Rethinking Ultra-Processed Foods in Dysphagia Management

Dysphagia, or difficulty swallowing, affects an estimated 9 million adults in the United States and is especially prevalent in older adults and individuals with neurological, oncological, or complex chronic conditions. Yet despite its widespread impact, dysphagia is not a disease itself. It is a condition that arises as a result of other illnesses, such as stroke, dementia, Parkinson's disease, or cancer treatment. And herein lies a unique challenge in dysphagia care: the need to support nutritional intake and safety while also addressing the broader health risks associated with chronic disease and aging.

One emerging area of concern in this space is the role of ultra-processed foods (UPFs) in oral nutritional supplements and snack products tailored for people with dysphagia. While UPFs have long been tolerated in clinical nutrition because of their convenience and caloric density, we must now ask: are we solving one problem while potentially worsening others?

What Are Ultra-Processed Foods?

The term "ultra-processed food" refers to formulations that include little or no whole food ingredients and are instead composed of industrially extracted components (e.g., protein isolates, oils, emulsifiers, flavor enhancers, stabilizers). According to the NOVA classification system, UPFs fall into the fourth and final group of processed foods—the most manipulated form. They are designed for convenience, long shelf life, and hyper-palatability rather than for whole-food nourishment.

Examples of common UPFs include sweetened beverages, packaged snacks, reconstituted meat products, and many oral nutritional supplements found in clinical and long-term care settings.

Why UPFs Are Problematic in Dysphagia Management

Dysphagia patients often rely on texture-modified diets and nutritional supplements to meet their caloric and protein needs. These products must be safe to swallow, easy to prepare, and palatable. As a result, many institutional menus and home care routines rely heavily on ready-to-eat puddings, thickeners, shakes, and frozen desserts like Magic Cup.

But many of these dysphagia-friendly foods fall squarely in the UPF category. They often contain:

• Artificial flavors

• Emulsifiers and stabilizers (e.g., carrageenan, xanthan gum, guar gum)

• Protein isolates

• High-fructose corn syrup or artificial sweeteners

• Colorants and anti-caking agents

While these ingredients may create a consistent texture or extend shelf life, they raise red flags from a health perspective—especially for individuals managing chronic diseases.

The Hidden Risks of UPFs for Vulnerable Populations

Unlike malnutrition or aspiration risk, the harms of UPFs are not immediately visible. However, recent research has linked high consumption of ultra-processed foods to:

• Gut dysbiosis: UPFs often lack fiber and contain additives that disrupt the gut microbiome. For people with neurological disease or immune dysfunction, gut health is foundational to systemic regulation.

• Cognitive decline: Emerging data suggest that high UPF consumption may be associated with an increased risk of dementia. This is especially relevant in dysphagia populations where cognitive impairment is already a concern.

• Cardiometabolic disease: UPFs are linked to increased risk of heart disease, hypertension, and diabetes. For stroke survivors and elderly patients with comorbidities, the dietary quality of supplements matters.

• Inflammation: Emulsifiers and other common additives have been shown in animal models to trigger low-grade inflammation, which is implicated in numerous age-related conditions.

• Overconsumption and obesity: UPFs are engineered to be hyper-palatable and easy to consume quickly, which can lead to excess calorie intake—especially in pediatric and long-term care populations.

UPF and the Disruption of Functional Eating

Beyond the nutritional concerns, there is a fundamental disruption of the eating experience. Many UPF-based dysphagia products are sweet, bland, uniform in texture, and visually unappealing. They eliminate the need to chew, reducing oral stimulation and removing the sensory cues that contribute to swallow safety and satisfaction.

This is especially concerning given the rise in oral frailty—a condition characterized by reduced chewing ability, dry mouth, and muscle loss in the oral cavity. Without sensory engagement, swallowing therapy becomes harder to achieve, and patients lose motivation to eat.

Time to Re-Evaluate: A Call for Innovation

Dysphagia management is at an inflection point. As clinicians, product developers, and caregivers, we must ask:

• Are we prioritizing short-term swallowing safety at the cost of long-term health?

• Can we maintain IDDSI-compliant textures without relying on ultra-processed ingredients?

• What is the role of sensory-rich, whole-food-based snacks and supplements in therapy?

We need nutritional solutions that do more than fill the stomach—they should engage the senses, support gut and brain health, and align with a food-as-medicine philosophy.

Savorease was developed in response to this gap. Our dissolvable finger foods provide a safe oral texture that encourages chewing and sensory stimulation, while being made from whole-food ingredients like aquafaba, vegetables, and plant protein. Importantly, they avoid the laundry list of emulsifiers and additives found in many institutional products. By adding it as a solid supplement to improve oral sensation and preparedness for the swallow, it can support functional eating practices and offer good nutrition. Most if not all transitional solids, liquid supplements, and puddings available today are UPFs, which invites important reconsideration.  Some leading companies are already exploring this evolution, and Savorease is proud to be part of that conversation. 

Toward a New Standard of Care

UPFs may offer convenience, but they are not a neutral choice. In populations as complex and vulnerable as those with dysphagia, every ingredient matters. It’s time to set a higher bar for what we consider "safe" food—one that accounts for the total health picture, not just the ability to swallow. 

While concern about UPFs is growing, it's important to acknowledge that the current body of research does not yet fully explain which ingredients or processing methods are most responsible for observed health risks. By grouping all UPFs together, we run the risk of oversimplifying the issue and potentially labeling all ultra-processed foods as harmful—even when some may play a role in clinical care. Further research is needed to clarify which additives or formulations contribute to adverse health outcomes, especially in vulnerable populations. Until then, applying caution and striving for whole-food-based alternatives where feasible is a pragmatic approach.

We don't need to politicize food to demand better. We need to acknowledge that older adults, stroke survivors, cancer patients, and children with neurodevelopmental challenges deserve nutritional options that reflect the best of what we know about science, sensory health, and dignity.

Reformulating dysphagia nutrition management away from ultra-processed foods for snacks and supplements isn't a trend. It's the evolution of care.