Dysphagia Diet

Updated 09/24/2018
Category: Diet

Dysphagia means difficulty with chewing or swallowing food or liquid. The dysphagia diet covers 5 levels for difficulty in swallowing. To understand how this might happen, it is important to know something about how swallowing occurs. First, food must be chewed thoroughly. Then it is moved to the back of the mouth by tightening the cheek muscles and pressing the tongue against the roof of the mouth. From this point on the process becomes automatic — it is a reflex that people do not actively control. In “rapid- fire” succession, the soft palate closes the nasal airway to prevent food from backing into it, the airway into the lungs is closed, and the esophagus (food pipe) relaxes allowing food and liquid to enter it. The muscular esophagus then contracts in a wave-like action, sweeping the food along into the stomach. A blockage or a malfunction anywhere in this part of the body or in the nervous system controlling swallowing can result in dysphagia. There are two types:

Esophageal dysphagia occurs when food/liquid stops in the esophagus. This can happen in several ways.  Stomach acid can reflux into the esophagus. Over time, the reflux causes inflammation and a narrowing (stricture) of the esophagus. Food and eventually liquids feel like they are sticking in the middle and lower chest. There may be chest discomfort or even real pain. Fortunately, physicians can usually dilate (widen) this narrowing, and there is now treatment available to keep it from returning. Cancer, hiatus hernia, and certain muscle disorders of the esophagus are less frequent causes of esophageal dysphagia. Solid food is usually more of a problem than liquids

Oropharyngeal dysphagia involves difficulty moving food to the back of the mouth and starting the swallowing process. This type of dysphagia can result from various nerve or brain disorders such as stroke, cerebral palsy, multiple sclerosis, Parkinson’s and Alzheimer’s diseases, cancer of the neck or throat, a blow to the brain or neck, or even dental disorders. Depending on the cause, symptoms may include drooling, choking, coughing during or after meals, pocketing of food between the teeth and cheeks, gurgly voice quality, inability to suck from a straw, nasal regurgitation (food backing into the nasal passage), chronic respiratory infection, or weight loss. Liquids are usually more of a problem in oropharyngeal dysphagia.

The first step in treatment is to make the proper diagnosis. This involves a medical history and various tests to find the cause of the dysphagia. Often a team approach to treatment is needed. Several types of health care providers — physicians, registered dietitian, psychologist, speech pathologist, occupational therapist — work together to develop the best program.

An important part of the treatment is helping the patient get adequate nutrition, while protecting against complications such as pneumonia from food or liquid getting into the lungs. Obviously, this requires a specialized diet. There are five different diet levels from puréed (level 1) up through modified regular food (level 5). The diets vary in texture and consistency, and are chosen depending on which would be most effective for a specific patient..

Nutrition facts

These diets are all nutritionally adequate. However, some patients may have difficulty taking enough fluid and food to get all the energy and nutrients they need. In this case, an adjustment to diet or treatment will be required.

Liquids

Fluids are essential to maintain body functions. Usually 6 to 8 cups of liquid (48-64 oz) are needed daily. For some dysphagia patients, this may present problems because thin liquid can be more difficult to swallow. In this case, fluid can be thickened to make it easier to swallow. However, close monitoring by the dysphagia team is required for anyone drinking less than 4 cups of thickened fluid a day or anyone not progressing to thin liquids within 4 weeks.

Calories

The greater problem for some patients is eating enough calories. The whole process of eating simply becomes too difficult and too tiring. However, calorie and protein intake can be increased by fortifying the foods the patient does eat.

• Fortify milk by adding 1 cup of dry powdered milk to one quart of liquid milk. Use this protein fortified milk when making hot cooked creamed soups, sauces, milkshakes, and puddings. Also add margarine, sugar, honey, jelly, or puréed baby food to increase calories.
• Add strained baby fruit to juices, milkshakes, and cooked cereals.
• Add 1 jar of strained baby meat to soup, such as strained chicken noodle soup. Also add strained baby meats to sauces and gravies, and mix with strained vegetables.
• Add juice to prepared fruit, cereal, or milkshakes.

Textures/Consistencies of Foods

The following are examples of medium and thick liquids and foods.

Medium (nectar consistency):

• eggnog
• fruit nectars
• (apricot, peach, pear)
• honey
• thick creamed soups
• soft set pudding with added
• milk
• tomato juice
• buttermilk
• ice cream
• (no nuts or fruit chunks)
• milkshakes

• Thick (yogurt or pudding consistency):

  • cooked hot cereal
  • pudding
  • custard
  • gravy
  • yogurt (no nuts or fruit chunks)
  • cottage cheese mixed in
  • blender with milk or fruit
  • thick malt and milkshakes

Thickening and Thinning Agents

Foods can be thickened or thinned to individual requirements. Many foods can be used to change a liquid to a different consistency. The amount of thickening agent needed to reach a certain food consistency varies depending on the food being thickened and on the thickening agent used.

How to Thin Liquids

• Add hot milk-based liquids (hot milk or cream) to puréed soups, puréed vegetables, or cooked cereal.
• Add other hot liquids (broth, gravy, sauces) to mashed potatoes, puréed or ground meats, and puréed or chopped vegetables. Butter or melted margarine may also be used.
• Add cold milk-based liquids to cream, yogurt, cold soups, puréed fruits, or puddings and custards.

How to Thicken Liquids and Foods

• Add baby rice or commercial thickener to hot milk-based liquids.
• Add potato flakes, mashed potatoes, or flaked baby cereal to other hot liquids (soups, sauces, gravies).
• Add plain unflavored gelatin, puréed fruits, banana flakes, or a commercial thickener to cold liquids.
• Add potato flakes, mashed potatoes, thick sauces or gravies, canned puréed or strained meat (baby food), or a commercial thickener to puréed soups.
• Add flaked baby cereal, flavored gelatin, cooked cream of rice or wheat cereal, or a commercial thickener to puréed fruits.
• Add mashed white or sweet potatoes, potato flakes, sauces, or commercial thickener to puréed vegetables.

If a Food is Too Thin, Add One of the Following:

• baby cereal
• banana flakes
• bread crumbs
• cornstarch
• cooked cereals (cream of wheat or rice)
• custard mix
• graham cracker crumbs
• gravy
• instant potato flakes
• mashed potatoes
• plain unflavored gelatin powder
• plain sauces (white, cheese, tomato)
• puréed fruits (baby food)
• puréed meats (baby food)
• puréed vegetables (baby food)
• saltine cracker crumbs

If a Food is Too Thick, Add One of the Following:

• broth
• bouillon
• gravy
• juice
• liquid flavored gelatin
• melted hot butter/margarine
• milk (hot or cold)
• plain yogurt
• strained puréed soups