Foods to Avoid in a Level 7 Easy to Chew Diet

According to the International Dysphagia Diet Standardisation Initiative (IDDSI), a global framework, certain food textures must be avoided even on a Level 7 easy to chew diet. While this diet is less restrictive, it is crucial to understand which foods still pose a risk due to their hard, tough, or sticky nature.

Quick Summary

This guide details the specific food characteristics and examples that must be excluded from a Level 7 easy to chew diet. It covers hard, dry, chewy, fibrous, and sticky foods that could be difficult to manage, ensuring dietary safety and comfort. Information is provided for proper food selection.

Key Points

• Avoid Hard and Dry Foods: Hard foods like nuts and uncooked vegetables, and dry foods such as hard-crusted bread and dry cakes, require excessive chewing and should be avoided.

• Exclude Tough and Fibrous Textures: Tough meats with gristle, pineapple, celery, and runner beans are fibrous and difficult to break down, posing a safety risk.

• Beware of Chewy and Sticky Items: Chewy candies, dried fruits, and sticky mashed potatoes can cling to the mouth and throat, increasing the risk of choking.

• Omit Crunchy and Sharp Foods: Crispy snacks, crackling, and popcorn create small, sharp, or hard pieces that are unsafe for individuals on this diet.

• Remove Seeds, Pips, and Bones: For fruits and meats, ensure all seeds, pips, gristle, and bones are removed before serving to prevent choking.

• Test Food Softness Regularly: Use the IDDSI Fork Pressure Test to check if a food is soft enough to break apart easily without regaining its shape.

• Consult a Professional: Always seek advice from a healthcare provider for personalized guidance and to address any ongoing swallowing difficulties.

A Level 7 easy to chew diet, also known as 'Regular Easy to Chew', is designed for individuals who have sufficient chewing ability for soft, tender foods but may struggle with harder, tougher textures. It is not a green light for all foods and requires careful selection to ensure food is easily broken down in the mouth and safely swallowed without tiring the person out. Avoiding specific food types is essential to prevent choking hazards and mealtime distress.

Hard and Dry Foods

These foods require significant force and repeated chewing, which can be challenging and tiring for someone on an easy-to-chew diet. They do not break down easily with fork pressure and can pose a choking risk.

• Nuts and Seeds: Whole nuts, pumpkin seeds, and sunflower seeds are too hard and small. Even large seeds in certain fruits must be removed.
• Raw Vegetables: Hard, raw vegetables like carrots, celery, and broccoli are unsuitable. They lack the softness needed to be easily mashed by the tongue and palate.
• Crispy and Crunchy Foods: This category includes items that shatter into hard, sharp pieces when bitten. Foods like hard crackers, crisp bacon, popcorn, and flaky pastries should be avoided.
• Dry Baked Goods: Hard-crusted bread, dry cakes, and crunchy biscuits can be difficult to manage, as they offer little moisture to help with chewing.

Tough and Fibrous Foods

Some foods are tender when cooked but contain tough, stringy fibers that are hard to chew and swallow safely. They can get stuck between teeth or in the throat.

• Tough Meats: Cuts of meat that are not cooked until fall-apart tender, including many types of steak, are inappropriate. Gristle and bones must also be completely removed.
• Fibrous Fruits: Certain fruits like pineapple and fibrous citrus parts (the white pith of an orange) should be avoided due to their tough, stringy nature.
• Stringy Vegetables: Vegetables with stringy textures, such as runner beans, celery, and rhubarb, are difficult to process safely.

Meats and Other Proteins to Avoid

When on a Level 7 diet, the preparation of protein is key. While tender meats and soft fish are acceptable, tough, fibrous, or dry options are not.

• Well-done, crispy bacon.
• Sausages with tough skins.
• Tough, dry deli meats.
• Meat with gristle or bones.

Chewy and Sticky Foods

Chewy and sticky foods can cling to the teeth and roof of the mouth, making them very difficult to clear. They can form a bolus that is hard to manage and swallow.

• Sticky Confections: Candies, chewy sweets, toffees, and marshmallows are difficult to chew and can pose a significant choking hazard.
• Dried Fruits: Items like dried apricots, dates, and raisins have a high sugar concentration and low moisture content, making them very chewy and sticky.
• Gummy Foods: This includes edible gelatine and other gummy sweets that stick together when chewed.
• Sticky Mashed Potatoes: Mashed potatoes can become sticky and pasty when prepared improperly, sticking to the mouth and making swallowing difficult.
• Chunky Cheese: Hard, chewy cheese chunks should be avoided, though grated or cream cheese is often acceptable.

Comparison Table: Unsuitable vs. Suitable Food Preparation

Food Type	Unsuitable Preparation (Avoid)	Suitable Preparation (Acceptable)
Meat	Tough steak, fried chicken with crispy skin, meat with gristle or bone.	Slow-cooked stew, tender minced meat dishes, skinless chicken.
Vegetables	Raw carrots, stir-fried vegetables, celery, peas with skins.	Softly boiled or steamed carrots, mashed cauliflower, skinless boiled potatoes.
Fruit	Raw apple, pineapple, melons with high water content, dried fruit.	Stewed apple, ripe banana, canned fruit (drained), peeled peaches.
Grains	Hard-crusted bread, dry biscuits, flaky pastry, crunchy cereal.	Soft bread without crusts, moistened porridge, well-cooked pasta.
Desserts	Dry cake, cakes with nuts/dried fruit, chewy sweets, chocolate bars with additions.	Soft sponge cake, custards, mousses, smooth pudding.

Conclusion

A Level 7 easy to chew diet focuses on soft, tender, and moist foods that can be effortlessly managed without excessive chewing. The key to success is to exclude any food with characteristics that are hard, tough, fibrous, chewy, sticky, crunchy, or containing small, hard parts like seeds, pips, or bones. By understanding these avoided food types and their prepared alternatives, individuals can safely and comfortably maintain their nutrition. Always consult a healthcare professional, such as a speech and language therapist or dietitian, for personalized dietary advice. Further resources can also be found on the IDDSI website to ensure full compliance. For those who still struggle, further modification of food textures may be needed.

What is the International Dysphagia Diet Standardisation Initiative (IDDSI) framework?

The IDDSI framework is a global standard for naming and describing texture-modified foods and thickened liquids for people with swallowing difficulties (dysphagia).

Why is a Level 7 easy to chew diet used?

This diet level is for individuals who can manage soft, tender foods but find tougher textures challenging. It helps reduce chewing effort and the risk of choking.

Are mixed-texture foods a concern on this diet?

Yes, foods with mixed textures, such as soup with solid chunks or hard cereal in milk, can be unsafe. The different consistencies can separate in the mouth, increasing the risk of aspiration.

Can I eat bread on a Level 7 diet?

Most hard, crusty, or dry bread should be avoided. Some soft breads, with crusts removed and possibly moistened with a sauce or gravy, may be suitable after consulting a healthcare provider.

Are crispy snacks like chips allowed?

No, crispy, crunchy, and sharp snacks like corn chips, crisps, and flaky pastry should be avoided as they can break into hard, jagged pieces.

How can I check if a food is soft enough?

The IDDSI Fork Pressure Test can be used to assess food texture. A food is considered soft enough if it completely squashes and doesn't return to its original shape when pressed with the side of a fork until your thumbnail turns white.

What should I do if I find it hard to follow the diet?

If you consistently struggle with the textures or experience difficulties, consult your speech and language therapist or dietitian. Further food texture modification may be necessary.

Frequently Asked Questions

What is the International Dysphagia Diet Standardisation Initiative (IDDSI) framework?

The IDDSI framework is a global standard for naming and describing texture-modified foods and thickened liquids for people with swallowing difficulties (dysphagia).

Why is a Level 7 easy to chew diet used?

This diet level is for individuals who can manage soft, tender foods but find tougher textures challenging. It helps reduce chewing effort and the risk of choking.

Are mixed-texture foods a concern on this diet?

Yes, foods with mixed textures, such as soup with solid chunks or hard cereal in milk, can be unsafe. The different consistencies can separate in the mouth, increasing the risk of aspiration.

Can I eat bread on a Level 7 diet?

Most hard, crusty, or dry bread should be avoided. Some soft breads, with crusts removed and possibly moistened with a sauce or gravy, may be suitable after consulting a healthcare provider.

Are crispy snacks like chips allowed?

No, crispy, crunchy, and sharp snacks like corn chips, crisps, and flaky pastry should be avoided as they can break into hard, jagged pieces.

How can I check if a food is soft enough?

The IDDSI Fork Pressure Test can be used to assess food texture. A food is considered soft enough if it completely squashes and doesn't return to its original shape when pressed with the side of a fork until your thumbnail turns white.

What should I do if I find it hard to follow the diet?

If you consistently struggle with the textures or experience difficulties, consult your speech and language therapist or dietitian. Further food texture modification may be necessary.