Dysphagia Diet: Level 3 (Advanced)

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 3 diet is the least limited. It is used as a transition to a normal diet. People on this diet can eat bite-sized pieces of moist foods with near-normal textures. They should avoid very hard, sticky, or crunchy foods, such as dried fruit or nuts.

If you are on a level 3 dysphagia diet, there are certain foods you can and can’t eat. The foods should all be easy to cut. You should avoid anything that is hard to chew. Make sure you follow all your healthcare provider’s instructions. Even eating one food that is not approved can greatly raise your risk for aspiration.

Foods you can eat:

• Well-moistened breads. You may need to add jelly, butter, or other soft spread.

• All well-moistened cereals

• Moist desserts that don’t contain nuts, seeds, or dried fruit

• All canned and cooked fruits, soft and peeled fresh fruit

• Tender, thin-sliced meats and fish

• Any kind of eggs

• Yogurt

• Rice, noodles, and most cooked potatoes

• Most soups

• Cottage cheese, tofu, and well-cooked beans

• All cooked, tender vegetables

• Most non-chewy candies

Foods to avoid:

• Dry bread, crackers, and tough breads

• Very coarse cereals or dry cereals

• Cookies or cakes that are very dry or that contain nuts, dried fruit, seeds, or other hard pieces

• Fresh fruit that is hard to chew

• Dry or tough meats

• Chunky peanut butter

• Potato skins, potato chips, corn, or popcorn

• Most raw vegetables

• Nuts, seeds, or coconut

• Very sticky foods, like 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 3 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 health care 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 get better 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 2 or 1 diet for a period of time.

Call 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