National Dysphagia Diet Level 4 – Rawsome?

4 Jun

This month might get a bit confusing, but bear with me.

The main focus of June is to follow all 4 levels of the National Dysphagia Diet.  This has been created to serve as the standard treatment protocol for people with notable swallowing difficulty.

One of the most common environments in which you’ll hear this term dysphagia thrown around is long-term care facilities.  It is suspected in a resident when certain characteristics are observed while eating.  A person with an impaired swallow reflex tends to exhibit one or more of the following: gagging, drooling, choking, taking longer than 10 seconds to swallow, &/or pocketing food in cheeks (maybe I should have blended those pellets for my childhood pet hamster, because he used to do this all the time ;-))

Generally, a speech pathologist determines what types of restrictions are necessary based on the severity of struggle.  Sometimes a dietitian is also consulted to help refine recommendations.  Oftentimes, liquids need to be thickened to a certain consistency as well.  It’s no wonder so many elderly folks suffer from dehydration.  Who wants to drink thickened water?

Each week, I will follow 1 level of the National Dysphagia Diet.  I have started with stage 4 (regular) and will work my way to the most restrictive stage 1 (strictly pureed foods).

Level 4 implies that a person is able to eat a regular diet.  Instead of following a normal diet for 1 week (borriinng!), I will be eating a raw foods diet.  So what is this raw foods hooplah and what’s the big fuss about?  There are all kinds of subcategories of the raw food movement, with a few common denominators.  At its core is the belief that raw foods are superior to cooked foods.

Many raw foodists follow a vegan approach.  They eat raw fruits, vegetables (including sea vegetables such as nori sheets), nuts, & seeds.  Others incorporate raw animal products such as seafood (sushi), raw milk products (such as cheese made with unpasteurized milk), & even raw eggs & meat :-/.  Occasionally, soaked and sprouted grains and legumes are eaten.  Not all raw foodists believe the same dogmas (such as the concept that cooked foods are “toxic”) or follow it for the same reasons.  Some people wish for the healthiest diet possible.  Others can’t help themselves from trying the newest weight loss diet trend.

Most raw foodists are not purists.  Certain foods such as “raw” cashews, agave nectar, and nutritional yeast flakes (an acceptable source of B12) are common ingredients in many raw gourmet cookbooks.  None of these items fit the strictly raw definition, however.  Even “raw” almonds are not usually “raw”, because there is a law that all U.S. almonds be pasteurized.  Nothing can be cooked above the temperature of  118 degrees.  Above this temperature, the food’s enzymes are considered denatured.  To be 100% raw, you have to be quite vigilant and possibly seek things out online.

So is it necessary to eat a 100% raw foods diet to achieve optimum health?  Personally, I don’t believe so.  While it’s true that some nutrients are destroyed during cooking (such as vitamin C and B vitamins), other healthful compounds (such as the lycopene in tomatoes) are actually enhanced by heat.

I also have a few concerns about people attempting a raw foods diet without an adequate background in nutritional requirements.  A 100% raw vegan diet may not contain adequate B12.  As mentioned before, B12 is generally obtained through the consumption of animal products or a supplement.  There are raw whole food supplements on the market that claim to contain B12.  The problem is that this B12 comes from a plant source (such as spirulina) and is likely an inactive analogue.  A second concern I have is that a very low-fat raw vegan diet (one containing less than 10% of its calories from fat) might lead to other serious deficiencies over the long run.  Certain minerals, such as zinc, can be obtained on a raw vegan diet through the consumption of raw nuts and seeds.  However, if you are only eating a handful of nuts per day, this may not be sufficient.

Even though many equate a raw foods diet with weight loss, it doesn’t mean one cannot maintain an adequate caloric intake while following such an approach.  Raw vegan foodists tend to obtain their calories from 1 of 2 ways.  You must eat a ridiculous amount of fruit and/or a fairly large amount of raw nuts & seeds.  While raw vegetables should certainly play a part in a raw foods diet, trying to obtain sufficient calories from vegetables would be an exhausting feat.  For someone who enjoys spending an arm and a leg on pounds & pounds of fruit everyday, can stomach all that fructose and/or fat, & isn’t so strict that certain nutrients get abandoned, knock yourself out.  I can’t argue with the notion that everyone could benefit from eating more fruits and vegetables.  However, eating a wide variety of raw and cooked foods seems a more reasonable goal for the general public.

Since large amounts of fruit and fat have both been known to make my stomach feel less than fantastic, I opted to try a mix of the 2.  Because I constantly refuse to accept my limitations (which means I’m either strong-willed or just plain dumb!), I decided to give this fat-heavy (natural) sugar binge a go.  For someone with severe fructmal (shout out to my ally), this list looks like intestinal suicide.

Here’s what I ate my first day as a raw foodist:

There’s no need for me to divide the meals up into proper categories, because I didn’t really eat a standard “breakfast”, “lunch”, or “dinner”.  I pretty much just snacked the day away.  P.S.  I am not going the 100%! route.  The almond butter I purchased was probably made with pasteurized almonds (even if it doesn’t tell me this on the jar).

Green smoothie with 1 banana, 1 6-oz container of blueberries, kale, collard greens, & spirulina

1 banana

1/2 oz raw carrot cake chips (expensive snack found at Sydney’s Health Market)

1/2 oz raw flax & sunflower seed crackers

~1/2 cup shelled peas (I ate these on the way to go camping.  It wasn’t a disappointing replacement for the roasted sunflower seeds I generally snack on during car rides.)

1 banana with walnut butter

Half of a pineapple

Spinach (2-3 cups) salad with 1 tomato, 1 avocado, & 1/4-1/2 cup of sunflower seeds

1 1/2 cups chopped watermelon

2 baby carrots

2 or 3 raw spirulina chips

Banana with almond butter + extra almond butter

As stated earlier, I will only be following this diet for 1 week.  So far, I’m not miserable but I don’t feel super spectacular either.  While doing research, I came across a blog documenting a man’s daily experience with a 30-day low-fat raw vegan diet.  It’s pretty interesting.  Check it out here:

Other sources:

Norris, J. & Messina, V. (2011) Vegan for Life.  (I can’t remember the page number, but this is where I found the info about B12 in raw diets.)

Davis, R. (2012) Coffee is Good for You: The Truth About Diet and Nutrition Claims. Pg. 70.


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