Unit 3 - Diet and nutritional treatment approach for dysphagia

3.2.4. Foods and ingredients for dysphagia diets

3.2.4.2. Dysphagia diet may be adapted to three levels

Food products: Protein foods

1. Dysphagia Soft and Bite Sized Diet	2. Dysphagia Ground Diet	3. Dysphagia Pureed Diet
Moist ground or finely diced meats Solid tender cuts of meat that can be cut with a fork Meatloaf, hamburger or cheeseburger Sausages, thin or sliced lunch meat Chicken, egg, or tuna salad Shredded cheese, cheese slices Eggs prepared any way except fried	Ground meats such as hamburger or ground turkey with gravy Meat loaf or meat balls Soft fish, tuna fish Chicken, tuna, egg salad (no large chunks) Poached, scrambled, or soft-cooked eggs Well-cooked slightly mashed beans Hummus, bean dips	Strained or pureed meat, fish, poultry – can add gravy or broth Smooth chicken, tuna and egg salad (no celery or onion)

To avoid

1. Dysphagia Soft and Bite Sized Diet	2. Dysphagia Ground Diet	3. Dysphagia Pureed Diet
Dry, tough, chewy or crispy meats; Meats with gristle; Pizza Dry fish or fish with bones; Nuts, Seeds.	Dried meats, jerky, bacon, fried food, hot dogs, salami, bratwurst, pizza Tough meat Beans, fried eggs, large cubes of meat in casseroles	Eggs unless scrambled or soft cooked which can be processed to puree consistency Bacon, hot dogs, sausage links Dried beans

Food products: milk, yoghourt, cheese

1. Dysphagia Soft and Bite Sized Diet	2. Dysphagia Ground Diet	3. Dysphagia Pureed Diet
Milk, milk shakes, smoothies, yogurt with soft fruit. Soft cheese such as ricotta. Cheddar cheese if grated and melted Shredded cheese, cheese slices	Yogurt with small pieces of fruit Milkshakes, malts, ice cream – do not use if on thickened liquid diet as these become thinner as they melt Pureed cottage cheese, think ricotta cheese, cheeses melted into a sauce Soft cheeses (cream cheese, cottage cheese)	All liquids such as milk are dependent on the thickness of liquids allowed Milkshakes, malts, ice cream – do not use if on thickened liquid diet as these become thinner as they melt Liquid nutritional supplements such as Ensure or Carnation Breakfast Smooth yogurt – plain or without fruit pieces Pureed cottage cheese, think ricotta cheese, cheeses melted into a sauce Smoothies made with bananas, peaches or sorbets

To avoid

1. Dysphagia Soft and Bite Sized Diet	2. Dysphagia Ground Diet	3. Dysphagia Pureed Diet
Yogurt with seeds, nuts, muesli or hard pieces of fruit, hard cheese such as cheddar.	Avoid ice cream, milk shakes, frozen yogurt, sherbet if on a thickened liquid as this melts into a thin liquid. Stringy or crumbly cheese, dry/hard	Solid cheeses, regular cottage cheese, farmer cheese and pot cheese Cubed or sliced cheese

Food products: soups

1. Dysphagia Soft and Bite Sized Diet	2. Dysphagia Ground Diet	3. Dysphagia Pureed Diet
All cream-based or broth-based soups (with thickness as recommended according to swallowing evaluation); Chili soup, not very spicy (beans must be soft); Chowder soup.	Soups (blended and smooth to avoid large chunks)	Soups with pureed or strained vegetables Strained and pureed creamed soups: pureed chicken noodle, chicken & rice soups Broth and bouillon (dependent on thickness of liquids allowed)

To avoid

1. Dysphagia Soft and Bite Sized Diet	2. Dysphagia Ground Diet	3. Dysphagia Pureed Diet
Soups with tough meats; Corn or clam chowder unless strained; Soups with meat or vegetable pieces greater than one inch in size.	Corn or clam chowder; Soups with lumps;	Soups with chunks of food in it

Food products: grains, cereals, breads, starches

1. Dysphagia Soft and Bite Sized Diet	2. Dysphagia Ground Diet	3. Dysphagia Pureed Diet
All porridges, without lumps; Well moistened breads, biscuits, muffins, pancakes, waffles (moisten with syrup, jelly or butter) Macaroni and cheese, moist rice. Tender fried potatoes.	Pancakes French toast, waffles All porridges, Moist muffins, soft breads without crusts Toast with butter and jelly – minced into 1/4 inch pieces Sticky rice or mix rice with soft beans and sauce Well-cooked pasta with sauce Potatoes without skin - soft & moist with butter, gravy, sauce, etc.	Cooked cereals, cream of wheat or rice – blend with milk and strain for any lumps Smooth or blended oatmeal Pureed pasta or rice Whipped or smooth mashed potatoes Baby cereal Pancakes, French toast – blend with syrup Muffins without nuts or seeds – blend to a pureed consistency and serve with butter

To avoid

1. Dysphagia Soft and Bite Sized Diet	2. Dysphagia Ground Diet	3. Dysphagia Pureed Diet
Bagels, dry bread, bread with seeds or grains, toast, crackers; Coarse or dry cereal such as shredded wheat or All Bran; granola Crispy, fried food, such as grilled cheese; Popcorn, chips. Tough, crisp-fried potatoes or potato skins.	Bagels English Muffins, French bread Granola, Cold, dry cereals with milk Dry crumbly rice	Bread, bagels, dinner rolls Crackers, chips, popcorn Cold cereal, granola, or cereals that are not easily blended and strained Rice, pizza

Food products: fruits and vegetables

1. Dysphagia Soft and Bite Sized Diet	2. Dysphagia Ground Diet	3. Dysphagia Pureed Diet
All canned and cooked fruit, ripe bananas; Soft pealed fresh fruits such as peaches, nectarines, kiwi, mango, cantaloupe, honeydew and watermelon without seeds; Soft berries with small seeds such as strawberries; Soft cooked vegetables that are fork tender; Shredded lettuce, tender fried potatoes.	Soft fruit like ripe bananas, mashed strawberries Canned or cooked fruits (peaches, pears; not pineapple or fruit cocktail) Well-cooked, soft vegetables such as carrots Squash Stewed tomatoes	Vegetable juices or tomato Fruit juices and nectars (liquids are dependent on thickness of liquids allowed) Cooked vegetables that can be mashed or don’t require a lot of chewing (must be processed into a puree) Pureed fruits – either raw or cooked Smooth applesauce Baby food fruit or vegetables Fruits such as mashed bananas or mashed canned fruits (blend smooth to a puree)

To avoid

1. Dysphagia Soft and Bite Sized Diet	2. Dysphagia Ground Diet	3. Dysphagia Pureed Diet
Hard to chew fresh fruits such as apples and pears; Grapes, raisins, coconut; Pineapple, oranges or other stringy high pulp fruit; Fruit leather, fruit roll-ups, fruit snacks; Raw vegetables, salads; Corn, broccoli, cabbage, brussels sprouts, asparagus, or other fibrous cooked vegetables;	Fruits that contain a lot of juice (melon, watermelon, grapes, oranges) as the liquid these contain can spill into the throat. Fruits with skins unless they can be removed Fruits with seeds Corn, peas, string beans Cole slaw, mixed salads, raw vegetables	Pineapple, oranges, or other stringy, high pulp fruit Vegetables or fruits that have seeds Salads, dried fruits

Food products: condiments

1. Dysphagia Soft and Bite Sized Diet	2. Dysphagia Ground Diet	3. Dysphagia Pureed Diet
Margarine or butter Sour cream, cream cheese Ketchup, mustard, mayonnaise Gravy, steak sauce, BBQ sauce Herbs, spices	Butter, margarine, syrup Sour cream, mayonnaise, Cream cheese, whipped cream Smooth jelly, (no seeds or chunks)	Salt, pepper, ketchup, mustard (without seeds), mayonnaise Herbs and spices Sauces such as BBQ

To avoid

1. Dysphagia Soft and Bite Sized Diet	2. Dysphagia Ground Diet	3. Dysphagia Pureed Diet
Olives, pickles Peanut butter	Nuts, seeds Peanut butter	Nuts, Coconut Olives Pickles Anything with seeds Peanut butter

Food products: desserts

1. Dysphagia Soft and Bite Sized Diet	2. Dysphagia Ground Diet	3. Dysphagia Pureed Diet
Soft cookies, custard, fruit pies; Jell-O, sherbet, sorbet Ice cream (unless on thickened liquids); Moist cakes, pudding, yogurt. Sugar, honey, syrup, jelly .	Desserts: Pudding, custard, mousse Cobbler bottom crust and soft topping Moist, soft cake with icing Soft cookies Yogurt with small pieces of fruit Fruit pies with soft crust (not too flaky)	Smooth custard and pudding Sherbet, ice cream, frozen yogurt – not allowed if on thickened liquids Flavored fruit ices, popsicles, fruit whips, and gelatins (dependent on ability to handle thin liquids). Syrups including chocolate or maple syrup Mousse. Clear jelly, honey, sugar

To avoid

1. Dysphagia Soft and Bite Sized Diet	2. Dysphagia Ground Diet	3. Dysphagia Pureed Diet
Hard cookies, hard candy, chewing gum Chewy candy or desserts Anything with nuts, seeds, dry fruits, coconut, or pineapple	Desserts that are dry, hard, crumbly, contain nuts or are too chewy. Avoid ice cream, milk shakes, frozen yogurt, sherbet if on a thickened liquid as this melts into a thin liquid.	Anything made with nuts, coconut, or whole fruits

Food products: beverages

You can choose any smooth, homogenous beverages without lumps, chunks, or pulp. Beverages may need to be thickened to appropriate consistency

You must avoid any beverages with lumps, chunks, seeds, pulp, etc