Dysphagia Diet – Pureed
Dysphagia Diet is helpful for people with moderate to severe swallowing problems. Pureed foods are smooth and are prepared without lumps so that they can be swallowed safely.
Work with your health care provider and your diet and nutrition specialist (dietitian) to make sure that you are following the Dysphagia Diet safely and getting all the nutrients you need.
What are tips for following this plan?
General instructions
- You may eat foods that are soft and have a pudding-like texture.
- Do not eat foods that you have to chew. If you have to chew the food, then you cannot eat it.
- Avoid foods that are hard, dry, sticky, chunky, lumpy, or stringy. Also avoid foods with nuts, seeds, raisins, skins, or pulp.
- You may be instructed to thicken liquids. Follow your health care provider’s instructions about how to do this and to what consistency.
Cooking
- If a
food is not originally a smooth texture, you may be able to eat the food
after:
- Pureeing it. This can be done with a blender.
- Moistening it. This can be done by adding juice, cooking liquid, gravy, or sauce to a dry food and then pureeing it. For example, you may have bread if you soak it in milk and puree it.
- If a food is too thin, you may add a commercial thickener, corn starch, rice cereal, or potato flakes to thicken it.
- Strain and throw away any liquid that separates from a solid pureed food before eating.
- Strain lumps, chunks, pulp, and seeds from pureed foods before eating.
Reheat foods slowly to prevent a tough crust from forming.
Meal planning
- Eat a variety of foods to get all the nutrients you need.
- Add dry milk or protein powder to food to increase calories and protein content.
- Follow your meal plan as told by your dietitian.
What foods are allowed?
The items listed may not be a complete list. Talk with your dietitian about what dietary choices are best for you.
Grains
Soft breads, pancakes, French toast, muffins, and bread stuffing pureed to a smooth, moist texture, without nuts or seeds. Cooked cereals that have a pudding-like consistency, such as cream of wheat or farina. Pureed oatmeal. Pureed, well-cooked pasta and rice.
Vegetables
Pureed vegetables. Smooth tomato paste or sauce. Mashed or pureed potatoes without skin.
Fruits
Pureed fruits such as melons and apples without seeds or pulp. Mashed bananas. Mashed avocado. Fruit juices without pulp or seeds.
Meats and other protein foods
Pureed meat, poultry, and fish. Smooth pate or liverwurst. Smooth souffles. Pureed beans (such as lentils). Pureed eggs. Smooth nut and seed butters. Pureed tofu.
Dairy
Yogurt. Milk. Pureed cottage cheese. Nutritional dairy drinks or shakes. Cream cheese. Smooth pudding, ice cream, sherbet, and malts.
Fats and oils
Butter. Margarine. Vegetable oils. Smooth and strained gravy. Sour cream. Mayonnaise. Smooth sauces such as white sauce, cheese sauce, or hollandaise sauce.
Sweets and desserts
Moistened and pureed cookies and cakes. Whipped topping. Gelatin. Pudding pops.
Seasoning and other foods
Finely ground spices. Jelly. Honey. Pureed casseroles. Strained soups. Pureed sandwiches.
Beverages
Anything prepared at the consistency recommended by your dietitian.
What foods are not allowed?
The items listed may not be a complete list. Talk with your dietitian about what dietary choices are best for you.
Grains
Oatmeal. Dry cereals. Hard breads. Breads with seeds or nuts. Whole pasta, rice, or other grains. Whole pancakes, waffles, biscuits, muffins, or rolls.
Vegetables
Whole vegetables. Stringy vegetables (such as celery). Tomatoes or tomato sauce with seeds. Fried vegetables.
Fruits
Whole fresh, frozen, canned, or dried fruits that have not been pureed. Stringy fruits, such as pineapple or coconut. Watermelon with seeds. Dried fruit or fruit leather.
Meat and other protein foods
Whole or ground meat, fish, or poultry. Dried or cooked lentils or legumes that have been cooked but not mashed or pureed. Non-pureed eggs. Nuts and seeds. Crunchy peanut butter. Whole tofu or other meat alternatives.
Dairy
Cheese cubes or slices. Non-pureed cottage cheese. Yogurt with fruit chunks.
Fats and oils
All fats and sauces that have lumps or chunks.
Sweets and desserts
Solid desserts. Sticky, chewy sweets (such as licorice and caramel). Candy with nuts or coconut.
Seasoning and other foods
Coarse or seeded herbs and spices. Chunky preserves. Jams with seeds. Whole sandwiches. Non-pureed casseroles. Chunky soups.
Summary
- Pureed foods can be helpful for people with moderate to severe swallowing problems.
- On the dysphagia eating plan, you may eat foods that are soft and have a pudding-like texture. You should avoid foods that you have to chew. If you have to chew the food, then you cannot eat it.
- You may be instructed to thicken liquids. Follow your health care provider’s instructions about how to do this and to what consistency.
Dysphagia Diet – Minced and Moist Foods
This eating plan is for people with moderate swallowing problems who are transitioning from pureed to solid foods. Moist and minced foods are soft and cut into very small chunks so that they can be swallowed safely. On this eating plan, you may be instructed to drink liquids that are thickened.
Work with your health care provider and your diet and nutrition specialist (dietitian) to make sure that you are following the diet safely and getting all the nutrients you need.
What are tips for following this plan?
General guidelines for foods
- You may eat foods that are soft and moist.
- Always test food texture before taking a bite. Poke food with a fork or spoon to make sure it is tender.
- Take small bites. Each bite should be smaller than your little finger nail (about 4 mm by 4 mm).
- If you were on a pureed food eating plan, you may still eat any of the foods included in that diet.
- Avoid foods that are dry, hard, sticky, chewy, coarse, or crunchy.
- Avoid foods that separate into thin liquids and solids, such as cereal with milk or chunky soups.
- Avoid liquids that have seeds or chunks.
If instructed by your health care provider, thicken liquids. Follow your health care provider’s instructions about what products to use, how to do this, and to what thickness.
- You may use a commercial thickener, rice cereal, or potato flakes.
- Thickened liquids are usually a “pudding-like” consistency, or they may be as thick as honey or thick enough to eat with a spoon.
Cooking
- You may need to use a blender, whisk, or masher to soften some of your foods.
- To moisten foods, you may add liquids while you are blending, mashing, or grinding your foods to the right consistency. These liquids include gravies, sauces, vegetable or fruit juice, milk, half and half, or water.
- Reheat foods slowly to prevent a tough crust from forming.
Meal planning
- Eat a variety of foods in order to get all the nutrients you need.
- Follow your meal plan as told by your health care provider or dietitian.
What foods are allowed?
Grains
Soaked soft breads without nuts or seeds. Pancakes, sweet rolls, pastries, and French toast that have been moistened with syrup or sauce. Well-cooked pasta, noodles, rice, and bread dressing in very small pieces and thick sauce. Soft dumplings or spaetzle in very small pieces and butter or gravy. Soft-cooked cereals.
Vegetables
Very soft, well-cooked vegetables in very small pieces. Soft-cooked, mashed potatoes. Thickened vegetable juice.
Fruits
Canned or cooked fruits that are soft or moist and do not have skin or seeds. Fresh, soft bananas. Thickened fruit juices.
Meat and other protein foods
Tender, moist, and finely minced or ground meats or poultry. Moist meatballs or meatloaf. Fish without bones. Scrambled, poached, or soft-cooked eggs. Tofu. Tempeh and meat alternatives in very small pieces. Well-cooked, moistened and mashed beans, baked beans, peas, and other legumes.
Dairy
Thickened milk. Cream cheese. Yogurt. Cottage cheese. Sour cream.
Fats and oils
Butter. Margarine. Cream for cereal, depending on liquid consistency allowed. Gravy. Cream sauces. Mayonnaise.
Sweets and desserts
Pudding. Custard. Ice cream and sherbet. Whipped toppings. Soft, moist cakes. Icing. Jelly. Jams and preserves without seeds.
Seasoning and other foods
Sauces and salsas that have soft chunks that are smaller than 4mm. Salad dressings. Casseroles with small pieces of tender meat. All seasonings and sweeteners.
Beverages
Anything prepared at the thickness recommended by your dietitian.
What foods are not allowed?
Grains
Breads that are hard or have nuts or seeds. Dry biscuits, pancakes, waffles, and bread dressing. Coarse cereals. Cereals that have nuts, seeds, dried fruits, or coconut. Sticky rice. Large pieces of pasta.
Vegetables
All raw vegetables. Tough, fibrous, chewy, or stringy cooked vegetables, such as celery, peas, broccoli, cabbage, Brussels sprouts, and asparagus. Potato skins. Potato and other vegetable chips. Fried or French-fried potatoes. Cooked corn and peas.
Fruits
Hard, crunchy, stringy, high-pulp, and juicy raw fruits such as apples, pineapple, papaya, and watermelon. Fruits with skins and seeds, such as grapes. Dried fruit and fruit leather.
Meats and other protein foods
Large pieces of meat. Dry, tough meats, such as bacon, sausage, and hot dogs. Chicken, turkey, or fish with skin and bones. Crunchy peanut butter. Nuts. Seeds.
Dairy
Yogurt with nuts, seeds, or large chunks. Large chunks of cheese. Frozen desserts and milk consistency not allowed by your dietitian.
Sweets and desserts
Coarse, hard, chewy, or sticky desserts. Any dessert with nuts, seeds, coconut, pineapple, or dried fruit. Bread pudding.
Seasoning and other foods
Soups and casseroles with large chunks. Sandwiches. Pizza.
Summary
- Moist and minced foods can be helpful for people with moderate swallowing problems.
- On the dysphagia eating plan, you may eat foods that are soft, moist, and cut into pieces smaller than 4mm by 4mm.
- You may be instructed to thicken liquids. Follow your health care provider’s instructions about how to do this and to what consistency.
Dysphagia Diet – Bite Size Food
This diet plan is for people with moderate swallowing problems who have transitioned from pureed and minced foods. Bite size foods are soft and cut into small chunks so that they can be swallowed safely. On this eating plan, you may be instructed to drink liquids that are thickened.
Work with your health care provider and your diet and nutrition specialist (dietitian) to make sure that you are following the diet safely and getting all the nutrients you need.
What are tips for following this plan?
General guidelines for foods
- You may eat foods that are tender, soft, and moist.
- Always test food texture before taking a bite. Poke food with a fork or spoon to make sure it is tender.
- Food should be easy to cut and shew. Avoid large pieces of food that require a lot of chewing.
- Take small bites. Each bite should be smaller than your thumb nail (about 15mm by 15 mm).
- If you were on pureed and minced food diet plans, you may eat any of the foods included in those diets.
- Avoid foods that are very dry, hard, sticky, chewy, coarse, or crunchy.
If instructed by your health care provider, thicken liquids. Follow your health care provider’s instructions for what products to use, how to do this, and to what thickness.
- Your health care provider may recommend using a commercial thickener, rice cereal, or potato flakes. Ask your health care provider to recommend thickeners.
- Thickened liquids are usually a “pudding-like” consistency, or they may be as thick as honey or thick enough to eat with a spoon.
Cooking
- To moisten foods, you may add liquids while you are blending, mashing, or grinding your foods to the right consistency. These liquids include gravies, sauces, vegetable or fruit juice, milk, half and half, or water.
- Strain extra liquid from foods before eating.
- Reheat foods slowly to prevent a tough crust from forming.
- Prepare foods in advance.
Meal planning
- Eat a variety of foods to get all the nutrients you need.
- Some foods may be tolerated better than others. Work with your dietitian to identify which foods are safest for you to eat.
- Follow your meal plan as told by your dietitian.
What foods are allowed?
Grains
Moist breads without nuts or seeds. Biscuits, muffins, pancakes, and waffles that are well-moistened with syrup, jelly, margarine, or butter. Cooked cereals. Moist bread stuffing. Moist rice. Well-moistened cold cereal with small chunks. Well-cooked pasta, noodles, rice, and bread dressing in small pieces and thick sauce. Soft dumplings or spaetzle in small pieces and butter or gravy.
Vegetables
Soft, well-cooked vegetables in small pieces. Soft-cooked, mashed potatoes. Thickened vegetable juice.
Fruits
Canned or cooked fruits that are soft or moist and do not have skin or seeds. Fresh, soft bananas. Thickened fruit juices.
Meat and other protein foods
Tender, moist meats or poultry in small pieces. Moist meatballs or meatloaf. Fish without bones. Eggs or egg substitutes in small pieces. Tofu. Tempeh and meat alternatives in small pieces. Well-cooked, tender beans, peas, baked beans, and other legumes.
Dairy
Thickened milk. Cream cheese. Yogurt. Cottage cheese. Sour cream. Small pieces of soft cheese.
Fats and oils
Butter. Oils. Margarine. Mayonnaise. Gravy. Spreads.
Sweets and desserts
Soft, smooth, moist desserts. Pudding. Custard. Moist cakes. Jam. Jelly. Honey. Preserves. Ask your health care provider whether you can have frozen desserts.
Seasoning and other foods
All seasonings and sweeteners. All sauces with small chunks. Prepared tuna, egg, or chicken salad without raw fruits or vegetables. Moist casseroles with small, tender pieces of meat. Soups with tender meat.
What foods are not allowed?
Grains
Coarse or dry cereals. Dry breads. Toast. Crackers. Tough, crusty breads, such as French bread and baguettes. Dry pancakes, waffles, and muffins. Sticky rice. Dry bread stuffing. Granola. Popcorn. Chips.
Vegetables
All raw vegetables. Cooked corn. Rubbery or stiff cooked vegetables. Stringy vegetables, such as celery. Tough, crisp fried potatoes. Potato skins.
Fruits
Hard, crunchy, stringy, high-pulp, and juicy raw fruits such as apples, pineapple, papaya, and watermelon. Small, round fruits, such as grapes. Dried fruit and fruit leather.
Meat and other protein foods
Large pieces of meat. Dry, tough meats, such as bacon, sausage, and hot dogs. Chicken, turkey, or fish with skin and bones. Crunchy peanut butter. Nuts. Seeds. Nut and seed butters.
Dairy
Yogurt with nuts, seeds, or large chunks. Large chunks of cheese. Frozen desserts and milk consistency not allowed by your dietitian.
Sweets and desserts
Dry cakes. Chewy or dry cookies. Any desserts with nuts, seeds, dry fruits, coconut, pineapple, or anything dry, sticky, or hard. Chewy caramel. Licorice. Taffy-type candies. Ask your health care provider whether you can have frozen desserts.
Seasoning and other foods
Soups with tough or large chunks of meats, poultry, or vegetables. Corn or clam chowder. Smoothies with large chunks of fruit.
Summary
- Bite size foods can be helpful for people with moderate swallowing problems.
- On the dysphagia eating plan, you may eat foods that are soft, moist, and cut into pieces smaller than 15mm by 15mm.
- You may be instructed to thicken liquids. Follow your health care provider’s instructions about how to do this and to what consistency.
What research says about the Dysphagia Diet?
A study with an objective to design, deliver, and evaluate a tailored intervention to facilitate IDDSI implementation in aged care.
The background of this study The International Dysphagia Diet Standardization Initiative (IDDSI) has created global standardized definitions for texture-modified diets (TMDs) and thickened liquids to improve the safety and care for individuals with swallowing difficulties. The IDDSI framework guides health care facilities, such as aged care, to provide food to at-risk patients.
