How does the level 7 diet work? Understanding this Clinical Diet

The International Dysphagia Diet Standardisation Initiative (IDDSI) defines the Level 7 diet as a 'Regular Easy to Chew' diet, developed to ensure food safety for individuals with chewing difficulties. Unlike fad diets that promise rapid weight loss, this is a medically prescribed eating plan focused on modifying food texture for safety and comfort.

Quick Summary

The Level 7 diet is a medical plan managed under the IDDSI framework, focusing on soft, tender, and easy-to-chew foods for individuals with chewing difficulties or health issues. It is not for weight loss.

Key Points

• Clinical Purpose: The Level 7 diet is a clinical plan for chewing problems, not for weight loss.

• Texture is Key: Food must be soft and tender, easily mashed with a fork.

• IDDSI Framework: This diet is part of the International Dysphagia Diet Standardisation Initiative (IDDSI), a global safety standard.

• Avoid Hard Foods: It requires avoiding hard, chewy, crunchy, and fibrous foods.

• Professional Guidance: A healthcare professional, like a dietitian or speech therapist, must prescribe and supervise the diet.

• Nutritional Adequacy: Monitoring nutrition is important, as weight loss on this diet may indicate a need for a nutritional boost.

What is the IDDSI Framework?

Before diving into the Level 7 diet, it's essential to understand its origin within the International Dysphagia Diet Standardisation Initiative (IDDSI) framework. IDDSI is a global initiative created to provide standardized terminology and definitions for texture-modified foods and thickened liquids for individuals with dysphagia, or swallowing difficulties.

The framework uses eight levels, numbered 0-7, to classify food textures and drink thickness. Level 7 represents two main textures: the 'Regular' diet and the 'Regular Easy to Chew' diet. The easy-to-chew variant is designed for those who can manage normal food consistency but struggle with specific textures. It is not a weight-loss diet, but a medically tailored eating plan to ensure safety and adequate nutrition.

Understanding the 'Regular Easy to Chew' (Level 7) Diet

So, how does the level 7 diet work? The core principle is modifying food texture to make it soft and tender, requiring less intense chewing. It is prescribed for people with weakened chewing ability due to age, dental issues, or recovery from illness. While it is part of the 'Regular' category, it specifically omits foods that are hard, tough, or chewy.

Key characteristics of Level 7 (Easy to Chew) food:

• Soft and Tender: Foods must break apart easily with the side of a fork or spoon.
• Not Restricted by Size: There are no restrictions on particle size, as the individual should be able to bite off and manage their own portion.
• Safe for Consumption: The texture is designed for those with sufficient chewing strength to handle softer foods without a heightened risk of choking.

Who needs a Level 7 diet?

This diet is typically recommended by a speech and language therapist or a registered dietitian. It is suitable for individuals who:

• Experience pain or discomfort when chewing hard or tough foods.
• Have dental problems, including ill-fitting dentures.
• Are recovering from a surgery or illness that has temporarily weakened their chewing ability.
• Have medical conditions, such as head and neck cancer, that impact oral function.
• Find chewing tiring but have no increased choking risk.

How to Test Foods for Level 7 Compliance

An easy way to check if a food is appropriate for a Level 7 diet is to use the Fork Pressure Test.

1. Press the Food: Use the back or tines of a fork to press down on the food item.
2. Observe the Result: The food should completely squash and not return to its original shape.
3. Check Your Thumbnail: The pressure applied should be enough to blanch your thumbnail white.
4. Confirm Separation: The food should also easily break apart or flake when separated with the fork.

Level 7 vs. Regular Diet: A Comparison

Feature	IDDSI Level 7 (Regular Easy to Chew)	Typical Regular Diet
Food Texture	Soft and tender textures only, breaks apart easily with a fork.	All textures, including hard, tough, and chewy foods.
Food Shape & Size	No restrictions on particle size; individual manages bite size.	No restrictions on food shape or size.
Preparation	May require additional cooking (e.g., simmering, stewing), mashing, or pureeing of certain items.	Standard food preparation methods.
Foods to Avoid	Hard, tough, fibrous, chewy, crunchy, and sharp foods.	No specific food exclusions based on texture, unless for dietary preference.
Target User	Individuals with chewing difficulties but no high choking risk.	Individuals without any chewing or swallowing problems.

Example Foods for the Level 7 Diet

Foods to Include:

• Proteins: Tender meat like casseroles, stews, fish cooked until soft, eggs, moist ground meat.
• Starches: Well-cooked pasta, rice, moist mashed potatoes, soft jacket potato filling.
• Vegetables: Softly boiled or steamed vegetables without skins, like carrots, parsnips, cauliflower.
• Fruits: Soft, ripe fruits such as bananas, mangoes, and tinned or stewed fruits without skin or seeds.
• Dairy: Yogurt, cottage cheese, milk puddings.

Foods to Avoid:

• Hard Foods: Nuts, raw vegetables (e.g., carrots, broccoli), dry cakes.
• Tough/Fibrous Foods: Steak, pineapple, celery, fibrous parts of fruit.
• Chewy Foods: Chewy sweets, marshmallows, thick cheese chunks, dried fruit.
• Crunchy/Crispy Foods: Raw apples, popcorn, crisps, crispy bacon.
• Sticky Foods: Peanut butter, sticky rice cakes, some cheeses.

Why a Level 7 diet is NOT for weight loss

It is a common misconception that any diet with a number is a weight-loss plan, but this is not the case for IDDSI Level 7. The diet's purpose is therapeutic, focusing on safety and ease of consumption, not calorie restriction. In fact, if a person on this diet is losing weight, it may be a sign of inadequate nutritional intake, and a dietitian should be consulted. High-calorie and high-energy foods, like full-fat dairy, can often be recommended to prevent unwanted weight loss in this population.

Conclusion: Prioritizing Safety and Nutrition

To conclude, the Level 7 diet, officially known as the 'Regular Easy to Chew' diet under the IDDSI framework, is a specialized clinical diet for individuals with chewing difficulties. It is not a fad or a weight-loss regimen, but a medically advised eating plan focused on safety, comfort, and appropriate nutrition. The diet works by modifying food texture to be soft and tender, while avoiding hard, tough, or chewy items. It is crucial for anyone considering this diet to consult with a healthcare professional, such as a speech therapist or a dietitian, to ensure it is the correct and safest choice for their specific needs.

IDDSI provides detailed resources on its framework, including Level 7.

Frequently Asked Questions

Frequently Asked Questions

Is the Level 7 diet for weight loss?

No, the Level 7 diet is not for weight loss. It is a medically prescribed diet for individuals with chewing difficulties, not a weight management plan. Using it for weight loss is a misunderstanding of its clinical purpose.

Who should follow a Level 7 diet?

A person with chewing difficulties due to dental issues, pain, fatigue, or recovery from an illness or surgery may be prescribed this diet. It is not for individuals with a high choking risk unless under strict professional guidance.

What is the Fork Pressure Test?

The Fork Pressure Test is a simple method to check if a food is soft enough for the Level 7 diet. The food should fully flatten when pressed with a fork, without regaining its shape, and the pressure applied should be enough to blanch your thumbnail white.

What are some example foods to avoid on this diet?

Foods to avoid include hard items like nuts and raw carrots, chewy foods like dried fruit, fibrous items like pineapple, and crunchy foods like crispy bacon or popcorn.

Can you eat mixed-consistency foods on a Level 7 diet?

Yes, some mixed-consistency foods are allowed, such as cereal softened with milk or soups with food pieces. However, this is specific to the 'Regular Easy to Chew' variant and should be confirmed with a clinician, especially for those with more severe dysphagia.

Do I need a doctor's referral for this diet?

Yes, the Level 7 diet is a clinical diet and should only be started under the recommendation and guidance of a qualified healthcare professional, such as a doctor, dietitian, or speech and language therapist.

What if I experience unintended weight loss on this diet?

Unintended weight loss may indicate a need for more energy-dense foods. A dietitian can provide recommendations on fortifying meals with high-energy ingredients like full-fat dairy or adding nutritious snacks to maintain a healthy weight.