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Dysphagia refers to a difficulty in swallowing.

People with dysphagia often need the texture of their foods, the thickness of their drinks, or both, modified to promote safe swallowing and good nutrition.

This article explains everything you need to know about the dysphagia diet, including what it is, its guidelines, and different levels.

dysphagia diet

What is dysphagia?

Dysphagia is the medical term that refers to a difficulty in swallowing.

The process of swallowing requires over 30 nerves and muscles (1).

Dysphagia can result from a variety of diseases and disorders that affect the function or structure of these nerves and muscles.

Causes of dysphagia include (2):

  • stroke
  • Parkinson’s disease
  • multiple sclerosis
  • dementia
  • myasthenia gravis
  • cancer
  • certain medications
  • GERD

Depending on the underlying cause, dysphagia can be improved with treatment, but a cure isn’t always possible.

An important part of dysphagia treatment involves diet modifications.

Diet modifications can help reduce the risk of complications from dysphagia, such as dehydration, malnutrition, choking, and pneumonia (3).

Levels of a dysphagia diet

There are several levels to a dysphagia diet.

A speech-language pathologist can recommend the safest level based on an individual’s ability to safely and efficiently swallow foods and drinks.

The International Dysphagia Diet Standardization Initiative (IDDSI) is the framework used to describe these levels.

IDDSI replaced the previous dysphagia diet framework — the National Dysphagia Diet (NDD).

Unlike the National Dysphagia Diet, IDDSI provides common terminology to describe food textures and drink thickness. IDDSI also provides standardized testing methods to ensure foods are the appropriate texture and drinks are the appropriate thickness (4).

Drinks and foods are divided into eight levels depending on their thickness and texture.

Drinks

Drinks are measured from levels 0–4.

  • Level 1 (thin): Regular fluids like water, skim milk, juice, coffee, and tea.
  • Level 2 (slightly thick): Slightly thicker than water. Some drinks like some fruit nectars and whole-fat milk may naturally be slightly thick.
  • Level 3 (moderately thick): Drinks at this level require some effort to drink through a wide diameter straw and can be taken with a spoon.
  • Level 4 (extremely thick): Drinks at this level are usually eaten with a spoon since they’re too thick to be drunk from a cup or sucked through a straw.

Most beverages — including those that are carbonated — can be thickened to any level using gel or powder thickener.

Gel thickeners tend to be more favored since they are tasteless and don’t clump like powdered thickeners.

You can purchase a gel thickener in bulk or individual packets online here.

Foods

Foods are measured from levels 3–7.

  • Level 3 (liquidized): Foods at this level can be eaten with a spoon or drink from a cup. However, they cannot be eaten with a fork because the food is too thin.
  • Level 4 (pureed): Pureed foods are usually eaten with a spoon and do not require chewing.
  • Level 5 (minced and moist): The food is soft, moist, and requires minimal chewing. The food particle size should be small enough to fit between fork tines.
  • Level 6 (soft and bite-sized): Foods at this level are soft, tender, and moist. The food particle size should be no larger than the width of a standard dinner fork.
  • Level 7 (easy to chew): Normal, everyday foods that are soft and tender. This level is for people with chewing problems rather than swallowing problems.
  • Level 7 (regular): Normal, everyday foods intended for people without chewing or swallowing problems.

Use milk, gravies, sauces, and broths rather than water to add moisture and thicken foods.

Other nutrition tips for dysphagia

Following a dysphagia diet can be overwhelming and challenging to some.

Here are a few tips to help:

  • Stay hydrated. Individuals with dysphagia are at an increased risk of dehydration. Beverages like tea, coffee, fruit juices, milk, and soups as well as water-rich foods like fruits and vegetables all contribute to hydration.
  • Use puree food molds. Puree food molds help foods retain their original appearance and can make food look more appetizing. Browse puree food molds online.
  • Use moist heat cooking methods. Poaching, simmering, steaming, and boiling are all moist cooking methods that can help foods — especially meats — stay moist and tender.
  • Practice good oral hygiene. Maintaining good oral hygiene can help decrease the risk of aspirating harmful bacteria into the lungs and any fluid that may be pooling in the mouth.
  • Avoid bread. Unless approved by your SLP, bread is generally considered a Level 7 (regular) food only since it can pose a significant choking risk.
  • Invest in a good blender. The right blender can make all the difference so invest in one that can handle just about anything you throw in it. Shop for blenders here.
  • Avoid mixed consistency foods. Mixed consistency foods include both solids and liquids. Think of vegetables in soup broth or gravy over mashed potatoes. Avoid mixed consistency foods since they can increase the risk of choking and aspiration.

The bottom line

People with dysphagia commonly require alterations to their diet to ensure safe swallowing and good nutrition.

Depending on the severity of an individual’s dysphagia, a speech-language pathologist can prescribe the least restrictive but safest levels possible.

There are several ways to make following a dysphasia diet less intimidating, more appetizing, and safer.


Gavin Van De Walle, MS, RD, LN
Gavin Van De Walle, MS, RD, LN

Gavin Van De Walle holds a master's degree in human nutrition and bioenergetics. He is a registered dietitian who aims to arm the public with evidence-based nutrition recommendations so they can make their own educated and informed health decisions.