For most people, swallowing foods and liquids is not a problem. However, if you have certain neurological or physical problems, swallowing becomes very difficult. This condition, called dysphagia, can lead to life-threatening choking episodes, as well as inhalation of foods. In order for food and liquid to be safely eaten, its texture has to be altered to make it easier to swallow.
History
Conditions that require mechanically altered diets range from head injury to Alzheimer's disease. Depending on the severity, food will have to be altered to different levels of size, texture and moistness. Before 2003, there was no standard to determine what consistency of food a patient might need. Then a committee of dietitians and speech pathologists created the National Dysphagia Diet, which was published by the American Dietetic Association in 2003. There are three levels of mechanically altered diet: pureed, mechanically altered, and advanced.
Pureed
The Level 1, or pureed diet, is for people with severe dysphagia. For this level of mechanical alteration, everything must be perfectly smooth, with no seeds, spices or any hard or tough parts. Foods need to not only be pureed, but also strained to remove any tough bits. Liquids, including water, must be thickened until it is the consistency of honey. Depending on the severity of the condition, liquids may have to be as thick as pudding.
Mechanically Altered
The Level 2, or mechanically altered level of the diet, is for people who have some chewing ability. Foods do not have to be perfectly smooth, but they foods should still be moist and soft. Pancakes well moistened with syrup are a good example. Any meats must be ground and moist. All liquids must be thickened to the consistency of nectar or honey to minimize the risk of breathing in the liquids.
Advanced
The Level 3 of the dysphagia diet is called advanced because it closely resembles a normal diet. Therefore, a person consuming this diet should have only mild dysphagia. Very hard, dry, sticky or crunchy foods should not be eaten. All the foods must be moist, and should be cut into bite-sized pieces before being eaten. Liquids may still need to be thickened, depending on the person's abilities.
Considerations
The National Dysphagia Diet represents the consensus of experts on what should constitute a mechanically altered diet. However, as Gary McCullough pointed out in the November 2003 issue of "The ASHA Leader," there is no scientific research behind the diet. In addition, many of the terms, such as "honey thick," do not have exact definitions. As a result, the only official guide to mechanically altered diets serves more as a guide for professionals than as a rule to follow.
References
- "National Dysphagia Diet: Standardization for Optimal Care"; American Dietetic Association; 2003
- American Speech-Language-Hearing Association: National Dysphagia Diet - What to Swallow?
- "Krause's Food and Nutrition Therapy"; L. Mahan, Sylvia Escott-Stump; 2008
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