Can a level 6 diet have soup?: A Guide to Safe and Nutritious Eating

October 14, 2025 •

4 min read

According to the International Dysphagia Diet Standardisation Initiative (IDDSI), a Level 6 diet requires foods that are soft, moist, and bite-sized. For many people managing swallowing difficulties, this raises a crucial question: Can a level 6 diet have soup? The key lies in understanding and correctly managing the soup's texture and consistency.

Quick Summary

This guide explains the specific requirements for incorporating soup into a Level 6 Soft & Bite-Sized diet, focusing on safety and texture. Learn how to prepare safe, nutritious soups by avoiding mixed consistencies and ensuring a uniformly thick, smooth result that meets IDDSI guidelines.

Key Points

Level 6 Diet Definition: A Level 6 diet, or 'Soft & Bite-Sized', is for individuals who can chew but need foods that are tender, moist, and cut into small, manageable pieces.
Consistency is Key: For soup to be safe on a Level 6 diet, it must be uniformly thick and smooth, with no separate thin liquid or lumps.
Avoid Mixed Consistencies: Soups containing both thin broth and solid pieces are unsafe and a high choking and aspiration risk for individuals on a Level 6 diet.
Proper Preparation: Safe Level 6 soup requires cooking ingredients until very soft, then blending them completely in a food processor or with a hand blender to achieve a uniform texture.
Fortify for Nutrition: Adding high-calorie and high-protein ingredients like full-fat cream, milk powder, or puréed proteins can boost the nutritional value of Level 6 soups.
Consult Professionals: Always seek advice from a Speech and Language Therapist (SLT) and a dietitian to ensure your diet is safe and meets your nutritional needs.
Safe Examples: Good options include smooth cream of vegetable soups, split pea soup blended until smooth, or fortified tomato soup with added thickeners.

Understanding the IDDSI Framework and Level 6

The International Dysphagia Diet Standardisation Initiative (IDDSI) provides a global framework for classifying texture-modified foods and thickened liquids for individuals with swallowing difficulties, or dysphagia. The framework uses a numbered system, from 0 to 7, to ensure that caregivers and patients can communicate about diet textures accurately, reducing the risk of choking and aspiration. The IDDSI Level 6 diet, specifically, is known as the 'Soft & Bite-Sized' diet.

What is a Level 6 Soft & Bite-Sized Diet?

A Level 6 diet is intended for individuals who can chew but have difficulty biting off pieces of food safely. The food on this diet must have several key characteristics:

Soft, tender, and moist throughout: The food should be cooked until tender and easily broken down.
Bite-sized pieces: For adults, food is cut into pieces no larger than 1.5 cm x 1.5 cm.
Fork-mashable: The food should be easily mashed or broken down with pressure from a fork or spoon.
Requires chewing: This diet still requires some chewing before swallowing.
No separate thin liquid: This is a critical point that directly relates to soups. Liquids should not leak or drip from the food.

The Nuance of Soup on a Level 6 Diet

The short answer to the question, can a level 6 diet have soup?, is yes, but with careful and specific preparation. The danger lies in soups with 'mixed consistencies', such as a thin, watery broth containing soft pieces of vegetables or meat. This combination can be particularly hazardous for individuals with dysphagia, as the thin liquid can separate from the solids in the mouth and enter the airway (aspiration) before the person is ready to swallow.

Safely Incorporating Soup: The Right Consistency

For a soup to be safe and compliant with a Level 6 diet, it must be uniform and thick. Safe options include:

Cream of soups: These must be completely smooth and lump-free.
Blended soups: Soups made with tender-cooked vegetables, lentils, or other soft ingredients can be blended until a thick, smooth, pudding-like texture is achieved.
Fortified soups: Adding thickeners like potato flakes or skim milk powder to smooth soups not only improves consistency but also boosts nutritional content.

Preparing Level 6 Compliant Soups

To ensure your soup meets the Level 6 standard, follow these steps and use the right equipment:

Use a food processor or liquidiser to blend all ingredients until completely smooth. A hand-held blender is also effective.
Cook vegetables until they are very soft before blending.
Use thickeners like potato flakes, blended bread, or cornflour to achieve the desired, uniform consistency.
For fortification, add ingredients like fortified milk, cream, Greek yogurt, or puréed tofu while blending.
Always check the final consistency using a fork or spoon pressure test to ensure it is thick and uniform.

Comparison: Safe vs. Unsafe Soup for a Level 6 Diet


Feature	Mixed-Consistency Soup (Unsafe)	Thick, Smooth Soup (Safe)
Consistency	Contains both thin liquid (broth) and solid lumps (e.g., chunky vegetable soup, minestrone).	Has a uniform, thick, smooth consistency, like pudding.
Preparation	No blending required, ingredients are cooked and left in separate pieces.	Ingredients are cooked until tender and then blended completely.
Safety Risk	High risk of aspiration and choking due to liquid separating from solid particles.	Low risk of aspiration and choking when correctly prepared and tested.
Examples	Scotch broth, chunky vegetable soup, any soup with floating vegetables or pasta.	Cream of mushroom, blended carrot and coriander, or fortified tomato soup.
Testing	Fails the IDDSI pressure test due to inconsistent texture and thin liquid.	Passes the IDDSI pressure test, holding its shape when pressed and not separating.

The Risks of Non-Compliance

Ignoring the specific texture requirements for a Level 6 diet can have serious health consequences. When food consistency is not uniform, it can increase the risk of aspiration, where food or liquid enters the airway instead of the oesophagus. This can lead to a potentially fatal chest infection known as aspiration pneumonia. Common soup-related issues include:

Lumps and bits: Hard or soft pieces, like those found in minestrone, can be difficult to chew and swallow.
Thin liquid: A watery broth can bypass the protective swallowing mechanism.
Inconsistent texture: Even in a thick soup, if solid pieces are not fully blended, they can pose a risk.

Fortifying Soups for Better Nutrition

Since texture-modified diets can sometimes lack adequate calories and nutrients, it is important to fortify foods, including soups. Fortification helps maintain weight and overall nutritional status. To fortify a Level 6 compliant soup, consider adding:

Full-fat dairy, such as cream, full-fat milk, or cheese.
Milk powder, which can be whisked into the soup.
Generous amounts of butter or margarine.
Smooth puréed proteins like silken tofu, lentils, or blended tender meat.

Consulting with Health Professionals

While this guide provides general information, it is no substitute for personalized medical advice. If you or a loved one are following a texture-modified diet, it is essential to consult with a Speech and Language Therapist (SLT) and a registered dietitian. They can provide a personalized assessment and ensure that your diet is both safe and nutritionally adequate. The IDDSI website (https://www.iddsi.org/) is also an excellent resource for detailed information on the framework and testing methods.

Conclusion

Incorporating soup into a Level 6 diet is possible and can be a nutritious and comforting addition to the meal plan. However, it requires a complete departure from traditional mixed-consistency soups. By ensuring the soup is uniformly thick, smooth, and free of any lumps or thin liquid, individuals can enjoy a delicious meal while minimizing the risk of choking and aspiration. Always adhere to professional guidance from your healthcare team to ensure safety and nutritional well-being.

Frequently Asked Questions

The main danger of lumpy soup is that the thin liquid component can separate from the solid lumps. This mixed consistency can cause aspiration, where the liquid accidentally enters the airway, increasing the risk of choking and chest infections like aspiration pneumonia.

Yes, but you must check its consistency carefully. Most tinned soups will need to be blended completely and, if necessary, thickened to ensure they are smooth, uniform, and lump-free before serving.

A soup is thick enough if it holds its shape on a spoon and does not drip through the tines of a fork. It should have a consistency similar to pudding or a thick gravy. You can perform a 'fork drip test' to check the thickness.

No, solid toppings such as croutons or floating cheese chunks should not be added to Level 6 soup. The meal's texture must be uniform to prevent the aspiration of solid pieces.

Yes, avoid fibrous or stringy vegetables like celery, as they may not blend completely. Also, avoid foods with husks (e.g., corn) or skins (e.g., peas, grapes) that can cause issues, even after blending.

You can add high-fat and high-protein ingredients such as cream, melted butter, full-fat milk powder, or blended grated cheese to the soup after blending. Pureed silken tofu is another excellent source of protein.

Aspiration occurs when food or liquid enters the airway instead of the esophagus. For a Level 6 diet, the risk is higher with 'mixed consistency' foods like lumpy soup, where the thin liquid can be aspirated before the solid parts are swallowed safely. This can lead to serious respiratory issues.