Advice when you need to follow an IDDSI (International Dysphagia Diet Standardisation Initiative) level 7 easy to chew diet
Information for patients from the Nutrition Team
You have been advised to follow a level 7 easy to chew diet. This leaflet will explain:
what level 7 easy to chew diet is
how to prepare and serve your food
which foods can be included in an easy to chew diet
practical tips and easy to chew meal ideas
what problems you may have
where to buy ready-prepared easy to chew meals from; and
how to contact us.
Why have I been referred to the speech and language therapist?
An easy to chew diet is helpful for people who find it difficult to chew hard foods. You may have a sore mouth, or have been ill and find chewing hard.
A speech and language therapist may have talked to you about this diet, and how it would help you manage your swallowing. Follow your speech and language therapist’s guidance. If you have any questions, please ask for advice.
A dietitian will advise on a suitable nutritionally adequate diet for you. They will give you practical advice on how to continue your diet at home.
Easy to chew food may be used if you have strong enough chewing ability to manage soft / tender foods. This texture may be right if you:
usually choose to eat soft food; or
have mild muscular difficulties, which affects your chewing.
You should be able to chew softer food without getting tired easily. It may be a good choice if you have been ill and are recovering strength.
What is an IDDSI level 7 easy to chew diet?
An IDDSI level 7 easy to chew diet, includes normal, ‘everyday foods’ of soft, tender texture. Food that can be cut or broken apart with the side of a fork or spoon.
You can eat these foods using a fork, spoon, or your fingers.
You may be able to eat foods which are ‘mixed thin and thick’ texture foods and drinks together. Ask your speech and language therapist for advice.
You should be able to ‘bite off’ pieces of tender food. Choose bite sizes that are small enough to chew and swallow safely. You should also be able to chew these until they are safe to swallow, without getting tired easily.
You should be able to move food for chewing around your mouth. You should be able to do this using your tongue, until food is soft and moist enough to be swallowed.
You should also be able to remove hard pieces of food from your mouth that cannot be swallowed, without help or prompting from others. Hard pieces of food can include bone or gristle.
How do I test my food to make sure it is easy to chew?
The food must break apart easily with the side of a fork or spoon.
To make sure the food is soft enough, press down on the fork until your thumbnail goes white.
Lift the fork to see that the food is completely squashed, and does not regain its shape.
Easy to chew foods must break apart easily and pass the fork pressure test.
Which foods can be included in an easy to chew diet?
It is important to eat a wide a variety of foods. Choose foods from each of the groups below.
Starchy foods
Aim to include at least one starchy food at each meal.
Cereals with a soft texture, and any excess liquid drained before serving. Use fine-grain oat porridge and other instant cereals, such as Ready Brek or Oats-So-Simple. Other breakfast cereals such as Weetabix or Cornflakes soaked in milk.
Avoid cereals with added nuts and dried fruit, such as muesli.
Cook potatoes until they are soft enough to be broken apart with the side of a fork or spoon.
Bread with butter or margarine. Remove the crusts and do not eat newly baked bread.
Some people find bread hard to swallow. Sandwiches are suitable for this diet, as long as the fillings are soft and tender. Examples of fillings include egg mayonnaise, pâté, or cream cheese.
Well-cooked pasta, such as macaroni cheese, ravioli, lasagne, and spaghetti bolognaise.
Rice does not have any special cooking requirements.
Cake or sponge, such as Eve’s pudding or chocolate Swiss roll.
Do not eat nuts or pieces of nut.
Soft biscuits, such as soft macaroons and Jaffa cakes.
Fruits and vegetables
Aim to have 5 portions of fruit and vegetables each day. One of these portions could be a glass of pure fruit juice or a smoothie.
Fruit that is ripe and soft enough to break apart into smaller pieces with the side of a fork or spoon. Drain any excess liquid.
Bananas, strawberries, raspberries, or ripe avocado.
Tinned fruit is good, but do not eat skins, stones, and pips.
Try stewed fruit, such as apples, pears or rhubarb. Remove the skins first.
Do not eat the fibrous parts of fruit. This includes the white parts of an orange.
Be careful when eating fruit with a high water content. These are fruits where the juice separates from the solid in the mouth during chewing. For example melon, oranges, or grapefruit.
Vegetables should be steamed or boiled until tender and soft. You must be able break the vegetables apart with the side of a fork or spoon. For example swede, broccoli, cauliflower, or carrots.
Tinned tomatoes, creamed sweetcorn, and mushy peas.
Stir fried vegetables may be too firm.
Meat, poultry, fish, eggs, and pulses
Aim to include 2 portions a day.
Cook meat and poultry until tender. If this is not possible, finely mince or chop the food to a 4mm lump size. Good examples include:
shepherd’s pie
pasta dishes with a meat sauce
meat loaf
chicken supreme
corned beef hash
tender casserole
tender meat or chicken curry
tender roast meat
soft skinless sausage
tinned meat or poultry, for example chicken in white sauce.
Boneless fish, cooked until soft enough to break apart easily with the side of a fork or spoon. Do not eat fish covered in batter and crumb coatings. Try tinned fish, such as salmon, tuna, or fish pie. Make sure any bones are removed. Fish cakes are suitable.
Omelettes or poached, scrambled, or fried eggs. Hard-boiled eggs mashed with mayonnaise. Do not eat scotch eggs.
Beans and lentils can be included in thick soups, stews, and casseroles (with or without meat).
Baked beans are suitable.
Smooth houmous and taramosalata.
Tofu, Quorn, and textured vegetable protein. Mince or cut into small manageable pieces.
Milk and milk products
Try to have a pint of milk every day, or include two to three servings of milk products.
Use milk in drinks and as the base for sauces.
Milk puddings are ideal.
Yoghurt, custard, trifle, and Fromage frais make good desserts. Do not eat those with nuts, seeds and / or grains.
Add evaporated or condensed milk to fruit, puddings, and sauces.
Add grated cheese to mashed potato, puréed soup, white sauce, and cauliflower cheese. Do not eat a chunk of hard cheese.
Ice-cream is not suitable for everyone with a swallowing difficulty. Please ask your speech and language therapist for advice.
Homemade, tinned or packet milk puddings. For example custard, semolina, rice pudding, Instant Whip, Angel Delight, or crème caramel.
Which foods should not be included in an easy to chew diet?
Hard or dry foods. For example:
nuts, raw vegetables like carrots, cauliflower or broccoli, dry cakes, dry bread, dry cereals, or dried fruit.
Tough, stringy or fibrous foods. For example:
steak, rhubarb, beans, celery or pineapple.
Chewy foods. For example:
lollies, toffees, sweets, chunks of cheese, marshmallows, chewing gum.
Crispy foods. For example:
crackling, crisp bacon or Cornflakes.
Crunchy foods. For example:
raw carrot, raw apple and popcorn.
Sharp or spiky foods. For example:
tortilla chips or crisps.
Pips and seeds. For example:
apple seeds, pumpkin seeds and orange pith.
Bone or gristle. For example:
chicken, fish or other bones, meat with gristle.
Sticky foods. For example:
overcooked porridge or sticky mashed potato.
Practical tips
It is important to enjoy your food and mealtimes. The following points may help.
Adding sauces to drier foods may make them easier to chew and swallow. For example thick gravy, parsley sauce, custard, double cream, or dunking biscuits in a hot drink.
To avoid boredom, include a variety of foods.
Serve food at the correct temperature, to bring out the flavour.
Try to eat slowly. Serve a small amount of food at a time, so your food does not get cold before you finish it. If you feel you can manage more, you can always heat up another small portion later. Warming your plate before serving may help to keep your food hot for longer.
Eat in a quiet, relaxed place, where there is no hurry to finish. Sit upright during your meal.
Finish each mouthful before taking the next. If any food remains in your mouth or at the back of your throat, swallow again until cleared, before continuing with your meal.
If you find it difficult to swallow food or fluids, ask your GP to refer you to a speech and language therapist.
If you cannot manage three meals a day, try eating ‘little and often’. Take advantage of times when your appetite is good.
Have nourishing snacks or drinks handy for when you feel hungry. For example mousses, milkshake, yogurts, and custard.
Drinks such as water, tea and coffee give very little nourishment and can fill you up. Try milky drinks instead. Try not to drink just before a meal, as you may not be able to eat as much.
A small amount of alcohol helps to stimulate your appetite, such as a small glass of sherry or brandy. Check with your doctor first.
If you have a sore mouth, avoid spicy and acidic foods or drinks. These include ’hot’ curries, chilli, and acidic fruit and juices, such as tomatoes, pineapple and orange.
Weigh yourself once a week. If you find that you are losing weight, see the tips listed below.
Easy to chew meal ideas
**If you are under a speech and language therapist, refer to their advice about bread.
Breakfast
Cereals soaked or cooked in milk, for example Ready Brek, Weetabix, and porridge.
Boiled, scrambled or poached eggs.
** Bread or toast, add butter, margarine, or jam. If needed, cut the crusts off.
marmalade or honey.
Yoghurt.
Between meal drinks and snacks:
Milky drinks, such as ‘cocoa’, ‘Horlicks’. Add extra sugar, but be careful if you have diabetes.
Drinking chocolate. Add extra sugar, but be careful if you have diabetes.
Coffee made with milk. Add extra sugar, but be careful if you have diabetes.
Milk.
Complan Shake / Aymes Shake.
Fruit juice, such as orange or cranberry juice.
Soft snacks, such as sponge cake or a biscuit softened / dunked in warm milk, tea, or milky coffee.
Full fat yoghurt or soft pudding. See pudding list below.
Crisps that melt in your mouth, such as Skips, Quavers, and Wotsits.
Snack meal ideas
Smooth soup (home-made, packet or tinned). Do not eat chunky soups, like minestrone.
Add grated cheese to soup.
Condensed cream of soups (such as Campbell’s) can be made up with milk.
** Scrambled, poached or boiled egg, and tinned chopped tomatoes / baked beans with bread and butter.
Corned beef, tinned ham, or baked beans, served with tinned spaghetti or potato.
** Soft sandwich fillings, such as cream cheese, pate, tuna, or egg or chicken mayonnaise.
Main meal ideas
Minced / soft / tender beef, lamb, pork, chicken or turkey.
Shepherd's or cottage pie.
Omelette (plain or with cheese).
Soft fish in sauce, such as cheese, parsley or white sauce.
Cauliflower or broccoli cheese, and cheese soufflé.
Meat curry or casserole.
Vegetable or lentil stew / curries, and well-cooked dhal.
Quorn mince / lentil bolognese.
Quorn pieces or tofu in sauce.
The above could be served with:
creamed / mashed or instant mashed potatoes
soft-boiled potatoes
soft chips in gravy
well-cooked pasta, tossed in butter / margarine
soft vegetables, such as carrots and swede, (mashed if needed) with butter, gravy or sauce such as white sauce
risotto
pasta dishes, such as spaghetti bolognaise. Baked pasta dishes (such as lasagne) may have a hard / chewy texture, especially on the top layer. If so, they may not be suitable for this diet.
Puddings
Sponge pudding and custard / cream.
Ice-cream.
Milk puddings, such as rice, tapioca, sago, semolina, or custard served with jam / honey / marmalade / cream / sugar / soft or puréed fruit.
Stewed fruit or tinned soft fruit in syrup, served with custard, evaporated or condensed milk, or cream.
Egg custard.
Full fat Fromage frais.
Crème caramel.
Trifle, with soft fruit.
Yoghurt, such as thick and creamy.
Mousse.
Blancmange.
Jelly or milk jelly.
Instant whip or Angel Delight.
Mashed banana and ice-cream / custard / evaporated milk.
Try adding the following to your puddings: cream, whole milk, full fat natural yoghurt.
What should I do if I am losing weight?
If you are losing weight, you can add extra nourishment to your food. By doing this, you will get more energy and protein, which will help to maintain your weight or stop further weight loss.
Use whole milk.
To make fortified milk, add 2 to 4 tablespoons of milk powder (such as Marvel) to 1 pint of whole milk. Use this milk whenever you use milk, such as in drinks, puddings, mashed potato, and sauces. One tablespoon of milk powder can also be added to porridge or soup.
Add grated cheese to cooked vegetables, mashed potato, soups and, sauces.
Make packet soups with fortified milk, or add 2 tablespoons of milk powder or cream to tinned or packet soup.
Try savoury Complan or Aymes. These are available from your chemist and some supermarkets.
Use plenty of butter / margarine / oil on pasta, potatoes, and vegetables.
Add double cream to soup, potato, cereals, milk puddings, and milky drinks.
Have puddings with ice-cream, evaporated or condensed milk, full fat yoghurt, or custard.
Add sugar, syrup, or honey to drinks, desserts, and cereals. Be careful if you have diabetes.
If you are diabetic, it is important to regularly monitor your blood sugar levels when you make changes to your diet. If you need advice, please speak to your diabetic nurse.
Store cupboard ideas
The following are examples of convenience foods to keep in your store cupboard.
Breakfast cereal and porridge oats (such as Ready Brek).
Tinned and packet soups, such as cream of chicken, tomato, mushroom, and lentil.
Tinned meats, such as cooked ham, and corned or minced beef.
Tinned fish, such as tuna mayonnaise, salmon, and sardines. Take care with bones.
Tinned pasta, such as macaroni cheese or spaghetti bolognaise.
Packets of pasta in sauce.
Powdered potato / instant mash.
Tinned milk puddings, such as custard, semolina, and creamed rice.
Packet mousses, instant whip and jelly.
Long-life products, such as UHT milk, fruit juice, yoghurts, and ready-made custard pots.
Powdered drinks, such as Horlicks, Ovaltine, cocoa, or drinking chocolate.
Tinned cream evaporated and condensed milk.
If you are trying to gain weight, do not eat / drink low fat or diet products.
Buying ready prepared moist or minced meals
Supermarkets now sell a wide variety of ready meals, some of which may be suitable for an easy to chew diet. For example:
Ready meals
Supermarkets now sell a wide variety of ready meals, some of which may be suitable for an easy to chew diet, for example:
Cottage or shepherd’s pie.
Fisherman’s pie (remove any bones first).
Corned beef hash.
Cheddar cheese and onion mash.
Pasta dishes, such as lasagne, spaghetti bolognese, and macaroni cheese.
Cauliflower cheese.
Casserole or hot pots.
Sauces can be made from granules or bought ready prepared.
Buying ready prepared minced and moist meals
Meals on Wheels can provide a meal on request. However, you may need to request or add additional gravy or sauce.
Wiltshire Farm Foods
Extra tender food.
Telephone: 0800 077 3100
The above products / services are listed solely to advise our NHS patients. It does not imply endorsement by East Kent Hospitals University NHS Foundation Trust, nor discrimination against similar brands, products, or services not mentioned. We are not responsible for the contents or reliability of any other websites to which we provide a link and do not necessarily endorse the views expressed within them.
Getting the right balance
If you choose a variety of foods from each of the five food groups, you should be having a balanced diet. However, it is sometimes more difficult to achieve this on a minced and moist diet, so here are a few tips.
Constipation (not pooing as often or finding it hard to poo)
Constipation may be a problem because you are lacking fibre in your diet. Slowly introduce more fibre into your diet. Good sources of fibre include:
Breakfast cereals, such as porridge, instant hot oat cereals, or Weetabix.
Fruits and vegetables. Try to have the recommended five portions a day. Prunes and prune juice may help.
Pulses, for example beans. All pulses are high in fibre.
Over-the-counter fibre supplements are available. Your GP can prescribe other fibre supplements.
Fluid is essential to:
help the fibre to work
prevent dehydration
make sure your skin keeps its elasticity; and
your kidneys work properly.
Aim for at least 6 to 8 drinks a day. Include a variety of tea, coffee, squash, juice, water, milk, milkshakes, and malted bedtime drinks.
Vitamin C
Having five portions of fruit and vegetables a day will help. Try to include a rich source of vitamin C, such as:
Ribena
C-Vit
supermarkets’ own fortified blackcurrant squash
rose-hip syrup; and
puréed fruit, such as strawberries or kiwis.
Iron
Meat is a good source of iron. If you are still finding meat especially difficult to swallow, please ask the dietitian for ideas.
Other good sources include egg yolk, breakfast cereals, pulses, and dark green leafy vegetables.
Drink a glass of fruit juice taken with a meal. This will help your body to absorb the iron.
What if I have any questions or concerns about my diet?
If you have any questions or concerns, please speak to your dietitian or GP.