MODIFIED DIETS: Dysphagia Part 3 (Liquids)

Wednesday, November 26, 2025

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Image: IDDSI Flow Test Diagram; accessed 30 October 2025 from IDDSI.org

MODIFIED DIETS: DYSPHAGIA PART 3 (LIQUIDS)

By Flora Baker MS, EdM, RD, LDN and Gail K. Kachnycz RN, MSN 24 October 2025

     Dysphagia is the medical term for swallowing difficulties. The inability to swallow liquids correctly may allow fluids to seep into the air passages or lungs. This condition is known as aspiration. The presence of a foreign substance in the lungs can lead to infection and pneumonia. Modifying liquids, usually by thickening them, can promote complete and correct swallowing and reduce the risk of aspiration.

     Since 2019, the standard for the dysphagia diet is the International Dysphagia Diet Standardisation Initiative (IDDSI). There are five levels of liquid thickness, ranging from thin (water) to extremely thick (similar to the consistency of pureed solids). The medical provider may specify the particular level of liquids according to the IDDSI guidelines. The caregiver or client should clarify any questions with the medical provider. The IDDSI website has patient handouts which can be downloaded and instructional videos on how to prepare the liquid and check for appropriate thickness. From the Home Page, click “Resources” along the top of the screen. The drop-down menu includes “Patient Handouts” and “Videos.”

 Here is the link for IDDSI www.IDDSI.org 


     There are products on the market that will thicken thin liquids. A quick online search listed these: Thick-It, Clear DysphagiAide, ThickenUP Clear, and Purathick. These clear powders are unflavored and some can be used in both cold and hot liquids.


     Some people cannot cook for themselves. Stores like Target and Walmart have a selection of pureed meals. Clients and caregivers can check for agencies in their community that provide home delivered meals that accommodate special diets. One such agency is Meals on Wheels.

https://www.mealsonwheelsamerica.org/find-meals-and-services/

Philadelphia Corporation on Aging may help with locating agencies that provide meals.

www.pcacares.org



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MODIFIED DIETS: Dysphagia Part 2 (Solids)

Wednesday, November 19, 2025

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Image: IDDSI Framework Chart, accessed from IDDSI.org 29 October 2025

MODIFIED DIETS: DYSPHAGIA PART 2 (SOLIDS)

By Flora Baker MS, EdM, RD, LDN and Gail K. Kachnycz RN, MSN 24 October 2025

     The goal of making modifications to the diet is to allow a person to safely consume and enjoy their food. If a person is having difficulty swallowing, small amounts of solid foods or liquids may be inhaled into the airways or lungs, a condition known as aspiration. If solid foods are not chewed sufficiently or swallowed completely, there is a risk of choking.

     This post targets general modifications for solid foods. The goal is to eliminate lumps and create a texture that is smooth and pudding-like. Some foods naturally have this consistency, or are easily prepared without special equipment. Examples are:

-Scrambled eggs

-Dairy products like cottage cheese (small curd), yogurt, custard, pudding

-Soft fruits such as mashed bananas, apple sauce, mashed avocado

-Cooked cereals such as oatmeal, grits, Cream of Wheat. Milk (dairy or oat/almond milk) can be added to create desired consistency.

     Some foods may require use of a blender or food processor to soften them. The University of Virginia School of Medicine recommends the following:

-Blended cooked protein (meat, fish, poultry, tofu, nut butters)

-Pureed beans, hummus

-Blended bananas, peaches, pears

-Blended cooked vegetables such as potatoes (white or sweet), peas, carrots, cauliflower, squash (acorn, butternut, spaghetti squash)

Adding sauces, broth, milk or gravy may enhance the flavor as well as help create a smooth, soft texture.

     What are some foods to avoid? In general, foods that are hard, dry, stringy, sticky or chunky. Examples include:

-Vegetables or fruits that have seeds, tough skins, or stringy fibers such as raw celery or mangoes.

-Dried fruit of any kind such as raisins, cranberries, dried apples

-Dried meat such as jerky.

-Fried foods, such as fish or chicken.

-Dry foods such as popcorn, nuts, hard cheeses

-Some bread products, even soft breads, may form a sticky chunk when exposed to saliva

     Since 2019, the standard for the dysphagia diet is the International Dysphagia Diet Standardisation Initiative (IDDSI). There are seven levels of food and liquids, ranging from a regular diet with all textures to liquids as thin as water. The medical provider may specify the particular level of texture for solids or liquids according to the IDDSI guidelines. The IDDSI website identifies and describes the textures and thickness for each level. Instructional videos are also available. These are helpful but the caregiver should clarify any questions with the medical provider.

Here is the link for IDDSI www.IDDSI.org 

From the Home Page, click “Resources” along the top of the screen. The drop-down menu includes “Patient Handouts” which give details of each level in the diet, and foods to avoid. “Videos” show exactly how to prepare and check if the food is the correct consistency.

 


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MODIFIED DIETS: Dysphagia (Swallowing Difficulties) Part 1

Wednesday, November 12, 2025

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Image: Flora Baker 2 April 2023

     This month we welcome a guest blogger. Flora Baker is a Registered Dietician, and a good friend. I asked her to lend her expertise as a resource to A Map Through The Valley blog readers. Our first subject addresses swallowing difficulties, which may become a problem in various types of chronic illness. The topic is divided into three parts. Today is general information about dysphagia. Part 2 addresses solid foods, and Part 3 reviews liquids and community resources. Thank you, Flora!

MODIFIED DIETS: DYSPHAGIA (SWALLOWING DIFFICULTIES) PART 1

By Flora Baker MS, EdM, RD, LDN and Gail K. Kachnycz RN, MSN 24 October 2025


     Nutrition is key to improving health. Mealtimes also provide opportunities for social interaction. Eating healthy foods is so important during chronic illness. However, the progressive nature of some chronic illnesses, or treatment interventions may make eating difficult. Early signs of swallowing difficulties include choking or pain when consuming solids and/or liquids. The medical term for this condition is dysphagia.

      Some causes of dysphagia are due to changes in the mouth or upper part of the digestive tract, such as:

-Missing or decayed teeth

-Oral surgery or ill-fitting dentures

-Injury to the lips or other parts of the mouth

-Cancer of the mouth, esophagus, stomach

-Ulcer of the stomach

Other medical conditions can contribute to dysphagia, including:

-Head or neck injury

-Treatment or chemotherapy for any type of cancer

-Stroke or other injury to the brain

-Degenerative conditions such as dementia, Alzheimer’s disease, Parkinson’s disease

-Inactivity or bedrest weakens all muscles, including the muscles that aid swallowing

     If your loved one has any of these conditions, chewing effectively or swallowing completely and safely may become an issue. Be sure to discuss this with the medical provider, especially if noticing signs such as food residual remaining in the mouth, drooling, a clear runny nose that occurs when eating, or choking/coughing when trying to swallow solids or liquids. The loved one may leave meals unfinished because chewing and swallowing solids may be tiring. 

     The medical provider may recommend a modified diet based on your loved one’s current condition, but changes may be needed over time. In 2019 the International Dysphagia Diet Standardisation Initiative (IDDSI) was introduced globally. The instructions for specific needs may be based on this protocol. Be sure to clarify any questions with the medical provider.  The levels of modification are identified on the IDDSI website and can be used as a reference. 


Here is the link for IDDSI www.IDDSI.org 

From the Home Page, click “Resources” along the top of the screen. The drop-down menu includes “Patient Handouts” which give details of each level in the diet, and foods to avoid. “Videos” show exactly how to prepare and check if the food is the correct consistency.

 

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RECIPE: PUMPKIN SWEETZEL CHEESECAKE

Wednesday, November 5, 2025

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Image: Spice Wafers and Cheesecake 11/22/2024 by Gail K. Kachnycz

RECIPE: PUMPKIN SWEETZEL CHEESECAKE by Gail K. Kachnycz 5 November 2025

     I am not a fan of pumpkin pie, so I went looking for an alternative and found this cheesecake recipe by Sam Merritt. Her recipe has a graham cracker crust, but using spice wafers, with their blend of warm autumn spices, is the perfect compliment. Most of my recipes for caregivers are simple and healthy. This is neither, but it is worth every minute and every calorie as a special treat for Thanksgiving or Christmas.

     NOTE: Spiced Wafers are a treat that is local to the Delaware Valley. We emphasize that they are NOT Ginger Snaps. However, if you live in an area where Spiced Wafers (Sweetzel or Ivan's) are not available, Ginger Snaps may be substituted.

For the original recipes by Sam Merritt, use these links:

Pumpkin Cheesecake by Sam Merritt Graham Cracker Crust by Sam Merritt

Gail Kachnycz put a “Sweetzel Spin” on the recipe (22 November 2024) Make 1 Day Ahead

My recipe is based on her recipe, but modified to use the Sweetzels Spiced Wafers for the crust.

SPECIAL EQUIPMENT: Food processor to make the crumbs. Spring-form pan (9-10 inch), sheet pan with rim to bake on, parchment paper. Microwave. Pyrex or microwave safe container to melt the butter. Stand mixer is best for mixing the batter, it is thick. Hand mixer can be used.

CRUST: original recipe calls for granulated sugar and brown sugar, but I don’t use these since the Sweetzels are already sweetened cookies.

CHEESECAKE: original recipe calls for softened cream cheese and eggs at room temperature. I assemble all the ingredients so they can warm up while I am making the crust.

INGREDIENTS

Crust: 1 sleeve of Spiced Wafers. 7 tablespoons melted butter.

Cheesecake: (whipped cream at serving time; Gail uses canned)

24 oz cream cheese (brick style, not spreadable) 3 eight oz bricks, warmed to room temperature

3/4 cup brown sugar packed

1/2 cup granulated sugar

1/3 cup sour cream

1 ½ teaspoon vanilla extract

1 cup pumpkin puree (check the label, do not buy pumpkin pie filling)

2 ½ teaspoons pumpkin pie spice

3 large eggs lightly beaten, room temperature preferred

INSTRUCTIONS:

1. Plan to make this one day in advance; the dessert needs to chill at least seven hours.

2. Set out all the ingredients so the cream cheese and eggs can warm.

CRUST:

1. Assemble the spring form pan: the circular bottom has a rim, the rim should face DOWN, so the flat edge of the pan allows the serving implement to slide easily under the crust to remove a slice. Cut parchment paper to fit the bottom of the pan, and a panel to cover the inside of the spring-form. Can also try cooking spray to prevent sticking.

2. Seven tablespoons of butter is 1 stick minus 1 tablespoon. Put the seven tablespoons in the Pyrex measuring cup and microwave to melt.

3. Slightly soften half a sleeve of Spiced Wafers by spreading them on a plate, cover with moist paper towel, and microwave on high for 10 seconds. Break each cookie to fit through the chute of the food processor. Pulse until small crumbs form. Remove any larger pieces to re-process with the next batch. Put first batch in a medium mixing bowl. Repeat with the second half of the sleeve. (Any large pieces left in the second batch can be eaten!)

4. Pour the melted butter into the Spiced Wafer crumbs, use a fork to combine until all of the crumbs are moistened.

5. Transfer the mixture into the pie plate or spring-form pan. Use the clean bottom of a measuring cup to firmly pack crumbs into the bottom of the pan. If using a pie pan, use your fingers to pack crumbs tightly into the sides of the pie pan. Refrigerate while making the filling.

CHEESECAKE:

1. Pre-heat oven to 350 degrees F (will bake at least 40 minutes) Line a sheet pan with parchment paper. Gail’s note: The butter from the crust will leak out of the seam where the bottom & side of the spring-form meet. The pan will collect the butter. Do not use aluminum foil, as this slows the heating process and will affect proper baking of the filling.

2. In the stand mixer (or large bowl & hand mixer) beat together softened cream cheese and sugars, scraping down the sides with a spatula occasionally to ensure ingredients are mixed well. Beat on medium-speed about 1-2 minutes, scraping down side occasionally.

3. Add sour cream and stir well, pausing once to scrape down the sides and bottom of the bowl.

4. Add vanilla extract, pumpkin puree, and pumpkin spice and stir until well combined.

5. Break eggs & beat them slightly (Gail uses the Pyrex cup that had the melted butter, so all the egg contents slide out). Add in three portions, beating until just mixed after each addition (and scraping down the sides after each addition).

6. Place the pan with crust on the sheet pan. Spread the cheesecake batter evenly over prepared crust.

7. Transfer to oven and bake on 350 F for 40 minutes or until center of cheesecake is set and bounces back to the touch.

8. Allow pumpkin cheesecake to cool to room temperature and then transfer to refrigerator and chill for 6 hours or overnight.

9. Serving: Release the spring-form. Should be able to insert wide spatula, perhaps 2, under the parchment paper & slide to serving platter. Remove parchment from the sides. Makes 12 slices.

Top with whipped cream (Gail uses canned) just before serving.

Serving: 1 cheesecake yields 12 slices. 520 kcal per slice (original recipe with graham cracker)

Storing: Use an airtight container; can store in refrigerator up to 5 days. Pumpkin cheesecake may also be frozen for several months.

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