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Dysphagia Diet
5
Levels Difficulty In Swallowing Diet |
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Purpose
Dysphagia means difficulty
with chewing or swallowing food or liquid. To understand how this might happen, it is important to know something about how
swallowing occurs.
First, food must be chewed thoroughly. Then it is moved to the
back of the mouth by tightening the cheek muscles and pressing the tongue against the roof of the mouth. From this point on
the process becomes automatic -- it is a reflex that people do not actively control. In "rapid- fire" succession, the soft
palate closes the nasal airway to prevent food from backing into it, the airway into the lungs is closed, and the esophagus
(food pipe) relaxes allowing food and liquid to enter it. The muscular esophagus then contracts in a wave-like action, sweeping
the food along into the stomach.
A blockage or a malfunction anywhere in this part of the body
or in the nervous system controlling swallowing can result in dysphagia. There are two types:
Esophageal dysphagia occurs when food/liquid stops in the esophagus.
This happens most often because of consistent stomach acid refluxing (backing up) into the esophagus. Over time, the reflux
causes inflammation and a narrowing (stricture) of the esophagus.
Food and eventually liquids feel like they are sticking in the middle and lower chest.
There may be chest discomfort or even real pain. Fortunately, physicians can usually dilate (widen) this narrowing, and there
is now treatment available to keep it from returning. Cancer, hiatus hernia, and certain muscle disorders of the esophagus
are less frequent causes of esophageal dysphagia.
Oropharyngeal dysphagia involves difficulty moving food to the back
of the mouth and starting the swallowing process. This type of dysphagia can result from various nerve or brain disorders
such as stroke, cerebral palsy, multiple sclerosis, Parkinson's and Alzheimer's diseases, cancer of the neck or throat, a
blow to the brain or neck, or even dental disorders.
Depending on the cause, symptoms may include drooling, choking, coughing during or
after meals, pocketing of food between the teeth and cheeks, gurgly voice quality, inability to suck from a straw, nasal regurgitation
(food backing into the nasal passage), chronic respiratory infection, or weight loss.
The first step in treating oropharyngeal dysphagia is to make the proper diagnosis.
This involves a medical history and various tests to find the cause of the dysphagia. Often a team approach to treatment is
needed. Several types of health care providers -- physicians, registered dietitian, psychologist, speech pathologist, occupational
therapist -- work together to develop the best program.
An important part of the treatment is helping the patient get adequate
nutrition, while protecting against complications such as pneumonia from food or liquid getting into the
lungs. Obviously, this requires a specialized diet.
There are five different diet levels from puréed (level 1) up through modified regular
food (level 5). The diets vary in texture and consistency, and are chosen depending on which would be most effective for a
specific patient.
Nutrition facts
These diets are all nutritionally
adequate. However, some patients may have difficulty taking enough fluid and food to get all the energy and nutrients they
need. In this case, an adjustment to diet or treatment will be required. |
Liquids
Fluids are essential to maintain body functions. Usually 6 to 8 cups of liquid (48-64 oz) are needed daily. For some
dysphagia patients, this may present problems because thin liquid can be more difficult to swallow. In this case, fluid can
be thickened to make it easier to swallow. However, close monitoring by the dysphagia team is required for anyone drinking
less than 4 cups of thickened fluid a day or anyone not progressing to thin liquids within 4 weeks.
Calories
The greater problem for some patients
is eating enough calories. The whole process of eating simply becomes too difficult and too tiring.
However, calorie and protein intake can be increased by fortifying
the foods the patient does eat.
- Fortify milk by adding 1 cup of dry powdered milk to one quart of liquid milk. Use
this protein fortified milk when making hot cooked creamed soups, sauces, milkshakes, and puddings. Also add margarine, sugar,
honey, jelly, or puréed baby food to increase calories.
- Add strained baby fruit to juices, milkshakes, and cooked cereals.
- Add 1 jar of strained baby meat to soup, such as strained chicken noodle soup. Also
add strained baby meats to sauces and gravies, and mix with strained vegetables.
- Add juice to prepared fruit, cereal, or milkshakes.
Special Considerations
The following are some general guidelines for safe swallowing. Remember that
dysphagia patients have individual requirements, so all of these guidelines may not apply to every patient.
- Maintain an upright position (as near 90 degrees as possible) whenever eating or drinking.
- Take small bites -- only 1/2 to 1 teaspoon at a time.
- Eat slowly. It may also help to eat only one food at a time.
- Avoid talking while eating.
- When one side of the mouth is weak, place food into the stronger side of the mouth. At
the end of the meal, check the inside of the cheek for any food that may have been pocketed.
- Try turning the head down, tucking the chin to the chest, and bending the body forward
when swallowing. This often provides greater swallowing ease and helps prevent food from entering the airway.
- Do not mix solid foods and liquids in the same mouthful and do not "wash foods down" with
liquids, unless you have been instructed to do so by the therapist.
- Eat in a relaxed atmosphere, with no distractions.
- Following each meal, sit in an upright position (90 degree angle) for 30 to 45 minutes.
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Level 1
Puréed Foods
Foods in
this group are puréed to a smooth, mashed potato-like consistency. If necessary, the puréed foods can keep their shape with
the addition of a thickening agent. Meat is puréed to a smooth pasty consistency. Hot broth or hot gravy may be added to the
puréed meat, approximately 1 oz of liquid per 3 oz serving of meat.
CAUTION: If any food does not purée into a smooth consistency,
it may make eating or swallowing more difficult. For example, zucchini seeds sometimes do not blend well.
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Hot Foods |
Cold Foods |
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Puréed meats, poultry, & fish |
Puréed cottage cheese |
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Puréed tuna, ham, & chicken salad |
Puréed fruit |
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Pureed scrambled eggs & cheese |
Thickened juices & nectars |
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Baby cereals |
Thickened milk or eggnog |
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Thinned cooked cereals (no lumps) |
Malts |
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Puréed French toast or pancakes |
Thick milkshakes |
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Mashed potatoes |
Ice cream |
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Puréed parsley, au gratin, scalloped potatoes, candied sweet potatoes |
Fruit or Italian ice, sherbet |
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Puréed buttered or Alfredo noodles |
Plain yogurt |
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Puréed vegetables (no corn or peas) |
Smooth & drinkable yogurt |
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Puréed soups & creamed soups |
Smooth pudding, mousse, custard |
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Puréed scalloped apples |
Whipped gelatin |
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Gravies |
Sugar, syrup, honey, jelly |
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Sauces: cheese, tomato, barbecue, white, creamed |
Cream |
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Decaffeinated coffee or tea |
Non-dairy creamer |
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Margarine |
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Mayonnaise |
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Ketchup, mustard |
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Sample Menu
Level 1 |
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Breakfast |
Lunch |
Dinner |
- orange juice 1/2 cup
- cream of wheat
1/2 cup
- scrambled eggs with cheese 1/2 cup
- decaffeinated tea
1 cup
- whole milk 1 cup
- non-dairy creamer
2 Tbsp
- ketchup 1 Tbsp
- margarine 1 tsp
- salt 1/4 tsp
- sugar 2 tsp
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- pineapple juice
1/2 cup
- puréed beef 3 oz
- gravy 2 Tbsp
- mashed potatoes
1/2 cup
- puréed fresh broccoli 1/2 cup
- apple sauce 1/2 cup
- decaffeinated coffee
1 cup
- non-dairy creamer
2 Tbsp
- margarine 1 tsp
- salt 1/4 tsp
- sugar 1 tsp
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- puréed turkey barley soup 3/4 cup
- puréed Hawaiian chicken 3 oz
- mashed potatoes
1/2 cup
- puréed spinach
1/2 cup
- frozen yogurt 1/2 cup
- decaffeinated tea
1 cup
- non-dairy creamer
2 Tbsp
- margarine 1 tsp
- salt 1/4 tsp
- sugar 1 tsp
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This Sample Diet Provides the Following |
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Calories |
1657 |
Fat |
61 gm |
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Protein |
92 gm |
Sodium |
2590 mg |
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Carbohydrates |
198 gm |
Fiber |
3163 mg |
Foods in this group should be minced/chopped into very small pieces (1/8 inch). The flecks of food are similar in size
to sesame seeds. |
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Hot Foods |
Cold Foods |
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Minced meat, fish, poultry |
Cottage cheese |
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Minced stuffed fish |
Junior baby fruit |
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Flaked fish |
Semi-thickened juices |
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Junior baby meats |
Nectars |
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Minced soft cooked, scrambled, poached eggs |
Ripe mashed bananas |
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Minced soufflé & omelets |
Minced canned fruit |
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Minced soft French toast |
Pineapple sauce |
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Minced soft pancakes |
Milk |
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Cooked cereals |
Milkshakes |
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Minced potatoes |
Custard |
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Minced buttered or Alfredo noodles |
Puddings, including rice & tapioca |
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Minced vegetables |
Yogurt |
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Creamed soups |
Fruit ice, Italian ice, sherbet |
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Puréed vegetables soup or alphabet soup |
Whipped gelatin |
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Minced scalloped apples |
Junior baby desserts |
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Gravies |
Sugar, syrup, honey, jelly |
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Sauces: cheese, creamed, barbecue, tomato, white |
Cream |
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Decaffeinated coffee or tea |
Margarine |
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Sample Menu
Level 2 |
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Breakfast |
Lunch |
Dinner |
- orange juice 1/2 cup
- oatmeal 1/2 cup
- scrambled eggs with cheese 1/2 cup
- decaffeinated tea 1 cup
- whole milk 1 cup
- non-dairy creamer
2 Tbsp
- ketchup 1 Tbsp
- margarine 1 tsp
- salt 1/4 tsp
- sugar 2 tsp
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- pineapple juice 1/2 cup
- minced beef 3 oz
- gravy 2 Tbsp
- mashed potatoes 1/2 cup
- minced fresh broccoli
1/2 cup
- applesauce 1/2 cup
- decaffeinated coffee
1 cup
- non-dairy creamer 2 Tbsp
- margarine 1 tsp
- salt 1/4 tsp
- sugar 1 tsp
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- puréed turkey barley soup 3/4 cup
- minced Hawaiian
chicken 3 oz
- mashed potatoes 1/2 cup
- puréed spinach 1/2 cup
- frozen yogurt 1/2 cup
- decaffeinated tea 1 cup
- non-dairy creamer 2 Tbsp
- margarine 1 tsp
- salt 1/4 tsp
- sugar 1 tsp
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This Sample Diet Provides the Following |
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Calories |
2022 |
Fat |
80 gm |
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Protein |
111 gm |
Sodium |
2992 mg |
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Carbohydrates |
231 gm |
Potassium |
4182 mg |
Level 3
Ground Foods
Foods in this group should be ground/diced into 1/4-inch pieces. These pieces
of food are similar in size to rice. |
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Hot Foods |
Cold Foods |
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Ground meat, fish, poultry |
Cottage cheese |
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Ground meat salads (no raw eggs) |
Smooth fruited yogurt |
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Ground Swedish meatballs |
Fruit juices or nectars |
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Scrambled eggs or soufflés |
Ground canned fruit |
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Ground poached eggs |
Crushed pineapple |
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Cooked cereals |
Ripe bananas |
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Ground soft French toast |
Lemonade/Limeade (no pulp) |
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Ground potatoes |
Milk |
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Ground noodles |
Ice cream |
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Ground baked potato (no skin) |
Custard |
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Ground well-cooked frozen vegetables (no corn, peas, or mixed vegetables) |
Puddings or mousse |
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Ground canned vegetables |
Fruit ice, Italian ice, sherbet |
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Creamed soups |
Cream |
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Puréed vegetables soup or alphabet soup |
Non-dairy creamer |
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Ground scalloped apples |
Margarine |
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Gravies |
Mayonnaise |
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Sauces: cheese, creamed, barbecue, tomato, white |
Ketchup |
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Decaffeinated tea or coffee |
Mustard |
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Sample Menu
Level 3 |
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Breakfast |
Lunch |
Dinner |
- orange juice 1/2 cup
- oatmeal 1/2 cup
- scrambled eggs with cheese 1/2 cup
- decaffeinated tea 1 cup
- whole milk 1 cup
- non-dairy creamer
2 Tbsp
- ketchup 1 Tbsp
- margarine 1 tsp
- salt 1/4 tsp
- sugar 2 tsp
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- pineapple juice 1/2 cup
- ground beef 3 oz
- gravy 2 Tbsp
- mashed potatoes 1/2 cup
- cooked spinach 1/2 cup
- applesauce 1/2 cup
- decaffeinated coffee
1 cup
- whole milk
- non-dairy creamer 2 Tbsp
- margarine 1 tsp
- salt 1/4 tsp
- sugar 1 tsp
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- puréed turkey barley soup 3/4 cup
- ground Hawaiian
chicken 3 oz
- mashed potatoes 1/2 cup
- ground fresh broccoli
1/2 cup
- frozen yogurt 1/2 cup
- decaffeinated tea 1 cup
- non-dairy creamer 2 Tbsp
- margarine 1 tsp
- salt 1/4 tsp
- sugar 1 tsp
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This Sample Diet Provides the Following |
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Calories |
2022 |
Fat |
80 gm |
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Protein |
111 gm |
Sodium |
2992 mg |
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Carbohydrates |
231 gm |
Potassium |
4182 mg |
Level 4
Chopped Foods
Foods in this group should be chopped into 1/2-inch pieces. These pieces of food are similar
in size to uncooked elbow macaroni or croutons (small bread cubes). |
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Hot Foods |
Cold Foods |
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Chopped meat or poultry |
Cottage cheese |
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Chopped Swedish meatballs |
Yogurt |
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Meat salads (ground or flaked meat) |
Milk |
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Flaked fish |
Milkshakes |
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Poached or scrambled eggs |
Soft, cold, dry cereal |
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Soufflés and omelets |
Soft bread (if approved by speech or occupational therapy) |
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Cooked cereals |
Fruit juice or nectars |
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Chopped French toast or pancakes |
Chopped canned fruit |
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Chopped noodles or pasta (no rice) |
Canned fruit cocktail |
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Chopped cooked vegetables (no frozen peas, corn, or mixed vegetables) |
Pudding, mousse, custard |
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Chopped canned small sweet peas |
Ice cream |
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Creamed soup or vegetable soup |
Fruit ice, Italian ice, sherbet |
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Canned chicken noodle soup |
Cream cheese |
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Chopped potatoes (all kind) |
Whipped topping |
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Gravies |
Whipped gelatin |
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Bacon dressing |
Sugar, syrup, honey, jam, jelly |
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Sauces: cheese, creamed, barbecue, tomato, white |
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Decaffeinated tea or coffee |
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Sample Menu
Level 4 |
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Breakfast |
Lunch |
Dinner |
- orange juice 1/2 cup
- oatmeal 1/2 cup
- scrambled eggs with cheese 1/2 cup
- decaffeinated tea 1 cup
- whole milk 1 cup
- non-dairy creamer
2 Tbsp
- ketchup 1 Tbsp
- margarine 1 tsp
- salt 1/4 tsp
- sugar 2 tsp
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- pineapple juice 1/2 cup
- chopped beef 3 oz
- gravy 2 Tbsp
- mashed potatoes 1/2 cup
- chopped fresh broccoli
1/2 cup
- applesauce 1/2 cup
- decaffeinated coffee
1 cup
- non-dairy creamer 2 Tbsp
- margarine 1 tsp
- salt 1/4 tsp
- sugar 1 tsp
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- turkey barley soup 3/4 cup
- chopped Hawaiian
chicken 3 oz
- mashed potatoes 1/2 cup
- cooked spinach 1/2 cup
- frozen yogurt 1/2 cup
- decaffeinated tea 1 cup
- non-dairy creamer 2 Tbsp
- margarine 1 tsp
- salt 1/4 tsp
- sugar 1 tsp
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This Sample Diet Provides the Following |
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Calories |
2097 |
Fat |
82 gm |
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Protein |
113 gm |
Sodium |
3213 mg |
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Carbohydrates |
243 gm |
Potassium |
4201 mg |
Level 5
Modified Regular Foods
Foods in this group are soft, moist, regularly textured foods |
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Hot Foods |
Cold Foods |
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Soft, moist meat, fish, poultry |
Soft cheeses |
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Baked fish |
Cottage cheese |
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Meat Salads |
Cream cheese |
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Soufflés and omelets |
Yogurt |
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Eggs |
Milk |
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Stuffed shells |
Milkshakes |
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Spaghetti with meat sauce |
Cold dry cereals (no nuts, dried fruit, coconut) |
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Cooked cereal |
Crackers |
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French toast or pancakes |
Soft breads (no hard rolls) |
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Toast |
Fruit juices or nectars |
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Noodles or pasta (no rice) |
Canned fruit |
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Potatoes (all types) |
Ripe bananas |
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Soft, cooked vegetables (no corn, lima, or baked beans) |
Peeled, ripe, fresh fruit |
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Creamed soups or vegetable soup |
Cakes (no nuts, dried fruit, coconut) |
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Canned chicken noodle soup |
Plain doughnuts |
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Gravies |
Ice cream |
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Bacon dressing |
Pudding, mousse, custard |
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Sauces: cheese, creamed, barbecue, tomato, white |
Fruit ice, Italian ice, sherbet |
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Decaffeinated tea or coffee |
Whipped gelatin |
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Regular gelatin |
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Canned fruited gelatin molds |
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Sugar, syrup, honey, jam, jelly |
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Cream |
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Non-dairy creamer |
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Margarine |
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Oil |
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Mayonnaise |
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Ketchup |
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Mustard |
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Sample Menu
Level 5 |
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Breakfast |
Lunch |
Dinner |
- orange juice 1/2 cup
- oatmeal 1/2 cup
- cheese omelet
- toast 1 slice
- decaffeinated tea 1 cup
- whole milk 1 cup
- non-dairy creamer
2 Tbsp
- ketchup 1 Tbsp
- margarine 1 tsp
- salt 1/4 tsp
- sugar 2 tsp
- jelly 2 tsp
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- pineapple juice 1/2 cup
- hamburger on bun 3 oz
- steak fries 1/2 cup
- green beans 1/2 cup
- applesauce 1/2 cup
- decaffeinated coffee
1 cup
- whole milk 1 cup
- non-dairy creamer 2 Tbsp
- margarine 1 tsp
- salt 1/4 tsp
- sugar 1 tsp
- ketchup 2 Tbsp
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- turkey barley soup 3/4 cup
- Hawaiian chicken 3 oz
- mashed potatoes 1/2 cup
- fresh broccoli 1/2 cup
- frozen yogurt 1/2 cup
- decaffeinated tea 1 cup
- non-dairy creamer 2 Tbsp
- saltine crackers 6
- margarine 1 tsp
- salt 1/4 tsp
- sugar 1 tsp
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This Sample Diet Provides the Following |
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Calories |
2851 |
Fat |
120 gm |
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Protein |
129 gm |
Sodium |
4062 mg |
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Carbohydrates |
327 gm |
Potassium |
4609 mg | |
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