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Nutrition in the Head & Neck Patient
Patients with cancer are at high risk for malnutrition, and those with primary tumors of the pharyngeal and hypopharyngeal structures in particular are among those most malnourished. Impaired nutritional status is associated with decreased quality of life and physical function. Commonly experienced symptoms before or after treatment include dysphagia, dry mouth, taste changes, trismus, nausea, mouth sores, and decreased appetite. These symptoms can greatly affect oral intake and ability to maintain adequate nutrition and hydration. However, early nutrition intervention in relation to these symptoms can help improve patient outcomes as well as physical function and quality of life.
Weight maintenance as well as maintenance of lean muscle mass are key goals in nutrition intervention during and after cancer treatment. In order to increase dietary intake, alterations in food and fluid temperature, changes in food texture and consistency, and increased frequency of meals and snacks may be warranted. If nausea is present, small, frequent high carbohydrate meals may be beneficial in helping to alleviate this symptom. The addition of ginger flavored lozenges as well as warm ginger tea may also be an effective strategy. Avoiding foods with strong smells and cooking in well-ventilated areas may also help with nausea.
If mouth sores are present, acidic foods or extreme food temperatures are typically not well tolerated. If there is no dysphagia, sometimes the use of a straw with beverages to help bypass the mouth sore itself can be effective. Dry mouth can be alleviated with sugar-free candies or gum, alcohol-free mouth rinses, or sipping on water throughout the day. There are a few artificial saliva sprays and gels that may also be beneficial. It is always important to maintain good oral care even if your primary means of nutrition is not orally (ie. tube feedings).
Oftentimes, supplementation with oral nutrition shakes or high calorie, high protein foods is warranted when oral intake begins to decrease. However, oral nutrition shakes should always follow oral intake of solid foods as to not replace the meal itself. Increasing intake of high calorie foods to help maintain weight can be done in a healthy manner and does not need to consist of predominately junk or processed foods. The addition of foods such as avocado, nuts & seeds, nut butters, full-fat dairy products, eggs, lean meats, beans and legumes, and olive oil can help increase the calorie and protein content of a diet and offer the benefit of additional vitamins and minerals.
Physical activity can also play an important part in decreasing fatigue and weakness as well as maintaining lean muscle mass. Resistance training can greatly improve physical function and overall quality of life. The best strategy for encouraging exercise is to choose an exercise that is enjoyable.
Early nutrition intervention is key in preventing and minimizing nutritional deficits in patients with head and neck cancer. A multidisciplinary treatment team with early and ongoing nutrition intervention can help improve clinical outcomes and optimize quality of life.
Heather Duby Shepard MS, RD, LD, CNSC
Senior Clinical Dietitian
MD Anderson Cancer Center, Houston, TX
References: Isenring, E. Esophageal and Head and Neck Cancer. In: Marian M, Roberts, S. Clinical Nutrition for Oncology Patients. 1st ed. Sudbury, MA: Jones and Bartlett; 2010: 165-185.
Eating with Dysphagia
Speech@NYU, the online master's in speech-language pathology from NYU Steinhardt and we have been working on a project to improve the eating experience for patients with swallowing disorders.
We have developed a cookbook of recipes created by masters students, during the school's annual Iron Chef competition, to meet the needs of their real life clients. You can find 'Dining with Dysphagia' at this link:
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