Difficulty swallowing is dysphagia. Certain medical conditions or injury can cause dysphagia, which can be either short-term or chronic. If you have dysphagia, your doctor may recommend a soft food diet—in particular, a mechanical soft diet, which uses appliances like blenders to puree or grind foods so they're easier to swallow.
Who is most likely to be put on a mechanical soft diet? If you are prescribed a mechanical soft diet, what kinds of foods and drinks are good choices—and which should you avoid?
Dysphagia can cause a variety of serious problems. In addition to choking, you could aspirate food or liquids into your lungs, putting you at risk for pneumonia or chest congestion. Also, if you are unable to swallow food or drink, you are at risk for weight loss, malnutrition and dehydration.
You can have trouble swallowing for a variety of reasons. You may be missing teeth or have poorly fitting dentures, making it difficult to chew food properly. You may be recovering from mouth or neck surgery. Or you may have a medical condition or injury, such as:
- Neurological disorder, including multiple sclerosis, muscular dystrophy, and Parkinson's disease
- Stroke
- Brain or spinal cord injury
- Alzheimer’s disease
- Cancer of the throat or neck
- Cancer treatment effects, such as from radiation to the head, neck or throat
- Problems with the esophagus, such as narrowing, tumors or tissue damage due to GERD (gastroesophageal reflux disease)
- Conditions that cause reduced saliva, such as Sjogren syndrome
- Pharyngoesophageal diverticulum, or Zenker's diverticulum, a condition in which food particles are collected in a pouch in the throat
If you have dysphagia for these or any other reason, your doctor is likely to put you on a special diet to make it easier for you to eat or drink.
Mechanical soft diets are less restrictive than a soft food diet. Foods that aren't normally soft can be eaten, once you puree, blend, chop, whip or grind them using blenders, food processors, or other devices. Mechanical diets also do not restrict fat, fiber, spices and seasonings, which soft diets often exclude.
The National Dysphagia Diet Guidelines list three mechanical soft food diet plans, depending on a person's chewing and swallowing abilities. However, advice regarding specific foods may vary depending on each person's individual comfort level. A doctor or registered dietitian may need to tailor a mechanical soft foods diet plan for each patient.
Here are the general guidelines:
- Level 1: Foods are pureed, with consistent and uniform textures—no surprise chunks. They are easy to swallow without any chewing required. Foods for this level include pudding, custard, yogurt, oatmeal, pureed fruits and pureed meats.
- Level 2: Foods are moist, with soft texture for easy swallowing. These can include small bites (for example, pieces of meat are ground or cut so that pieces are no bigger than a quarter of an inch). Some mixed textures are allowed, such as in casseroles. Level 1 foods can be given, plus such foods as soft pancakes moistened with syrup, soft canned fruits, soft meats like fish, moist macaroni, and scrambled eggs.
- Level 3: Food at this stage is much closer to normal, but should still be moist and bite-size. It also excludes foods that are very hard, sticky, crunchy or overly dry. Mechanical soft food diet foods to avoid at this level include dry bread, toast, crackers, coarse cereal like shredded wheat, foods with nuts, fruits that are hard to chew (such as apples), seeds, chunky peanut butter, and meats that are tough and dry.
Depending on how severe a person's dysphagia, liquids may have to be thickened with thickening agents like cornstarch or gelatin. (Pre-thickened liquids are available commercially.) If you or someone you care for is on a mechanical soft food diet, your healthcare provider may determine the safe level of beverage thickness you can tolerate.
Liquid consistency levels include:
- "Pudding thick" or "spoon thick." This requires drinks to be thickened to such a degree that they require eating with a spoon.
- "Honey thick." Drinks must be prepared so they are the consistency of honey. They can't be ingested with a straw.
- "Nectar thick." Drinks are thickened to nectar or maple-syrup consistency.
- Thin liquids. These are drinks at normal consistency.
Anything that melts at room temperature is treated as a liquid. That means ice cream, popsicles or sherbet should not be served to someone with dysphagia unless they are able to ingest them at their melted consistency.
A mechanical soft food diet can be a lifelong diet or may be only temporary, depending on the reason for dysphagia. For example, many stroke patients may need to be on this diet at first, but as brain inflammation recedes, they may be able to return to a normal diet. Therapy with a speech-language pathologist may help some people improve their ability to swallow.