8 Things to Consider for a Dysphagia Diet
Dysphagia, or difficulty swallowing, is a disorder that may be caused by stroke, neurological disease, dementia, or other factors. It poses the danger of aspiration and choking, while also increasing the likelihood of dehydration and malnutrition over time.1
Obviously, a dysphagia diagnosis can seem intimidating, but taking steps to maintain adequate nutrition and hydration levels are important factors in minimizing the negative effects of a swallowing disorder. Here are some commonly asked questions about dysphagia diets.
1. What are common signs of dysphagia?
A number of signs may suggest a person is experiencing a problem with dysphagia, including:
- Oral leaking or drooling
- Choking or gagging
- Pocketing food (capturing it in the cheeks)
- Taking longer than 10 seconds to swallow
- Weakness, poor motivation
- Poor chewing ability, which may lead to choking on food 2
2. What is a dysphagia diet?
A dysphagia diet is one that features different textures of foods and liquids. It is used with people who have problems with chewing and swallowing. 3
3. What is the purpose of a dysphagia diet?
A dysphagia diet is used for people with swallowing problems because it:
- Makes it easier to chew and move food in the mouth.
- Reduces the risk of food going into the windpipe or trachea, which leads to the lungs.4
4. What is the National Dysphagia Diet?
While there is no universal diet for clients with dysphagia, the National Dysphagia Diet (NDD), is now considered by many dietary, nutritional and medical experts to be the general national standard. It is important to remember, however, that every dysphagia patient is different and has his or her own specific challenges that will need to be addressed. The NDD categorizes food and liquid levels by level of swallowing difficulty.5
5. What are the food levels of the National Dysphagia Diet?
The National Dysphagia Diets have three levels. The level of diet a person follows depends on the severity of their dysphagia.
National Dysphagia Diet Level 1
- This level is for people with moderate to severe swallowing difficulty and have a poor ability to protect their airway.
- This diet allows pureed food (pudding like consistency) that is smooth and easily stays together.
- Foods should be avoided if they require chewing. Coarse and dry textures, raw fruits and vegetables, and breads and nuts should also be avoided.
- It may be difficult to meet calorie and nutrition needs on this diet. It is important to use high calorie, nutrient dense food such as cheese sauce, gravy and whole or buttermilk in this diet. Eating more frequently through the day can also help increase caloric intake.6
National Dysphagia Diet Level 2
- The Level 2 diet is for people with mild to moderate swallowing difficulty. Some chewing ability is required.
- This diet consists of foods that are moist, soft and easily formed into a bolus (soft wad of food). Avoid foods that are difficult to chew, dry and coarse.
- Meats should be ground or minced and should be keep moist with sauces and gravies.7
National Dysphagia Diet Level 3
- This diet for individuals with mild swallowing problems.
- This diet consists of all foods, except very hard, sticky or crunchy foods. Foods should be moist and should be cut up into bite size pieces.8
6. What are the liquid levels of the National Dysphagia Diet?
National Dysphagia Diet Levels for liquids include:
Thin liquids include clear liquids, milk, commercial nutritional supplements, water, tea, coffee, soda, beer, wine, broth, and clear juice. Individuals tolerating thin liquids will also be able to tolerate foods containing thin liquids, such as watermelon, grapefruit or oranges. Foods like ice cream, frozen yogurt, or plain gelatin which turn to liquid in the mouth are also considered thin liquids.9
Medium thickness liquids include nectars, vegetable juices, and handmade milkshakes made with thickeners. Thin liquids can be thickened with commercial thickeners to nectar-like thickness or purchased pre-thickened in nectar-like consistency.10
Honey-like liquids are thicker than the nectar-like level and resemble the consistency of honey at room temperature. Commercial thickeners can be added using package instructions to bring any liquids to this level of thickness or purchased commercially pre-thickened in honey-like consistency.11
This includes high viscosity liquids too thick for a straw. Commercial thickeners can be added to any beverage to obtain this level of thickness.12
7. How can dysphagia patients ensure they are getting enough nutrition?
When following a dysphagia diet, it is important for patients to:
- Eat from a variety of food groups for proper nutritional needs.
- Be creative – many foods can be put in a blender to provide a nutritious meal.
- Eat small, frequent meals, especially if they are not able to eat large meals.
- Serve both hot and cold foods to provide a variety of temperatures in their diet and to avoid food contamination.13
8. Who can dysphagia patients turn to for expert medical and nutritional advice?
Speech-Language Pathologist (SLP) may have more ways to help dysphagia patients with swallowing. A Registered Dietitian (RD) can also answer questions or concerns about this diet.14
By having a better understanding of the applications and benefits of a dysphagia diet, dysphagia patients and their loved ones can approach meal time with less apprehension, while also ensuring that they safely receive the nutrition they need for the healthiest possible outcomes. A complete listing of Thick-It® dysphagia nutrition solutions is available for review.
- Carlene Russell, MS, RD, LD, FADA, “Dining With Dysphagia,” The Master Track Series, Dietary Managers Association, 2003.
- Frank W. Jackson, M.D., “5 Levels for Difficulty In Swallowing Diet”, Dysphagia Diet, 2010.
- Grossbauer, Sue, “Medical Nutrition Therapy for Dietary Managers”, 2014, www.dmaonline.org.
- Black, Melissa, “Dysphagia Diet: By following the correct diet it is possible for people with dysphagia to meet their nutritional needs.” https://suite.io/melissa-black/20f02sc,2013.
- ASHA Special Interest Division 13, Swallowing and Swallowing Disorders (Dysphagia). (1997). Graduate curriculum on swallowing and swallowing disorders (adult and pediatric dysphagia). ASHA Desk Reference, 3, 248a–248n.
- American Speech-Language-Hearing Association. (1992). Position statement and guidelines for instrumental diagnostic procedures for swallowing. Asha, 34(Suppl. 7), 25–33
- Disease and conditions: Dysphagia. 2009, Mayo Clinic Staff
- American Speech-Language-Hearing Association. (2001b). Knowledge and skills for speech-language pathologists providing services to individuals with swallowing and feeding disorders in press. In Rockville, MD: Author.