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Dysphagia Level 3 Diet


Dysphagia Level 3 Diet 

(dysphagia advanced)

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 advanced diet (level 3) is one of three levels of texture modification that is used.

Who orders a dysphagia advanced diet?
Normally a speech and language pathologist will recommend a dysphagia advanced 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?
Foods that are nearly normal textures are allowed on the dysphagia advanced diet, with the exception of crunchy, sticky, or very hard foods. The diet includes bite-sized foods that are moist. Foods that are allowed on dysphagia level 1 and level 2 diets also are allowed on the dysphagia advanced diet.

It is important to include a variety of foods from all different food groups when providing a dysphagia advanced diet, including fruits, vegetables, grains, meats and meat substitutes, and dairy foods. The following table provides specific information about foods that are allowed on the dysphagia level 3 diet.


Food Textures for Dysphagia Advanced Diet
(dysphagia level 3)

Food Groups

Foods Allowed

Foods to Avoid

Meat and meat substitutes

  • Thin-sliced, tender, or ground meats or poultry, well-moistened
  • Fish
  • Eggs (any preparation acceptable)
  • Yogurt (no nuts or coconut)
  • Casseroles with small chunks of tender or ground meat


  • Tough or dry meats or poultry
  • Dry fish or fish with bones
  • Chunky peanut butter
  • Yogurt with nuts or coconut


  • Well-moistened breads, biscuits, muffins, pancakes, waffles, etc (add jelly, margarine, and other toppings to moisten well)
  • Dry bread, toast, crackers, etc
  • Tough, crusty breads, such as French bread


  • All well-moistened cereals
  • Coarse or dry cereals


  • All canned and cooked fruits
  • Soft, peeled, ripe fresh fruits, such as peaches, kiwi, mangos, cantaloupe, etc
  • Soft berries with small seeds, such as strawberries
  • Hard-to-chew fresh fruits, such as apples or pears
  • Stringy, pulpy fruits, such as papaya, pineapple, or mango
  • Fresh fruits with tough peels, such as grapes
  • Prunes, apricots, and other dried fruits (unless cooked)


  • All cooked, tender vegetables
  • Shredded lettuce
  • All raw vegetables, except shredded lettuce
  • Cooked corn
  • Rubbery cooked vegetables

Potatoes and starches

  • All, including rice and tender fried potatoes
  • Tough or crisp fried potatoes


  • All desserts, except those on the avoid list
  • Dry cakes or cookies that are chewy
  • Anything with nuts, seeds, dry fruits, coconut, and pineapple


  • Any beverage of recommended consistency



Can I drink regular liquids if I am on a dysphagia pureed 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.

References and recommended readings

American Dietetic Association. Level 3 advanced diet: patient handout. In: Nutrition Care Manual®.
Available to subscribers at:
Accessed January 13, 2011.

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


Review Date 3/11


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