DYSPHAGIA 5 LEVELS
Dysphagia Level 1 Diet
(dysphagia pureed)
Sometimes patients who have trouble chewing and/or swallowing whole foods need a special diet. The National Dysphagia Diet, published in 2002, developed universal terminology for texture-modified diets. The dysphagia pureed diet (level 1) is one of three levels of texture modification that is used.
Who orders a dysphagia pureed diet?
Normally a speech therapist will recommend a dysphagia pureed diet after evaluating a patient who has problems chewing or swallowing food. In some cases, medical tests are used to determine the best texture for a patient.
What types of foods are allowed on this diet?
All foods are totally pureed to a pudding-like consistency. No coarse textures, raw fruits or vegetables, or nuts are allowed. It is important to include a variety of foods from all different food groups when providing a pureed diet, including fruits, vegetables, grains, meats and meat substitutes, and dairy foods.
Does pureed food taste bland?
Unless you have another dietary restriction, you should receive food that is flavored and seasoned like the food on a regular consistency diet.
Are regular liquids allowed on a dysphagia pureed diet?
Possibly. Regular liquids are OK for some patients. However, depending on your condition, you might need to have thickened liquids, so you can swallow them safely
Talk to your speech and language pathologist to learn more.
What is a slurry?
A slurry is a soft, moist mixture often used for people with swallowing problems. An example is a slice of bread or a pancake moistened with milk. The moisture of the liquid makes it easier for someone with swallowing problems to swallow soft bread products.
Food Textures for Dysphagia Pureed Diet
(dysphagia level 1)
Food Groups | Foods Allowed | Foods to Avoid |
Meats and meat substitutes | • · Pureed meats (pureed to pudding-like consistency) •· Smooth soufflés •· Soft, moist tofu •· Hummus •· Whole, ground, or chopped meats, fish, or poultry •· Legumes or lentils, unless pureed •· Cheese and cottage cheese, unless pureed •· Eggs that are not pureed •· Nut butters, unless pureed into other foods to correct consistency | |
Breads | • · Pureed bread mixes •· Pregelled slurried breads, pancakes, French toast, waffles, sweet rolls, etc | • · All other bread, rolls, crackers, biscuits, pancakes, French toast, muffins, etc |
Cereals | • · Smooth cooked cereals, such as farina-type cereals with a pudding-like consistency | • · Dry cereals and cooked cereals with lumps, seeds, or chunks •· Oatmeal |
Fruits | • · Pureed fruit •· Well-mashed fresh bananas | • · Whole fruits (fresh, frozen, canned, or dried) |
Vegetables | • · Pureed vegetables without lumps, pulp, or seeds •· Tomato sauce without seeds | • · All other vegetables that are not pureed |
Potatoes and starches | • · Mashed potatoes and pureed potatoes with gravy, butter, margarine, or sour cream •· Well-cooked pasta, noodles, or pureed rice (blended to a smooth consistency) | • · All other potatoes, rice, and noodles •· Plain mashed potatoes •· Cooked grains |
Desserts | • · Smooth pudding custards, yogurt, pureed desserts, and soufflés •· All other desserts •· If patient is on thickened liquids, restrict ice cream, ices, milk shakes, frozen yogurt, gelatin, and other frozen desserts, because they are thin-liquid consistency at room temperature | |
Beverages | • · Any smooth, homogenous beverage without lumps, chunks, or pulp (may need to thicken to proper consistency) |
References and recommended readings
American Dietetic Association. Level 1 pureed diet: patient handout. In: Nutrition Care Manual®. Available to subscribers at: www.nutritioncaremanual.org. Accessed January 10, 2011.
National Dysphagia Diet Task Force. National Dysphagia Diet: Standardization for Optimal Care. Chicago, IL: The American Dietetic Association; 2002.
Dysphagia Level 2 Diet
(mechanically altered)
Sometimes patients who have trouble chewing and/or swallowing whole foods need a special diet. The National Dysphagia Diet, published in 2002, developed universal terminology for texture-modified diets. The dysphagia mechanically altered diet (level 2) is one of three levels of texture modification that is used.
Who orders a dysphagia diet?
Normally a speech and language pathologist will recommend a dysphagia mechanically altered diet after evaluating a patient who has problems chewing or swallowing food. In some cases, medical tests are used to determine the best texture for a patient.
What types of foods are allowed on this diet?
Patients on a dysphagia level 2 diet can tolerate some textures of foods, but not all. The diet includes foods that are soft textured and moist, making them easy to swallow. Soft, well-cooked foods, well-moistened ground meats, moist and well-cooked potatoes, noodles, and dumplings are examples of foods that are the proper texture for this diet. All foods of a pureed consistency are allowed on this diet.
It is important to include a variety of foods from all different food groups when providing a mechanically altered diet, including fruits, vegetables, grains, meats and meat substitutes, and dairy foods.
Are regular liquids allowed on a mechanically altered diet?
Possibly. For some patients, regular liquids are OK. However, depending on your condition, you might need to have thickened liquids, so you can swallow them safely. Talk to your speech and language pathologist to learn more.
What is a slurry?
A slurry is a soft, moist mixture often used for people with swallowing problems. An example is a slice of bread or a pancake moistened with milk. The moisture of the liquid makes it easier for someone with swallowing problems to swallow soft bread products.
Food Textures for Dysphagia Mechanically Altered Diet
(dysphagia level 2 diet)
Food Groups | Foods Allowed | Foods to Avoid |
Meats and meat substitutes | • Moistened ground or cooked meat, poultry, or fish (serve with sauces) •Casseroles without rice •Moist, well-cooked pasta •Moist meat loaf or meatballs •Poached, scrambled, or soft-cooked eggs •Tofu •Well-cooked and moist mashed legumes or beans | • Dry meats, such as bacon, sausage, or hot dogs •Dry casseroles or casseroles with rice or large chunks •Cheese cubes and slices •Peanut butter •Hard-cooked or crisp fried eggs •Sandwiches and pizza |
Breads | • Soft, well-moistened pancakes •Pureed bread mixes or slurried breads | • Slices of bread •Toast |
Cereals | • Cooked cereals with little texture, including oatmeal •Slightly moistened, dry cereals with little texture | • Coarse cooked cereals •Whole-grain or coarse dry cereals |
Fruits | • Soft and drained canned or cooked fruits without seeds or skin •Ripe bananas | • Fresh or frozen fruits •Cooked fruit with skin or seeds |
Vegetables | • All soft, well-cooked vegetables that are in small pieces and mashable with a fork •Cooked corn and peas •Brussels sprouts, broccoli, cabbage, asparagus, or other rubbery cooked vegetables | |
Potatoes and starches | • Well-cooked and moistened boiled, baked, shredded, or mashed potatoes •Well-cooked pasta noodles in sauce | • Potato skins and chips •Fried potatoes •Rice |
Desserts | • Puddings and custards •Soft fruit pies (bottom crust only) •Crisps and cobblers with soft topping and no seeds •Most canned fruits •Soft moist cakes with icing or slurried cakes | • Dry, coarse cakes and cookies •Desserts with nuts, seeds, coconut, pineapple, or dried fruit •Rice or bread pudding |
Beverages | • All beverages with little texture or pulp |
References and recommended readings
American Dietetic Association. Level 2 dysphagia diet (dysphagia mechanically altered): patient handout. In: Nutrition Care Manual®. Available to subscribers at: www.nutritioncaremanual.org. Accessed January 10, 2011.
National Dysphagia Diet Task Force. National Dysphagia Diet: Standardization for Optimal Care. Chicago IL: The American Dietetic Association; 2002.
Dysphagia Level 3 Diet
(dysphagia advanced)
Sometimes patients who have trouble chewing and/or swallowing whole foods need a special diet. The National Dysphagia Diet, published in 2002, developed universal terminology for texture-modified diets. The dysphagia advanced diet (level 3) is one of three levels of texture modification that is used.
Who orders a dysphagia advanced diet?
Normally a speech and language pathologist will recommend a dysphagia advanced diet after evaluating a patient who has problems chewing or swallowing food. In some cases, medical tests are used to determine the best texture for a patient.
What types of foods are allowed on this diet?
Foods that are nearly normal textures are allowed on the dysphagia advanced diet, with the exception of crunchy, sticky, or very hard foods. The diet includes bite-sized foods that are moist. Foods that are allowed on dysphagia level 1 and level 2 diets also are allowed on the dysphagia advanced diet.
It is important to include a variety of foods from all different food groups when providing a dysphagia advanced diet, including fruits, vegetables, grains, meats and meat substitutes, and dairy foods. The following table provides specific information about foods that are allowed on the dysphagia level 3 diet.
Food Textures for Dysphagia Advanced Diet
(dysphagia level 3)
Food Groups | Foods Allowed | Foods to Avoid |
Meat and meat substitutes | • Thin-sliced, tender, or ground meats or poultry, well-moistened •Fish •Eggs (any preparation acceptable) •Yogurt (no nuts or coconut) •Casseroles with small chunks of tender or ground meat | • Tough or dry meats or poultry •Dry fish or fish with bones •Chunky peanut butter •Yogurt with nuts or coconut |
Bread | • Well-moistened breads, biscuits, muffins, pancakes, waffles, etc (add jelly, margarine, and other toppings to moisten well) •Dry bread, toast, crackers, etc •Tough, crusty breads, such as French bread | |
Cereals | • All well-moistened cereals •Coarse or dry cereals | |
Fruits | • All canned and cooked fruits •Soft, peeled, ripe fresh fruits, such as peaches, kiwi, mangos, cantaloupe, etc •Soft berries with small seeds, such as strawberries •Hard-to-chew fresh fruits, such as apples or pears •Stringy, pulpy fruits, such as papaya, pineapple, or mango •Fresh fruits with tough peels, such as grapes •Prunes, apricots, and other dried fruits (unless cooked) | |
Vegetables | • All cooked, tender vegetables •Shredded lettuce •All raw vegetables, except shredded lettuce •Cooked corn •Rubbery cooked vegetables | |
Potatoes and starches | • All, including rice and tender fried potatoes •Tough or crisp fried potatoes | |
Desserts | • All desserts, except those on the avoid list •Dry cakes or cookies that are chewy •Anything with nuts, seeds, dry fruits, coconut, and pineapple | |
Beverages | • Any beverage of recommended consistency |
Can I drink regular liquids if I am on a dysphagia pureed diet?
Possibly. For some patients, regular liquids are OK. However, depending on your condition, you might need to have thickened liquids, so you can swallow them safely. Talk to your speech and language pathologist to learn more.
References and recommended readings
American Dietetic Association. Level 3 advanced diet: patient handout. In: Nutrition Care Manual®. Available to subscribers at: www.nutritioncaremanual.org. Accessed January 13, 2011.
National Dysphagia Diet Task Force. National Dysphagia Diet: Standardization for Optimal Care. Chicago, IL: The American Dietetic Association; 2002.
