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IDDSI Level 4 Food & Beverage Diet: Explained

The Dysphagia Diet Level 4, also known as the Dysphagia Extremely Thick/Pureed, is a specific dietary plan designed for individuals with severe swallowing difficulties (dysphagia). This level of the diet focuses on providing foods that have a smooth, cohesive, and pudding-like consistency, making them easier to swallow for people who have trouble chewing and moving food through the mouth and throat.

Here are the characteristics of the Dysphagia Diet Level 4:


  • All foods at this level are pureed to a smooth and uniform texture without any lumps, chunks, or solid pieces.
  • Foods are usually blended, mashed, or processed to achieve the desired consistency.
  • The goal is to eliminate any potential choking hazards or difficulties in swallowing due to texture/thickness.

Examples of Foods:

  • Pureed fruits (e.g., applesauce, bananas)
  • Pureed vegetables (e.g., mashed potatoes, smooth carrots)
  • Smooth, pureed meats (e.g., blended chicken, beef, fish)
  • Creamy soups and pureed soups (Given they meet the required thickness)
  • Pureed dairy products (e.g., yogurt, cottage cheese – given they meet the required thickness)


  • Liquids at this level are often thickened to a pudding-like consistency to minimize the risk of aspiration (inhaling liquid into the lungs) and make swallowing safer.


Individuals on the Dysphagia Diet Level 4 should work closely with healthcare professionals to ensure that their nutritional needs are being met and they are accurately following the diet. Please refer to for more information.

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