You may be having difficulty eating, drinking and swallowing. The medical term for this is dysphagia.

Dysphagia can occur for many reasons, for example as a result of stroke, multiple sclerosis (MS), motor neurone disease, Parkinson’s disease, dementia, developmental disorders, head trauma or head and neck surgery.

This can make having an adequate and nourishing diet difficult. As a result, weight loss, dehydration, weakness, depression, nutritional deficiencies and a reduced ability to fight off infection can occur.

Your speech and language therapist will assess and diagnose any eating, drinking and swallowing problems you may have. They will then recommend the safest consistencies of food and drink and any strategies that may help. This will mean that eating and drinking can be as safe and comfortable as possible.

Follow your speech and language therapist’s guidance. If you have any questions, please ask for advice.

The dietitian will advise on a suitable nutritionally adequate diet for you and give you practical advice on how to continue the diet at home.

Level five minced and moist food may be used if you are not able to bite off pieces of food safely but have some basic chewing ability. Some people may be able to bite off a large piece of food, but are not able to chew it down into little pieces that are safe to swallow. Minced and moist foods only need a small amount of chewing and for the tongue to ‘collect’ the food into a ball and bring it to the back of the mouth for swallowing. Level five minced and moist may also be used if the muscles in your throat are weaker than usual and it is difficult to swallow some solid foods.

In this leaflet we cover:

• what is a level five minced and moist diet?
• how do I check my food to make sure it is minced and moist?
• which foods should not be included in a minced and moist diet?
• what foods can be included in a minced and moist diet?
• sample meal plan
• equipment needed
• ready meals
• getting the right balance
• food fortification.

What is a level five minced and moist diet?

It consists of a variety of foods that are soft, tender and moist and have been mashed with a fork. They are coated with a thick smooth gravy or sauce and need no biting and very little chewing. Food should be easily mashed with just a little pressure from a fork. These foods have lumps of no more than 4mm in size (the gap between the prongs of a fork).

The food should be able to be scooped on to a fork with no liquid leaking or dripping and no crumbs falling off the fork. The food can be mashed with just a little pressure from a fork and lumps are easy to squash with the tongue.

Foods may have some variation in texture and do not have to be pureed or sieved.

Tips for preparing a minced and moist diet

• Mash foods well with a fork and make sure there are no lumps bigger than 4mm in size. Serve with a thick, non-pouring gravy or sauce.
• Remove any skins and seeds before mashing.
• You can make meals more appetising by mashing and serving the different elements of a course separately on the plate.
• Check before serving that no hard pieces, crusts or skin have formed and that fluid within or on the food has not thinned or separated out.
• You may find it useful to only heat up small amounts of food at a time so that food does not get cold while you are eating.
• Ice cream and jelly turn to a thin liquid in the mouth and may not be suitable for someone who needs thickened fluids. Ask your speech and language therapist for advice.
• You can use a soaking solution for cakes and biscuits. Ask your speech and language therapist for advice.

How do I check my food to make sure it is minced and moist?

• Foods should have lumps of no more than 4mm in size (the gap between the prongs of a dinner fork).
• The food holds its shape on the spoon and falls off fairly easily if the spoon is tilted or lightly flicked.
• The food should not be firm or sticky.
• Minced and moist food must pass both tests.

 What foods should not be included in this minced and moist diet?

• Foods with skins, husks or outer shells, such as peas, corn, shredded wheat, soya beans, grapes, sweetcorn, chicken skin, fish skin or sausage skin.

• Crunchy, sharp or crispy foods such as toast, dry biscuits, crisps, crackling, crisp bacon, lettuce, cucumber, popcorn or cornflakes.

• Pips and seeds, for example, apple seeds, pumpkin seeds or orange pith.

• Hard or dry textures, including pieces of apple, chunks of cheese, nuts, raw vegetables (carrot, cauliflower, broccoli etc.), dry cakes, bread and dry cereal.

• Mixed consistencies, such as soups with lumps or bits, mince in thin gravy, cereal in milk (that does not soak up the milk) or juicy fruits with thin liquid such as watermelon.

• Tough, stringy fibrous textures, for example steak, pineapple, celery, rhubarb, runner beans or celery.

• Crumbly foods, for instance dry cake, crumble, bread crusts, pie crusts and dry biscuits.

• Chewy textures, such as toffees, sweets, cheese chunks, chewing gum, marshmallows or dried fruits.

• Sticky foods, including nut butter, overcooked porridge or oatmeal or sticky mashed potato.

• Bones or gristle, for example chicken, fish or other bones or meat with gristle.

• Foods with large or hard lumps, including casserole pieces larger than 4mm x 4mm, fruit, vegetable, meat or other food pieces larger than 4mm x 4mm.

• Any crusts or skins that form on foods during cooking or after heating, for example cheese topping or mashed potato.

• Floppy foods such as lettuce, cucumber or raw spinach leaves

• Round or long shaped food, such as grapes, whole cherry tomatoes or sausages.

What foods can be included this diet?

It’s important to eat as wide a variety of foods as possible, and to choose foods from each of the groups below.

Starchy foods                 

Aim to include at least one starchy food at each meal.

• Cereal should be thick with lumps no bigger than 4mm. Any milk or fluid should not separate from the cereal. Any excess fluid should be drained before serving. You could try porridge (use fine grain oats) and other instant cereals such as Ready Brek or Oats So Simple. Other breakfast cereals such as Weetabix soaked in milk are suitable with any excess milk drained off. Avoid cereals with added nuts and dried fruit, such as muesli.
• Rice needs to have a thick, smooth, non-pouring sauce to moisten it and hold it together. Rice should not be sticky or gluey and should not separate into individual grains when cooked and served. Try well cooked rice with a thick sauce such as curry, chili con carne or casserole.
• Mashed potato with milk and butter or margarine. You could try the inside of a jacket potato (no skin) with spreading cheese or tuna or egg mayonnaise. Cheese and potato pie is another suggestion.
• Well cooked, soft pasta mashed with a thick sauce, for example macaroni cheese, ravioli, lasagne, spaghetti bolognaise or mashed tinned pasta.
• Sponge puddings or cake mashed with custard or cream.
• Bread is not advised at this level. Speak to your speech and language therapist for further advice.

Fruits and vegetables

Aim to have five portions each day, one of which could be a glass of pure fruit juice or a smoothie.

• Fruit should be finely mashed or pureed to 4mm lump sizes. Any excess liquid should be drained.
• Fresh fruits should be ripe, soft and mashed, such as bananas, avocados, strawberries, raspberries, papaya, mango and kiwi.
• Mashed tinned or stewed fruit can be included if excess juice is strained off, and skins, stones and/or pips are removed.
• Fresh fruits that release a lot of juice and fibres in the mouth such as oranges, satsumas and grapefruit are not suitable.
• Vegetables should be cooked until soft and then finely mashed or blended to 4mm lump sizes. Any excess liquid should be drained. You could try swede, broccoli, cauliflower or carrots.
• Stringy vegetables or vegetables with skins such as peas and sweetcorn will need to be pureed and sieved.
• Tinned chopped tomatoes, creamed sweetcorn and mushy peas are suitable without mashing.
• Ideas for vegetables include mashed cauliflower cheese

Meat, poultry, fish, eggs and pulses

• Meat and poultry should be finely minced or pureed to a 4mm lump size and served in a thick, smooth, non-pouring sauce or gravy. Try shepherd’s pie, pasta dishes, meat loaf mashed with thick gravy, paté and meat paste, corned beef hash, tender casserole, curried meat or liver served with thick gravy, spaghetti bolognese, tender roasted meat mashed or pureed with thick gravy or sauce, mashed soft skinless sausage and mashed soft, skinless black pudding are all suitable. Tinned meat or poultry in sauce are suitable if mashed, for example chicken in white sauce
• Fish should be finely mashed or pureed to a 4mm lump size and served in a thick, smooth, non-pouring sauce or gravy. Fish should be boneless. Steam, poach or microwave the fish. Condensed soup makes a simple sauce. Tinned fish with the bones removed, such as salmon or tuna can be mashed and mixed with mayonnaise. Fish pie and fish cakes with sauce are suitable.
• Poached and scrambled eggs are suitable. Hard boiled eggs can be mashed with mayonnaise. You could also try a finely mashed soft omelette.
• Beans and lentils can be included in thick soups, stews and casseroles (with or without meat) but will require mashing with a fork.
• Baked beans are suitable when mashed.
• Smooth hummus and taramasalata are suitable.
• Tofu, Quorn and textured vegetable protein should be minced or cut into small mashable lumps and mashed with a sauce.

Milk and milk products

Try to have a pint of milk every day or include two to three servings of milk products.

• Milk can be used in drinks and as the base for many sauces.
• Milk puddings are ideal for a minced and moist diet.
• Thick and creamy yoghurt, custard, trifle and fromage frais make good minced and moist desserts (avoid those with nuts, seeds and grains).
• Grated cheese can be added to mashed potato, pureed soup, white sauce and cauliflower cheese. Eating a chunk of cheese is not recommended but very soft cheeses such as brie or soft goat’s cheese are suitable.
• Ice cream is not suitable for everyone with a swallowing difficulty, please ask your speech and language therapist for advice.
• Homemade, tinned or packet milk puddings for example custard, semolina, and rice pudding, blancmange, Instant Whip, Angel Delight or crème caramel.

Sample menu plan                                 

Breakfast

Fruit or juice

Weetabix and milk

Porridge

Tea

Mid-morning         

Milky coffee/drink

Cake mashed with cream or custard

Lunch

Soup (no lumps)

Pasta with Bolognese sauce

Mashed jacket potato (skin removed)

Stewed apples with custard

Mid-afternoon

Milkshake

Cake mashed with cream or custard

Evening meal        

Glass of fruit juice

Minced lamb or meat casserole with gravy

Mashed broccoli and parsnip

Bedtime                                   

Malted milk drink

Equipment needed

The basic equipment required to produce a minced and moist diet is a standard fork for mashing.

Other pieces of equipment which can be helpful are:

• potato masher
• hand blender
• blender.

A blender or food processor can be useful for mincing or pureeing very solid food like some meats.

A freezer is useful to enable large quantities of food to be prepared to the correct texture and then frozen for future use. Freeze food in individual portions, if possible.

Ready meals

Supermarkets now sell a wide variety of ready meals, some of which may be suitable for a minced and moist diet.

Mash before serving:

• cottage or shepherd’s pie
• fisherman’s pie (remove any bones first)
• corned beef hash
• cheddar cheese and onion mash
• pasta dishes such as lasagne, spaghetti bolognese or macaroni cheese
• cauliflower cheese.

It is also possible to buy pre-prepared mashed potato and other mashed and creamed vegetables, which are suitable for minced and moist diets.

Sauces can be made from granules or bought ready prepared.

Delivered meals

These services can provide a minced and moist diet on request, however, you may need to request or add additional gravy or sauce.

Specialist companies who deliver frozen meals to clients, such as Wiltshire Farm Foods, Simply Puree and Mrs Gills cater for people with swallowing problems. Level five minced and moist meals are available.

Getting the right balance

If you choose a variety of foods from each of the five food groups, you should be having a balanced diet. However, it is sometimes more difficult to achieve this on a minced and moist diet so here are a few tips.

Energy (calories)

If you are having difficulty maintaining your weight, please read the section on food fortification to boost the energy and nutrient content of your diet.

Constipation

Constipation may be a problem because you are lacking fibre in your diet. Introduce more fibre slowly into your diet to let your body adapt.

Good sources of fibre are:

• breakfast cereals such as porridge and instant hot oat cereals or Weetabix
• fruits and vegetables. Try to have the recommended five portions a day. Pureed prunes and prune juice may be helpful
• pulses for example beans. All pulses are high in fibre.

Over-the-counter fibre supplements are available if recommended. Your GP can prescribe other fibre supplements.

Fluid

This is essential to help the fibre to work, prevent dehydration ensure your skin retains its elasticity and your kidneys function properly. You should aim for at least six to eight drinks a day, include a variety of tea, coffee, squash, juice, water, milk, milkshakes or malted bedtime drinks.

Vitamin C

Having five portions of fruit and vegetables a day will help, try to include a rich source of vitamin C such as Ribena, C-Vit, supermarket own fortified blackcurrant squash, rose-hip syrup, and pureed fruit such as strawberries or kiwis.

Iron

Meat is a good source of iron. If you are still finding meat especially difficult to swallow, please ask the dietitian for ideas. Other good sources include egg yolk, breakfast cereals, pulses and dark green leafy vegetables.  A glass of fruit juice taken with a meal will help your body to absorb the iron.

Food fortification

Food fortification is a way of boosting the amount of nutrients in your food.

Having a good nutritional intake will help you:

• regain lost weight or maintain your current weight
• maintain your muscles and keep your skin healthy
• feel healthier and have more energy.

How to fortify your food

Skimmed milk powder

• Add two to four tablespoons to a pint of full fat milk and use whenever you take milk. Add one tablespoon to porridge, soups, mashed potato etc.

 Cheese

• Add grated cheese to cooked vegetables, potatoes, soup, pasta and sauces.

 Yoghurt or fromage frais

• Choose thick and creamy, full fat varieties or Greek yoghurt.

 Butter, margarine and/or oil

• Use full fat spreads added generously on all foods.
• Fry foods such as onions, vegetables and meat.
• Use oil-based dressings generously, you could add to hot potatoes or pasta.
• Mayonnaise and salad cream can be added to food.

 Cream

• Add to soups, sauces, custard, milk puddings and porridge.
• Serve whipped or clotted cream with mousse or fruit.
• Add to milky drinks and coffee.

 Sugar and sugary foods – check with your health professional if you have diabetes.

• Add sugar to drinks, cereals and desserts.
• Use ordinary fizzy drinks and squashes, rather than low calorie or sugar free.
• Add seedless jam, honey or syrup to fruit or puddings.

Alcohol

In small amounts alcohol can stimulate your appetite for example sherry or an aperitif. Please check that alcohol will not react with any medications you are taking.

Oral nutritional supplements

If you are not managing to eat and drink enough to meet your protein and calorie requirements your healthcare professional may recommend an oral nutritional supplement. These are specialist products, usually drinks or puddings that contain increased levels of nutrition. They should be taken in addition to your normal meals and snacks.

General tips to improve intake

• Make sure all your food is served at the correct texture and consistency suited to your swallowing and chewing ability.
• Remember that tiredness may affect your food intake and your swallowing ability.
• Try to eat little and often, aim for three small meals and two to three snacks.
• Have nourishing drinks between meals, such as milk, Horlicks, hot chocolate or Ovaltine. Follow your speech and language therapist’s advice about drinks.
• Try to have a portion of meat or fish (or an alternative) at each main meal.
• Use full fat products, for example full fat milk, thick and creamy yoghurts and full fat cheese.
• It is a good idea, if you are able, to check and record your weight regularly (every two to four weeks).
• Speak to your dietitian or speech and language therapist if you are unsure of anything.

Get in touch

Contact the Nutrition and Dietetics Service or Adult Speech and Language Therapy Service, using the details below.