DYSPHAGIA DIETS;
Diet Restrictions, Modifications, Recommendations
As a caregiver or possibly the Dysphagia patient, you have been given recommendations based on your level of Dysphagia on what you should eat now that you have been discharged from the hospital or rehab. This can sometimes be confusing or scary for you. Therefore, I am posting diet recommendations for each level of Dysphagia.
When appetite declines and your loved one is refusing food, it's quite difficult to accept. We all know that you have to eat to live, but what many of us don't know is that if your body can't process the food because of a terminal illness, forcing nutrition in will not prolong life at this time. There is a natural process in the dying: decreased appetite, decreased thirst, gradual withdrawal from the concerns of this world and focus on concerns about death and taking care of "unfinished business" with family.
When the body's metabolism begins to shut down in the dying process, it no longer builds the body's tissues and organs; this is what's called an "anabolic" state of metabolism. When the body's tissues and organs begin to break down, whether or not nutrition is taken in, it's called a "catabolic" state of metabolism. In the catabolic state, food is not absorbed, tissues no longer heal well, infection is difficult to cure and an irreversible downward spiral is set into motion. Whether a patient eats food, is fed a liquid diet through a feeding tube, or gets intravenous nutrition ("total parenteral nutrition" or "TPN"), the nutrients taken in will not stop this catabolic process. That is why it is imperative we take into account Quality of Life when a patient is at this point especially but at all times during an illness so hopefully with support, a smiling face, providing the patient with what THEY want will keep them fighting and here longer. There are several ways to provide nutrition and liquids. The patient is the professional in what is happening to their body and what they want. When deciding on a treatment plan it must be a collaborative decision. We must educate, offer options, allow the patient/family to decide treatment, and execute their choice of treatment.
National Dysphagia Diet Levels
- NDD Level 1: Dysphagia-Pureed (homogenous, very cohesive, pudding-like, requiring very little chewing ability).
- NDD Level 2: Dysphagia-Mechanical Altered (cohesive, moist, semisolid foods, requiring some chewing).
- NDD Level 3: Dysphagia-Advanced (soft foods that require more chewing ability).
- Regular (all foods allowed).
- Modified Regular Food Diet
- May note certain foods to avoid
- May restrict liquids completely
- May alter liquids to either Thicken liquids; nectar thick, honey thick, pudding thick, or may alter how they are swallowed (i.e., use of teaspoon).
- May provide "pleasure feeds" or "pleasure drinks" throughout a day
The International Dysphagia Diet Standardization Initiative (IDDSI)
The International Dysphagia Diet Standardization Initiative (IDDSI) has recently created an initiative for global diet terminology and definitions to ensure safe and effective treatment for our patients on an international level. The IDDSI has standardized food textures and liquids for global use and can be found here: http://iddsi.org/
**Please as always, keep in mind to discuss these new dysphagia diet recommendations with your Speech Language Pathologist and your Physician as you are an individual and every diet/treatment plan is individualized based on each condition we treat. Also keep in mind that below are diet recommendations, not diet rules! These recommendations do not consider liquid restrictions. For example, if your loved one is on a mechanical soft diet, that menu may recommend ice cream, as we know that is a soft food, however, if the patient is on a liquid restriction, ice cream may not be a good choice due to difficulties with liquid. So please, consult with, or ask any questions with your Speech Language Pathologist.
Considerations:
- Maintaining adequate nutrition is necessary especially in the older adult. Consulting with a Nutritionist may be a possibility,
- Minimize dietary restrictions to encourage better food intake and quality of life. Maintaining the desire to eat and the enjoyment of food minimizes the risks of malnutrition and weight loss.
- Consider providing Ensure at meals to increase nutrients and calories.
NDD Level 1: Dysphagia-Pureed Diet
Description: The diet is soft in texture, mechanically nonirritating, and low in fiber. Foods prepared on the Pureed Diet should be smooth and pudding-like. Foods are thick and smooth and have a moist pudding like consistency without pulp or small food particles. They should cling together, be easy to swallow, and require a minimum amount of manipulation in the mouth. Sticky foods or foods that require bolus formation (chewing) or controlled manipulation of the mouth (eg, melted cheese and peanut butter) are omitted. Food and fluid intake should be closely monitored.
Click HERE for a great website with that offers great appetizing meals for pureed diets. They print new recipes often. http://pureeddietoptions.wordpress.com/
You can also go to this website http://www.dysphagia-diet.com/t-resources.aspx to download the below NDD Food Guides ! & 2 written in English and in Spanish
National Dysphagia Diet
NDD Food Guide - Pureed Diet
Food Group
Beverages & Milk Cereals and Grains Vegetables & Potatoes/Soups Fruits & Juices Meats, Meat Substitutes, Entrees Desserts Fats Miscellaneous |
Foods Allowed
All smooth, as desired thin liquids if allowed All farina type cooked cereals; strained oatmeal, Pregaelled or slurried through entire thickness, doughnuts, pancakes, waffles, French toast, & soft bread Pasta, rice, & dressing that are pureed to smooth consistency Regular soft bread if resident's swallowing ability permits Pureed or strained vegetables without chunks or seeds, mashed white potatoes All smooth cream soups or broth-type soups with pureed or strained ingredients Applesauce, pureed fruits, well mashed bananas, fruit juices without pulp Pureed or strained meats, poultry, or fish, cottage cheese, scrambled egg, cheese sauce Custard, pudding, gelatin, fruit whips, cakes, cobblers, & pies pureed soft cookies & plain cakes ice cream, sherbert, & frozen yogurt are allowed if on thin liquids Butter, margarine, smooth gravy, cream sauces, mayonnaise, salad dressings, cream cheese, sour cream, whipped toppings Sugar, jelly, honey, syrup, ketchup, mustard, smooth sauces |
Foods Excluded
Beverages with seeds, lumps, or pulp Milk, coffee, tea, sodas, nutritional supplements (may be given if thin liquids are allowed) Coarse cooked cereal, dry cereals, cereals with seeds or nuts All other breads Crackers Regular cooked or raw vegetables (not pureed) Potato skins and chips Fried or french-fried potatoes or vegetables Regular soups with rice, corn, peas, or large chunks of meat & vegetables Regular canned, fresh, or frozen fruits, fruit juice with pulp (may be given if thin liquids are allowed) Regular or chopped meats or casseroles, cheese slices or cubes, hard cooked egg, peanut butter, sandwiches, pizza Regular cake, pie, cookies, bread & rice pudding, fruited yogurt Fats with course or chunky additives Jams & preserves, Coarsely ground pepper & spices |
NDD Level 2: Dysphagia-Mechanical Altered
Description: Foods are moist, soft, easy to chew, and easily form into a cohesive bolus. The diet is intended to provide a transition from puree to easy to chew foods. Moistened ground meats (pieces should not exceed 1/4 inch cube), vegetables cooked to a soft mashable texture, soft cooked or canned fruits, and mashed bananas are included. Some mixed textures are expected to be tolerated. More frequent feedings may find to be beneficial. Food and fluid intake should be closely monitored.
National Dysphagia Diet
NDD Food Guide - Mechanical Soft Diet
Food Group
Beverages & Milk Cereals & Grains Cereals may have 1/4 cup milk or just enough to moisten if thin liquids are restricted. The moisture should be well blended. Vegetables & Potatoes/Soups Vegetables should be less than 1/2 inch and easily mashable with a fork Fruits & Juices Meats, Meat Substitutes, Entrees Meat pieces should not exceed 1/4 inch cube & should be tender Desert Fats Miscellaneous |
Foods Allowed
Beverages with minimal amounts of texture or pulp (any texture should be suspended in the liquid & should not precipitate out) Soft pancakes, well moistened with syrup, Cooked cereal with little texture, including oatmeal, slightly moistened cold cereals with little structure such as corn flakes Unprocessed wheat bran stirred into cereals for bulk Pregelled or slurried breads that are gelled through the entire thickness Well cooked pasta in sauce Soft cooked or mashed vegetables including cooked vegetables without hull or stringy fibers Well cooked shredded hash browns that are not crisp Soups with easy to chew or easy to swallow meats or vegetables thickened to appropriate viscosity Soft drained canned or cooked fruits without seeds or skin, fresh soft/ripe bananas, jelled cranberry sauce Fruit juices with small amounts of pulp thickened if needed Moist ground meat, casseroles (without rice); melted cheese in casseroles, Protein salads, such as tuna or egg, without large chunks, celery or onion, Cottage cheese, smooth quiche without large chunks Scrambled eggs, souflees Well cooked, slightly mashed moist legumes such as baked beans Custard, pudding Soft fruit pies with bottom crust only Crisps and cobblers without seeds, coconut, or nuts & with soft breading or crumb mixture Soft, moist cakes with icing or slurried cakes Pregelled cookies or soft, moist cookies that have been dunked in milk, coffee, or other liquid Soft, smooth chocolate bars that are easily chewed Butter, margarine, smooth gravy, cream sauces, mayonnaise, salad dressings, cream cheese, sour cream, whipped toppings Jams & preserves without seeds; jelly Sauces & salsas with small tender chunks, less than 1/2 inch |
Foods Excluded
Milk, coffee, tea, sodas, nutritional supplements (may be given if thin liquids are allowed) Coarse cooked or whole grain dry cereals with seeds or nuts All other breads Crackers Rice Cooked peas or corn, raw vegetables Potato skins & chips Fried or french fried potatoes or vegetables Broccoli, cabbage, brussels sprouts, asparagus, or other fibrous non-tender, or rubbery cooked vegetables Soups with rice, corn, peas, or large chunks or meat & vegetables Fruit cocktail, grapes cherries, or apricots with skin; fresh, canned or cooked pineapple, fresh fruits except ripe banana, dried fruits, frozen fruits Watermelon without seeds (may be given if thin liquids are allowed) Dry or tough meats (such as bacon, sausage, hot dogs, bratwurst) Dry casseroles or casseroles with rice or large chunks Cheese slices or cubes Hard cooked eggs Peanut butter Sandwiches Pizza Ice cream, sherbet, frozen yogurt, & other ices (may be given if thin liquids are allowed) Dry cookies or cake Bread & rice pudding Fats with course or chunky additives Seeds, coconut, nuts Sticky or hard foods |