Dysphagia is a difficulty swallowing or a disturbance in the normal transfer of food from the oral cavity to the stomach. Improperly treated dysphagia can lead to choking, aspiration of food into the lungs and pneumonia. Prolonged untreated dysphagia can also cause inadequate nutrition and weight loss. Common causes of dysphagia include: stroke, head and neck injury, Parkinson’s disease, Multiple sclerosis, Amyotrophic lateral sclerosis, congestive heart failure and esophageal trauma.
Types of Dysphagia
- Oropharyngeal dysphagia: A difficulty emptying food from the oropharynx (back of mouth) into the esophagus.
- Esophageal dysphagia: A difficulty passing food down the esophagus
Signs and Diagnosis of Dysphagia
A person with dysphagia will commonly cough when eating, drool or pocket food in the cheeks. If a difficulty swallowing is expected a Speech and Swallow Therapist should be consulted to evaluate the person's swallow. A Barium swallow test can be done to diagnosis the type and severity of the dysphagia. The Speech and Swallow Therapist can also teach swallowing techniques to improve the quality of the swallow.
Dysphagia Diets
For those diagnosed with dysphagia the texture of their food may need to be modified to help make swallowing easier and to help prevent choking. The National Dysphagia diets have 3 levels. The level of diet a person follows depends on the severity of the dysphagia.
Dysphagia diet level 1
- This level is for people with moderate to severe swallowing difficulty and have a poor ability to protect their air way
- This diet allows pureed food (pudding like consistency) that is smooth and easily stays together
- Food should be avoided if they require chewing. Coarse and dry textures, raw fruits and vegetables, breads and nuts should also be avoided.
- It may be difficult to meet calorie and nutrition needs on this diet. It is important to use high calorie, nutrient dense food such as cheese sauce, gravy and whole or butter milk in this diet. Eating more frequently through the day can also help increase intake.
Dysphagia diet level 2
- This is a step up from the pureed diet. Some chewing ability is required. The level 2 diet is for people with mild to moderate swallowing difficulty.
- This diet consists of foods that are moist, soft and easily formed into a bolus (soft wad of food). Avoid foods that are difficult to chew, dry and coarse
- Meats should be ground or minced and should be keep moist with sauces and gravies.
Dysphagia diet level 3
- This diet is a step down from a regular diet and is for individuals with mild swallowing problems.
- This diet consists of all foods, except very hard sticky or crunchy foods.
- Foods should be moist and should be cut up into bite size pieces.
Liquids
Thin liquids can be very difficult for people with dysphagia to swallow and are very easy to choke on or aspirate into the lungs. It may be recommended by the Speech and Swallow therapist or doctor to use thickened liquids. Over the counter products such as “thick-it” are available to thicken liquids to appropriate textures.
When following a dysphagia diet it is also important to add wide variety of foods in the diet. Do not get stuck eating the same foods. Be creative, a lot of foods can be put in a blender to provide a nutritious meal. While dysphagia can make eating challenging it is possible by following the correct recommendations to meet the appropriate nutritional needs.
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