What is a type 7 diet? Understanding IDDSI Level 7

According to the International Dysphagia Diet Standardisation Initiative (IDDSI), a global framework standardizing food textures, what is a type 7 diet? It represents the highest level in this framework, covering regular and soft foods for individuals with minimal or no chewing difficulties.

Quick Summary

This guide explains the IDDSI Level 7 diet, covering both regular and easy-to-chew variations. It details the characteristics of these diets, who they are designed for, and offers examples of suitable foods and those to avoid.

Key Points

• IDDSI Level 7 is not a general diet, but a framework: It’s a texture-modified diet standard created by the International Dysphagia Diet Standardisation Initiative (IDDSI).

• Level 7 has two categories: Regular and Easy to Chew: The Regular diet is for those with no issues, while the Easy to Chew version is for individuals with specific chewing difficulties.

• Easy to Chew (EC7) foods must be soft and tender: Foods should be easily broken apart with a fork, moist, and free from hard or tough bits like nuts or gristle.

• Ideal for people with dental or fatigue issues: This diet is suitable for those with problems like ill-fitting dentures, weak chewing muscles, or recovery from oral surgery.

• It is important to avoid certain textures on an EC7 diet: Hard, crunchy, sticky, or fibrous foods can pose a risk and should be avoided.

• A healthcare professional should be consulted for personalized advice: An IDDSI diet should be recommended by a clinician, such as a Speech-Language Pathologist or Dietitian, based on individual needs.

What is the International Dysphagia Diet Standardisation Initiative (IDDSI)?

The International Dysphagia Diet Standardisation Initiative (IDDSI) is a global standard developed to provide a consistent terminology and set of definitions for texture-modified foods and thickened liquids. This framework is crucial for patient safety, especially for those with dysphagia, or swallowing difficulties. The IDDSI framework is made up of eight levels, numbered from 0 (Thin Liquids) to 7 (Regular Food), identified by unique color-coded labels. The topic of what is a type 7 diet falls at the top of this scale.

IDDSI Level 7: Regular vs. Easy to Chew

Level 7 is the final level of the IDDSI framework and is split into two categories: Regular (RG7) and Regular Easy to Chew (EC7).

• Regular (RG7): This diet is for individuals who have no chewing or swallowing issues and can safely eat all everyday food textures without any restrictions on size, texture, or shape.

• Regular Easy to Chew (EC7): A sub-category of the Regular diet, this is suitable for those who may have some difficulty chewing hard, tough, or chewy foods, but do not have dysphagia. Foods at this level must be soft and tender, easily broken apart with the side of a fork or spoon, and can be of any size.

Who Needs a Type 7 Easy to Chew Diet?

The EC7 diet is designed for specific populations who, while not at high risk for choking, may find regular food challenging. Individuals may benefit from this diet if they experience:

• Difficulty Chewing Due to Dental Issues: People with poor-fitting dentures, missing teeth, or sore gums.
• Oral Discomfort: Those recovering from mouth surgery or with temporary pain.
• Fatigue While Chewing: Individuals who tire easily when chewing, often due to age or illness.
• Specific Medical Conditions: People with head and neck cancer, oesophageal issues, or certain respiratory problems.

Characteristics of a Level 7 Easy to Chew Diet

To ensure a diet meets the EC7 standard, the foods must possess specific characteristics:

• Soft and Tender: Foods must be soft, tender, and moist throughout.
• Easy to Break: The food must easily break apart when pressure is applied with the side of a fork or spoon.
• No Hard or Chewy Bits: The diet omits foods that are hard, crunchy, tough, chewy, or stringy. This includes nuts, raw vegetables, and fibrous fruits.
• No Pips, Seeds, or Gristle: Food must be free from difficult-to-chew components like seeds, bones, gristle, or tough skins.

Food Examples for a Level 7 Easy to Chew Diet

Suitable Foods

• Proteins: Tender cooked meats (e.g., casseroles, stews, ground meat), baked or steamed fish that flakes easily, eggs (scrambled, poached), smooth nut butters, tofu.
• Starches: Well-cooked pasta, white rice, moist cereals, soft breads without hard crusts (like plain muffins or soaked toast), and potatoes (mashed, boiled, or baked without the skin).
• Fruits: Ripe bananas, soft melons, canned or stewed fruits, soft fresh fruits like peaches or nectarines (peeled).
• Vegetables: Boiled or steamed vegetables like carrots, cauliflower, broccoli florets, and mushy peas.
• Dairy: Yogurt, cottage cheese, milk puddings, and soft cheeses.

Foods to Avoid

• Hard, dry, or crunchy foods (e.g., nuts, popcorn, raw apples).
• Tough or chewy meats (e.g., steak, crackling bacon).
• Fibrous or stringy textures (e.g., pineapple, string beans).
• Chewy candies, gum, and dried fruits.
• Foods with small, hard parts like pips, seeds, or bones.
• Crumbly items like dry biscuits or flaky pastry.

Comparison: Regular (RG7) vs. Easy to Chew (EC7)

Feature	Regular (RG7)	Regular Easy to Chew (EC7)
Chewing Ability	Normal, no issues.	Chewing is required, but may be easily fatigued.
Food Texture	All everyday food textures (hard, crunchy, etc.).	Soft and tender foods only.
Food Piece Size	No restriction on size.	No restriction on piece size, but food must be soft enough to break easily.
Risks	No risk of choking from texture.	No increased risk of choking, but easier chewing prevents discomfort.
Supervision	No supervision required.	No supervision required.
Examples	Steak, crusty bread, popcorn.	Casseroles, well-cooked pasta, soft fish.

Conclusion

A type 7 diet, specifically the Regular Easy to Chew version under the IDDSI framework, is a vital tool for managing dietary needs for those with chewing challenges. It provides a safe, standardized approach to ensure nutritional intake without the discomfort or pain caused by firmer foods. For anyone with persistent chewing difficulties due to age, dental issues, or recovery from illness, understanding and following the EC7 guidelines can significantly improve the quality and safety of mealtimes. Always consult with a healthcare professional or a Speech-Language Pathologist for personalized recommendations. For more information on the IDDSI framework, visit the official IDDSI website.

References

1. IDDSI.org, Guide to IDDSI Regular Easy to Chew (Level 7).
2. MSKCC.org, How To Follow a Level 7 Easy-to-Chew Diet.

Frequently Asked Questions

Who is the Level 7 Easy to Chew diet primarily for?

This diet is for individuals who have difficulty chewing tougher foods due to issues like dental problems, muscle weakness from aging, fatigue, or recovery from illness. It is not for people with diagnosed swallowing disorders (dysphagia) that pose a high choking risk.

What is the difference between a Regular and an Easy to Chew Level 7 diet?

A Regular Level 7 diet includes all food textures and is for people with no chewing or swallowing difficulties. The Easy to Chew sub-category requires foods to be soft and tender, excluding hard, tough, or chewy textures, for individuals who find chewing difficult.

Are there any specific tests for the Easy to Chew diet?

Yes, a simple 'Fork Pressure Test' can be used. Foods should be soft and tender enough to break apart easily with the side of a fork or spoon when light pressure is applied.

What are some examples of foods to avoid on an EC7 diet?

You should avoid hard, crunchy, sticky, or tough foods like nuts, raw carrots, chewy sweets, steak, popcorn, and breads with thick crusts.

Can people on a Level 7 diet eat mixed-consistency foods?

Yes, the Easy to Chew diet (EC7) can include mixed-consistency foods, such as stews with tender meat and vegetables in a sauce, as long as the food particles are soft and easy to chew.

Is this diet suitable for someone with severe swallowing problems (dysphagia)?

No, Level 7 is not recommended for individuals with a high risk of choking or significant dysphagia. The IDDSI framework has other, more modified levels for those with more severe swallowing issues.

How can a person on a Level 7 Easy to Chew diet get enough calories?

To increase caloric intake, individuals can use full-fat dairy products, add butter or cream to mashed foods, incorporate gravy or sauces, or drink smoothies made with yogurt and avocado.