Dysphagia Diet and its 4 Levels of Foods

Dysphagia is a medical condition characterized by difficulty swallowing, which can range from mild discomfort to severe pain and complete obstruction. The condition can be caused by a variety of factors, including stroke, head injury, multiple sclerosis, dementia, cancer, and gastroesophageal reflux disease (GERD).

Individuals with dysphagia need to modify their diet to ensure that they can safely and comfortably consume foods and liquids. A dysphagia diet usually involves choosing foods that are easy to swallow and avoiding foods that may cause choking or aspiration.

This article provides an overview of dysphagia and its causes, with a special focus on the dysphagia diet. This includes information on which foods may be better to eat and which foods should be avoided for safe and comfortable swallowing.

Various factors such as aging, malnutrition, muscle deterioration, surgery, neurological disorders, severe dental problems, mouth ulcers, and reduced salivation can negatively affect the normal swallowing response, leading to dysphagia.

Dysphagia can significantly affect a person’s quality of life, and proper diagnosis and management of the underlying cause, along with appropriate dietary modifications, can help by maintaining adequate nutrition and hydration.

Symptoms of Dysphagia

Dysphagia may present with a variety of symptoms, which may vary in severity depending on the underlying cause. Some common symptoms associated with dysphagia include:

  • pain or discomfort when swallowing
  • inability to swallow food or liquids
  • feeling that food is stuck in the throat, chest, or behind the sternum
  • Coughing, choking, or vomiting while eating or drinking.

It is important to note that dysphagia can be a serious medical condition that requires immediate attention and treatment. Individuals experiencing any of these symptoms should seek medical evaluation.

Main Considerations of Dysphagia

Choosing the right foods to eat can be a challenge when living with dysphagia, as it’s important to make sure the food is safe and easy to swallow. Along with the texture and thickness of food, it is important to consider its rheology, which is the science of identifying and measuring the texture of food.

The process of chewing and swallowing food involves various effects, such as compression, viscosity, tensile, shear, and fracture.

  • Compression: Compression refers to the act of crushing food and deforming it.
  • Adhesiveness: Adhesion occurs when food sticks to another surface, such as the roof of the mouth.
  • Tensile: Tensile means pushing food toward the esophagus by the muscles of the throat.
  • Shear: Shearing occurs when food is broken up by molars during chewing.
  • Fracture: The fracture occurs when food is broken by two opposing forces, as when biting into a cracker.

If any of these effects are disrupted, it can result in dysphagia. Therefore, it is necessary to modify the texture of the food to ensure that it is safe to swallow.

Dysphagia Diet Levels

Choosing the right diet for someone with dysphagia can be a challenging process.

One approach is to use the four different Levels of Dysphagia Diet, which provides a framework for caregivers and health care professionals to determine which foods and liquids are safe for the individual to consume.

Dysphagia Diet Level 1

The dysphagia diet consists primarily of pureed or smooth foods that do not require chewings, such as yogurt, smooth soups, pureed vegetables and meats, and mashed potatoes with gravy.

Careful attention must be paid to the texture and consistency of these foods to ensure they can be swallowed safely without choking or discomfort. Those preparing food for someone on a dysphagia diet should follow puree food recipes to ensure that the food is prepared appropriately.

Dysphagia Diet Level 2

The next level of the dysphagia diet includes foods that are moist and may require some chewing, such as soft scrambled eggs, cheese, peanut butter, and soft or ground meat. Soft-cooked or mashed fruits and vegetables and foods with extra gravy can also be included.

However, dry and crunchy foods such as crackers and nuts are generally excluded from this diet. It is important to note that foods at this level must be prepared and served in a way that ensures they can be swallowed safely without causing discomfort or choking.

Dysphagia Diet Level 3

To progress from the previous level, this level of the dysphagia diet requires a high level of chewing. This includes foods such as sliced or diced meat, soft bread, cooked fruits and vegetables, and mashed potatoes.

However, crunchy or sticky foods as well as dry foods such as crackers, chips, and nuts should still be avoided. These foods can pose a choking hazard or cause discomfort when swallowed.

It is essential to work with a health care professional or dietitian to ensure that the individual’s nutritional needs are being met while following the guidelines for the dysphagia diet.

Dysphagia Diet Level 4

All types of food are allowed.

In addition to these Dysphagia Diet Levels, a common solution is to thicken the liquid with a gel, gum, or powder-like substance. This can help slow the rate of fluid flow and reduce the risk of aspiration.

Dysphagia Diet Menu

Foods to Eat

Here is a list of food options that are commonly recommended for people with dysphagia:

  • Pureed or mashed fruits and vegetables such as applesauce, mashed bananas, and pureed carrots
  • Mashed Potatoes
  • Smooth Soups and Broths
  • soft scrambled eggs
  • cottage cheese
  • Smoothie made of yogurt, milk, and soft fruits
  • ground or puréed meats such as meatloaf, puréed chicken, and puréed fish
  • moist, soft slices of bread such as white bread and soft tortillas
  • cooked, soft cereals such as cream of wheat or oatmeal
  • soft, cooked pasta such as spaghetti and macaroni

Foods to Avoid

List of foods to avoid for individuals with dysphagia:

  • Bacon
  • Bread pudding
  • Broccoli or cabbage
  • Cakes or cookies that are not moist
  • Canned pineapple
  • Cereals that have seeds, nuts, or small bits of other foods in them
  • Chips
  • Cooked corn
  • Cooked peas
  • Cooked pineapple
  • Dry slices of bread and rolls
  • Dry, tough meats
  • Fresh pineapple
  • Hard candies
  • Hot dogs
  • Peanut butter
  • Raw fruits
  • Raw vegetables
  • Rice pudding
  • Sausage
  • Sandwiches


While managing dysphagia can be a challenging condition, there are many ways to address it. In some cases, it may be possible to correct the underlying cause of dysphagia. However, it requires thinking outside the box and special care.

Starting with an appropriate level of dysphagia diet may be one approach, along with consulting a functional medicine specialist who has experience treating the condition. It’s important to find a specialist who has a proven track record of success in treating dysphagia.

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