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Dysphagia: Foods to Avoid for Safe Eating

Nutrition Despina Moshopoulos
Dysphagia: Foods to Avoid for Safe Eating

Dysphagia is the medical term for those who have difficulty swallowing both solids and 

liquids. In Australia dysphagia is estimated to impact 22% of people aged 50 and above. Within aged care facilities, dysphagia affects 50% of residents. It can be caused by a number of things such as neurological and muscle disorders, structural problems in the throat or esophagus and can even be the result of certain medical treatments. 

Dysphagia can range from mild sensations of food getting stuck in the throat to the complete inability to swallow and painful blockage.

Understanding, as a carer, what your client can and can’t eat as someone who experiences dysphagia can reduce the risk of any medical problems like choking, aspiration or impacting the medical needs of your care recipient. 

Understanding Dysphagia Diet Levels 

According to the International Dysphagia Diet Standardisation Initiative (IDDSI), a global collaborative effort of professionals who are working to standardise the terminology and definitions for modified textures of foods and liquids for those with dysphagia, there is a continuum of 8 levels of liquid and food diets. For carers, this list of dysphagia diet levels should be used as a resource to help you improve the care you provide. 

Liquid Diet Levels 

IDDSI sets out 5 different liquid levels of thickness ranging from thin (Level 0) to Extremely Thick (Level 4). 

Level 0 (Thin) - This refers to fluids like water, juice and milk.

Level 1 (Slightly Thick) - At this level, liquids are slightly thicker than water but still capable of flowing through a straw. 

Level 2 (Mildly Thick) - Mildly thick liquids can be sipped from a cup but requires mild effort to suck through a straw. 

Level 3 (Moderately Thick) - Can be drunk from a cup but not through a straw. This is the consistency of custard. 

Level 4 (Extremely Thick) - Can only be eaten with a spoon. 

Hard Food Diet Levels 

The hard food diet levels, as set out by IDDSI, starts from Level 3 and continues to Level 7. Levels 3 and 4 appear in both the liquid and hard food diet levels. 

Level 3 (Liquidised) - Aligning with the liquid level 3, this includes food that is smooth, moderately thick and can be eaten with a spoon or drunk from a cup. Things like yoghurt and custard. 

Level 4 (Pureed) - Connected to level 4 of the liquid diet levels, the pureed food level includes food with a homogenous consistency typically created by using a blender,food processor or by running through a sieve. Food at this stage includes pureed meats, fruits, vegetables and soups that are thick and smooth. 

Level 5 (Minced & Moist) - Foods that are included at this level are things like mashed or minced vegetables, finely chopped meats, thick sauces and gravies and soft cereal. 

Level 6 (Soft & Bite-Sized) - Food at this level should be bite sized (1.5cm x 1.5cm). The texture of these food items should be soft, tender and moist. Examples of food that you can consume at this level are chopped meats in sauce, well cooked vegetables in a sauce, soft bread products and starchy foods like rice, potatoes (mashed or cut into small pieces) and pasta. 

Level 7 (Easy to Chew) - Food at the ‘Easy to Chew’ level can be most everyday foods but doesn’t include hard, dry or chewy foods. Some examples of foods at this level include cooked vegetables, soft meats and fish, porridge and foods with a dual consistency. 

Foods to Avoid with Dysphagia and Their Safer Alternatives

Avoiding particular food when experiencing dysphagia will minimise the risks of choking, aspirating and prevent your care recipient from experiencing malnutrition. Consuming foods that should be avoided can negatively impact your care recipient.  

Hard and Crunchy Foods - Softer Substitutes 

People who experience dysphagia should avoid hard and crunchy foods like raw vegetables, nuts, tough meats and raw fruits. Things like that can make swallowing and chewing difficult for your client, increasing the risk of choking and causing irritation. 

Instead, opting for cooked fruits and vegetables as well as tender meats like fish and chicken are safer alternatives. 

Sticky and Chewy foods - Easy-to-Swallow Alternatives

Some sticky and chewy foods to avoid with dysphagia are things like peanut butter, chewy sweets like toffee and granola bars. These food options should be avoided as they often cling to the mouth making the swallowing manoeuver difficult for your client. Eating foods like this can increase the risk of aspiration (food entering the lungs). 

Smooth and soft food options that are easy-to-swallow such as purees and yoghurt should be consumed as an alternative to the above sticky foods. 

Dry Foods that Can Cause Throat Irritation - Moist Options

Other types of food that should be avoided when experiencing dysphagia are dry foods. This includes crackers, dry bread, plain toast and pasties that have no moist filling. Dry foods make swallowing difficult and could result in choking for your client. 

Instead of offering dry foods, choose moist foods that are easier to swallow or add sauces, gravies or broths to dry foods in order to soften them for your care recipient. 

Stringy and Fibrous Foods - Tender Alternatives 

Stringy and fibrous foods should be avoided by those with dysphagia as they don’t break down easily and can be a challenge to chew and swallow. Examples of these foods are string beans, celery and some fruits with thick skin and seeds like grapes or tomatoes. 

Some tender alternatives to fibrous or stringy foods are things like moistened potatoes, soft ripe bananas, canned fruits and well cooked mince meat, chicken or fish. 

Thin Liquids and Carbonated Beverages - Thickened Drinks 

Another food option that should be avoided for someone with dysphagia is thin and carbonated drinks. Surprisingly, thin drinks like water, tea/ coffee, juices and carbonated drinks like soda, are difficult to control and swallow for those experiencing dysphagia. This could lead to aspiration and vomiting. 

Alternatively, try adding thickeners to your clients thin liquids. This will help your client to control the swallowing of these liquids without changing the taste or nutritional value of some of these drinks. 

The Role of Dietitians in Dysphagia Management 

When it comes to health conditions that affect how individuals are ingesting nutrients, working with a dietitian to ensure your care recipient is consuming food safely is essential. 

So what is the role of a dietitian for dysphagia management?

A dietitian’s main role in helping manage dysphagia is to help their patients in receiving nutrients and hydration as well as making the eating experience enjoyable. Dietitians can perform nutritional assessments where they evaluate a patient based on their intake of protein, calories, hydration and any deficiencies they may have. At this assessment of your care recipient, the dietitian can develop a guide of personalised dietary recommendations. After this assessment, your dietitian can create a modified diet plan based on the swallowing abilities of your client. Here is where the dietitian can recommend modified food textures to ensure safe and nutritional eating and what those nutrition products may be. 

A dietitian’s role is to also educate patients and caregivers on techniques that make mealtime effective for the person experiencing dysphagia. These are things like positioning, pacing and swallowing manoeuvers. They will also suggest oral nutritional supplements they think will be useful or in some cases will suggest enteral nutrition (tube feeding) if necessary to meet nutritional requirements. 

Consulting a dietitian is beneficial to both the caregiver and the recipient as they can offer solutions and education that both people can do to manage dysphagia. 

Nutrition Tips for Dysphagia

  • Eating smaller meals, more frequently throughout the day will help manage dysphagia.

  • If you are finding it hard to eat particular types of food, try out different textures and consistencies to see what works the best for you. 

  • As a caregiver, ensure that your client is in a quiet environment when eating to minimise distractions and allow them to focus on eating. 

  • Some of the recommended foods for dysphagia include pureed meats, fruits and vegetables as these are often soft and nutritious sources.

Preparing Food for Dysphagia Patients at Home 

Preparing foods for those impacted by dysphagia can involve modifying the texture and consistency of food making it easier to swallow. This can be done by softening and pureeing foods. 

To create soft foods that are safer to swallow for your care recipient, you can moisten foods by adding broth, sauces or gravy, dice mince or mash foods to make them more manageable and remove the tough parts like skin, bones and rinds. 

For the preparation of pureed foods you should use a food processor that will blend the food until smooth. Then add a liquid like milk, cream, broth or sauce to create a smooth and moist texture. After the food has been pureed add seasoning to make it more palatable for your patient. 

Conclusion 

Managing dysphagia safely and effectively requires more than just following dietary texture guidelines—it demands a holistic understanding of the condition, informed food choices, and individualised care. 

In Australia, where dysphagia affects a significant portion of the ageing population, preparing thickened food and drinks at home with attention to taste, nutritional density, and safety can dramatically improve quality of life. With the right knowledge and support, caregivers can ensure that eating remains a safe, nourishing, and dignified experience for those living with dysphagia.

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