Understanding the International Dysphagia Diet Standardisation Initiative (IDDSI)
To understand if a Level 7 diet is a normal diet, one must first grasp the IDDSI framework, a global standard designed to improve the safety of individuals with dysphagia, or swallowing difficulties. The framework standardizes terminology for food textures and drink thickness across a continuum of eight levels, from Level 0 (thin liquids) to Level 7 (regular foods). This standardization eliminates the confusion caused by ambiguous terms like 'soft' or 'chopped' that vary between facilities, thereby reducing the risk of choking and other adverse events.
The Two Sides of a Level 7 Diet
Within the IDDSI framework, Level 7 is not a single, monolithic diet but is divided into two distinct subcategories, each with different implications for what constitutes a 'normal' diet. The key lies in understanding the subtle yet crucial differences between them.
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Level 7 Regular (RG7): This is the standard, everyday diet for individuals who do not have any chewing or swallowing problems. It includes all types of food and drink, with no restrictions on texture or piece size. For a healthy person without dysphagia, a Level 7 Regular diet is the normal diet.
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Level 7 Easy to Chew (EC7): This diet is a modified version of a regular diet for people who can chew and swallow safely but may find hard or tough foods difficult, painful, or tiring to manage. While it consists of normal, everyday foods, these foods must be soft and tender enough to break apart easily with the side of a fork or spoon. This modification is common for individuals recovering from illness or oral surgery, or for those with dental issues. Because it places restrictions on the type of food texture (excluding hard, tough, and chewy items), it is a modified diet and not a normal, unrestricted diet.
How to Distinguish Between Easy to Chew and a Regular Diet
For a regular diet, there are no restrictions on food characteristics. For the 'Easy to Chew' subcategory, several specific food textures and items must be avoided.
Foods to Avoid on an 'Easy to Chew' (EC7) Diet:
- Hard, dry foods like nuts, hard crackers, or dry toast.
- Tough or fibrous foods such as pineapple or steak.
- Chewy items like dried fruit, chewy sweets, or tough meats.
- Crispy or crunchy foods, including cornflakes, popcorn, and raw vegetables like carrots or apples.
- Sticky or gummy foods like some marshmallows or sticky rice cakes.
- Items with pips, seeds, bones, gristle, or tough skins, such as grapes, peas, or chicken with the skin on.
- Food with mixed consistencies, such as soup with hard chunks or cereal with milk that does not soften.
Level 7 vs. Other IDDSI Levels
Comparing Level 7 with the other dysphagia diet levels highlights its proximity to a normal diet. It sits at the top of the IDDSI food texture spectrum, with lower levels requiring increasingly modified textures.
| Feature | Level 7 Regular | Level 7 Easy to Chew | Level 6 Soft & Bite-Sized | Level 5 Minced & Moist |
|---|---|---|---|---|
| Chewing | Not required to fatigue easily. | Requires chewing soft/tender foods. | Requires biting/chewing; particle size restricted. | Requires minimal chewing; particles 4mm or less. |
| Food Texture | Unrestricted; all textures allowed. | Normal, soft/tender foods only. | Soft, solid foods. | Minced and moist, cohesive. |
| Particle Size | Not restricted. | Not restricted. | Max 1.5 cm for adults; must be manageable. | Max 4mm for adults. |
| Swallowing Risk | Minimal for those without dysphagia. | No increased risk of choking if able to chew soft foods. | Low risk; particle restriction helps prevent choking. | Lower risk; very small particles are safer. |
| Who It's For | General population. | Individuals with mild chewing difficulties. | Dysphagia patients needing some chewing ability. | Dysphagia patients with limited chewing ability. |
The Clinical Context of a Level 7 Diet
It's important to recognize that while Level 7 Regular is a normal diet, the prescribed use of a Level 7 Easy to Chew diet indicates a clinical need for modification. A healthcare professional, often a Speech and Language Therapist, determines the appropriate IDDSI level based on a comprehensive assessment of an individual's chewing and swallowing abilities. The goal is always to provide the least restrictive diet that is still safe, balancing nutritional needs with quality of life. A person on a Level 7 Easy to Chew diet can and should enjoy a varied and palatable menu, so long as it adheres to the softness criteria. For example, a tender casserole or softly cooked vegetables are appropriate, while tough meat or crunchy vegetables are not.
Conclusion
In summary, a Level 7 diet within the IDDSI framework can indeed be a normal, unrestricted diet, but only if it is the 'Regular' subcategory. However, it is also a term used for the 'Easy to Chew' diet, which is a modified version for individuals with specific chewing limitations, and therefore not a normal diet. This distinction is critical for patient safety and underscores the importance of the standardized IDDSI terminology. For the general population, a 'Level 7 Regular' diet is simply the standard way of eating, but for someone with mild chewing difficulties, the modifications of a 'Level 7 Easy to Chew' diet are essential for a safe eating experience.
For more detailed guidance on the IDDSI framework and its various levels, you can refer to the official website of the International Dysphagia Diet Standardisation Initiative (IDDSI) at https://iddsi.org/.
