The International Dysphagia Diet Standardisation Initiative (IDDSI)
The International Dysphagia Diet Standardisation Initiative (IDDSI) provides a global framework for modifying foods and drinks for people with swallowing difficulties, or dysphagia. Before IDDSI, diet recommendations varied widely, creating confusion and increasing the risk of choking. The IDDSI framework uses eight numbered levels, from 0 to 7, to classify food texture and drink thickness. IDDSI Level 7 is the highest level, representing the least restrictive modification.
What is the IDDSI Level 7 diet?
The Level 7 dysphagia diet is officially called "Regular Easy to Chew". It allows for normal, everyday foods but with an important modification: all foods must be soft and tender. This means they are easy to chew and break apart. Unlike more restrictive levels, there are no limits on the size of food pieces, but the overall texture must be managed to be easily chewed and swallowed. The goal is to provide maximum dietary freedom while reducing the risk associated with harder, tougher foods.
Key characteristics of Level 7 foods
- Soft and tender: Foods should be cooked until they are soft and tender.
- Easily separated: A key test is that the food can be easily broken apart with the side of a fork or spoon.
- Squashable: When pressed with a fork, the food should easily squash and not return to its original shape.
- Regular size: The size of food pieces is not restricted, as long as the texture is soft.
- Moist: Adding sauces, gravies, and moisture can help with swallowing and flavour.
Who is the Level 7 diet for?
The Level 7 easy-to-chew diet is designed for individuals who have some difficulty chewing but do not have an increased risk of choking. It is a transitional diet for those recovering from an illness or surgery, or for individuals with conditions that cause mild fatigue or weakness in their chewing muscles. It is often prescribed when someone's swallowing function is considered safe for normal textures, but they still benefit from a softer consistency. This diet is not suitable for people with a high choking risk or those who require supervision while eating. A healthcare professional, such as a speech-language pathologist or dietitian, determines the appropriate diet level.
Food choices for the Level 7 diet
Allowed foods list
- Meats and protein: Tender, cooked meat (like stewed meat), finely minced meat, soft fish (without bones), boneless fish cakes, poached, scrambled, or soft-boiled eggs.
- Starches and grains: Well-cooked pasta, rice, porridge, and soft cereals soaked in milk. Some soft sandwiches with moist fillings (like egg mayonnaise) are also suitable.
- Fruits and vegetables: Soft, ripe fresh fruit (e.g., banana, berries), canned fruit, well-cooked vegetables that are tender (e.g., steamed carrots, broccoli).
- Dairy: Yoghurt, custard, ice cream, soft cheese, and milk puddings.
- Desserts: Plain, moist cake or sponge pudding with custard.
Foods to avoid list
- Hard and dry foods: Nuts, dry cereals, dry cakes, hard biscuits, hard cheese, raw vegetables.
- Tough and chewy foods: Steak, chewy lollies, marshmallows, fibrous fruit (like pineapple), and meat with gristle.
- Crispy, crunchy, or crumbly foods: Toast, crisp bacon, flaky pastry, cornflakes.
- Sticky or stringy foods: Sticky rice cakes, edible gelatin, runner beans.
- Foods with pips, seeds, or bones: Seeds in bread or fruits, bones in meat or fish.
- Mixed consistency foods: Cereal that doesn't fully soften in milk, chunky soups.
Comparison: IDDSI Levels 5, 6, and 7
| Feature | IDDSI Level 5: Minced & Moist | IDDSI Level 6: Soft & Bite-Sized | IDDSI Level 7: Regular Easy to Chew |
|---|---|---|---|
| Particle Size | Max 4mm, soft and minced | Max 1.5 cm x 1.5 cm pieces | Regular size, but tender |
| Texture | Soft, moist, lump-free, holds shape | Soft, tender, moist, no thin liquid | Soft, tender, moist (no chewing fatigue) |
| Utensil Test | Falls off spoon when tilted | No pressure needed with a fork side | Easily broken with a fork side |
| Chewing Skill | Minimal chewing required | Mild to moderate chewing ability | Strong enough chewing for tender foods |
| Patient Profile | Moderate dysphagia | Moderate dysphagia, needs limited size | Mild chewing issues (dental, fatigue) |
| Supervision | Often required during meals | Supervision recommended for safety | May or may not require supervision |
Preparing and serving tips for Level 7
To ensure foods are safe and palatable, preparation is key. Cooking methods like boiling or steaming can help soften vegetables and meat. Adding extra sauces, gravy, or butter can increase moisture and make foods easier to swallow. Serving meals in smaller portions can prevent the food from getting cold and hard. It is also important to maintain proper posture while eating, sitting upright at a 90-degree angle if possible. Eating in a calm, distraction-free environment and taking small, manageable bites can further reduce risks.
Nutritional considerations and weight management
Individuals on a Level 7 diet may have a reduced appetite or find eating more tiring, which can lead to unintentional weight loss. A balanced diet from all food groups is important for maintaining health. To boost calorie and protein intake, a dietitian may recommend adding extra nourishment. This can include adding full-fat dairy products, using fortified milk, or incorporating high-calorie snacks. Regularly weighing oneself can help track changes in weight and address any concerns with a healthcare provider.
Conclusion
The dysphagia 7 diet, or IDDSI Level 7 Easy to Chew, is an important part of the care continuum for individuals with mild chewing challenges. It allows for normal foods with specific texture modifications to ensure safety and comfort. By understanding the characteristics of this diet, identifying appropriate food choices, and implementing safe preparation techniques, patients can enjoy a wider variety of foods while managing their swallowing difficulty. Always follow the specific recommendations of a speech-language pathologist or dietitian. For more official information, you can visit the International Dysphagia Diet Standardisation Initiative website.
