods. I talked with my team, and we decided to fill the gap!


We created Modern Dysphagia Cooking, to be the ultimate guide for home dysphagia diet cooking. Beyond simply incorporating IDDSI terms, definitions, and testing methods into the recipes, Modern Dysphagia Cooking addresses the unique needs of a home caregiver. We started by assuming every family has favorite foods and aims to provide the tools, tricks, and techniques to allow the home caregiver to turn these foods into dysphagia-friendly dishes that comply with the dietary standards and testing methods of the specified IDDSI level. By starting with the food prepared the way the person with dysphagia has always had their food prepared, the hope is to make the foods as familiar and comforting as possible.


Modern Dysphagia Cooking - A cookbook designed to turn family favorites into IDDSI-compliant dysphagia friendly dishes.

Modern Dysphagia Cooking offers flexible processes to allow for differences in individual tastes and preferences. For example, consider two different people with different opinions on what makes a great serving of pulled pork. One prefers the pork plain with a little sauce to dip the meat into on the side, while the other prefers barbecue sauce thoroughly mixed into the meat. Whether we are making the pulled pork into a Level 4, Pureed or a Level 5, Minced & Moist serving, we need to use a Level 4, Extremely Thick liquid to moisten and lubricate and help process the pork. Depending on whom you are preparing the food for, the choice of the most appropriate Level 4, Extremely Thick liquid will vary. For the person that prefers plain pork, use a thickened cooking stock with some thick sauce on the side. For the person that loves barbecue sauce thoroughly mixed into the meat, use a thick barbecue sauce. There is no perfect choice in this situation. But there is the choice that is right for the person for whom you are processing the pulled pork.


We wrote Modern Dysphagia Cooking with these ambiguous yet critical choices in mind. We teach the caregiver about the process of transforming family favorites. This gives the caregiver the confidence and the flexibility to choose which way to proceed to best match the preferences of the person they are cooking for.


There are no “standard” answers when cooking and transforming foods into the best texture-modified foods for a loved one’s personal tastes and preferences. However, there are many common questions and approaches that can work. Modern Dysphagia Cooking provides the roadmap and the structure to help caregivers quickly and easily choose how to transform their food into appropriate dishes for their loved one specifically!

IDDSI compliant Soft and Bite-Sized, Level 6 Lasagna for a Dysphagia Diet

In addition to providing recipes and instructions for making dysphagia-friendly dishes, we made Modern Dysphagia Cooking into a complete reference guide for home caregivers. There are chapters on the IDDSI Framework, the special dietary tricks that may be needed to provide additional nutrition and even full reproductions of the IDDSI Framework and Testing Methods documents.


This unexpected journey led us to create Modern Dysphagia Cooking. It is the only dysphagia cookbook focused on home users that teaches how to transform food at home into IDDSI-compliant dishes. By starting with the food prepared the way you have always prepared it at home, our book aims to make the foods you serve as familiar and comforting as possible.


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