Dysphagia Diet Level 2, Mechanically Altered

This dysphagia mechanically altered diet is restricted to:

  • Foods that are moist, soft-textured, and easy to chew and swallow.

  • Meats that are ground or minced to no larger than ¼-inch pieces. Meats are moist with gravy or sauce added.

  • Foods that do not include bread or bread-like textures except soft pancakes, well-moistened with syrup or sauce.

  • Textures with some chewing ability required.

  • Casseroles without rice.

  • Cooked vegetables that are less than ½-inch in size and easily mashed with a fork. No cooked corn, peas, broccoli, cauliflower, cabbage, Brussels sprouts, asparagus, or other fibrous, non-tender, or rubbery cooked vegetables.

  • Canned fruit except for pineapple. Fruit must be cut into no larger than ½-inch pieces.

  • Foods that do not include nuts, seeds, coconut, or sticky textures.

FOOD TEXTURES

Includes all foods listed on Dysphagia Diet Level 1, Pureed, in addition to the foods listed below.

Beverages

  • Recommended: All beverages thickened to recommended consistency with minimal amounts of texture pulp. Any texture should be suspended in the liquid and should not fall out.

  • Avoid: All others.

  • You are currently limited to one of the following liquid consistency levels:

  • Thin.

  • Nectar-like.

  • Honey-like.

  • Spoon-thick.

Breads

  • Recommended: Soft pancakes, well-moistened with syrup or sauce.

  • Avoid: All others.

Cereals

  • Recommended: Cooked cereals with little texture, including oatmeal. Unprocessed wheat bran stirred into cereals for bulk. If thin liquids are restricted, it is important that all of the liquid is absorbed into the cereal.

  • Avoid: All dry cereals and any cooked cereals that may contain flax seeds or other seeds or nuts. Whole-grain, dry, or coarse cereals. Cereals with nuts, seeds, dried fruit, or coconut.

Desserts

  • Recommended: Pudding, custard. Soft fruit pies with bottom crust only. Canned fruit (excluding pineapple). Soft, moist cakes with icing.

  • Avoid: Dry, coarse cakes and cookies. Anything with nuts, seeds, coconut, pineapple, or dried fruit. Breakfast yogurt with nuts. Rice or bread pudding.

  • These foods are considered thin liquids and should be avoided if thin liquids are restricted:

  • Frozen malts, milk shakes, frozen yogurt, eggnog, nutritional supplements, ice cream, sherbet, regular or sugar-free gelatin, or any foods that become thin liquid at either room temperature, 70° F (21.1° C) or body temperature, 98° F (36.7° C).

Fats

  • Recommended: Butter, margarine, cream for cereal (depending on liquid consistency recommendations), gravy, cream sauces, sour cream, sour cream dips with soft additives, mayonnaise, salad dressings, cream cheese, cream cheese spreads with soft additives, whipped toppings.

  • Avoid: All fats with coarse or chunky additives.

Fruits

  • Recommended: Soft drained, canned, or cooked fruits without seeds or skin. Fresh soft and ripe banana. Fruit juices with a small amount of pulp. If thin liquids are restricted, fruit juices should be thickened to appropriate consistency.

  • Avoid: Fresh or frozen fruits. Cooked fruit with skin or seeds. Dried fruits. Fresh, canned, or cooked pineapple.

Meats and Meat Substitutes

Meat pieces should not exceed ¼-inch cubes and should be tender.

  • Recommended: Moistened ground or cooked meat, poultry, or fish. Moist ground or tender meat may be served with gravy or sauce. Casseroles without rice. Moist macaroni and cheese, well-cooked pasta with meat sauce, tuna noodle casserole, soft, moist lasagna. Moist meatballs, meatloaf, or fish loaf. Protein salads, such as tuna or egg without large chunks, celery, or onion. Cottage cheese, smooth quiche without large chunks. Poached, scrambled, or soft-cooked eggs (egg yolks should not be "runny" but should be moist and able to be mashed with butter, margarine, or other moisture added to them). Cook eggs to 160° F (71.1° C) or use pasteurized eggs for safety. Soufflés may have small, soft chunks. Tofu. Well-cooked, slightly mashed, moist legumes such as baked beans. All meats or protein substitutes should be served with sauces or moistened to help maintain cohesiveness in the mouth.

  • Avoid: Dry meats and tough meats, such as bacon, sausage, hot dogs, and bratwurst. Dry casseroles or casseroles with rice or large chunks. Peanut butter. Cheese slices and cubes. Hard-cooked or crisp fried eggs. Sandwiches. Pizza.

Potatoes and Starches

  • Recommended: Well-cooked, moistened, boiled, baked, or mashed potatoes. Well-cooked shredded hash brown potatoes that are not crisp. All potatoes need to be moist and in sauces. Well-cooked noodles in sauce. Spaetzel or soft dumplings that have been moistened with butter or gravy.

  • Avoid: Potato skins and chips. Fried or French-fried potatoes. Rice.

Soups

  • Recommended: Soups with easy-to-chew or easy-to-swallow meats or vegetables. Contents in soups should be less than ½-inch pieces. Soups will need to be thickened to appropriate consistency if soup is thinner than prescribed liquid consistency.

  • Avoid: Soups with large chunks of meat and vegetables. Soups with rice, corn, peas.

Vegetables

  • Recommended: All soft, well-cooked vegetables. Vegetables should be less than ½-inch pieces. They should be easily mashed with a fork.

  • Avoid: Cooked corn and peas. Broccoli, cabbage, Brussels sprouts, asparagus, or other fibrous, non-tender, or rubbery cooked vegetables.

Miscellaneous

  • Recommended: Jams and preserves without seeds, jelly. Sauces or salsas with small, tender, less than ½-inch pieces. Soft, smooth chocolate bars that are easily chewed.

  • Avoid: Seeds, nuts, coconut, or sticky foods. Chewy candies such as caramels or licorice.