The Pureed food diet: NDD Dysphagia Diet Level 1. Cat Ludwig, RDN, CLT on green background with picture of pureed layered turkey sandwich: turkey, tomato, lettuce, cheese, and bread.

The Pureed Food Diet: Dysphagia Diet Level 1

Sharing is caring!

This article about pureed food diet includes affiliate links. As an Amazon Associate I earn from qualifying purchases. at no additional cost to you.

Introduction to Dysphagia Diet Levels and Pureed Food

I worked in hospital food service and nursing homes for several years, in a number of different states. At each facility we implemented different dysphagia diet levels. We took the normal, regular menu and altered each item so that we were able to offer mechanically altered and pureed food to meet the needs of every dysphagia diet level.

The altered food items were the same as the regular menu items. The biggest problem with this was that the food looked terrible. The cooks scooped pureed food (dysphagia diet level 1), out of a dish and plopped it on each plate. It was then finished by pouring a bland sauce over the top. What a disaster!

As the dietary manager I would help prepare the pureed and mechanically altered foods so that I could pour a little culinary love into what otherwise would have been a sad blob of meat, gravy, starch, and vegetable on each plate, (and dessert on the side of course). Now, some foods are perfect as puree. These foods include mashed potatoes and gravy, tomato soup, and pudding.

But let’s be honest, salmon and broccoli do not quite have the same appeal. Some textures, like crunchy, cannot be replicated no matter what you do to them. In light of these ideas, I would like to show you how pureed food can still taste good and look beautiful.

What is Dysphagia and Why the Need for Diet Levels?

Dysphagia is a medical condition that simply means difficulty swallowing. Furthermore, we also include difficulty chewing in the definition because if you cannot chew properly, it can make swallowing even more difficult. Any number of medical problems may lead to requiring a special diet texture. Problems with chewing and swallowing can be dangerous. By changing the diet texture, of both liquids and solids, we can increase the ability to eat safely.

There are two schools of thought when it comes to classifying diet textures. National Dysphagia Diet (NDD) and IDDSI (International Dysphagia Diet Standardisation Initiative). The NDD and IDDSI were developed to provide clarity of the dysphagia diet levels. Each level is specific for a person’s chewing and swallowing ability in order to provide adequate nutrition and safety. IDDSI further clarifies the NDD.

Introduction to Dysphagia Diet Levels and Pureed Food

I worked in hospital food service and nursing homes for several years, in a number of different states. At each facility we implemented different dysphagia diet levels. We took the normal, regular menu and altered each item so that we were able to offer mechanically altered and pureed food to meet the needs of every dysphagia diet level.

The altered food items were the same as the regular menu items. The biggest problem with this was that the food looked terrible. The cooks scooped pureed food (dysphagia diet level 1), out of a dish and plopped it on each plate. It was then finished by pouring a bland sauce over the top. What a disaster!

As the dietary manager I would help prepare the pureed and mechanically altered foods so that I could pour a little culinary love into what otherwise would have been a sad blob of meat, gravy, starch, and vegetable on each plate, (and dessert on the side of course).

Now, some foods are perfect as puree. These foods include mashed potatoes and gravy, tomato soup, and pudding. But let’s be honest, salmon and broccoli do not quite have the same appeal. Some textures, like crunchy, cannot be replicated no matter what you do to them. In light of these ideas, I would like to show you how pureed food can still taste good and look beautiful.

National Dysphagia Diet (NDD)

The National Dysphagia Diet was developed in 2002 by dietitians, speech therapists, and a food scientist. It contains four levels:

  • Pureed (Level 1)
  • Mechanically altered (level 2)
  • Advanced (Level 3)
  • Regular (Level 4)

The main issue with these levels is that it does not include terminology that would make these levels easier to understand. It also does not discuss what foods to avoid. It also does not give any information about liquids and the thickness they should be. Thickening liquids is necessary for many people. It can improve ability to swallow liquids safely depending on the health problem a person might have. Comparatively, the IDDSI breaks down the diet into very specific parts.

IDDSI (International Dysphagia Diet Standardisation Initiative)

The IDDSI Framework. Two pyramids, the first is upside down and describes the foods and their consistencies, level 3-7, liquidised to regular/easy to chew. The second pyramid is right side up and describes liquid consistencies, levels 0-4, from thin to extremely thick. Level 4 describes pureed food and extremely thick liquid.

As you can see by the above image, liquids and solids are classified more specifically with the IDDSI framework. There are even two levels that include both solids and liquids.

For the remainder of this article, we are going to discuss the pureed diet: dysphagia diet level 1 in NDD and level 4 in the IDDSI framework.

Pureeing food

Tools

The most important part of the pureed diet is to end up with a smooth, homogenous consistency. It cannot have any chunks or lumps. It should be thick but not so thick that you have to chew it. You should be able to move it around in your mouth easily with your tongue. If your tongue doesn’t work properly, it is even more important to have the right consistency! Talk to your Speech Therapist, Doctor, and Dietitian if you need clarification.

In order to puree food properly you need the right tool. I recommend a good blender or food processor. I prefer a Vitamix blender but other options will work. A hand blender (otherwise known as an immersion or stick blender) can be used as well.

Flavor

What is flavor? It means a distinctive taste, it can be altered or enhanced. You do NOT have to take a boring piece of chicken, put it in a blender, puree it, and eat it. You CAN add herbs, spices, vegetables, fruit, and anything else your imagination tells you to use in order to make your pureed food taste good.

When adding food to a blender or food processor, it is important to remember to add extra liquid. When a person has difficulty swallowing it may be made worse by having dry mouth. Dehydration can occur when a person that cannot drink regular thin liquids safely. Adding liquid to your food for pureeing is important for helping with hydration and preventing choking. PLUS, your liquid can add flavor!

One of my favorite books is called Culinary Artistry, by Karen Page and Andrew Dornenburg. The latest version is called Look up herbs, spices, and other options to add flavor to your dish. Next let’s discuss cooking your foods before you puree them.

Cooking and Storing Pureed Food

I start almost all my savory dish by sautéing onion and garlic. It adds flavor and is full of nutrition. Chicken, vegetable, or beef broth are always flavorful, protein rich options to add to your blender or food processor. If you require thickened liquids, adding a thickener to your blender is necessary. There are many thickeners you can use and they are readily available for purchase. I will cover thickeners in another article.

Cooking large amounts of food at a time, or batch cooking, will make pureeing easier. Small amounts typically do not puree well. Some types of foods are easiest to batch cook, including soups, casseroles, curries, and many others. These foods are also easy to puree. Pureed foods can be simple and delicious. Almost any recipe can be pureed if done correctly.

Next, batch cooking means you should have plenty of leftovers. I recommend storing in freezer/microwavable safe containers. Portioning meals into containers and freezing them is your best option. For food safety reasons, you should not keep foods, especially proteins (chicken, beef, seafood), in the refrigerator for more than 3 days. When reheating your food in the microwave, adding a bit of liquid can help keep the food from drying out.

Conclusion

In Conclusion, eating pureed food does not have to be a disappointing experience. You can add flavor in many ways. The right tools and ingredients can make pureeing food a breeze.

If you have questions about preparing, cooking, pureeing, or food safety please visit my Contact me page and send me a message!

1 thought on “The Pureed Food Diet: Dysphagia Diet Level 1”

Leave a Comment

Your email address will not be published. Required fields are marked *

Scroll to Top