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  • Writer's pictureSandra Robinson

IDDSI peasy, lemon squeezy?

Updated: Jun 1, 2023

Dysphagia Kitchen had the pleasure of working with some very talented chefs this week. Gary Brailsford, dysphagia specialist chef and I headed down to the beautiful setting of St Paul’s school by the river Thames in Barnes, London.

There, we met with chefs Owen and Guy along with Ellena, General Food Services Manager, who all work with CH&CO, a company providing food and service experiences across the UK and Ireland.

We were really pleased to be able to support them in their understanding and development of high-end IDDSI cuisine for the new private Cleveland Clinic hospital in London.

As I reflected on the work that Owen and Guy were doing in the kitchen alongside Gary, it highlighted how tricky getting IDDSI-compliant food right can be, even for the experts. The photos here show the experimentation (not the final meals!) and auditing process.

A perfectly puréed broccoli with an amazing shine but the carrot and lamb needed work

Chefs aren’t trained in IDDSI as a matter of course (yet) but they can combine their expertise and experience with the knowledge and skills provided by Dysphagia Kitchen.

Guy told me that creating and plating gourmet purée dishes is a fundamental skill in fine dining. As he and Owen experimented with puréeing the meat and vegetables to meet the IDDSI Level 4 purée diet standards, they were able to prevent or problem-solve issues by understanding;

  1. whether the food was suitable for adapting to IDDSI e.g. getting the right cut of meat

  2. whether to prepare the food by chopping small or leaving it whole or larger pieces

  3. whether parts needed removing first such as skins and pips

  4. how to cook it most effectively – boil, steam, fry etc.

  5. how long to cook it for

  6. how to test that it was cooked enough / over-cooked

  7. how to blend it effectively including adding extra liquid or naturally thickening food powders

  8. how to plate it up with height, colour contrast, and appealing styles

  9. how to check it meets the standards at serving (pass at the pass!) and at 15 and 30 minutes post-serving

Level 4 purée diet fish, carrot and potato – getting there!

Unlike puréeing, Level 5 minced and moist diet and Level 6 soft and bite-sized diet are not something you’d generally find in a regular professional kitchen outside of the care sector. Working out what the standards were and unlearning some habits was key. Chopped tomato and onion is found in many dishes. But beware of skins, pips and of foods that slip between your fingers rather than squash (or as I prefer, ‘squish‘) like onion. These can catch people out.

Another handy option is a soaking solution (other thickeners are available). Many people who have Level 4 purée diet meals can also manage biscuits or cake prepared as a soaking solution. It’s a lovely way for people with dysphagia to enjoy elevenses or a birthday treat. Always check with the speech and language therapist first.

Experimenting with Level 4 purée diet puddings and soaking solutions

Once these dishes are perfected they’ll also be packed with all the nutrition a rehab patient could need.

We ask a lot of chefs, cooks and family members to provide IDDSI food and drink. It’s not as straightforward as you think. Dr. Ben Hanson is right when he says that IDDSI is a language to help us all understand what’s needed; it takes time and practice to learn that language. It might be close to a language you already speak or you might be starting from scratch.

We’re all more proficient in the language of IDDSI by learning and talking together.

Excellent work chefs!

Level 4 purée blackberry cheesecake – look at that perfect line where the blackberry touches the base

Level 5 minced and moist diet of roast chicken, carrots and potato. It was tricky to get the particle sizes right at first.

More experimentation. It takes practice to get fish pieces right at Level 6 soft and bite-sized. A Level 4 purée addition on the plate can be acceptable and even desirable.


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