Get Started With Real Meals Modified

Welcome to Real Meals Modified!

We are a food blog with a focus on modified diet textures.

We use the International Dysphagia Diet Standardization Initiative (IDDSI) levels to classify the texture of each recipe.

Our goal is to provide you with recipes that fit your or your loved ones’ texture needs, while remaining realistic that food should look good and taste good – or it’s not worth anyone’s time.

Get started below!

What am I doing here?

Well, we can’t know for sure why you’re here, but we’re guessing that you or a loved one have a need for a modified food texture.

Maybe you just came from your speech-language pathologist, primary care, specialist, ENT, etc and they recommended that you eat foods with a certain consistency.

Unfortunately, once you get the news that you need a modified diet, you’re often on your own. Their facility might have some food examples or ideas, maybe even a short recipe book, but they mostly leave you on your own to figure out what to do next.

Maybe your loved one was just sent home from the hospital or a rehab facility and all of a sudden you learn that they need to eat “mechanical soft” foods. Now it’s dinner time and you’re wondering, “What does that even mean?”

We’re hoping that you found us because you are looking for information for how to prepare this new, unfamiliar texture for yourself or your loved one. We’re here to help!

Our goal is to take the guesswork out of preparing modified textures by providing recipes and information to make your life easier.

Unlike those generic food examples (we’re looking at you, ground-beef-with-salsa/pesto/spaghetti sauce), we’re not going to provide a recipe we would not eat ourselves. Some recipes are meant to be cooked as a family or multi-serving meal and then modified for an individual serving. Other recipes are intended to be prepared as a fully modified meal that everyone (even “regular” dinner partners) can enjoy.

We hope you find everything you’re looking for. Please reach out with any questions, comments, or concerns on our contact page!

What is dysphagia?

Dysphagia (dis-FAY-juh) is any swallowing disorder.

Swallowing disorders can occur with any aspect of the swallow. This could include putting food in the mouth, chewing food, moving food from the mouth to the throat, sending food down the throat, mobilizing food from the throat to the esophagus, squeezing food through the esophagus, all the way to the foods final swallowing destination: the stomach. 

The American Speech-Language-Hearing Association (ASHA), the professional association for audiologists, speech-language pathologists (SLPs), and speech, language, and hearing scientists, asserts that SLPs are an important piece of the diagnosis and treatment of oral (mouth) and pharyngeal (throat) dysphagia.

One  component of dysphagia treatment is often diet texture modification. While SLPs do not diagnose or treat esophageal dysphagia, as that is usually the domain of a GI doctor, modified diets can be a factor in treatment of esophageal dysphagia as well.

Dysphagia can arise from any variety or combination of causes. Treatment of dysphagia may also include exercises or positioning strategies to increase swallowing safety. Dysphagia does not always require texture modification. Every patient with dysphagia is unique and thus every patient will have a different plan of care.

An unsafe swallow can lead to many complications. Per ASHA:

“Malnutrition and dehydration, aspiration pneumonia, compromised general health, chronic lung disease, choking, and even death may be a consequence of dysphagia. Morbidity related to dysphagia is a major concern. Adults with dysphagia may also experience (a) disinterest and/or less enjoyment of eating or drinking and/or (b) embarrassment or isolation in social situations involving eating. Dysphagia may increase caregiver burden and may require significant lifestyle alterations for the patient and the patient’s family.”

If you or a loved one have modified diet textures as an aspect of dysphagia treatment, it is important to thoroughly discuss the recommendations with your provider. Your SLP should be able to tell you their reasoning behind the texture, give you examples of foods to eat and foods to avoid, and tell you what their plan is for your dysphagia treatment overall and how they intend to include diet modification. Consuming an incorrect texture may not always lead to consequences you can notice, such as with individuals who may leak liquids into their lungs when drinking but have no cough response. To you, this individual may look safe to drink whatever they like, but your SLP has the tools to make an evidence-based recommendation and always has a plan to keep them as safe as possible when swallowing.

What is a modified diet?

A modified diet is technically any diet modified in any way to change any component of the diet. This means that “modified diets” include diets that are tailored to individuals with special nutritional needs, such as individuals with diabetes or renal concerns. A modified diet may also include diets for individuals trying to gain or lose weight. These diets are typically overseen by a nutritionist or a dietician.

The modified diets we’re discussing are modified in texture. This could include thickening or thinning out liquids, blending, chopping, or dicing solids, or any combination of any texture you can imagine. The modification of texture is a common fixture in the treatment of dysphagia.

Currently, modified texture levels are not standardized across facilities. However, there are many common terms you may run into. You must check the specific dietary compliance information for each specific facility to determine what their requirements are for each level. Always do your research and talk to your provider before you begin any diet level!

Regular: this diet level has typically not been modified in any way and can include any texture or combination of textures

Mechanical soft: this diet level typically includes “softer” foods, and may or may not include breads. This level may have a list of foods that are not allowed, but is typically the “least restrictive” of modified texture levels, depending on the facility.

Chopped: this diet level often means that foods are cut into “bite-sized” pieces. The size of the piece is likely determined by facility requirements.

Ground: this diet level may mean that meat is ground, or that all components of the meal are ground.

Puree: this diet level typically includes foods that have been blended. Each facility may have a different thickness for their purees.

Nectar thick: this is a liquid level that is thicker than water and because of the commercialization of thickening products, this level is sometimes more standardized. However, unless you are provided a detailed way to test whether a liquid is nectar thick, this means almost nothing other than “thicker than water.”

Thin: this typically signifies the texture of water straight from the faucet or fridge, no modifications.

These are common terms that we have seen used across the facilities we’ve worked at. As we said though, each building and even each kitchen within a set of facilities will have different definitions of these terms. As you can see from our generic definitions here, anything about any diet level can change at any time.

In order to provide everyone the same basis for the textures included on Real Meals Modified, we have opted to use the International Dysphagia Diet Standardization Initiative (IDDSI) levels as opposed to the common terms listed above.

What is IDDSI?

The International Dysphagia Diet Standardisation Initiative (IDDSI) set a framework “to describe food textures and drink thickness.” Visit their website here.

While we use the IDDSI levels to classify our recipes, we are not affiliated officially in any way with IDDSI.

IDDSI’s goal is to make it easy for individuals with dysphagia to understand what texture of food is safest for them across facilities.

The IDDSI committee released the original framework and testing methods in 2015 with an update in 2019 to include Level 7 Easy to Chew.

The eight levels increase in thickness from zero (thin) to seven (regular). Your clinician will make a recommendation for which level(s) are safest for you to eat and drink.

IDDSI testing methods are explicitly described on the IDDSI website for drinks here and for foods here. The IDDSI framework and other materials have been translated into many languages.

IDDSI is intended to be used by any clinician who makes recommendations for diet texture modifications, not just speech pathologists.

IDDSI framework

How do I use Real Meals Modified?

You can use Real Meals Modified just like any other food blog or recipe site.

Simply use the drop-down menu in the All Recipes tab to choose which level you want to search.

From there, enjoy Louisa’s beautiful pictures and choose a recipe to make! When you make a recipe, rate and comment so we know whether you liked it.

In our Blog section, we’ll provide helpful tips and tricks for living with a modified diet.

Please reach out to us on our contact page with any questions or requests. Maybe you’d like us to recreate your favorite dinner at your new modified level, or you have an idea for a recipe you’d like to share with us. We’d love to hear from you!