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Food Hierarchy

Date issued: May 2021

Review date: May 2023

Ref: C-361/CJ/S&L/Food hierarch v3

PDF:  Food Hierarchy final May 2021 v3.pdf [pdf] 393KB

Radiotherapy and chemoradiotherapy can make eating and drinking problematic, and meal choices more challenging. This leaflet aims to help you adapt your diet as your radiotherapy progresses, and give ideas of foods and textures to try if you are finding normal meals too difficult. You may find it helpful to work through the options step-by-step, going up and down the ladder as and when your eating changes.

General Dietary Advice for Radiotherapy

  • Radiotherapy can make your mouth increasingly sore so, if you experience pain, try avoiding the following foods:

    • Acidic foods (e.g. orange/lemon-flavours, tomato-based foods, vinegar)

    • Salty or spicy foods (e.g. chilli, curries, black pepper, bacon, crisps)

    • Scratchy foods (e.g. toast, dry biscuits)

    • Alcoholic drinks, or foods cooked in alcohol

  • You may also find your mouth becomes drier, so add extra moisture (e.g. sauces, gravies, custards, cream etc.) to foods that could stick around in your mouth or throat (e.g. bread, chocolate, pastries, mashed potato)

  • Changes in taste mean you may start adding more salt, pepper or spices to foods to increase their flavour. This may irritate your mouth so try to choose blander foods whilst you are going through treatment. You can start adding more flavours again once the side effects have improved.

  • Ensure you have a drink with you at mealtimes to help wash foods down, and add extra moisture to your meals with plenty of sauce or gravy.

  • If you aren’t able to eat much you can fortify your food to make each mouthful more nutritious e.g. by switching to full fat milk or adding extra cheese or cream. The dietitian will be able advise you regarding this.

  • If your mouth or throat is sore when you eat, take pain relief 30 minutes before you eat to get the maximum benefit. You may also be given mouthwashes that numb the mouth, speak to your team about this.

  • Try eating little and often rather than aiming for big meals, as a full plate of food can often be overwhelming. Snack on easy-to-swallow foods such as yoghurt, custard or rice pudding pots, banana with custard or hummus/guacamole.

  • Nourishing drinks such as milk or yoghurt-based smoothies, hot chocolate, Horlicks or Ovaltine, milkshakes and milky coffees can be beneficial to consume between meals if your appetite has reduced. They can help to provide extra energy (calories), protein and other nutrients.

What foods do I need to eat?

As far as possible, try to have a variety of different foods each day as no single food group has all the nutrients necessary to maintain health.  You can still choose from all the food groups when having a modified diet. Try to have energy and protein foods together at every snack and meal. There are some examples of these later on in this leaflet.

ladder of food

6. Normal Foods

  • Foods with no restriction in texture.  These may be dry, stringy and crunchy.

  • E.g. salad, bacon, crisps, most meat, chips, grapes, crackers etc.

5.  Easy Chew

  • Drier foods that can easily be broken down without much chewing.

  • E.g. omelette, cake, pasta, tuna/egg mayonnaise sandwich, jacket potato, quiche, banana, corned beef hash, faggots, skinless sausage etc.

4.  Soft and bite-sized

  • Foods with a sauce that can easily be broken down without much chewing, cut into bite-sized pieces.

  • E.g. fish pie with creamy sauce, cottage pie with gravy, bread soaked in soup, dunked biscuits, stew, well cooked pasta with creamy sauce, cake with custard, soft boiled eggs etc.

3.  Minced and moist

  • Small soft pieces of food that have been broken down with a fork before eating. Adding a sauce may also be helpful.

  • E.g. mashed banana with custard, stewed fruit, mashed vegetables with gravy, well-flaked fish with sauce, mashed potatoes with gravy, scrambled egg etc.

2. Pureed Foods

  • Smooth foods with no lumps or bits in them.

  • Items can be made to this consistency by blending and passing through a sieve.

  • E.g. yoghurt, custard, thick smooth soups, mousse, crème caramel, smooth pâtés, pureed meats etc.

1. Liquidised Foods

  • Smooth runny foods that have a pouring consistency.  These can be drunk easily from a cup.

  • E.g. full fat milk or milkshakes, thin smooth soup, pourable custard with extra milk, hot chocolate, yoghurt drinks etc.

Protein-containing foods

These are the building blocks of the body and we need them to maintain and repair body tissues.  Examples include:

Protein containing foods
  • Meat
  • Poultry
  • Pate
  • Fish: fresh, frozen or tinned
  • Eggs
  • Yoghurt, custard or fromage frais
  • Milk
  • Cheese and paneer
  • Lentils and beans
  • Hummus
  • Tofu, Quorn® or soya
  • Nuts (e.g. smooth nut butters or ground almonds)



Energy-containing foods

These provide fuel for the body.  During radiotherapy your body needs more energy than normal.  If you are underweight or losing weight try to eat more of these foods. Energy, containing foods include:

Starchy foods e.g. cereals, potato, bread, chapatti, rice and pasta.  These may be more difficult when your mouth becomes dry, so try adding extra sauce,

gravy or milk/cream.

Fat and sugar containing foods e.g. butter, ghee, margarine, vegetable oils, mayonnaise, cream, full fat milk/yoghurt, custard, crème caramel, rice pudding etc. 

You may find that by altering what you eat you increase the amount of sugar within your diet.  Ensure you protect your teeth with good oral care, as advised by your dentist.  If you are diabetic please inform your dietitian and discuss treatment with your diabetes nurse.

Fruit and Vegetables

These provide the body with a good source of vitamins, minerals and fibre.  You can use fresh, frozen or tinned varieties or alternatively use fruit or vegetable juices.  Acidic or crunchy fruits such as oranges, berries or apples may be painful to swallow, so try stewing these and add custard or cream.  You may find tinned fruits (e.g. peaches in syrup/pears) easier.  Tomatoes can be acidic, so use caution with tomato-based soups or sauces.

If you have any questions or comments regarding this leaflet please contact Speech and Language Therapy (swallowing advice) or Dietetics (nutrition/diet advice).

Speech and Language Therapy: 01752 439826

Dietitian: 01752 432247


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