Dysphagia can be a daunting and difficult condition to deal with, both for the sufferer and their caregivers. Hopefully this comprehensive guide to the condition and the ideal diet will give you the tools you need to navigate this disease with confidence. Learn about the condition itself, the ideal diet that goes along with it, and some top tips and recommendations for lifestyle adjustments.

What is Dysphagia?

Dysphagia is a disorder characterized by difficulty swallowing. It has a variety of causes, but the most common are as a side effect of a stroke, neurological disease, dementia, or other disorders. This means it is especially common in elderly people.

Some signs of dysphagia include drooling, choking, gagging, oral leaking, taking longer than 10 seconds to swallow, poor chewing ability, general weakness, and pocketing food out of embarrassment of not being able to swallow it.

This diagnosis is dangerous because it increases the patient’s chances of choking short term, but also the chances of malnutrition and dehydration long-term.

There are two common times of dysphagia diagnoses:

Esophageal dysphagia

As you may have guessed from the name, esophageal dysphagia happens when foods or liquids get caught in the esophagus. Due to consistent stomach acid backup into the esophagus, the esophagus can become inflamed and more narrow than it should be. This makes it incredibly difficult for food and even some liquids to pass through it. To the patient, it feels as though food is “stuck” in the mid to lower chest, which can cause pain or cramps in this area as well. Solid foods are usually more of a problem here.

Luckily, there is actually a cure and prevention system in place for this kind of dysphagia. Doctors can widen the narrowing of the esophagus back to its original size with a surgical procedure, and there’s a treatment plan for keeping the passageway open after this procedure as well.

Oropharyngeal dysphagia

The second type of dysphagia, oropharyngeal, is the kind that usually results from another disorder, such as stroke, Alzheimer’s disease, various cancers, multiple sclerosis, or cerebral palsy. The cause usually determines the symptoms, but generally, this kind of dysphagia is characterized by difficulty moving food to the back of the mouth or down the throat to start the swallowing process. Liquids are usually more of a problem with this type.

Why Someone Might Need a Dysphagia Diet

A dysphagia diet can help people with either of these conditions. It involves different textured foods and liquids that are easier to swallow for narrow passageways or disordered mouths/throats. The various textures make it easier to chew and move the food, and also reduces the risk of the foods/liquids going into the windpipe or trachea, which leads to the lungs and can cause choking or worse.

A specialized dysphagia diet can help the person diagnosed get sufficient nutrients and hydration without the complications or potential side effects of trying to continue on with a normal dietary regimen.

medical tools and equipment laid out neatly ready for an exam and testingResources

While I understand that all of this can seem overwhelming, it is important to keep in mind that you are not alone in this process. There are many certified specialists and doctors out there that can help you navigate this new lifestyle.

A proper diagnosis is the most important part of correctly treating this condition, as each person has a unique experience with it. Getting a comprehensive medical background history and various tests by doctors will help diagnose the cause of the dysphagia, and allow you to treat it in the most effective way possible.

Often, a team of healthcare providers will be able to work together to provide this information for you. It usually involves physicians, dietitians, speech pathologists, occupational therapists, and psychologists, or a combination of 2 or 3 of these registered specialists.

Once you have a comprehensive and accurate diagnosis, the team will work to get a meal and lifestyle plan in order, tailored to your unique needs. Some can also check in periodically to help with swallowing and coach the patient through other issues.

The Dysphagia Diet Overview

While your team of experts will craft the perfect diet plan to fit your unique condition and needs, there are a few general themes and patterns to most dysphagia diets.

The main problem that this type of diet tries to address is the common inability of dysphagia patients to get enough calories and nutrients. To remedy this issue, the dysphagia diet allows the patient to eat from a variety of food groups at once, be creative with the meals and cook in new and innovative ways, eat small (but frequent) meals, and serve both hot and cold foods to prevent contamination, but also make the food more enjoyable for the patient.

The key to a successful dysphagia diet is variety. Dysphagia makes eating difficult, tiring, and just plain un-enjoyable. Patients need hot and cold foods, different textures, salty and sweet tastes, and all kinds of variety like this in order to make their meals as enjoyable as possible. This is the only way to ensure that they will get enough nutrients and hydration.

Levels

To account for all of this variety, and keep the diet organized and easy to navigate, many dietary experts organize the dysphagia diet into levels based on consistency. There are generally about 5 levels, level 1 being a very thin liquid-only diet to level 5 being solid, but small, bite sized foods.

Depending on the patient’s unique condition, they will probably be restricted to one or two of the levels outlined below. Read through to get a better sense of the levels of the dysphagia diet, as well as some food recommendations in each category to keep the diet varied and exciting.

bowl of bright orange carrot soup with sour cream garnish in a white bowl with blue stripesLevel 1 Dysphagia Diet

Foods in the first level of the dysphagia diet are puréed. They should have a very smooth, mashed consistency with no solid bits leftover. Generally, about 1 ounce of liquid is needed per 3 ounces of meat or other solid food in order to get it to this consistency.

Use a potato ricer, food mill, food processor, or blender to achieve this texture.

Below are some recommended easy foods to puree together. Get creative and have fun with it! But remember, some foods with seeds or skins do not puree easily and can leave solid parts left that the patient may not be able to digest.

Food Recommendations:

  • Breakfast:
    • Thinned cooked cereals (no solid parts)
    • Pureed french toast or pancakes
    • Puréed fruit
    • Pureed scrambled eggs & cheese
    • Baby cereals
    • Plain Yogurt
  • Lunch/Dinner:
    • Pureed meats, poultry, fish
    • Pureed chicken or tuna salad
    • Pureed cottage cheese
    • Mashed potatoes
    • Pureed Scalloped potatoes or candied sweet potatoes
    • Pureed vegetables (no corn or peas due to their skin)
    • Pureed buttered or Alfredo noodles
    • Pureed soups and creamed soups with no solid parts
  • Dessert:
    • Thick milkshakes
    • Ice cream
    • Sherbert
    • Smooth pudding
  • Drinks:
    • Thickened milk or eggnog
    • Thickened juice
    • Decaffeinated coffee or tea, non-dairy creamer
    • Water, of course

Level 2 Dysphagia Diet

In level two of the diet, foods should be minced into very small pieces, about the size of sesame seeds. Potato ricers and food mills with small screen sizes are good for this. Food processors can also be used on a slower speed so that the food isn’t completely pulverized.

Food Recommendations:

  • Breakfast:
    • Minced soft cooked, scrambled, poached eggs
    • Minced soufflé or omelets
    • Minced soft French toast
    • Minced soft pancakes
    • Cooked cereal
    • Plain Yogurt
  • Lunch/Dinner:
    • Minced meats, poultry, fish
    • Cottage cheese
    • Mashed or minced potatoes
    • Minced vegetables (no corn or peas due to their skin)
    • Minced buttered or Alfredo noodles
    • Pureed soups and creamed soups
    • Minced fruits
    • Mashed bananas
  • Dessert:
    • Thick milkshakes
    • Ice cream
    • Sherbert
    • Pudding, including rice and tapioca
    • Italian ice
  • Drinks:
    • Milk or eggnog
    • Juice
    • Decaffeinated coffee or tea, non-dairy creamer
    • Water, of course

pureed meal molded into stars with a side of mashed potatoesLevel 3 Dysphagia Diet

Foods in this level are ground into about 1/4-inch pieces, which is similar to the size of rice. Again, potato ricers and food mills will be best for getting this size. Food processors may be able to do this on a pulse setting with some skill and practice.

Food Recommendations:

  • Breakfast:
    • Scrambled Eggs
    • Souffle
    • Cooked cereal
    • Chopped pancakes, french toast, etc.
    • Yogurt with fruit at the bottom
  • Lunch/Dinner:
    • Ground meats, poultry, fish
    • Cottage cheese
    • Mashed or minced potatoes
    • Ground baked potato (no skin)
    • Ground, well cooked frozen or canned vegetables
    • Chopped noodle dishes
    • Pureed or creamed soups
    • Chopped fruits
    • Mashed bananas
  • Dessert:
    • Thick milkshakes
    • Ice cream
    • Sherbert
    • Pudding, including rice and tapioca
    • Italian ice
  • Drinks:
    • Milk or eggnog
    • Juice
    • Decaffeinated coffee or tea, non-dairy creamer
    • Water, of course

Level 4 Dysphagia Diet

All foods in this group should be chopped up into 1/2-inch pieces, about the size of a crouton. Food choppers and food processors on a pulse setting are the easiest way to get food to this size.

Food Recommendations:

  • Breakfast:
    • Poached or scrambled eggs
    • Soft, cold,  dry cereal
    • Souffle or omelets
    • Soft bread
    • Cooked cereal
    • Chopped pancakes, french toast, etc.
    • Yogurt with fruit at the bottom
  • Lunch/Dinner:
    • Chopped meats, poultry, fish
    • Cottage cheese
    • Cream cheese
    • Mashed or minced potatoes
    • Chopped baked potato (no skin)
    • Chopped, well-cooked vegetables
    • Chopped pasta dishes
    • Pureed or creamed soups (canned is okay)
    • Chopped fruits
    • Mashed bananas
  • Dessert:
    • Thick milkshakes
    • Ice cream
    • Sherbert
    • Pudding, including rice and tapioca
    • Italian ice
  • Drinks:
    • Milk or eggnog
    • Juice
    • Decaffeinated coffee or tea, non-dairy creamer
    • Water, of course

platter of pancakes with a side of syrup, whipped cream, and bananasLevel 5 Dysphagia Diet

In this final level of the dysphagia diet, foods should be regularly textured, but still soft and moist for easy digestion.

Food Recommendations:

  • Breakfast:
    • Eggs (any type)
    • Yogurt
    • French toast
    • Pancakes
    • Soft breads
    • Cold, dry cereal
    • Cooked cereal
  • Lunch/Dinner:
    • Soft, moist meat, fish, poultry
    • Baked fish
    • Cottage cheese, other soft cheeses
    • Tuna or chicken salad, other meat salads
    • Pasta dishes with sauces
    • Potatoes (any type)
    • Soft cooked vegetables
    • Soups (any kind)
    • Canned fruits
    • Most fresh, ripe fruits
  • Dessert:
    • Doughnuts
    • Milkshakes
    • Ice cream
    • Sherbert
    • Italian Ice
    • Cakes
  • Drinks:
    • Milk or eggnog
    • Juice
    • Decaffeinated coffee or tea, non-dairy creamer
    • Water, of course

Food Tip: Thickening and Thinning Agents

Obviously, that list is pretty comprehensive, but the texture still may not be just right for your patient. The good news is there are many natural thickening and thinning agents available to achieve your desired texture, no matter what level you’re at. You’ll want to consult with your specialist to get the best thickening or thinning agent for your unique needs, as there are many different types on the market today.

Mealtime Tips

Mealtime can be stressful and daunting for the patient and caretaker alike, but it doesn’t have to be. Following these tips can make it much easier on everyone.

  1. Keep the patient in an upright position the entire time they are eating or drinking, as close to 90 degrees as possible. Stay upright for at least 30 to 45 minutes after each meal.
  2. The patient should avoid talking while eating.
  3. Take very small bites, a maximum of 1 teaspoon at a time.
  4. Eat slowly and make sure you’ve completely swallowed before taking another bite,
  5. Don’t “wash down” foods – don’t mix solid with liquid foods, as this could cause complications.
  6. Turn the head downward and lean the body forward to aid in swallowing and prevent food from entering your airways.
  7. Place food on the strong side of the mouth if there is a weak side.
  8. Check the cheek for any pocketed food after each meal.
  9. Eat in a relaxed atmosphere with little distractions (no TV).
  10. Stay calm while eating.

Summary and Sources

Dysphagia is a very dangerous and scary condition that affects the elderly community more than any other. It can be caused by stroke, dementia, or a variety of other conditions and factors. There are two types, both of which have symptoms that can be managed with a proper diet and monitoring by specialists in the field.

Your doctor and other specialists will work together to prepare your unique, ideal meal and lifestyle plan, but generally, the dysphagia diet is broken up into 5 levels, organized by consistency. Depending on your condition, you may be able to draw from one or two levels. As long as you keep your diet varied and interesting, eating won’t be such a hassle. Make sure to keep your eating environment calm and focused as well with the help of a caretaker.

Have you had any experience with dysphagia – either yourself or with a loved one? Please share your best tips below to help others who may be just starting to navigate this condition.

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