Understanding the IDDSI Framework
The International Dysphagia Diet Standardisation Initiative, or IDDSI, is a globally recognized framework that provides standardized descriptions for texture-modified foods and thickened liquids for individuals with swallowing difficulties (dysphagia). The framework uses a numbered system from 0 to 7. Level 7 represents the regular diet, which has two main classifications: Regular (RG7) and Regular Easy to Chew (EC7). The Level 7 EC diet is a specific sub-category for people who require softer foods due to weak chewing muscles but do not have an increased risk of choking.
What is a Level 7 EC diet? The Basics
A Level 7 EC diet (Easy to Chew) features regular, everyday foods but with a specifically soft and tender texture. While the diet doesn't restrict food piece size, it requires that all foods are moist and soft enough to be easily broken apart by the side of a fork or spoon. This is distinct from a Level 7 Regular diet, which includes all textures and requires full chewing and swallowing ability. Individuals on a Level 7 EC diet should be able to chew soft, tender foods without tiring and safely remove any hard pieces, such as bone or gristle, from their mouth.
Who Needs a Level 7 EC Diet?
This diet is not for those with significant dysphagia or a high choking risk. Instead, it is prescribed by a healthcare professional for individuals who might struggle with harder, tougher food textures for a variety of reasons, including:
- Age: Chewing strength can decline with age, making softer foods more manageable.
- Fatigue: Individuals recovering from an illness may have less energy to chew tough foods.
- Dental Issues: Sore gums, missing teeth, or poorly fitting dentures can make chewing difficult and painful.
- Advanced Chewing Skill Development: A clinician may recommend this texture to help a person progress from softer textures towards a regular diet.
Suitable Foods for the Level 7 EC Diet
Preparation is key for this diet, ensuring foods are cooked until tender and served moist. Portion sizes are not restricted, allowing for normal, appetizing meals.
Meats and Proteins
- Fish cooked until tender and flaky, such as steamed white fish.
- Tender, slow-cooked meats like casseroles, stews, or ground meat dishes.
- Soft chicken or turkey, served moist with gravy or sauce.
- Eggs prepared scrambled, poached, or in a soft, moist omelette.
- Tofu or soft pulses like lentils and beans, cooked until very soft.
Fruits and Vegetables
- Soft, ripe, or canned fruits such as bananas, mangoes, peaches, and pears.
- Stewed fruits, with skins and seeds removed.
- Softly boiled or steamed vegetables like carrots, cauliflower, and sweet potato.
- Mashed potatoes, without crispy skins.
- Avocado and guacamole.
Grains and Starches
- Well-cooked pasta and rice.
- Cereals softened completely with milk.
- Soft, moist breads and muffins.
- Pancakes.
Foods to Avoid on a Level 7 EC Diet
To ensure safety, certain food textures must be avoided on a Level 7 EC diet. These include:
- Hard or Dry Foods: Nuts, seeds, dry cakes, hard toast, crackers, and popcorn.
- Tough or Fibrous Foods: Steak, pineapple, celery, string beans, and foods with tough husks.
- Chewy Foods: Chewing gum, marshmallows, sticky rice cakes, and dried fruits.
- Crunchy or Crispy Foods: Raw carrot, raw apple, crispy bacon, and corn chips.
- Mixed Consistencies: Soups with large chunks of food or cereal with un-softened pieces.
How to Test Food for Level 7 EC Compliance
IDDSI provides a simple, reliable test to confirm if a food item is suitable. The IDDSI Fork Pressure Test requires you to press down on the food with the side of a fork until your thumbnail blanches (turns white). The food is safe for a Level 7 EC diet if it squashes completely and does not return to its original shape. This test should be performed on all food items served on the diet.
Managing Nutrition and Hydration
Because the diet restricts some food groups, it is important to ensure nutritional needs are met. Fortifying foods with extra calories and protein can help prevent weight loss. This can involve adding sauces, butter, gravy, or full-fat dairy products like cheese and yogurt to meals. Staying hydrated is also crucial, and nourishing drinks like smoothies or milkshakes can supplement calorie intake. Always consult a dietitian for personalized advice.
Level 7 EC vs. Regular Diet: A Comparison
| Feature | Level 7 Easy to Chew (EC) | Level 7 Regular (RG7) |
|---|---|---|
| Texture | Soft and tender | All textures, including hard, tough, and chewy |
| Chewing Ability | Requires some chewing, but no tiring | Requires full chewing ability and endurance |
| Food Piece Size | No restrictions | No restrictions |
| Preparation | Foods cooked or modified to be soft | No special preparation required |
| Safety Check | Must pass the Fork Pressure Test | No texture testing required |
| Target User | Those with mild chewing difficulties, no swallowing problems | Individuals with no chewing or swallowing issues |
Conclusion
The Level 7 EC diet provides a safe and palatable way for individuals with mild chewing difficulties to maintain adequate nutrition. By focusing on soft and tender foods while avoiding hard, tough, and fibrous textures, it minimizes the risk of eating discomfort and potential issues without requiring the supervision needed for more restricted diets. As part of the IDDSI framework, its clear guidelines and simple testing methods ensure consistency and safety in meal preparation, allowing individuals to enjoy a wide variety of foods with confidence. For more information, visit the official IDDSI website to explore the full framework and resources available: IDDSI.org.
