What is a Level 2 Soft Food Diet?

According to the National Dysphagia Diet framework, a Level 2 soft food diet consists of moist, cohesive, and soft-textured foods that require some chewing before swallowing. This diet is often prescribed for individuals with mild to moderate dysphagia, dental issues, or those recovering from head, neck, or stomach surgery. It is a critical transitional step toward a regular diet, reducing the risk of choking and aspiration.

Quick Summary

A Level 2 soft food diet, aligned with IDDSI Level 5, includes foods that are soft, moist, and easily mashed with a fork, requiring minimal chewing. It is prescribed for those with swallowing difficulties, poor dental health, or post-surgery to ensure safe and adequate nutrition.

Key Points

• Texture Requirements: A Level 2 soft food diet features moist, cohesive foods that are minced or mashed and can be easily handled with a fork, requiring minimal chewing.

• IDDSI Classification: This diet aligns with the International Dysphagia Diet Standardisation Initiative's (IDDSI) Level 5, also known as "Minced & Moist".

• Approved Foods: Suitable options include moistened ground meat, soft-cooked vegetables, mashed potatoes, cottage cheese, and soft fruits without skin or seeds.

• Foods to Avoid: Steer clear of hard, sticky, dry, or crunchy foods, as well as those with tough skins, seeds, or nuts.

• Medical Indications: It is prescribed for conditions like dysphagia, poor dental health, and post-operative recovery to reduce the risk of choking and aspiration.

• Preparation Techniques: Foods should be cooked until tender, mashed, or minced into small pieces (4mm max for adults), and moistened with sauces, gravy, or milk.

• Nutrient Fortification: Individuals may need to add nutritional boosters like protein powder, dried milk powder, or fats to meals to ensure adequate calorie and protein intake.

What is a Level 2 Soft Food Diet?

The Level 2 Soft Food Diet, formerly known as Dysphagia-Mechanically Altered under the National Dysphagia Diet (NDD), is a diet for individuals who need foods that are easy to chew and swallow but can handle more texture than a puréed diet. This diet features foods that are moist, cohesive, and minced into small pieces. The International Dysphagia Diet Standardisation Initiative (IDDSI) framework now aligns this with their Level 5, or "Minced & Moist" texture. This standardization helps ensure safety for those with swallowing difficulties, or dysphagia.

Why is a Level 2 Soft Food Diet prescribed?

This diet is recommended by healthcare professionals for several reasons, focusing on safety and comfort. Conditions that might require a Level 2 diet include:

• Dysphagia: For individuals with mild to moderate swallowing difficulties, it makes processing food easier.
• Dental Issues: It is suitable for those with problems like ill-fitting dentures or missing teeth.
• Post-Operative Recovery: Patients recovering from surgeries involving the head, neck, or stomach may need this diet as they transition back to solid foods.
• Certain Medical Conditions: Neurological conditions can affect chewing and swallowing, making this a safer option.

Key characteristics of a Level 2 diet

Foods for a Level 2 diet must meet IDDSI guidelines:

• Soft and Moist: Foods should be easily mashable with a fork and served with added moisture.
• Minimal Chewing: Some chewing is needed, but foods shouldn't require excessive breakdown.
• No Loose Liquid: The food should hold together; thin liquids shouldn't separate from solid parts.
• Specific Particle Size: Minced or chopped pieces should be no larger than 4mm for adults.

Approved foods and meal ideas

Creating nutritious and appealing meals on a Level 2 diet is important. Here are some suitable foods:

Grains and Starches:

• Cooked cereals like oatmeal.
• Soft pancakes or moist muffins.
• Well-cooked pasta in sauce.
• Mashed potatoes with gravy.

Protein Sources:

• Ground meat, poultry, or fish with gravy or sauce.
• Tuna or egg salad without large chunks.
• Soft-cooked or scrambled eggs.
• Tofu and well-cooked, mashed beans.
• Cottage cheese.

Fruits and Vegetables:

• Cooked or canned fruits without skins or seeds.
• Mashed ripe bananas.
• Well-cooked, soft vegetables like carrots or peas.
• Applesauce.

Dairy and Fats:

• Milk, milkshakes, and yogurt.
• Pudding and custard.
• Butter, margarine, and cream sauces.

Foods to avoid on a Level 2 diet

Certain foods are unsafe and must be avoided to prevent choking:

• Hard, crunchy, or chewy foods such as nuts, seeds, popcorn, or tough meat.
• Dry, crumbly items like plain crackers or bread crusts.
• Sticky foods such as peanut butter or caramel.
• Fibrous vegetables like celery.
• Foods with skins, husks, or seeds like corn or grapes.
• Mixed textures, like soup with solid pieces.

Comparison: Level 1 (Puréed) vs. Level 2 (Mechanically Altered)

Feature	Level 1: Dysphagia Puréed (IDDSI Level 4)	Level 2: Dysphagia Mechanically Altered (IDDSI Level 5)
Texture	Smooth, uniform, and pudding-like.	Soft, moist, cohesive, with small, soft lumps.
Chewing	Requires very little to no chewing ability.	Requires some, but minimal, chewing.
Appearance	Foods are blended to a homogenous consistency.	Foods are minced or mashed, with visible small pieces.
Fluid Content	Foods hold their shape on a spoon.	Cohesive, no thin liquid dripping from food.
Preparation	Processed with a blender or food processor to a smooth texture.	Minced, ground, or mashed to create small, soft pieces.
Appropriate For	Severe swallowing difficulties.	Mild to moderate swallowing difficulties, poor dental health.

Conclusion

Understanding what a Level 2 soft food diet is is vital for individuals needing a safe and nourishing eating plan due to conditions like dysphagia, dental issues, or post-surgery recovery. By focusing on moist, minced, and soft foods, individuals can consume a variety of meals while lowering the risk of choking. Following the guidelines and consulting healthcare professionals ensures the diet meets individual needs. Moving from a puréed to a mechanically altered diet is a positive step towards a more varied diet.

Recipe idea: Moist Chicken and Vegetable Casserole

Combine cooked ground chicken, finely minced and mashed carrots and potatoes with cream of mushroom soup and a little chicken broth for moisture. Bake until hot for a cohesive and flavorful Level 2 meal.

More information on dysphagia and IDDSI

For more details on dysphagia diet standards and testing, the International Dysphagia Diet Standardisation Initiative (IDDSI) provides extensive resources. Visit the official IDDSI website for the full framework.

Preparing foods for a Level 2 diet

Follow these tips for proper food consistency:

• Use a food processor or grinder for protein sources.
• Mash vegetables with a fork.
• Add broth, gravy, or sauce to moisten foods.
• When reheating, prevent drying out.

Nutritional considerations

A soft food diet can be lower in fiber and calories, so fortification may be needed. Consider:

• Adding protein or dried milk powder to meals.
• Using full-fat dairy products.
• Mixing in extra fats.
• Including nutritional supplement drinks as advised by a healthcare provider.

Monitoring and next steps

Monitoring for signs of worsening swallowing difficulties, such as coughing, is crucial. If this occurs, a healthcare professional should reassess the diet. Based on progress, a speech-language pathologist may recommend moving to a less restrictive diet, like Level 3 (Soft & Bite-Sized). This transition should always be guided by medical advice.

Frequently Asked Questions

What is the difference between a Level 1 and a Level 2 diet?

A Level 1 diet is puréed, with a uniform, smooth consistency that requires no chewing. A Level 2 diet is mechanically altered, meaning foods are soft, moist, and minced or mashed, requiring some but minimal chewing.

Can I eat bread on a Level 2 diet?

Yes, but only if it is soft and well-moistened. Avoid dry toast or hard bread crusts. Soft pancakes, rolls, or bread soaked in gravy or sauce are appropriate.

How do I make foods moist enough for a Level 2 diet?

You can add extra moisture by using gravy, broth, milk, butter, or sauces when preparing or serving your food. This helps keep the food cohesive and easier to swallow.

What if I experience coughing or choking on this diet?

Coughing or choking can be a sign that the food texture is still too difficult to manage. You should immediately consult your doctor or speech-language pathologist to have your diet reassessed.

Are there any risks to being on a Level 2 diet long-term?

Extended use of a soft food diet without professional guidance can lead to dental issues due to reduced chewing stimulation. It is important to work with a healthcare team to transition to a more regular diet as appropriate.

Is peanut butter allowed on a Level 2 diet?

No, traditional peanut butter is too sticky and poses a choking risk. Sticky or gummy foods should be avoided on this diet.

Can I eat fruits and vegetables with skin?

No, fruits and vegetables with skins, seeds, or tough fibers should be avoided. Only use well-cooked, peeled, and mashed varieties or canned fruit without skins.

How can I ensure my meals are nutritionally balanced?

You can fortify meals by adding protein powder, dried milk powder, or extra fats like butter or cream. Aim for small, frequent meals and snacks throughout the day, and consider nutritional supplement drinks.