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Peanut Butter: A Sticky Situation for people with dysphagia

Peanut butter is a first choice for many when it comes to the array of spreads available to us, especially on toast for breakfast or a sandwich for lunch. There are smooth and crunchy varieties available, it is a source of protein and it tastes great. So, what’s the catch? For individuals with swallowing difficulties, peanut butter can be a challenge.


Peanut butter can be prepared in many ways, and therefore it is difficult to maintain a consistent standard. For example – some peanut butters may be too runny, too hard, too sticky or too crunchy. Even the more smooth varieties of peanut butter can and will stick to the inside of someone’s mouth. This could be the case for anybody eating peanut butter, but particularly for individuals with dysphagia. Additionally, ‘crunchy’ peanut butters offer a ‘dual’ or ‘mixed’ consistency (hard, crunchy parts of the peanut mixed with the smooth part of the spread). Dual consistency foods are more difficult to manage and also unsafe for people with dysphagia.


Swallowing awareness peanut better and dysphagia

The difficulty with peanut butters and spreads

It is important to consider someone’s overall difficulties with swallowing in a broader sense, as well as eating or swallowing peanut butter and spreads specifically. Our other articles, such as our recent write-up about bread, cover the key signs to look out for with swallowing difficulties and dysphagia.


If someone is experiencing one or more of the following signs, a Speech Pathology referral is necessary:

  • Taking an extra amount of time to chew and breakdown foods and long mealtimes

  • Having peanut butter, spreads and other foods stuck inside of their teeth, mouth or oral cavity, especially after trying to clear with multiple swallows and drinks

  • Peanut butter, spreads and other foods sticking to the inside of someone’s mouth, and ‘pockets’ within their oral cavity. This might not be immediately obvious – particularly with residents who are unable to communicate their difficulties

  • Coughing or choking on foods and spreads

  • Having broken or ill-fitting dentures that impact ability to chew foods, spreads getting stuck inside of dentures or teeth.


Or download our Signs of Dysphagia checklist here.


When is peanut butter a suitable choice?

Each individual’s circumstances are unique, and therefore it is important to consult with a Speech Pathologist to establish whether or not peanut butter or other foods are suitable for the person.


The International Dysphagia Dietary Standardisation Initiative (IDDSI) provides global guidelines for both paediatric and adult populations regarding modified food textures and fluid consistencies.


According to these guidelines, peanut butter, or ‘nut’ spreads

  • Would be suitable for individuals on a Level 7 – Regular Diet. Individuals on a Level 7- regular diet do not have any restrictions on the foods that they are allowed to have. They can eat “typical”, everyday foods including peanut butter and spreads. This is applicable for individuals without any swallowing difficulties.

  • Would not be suitable for individuals on a Level 7 – Easy to Chew, or any dietary level below this. The guidelines for Level 7 – Easy to Chew specify that sticky foods should be avoided. The guidelines for a Level 6 – Soft and Bite Size diet specifically state to avoid ‘nut butters.’

  • For anyone on IDDSI Level 7 Easy to Chew, Level 6 Soft & Bit Sized, Level 5 Minced and Moist and Level 4 Pureed, it is recommended not to have peanut butter.


Not sure what IDDSI is? We regularly hold education sessions to help! Check out the details here

How to test peanut butter and spreads?

Using the IDDSI ‘Spoon Tilt Test’ is the most reliable way to determine whether peanut butter and spreads may be too sticky for consumption. The spoon tilt test is used to determine the stickiness of foods (adhesiveness) and the ability of the food to hold together (cohesiveness).

The food must hold its shape on a spoon and when titled, it should fall off with little residue. If it sticks to the spoon and does not fall when tilted, or there is too much residue on the spoon, then it is too sticky for consumption (for individuals with dysphagia).


Photo and video demonstrations of the spoon tilt test are available on the IDDSI website.


What about Peanut butter powders?

Peanut butter powder is made by removing the natural oils from roasted peanuts, and then grinding the nuts into a fine powder. Peanut butter powders are not intended to eat on their own, but rather used for baking, smoothies, protein shakes and other recipes. Peanut butter powders may be appropriate, depending on the context of it’s use.


As per usual, always consult with a Speech Pathologist first, like us!


  • Do not consume peanut butter powder on it’s own

  • If using nut powders for baking or mixing, ensure the final product fits into the persons IDDSI food texture recommendations. E.g., if the powder is being used to make a cake, is this person allowed to eat cake within their swallowing guidelines and recommendations?

  • If a powder is being used for smoothies – check consistency of food/fluid level with the Speech Pathologist first. Ensure smoothies fit in with the person’s individual recommendations. Ensure smoothies are completely smooth, lump-free with no bits at all.


We're here to help

If you or someone you know is experiencing swallowing difficulties, or has questions related to modified diets, please get in contact us. Our OSCAR Care Group Speech Pathology team today are able to help residents in Aged Care Homes, NDIS participants and private appointments through our clinic in Mulgrave.


 

Upcoming IDDSI Training sessions





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