Dysphagia.

Not many people know what this word means even though it affects about one in seven people, including some of our closest friends and loved ones. 

Dysphagia is a medical term used to describe difficulty swallowing, and in many cases, it can make each snack or meal a challenge to overcome. 

One of the best tools for those living with dysphagia is the International Dysphagia Diet (IDDSI). After a thorough evaluation, those living with dysphagia will likely be introduced to this complex categorization system. The IDDSI matches patients with foods that are best suited to their specific needs and swallowing abilities. 

Let’s learn all about the International Dysphagia Diet and brainstorm some delicious dishes that can be found at every consistency level of the IDDSI.

Medical Disclaimer: All content on this website is for informational purposes only and is not intended to serve as a substitute for the consultation and/or medical treatment of a qualified physician. Always seek the medical advice of your healthcare team (physician, speech pathologist, dietician, etc.) for your specific dietary needs. Visit www.iddsi.org for further details.

Defining the IDDSI Diet Levels

The International Dysphagia Diet or IDDSI is a standardized method to define food texture and drink thickness. It’s an incredibly useful tool for millions of people living with dysphagia in improving their safety during eating and drinking.

Based on one’s condition or recovery, they may move to different levels of this diet. From a patient’s perspective, the goal is always to move towards the least restrictive and safest diet prescribed by your healthcare team.

All in all, there are 8 levels of consistency in the IDDSI Diet, with four levels of liquids and four levels of solids, along with some key concepts like transitional foods. The International Dysphagia Diet is designed to provide a consistency level for everyone, no matter their chewing or swallowing capabilities.

Levels 0-4 of the IDDSI cover all types of drinks from water-like substances (Level 0) to extremely thick liquids (Level 4). While Levels 0-2 are an integral part of any dysphagia diet, for the purpose of this article, we’re going to be covering the upper levels of the IDDSI (Levels 3-7) as these are where most foods fall on the International Dysphagia Diet scale.

Click here if you have any questions about liquids or check out the full IDDSI framework.

Read on to learn all about the five upper levels of the International Dysphagia Diet covering every texture and consistency you can think of when it comes to your favorite dishes and snacks.

IDDSI Level 3

Level 3 of the International Dysphagia Diet comprises foods that are fully liquidized or moderately thick. 

Some characteristics of foods that fit into level 3 of the IDDSI Diet are:

• No chewing required
• Does not retain its shape
• Can be eaten with a spoon, but not a fork
• Entirely smooth texture with no lumps or bits
• Usually drunk from a cup

If you’re not sure whether your food fits into Level 3 of the IDDSI diet, try scooping up your food with a fork. If it drips through the tongs of the fork in dollops or strands, it’s most likely a Level 3 liquidized food. 

Visit the IDDSI testing methods page for photos and videos breaking down the best way to test your foods.

If you’d like to prepare some foods that fit into Level 3 of the IDDSI Diet, we recommend salty broth or fully liquidized apples. 

IDDSI Level 4

Level 4 of the IDDSI Diet comprises foods that are pureéd in the form of extremely thick liquids. 

Here are some characteristics of Level 4 of the IDDSI Diet:

• No chewing required
• No lumps; does not flow easily
• Retains its shape
• A spoon is generally the best utensil, though a fork is possible.

If you’d like to test whether your food fits into Level 4, you can test it by conducting the spoon-tilt test. Take a spoonful of whatever you’re eating and slowly tip the spoon. The food should slide off fairly easily with minimal sticking to the spoon. 

If you’re using a fork, the food should sit in a mound and not drip continuously through the fork. If it does, it is too thin and would classify more closely as a liquid lower on the scale. 

Don’t forget to check out the IDDSI testing methods page for detailed photos and videos on Level 4 testing.

Some delicious dishes that fit into level 4 of the IDDSI diet are a seedless smoothie, creamy yogurt, or spicy hummus.

IDDSI Level 5

This level of the International Dysphagia Diet comprises minced and moist foods.

Here are some characteristics of foods that fit into level 5 of the IDDSI diet:

• Minimal chewing is required
• Biting isn’t necessary
• Small lumps, though the lumps should be easy to squash with the tongue
• Can be eaten with both a spoon and a fork

The food should sit in a small mound on your fork and not easily flow through the prongs of the fork. If you’d like to test whether your dish fits into level 5 of the IDDSI diet, use the fork pressure test.

Press your fork down onto your food. The particles should easily be mashed and separated, and push through the tongs of the fork. If you’re a bit confused, check out the IDDSI testing methods page for detailed photos and videos on Level 5 testing.

Some delicious foods within level 5 of the IDDSI Diet are rich macaroni and cheese, peppered mashed potatoes, or even moist and finely minced brisket.

IDDSI Level 6

This stage of the International Dysphagia Diet comprises soft and bite-sized foods.

Here are some characteristics of dishes that fit into level 6 of the IDDSI diet: 

• Moderate chewing is required
• Can be mashed or broken with moderate pressure
• Can be eaten with either a fork or spoon

If you’re looking to cook up some scrumptious dishes that fit into level 6 of the IDDSI Diet, try some flaky salmon, creamy potato casserole, or savory mushroom (bite-sized) risotto.

IDDSI Level 7

This level of the International Dysphagia Diet comprises regular and easy-chew foods.

While regular foods fall under the wide umbrella of all consistencies and textures we love in food, the easy-chew diet avoids foods that are especially stringy and chewy or contain any particularly tough parts like pits, seeds, or bones and gristle.

If you’re on the easy-chew level of the IDDSI diet, you should be able to use any utensil you like such as spoons, forks, or chopsticks, so there aren’t many pressure tests you need to conduct before eating. Just remember to check whether your food contains any challenging small bits before chowing down.

Even if you love foods that do have seeds or bone parts, you can often find suitable alternatives without any compromise like boneless chicken wings, seedless strawberries, or deliciously salty pitted olives. 

Transitional Foods like theEATBar

Transitional foods, covering levels 4-7 of the IDDSI, are one of the most interesting components of the International Dysphagia Diet.

Transitional foods are those that start as one texture, like a firm solid, but change into softer textures as they’re heated up or moisture is added, as happens with saliva inside the mouth.

Many speech pathologists believe that these foods are helpful in helping those with dysphagia gradually re-learn the process of chewing.

To determine whether a food qualifies as transitional or not, you can conduct a basic fork pressure test. If you apply minimal pressure to the exterior of your snack, the food should retain its shape. Now, apply moisture or raise the temperature of the food substantially. The food should now crumble or soften when minimal fork pressure is applied.

One of our favorite transitional foods is theEATBar, a scrumptious sweet treat designed for those with swallowing troubles. After a satisfying opening crunch, theEATBar softens with saliva and heat from the tongue to deliver delicious, melt-in-your-mouth meringue flavor. Indeed, it may be suitable for those on a level 4-7 diet (general to minced & moist).

With four decadent bars and a design curated by a speech-language pathologist, theEATBar is tailor-made to help those with dysphagia fall in love with eating over and over again.  

Follow the IDDSI Framework With theEATBar

The International Dysphagia Diet is one of the most important tools in the arsenal of someone living with dysphagia. Even with all the help in the world, we understand that mealtimes can still be a struggle and challenge for those living with dysphagia.

That’s exactly why we created theEATBar.

With flavors ranging from creamy Vanilla Chocolate to delightfully tart Lemon, theEATBar is the perfect transitional food option for those within the IDDSI diet.

Speak with your physician or speech-language pathologist to find out if theEATBar is the right option for your specific needs.  

Use our discount code BLOG15 for 15% off your order at checkout! 

While you’re waiting for your order to arrive, browse our blog to discover more about the dysphagia diet and learn about the importance of snack time.