Dysphagia Diet Levels
National Dysphagia Diet Level 2: Mechanical Altered (cohesive, moist, semisolid foods, requiring some chewing).
Preparation for Dyphagia II
Meats, fruits and vegetables should be moist, soft and finely chopped into 1/4 inch pieces. Meats should be served with sauces or gravy, and vegetables should be easily mashed with a fork. Some foods will remain pureed due to tough or chewy texture. All Dysphagia I foods are acceptable.
No breads, unless pureed are allowed on a Dysphagia II diet. No tough, hard foods such as rice, nuts, seeds, corn, peas, fried foods or candy on this diet.
Sample of Foods Allowed on Dysphagia Diet Level II (Mechanical Altered)
| Food Groups | Foods Allowed | Foods to Avoid |
| Meats and Meat Substitutes | Moistened ground or cooked meat, poultry, or fish (serve with sauces) Casseroles without rice Moist, well-cooked pasta Moist meat loaf or meat balls Poached, scrambled, or soft-cooked eggs Tofu Well-cooked and moist mashed legumes or beans |
Dry meats such as bacons, sausage, or hot dogs Dry casseroles or casseroles with rice or large chunks Cheese cubes and slices Peanut butter Hard-cooked or crisp fried eggs Sandwiches and pizza |
| Breads | Soft, well-moistened pancakes Pureed bread mixes or slurried breads |
Slices of bread Toast |
| Cereals | Cooked cereals with little texture, including oatmeal Slightly moistened-dry cereals with little texture |
Coarse cooked cereals Whole-grain or coarse dry cereals |
| Fruits | Soft drained canned or cooked fruits without seeds or skin Ripe bananas |
Fresh or frozen fruits Cooked fruit with skin or seeds |
| Vegetables | All soft, well-cooked vegetables that are in small pieces and mashable with a fork | Cooked corn and peas Broccoli, cabbage, Brussels sprouts, asparagus, or other rubbery cooked vegetables |
| Potatoes and starches | Well-cooked and moistened boiled, baked, or shredded, mashed potatoes Well-cooked pasta noodles in sauce |
Potato skins and chips Fried potatoes Rice |
| Desserts | Puddings and custards Soft fruit pies (bottom crust only) Crisps and cobblers with soft topping and no seeds Most canned fruits Soft moist cakes with icing or “slurried” cakes |
Dry, coarse cakes and cookies Desserts with nuts, seeds, coconut, pineapple, or dried fruitRice or bread pudding |
| Beverages | All beverages with little texture or pulp. |
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10 Responses to “Dysphagia Diet Levels”
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Comment made by Sharon Burns on Jul 2nd 2012 at 10:13:
I have a man with developmental disabilities (low IQ) who is on a Dysphagia II Diet. He is doing very well on the diet, however an issue has come up about pizza and whether it is a bread or not. He loves pizza and the staff get thin crust pizza and never give him edge pieces plus they cut the pizza into very small bites. Do you have any suggestions for this. He has not had any problems with choking or difficulty swallowing the pizza.
Thank you for any help you can give me.
Comment made by Everything Speech on Jul 2nd 2012 at 11:01:
The Dyphagia II diet does not allow for breads and that would include pizza. However, if this man is doing fine with the pizza, he should be allowed to eat it. You can definitely make an exception and have the doctor write an order for “allow chopped pizza, no crust” or something to that effect. Hope that helps!
Comment made by Anita Hunter on Oct 4th 2012 at 17:22:
Where do “steak fries” fall into level 3 catagory? Not like a regular “fry”, can it be left whole and how do you subjectivly determine if it is soft enough, has soft or hard edges, etc.
Comment made by Everything Speech on Oct 4th 2012 at 20:52:
Steak Fries would fall into Dysphagia III. It can be left whole, so you don’t have to cut it up. The fries should not be “crispy” or overcooked. An SLP can assess the individual in question to determine if the patient can or cannot tolerate the fries and other foods.
Comment made by Melissa Geib on Jan 14th 2013 at 19:38:
What is the premise for allowing regular chicken n the Dysphagia Level 3 diet? In my experience as a clinical Speech Language Pathologist for 23 years, chicken continues to be a food items that is very difficult for most people to masticate putting them at increased risk. I can understand allowing fish, but the chicken at the SNF that I work at is regularly dry, and overcooked.
Comment made by Everything Speech on Jan 20th 2013 at 12:45:
The Dysphagia 3 diet allows for chicken that is thinly sliced and well-moistened. If the chicken is dry and over-cooked than it would be regular consistency (see “foods to avoid” under the Dysphagia 3 list). Your kitchen may need some education on proper cooking and moistening techniques before allowing a Dysphagia 3 diet to include chicken.
Comment made by PLove on Jan 31st 2013 at 00:47:
Hello I have a patient who is currently on Dysphagia III and he is tolerating his current diet. He has a hiatal hernia which has caused him to aspirate on rice and dry chicken. These are the only two foods he has trouble safely consuming. No true oral or pharyngeal deficits but the “bowing” in the esophagus because of the hernia has caused the aspiration. He would like to eat “hard candy” (i.e. werthers, butterscotch, circular peppermint, etc..)for gratification after meals and although he has been sneaking these candies without any aspiration/penetration I don’t feel it is afe for patient to consume this candy because they can become very slippery in his mouth and slide into his pharynx and become logged.I have asked the nursing staff to remove candy from the patient if/when they see him eating these types of hard candy. Any advice on whether hard candy would be safe or not?
Comment made by Everything Speech on Jan 31st 2013 at 20:39:
Hello, and thank you for your comments. Hard candy is not included on the Dysphagia III diet. This is in part because of the reasons that you describe “become very slippery… and slide into his pharynx.” I cannot say if this particular patient is safe for the hard candy or not because I would need to evaluate the patient. Try to see how the patient is doing on the hard candy and if he is not having any difficulty, cognitively intact, etc. then you might allow this item. An order for “allow hard candies” might be appropriate depending on how he did at bedside. Or maybe “regular diet, no rice or dry chicken” if that is the only difficulty.
Comment made by Patricia Stretchberry on May 9th 2013 at 00:17:
My daughter, who has Down Syndrome with developmental delays, is on a stage 3 diet following an episode of aspiration pneumonia. Would it be okay for her to eat thin crust pizza cut into small pieces?
Comment made by Everything Speech on May 9th 2013 at 09:17:
Patricia, if the bread is soft on the thin crust pizza and cut into small pieces, this would fit into a Stage 3 diet. Every person is different and since I have not evaluated your daughter I can not say that she will tolerate this safely. A speech-pathologist is the best person to evaluate your daughter for the safest, least restrictive consistencies.