For the more than 10 million American adults who have trouble swallowing, the average 28,000-product supermarket might as well be a barren wasteland. The typical store stocks just three product lines geared specifically for people with dysphagia, as their condition is known, and they’re all ultra sweet liquid meal replacements: Ensure, Boost, and a generic equivalent. These $1.50-a-pop thickened beverages are often stocked less like food and more like toiletries, down near the contact lens fluid and the toothpaste.
Most of us hardly think about how food goes from mouth to gut, but it’s a complex process involving the teeth, the tongue, and dozens of muscles and nerves. If even one part of the system isn’t working properly, a lot can go wrong. (Food or drink can slide down the wrong pipe, into the lungs, for example.) Dysphagia is common in people with autism spectrum disorders, Down syndrome, Parkinson’s disease, dementia, and cleft palate, and it can be a problem for people who have multiple sclerosis, who are under going chemotherapy, or who’ve recently been on an IV feeding tube or a ventilator. Although some overcome dysphagia, others don’t. Many are staring down a lifetime of Ensure and Boost, hoping to maybe work their way up to applesauce. Flavors of the nutritional supplement drinks rarely venture outside those of the ice cream family, and none of the options fulfill most people’s nutritional needs.
“It’s like a silent problem,” says Reva Barewal. “We need to make a paradigm shift in how we approach nutrition for people with disabilities.” Baral is a prosthodontist, meaning she specializes in the restoration or replacement of teeth or other parts of the mouth. From birth, she suffered profound jaw problems that required years of brutal medical treatments and left her with chronic jaw pain. She’s spent much of the past six years trying to develop a wholly new kind of food for people who can’t eat the standard way. She started with experiments in her kitchen in Portland, Ore., took notes at conferences and support groups, then worked her products through safety studies and clinical trials.
Her efforts led to Dr. Reva’s Savorease, savory little crisps that are tough enough to scoop a dip but have been engineered to melt fully in the mouth, even without the assistance of teeth, normal tongue function, or saliva. They come in several flavors that sell online for $2 to $4 per bag of about 25 crisps through her company, Taste For Life LLC. Most of the initial sales have occurred during the pandemic.
Along with dentistry, Barewal has formal training as a French chef, and she used the tools of both trades to make her self-puréeing products as tasty as possible. Customers’ emailed reviews tend toward the effusive. “I want to thank you profusely for offering this creation to patients like me,” wrote a reviewer who identified herself as Karen from Georgia and said she normally subsists on purées and smoothies. “What a super product,” wrote a customer who gets most of her nutrition through a feeding tube.
Barewal says the science behind the crackers could also be used to make chewing-optional versions of tortilla chips, popcorn, or cinnamon toast. But before she can think about expanding her product line, she needs to raise Savorease’s profile and, most likely, a good deal more cash.
Born in Punjab state in India, Barewal grew up in Ottawa in the 1970s. Her mom was an economist with Canada’s agriculture department; her father was a government accountant who went on to work for the International Monetary Fund. When she was a child, one side of Barewal’s jaw didn’t develop properly, which doctors guessed was caused by forceps damage at birth. By age 7, the consequences were pronounced. On her right side, she had a walnut-size space between her upper and lower teeth, and her tongue spilled through the gap. Her parents found a specialist at the University of California at San Francisco, and visits to him began to take the place of family vacations.
The treatment Barewal endured as a child sounds downright medieval. The specialist fitted her with a series of appliances called Bionators to stretch the jaw and stimulate growth. She spent a decade in braces and headgear, including an upper and lower retainer that trapped her tongue in a bulb, preventing her from talking. At age 16, a surgery that shaved the jawbone on the other side to give her a more symmetrical appearance left her in a full facial cast, breathing through a straw for days. “I was a brown girl in a very White city who was disfigured and undergoing massive amounts of therapy in the ’70s,” she says. “It was a hard start.”
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