Understanding the IDDSI Level 7 Diet
The International Dysphagia Diet Standardisation Initiative (IDDSI) provides a global framework for modified food textures and thickened liquids. The framework consists of eight levels, with Level 7 being the most advanced, representing regular, everyday foods. Level 7 is split into two categories: 'Regular' and 'Easy to Chew' (EC7).
- IDDSI Level 7 Regular (RG7): This diet is for individuals with no chewing or swallowing issues. They can safely consume foods of any texture and size.
- IDDSI Level 7 Easy to Chew (EC7): This modified diet is for those who need softer, more tender foods because they struggle with hard or chewy textures, perhaps due to weak chewing muscles, fatigue, or dental status. It is not for people with an identified choking risk.
The ability to eat bread on a Level 7 diet depends on which subcategory a person is on and whether they have been cleared by a healthcare professional, such as a Speech-Language Pathologist or dysphagia clinician.
Why Regular Bread is a Concern for Texture-Modified Diets
For many on a modified texture diet, standard bread poses a significant risk. The reasons are multifaceted and relate to the food's properties when chewed and swallowed.
- Choking risk: Literature on choking often identifies bread as a cause, particularly for those with dysphagia.
- Extensive chewing required: Bread, even soft plain bread, requires extensive chewing to become 'swallow-safe.' The IDDSI notes this chewing effort is similar to that required for peanuts, which is beyond the capability of many with dysphagia.
- Sticky texture (bolus formation): Bread absorbs saliva, and when mixed with moisture, it can form a gummy, sticky bolus. This can be difficult to manage and poses a choking risk for those with impaired swallowing.
- Dryness: Dry bread, toast, or crackers are particularly problematic as they can crumble into small, sharp pieces or be difficult to moisten, increasing the choking risk.
- High-risk characteristics: Tough, crusty, or seeded breads are explicitly listed as foods to avoid on an Easy to Chew diet.
Making Bread Safe on an Easy to Chew Diet (If Approved)
If a healthcare professional has deemed it safe for an individual on an Easy to Chew (EC7) diet to consume some form of bread, specific modifications must be made. This is not appropriate for all patients and must be done under clinical guidance.
Guidelines for safer bread preparation:
- Use plain, soft, white or wholemeal bread with a fine texture.
- Moisten the bread thoroughly with a sauce, gravy, or soup to ensure it is not dry.
- Cut bread into small, manageable pieces, especially in sandwiches with soft fillings like tuna or egg mayo.
- Consider dunking soft plain biscuits or toast in a drink to soften it completely.
- Remove crusts, especially on tougher bread types.
- Never use hard-crusted breads, bagels, or seeded options.
Approved soft bread options for EC7:
- Croissants
- Soft bread rolls
- Plain sandwiches with soft, moist fillings
- Softened cereal or porridge
- Muffins or soft cakes (without dry crumbs)
The Role of Alternative Carbohydrates
For individuals with more significant dysphagia or those on lower IDDSI levels, alternatives to bread are much safer and should be prioritized. These options provide necessary energy and nutrients without the associated texture risks of plain bread.
Comparison Table: Bread vs. Safer Carbohydrate Alternatives on IDDSI Level 7
| Feature | Plain Bread (Potential Risk) | Safer Carbohydrate Alternatives | Description |
|---|---|---|---|
| Texture | Can be dry, fibrous, or form a sticky bolus. | Soft, moist, and tender. Easily mashes with a fork. | Avoids choking hazards associated with dry or sticky textures. |
| Chewing Effort | High, requiring extensive chewing and strong tongue control. | Low, requiring minimal to moderate chewing, with less force needed. | Reduces muscle fatigue and effort required to prepare for swallowing. |
| Food Preparation | Often needs modifications like softening with liquid or removing crusts. | Ready to serve or requires simple preparation (e.g., cooking until tender). | Provides reliable texture consistency for safer eating. |
| Risk of Choking | Identified as a significant risk for those with dysphagia. | Minimal risk when prepared correctly. | Higher safety margin for individuals with swallowing difficulties. |
| Examples | Dry toast, baguettes, seeded bread. | Moist cooked pasta, mashed potatoes, porridge, couscous, well-cooked rice. | Provides a range of choices for meals and snacks without compromise. |
Conclusion: Navigating Bread and Other Textures on a Level 7 Diet
Navigating the nuances of a Level 7 diet, particularly the inclusion of bread, requires careful consideration of texture and individual swallowing ability. The IDDSI framework has significantly clarified why standard bread presents a risk for those with chewing difficulties, even at this advanced diet level. For individuals on the 'Easy to Chew' subcategory, the ability to safely consume bread must be confirmed by a healthcare professional, followed by rigorous preparation to ensure it is soft and moist. When in doubt, safer and equally nutritious carbohydrate alternatives are readily available. Prioritizing safety through proper texture modification and adhering to professional medical advice is paramount for anyone on a modified diet. For further reading on IDDSI guidelines, visit their official website IDDSI.org.
