Advice when you need to follow an IDDSI (International Dysphagia Diet Standardisation Initiative) level 5 minced and moist diet
Information for patients from the Nutrition Team
You have been advised to follow a level 5 minced and moist diet. This leaflet will explain:
what level 5 pureed diet is
how to prepare and serve your food
which foods can be included in a minced and moist diet
practical tips and minced and moist meal ideas
what problems you may have
where to buy ready-prepared minced and moist meals from; and
how to contact us.
It is important that you keep eating different foods to make sure you get all the vitamins and minerals that your body needs to stay healthy. This leaflet gives you practical advice on how to continue this diet at home.
We hope this leaflet will help to answer some of the questions you may have. If you have any further questions or concerns, please speak to a member of your healthcare team.
Introduction
You may be experiencing difficulty in eating, drinking, and swallowing. The medical term for this is “dysphagia”.
Dysphagia can occur for many reasons, for example as a result of:
a stroke
a progressive neurological condition
dementia
a developmental disorder
learning disability
a respiratory complaint
a head trauma (injury); or
head and neck surgery.
This can make having an adequate and nourishing diet difficult. As a result, you may experience:
weight loss
dehydration (not enough fluids)
weakness
depression
malnutrition (a serious condition, when your diet does not contain the right amount of nutrients); and
a reduced ability to fight off infection.
Why have I been referred to the speech and language therapist?
A speech and language therapist will assess you. They will recommend the most appropriate consistencies of food and drink, and any strategies that may help. This will mean that eating and drinking can be as safe, enjoyable, and comfortable as possible.
Follow your speech and language therapist’s guidance. If you have any questions, please ask for advice.
The speech and language therapist may advise you follow a minced and moist diet, if you have issues:
with biting or chewing
handling more challenging food textures with your tongue
swallowing more challenging food textures safely.
A level 5 diet may also be used if the muscles in your throat are not working as well as usual. If it is difficult to swallow more solid foods.
Minced and moist foods only need a small amount of chewing. After chewing, the tongue ‘collects’ the food into a ball and brings it to the back of the mouth for swallowing.
What is a minced and moist diet?
A minced and moist diet consists of foods which are very soft and moist.
Food has been minced or mashed before serving (such as with a fork). There are no big lumps remaining, and the food needs no biting or little chewing.
For adults, lumps should be no more than 4mm in size. This is about the space between the prongs of a standard fork.
Lumps should be easy to squash with your tongue.
If meat cannot be finely minced, it should be puréed.
To make the food the right consistency, mix in gravy or extra thick sauce, such as a cheese sauce. There should be no separate thin liquid.
Minced or moist food can be eaten with a fork or spoon. It should hold its shape on a plate.
How do I prepare and serve my food?
Equipment you will need
A hand blender can be used to purée small amounts of food, such as soups or sauces.
Or a food processor or liquidizer would be useful to mince / finely chop meat, fish, or fruit.
Some foods may not need puréeing or processing beforehand, such as thick, smooth soup.
Well-cooked vegetables can be mashed with a fork / potato masher.
Presentation
Make your meals look appealing, by using foods that are different colours. Foods that are light in colour, such as chicken or fish, are better served with brightly coloured vegetables, such as carrots or broccoli.
Thickening foods
Once you have prepared your food to the right texture, you may need to thicken it. Only do this if it has been recommended by your speech and language therapist. You can use the following to thicken your food:
mashed potato (must be really smooth, no lumps)
cornflour
custard powder
ground rice
jelly crystals / gelatine
instant sauce (smooth, no lumps) or gravy granules
the thickening agent you may be using for your drinks (if recommended by your speech and language therapist).
Flavours
To help improve the flavour of your food, add herbs, spices or, lemon juice.
What foods can be included in a minced and moist diet?
It is important to eat as wide a variety of foods as possible. 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. Other breakfast cereals such as Weetabix soaked in milk are suitable, with excess milk drained off.
Avoid cereals with added nuts and dried fruit, such as muesli.
Porridge (use fine grain oats) and other instant cereals, such as Ready Brek or Oats-So-Simple
Rice needs to have a thick, smooth, non-pouring sauce to moisten it and hold it together. Rice should not be sticky or gluey. When cooked and served, it should not separate into individual grains. Try well-cooked rice with a thick sauce, such as curry, chilli con carne, or casserole.
Mashed potato, with milk and butter or margarine added. Try the inside of a jacket potato (no skin) with spreading cheese, 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.
Do not eat bread. Speak to your speech and language therapist for further advice.
Fruits and vegetables
Aim to have 5 portions of fruit and vegetables each day. One of these portions could be a glass of pure fruit juice or a smoothie.
Mash or purée fruit to 4mm lump sizes. Drain any excess liquid.
Make sure fresh fruits are ripe, soft, and mashed. For example, bananas, avocados, strawberries, raspberries, papaya, mango, and kiwi.
Mashed tinned or stewed fruit can be included, if excess juice is strained off. Skin, stones and / or pips must be removed.
Fresh fruits that release a lot of juice and fibres in the mouth. Oranges, satsumas, and grapefruit are not suitable.
Cook vegetables until soft, before finely mashing or blending to 4mm lump sizes. Drain any excess liquid. You could try swede, broccoli, cauliflower, or carrots.
Purée and sieve stringy vegetables or vegetables with skins, such as peas and sweetcorn.
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
Mince and purée meat and poultry to 4mm lump sizes. Serve in a thick, smooth, non-pouring sauce or gravy. Try:
shepherd’s pie, pasta dishes, meat loaf mashed with thick gravy, pâté and meat paste.
corned beef hash, tender casserole, curried meat, or liver served with thick gravy.
tender roasted meat mashed or puréed with thick gravy or sauce.
mashed soft skinless sausage
mashed soft, skinless black pudding
tinned meat or poultry in sauce are suitable if mashed, for example chicken in white sauce.
Finely mash or purée fish to 4mm lump sizes. Serve in a thick, smooth, non-pouring sauce or gravy.
Fish must 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.
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). Mash with a fork.
Baked beans, when mashed.
Smooth hummus and taramosalata.
Tofu, Quorn, and textured vegetable protein. 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. Do not eat those with nuts, seeds, and grains.
Add grated cheese to mashed potato, puréed soup, white sauce, and cauliflower cheese. Do not eat a chunk of cheese, but you can eat very soft cheeses, such as brie or soft goat’s cheese.
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, rice pudding, blancmange, Instant Whip, Angel Delight, or crème caramel.
What foods should not be included in a minced and moist diet?
Foods with skins, husks or outer shells. For example:
peas, corn, shredded wheat, soya beans, grapes, sweetcorn, chicken skin, fish or sausage skin.
Crunchy, sharp or crispy foods. For example:
toast, dry biscuits, crisps, crackling, crisp bacon, lettuce, cucumber, popcorn, cornflakes.
Pips and seeds. For example:
apple seeds, pumpkin seeds, orange pith.
Hard or dry textures. For example:
pieces of apple, chunks of cheese, nuts, raw vegetables (such as carrot, cauliflower, and broccoli), dry cakes, bread, dry cereal.
Mixed consistencies. For example:
soups with lumps or bits, mince in thin gravy, cereal in milk (that does not soak up the milk), juicy fruits with thin liquid (such as watermelon).
Tough, stringy fibrous textures. For example:
steak, pineapple, celery, rhubarb, runner beans.
Crumbly foods. For example:
dry cake, crumble, bread crusts, pie crusts, dry biscuits.
Chewy textures. For example:
toffees, sweets, cheese chunks, chewing gum, marshmallows, dried fruits.
Sticky foods. For example:
nut butter, overcooked porridge or oatmeal, sticky mashed potato.
Bones or gristle. For example
chicken, fish or other bones or meat with gristle.
Foods with large or hard lumps. For example:
casserole pieces larger than 4mm x 4mm, fruit, vegetable, meat, 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, mashed potato.
Floppy foods. For example:
lettuce, cucumber, raw spinach leaves.
Round or long-shaped foods. For example:
grapes, whole cherry tomatoes, sausages.
Practical tips
We all must eat. For most of us it is an enjoyable time, often involving family and friends. Eating a minced and moist diet will mean a change from your normal routine. However, by following these ideas, you can hopefully still enjoy your food.
Eat a wide range of foods. This will give you lots of different nutrients to keep you healthy and stop you getting bored.
Make the food look appetizing, choose food of different colours. Mince / mash each food separately, so it keeps its own colour and flavour.
You may find it easier to prepare food in bulk, and store it in your freezer. Make sure that the food is defrosted thoroughly before reheating. Plan ahead to leave enough time and space to defrost small amounts of food in the fridge.
Eat in a quiet, relaxed place, and take your time. Sit upright during your meal.
Finish each mouthful before taking the next. Make sure your mouth is fully cleared at the end of your meal.
If you are eating out, let the restaurant know beforehand that you have a special diet and what your needs are. Most places will be happy to cater for you. If you know you take longer to eat, think about ordering a main course and ask for that while everyone else is eating their starter. You may be ready for dessert at the same time as everyone else.
If you are struggling to cook or shop on a regular basis, use of convenience foods which need very little preparation. Or consider ordering pre-prepared food from delivery companies.
If possible, weigh yourself once a week. If you are losing weight or your appetite is poor, follow the ideas under the headings Problems you may have later in this leaflet.
Your dietitian or speech and language therapist will be happy to help you. Please contact them if you are worried or have any questions about your diet or swallowing.
Minced and moist meal ideas
Breakfast
Ready Brek (not apple), smooth porridge, or Weetabix. Make sure the food is well-soaked with warm whole milk and sugar, and there is no separate fluid.
Soft mashed fruit and full fat smooth yogurt, such as Greek yogurt.
Scrambled egg cooked with milk, very creamy, soft and smooth, no big lumps.
Between meal snacks
Milky drink such as Ovaltine, Horlicks, Aymes or Complan, or smooth soup. These may need to be thickened; check with your speech and language therapist.
Ripe avocado, mashed and mixed with Greek yogurt, cream cheese, or mashed banana.
Full fat smooth yogurt, custard pot, or soft pudding (see pudding list below).
Snack and main meal ideas
Cream of tomato soup (smooth, no bits).
Other smooth soups that have been puréed or sieved. Soups must contain meat, fish, lentils, or have cheese, cream, or soft breadcrumbs added for extra nourishment.
Note: soups need to be of a thick consistency or thickened. Please follow your speech and language therapist’s advice.
Scrambled egg cooked with whole milk. Make very creamy, soft, smooth, no lumps.
Hard-boiled egg, mashed and mixed with salad cream or mayonnaise to a soft, moist paste.
Smooth pâté.
Well-cooked and well-mashed cauliflower / broccoli cheese.
Finely minced, well cooked meat with thick gravy / sauce.
Shepherd’s or cottage pie.
Well-mashed corned beef.
Salmon / mackerel mousse, with mashed avocado.
Tinned fish, mashed and mixed with mayonnaise (such as tuna or salmon).
Well-mashed white fish, with thick sauce.
Well-cooked thick lentil-based dishes, such as dhal.
Well-cooked and well-mashed vegetable / tofu curry or stew.
The above could be served with:
Creamed / mashed or instant mashed potatoes (no lumps).
Well-mashed jacket potato (no skin) with butter.
Well-cooked white rice, finely mashed with sauce. Or as risotto with your main dish, such as curry.
Well-cooked pasta, finely mashed into smooth or finely minced sauce. For example cheese or Bolognese / tinned spaghetti or ravioli, mashed with fork.
Mashed soft vegetables (without skins), with butter, gravy or sauce. For example:
well-cooked root vegetables, broccoli tops, baked beans, mushy peas, or finely chopped tomatoes. Tinned or fresh tomatoes, skinned and deseeded first.
Puddings
Where applicable, make all desserts with full fat cream or milk.
Yogurt, smooth with no ‘bits’. Use thick and creamy varieties, such as Greek yogurt.
Fromage frais, smooth with no ‘bits’.
Mousse, for example chocolate.
Blancmange.
Instant Whip.
Baked egg custard, mashed with fork and no pastry.
Soft mashed fresh or tinned fruit. For example banana, mashed or stewed apple or peaches, with cream or thick custard.
Custard (thick).
Sponge pudding with puréed fruit, mashed well with custard or cream.
Crème caramel.
Thick milk pudding (such as semolina, tapioca, rice pudding, or sago) with seedless jam.
Fruit smoothies (these may need sieving).
Milkshakes.
Problems you may have
Poor appetite / weight loss
If you have a small appetite or find that you are losing weight, you should make your foods more nourishing. There are some ideas below on how to do this.
Useful tips
Try to have regular small meals or snacks. Aim for 3 small meals and 2 to 3 snacks per day. This is called ‘little and often’.
If you are not able to manage a full meal, try a milkshake, soup, or pudding instead. Add a fortifier, such as Complan or Aymes. Fortifiers are available from chemists or supermarkets.
Drinks can be quite filling, so only take sips with a meal. Remember to drink more between meals and snacks. Follow any advice your speech and language therapist may have given you about the use of drinks during meals.
Extra nourishment can be added to your food in different ways, for example:
Use whole milk to make milk puddings, milky drinks, and sauces.
Add 4 tablespoons of milk powder (for example Marvel) to 1 pint of whole milk. Use this in hot drinks, puddings, mashed potato (no lumps), and sauces.
Make packet soups with fortified milk, or add 2 tablespoons of milk powder to smooth tinned or packet soup.
Add grated cheese to vegetables, potato, soups, and sauces.
Add extra butter / margarine / oil to sauces, potatoes, vegetables, and pasta.
Use double cream in soups, sauces, cereals, potatoes, and puddings (for example custard).
Add extra sugar, syrup, jam without bits, or honey into puddings, drinks, or cereals.
Make sure your meals are puréed with nourishing fluids, such as thick gravy or sauces, not just water.
If you continue to lose weight, please contact your dietitian for advice.
If you are diabetic, it is important to regularly monitor your blood sugar levels when you make changes to your diet. If you need advice, please speak to your diabetic nurse.
Note: Remember to thicken all drinks and foods, if advised by your speech and language therapist.
Buying ready prepared moist or minced meals
Supermarkets now sell a wide variety of ready meals, some of which may be suitable for a minced and moist diet. For example:
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.
Buying ready prepared minced and moist meals
The following companies provide meals delivered to your door:
Wiltshire Farm Foods
Minced meals.
Telephone: 0800 077 3100
Simply Food Solutions
A range of texture modified meals and puddings.
Telephone: 0191 4560456
Oakhouse Foods
A selection of minced and moist meals, as part of softer foods range.
Telephone: 0333 370 6700
The above products / services are listed solely to advise our NHS patients. It does not imply endorsement by East Kent Hospitals University NHS Foundation Trust, nor discrimination against similar brands, products, or services not mentioned. We are not responsible for the contents or reliability of any other websites to which we provide a link and do not necessarily endorse the views expressed within them.
Store cupboard ideas
The following are examples of convenience foods to keep in your store cupboard. These can be modified to a minced and moist consistency.
Tinned minced meat, corned beef, or fish.
Tinned or packet soup (without bits).
Tinned cream / evaporated milk.
Ready Brek / porridge oats.
Custard / instant whip / milk puddings.
Soft tinned fruit.
Instant mashed potato.
Pasta and pasta sauces.
Tinned vegetables and spaghetti.
Gravy granules.
Milk powder, Complan Shake, Aymes Shake.
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.
Constipation (not pooing as often or finding it hard to poo)
Constipation may be a problem because you are lacking fibre in your diet. Slowly introduce more fibre into your diet. Good sources of fibre include:
Breakfast cereals, such as porridge, instant hot oat cereals, or Weetabix.
Fruits and vegetables. Try to have the recommended five portions a day. Pureed prunes and prune juice may help.
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.
Fluids are essential to:
help the fibre to work
prevent dehydration
make sure your skin keeps its elasticity; and
your kidneys work properly.
Aim for at least 6 to 8 drinks a day. Include a variety of tea, coffee, squash, juice, water, milk, milkshakes, and 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
supermarkets’ 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 your dietitian for ideas.
Other good sources include egg yolk, breakfast cereals, pulses, and dark green leafy vegetables.
Drink a glass of fruit juice with a meal. This will help your body to absorb the iron.
What if I have any questions or concerns about my diet?
If you have any questions or concerns, please speak to your dietitian or GP.