Recipes and meal suggestions

MND/ALS may affect the ability of the person to eat in a few different ways. Bulbar symptoms occur as the tongue becomes paralysed and begins to waste away and so moving food around the mouth and swallowing become increasingly difficult. Breathing difficulties also affect the ability to eat well. Even if there are no bulbar symptoms as breathing becomes more difficult, so can chewing and swallowing.

People with MND/ALS have a high calorie requirement - much higher than they normally had even if they were very active previously. There are a number of ways to increase calories. It honestly does not matter how you manage this. We have been taught to try to limit calorie intake in our western culture and to avoid many types of food for general health.

This can all now be thrown out the window as it truly does not matter how a high calorie intake is achieved.

Carers however should beware that if they take on the same eating habits they will be likely to put on a lot of weight than can be difficult to take off again later.

Dairy foods are very high in calories and contain proteins and calcium. If they are tolerated well they are the simplest way to shoot that calorie count up high by simply adding lots of butter, yoghurt, cream, sour cream, soft cheeses, ice cream or milk to any meal. Smother vegetables in butter, mash cream or sour cream into any vegetable, make rich sauces and gravies and mix up super smoothies.

If the person does not tolerate dairy products well you can replace them with coconut cream or milk, coconut oil, any vegetable oil, soy sour cream, vegan yoghurt. You can replace butter with lots of beautiful vegan spreads that you can buy or make yourself and as these are usually nut based they will be high in protein.

In all recipes on this site, if you see any dairy product used, simply substitute this. Some people can tolerate some dairy products but not others and so again you can substitute yoghurt for any milk, cream or sour cream if these are not tolerated as well. MND/ALS does not affect the person's ability to tolerate dairy products, however some people find that they have problems with excess saliva or mucous and swallowing and that a lot of dairy products begins to aggravate this.

As MND/ALS progresses and affects the ability to chew and swallow, you may find that you need to change the consistency of the meals progressively as the person weakens. This can often mean you can continue to supply the same meals, but you need to change the texture, and you may end up providing the same favourite meals in a soup-like consistency that is delivered directly into the stomach through a feeding tube.

Some meals can simply be put through a food processor or blender, but some meals need some help to get them to a good consistency. A stew for example will usually blend easily, but steak and veges will need some extra help. Some people are happy to have an entire meal like steak and veges blended all together into a single serving of puree, while others will want separation for retaining separate tastes and colours.

When you have mastered how to get the right consistency, it can be far easier to cook in a larger quantity and freeze several meals. It is not easy to put 8 beans into a food processor and blend them, but it's very easy to put a few dozen in and freeze several portions afterwards.

A collection of recipes from MND NSW members

Smoothies

The humble smoothie is perhaps the single most important supplement you can use to boost calories. There are endless recipes you can try out and they can be taken by mouth or peg. The great thing about using these are that they can be started right after diagnosis and continue right through and they should always be totally delicious. They can be based on dairy products or anything you prefer. They can be made first thing in the morning and stored in the fridge to have in small amounts all through the day. They can be taken alone as a meal, or in smaller amounts with a meal or between meals. It is easy to pack a smoothie with hundreds of calories, and usually the more calories you pack in the better the smoothie will be tasting.

There are loads of websites filled with great recipes, but you can just make up your own. The main thing will be to ensure you get the consistency right as the swallowing ability deteriorates or to put through a peg tube.

All recipes site for smoothies

The main thing with your smoothies is to make them thick, and if there are swallowing issues make sure they are really smooth. If you want to add things like chia and quinoa it's best to soak them well overnight so they go very soft.

Back to top of the page

Mashes

Just about any vegetable can actually be boiled and mashed. So often we only think of potato, pumpkin or sweet potato in this light. If you just need to provide a soft diet, mashing with lots of butter and maybe a dash of cream, sour cream, yoghurt, honey, coconut cream or some soft cheese, can provide a really tasty soft meal.

You can mash some vegetables together and do some separately. Cauliflower mashes into nearly any other vegetable beautifully and is particularly good mashed with carrots. Fresh beetroot boiled and mashed with yoghurt is a treat for everyone.

Green vegetables don't tend to mash well but you can put them in a food processor or blender and get a great green mash. Try a mix of peas, beans and broccoli with loads of butter and a dash of cream.

The softer the mash needs to be, the more you need to add of your choice of cream or whatever. You can make a white sauce and mash that into nearly any vegetable too. Many people find the soft meal is far more palatable if there are still some separate colours. So you can mash some potato, then mash some sweet potato and carrot and then some greens and you still can present a meal with separate flavours. Ensure you cook the vegetables more than you might normally so that they are really soft and readily become a fine mash.

Back to top of the page

Stews and casseroles

The slow cooker can become your very best friend. It's amazing how much variety can still be eaten if you cook everything together with rich gravy juices. Do be aware that some people with bulbar issues also find their taste buds change and they may start to have difficulty with spicy foods. Going for rich tastes, rather than hot and spicy may be the better way to go.

Many of your favourite recipes for a stew, casserole or soup can be simply cooked in a slow cooker and it makes things so easy. Chop everything up, throw it in, turn it on and forget it for the bulk of the day! Cook it on low for hours and you have an incredibly tender meal that stays very moist.

If you need to go beyond a soft meal it is easy to then put this food into a food processor and turn into puree or whatever texture you need.

Some links to hearty casserole meals you can try out

http://www.southernliving.com/casseroles

http://www.bhg.com/recipes/casseroles

Back to top of the page

Meat

Meat seems to be the thing most people get stuck on when it comes to the point of needing puree.

One of important points if you want to cook steak or chops is not to overcook as the protein fibres become hard. Cook the meat under the griller or in a frying pan or baking dish so that it is medium rare (cooked but still pink inside).

Cut the meat into chunks and place in the blender with a selection of the following:

• mushrooms lightly butter fried
• smoked oysters (half a dozen to a serving)
• well cooked fried onion
• fried capsicum, zucchini, squash or eggplant

To moisten this down into a mash or puree texture now add a selection of the following:

• cream, sour cream, yoghurt or coconut cream
• tomato paste
• any gravy mix you like

You need to just test out the amounts of each thing you need as it's the consistency you are aiming for depending on the swallowing ability of the person you are cooking for.

You can add some bread into the blender first and reduce to crumbs and then add your meat and other ingredients, which adds more calories and can give a nice taste for a difference.

Serve this with a selection of mashed vegetables from above and you have a balanced meal that is very tasty and can be served at the consistency the person needs.

Back to top of the page

Cereals and fruits

There are a variety of cereals that can be easily softened by soaking in juice or milk overnight.

• flaked cereal with or without dried fruits
• muesli
• bran and additives such as chia or quinoa

Oats can be cooked and then put through the blender.

Biscuit type cereal can be soaked for up to an hour before serving to ensure they are well hydrated.

If you soften cereal in juice or milk you can then still put through a blender to a puree consistency.

Fruits great for stewing:

• apples
• pears
• frozen berries of any kind
• rhubarb
• mango

Whatever cereal you use you can then blend them with the addition of any fresh fruits or you can stew fruits to add. You can blend up the cereal first and then put stewed or pureed fruit on top, or blend them up together. Any of these are delicious if you use yoghurt and juice as the softener when blending.

Stew your fruit up in advance and just store in the fridge. Many of the blends of cereals and fruits here can be as good to eat cold as warmed in the winter. Fruits with skin texture are often the first that are avoided as it is too hard to control. Skin these fruits (apples, pears, plums, nectarines etc) and lightly stew them. Don't worry about adding lots of sugar or honey, you will increase the calorie count!

Most fruits will pose issues to anyone with swallowing problems because they either have two textures - skin and pulp that is juicy. When the tongue is not working correctly to move food around the mouth, and the swallow reflex is difficult, the two textures, or just the amount of juice in fruit can create issues.

Many fruits can be simply crushed with a fork such as banana, mango, and rockmelon. This helps to release a lot of the juice if present, or simply prevent the issue of chewing something that is not well controlled in the mouth. Add a dollop of cream, ice cream or yoghurt over some crushed fruit and mix it in well if needed.

Back to top of the page

Cakes and cookies

Drier foods are very difficult to eat, but who doesn't like a nice piece of cake?

Cut a slice of cake or a couple of biscuits and cut or crumble into squares.

Put in the blender with a generous helping of cream or ice cream to the consistency you need. Be careful though, these are really delicious and carers can become a bit hooked on them!

If the cookies are particularly hard, soak them in milk or coconut cream for half an hour before blending.

Back to top of the page

Thickening agents

There are proprietary thickening agents you can purchase at a pharmacy to help with swallowing issues, particularly for thin liquids. These can be added to cups of tea, coffee, hot chocolate and even to any soft drink or alcoholic drink.

You can control how much you need to add to give the thickness needed. Starting to use these early may make the difference between becoming dehydrated if a peg has not been placed yet. Drinking thin liquids is usually the first signs of bulbar issues and many people find they simply start drinking less because it is frightening to feel you are choking, or embarrassing to have liquids come spraying out of your mouth.

Hydration is so important for overall health. Some thickening agents seem to be preferable than others to different people. See if your speech pathologist has any samples they can give you of different brands so you can see if you have a preference before laying out money.

If the person does not like the thickening agents you may need to encourage lots of smoothies instead. Sometimes, just having a few sips of a thickened cup of coffee can provide the person with the satisfaction of taste.

Remember, if you offer any drink by mouth and they only manage a few sips, if they have a peg, you can simply put the rest of the drink through the peg. This often gives a feeling of satisfaction because they got the taste, and now have the full feeling afterwards too.

Back to top of the page