Dysphagia Diet Recipes: A Comprehensive Guide to Safe and Enjoyable Eating

Each year, between 300,000 and 700,000 individuals in the United States experience difficulty swallowing, a condition referred to as dysphagia. This condition commonly involves complications and pain or discomfort when swallowing, affecting a person’s ability to eat or drink. While dysphagia can occur at any age, it is more common in older adults, affecting 30% of adults more than 50 years of age and up to 68% of nursing home residents. Dysphagia may be an acute or chronic condition. People with dysphagia report having difficulty swallowing food or drinks, chewing, sucking, controlling saliva, taking medication, or protecting their airway from choking. If left untreated, ongoing problems can affect a person’s ability to meet their nutrition and hydration needs and can lead to mealtime anxieties due to choking risks or swallowing discomfort.

Introduction to Dysphagia

Dysphagia, or difficulty swallowing, is a condition that affects millions of people worldwide. For individuals with dysphagia, eating can be a challenging and sometimes dangerous activity. However, with the right recipes and preparation techniques, it is possible to create delicious and nutritious meals that are easy to swallow.

What is Dysphagia?

Dysphagia can result from a variety of causes, including neurological conditions like stroke, Parkinson’s disease, or multiple sclerosis, as well as structural issues such as head or neck surgery, esophageal disorders, or age-related changes in swallowing ability.

Types of Dysphagia

Dysphagia, or difficulty swallowing, can be classified into different types based on the location and nature of the swallowing problem:

• Oropharyngeal Dysphagia: Oropharyngeal dysphagia occurs when there is difficulty moving food from the mouth to the pharynx and into the esophagus. This type of dysphagia is often related to problems with the muscles and nerves that control swallowing.
• Esophageal Dysphagia: Esophageal dysphagia occurs when there is difficulty moving food through the esophagus and into the stomach. This type of dysphagia is often related to structural or motility issues within the esophagus.
• Functional Dysphagia: Functional dysphagia occurs when there is difficulty swallowing without any apparent structural or motility abnormalities. This type of dysphagia is often related to psychological or idiopathic factors.

People with dysphagia may experience symptoms such as coughing or choking while eating or drinking, food or liquids getting stuck in the throat, or even regurgitation. These difficulties make it necessary to adjust the consistency of food and drinks to ensure they are safe to swallow. Effectively managing dysphagia involves modifying the texture of foods, often by pureeing, blending, or thickening them, to create a smooth and uniform consistency that is easier to swallow.

Read also: Understanding Dysphagia Diets

Common Causes of Dysphagia

The most common causes of dysphagia are related to underlying medical or physical conditions. Individuals may have impaired swallowing secondary to a variety of challenges, including reduced mastication (chewing) or lost or missing teeth/dentures and reduced oral and pharyngeal sensitivity.

Dysphagia can often be caused by:

• Alzheimer’s disease
• Cerebral palsy
• Meningitis and brain tumors
• Mouth, throat, or esophageal cancer
• Multiple sclerosis
• Parkinson's disease
• Traumatic brain injury
• Spinal cord injury
• Stroke

Typically, a full assessment, including a bedside swallowing evaluation or a barium swallow study, will be used to make a diagnosis.

Complications from Dysphagia

A common warning sign of dysphagia is chronic coughing or choking while eating and gagging when swallowing. If a person does not receive treatment to help with their symptoms and continues to have challenges swallowing, especially when eating and drinking, they can be at risk for developing other health issues, including:

• Dehydration
• Malnutrition
• Pneumonia or respiratory infections
• Weight loss
• Anxiety and depression

Since dysphagia accompanies an underlying condition or is due to weakened or damaged muscles and nerves used for swallowing, diagnosing and treating what is causing the condition is essential to improving a person’s quality of life.

Read also: The Hoxsey Diet

Treating Dysphagia

Depending on the cause of the dysphagia, treatment may include swallowing exercises, positioning the head to allow for easier swallowing, and prescribing medication to treat the condition causing the dysphagia. Another effective way of managing dysphagia is modifying the texture of foods (chopped, minced, pureed) and thickening liquids to make eating and swallowing safer and easier. This helps reduce the risk of choking or having material enter the airway.

The International Dysphagia Diet Standardization Initiative (IDDSI)

In the past, health care providers often used a variety of terms to describe diets for those requiring altered consistency foods, including “mechanical soft,” “blended smooth,” and “chopped.” To help provide universal guidelines for the dysphagia diet, the International Dysphagia Diet Standardization Initiative (IDDSI) set out to standardize diets and liquid consistency. In 2019, the American Speech Language-Hearing Association and Academy of Nutrition and Dietetics endorsed the use of this International Dysphagia Diet.

The IDDSI framework provides common terminology for describing food textures and drink thickness to improve safety for individuals with swallowing difficulties. The IDDSI framework consists of a continuum of 8 levels (0 - 7). Drinks are categorized by their thickness and are assigned to a level between 0 and 4. Foods range from liquidized (level 3) to regular and easy to chew (level 7). This provides consistent terminology for providers to use to describe the precise level of texture modification needed for foods and thickness for drinks.

Key Principles of Dysphagia-Friendly Food Recipes

When preparing meals for someone with dysphagia, there are a few important things to keep in mind to make sure the food is safe and easy to eat. These key principles can help guide your cooking:

• Texture Modification: The food should be soft, smooth, and easy to swallow. This might mean pureeing, mashing, or blending foods so they don’t have any lumps or chunks that could be a choking hazard. The goal is to make the food smooth and uniform in texture.
• Avoid Dry or Tough Foods: Dry, hard, or fibrous foods (like crackers, dry toast, or raw vegetables) should be avoided, as they can cause discomfort or pose a choking risk.
• Moisture Content: Dry foods are much harder to swallow and can cause discomfort. Adding moisture, like sauces, gravies, or broths, can help achieve the right consistency, making the food easier to swallow.
• Small, Manageable Portions: Small bites or spoonfuls of food are easier to manage and swallow. It’s also beneficial to encourage frequent, smaller meals instead of large ones.
• Focus on Nutrient-Dense Foods: Ensure the meals are nutritionally balanced, as individuals with dysphagia may have a reduced appetite or difficulty consuming enough food to meet their daily nutrient needs.
• Safety: Always check that the food is at a safe temperature before serving. Foods that are too hot can burn, and foods that are too cold might be harder to swallow. A comfortable temperature ensures a safer, more pleasant eating experience.

Dysphagia-Friendly Food Recipes

Here are some delicious and easy-to-prepare recipes for individuals with dysphagia that maintain flavor and nutrition while promoting safe swallowing.

Read also: Walnut Keto Guide

1. Egg Custard

Egg custard is a smooth, nutrient-dense dessert that provides protein and calcium, making it a perfect option for people with dysphagia.

Ingredients:

• 2 large eggs
• 1 1/2 cups whole milk
• 1/4 cup sugar
• 1/2 teaspoon vanilla extract
• A pinch of salt

Instructions:

1. Preheat your oven to 325°F (163°C). Lightly grease custard cups or ramekins.
2. In a bowl, whisk the eggs, milk, sugar, vanilla, and salt until smooth.
3. Pour the mixture into the prepared cups.
4. Place the cups in a baking pan and add hot water to the pan until it reaches halfway up the sides of the cups.
5. Bake for 40-45 minutes, or until a knife inserted into the center comes out clean.
6. Allow the custards to cool slightly before serving.

2. Smooth Avocado and Banana Mash

Avocados and bananas are both soft, nutrient-packed fruits that blend well into a dysphagia-friendly mash.

3. Mashed Sweet Potatoes

Sweet potatoes are rich in vitamins and fiber, but they must be prepared to the right consistency for those with dysphagia. This mashed sweet potato is soft and creamy, making it easy to swallow while still providing essential nutrients.

Ingredients:

• 2 medium sweet potatoes
• 1/4 cup unsalted butter or margarine
• 1/4 cup milk (or more, depending on desired consistency)
• 1 teaspoon ground cinnamon (optional)
• Salt and pepper to taste

Instructions:

1. Peel and cube the sweet potatoes.
2. Boil them in water for 15-20 minutes, or until they are tender and easily pierced with a fork.
3. Drain the potatoes and place them in a bowl.
4. Mash them with a potato masher or use a blender for a smoother texture.
5. Add butter and milk, mixing until you achieve a smooth, creamy consistency. If needed, add more milk to reach a texture that is easy to swallow.
6. Season with cinnamon, salt, and pepper to taste.

4. Chicken and Vegetable Puree

This pureed chicken and vegetable soup is rich in protein, vitamins, and minerals while being soft enough for individuals with dysphagia to safely enjoy.

Ingredients:

• 2 boneless, skinless chicken breasts
• 1 medium carrot, peeled and chopped
• 1 medium potato, peeled and chopped
• 1/2 cup peas (frozen or fresh)
• 4 cups low-sodium chicken broth
• 1/4 cup heavy cream (optional for added richness)
• Salt and pepper to taste

Instructions:

1. In a large pot, combine the chicken breasts, carrot, potato, peas, and chicken broth.
2. Bring to a boil, then reduce the heat and simmer for about 25-30 minutes, or until the vegetables are tender and the chicken is fully cooked.
3. Remove the chicken breasts and shred or chop them into small, fine pieces.
4. Blend the soup using an immersion blender or regular blender until smooth. Add heavy cream for extra creaminess, if desired.
5. Return the chicken to the soup and blend again until the entire mixture is smooth and easy to swallow.
6. Season with salt and pepper.

5. Apple Cinnamon Oatmeal

This warm and comforting oatmeal is perfect for a dysphagia-friendly breakfast. It's soft, smooth, and packed with flavor!

Ingredients:

• 1 cup rolled oats
• 2 cups water or milk (or a dairy-free alternative)
• 1 apple, peeled and chopped
• 1 teaspoon cinnamon
• 1 tablespoon honey (optional)

Instructions:

1. In a pot, combine the oats, water or milk, chopped apple, and cinnamon.
2. Bring the mixture to a boil, then reduce the heat and let it simmer until the oats are soft and the mixture has thickened.
3. Use an immersion blender to puree the oatmeal until smooth. If you don’t have an immersion blender, you can also use a regular blender.
4. Stir in honey if you like a little extra sweetness.
5. Serve warm

6. Butternut Squash Soup with Black Bean Topping

Cut butternut squash in half lengthwise and scoop out and discard seeds. Pour ¼ teaspoon olive oil on each half and rub onto surface. Sprinkle cinnamon on both halves then place squash face down on baking sheet and roast in oven until soft and easily pierced with a knife, about 30 minutes. Scoop cooked squash into blender and discard squash peel. Add curry powder, vegetable broth, and salt. Blend until smooth. Pour mixture into medium pot. Add coconut milk and maple syrup. Stir to combine. Warm over medium until heated through, about five minutes. To make black bean topping, heat olive oil in medium skillet. Toss in garlic and cook for one minute, stirring regularly so garlic doesn’t burn. Add black beans, cumin, chili powder, ¼ teaspoon salt, black pepper, scallions, and cilantro. Lower heat to medium and cook until beans and scallions soften, about three to five minutes. Stir occasionally. In small bowl, combine tomatoes, 1/8 teaspoon salt, avocado, and lime juice. When sweet potatoes are done, cut them down the middle to open and place one on each plate.

7. Herb Omelet

Crack eggs into small bowl and whisk well until eggs turn pale yellow. Add remaining salt and pepper and whisk until combined. Pour eggs into pan and spread mixture evenly throughout. When eggs start to set, use spatula to drag cooked edges into center of pan. Tilt pan to let uncooked eggs move to edge. Once bottom of egg mixture is set, but top is still a bit wet, use spatula to fold omelet so edges meet. Cut omelet in half and transfer each to separate plates. To make herb sauce, add parsley, chives, arugula, avocado, lemon juice, ¼ cup olive oil, 1/8 teaspoon salt, and 1/8 teaspoon black pepper to blender or food processor and pulse until mixture is smooth.

8. Pureed Lasagna

Place cooked lasagna noodles in processor with olive oil and pulse a few times to break up noodles. Add six tablespoons water and blend until noodles are pureed. Continue to add water, one tablespoon at a time, if noodles aren’t fully pureed. Divide noodle puree into thirds. Add 1/3 of pureed noodles to an 8” x 5” baking dish or loaf pan, and carefully spread on the bottom using a slightly wet spatula. Add ½ of ricotta mixture and spread on top of noodle puree. Repeat with another layer of noodle puree and then another ricotta layer. Finish with a final layer of noodle puree and top with remaining tomato sauce. Cover dish with foil and bake for 30 minutes. Remove foil and cook additional five minutes. Remove from oven and let sit for five minutes. Cut lasagna into six pieces and serve. To make spinach ricotta, squeeze excess liquid from thawed spinach. Add spinach, ricotta cheese, salt, dried basil, dried oregano, and garlic powder to food processor. Pulse until smooth and ingredients are combined. Transfer to small bowl and set aside.

9. Pureed Black Bean Tacos (Levels 4-7)

This recipe demonstrates how to adapt a single dish for different levels of dysphagia, following the IDDSI framework.

• Level 6/7 (Soft and Bite-Sized/Easy to Chew):

  • To make salsa, combine tomatoes, red onion, and jalapeno in small bowl.
  • To make guacamole, cut avocado in quarters, remove pit, and place quarters in small bowl.
  • In blender or food processor combine olive oil, cilantro, oregano, and chives and blend until no large pieces of herbs remain, and oil has been infused with herbs. If herbs stick to sides of blender, turn off and scrape before continuing to blend again.
  • Place medium skillet over high heat. Pour in herb oil and allow it to warm for one minute. Add beans and stir to coat with oil. Stir in smoked paprika, cumin, garlic powder, ground black pepper, and ¼ teaspoon salt. Cook over low heat for five minutes, stirring occasionally.
  • To assemble, place warmed corn tortilla on plate, spread ¼ guacamole, top with ¼ of bean mixture and ¼ of tomato salsa. Add one tablespoon yogurt on top.

• Level 5 (Minced and Moist):

  • Cook beans as above in level 6/7 directions, then add vegetable broth. Bring mixture to boil, then reduce heat to medium-low. Stir occasionally and simmer until beans begin to break down, and liquid has been absorbed, about five to 10 minutes.
  • Tear tortillas into pieces, place in blender, and pulse three or four times until crumbled. Add ½ cup water and blend again on high until mixture is combined and sticks together. Scrape down the sides of blender to get uniform mixture. Transfer tortilla mixture to medium bowl.
  • Make guacamole as instructed for Level 6/7 but create a smoother texture by using a whisk or large spoon to quickly stir the mixture until no chunks of avocado remain.
  • To make salsa, put all salsa ingredients in a blender (or food processor) and pulse until no big chunks remain and texture resembles apple sauce.
  • To assemble tacos, scoop out ¼-size measuring cup’s worth of tortilla mixture for each plate.

• Level 4 (Pureed):

  • Prepare as in Level 5 but put bean mixture in blender and mix until smooth and to a consistency that slides off a spoon easily with very little food left on the spoon.
  • Make sure tortilla mixture is fully blended, with no chunks, then divide mixture evenly between four medium ramekins.
  • Prepare beans, guacamole, and salsa as in Level 4, but puree beans in blender with additional two cups low-salt vegetable broth. Once mixed, add guacamole and tomato salsa and blend again until smooth.

• Level 3 (Liquidised):

  • Prepare beans, guacamole and salsa as above in Level 4, but puree the beans in blender with an additional 2 cups low-salt vegetable broth. Mixture should pour nicely off of a spoon without sticking or clumping.

10. Protein-Rich Recipes

For those on dysphagia diets, getting proper nutrition while also having a varied diet can be difficult. When it comes to getting protein for those on dysphagia diets, many turn to protein-shakes or microwavable meals, but it doesn’t always have to be this way. The following recipes will add some variety to your diet, and are rich in protein.

• Easy-to-Swallow Shepherd’s Pie: An easy-to-swallow take on a classic dish.
• Minced Ground Beef with Noodles: Features a delicious sauce using Thick & Easy® Minced Ground Beef.
• Pureed Pasta with Meat Sauce: Pureed pasta and a delicious meat sauce using Thick & Easy® Level 5 Meats will give you all the flavors of Italy in this dish.

11. Macaroni and Cheese

Cook macaroni according to package directions. Note: If macaroni is still tough after cooking, continue cooking until soft enough for your specific preferences. Melt butter over medium heat in a large saucepan. Whisk in flour and let cook two minutes while stirring. Slowly whisk in cream, milk, mustard powder, onion powder, salt and pepper to taste. Remove from heat and stir in parmesan cheese and three cups cheddar cheese until melted. Toss cheese sauce & macaroni noodles together. Pour into a greased 9×13 pan. Bake 18-24 minutes or until bubbly. Do not overcook.

12. Berry Smoothie

Place the frozen berries, ice cubes, coconut milk, almond butter and spinach in a blender. If you like, add acai powder as well. Blend until smooth, adding additional coconut milk as needed. (Add as little as necessary so your smoothie will be thick). Taste and add maple syrup or sweetener of choice, if desired. Note: Remember, you can adjust this recipe to your specific flavor or texture preferences!

General Dietary Recommendations for Dysphagia

A Dysphagia Diet is used for people who have difficulty swallowing. Foods on this diet are easier to chew and move around in your mouth. This will reduce the risk of food and liquids going the wrong way. Foods that are on mechanical soft diets are all made of moist and soft textures. Eating foods not allowed on this diet will increase your chance of swallowing problems and can result in food going into your airway (windpipe) instead of your esophagus (food tube). Food or liquid that goes into your airway instead of your stomach puts you at risk for not getting enough nutrition and getting sick (pneumonia).

Recommended Foods:

• Beverages/Liquids: Liquids should be the thickness recommended by your SLP or doctor: thin, nectar, or honey-thickened.
• Starches, Breads, and Cereals: Pancakes or French Toast, well moistened with syrup; well cooked, moistened, boiled, baked, or mashed potatoes; oatmeal; cold cereal moistened with milk; moist macaroni and cheese/well-cooked pasta with meat sauce
• Meats and Meat Substitutes: Moist, ground/finely diced meats, poultry, or fish (served with gravy or sauces); poached, scrambled, or soft cooked eggs; slightly mashed, moist legumes (baked beans); tofu; tuna or egg salads (without large chunks, celery, or onion)
• Fruits and Vegetables: Fresh, soft ripe bananas or soft drained, canned fruit without seeds or skin; soft, cooked vegetables that are fork tender and diced to less than ½ inch
• Desserts: Pudding, custard, apple sauce; Jello, sherbert, sorbet, ice cream; cobblers without seeds/nuts and with soft breading or crumb mixture

Foods to Avoid:

• Starches, Breads, and Cereals: Chips, dry breads/rolls, coarse cereals that include seeds/nuts
• Meats and Meat Substitutes: Dry, tough meats (bacon, hot dogs, sausage), sandwiches, peanut butter
• Fruits and Vegetables: Raw fruits and vegetables (no fresh, canned, or cooked pineapple), cooked corn or peas, broccoli, cabbage
• Desserts: Dry, coarse cakes or cookies, rice or bread pudding, hard candies

Tips for Getting Enough Nutrition:

• Try to eat from a variety of food groups, so your body gets the nutrients it needs.
• To make sure you get enough calories and protein, you may include liquid nutrition supplements, such as Ensure, Boost, or Carnation Instant Breakfast if they are thickened to the correct texture, if needed. “Plus” versions of these products provide the most calories and protein per serving.

Managing Dysphagia During the Holidays

Getting together in-person with family and friends is wonderful, but - let’s face it - it may be stressful at times. If you, your loved ones, or friends have difficulty swallowing (dysphagia), these gatherings can be extra challenging. Not everyone with dysphagia will require a texture modification in what they eat and drink; therefore, those tips covered a wide variety of topics to make for a successful gathering.

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