Dietetics input can be a huge part of dysphagia management, especially in clinical contexts where people are at risk of malnutrition and dysphagia. Speech Pathologists and Dietitians have an integral interdisciplinary relationship when working with people with dysphagia. When the goals of care are aligned, these two disciplines can hit a sweet spot that allows a person to meet both their nutritional and safety needs, and maximise their quality of life. Here, Matthew has kindly taken some time to explain his role in dysphagia management as a dietitian and how his relationship with food has changed over the years and still impacts his clinical practice.
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The Fourth Place talks a lot about the speech pathologist’s role in dysphagia but how would you describe the dietitian’s role in dysphagia management?
There are often two key focuses when it comes to nutrition and dysphagia - that food can still be enjoyable to consume and for you to be able to have adequate nutrition from a texture modified diet. Often many patients with dysphagia have other comorbidities that can increase nutritional needs and make it difficult to be met with texture modified foods. Our focus is to first see if we can provide palatable options to meet those requirements. If we cannot achieve this then we can utilize a variety of oral nutrition supplements or food fortification strategies.
What are some ways that dysphagia can impact a person’s nutrition?
Dysphagia for many people can make eating a chore rather than something that is enjoyable.
Each meal can be a task and due to the altered texture we find there is a high rate of malnutrition risk associated with dysphagia. Specifically in the hospital setting, texture modified menu options for dysphagia patients have less energy and protein due to the way they are prepared. When this is combined with a reduced appetite and increased nutrition burden it can put a lot of pressure on patients to consume large amounts of food and even still not be eating enough.
In your experience, does everyone with dysphagia need to see a dietitian?
Not everyone with dysphagia needs to see a dietitian however it can definitely be a benefit. It can often depend on the severity of dysphagia in conjunction with other medical conditions that would call for dietitian input or whether nutritional management can be completed by speech pathology with swallowing strategies and recommendations.
On The Fourth Place, we recently spoke a little bit about dysphagia during and after oncology treatment. How do you think food and drink impacts a person undergoing treatment and/or influences the outcome?
Nutrition plays such a vital role for oncology patients undergoing treatment – this cohort has
such a high rate of malnutrition. Poor nutrition can lead to worse outcomes with treatment if they're
unable to stay weight-stable and preserve lean muscle. Oncology treatment can lead to a variety
of symptoms including anorexia, nausea, vomiting, early satiety, lethargy and diarrhoea – all of which decrease a person’s ability to meet nutritional requirements. If you add any of these symptoms in addition to dysphagia you can imagine it becomes very hard to meet nutritional
requirements and can often require a combination of oral nutrition supplements, enteral feeding or parental nutrition.
If someone is living with long term effects of treatment such as chronic dysphagia and dysgeusia (taste changes), how do you think this can impact a person and their quality of life?
Food is one of the greatest joys we can experience – the brain releases dopamine twice when we eat. When food is first ingested and another once the food reaches the stomach. Chronic dysphagia and dysgeusia sadly can interfere with these positive experiences of eating and effect quality of life. A key focus is to try and make texture modified foods as palatable as possible to ensure people can still experience those enjoyable experiences when eating.
Can you tell us about your relationship with food; what does it mean to you and what role does it play in your life?
My relationship with food has been mixed over my life. During my adolescent years I battled
with years of unhealthy eating and was obese. This then, unfortunately, turned into a period of
(undiagnosed) disordered eating and restrictive eating habits to lose 40kg. It wasn’t until I was in
my mid-twenties that I was able to build a positive relationship with food and this led me to the path of dietetics. I now am able to enjoy all foods and know that all types of foods can be eaten (just some in moderation). I think having been all body types in my life has allowed me to relate, when necessary, to patients and also encourage food variety to patients in the correct setting.
Do you have a favourite go-to meal either for convenience or for indulgence?
It is ironic that as a dietitian I am not very good in the kitchen! Easily my top two go-to meals are
scrambled eggs (made with cream) on toast or a loaded chicken sandwich (chicken, cheese, avocado, tomato, lettuce, onion and, of course – mayonnaise). I have recently been trying to improve my cooking and have more variety so as to encourage our two-year old daughter to do the same (still a work in progress).
Finally, what would be a piece of advice you have for someone living with dysphagia to safeguard their nutrition?
Once you have been seen by a speech pathologist I would recommend speaking to a dietitian. Both of our disciplines work very well together to provide the safest and nutritious options to manage your dysphagia with a key focus on quality of life. Food is not just a necessity to function, it is also something that can bring great joy in life and that she be available to every one.
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A huge thank you to Matthew for taking the time to answer some questions for The Fourth Place and share his personal and professional insights into our relationship with food.
If you feel you need support around healthy eating habits you can find some helpful resources at The Butterfly Foundation or call their hotline on 1800 33 4673.
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