A Level 7 easy-to-chew diet focuses on consuming foods that are soft, tender, and require minimal chewing. This dietary approach is often recommended for individuals experiencing dysphagia or those who have difficulty with chewing due to various reasons. This article provides a detailed explanation of the Level 7 easy-to-chew diet, including how to ensure food softness, what foods to include and avoid, and the significance of the International Dysphagia Diet Standardization Initiative (IDDSI) in standardizing food textures for individuals with dysphagia.
What is a Level 7 Easy-to-Chew Diet?
A Level 7 easy-to-chew diet involves eating foods that are soft, tender, and require less chewing. This diet is suitable for individuals who may have some difficulty chewing hard or firm textures but do not have dysphagia or problems with swallowing. Individuals on this diet can bite and chew soft foods without tiring easily but may experience pain when swallowing hard or chewy foods. They can also form a bolus of food in the mouth and do not have an increased risk of choking.
How to Ensure Food Softness
To ensure that food is soft enough for a Level 7 easy-to-chew diet, you can perform a fork pressure test. The food’s texture can change based on its temperature and how it was cooked, so it is essential to test the food right before eating it to ensure it is the right softness.
Fork or Spoon Pressure Test
- Place your fork or spoon over your food.
- Using your thumb, press down on your fork or spoon until part of your nail turns white.
- Your food is soft enough if it is completely squashed and does not go back to its original shape.
Foods to Eat and Avoid on a Level 7 Easy-to-Chew Diet
The following tables provide examples of foods that can be included and should be avoided while following a Level 7 easy-to-chew diet. Note that these lists are not exhaustive.
Foods to Include
- Soft Fruits: Bananas, peaches, pears
- Cooked Vegetables: Steamed carrots, mashed sweet potatoes
- Soft Proteins: Ground meats, well-cooked fish
- Grains: Cooked cereals, soft bread
Foods to Avoid
- Hard Fruits and Vegetables: Raw apples, raw carrots
- Chewy Meats: Steak, jerky
- Nuts and Seeds: Whole nuts, seeds
- Crusty Breads: Hard rolls, toast
Tips for Adding Calories
- Add 2 to 4 tablespoons of canned coconut milk or cream to smoothies, shakes, cereals, and yogurts for extra calories.
- Make ice cubes from milk or fruit nectar and use these high-calorie ice cubes in smoothies or to keep your shakes cold.
- Add sour cream, half and half, heavy cream, or whole milk to your foods.
- Add pureed tofu to cooked vegetables, soups, or smoothies.
The International Dysphagia Diet Standardization Initiative (IDDSI)
The International Dysphagia Diet Standardization Initiative (IDDSI) Committee developed guidelines for serving texture-modified foods and thickened liquids to individuals with dysphagia around the world. The initiative challenges healthcare facilities to prioritize safety and prevent the risk of choking by providing a solution to the outdated, ambiguous language like “soft,” “chopped,” and “nectar-thick” that vary between every facility. The new IDDSI standards establish unified principles for all food service operations to follow, including consistent diet terminology, standardized definitions of the diet, and simple, reliable testing methods.
Read also: Understanding Dysphagia Diets
IDDSI Framework
The IDDSI Framework consists of eight levels (Level 0-7), ranging from Thin Liquids (Level 0) to Regular (Level 7) texture foods. Level 7 has two texture levels: IDDSI Regular and IDDSI Regular Easy to Chew. The only difference is that IDDSI Regular Easy to Chew has a specific food texture level (soft/tender). IDDSI Regular Easy to Chew is the Regular Diet with changes to make it soft and easier to eat. Both IDDSI Easy to Chew (Level 7) and IDDSI Regular (Level 7) are represented by the number 7 and the color black.
Characteristics of IDDSI Easy to Chew (Level 7)
IDDSI introduces new and more specific characteristics like particle size, moisture, stickiness, and softness. Although IDDSI Easy to Chew (Level 7) allows for regular, everyday foods, they still need to be soft and moist to accommodate the pain or discomfort individuals may experience while chewing. Foods on IDDSI Easy to Chew (Level 7) will maintain the same characteristics no matter where in the world you serve easy-to-chew foods.
Testing Methods for IDDSI Easy to Chew (Level 7)
Testing IDDSI Easy to Chew (Level 7) requires only a fork and straightforward observation. These foods don’t have particle size restrictions, but they do need to be soft and tender enough to break apart easily with the side of a fork or spoon. The Fork/Spoon Separation and Pressure Test is used to measure this:
- Food cuts/breaks apart easily with the side of a fork (or spoon) or the texture can flake into smaller pieces.
- Food can easily squash, break apart, and change shape without returning to its original shape when applying pressure with a fork/spoon. You may apply enough pressure with the tines of a fork that the nail bed turns white.
These tests are done during preparation and again at the time of service under the same conditions we intend to serve our food, especially temperature.
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