Planning a
Healthy
Menu
A Toolkit for Supportive
Living Sites
May 2017
Developed by Registered Dietitians
Copyright © (2015), updated May 2017. Alberta Health Services. This material is protected by Canadian
and other international copyright laws. All rights reserved. These materials are intended for general
information only and are provided on an "as is", "where is" basis. Although reasonable efforts were made
to confirm the accuracy of the information, Alberta Health Services does not make any representation or
warranty, express, implied or statutory, as to the accuracy, reliability, completeness, applicability or
fitness for a particular purpose of such information. These materials are not a substitute for the advice of a
qualified health professional. Alberta Health Services expressly disclaims all liability for the use of these
materials, and for any claims, actions, demands or suits arising from such use. This material may be
reproduced without permission for non-profit education purposes. This material may not be changed
without written permission from [email protected].
2
Table of Contents
1.0 Background Information
1.1
1.2
1.3
1.4
1.5
1.6
Introduction ............................................................................................................................. 6
Government of Alberta Supportive Living Accommodation Standards .................................... 7
Eating Well with Canada’s Food Guide ................................................................................... 9
Food Safety .......................................................................................................................... 10
Food Allergies and Intolerances ............................................................................................ 12
Cultural Considerations ......................................................................................................... 13
2.0 Menu Planning
2.1 How to Plan a Menu .............................................................................................................. 16
Part A: Menu Planning Guidelines............................................................................................. 17
Part B: How to Choose and Prepare Healthy Foods ................................................................. 19
Part C: How to Build a Cycle Menu Step-by-Step...................................................................... 20
Part D: Example of a Completed Regular Menu Plan ................................................................ 32
2.2 Healthy Standardized Recipes .............................................................................................. 34
2.3 Standardized Portion Sizes ................................................................................................... 36
2.4 Planning Healthy Meals in Smaller Supportive Living Sites ................................................... 45
2.5 Budgeting.............................................................................................................................. 49
3.0 Menu Substitutions and Preparing Special Diets
3.1 Overview ............................................................................................................................... 52
3.2 Special Diets ......................................................................................................................... 53
Diabetes, Heart Healthy, and Low Sodium ................................................................................ 54
Kidney ....................................................................................................................................... 56
Vegetarian ................................................................................................................................ 63
Gluten-Free............................................................................................................................... 66
High Protein, High Calorie ......................................................................................................... 70
3.3 Texture Modified Diets .......................................................................................................... 74
Easy to Chew ....... ………………………………………………………………………………………74
Dysphagia Soft.......................................................................................................................... 80
Minced ...................................................................................................................................... 88
Pureed ...................................................................................................................................... 97
Cut/Diced ................................................................................................................................ 105
No Mixed Consistencies .......................................................................................................... 107
Pureed Bread Products ........................................................................................................... 109
Thick Fluids ............................................................................................................................. 113
Education and Resources ....................................................................................................... 116
4.0 Right Diet to the Right Resident
4.1 Overview ............................................................................................................................. 118
4.2 Assigning Tasks for Diet Process Flow for Meal Services ................................................... 120
Sample Diet Process Flow for Meal Services .......................................................................... 121
3
Appendices
1. Background Information
A. Food Allergies, Intolerances and Restrictions Record
2. Menu Planning
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
K.
L.
Sample One Week Regular Menu
Sample Grocery List
Nutrition and Menu Planning Resources
Sample “Always on the Menu”
Menu Substitution Form
Low Sodium Substitutions
Cycle Menu Template
Menu Item Suggestions
How to Calculate Canada’s Food Guide Servings for Mixed Dishes
Recipes
Menu Planning Checklist
Serving Sizes from Canada’s Food Guide
3. Making Menu Substitutions
A. Texture Modified Diet Poster
B. Thick Fluids Poster
C. Texture Modified Diet Training
4. Right Diet to the Right Resident
A. Sample Resident Diet Request Form
B. Colour Coded Special Diet Cards
5. Feedback or Questions
A. Feedback or Questions
4
1.0
Background
Information
5
1.1 Introduction
The Planning a Healthy Menu toolkit is for operators of Supportive Living sites in Alberta. It is a “howto-guide” to help the site; plan, prepare, and provide healthy menus to residents. This applies to both
larger supportive living sites that have more than eleven residents and smaller sites less than eleven
residents.
Who is this toolkit for?
All staff involved in food service and food programs including operators, food service staff, nursing, and
recreation staff can use this toolkit.
How can this toolkit help supportive living sites?1

Supports operators in meeting the Government of Alberta Supportive Living Accommodation
Standards and Checklist.2

Provides menu examples and step by step guidance to build a healthy menu to meet the nutrition
requirements of Canada’s Food Guide.3

Offers guidance to meet the dietary needs of residents requiring special diets, such as Texture
Modified (for example, Pureed or Minced) or other diets (such as High Protein, High Calorie
diets), by adapting available regular menu items.
What is in this toolkit?
This toolkit can be used to revise, improve or create a new menu. It provides:
 Guidance on how to plan a menu step-by-step including a sample one week menu.
 Information on how to standardize portion sizes, read labels, and budget for menu items.
 Guidance on menu substitutions for special diets, such as texture modified, vegetarian, and glutenfree diets.
 Helpful hints and processes to help ensure that all residents have the ability to meet their nutrition
and fluid needs at each meal.
What are hyperlinks and how to use them in this toolkit?
Hyperlinks are direct links to a web site or page. The hyperlinks are outlined in blue and
underlined in the toolkit. To use them, move your mouse over each hyperlink and click.
The link will open in your internet browser and take you directly to the web site or page
for additional information.
6
1.2 Government of Alberta Supportive
Living Accommodation Standards
All Supportive Living sites must follow the Supportive Living Accommodation Standards as regulated by
the Government of Alberta.2
The Standards support a safe and comfortable environment that helps maintain or increase the quality of
life for Albertans residing in supportive living accommodations.

The Standards are mandatory for all sites where four or more people live together and the operator
provides or arranges for at least one meal per day.

The Standards were released in April 2010 under the new Supportive Living Accommodation
Licensing Act.

The Accommodation Standards and Licensing Information Guide provides additional information
on the standards.

All supportive living accommodations are required to comply with the standards.
Standards 13 and 14 relate to the Nutritional and Menu Requirements from the Supportive
Living Accommodation Standards and Checklist. This toolkit is designed to support
operators in meeting the Standards. These two Standards are below for reference.
Nutritional Requirements2
Standard 13
13(1) An operator of a supportive living accommodation who provides residents with a meal, fluids and
a snack daily shall ensure that a menu for residents, representing at a minimum a 3-week cycle, is
prepared and that
(a) the meals, fluids and snacks provided meet the current nutritional requirements of the Canada
Food Guide,
(b) the meals, fluids and snacks are
(i) palatable, safe and pleasingly presented, and
(ii) provided in sufficient quantities to ensure adequate hydration and that the residents’
nutritional needs are met, and
(c) the menu and times at which the meals, fluids and snacks will be served are communicated to
each resident in an appropriate manner.
7
13(2) In addition to the requirements of subsection (1), an operator of a supportive living
accommodation that accommodates 11 or more residents shall ensure that the menu referred to in
subsection (1) is reviewed and approved as meeting the current nutritional requirements of the
Canada Food Guide by a registered dietitian or a food and nutrition manager registered with the
Canadian Society of Nutrition Management.
Menu Requirements2
Standard 14
14(1) The operator of a supportive living accommodation shall ensure that the menu provided for
residents
(a) offers variety and seasonal variation,
(b) provides residents with a choice from within at least one food group at every meal, and
(c) as far as is reasonably practicable, recognizes residents’ food preferences, religious practices,
and cultural customs in the planning, preparation, and service of meals.
14(2) Where substitutions must be made respecting items on a menu, those substitutions must be
(a) from within the same food groups and provide similar nutritional value as the original menu
items, and
(b) communicated to the residents.
14(3) An operator shall ensure that residents’ opinions and feedback regarding meals, fluids, and snacks
are periodically collected and considered in the development of the menu.
14(4) An operator shall ensure that residents are consulted on a periodic basis respecting the times of the
day at which meals, fluids, and snacks are to be provided or made available to them and shall
respond to the residents’ comments or concerns.
14(5) An operator shall ensure that a record is created of meals served and any substitutions made to the
menu and that the record is maintained for at least 3 months.
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1.3 Eating Well with Canada’s Food
Guide
All supportive living sites must ensure all meals, snacks, and fluids provided meet the current nutrition
requirements set forth by Canada’s Food Guide.3
Canada’s Food Guide defines and promotes healthy
eating for Canadians of all ages.3 It describes the amount
and types of food needed from each of the four food
groups every day.
 Vegetables and Fruit
 Grain Products
 Milk and Alternatives
 Meat and Alternatives
Eating according to Canada’s Food Guide helps
Canadians meet their individual nutrient needs, which
contributes to overall health and vitality. This can help to
reduce the risk of obesity and other chronic diseases.3
Canada’s Food Guide is available in languages other than
English from the Health Canada website.
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1.4 Food Safety
Safe food handling is important to reduce the risk of food-borne illness. If food is not safely prepared,
handled, and stored; bacteria can grow on it and produce harmful substances called toxins. These bacteria
and toxins in food (which cannot be seen, smelled, tasted, or felt) can cause food-borne illness if the food
is eaten. It is commonly called “food poisoning”. Symptoms of food-borne illness vary, but can include
nausea, vomiting, and/or diarrhea. Older adults, young children, pregnant women, and those with
weakened immune systems are at greater risk for severe bouts of food-borne illness.4
The four principles of safe food handling are clean, separate, cook, and chill.4
1. Clean
 Ensure all staff handling food; wash hands with warm water and soap for
20 seconds before handling food, during preparation, after using the toilet,
and when finished preparing food.
 Wash all vegetables and fruit under cool running water before eating or cooking.
 Clean utensils and cooking surfaces (including microwaves) with soap and hot water, before,
during, and after preparation.
 Sanitize countertops, cutting boards, and utensils after use. Use the sanitizing solution available at
the facility or mix a mild bleach solution by combining 1 tsp (5 mL) bleach to 3 cups (750 mL)
water. Store the mild bleach solution in a spray bottle labeled “sanitizer”.
 Wash the tops of cans and jars before opening.
 Clean can openers, blenders, and mixer blades before/after each use.
 Clean lunch bags every day with hot, soapy water, or bleach sanitizer.
 Wash and sanitize the refrigerator and food preparation equipment on a regular established cycle.
This should also include faucets, sink drains, fridge handles, and small appliances.
2. Separate
 Store raw foods, including uncooked meat, fish, and poultry tightly covered in sealed containers
below cooked foods in the refrigerator. Keep eggs covered or in original container.
 Keep raw eggs, meats, poultry, fish, and their juices separated from other food during storage and
preparation.
 Use three separate cutting boards to prepare food. Use one board for produce, one for uncooked
meat fish and poultry, and one for cooked meat.
3. Cook
 Cook foods to recommended temperatures and serve immediately. Health
Canada’s Safe internal cooking temperatures web page provides guidance
for a variety of foods.
 Reheat foods to 74ºC (165ºF).
10
4. Chill
 Ensure refrigerator(s) and freezer(s) are set at the correct temperatures. The refrigerator
temperature should be 4°C (40°F) or colder. The freezer temperature should be -18°C (0°F) or
colder.
 Refrigerate all raw meat, fish, poultry, eggs, fresh produce, and dairy products after delivery or as
soon as possible after purchase.
 Leftovers should be refrigerated or frozen within two hours of
serving. Place in shallow, covered containers or zip locked plastic
bags for quick cooling. Label with food name, preparation date, and
time refrigerated.
 Refrigerated and frozen leftovers should be used in accordance with
the guidelines provided by Health Canada’s Safe food storage
guidelines.4
For more information


The Environmental and Public Health Education Program at Alberta Health Services offers home
study courses in food safety and preparation. The online food safety course is recommended for
operators that do not have a current food safety certificate.
For information on food safety, visit the Health Canada’s Safe food storage web pages.
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1.5 Food Allergies and Intolerances
It is important to know if any residents have food allergies, intolerances, or diseases which could affect
the foods they can eat.
Food allergies
Food allergies can be life threatening. Common food allergens are – peanuts, eggs, milk, tree nuts, wheat,
soy, sesame, seafood (fish, crustaceans and shellfish), sulphites, and mustard. A food allergy occurs when
the body’s immune system responds to the protein in food in the wrong way. 5
Health Canada’s website contains more information on Food Allergies.
A resident with food allergies can have severe reactions to even very small amounts of the food allergen.
Ensure all meals, snacks, and drinks prepared for someone with a food allergy do not contain any of the
food allergens. Some ingredients, or entire recipes from the menu, may have to be changed to meet the
needs of the resident.
All food storage and preparation methods should ensure foods are kept separate to prevent cross
contamination of foods at all stages.4 Cross-contamination occurs when a food or ingredient is
accidentally spread to other foods or items by touching with hands, other foods, utensils, cutting boards, or
counter tops.
Food intolerances
Food intolerance is a reaction to a food or food additive that does not involve the immune system. For
example, lactose intolerance is sensitivity to the natural sugars found in some milk products. Some people
may not be able to tolerate lactose containing foods at all, while others may be able to eat small servings
of the lactose containing foods without side effects.6
If there are residents with food allergies or intolerances, it is important to have this information posted in
the kitchen. A sample Food Allergies, Intolerances and Restrictions Record can be found in Appendix 1A.
This record can be adapted to meet the needs of the facility.
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1.6 Cultural Considerations
Many residents have important cultural considerations that influence their eating habits and the foods they
choose. Food habits can be influenced by customs, traditions, and religion. Some examples may include a
special dish to celebrate a holiday or an event, or restricting food or types of foods.
Ask each resident if they have specific food preferences or habits that will affect what, when and how they
choose to eat.
Meeting needs of different cultures
You can offer more variety in the menu by using foods and recipes from different cultures. Below are
some ideas for including multicultural foods and cooking methods in the menu:












Serve legumes (beans, dried peas or lentils).
Add spices and herbs to make beans more flavourful.
Bean flour can be added to batters in place of refined white flour.
Use tofu (soft, firm, or flavoured with herbs).
Soya nuggets are found in Indian food markets. Cook with rice or pasta.
Make dips and spreads such as hummus with cooked legumes.
Asian cultures may prefer foods portioned and served in small bowls rather than on a big plate.
Use the Chinese method of quick stir-fry. Stir-fries may contain noodles or rice, vegetables, and
include meat alternatives, like nuts or tofu.
Use whole grain flatbreads to make quick pizza, fajitas, quesadillas or wraps and choose the
resident’s favourite fillings or toppings.
Grind vegetables and add them to flour dough (for example, Punjabi missi roti).
Grill colourful vegetables and fruit and use as pizza toppings, or as fillings in sandwiches and
wraps. Serve grilled fruit as a dessert.
Use vegetables or fruit to make dips, spreads, or salsas (for example, an avocado can be used to
make guacamole).
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No pork and no beef diets
When a resident chooses to eliminate a specific type of food from their diet, there may be many foods
which contain sources of that food item, which will also need to be avoided. Beef and pork are examples of
two foods commonly avoided for cultural or religious reasons. Some foods containing pork and beef are
shown in the lists below. These foods would also need to be eliminated from the diet. The information
below provides a starting point in planning menus for residents who do not consume pork and/or beef.
No pork diet- Avoid pork in any form (meat, broth, gravy, by-products)
No beef diet- Avoid beef in any form (meat, veal, broth, gravy, by-products)
Other ingredients to avoid on a no beef or no pork diet
Gelatin-containing products–jellies, gelatin desserts, some yogurts, milk puddings, and cheeses
Lard
Shortening with unspecified sources of fat
Tallow
Processed cheese spreads
Worcestershire sauce
Some types of marshmallows
Non-dairy creamers, artificial whipped toppings, and powdered coffee whitener
Note: the list above is not a complete list of foods.
Read ingredient lists on product labels to find other sources of
beef and pork.
14
Document
T2.0
Menu
Planning
itle Goes
Here
15
Why is menu planning important?
2.1 How to Plan a Menu
Overview:
A menu is a plan of all meals and snacks including portion sizes that will be served, over a specific period
of time.
All Supportive Living sites must follow the Supportive Living
Accommodation Standards and Checklist as outlined by the
Government of Alberta.2 Standards 13 and 14 from the Supportive
Living Accommodation Standards contain the nutrition and menu
requirements. More detailed information on these standards can be
found in the Accommodation Standards and Licensing Information Guide.
Computer Tip!
Click on each hyperlink
to take you to the website
for more information.
The standards indicate that supportive living sites must:
 Provide a minimum 21-day menu cycle.
 Communicate the complete menu and/or menu substitutions to residents in an appropriate manner.
The Standards require all sites with 11 or more residents to have their menu reviewed and approved by a
Registered Dietitian (or by a Food and Nutrition Manager registered with the Canadian Society of
Nutrition Management).2 This applies to all new menus (including seasonal menus). To find a Registered
Dietitian in your area, visit the Dietitians of Canada Find a Dietitian7 website.
Having a planned, written menu helps to:1
 Meet recommendations from Canada’s Food Guide.3
 Increase healthy food choices to help promote a healthy eating environment.
 Offer a variety of foods that look good, taste good, and are safe and appealing to eat.
 Save money and time.
 Reduce food waste.
 Meet the needs of residents with special diets (such as Pureed or High Protein, High Calorie diets).
This section contains the following information to help operators plan, develop, and use a cycle menu:
Part A: Menu Planning Guidelines
Part B: How to Choose and Prepare Healthy Foods
Part C: How to Build a Cycle Menu Step-by-Step
Part D: Example of Completed Menu Plan
Other tools to assist with menu planning, especially for smaller sites, include:
 Budgeting: page 49
 Sample Grocery List: Appendix 2B
 Menu Substitutions and Preparing
Special Diets: page 52



Using the food label: page 19
Healthy Standardized Recipes: page 34
Planning Healthy Meals in Smaller Supportive
Living Sites: page 45
Appendix 2A contains a Sample One Week Regular Menu which includes portion sizes and the number of
Canada’s Food Guide servings for each day.
16
Part A: Menu Planning Guidelines1,2,3,8,9
Follow these guidelines to help create a healthy menu that
meets the Supportive Living Accommodation Standards
and Checklist.2
How do I know that the menu is
healthy and meets the Supportive
Living Accommodation Standards?2
1. Make sure the menu provides at least the minimum number of daily servings from each of the four
food groups from Canada’s Food Guide. Offer meals, snacks, and drinks in amounts to meet the
nutrition and fluid needs of all residents.
2. Aim to include foods from each of the four food groups at each meal.
3. Ensure each snack provides at least one of the four food groups and a drink.
4. Plan at least a 21-day cycle menu that includes three meals and 23 snacks per day, listing all food
and drinks served. A cycle menu means that all meals and snacks are planned for a certain number
of days, and then the menu is repeated.
5. List the standard portion size for each menu item. This helps with planning, purchasing,
preparation, and serving. Refer to the Standardized Portions Sizes section of this document on
page 36. Residents may ask for smaller or larger portions.
6. Improve meal acceptance and enjoyment by providing foods with a variety of:
a. colour (for example, orange, green, yellow)
b. texture (for example, soft, crisp)
c. flavour (for example, sweet, sour, mild)
d. shape (for example, round, sticks, diced)
e. temperature (for example, cold salad, hot beef sandwich)
7. Offer foods that complement each other. For example, scalloped potatoes with ham, or whole
wheat rolls with beef stew.
8. Provide at least 6 cups (1500 mL) of fluid per day. Offer at least 1 cup (250 mL) of fluid at each
meal and snack. Fluids may be hot or cold. Water should be available at all meals and snacks.
9. Modify the regular menu to help residents with special diet needs, such as diets for disease
management, food allergies or intolerances, or difficulty chewing and/or swallowing. Learn more
about Menu Substitutions and Preparing Special Diets in section 3.
10. Include religious and cultural food items for residents. See page 13 to learn more.
11. For special occasions and celebrations, offer foods such as birthday cake that are not part of the
regular menu.
17
12. Consider having “À la Carte” or “Always on the Menu” options for residents who may not eat the
first or second choice menu items served. This helps residents to meet their daily nutrition
requirements. “Always on the Menu” items are usually simple to prepare, easy to chew, widely
accepted foods that can easily be adapted to suit the needs of the residents. Examples include a
fresh fruit and cottage cheese plate, assorted sandwiches, or a bowl of soup. Other Sample Always
on the Menu items can be found in Appendix 2D.
13. Revise and/or update menus at least twice per year to improve variety. Include seasonal and local
foods when possible. A facility may use both a fall/winter and spring/summer menu or provide
seasonal menu substitutions.
14. Collect feedback from residents prior to each seasonal menu change. Use feedback to improve the
content and timing of meals and snacks as needed.
15. Post the menu in a common area, such as the dining room or kitchen for viewing by residents,
family members, visitors, and staff.
16. Keep a record of all meals served, any changes to the menu and the reasons for the changes.
Records must be kept on file for at least three months. Menu changes can be tracked using the
Menu Substitution Form in Appendix 2E, or by changing and initialing the posted menu.
18
Part B: How to Choose and Prepare
Healthy Foods8
How can I plan a healthy menu
and create a healthy eating
environment for my residents?
Using the food label
Food labels provide useful information for selecting menu items.
Health Canada’s Nutrition Labelling regulations specify the information food labels must contain. Food
labels are required on almost all pre-packaged foods. The supplier can provide the label information if
food is ordered in bulk. Label information can be used to compare products and choose healthy foods.
Nutrition information is found in three places on a food label:
1. Ingredient List
2. Nutrition Claims
3. Nutrition Facts table
The Nutrition and Menu Planning Resources list in Appendix 2C provides more information on label
reading.
Preparing healthy foods
Food preparation methods can affect the nutrition content of menu items. Use recipes that contain less fat,
sugar and salt. See the Nutrition and Menu Planning Resources list in Appendix 2C for more information.
Below are some other healthy preparation tips:
1. Use a variety of healthy cooking methods that use little or no added fat. For example, bake, roast, steam,
barbeque, broil, boil, microwave, stew, or sauté. Pan-fry or deep-fry least often.
2. Cook with and use healthy fats such as oils and soft margarines (instead of hard margarine, lard, and
shortening that contain unhealthy saturated and trans fats).
3. Offer fresh cooked lean meats most often. Processed meat (bacon, ham, and deli meats) are high in salt
(sodium) and can be high in fat. These meats should be offered less often than fresh meats.
4. Whenever possible, cook with and offer lower sodium foods. Foods high in sodium include soups,
dried soup bases, condiments, sauces, and salad dressings. Use only small portions of high sodium
items like soy, hoisin, Worcestershire sauces when offered.
5. Flavour food with garlic, onion, herbs, spices, and lemon juice instead of salt. For more ideas, see
Appendix 2F on Low Sodium Substitutions.
19
Part C: How to Build a Cycle Menu Step-by-Step 1,8,10,11
Below is a flow chart of the steps to building a cycle menu. Each step is described in greater detail in the
How to Build a Cycle Menu Step-by-Step Overview
following pages.
Check the age range and gender of clients
to determine the number of Canada’s Food
Guide servings of each food group
needed daily.
Gather menu planning materials needed
Plan the food and drinks that will be
offered daily. Determine how many
alternate choices will be offered. Select
drinks for all meals and snacks.
Meat and Alternatives
and/or
Milk and Alternatives
Grain Products
Plan breakfast for each day, in the order
listed.
Vegetables and Fruit
Plan lunch and supper for each day,
in the order listed.
Meat and Alternatives
and/or
Milk and Alternatives
Plan daily snacks which include at least
one food group from Canada’s Food
Guide.
Grain Products
Vegetables and Fruit
Select condiments and garnishes for all
meals and snacks as needed.
Plan modifications for each day’s menu as
required for special diets.
Review the menu and complete the
Menu Planning Checklist.
Test the menu.
Evaluate the menu.
20
Dessert/Fruit
Soups
Menu substitutions can be made throughout the year to allow for variety and seasonal variation. Keep a
record to show that the menu has been altered throughout the different seasons. A new menu for
spring/summer could include colder and lighter foods and seasonal items such as fresh fruit. A fall/winter
menu could include warmer and comfort foods, such as hearty soups and stews. Develop one new menu.
Then use it as a starting point to develop the second menu.
1. Check the age range and gender of residents.
Canada’s Food Guide outlines the number of food group servings to meet daily nutrient and energy
requirements for each age group. The daily menu must meet the minimum number of servings from each
food group as shown below:
Canada’s Food Guide
Food Groups
Vegetables and Fruit
Grain Products
Milk and Alternatives
Meat and Alternatives
19-50 years
Females
Males
7-8
8-10
6-7
8
2
2
2
3
51+ years
Females
7
6
3
2
Males
7
7
3
3
2. Gather menu planning resources such as feedback from residents (see page 18
and 31) and:
Cycle Menu Template (Appendix 2G).
Menu Item Suggestions (Appendix 2H).
Food Allergies, Intolerances, and Restrictions Record (Appendix 1A).
Standardized Portion Sizes (see page 36).
Healthy Standardized Recipes (see page 34).





3. Plan the food and drinks to be offered daily.
a) Decide how many choices will be offered for each meal
Residents must be offered an alternate choice from within at least one food group at each meal.2
For example, a choice of cereal (hot and cold), an entrée (beef or chicken), or soup (cream or
broth). Ensure that the menu template allows space for extra choices as needed.
b) Select drinks for all meals and snacks
o
o
o
o
Provide water at all meals and snacks.
Offer both hot and cold drinks, such as milk, 100% juice, coffee or tea. Provide decaffeinated
options, such as decaffeinated coffee, tea, or herbal tea.
Serve lower fat milk (2%, 1%, or skim) or fortified soy beverage at least twice a day.
Decide how often, and when to offer 100% juice, such as apple, orange, or cranberry juice
blend. If vegetable juice is offered, a sodium-reduced juice is preferred.
21
9
Use the “Nutrition tips” in the right hand column for each meal and
food group in your menu to help with healthy menu planning:9
 Offer most often foods (on a daily basis)
 Offer least often foods
4. Plan breakfast for each day.
a)
Select the Meat and Alternatives
Nutrition Tips
Meat and Alternatives
Examples include eggs, nut butters and baked Offer Most Often
beans.
 Egg substitutes can be used as a healthy
choice. For example, egg whites and egg
Eggs can be included in the
white based omelets.
menu daily, prepared in a
variety of ways
 Offer Least Often
(for example, boiled,
 Ham, bacon, sausage, quiche and fried
poached, or scrambled).
eggs.
Note: Milk and Alternatives such as cottage cheese, cheese and yogurt can be
offered instead of a Meat and Alternative as long as the total number of servings
for each group is met at other meals and snacks throughout the day.
Milk and Alternatives
Examples include milk and fortified soy
beverages, cottage
cheese, cheese and
yogurt.
Check the Nutrition
Facts label to ensure that milk and soy
beverages are fortified with calcium and
vitamin D.
Nutrition Tips
Offer Most Often
Yogurt with 2% M.F. or less.
Low fat milk or evaporated milk in coffee
or tea.
 Lower fat cheeses with 20% M.F. or less.
 No salt added cottage cheese.
 Offer Least Often
 Cream cheese, ice cream, coffee cream,
whipping cream, and regular sour cream.
 Processed cheese products such as
processed cheese slices or spreads are
high in salt.


22
b) Select the Grain Products
Grain Products
Examples include cooked or cold cereals, toast, French
toast, muffins, pancakes, scones or waffles.
Nutrition Tips
Offer Most Often

Make at least half of the grains
offered each day whole grain. For
example, whole grain breads for
toast, whole grain cold cereals, and
oatmeal.

Bran cereal (such as Bran Buds®)
can be offered on the side to increase
fibre content.

Stove-top prepared hot cereals are
preferred over instant as they are
lower in sodium.

Ground flax seed, dried fruit, or nuts
with hot cereals to increase fibre
content and add more flavour and
variety.
Provide hot and cold cereal options.
Offer a high fibre cereal (that has at least
4 g of fibre per serving) as a choice each day.10
To learn how to find a high
fibre cereal, see Appendix
2C, Nutrition and Menu
Planning Resources for tips
on label reading.
Starchy vegetables such as potatoes or corn can be
offered instead of a Grain Product at meals. If done,
offer enough Grain Products at other meals and snacks to
meet total daily grain servings.
c)
Select the Vegetables and Fruit
Vegetables and Fruit
Nutrition Tips
Examples include fresh, frozen or canned
fruits or vegetables, or 100% juice. Fresh
fruit and/or canned fruit can be offered in
addition to, or instead of, juice at
breakfast.
Offer Most Often

If canned fruit is used, then ‘no-sugar
added’ or ‘in water or fruit juice’ is
preferred over ‘in syrup’ varieties.
 Offer Least Often
 Hash browns or fried potatoes.
Vegetables can be added to mixed dishes, such as
mushrooms or bell peppers in an omelet.
Vegetables and fruit such as tomato slices or fresh
orange slices can be used as a garnish.
Offer fruit in a smoothie to increase variety.
Caution: Grapefruit and grapefruit juice
Grapefruit and grapefruit juice can react with some medications so may not be safe
or suitable for all residents. If these are served, provide another juice or fruit
choice.
23
5. Plan lunch and supper for each day.
Offer a main meal (with a hot entrée) and a lighter meal (with the option of cold foods) each day. The
main meal may be provided at either lunch or supper.
a) Select the entrée using Meat and Alternatives choices
Meat and Alternatives
Nutrition Tips
The entrées offered at lunch and supper
Offer Most Often
should each provide at least one serving of
 Provide fish at least twice a week3 Offer
Meat and Alternatives. Examples include fish,
fish such as salmon, mackerel, sardines,
poultry, lean meat, legumes (beans, peas, and
herring, Arctic char, anchovies and trout
lentils), tofu, or eggs.
that contain healthy fats.

Include a vegetarian option (meat alternative),
at least once per week, such as baked beans.
Have an alternate entrée available such as a
cold sandwich.
Sandwiches made with leftover meats
(such as roasted/baked chicken) are lower
in sodium and fat than those made with
deli meats. Canned meats/fish (canned in
water) or egg salad may also be used.
 Offer Least Often
 Processed meats, such as bacon, bologna,
ham, salami, sausage, and wieners.
 Deep fried foods.*
Note: Milk and Alternatives such as cottage cheese, cheese, and yogurt can be
offered instead of a Meat and Alternative as long as the total number of servings
for each group is met at other meals and snacks throughout the day.
Milk and Alternatives
Examples include milk and fortified soy
beverages, cottage cheese,
cheese and yogurt.
Check the Nutrition Facts
label to ensure that milk
and soy beverages are fortified with calcium
and vitamin D.
Nutrition Tips
Offer Most Often
Yogurt with 2% M.F. or less.
Low fat milk or evaporated milk in coffee
or tea.
 Lower fat cheeses with 20% M.F. or less.
 Offer no-sodium added cottage cheese.
 Offer Least Often
 Cream cheese, ice cream, coffee cream,
whipping cream, and regular sour cream.
 Processed cheese products such as
processed cheese slices or spreads are
high in salt.


* If a deep fried food is offered, a non-fried option should also be available. For example, provide roast
chicken as an alternative to fried fish or steamed rice if French fries are served.
24
b) Select the Grain Products to accompany the entrée
Grain Products
Offer rice, pasta or
potatoes as a side at the
main meal, unless they are
included as part of an
entrée. For example,
shepherd’s pie, or chicken
stir-fry with brown rice.
Nutrition Tips
Offer Most Often

Make at least half of the grains offered
each day whole grain. Examples of whole
grains include barley, brown rice, oats and
oatmeal, quinoa, whole wheat pasta, and
wild rice.
Offer a variety of Grain Products to help meet
cultural considerations.
For more tips on choosing whole grains, see
the Nutrition and Menu Planning Resources
list in Appendix 2C.
Note: Starchy vegetables such as potatoes or corn can be offered instead of
a Grain Product at meals. If done, offer enough Grain Products at other meals
and snacks to meet total daily grain servings.
25
c) Select at least 2 servings of Vegetables for each meal
Vegetables and Fruit
Offer a variety of colours. For example,
potatoes with broccoli and carrots.
Nutrition Tips
Offer Most Often

Serve one hot vegetable and
one cold vegetable together.
For example, steamed
cauliflower and raw spinach
salad.
At least one dark green and one orange
vegetable every day. A list of dark green
and orange vegetables can be found in
Appendix 2H, Menu Item Suggestions.
Fresh, frozen or canned vegetables can be
used.
Salads can be provided as entrées if they
include one serving of Meat and Alternatives
per portion, such as Cobb or chef’s salads.
Try not to offer the same vegetable more than
once per day. For example, if carrots sticks are
offered at lunch, then avoid offering again at
supper.
Use local seasonal vegetables whenever
possible.
 Offer Least Often
 If canned vegetables are used, choose no
salt added, sodium reduced, low sodium,
or less salt varieties.
Note: Starchy vegetables such as potatoes or corn can be offered instead of
a Grain Product at meals. If done, offer enough Grain Products at other meals
and snacks to meet total daily grain servings.
Note: If the main entrée or soup has more than ½ cup of vegetables per serving,
this could count as a serving of Vegetables and Fruit. For example, chicken
vegetable soup or tuna vegetable casserole. See Appendix 2I, How to Calculate
Canada’s Food Guide Servings for Mixed Dishes.
26
d) Select the Dessert for each meal
A healthy balanced diet should be offered to all residents. However, there are times when a resident may
choose foods that are recommended least often, for quality of life. Therefore, the diet provided to that
resident may offer more comfort foods (and less healthy choices) to help improve intake (for example, a
higher calorie or higher fat dessert can be provided once a day). Use the nutrition tips below to provide a
balanced menu at your site.
Dessert
Offer fresh or canned
fruit as dessert most
often.
Fruit based or milk based desserts are also good
options. Examples include fruit crumbles, milk
pudding, custard, mousse, frozen yogurt and
Appendix 2C.
tofu desserts. Refer to dessert recipes: Apple
and Peach Crisp, Slow Cooker Fruit Pudding,
and Instant Berry-Mango Frozen Yogurt in
Appendix 2J.
Nutrition Tips
Offer Most Often

If canned fruit is used choose ‘no-sugar
added’ or ‘in water or fruit juice’
varieties.

Always provide another dessert choice
such as fruit or yogurt when serving
desserts higher in sugar or fat.
For tips on healthy baking, see the Nutrition and
Menu Planning Resources list in Appendix 2C.
 Offer Least Often

Dessert items which are higher in fat,
sugar, and salt such as ice cream, cake,
and pastries.
Note: Consider fruit based dessert/baked goods as a Vegetable and Fruit serving if
the dessert contains at least ½ cup (125 mL) of fruit per serving.
27
e) Select Soups as needed
Nutrition Tips
Soups
Offer soup daily at the lighter meal. Soup can
also be offered at the main meal as an option.
Offer Most Often
Soups can be included as an appetizer or an
entrée. If served as an entrée, ensure it provides
at least ½ serving of Meat and Alternatives.
(For more information, see Appendix 2I How to
Calculate Canada’s Food Guide (Serving Sizes
for Mixed Dishes).
 Offer Least Often


Left-over meat, vegetables or pasta can be used
in soups to help reduce food wastage.
Switch between broth and cream based soups
for variety.
In summer, cold soups, such
as chilled cucumber, can be
offered to increase variety.
28
Make or buy low salt and low fat varieties
whenever possible. For example, low
sodium chicken-noodle, and low fat cream
of broccoli.
Clear broth/consommé does not provide
enough nutrition to be the soup choice.
6. Plan snacks daily.
Snacks
Each snack should include at least one food
group, and a drink.
Snacks can be used to help ensure residents
have enough choices from each food group
daily. For example, if a day is low in
Vegetables and Fruit at meals, offer a choice
from this food group
as part of a snack to
meet requirements.
The number and
timing of snacks
offered can vary depending on meal times and
specific resident needs.
Offer fresh fruit and/or canned fruit at least
23 times per day.
Nutrition Tips
Offer Most Often
 Milk and Alternatives such as low-fat
yogurt, and ‘light’ or ’partly-skimmed’
cheese.

Choose lower fat cheeses with 20% M.F.
or less on the label.

Choose fresh fruit and vegetables for a
quick and healthy snack.

Always provide an alternative choice such
as fruit or yogurt when offering snacks
higher in fat or sugar.
To access more healthy snack ideas and tips on
using less fat and sugar in baking, see the
Nutrition and Menu Planning Resources list in
Appendix 2C.
 Offer Least Often
 Dessert items higher in fat, sugar, and salt
such as ice cream, cake, and pastries.

Snacks higher in fat, sugar, and salt. If
snacks higher in fat, sugar, or salt are
offered, serving sizes should be limited
to:9
o
o
o
o
o
29
1 cup/ 250 mL (30 g) of chips and
crackers or high sugar cereal
2 cookies (30-38 g cookies) about
and 1 small cereal bar (30 g)
55 g baked goods (for example,
pastries, muffins, doughnuts)
½ cup/ 125 mL (85 g) frozen desserts
(for example, ice cream, frozen ice
cream bar)
1 cup/250 mL sweetened drink
(for example, iced tea, lemonade)
7. Select condiments and garnishes for all meals and snacks as needed.
Condiments and Garnishes
All condiments and sauces should complement
the meal. For example, a lemon wedge or tartar
sauce with baked fish, syrup with waffles, and
gravy for mashed potatoes.
Nutrition Tips
Offer Most Often
Examples include ketchup,
mustard, relish, vinegar, jam,
sugar, sugar substitutes,
syrup, pepper, and herbs.
Garnishes are used for decoration and visual
appeal, but can also add flavour. For example,
cinnamon on hot cereal, parsley on lasagna, or
fresh dill on salmon filets.

Salt and low sodium soy sauce can be
available upon resident request instead of
leaving them on the table or displayed.

Milk with coffee/tea. Cream or coffee
whitener can be available upon resident
request.

Soft, non-hydrogenated margarine more
often. Butter can be available upon
resident request.

Crackers with unsalted tops.
Crackers with unsalted tops should be
available with soup.
8. Plan how to change each day’s menu for special diets.
Consider residents that need special diet changes due to food allergies, to manage a chronic disease, or
require a texture modified diet.

Changes can be written on the menu or written as separate menus. Keep a record of any changes to
the menu (see page 18). Menu changes can be used using the Menu Substitution Form in
Appendix 2E.

Check what special diets are needed for your residents. See Menu Substitutions and Special Diets,
(Section 3) for more information.

Adapt the foods offered on the regular menu as much as possible. For example, if the menu offers
roast beef, mashed potatoes and green beans, the same items can be pureed for those requiring a
pureed diet. In situations where menu items cannot be modified to the recommended texture, such
as corn on the cob, offer a substitute food from the same food group.

Inform the residents of what they are being served (through conversations and/or postings).
9. Review the menu and complete the Menu Planning Checklist.

See Appendix 2K for a sample Menu Planning Checklist.
30
10. Test the menu.


Test the complete menu with residents and get feedback. Adjust as needed and complete the menu
checklist again.
Make note of any recipes that did not work as soon as they are made, as well as food waste from
uneaten items. Consider changing a menu item or recipe if there is high food wastage.
11. Evaluate the menu.

Collect feedback from residents prior
to each seasonal menu change, at least
twice a year. Use this feedback to
improve the content and timing of
meals and snacks as needed.
31
How do I use these guidelines to
build a menu each day?
Part D: Example of a Completed Regular Menu Plan
Lunch
Breakfast
Meal
Menu Item
Portion Size
Coffee/tea and water
100% apple juice
Banana
Bran cereal with raisins
Whole grain toast
Milk/fortified soy beverage
Peanut butter
1 cup/ 250 mL
½ cup/ 125 mL
1 medium
¾ cup/ 175 mL
2 slices (1 oz/35 g each)
1 cup/ 250 mL
1 tbsp/ 15 mL
Water and coffee/tea
Beef barley soup
Crackers, saltines
Turkey sandwich wrap on
whole grain whole wheat
pita bread, with romaine
lettuce and tomato slices
1 cup/ 250 mL
1 cup/ 250 mL
1 package (2 crackers)
1 wrap (2 ½ oz/75 g lean
turkey breast)
6 inch/15 cm (2 oz/70 g)
whole grain pita bread
1 piece of romaine
2 slices of tomato
56 pieces
(3 inches/ 7 ½ cm long)
½ cup/ 125 mL
1 cup/ 250 mL
½ cup/ 125 mL
Carrot sticks
Evening
Snack
Supper
Afternoon
Snack
Tossed salad
Milk/fortified soy beverage
Grapes
Water and coffee/tea
Orange
Oatmeal cookie
1 cup/ 250 mL
1 medium
2 small cookies
(1-1 ½ oz/30-38 g total)
Water and coffee/tea
Meatloaf
1 cup/ 250 mL
1 slice (2 x 4 x ½ inches/
5 x 10 x 1.5 cm)
1 medium
½ cup/ 125 mL
1 small bun (1 oz/35 g each)
1 cup/ 250 mL
1 medium
½ cup/ 125 mL
Baked potato
Green beans
Whole grain tray bun
Milk/fortified soy beverage
Baked apple with cinnamon
Vanilla pudding
Water and coffee/tea
Salmon salad sandwich on
whole wheat bread
1 cup/ 250 mL
½ sandwich (1 ½ oz/ 30-45 g
salmon)
1 slice bread (1 oz/35 g)
32
Canada’s Food Guide
Servings
Standardized
portion sizes
for each menu
item
1 Vegetables and Fruit
1 Vegetables and Fruit
1 Grain Products
2 Grain Products
1 Milk and Alternatives
½ Meat and Alternatives
½ Grain Products
¼ Grain Products
1 Meat and Alternatives
2 Grain Products
½ Vegetables and Fruit
1 Vegetables and Fruit
½ Vegetables and Fruit
1 Milk and Alternatives
1 Vegetables and Fruit
1 Vegetables and Fruit
1 Grain Products
1 Meat and Alternatives
2 Vegetables and Fruit
1 Vegetables and Fruit
1 Grain Products
1 Milk and Alternatives
1 Vegetables and Fruit
1 Milk and Alternatives
½ Meat and Alternatives
1 Grain Products
Includes
each of
the four
food
groups
at each
meal
Canada’s Food Guide
Food Groups
Vegetables and Fruit
Grain Products
Milk and Alternatives
Meat and Alternatives
Fluid
Number of
servings
10
8¾
4
3
9 ½ cups
2375 mL
Provides the minimum number of servings each
day through meals and snacks.
Provides a minimum of six cups of fluids daily,
and at least one cup at each meal and snack.
33
2.2 Healthy Standardized Recipes
Using standardized recipes helps to make sure the quality and quantity of food is consistent each time the
recipe is prepared. This can also help to control costs, reduce waste, and make planning and purchasing
more efficient.
How to standardize a recipe1









Choose a recipe. Look for recipes that:
Use healthy cooking methods like grilling, baking, broiling, poaching, and steaming.
Contain lots of vegetables and fruits.
Are made with whole grains such as whole grain flour, brown rice or whole wheat pasta.
Use lower fat cheese (20% M.F. or less) and yogurt (2% M.F. or less).
Have lean meats or meat alternatives such as lentils, beans and chickpeas.
Include small amounts of healthy fats such as soft non-hydrogenated margarine or vegetable oil
instead of lard, hard margarine, butter, or cream.
Are seasoned with herbs and spices instead of salt.
Have lower amounts of added sugars.
1. Check the recipe to make sure it is not missing any ingredients or instructions.
2. Convert the recipe to larger servings if necessary. Adjust weight and volume measures if needed.
Please refer to Conversions and Equivalents on page 42 in the Standardized Portion Sizes section for
information.
3. Prepare the recipe. Taste test with residents and staff, by selecting a group of people to provide
feedback. Evaluate the recipe for quality, yield, portion size, flavour, colour, and texture, etc.
4. Adjust the recipe as needed based on feedback. Prepare the recipe again until there is an acceptable
product.
5. Use a standardized recipe template to record details related to the recipe including:




Recipe title: Pick a name that describes the recipe.
Recipe category: Label the recipe as an entrée, grain, salad, dessert, etc.
Ingredients: List the ingredients used in a recipe in the order used in the directions. Include any
preparation techniques (for example: carrots, peeled, diced).
Weight and/or volume of each ingredient: List each ingredient in both imperial and metric
measurements. For example:
Imperial
Ingredient
Metric
1 cup
Bananas, mashed
250 mL
34





Directions: List the steps for preparing the recipe. Use clear, concise language. Include cooking
temperature and time and food safety tips as necessary (for example: proper thawing or internal
cooking temperature).
Portion size: List the amount to be served in a single portion. See the Standardized Portion Sizes
section on page 36 for more information.
Recipe yield: List the total amount of product after the recipe is made.
This includes the weight or volume of food prepared and/or size and
total number of servings.
List all equipment and utensils to be used during preparation.
Include the utensils needed for serving. For example, include the scoop
number or size needed to serve each portion.
Refer to Appendix 2I on How to Calculate Serving Sizes for Mixed Dishes to see an example of a
completed standardized recipe using a Shepherd’s pie recipe.
35
2.3 Standardized Portion Sizes
Using standardized portion sizes helps with planning,
purchasing, and preparation of foods, as well as providing a
healthy diet for residents. Serving standardized portions to
residents can help ensure the recommended number of daily
servings from Canada’s Food Guide is available.
Computer Tip!
Click on each hyperlink
to take you to the website
for more information.
Operators are responsible to ensure the minimum daily
number of servings, are provided from each food group. Use
the information which follows in menu planning to ensure
these requirements are met. For more information about
serving sizes, please refer to Appendix 2L Serving Sizes from
Canada’s Food Guide.
This section provides a food portion size guide. For more
information on healthy food choices, see How to Plan a Menu
(page 16).
Food Portions and Servings
A portion is the amount of food a person plans to eat at one
time. There are many factors that can affect food portion
sizes. These factors can include the person’s age, gender,
activity level and appetite, and where the food was obtained
and eaten. To meet the needs of residents, serve portions that
do not overwhelm the smaller eater, or leave the larger eater
feeling that they need more. Assessing individual resident
needs will help ensure that the right amounts and types of
foods are made and served. This also helps to meet resident’s
nutrition needs, prevents food wastage, and helps control food
cost.
A serving is a set amount of food as recommended by Canada’s Food Guide. It may not be the portion of
food a person eats at one sitting.
Using What is a Food Guide Serving? is a way of comparing the food eaten to the amount recommended
each day for an individual.
The table on the following pages lists standard food portion sizes and compares these to Canada’s Food
Guide Servings.
36
Standardized portions for food items
Listed below are suggested portion sizes .To provide more choice for residents, it is helpful to have the
option of regular, small, or large portions.
Food Item
Standard Food
Portion Sizes
Number of Canada’s
Food Guide Servings
Vegetables
Mashed potato
(regular or sweet potato)
Baked potato
(regular or sweet potato)
Scalloped potatoes
Potato wedges
Cooked vegetable
Leafy salads: tossed,
romaine, spinach, Caesar
Raw vegetable salads
(carrot raisin salad; broccoli
salad; corn salad)
½ cup/ 125 mL
#8 scoop
1 medium
or ½ large
½ cup/ 125 mL
#8 scoop
3 oz/ 90 g
34 each
½ cup/ 125 mL
4 oz portion server
1 serving Vegetables and Fruit
2 serving Vegetables and Fruit
1 serving Vegetables and Fruit
1 serving Vegetables and Fruit
1 serving Vegetables and Fruit
1 cup/ 250 mL
1 serving Vegetables and Fruit
½ cup/ 125 mL
4 oz portion server
1 serving Vegetables and Fruit
2
½ serving Vegetables and Fruit
56 pieces
(3 inches/ 7 ½ cm long)
1 serving Vegetables and Fruit
½ cup/ 125 mL
1 serving Vegetables and Fruit
Prunes, cooked
¼ cup/ 60 mL
2 oz portion server
1 serving Vegetables and Fruit
Fresh fruit
1 whole, medium
1 serving Vegetables and Fruit
Fruit cocktail, strawberries,
pears, peaches, mandarin
oranges, pineapple, melon
(diced), apricots, stewed fruit
½ cup/ 125 mL
4 oz portion server
1 serving Vegetables and Fruit
½ cup/ 125 mL
4 oz portion server
1 serving Vegetables and Fruit
½ cup/ 125 mL
1 serving Vegetables and Fruit
Tomato slices
Vegetable sticks
Juice, 100%; no salt added or
reduced in sodium
Fruit
Fruit sauce
Juice, 100% / from
concentrate
37
Food Item
Standard Food
Portion Sizes
Number of Canada’s
Food Guide Servings
Grain Products
Stuffing, bread
Rice (steamed, pilaf)
Pasta / Noodles
Bread, slice
¼ cup/ 60 mL
#16 scoop
½ cup/ 125 mL
#8 scoop
½ cup/ 125 mL
4 oz portion server
2 slices (1 oz/ 35 g each)
(breakfast or lunch)
1 slice (1 oz/ 35 g) (supper)
½ serving Grain Products
1 serving Grain Products
1 serving Grain Products
2 servings Grain Products
1 serving Grain Products
Bun / Roll
1 bun (1 oz/ 35 g)
1 serving Grain Products
Pita bread
½ pita (1 oz/ 35 g)
1 serving Grain Products
1 package (2 crackers)
¼ serving Grain Products
2 (4 inches/ 10 cm)
2 serving Grain Products
½ muffin (1 oz/ 35 g)
1 serving Grain Products
Soda crackers
French toast, waffles,
pancakes
English muffin
Hot cereal
Cold cereal
¾ cup/ 175 mL
6 oz portion server
¾ cup/ 175 mL
6 oz portion server
1 serving Grain Products
1 serving Grain Products
Milk and Alternatives
Milk whole, 2%, 1%, or
skim, chocolate, lactose free
1 cup/ 250 mL
1 serving Milk and Alternatives
Fortified soy beverage
1 cup/ 250 mL
1 serving Milk and Alternatives
Evaporated milk, canned
(undiluted)
½ cup/ 125 mL
1 serving Milk and Alternatives
1 oz/ 25 g
⅓ cup/ 75 mL
(to make 1 cup/ 250 mL)
1 serving Milk and Alternatives
Buttermilk
1 cup/ 250 mL
1 serving Milk and Alternatives
Goat milk, fortified
1 cup/ 250 mL
1 serving Milk and Alternatives
1 ½ oz/ 50 g
1 serving Milk and Alternatives
Powdered milk
Block cheese (cheddar,
Mozzarella, Swiss)
38
Food Item
Cheese slice
Cottage cheese or quark
cheese
Yogurt (plain and flavoured)
Standard Food
Portion Sizes
1-2 slices
1 oz/ 30 g
½ cup/ 125 mL
#8 scoop
½ cup/ 125 mL
#8 scoop
Number of Canada’s
Food Guide Servings
½ serving Milk and Alternatives
½ serving Milk and Alternatives
¾ serving Milk and Alternatives
Yogurt drink
¾ cup/ 175 mL
1serving Milk and Alternatives
Kefir
6 oz/ 175 g
¾ cup/ 175 mL
1 serving Milk and Alternatives
1 ½oz/ 50 g
1 serving Milk and Alternatives
Paneer
Pudding/custard
(made with milk)
Frozen yogurt, low fat
½ cup/ 125 mL
#8 scoop
½ cup/ 125 mL
#8 scoop
1 serving Milk and Alternatives
¼ serving Milk and Alternatives
Meat and Alternatives
Bacon
3 slices
¼ serving Meat and Alternatives
1 oz/ 30 g
½ serving Meat and Alternatives
2 links
(½ oz/ 15 g each)
½ serving Meat and Alternatives
1 large
½ serving Meat and Alternatives
¼ cup/ 60 mL
#16 scoop
½ serving Meat and Alternatives
1
1 serving Meat and Alternatives
Peanut butter
1 package/1 Tbsp/ 15 mL
½ serving Meat and Alternatives
Legumes
(beans, lentils, dried peas)
½ cup/ 125 mL
4 oz portion server
¼ cup/ 60 mL (as snack)
2 oz portion server
½ cup/ 125 mL
4 oz portion server
Breakfast ham
Breakfast sausage
Egg (boiled or poached)
Egg (scrambled)
Omelet, made with 2 eggs
Hummus
Tofu
Roast meats
(beef, pork, turkey)
23 oz/ 6090 g
39
¾ serving Meat and Alternatives
¼ serving Meat and Alternatives
¾ serving Meat and Alternatives
1 serving Meat and Alternatives
Food Item
Salisbury steak
Meatloaf
Meat sauce
Meatballs
Baked ham
Sausage
Pork chop
Chicken breast
Chicken drumstick
Chicken leg and thigh
Chicken strips
Fish
(salmon, cod, tilapia, etc.)
Standard Food
Portion Sizes
1 patty
23 oz/ 6090 g
1 slice
(about 2 x 4 x ½ inch/
5 x 10 x 1 ½ cm slice)
¼ cup/ 60 mL
2 oz portion server
5 meatballs
(½ oz/ 15 g each)
23 oz / 6090 g
1 sausage
(23 oz/ 6090 g)
1 chop
23 oz/ 6090 g
1 breast
23 oz/ 6090 g
2 drumsticks
23 oz/ 6090 g
1 leg and thigh
23 oz/ 6090 g
2 strips
23 oz/ 6090 g
1 piece
23 oz/ 6090 g
Number of Canada’s
Food Guide Servings
1 serving Meat and Alternatives
1 serving Meat and Alternatives
½ serving Meat and Alternatives
1 serving Meat and Alternatives
1 serving Meat and Alternatives
1 serving Meat and Alternatives
1 serving Meat and Alternatives
1 serving Meat and Alternatives
1 serving Meat and Alternatives
1 serving Meat and Alternatives
1 serving Meat and Alternatives
1 serving Meat and Alternatives
Mixed Dishes
Fruit and yogurt smoothie
Soup (cream or broth)
Stew / Chili
Casserole
Chicken cacciatore
Lasagna (meat or vegetarian)
Sandwich
1 cup / 250 mL
1 cup/ 250 mL
8 oz portion server
1 cup/ 250 mL
8 oz portion server
1 cup/ 250 mL
8 oz portion server
¾ cup/ 175 mL
6 oz portion server
1 cup/ 250 mL
8 oz portion server
1 whole
½ whole (as snack)
40
See Appendix 2I:
How to Calculate Canada’s
Food Guide Servings for Mixed
Dishes.
Food Item
Standard Food
Portion Sizes
Number of Canada’s
Food Guide Servings
Mixed Dishes
Hamburger
Pizza
Shepherd’s pie
Quiche
Perogies
1 whole bun (1 oz/ 35 g) +
1 patty (23 oz/ 6090 g)
1 piece
(4 inch/ 10 cm slice)
1 cup/ 250 mL
8 oz portion server
1 piece (4 inch/ 10 cm slice)
3 oz/ 90 g
See Appendix 2I:
How to Calculate Canada’s
Food Guide Servings for Mixed
Dishes.
3 (3 oz/ 90 g)
Desserts
Muffin
Loaf (e.g., banana loaf)
Frozen yogurt
Milk pudding
Custard (made with milk)
Mousse
Fruit crumble/crisp/cobbler
Cereal bar
Square
Cookie
1 small
(2 ½ oz/ 70 g)
½ slice
(1 inch/ 2 ½ cm thick)
½ cup/ 125 mL
#8 scoop
½ cup/ 125 mL
#8 scoop
½ cup/ 125 mL
#8 scoop
½ cup/ 125 mL
#8 scoop
½ cup/ 125 mL
4 oz portion server
1 bar
(11 ½ oz/ 3038 g)
1 square
2 x 2 x 1 inch/ 5 x 5 x 2 ½ cm
2 small cookies
(2 ½ inches/
6 cm diameter each)
1-1 ½ oz/ 3038 g
2 servings Grain Products
½ serving Grain Products
¼ serving Milk and Alternatives
1 serving Milk and Alternatives
1 serving Milk and Alternatives
The number of Food Guide
servings provided by these menu
items will depend on the recipe,
preparation method or product
brand. Choose recipes that
contain more fruit and/or milk
and limited amounts of fat and
sugar.
See Appendix 2C, Nutrition and
Menu Planning Resources for
tips on making foods with less
fat and sugar.
High fat, sugar, and salt foods are not part of Canada’s Food Guide. Offer higher fat and/or sugar desserts
such as ice cream, cake, and pastries least often. Always provide another healthier dessert choice such as
fruit or yogurt.
41
Conversions and Equivalents
Volume
Equivalents for
Liquids
60 drops
1 Tbsp (15 mL)
⅛ cup (30 mL)
¼ cup (60 mL)
⅓ cup (80 mL)
⅜ cup (90 mL)
½ cup (125 mL)
⅝ cup (150 mL)
⅔ cup (160 mL)
¾ cup (175 mL)
⅞ cup (210 mL)
1 cup (250 mL)
½ pint (250 mL)
1 pint (480 mL)
1 quart (960 mL)
1 gallon
= 1 tsp
= 3 tsp
= 2 Tbsp
= 4 Tbsp
= 5 Tbsp + 1 tsp
= 6 Tbsp
= 8 Tbsp
= 10 Tbsp
= 10 Tbsp + 2 tsp
= 12 Tbsp
= 14 Tbsp
= 16 Tbsp
= 1 cup
= 2 cups
= 2 pt
= 4 qt
= 0.5 fl oz
= 1 fl oz
= 2 fl oz
= 2.65 fl oz
= 3 fl oz
= 4 fl oz
= 5 fl oz
= 5.3 fl oz
= 6 fl oz
= 7 fl oz
= 8 fl oz
= 8 fl oz
= 16 fl oz
= 32 fl oz
= 128 fl oz
Equivalent
Weights
32 oz
16 oz
12 oz
8 oz
4 oz
1 oz
2.2 lb
= 2 lb
= 1 lb
= ¾ lb / 0.75 lb
= ½ lb / 0.50 lb
= ¼ lb / 0.25 lb
= 1/16 lb / 0.063 lb
= 1000 g
= 907 g
= 454 g
= 340 g
= 227 g
= 113 g
= 28 g
= 1.0 kg
Scoop Sizes /
Volume Measure
No. 6
No. 8
No. 10
No. 12
No. 16
No. 20
No. 24
No. 30
No. 40
No. 60
= 6 oz
= 4–5 oz
= 3–4 oz
= 2 ½3 oz
= 2–2 ½ oz
= 1 ¾ oz
= 1 ⅓ oz
= 1–1 ¼ oz
= ¾ oz
= 9/16–½ oz
= ⅔ cup (160 mL)
= ½ cup (125 mL)
= ⅜ cup (90 mL)
= ⅓ cup (80 mL)
= ¼ cup (60 mL)
= 3 ⅓ Tbsp (50 mL)
= 2 ⅔ Tbsp (40 mL)
= 2 Tbsp (30 mL)
= 1 ⅔ Tbsp (25 mL)
= 3 ¼ tsp (16 mL)
Ladles / Portion
Servers
1 oz
= ⅛ cup
= 30 mL
2 oz
= ¼ cup
= 60 mL
3 oz
= ⅜ cup
= 90 mL
4 oz
= ½ cup
= 125 mL
6 oz
= ¾ cup
= 175 mL
8 oz
= 1 cup
= 250 mL
*Use ladles for serving soups, stews, creamed dishes, sauces, gravies and other liquid products.
Use portion servers (solid or perforated) for portioning solids and semi-solids such as fruits and
vegetables and condiments.
42
Conversions and Equivalents (Continued)
Steam Table Pan Size
Pan Capacity
Portion Size
12 x 20 x 2 ½ inches/
30 x 50 x 6 cm
(capacity = 2 gal/ 7 ½ L)
½ cup/ 125 mL (4 oz ladle or No. 8 scoop)
⅜ cup/ 90 mL (3 oz ladle or No. 10 scoop)
⅓ cup/ 80 mL (No. 12 scoop)
¼ cup/ 60 mL (2 oz ladle or No. 16 scoop)
Number
of
Portions
64
80
96
128
12 x 20 x 4 inches/
30 x 50 x 10 cm
(capacity = 3 ½ gal/ 13 L)
½ cup/ 125 mL (4 oz ladle or No. 8 scoop)
⅜ cup/ 90 mL (3 oz ladle or No. 10 scoop)
⅓ cup/ 80 mL (No. 12 scoop)
¼ cup/ 60 mL (2 oz ladle or No. 16 scoop
112
135
168
224
12 x 20 x 6 inches/ 30 x
20 x 15 cm
(capacity = 5 gal/ 19 L)
½ cup/ 125 mL (4 oz ladle or No. 8 scoop)
⅜ cup/ 90 mL (3 oz ladle or No. 10 scoop)
⅓ cup/ 80 mL (No. 12 scoop)
¼ cup/ 60 mL (2 oz ladle or No. 16 scoop
160
200
250
320
43
Cutting Diagrams for Portioning
See below for examples of cutting diagrams for portioning. For packaged items, please follow
manufacturer’s instructions for cutting to achieve an appropriate portion size for serving.
For 25 servings make 4 cuts across and 4 cuts down.
For 50 servings make 4 cuts across and 9 cuts down (make the longest cuts first).
44
2.4 Planning Healthy Meals in Smaller
Supportive Living Sites
This section is for smaller supportive living sites (with less than
11 residents), that provide meals on a smaller scale as
compared with larger supportive living sites. The information
will help you plan and prepare healthy meals for residents in a
smaller, home-like environment.
Computer Tip!
Click on each hyperlink
to take you to the website
for more information.
It is important to ensure the correct portion sizes are available at each meal and snack. How much a
resident eats is as important as what they eat. Below are some tips on ideal portion sizes for meals and
snacks.
Meals
If possible, food should be measured to provide standardized portion sizes. Below is a list of suggested
equipment to manage standardized portion sizes.
 Dry measuring cups or numbered scoops (#6, #8, #16 etc)
 Liquid measuring cup
 Measuring spoons
 Food scale
Common household objects can also be used as visual guides to serving sizes from Canada’s Food Guide.
Please refer to Appendix 2C, Nutrition and Menu Planning Resources for the handout on healthy food
portions to learn more about the healthy plate and portion sizes.
If standardized portion equipment is unavailable, here are some tips to help manage portion sizes:

Use medium sized 23 cm/ 9 in plates (about the size of a Frisbee®) to help provide a healthy
serving. If a large plate must be used, fill only the middle of the plate. Do not fill a larger plate
right to the edge with food.
45
Meat and
Alternatives
¼ plate
Grain
Products
¼ plate
Vegetables
and Fruit
½ plate
Milk and
Alternatives

½ Plate Vegetables and Fruit: Fill half of the
plate with a variety of colourful Vegetables and
Fruit. Fruit can also be used as a dessert choice to
round out the meal.

¼ Plate Meat and Alternatives: Fill a quarter of
the plate with lower fat Meat and Alternatives.
This food group provides good sources of protein.

¼ Plate Grain Products: Fill a quarter of the plate
with Grain Products. Serve whole grain more often
to provide residents with more fibre.

Complete the meal with a serving of Milk and
Alternatives. For example, 1 cup (250 mL) of
lower-fat milk.
Fruit
Snacks
Snacks can be used to ensure the total number of servings from each group on Canada’s Food Guide are
available each day.
To provide residents with healthy snack options:

Ensure each snack provides at least one of the four food groups from Canada’s Food Guide.

Include a healthy drink at each snack. Offer water, lower fat milk or fortified soy beverage as a
drink most often. Juice should be limited. If provided, serve only 100% fruit juice or low-sodium
vegetable juice in ½ cup / 125 mL portions, no more than once/day.

Space snacks evenly between meals.

Leave a bowl of prewashed fresh fruit on the counter.

Have fresh vegetables cut and readily available.

Baked goods (such as muffins and cookies) should be provided least often. If they are provided,
also always offer a healthier choice such as fruit and yogurt, and ‘light’ or ‘partly-skimmed’
cheese.
For more healthy snack ideas, see the Nutrition and Menu Planning Resources list in Appendix 2C.
46
Bagged Meals
Residents may be away from home during meal times for many reasons, such as day programs or medical
appointments. To help residents meet nutrition needs on days away from home, a well-balanced bagged
meal should be available to take along.
The bagged meal should include a sandwich (or wrap, pita, etc.), fruit, beverage, and a dessert (if
appropriate). Try to include the following:
Sandwich/Wrap/Pita:






Meat and Alternatives:
o Choose lean and low sodium protein
sources, such as peanut butter, canned
fish, chicken, turkey, or egg fillings.
o If using canned meat/chicken or fish,
choose no salt-added brands or rinse
salted products under water to decrease
sodium content.
Grain Products:
o Choose whole grain breads, buns, small
bagels, pitas, tortillas, or crackers.
Spreads or condiments:
o Choose from cranberry sauce, mustard,
horseradish, jam, jelly, reduced fat
mayonnaise, salad dressing (low sodium), or low-fat sour cream.
Toppings:
o Choose from bean sprouts, bell peppers, cucumber, dark green lettuce (such as romaine or
spinach), onions, roasted red peppers, or tomato slices.
Add flavour:
o Choose from black pepper, curry powder, no salt added herb seasonings, red pepper flakes,
sweet pickle relish, lemon juice, or vinegar.
Vegetable or Fruit side:
o Choose carrot or celery sticks, cucumber slices, snap peas,
cauliflower, or broccoli. Fresh, frozen or canned fruit (packed in
water or fruit juice), or dried fruit without added sugar are also great
additions.
47
Build Your Own Bagged Meal
Option 1
Turkey
Meat and
Alternative
Grain
Product
Vegetables
and Fruit
Beverage
Small whole
wheat bagel
Banana
Water or 100%
fruit juice or
low-fat milk or
fortified soy
beverage
Milk based
Desserts
pudding
Spread or Cranberry
Condiment sauce
Option 2
Chicken
Option 3
Egg Salad
Option 4
Tuna Salad
Option 5
Roast Beef
Whole grain
flour tortillas
Carrot sticks
with hummus
Water or 100%
fruit juice or
low-fat milk or
fortified soy
beverage
Canned fruit
Whole grain
rye bread
Canned fruit
Pita
Hamburger roll
Cucumber
slices
Water or 100%
fruit juice or
low-fat milk or
fortified soy
beverage
Applesauce
Reduced fat
mayonnaise
and mustard
Reduced fat
mayonnaise
included in egg
salad
Celery sticks
with hummus
Water or 100%
fruit juice or
low-fat milk or
fortified soy
beverage
Milk based
pudding
Reduced fat
mayonnaise
included in
tuna salad
Water or 100%
fruit juice or
low-fat milk or
fortified soy
beverage
Granola bar
Bagged meals provided to residents should be refrigerated after
preparation and until served to ensure food safety. If refrigeration is not
available, an ice pack can be included in the bagged meal. Refer to the
Food Safety section on page 10.
Note: If the resident is on a special diet, please refer to the Menu
Substitutions and Preparing Special Diets Section in this toolkit
starting on page 52.
48
Horseradish
2.5 Budgeting
Planning ahead helps you make the most out of your food
budget.
Computer Tip!
Click on each hyperlink
to take you to the website
for more information.
Plan Ahead1

Food can be purchased from retail grocery
stores, wholesale stores, or from a supplier. An
up-to-date grocery list or order sheet can help
with planning. Using a list can prevent extra
grocery shopping later for forgotten items. A
list can also be used to check deliveries if food
is received from a supplier. A Sample Grocery
List has been included in Appendix 2B.

If you operate more than one site, purchase all
food in the same trip, instead of making a separate trip for each site.

Some grocery stores offer 1015% off your total bill if food is purchased on certain days of the
month (often it is the first Tuesday of the month). Check with local grocery stores to find out about
special shopping days.
In the Store1

Whenever possible, purchase food at a wholesale store. Buying basic food and supplies such as
pasta, potatoes, rice, flour, oatmeal, dried fruit, nuts, seeds, and beans in bulk can save money.

Check the “best before” or “expiry” date on perishable foods. Only purchase items which can be
used before the best before or expiry date.

Purchase food on sale when possible. If the sale item is not available, ask for a “rain check”. A
“rain check” can be used to purchase the food at a later date for the sale price.

Compare prices between name brands and store brands, and package sizes. Store brands are often
available for a lower price.
49
Storing Food
Proper food storage can help food to last longer. Use the following tips:

Put groceries that need to be stored in the fridge and freezer away right after shopping or receiving
them from your supplier.

Follow the “First In, First Out (FIFO)” rule. This means using foods with the shortest expiry dates
first, and storing newer stock at the back to be used later. This can help reduce food waste, which
saves money and time.

Please refer to Health Canada’s General Food Safety tips on Safe Food Storage for detailed
information for proper food storage.
50
Document
T3.0
Menu
Substitutions
and Special
Diets
itle Goes
Here
51
3.1 Overview
Menu substitutions occur for many different reasons, such as
product unavailability, incorporating seasonal foods into the
menu, ordering/shipping errors, preparation issues,
equipment problems and/or adjustment for special diets.
Computer Tip!
Click on each hyperlink
to take you to the website
for more information.
The goal when making menu substitutions is to provide foods that contain the same nutrients. Foods
within the same food group on Canada’s Food Guide contain similar nutrients. Most often, using another
food item from the same food group on Canada’s Food Guide will meet the needs of residents on regular
diets. For example, if roast chicken is not available, another food from the Meat and Alternatives food
group could be used, such as roast turkey or beef. If green peas are not available, any other dark green
vegetable, from the Vegetables and Fruits food group, such as asparagus or broccoli can be used.
However, adaptation for special diets is more complex and food service staff will need an understanding
of special diets to help meet resident’s needs.
For more information see What is a Food Guide Serving? Please refer to Appendix 2L Serving Sizes from
Canada’s Food Guide.
52
3.2 Special Diets
This section will provide guidance on how to make menu substitutions, and meet the special diet needs of
residents.
The regular menu may need to be adapted to meet the needs of residents with:
 Diets for disease management
 Food allergies or intolerances
 Difficulty chewing and/or swallowing
When the regular menu changes for any of the above reasons, these diets are called special diets. Special
diets altered to help with chewing and/or swallowing difficulties are collectively called texture modified
diets. Texture modified diets require changing the texture of the foods on the regular menu, or choosing
appropriate textured foods.
A dietitian can provide more information on any type of special diet to either the individual, and/or the
facility.
Some residents may choose not to follow their special diet. A Managed Risk Agreement could be
considered for these residents. This is an arrangement between a resident and a supportive living site that
shows that the resident is aware of the risks of their choices and the site agrees to respect the resident’s
decision and their right to take risks. The resident should be informed of all possible risks and benefits.
Diets for food allergies or intolerances and disease management are considered the main diet, and are
ordered first. Texture modified diets, are divided into primary textures, and additional texture
modifications. When ordering, a primary texture is ordered after the main diet is ordered; and if needed,
additional texture modifications are added.
Examples of special diets included in this toolkit are:
Diets for disease management (Main Diet)
 Diabetes, Heart Healthy and Low sodium
 Kidney
 Vegetarian
 High Protein, High Calorie
Food allergies or intolerances (Main Diet)
 Gluten free
Texture Modified Diets
Primary Textures:
Additional Texture Modifications:
 Easy to Chew
 Cut/Diced
 Dysphagia Soft
 Pureed Bread Products
 Minced
 No Mixed Consistencies
 Pureed
 Thick Fluids
For more information on menu planning, please refer to How to Plan a Menu section (on page 16).
53
Diabetes, Heart Healthy and Low Sodium
A well-planned regular menu using Canada’s Food Guide eliminates the need for special diabetes, heart
healthy and low sodium menus. A menu, based on the four food groups, includes meals and snacks
prepared in a healthy way, with limited amounts of added fat, sugar and sodium.
For more information on making low sodium substitutions, please refer to Appendix 2F Low Sodium
Substitutions.
Tips for Diabetes:
Though a special menu is not necessary considerations should be made for residents with diabetes. Sugarreduced items should be available, to help to promote good blood sugar control. This includes providing:

Sugar substitutes instead of granulated or brown sugar.

Condiments such as sugar-reduced or no sugar added spreads, syrups,
and spices.

Lower sugar beverages such as water, tea, coffee, and sugar free soft
drinks (for example, sugar free drink flavoured waters like sugar free
lemonade).

Sugar- reduced dessert options, such as those listed below.
Dessert ideas for a Diabetic Diet
Low fat, sugar reduced whole grain muffins, cookies or other baked goods in
appropriate portions. See section 2.3 Standardized Portion Sizes.
Sugar free gelatin or mousse desserts
No sugar added custard
No sugar added milk pudding
No sugar added, fat free or low fat (0-2% M.F.) yogurt or frozen yogurt
Fresh fruit or fruit canned in water or juice
54
Residents with diabetes may or may not need snacks. This will vary depending on the type of diabetes,
medicines used to manage blood glucose and activity level of the individual. Snacks may be required if
meals are 6 or more hours apart, but not when meals are closer together. The need for an evening snack
will vary. If snacks are required, some healthy ideas include:








sandwich (meat and/or cheese filling)
yogurt and fresh fruit
milk and plain cookies (arrowroot, digestives)
cheese and whole grain crackers with unsalted
tops
peanut butter and whole grain toast
no salt added cottage cheese and fruit
unsweetened fruit sauce (any flavour) and piece of
cheese
no sugar added cereal and milk
See section 2.3 (page 36) for information on Standardized Portion Sizes for these foods
55
Kidney
A kidney (renal) diet may be needed for residents with kidney disease and will vary depending on the
individual’s kidney function. The amounts of nutrients such as protein, sodium, potassium, phosphorous,
or fluid needed may be different for each person. A regular menu can be modified to meet the resident’s
dietary needs. Each resident can choose the recommended foods and the portions from the modified
regular menu to meet their own dietary needs.
The following information provides general guidance for food choices on a kidney diet that should be
available so that residents can make choices as per their dietary needs.
Protein
The meal plan provided by the dietitian to a resident with kidney disease will specify the amount of
protein needed per day.
Lean meats (beef, pork), poultry, fish, or eggs are the best sources of protein for these individuals. Beans,
lentils, nuts and nut butters, seeds (pumpkin, sunflower), split peas, tofu, milk, yogurt, cheese, and soy
beverages also contain protein.
Sodium
Individuals may have a specific sodium limit provided by their doctor or dietitian.
Canada’s Food Guide recommends choosing and preparing foods with little or no added salt (sodium). A
lower salt menu is healthy for all residents, especially those with heart disease, high blood pressure or
diabetes.
Refer to Appendix 2F for Low Sodium Substitutions.
56
Potassium (Kidney)
Some residents with kidney disease may need to limit the servings of higher potassium foods they eat.
They may be allowed smaller amounts of these foods depending on the diet ordered by their health
professional. The chart which follows shows foods which are lower and higher in potassium. Offer lower
potassium food choices daily.
Foods lower in potassium
Vegetables and Fruit
 Apple
 Apple juice, grape juice, or cranberry 100% juice
blend
 Bell pepper
 Berries
 Cabbage
 Canned pears, peaches or fruit cocktail
 Carrot
 Cauliflower
 Coconut, raw or dried flakes
 Corn
 Cucumber
 Garlic
 Grapes, raw
 Green or yellow beans, snow peas
 Honeydew
 Lettuce, all varieties
 Mandarin orange
 Mushroom
 Onion
 Peach
 Pear
 Pineapple
 Summer squash, zucchini
 Turnip
 Watermelon
Grain Products
 Cooked oatmeal, cream of wheat
 Enriched pasta
 White, 60% whole wheat, light rye, or sourdough
breads
 White enriched grain products
 White rice
57
Foods higher in potassium













Banana
Beets
Brussels sprouts
Cantaloupe
Nectarine
Orange or tomato juice
Orange, navel
Parsnips
Potatoes: baked, whole boiled, hash
browns, scalloped or fries
Prunes
Raisins
Tomatoes, tomato sauce or chili sauce
Winter squash (acorn, butternut) and
pumpkin
Tip: To help lower potassium: Peel potatoes
and cut into small cubes or shred before
boiling. Discard the water.
 Cereals made with whole bran and foods
made with these cereals
 Brown or wild rice
 Whole grain products
Potassium (Kidney) (Continued)
Foods lower in potassium
Foods higher in potassium
Milk and Alternatives
All milk products contain potassium. This includes fluid milks, soy beverages, yogurt, pudding, and
ice cream. Most individuals following a kidney diet can have 1 cup / 250 mL or less of these milk
products per day.
 Cheese
Meat and Alternatives
 All lean meats, poultry, and fish with little to no
 Canned beans, drained and rinsed (can
added salt
have up to ½ cup/ 125 mL cooked per
 Tofu
week)
 Fried eggs
 Fried or battered meat, poultry, or fish
 Nuts or seeds
 Nut butters with hydrogenated oils
 Processed meats
 Ribs
 Salted meats
Other Foods
 Black tea and coffee, water
 Chocolate
 Jam, jelly, honey, margarine or butter
 Salt substitutes with potassium chloride
 Lemon juice
 Pepper or low sodium herb and spice blends
 Sherbet, sorbet, or popsicles
 Sugar cookies, shortbread cookies, vanilla wafers
or vanilla, lemon, or angel food cake
 Unsalted popcorn or pretzels, rice cakes
58
Phosphorous (Kidney)
Some residents with kidney disease may need to limit the number of higher phosphorus foods they eat.
They may be allowed smaller amounts of these foods depending on the diet ordered by their health
professional. The chart which follows shows foods which are lower and higher in phosphorus. Offer lower
phosphorus food choices with each meal.
Foods lower in phosphorus
Vegetables and Fruit
 Fresh, frozen, or canned vegetables and fruit
Foods higher in phosphorus
Grain Products
 60% whole wheat bread and bread products (French,  Bran and oat bran muffins
Italian, white bread, pita bread)
 Brown or wild rice
 Cold cereal
 Instant hot cereal, rolled oats
 Muffins, homemade plain, berry, or oatmeal
 Pancake or waffles (frozen or from
 Cooked wheat cereal
mix)
 Crackers (soda crackers, Melba toast, whole wheat
 Whole bran products
unsalted)
 Whole grain cereals
 Pasta, white
 Whole wheat pasta
 White rice or couscous
Milk and Alternatives
All milk products contain phosphorus. This includes fluid milk, soy beverages, yogurt, puddings,
cheeses and ice cream. Most individuals following a kidney diet can have 1 cup/ 250 mL or less of all
milk products per day. 1 oz/ 30 g of cheese (block cheddar, mozzarella or Swiss) can be offered in
place of ½ cup/ 125 mL of these milk products.
 Processed cheese slices and spreads
Meat and Alternatives
 All lean meats, poultry, and fish with little to no
 Canned beans, drained and rinsed (can
added salt, eggs
have up to ½ cup/ 125 mL cooked per
 Canned salmon, with bones removed
week)
 Nuts and nut butters
 Organ meats (example: liver)
 Processed meats (sausage, bacon,
ham, hot dogs, salami, pepperoni)
 Salmon, canned with bones
Other Foods
 Jam, jelly
 Hot chocolate mix, cocoa
 Sherbet
 Pizza
 Sugar substitutes, sugar (white or brown), honey
 Sour cream and whipping cream
 Chocolate
 Eggnog
59
Fluids (Kidney)
Some residents with kidney disease (and other health conditions, such as heart disease) may need to limit
their fluid intake. A daily fluid limit may be advised by the doctor or dietitian.
What are fluids?
Anything liquid at room temperature is a fluid.
Examples of fluids include:









All drinks (includes water, milk, juice, coffee, tea, and pop)
Crushed ice and ice cubes
Gelatin desserts
Ice cream and sherbet
Juice from canned fruit
Nutrition supplement drinks
Popsicles
Sauces and gravy
Soups and broth
Fluids provided at meals, snacks and to take pills should be considered if the resident has a daily fluid
limit.
60
Kidney-Friendly Bagged Meals
All residents should receive three regular meals (and snacks as necessary) each day to meet their nutrition
needs. Those with kidney disease may have medical appointments, be receiving dialysis or be enrolled in
day programs, and may be offsite during meal times. It is important to provide a well-balanced bagged meal
in these cases.
A bagged meal should include a sandwich (or wrap, pita, etc.), fruit (lower potassium, if appropriate),
beverage and a dessert. The following are guidelines for kidney-friendly bagged meals:
Sandwich/Wrap/Pita

Meat and Alternatives:
o Choose lean, fresh cooked and low sodium protein sources
such as chicken, turkey breast, roast beef, pork, or fish, or
healthy alternatives such as peanut butter or egg fillings.
o
Avoid processed meats (hot dogs, bacon, bologna, salami,
sausages, ham, pepperoni, etc).
o
If using canned meat/chicken or fish, choose no-salt-added
varieties, or rinse salted products thoroughly to reduce salt
content.

Grain Products:
o Choose from: bagels, dinner rolls (white), flour tortillas, French bread, hamburger buns,
Italian bread, light rye, pita bread, rice cakes, sourdough, or white bread.

Spreads or condiments:
o Choose from: cranberry sauce, low-fat cream cheese, mustard, horseradish, jam, jelly,
ketchup (limit serving to 1 Tbsp/ 15 mL), low fat mayonnaise, salad dressing (low sodium),
or low fat sour cream.

Toppings:
o Choose from: bean sprouts, bell peppers, cucumber, dark green lettuce (romaine and
spinach), onions, roasted red peppers, tomato slice (1), or water chestnuts.

Add flavour:
o Choose from: black pepper, curry powder, flavoured oil, mixed herb seasoning, olive oil,
red pepper flakes, sweet pickle relish, or vinegar.
61
Build Your Own Bagged Meal (Kidney)
Meat and
Alternatives
Grain Products
Option 1
Turkey
Option 2
Chicken
Option 3
Egg salad
Option 4
Tuna salad
Option 5
Roast beef
Small bagel
(white)
White flour
tortillas
Pita (white)
Hamburger
bun (white)
Fruit cocktail
or grapes
Bread
(60% whole
wheat or
white)
Pear or
pineapple
Grapes or
berries
Peach or
applesauce
Water, 100%
fruit juice,
low-fat milk,
or fortified
soy beverage
Water, 100%
fruit juice,
low-fat milk,
or fortified
soy beverage
Sugar
cookies
Reduced fat
mayonnaise
or mustard
Graham
crackers
Reduced fat
mayonnaise
Water,
100% fruit
juice, lowfat milk, or
fortified soy
beverage
Angel food
cake
Reduced fat
mayonnaise
Water,
100% fruit
juice, lowfat milk, or
fortified soy
beverage
Lemon cake
Vegetables and Fruit Apple or
(drained canned fruit mandarin
oranges
is acceptable)
Water, 100%
fruit juice,
low-fat milk,
Beverage
or fortified
soy beverage
Desserts
Spread or
Condiment
Vanilla
wafers
Cranberry
sauce
Horseradish
Bagged meals provided to residents should be refrigerated after preparation and until served to ensure
food safety. If refrigeration is not available, an ice pack can be included in the bagged meal. Refer to the
Food Safety section on page 10.
Kidney Diet Websites
Below is a list of websites helpful in menu planning for a kidney diet:





Kidney Foundation of Canada
Kidney Community Kitchen
National Kidney Foundation: List of Cookbooks
Alberta Kidney Disease Network
Renal Web – The Well Nourished Patient
62
Vegetarian
An individual may choose to follow a vegetarian diet for health, ethical, environmental or religious
reasons. Below is a list of foods included on common vegetarian diets.
Type of Vegetarian Diet
Vegan
Lacto
Lacto-Ovo
Semi-Vegetarian
Includes:
Excludes:
All foods of animal origin, including
red meats, poultry, fish, eggs, honey,
milk and milk products
Milk and milk products
Red meats, poultry, fish and eggs
Eggs, milk, and milk products Red meats, poultry and fish
May include some fish, and maybe even small amounts of meat and
poultry
Examples of vegetarian choices from the Meat and Alternatives, and Milk and Alternatives groups on
Canada’s Food Guide are shown below. The type of vegetarian diet will determine which alternatives are
options.
Food Item
Standardized Portion Size
Meat and Alternatives
Beans, lentils, or dried peas, cooked or canned
Hummus
Egg
Tofu
Nuts or seeds, shelled
Peanut butter or nut butter
Cooked fish, shellfish, poultry and lean meat
Milk and Alternatives
Milk (whole 3.25%, 2%, 1%, or skim)
Yogurt (plain and flavoured)
Cheese (cheddar, mozzarella, Swiss)
Soy beverage, calcium and vitamin D fortified
Almond/Rice beverage, calcium and vitamin
D fortified (Note: Almond/Rice beverages
contain little protein)
63
½ cup/ 125 mL
¼ cup/ 60 mL
1 large
½ cup/ 125 mL
¼ cup/ 60 mL
1 tbsp/ 15 mL
23 oz/ 6090 g
1 cup/ 250 mL
½ cup/ 125 mL
1 ½ oz/ 50 g
1 cup/ 250 mL
1 cup/ 250 mL
Sample Lacto Ovo Vegetarian Menu Plan
Below is a one day vegetarian menu that has been adapted from the Example of a Completed Regular
Menu Plan on page 32. Changes made to the regular menu to fit the vegetarian diet are shown in bold.
Lunch
Breakfast
Meal
Portion Size
Coffee/tea and water
100% apple juice
Banana
Bran cereal with raisins
Whole grain toast
Milk/fortified soy beverage
Peanut butter
1 cup/ 250 mL
½ cup/ 125 mL
1 medium
¾ cup/ 175 mL
2 slices (1 oz/ 35 g each)
1 cup/ 250 mL
1 package (1 Tbsp/ 15 mL)
1 Vegetables and Fruit
1 Vegetables and Fruit
1 Grain Products
2 Grain Products
1 Milk and Alternatives
½ Meat and Alternatives
Water and coffee/tea
Lentil soup
Crackers, saltines
Baked beans
1 cup/ 250 mL
1 cup/ 250 mL
1 package (2 crackers)
¾ cup/ 175 mL
½ Meat and Alternatives
¼ Grain Products
1 Meat and Alternatives
Pita bread, whole grain whole
wheat
Romaine lettuce, tomato in
wrap
Carrot sticks
1 pita (2 oz/ 70 g)
2 Grain Products
1 piece of romaine
2 slices of tomato
56 pieces
(3 inches/ 7 ½ cm long)
½ cup/ 125 mL
1 cup/ 250 mL
½ cup/ 125 mL
½ Vegetables and Fruit
Tossed salad
Milk/fortified soy beverage
Grapes
Afternoon
Snack
Canada’s Food
Guide Servings
Menu Item
Water and coffee/tea
Orange
Oatmeal cookie
1 cup/ 250 mL
1 medium
2 small cookies
(11 ½ oz/ 3038 g total)
64
1 Vegetables and Fruit
½ Vegetables and Fruit
1 Milk and Alternatives
1 Vegetables and Fruit
1 Vegetables and Fruit
1 Grain Products
Sample Lacto Ovo Vegetarian Menu Plan (Continued)
Evening
Snack
Dinner
Meal
Canada’s Food
Guide Servings
Menu Item
Portion Size
Water and coffee/tea
Tofu stir fry
Brown rice
Broccoli and carrots (in stir-fry)
Milk/fortified soy beverage
Baked apple with cinnamon
Vanilla pudding
1 cup/ 250 mL
¾ cup/ 175 mL
½ cup/ 125 mL
½ cup/ 125 mL
1 cup/ 250 mL
1 medium
½ cup/ 125 mL
1 Meat and Alternatives
1 Grain Products
1 Vegetables and Fruit
1 Milk and Alternatives
1 Vegetables and Fruit
1 Milk and Alternatives
Water and coffee/tea
Hummus
Whole wheat crackers
1 cup/ 250 mL
¼ cup/ 60 mL
5 each
¼ Meat and Alternatives
½ Grain Products
Canada’s Food Guide
Food Groups
Vegetables and Fruit
Grain Products
Milk and Alternatives
Meat and Alternatives
Fluid
Number of
servings
8
7¾
4
3¼
9 ½ cups/
2375 mL
Provides the minimum number of
servings each day through meals
and snacks.
Provides a minimum of six cups of
fluids daily and at least one cup at
each meal and snack.
65
Gluten-Free
What is a gluten-free diet?3
A gluten-free diet is one that completely avoids the following grains:
 Wheat
 Rye
 Barley
These grains contain a protein called gluten that can damage the small intestine in people who have celiac
disease. When this happens, important nutrients are not absorbed into the body. This may lead to a variety
of nutrient deficiencies.
If an individual has celiac disease, then the gluten-free diet should be strictly followed as it is the only way
to keep the intestine healthy and reduce the risk of health problems.
What foods can be eaten on a gluten-free diet?
There are many foods that can be eaten on a gluten-free diet; some individuals can even tolerate oats in
small amounts. A dietitian can provide dietary guidance for the residents or the supportive living facility.
For more information on which foods to choose and avoid on a gluten-free diet, refer to the handout
(Gluten-Free Diet) in Appendix 2C, Nutrition and Menu Planning Resources.
Gluten-free baking and cooking
When cooking or baking, it is important to keep foods gluten-free. Even a crumb from gluten-containing
bread can affect the individual. Baking or cooking surfaces should be clean and gluten-free. Use these tips
to keep foods from coming in contact with gluten (becoming “cross-contaminated”).
To avoid cross contamination:

Buy flours labeled gluten-free. Flours without the gluten-free claim may be
cross-contaminated during production.

Store all gluten-free products separately. Have a separate cupboard and containers for glutenfree products.

Use clean equipment for gluten-free food preparation. Make sure all pots, pans, utensils, utensil
drawers and counter spaces are clean before using. Use a separate strainer for gluten-free foods.

Prepare and cook gluten-free foods separately from regular foods. Glass or metal dishes are
best. Avoid wooden cutting boards and utensils.
See the Canadian Celiac Association for more resources about gluten-free eating.
66
 Have a separate toaster. It’s best to buy a new toaster and use it only for
gluten-free bread. A shared toaster will have crumbs from gluten containing
breads. Another option is to use toaster bags. These re-useable bags cover
bread so it can be placed in any toaster. They are available in some gluten-free
stores and online.
 Use separate condiment containers. Have separate containers for items such
as margarine, jam, peanut butter, honey, mayonnaise, relish, and mustard; or serve food with
individually wrapped condiments. A shared dish or jar may have crumbs from gluten-containing
foods.
Cooking and Baking Resources
Cooking and baking with gluten-free flours can be a challenge and often requires experimenting and
practice. For ideas and tips on adapting recipes or substituting with gluten-free flours, visit the In the
Kitchen section of the Canadian Celiac Association website.11 The association offers reliable information
about the gluten-free diet.
67
Sample Gluten-Free Menu Plan
Below is a one day gluten-free menu that has been adapted from the Example of a Completed Regular
Menu Plan on page 32. Changes made to the regular menu to fit the gluten free diet are shown in bold.
Lunch
Breakfast
Meal
Portion Size
Coffee/tea and water
100% apple juice
Banana
Gluten-free cereal
Gluten-free toast
Milk/fortified soy beverage
Gluten-free peanut butter
1 cup/ 250 mL
½ cup/ 125 mL
1 medium
¾ cup/ 175 mL
2 slices (1 oz/ 35 g each)
1 cup/ 250 mL
1 package (1 Tbsp/ 15 mL)
1 Vegetables and Fruit
1 Vegetables and Fruit
1 Grain Products
2 Grain Products
1 Milk and Alternatives
½ Meat and Alternatives
Water and coffee/tea
Beef vegetable soup (made
with gluten-free soup base)
Gluten-free crackers, saltines
Turkey wrap
(on gluten-free pita)
Gluten-free pita
1 cup/ 250 mL
1 cup/ 250 mL
½ Vegetables and Fruit
1 package (2 crackers)
23 oz/ 6090 g
lean turkey breast
1 whole (2 oz/ 70g)
¼ Grain Products
1 Meat and Alternatives
Romaine lettuce, tomato in
sandwich
Carrot sticks
1 piece of romaine
2 slices of tomato
56 pieces
(3 inches/ 7 ½ cm long)
½ cup/ 125 mL
1 cup/ 250 mL
½ cup/ 125 mL
½ Vegetables and Fruit
Tossed salad
Milk/fortified soy beverage
Grapes
Afternoon
Snack
Canada’s Food
Guide Servings
Menu Item
Water and coffee/tea
Orange
Gluten-free oatmeal cookie
1 cup/ 250 mL
1 medium
2 small cookies
(11 ½ oz/ 3038 g total)
68
2 Grain Products
1 Vegetables and Fruit
½ Vegetables and Fruit
1 Milk and Alternatives
1 Vegetables and Fruit
1 Vegetables and Fruit
1 Grain Products
Sample Gluten-Free Menu Plan (Continued)
Evening
Snack
Dinner
Meal
Menu Item
Portion Size
Water and coffee/tea
Meatloaf (with gluten-free
or no breadcrumbs)
Baked potato
Green beans
Gluten-free bun
Milk/fortified soy beverage
Baked apple with cinnamon
Vanilla pudding made with
cornstarch
1 cup/ 250 mL
1 slice (approx 2 x 4 x ½
inch/5 x 10 x 1 ½ cm)
1 medium
½ cup/ 125 mL
1 bun (1 oz/ 35 g)
1 cup/ 250 mL
1 medium
½ cup/ 125 mL
Water and coffee/tea
Salmon salad sandwich
1 cup/ 250 mL
½ sandwich (11 ½ oz/
3045 g salmon salad)
1 slice (1 oz/ 35 g)
Gluten-free bread
Canada’s Food Guide
Food Groups
Vegetables and Fruit
Grain Products
Milk and Alternatives
Meat and Alternatives
Fluid
Number of
servings
10 ½
8
4
3
9 ½ cups/
2375 mL
Canada’s Food
Guide Servings
1 Meat and Alternatives
2 Vegetables and Fruit
1 Vegetables and Fruit
1 Grain Products
1 Milk and Alternatives
1 Vegetables and Fruit
1 Milk and Alternatives
½ Meat and Alternatives
1 Grain Products
Provides the minimum number of
servings each day through meals
and snacks.
Provides a minimum of six cups of
fluids daily, and at least one cup at
each meal and snack.
69
High Protein, High Calorie
A high protein, high calorie diet is used to improve nutrition status and helps reduce the risk of malnutrition
due to poor intake, decreased appetite, or weight loss. Protein provides building blocks for healing and
keeping the immune system strong. Eating extra protein and calories can help a resident to maintain or gain
weight and strength.
Tips to improve protein and calorie intake:

Include a source of protein at each meal, from either the Meat and Alternatives or Milk and Alternatives
food group. Choose foods such as meat, fish, poultry, nuts, eggs, cheese, or milk.

Offer snacks between meals. A resident may not be able to eat a big meal at one sitting, but may eat
more if offered food throughout the day.

Replace lower calorie drinks such as water, tea, coffee, and broth with more calorie-dense options such
as juice, milk, and cream-based soup.

Use the high protein, high calorie recipes which follow.
70
Recipes to increase protein and calories
High Protein Milk
Ingredients:
4 cups
½ cup
½ cup
Directions:
Homogenized milk, 3.25% M.F.
Skim milk powder
Cereal cream 12% M.F.
1L
125 mL
125 mL
1. Mix the ingredients and refrigerate overnight.
2. Use in place of milk in recipes.
3. Stir before using. Use in place of milk in recipes.
Makes 4 servings, (1 cup/ 250 mL)
Nutrition information per serving: 216 calories, 12 g fat, 7 g saturated fat, 0 g trans fat, 12 g protein, 17
g carbohydrate, 157 mg sodium, 413 mg calcium.
____________________________________________________________________________
Super Pudding
Ingredients:
2 cups
2 Tbsp
1 package
2 Tbsp
Directions:
Evaporated skim milk
Canola oil
Instant pudding mix (any flavour)
Skim milk powder
500 mL
30 mL
1 package
30 mL
1. Blend the milk and oil a bowl or large measuring cup.
2. Add the pudding mix and skim milk powder, mix well.
3. Pour evenly into 4 small bowls.
Makes 4 servings (½ cup/ 125 mL)
Nutrition information per serving: 246 calories, 15 g fat, 7 g saturated fat, 0 g trans fat, 9 g protein,
18 g carbohydrate, 172 mg sodium, 355 mg calcium.
For links to additional resources about adding protein and calories, please see Appendix 2C, Nutrition and
Menu Planning Resources.
71
Sample High Protein, High Calorie Menu Plan
Below is a one day high protein, high calorie menu that has been adapted from the Example of a
Completed Regular Menu Plan on page 32. Changes made to fit the high protein, high calorie diet are
shown in bold.
Afternoon
Snack
Lunch
Breakfast
Meal
Canada’s Food
Guide Servings
Menu Item
Portion Size
Coffee/tea and water
100% apple juice
Banana
Bran cereal with raisins
Whole grain toast with extra
margarine
High Protein milk/ soy
beverage
Peanut butter
1 cup/ 250 mL
½ cup/ 125 mL
1 medium
¾ cup/ 175 mL
2 slices (1 oz/ 35 g each)
1 Vegetables and Fruit
1 Vegetables and Fruit
1 Grain Products
2 Grain Products
1 cup/ 250 mL
1 Milk and Alternatives
1 package (1 Tbsp/ 15 mL)
½ Meat and Alternatives
Water and coffee/tea
Beef barley soup
Crackers, saltines
Turkey sandwich wrap
(made with mayonnaise)
Pita bread, whole grain whole
wheat, spread with extra
margarine, mayonnaise or
hummus
Romaine lettuce, tomato in
wrap
Carrot sticks, served with
Ranch dip
Tossed salad
High Protein milk/
soy beverage
Grapes
1 cup/ 250 mL
1 cup/ 250 mL
1 package (2 crackers)
23 oz/ 6090 g lean turkey
breast
1 whole (2 oz/ 70g)
Water and coffee/tea
Apple
Cheddar cheese slice
½ Grain Products
¼ Grain Products
1 Meat and Alternatives
2 Grain Products
1 piece of romaine
2 slices of tomato
56 pieces
(3 inches/ 7 ½ cm long)
½ cup/ 125 mL
1 cup/ 250 mL
½ Vegetables and Fruit
½ cup/ 125 mL
1 Vegetables and Fruit
1 cup/ 250 mL
1 medium
1 ½ oz/ 50 g
1 Vegetables and Fruit
1 Milk and Alternatives
72
1 Vegetables and Fruit
½ Vegetables and Fruit
1 Milk and Alternatives
Sample High Protein, High Calorie Menu Plan (Continued)
Evening
Snack
Dinner
Meal
Menu Item
Portion Size
Water and coffee/tea
Meatloaf, served with extra
gravy
Baked potato, served with
margarine, sour cream and
grated cheese
Green beans
Whole grain tray bun
(with margarine)
High Protein milk/
soy beverage
Baked apple with cinnamon
Super Pudding
1 cup/ 250 mL
1 slice (approx 2 x 4 x ½ inch/
5 x 10 x 1 ½ cm )
1 medium
Water and coffee/tea
Salmon salad sandwich
1 cup/ 250 mL
½ sandwich (11 ½ oz/ 3045 g
salmon salad)
1 slice (1 oz/ 35 g)
Whole wheat bread
Canada’s Food Guide
Food Groups
Vegetables and Fruit
Grain Products
Milk and Alternatives
Meat and Alternatives
Fluid
Canada’s Food
Guide Servings
1 Meat and Alternatives
2 Vegetables and Fruit
½ cup/ 125 mL
1 bun (1 oz/ 35 g)
1 Vegetables and Fruit
1 Grain Products
1 cup/ 250 mL
1 Milk and Alternatives
1 medium
½ cup/ 125 mL
1 Vegetables and Fruit
1 Milk and Alternatives
Number of
servings
10
7½
5
3
9 ½ cups/
2375 mL
½ Meat and Alternatives
1 Grain Products
Provides the minimum number of
servings each day through meals
and snacks.
Provides a minimum of six cups of
fluids daily, and at least one cup at
each meal and snack.
73
3.3 Texture Modified Diets
Easy to Chew
Description
An Easy to Chew diet is for people who have trouble chewing foods that are hard or crunchy. They may
have poor fitting dentures or may be missing teeth. Easy to chew diets must provide the daily
recommended number of servings from each food group in Canada’s Food Guide and should follow the
Menu Planning Guidelines, on page 17.
Easy to chew foods need to be soft and moist.
Shown below are sample meals for an Easy to Chew diet:
Diced ham with macaroni
and cheese and
French cut green beans
Chicken à la king with
mashed potato and gravy
and steamed carrots
Poached cod tail with
canned green beans and
mashed turnip
Foods Allowed and Not Allowed on an Easy to Chew Diet
Foods allowed include soft foods that are easy to chew. Foods not allowed are dry, crispy or hard foods;
foods with long or stringy pieces and foods with tough skins. See the table which follows for foods
allowed and not allowed on an easy to chew diet.
Foods Allowed
Vegetables and Fruit
 Soft cooked fresh, frozen or canned vegetables
 Soft raw vegetables
 Finely shredded salads
 Mashed or whipped potato, or other well
cooked potato side dishes
 Soft, frozen or canned fruit
 Cooked or stewed dried fruit
 Soft ripe fresh fruit including those with seeds
(for example, pear, banana, melons)
74
Foods Not Allowed





Hard and/or unripe raw vegetables and
fruit
Salads that are not shredded
Potato skins, hash browns
Uncooked dried fruit
All pineapple except crushed
Foods Allowed and Not Allowed on an Easy to Chew Diet (Continued)
Foods Not Allowed
Foods Allowed
Grain Products
 Soft breads, buttered toast, buns, biscuits, soft
tortillas and moist muffins
 Cooked hot cereals
 Cold cereals softened in milk
 Soft cooked pasta, rice, barley

Milk and Alternatives
Yogurt, milk pudding or custard, without
granola
 Cheeses (diced, cubed, grated, soft and cottage
cheese)
Meat and Alternatives
 Tender moist meat or poultry or boneless fish,
with sauces or gravy, prepared in one of the
following ways:
 Shaved, sliced, or whole meat
 Fork tender meats that are either sliced or
whole, shaved to paper thin
 Sausages and wieners in soft casings, shaved
processed meats
 Soft cooked legumes
 All cooked eggs or egg substitutes, including
quiche or omelets with allowed ingredients
 Smooth or crunchy nut butters mixed into or
spread on allowed foods

Mixed Dishes and Condiments
 Soft casseroles, stews and chili made with
allowed ingredients
 Sandwiches with salad type or minced fillings,
shaved meat or cheese on regular bread with
shredded vegetables
 Grilled cheese sandwiches
 All soups with allowed ingredients
Drinks
 All drinks
75



Dry, crusty, or chewy bread products,
(for example, bagels, crusty buns,
French bread, dry muffins, bread sticks,
pitas)
Cold cereals that do not soften in milk
Hard crackers and granola bars
Hard toast

Yogurt, milk pudding or custard
containing hard or large firm pieces
such as granola


Crispy refried meat, poultry and fish
Meats in hard casings (for example,
kolbasa, garlic sausage)
Fish (canned, fresh or frozen)
containing bones
Whole fried eggs or egg substitutes
Large chopped or whole nuts or seeds
Smooth or crunchy nut butters served
alone







Most main entrée salads
Wieners or hamburgers in a bun
Pizza
Tips for Preparing Easy to Chew Food







Choose soft moist foods. Foods may need to be chopped, minced, or mashed to make them easier
to chew.
Add butter, margarine, gravy or sauces, oils, salad dressing, or sour cream to moisten foods.
Blend fruits into smoothies, milkshakes, popsicles, puddings, or sauces.
Remove tough skins and/or seeds on fruit (for example, sliced apple and watermelon). Stew or
cook dried fruit.
Soak bread, biscuits, hard cookies, or muffins in milk or soup to soften, if required.
Braise, boil, simmer, or poach meats slowly in water, broth, or juice to make them tender. Use of a
slow cooker or pressure cooker can also help soften meats.
Cut meat into bite-sized pieces. Grind or blend meat if it is still too hard or chewy.
Taste and Appearance




Offer a variety of colourful and appetizing foods.
Use appropriate texture garnishes to add colour and appeal.
Taste the food before serving it to make sure it is acceptable.
Serve meals at the right temperature (hot foods should be served hot, cold foods should be served
cold).
Snack Ideas






Crushed pineapple
Canned pears
Soft cereal bars
Tapioca, rice or bread pudding
Cottage cheese
Soft sandwiches
For more information, please see Appendix 2C, Nutrition and Menu Planning Resources for the handout
Easy to Chew diet.
76
Sample Easy to Chew Menu Plan
Below is a one day Easy to Chew menu that has been adapted from the Example of a Completed Regular Menu Plan on page 32. Changes made to
the Regular menu to fit the Easy to Chew diet are shown in bold. If a resident is on an Easy to Chew diet and has trouble cutting food, Cut/Diced
foods may also be needed as an additional texture modification, as shown below. A  indicates no change from the Easy to Chew menu item.
Lunch
Breakfast
Meal
Regular Menu Item
Easy to Chew Menu Item
Coffee/tea and water
100% apple juice
Coffee/tea and water
100% apple juice
Banana
Banana
Bran cereal with raisins
Bran cereal (no raisins)
softened in milk
Buttered whole grain toast
Whole grain toast
Easy to Chew
with Cut/Diced


Portion Size
1 cup/ 250 mL
½ cup/ 125 mL
1 Vegetables and Fruit
Cut into bite-sized
pieces

1 medium
1 Vegetables and Fruit
¾ cup/ 175 mL
1 Grain Products
2 slices (1 oz/ 35 g each slice)
2 Grain Products
1 cup/ 250 mL
1 Milk and Alternatives
½ Meat and Alternatives
Milk/fortified soy
beverage
Peanut butter
Milk/fortified soy beverage
Cut toast in halves or
quarters

Peanut butter

1 package (1 Tbsp/ 15 mL)
Water and coffee/tea
Beef barley soup
Crackers, soda
Turkey sandwich wrap on
whole grain whole wheat
pita bread, with romaine
lettuce and tomato slices
Water and coffee/tea
Beef barley soup
Crackers, soda
Turkey sandwich wrap (turkey
shaved paper thin)
Pita bread, whole grain whole
wheat
Finely shredded romaine
lettuce, tomato in wrap
Soft cooked carrot sticks



Cut wrap into halves
or quarters
1 cup/ 250 mL
1 cup/ 250 mL
1 package (2crackers)
1 whole (includes 23 oz/
6090 g lean turkey breast)
1 whole (2 oz/ 70 g)
Carrot sticks
Tossed salad
Milk/fortified soy
beverage
Grapes
Number of Canada’s
Food Guide Servings
½ Grain Products
¼ Grain Products
1 Meat and Alternatives
2 Grain Products
½ Vegetables and Fruit
Finely shredded tossed salad
Milk/fortified soy beverage
Cut into bite-sized
pieces


¼ cup/ 60 mL lettuce
2 slices tomato
56 pieces
(3 inches/ 7 ½ cm long)
½ cup/ 125 mL
1 cup/ 250 mL
Grapes

½ cup/ 125 mL
1 Vegetables and Fruit
77
1 Vegetables and Fruit
½ Vegetables and Fruit
1 Milk and Alternatives
Sample Easy to Chew Menu Plan (Continued)
Evening
Snack
Supper
Afternoon
Snack
Meal
Regular Menu Item
Water and coffee/tea
Orange
Easy to Chew Menu Item
Oatmeal Cookie
Water and coffee/tea
Orange
(peeled and sectioned)
Oatmeal cookie, soft baked
Water and coffee/tea
Meatloaf
Easy to Chew
with Cut/Diced


Portion Size
1 cup/ 250 mL
1 medium

2 small cookies
(1-1 ½ oz / 30-38 g total)
Water and coffee/tea
Meatloaf


Baked potato
Baked potato (with no skin)
Green beans
Green beans
Whole grain tray bun
Whole grain tray bun (soft)
Milk/fortified soy
beverage
Baked apple with
cinnamon
Vanilla pudding
Milk/fortified soy beverage
Cut into bite-sized
pieces
Cut into bite-sized
pieces
Cut in halves or
quarters

1 cup/ 250 mL
1 slice ( 2 x 4 x ½ inch /
5 x 10 x 1 ½ cm)
1 medium
Number of Canada’s
Food Guide Servings
1 Vegetables and Fruit
1 Grain Products
1 Meat and Alternatives
2 Vegetables and Fruit
½ cup/ 125 mL
1 Vegetables and Fruit
1 bun (1 oz/ 35 g)
1 Grain Products
1 cup/ 250 mL
1 Milk and Alternatives
1 medium
1 Vegetables and Fruit
Vanilla pudding
Cut into bite-sizes
pieces

½ cup/ 125 mL
1 Milk and Alternatives
Water and coffee/tea
Water and coffee/tea

1 cup/ 250 mL
Salmon salad sandwich on
whole wheat bread
Salmon salad sandwich on
whole wheat bread

1-1 ½ oz/ 30-45 g salmon
½ Meat and Alternatives
1 slice bread (1 oz/ 35 g)
1 Grain Product
Baked apple with cinnamon
78
Canada’s Food Guide
Food Groups
Vegetables and Fruit
Grain Products
Milk and Alternatives
Meat and Alternatives
Fluid
Number of servings
10
8½
4
3
9 ½ cups/ 2375 mL
Provides the minimum number of servings from
each of the four food groups each day through
meals and snacks.
Provides a minimum of six cups of fluids daily,
and at least one cup at each meal and snack.
If a resident on an Easy to Chew diet has trouble cutting food, Cut/Diced foods may also be needed. For more details on Foods Allowed/Not
Allowed on Cut/Diced, see page 105.
If ‘Cut/Diced’ is ordered




Toast, bread or buns should be cut into halves or quarters.
Sandwiches or wraps should be cut into halves or quarters.
Fruit and vegetables should be peeled and sectioned, mashed, cut or diced.
Meat, poultry, or fish should be cut into bite-sized pieces.
79
Dysphagia Soft
Description
A Dysphagia Soft diet may be needed for people who have trouble chewing or swallowing, but do not
need food minced or pureed. A Dysphagia Soft diet must provide the daily recommended number of
servings from each food group in Canada’s Food Guide and should follow the Menu Planning Guidelines,
on page 17.
Dysphagia Soft food must be soft and moist. Some foods may need to be served with a sauce, gravy, or
condiment. Firm foods need to be diced ½ inch/ (1 cm) cubed or less on the longest side. Other foods that
can be mashed with a fork in one hand are soft enough to be served without dicing, such as cooked
vegetables.
Shown below are sample meals for a Dysphagia Soft diet:
Poached cod tail
with mashed potato and
minced green beans
Diced turkey and gravy,
with mashed potato, peas
and carrots
Soft salmon loaf with
mashed potato and gravy,
and green peas
Foods Allowed/Not Allowed
Foods allowed include soft and moist foods. Though most food can be altered to fit into a Dysphagia Soft
diet, some foods need to be avoided altogether. Avoid foods that are dry, crumbly, sticky, gummy, hard or
chewy. Some foods need to be minced to be safe on a Dysphagia Soft diet. See the table below for a list of
foods allowed and not allowed on a Dysphagia Soft diet.
80
Foods Allowed and Not Allowed on a Dysphagia Soft Diet
Foods Allowed
Vegetables and Fruit
 Soft diced cooked vegetables (for example,
diced carrots)
 Mashable cooked vegetables (for example,
cooked peas, squash)
 Fibrous or stringy vegetables like broccoli and
green beans need to be minced
 Very finely shredded lettuce, coleslaw, and
other leafy greens
 Peeled finely diced cucumber
 Soft ripe diced or mashed fruit
Grain Products
 Soft breads, buttered toast, buns, biscuits and
moist muffins containing allowable
ingredients served with a spread
 Cooked cereals; cold cereals softened in milk
(no hard pieces)
 Fork-tender, mashable pasta with or without a
sauce, couscous, or barley in a sauce or
casserole, or moist rice that stays together
 Pancakes, waffles or French toast served with
syrup or applesauce to moisten
Milk and Alternatives
 All yogurt, custard or milk pudding, smooth
or with small pieces of fruit or seeds
 Cheeses, sliced, diced, or grated
 Cottage cheese
81
Foods Not Allowed





Raw vegetables
Whole kernel corn
Fruit with tough skins
All pineapple except crushed
Dried fruit or fruit with hard seeds

Dry, crumbly, crusty or chewy bread
products
Cold cereals that do not soften in milk
Dry, loose rice




Yogurt, milk pudding or custard with
large pieces of fruit, nuts or granola
Crispy melted stringy cheese topping
Foods Allowed and Not Allowed on a Dysphagia Soft Diet (Continued)
Foods Allowed
Meat and Alternatives
 Tender moist meat, poultry or organ meat
with sauces or gravies prepared in one of the
following ways:
 Diced (½ inch / 1 cm cubed) meat
(for example, roast or Salisbury steak)
 Fork tender, mashable meat (for example,
Shepherd’s pie, meatloaf, meatballs)
 Meat shaved and diced ½ inch (1 cm) on
longest side
 Processed meats shaved and diced (½ inch /
1 cm on longest side) such as deli-style meats,
luncheon meats
 Canned fish with bones removed, and tender,
boneless flaked fish served with or without a
sauce or gravy or in a moist coating
 All cooked and mashable eggs or egg
substitutes, including quiche or omelets with
allowed ingredients
 Smooth nut butters mixed into allowed foods
(for example, peanut butter smoothie)
 Soft cooked mashable legumes or tofu
Mixed Dishes and Condiments
 Very tender casseroles, stews and chili made
with tender diced or mashable allowed
ingredients (for example, lasagna, macaroni
and cheese, tuna macaroni casserole)
 Sandwiches with salad type, finely minced
fillings or cheese, on regular bread without
lettuce or whole raw vegetables
 Grilled cheese sandwiches
 Soups with allowed ingredients or pureed
soups
 Smooth gravies or sauces such as white sauce
or cheese sauce, added to allowed foods
 Sauces that are smooth or with small to
medium pieces such as BBQ sauce, ketchup,
horseradish, relish, and cranberry sauce
 Jams or marmalades in jars if fruit pieces are
less than ½ inch (1 cm) cubed and/or soft and
mashable
Drinks
 All drinks
Foods Not Allowed
82











Dry, or tough, breaded, battered or fried
meats, poultry or fish
Crispy whole fried eggs or egg substitutes
Large chopped or whole nuts and seeds
Crunchy nut butters
Smooth nut butters spread on foods
Casseroles, stews or chili made with not
allowed ingredients
Pizza
Shaved meat sandwiches
Wieners or hamburgers in buns
Soups containing not allowed foods or
larger pieces
Sauces with larger pieces or not allowed
ingredients, such as salsa with corn
Tips for Preparing Dysphagia Soft Food
The preparation method for Dysphagia Soft foods depends on the type of food being served.
Foods that need to be diced should be less than ½ inch/ 1 cm, as shown.
 Measure or portion out pieces before cutting to ensure they are the right
portion size.
Foods can be chopped or mashed with a knife, pastry blender, potato
masher, or fork.
 Cooked and mashable eggs or egg substitutes, peas, beans, or lentils are
appropriate.
 Tender moist meat, poultry or organ meat must be prepared in one of the following ways:
o Diced (for example, roast, Salisbury steak, hamburger patty, breaded pork cutlet, liver).
o Fork tender, mashable meat (for example, Shepherd’s pie, meatloaf, or meatballs)
o Meat shaved and diced (½ inch/ 1 cm on longest side) or shaved paper thin (such as roast
beef or ham) with a meat slicer or knife so that it looks like thinly-sliced deli meat.
 Meat, poultry, and boneless fish should have added sauce/gravy to make it tender, soft, and moist.
 Vegetables must be cooked until soft. Most can be served ‘as is’ once they are cooked to a soft
texture, however, some will need to be diced or minced after cooking. For example, cooked
vegetables that are fibrous and stringy like green beans and broccoli should be minced. Lettuce,
coleslaw, and leafy green vegetables may be served raw as long as they are finely shredded.
 Fruits that are canned, frozen, or fresh can be served as long as they are soft in texture. All fruits
should be diced or mashed before serving.
Taste and Appearance




Offer a variety of colourful and appetizing foods.
Use appropriate textured garnishes to add colour and appeal.
Taste the food before serving it to make sure it is acceptable.
Serve meals at the right temperature (hot foods should be served hot, cold foods should be
served cold).
Snack Ideas






Soft moist muffin
Ripe banana, diced or mashed
Smooth yogurt or pudding
Soft cooked, canned, or ripe fruit, with skins removed, diced or mashed
Cottage cheese
Soft crackers (such as soda crackers) with soft cubed cheese
For more information, please see Appendix 2C, Nutrition and Menu Planning Resources for the handout
Dysphagia Soft Diet.
83
Sample Dysphagia Soft Menu Plan
Below is a one day Dysphagia Soft menu that has been adapted from the Example of a Completed Regular Menu Plan on page 32. Changes
hanges made to the Regular menu to fit the Dysphagia Soft diet are shown in bold. If a Dysphagia Soft diet is ordered along with another
additional texture modification, such as Thick Fluids, No Mixed Consistencies, and/or Pureed Bread Products, more foods will need to be
avoided or altered, as shown below. A  indicates no change from the Dysphagia Soft menu item.
Breakfast
Meal
Dysphagia
Soft with No
Mixed
Consistencies
Dysphagia
Soft with
Thick Fluids
Regular Menu Item
Dysphagia Soft
Menu Item
Coffee/tea and water
100% apple juice
Bran cereal with raisins
Coffee/tea and water
100% apple juice
Oatmeal



Thicken
Thicken

Whole grain toast
Buttered whole grain
toast


Banana
Milk/fortified soy
beverage
Peanut butter
Peanut Butter
Smoothie including:
Banana
Milk/fortified soy
beverage
Smooth peanut butter
 (must be
smooth)
Thicken (Note:
smoothies
should not
contain any ice,
ice cream or
sherbet and must
be smooth).
84
Dysphagia
Soft with
Pureed
Bread
Products



Slurried French
toast (see page
109 for a
recipe on how
to make a
slurry)

Portion Size
Number of Canada’s
Food Guide Servings
1 cup/ 250 mL
½ cup/ 125 mL
¾ cup/ 175 mL
1 Vegetables and Fruit
1 Grain Products
2 slices
(1 oz/ 35 g
each)
2 Grain Products
1 medium
1 cup/ 250 mL
1 Vegetables and Fruit
1 Milk and Alternatives
1 package
(1 Tbsp/
15 mL)
½ Meat and Alternatives
Sample Dysphagia Soft Menu Plan (Continued)
Meal
Regular Menu Item
Lunch
Water and coffee/tea
Beef barley soup
Dysphagia Soft
Menu Item
Dysphagia
Soft with No
Mixed
Consistencies
Dysphagia
Soft with
Thick Fluids
Dysphagia
Soft with
Pureed
Bread
Products



Blend
Thicken
Blend and
thicken
Crackers, soda
Water and coffee/tea
Beef barley soup (beef
needs to be tender and
less than ½ inch/ 1 cm
cubed)
Crackers, soda
Remove
Remove
Remove
Turkey sandwich wrap
on whole grain whole
wheat pita bread, with
romaine lettuce and
tomato slices
Turkey salad sandwich
on Whole grain whole
wheat bread (no
lettuce or tomato
slices)


Carrot sticks




Milk/fortified soy
beverage
Soft cooked diced
carrots
Very finely shredded
salad
Milk/fortified soy
beverage
Pureed bread
with turkey
salad OR
mashed
potatoes with
soft diced
turkey


Grapes
Diced kiwi
Drain excess
liquid
Tossed salad
Portion Size
Number of
Canada’s Food
Guide Servings
1 cup/ 250 mL
1cup/ 250 mL
½ Grain Products
1 package
(2 crackers)
1 whole (includes
23 oz/ 6090 g
lean turkey
breast)
2 slices bread
(1 oz/ 35 g each)
¼ Grain Products
½ cup/ 125 mL
1 Vegetables and Fruit

½ cup/ 125 mL
Thicken

1 cup/ 250 mL
Drain excess
liquid

½ cup/ 125 mL
½ Vegetables and
Fruit
1 Milk and
Alternatives
1 Vegetables and Fruit
85
1 Meat and
Alternatives
2 Grain Products
Sample Dysphagia Soft Menu Plan (Continued)
Evening
Snack
Supper
Afternoon
Snack
Meal
Regular Menu Item
Dysphagia Soft
Menu Item
Dysphagia Soft
with No Mixed
Consistencies
Dysphagia
Soft with
Thick
Fluids
Water and coffee/tea
Orange
Water and coffee/tea
Canned mandarin
oranges

Replace with fruit
sauce (like apple)
Oatmeal Cookie
Oatmeal cookie, soft
baked

Water and coffee/tea
Meatloaf
Water and coffee/tea
Meatloaf topped with
gravy

Serve gravy on
food, not on side
Baked potato
Baked potato (with no
skin)
Minced green beans

Thicken
Serve gravy
on food, not
on side


Whole grain tray bun
(soft), with margarine
Milk/fortified soy
beverage
Diced baked apple with
cinnamon
Vanilla pudding
Water and coffee/tea
Salmon salad sandwich
on whole wheat bread
Green beans
Whole grain tray bun
Milk/fortified soy
beverage
Baked apple with
cinnamon
Vanilla pudding
Water and coffee/tea
Salmon salad
sandwich on whole
wheat bread
Thicken
Replace with
fruit sauce
(like apple)

Dysphagia
Soft with
Pureed
Bread
Products


1 cup/ 250 mL
½ cup/ 125 mL
1 Vegetables and Fruit
2 small cookies
(11 ½ oz /
3038 g total)
1 Grain Product
1 Meat and
Alternatives

1 cup/ 250 mL
1 slice ( 2 x 4 x
½ inch /
5 x 10 x 1 ½ cm)
1 medium


½ cup/ 125 mL
1 Vegetables and Fruit


Puree tray bun
1 Grain Products

Thicken

1 bun
(1 oz/ 35 g)
1 cup/ 250 mL



1 medium
1 Vegetables and Fruit
(must be smooth)
(must be
smooth)

½ cup/ 125 mL
1 Milk and Alternatives


Thicken


Salmon salad
with biscuit
slurry
1 cup/ 250 mL
1-1 ½ oz/
30-45 g salmon
½ Meat and
Alternatives
1 biscuit
(1 oz/35 g)
1 Grain Products
86
Replace with
blended bread
pudding (125
mL/ ½ cup)


Portion Size
Number of
Canada’s Food
Guide Servings
2 Vegetables and Fruit
1 Milk and Alternatives
Canada’s Food Guide
Food Groups
Vegetables and Fruit
Grain Products
Milk and Alternatives
Meat and Alternatives
Fluid
Number of servings
9½
8½
4
3
9 ½ cups/ 2375 mL
Provides the minimum number of servings from
each of the four food groups each day through
meals and snacks.
Provides a minimum of six cups of fluids daily,
and at least one cup at each meal and snack.
Below is a further description of foods that will need to be avoided or altered for the menu above if additional texture modifications are ordered
along with the Dysphagia Soft Diet. For more details on Foods Allowed and Not Allowed for these diet modifications, see the pages as noted.
If ‘No Mixed Consistencies’ is ordered
 Serve hot cereal only (no cold or dry cereal).
 Blend/puree soups.
 Serve yogurt or pudding that is smooth or with small soft pieces of fruit.
 Ensure there are no firm fruit chunks or ice cubes in milkshakes or smoothies.
 See page 107 for more information.
If ‘Thick Fluids’ is ordered
 Follow the changes for ‘No Mixed Consistencies’.
 Provide juice, milk, hot beverages and soup thickened to the ordered consistency (Nectar, Honey, or Pudding thick).
 Replace thin fluids (ice cream, sherbet, popsicles or gelatin) with thickened fluids.
 Serve gravies/sauces on the food, not on the side. Gravies do not need to be thickened as long as they do not pool on the plate.
 Smoothies or milkshakes can be offered if thickened to the appropriate consistency. Ice, ice cream, or sherbet should not be used, as these
ingredients will melt, causing the smoothie or milkshake to change consistency after serving.
 See page 113 for more information.
If ‘Pureed Bread Products’ is ordered
 Remove all regular texture bread products. Replace with pureed bread products or allowed grains.
 Additional servings of Meat and Alternatives can be offered at meals so that snacks (for example, sandwiches) can be substituted with other
items such as yogurt or pudding for ease of menu planning.
 See page 109 for more information.
87
Minced
Description
A Minced diet is for people who have trouble chewing or swallowing. Minced diets must provide the daily
recommended number of servings from each food group in Canada’s Food Guide and should follow the
Menu Planning Guidelines on page 17.
Minced foods are grated, ground, or mashed, to a size less than ¼ inch or ½ cm. Minced food should be
moist, stay together, and have no liquid separation. Minced food should require little chewing.
Shown below are sample meals for a Minced diet:
Minced baked beans and
wieners with mashed
potato and minced peas
Baked fish with mashed
potato and gravy, and
minced green beans
Minced minute steak with
mashed potato and gravy, and
minced parsnip/carrot medley
Foods Allowed/Not Allowed
Most regular foods can be altered to fit into a Minced diet, but some foods do not mince well and need to
be avoided. These foods include:
 Fruit with tough skins or hard seeds (for example, raspberries or pineapple)
 Dry, crumbly, chewy breads (for example, bagels, and dry muffins)
 Foods that are sticky and gummy (for example, toffee, licorice, or gum)
Some foods need to be pureed to be safe on a Minced diet (for example, kernel corn and stewed pitted
prunes). Foods which do not require mincing, and can be part of a minced diet include: soft breads,
muffins, pancakes, or buttered toast. See the table below for a list of foods allowed and not allowed on a
minced diet.
88
Foods Allowed and Not Allowed on a Minced Diet
Foods Allowed
Vegetables and Fruit
 Minced soft canned or soft cooked
vegetables and fruit
 Mashed or whipped potato or other minced
potato side dishes
 Mashed ripe banana
Grain Products
 Soft, moist regular bread products
 Smooth hot cereals
 Minced or bite sized pasta, cooked until
very soft
 Rice, barley or couscous in a sauce or
casserole, or moist rice that stays together
Milk and Alternatives
 Yogurt that is smooth or has soft pieces of
fruit
 Smooth milk pudding or custard
 Soft or grated cheese, creamed cottage
cheese
Meat and Alternatives
 Minced, moist meat and poultry with
smooth sauces or gravies
 Tender, boneless flaked fish or canned fish
with bones removed with or without sauce
or gravy or in a moist coating
 Cooked scrambled eggs or egg substitutes
 Hard cooked or poached eggs or egg
substitutes, minced or finely mashed
 Smooth nut butters mixed into allowed
foods (for example, peanut butter
smoothie)
 All minced or mashed soft cooked legumes
(beans, peas, or lentils)
Foods Not Allowed

















89
Cooked vegetables that are rubbery, not
tender or do not mince well (for example,
cooked peas, lima beans, broccoli,
cabbage, Brussels sprouts)
Raw vegetables and salads
Fruit that has tough skins, hulls or seeds
that do not mince well (for example,
raspberries, whole grapes, pineapple)
Dried fruit
Dry, crumbly, crusty or chewy bread
products (for example, French bread,
crusty buns, bagels, dry muffins,
breadsticks)
Hot cereals containing seeds, or hard
particles
All cold cereals
Dry, loose rice
Hard crackers
Yogurt, milk pudding or custard
containing firm pieces of fruit, dried fruit,
nuts, granola, seeds or other hard particles
Slices or cubes of hard cheese
Crispy melted stringy cheese topping
Breaded or battered meats, even if
minced; all nuts and seeds
Whole fried eggs or egg substitutes,
quiche
All nuts or seeds in any form
Crunchy nut butters
Smooth nut butters spread on foods
Foods Allowed and Not Allowed on a Minced Diet (Continued)
Mixed Dishes and Condiments
 Very tender casseroles, stews and chili
made with minced or allowed ingredients
 Sandwiches with salad type or finely
minced fillings on regular bread with no
lettuce or vegetables
 Pureed soups
 Soft, moist, or easy to break cookies and
baked products
 Smooth gravies and sauces such as white
sauce or cheese sauce, added to allowed
foods (maximum 2 Tbsp/ 30 mL per menu
item)
Drinks
 All drinks







Main entrée salads
Pizza
Wieners or hamburgers in a bun
Grilled cheese sandwiches
All unblended soups
Hard cookies or cookies with large hard
pieces
Sauces with larger pieces (for example,
salsa, cranberry sauce)
Steps for Preparing Minced Food
1. Before mincing food, drain liquid from food portions to be minced, such as canned fruit. This will help
avoid liquid separation.
2. Weigh or measure the number of portions required. Chop or dice larger pieces of food before mincing.
3. Process foods until uniform in size and texture.
a. Mince small amounts of food using a blender, mini chopper, or a food processor.
b. For larger amounts of food use a large institutional meat grinder or food processor.
c. Mince soft foods with a fork, pastry blender, or potato masher.
4. Add liquid to get the right consistency.
a. Use hot liquids for hot foods and cold liquids for cold foods. This helps to keep safe food
temperatures during preparation.
b. Do not use water. Use cooking liquids, gravy, milk, juice, melted margarine, or sauces to enhance
colour, flavour, and the nutrient value of the food.
c. When mincing food, add 1 Tbsp/ 15 mL of liquid at a time until it looks smooth and moist. Foods
should be moist but should not have liquid separation.
5. Add spices (excluding salt) to enhance flavour.
6. The finished product should be uniform in size and texture. Food should be less than ¼ inch/ ½ cm
thick. Take care not to over process food, or it will end up pureed.
Commercial Products
Commercial minced products are also available through various suppliers. Use of these products can help
ensure consistency in products, nutrition, and safety. For further information on these products, please ask
a dietitian.
90
Taste and Appearance






Be positive when serving minced foods to the resident. This will help the resident accept and eat
the food.
Offer a variety of colourful and appetizing food.
Offer each food item separately on the plate, without mixing or blending them together, to enhance
the look and taste.
Use appropriate textured garnishes that add colour and appeal.
Taste the food before serving it to make sure it tastes good.
Serve meals at the right temperature (hot foods should be served hot, cold foods should be served
cold).
Snack Ideas





Minced canned fruit
Smooth yogurt or pudding
Sandwiches with minced filling
Soft cereal bars
Banana loaf
For more information, please see Appendix 2C, Nutrition and Menu Planning Resources for the handout
Minced Diet.
91
Sample Minced Menu Plan
Below is a one day Minced menu that has been adapted from the Example of a Completed Regular Menu Plan on page 32. Changes made to
the Regular menu to fit the Minced diet are shown in bold. If a Minced diet is ordered along with additional texture modification, such as
Thick Fluids, No Mixed Consistencies, and/or Pureed Bread Products, more foods will need to be avoided or altered, as shown below. A 
indicates no change from the Minced menu item.
Breakfast
Meal
Coffee/tea and
water
100% apple juice
Bran cereal with
raisins
Whole grain toast
Coffee/tea and
water
100% apple juice
Oatmeal

Thicken
Minced with
Pureed
Bread
Products



Thicken



½ cup/ 125 mL
¾ cup/ 175 mL
1 Vegetables and Fruit
1 Grain Products
Buttered whole
grain toast


2 slices (1 oz/
35 g each)
2 Grain Products
Banana
Milk/fortified soy
beverage
Peanut butter
Peanut Butter
Smoothie
including:
Banana
Milk/fortified soy
beverage
Smooth peanut
butter
 (must be
smooth)
Thicken (Note:
smoothies should
not contain any
ice, ice cream or
sherbet and must
be smooth).
Slurried French
toast (see page
111 for a
recipe on how
to make a
slurry)

1 medium
1 cup/ 250 mL
1 Vegetables and Fruit
1 Milk and Alternatives
1 package
(1 Tbsp/ 15 mL)
½ Meat and Alternatives
Regular Menu
Item
Minced
Menu Item
Minced with
No Mixed
Consistencies
Minced with
Thick Fluids
92
Portion Size
Number of Canada’s
Food Guide
Servings
1 cup/ 250 mL
-
Sample Minced Menu Plan (Continued)
Meal
Regular Menu
Item
Water and
coffee/tea
Beef barley soup
Lunch
Crackers, soda
Turkey sandwich
wrap on whole
grain whole wheat
pita bread, with
romaine lettuce and
tomato slices
Carrot sticks
Tossed salad
Milk/fortified soy
beverage
Grapes
Water and
coffee/tea
Blended beef
barley soup
Crackers, soda
(softened in soup)
Turkey salad
sandwich on
Whole grain
whole wheat
bread (no lettuce
or tomato slices)

Thicken
Minced with
Pureed
Bread
Products

Blend
Blend and thicken

1 cup/ 250 mL
½ Grain Products
Remove
Remove
Remove
¼ Grain Products


Pureed bread
with turkey
salad OR
mashed
potatoes with
soft diced
turkey
1 package
(2 crackers)
1 whole
(includes 2-3 oz/
60-90 g lean
turkey breast)
2 slices bread
(1 oz/ 35 g each)
Minced cooked
carrots
Pureed green peas
Milk/fortified soy
beverage
Minced kiwi



½ cup/ 125 mL
1 Vegetables and Fruit



Thicken


½ cup/ 125 mL
1 cup/ 250 mL
1 Vegetables and Fruit
1 Milk and Alternatives
Drain excess
liquid before
and after
mincing
Drain excess
liquid before and
after mincing

½ cup/ 125 mL
1 Vegetables and Fruit
Minced
Menu Item
Minced with
No Mixed
Consistencies
Minced with
Thick Fluids
93
Portion Size
1 cup/ 250 mL
Number of Canada’s
Food Guide
Servings
1 Meat and Alternatives
2 Grain Products
Sample Minced Menu Plan (Continued)
Supper
Afternoon Snack
Meal
Regular Menu
Item
Minced
Menu Item
Minced with
No Mixed
Consistencies
Minced with
Thick Fluids
Minced with
Pureed
Bread
Products

1 cup/ 250 mL
Portion Size
Number of Canada’s
Food Guide
Servings
Water and
coffee/tea
Orange
Water and coffee/tea

Thicken
Minced canned
mandarin oranges
Remove and
replace with fruit
sauce (like apple)

½ cup/ 125 mL
1 Vegetables and Fruit
Oatmeal Cookie
Oatmeal cookie, soft
baked
Remove and
replace with
fruit sauce (like
apple)


Replace with
blended bread
pudding (½
cup/125 mL)
2 small cookies
(11 ½ oz /
30-38 g total)
1 Grain Products
Water and
coffee/tea
Meatloaf
Water and coffee/tea

Thicken

1 cup/ 250 mL
Minced meatloaf
topped with
2 Tbsp/ 30 mL gravy
Serve gravy on
food, not on side
Serve gravy on
food, not on side

1 Meat and Alternatives
Baked potato
Green beans
Whole grain tray
bun
Milk/fortified soy
beverage
Minced potato salad
Minced green beans
Whole grain tray bun
(soft) with margarine
Milk/fortified soy
beverage








Puree tray bun
1 slice
( 2 x 4 x ½ inch
or
/5 x 10 x 1 ½ cm)
½ cup/ 125 mL
½ cup/ 125 mL
1 bun (1 oz/35 g)

Thicken

1 cup/ 250 mL
1 Milk and Alternatives
94
1 Vegetables and Fruit
1 Vegetables and Fruit
1 Grain Products
Sample Minced Menu Plan (Continued)
Meal


Vanilla pudding
Minced baked
apple with
cinnamon

Minced with
Pureed
Bread
Products

(smooth)
(smooth)

½ cup/ 125 mL
Water and
coffee/tea
Salmon salad
sandwich on whole
wheat bread
Water and
coffee/tea
Salmon salad
sandwich on whole
wheat bread

Thicken

1 cup/ 250 mL


Salmon salad
with biscuit
slurry
11 ½ oz/
3045 g salmon
1 slice bread
(1 oz/ 35 g)
Regular Menu
Item
Evening
Snack
Baked apple with
cinnamon
Minced
Menu Item
Minced with
No Mixed
Consistencies
Minced with
Thick Fluids
95
Portion Size
Number of Canada’s
Food Guide
Servings
1 medium
1 Vegetables and Fruit
1 Milk and Alternatives
½ Meat and Alternatives
1 Grain Products
Canada’s Food Guide
Food Groups
Vegetables and Fruit
Grain Products
Milk and Alternatives
Meat and Alternatives
Fluid
Number of servings
9
8½
4
3
9 ½ cups / 2375 mL
Provides the minimum number of servings from
each of the four food groups each day through
meals and snacks.
Provides a minimum of six cups of fluids daily,
and at least one cup at each meal and snack.
If a Minced diet is ordered along with additional texture modifications, more foods will need to be avoided or altered. For more details on
foods allowed for these diet modifications, see the corresponding section.
If ‘No Mixed Consistencies’ is ordered
 Do not add crackers to soup.
 See page 107 for more information.
If ‘Thick Fluids’ is ordered
 Follow the changes for ‘No Mixed Consistencies’.
 Provide juice, milk, hot beverages, and soup thickened to the ordered consistency (Nectar, Honey, or Pudding thick).
 Replace thin fluids (ice cream, sherbet, popsicles, or gelatin desserts) with thickened fluids.
 Serve gravies/sauces on the food, not on the side. As long as they do not pool on the plate, these do not need to be thickened.
 Smoothies or milkshakes can be offered if thickened to the appropriate consistency. Ice, ice cream, or sherbet should not be used, as these
ingredients will melt, causing the smoothie or milkshake to change consistency after serving.
 See page 103 for more information.
If ‘Pureed Bread Products’ are ordered
 Remove all regular texture bread products. Replace with pureed bread products or allowed grains.
 See page 109 for more information.
96
Pureed
Description
A Pureed diet may be needed for people who have trouble chewing or swallowing, or have a sore or dry
mouth. A Pureed diet must provide the daily recommended number of servings from each food group in
Canada’s Food Guide and should follow the Menu Planning Guidelines, on page 17.
Pureed foods are soft, moist, and smoothly blended. Foods have the look and texture of a pudding or
mousse and hold their shape when mounded on a spoon. There should be no lumps or visible particles.
Pureed foods should not be thin or runny. Liquids and solids should not separate.
Shown below are sample meals for a Pureed diet:
Pureed roast beef with
mashed potato and
carrot puree
Pureed roast beef with
mashed potato and
pureed peas
Foods Allowed/Not Allowed
Most foods can be altered to fit into a pureed diet, but some foods do not puree well and should be
avoided. These foods include:
 Vegetables and fruit with skin or seeds. For example, raspberries and blackberries.
 All forms of pineapple.
 Dried fruit such as coconut or raisins.
 Grain products and cereals with any hard particles. For example, multigrain bread with seeds,
granola, or dry rice.
 Crispy cheese toppings, deep fried crispy, or battered meats.
 Crunchy nut butters. Smooth nut butters can be included if mixed with other allowed foods. For
example, a peanut butter smoothie.
See the table on the next page for a list of foods allowed and not allowed on a Pureed diet.
97
Foods Allowed and Not Allowed on a Pureed Diet
Foods Allowed
Vegetables and Fruit
 All commercially prepared pureed vegetables
and fruit
 Pureed vegetables and fruits with strained
skins and small seeds (for example, green
beans, corn)
 Smooth mashed or whipped potatoes, other
pureed potato side dishes
 Applesauce or other fruit sauces
 Pureed ripe banana
Grain Products
 Pureed bread products (for example, bread,
bread stuffing, pancakes)
 Slurried bread products (for example, muffins,
waffles, crackers, pancakes)
 Smooth hot cereals
 Pureed pasta, rice, barley, or couscous
For more information and recipes on pureed and
slurried bread products, see page 109.
Milk and Alternatives
 Smooth yogurt, custard, or milk pudding
 Pureed rice pudding
 Melted or pureed cheese or cottage cheese
Meat and Alternatives
 Pureed
o moist meat, poultry, or fish
o sausages or wieners without the casing
o cooked eggs or egg substitutes
o soft cooked legumes or tofu
 Smooth nut butter mixed into allowed foods
(for example, peanut butter smoothie)
Mixed Dishes and Condiments
 Pureed mixed entrees made with allowed
ingredients
 Pureed soups
 Smooth gravies and sauces such as white
sauce or cheese sauce added to allowed foods
(maximum 2 Tbsp/ 30 mL per menu item)
Drinks
 All drinks
Foods Not Allowed
 Vegetables and fruit with membranes,
skin, hulls or seeds that do not puree well
(for example, raspberries, whole grapes)
 Raw vegetables and salads
 All forms of pineapple
 All fresh fruits except for pureed ripe
banana
 Dried fruit, even if pureed
 All regular texture bread products
 Grain products containing nuts, seeds,
chocolate chips, dried fruit, or any hard
food particles, even if pureed
 All hot cereals containing seeds, whole
flax seeds, or any hard food pieces (for
example, large flake oatmeal)
 All cold cereals
 Yogurt, custard, or milk pudding
containing any hard particles
 Crispy melted stringy cheese topping
 Breaded, battered, or fried meats, poultry,
or fish (even if pureed)
 Meat in casings (even if pureed)
 Fish containing bones (even if pureed)
 All nuts or seeds in any form
 Crunchy nut butters
 Smooth nut butters spread on foods
 All unblended soups
 Chunky sauces or condiments (for
example, jam, marmalade, relish)
 Any mixed consistencies
98
Steps for Preparing Pureed Food
1. Drain liquid from portions needing to be pureed, such as canned fruit. This will help avoid liquid
separation.
2. Weigh or measure the number of portions needed. If making more than 10 servings, add 1 extra
serving for every 10 servings. Some food can be lost in the preparation process.
3. Process foods fine and smooth in texture.
a. Puree small amounts of food using a mini chopper, food processor, or blender.
b. Use an institutional mixer or food processor for larger amounts of food.
4. Once food is pureed, add liquid until food looks smooth and moist, like a pudding or mousse.
a. Use hot liquids for hot foods and cold liquids for cold foods. This helps keep safe food
temperatures during preparation.
b. Do not use water. Instead use cooking liquids, gravy, milk, juice, melted margarine, or sauces to
enhance colour, flavour, and the nutrition content of the food.
c. Add liquid 1 Tbsp/ 15 mL at a time. This helps to avoid adding too much liquid which could result
in a runny food.
5. If the food is too thin, use a commercial thickener to thicken to the right consistency. Do not use bread
crumbs or flour.
6. The pureed food should be smooth without any lumps or stringy bits. There must be no visible
particles. Oatmeal is the only exception to this –it is consistent in texture and is appropriate on a
pureed diet.
Test consistency. Ensure that the solid pureed food is thick enough to spoon up a minimum of about
1 ½2 tsp /810 mL onto a teaspoon. Some liquids such as pureed soups may be thinner.
Commercial Products
Commercial pureed products are available through various suppliers. Use of these products can help
ensure consistency in products, nutrition and safety. Compare the nutrition facts table on these products to
choose one that meets the needs of residents. For further information on these products, please ask a
dietitian.
99
Taste and Appearance






Present a positive view of pureed foods to the resident. This will help the resident accept and eat
the food.
Offer a variety of colourful and appetizing foods.
Use garnishes that are the appropriate texture to add colour and appeal.
Avoid mixing pureed foods together. This can change the look and taste of the food, which can
decrease the resident’s intake and create a dislike for the food.
Taste the food before serving it to make sure it tastes good.
Serve meals at the right temperature (hot foods should be served hot, cold foods should be served
cold).
Snack Ideas





Muffin, pureed
Blended bread pudding
Soft cooked or canned fruit, pureed
Ripe banana, pureed
Smooth yogurt or pudding
Nutrition Tips



Residents on a pureed diet may eat less food and therefore not consume enough calories and
protein. This can lead to poor nutrition status. Snacks may need to be encouraged. Offer high
protein high calorie snacks.
High protein high calorie foods can also be provided to a resident based on needs. Refer to High
Protein High Calorie ideas on page 70 for more information.
Drinks such as water, coffee, and tea are important to provide enough fluids, but contain no
calories or nutrients. Offer high protein high calorie drinks as well. For example, homogenized
(3.25% M.F.) milk.
For more information, please see Appendix 2C, Nutrition and Menu Planning Resources for the handout
Pureed Diet.
100
Sample Pureed Menu Plan
Below is a one day Pureed menu that has been adapted from the Example of a Completed Regular Menu Plan on page 32. Changes made to
the Regular menu to fit the Pureed diet are shown in bold. If a Pureed diet is ordered along with Thick Fluids, more foods will need to be
avoided or altered, as shown below. A Pureed diet will automatically include both the texture modifications, Pureed Bread Products and No
Mixed Consistencies (as described on pages 107109). A  indicates no change from the Pureed menu item.
Breakfast
Meal
Regular Menu Item
Coffee/tea and water
100% apple juice
Bran cereal with raisins
Whole grain toast
Banana
Milk/fortified soy beverage
Peanut butter
Pureed Menu Item
Coffee/tea and water
100% apple juice
Oatmeal
Slurried French toast
(See page 111 for a recipe on how
to make a slurry)
Peanut Butter and Banana
Smoothie including:
Banana
Whole (Homo) 3.25% Milk or
fortified soy beverage
Smooth peanut butter
Pureed with Thick
Fluids
Thicken
Thicken


Thicken (Note: smoothies
should not contain any ice,
ice cream, or sherbet).
101
Portion Size
1 cup/ 250 mL
½ cup/ 125 mL
¾ cup/ 175 mL
2 slices
(1 oz/ 35 g each)
1 medium
1 cup/ 250 mL
1 package
(1 Tbsp/ 15 mL)
Number of Canada’s
Food Guide Servings
1 Vegetables and Fruit
1 Grain Products
2 Grain Products
1 Vegetables and Fruit
1 Milk and Alternatives
½ Meat and Alternatives
Sample Pureed Menu Plan (Continued)
Lunch
Meal
Water and coffee/tea
Water and coffee/tea
Pureed with Thick
Fluids
Thicken
Beef barley soup
Blended beef barley soup
Thicken as needed
1 cup/ 250 mL
Crackers, soda
Remove
Remove
-
Turkey sandwich wrap on
whole grain whole wheat
pita bread, with romaine
lettuce and tomato slices
Pureed turkey salad with
pureed whole grain whole
wheat bread (no lettuce or
tomato slices)
OR Pureed turkey with pureed
pasta
Pureed carrots, topped with
margarine
Pureed green peas

2-3 oz/ 60-90 g
lean turkey
breast
2 slices
(1 oz/35 g each)
1 Meat and Alternatives

½ cup/ 125 mL
1 Vegetables and Fruit

½ cup/ 125 mL
1 Vegetables and Fruit
Thicken
1 cup/ 250 mL
1 Milk and Alternatives
Grapes
Whole (Homo) 3.25% Milk or
fortified soy beverage
Apple sauce

½ cup/ 125 mL
1 Vegetables and Fruit
Water and coffee/tea
Water and coffee/tea
Thicken
1 cup/ 250 mL
Orange
Pureed canned mandarin
oranges
Blended bread pudding
Drain excess liquid
½ cup/ 125 mL
1 Vegetables and Fruit

½ cup/ 125 mL
1 Grain Products
Regular Menu Item
Carrot sticks
Tossed salad
Afternoon
Snack
Milk/fortified soy beverage
Oatmeal Cookie
Pureed Menu Item
102
Portion Size
1 cup/ 250 mL
Number of Canada’s
Food Guide Servings
½ Grain Products
2 Grain Products
Sample Pureed Menu Plan (Continued)
Supper
Meal
Water and coffee/tea
Water and coffee/tea
Pureed with Thick
Fluids
Thicken
Meatloaf
Pureed meatloaf, topped with 2
Tbsp/ 30 mL gravy
Serve gravy on food, not on
side
Baked potato
Smooth mashed potatoes,
topped with 2 Tbsp/ 30 mL
gravy
Pureed green beans, topped
with margarine
Pureed whole grain tray bun
Serve gravy on food, not on
side
Regular Menu Item
Portion Size
1 cup/ 250 mL
Number of Canada’s
Food Guide Servings
1 slice
(2 x 4 x ½ inch/
5 x 10 x 1 ½ cm)
½ cup/ 125 mL
1 Meat and Alternatives

½ cup/ 125 mL
1 Vegetables and Fruit

1 bun (1 oz/35 g)
1 Grain Products
Thicken
1 cup/ 250 mL
1 Milk and Alternatives

1 medium
1 Vegetables and Fruit
Vanilla pudding
Whole (Homo) 3.25% Milk or
fortified soy beverage
Pureed baked apple with
cinnamon
Vanilla pudding

½ cup/ 125 mL
1 Milk and Alternatives
Water and coffee/tea
Water and coffee/tea
Thicken
1 cup/ 250 mL
Salmon salad sandwich on
whole wheat bread
Pureed salmon with biscuit
slurry

1 – 1 ½ oz /
30-45 g salmon
1 biscuit
(1 oz / 35 g)
Green beans
Whole grain tray bun
Milk/fortified soy beverage
Baked apple with cinnamon
Evening
Snack
Pureed Menu Item
103
1 Vegetables and Fruit
½ Meat and Alternatives
1 Grain Products
Canada’s Food Guide
Food Groups
Vegetables and Fruit
Grain Products
Milk and Alternatives
Meat and Alternatives
Fluid
Number of servings
9
8½
4
3
9 ½ cups/ 2375 mL
Provides the minimum number of servings from
each of the four food groups each day through
meals and snacks.
Provides a minimum of six cups of fluids daily,
and at least one cup at each meal and snack.
Below is a further description on foods that will need to be avoided or altered for the menu above if Thick Fluids are ordered along with the
Pureed Diet. For more details on Foods Allowed and Not Allowed for this diet modification, see the corresponding section.
If ‘Thick Fluids’ is ordered





Provide juice, milk, hot beverages and soup thickened to the ordered consistency (Nectar, Honey or Pudding thick).
Replace thin fluids (ice cream, sherbet, popsicles, or gelatin desserts) with thickened fluids.
Serve gravies/sauces on the food, not on the side. As long as they do not pool on the plate, they do not need to be thickened.
Smoothies or milkshakes can be offered if thickened to the appropriate consistency. Ice, ice cream, or sherbet should not be used, as
these ingredients will melt, causing the smoothie or milkshake to change consistency after serving.
See page 113 for more information.
104
Cut/Diced
Description
A Cut/Diced diet is not meant for those with chewing or swallowing problems. A Regular diet or an Easy
to Chew diet can be modified to include Cut/Diced. The Cut/Diced diet must provide the daily
recommended number of servings from each food group in Canada’s Food Guide and follow the Menu
Planning Guidelines on page 17.
Foods on a Cut/Diced diet are bite-sized pieces or pieces that can be picked up easily to promote selffeeding. This is helpful for individuals who eat with one hand, or have trouble cutting food.
Shown below are sample meals for a Cut/Diced diet:
Diced turkey schnitzel
with mashed potato and
canned green beans
Chicken à la king with
mashed potato and
diced carrots
Diced chicken breast with
mashed potato and gravy
and green peas
Foods Allowed/Not Allowed
All foods are allowed on a Cut/Diced diet, as long as the food is in bite sized pieces and meets the primary
texture modification (Regular or Easy to Chew). See steps on the next page to prepare Cut/Diced foods.
For a list of snack ideas and a sample meal for Easy to Chew and Cut/Diced, refer to the Easy to Chew
diet section starting on page 74.
105
Tip for preparing Cut/Diced foods
Cut food into bite-sized pieces, or into finger foods that can easily be picked up.
 Fruit and vegetables should be peeled and sectioned, mashed, cut, or diced.
 Toast or bread should be cut in half.
 All meat, poultry, or fish, should be prepared in one of the following ways:
o cut/diced (for example, roast, Salisbury steak, hamburger patty, breaded meat,
poultry, or fish).
o fork tender (for example, minced meats such as meatballs or Shepherd’s pie).
o meats shaved to paper thin.
 Sandwiches, hamburgers, or hotdogs should be cut in halves or quarters.
Taste and Appearance




Offer a variety of colourful and appetizing foods.
Use garnishes to add colour and appeal.
Taste food before serving it to make sure it is acceptable.
Serve meals at the correct temperature (hot foods should be served hot, cold foods should be
served cold).
106
No Mixed Consistencies
Description
Some people may not be able to control liquid and solid foods in the mouth at the same time due to
chewing and/or swallowing problems. In these instances, mixed consistencies should be removed from the
diet. The No Mixed Consistencies diet must provide the daily recommended number of servings from
each food group in Canada’s Food Guide and should follow the Menu Planning Guidelines, on page 17.
“Mixed consistencies” are foods that have a thin fluid and a solid food in the same mouthful. Some
examples include cold cereal with milk, soup with pieces of vegetables, noodles or meat, and canned fruit
with juice. This also refers to foods that release liquid when chewed (for example, watermelon and cherry
tomatoes).
Frozen yogurt, ice cream, soy frozen desserts, sherbet, and popsicles containing hard particles such as
dried fruit, nuts, or granola become a thin fluid with solids once the frozen fluid has melted. These are
mixed consistencies and should be avoided with a no mixed consistency diet.
Examples of mixed consistencies and how they can be modified are shown below:
Mixed consistencies
Modify
Modified
Regular Soup
Blended Soup
Fruit Cocktail
Blended Fruit
107
Foods Allowed and Not Allowed on No Mixed Consistencies
Foods Allowed
Vegetables and Fruit
 Pureed stewed tomatoes, sliced
tomatoes
 Creamed corn
Grain Products
 Hot cereals
Foods Not Allowed






Milk and Alternatives
 Yogurt, milk pudding or custard
that is smooth or contains soft
fruit pieces
 Milk pudding including rice
pudding with or without raisins,
custard
Mixed Dishes and Condiments
 Pureed soups
 Less than 2 Tbsp/30 mL of gravy
pooling around meat
 Frozen yogurt, ice cream, soy
frozen desserts, sherbet, or
popsicles that are smooth
Drinks
Most drinks, except those listed
as not allowed

Whole, diced or mashed, stewed or baked
tomatoes, whole cherry tomatoes
Green or wax beans
All canned fruit, even if drained
Watermelon, oranges (navel, canned or fresh
mandarins) and grapes
Crackers, Melba toast, or rice cakes when added
to soup
All cold cereal when milk or other thin liquid is
added

Yogurt or sherbet containing dried fruit, nuts,
granola, seeds, or any other hard particles


All unblended soups
More than 2 Tbsp/30 mL of gravy pooling around
meat
Gelatin with fruit
Frozen yogurt, ice cream, soy frozen desserts,
sherbet, or popsicles that contain hard particles
such as dried fruit, nuts, or granola



Drinks with firm fruit chunks or ice cubes,
(for example, milkshakes with fruit)
Altering foods to remove Mixed Consistencies


Soup: Puree or strain soups so that no mixed consistencies remain. Do not serve with crackers.
Cereal: Serve hot cereal only. Do not serve any dry cereal.
Menu planning for texture modified diets with No Mixed Consistencies will depend on the primary
texture modification ordered, for example; a patient, who needs Dysphagia Soft and No Mixed
Consistencies modification, will have a much different menu than a patient needing Pureed and No Mixed
Consistencies modification. Refer to the primary texture modification ordered for a list of snack ideas and
a sample meal plan.
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Pureed Bread Products
Description
A change from regular bread products to pureed bread products may be needed for some people with
chewing and/or swallowing problems. When an individual is on a Pureed diet, Pureed Bread Products
should automatically be provided. However, Pureed Bread Products can also be given with other primary
texture modifications as needed. For example, Minced diet with Pureed Bread Products, or Dysphagia
Soft diet with Pureed Bread Products.
Pureed bread products are soft and moist, like all other pureed foods. Bread products must be smoothly
blended to a pudding or mousse consistency. Bread products include all breads, muffins, crackers,
sandwiches, pancakes, cookies, cakes, and bread pudding.
Examples of pureed bread products:
Pureed bread
Pureed waffle
Oatmeal
Foods Allowed and Not Allowed on Pureed Bread Products
Foods Allowed
Foods Not Allowed
Grain Products
 Pureed or slurried bread products (including
 All regular texture bread products
bagels, biscuits, bread, cakes, cookies,
 All grain products that contain chocolate
crackers, muffins, pancakes, pastry crust,
chips, nuts, seeds, dried fruit, or any hard
pita, buns, or any other bread product)
particles, even if pureed or slurried
 Smooth hot cereals
 Hot cereal with seeds; large flake oatmeal
 Rice, couscous, or barley in a sauce or
 All cold cereals
gravy.
 Dry, loose rice
 Minced or bite-sized pasta, cooked until
very soft, and served in a sauce or casserole
 Pureed sandwiches with allowed ingredients
Drinks
 All drinks allowed depending on the diet
texture and fluid order
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Steps for Preparing Pureed Bread Products
Pureed bread products can be made by either pureeing or by making a slurry.
Pureeing
To make a pureed bread product, use a hand blender with a chopper attachment, mini chopper, food
processor, or blender.
1. Take one serving of bread product and break into small pieces if needed.
2. Add 1 Tbsp/ 15 mL of liquid, such as milk, juice, syrup, broth, melted butter or margarine to puree the
food.
3. Blend together until smooth and moist like a pudding or mousse.
If the pureed food is too thick:
 Add extra liquid to your pureed food. Add 1 Tbsp/ 15 mL of liquid at a time.
 Puree food again to make bread product smooth and moist.
If the pureed food is too thin:
 Thicken using more of the food being pureed or add a commercial thickener.
 Puree food again. If pureed food is still too thin, repeat the steps above.
Slurries
Slurries can be used to soften bread or baked items to ensure the right texture for the pureed diet. The
finished product looks like the initial product, but feels like pudding in the mouth. A slurry is made using
liquid (juice or milk) and a commercial thickener.
Examples of slurries include; a bread slurry, a French toast, pancake or waffle slurry, a muffin slurry, a
cake/cookie slurry, or a brownie/bar slurry. Foods prepared as a slurry, should not contain; nuts, seeds,
dried fruit or coconut.
Directions and recipes for slurries can be found on the next page.
Commercial Pureed Products
Commercial pureed bread products are available through many suppliers. Using these products will help
ensure consistency in products, nutrition and safety.
Planning Menus with Pureed Bread Products
Menu planning for texture modified diets with pureed bread products will depend on the primary texture
modification ordered. For example, a resident on Dysphagia Soft with Pureed Bread Products will have a
different menu than a resident on Easy to Chew with Pureed Bread Products. Refer to the primary texture
modification for a list of snack ideas and a sample meal plan.
For more information, please see Appendix 2C, Nutrition and Menu Planning Resources for the handout
Pureed Bread Products.
110
Preparing Slurries
Below is a recipe for a Slurry Mix, followed by two recipes that show how to use the mix.
Slurry Mix:
Ingredients:
1 Tbsp
½ cup
Commercial thickener
1% Milk, heated
15 mL
125 mL
Directions:
1. Mix commercial thickener with hot milk and stir until smooth.
Makes 1 serving (½ cup/ 125 mL)
Nutrition information per serving: 66 calories, 1g fat (0.8 g saturated fat, 0 g trans fat),
63 mg sodium, 10 g carbohydrate, 4 g protein, 145 mg calcium.
Note: A higher fat milk (such as homogenized- 3.25% M.F.) or cream may be used for
individuals who require extra calories. Hot juice, water, or a nutrition supplement can also
be used. If another liquid is used it will change the nutrition content of the recipe.
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Slurry Cookies:
Ingredients:
¼ cup
2 each
Slurry mix (see above)
Digestive cookies
50 mL
2 each
Directions:
1. Place two digestive cookies in a dish.
2. Cover with slurry mix. Let stand until soft, and then serve.
Makes 1 serving (2 cookies)
Nutrition information per serving: 119 calories, 4 g fat, (1.7 g saturated fat,
0 g trans fat), 116 mg sodium, 17 g carbohydrate, 3 g protein, 73 mg calcium.
_________________________________________________________
Slurry Pancake:
Ingredients:
½ cup
1 each
Slurry mix (see above)
Pancake, frozen
125 mL
1 each
Directions:
1. Place pancake in a dish and add slurry mix. Spread evenly and cover. Put in the
refrigerator overnight to let the pancake absorb the slurry mix.
2. Warm in a microwave, oven, or toaster oven. Remove and serve.
Makes 1 serving (1 pancake)
Nutrition information per serving: 152 calories, 5 g fat (1.6 g saturated fat,
0 g trans fat), 230 mg sodium, 21 g carbohydrate, 6 g protein, 226 mg calcium.
112
Thick Fluids
Description
Thick fluids may be needed for people with swallowing difficulties, to safely manage taking fluids by
mouth. Thick fluids can be controlled in the mouth and swallowed more safely. This reduces the risk of
the fluid going down the wrong way, into the lungs.
A fluid is any liquid like water, juice, soup or milk. A fluid can also be a food that melts at body
temperature, such as gelatin or ice cream. The thickness of fluids can vary but most fluids are naturally
thin.
Below are examples of three different thick fluid levels:
Nectar Thick Fluids



Mildly thick
Pours like fruit nectar
Fluid runs freely off the spoon but leaves a thin coating on the spoon
Honey Thick Fluids



Moderately thick
Fluid slowly drips in dollops off the end of the spoon
Pours slowly, like liquid honey
Pudding Thick Fluids


Extremely thick
Fluid sits on the spoon, and does not flow off
Images used with permission from Nestlé HealthCare Nutrition.
Most people on Thick Fluids can also tolerate thicker fluid levels than ordered, but not thinner fluid levels.
For example, a person needing Honey Thick can usually tolerate both Honey, and Pudding Thick, but not
thinner fluids like Nectar Thick. Check with the residents’ health care provider to confirm their tolerance.
113
Foods Allowed and Not Allowed with Thick Fluids
Foods Not Allowed
(Unless Thickened)
Nectar Thick fluids
Thin fluids
 Au jus
 Some brands of tomato juice
 Broth
 Fruit nectar (such as prune nectar)
 Buttermilk
 Yogurt that is smooth or contains soft fruit pieces (for
 Coffee
example, plain or flavoured) at a Nectar Thick consistency
 Eggnog
 Pureed or strained soup thickened to Nectar Thick consistency
 Fruit juice
 Fluids thickened to Nectar consistency
 Gelatin desserts
 Gravy
Honey Thick fluids
 Ice
 Liquid honey
 Ice cream
 Yogurt that is smooth or with soft fruit pieces (for example,
 Liquid medications
plain or flavoured) at a Honey Thick consistency
 Milk
 Pureed or strained soup thickened to Honey Thick consistency  Milkshake
 Nutrition supplement drinks
 Fluids thickened to a Honey consistency
 Pop
Pudding Thick fluids
 Popsicles
 Pureed fruit at a Pudding thickness
 Sauces
 Smooth cooked cereal
 Sherbet
 Smooth custard or pudding
 Slushy drinks
 Yogurt that is smooth or contains soft fruit pieces (for
 Spirits, wine, alcohol
example, plain or flavoured) at a Pudding Thick consistency
 Soup
 Pureed foods that sit on the spoon
 Syrup
 Pureed or strained soup thickened to a Pudding Thick
 Table cream (10-36% M.F.)
consistency
 Tea
 Thin fluids thickened to a Pudding consistency
 Vegetable juice
(except some brands of
tomato)
 Water
Foods Allowed
114
Tips for Thickened Fluids



Smooth yogurt available in the grocery store may vary in thickness from nectar to pudding
depending on brand and type. Smooth yogurt consistency should not be changed by adding
thickener.
Small amounts of thin milk or cream (1 ½2 tsp/ 810 mL) and/or sugar can be added to already
thickened beverages such as coffee and tea without changing the consistency.
Gravies, sauces, and syrups do not need to be thickened if served in standard portions on top of the
food item (for example, on top of the mashed potatoes). If these items are “pooling” on the plate or
are served on the side, they will need to be thickened to the proper consistency.
Steps for Preparing Thickened Fluids
1. Portion the amount of fluid and sprinkle the required amount of powder or gel thickener on top and
mix briskly until dissolved. Always follow the directions on the commercial thickener container to
thicken the fluids correctly. Different fluids will need different amounts of thickener.
2. Wait 5 minutes to ensure the fluid is thickened to the right consistency. (Or longer, if specified by
the manufacturer).
3. Test the thickness to match the description.
Commercial Thickeners and Pre-Thickened Beverages


Commercial thickeners are products that can be added to a fluid to thicken it up to a desired and
safe consistency (Nectar, Honey, or Pudding). There are both powder and gel forms. These are
made from a starch or gel which acts as a thickening agent.
Pre-thickened beverages such as water, juice, milk, and coffee can be purchased from local
pharmacies or food suppliers. Using these products will help ensure consistency in products,
nutrition and safety.
Fluid Needs
Residents must be provided with at least 6 cups/ 1500 mL of fluid each day. Refer to the How to Plan a
Menu section of this toolkit for more information on meeting fluid needs.
For more information, please see Appendix 2C, Nutrition and Menu Planning Resources or the resource
Thick Fluids.
115
Education and Resources
It is important that food service staff are aware of the foods and fluids appropriate for various special diets
and how much to serve. The following tools may be useful:


The Texture Modified Diet poster in Appendix 3A and the Thick Fluids poster in Appendix 3B can
be used as a quick reference for production staff on appropriate food and fluid choices.
The Texture Modified and Thick Fluids Preparation Training programs can be found in
Appendix 3C.
A registered dietitian can provide staff with more education on special diets.
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Document
4.0 Right Diet
to the Right
Resident
itle Goes
Here
117
Computer Tip!
Click on each hyperlink
to take you to the website
for more information.
4.1 Overview
Written processes and clear communication are needed within food production, delivery and service.
Providing residents with the right food at meals and snacks is important to keep them safe and to help
meet their nutritional needs. Food service and other staff should be familiar with the dietary needs of
individual residents. A system should be in place to ensure the correct food and fluids are provided at each
meal. Policies and procedures related to food service should be developed and staff should be educated on
the processes.
Tips for Diet Process Flow8
Have a process in place for clearly communicating and identifying residents with special diets, food
allergies, intolerances or restrictions, and/or likes and dislikes.

Communicate all new requests or changes to a diet to nursing, food service and dining
room staff:
o A “Diet Request Form” completed by an assigned staff member can help outline special
dietary requirements for all diet types. A Sample Diet Request Form is available in
Appendix 4A.
o Any diet changes should be communicated using the diet request form. The assigned staff
member (see section 4.2 for staff assignments) should update the form and make sure all
areas, such as the kitchen, dining area and resident’s chart reflect the change.
o A similar process can also be used to update the “Food Allergies, Intolerances and
Restrictions Record” (see Appendix 1A).
o New requests or changes should follow the sites privacy policy.

Identify each resident following a special diet.
o This can be done using a dining room table card with the resident’s name and special diet
(see Appendix 4B, Colour Coded Special Diet Cards), diet binder/kardex, spreadsheet or
whiteboard. These can list a resident’s dietary needs such as special diet, food
allergies/intolerances, restrictions (for example, religious or cultural), and food
likes/dislikes.
o Use this system to cross check all diets to ensure residents are receiving the correct meals
and snacks daily. Keep this cross check system regularly updated and easily available for
staff to reference.
o Any process developed should meet the privacy policy requirements of the site.

Ensure meals and snacks are prepared and labeled to meet any special dietary requirements.
See Section 3.1, Menu Substitutions and Preparing Special Diets for more information.

Have a system to transport bulk meals to the dining room following food safety guidelines.
Check the temperature of the food to make sure it is appropriate (keep hot foods hot, and cold
foods cold). See Section 1.4 Food Safety for more information.
118

Plate meals for individual residents as appropriate and ensure the right meal goes to the
right resident.
o Use the correct size serving utensils to ensure standard portions when plating foods. Please
refer to the Standardized Portion Sizes section of the toolkit on page 36 for further
information.

Have processes in place for meal service and distribution.
o Ensure residents are in the dining area at the start of meal service so there are no delays.
o Make sure meals are served at the posted time.
o Everyone at the same table should be served at the same time.
o Have extra food and beverage servings available.
o Rotate the order of table-by-table service on a regular basis to allow each resident the
chance to be served first.
o Assign staff regular tables so they become familiar with the dietary needs and preferences
of individuals.
o Inform the residents of what they are being served.

Provide meal and snack assistance.
o Review seating patterns often to ensure
individuals are eating with suitable
tablemates.
o As appropriate, seat those requiring
assistance (such as help opening
packages or having foods cut up) at
tables together.
Tray Service: Tray service is where the complete meal is assembled on a tray ahead of time and brought
to the resident. If using tray service, meals need to be plated and labeled with the individual’s name and
special diet before bringing the meal to the individual in the dining room or their room.
119
4.2 Assigning Tasks for Diet Process
Flow for Meal Services
A variety of staff members may be involved in ensuring the process of providing the right diet to the right
resident flows smoothly. The Sample Diet Process Flow Chart on the next page, outlines food service
tasks to be completed and the suggested staff member(s) responsible. The chart provides space to list
individuals assigned to each task. The staff completing these tasks can vary from site to site, but all these
tasks should be clearly defined and assigned. Place the diet process flow chart where all staff can access it,
such as the site’s policies and procedures manual.
120
Sample Diet Process Flow for Meal Service
Task
Develop policies and procedures
related to food service and provide
education to staff on the processes.
Suggested Staff
Member
Food Service
Manager, Supervisor
Communicate all new requests or
changes to diet using a ‘diet request
form’. Update form with any changes,
ensuring the kitchen, dining area and
resident’s chart reflect changes.
Chef, Food Service Staff,
Case Manager, Nursing
Staff, Dietitian
Identify residents following special
diets using a dining room table card,
diet binder/kardex, spreadsheet, etc.
Use the system to cross check meals
and snacks when served.
Chef, Food Service Staff,
Nursing Staff
Prepare meals and appropriate special
diet items. Label special and/or texture
modified meal items for residents.
Chef, Food Service Staff
Transport meals in bulk to the dining
area. Check food temperatures to
ensure foods are in the safe
temperature zone.
Food Service Staff
Use the correct serving utensils to
plate appropriate meals with standard
portions for individual residents.
Food Service Staff
Distribute meals to residents. using
the cross check system to ensure the
right food goes to the right resident.
Food Service Staff,
Nursing Staff
Provide meal and snack assistance to
residents as required, (for example,
help open packages or cutting up
foods.
Food Service Staff,
Nursing Staff
121
Assigned Staff
Member
References
1
British Columbia Ministry of Health. Meals and more manual: a food and nutrition manual for homes of
adults and children with 24 or fewer persons in care. [Online]. 28 November 2008 [cited 2012 March 01].
Available from:/www.health.gov.bc.ca/library/publications/year/2008/Meals_and_More_Manual.pdf
2
Government of Alberta. Supportive living accommodation standards and checklist. [Online]. April 2010
[cited 2012 March 01]; Available from: http://www.health.alberta.ca/services/supportive-livinglicensing.html
3
Health Canada. Eating well with Canada’s food guide. [Online]. 2011 [cited 2012 March 01]. Available
from: www.hc-sc.gc.ca/fn-an/food-guide-aliment/index-eng.php
4
Health Canada. Safe food storage [Online]. 2013 [cited 2012 March 01]. Available from:
www.healthycanadians.gc.ca/eating-nutrition/safety-salubrite/storage-entreposage-eng.php
5
Health Canada. Food allergies. [Online]. Updated 2011 Feb 10 [cited 2011 Nov 21]. Available from:
http://www.hc-sc.gc.ca/fn-an/securit/allerg/fa-aa/index-eng.php
6
Health Canada. Food allergies and intolerances. [Online]. Updated 2010 Aug 26 [cited 2011 Nov 21].
Available from: http://www.hc-sc.gc.ca/fn-an/securit/allerg/index-eng.php
7
Dietitians of Canada. Find a dietitian. [Online]. 2012 [cited 2012 June 22]. Available from:
http://www.dietitians.ca/Find-a-Dietitian
8
Health Canada. Eating well with Canada’s food guide: a resource for educators and communicators.
[Online]. 2011 [cited 2012 March 01]. Available from: http://www.hc-sc.gc.ca/fn-an/alt_formats/hpfbdgpsa/pdf/pubs/res-educat-eng.pdf
9
Government of Alberta. Alberta nutrition guidelines for adults. [Online]. August 2012 [cited 2014 March
01]. Available from: http://www.health.alberta.ca/documents/Nutrition-Guidelines-AB-Adults.pdf
10
Health Canada. Food and nutrition: nutrient content claims and what they mean [Online.] 2012 [cited
2012 March 01]. Available from: http://healthycanadians.gc.ca/eating-nutrition/labeletiquetage/nutrient_claims-allegations_nutriment-eng.php
11
Canadian Celiac Association. In the kitchen. [Online] March 2012 [cited 2012 March] Available from:
[Online]: http://www.celiac.ca/?page_id=685
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