Advanced textures are Dysphagia Diet Level 3. Dysphagia Cat Ludwig, RDN, LD

Dysphagia Diet Level 3: Advanced Textures

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National Dysphagia Diet Levels

The National Dysphagia Diet, published in 2002, by the Academy of Nutrition and Dietetics, formerly called the American Dietetic Association, listed 4 levels of food textures. Each texture is specific for managing a specific chew or swallowing issues. They are:

Each level of the NDD works to address individual needs related to a person’s diagnosis of chewing or swallowing difficulty. The levels are subjective. Most facilities, like hospitals and nursing homes, have developed their own protocols for how the need for a diet is assessed and ordered.

A new system, called IDDSI (international dysphagia diet standardization initiative), was developed to give a more structured framework to dysphagia diets. It is much more comprehensive and specifically addresses the need for a modified textured food and thickened liquids. I will discuss this in a separate post.

What are Advanced Textures?

The National Dysphagia Diet Level 3, also called Advanced textures, include foods that are almost regular textured (food minus hard, crunchy, and very sticky foods). This level is transitional, linking the mechanically altered foods and regular textured foods.

Please remember that being able to properly chew food is integral to swallowing properly. Also, being able to move the food around in the mouth well with the tongue is very important for swallowing safely and effectively.

Transitional foods must be moist, and they should also be in small pieces, or bite-sized. They should be easy to chew.

My list of food ideas for Level 3 advanced texture diets:

  • Fruits – canned or cooked, peeled, no seeds
  • Breads – must be soft and moist with added jelly, syrup, butter, etc
  • Cereal – must but well cooked for hot cereal and with milk or juice added to soften cold cereal
  • Meat – well cooked, very tender, with added sauce or gravy. Eat it after cutting or shredding into small bite sized pieces
  • Potato and other starch – well cooked with added sauce or gravy
  • Vegetables – well cooked tender veggies, add sauce as desired
  • Desserts – softer is better, hot or cold are both okay as long as you tolerate different temperatures

Foods to Avoid with Dysphagia Diet Level 3 – Advanced textures

As mentioned above, there are a few foods to avoid. These foods are anything crunchy, hard, difficult to chew, or very sticky. Sticky foods can be difficult to maneuver in the mouth.

  • Bread – avoid hard, dry, or crusty bread. This also includes crackers and toast.
  • Cereal – bran or shredded wheat may not soften well in liquid
  • Dessert – dry cake or cookies, anything that includes nuts or seed as these can be difficult to chew properly and can cause coughing or choking
  • Fruits – fresh, firm, crunchy fruits, especially those with skins and fruits that have a lot of pulp or seeds
  • Meat – any type that is tough and dry, also fish with bones
  • Nuts – peanut butter and other nuts/nut butters IF they cannot be maneuvered well in the mouth
  • Soups – BEWARE of soups if you cannot handle two different consistencies (liquid and solid), be sure to avoid tough meats and veggies in soups that may be difficult to chew
  • Potatoes – chips or overcooked hard potatoes, potatoes with skins, etc.
  • Vegetables – raw veggies, corn and peas (types with skins can be hard to chew even when cooked)
  • Candy – caramel and other chewy type candies, coconut, and candies with nuts or seeds

Conclusion for Dysphagia Diet Level 3 Advanced Textures

Work with your doctor and speech therapist to determine what texture of food is safest for you. Work with your dietitian to develop a plan for meeting your nutritional needs.

You can get creative with your food to improve flavor with herbs, spices, and pairing the right foods. Avoid foods that cause you trouble or give you anxiety when eating. Eat slowly and listen to what your body is telling you, especially when eating.

If you have a specific question for a Speech Therapist or Dietitian please send me an email at Good luck and happy eating!

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