Dysphagia Diet: Level 2 (Mechanically Altered)

When you have dysphagia, you have trouble swallowing. You are also at risk for aspiration. Aspiration is when food or liquid enters the lungs by accident. It can cause pneumonia and other problems. A dysphagia diet can help prevent aspiration.

The foods you eat can affect your ability to swallow. For example, soft foods are easier to swallow than hard foods. A dysphagia diet plan has 3 levels. Each level is based on how serious a person’s dysphagia is. A level 2 diet is the intermediate level. People on this diet should eat moist and soft-textured foods that are easy to chew. They can also eat pureed, pudding-like foods. They should avoid foods with coarse textures.

If you are on a level 2 dysphagia diet, there are certain foods you can and can’t eat. Make sure you follow all your healthcare provider’s instructions. Even eating 1 food that is not approved can greatly raise your risk for aspiration.

Foods you can eat:

• Pureed breads (also called pre-gelled breads)

• Cooked cereals with little texture, such as oatmeal, or slightly moistened dry cereals with little texture, such as corn flakes

• Smooth puddings, custards, yogurts, and pureed desserts

• Soft bananas, pureed fruits, and most canned and cooked fruits without seeds or skins

• Tender meat moistened with gravy, cut into very small pieces

• Cottage cheese, tofu, and well-cooked beans

• Poached, scrambled, or soft-cooked eggs

• Well-cooked potatoes, noodles, and dumplings

• Mashed potatoes

• Soups with easily chewed pieces

• Soft, well-cooked vegetables, cut into very small pieces

• Souffles

Foods to avoid:

• Other non-pureed dry breads

• Very coarse cereals

• Coarse, dry cakes and cookies, or any desserts with added dried fruits, seeds, or nuts

• Fresh or frozen whole fruit or cooked fruit with skin or seeds, or dried fruit

• Canned pineapple

• Dry or tough meats

• Soups with large chunks

• Raw or barely cooked vegetables

• Seeds, nuts, or chewy candies

While eating, it may help to sit upright. You may need support pillows to get into the best position. It may also help to have few distractions while drinking. Changing between solid food and liquids may also help your swallowing.

Stay upright for at least 30 minutes after eating. This can help reduce the risk for aspiration. Keep watch for symptoms of aspiration such as:

• Coughing or wheezing during or right after eating

• Too much saliva

• Shortness of breath or tiredness while eating

• A wet-sounding voice during or after eating or drinking

• Fever 30 to 60 minutes after eating

Ask your healthcare provider about what kinds of liquids are safe for you on a level 2 dysphagia diet. Some people can drink thin liquids, but others should not. If you can’t have thin liquids, make sure your liquids are thickened. Your healthcare provider will give you more information about how to manage the thickness of liquids.

• Follow all instructions about what food and drink you can have.

• Do swallowing exercises as advised.

• Do not change your food or liquids, even if your swallowing gets better. Talk with your healthcare provider first.

• Tell all healthcare providers and caregivers that you are on a dysphagia diet. Explain which foods and liquids you can and can’t have.

Your healthcare team will keep track of how well you are swallowing. You may need follow-up tests such as a fiberoptic endoscopic evaluation of swallowing (FEES) test. If your swallowing gets better, you may be able to change your diet. Many people who have dysphagia because of a stroke find that their swallowing problems improve with time and therapy. If your swallowing gets better, you may be able to change to a less restrictive diet. If your swallowing gets worse, you may need to change to a level 1 diet for a period of time. Or you may need other methods of getting nutrition for a period of time. For example, you may need a feeding tube.

Call 911 if you have trouble breathing during or after eating.

Call your healthcare provider right away if you have any of these:

• Your trouble swallowing gets worse

• Unintended weight loss

• Food comes back up into your mouth

• Vomiting

• A wet-sounding voice after eating or drinking