Throughout your experience with dysphagia, you will likely encounter many professionals. A team approach is necessary to assess, treat and manage dysphagia, but it can be difficult to remember who does what. One crucial team member is your dietitian. Dietitians are tasked with helping people with swallowing disorders (dysphagia) navigate the rough terrain of how to best get the nutrients the body needs. In this article, we speak with Sheri Stillman, a dietitian, to provide you with suggestions for maintaining nutrition and hydration while living with dysphagia.
What does a dietitian do and where do I find one?
According to the Academy of Nutrition and Dietetics, Registered Dietitian Nutritionists “are the food and nutrition experts who can translate the science of nutrition into practical solutions for healthy living.” They offer expertise and use the science of food to optimize and promote health, as well as to prevent and treat disease. Based on your geographic location, there can be differences between the terms “nutritionist” and “dietitian.” It is a good idea to look into what kind of training your dietetic professional has and whether they are a regulated health professional.
How you access these services may vary depending on where you live. For example, “consultation with a dietitian might be a standard part of your medical care after certain diagnoses or surgeries, or you may have to look further to request access,” Stillman says. She suggests looking at reputable sources online that can guide you in finding a regulated dietitian or nutrition professional. “In some places they even have dietitians in grocery stores,” Stillman remarks, so be sure to check resources in your area.
Getting enough nutrition and hydration
Dietitians can help you ensure that you are getting enough of what your body needs from food. “It’s so common for people with dysphagia to have issues getting enough nutrition,” Stillman says. She teaches her patients with swallowing difficulties to choose high calorie foods first. She suggests adding cream sauces, gravies, mashed avocados, oils, and butter to foods to make them high calorie and dense in nutrients. People with swallowing disorders can also make sure their liquid intake is high in nutrients. “Make sure every sip counts. High fat milk, smoothies, juices, chocolate milk, or nutrition supplement beverages are all good options.”
One of the difficulties with dysphagia is that it can limit the textures of foods you can eat.
Your dietitian can help you maintain variety in the foods you are having. “Never cut out a food group,” says Stillman, “but don’t focus too much on one food group. People think they need to focus on fruits and vegetables but that’s low calorie and low protein, which may not be the best option for someone with a swallowing disorder.” Balance is important. Your dietitian can provide suggestions on how to help you strike that balance.
Looking at the whole person
One of the dietitian’s most important roles is tailoring a meal plan to suit you, as an individual. There is no one-size-fits-all solution. When assessing and coming up with a treatment plan, Stillman says the most important thing is to consider the big picture. “Dietitians in general will look at the whole person. Dysphagia is multifactorial,” she explains. What will work for one person will not work for another, so the skill of the dietitian is to consider all factors relevant to you and your care.
Some of these factors include:
- Medical information or cause of the dysphagia
- Medications: Some may interact with diet or affect appetite
- Social supports: Are there others living with you? Who does the cooking? Is there a caregiver involved?
- Cooking skills
- Cultural factors and food preferences
- Trauma and stress
- Schedules: Is there a lot of time to cook and eat?
- Mental health
Considering the person as a whole is one of Stillman’s most challenging and rewarding aspects of her job. “I have patients who are new immigrants, who are truck drivers, single moms with three kids, or a business person in meetings all day with limited time to eat”, she explains. All of these people will require different accommodations and approaches to their care.
Where to go from here
Rehabilitation and management of dysphagia is a complex process and not something you should have to do alone. A dietitian, especially when working in conjunction with your speech-language pathologist, can bring tremendous value to you and your care. If you have the opportunity, do consult a dietitian about how you can make your nutritional intake work best for you.
About the Authors.
Sheri Stillman, RD. Sheri is a Registered Dietitian, working in Toronto, Canada. She has experience working in hospitals on specialized head and neck cancer and thoracic surgery teams. She has also worked alongside family doctors in primary care. We reached her for a phone interview on July 27, 2021.
Jana Zalmanowitz M.Cl.Sc, Reg. SLP, SLP(C)
Prior to becoming a Speech-Language Pathologist (SLP), Jana worked as a research technologist, assisting in dysphagia research. This sparked her interest and she has continued to serve this population as a SLP in both hospital and private practice settings.
About Mobili-T: Mobili-T is the innovative wireless sEMG biofeedback device that helps you live well with dysphagia.