Easy to Chew – Level 7

Easy to Chew – Level 7

EASY TO CHEW

 Level 7

THIS BOOKLET CONTAINS IMPORTANT INFORMATION ABOUT YOUR EATING AND DRINKING. It is designed to give you practical guidance to help you follow the advice you have been given by the Speech & Language Therapist and Dietitian.

Provided by Worcestershire Acute Hospitals NHS Trust and Worcestershire Health and Care NHS Trust

INTRODUCTION

This booklet is designed to give you practical guidance to help you follow the advice you have been given by the Speech & Language Therapist and/or Dietitian.

WHAT ARE SWALLOWING PROBLEMS?

Swallowing problems are known as dysphagia which can affect the ability to eat and drink. 

You may have been assessed by a Speech and Language Therapist and they have recommended that you have ‘easy to chew’ food.

The Dietitian can give you advice on how to achieve a balanced diet.

Changing food and drink consistency

• Modified textures (consistencies) may help you to swallow more easily and safely.   An SLT may assess your swallow and let you know the most beneficial  consistencies  of food and drink for you.

• This reduces the likelihood of food going the ‘wrong way’ and entering the lungs (aspiration), rather than the stomach.  This can result in coughing, choking and/or chest infections.

Where to find more information about creating modified texture diets:

• Altered food and drink consistencies are given labels called ‘Levels’ with a number (e.g. Level 1, Level 7) to help you know exactly what type of food and drink is safest.  This labelling system is called  IDDSI.

• The IDDSI website https://iddsi.org/ has more information on different food consistencies, including information for people who are preparing the food.  

ADVICE TO ENCOURAGE SAFER EATING AND DRINKING

Mouth Care

• Your mouth should be clean and moist.  If you usually have a dry mouth, discuss this with your Doctor and/or Speech and Language Therapist.

• If you have dentures, they should be worn while eating (provided they fit well).  You may wish to consider dental fixative. 

Positioning

• Preferably sit out in a chair to eat or drink.

• If in bed, sit so you are not leaning to the side or slumped over.  Use pillows, if needed, to support you and maintain a straight upright  position.

• Your head and chin should be in a central position, not tipped sideways, backwards or forwards. Unless otherwise specified by your SLT.

Pacing

• Take the time you need, do not rush.

• Swallow each mouthful before taking the next. Don’t overfill your mouth.

• Take a single sip at a time. Don’t gulp the drink.

Utensils

• Use normal cups and beakers unless otherwise recommended. Your SLT may advise you whether it is appropriate to use straws, spouted cups or adapted drinks containers.

• You may benefit from equipment that makes eating and drinking easier (e.g. plate guards, adapted cups and cutlery, non-slip mats).   This equipment can be bought online, or you may wish to consult an Occupational Therapist about what equipment might help.

Easy to Chew  – Level 7 Regular Diet

• This is a sub-category of regular or ‘normal’ diet  (Level 7) for people who may have difficulty chewing.  It isn’t designed for people with swallowing problems or increased choking risk, although some people with swallowing problems may benefit from it.  If you have swallowing difficulties, your Speech and Language Therapist should assess whether this is the right diet for you. 

• Some examples of people who may benefit from this diet level:
• People with dentures who have difficulty with regular diet.
• People with temporary mouth discomfort or pain.
• People with no swallowing difficulties who are easily tired by                     chewing a regular diet.
• People with Head & Neck cancer.
• People with oesophageal issues/cancer.
• People with respiratory problems such as: COPD, asthma.

Easy to Chew – Level 7 Regular Diet

• Needs some chewing.

• May require biting.

• Can be easily cut with the side of a fork.

• Is soft and tender.

• May include mixed consistencies unless otherwise specified (see page 7).

• Can include bread unless otherwise specified.

• Does NOT include high-risk foods (see page 7) unless specified.

Easy to chew diet : subcategory level 7 regular

Meal Suggestions
Breakfast	· Cereals softened in milk. · Porridge, Ready Brek, Weetabix. · Omelette, eggs of any type (try with beans or avocado). · Soft pastries that will be easily cut with a fork and are not crumbly. · Soft fruit (e.g. banana, canned peaches). · Sweet waffles or pancakes. · Smoked haddock, smoked salmon. · Yoghurt with soft fruit. · Smoothies with pieces of soft fruit in them. · Halwa puri (puri soft rather than crispy).
Main Meals	· Vegetables without tough/fibrous skins (e.g. tomatoes, cooked cabbage, cooked peas). · Tender meats e.g. pulled pork. · Lentil, vegetable or meat curry. · Egg dishes: e.g. quiche, flan, frittata, omelette, etc. · Quorn meat substitute, e.g. Tofu. Try with chilli and rice or in gravy with potatoes and vegetables. · Beans: baked beans or canned beans without tough skins. · Pasta: e.g. spaghetti bolognaise, macaroni cheese, vegetable pasta with tomato sauce etc. · Potatoes: baked (inside but not skins) with fillings such as tuna mayonnaise, egg mayonnaise, chilli, cheese and beans; soft (but not crunchy) chips. · Fish: soft cooked fish, in sauce or fish fingers with mash potato and soft vegetables. · Cottage pie, shepherds pie, fish pie, corned beef hash. · Soups: chowder, minestrone. · Salad without hard or fibrous vegetables or tough skins. · Rice dishes e.g. risotto, biryani. · Stew/casserole: lentil, Quorn, vegetable or tender meat. Bigos, gulasz, nihari. · Khichdi. Serve all meals with well cooked/soft vegetables e.g. carrots, swede, broccoli, parsnips, cauliflower.

Easy to chew diet : subcategory level 7 regular

Meal Suggestions
Desserts	· Puddings: steamed, rice, bread and butter, etc. · Soft baked breakfast bars with soft fruit filling. · Chocolate that melts in the mouth and does not have hard pieces such as nuts or biscuit in it: e.g. Maltesers, Milky Way, chocolate buttons. · Yoghurt, mousse, custard, instant whip, fromage frais. · Panna cotta. Tiramisu. Crème caramel. Trifle. · Cheesecake (without biscuit base). · Soft fruit (no skins, seeds or pips): e.g. banana, peaches, pears. · Fruit smoothie. Milkshake. · Soft sponge cake with custard/cream.  · Baked egg custard (with or without pastry). · Kheer.
Snacks	· Crisps that easily dissolve in the mouth: e.g. Quavers, Skips, Pom Bears, Wotsits etc. · Soft biscuits (dunked in a hot drink of your choice). · Soft cheese, cottage cheese, cheese spread. · Egg/tuna mayonnaise. · Tinned spaghetti/ravioli. · Soft cheese crackers (not dry/crumbly/hard) e.g. ‘cheese thin melts’. Try with Pâté, hummus or soft cheeses. · Soft dried fruit (not hard) e.g. prunes, soft apricots etc. · Mashed avocado with scrambled eggs. · Kluski śląskie · Lassi. · Ryz z jabłkami.

High risk foods:

High risk foods can cause choking and are more difficult to chew and swallow.  The list below is not exhaustive but gives you an indication of the types of food which may be considered high risk.  Not everyone who is recommended a regular diet will find all these foods difficult – this can be judged on an individual  basis, with advice from the multidisciplinary team looking after you.

• Stringy, fibrous textures: e.g. pineapple, runner beans, celery, lettuce.
• Mixed consistency foods: see below.
• Crunchy dry foods: e.g. toast, flaky pastry, dry biscuits, crisps.
• Crumbly dry textures: e.g. biscuits, crackers, pie crusts, crumble topping.
• Hard foods: e.g. boiled and chewy sweets, nuts and seeds, raw vegetables.
• Vegetable and fruit skins, husks:  e.g. grapes, peas, sweetcorn, broad beans, ‘bits’ in granary bread.
• Stodgy, chewy textures: e.g. some meats, white bread, toffee, sweets.

More about ‘mixed consistencies’:

• Foods that have more than one texture are called ‘mixed consistencies’ (e.g. cereals which do not blend with milk such as muesli, mince with thin gravy, soup with lumps, fruit pieces in jelly, salad, cake with dried fruit).

• Mixed consistencies can be harder to swallow, especially for people with swallowing problems.

• The risk of choking can be increased.

• Mixed consistencies are usually only recommended as part of a regular or regular easy to chew diet, as near-normal swallowing is needed to take them safely.

How to improve flavours:

The taste of your food is important, here are some ideas to make your food more appetising:

Savoury	Sweet
· Salt/pepper · Curry powder · Herbs/spices · Garlic · Lemon · Tomato sauce/puree · Cheese or parsley sauce · Gravy granules · Worcester sauce	· Coffee · Cocoa/drinking chocolate · Honey · Seedless jam · Lemon curd · Fruit syrups · Squash · Cinnamon · Nutmeg · Ginger

What to do if you are losing weight or underweight?

• Use full fat products, e.g. whole milk instead of skimmed or semi-skimmed.
• Try ‘little and often’ – aim for 3 small meals a day and 3 snacks.
• Have nourishing snacks between meals.
• Have nourishing drinks between meals (fortified full fat milk, hot chocolate, malted milk drinks).

Food fortification:

You can fortify foods to boost the nutritional content to help prevent weight loss or promote weight gain:

• Fortified full fat milk. Add 2-4 tablespoons of skimmed milk powder to 1 pint of full fat milk (this can be used in cooking e.g. in mashed potatoes, sauces, porridge and puddings or to drink).

• Add grated cheese to foods like mashed potatoes, scrambled eggs, soups.

• Add double cream to foods e.g. soups, potatoes, porridge.

• Add honey/jam/sugar/syrup to foods.

• Add butter/spread or oil such as olive/rapeseed oil to foods e.g. potatoes, vegetables, scrambled eggs.

If you continue to lose weight your GP may refer you to a Dietitian.

How to have a healthy balanced diet

• Fruit and vegetables: aim to have 5 portions per day, includes fresh, frozen or tinned.

• Milk and dairy foods: aim to have 3 servings per day.

• Protein: (meat, fish, eggs, beans and other non-dairy sources of protein), aim to have 2-3 servings per day.

• Carbohydrates: (bread, rice, pasta, potatoes and other starchy foods), aim to have 3-5 servings per day.

• Food and drink high in fat and/or sugar: if overweight, limit these foods, if underweight these foods can help you gain weight; therefore, include more in your diet.     

Supplements

If you have tried food fortification and are still losing weight or are unable to gain weight, you may need to trial oral nutritional supplements.

These can be purchased from a chemist or pharmacy (e.g. Complan, Meritene or Aymes soups/shakes). Please be cautious if you are on thickened fluids as these over the counter supplements may not be the correct thickeness for the IDDSI level you have been recommended. . Please speak to your GP, Dietitian or SLT for further information regarding this.

USEFUL INFORMATION—some options for food suppliers

Simply Puree	Apetito
Tel: 0191 456 0456	Tel: 01225 234509
https://simplyfoodsolutions.co.uk/simply-puree/	http://www.apetito.co.uk/
NH Case Ltd	Oak House Foods
Tel: 01963 828900	Tel: 0333 370 6700
http://www.nhcase.com/	https://www.oakhousefoods.co.uk/
Wiltshire Farm Foods	Mrs Gills Kitchen
Tel: 0800 077 3100	Tel: 020 8807 6584
https://www.wiltshirefarmfoods.com/	https://mrgills.co.uk/

Other providers are available

USEFUL CONTACTS

SPEECH AND LANGUAGE THERAPY

Acute adults—Worcestershire Acute Hospitals NHS Trust

Covering the Alexandra Hospital, Redditch and Worcester Royal Hospital.

Tel No: 01905 760 475

Email: [email protected]

Community adults—Worcestershire Health and Care NHS Trust

Covering the community; including rehabilitation wards and places of residence, e.g. home, nursing/care homes.

Tel No: 01905 681 049

DIETITIAN

Acute service—Worcestershire Acute Hospitals NHS Trust

Covering the Alexandra Hospital, Redditch, Worcestershire Royal Hospital and Kidderminster Hospital.

Tel No: 01905 760 136

Email: [email protected]

Community Dietitian

Tel No: 0300 123 8098

Produced by: The Speech & Language TherapyAndThe Nutrition & Dietetic DepartmentsWorcestershire Acute Hospitals NHS Trust

Updated: June 2026

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