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Dysphagia Diet Level 2: What Are Mechanically Altered Foods?

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National Dysphagia Diet (NDD)

The Dysphagia Diet Level 2 fits into the NDD which consists of 4 levels. These levels are pureed (level 1), mechanical soft food or mechanically altered (level 2), advanced textures (level 3), and regular (level 4). Each level addresses a specific need for a person’s ability to chew and/or swallow food safely.

A group of dietitians, speech therapists, and a food scientist developed the NDD. Published in 2002, it standardized the way we address dysphagia through food and drinks. First we need to understand what dysphagia is and why changing the texture of food and drink can be beneficial.

What is Dysphagia?

Dysphagia is a diagnosis from a doctor that means difficulty swallowing. It is a frustrating, possibly painful, and potentially dangerous problem that can affect babies, children, teenagers, adults, and elderly. It can be short term or last a very long time. Dysphagia may or may not be able to be cured but it can be treated by a Speech Language Pathologist who specializes in swallowing therapy.

Evaluation and Treatment

Your doctor will send you to a specialist or run tests to determine your swallowing ability. A speech language pathologist, or speech therapist, will first evaluate your overall ability to maneuver food and/or drinks, then develop a plan to strengthen or improve your coordination.

Working with a speech therapist will greatly improve your ability and confidence to eat and drink. Adding a dietitian to your team can be beneficial as well for figuring out what to eat and how to plan, cook, and modify the texture.

Modifying Your Diet

Each level requires a different type and amount of processing to get it to the appropriate size and texture. We are specifically going to discuss how to mechanically alter foods for dysphagia diet level 2 in this article.

Let’s review the different levels:

  • Level 1 – Pureed – smooth, homogenous
  • Level 2 – Mechanically Altered – tiny sized pieces, easy to chew, extra moisture
  • Level 3 – Advanced Textures – soft, bite sized, extra moisture
  • Level 4 – Regular


Tools such as a blender, food processor, hand chopper, or chef knife may be appropriate depending on your skill level. Other cooking equipment like a slow cooker, pressure cooker, or Dutch oven may be helpful for cooking your food thoroughly.

Dysphagia Diet Level 2

It is not a homogenous, smooth texture like puree. Level 2 can tolerate (most of the time) this texture as it should be easiest to maneuver and safe to swallow. Mechanically altered food should be very small in size, soft, and with extra moisture added.

What is a dysphagia diet level 2 or mechanically altered diet?

9 bowls of chopped raw foods: onion, green onion, parsnip, tomato, yellow bell pepper, lettuce, onion, red bell pepper, purple cabbage with words bite size, cooked well, diced, minced, extra moisture, chopped, and soft shown over the bowls of foods

Level 2 foods are NOT homogenous. They have texture to them. They may be finely minced or chopped or soft cooked and smashed through a fork. The food can be added to a food processor and pulsed until the pieces are very small.

These foods are easy to chew without much effort and are easier to move around with the tongue.

Mech soft foods should always have extra moisture added to them or on the side. This can be in the form of sauce (bbq, dressing, marinara, etc.), gravy, butter or any other option that tastes good with the food you are preparing. This is subjective so you get to choose what you want!

Dry baked goods, desserts, or cereal (hot or cold) can have dairy or non-dairy milk, yogurt, or ice cream added to moisten them and also to add protein, fat, or extra liquid/moisture to your diet.

Dysphagia Diet Level 2 Foods to Avoid*

  • Hard, tough, or crunchy breads and crackers including pizza
  • Cereals that do no soften
  • Seeds and nuts
  • Dried fruit including coconut
  • Dry baked goods
  • Whole fruit with seeds or skins
  • Cooked fruit with skins and seeds
  • Pineapple, oranges, grapefruit
  • Tough meats and large pieces of meat that may be difficult to chew including sausages, brats, hot dogs
  • Rice, french fries, or other fried potatoes
  • Crispy fried eggs
  • Sticky food like peanut butter
  • Veggies with hulls or skins including corn, peas and beans
  • Soups with large chunks, rice, corn
  • Tough veggies like broccoli, cabbage, brussels sprouts and asparagus
  • Chewy foods including candy

*Other foods may be included in this list as each person’s needs are different. You may want to add more foods to this list.

Foods to Choose for Level 2

There are plenty of foods to choose from when on a mechanically altered diet. These foods may be canned, frozen, or bought fresh and cooked. Learning to adjust the texture of your food may be difficult at first but is worthwhile for improving your quality of life.

  • Soft, moist pancakes or breads with syrup, jam, butter, etc.
  • Cooked cereal like oatmeal or cream of wheat, added moisture may be helpful
  • Cold, well soaked cereal without nuts or seeds
  • Pudding, custard, ice cream, cheesecake, yogurt, cottage cheese (etc)
  • Canned fruit
  • Fruit pies and other cooked fruit desserts without nuts or seeds
  • Raw fruit like banana
  • Well cooked chopped meats
  • Ground meats
  • Well cooked pasta with sauce (casseroles)
  • Tuna salad, small diced/minced chicken salad, egg salad
  • Soft cooked eggs (boiled, poached, scrambled)
  • Soft cooked potatoes
  • Smooth soups or soup with small pieces (unless there is an issue with mixed consistencies)
  • Diced, soft cooked vegetables
  • Candy that melts in the mouth easily


Each person’s needs are very different when it comes to swallowing difficulties. A person may be able to go from pureed to mechanically altered texture but then have to learn what to do to change the food so it is appropriate and safe. Knowing about the details of level 2 is the first part, the second is having the right tools to process the food.

Dysphagia diet level 2 is not a smooth, consistent texture and can provide increased variety from a pureed diet. Food may look prettier on level 2 and the texture can provide mental stimulation that is missing from a pureed texture. Transitioning from puree to mechanically altered may be scary at first as the texture is different and may feel weird but it means your brain is relearning how to tell your body that food has more texture to it.

You can successfully learn to prepare mechanical soft/mechanically altered food, you can improve your quality of life and Dysphagia Dietitian is here to support you. For questions or help please visit the Contact page and send me a message. Good luck and lets get back to enjoying food again!

2 thoughts on “Dysphagia Diet Level 2: What Are Mechanically Altered Foods?”

  1. Need help! Husband is now on Dysphasia level 2 michanically Altered nutrition therapy diet. I will start caregiver in a day or two. Are there food prep/ delivery services for this diet. Nervous about aspiration in my care. He will be discharged from nursing and rehab. Where do I go from here?
    Virgie Gail Riley

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