Dysphagia Diet

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[1]

Dysphagia is a term that means difficulty swallowing food and/or liquids properly. The diet for dysphagia involves five various levels of difficulty in swallowing, which we will detail below. It is crucial to know the process of swallowing to understand dysphagia. First and foremost, it is important for all individuals to chew food slowly and thoroughly. Once this process is completed, the food is moved to the back of the mouth by stretching of the cheek muscles and pressing the tongue against the roof of the mouth. From this moment on, the process of swallowing becomes spontaneous and reflexive. [2]

When the esophagus is relaxed, the airway is automatically closed by the soft palate, preventing food from entering the lungs. As food and liquid enter, the muscular esophagus contracts in the form of waves, which sweeps the food along and down into the stomach.

Hence, any blockage or malfunction in this function results in dysphagia.

Types of Dysphagia

There are two types of dysphagia.

  1. Esophageal Dysphagia
  2. Oropharyngeal Dysphagia

Esophageal Dysphagia

Esophageal dysphagia occurs when food or liquid stops in the esophagus during swallowing.

Esophageal dysphagia occurs in several ways. Sometimes, stomach acid can reflux into the esophagus, which causes inflammation. A hiatal hernia can increase the occurrence of acid reflux as well. Over time, inflammation from reflux can lead to narrowing of the esophagus. As a result, food and even liquids can cause a sticking sensation in the middle and lower chest. Individuals might feel discomfort and even pain in the chest. Fortunately, the narrowed region can be dilated during endoscopy with a balloon-guided technique. Other, less frequent causes of esophageal dysphagia are cancer and muscle disorders.

Oropharyngeal Dysphagia

The difficulty in moving food to the back of the mouth and swallowing it is called oropharyngeal dysphagia. This type of condition is a result of various nerve or brain disorders, including stroke, cerebral palsy, multiple sclerosis, Parkinson’s and Alzheimer’s diseases, throat or neck cancer, and even dental disorders.

The main symptoms of oropharyngeal dysphagia include drooling, choking, coughing after or during meals, impaired voice quality, chronic respiratory infections, or weight loss. Liquids are more problematic than solids in oropharyngeal dysphagia. Esophageal dysphagia typically involves solids being more problematic.

The treatment of oropharyngeal dysphagia requires a proper diagnosis involving a medical history and several tests to determine the cause of dysphagia. GI providers often direct the strategy for treatment, and will involve dietitians, psychologists, speech pathologists, and occupational therapists as necessary to collaborate and design the best program tailored for individual needs [3].

The most crucial part of treatment involves helping the patient with adequate nutrition and protecting against complications, including pneumonia from solid food or liquids getting into the lungs. This treatment requires a special diet of five levels, from level 1 (pureed food) to level 5 (regular, modified food). The levels of this diet vary in texture and consistency, and are made to suit each individual patient [4].

Special Considerations for Dysphagia Patients

We suggest the following guidelines for the safe swallowing when a patient has dysphagia. [5]

  1. Maintain an upright position (near 90 degrees as possible) whenever eating or drinking.
  2. Take small bites — only 1/2 to 1 teaspoon at a time.
  3. Eat slowly. It may also help to eat only one food at a time.
  4. Avoid talking while eating.
  5. When one side of the mouth is weak, place food into the stronger side of the mouth. At the end of the meal, check inside the cheek for any food that may become pocketed.
  6. Try turning the head down, tucking the chin to the chest, and bending the body forward when swallowing. It often provides greater swallowing ease and helps prevent food from entering the airway.
  7. Do not mix solid foods and liquids in the same mouthful, and do not “wash foods down” with liquids unless instructed by the therapist.
  8. Eat in a relaxed atmosphere, with no distractions.
  9. Sit in an upright position (90-degree angle) for 30 to 45 minutes following each meal.
Level 1
Puréed Foods
Foods in this group are puréed to a smooth, mashed potato-like consistency. If necessary, the puréed foods can keep their shape with the addition of a thickening agent. Meat is puréed to a smooth pasty consistency. Hot broth or hot gravy may be added to the puréed meat, approximately 1 oz of liquid per 3 oz serving of meat.

CAUTION:
If any food does not purée into a smooth consistency, eating or swallowing may be more difficult. For example, zucchini seeds sometimes do not blend well.
Puréed meats, poultry, & fish Puréed cottage cheese
Puréed tuna, ham, & chicken salad Puréed fruit
Pureed scrambled eggs & cheese Thickened juices & nectars
Baby cereals Thickened milk or eggnog
Thinned cooked cereals (no lumps) Malts
Puréed French toast or pancakes Thick milkshakes
Mashed potatoes Ice cream
Puréed parsley, au gratin, scalloped potatoes, candied sweet potatoes Fruit or Italian ice, sherbet
Puréed buttered or Alfredo noodles Plain yogurt
Puréed vegetables (no corn or peas) Smooth & drinkable yogurt
Puréed soups & creamed soups Smooth pudding, mousse, custard
Puréed scalloped apples Whipped gelatin
Gravies Sugar, syrup, honey, jelly
Sauces: cheese, tomato, barbecue, white, cream Cream
Decaffeinated coffee or tea Non-dairy creamer
Margarine
Mayonnaise
Ketchup, mustard
Level 2
Minced Foods
Foods in this group should be minced/chopped into tiny pieces (1/8 inch). The flecks of food are similar in size to sesame seeds.
Minced meat, fish, poultry Cottage cheese
Minced stuffed fish Junior baby fruit
Flaked fish Semi-thickened juices
Junior baby meats Nectars
Minced soft-cooked, scrambled, poached eggs Ripe mashed bananas
Minced soufflé & omelets Minced canned fruit
Minced soft French toast Pineapple sauce
Minced soft pancakes Milk
Cooked cereals Milkshakes
Minced potatoes Custard
Minced buttered or Alfredo noodles Puddings, including rice & tapioca
Minced vegetables Yogurt
Creamed soups Fruit ice, Italian ice, sherbet
Puréed vegetables soup or alphabet soup Whipped gelatin
Minced scalloped apples Junior baby desserts
Gravy Sugar, syrup, honey, jelly
Sauces: cheese, creamed, barbecue, tomato, white Cream
Decaffeinated coffee or tea Margarine
Level 3
Ground Foods
Foods in this group should be ground/diced into 1/4-inch pieces. These pieces of food are similar in size to rice.
Ground meat, fish, poultry Cottage cheese
Ground meat salads (no raw eggs) Smooth fruited yogurt
Ground Swedish meatballs Fruit juices or nectars
Scrambled eggs or soufflés Ground canned fruit
Ground poached eggs Crushed pineapple
Cooked cereals Ripe bananas
Ground soft French toast Lemonade/Limeade (no pulp)
Ground potatoes Milk
Ground noodles Ice cream
Ground baked potato (no skin) Custard
Ground well-cooked frozen vegetables (no corn, peas, or mixed vegetables) Puddings or mousse
Ground canned vegetable Fruit ice, Italian ice, sherbet
Creamed soups Cream
Puréed vegetables soup or alphabet soup Non-dairy creamer
Ground scalloped apples Margarine
Gravies Mayonnaise
Sauces: cheese, creamed, barbecue, tomato, white Ketchup
Decaffeinated tea or coffee Mustard
Level 4
Chopped Foods
Foods in this group should be chopped into 1/2-inch pieces. These pieces of food are similar in size to uncooked elbow macaroni or croutons (small bread cubes).
Chopped meat or poultry Cottage cheese
Chopped Swedish meatballs Yogurt
Meat salads (ground or flaked meat) Milk
Flaked fish Milkshakes
Poached or scrambled eggs Soft, cold, dry cereal
Soufflés and omelets Soft bread (if approved by speech or occupational therapy)
Cooked cereals Fruit juice or nectars
Chopped French toast or pancakes Chopped canned fruit
Chopped noodles or pasta (no rice) Canned fruit cocktail
Chopped cooked vegetables (no frozen peas, corn, or mixed vegetables) Pudding, mousse, custard
Chopped canned small sweet peas Ice cream
Creamed soup or vegetable soup Fruit ice, Italian ice, sherbet
Canned chicken noodle soup Cream cheese
Chopped potatoes (all kinds) Whipped topping
Gravy Whipped gelatin
Bacon dressing Sugar, syrup, honey, jam, jelly
Sauces: cheese, creamed, barbecue, tomato, white
Decaffeinated tea or coffee
Level 5
Modified Regular Foods
Foods in this group are soft, moist, regularly textured foods
Soft, moist meat, fish, poultry Soft cheeses
Baked fish Cottage cheese
Meat Salads Cream cheese
Soufflés and omelets Yogurt
Eggs Milk
Stuffed shells Milkshakes
Spaghetti with meat sauce Cold, dry cereals (no nuts, dried fruit, coconut)
Cooked cereal Crackers
French toast or pancakes Soft bread (no hard rolls)
Toast Fruit juices or nectars
Noodles or pasta (no rice) Canned fruit
Potatoes (all types) Ripe bananas
Soft, cooked vegetables (no corn, lima, or baked beans) Peeled, ripe, fresh fruit
Creamed soups or vegetable soup Cakes (no nuts, dried fruit, coconut)
Canned chicken noodle soup Plain doughnuts
Gravies Ice cream
Bacon dressing Pudding, mousse, custard
Sauces: cheese, creamed, barbecue, tomato, white Fruit ice, Italian ice, sherbet
Decaffeinated tea or coffee Whipped gelatin
Regular gelatin
Canned fruited gelatin molds
Sugar, syrup, honey, jam, jelly
Cream
Non-dairy creamer
Margarine
Oil
Mayonnaise
Ketchup
Mustard

References

[1]       “Person Mixing Cereal, Milk, and Strawberry Jam on White Ceramic Bowl · Free Stock Photo.” https://www.pexels.com/photo/person-mixing-cereal-milk-and-strawberry-jam-on-white-ceramic-bowl-704971/ (accessed Mar. 28, 2022).

[2]       S. T. O’Keeffe, “Use of modified diets to prevent aspiration in oropharyngeal dysphagia: is current practice justified?,” BMC Geriatr, vol. 18, no. 1, Jul. 2018, doi: 10.1186/S12877-018-0839-7.

[3]       Y. Chen, M. Zong, S. Li, L. Tang, Y. Feng, and J. Sun, “Nutritional diet plan for patients with dysphagia,” Asia Pac J Clin Nutr, vol. 30, no. 2, pp. 238–244, 2021, doi: 10.6133/APJCN.202106_30(2).0008.

[4]       J. M. Garcia and E. Chambers, “Managing dysphagia through diet modifications,” Am J Nurs, vol. 110, no. 11, pp. 26–33, Nov. 2010, doi: 10.1097/01.NAJ.0000390519.83887.02.

[5]       I. Germain, T. Dufresne, and K. Gray-Donald, “A novel dysphagia diet improves the nutrient intake of institutionalized elders,” J Am Diet Assoc, vol. 106, no. 10, pp. 1614–1623, Oct. 2006, doi: 10.1016/J.JADA.2006.07.008.

 

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