Interviewed & composed by Isao Tokuhashi
Edited by Daniel Penso
Mail to: info@myeyestokyo.com
Photo provided by NUTRI Co., Ltd.
Do you know “Engay food”?
Engay (“嚥下” in Chinese characters) means “swallowing”. There are meals for people who cannot swallow food or people with swallowing disorder or the dysphagia. They can take it from their mouth free from anxiety – that is “Engay food”.
Dysphagia can lead to pneumonia. About 70% of people 70 and over are said to have aspiration pneumonia (pneumonia caused by bacteria flowing into the lungs with saliva and gastric juice) and some of them die from it. It’s caused by the age-related decline of muscular functions necessary for swallowing and cough reflexes (discharging and removing foreign substances entering the airways).
Food which can be eaten by people with the dysphagia easily – that’s Engay food. There is still room for becoming universal, but recently it has been spreading like recipe book publications and making local cuisines with engay food.
And now it opened the door to the world. Even though Japan is considered an “advanced country on issues of aging”, we at My Eyes Tokyo hardly knew anything about this type of food. In this interview, we heard from a “Pioneer of Engay Food” about the efforts of providing the enjoyment of eating to people all over the world who have given up on eating.
*Interview at NUTRI Co., Ltd. Tokyo Branch (Chuo-ku, Tokyo)
How does dysphagia happen?
Food and water swallowed from the mouth flow to the esophagus after passing through the throat and the way leading to the trachea is blocked. That is the mechanism of swallowing. However, in case of a person with dysphagia, the trachea would not close properly and food would enter it. That is “aspiration”.
A typical example of a substance which is difficult to swallow for people with dysphagia is water, including tea, miso soup and so on. Those go through the throat fast and pass through the bifurcation point with the esophagus before the trachea is occluded, so it enters the trachea. Also, even if a commercial gelatin is used to make the water jelly decrease its transit speed, it will melt into water if it exceeds 40 degrees Celsius so making water with gelatin is not the solution to prevent aspiration.
Dry food such as grilled fish, boiled eggs, kamaboko (fish minced and steamed), agar etc. are likely to fall apart after entering the mouth, and its fragments enter the trachea. Also, in case of sticky food like rice cake or porridge, there are times that it will get attached to the pharynx after swallowing and enter the trachea erroneously after time has elapsed. In addition, the risk of aspiration increases if you chew food into smaller pieces.
Mechanisms of Dysphagia and the introduction of food for people with swallowing disorders. *Produced by NUTRI Co.,Ltd.
Joy of eating food with your own mouth
People with such disabilities often gave up eating from the mouth to avoid risks of aspiration pneumoniaso techniques of artificial nutrition ingestion with a tube, such as gastrostomy, which inject nutrients directly into the stomach by opening a small hole in the belly, and nasogastric feeding, which is to pour the nutrient into the stomach from the nose, and infusion, which is to inject nutrients into the blood vessel, were taken. However, the psychological effect on people by the state of “being unable to eat” is immeasurable.
In such circumstances, a movement to provide food in an edible way for those with dysphagia started about 20 years ago. Then, the food was made into a swallowable form for even people with dysphagia. . That is “Engay food”. Alimentary bolus (the chunk right before being swallowed, which is formed by putting it into the mouth, chewing it up and mixing it with saliva) satisfies the following three conditions; 1. Easy to be clumped together, 2. Not sticky, 3. Moderately soft. We tend to think that that soft food is suitable for elderly people, but given the swallowing, it needs to not only be soft, but also it should be easy to be clumped together and must not be sticky.
We have developed and manufactured a special powder called ” Swallowing Assisting Food”, which is used in medical institutions and nursing-care facilities. Those thicken solids and jellify water (gelification). You can make meals for people with swallowing disorders by using those products. However, as our products are mainly used in hospitals and nursing homes, actually many people are still unfamiliar with those products and engay food itself.
Making engay food more fun!
On the other hand, with the capacity of hospitals and nursing home care facilities is approaching the limit in Japan, the necessity of home care is increasing so it is expected that nursing care sites will shift to home. Considering that patients or their families would make engay food in the future, we feel the necessity for promoting dysphagia and engay food widely.
A meal is a culmination of wisdom, ingenuity and cordiality. We would like people with swallowing disorders to feel the “enjoyment of eating” so we offer editorial/technical assistance with the publications of recipe books of “home made engay food” and monthly recipes to the recipe posting website, which is supervised by a managerial dietician. In addition, our managerial dietician gives practical information about engay food to the public at the request of cultural centers across the country.
Various kinds of engay food. *Photos provided by NUTRI Co.,Ltd.
Currently, we are working on a project to make local cuisine engay food. We conduct seminars for people such as managerial dieticians who work at hospitals and nursing-care facilities every month with the efforts of local newspapers and publish recipes of local engay food to the recipe posting site described above. We have done that in 38 prefectures out of 47 ones (as of December 6, 2016).
In 2015, we launched an overseas business department at our company to promote “Japanese engay food” to the world.
Engay food in the world
As for the response to swallowing disorder, including the dietary, the United States is a step ahead of other countries besides Japan, and several European countries and Australia are following in our impression. Also we know that products that thicken drinks are developed in some countries, but the products that thicken solids or make them into jelly have not been developed so much.
We have already visited the United States and we saw their engay food – those were paste/puree-like meat, fish, vegetables etc and simply served on a dish. Actually tastes of each food was the same as the original ingredients, but patients had them as if they were unfeeling machines.
Glitz and glamour to engay food all over the world
Taste is important for meals, but its nutrition and appearance also matters. Meals in paste form or meals served like a real one, which would you like to have as a person? Which would you like your parents to have?
Therefore, we want to share the idea of “beauty” to overseas. As a first step toward it, we will tell doctors who provide medical explanation the “concept” of engay food. Eventually we are also intending to hold engay food seminars that are currently held in Japan all around the world. It’s like “Enlightenment Activities”.
There would be some walls. One of those could be “cultural differences”. Japanese food, for example, places great importance on coloring, but steak meals do not need to be too colorful . Perhaps there is a possibility that “beauty” is not required in other countries so much. Also, you may think that people overseas do not cook as elaborately as in Japan.
We will pursue “QOL” overseas as well
The thing we want to convey to people in the world is that you can make engay food with the same appearance as the dish you normally eat and it would be better for your family healthcare providers, who serve meals, and patients themselves, to eat something pleasing to the eye if they can have food with their mouths. In other words, we will think a great deal about “Quality of life”.
If you still have a function of “eating” in your own mouth, you do not need to take nutrition from a tube because we offer it to you in a form close to ordinary meal – we would like to convey this to people all over the world.
An engay food symposium for foreign media and embassies was held in preparation for the aging problem which the world will face.
February 3, 2017
The idea of engay food that has been cultivated in Japan will be understood by people overseas, and everyone learns about that kind of food – that is our ideal.
*Interviewed with;
Ms. Shoko Yokoyama, PR at Public Relations Division of NUTRI Co., Ltd.
Mr. Satoshi Murakami/Mr. Koichi Yanagisawa, Overseas Business Division of NUTRI Co., Ltd.
