A number of physical illnesses make it difficult or painful to swallow. Other illnesses such as myasthenia gravis don't affect swallowing but can turn chewing into an extremely tiring act. People with these conditions need a diet that accommodates their physical difficulties and offers adequate nutrition. The NDD diet fulfills all these needs by assigning patients particular categories of foods and liquids to ingest.
Identification
The National Dysphagia Diet was created for people suffering from dysphagia, or difficulty swallowing. In 2002, the American Dietetic Association and the National Dysphagia Diet Task Force issued a joint publication, "National Dysphagia Diet: Standardization for Optimal Care," which classifies levels of dysphagia and the textures of foods appropriate for each level. A patient's speech pathologist is responsible for assigning her to a specific category of foods and liquids, indicating the texture and viscosity of foods she can safely consume.
NDD Solid Food Categories
The NDD diet includes four different levels for classifying solid food. The "Regular" level is no different than the diet you eat now: all foods are permitted. "Dysphagia Advanced" consists of soft yet solid foods that require some chewing. "Dysphagia Mechanically Altered" consists of semi-solid foods described as moist and cohesive, foods that require some chewing. "Dysphagia Pureed" is similar to a liquid diet, developed for patients who cannot swallow chewed food at all. The food is cohesive yet largely liquid, with a consistency similar to pudding.
NDD Liquid Categories
In "Quick Reference to Clinical Dietetics," author Lucinda Lysen describes the NDD's four liquid textures as follows. "Thin" liquids include water, milk and tea, consumable as long as the patient can swallow liquids. "Nectar-like" liquid is thin enough to be sipped but thick enough to fall slowly off a tipped spoon. "Honey-like" liquid is amorphous like a thin liquid, but can still be eaten with a spoon. "Spoon-thick" liquids hold their shape and are eaten with a spoon.
Sample Foods
California's Department of Developmental Services offers lists of sample foods applicable to each level of the NDD. For example, foods suitable for the "Dysphagia Advanced" category include diced, bite-sized foods such as cubed meat, eggs, diced fruit or peanut butter softened with jelly. Foods for the "Mechanically Altered" category include finely ground, minced, moistened foods such as cottage cheese, ground beef, moist bread crumbs, crushed fruit and creamed veggies. The "Pureed" category includes liquified versions of most regular foods such as meats, fruits, breads and veggies.
Sample Meals
California's DDS also offers sample meals that fit the guidelines established. "Dysphagia Advanced" meals might include scrambled eggs, dry cereal, minced spaghetti with cubed meatballs, shredded lettuce salad, cubed chicken breast and diced veggies. "Mechanically Altered" meals might include cooked cereal such as oatmeal, ground lettuce salad, ground chicken with gravy, steamed potatoes and moistened breadcrumbs. "Pureed" meals might include pureed oatmeal or eggs, pureed spaghetti, pureed garlic bread, pureed veggies such as potatoes or broccoli and pureed chicken breast with gravy.
References
- "National Dysphagia Diet: Standardization for Optimal Care"; National Dysphagia Diet Task Force and the American Dietetic Association; 2002
- "Quick Reference to Clinical Dietetics"; Lucinda K. Lysen; 2006
- State of California Department of Developmental Services Health and Human Services Agency: Diet Manual
