What is a level 1 national dysphagia diet?

    A level 1 national dysphagia diet includes only pureed foods. Pureed foods should have the same texture as pudding. They should be smooth and free of lumps. Pureed foods require very little chewing. Thin liquids need to be thickened because they are hard to swallow and more likely to enter the lungs. The level of thickness you need depends on your swallowing issues. Your doctor will tell you how long you need to follow this diet.

    What do I need to know about thickened liquids? 

    Thin liquids can be thickened with special thickeners, flour, cornstarch, or potato flakes. Thin liquids include milk, juice, coffee, tea, soda, and nutritional supplements. Foods that are liquid at room temperature should also be thickened. These include frozen malts, yogurt, milk shakes, eggnog, ice cream, and gelatin. Your doctor or dietitian will tell you which of the following types of thickened liquids you need:

    • Nectar-like liquids have the same thickness as nectars, vegetable juices, and milkshakes

    • Honey-like liquids are thicker than nectar-like liquids. The thickness is similar to honey at room temperature

    • Spoon-thick liquids are the thickest. The thickness is similar to that of pudding. These liquids need to be eaten with a spoon

    How do I prepare pureed foods? 

    • Add small amounts of gravy, sauce, vegetable or fruit juice, milk, or half and half to the food. Use only a small amount of liquid at first. Puree the food and add water as needed to get the same texture as pudding

    • Potato flakes can be used to thicken your food if you thinned it too much with liquid

    • Add dry milk powder to foods for extra protein and calories, if needed

    • Pureed foods can be frozen in small portions and reheated at a later time. When you reheat foods, do not allow a tough outer crust to form on the pureed food. This can make it hard to swallow

    What foods can I eat?

    All foods listed below should be pureed to the same texture as pudding.

    • Grains: 

      o Smooth cooked cereals such as cream of wheat 

      o Breads, rolls, and crackers

      o Pancakes, sweet rolls, Danish pastries, French toast, and muffins

      o Well-cooked pasta

    • Vegetables and fruits: 

      o Any pureed cooked vegetable

      o Tomato sauce or tomato paste without seeds

      o Mashed or pureed potatoes without skins 

      o Any pureed fruit

      o Well-mashed bananas 

      o Well-mashed avocados

    • Dairy products: 

      o Smooth puddings or custards

      o Yogurt

    • Meat and other protein foods: 

      o Pureed cooked meats

      o Pureed casseroles

      o Egg soufflés

    • Fats and oils: 

      o Butter and margarine

      o Mayonnaise, sour cream, and cream cheese

      o Whipped topping

      o Smooth sauces such as white sauce, cheese sauce, or hollandaise sauce

    What foods should I avoid? 

    • Any food that has not been pureed 

    • Foods with a tough texture such as raw fruits or vegetables, or nuts

    • Pureed foods that still contain pulp, seeds, or chunks

    • Fruited yogurts

    • Any food with lumps, including soups and oatmeal 

    • Peanut butter (unless it is part of a recipe for a pureed food)


    You have the right to help plan your care. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

    © 2017 Truven Health Analytics LLC All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

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