Dysphagia Level 2 Diet

Dysphagia Level 2 Diet 

(mechanically altered)

Sometimes patients who have trouble chewing and/or swallowing whole foods need a special diet. The National Dysphagia Diet, published in 2002, developed universal terminology for texture-modified diets. The dysphagia mechanically altered diet (level 2) is one of three levels of texture modification that is used.

Who orders a dysphagia diet?
Normally a speech and language pathologist will recommend a dysphagia mechanically altered diet after evaluating a patient who has problems chewing or swallowing food. In some cases, medical tests are used to determine the best texture for a patient.

What types of foods are allowed on this diet?
Patients on a dysphagia level 2 diet can tolerate some textures of foods, but not all. The diet  includes foods that are soft textured and moist, making them easy to swallow. Soft, well-cooked foods, well-moistened ground meats, moist and well-cooked potatoes, noodles, and dumplings are examples of foods that are the proper texture for this diet. All foods of a pureed consistency are allowed on this diet.

It is important to include a variety of foods from all different food groups when providing a mechanically altered diet, including fruits, vegetables, grains, meats and meat substitutes, and dairy foods.

Are regular liquids allowed on a mechanically altered diet?
Possibly. For some patients, regular liquids are OK. However, depending on your condition, you might need to have thickened liquids, so you can swallow them safely. Talk to your speech and language pathologist to learn more.

What is a slurry?
A slurry is a soft, moist mixture often used for people with swallowing problems. An example is a slice of bread or a pancake moistened with milk. The moisture of the liquid makes it easier for someone with swallowing problems to swallow soft bread products.

Food Textures for Dysphagia Mechanically Altered Diet
(dysphagia level 2 diet)

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 meatballs
  • Poached, scrambled, or soft-cooked eggs
  • Tofu
  • Well-cooked and moist mashed legumes or beans

 

  • Dry meats, such as bacon, 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 and 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
  • Brussels sprouts, broccoli, cabbage, asparagus, or other rubbery cooked vegetables

 

Potatoes and starches

  • Well-cooked and moistened boiled, baked, shredded, or 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 fruit
  • Rice or bread pudding

Beverages

  • All beverages with little texture or pulp

 

 

 


References and recommended readings


American Dietetic Association. Level 2 dysphagia diet (dysphagia mechanically altered): patient handout. In: Nutrition Care Manual®. Available to subscribers at: www.nutritioncaremanual.org.
Accessed January 10, 2011.

National Dysphagia Diet Task Force. National Dysphagia Diet: Standardization for Optimal Care.
Chicago IL: The American Dietetic Association; 2002.

 

Review Date 3/11
G-1542

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