Dysphagia is a condition in which those affected have difficulty swallowing. Typically it refers to food and drink but it also extends to medications and in extreme cases even saliva.
When someone needs a dysphagia diet it’s important to know dysphagia foods to avoid and which foods are good choices. As a Registered Dietitian with years of experience working with patients with Dysphagia, I’ve developed easy to understand lists to make their nutrition as good as it can be.
What is the Dysphagia Diet?
The Dysphagia diet is a diet that alters the texture of foods to make it easier for someone with swallowing difficulty to eat comfortably and safely. This makes chewing and swallowing much easier. It is prescribed on a scale from minor adjustments to texture, all the way to liquid foods.
A Dysphagia diet can include foods from all four food groups, but as the difficulty becomes more difficult, there may be some foods eliminated. It is highly individual what diet someone will be prescribed.
A Speech Language-Pathologist (SLP) and Registered Dietitian will be involved with anyone that is on a Dysphagia diet. These two help to ensure that someone has safe foods and a nutritious diet to meet all their needs.
Currently the Dysphagia diet is largely recognized by the International Dysphagia Diet Standardization Initiative (IDDSI) for their terms. Here is the current list of diets:
- Level 3: Liquidised
- Level 4: Pureed
- Level 5: Minced and Mosit
- Level 6: Soft and Bite Sized
- Level 7: Regular and Easy to Chew
IDDSI Fluid Levels
- Level 0: Thin
- Level 1: Slightly Thick
- Level 2: Mildly Thick
- Level 3: Moderately Thick
- Level 4: Extremely Thick
It will vary by facility whether they have adapted IDDSI standards or not, you can see in this article what I think about IDDSI in Long Term Care. Whether a facility has or hasn’t, they will still have some type of Dysphagia diet available.
Why Does Someone Need a Dysphagia Diet?
Someone may need a Dysphagia diet for various health and dental reasons. There is not necessarily always a root cause as the reason. As we age our throat muscles becomes weakened, this can make swallowing increasingly difficult leaving someone to need the diet.
Other times there may be a root cause as a reason some needs the diet. This can include various health conditions such as:
Head, Neck, Throat Cancer
There may also be dental reasons why someone may need the diet. If someone has no teeth and no dentures, they may be prescribed a level on the dysphagia diet in order to allow them easier chewing and reduce choking risk.
There are two nutrition goals for someone to be put on a Dysphagia diet, I will put it in terms of a nutrition care plan:
- Resident will have reduced risk of choking on food and fluids.
- Resident will have reduced risk of aspiration pneumonia through altered diet texture and fluid viscosity.
Ultimately it will come down to improving the quality of life of someone that has difficulty swallowing. Quality of life will play a factor in determining what diet someone will go on. Just because someone needs a minced and moist diet doesn’t automatically mean they will choose that one.
Anyone requiring the diet ultimately gets the final say in whether they choose that diet or not.
Top Dysphagia Foods to Avoid
Here are the top foods to avoid if someone has difficulty swallowing.
Hard and Crunchy Foods
Dry Tough Meats
Dry and Crusty Breads
Tough Raw Fruits and Vegetables
Nuts and Seeds
The foods and the way foods are prepared will vary by the Dysphagia diet level someone is on. Someone on the Dysphagia diet level 1 will have different food options compared with someone on the other end of the spectrum. But in general, these foods are restricted on the diet.
The reason these foods are restricted as they put someone at a high choking risk. Take for example sausages. Most sausages are in circumference almost the exact size of someones wind pipe. If someone with Dysphagia were to eat this, it will block the wind pipe, and they will choke.
It is very important that anyone with Dysphagia takes seriously the dysphagia foods to avoid to reduce choking to death risk.
Risks of Not Following a Dysphagia Diet
Following a Dysphagia diet is important for individuals with swallowing difficulties, as it helps mitigate the risk of potentially life-threatening complications such as aspiration pneumonia.
When someone struggles to swallow safely, there is a heightened risk of food or liquids entering the airway, instead of reaching the stomach. Aspiration pneumonia occurs when foreign materials, like food or liquids, are inhaled into the lungs, leading to inflammation and infection.
By adhering to a carefully tailored Dysphagia diet, individuals can ensure that their food and drink consistency matches their specific swallowing abilities, reducing the likelihood of aspiration incidents.
A Dysphagia diet not only safeguards against immediate health risks but also plays a pivotal role in long-term well-being. Proper nutrition is essential for maintaining overall health and energy levels, which can be compromised when swallowing challenges hinder a person’s ability to consume a balanced diet.
Dysphagia Friendly Foods
Here are the best foods that someone with Dysphagia can have:
Fruits without Skin
Applesauce and Pureed Fruits
Pudding or Custard
Mashed or Pureed Legumes (Beans, Lentils, etc.)
Soft and Well-Cooked Pasta
Scrambled or Pureed Eggs
Mashed or Pureed Tofu
Oatmeal or Cream of Wheat
Ground or Minced Meats
Frequently Asked Questions
What Foods Make Dysphagia Worse?
The food that makes Dysphagia worse will depend on the diet level that someone is on. In general though foods that are difficult to swallow that include raw fruits and vegetables, tough dry meats, nuts and seeds, popcorn, dry crackers, and dry crusty bread products. These foods have a high choking risk for anyone with Dysphagia.
What is the Best Drink for Dysphagia?
The best drink for Dysphagia will depend if someone needs thickened fluids or not. If someone needs thickened fluids, just about any type of fluid can be thickened with proper thickening powder. A few options include ThickenUp and pre-thickened fluids which are available online and at pharmacies.
If someone needs thickened fluids it’s important to add the exact amount necessary and to allow sufficient time for it to thicken.
Is Ice Cream Good for Dysphagia?
Unfortunately ice cream by itself is not good for anyone on a Dysphagia diet that needs thickened fluids. If someone is on mildly or moderately thick fluids, ice cream is not permitted on these diets. Ice cream turns to a thin fluid when it hits the throat, which can increase the risk of aspiration pneumonia in someone with swallowing difficulty.
What Worsens Dysphagia?
What worsens Dysphagia will be different for everyone, but it is largely a progressive condition. If someone is suffering from Dementia, their Dysphagia will likely progress with time and they will need a more restrictive Dysphagia diet. It’s best to work with an SLP to see if there is anything that can be done for preventative care.
Other Articles You May Find Helpful
Michelle Saari is a Registered Dietitian based in Canada. She has a Master's Degree in Human Nutritional Sciences and is a passionate advocate for spreading easy to understand, reliable, and trustworthy nutrition information. She is currently a full time online entrepreneur with two nutrition focused websites.