What is the IDDSI Framework?
Before diving into Level 7, it's essential to understand the IDDSI framework. This global standard provides eight levels (0-7) for food and drink, using numbers, text names, and colors to eliminate confusion. The levels range from thin liquids (Level 0) to regular texture foods (Level 7). This universal terminology is critical in healthcare settings to ensure patient safety and proper meal planning.
The Characteristics of a Level 7 Normal Diet
IDDSI Level 7 represents a normal, everyday diet with standard textures and consistencies. It is intended for individuals with competent chewing and swallowing abilities and no identified risk of choking. Unlike other levels that require specific food preparation techniques, Level 7 involves no restrictions on texture or the size of food pieces.
However, it's important to recognize that Level 7 is often broken down into two parts to address the needs of those who may need a slight modification to their regular food intake without needing more severe texture changes:
IDDSI Level 7 Regular
This is the diet most people are familiar with. It includes all normal, everyday foods of various textures and sizes, without any limitations. Foods can be hard, crunchy, fibrous, or contain bones and seeds. This is the diet for someone with no chewing or swallowing difficulties.
IDDSI Level 7 Regular Easy to Chew
This is a sub-level designed for people who do not have dysphagia but may have weaker chewing muscles, dental issues, or fatigue that makes processing harder textures difficult. While food size is not restricted, the texture is modified to be soft and tender. The food must be easy to break apart with the side of a fork or spoon, and foods that are hard, tough, crunchy, or chewy are avoided.
Foods Appropriate for a Level 7 Diet
Whether you are preparing a meal for a patient or a loved one, knowing which foods fit within the easy-to-chew category is crucial.
Examples of Easy-to-Chew Foods
- Proteins: Soft and tender cooked meats, fish that flakes easily, ground or minced meat dishes, and soft-cooked casseroles.
- Fruits: Soft, peeled fresh fruits like bananas, kiwis, peaches, and melon. Canned or cooked fruits are also suitable. Fibrous fruits like pineapples should be avoided.
- Vegetables: All soft, cooked vegetables that are easily mashed with a fork, such as carrots, potatoes, cauliflower, and zucchini.
- Grains: Well-moistened soft cereals, soft bread or toast with crusts removed, and cooked pasta or rice.
- Dairy: Yogurt, cottage cheese, cream cheese, and ice cream.
Foods to Avoid on a Level 7 Easy-to-Chew Diet
- Hard or dry foods like nuts, hard candies, or dry cakes.
- Tough or fibrous meats such as steak.
- Chewy foods like gum, marshmallows, or chewy sweets.
- Crispy or crunchy foods like crisps, flaky pastry, or raw apples.
- Stringy vegetables such as rhubarb or green beans.
- Foods with skins, bones, or seeds that are difficult to manage.
Comparison: IDDSI Level 7 Regular vs. Level 7 Easy to Chew
Understanding the subtle differences is key to ensuring meal safety for individuals with specific needs.
| Feature | IDDSI Level 7 Regular | IDDSI Level 7 Regular Easy to Chew |
|---|---|---|
| Chewing Ability | Requires strong, functional chewing | Requires weaker chewing, fatigue can be a factor |
| Food Texture | All normal, everyday food textures | Only soft, tender textures |
| Food Size | No restrictions on particle size | No restrictions on particle size, but should be easily manageable with soft texture |
| Excluded Foods | None, includes crunchy, fibrous, chewy foods | Hard, tough, chewy, sticky, fibrous, crunchy, or crumbly foods |
| Who it's for | Individuals without swallowing or chewing issues | Individuals with reduced chewing ability but no identified choking risk |
Who Needs a Level 7 Easy-to-Chew Diet?
A healthcare professional, such as a speech-language pathologist or dietitian, typically recommends the Easy-to-Chew modification. It is suitable for a variety of conditions where chewing is affected but swallowing remains safe. This might include:
- Individuals recovering from mouth surgery.
- Patients with poor dental status or wearing new dentures.
- Older adults experiencing fatigue or reduced muscular strength involved in chewing.
- Patients transitioning back to a regular diet after a period of dysphagia management.
Practical Meal Preparation for Level 7 Easy to Chew
To accommodate a Level 7 Easy-to-Chew diet, meal preparation techniques should focus on tenderizing food and avoiding problematic textures. For instance, meat should be slow-cooked or braised until very tender. Vegetables should be steamed or boiled until soft. Incorporating sauces or gravies can help add moisture to dishes, aiding in bolus formation. It is also essential to perform the Fork Pressure Test at the time of service, which involves pressing the food with a fork until the thumbnail blanches white to ensure the food can be completely squashed.
Conclusion
A Level 7 normal diet, under the IDDSI framework, caters to individuals with normal swallowing and chewing abilities. However, the designation also includes a crucial modification for those with less robust chewing: Level 7 Regular Easy to Chew. Understanding the characteristics of these two sub-levels is vital for providing safe and comfortable meals, particularly in healthcare and assisted living environments. When texture modification is necessary, the IDDSI guidelines provide clear, objective standards that help improve patient outcomes and ensure safety. For further reading, you can visit the official IDDSI website. International Dysphagia Diet Standardisation Initiative
