Welcome to the Swallow Your Pride podcast. I'm
your host, Theresa Richard. I'm a board certified
specialist in swallowing and swallowing disorders, a mobile
thieves business owner, and founder of the MedSLP
Collective.
This podcast is all about delivering the latest
evidence based practice to medical SLPs everywhere.
Whether you're a new clinician seeking tangible tools
for treatment or a seasoned vet stuck in
a rut, my goal is to help ditch
the old school ways of the past that
no longer serve you or your patients, to
reinvigorate your passion for our field, to broaden
your knowledge about our scope of practice, and
to inspire you to practice at the top
of your license. So if you're listening, I
encourage you to swallow your pride, be open
and willing to learn because let's face it,
your patients deserve that kind of care. With
that, let's dive right in.
Just a quick disclaimer that all statements and
opinions expressed in this episode do not reflect
on the organizations associated with the speakers and
are their own opinions solely. Hello. Welcome to
the Swallow Your Pride podcast, everyone. Today, we
have an awesome guest. His name is Andy
Cullum. He is a chef and IDDSI trainer,
and he also goes by the IDDSI guy.
So he has been a chef for over
thirty years. He brings a wealth of culinary
experience to the health care sector, including budgeting,
menu planning, kitchen audits, and SOPs. Over the
last ten years, he's been focusing on aiding
residents with dysphasia to dine with dignity. He's
been modifying the texture of the meals served
in care homes and presenting them in a
luxurious manner, showing that simple yet effective methods
on how to present meals and drinks in
a person centered way. He's made contributions to
training chefs and care team members, and he's
been recognized with prestigious training and apprenticeship award
in the twenty twenty four public sector catering
awards,
a testament to the impact on catering and
care team members across the health care. He
is also a valued member of the National
Association of Care Catering and The UK IDDSI
Reference Group, promoting awareness and the ongoing use
of the IDDSI framework. Awesome. Welcome so much,
IDDSI guy. Oh, thank you for having me.
Alright. So, yeah, tell us a little bit
about your background. How how you got into
this? How are you I see you've been
a chef for so long, but, you know,
what really inspired you to get interested in
IDDSI and patients with dysphagia? So it's it's
quite a good question that really.
In about 02/2002,
I was working for hotels and restaurants.
As as things turn,
I went to a couple of hospitals,
saw a loved one. The food in there
they were getting wasn't very good.
And
I just thought to myself, I can make
a difference.
So for many years, I was within health
within health care doing things like operation managers
roles, stuff like that, but always trying to
build on the importance of modified foods, making
food look like food. About,
I would say, the last six years, I've
really been focusing completely
on modified foods. You're gonna find this quite
quite funny. A lot of people thought to
themselves,
you probably put a lot of thought into
the name of your business. I haven't.
For many years, I used to walk into
kitchens and nobody could remember my name. So
they used to go, hey. You're the Itsy
guy. Hence,
why I call myself the ITZY guy limited.
The ITZY guy has no affiliation towards ITZY
itself. I'm a trainer provider, and I help
people with their modified foods and drinks. Awesome.
Awesome. Thank you for sharing that. How did
how did you learn about Ipsy? Because I've
been gosh. I've been talking about Ipsy since
since the onset. We had, you know, some
of the biggest conversations when Ipsy first started
here on the podcast, and it's this is
almost like a full circle moment for me
to now be hearing you say something like,
you know, I'm not affiliated with Etsy, but
I just I heard about it, and this
is all I do now. And at night,
I love that. That makes my, dysphagia heart
so happy to hear. But, yeah, tell us
about how you got involved with with Etsy
or or you learned about Etsy specifically. So
for many years in The UK, nobody could
really make their mind up what they were
doing. One minute, it was b c d
e, then it was fork mashable.
Believe it or not, if we were ever
unsure, we used to put the meat, the
veg, the gravy, all in the jug, blend
it together, and pour it in a cup.
When you turn the clock back, it's quite
barbaric, really, isn't it?
One of my favorite is when we went
through the stage custard thick, jam thick, and
treacle thick. You know? And I used to
sit there and just pull my hair out
because your interpretation
of thick custard and my interpretation of thick
custard is gonna be completely different.
We saw ITZY come out in the early
stages of 02/2017.
There was a lot of hoo Are we
gonna use it? Shall we not?
So I basically jumped on board on the
early stages and tried to get abreast of
it. Does that make sense? But the struggle
was, during 02/2017,
02/2018,
was getting other people to jump on board
with it. I look.
I think we should be using this, and
you'd have one speech and language therapist say,
no. I wanna use this, and the other
one, I wanna use this. And it wasn't
really until we got to 2019
when people turned around and said, hey. Look.
We better start using this. This is one
language that everybody's gonna start talking.
And then it was great to just try
and promote it and take it forward.
Talk to me a little bit about you
know, I love that you're coming from The
UK with this, and, you know, it's one
thing that we're all all passionate about is
just dysphagia care across the world. Talk to
me about, you know, have you worked in
different settings? Have you always been in the
nursing home sector? Do you provide IDC guidance
for other facilities? What does that look like
for you in The UK? For me,
I have quite a broad range.
I work with a lot of different people
ranging from mental health to learning disabilities,
to neurological
care homes. I even have got two Facebook
groups on the go where we actually help
people that are living at home, looking after
their loved one because there's no support out
there. And we'll give online cooking lessons and
show them how they can modify food and
stuff like that. So to be fair, if
anybody's silly enough to listen to me talk
about Etsy, then I'm silly enough to show
you. Love it. Love it. Love it. Talk
to me a little bit about your your
methodology because I know, you know, you're a
chef, but you also you know, you wrote
here, you don't use piping nozzles or things
like that. You like to actually make things
look like food. So talk about that. I
like to keep things simple. I think when
we
overthink
Etsy, this is where it goes wrong. You
have to remember, Etsy is a framework. It's
a language and not a law. It's a
method and not a recipe. So as long
as we follow the method and follow the
tested guidelines,
we should be okay. Some people might turn
around and say, you know, it's too hard.
I don't have time. This, that, the other,
which you've probably heard yourself many times. My
method is to get in the kitchen nice
and early with the chefs, and we show
them that Itsy starts from the first vegetable
you cut to piece of meat you cook.
Things like if you're gonna be doing lots
of easy to choose and level six soft
and bite sized, Make sure you stay away
from the problematic ingredients. That way you're making
it more accessible for everybody from the beginning.
When you're doing your level six, cut it
up when it's raw. If you're doing casserole,
cut your meat up to that 1.5 centimeter
size, fry it off, get a little bit
of gravy, get it in the bottom of
the oven. Forget about it. When it then
comes to the point of service,
all you've got to do
is then put your level six on its
plate. You're only really then focusing on your
level three, four, and five. When we do
work with the chefs in the kitchen, there's
so much focus on food stickiness. I think
food thickener is great, okay, when it's used
correctly.
But wherever possible, when we're working with the
guys, we try to promote what's called a
nutrient dense approach. Is that something that you
guys use?
I would say not commonly, but it would
be nice.
So the new nutrient dense comes from a
document called the Care Home Digest. The Care
Home Digest was released in 2024
by the British dietary association. I think a
few of your guys at the Mayo Clinic
actually have it.
Now what it's basically saying in there that
if the people we're looking after aren't mobile,
we need to be reducing the amount of
saturated fats we give them. So we need
to be promoting
nutrient density.
So nutrient density is anything that can sustain
life or grow life like milk. Milk powder
can help a newborn baby develop, a baby
calf grow, seeds can grow crops that we
can live off. So when we work with
the guys in the kitchen, we show them
that if we're adding anything to our blended
mix, they need to add value. So we'll
use things like lentils, chickpeas,
powdered
rice, potato flakes, stuff like this. There is
a place
for food thickeners, but there's no nutritional value
in them whatsoever. So if we can add
goodness into our blends as we're doing it,
it makes everybody's life easier. When we're doing
our blends, we we always try and promote
our food to stay hot. And what I
mean by that, do you guys have Robot
Couplets out there? I don't believe so. Okay.
So a lot of people have blending machines
with metal bowls. So the common mistake you'll
see is people will put the hot food
into the metal bowl and press blend, and
then they go, it's gone cold.
If you do simple things like swill out
your bowl with boiling water first, tip it
away, that raises the temperature of the metal.
So when you're then putting your blend, your
carrots, for example, hot into the bowl, they
return the heat. Have a little bit of
carrot juice, for example. Make sure that's hot.
Okay? And then thicken with some hot lentils.
This way,
your mix is staying above the 63 degrees.
Then this is what we try and teach
people in the kitchens. We then use a
thick disposable piping bag. I don't know if
I've got any here. Always the way. There's
always some on the shelf here.
These bags are quite thick. So what they
enable you to do is they enable you
to put your hot mix once it's sieved,
if it needs sieving, straight into the bags.
You need to make sure you get the
air out of the bag and then tie
the bag. Okay?
If there's any air left in the bag,
once you put this on a tray and
you put it into the hot cupboard, the
air would allow the mix to cook in
the bag, which you don't want. If you
take the air out of the bag, tie
it, it keeps all the moisture in. I
can now save that bag in the hot
cupboard for half an hour, forty minutes.
Please, when you take the bags out to
pipe, do not grab them straight away because
it's gonna be like grabbing a hot potato.
Just leave them for five minutes. You can
then cut the end off, and then you've
once you've learned how to pipe, you can
pipe straight onto the plate. If you've looked
at well, you have looked at some of
the work I've done on LinkedIn,
I hope,
and the brochures and the books that I
sent over. Anything is possible with practice. So
what we do is we try to show
the kitchen that there is time when you
are organized.
The biggest problem the kitchen have when it
comes to IT C is their self belief.
Once they believe in themselves
and they believe that they can pipe and
they can believe they can make a meal
look like a meal, you can see them
just going from strength to strength to strength.
If you think about it I mean, can
I ask how old are you? I am
gonna be 41 tomorrow. 41.
Let's just say you're walking down the street
with your kids and somebody runs you over
on one of them e scooters. You fall
down, you damage your spine, you can't feed
yourself, you can't look after yourself. What have
you got to look forward to? Food pays
pays a major, major part in this. So
if we can make food look like food,
you know, we're halfway there to stimulating the
appetite.
Anthony Worrell Thompson done a study.
He came up with he'd done some work
with the Alzheimer's Society
that there's we've got thirteen seconds, thirteen seconds
from the time I put that meal down
in front of you to the time your
brain switches off and goes,
I'm not eating that. Does that make sense?
Yeah. Totally. If I can make food look
like food, smell like food, and taste like
food, you know, I've got a better chance
of that person
eating it and proving their appetite. Yep. We
hear a big myth as well that, you
you know, Betty doesn't like a lot of
food. So we're gonna put a small portion
of food on a small plate. Jordy, we're
just defeating the object there. In my opinion,
why don't we put the small portion of
food on a big plate? Because it makes
it look less. Does that make sense? Yep.
When you know, people are gonna be anxious.
They're gonna be nervous about the mealtime experience
if they feel that something is gonna
something bad is gonna happen to them. So
let's just reassure
them. Make the food look like food. So
whenever you see me do anything, this is
why I try and promote it. We see
so many chefs.
They do a gloob of this. They do
a swirl of that.
Looks very
nice. If we go into a restaurant, I'm
now 85 years old. I've got dysphagia.
I've got dementia.
I look at that plate. What is it?
So this is why I really promote piping
food hot and making it look like food.
If the food is piped hot,
okay, it reduces the risk of reheating.
It makes it safer.
And
I done a study with a care home
group two years ago, and we were using
piper nozzles.
And
when we're putting food in front of people,
people are getting it confused with a savory
dessert.
So this is another reason why I don't
use the nozzles because I find that I
can get the smoother lines.
It just makes makes life so much easier.
Yeah. Yeah. No. I I I love this,
Andy. I just you know, so much of
what I do, and I I'm almost finished
with my dissertation for my PhD. And, you
know, it's when when it goes back to
the root of it, right, the simplicity of
it all, it's just
people want quality of life around mealtimes.
You know, there's so much
so much of our cultures
are around food and around meals. And when
you take that away from people, it's
this really jarring life altering thing. And, you
know, you're on the other side of it
where, you know, when people okay. Now they're
they might just be facing
this, you know, for the rest of their
life, they need more
they they need help with the way their
food is prepared. You know, for some patients
that have, you know, maybe had neck cancer,
it's maybe just a blip in time. You
know, it might be a year or two.
But for some of our, you know, older
patients, this is pretty much what they're looking
for for the rest of their life. And,
you know, how can we honor these people
that have lived their lives for seventy, eighty,
ninety years and provide them with not only
good looking food, but what I love that
you said too, was nutritious food. And, you
know, I've, I've had some experiences in, in
wonderful, wonderful nursing homes, but just the, the
nutritional value of the food is just awful.
And, you know, on on the flip side
too, I also I have a son with
feeding and swallowing issues, and we ended up
getting him a a tube and, you know,
he's by by mouth, but also has a
tube feeding. But I just look at some
of the ingredients in this, quote, unquote, food
that they want us to give him, and
it's it's not. It's not nutritious at all.
It's awful. And so I really I admire
you for both combining the nutritional aspect, which
is really what we need food to do,
but also how does it look and how
does it make it appealing? And, you know,
it it broke my heart. I've worked in
so many nursing homes or just couldn't even
tell what the food was on the plate.
You know, it just was so unappealing and
so just not you know, I wouldn't wanna
touch that either. And and then we wonder
why patients have even more issues with nutrition
and hydration and
yeah. So
I think this is this is just wonderful,
and I I really love your whole perspective
behind it. It's not that you're, quote, unquote,
just a chef, but you really have a,
you know, a a strong passion and desire
behind the why of making food pretty.
Well,
it's not just that. It's you've got to
remember. When we get older,
a a lot of our memories turn back
to our past, and especially when you have
dementia. Because if you turn the clock back,
I don't know if if it's the same
for you, but for me, if we turn
the clock back to the seventies when I
was a small child, a lot of the
a lot of decisions were made around the
dining room table. You know?
Your mom used to say to you that
you will be in at 05:00, your hands
will be washed, and you'll be up against
that table. When you were in at ten
two with your hands washed, there was no
mobile phones there. The mealtimes back then were
very significant. They were a focal point for
everyone to meet and talk.
So
if I can do things and I can
try and replicate, I don't know, for example,
a steak and kidney pudding. Obviously, I'm not
gonna be able to do the pudding, but
if I can
make that look
sorta like that, smell like that,
might stand that chance
of revoking somebody's memory for just just that
second just that second to give them the
joy of that smell and that taste. One
of my earliest memories is my grandma's cooking.
It's mashed potato. She used to go into
the garden, pick
pick the potatoes up herself, wash them, and
make the mash. And it always used to
have, like, little lumps in. Do you know
what I mean? Yep. There's a food is
so invoking
and so powerful.
We just need everybody to to to believe
how important it is. Does that make sense?
Yep. 1100%.
And I think, you know, I think at
our core, we all do feel this and
we all do know this, but I think
it's easy to get lost in the day
to day. You know? I I I think
care homes and and nursing homes and hospitals
are just up under
a ton of stress of of just getting
food on the table for lack of a
better term. You know? And it's people like
you and people behind you know? I I
know so many of the people that actually
created IDDSI, and they're just some of the
most phenomenal
researchers and clinicians we have in the world.
But, you know, just have a real desire
to change this for our patients and and
to make things better for our patients, but
also easier for us as speech pathologists that
sometimes have to be the bearer of bad
news and and say, you know, hey. It
looks like this is gonna be your new
normal or this is gonna be your new
future. And and how do we not just
deliver horrible news, but, you know, try to
make it a little bit better, make it
a little bit easier. I think for me,
this is where you see the difference in
speech and language therapists with the people that
truly care to the people that do it
with a job.
The people that do it for a job
just tick the boxes off as they go.
Yep. You know, where the people that truly
care will focus on what you can eat
rather than what you can't,
rather than put that blanket approach across every
thing, problematic ingredients, ice cream, this, that, the
other, they'll sit there, and they'll work with
that person and go, well, you can't they
can't have this, but they can have that.
Does that make sense? Yep. And so often,
I see that blanket approach. And, unfortunately,
as I'm not medically qualified, all I can
do is work with people on the guide,
but it is heartbreaking sometimes.
Yep. Yep. And and it's such a you
know, it's an interesting psychology too of telling
patients all the things they cannot have versus
telling them all the things they can have.
And I think sometimes we do a very
poor job of presenting it that way of
saying, you know, no more this, no more
that, no more this, no more that, but
reframing it of, but you can have all
of these things or you can have these
things. We just have to prepare them differently.
You know, and and I know I've had
some different caregivers on the podcast too, and
I just have so much respect
for caregivers that work with with these patients
and, you know,
spouses, loved ones that prepare meals, especially for
their loved ones with dysphasia and put a
lot of care into making it, you know,
mom or or wife or husband's favorite meal,
but just in a IDDSI
approved format and and in a way that
they can eat joyfully,
safely,
and and still have it be a a
big part of their quality of life.
But I think this is why the Facebook
groups are quite important to me because there's
nothing out there for them. They're
you know, you take your loved one to
the doctors. You know? They've got dysphasia.
They're on,
a level four puree. They're on this taken
drink. There's a brochure.
Go home.
Here's a Wilson Farm Foods brochure, for example.
Yep.
Yep. Audio meals from there.
These meals,
anything from between six to eight pounds each.
You're now looking at breakfast,
snack, lunch,
snack,
evening meal. Yep. People can't afford it. So
they happen to cook for themselves at home
and there's no guidance, even down to simple
stuff.
You know, just by showing people what they
can buy and how they can turn that
simple meal into something nutritious
and safe,
it's it's so rewarding.
Any anything else that really comes to mind
for you? If people could believe in themselves,
just read the ITSA framework.
Okay?
If they don't understand it or they, you
know, they've got questions, just reach out
because people are always there to help.
You know, just send the questions to itsy
dot org. You know, Peter is a really
nice guy. Yeah. He tries to help to
save everybody's questions. You've got John the mad
professor.
Yes. Yes. He's one of my dear friends
too. I yes. Yes. I love I love
his his nerdy brain, and I tell him
that in a very respectful way. Yes. Mary
Ryback, you know, you've got some very, very
good people there. If you guys are let
you know, drop me a message if you
wanna see how we do it in The
UK. If you are unsure, get the app
and just read it and refresh and refresh
and refresh. If you understand the framework, producing
modified meals can be fun,
not just for you, but also for the
person you're gonna be serving them to. Yep.
And keep it safe.
Yep. Yep.
Andy, how can how can people reach out
to you, or how can people work with
you? So you said you do consulting to
different care homes, different nursing homes. Do you
do consulting for families? Share a little bit
more about exactly what you do other than
being, quote, unquote, ITZY guy. Okay. So when
I say I do consultant for families, I
just need to clarify what you just said.
Okay. Thank you. I I am not medically
qualified to make any decisions.
So what I will do is we will
do simple recipes.
We'll turn them into into webinars, podcasts where
people can join. A couple of months ago,
we were good enough to have the town
hall in Doncaster,
and we managed to get 15 families in
to do a live cooking demonstration where they
all joined in. People will talk about their
favorite foods, and I will show them how
the best way is to modify them. Does
does does that make sense? Yep.
Using household equipment. If anybody does wanna get
a hold of me,
LinkedIn,
Andrew Cullum, or just go on the Internet
and put the ITSA guy, and I'll pop
up. Awesome. Thanks, Andy. I I love chatting
with you. It's I love when you find
people that are just incredibly like minded and
and brilliant across the pond. So thank you.
Thank you so much for And if you
are wondering how hard it is to actually
pipe, I think I'm on with John in
a couple of weeks' time. Awesome.
We actually could be doing pipe and demonstrations.
Oh, good. I'd love to hear that. Okay.
I will see if we can get those
details from John, and I would love to
share that because I I would love to
see that. And I know there's a lot
of speech pathologists out there that work with
these families that would love to see that
and and just families, you know, as as
caregivers too. So, awesome. I love that you
guys are doing that. So If I can
ask you to just hop on to the
British dietary associations
page and download the Care Home Digest, the
worst thing they've done was called a care
home because nobody ever read it, but they've
done supplements April 1 for learning disabilities,
mental health, and hospitals.
But
it's talking about nutrient density,
and how to thicken foods and
how much energy is coming from this and
proteins coming from that. It's just
so refreshing to read. Yeah. Yeah. Awesome. Thank
you for sharing that. Like I said, I
think that's something that's just a big missing
piece in in a lot of this too.
Not not by anyone's fault. Just it's a
it's hasn't really been looked at as much
as it should. So thank you. Uh-huh. No
worries. Thank you so much for having me.
Yeah. You're so welcome.
And that's a wrap for this episode.
As always, thank you so much for listening.
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