What Is a level 1 dysphagia diet?

A level 1 dysphagia diet is a special eating plan. Your health care provider may recommend it if you have moderate to severe dysphagia. When you have dysphagia, you have trouble swallowing. You are also at risk for aspiration. Aspiration is when food particles or liquid enter the lungs by accident. It can cause pneumonia and other medical problems. This type of diet can help prevent aspiration.

When you swallow, food passes through your mouth and into a part of your throat called the pharynx. From there, it travels through a long tube called the esophagus. It then enters your stomach. This movement is made possible by a series of actions from your muscles in these areas. If you have dysphagia, the muscles don’t work properly. You may not be able to swallow normally.

When you breathe, air also enters your mouth and pharynx. From there, it travels to your lungs. Normally, a flap called the epiglottis blocks food particles and liquid from going into your lungs. If something does enter your lungs, you may aspirate. You are much more likely to aspirate if you have dysphagia.

The foods you eat have different properties that can affect your ability to swallow. For example, a food item can have a certain firmness or springiness.

To help people with dysphagia, the Academy of Nutrition and Dietetics created the National Dysphagia Diet. This diet plan has three levels. Each level is based on the severity of a person’s dysphagia. A level 1 dysphagia diet is the most restrictive. People on this diet should eat only pureed “pudding-like” foods. They should avoid foods with coarse textures.

The National Dysphagia Diet also addresses liquids. They are evaluated separately from solid foods. They are categorized by their thickness, which can affect how well a person can swallow them.

Why might I need a level 1 dysphagia diet?

Some medical conditions can make it hard to swallow. These include:

  • Stroke
  • Major dental problems
  • Conditions that reduce saliva (like Sjogren’s syndrome)
  • Mouth sores
  • Parkinson’s disease or other neurologic conditions
  • Muscular dystrophies
  • Blockage in the esophagus (such as from a tumor)

If you have severe or moderate dysphagia, you may need to follow the level 1 dysphagia diet as part of your treatment plan. Doing so can help lower your risk for aspiration. Your treatment may also include other therapies. You may need to do special swallowing exercises or take medicine. You may also need surgery.

How do I prepare for a level 1 dysphagia diet?

Before eating, you may need to make some preparations. For example, it may be helpful to sit upright at a 90-degree angle while eating. You may need support pillows to get into the best position. Try to reduce distractions. Changing between solids and liquids may also help.

Make sure you fully understand what foods and liquids you can and can’t have according to your prescribed diet. Some people need to avoid “thin liquids” unless they have been thickened. These types of liquids include water, tea, and milk. You can thicken these liquids by adding a thickening agent. Be sure to follow the package directions when using one. You can purchase thickeners and some prethickened liquids at your local drugstore.

Your speech-language pathologist (SLP) can show you liquids that have been thickened to various degrees. A member of your health care team can also tell you how to modify other foods, such as pureeing them. If you have any questions about preparing foods or liquids, don’t hesitate to ask.

You may find it easier to adjust to a new diet if your food smells and tastes appealing. Take time to season it. It also may help to prepare meals that are visually appealing. Even though you can’t have certain types of foods, you can still enjoy eating.

What happens during a level 1 dysphagia diet?

If you are on a level 1 dysphagia diet, there are certain foods you can and can’t eat. The following are some of the permitted foods:

  • Pureed breads (also called “pre-gelled” breads)
  • Smooth puddings, custards, yogurts, and pureed desserts
  • Pureed fruits and well-mashed bananas
  • Pureed meats
  • Souffles
  • Well-moistened mashed potatoes
  • Pureed soups
  • Pureed vegetables without lumps, chunks, or seeds


It is important to avoid other foods, including:

  • Non-pureed breads
  • Any cereal with lumps
  • Cookies, cakes, or pastry
  • Whole fruit of any kind
  • Non-pureed meats, beans, or cheese
  • Scrambled, fried, or hard-boiled eggs
  • Non-pureed potatoes, pasta, or rice
  • Non-pureed soups
  • Non-pureed vegetables
  • Seeds, nuts, or chewy candies


You may be able to prepare many of the allowed foods on your own. Follow proper instruction. You may also purchase commercially prepared products.

Some people on a level 1 dysphagia diet can drink thin liquids. But some should not. If you can’t have thin liquids, don’t drink liquids that haven’t been thickened.

Make sure you follow all your health care provider’s instructions about the foods and liquids you can and can’t have. Eating even a single food item on the “avoid” list can greatly increase your chances of aspiration.

What happens after a level 1 dysphagia diet?

Your health care team will keep track of how well you are swallowing. You may need follow-up tests, such as a fiberoptic endoscopic evaluation of swallowing (FEES) test.

Many people who have dysphagia due to a stroke find that their swallowing problems improve with time and therapy. If your swallowing gets better, you may be able to move to a less restrictive diet. If your swallowing worsens, you may need to temporarily use other methods of getting nutrition. For example, you may need a feeding tube.

While you are on a dysphagia diet:

  • Follow all instructions about what food and drink you can have.
  • Do swallowing exercises as advised.
  • Do not change your food or liquids, even if your swallowing gets better. Talk with your health care provider first.
  • Tell all health care providers and caregivers that you are on a dysphagia diet. Explain which foods and liquids you can and can’t have.


Next step

Before you agree to the test or the procedure make sure you know:

  • The name of the test or procedure
  • The reason you are having the test or procedure
  • The risks and benefits of the test or procedure
  • When and where you are to have the test or procedure and who will do it
  • When and how will you get the results
  • How much will you have to pay for the test or procedure