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[Liquid] Food for Thought

A CT scan of my jaw. See if you can spot the break!

The last Saturday in April, I was biking around my neighborhood, enjoying the early-morning quiet and sunny weather. I remember reaching for the water bottle I kept in the front basket when, before I knew it, I was flying over the handlebars and crashing, face first, onto the street. I didn’t lose consciousness, but I felt bruised and knew I was bleeding. My mouth felt totally out of alignment. Very luckily, friends of mine who live close by were able to pick me and my bike up and bring me to a local Emergency Department. A CAT scan showed why my mouth was feeling not quite right: I had broken – and displaced – my jaw. Luckily, that was the only thing I broke.

The following day I went to the ED at Penn Presbyterian Medical Center to have a specialist examine my jaw and develop a treatment plan. I was told the bones of the jaw heal very quickly but fixing it would require surgery to wire it shut so the jaw would stay in place as the bones reset.

By wiring it shut, I mean bars – not thin malleable wire – that prohibit any movement of the mouth at all. In fact, before I was discharged the night after surgery, I was given a pair of special stainless steel scissors to cut my mouth open in an emergency (if I felt on the verge of throwing up, for example). I also had a prescription for anti-nausea medication which I immediately filled, keeping it – and the scissors – with me at all times. Luckily I never had occasion to use either.

My more immediate concern was figuring out how and what to eat. Clearly I’d be sipping all my meals through a straw for a while (six weeks as it turned out). I normally eat a healthy diet so I decided that a “meal replacement” protein powder at my local health food store seemed the best way to go. It was quick to make up in the mornings and easy to bring to work. Plus, the powder seemed to have all the protein, vitamins and other nutrients needed for a healthy diet. I made three shakes a day with unsweetened almond milk and thought I had it all worked out.

But I was wrong. I discovered that, although my shakes did contain a lot of necessary vitamins and minerals, the quantities of some vital ones were significantly below the recommended dietary allowance set by the government. Wanting to make sure I gave my body what it needed to fully recover, I decided to talk with a pro to see what I was lacking and how I could get it. Audrey Clark, MA, RD, advanced clinical dietitian at the Hospital of the University of Pennsylvania, set me straight.

Ironically, in a country that consumes an overabundance of salt – mostly from processed foods – my sodium intake was way below the recommended daily requirement of 1500 mg (about ¾ tsp of salt). And less, Clark told me, is not better. Sodium helps our muscles contract, sends nerve impulses throughout our bodies, and regulates fluid balance so we don't become dehydrated. Basically, “we can’t survive without sodium,” she said. Rather than throwing salt in the shakes, she suggested adding pureed, ready-made soups to my daily intake, which would increase both my sodium levels and my calorie intake.

I was also losing weight on my forced diet and needed to boost my fat consumption. Ice cream sounded great but, Clark said, “use good fats, like avocado, tahini, and whole fat yogurt or milk … or even a tablespoon of olive oil.”

Other elements on my diet that she examined included my intake of fluids (“Dehydration is a definite risk on this kind of diet.”), not getting enough microvitamins such as B12 (which can lead to cognitive impairment and other neurological damage), and the amount of protein I was taking in. With three shakes a day, I was getting about 60 grams of protein every day, much more than my estimated daily need (0.8 grams per kilogram of weight). Although high-level exercise, healing from major surgery, and even a person’s age can all boost the body’s protein needs, “people go way overboard with protein … and the kidneys suffer while they’re working hard to eliminate blood urea nitrogen, a byproduct of protein metabolism.”

Clark told me my diet – although not perfect – would work for my situation because it was temporary and I didn’t have any major medical problems. She keeps a much closer eye on patients with serious disease, such as those with head and neck cancer, who are often restricted to a liquid diet due to dysphagia (difficulty swallowing) or strictures (scar tissue) from radiation or surgery that cause a narrowing of the esophagus.

She often recommends to these patients that they use a blender to turn a normal, healthy diet into liquid form. Recipes online – and in cookbooks – show how to turn almost any food into a drinkable form, for example, blending meat and vegetables with broth, or macaroni and cheese with milk. The key, she said, is making it the right consistency to sip through a straw. One of her patients goes out of his way to keep to his “regular” diet: “He stops at McDonald’s every week for a Big Mac, removes the bun and blends the rest!”  Clark also suggests patients use SuperTracker (a tool from the U.S. Department of Agriculture) to help them keep track of protein, carbs, sodium, calories, etc.  

Of course, people who have to stay on a liquid diet for medical reasons aren’t the only ones who turn to shakes. Many people have embraced a partially liquid diet – for example, drinking one shake a day – to lose weight or because it’s a fast and convenient way of getting some necessary nutrients; high-speed blenders can turn a day’s worth of fruits and vegetables into a drinkable form. But drinking calories doesn’t always satisfy hunger the same way chewing does. “Chewing stimulates both digestion and the hormones involved in the feedback process of feeling full,” Clark said. “It’s easy to overconsume calories in liquid form – it doesn’t take long to drink a shake.”

Plus, food’s “smell, texture, and how it feels in our mouth is what makes eating pleasurable,” she said. Many patients on a permanent liquid diet (or tube feeding) “mourn the loss of foods they can never eat again.”

Bottom line from both the experts and based on my own personal experience: If you can, “chew your way through whole food instead of slurping.” It’s not only more pleasurable but it’s also an easier way to make sure your body is getting what it needs.

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