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Level 3 National Dysphagia Diet

AMBULATORY CARE:

A level 3 National Dysphagia Diet

includes moist foods in bite-sized pieces. These foods are easier for you to chew and swallow. Avoid foods that are hard, sticky, crunchy, or very dry. Your healthcare provider will tell you how long you need to follow this diet. He or she may also explain the International Dysphagia Diet Standardization Initiative (IDDSI). The IDDSI contains 8 levels, from the thinnest liquids and foods to the thickest. Foods from the National Dysphagia Diet level 3 diet are on IDDSI level 6. Your provider may show you how to use IDDSI guidelines to test the thickness of your food or liquid.

Call your doctor or dietitian if:

  • You cough or choke when you swallow food or liquid.
  • You think the foods or liquids on your plan are difficult to swallow.
  • You are having new or worsening problems swallowing.
  • You have questions or concerns about your condition or care.

What you need to know about liquids:

Your healthcare provider will tell you how thick your liquids need to be. This depends on your ability to swallow. For the IDDSI system, liquids are levels 0 through 4. Your healthcare provider will tell you if which liquids you can have. Liquids can be thickened, if needed, with thickeners, flour, cornstarch, or potato flakes. Foods that are liquid at room temperature should also be thickened. These include frozen malts, yogurt, milk shakes, eggnog, ice cream, and gelatin.

  • Thin liquids flow quickly. These liquids take little or no effort to drink. Examples include water, non-fat milk, no-pulp juice, coffee, tea, and soft drinks. The IDDSI level for these liquids is 0 (thin).
  • Slightly thick liquids are thicker than water but still flow through a bottle's nipple. A little more effort is needed to drink these liquids. The IDDSI level for these liquids is 1 (slightly thick).
  • Nectar-thick liquids have the same thickness as vegetable juices and milkshakes. It should take some effort to drink the liquid through a straw. The IDDSI level for these liquids is 2 (mildly thick).
  • Honey-thick liquids should be difficult to drink through a straw. The IDDSI level for these liquids is 3 (moderately thick).
  • Pudding-thick liquids need to be eaten with a spoon. You should not be able to drink them through a straw. The IDDSI level for these liquids is 4 (extremely thick).

How to prepare foods:

  • Cut all food into small pieces. Pieces need to be smaller than 1 inch (2.54 cm).
  • Moisten the food by adding gravy, sauce, vegetable or fruit juice, milk, or half and half. Pour sauce or gravy over bread slices or syrup over pancakes. Allow the food to soften and dissolve.
  • Add dry milk powder to foods for extra protein and calories, if needed.
  • Cook vegetables so they are tender enough to be mashed with a fork.

Foods you can eat:

Remember to make food pieces smaller than 1 inch (2.54 cm).

  • Grains:
    • Soft pancakes, breads, sweet rolls, Danish pastries, and French toast with syrup or sauce
    • Soft dumplings moistened with butter or gravy
    • Rice or wild rice, if healthcare providers tell you it is safe for you
    • Dry cereals moistened and softened with milk or cooked cereals
    • Cakes or cookies moistened and softened with milk, coffee, or other liquid
  • Vegetables and fruits:
    • Cooked, boiled, baked, or mashed potatoes
    • Cooked, tender vegetables
    • Shredded lettuce
    • Soft, peeled fresh fruits such as peaches, nectarines, kiwi, mangoes, cantaloupe, honeydew melon, or watermelon
    • Canned or cooked fruits without seeds or skins
  • Dairy products:
    • Pudding, custard, or cottage cheese
    • Ice cream, sherbet, frozen yogurt, and malts
  • Meat and other protein foods:
    • Moistened ground or tender cooked meat, poultry, and fish with gravy or sauce
    • Eggs
    • Casseroles with small chunks of meat, ground meats, or tender meats
    • Strained corn and clam chowder

Foods to avoid:

  • Grains:
    • Dry toast, crackers, or tough crusty breads such as French bread
    • Bread that contains nuts
    • Very coarse cereals such as shredded wheat or bran cereals
    • Dry cakes or dry or chewy cookies
  • Vegetables and fruits:
    • Raw or fried vegetables
    • Tough, crisp-fried potatoes or potato skins
    • Cooked corn
    • Fruits that are difficult to chew, such as apples or pears
    • Stringy fruits such as pineapple, papaya, or mango
    • Grapes, dried fruits, or coconut
  • Dairy, meat, and other foods:
    • Tough, dry meats and poultry (chicken and turkey)
    • Nuts, seeds, or peanut butter
    • Pizza
    • Soups with tough meats
    • Chewy caramel or taffy
    • Yogurt that contains nuts

Other guidelines to follow:

  • Prepared foods can be frozen in small portions and reheated later. When you reheat foods, do not allow a tough outer crust to form on the food. This can make the food hard to swallow.
  • Eat a variety of healthy foods. Eat 6 to 8 small meals each day to get enough calories and nutrients. You may need to take a multivitamin and mineral supplement if you do not get all the nutrients you need. Ask if you can crush these and add them to pureed food.
    Healthy Foods
  • Rinse your mouth with water after each meal. This will help to prevent infections and problems with your teeth.

Follow up with your doctor or dietitian as directed:

Your plan may change over time if your ability to swallow changes. Follow the instructions you get at each follow-up visit. Write down your questions so you remember to ask them during your visits.

For more information about the IDDSI:

You can find official information about IDDSI levels and instructions for thickness testing by going to www.IDDSI.org.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

Further information

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