Ruth: Today let’s focus on the texture of the food we eat, and how that texture can help when chemotherapy is affecting our eating.

The likelihood of your eating anything can be improved by focusing on a meal’s texture  rather than its ingredients. Different textures will work at different times for different people, so it might take a little experimenting. Let’s start by looking at the different types of textures.

Food Texture

Liquid

If your mouth or throat is badly affected and you find chewing and swallowing painful, liquid foods are a good option. Liquid foods are also good for people who have had GI surgery and whose digestive systems aren’t functioning well. For them, initially fiber may not be tolerated, and so clear liquid foods such as broths or fresh juices that don’t contain any fiber may be the only option to begin with. Fresh juices, particularly vegetable juices with more veg than fruit (see Kathie’s post on broccoli juice) provide phytonutrients, vitamins, minerals, etc., while still being gentle on the digestive system. However, to ensure adequate nutritional intake it is important to transition onto other foods/textures as soon as possible.

The category of “liquid foods” also includes soups – hot and cold – which are either clear or pureed with plenty of liquid. Drinks such as teas with non-dairy milks or creams are also options, or golden milk – a combination of anti-inflammatory turmeric and milk. These can be sipped slowly throughout the day.

The goal here is to stimulate eating in a very gentle way. The use of prepared drinks like Ensure is not recommended as they contain high amounts of sugar, and other components that are difficult to digest. It’s much better to prepare runny smoothies or soups.

Although liquid foods are useful if chewing is painful, it is recommended that you should still  “chew” them – i.e., swish them around your mouth. This chewing action ensures that digestive enzymes start working to break down the food right there in your mouth. Amylase is an enzyme that helps to digest carbohydrates and is present in saliva; by your “chewing” the liquid, amylase can begin to digest carbohydrates in the food before you’ve even swallowed them. So even if you are drinking from a glass (or through a straw if you find it easier), still try to use some chewing action.

Light and fluffy

As your ability to eat improves, often the next stage after liquid foods is to try eating light and fluffy foods. Like liquid foods, these foods don’t require chewing and are particularly useful for people with sore mouths and throats. They tend to be whipped, mousse-like dishes or souffles. Many different variations will work for mousses which you might not have considered before:

mousse and strawberries
  • Fruity mousses are often what we think of when we picture a mousse, such as a fig and banana mousse or an apple and cinnamon mousse. These can be made with non-dairy* yogurts, milks, and creams and are quick to make in a blender or food processor. 
  • Savory mousses can be just as delicious – try using vegetables, fish or chicken. To get a savory mousse texture, you can use the same non-dairy* creams and yogurts you’d use for a fruity mousse. Another idea is to mix together some wholemeal bread, an egg yolk, and the meat/fish/vegetable, and then fold in a beaten egg white separately. When steamed or baked, this type of dish will give you a nice warm comforting mousse-like texture. 
  • Temperature – mousses can be served warm or cold. Imagine a warm apple cinnamon mousse for some comfort or a cold tuna mousse if your mouth is feeling sore.
  • Flavors – the flavors can be mild, moderate, or strong, depending on what you feel like. For example, a mild aubergine mousse or strong flavored chicken curry mousse or a mushroom mousse. All delicious, and all easy to make.

 * During cancer, and after cancer, the use of non-dairy yogurts, milks, and creams might be preferable over dairy products for several reasons including the difficulty of digesting dairy products, as well as the growth factor components included in dairy products. Instead of dairy, look for nut-based products as alternatives such as coconut, almond, cashew, and so on. Coconut products are particularly useful as they are easy to digest and high in calories which could be a good thing if you aren’t eating much. 

A “light and fluffy” meal has three basic components: the main flavor (meat, fish, vegetable, or fruit), a seasoning (herb or spice), and a base to form the mousse (described below). All you need to do is to mix the components together, cook if needed, garnish nicely so it looks appetizing, and serve.

In the table below, I give some ingredient options for the three basic components. Use them as general guidelines, and mix and match them depending on your taste, whether you want something warm or cold, sweet or savory, etc. 

I’ve used three different types of mousse bases in the table below:

  • Y&C – yogurt and cream. If you are avoiding dairy (as recommended *), whip 1/3 cup (80ml) coconut cream until fluffy and add 2/3 cup (150ml) non-dairy yogurt. 
  • If you don’t like coconut in the above mousse base, instead of using coconut cream you can make a whipping style cream from cashew nuts.  As it is heated, make it the previous day to give it time to chill. It keeps well in the fridge for a few days. Drain and rinse 1 cup of cashews that have been soaking for at least 1 hour and place in food processor or blender. Add 1/2 cup water and blend well. Add another 1/2 cup water and blend again. Pour into a saucepan and add 2 tablespoons coconut oil and heat gently, with stirring until it boils. Let it simmer at low temperature, while continuing to stir for about 5 minutes. It will thicken. Remove from the heat and blend with a hand blender or upright blender. Place in fridge to cool.  When cool, whip as much as you need. This recipe is not flavored so add stevia, vanilla, herbs and spices as desired to go with the recipe you are using it for. It is a very firm cream so can be pipped too. 
  • Y&M&C – yogurt, mayonnaise, and cream. If avoiding dairy, whip 1/3 cup (80ml) coconut cream and add 1 tablespoon each of mayonnaise and yogurt. 
  • B&Y – bread and yogurt. In a blender, whizz together 1/2 slice of wholegrain bread with the main ingredient (cooked meat, fish, veg) and a little stock/water to make a puree, then whisk in 1/4 cup (60ml) yogurt to make the mousse.
  • B&E – bread and egg. In a blender, whizz together 1/2 slice of wholegrain bread with the main ingredient (cooked meat, fish, veg) and an egg yolk until smooth. Whisk the egg white until stiff and gently fold in the other ingredients to the yolk. Steam for 10 mins or bake at 350F for 15 mins. 

 These all make two small to medium servings. 

Main flavor Seasoning Mousse base How to:
1 cup or 100g blueberries grated nutmeg Y&C Blend fruit. Add yogurt and spice and blend again. Whip the cream in a bowl and fold in the fruit mixture.
1/2 banana + 2 figs grated ginger Y&C Blend fruit. Add yogurt and spice and blend again. Whip the cream in a bowl and fold in the fruit mixture.
1/2 cup unsweetened applesauce cinnamon Y&C Blend fruit. Add yogurt and spice and blend again. Whip the cream in a bowl and fold in the fruit mixture.
3/4 cup or 100g raspberries mint or pink peppercorns Y&C Blend fruit. Add yogurt and spice and blend again. Whip the cream in a bowl and fold in the fruit mixture.
1/2 cup or 115g cooked tuna juice of a lemon Y&M&C Blend tuna and juice. Add other ingredients and blend until fluffy. Season with salt and pepper, garnish with lemon zest.
150ml or 2/3 cup strained tomatoes chives, salt, pepper, vinegar Y&C Whip cream then add yogurt and tomatoes and whip again until fluffy. Season with salt and pepper, garnish with chives and a little drizzled vinegar.
5 small cooked carrots grated ginger B&Y Cook carrots just covered with water with optional ginger. Blend with bread then whisk with yogurt. Season with salt and pepper and garnish with parsley.
50g cooked chicken 2 apricots and pinch curry powder B&E Separate egg. Blend bread, chicken, apricot, curry powder and egg yolk until smooth. Beat egg white until stiff; fold into chicken mixture. Spoon into two ramekin dishes. Cover with foil and steam in a pan of boiling water for 10 minutes or bake at 350F/180C for 15 mins. Season, then garnish with shredded coconut.

Start experimenting and see how you get on. Here are some other ideas:

Main flavor options: aubergine, mushroom, spinach, turkey, salmon, smoked salmon, lemon, rhubarb, vanilla.

Seasoning options: walnuts, pistachios, roasted red pepper,onions, garlic, dill, horseradish, vinegar, flaxseed, vanilla, allspice, turmeric, chilli pepper seeds.

What combination catches your eye and imagination?

Smooth

Foods with smooth textures are creamy, and need only a little chewing. They are easy to swallow and so are ideal for people with dry or sore throats, or sore mouths. Think of mashed vegetables, smooth pates, steamed fish cakes, scrambled eggs, panna cotta. Although smooth foods are similar to light and fluffy foods in that they both have a blended texture, smooth foods have more substance.

A key ingredient for smooth foods is avocados. A highly nutritious food, avocados add a lovely creamy finish to both savory and sweet dishes. Try searching the web for some avocado dishes, you might be surprised at how many there are! I made avocado fritters the other day and they were delicious. There are also some great dark chocolate avocado mousse recipes too with just avocado, cocoa powder and non dairy milk.

Pates – vegetable, meat or fish – can have a nice soft texture but taste substantial. Try just putting some on a leaf of butter lettuce.

One of my favorite smooth foods is cooked apple.  Make sure you remove the skin if your digestion isn’t back to normal, then cook gently but thoroughly in water with spices like cinnamon, nutmeg, ginger, and lemon juice until really soft. You can enjoy them either warm or cold.

To give more substance to some of these dishes, you can add some wholegrain bread. First, make breadcrumbs and then add it to the dishes. For example, with scrambled eggs, you can add 1/2 slice of bread as crumbs to the egg mixture and cook as normal. This keeps the bread soft and gives a nice smooth but filling texture to the dish.

Then, of course, this section wouldn’t be complete without mentioning smoothies! Smoothies are a great way to get lots of nutritious food into a creamy drink. Search the web for green smoothies or avocado smoothies and you’ll find 1,000s of recipes. By blending, you can include ingredients such as flaxseed or green leafy vegetables that might not be tolerated otherwise if a sore mouth is an issue. You can also add in some supplements such as probiotics, vitamins, fish oil, matcha green tea powder and so on, and you’ll get all the benefits of them without having to taste them. 

oatmeal and berries

Soft with some bite

These are good transition foods. Still easy to eat but they feel more “normal” and something that everyone in the family might choose to eat rather than only  the person who is going through treatment, which can be a good thing. 

Some soft salads are good for this texture, like potato salad, pasta salad, and fruit salad. Pasta and rice dishes also fit into this category. All the ingredients are still relatively soft but they aren’t mush, so they need some chewing without being rough on the mouth. 

 Oatmeal with berries is a lovely dish that can be served any time of the day. There are many variations of oatmeal recipes; I particularly like the overnight oats that you can make in individual small jars and keep in the fridge for a few days. 

Or pancakes and muffins – sweet or savory. Don’t get stuck with the idea that certain foods are specific to certain times of the day, but rather try to focus on which texture feels good and choose accordingly. 

Crispy

Crispy textures can be used to stimulate appetite. Even if you don’t fancy anything to eat, the idea of crisp snack might just encourage you to take a bite. These foods don’t work if your mouth or throat is sore, however – but if chewing and swallowing are not a problem, they can be foods to excite the palate.

Lots of snacks fall in this category – like slices of apple, vegetable sticks, crackers. Other ideas are vegetable crisps or chips like kale chips or parsnip chips – or baked tortilla chips with avocado dip… Cesar salad with crunchy croutons. There are a lot of options in this category!

For meal ideas, think of food with a crispy outside like a fish cake, for instance. You could coat fish with ground-up red lentils to make a fish finger-like texture. What about baked falafels? Toasted sandwiches are great too, with a mixture of textures from the crunch on the outside to a soft and creamy inside. You can even put fruit in a toasted sandwich, like  apple slices with cinnamon. And any food on toast can give a nice crisp texture that can stimulate the taste buds and encourage the appetite.

Firm

The last texture we will consider is firm. These foods really help people feel like their eating is back to normal. Firm foods are suitable when the throat and mouth are not affected and appetite is improving. Be mindful of portion size, so as not to overwhelm a newly revived appetite. 

Some examples of firm foods include:

  • quiche
  • sandwiches – try closed, or open-faced for a new presentation 
  • grilled vegetables
  • prawn and vegetable stir fry
  • chicken kebabs
  • baked potatoes with different toppings
  • spiralized vegetables with sauces 
  • salads
  • hummus and bean dishes
  • pancakes/crepes
  • wholegrain or bean noodles and pasta

Although firm, the food isn’t hard and sharp – it’s important to still focus on foods you would consider gentle until all symptoms have improved significantly.

I know that there’s a lot of information here.  Hopefully, you can now see that by focusing on different textures this can help encourage eating when the mouth or throat is sore and when appetite isn’t good. 

Start thinking about the textures of your food as you eat. Do different textures create different feelings for you – comfort, stimulating, livening, calming…

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