Dysphagia Diet: Level 2 (Mechanically Altered)
A level 2 dysphagia diet is a special eating plan. Your healthcare provider may tell you to use it if you have mild to moderate dysphagia and are able to do some chewing.
What is a dysphagia diet?
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.
What can you eat?
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
Soups with easily chewed pieces
Soft, well-cooked vegetables, cut into very small pieces
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
Dry or tough meats
Soups with large chunks
Raw or barely cooked vegetables
Seeds, nuts, or chewy candies
During and after eating
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
Take the time to make meals that look, smell, and taste good. Add seasonings to your food. Set the table. Even though you can’t have certain foods, you can still enjoy 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.
While you’re on a dysphagia diet
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.
How long a dysphagia diet is needed?
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.
When to call your healthcare provider
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
A wet-sounding voice after eating or drinking
September 04, 2017
National Dysphagia Level 2: Mechanically Altered Nutrition Therapy. American Dietetic Association (currently known as Academy of Nutrition and Dietetics)., Richardson, Brenda. Revisiting Nutrition Best Practice for Dysphagia. Nutrition and Foodservice Edge. 2015: pp. 16-22., Sura, Livia. Dysphagia in the elderly: management and nutritional considerations. Clinical Interventions in Aging. 2012: 7; pp. 287-298.
Dozier, Tennille, RN, BSN, RDMS,Jothi, Sumana MD