I recently met a married couple living at home, in their late 80s, who suddenly had to eat pureed food with nectar-thick liquids. My patient, “Sam”, came home from the hospital downgraded from a normal diet to pureed solids. His wife, an excellent cook, was struggling with what to fix him and how to do it.
My plan is to improve Sam’s swallowing ability with direct therapy, but in the meantime, he’s gotta eat three meals a day plus a snack. As a good cook and loving wife, “Maria” was frustrated at not being able to provide the same variety of healthy and tasty meals that she’s been doing for the past 60 plus years.
Maria wanted specific ideas for what to make as well as recommendations for tools. Although I understand the principles of making pureed food, and I gave her basic information, she wanted more. So I did some research, and we put her food processor to use during visits.
Free DIRECT download: Tips for pureeing food at home (patient handout). (Email subscribers get free access to all the resources in the Free Subscription Library.)
Outline:
- What exactly is pureed food?
- When is pureed food recommended?
- Which foods can be pureed?
- Are any foods banned?
- What equipment do I need?
- Tips for pureeing food.
- Tasty food combinations.
- Free pureed food recipes online.
- Cookbooks for a pureed diet.
- Purchasing pureed food.
- Related Eat, Speak, & Think posts.
- Please share this information.
What exactly is pureed food?
Pureed food, as quoted from this patient handout from IDDSI (the International Dysphagia Diet Standardization Initiative):
- Is usually eaten with a spoon.
- Does not require chewing.
- Has a smooth texture with no lumps.
- Holds shape on a spoon.
- Falls off a spoon in a single spoonful when tilted.
- Is not sticky.
- Liquid (like sauces) must not separate from solids.
IDDSI emphases that it really comes down to how the food is prepared. So for example, mashed potatoes may be not be a true puree because they could be lumpy or sticky.
But since we all like examples, here are examples of commonly-pureed food. Just be sure the results pass the criteria above!
- Mashed potatoes.
- Souffles.
- Cream of Wheat (farina) cereal.
- Pudding.
- Applesauce.
- Yogurt.
- Ice cream.
When is pureed food recommended?
Chewing and swallowing regular foods safely and efficiently requires a certain level of strength and coordination. Many things can go wrong that affect the swallowing process, for instance a stroke, Parkinson’s disease, certain types of dementia, ALS (amyotrophic lateral sclerosis or Lou Gherig’s disease), and head or neck cancer.
Sometimes a person has a high risk of choking or aspirating normal solid foods into the lungs, or is at risk of malnutrition because they struggle so much to eat. Often, in these case, the person can manage to eat pureed foods with minimal risk.
Pureed foods don’t require chewing and aren’t as likely to remain in the mouth or throat after swallowing.
But pureed foods aren’t always safe in every situation, so it’s important that anyone with difficulty swallowing see a speech-language pathologist for an evaluation.
Which foods can be pureed?
Any food that isn’t hard or has seeds are good candidates. What’s critical is that the resulting puree fits the definition above.
MyHealth Alberta provides this list:
- Cooked meats, fish, and chicken.
- Dairy products such as cottage cheese, yogurt, and ice cream.
- Cooked vegetables such as potatoes and beans.
- Canned fruits.
- Ripe bananas and avocados.
You can also puree:
- Soup.
- Eggs.
- Cooked pasta.
- Bread, muffins, and pancakes.
- Fresh ripe fruits without skin or seeds.
Are any foods banned?
IDDSI provides a patient handout with a list of food textures to avoid. Some of these foods can still be eaten if they are cooked until soft and then pureed.
In general, foods that don’t puree well are hard, tough, chewy, crispy, sticky, or have skins or seeds. For example:
- Raw vegetables.
- Grapes.
- Dried fruits.
- Nut butters (can be an ingredient).
- Crispy bacon.
- Popcorn.
- Potato chips and other crunchy snack foods.
- Hard candy.
- Chewing gum.
However, with the right equipment, it may still be possible to achieve a smooth puree with some of these foods.
What equipment do I need?
Essential Puree offers a free ebook “Tools for the Puree Kitchen” that offers recommendations and pro tips on the equipment that is necessary, as well as nice-to-have. I also found some good advice on the Facebook Dysphagia Foods & Recipes Group.
Recommended basic tools
- A food processor (either size or both):
- Mini-food processor, such as the Cuisinart Mini Prep* or the KitchenAid Mini Food Processor*.
- 7 cup food processor with a good motor. You don’t need a lot of attachments.
- A powerful blender, such as the Ninja*, Vitamix or Blandtec. Choose one that is easy to clean.
- A nutrient extractor, such as the NutriBullet*, especially good for fresh fruit and vegetables.
- A fine mesh sieve to strain particles and seeds.
*This is an Amazon affiliate link. As an Amazon associate, I may earn a small commission on qualifying purchases. There is no extra charge to you, and it will help keep Eat, Speak, & Think sustainable.
Financial assistance
The Facebook group mentioned that Vitamix and Blandtec offer a hardship program. Vitamix specifically mentions “children” and I don’t see specific information on Blandtec’s sites. But from online comments, it appears that both companies will provide at least a discount if there is a medical need for the device.
Start with what is available
If your patient has a food processor, blender, or nutrient extractor, I’d recommend starting with that tool and see how it works out before buying a lot of equipment. Maria has been using her food processor for a variety of meats, vegetables, fruits, beans, etc… with good results.
Tips for pureeing food
Cook food until soft, cut into small chunks, and place into blender or food processor. Or use an immersion blender.
Add a little liquid and puree or blend. Keep adding a little liquid until you have a smooth puree.
How to puree meat and keep the flavor
Pureeing meat can be a little tricky. Here are specific tips, from WikiHow:
- Cook the meat. Slow cooking is best for flavor – braise, boil, slow cook, or pressure cook.
- Refrigerate for at least 2 hours.
- Chop into 1-inch pieces.
- Put a cup of meat into your food processor or blender.
- Blend the meat until it’s fine and powder, almost like sand.
- Then add ½ cup of water, meat broth, or reserved cooking liquid per cup of meat.
- Safe in refrigerate for 3-4 days. Or freeze it.
- Add ¼ teaspoon salt and ½ teaspoon of spices of your choice to 1 cup of pureed meat.
Products to use to thicken pureed food
If you add too much liquid, you can thicken it up by adding more food, dried potato flakes, gelatin, flour, or a commercial thickener such as Simply Thick or ThickIt.
Ways to improve flavor
To avoid bland food, put the flavor in the sauce – not in the food as it’s cooking. In other words, add herbs, spices, and flavorful sauces during the blending phase.
IDDSI points out in their FAQ for liquidized foods that people who eat an altered diet are at risk for protein-energy malnutrition and may find it hard to meet their nutritional needs.
IDDSI suggests that we don’t use water as the liquid. Instead, use a compatible liquid that offers added nutrition (and more flavor) such as:
- Milk.
- Butter.
- Cream.
- Cheese.
- Gravy.
- Cream soup.
- Sour cream.
Tasty food combinations
Maria wanted specific examples. I can relate to this, because I personally want specific examples when I walk into my kitchen and look at all the ingredients I can use to make dinner.
The best source I found online was the Facebook Dysphagia Foods & Recipes Group. These suggestions are from people living with a pureed food diet.
First, use a variety of liquids when pureeing food:
- Applesauce
- Guacamole
- Salsa
- Sour cream
- Yogurt
- Butter
- Whipping cream
- Milk (dairy, soy, rice, cashew)
- Coconut milk
- Maple syrup
- Peanut butter
- Broth
- Tomato sauce
- Tomato juice (V8)
- Ensure or Boost
Second, consider these specific combinations:
- Cooked rice and butter.
- Cooked rice with coconut milk (or yogurt), frozen fruit, walnuts, and honey.
- Chicken and applesauce.
- Pork and applesauce.
- Oatmeal with peanut butter and melted chocolate chips.
- Peanut butter & jelly sandwich and milk.
- Baked potato and beef broth.
- Ensure with banana and strawberries and canned peaches.
- Scrambled eggs with cottage cheese and milk.
- Soak banana bread in milk and then puree it.
- Baked sweet potato with butter, cinnamon, ground ginger, nutmeg, maple syrup (or brown sugar).
Free pureed food recipes online
Elmcroft Senior Living provides eight recipes for delicious pureed foods, including macaroni & cheese, guacamole, cauliflower, a chicken dish, maple-whipped sweet potatoes, and two smoothies.
Jeanette’s Healthy Living site offers many recipes for pureed foods that look delicious. She also has pages for other special diets, including liquid/soft food diet, low-residue diet, and cancer.
Cookbooks for a pureed diet
You can find a number of cookbooks for people who have trouble chewing or swallowing. Here are a few:
Essential Puree offers a number of cookbooks under $20, including a Master Sauce Guide for $4.99 and a free e-book of 3 interesting shakes inspired by music.
Nutritionists Sandra Woodruff and Leah Gilbert-Henderson wrote the Soft Foods for Easier Eating Cookbook*. This cookbook includes more than 150 recipes for pureed, soft, and easy-to-chew foods. Each recipe is marked for the level and contains nutritional information.
The book also includes more than 90 pages of educational material about swallowing problems, nutritional tips, and practical recommendations.
*This is an Amazon affiliate link. As an Amazon associate, I may earn a small commission on qualifying purchases. There is no extra charge to you, and it will help keep Eat, Speak, & Think sustainable.
Nutritionist Donna Weihofen and speech-language pathologists JoAnne Robbins and Paula Sullivan wrote the Easy-to-Swallow, Easy-to-Chew Cookbook*. This cookbook includes more than 150 recipes. Each recipe is marked for level: “easy to chew”, “very easy to chew”, or “soft and smooth”. Some recipes give instructions for different levels. Each recipe contains nutritional information.
The book also contains 40 pages of educational material about swallowing problems, nutritional tips, and practical recommendations.
*This is an Amazon affiliate link. As an Amazon associate, I may earn a small commission on qualifying purchases. There is no extra charge to you, and it will help keep Eat, Speak, & Think sustainable.
Purchasing pureed food
Blossom Foods is the brainchild of speech-language pathologist Sue Adams. Blossom Foods sells 18 frozen pureed meals by the case (12 meals to a case) or individual items by the case (18 to a case). Recipes were developed by a Swiss chef, Juerg Aeschbach. Meals are shipped frozen.
Gourmet Pureed sells 14 pureed meals through Mom’s Meals. Meals have to be refrigerated.
Hormel offers Thick & Easy Pureed Meals that don’t require refrigeration.
Phagia sells pureed mixes for fruit, vegetables, pasta, and bread products. It doesn’t appear that they have to be refrigerated.
Simple Serve sells canned pureed beef, chicken, ham, pork, and turkey.
Thick-It offers canned pureed meals for sale, which can be purchased in pharmacies (may have to order), online, or by phone. One place to order online is Dysphagia Diet.
Naturally Thick sells IDDSI 4 extremely thick beverages, which is the same consistency as IDDSI 4 pureed food. Try their mango or strawberry products for a tasty alternative to applesauce.
Related Eat, Speak, & Think posts
- 9 free swallow assessment tools.
- Single-use swallow evaluation folders.
- Take the guesswork out of thickening liquids with the IDDSI flow test.
- ALS guide for SLPs.
Please share this information
From now on when I have to educate someone about a pureed diet, I feel confident that I can offer practical and helpful information. But I know there’s always more to learn! Please share your tips, recipes, and resources in the comments below.
I hope that you find this information useful, and please share with others!
Free DIRECT download: Tips for pureeing food at home (patient handout). (Email subscribers get free access to all the resources in the Free Subscription Library.)
Featured image by Toa Heftiba on Unsplash.
Lisa earned her M.A. in Speech-Language Pathology from the University of Maryland, College Park and her M.A. in Linguistics from the University of California, San Diego.
She participated in research studies with the National Institute on Deafness and other Communication Disorders (NIDCD) and the University of Maryland in the areas of aphasia, Parkinson’s Disease, epilepsy, and fluency disorders.
Lisa has been working as a medical speech-language pathologist since 2008. She has a strong passion for evidence-based assessment and therapy, having earned five ASHA Awards for Professional Participation in Continuing Education.
She launched EatSpeakThink.com in June 2018 to help other clinicians be more successful working in home health, as well as to provide strategies and resources to people living with problems eating, speaking, or thinking.
[…] or vegetables, that has been cooked and reduced to the consistency of a creamy liquid or paste. Pureed food should have a smooth texture that does not require chewing. It should also be able to hold its […]
How does eating pureed foods affect your bowels?
That is an excellent question, and one that is unfortunately outside the area of my training. You may want to ask your doctor or perhaps a speech-language pathologist who specializes in swallowing, such as Jonathan Waller: https://dysphagiacafe.com/contact/
Bowel problems
on the non recommended foods list at the bottom it says may still be able to achieve a smooth puree with the right equipment. any ideas, tips, recipes for these items? am looking for a way to puree bacon.
That’s a great question! You can find some recipes by doing an online search.
Here is what Wiki-How says:
You can just about puree anything. The most important part is the moisture and tenderness of the meat. Bacon is normally crispy or thick. Cook it tenderly by adding broth to it and then blending it with the broth as well. The consistency will change depending on how long blended and how much broth is used.
https://www.wikihow.com/Puree-Meat
Strongly advise against purchasing Blendtec products. Their blenders do not pulverize seeds as they claim to, and the company does not stand by its products. It refuses to respond to queries and even removes negative reviews. I spent hundreds of dollars on a blender that my dysphagic husband cannot use.
My Dad is on a puréed diet due to a recent history of aspiration leading to pneumonia. He loves popcorn and keeps asking for it. Is there anyway we can prepare it for him? Thank you!
Hi Janet,
I’m sorry to hear that your father is craving popcorn. As you know, popcorn is a difficult food to eat, and isn’t recommended on a pureed diet.
The pleasure of eating popcorn comes from both the taste and the texture. So preparing popcorn puree may not satisfy his urge for popcorn.
However, popcorn puree is actually used as a sauce in recipes, which could be worth a try. I’ve never made it, so I don’t know how smooth this gets. You may need to strain it to remove small pieces that don’t puree.
You can find recipes online, but here is one example: https://www.feastmagazine.com/recipes/mains/article_b9b84270-c827-11df-ae19-00127992bc8b.html
I also found a recipe for buttered popcorn ice cream. I haven’t made this either, so I don’t know if the result is a puree. You may want to skip the step that calls for adding in additional un-popped kernels. I’d bet the recipe would end up softening the kernels enough to chew but I doubt it would puree them.
https://food52.com/recipes/81570-buttered-popcorn-ice-cream
How do you heat up puréed food?
Especially hamburger patties.
That’s a great question! SimplyThick.com has a recipe for pureed hamburgers. They might be a better person to ask about how to re-heat a pureed hamburger. If you do a search on “recipe pureed hamburger Simply Thick”, you should get a link to a PDF that has the recipe and contact info.
Pureed food could be re-heated on stove top or microwave. I would imagine you could also use a slow cooker. Have you re-heated mashed potatoes or a cream soup? I’d handle it the same way. For example, lets say in a microwave. I’d put the puree in a microwave safe dish, loosely cover to prevent spatters, and heat it for 1-2 minutes, stir, then heat more if needed. If your microwave is strong, maybe drop the power to 50%.
I think you could probably reheat the pureed hamburger in the microwave the same way.
Best recipe for beef