Dysphagia Diets. Dysphagia is difficulty in swallowing. Problems at any point during the swallow (from chewing food and moving it into the back of the mouth, to moving the food into the stomach) can result in difficulty in swallowing.
When you have dysphagia, you are at risk for aspiration. Aspiration is when food or liquid enters the lungs by accident.
It can cause pneumonia and other problems. The foods you eat can affect your ability to swallow.
For example, soft foods are easier to swallow than hard foods. A dysphagia diet can help prevent aspiration. You may be at risk for aspiration from dysphagia if you have any of these health conditions:
- Severe dental problems
- Conditions that lead to less saliva, such as Sjogren syndrome
- Mouth sores
- Parkinson disease or other nervous system conditions
- Muscular dystrophies
- Blockage in the esophagus, such as a growth from cancer
- History of radiation therapy or surgery for throat cancer
The first step in treatment is to make the proper diagnosis. This involves a medical history and various tests to find the cause of the dysphagia.
Often a team approach to treatment is needed. Several types of health care providers such as physicians, registered dietitian, psychologist, speech pathologist, occupational therapist – work together to develop the best program.
An important part of the treatment is helping the patient get adequate nutrition, while protecting against complications such as pneumonia from food or liquid getting into the lungs.
Obviously, this requires a specialized diet. There are five different diet levels from puréed (level 1) up through modified regular food (level 5).
The diets vary in texture and consistency, and are chosen depending on which would be most effective for a specific patient.
Level 1: Dysphagia Pureed Diet
This diet uses pureed, homogenous, cohesive, pudding like consistency foods. No coarse textures, raw fruits or vegetable, nuts and such are allowed. Any food that needs mastication and bolus formation are avoided.
Indication for Use:
- Designed for people who have moderate to severe dysphagia
- Those with poor phase abilities
- Reduced ability to protect their airways
- Thick, homogeneous textures
- Spoon-thick or Pudding thick pureed foods
- No coarse textures such as nuts and raw vegetables or fruits
- Liquids are thickened to recommended consistency using a commercial thickening agent.
Recommended: Beverages may be thickened to appropriate consistency. If thin liquids – milk, juices, coffee, tea, alcoholic beverages, sodas, nutritional supplement, ice chips.
Avoided: All beverages with lumps, chunks, seeds, pulp, etc.
Recommended: Pureed bread mixes, pre-gelled slurried bread, pancakes, sweet rolls
Avoided: Crackers, biscuits, pancakes with fruit and/or choco chips, muffins
Recommended: Those that have pudding like consistency
Avoided: Oatmeal, all dry cereals and any cooked cereals with lumps, chunks etc.
Recommended: Smooth puddings, custard, yogurt, pureed desserts and soufflés, smooth jellies, truffles. If thin liquid – frozen malts, milk shakes, eggnog, sherbet, fats.
Avoided: Ices, gelatin, frozen juice bars, cookies, cakes, pies, pastries, rice pudding, chunky sauces and gravies. Thin liquid restricted – frozen yogurt, eggnog, ice cream, nutritional supplements, sherbet, gelatin, or any foods that become thin liquid at either body or room temperature.
Meat and meat substitutes
Recommended: Pureed meats, softened tofu
Avoided: Whole or ground meats, fish, or poultry, non pureed lentils or legumes, cheeses, non pureed fried, scrambled or hard cooked eggs, peanut butter unless pureed.
Recommended: Pureed fruits or well mashed bananas, fruit juices without pulp, seeds or chunks.
Avoided: Whole fruits (fresh, frozen, canned, dried)
Recommended: All without seeds, chunks, lump and pulps and all must be pureed
Avoided: All other vegetables that have not been pureed, tomato sauces with seeds, thin tomato juice
Recommended: Butter, margarine, strained gravy, sour cream, mayonnaise, cream cheese, whipped topping. Smooth sauces, cheese sauce or hollandaise sauce
Avoided: All fats with coarse or chunky additives.
Food Groups: Miscellaneous
Recommended: Sugar, artificial sweetener, fine salt, fine pepper, and finely ground spices, ketchup, mustard, BBQ sauce, and other smooth sauces, honey.
Avoided: Coarsely ground pepper and herbs and spices, chunky fruit preserve, and seedy jams. Seeds, nuts, sticky food, chewy candies such as caramels or licorice.
Level 2: Dysphagia Mechanically Altered
Food is cohesive, moist, semi-solid diet which requires some chewing ability. It includes moist, ground, soft textured, minced or can be mashed easily, simple to chew foods that are included in a transition from puree texture to mechanical soft texture.
The food forms easily into a cohesive bolus. These guidelines are intended for use with adults. All foods from dysphargia pureed diet are acceptable.
Indication for Use
- Transition from pureed textures to more solid textures
- Appropriate for individuals with mild to moderate oral and/or pharyngeal dysphargia
- Patients who can tolerate little chewing ability
Beverages / Milk
Allowed: Liquids must be the thickness as recommended by the doctor (thin, nectar, honey, pudding)
Avoided: As advised by the physician
Meats and Meat Substitute
Allowed: Moist ground or finely diced meats, meatloaf hamburger or cheeseburger, no bun, sausage patty, chicken, egg or tuna salad, shredded cheese, cheese slices, cottage cheese, well-cooked, slightly mashed, moist legumes, Eggs cooked and style
Avoided: Whole pieces of meat, dry or tough meats, hotdog, bacon, sausage links, peanut butter, cubed cheese crisp fried egg
Starches, Breads and Cereal
Allowed: All hot cereals, Cold flaked cereal such as cornflakes, rice crispies, pancakes-well moistened with syrup, Macaroni and Cheese, pasta
Avoided: Bread or bread products; sandwiches on a bun; dinner rolls; pizza; rice; French toast; fried food; granola; cold cereal; cold cereal with granola, nuts or raisins
Allowed: Soft canned fruit without seeds/skin; ripe bananas; applesauce
Avoid: Raw fruit, grapes, pineapple, raisins
Allowed: Soft cooked vegetables, fork tender
Avoided: Raw vegetables, corn; peas; salads; fibrous, non-tender or rubbery cooked vegetables
Allowed: All cream based soups; broth based soups; chilli
Avoided: As advised
Allowed: Pudding, Ice cream, gelatin, cheese cake, no crust, custard, yogurt
Avoided: Cakes, cookies, pies, hard candy, chewing gum, chewy desserts
Allowed: Margarine, butter, sugar, nuts, seeds, olives, pickles, honey, syrup, jelly, sour cream, cream cheese, gravy, mustard, ketchup, mayonnaise, steak sauce, BBQ sauce, herbs, spices
Avoided: Nuts, seeds, olives, pickles, popcorn, chips
Level 3: Dysphagia Advanced Diet
The foods are nearly in regular textures but still, need to be moist and should be in bite size pieces at the oral phase of the swallow. Food that are very hard, sticky or crunchy must still be avoided.
Indication for Use
- Transition to regular diet
- Patients that can tolerate adequate mastication and dentition
- Appropriate with mild oral and pharyngeal phase dysphagia
- Mixed textures are tolerated in this diet
Starches, breads, cereals
Allowed: All cooked potatoes, pasta, rice, moistened bread with adequate syrup, jelly, margarine, butter to moisten well and tender fried potatoes.
Avoided: Potato skins, cooked corn, tough, crisp fried potatoes, dry bread, toast, crakers
Allowed: All soups except those on the avoid list. Strained corn or clam chowder. (If you require thicker liquids, thicken as needed)
Avoided: Soups with tough meats, corn or clam chowder, soups that have large chunks of meat or vegetables greater than 1 inch.
Allowed: All cooked, tender vegetables, Shredded lettuce
Avoided: All raw vegetables except shredded lettuce, non tender or rubbery cooked vegetables, cooked corn.
Allowed: All canned and cooked fruits, soft, peeled fresh fruits such as banana, watermelon (without seeds), soft berries with small seeds such as strawberries, Fruit juices if thin liquids are allowed.
Avoided: Crunchy, crispy fresh fruits like apples or pears, fruits with hard skins like grapes, stringy fruits like pineapple, papaya, or mango, uncooked dried fruits such as prunes and apricots, dried fruits.
Meat and Meat substitutes
Allowed: Thin sliced, tender, or ground meats and poultry, well moistened fish, eggs prepared any way, casseroles with small chunks of moistened, ground and cooked tender meats.
Avoided: Tough, dry meats and poultry, dry fish or fish with bones, chunky peanut butter.
Milk and yogurt
Allowed: Milk and milkshakes, yogurt without nuts or coconut.
Avoided: Yogurt with nuts or coconut or granola
Allowed: All other fats except those listed in the avoid list
Avoided: All fats with course, difficult to chew or chunky additives such as cream cheese spread with nuts or pineapple.
Allowed: All other except those on the avoid list. Non chewy candies without nuts, seeds or coconut.
Avoided: Dry cakes, cookies that are chewy or very dry. Anything with nuts, seeds, dry fruits, coconuts, pineapple. chewy caramel or taffy type candies.
Allowed: Any seasonings and sweeteners, jellies, honey, preserves, sauces.
Avoided: Whole pieces of hard herbs unless removed prior to eating.