Why a dysphagia diet is needed

When you have dysphagia, you are at risk for aspiration. Aspiration is when food or liquid enters the windpipe and/or lungs. It can cause pneumonia and other problems. The foods you eat and liquids you drink can affect your ability to swallow safely. For example, soft foods are easier to swallow than hard foods. Thickened liquids may be needed for safe liquid intake. A dysphagia diet can help prevent aspiration. You may be at risk for aspiration from dysphagia if you have any of these health conditions:

• Stroke

• Severe dental problems

• Conditions that lead to less saliva (dry mouth), 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 head and neck cancer

You may need to follow a dysphagia diet for only a short time. Or you may be on it for a while. It depends on what is causing your dysphagia and how serious it is. A speech-language pathologist (SLP) assesses a person with dysphagia. The SLP will determine your risk for aspiration and recommend the best food and drink choices for you.

Levels of a dysphagia diet

The Academy of Nutrition and Dietetics has created a diet plan for people with dysphagia. The plan is called the National Dysphagia Diet. The dysphagia diet has 3 levels of foods. The levels are:

• Level 1 - Pureed. These are foods that are pureed or smooth, like pudding. They need no chewing. This includes foods such as yogurt, mashed potatoes with gravy to moisten it, smooth soups, and pureed vegetables and meats.
• Level 2 - Mechanical Soft. These are moist foods that need some chewing. They include soft, cooked, or mashed fruits or vegetables, soft or ground meats moist with gravy, cottage cheese, peanut butter, and soft scrambled eggs. You should avoid crackers, nuts, and other dry foods.
• Level 3 - Soft. This includes soft-solid foods that need more chewing. This includes meat, fruit, and vegetables that are easy to cut or mash. You should avoid crunchy, sticky, or very dry foods. This includes nuts, crackers, chips, and other snack foods.

You will also need to be careful about the liquids you drink. Talk with your SLP about the liquids that are allowed on your dysphagia diet. Here is more information on managing liquids in a dysphagia diet.

• All level liquids. The person is safe with drinking all types of liquids, both thin and thicker liquids. 
• Nectar thick liquids. These liquids are easily pourable and comparable to thicker tomato juice and fruit nectars, thicker creamed soups, and the heavy syrup found in canned fruit.
• Honey thick liquids. These liquids are similar in thickness to honey or a milkshake. They pour more slowly than nectar thick liquids.
• Pudding thick liquids. These items are similar to pudding or a mousse consistency. They do not flow but instead hold their shape. They are difficult to drink from a cup; easiest to take using a spoon.

Preparing food and liquids

Your SLP will give you instructions about the safest foods and liquids for you and how to prepare them. You may need to not eat certain foods, or make changes to some foods. For example, you may need to puree your food. Make sure to taste and season your food before pureeing it. It will be easier to adjust to a new diet if your food smells and tastes appealing.

You may also need to make liquids thicker. You can manage your liquids by making thin liquids thicker. This is done by adding a flavorless gel, gum, powder, or other liquid to it. These are called thickeners. You can also buy pre-thickened liquids. Talk with your SLP if you have any questions about managing your liquids with thickener products. 

While you eat

While eating or drinking, it may help to sit upright, with your back straight. You may need support pillows to get into the best position. It may also help to have few distractions while eating or drinking. Changing between solid food and liquids may also help your swallowing. Stay upright for at least 30 minutes after eating. Follow the instructions on your swallowing guidelines sheet. This can help reduce the risk for aspiration.

Watch for symptoms of aspiration such as:

• Coughing or wheezing during or right after eating

• Excess saliva

• Shortness of breath or fatigue while eating

• A wet-sounding voice during or after eating or drinking

• Fever 30 to 60 minutes after eating

After you eat

After meals, it’s important to do proper oral care. The SLP can give you instructions for your teeth or dentures. Make sure to not swallow any water during your oral care routine if thin liquids are unsafe for you to consume.

Checking your health

Your healthcare team will keep track of how well you are swallowing. You may need follow-up tests such as a fiberoptic endoscopic evaluation of swallowing (FEES) test or a videofluoroscopic swallowing study (VFSS). If your swallowing gets better or worse, your SLP may change your dysphagia diet over time. In time, you may be able to eat and drink foods and liquids of all kinds.

Getting enough liquids

While on a dysphagia diet, you may have trouble taking in enough fluid. This can cause dehydration, which can lead to serious health problems. Talk with your healthcare team about how you can help prevent this. In some cases drinking thicker liquids may make some of your medicines work less well. Because of this, you may need some of your medicines changed for a while.

While you are on a dysphagia diet

• Follow all instructions about what food and drink you can have.

• Do swallowing exercises as advised.

• Don't change your food or liquids on your own, even if your swallowing seems better. Talk with your SLP and health care provider first.

• Crush medicines and mix them with food as needed.

• Tell all healthcare providers and caregivers that you are on a dysphagia diet. Explain which foods and liquids you can and cannot have.

Call 911

Call 911 or have someone else call if you have trouble breathing because of food blocking your airway.

When to call your healthcare provider

Call your healthcare provider right away if you have any of these:

• Trouble swallowing that gets worse

• Unplanned weight loss

• Chewed food coming back up into the mouth

• Vomiting