The Level 7 Easy to Chew diet, developed by IDDSI, is designed for individuals who can safely manage soft and tender foods but need to avoid certain food textures that pose a choking risk. While this diet is less restrictive than lower-level dysphagia diets, careful attention to food preparation and consistency is still necessary. Foods are typically soft enough to be broken apart with a fork or spoon. Below is a detailed breakdown of the types of food not allowed.
Foods to Avoid by Texture Category
Hard or Dry Foods
These foods can be difficult to break down with chewing and may pose a choking risk, especially when dry. They require more effort and saliva to be safely managed.
- Nuts and seeds: All types of nuts, pumpkin seeds, and apple seeds are forbidden.
- Raw vegetables: Hard, uncooked vegetables like carrots, celery, broccoli, and cauliflower are not allowed. They are too firm and require significant chewing.
- Dry cakes and bread: Items like dry toast, crusty bread, and plain crackers can be crumbly and difficult to moisten, creating a choking hazard.
- Dry cereals: Hard cereals and cornflakes are generally restricted unless softened completely with milk.
- Hard candy: Boiled sweets, lozenges, and other hard candies are strictly forbidden due to the risk of swallowing them whole.
Chewy or Sticky Foods
Chewy and sticky textures can be challenging to clear from the mouth and swallow effectively, increasing the risk of residue being left behind or aspiration.
- Chewy lollies and sweets: Gummy candies and chewy sweets can easily get stuck and are not permitted.
- Sticky foods: Items like dried fruit, sticky mashed potato, and sticky rice cakes are often difficult to clear from the mouth.
- Marshmallows and gum: Chewing gum and marshmallows are chewy and sticky, making them unsuitable for a Level 7 diet.
- Certain cheeses: Chunks of hard or sticky cheese are not allowed.
Fibrous, Stringy, or Mixed Consistency Foods
Foods with stringy or fibrous textures can be hard to chew and break down, while mixed consistencies can be dangerous when the thinner liquid separates from the solid food.
- Fibrous vegetables and fruits: Stringy vegetables like rhubarb, runner beans, and celery are forbidden. Fibrous parts of fruit, like the white pith of an orange, must also be avoided.
- Tough meats: Steak, pork chops, and other tough cuts of meat with gristle are not allowed. All meat must be cooked until tender and easily broken apart.
- Soups with solid pieces: Soups containing solid pieces of vegetables or meat mixed with a thin broth are a high-risk mixed-consistency food.
- Juicy foods that separate: Watermelon and oranges, which can release thin liquid while being chewed, can increase the risk of aspiration.
Crispy, Crunchy, or Sharp Foods
These textures shatter into small, hard, or sharp pieces upon chewing, which can scratch the mouth or pose a choking hazard.
- Crispy items: Crispy bacon, cornflakes, and crackling are all restricted.
- Crunchy items: Raw apples, popcorn, and crunchy cereals are to be avoided.
- Sharp or spiky foods: Hard corn chips or crisps that can break into sharp pieces are not allowed.
- Crumbly items: Dry pie crusts, biscuits, and dry cakes that can produce crumbs are generally restricted.
Comparison of Acceptable vs. Unacceptable Foods for Level 7
| Food Category | Acceptable Examples | Unacceptable Examples |
|---|---|---|
| Meat & Protein | Tender, slow-cooked meat; finely minced meat; boneless, soft-cooked fish; skinless sausages; scrambled eggs | Steak, chewy pork, gristly meat, bony fish, tough chicken skin |
| Fruits | Soft, ripe fruits like bananas, mashed berries, or tinned peaches (drained); cooked or stewed fruits without skins or seeds | Raw apples, pineapple, watermelon, oranges with fibrous pith, dried fruit |
| Vegetables | Steamed or boiled vegetables cooked until very tender; mushy peas; skinless potatoes | Raw carrots, celery, broccoli; stir-fried vegetables that are too firm |
| Grains & Cereals | Well-cooked pasta; rice; porridge or soft cereal soaked in milk | Dry, crunchy cereals; toast or bread with crusts; flaky pastry; dry biscuits |
| Desserts & Snacks | Plain sponge cake with custard or cream; milk puddings; mousse; soft yogurt | Chewy sweets, marshmallows, dried fruit, hard chocolate, cakes with nuts |
Guidelines for Safe Eating on a Level 7 Diet
Ensuring food is prepared and eaten correctly is as important as knowing what to avoid. Several key principles should be followed:
- Verify Food Texture: Use the IDDSI fork pressure test to check if foods are soft enough. Press a fork onto the food until your thumbnail blanches white; the food should completely squash and not return to its original shape.
- Maintain Moisture: All foods should be served with sufficient sauce, gravy, or custard to ensure they remain moist. Avoid allowing food to dry out on the plate.
- Check for Bones and Gristle: It is vital to remove all bones, skin, and gristle from meat and fish before serving.
- Beware of Mixed Consistencies: Be cautious with foods that have both a solid and a thin liquid component, as the liquid can be aspirated before the solid is ready to swallow.
- Eat Slowly and Attentively: Encouraging slow, small bites and a focus on chewing can reduce the risk of choking. Avoid distracting conversation during meals.
- Seek Professional Advice: Always consult with a speech and language therapist or dietitian for personalized guidance and to ensure the diet is appropriate.
Conclusion
Understanding what food is not allowed for Level 7 Easy to Chew is paramount for anyone managing this dietary requirement, whether for themselves or a loved one. By strictly avoiding hard, tough, chewy, fibrous, and sticky items, and ensuring all permitted foods are served tender and moist, the risk of choking and swallowing difficulties is significantly reduced. Following IDDSI guidelines and consulting with healthcare professionals provides the safest path for managing a Level 7 diet effectively and ensuring adequate nutrition is maintained. (Please note: This information is for guidance and is not a substitute for professional medical advice).
Common Mistakes to Avoid
Beyond simply listing prohibited items, it's helpful to understand common mistakes made when preparing meals for a Level 7 diet. One of the most frequent errors is assuming that because a food is cooked, it is automatically safe. For example, a boiled carrot may be soft, but if it is served with a thin, watery sauce, the combined consistency can be hazardous. Another common mistake is failing to remove all fibrous parts or skins from fruits and vegetables, like the pith from an orange or the skin from a cooked tomato. Lastly, caregivers sometimes forget to test the food's texture with the simple fork pressure test, which is a critical step in verifying the meal's safety. Consistent attention to these details can prevent accidents and make mealtime safer for the individual.
