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Guide for swallowing

Levels of dysphagia diet

The International Dysphagia Diet Standardization Initiative (IDDSI) has created a diet plan or framework for people with dysphagia. The dysphagia diet has levels that rate drinks and foods on a thickness scale from 0 to 7. Drinks are ranked from 0 to 4. Foods are ranked from 3 to 7, depending on thickness. The levels are:

Liquid levels

• Level 0 (thin). These are watery liquids, such as juice, tea, milk, soda, beer, and broth. You can drink them through a nipple, cup, or straw.

• Level 1 (slightly thick). These are thicker than water. They need more effort to drink than thinner liquids but still flow through a straw or nipple.

• Level 2 (mildly thick). These liquids flow off a spoon but more slowly than thinner drinks. They can be sipped or sucked from a straw with some effort.

• Level 3 (liquidized, moderately thick). You can drink these from a cup or sucked from a straw with some effort. These are liquids that may be thick enough to be eaten with a spoon. An example is a thick milkshake. Their texture is smooth without lumps.

• Level 4 (pureed, extremely thick). These are usually eaten with a spoon. You can't drink them from a cup. An example is pudding.

Food levels

• Level 3 (moderately thick). These are foods that:

  • Don't require chewing

  • Have a smooth texture but are not lumpy

  • Can be eaten with a spoon, but not with a fork

  • Are not thick enough to stand stiff on a plate. For example, not stiff like molded gelatin.

• Level 4 (pureed, extremely thick). These foods:

  • Can often be eaten with a spoon, but sometimes a fork

  • Can't be drunk from a cup

  • Don't need to be chewed

  • Can be molded, such as gelatin

  • Are not sticky or lumpy

  • Fall off a spoon all together when tilted and still hold shape on a plate. For example, pudding.

  • Can't be poured but move very slowly if the plate is tilted

• Level 5 (minced, moist). These foods:

  • Can be eaten with a fork or spoon, or a chopstick if you have good hand control

  • Can be scooped and shaped on a plate. For example, mashed potatoes.

  • Are soft and moist but don't separate into liquid

  • May have small lumps that can be mashed with the tongue

• Level 6 (soft). These foods:

  • Are tender, moist, and bite-sized

  • Can be eaten with a fork, spoon, or chopsticks but don't need a knife to cut

  • Must be chewed

• Level 7 (regular). These are:

  • Normal, everyday foods of varying textures, including soft, stringy, and hard and crunchy

  • Foods that can be eaten by any method. For example, from a cup or using utensils.

  • Foods that need to be chewed, with all types of textures and may have pieces that can't be swallowed, such as gristle