“Minced & Moist” Diet Replaces “Dysphagia Mechanically Altered,” “Ground,” “Mechanical Soft”
by Karen Sheffler, MS, CCC-SLP, BCS-S of SwallowStudy.com
Being discharged to home from a hospital or rehab facility can be an overwhelming process especially if your Speech-Language Pathologist (SLP) and medical team have prescribed a modified diet due to difficulty swallowing (dysphagia). Diet modifications are made to attempt to prevent choking and to avoid getting food stuck in the mouth, throat and/or esophagus (food tube to the stomach). Food that gets stuck can fall into the airway after the swallow, causing aspiration of food particles or actual choking (airway blockage or asphyxiation).
You may be having difficulty with regular foods like meats, breads, dry-hard textures, and crumbly-dry foods. You may be having difficulty chewing to break down your foods to make them safe to swallow. Make sure you have had your swallow fully evaluated to know where the problem is, as we treat issues differently depending on whether the problem is in your mouth, throat, and/or esophagus.
Examples of challenging foods:
- Peas and corn may roll to the back of your throat before you are ready to swallow them.
- Meat may may be hard to chew, cause significant fatigue, or get stuck in your throat or esophagus.
- Rice may get stuck in your throat and fall into your airway.
- Mixed consistencies are part solid and part liquid. While you are chewing the solid, the liquid may accidentally fall into your throat and airway, causing aspiration.
- Bread can cause an especially high risk for choking. People tend to swallow bread before it is really “swallow-ready.” Breads can really stay in a sticky ball in the throat and actually block your airway.
You may do best with very soft foods that are ground/minced, moist and cohesive (not sticky or crumbly). You want foods to stay together in the mouth and slide down easily.
Unfortunately, healthcare professionals have been labeling this diet with so many different terms: Dysphagia Mechanically Altered, Mechanical Soft, Dysphagia Ground, Moist Ground. That makes it very confusing.
Fortunately, now the International Dysphagia Diet Standardisation Initiative or IDDSI.org has standardized diet labels and descriptions. The new diet label of “Minced & Moist” tells it all.
Characteristics of Minced & Moist:
- Meats are ground-up or minced but with extra gravy or sauce. You want the pieces of meat to stay together in a cohesive ball. All foods within this diet can form into a moist-cohesive ball in your mouth and slide down your throat easily. (For examples: If you make risotto, make sure to have lots of sauce to prevent it from being crumbly. If you have a lentil stew (aka, dal), make sure the lentils are well cooked and with plenty of thick sauce.)
- No biting is required, minimal chewing is necessary, and the food should easily mash with your tongue.
- Moist and cohesive foods stay together while you try to chew them and move them around in your mouth. No liquid separating from the solid (e.g., mixed consistencies should be avoided, as they are difficult, such as soup with both solids and a thin liquid broth).
- Per the IDDSI recommendations, minced foods should be cut into food particle sizes of 4mm wide and no more than 15 mm long which can be easily swallowed without much chewing. This is the distance between two tines on a fork.
If you get food stuck in your throat, a cohesive food may stay in a pocket in your throat until you are able to swallow again or use liquid to wash it down. Moist textures may slide down better if you have dry mouth. You may need to get creative with gravies, sauces and condiments. Applesauce, guacamole or hummus make good additions to add moisture in a healthy way. You can also swish and swallow with an artificial saliva substitute (gel or spray) before meals to literally lubricate your pipes!
Overall, this diet may be good to reduce fatigue that may occur in trying to eat a full regular meal.
Again, the most confusing aspect of this diet texture, as there are way too many terms out there that mean the same thing!
Again these old diet terms may have meant the same thing. We don’t know! Prior to IDDSI, there was no globally standardization based on years of interdisciplinary research.
Old diet terms:
- Dysphagia Ground,
- Moist Ground, Ground,
- Minced & Moist,
- Mechanical Soft,
- Mechanically Altered, and
You need to ask your SLP and healthcare team for specifics on what foods you should eat versus what foods should be avoided?
For reference only, here is an old handout of the diet based on the National Dysphagia Diet. Please note: this Dysphagia Mechanically Altered or Dysphagia Ground diet label and descriptions are from 2002 and NOT from the new IDDSI diet framework and descriptions. The chart may give you an idea of the food categories and how to customize a food chart for you, per your SLP and the new IDDSI framework. Click on this link to download the pdf: Dysphagia Ground Diet – OLD patient handout
By Karen Sheffler