Learning About Dysphagia

by Savannah Greiner

Dysphagia is a swallowing disorder that can lead to painful or difficult swallowing. This disorder is common in the elderly and can be a result of stroke, nervous system disorders, esophageal problems, head injuries, and cancers of the mouth, neck, or esophagus (1).

A major concern for patients with dysphagia is aspiration. Aspiration occurs when food or liquid enters the lungs as a result of improper swallowing technique. Patients work with Speech-Language Pathologists and Registered Dietitian-Nutritionists to learn safe swallowing techniques and discuss consistencies of foods and liquids that are safe to swallow (S-LPs) and to ensure dietary adequacy (RDNs).

There are three levels in a dysphagia diet (1):

  • Level one consists of foods that are completely pureed.
  • Level two, also known as “mechanical-soft” or “minced” includes foods that require minimal, easy chewing and are very moist.
  • Level three is any food that is easy to cut through but is not dry, sticky, or crunchy. 1

A dysphagia diagnosis can be an overwhelming experience for patients. It is important for dietitians to empathize and provide education as to what foods are safe. It is also important for dietitians to be creative and provide ideas about how to make safe food taste appetizing. Patients with dysphagia are at risk for malnutrition and dehydration because the food and thickened beverages included in the dysphagia diet may not be appealing.

The NTDT 267: Culinary Nutrition class created recipes that are both tasty and safe for patients with dysphagia. By creating and testing pureed and mechanical soft food, and trying thickened beverages, the students were able to experience what it would be like to have dysphagia. This exercise will allow the students to empathize with their patients in the future.

The students cooked breakfast, lunch, and dinner to fully understand “a day in the life” with dysphagia. The meals were made as they normally would be, and then manipulated in a food processor or blender. All of these recipes include herbs and spices to enhance the flavor of the foods and make them more appetizing.

Level 1: Pureed eggs, pancakes and peaches with thickened tea and milk.

Level 2: mechanically-softened ground turkey with gravy, pureed carrots (level 1), and mashed cauliflower-mashed potatoes and gravy.

Level 3: mechanically softened pasta (level 2) with easy-to-chew minced chicken Parmesan.

In addition to modifying food, the students also modified beverages. Tea with milk, plain milk, and apple juice were thickened with a product called “Thick-It”. Thick-It is a starch based powder that can be added to foods and beverages to change the consistency. Pudding- thick, honey-thick and nectar-thick are all measures of consistency with pudding-thick being the most severe and nectar-thick being the least severe (2).

It may be necessary for patients with a swallowing disorders to thicken all of their beverages to the recommended consistency. Though commercial thickeners advertise that they are taste free, this is not typically the case. Having to thicken all beverages can be very difficult for patients because the taste and texture of the liquid can become unappetizing. Students were given Thick-It and instructed to only drink nectar-thick beverages for an entire morning so they could understand what their future patients suffering from dysphagia will have to go through on a daily basis.

Though suffering from a swallowing disorder inhibits the types of food that can be consumed, there are still plenty of healthy and delicious options available. Eating softened and pureed foods doesn’t have to be boring, like many people think! The students in Professor Wiens’ class proved that tasty, everyday foods can still be enjoyed. Surely, these modifications to typical meals take time, but they also provide an alternative to basic, pureed food for those who can no longer chew or swallow correctly.  Taking time to empathize and educate patients with dysphagia is important to ensure that they are consuming enough food to avoid malnutrition and enough liquid to avoid dehydration; both of which are major concerns.


  1. “Swallowing Disorders.” MedlinePlus National Library of Medicine, n.d. Web.5 Apr. 2017
  2. McCullough, Gary, Cathy Pelletier, and Catriona Steele. “National Dysphagia Diet: What to Swallow?” The ASHA Leader. American Speech-Language-Hearing Association, 01 Nov. 2003. Web. 05 Apr.2017



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