What is a level 7 diet?

According to the International Dysphagia Diet Standardisation Initiative (IDDSI), a global framework standardizing food textures and liquid thickness, a level 7 diet is classified as "Regular Easy to Chew". This diet is designed for individuals who have mild chewing difficulties but do not have an increased risk of choking.

Quick Summary

The level 7 diet consists of soft, tender, and moist foods that are easy to bite and chew, eliminating tough, hard, or crunchy textures. It is part of the IDDSI framework and is intended for individuals with minor chewing problems due to factors like fatigue, dental issues, or recovery from illness.

Key Points

• Definition: A level 7 diet, or Easy to Chew (EC7), is part of the IDDSI framework for individuals with mild chewing difficulties.

• Food Texture: Foods must be soft, tender, and moist, easily broken with the side of a fork.

• Particle Size: Unlike other modified diets, Level 7 has no restriction on the size of food pieces.

• Who is it for?: It is suitable for those with dental problems, post-illness recovery, or mild dysphagia who can chew without tiring.

• Foods to Eat: Includes soft meats, tender cooked vegetables, ripe fruits, soft pasta, and dairy products like yogurt.

• Foods to Avoid: Excludes hard, crunchy, sticky, chewy, or fibrous foods, as well as those with bones, skins, or seeds.

• Safety Check: The 'Fork Pressure Test' can be used to ensure food is soft enough to be squashed easily.

Understanding the IDDSI Framework

To understand what is a level 7 diet, it's essential to know its place within the International Dysphagia Diet Standardisation Initiative (IDDSI) framework. IDDSI was created to standardize terminology for modified food textures and drinks for people with dysphagia (swallowing difficulties). The framework consists of eight levels, from 0 (thin liquids) to 7 (regular foods).

IDDSI Level 7 actually has two sub-categories: IDDSI Regular (RG7) and IDDSI Regular Easy to Chew (EC7). The 'Easy to Chew' modification is the focus of this article. Unlike other modified diets, Level 7 Easy to Chew does not restrict food piece size, but the texture is specifically adapted to be soft and tender. This contrasts with lower levels, such as Level 5 (Minced and Moist) or Level 4 (Pureed), which require strict control over particle size and consistency.

Who Needs a Level 7 Diet?

The Level 7 Easy to Chew diet is prescribed for people who can bite and chew soft foods without tiring but may find harder textures painful or difficult to manage. It is often a temporary solution but can become a long-term dietary approach for some individuals.

This diet is often recommended by speech-language therapists or dietitians for those with conditions such as:

• Dental issues: Poorly-fitting dentures, missing teeth, or recovery after dental surgery.
• Fatigue: Individuals who tire easily during mealtime, such as those recovering from an illness or older adults.
• Pain: People who experience discomfort when chewing or swallowing harder foods due to mouth or jaw pain.
• Mild dysphagia: Cases where swallowing function is not severely impaired but requires softer textures for safety and comfort.

What Foods Can You Eat on a Level 7 Diet?

The key to a level 7 diet is selecting foods that are naturally soft or can be cooked until tender and moist. The food should break apart easily when pressed with the side of a fork.

Examples of suitable foods:

• Proteins: Finely minced meat, tender cooked chicken, soft fish fillets (with bones removed), eggs (scrambled or soft-boiled), and well-cooked legumes.
• Fruits: Ripe bananas, soft melons, peaches, pears, and strawberries. Canned or stewed fruits with skins and seeds removed are also acceptable.
• Vegetables: Soft-boiled or steamed vegetables without skins or fibrous parts, such as carrots, sweet potatoes, cauliflower, and zucchini. Mashed potatoes are also a good option.
• Carbohydrates: Porridge, well-cooked pasta, noodles, soft rice, and soft bread (crusts may need to be removed).
• Dairy: Smooth yogurts, soft cheeses, milk puddings, and custard.
• Snacks and Desserts: Mousse, plain cakes soaked with cream or custard, and soft fruit desserts.

What Foods Should You Avoid on a Level 7 Diet?

Certain food textures pose a risk for those on an easy-to-chew diet and should be avoided.

Foods to avoid include:

• Hard or Dry: Nuts, crackers, dry cereal, crispy bacon, and uncooked vegetables.
• Chewy or Sticky: Chewy candies, dried fruit, sticky rice cakes, and tough cuts of meat.
• Crunchy: Popcorn, hard apples, corn chips, and crusty bread.
• Fibrous or Stringy: Pineapple, green beans, celery, and rhubarb.
• With Bits or Skins: Fruit or vegetable skins, seeds, husks, pips, and tough gristle or bones.
• Mixed Consistency: Foods with both solid and thin liquid components, such as some soups with chunky bits.

Comparison: Level 7 Easy to Chew vs. Other Diets

Feature	Level 7: Easy to Chew (EC7)	Level 5: Minced & Moist (MM5)	Level 4: Pureed (PU4)
Food Texture	Soft, tender, and moist. Can be easily broken with a fork.	Soft, moist, and cohesive with no separate thin liquid. Minced pieces are 4mm max.	Pureed, smooth, and lump-free. Holds shape on a plate.
Bite Size	No restriction on particle size.	Particles must be no larger than 4mm.	No chewing required; food is a smooth consistency.
Chewing Ability	Requires some chewing strength, but no tiring.	Requires minimal chewing.	No chewing required.
Swallowing Risk	Minimal risk of choking or aspiration for those able to manage.	Low risk for those able to manage.	Very low risk of choking or aspiration.
Suitability	Mild chewing problems (dental, fatigue, recovery).	More significant chewing difficulty.	Severe swallowing difficulties (dysphagia).

Safely Preparing Foods for a Level 7 Diet

Following a level 7 diet requires careful food preparation to ensure safety and comfort.

1. Cooking Methods: Cook foods like meat and vegetables until they are soft and tender using methods such as steaming, boiling, or stewing. Slow cookers can also help make tougher meats tender.
2. Moisture is Key: Ensure foods are moist by adding sauces, gravies, or broth to prevent dryness. Using milk, cream, or soft margarine with mashed vegetables and potatoes can also add moisture and calories.
3. Use a Fork Test: An easy and reliable way to check the food's texture is the 'Fork Pressure Test'. Press down on the food with a fork until your nail turns white; the food should squash and not regain its original shape.
4. Enrich Meals: To prevent unintentional weight loss, especially common in individuals with appetite issues, use full-fat dairy products, add extra butter or cream, and use honey or syrup in desserts.
5. Serve Attractively: Maintaining visual appeal is important for appetite. Consider using food molds or simple garnishes to make meals more appealing.

Conclusion

A level 7 diet, or Easy to Chew, is an important texture-modified diet defined by the IDDSI framework for individuals who can manage soft, tender foods without tiring. It provides a safe and comfortable way for those with minor chewing problems, dental issues, or recovery-related fatigue to enjoy a varied and nutritionally balanced diet. By carefully selecting and preparing soft, moist, and tender foods, and avoiding hard, crunchy, or chewy items, individuals can maintain their nutritional intake while minimizing risks. A healthcare professional, such as a speech-language pathologist or dietitian, should always be consulted before starting or changing a texture-modified diet.

This guide is for informational purposes only and not a substitute for professional medical advice. For more information on the IDDSI framework and its various levels, you can visit their website. https://www.iddsi.org/

Frequently Asked Questions

What does IDDSI stand for?

IDDSI stands for the International Dysphagia Diet Standardisation Initiative, a global framework used to classify and describe food textures and liquid thickness for people with swallowing difficulties.

Is a level 7 diet the same as a regular diet?

No. While it is the highest level on the IDDSI scale, the 'Easy to Chew' sub-category requires a soft and tender texture, unlike a standard regular diet which has no texture limitations.

Can I eat bread on a level 7 easy-to-chew diet?

Soft bread may be acceptable, but hard crusts should be removed. Dry or crusty bread should generally be avoided. It is best to consult a healthcare professional for specific advice.

What is the difference between a Level 7 and a Level 5 diet?

A Level 7 diet consists of soft and tender foods with no particle size restrictions, requiring some chewing ability. A Level 5 (Minced and Moist) diet requires foods to be minced into pieces no larger than 4mm and requires minimal chewing.

Are salads allowed on a level 7 diet?

No, raw, fibrous, or floppy foods like lettuce and cucumber should be avoided on a level 7 diet. Vegetables should be cooked until tender.

How do I check if a food is suitable for Level 7?

Use the 'Fork Pressure Test'. Press a fork into the food until your thumbnail blanches white. The food should easily squash and not return to its original shape.

Can children be on a level 7 diet?

Yes, children can be prescribed an Easy to Chew diet, but special care must be taken with bite sizes, especially for those under three years old, to prevent choking risks.