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Dysphagia Diet: Foods, Preparation Tips, and Safe Eating for Swallowing Difficulties

Kind Co.

Aug 19, 2025 2 months ago

Dysphagia Diet: Foods, Preparation Tips, and Safe Eating for Swallowing Difficulties

Difficulty swallowing, also called dysphagia, can significantly impact your mental and physical health.

You may require a specialized diet if you struggle to swallow certain textures of food. LifeSpring Home Nutrition supports a dysphagia diet with home-delivered meals that improve nutrition and reduce health risks.

Understanding Dysphagia and Swallowing Safety

You may experience dysphagia due to age-related health issues or other medical conditions impacting swallowing, chewing, or breathing.

According to the Annals of Rehabilitation Medicine, “[P]roper assessment and management of dysphagia are critical for improving swallowing function and preventing complications.” Dietary changes reduce the risk of health complications, illness, injury, or death by eliminating foods that may pose a safety hazard.

LifeSpring Home Nutrition offers a variety of pureed foods and other meal options if you experience difficulty swallowing. Treatment for dysphagia often involves removing certain textured foods from your diet to decrease the risk of choking.

What Is Dysphagia and How Does It Affect the Airway and Esophagus?

Dysphagia may cause you to aspirate food or drinks, causing them to enter the airway instead of the esophagus. 

You may feel like food often gets “stuck” in your esophagus. Tailoring meals to your specific needs with the support of healthcare professionals can reduce the risk of aspiration, choking, or pain when swallowing.

What Are the Risks of Swallowing Problems Without a Modified Diet?

Unmodified diets can cause significant choking hazards by increasing the likelihood that you will encounter swallowing problems. 

Depending on the type of condition causing the dysphagia, you may struggle to chew, swallow, or breathe while eating some foods. For example, foods that are hard, dry, or sticky may cause swallowing problems. LifeSpring Home Nutrition makes it easy to eliminate these foods from your diet.

Dysphagia Diet Levels and Standards

You can use multiple standards to determine what foods will be easiest to eat with your specific condition. 

The Dysphagia Diet Standardization Initiative (iDDSI) is a global standard for describing food textures. IDDSI replaces the National Dysphagia Diet (NDD). You can use these standards to quickly and easily check the viscosity of your foods.

What Are the IDDSI Levels and the National Dysphagia Diet?

IDDSI and NDD levels help you create a more accommodating diet.

According to Preventive Nutrition and Food Science, “Recently, nectar- (NDD level 2), honey- (NDD level 3), and pudding-like (NDD level 4) fluids are recognized to correspond to mildly (IDDSI level 2), moderately (IDDSI level 3), and extremely (IDDSI level 4) thick fluids, respectively.”

In addition, “The IDDSI board suggested categorizing thickened fluids by levels using the syringe flow test (SFT) or the fork drip test (FDT) as the IDDSI testing method.”

You can use both methods easily. The SFT involves filling a slip-tip syringe with liquid and then measuring the amount that drips out during a ten-second period. The amount of liquid left in the syringe after ten seconds determines the level. The FDT involves scooping the food up with a fork and seeing how it falls through the tines.

Which Level Matches Pureed, Pudding-Like, and Soft Foods?

The IDDSI levels correspond with specific food or drink characteristics. 

IDDSI has eight levels, including: 

  • Zero: Thin, water-like consistency
  • One: Falls easily off a spoon
  • Two: You can drink easily using a straw
  • Three: Liquidized, smooth, free of lumps, and unable to hold its shape on a spoon
  • Four: Smooth, free of lumps, and holds its shape on a spoon 
  • Five: Soft, moist lumps 4 mm or smaller that you can easily squash with your tongue 
  • Six: Bite-sized, soft, and easy-to-chew textures 
  • Seven: Normal textures

You may be able to eat at multiple levels, or your ability to eat at different levels may fluctuate depending on various factors.

Liquid Consistencies and Thickening Guidelines

Thickened liquids may cause some issues unless you follow the guidelines on liquid consistency provided by healthcare experts. 

The first three IDDSI levels pertain to liquids. Overly thick liquids may increase choking hazards, and the same can happen with thin liquids, especially thin liquids with inconsistent pulp or other forms of fiber.

What Are Thin, Nectar-Thick, Honey-Thick, and Pudding-Like Liquids?

The NDD levels help you determine the consistency and viscosity of various liquids. 

Nectar-thick liquids, such as fruit nectar, are easily poured while leaving a coating behind on eating utensils. Honey-thick liquids slowly drizzle and coat the utensil. Pudding-like liquids hold their shape and must be eaten with a spoon. Checking food items or drinks with a fork can help you measure their thickness.

When Should Thickeners Be Used for Fruit Juices or Milkshakes?

Thickened liquids allow you to control better how you swallow them by giving you more time to manipulate and direct the liquid to ensure a safe swallow.

Juices almost always require thickening due to their thin consistency. Milkshakes may require thickening because the primary ingredient, ice cream, melts into a thin liquid.

A speech-language pathologist, or other professional, can provide guidance on which liquids to thicken and how much to thicken them. LifeSpring Home Nutrition offers a variety of thickened meals to accommodate your dietary needs.

How Do I Test Liquid Consistency at Home Using IDDSI?

The best way to test liquid consistency is with a fork, spoon, chopsticks, or a slip-tip syringe.

Forks, spoons, and chopsticks are generally on hand and easy to use for determining if a food or drink needs thickening before you consume it. The syringe offers more consistent measurements for IDDSI, particularly for individuals with conditions that cause severe or life-threatening side effects if food and drinks have an excessively thin or thick consistency.

Safe Foods for Each Dysphagia Level

You are probably familiar now with the various dysphasia levels used to determine safe foods. 

However, you may benefit from having some examples of the various types of food, including: 

  • Safe Pureed Foods: Mashed potatoes, applesauce, and cream of wheat 
  • Soft Foods: cooked Eggs, casseroles, soufflés, and cottage cheese
  • Desserts: Ice cream, frozen yogurt, custard, and sherbet 

Not everyone can eat all of these foods. You must test each food to determine the NDD or IDDSI levels and whether or not they require thickening agents to be safely consumed.

LifeSpring Home Nutrition offers a variety of food options for different levels to ensure everyone has access to safe and nutritious meals.

Foods and Textures to Avoid

Some foods and textures to avoid if you experience dysphagia include: 

  • Unsafe Solid Foods: Dry bread, tough meats, and hard candy 
  • Stringy, Chewy, and Crunchy Foods: Potato skins, raw vegetables, soufflés, and dried fruit
  • Thin Liquids With Large Chunks: Soups, boba tea, and fruit jelly

You can manage thin liquids with large chunks in several ways, including adding thickener to increase the viscosity of the liquid or eating the liquid and chunks separately to give you more control over your chewing, swallowing, and breathing.

Meal Prep, Menu Planning, and Flavor Tips

Preparing your weekly meals in advance through meal prep or home-delivery services allows you to take control of what you eat and when. 

You have complete control over the flavor, texture, and thickness level of the foods you will eat for that week without needing to accommodate any unexpected foods that may pose a hazard to your health. LifeSpring Home Nutrition makes it easy by offering a complete catalogue of delicious, nutrient-rich meals for you to choose from.

How Do I Puree Foods Safely and Maintain Nutrition and Flavor?

Understanding how the puree process impacts various nutrients and tastes can help you create more enjoyable and healthy meals. 

According to Foods, “[P]uréeing food changes the recognition and dynamics of flavors.” However, you can easily maintain the taste and nutrients by “using different techniques, such as changing the food structure by adding different thickeners or adding more flavors.”

What Are Easy Moisture Additions?

You can easily add moisture to dry foods by using the following:

  • Margarine 
  • Sour cream
  • Salad dressings

In some cases, you may use these add-ons to make foods easier to control as you swallow.

How Can I Build a Balanced Plate With Pureed Foods and Cooked Vegetables?

You can create a balanced diet by mixing vegetables into various meals.

Pureeing cooked vegetables into foods creates a more balanced plate by increasing essential vitamins and minerals. Soft, cooked vegetables can also be eaten alongside pureed foods.

Working With Your Care Team

Anyone with dysphagia should work with a care team. 

Collaborating with a primary care doctor, nutritionist, dietitian, speech-language pathologist, and other professionals can reduce your risk of health complications. Medical experts will help you determine the best diet to meet your needs.

A dietitian customizes your dysphagia diet to include the recommended amount of calories and protein. You can also see a speech-language pathologist to improve your ability to swallow food and increase your quality of life.

What Should I Ask My Healthcare Provider About IDDSI Levels?

Most people have a list of questions to ask their doctor, including what level would be best for food or drinks, and whether food and drink levels will always be the same or different. 

You may find swallowing food easier if you work with your healthcare provider to learn about testing IDDSI levels to ensure you only eat food and drinks that meet their recommendations.

Additional topics you may want to discuss with your healthcare provider include: 

  • Specific characteristics of food and drink levels
  • Mixing foods with different consistencies (e.g., soup, noodles, etc.)
  • How to accurately test food and drinks at home 

Coming to your medical appointment with a list of questions will help you remember to ask about essential factors affecting your condition. A healthcare expert can also give you advice on how to take liquid form medications safely.

Dining Safety and Mealtime Strategies

You will need to learn safe ways of eating and develop mealtime strategies designed around your specific condition.

LifeSpring Home Nutrition makes it easy to create a positive and healthy dining experience.

What Posture and Pace Help Prevent Aspiration?

Eat slowly and deliberately while your posture remains straight, without slumping or leaning back. 

The straight 90° posture allows gravity to assist food down the esophagus.

Some other things you may use to improve your eating experience include: 

  • Turning your head if one side is weaker than the other 
  • Using a pillow to prop yourself up if you have trouble maintaining posture 
  • Tucking your chin to protect the airway and reduce the risk of aspiration 
  • Taking small bites or sips
  • Chewing food thoroughly before swallowing 
  • Eating slowly and avoiding distractions

A healthcare provider can help you develop mealtime strategies involving these techniques and additional recommendations.

Which Eating Cues Signal Fatigue or Need to Stop?

The multiple areas of focus during meals may cause you to experience fatigue or a need to stop eating. 

A few eating cues that may indicate you need to take a break from eating include: 

  • Food resting in the mouth
  • Needing to swallow multiple times
  • Gurgling voice 
  • Choking or gagging 
  • Regurgitation 
  • Labored breathing 

You should not push yourself to eat if you experience signs of exhaustion.

Sample Menus and Meal Ideas

You can work with your SLP or other medical expert to create sample menus or meal ideas that support a safe and healthy diet. 

Your care team can help you determine the following: 

  • How best to puree breakfast foods, including French toast puree, cream of wheat, and ripe bananas
  • The best way to adapt lunches such as casseroles and cooked cereals 
  • Determine the safety of foods like smooth peanut butter or soft breads 

Creating a sample menu can give you a blueprint to work off and allow you to better prepare for your meals. Weekly meal deliveries take some of the guesswork out of meal planning.

Frequently Asked Questions About the Dysphagia Diet

Below are some frequently asked questions about dysphagia and nutrition.

Are milkshakes and fruit juices safe if I use thickeners?

Yes, you can make milkshakes and fruit juices safer by using thickeners.

However, you should thicken these drinks and foods using the guidelines provided by an SLP or other medical professional. You can also speak with a professional about how to safely eat fresh fruits or canned fruit with dysphagia.

How do I transition between levels as swallowing improves?

Working closely with a speech-language pathologist is the best way to transition between levels safely.

An SLP will give you detailed information on changes between different levels as your swallowing improves.

When to Seek Medical Help

You may have noticed warning signs that mean you should contact a healthcare provider immediately, including: 

  • A blockage that makes it hard to breathe 
  • An inability to swallow or extreme difficulty swallowing 
  • Feeling good stuck in your throat
  • Chest pain during or directly after meals
  • Coughing or vomiting blood
  • Aspiration or symptoms of possible pneumonia 
  • Frequent regurgitation or heartburn

A medical professional can evaluate you to provide accurate treatment.

When Do Coughing, Choking, or Weight Loss Require Reassessment?

If you experience persistent coughing, choking, or unintentional weight loss, it may indicate that some aspect of your condition has changed. 

A medical professional may have you go through additional dysphagia testing to ensure nothing significant has changed in how you swallow or chew food. Testing generally consists of a physical examination and imaging of you swallowing various liquids.

Should an SLP Reevaluate After Illness or Surgery?

An illness, accident, surgery, or other significant health event may cause changes to your ability to swallow, making it essential to receive an SLP reevaluation.

A reevaluation will ensure your eating and swallowing plan and diet remain appropriate.

Resources and Next Steps

Everyone benefits from utilizing community-based resources. 

Next steps may involve referrals and acquiring testing tools for food.

Where Can I Find IDDSI Testing Tools and Guidance?

The official IDDSI website offers various tools and guidance, including: 

  • Informational printouts or digital resource packets 
  • Detailed instructions and methods for testing food or liquids 
  • Video examples and instructions 

The website also has links to other resources.

How Do I Get a Referral to an SLP or Dietitian?

You can speak with your primary care provider to get a referral for a local SLP or dietitian.

Your primary care doctor will be able to provide detailed information about how each type of referral may help you improve your diet. The nature of your condition will determine what referrals can provide the best outcomes.

What Community Support Exists for People With Swallowing Problems?

Some of the community-based support you can use to educate yourself, access dysphagia-friendly foods, and meet with peers or experts include: 

  • Registered Dietitians (RDs)
  • VA Intensive Dysphagia Treatment Program
  • Speech-Language Pathologists
  • Online Dysphagia Cafe
  • Hospital and Clinic Groups
  • Disease-Specific Organizations (e.g., American Stroke Association, etc.)
  • American Speech-Language-Hearing Association (ASHA)
  • National Foundation of Swallowing Disorders (NFOSD)

Many communities have local outreach programs you can use to access critical resources and support.

Dysphagia can affect mental health, physical wellness, and quality of life. LifeSpring Home Nutrition offers pureed meals and other foods that support a dysphagia-friendly diet. To learn more about the resources available in your community and how to use meal delivery services, contact our office today at (800) 798-5767.

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05:05 30 Apr 24
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