1. What is Dysphagia? DID YOU KNOW? Difficulty Swallowing
Typically caused by nerve or muscle problems of throat or esophagus
DID YOU KNOW?
Up to 75% of nursing home patients experience some degree of dysphagia and as many as half of all Americans over 60 years old will experience dysphagia

2. Causes & Symptoms of Dysphagia
Pain when swallowing
Feel as though food is getting stuck in throat
Drooling
Food comes back up esophagus
Coughing or gagging when swallowing
Unintentional weight loss
Causes
Stroke
Brain or Spinal Cord Injury
Multiple Sclerosis
Muscular Dystrophy
Parkinson’s Disease
Swelling of throat or esophagus
GERD

3. Normal Swallow versus Swallowing with Dysphagia
Those with dysphagia have the risk of food entering the lungs which can result in aspiration pneumonia

4. Treatment for Dysphagia Speech Language Pathologist
NUTRITION AND DYSPHAGIA
Treatment for Dysphagia
Speech Pathologists and Registered Dietitians work together to treat and educate those with dysphagia and/or swallowing difficulties.
Speech Language Pathologist
-Identifies the specific problem and makes recommendations that may include changes in positioning or posture when eating or drinking, exercises to strengthen or improve swallowing muscles, techniques to aid in swallowing more safely, or changes in consistency of foods
Registered Dietitian
-Outline the appropriate consistency of foods that minimizes the difficulties of swallowing and eating

5. Why is a Dysphagia Diet Needed?
To prevent choking/aspiration:
- Aspiration is when foods, liquids, or salvia is breathed into the airway. This is especially dangerous because it can cause pneumonia.
Certain health conditions/disease states:
- Radiology
- Neurological disorders
- GERD
Aging
Esophageal strictures

6. Dysphagia Diet Levels: Level 1
NUTRITION AND DYSPHAGIA
Dysphagia Diet Levels: Level 1
Foods are totally pureed.
Bread: must be pureed or pre-gelled
Cereals: must be homogenous and “pudding-like” (ex: cream of wheat or rice, farina). Avoid oatmeal
Desserts should be smooth (ex: custard or yogurt)
Fruits must be pureed or well-mashed without pulp, seeds, or skins
Meats must be of very smooth consistency or pureed
Mashed potatoes and pureed pasta are allowed and should be served with gravy, sauce, or extra butter/margarine to ensure it is moist and not sticky
Soups should be strained to ensure no chunks or lumps with smooth consistency or pureed to appropriate fluid consistency.
Honey, ketchup, smooth jellies, and syrup are allowed

7. Dysphagia Diet Levels: Level 2
NUTRITION AND DYSPHAGIA
Dysphagia Diet Levels: Level 2
Mechanically Soft
Bread: needs to be slurried/pre-gelled
Cereal: well-moistened cereals are allowed (ex: oatmeal, grits). Dry or coarse whole grain cereals are not allowed
Desserts may include canned fruits, moist cobblers, and moist soft cookies
Soft canned or cooked fruits, soft banana, and fruit juices with a small amount of pulp are allowed.
Moist-ground or minced, tender-cooked meat with no larger than ¼” pieces, well cooked pasta casseroles, cottage cheese, and tofu are allowed.
Avoid peanut butter, sandwiches, and pizza
Moist, well-cooked potatoes, noodles, and dumplings are allowed. Continue to avoid rice
Almost all soups with less than ½” chunks of easy to chew meat or vegetables are allowed
Soft, well-cooked vegetables with less than ½” pieces are allowed with the exception of corn and peas. Vegetables should easily mash with a fork

8. Dysphagia Diet Levels: Level 3
NUTRITION AND DYSPHAGIA
Dysphagia Diet Levels: Level 3
*Foods are nearly normal textures, yet exclude crunchy, sticky, or very hard foods. --*There is a need for food items to be bite sized and moist.
*Bread: all moist breads are allowed. No tough, crusty breads.
*Moist cereal may be consumed. Only very coarse or dry grains need to be avoided.
*Most desserts are allowed, except those that are dry, chewy, or have nuts, seeds, coconut, pineapple, or dried fruit
*Fruits should be soft, peeled, and without seeds
meats that are moist and tender or casseroles with small chunks of meat are allowed. Only dry meats and fish, chunky peanut butter, and yogurt with nuts or coconut should be avoided.
*All soups are allowed except those with tough meats or vegetables.
*Most cooked, tender vegetables are allowed except corn and vegetables that are rubbery when cooked; may add shredded lettuce

9. Dysphagia Diet Levels: Liquids
NUTRITION AND DYSPHAGIA
Dysphagia Diet Levels: Liquids
Thin: (non-restrictive) includes all liquids, Jell-O, Italian ice, ice cream.
Nectar-thick liquids are easily pourable and are comparable to apricot nectar or thicker cream soups.
Honey-thick liquids are slightly thicker, are less pourable, and drizzle from a cup or bowl.
Pudding-thick liquids hold their own shape. They are not pourable and are usually eaten with a spoon.
Can use a commercial thickener to achieve nectar, honey, and pudding-thick consistencies

10. Meals/Snacks for Dysphagia Diet
Level 1: Pureed
Breakfast: farina cooked with milk, pureed scrambled eggs with purred sausage
Lunch: pureed tomato soup made with milk, pureed turkey with gravy, mashed potatoes, pureed carrots and peas
Dinner: Pureed chicken with purred noodles and marinara sauce, smooth whipped fruit flavored yogurt
Level 2: Mechanically Soft
Breakfast: oatmeal moistened with milk, scrambled egg, and muffin with butter
Lunch: moist meatloaf and potatoes, well-cooked carrots, vanilla pudding
Dinner: potato soup, moist chicken-noodle casserole, well-cooked green beans, ice cream
Level 3:
Breakfast: Cheerios with milk, cottage cheese with canned peaches
Lunch: Beef stew with vegetables (well-cooked), slice of bread, pudding
Dinner: pork roast, soft-cooked rice, cooked zucchini slices, slice of apple pie

11. Dysphagia Friendly Recipes
Maple Sweet Potato Puree (Yield: 4 servings)
2 large sweet potatoes, peeled and chopped into rough chunks
3 tbsp of maple syrup
2 tbsp olive oil
½ tsp kosher salt
¼ tsp black pepper
Directions:
-Preheat oven to 375 degrees F
-Place sweet potatoes,maple syrup, olive oil, salt, and pepper in a large mixing bowl. Toss to evenly coat and place on sheet tray. Roast in the preheated oven for 35 to 40 minutes or until sweet potatoes are soft. Be sure to check on them after 15 minutes and stir, if needed.
Transfer the sweet potato mixture to a food processor (can be done in batches) and add about ½ tbsp of hot water. Pulse until well blended. Add more hot water if needed for a smoother puree.

12. Dysphagia Friendly Recipes
Roasted Garlic Hummus
1 can (about 1 cup) of chickpeas
1/8 cup water
juice of 1/2 lemon
3 tsp tahini
1 head of garlic, roasted
1/2 tsp salt
2 Tbsp olive oil
1/4 tsp cumin
Directions
Roast the garlic by cutting off the top (the end opposite the root) and drizzling with olive oil. Place cut-side-down on a pan and roast in the oven at 350 for minutes. Put all the ingredients in a blender or food processor, and squeeze the garlic out on top. Process or blend together until smooth. Taste for salt.