IDDSI Diet Levels Explained In Easy Terms on wooden background with 4 gourds at bottom of picture with blender full of fruits and vegetables pureeing and spilling out the top

IDDSI Diet Levels Explained In Easy Terms

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Are you struggling to understand the different food textures in dysphagia diets? Don’t worry, I’ve got you covered!

In this article, I will explain the IDDSI diet levels in easy terms. This will provide the tools to navigate these diets with confidence and ease. Dysphagia diets can often be overwhelming and confusing. The International Dysphagia Diet Standardisation Initiative (IDDSI) has created a framework to simplify things for you.

With these diet levels, people with swallowing issues will be able to better understand the food and drink textures. This will increase safety for anyone wanting to enjoy eating and drinking. This article is for caregiver or an individual managing a swallowing disorder. It will empower you to master the different IDDSI diet levels and make informed choices about food textures.

So let’s dive in and de-mystify the IDDSI diet levels!

Introduction to IDDSI

Many people struggle to understand dysphagia diets. Prepare to feel relieved because the IDDSI framework simplifies the complexities and makes it easier for everyone to understand.

The International Dysphagia Diet Standardisation Initiative (IDDSI) is an internationally recognized framework that provides standardized terms and testing methods for food textures and drink consistencies for individuals with swallowing difficulties. This framework was developed to address the confusion and inconsistencies of existing dysphagia diets. This confusion happens not only across different countries but also and healthcare settings.

IDDSI Diet Levels Framework. Upside down pyramid with level 7 regular & easy to chew food, level 6 soft and bite-sized, and level 5 minced and moist. Left side shows these food as transitional. Level 4 is connected to a right side up pyramid that has (left) pureed food linked to (right) extremely thick liquids, level 3 is liquidized food (left) linked to moderately thick liquids (right side). Level 2 liquids are middle of pyramid on the right as mildly thick, level 1 as slightly thick, and level 0 on the bottom as thin liquids

The IDDSI framework groups food textures and drink consistencies into eight levels, ranging from Level 0 to Level 7. Each level has specific guidelines that help healthcare professionals, caregivers, and individuals make informed decisions about foods and drinks.

*To clarify, please contact your Speech Language Pathologist and/or Dietitian for clarification of your recommended food and drink levels.*

By using a standardized framework like IDDSI, individuals with dysphagia and their caregivers can have a clear understanding of the texture and consistency of foods and drinks. Knowing more can reduce the risk of choking or aspiration. This empowers them to make choices that promote safe and enjoyable eating experiences. Ultimately, leading to a greater sense of control and mastery over the dysphagia diet.

So, say goodbye to the confusion and frustration of trying to figure out dysphagia diets! Embrace the simplicity and clarity of the IDDSI framework.

Liquids Levels Overview

In the IDDSI framework, there are four levels for liquids:

  • Level 0 – Thin,
  • Level 1 – Slightly Thick,
  • Level 2 – Mildly Thick,
  • Level 3 – Moderately Thick,
  • Level 4 – Extremely Thick

Understanding the different levels of liquids in the IDDSI diet can help you make informed choices about what you drink.

*It’s important to follow the recommendations of your healthcare team and adhere to the appropriate level for your specific swallowing needs.*

By doing so, you can ensure that you are providing your body with the right consistency of liquids to help stay hydrated and maintain overall well-being.

IDDSI Diet Level 0 – Thin

Level 0 is often referred to as the ‘thin’ liquids level. It consists of liquids that are “regular” without any changes or thickeners. This means that you can indulge in almost any drink. These include water, lemonade, tea, coffee, soda, ice cream, gelatin desserts, and many others.

Level 0 liquids move freely and require you to manage the speed of them in your mouth. This means if you are able to control fast moving liquids your risk of aspiration may go down.

*aspiration means food or liquid going into your breathing tube*

Ultimately, Level 0 of the IDDSI diet simply refers to thin, un-changed liquids.

Level 1 – Slightly Thick

So what is Level 1 of the dysphagia diet? Also known as ‘slightly thick’, it offers a variety of safe and enjoyable liquids for individuals with swallowing difficulties. This level is perfect for those who have minimal difficulty with moving liquids safely in the mouth. The foods in this level are slightly thickened, making them easier to swallow and reducing the risk of aspiration.

In Level 1 you can enjoy a variety of liquids that are naturally slightly thick. This list includes tomato juice or V8, Jumex, and possibly some kinds of melted ice cream, along with others.

To change the texture of a thin liquid into a level 1, add thickener to your drink. Mix the measured thickener into a specific amount of thin liquid and stir or shake. It may take up to 10 minutes to thicken to the correct consistency.

Level 1 of the dysphagia diet can increasing feels confidence knowing that you’re giving your body the hydration it needs. And you can still enjoy the pleasure of drinking. You don’t have to feel limited or restricted in your choices. So go ahead and explore the world of slightly thick liquids. Discover a whole new level of delight and mastery over swallowing difficulties.

Level 2 – Mildly Thick

Get ready to experience a whole new world of satisfying drinks with Level 2 of the dysphagia diet. This level is designed for individuals with difficulty moving thin and slightly thick liquids safely in the mouth. This problem may be with coordination of the muscles.

Level 2 drinks are mildly thick. They can still be appealing and enjoyable for those on the dysphagia diet. Some smoothies, milkshakes, and yogurt drinks may be mildly thick and can be enjoyed without adding thickener.

However, most liquids are naturally thin and need to have thickener added in order to fall into the correct consistency. Use a 10 ml syringe to test the appropriate thickness of your liquids. Use any drink, hot or cold, of your choice. Measure the correct amount of your drink and the thickener, stir, and wait 5-10 minutes until desired thickness is achieved.

With Level 2 of the dysphagia diet, people no longer have to feel limited in drink choices. You can enjoy a variety of flavors while ensuring that your liquids are safe and easy to swallow. So go ahead, explore the delicious world of Level 2 and enjoy every sip!

Level 3 – Moderately Thick Liquids and Liquidized Foods

Level 3 of the IDDSI diet is a bit different. You’ll find that this level refers to both foods that have been blended to a smooth, liquid consistency and drinks that have been thickened to a moderately thick (previously called honey thick) texture.


Take a sip of the delectable liquidized food dishes, specially prepared to suit your swallowing needs.

Level 3 foods of the IDDSI diet focuses on smoothness with no separate solid pieces. This means that the texture is similar to that of thin pudding or yogurt. Many soups fall into this category as long as they are blended. They must be completely smooth and but thin enough to drink through a straw.

From creamy soups and thin mashed potatoes with gravy to smooth fruit purees and custards, there are endless possibilities to satisfy your taste buds. The key is to ensure that the food is cohesive, homogenous, moist, and easy to swallow.

So go ahead and indulge in these delightful liquidized dishes. Know that they’re not only delicious but also safe for your swallowing needs.


Now that you have a good understanding of food textures in the IDDSI level 3, let’s dive into the next important aspect: level 3 liquids.

When it comes to managing liquids for swallowing disorders, two things are important. It’s crucial to pay attention not only to the texture of the food but also the consistency of the liquids. This level is appropriate for many people that have esophageal disorders or severe oropharyngeal dysphagia.

These liquids are thick like honey or thin pudding. They have had thickener added and typically take time to drink in order to ensure safe swallowing. Using a spoon is an easy way to take in these liquids. They may be too thick to be sucked through a straw depending on the strength of a person’s oral muscles.

Treat these liquids like you would a thick soup. They flow slowly to give the muscles time to coordinate and increase the safety of swallowing.

Level 4 – Extremely Thick Liquids and Pureed Foods

Level 4 of the IDDSI diet focuses on food and liquids that are ‘pureed.’

Pureed foods are mostly smooth but may have increased texture, and have a pudding-like consistency. This makes them easier to swallow for individuals with some types of dysphagia.

These foods are typically prepared by blending, mashing, or processing in a food processor. This helps smooth lumps or chunks into smaller, more manageable pieces.

As for liquids, they should have a very thick consistency, similar to pudding, to ensure safe swallowing.


Level 4 is all about pureed foods that are blended to be cohesive and moist. It’s like diving into a bowl of creamy mashed potatoes with gravy or enjoying the velvety goodness of a fruit puree.

With pureed food, try to savor the flavors of your favorite foods without worrying about any chunky or hard-to-swallow bits. These foods are incredibly versatile, allowing you to experiment with different flavors and spices. Try enjoying pureed soups, such as tomato bisque or butternut squash soup. They will warm your soul and tantalize your taste buds.

Meats and Vegetables

You may also be interested in experimenting with pureeing meats and/or vegetables. This requires practice and trial-and-error at times. Blend foods after cooking very soft, and adding liquid (like broth). Try also possibly adding fat (like butter or olive oil) and thickener until you reach the right consistency.


You can also indulge in smooth and creamy desserts like chocolate mousse or vanilla pudding. These will satisfy your sweet tooth. The best part is that level 4 foods are designed to be easy to eat without chewing. Therefore, a person can focus on enjoying the meal rather than worrying about swallowing trouble.

As we continue our journey through the IDDSI diet levels, learning about Level 4 is a significant step towards mastering the dysphagia diet. It offers a wide range of delicious options that will support your swallowing abilities and nutrition.

By following the guidelines of this level, you can continue to explore new tastes and textures. Get creative and expand your culinary horizons while still maintaining a safe and manageable diet.

So, remember that Level 4 of the IDDSI diet allows people to experience the joy of flavor without compromising health. Take pleasure in the varied flavors that this level offers. Get creative and know that each bite is carefully prepared to be safely swallowed.


Liquids play a crucial role in our daily lives, providing hydration and nourishment. When it comes to dysphagia diets, understanding the levels of liquids can make a huge impact on a person’s dysphagia experience.

Level 4 liquids are known as extremely thick, or pudding-like liquids. They are the thickest and most challenging to swallow. This is because they require strength of your muscles but move very slowly.

These liquids are thickened until similar to pudding. This requires more effort to move through the swallowing process.

Understanding the different levels of liquid textures can help you make informed choices depending on your specific swallowing needs.

So, whether you prefer a refreshing glass of water or a thick and creamy milkshake, knowing the IDDSI diet levels and altering them to fit your needs can empower you to savor the joy of drinking while ensuring a safe and enjoyable swallowing experience.

Level 5 – Minced and Moist Foods

Level 5 of the IDDSI diet provides increased texture that is not as easy to swallow for those with severe Dysphagia. This level is often referred to as ‘minced and moist’. It is suitable for individuals transitioning to more texture in their food. These people may also have difficulty chewing and this diet supports their oral troubles.

The goal of Level 5 is to make it easier to control the food in the mouth. It also helps to minimize the risk of choking or aspiration while increasing strength of swallowing muscles.

Most importantly, foods at this level are finely minced or ground into small, manageable pieces. We often see them mixed with a moist substance, like gravy or sauce, to ensure a cohesive texture in the mouth.

At Level 5, people can enjoy a variety of foods that have been minced and moistened. This includes foods like ground meat, soft cooked vegetables, and soft fruits. The texture of these foods allows for easier chewing and swallowing, giving the confidence to enjoy meals without worry.

It’s important to note that while Level 5 provides a safe texture for swallowing for many people, it is still important to monitor your own swallowing abilities and make necessary changes to ensure your safety and comfort.

By following the guidelines of Level 5, people can continue to enjoy a wide range of flavors and textures while maintaining a diet that is safe to swallow.

Level 6 – Soft and Bite-Sized Foods

Experience the next level of satisfaction with Level 6 of the dysphagia diet, as it offers more texture with solid foods that’ll leave you feeling nourished and content. Level 6 foods are chopped into bite size pieces which means more chewing and challenge.

This texture is perfect for individuals who have adequate chewing ability and need more challenge swallowing solid textures. Level 6 foods are transitional, like level 5, and may be the final leg of your dysphagia journey.

Using a food processor on pulse to prepare these foods is easiest. Continue pulsing until the ingredients are chopped up and have a chunky consistency. Chopping with a knife or a hand chopper and then cover in sauce to add moisture also works well.

Level 6 foods can be enjoyed in a variety of flavors, from savory to sweet, and most importantly, this makes meals highly enjoyable and satisfying. They provide a sense of familiarity and allow you to continue enjoying your favorite dishes, even with swallowing difficulties.

Almost any food can be chopped or processed into small pieces. As a result, this level is friendly for most people.

Level 7 – Regular Texture Foods

The final IDDSI Diet Level: 7, the last step on our dysphagia diet review. This level on not modified in any way. The goal of Levels 5 & 6 are to provide a seamless transition back to a regular diet, where you can enjoy all (or most) of the foods you love with confidence and ease.

Some people may find that having well cooked and easy to chew foods are best, luckily these foods still fit into level 7. You may desire to continue adding sauce or gravy to your food, especially if trying to maintain weight and hydration.

Some people with dysphagia may find they are able to tolerate most foods at level 7 but have moments where they return to a previous level to address a health concern or setback. These levels are set up to allow this transition to happen as easily as possible.

As people delve into the world of Level 7, they’ll discover a newfound sense of freedom and joy. No longer restricted by the limitations of dysphagia, able to explore a variety of culinary delights and expand horizons. With each bite, many people will feel a sense of accomplishment and mastery, knowing they have conquered the challenges that dysphagia once presented.

Conclusion of IDDSI Diet Levels

In conclusion, understanding the IDDSI diet levels is essential for individuals and caregivers dealing with dysphagia. By following this standardized framework, you can easily categorize food textures and ensure safe and enjoyable meals for those with swallowing difficulties.

Starting at Level 0, which involves thin liquids, and then learning about each individual level can provide people with help for determining what is safe. Its always important to talk with your doctor, SLP and RD about what liquid and food textures are safest for you.

Testing your liquids can increase your safety and ensure that your liquid is the right consistency.

In conclusion, by familiarizing yourself with these diet levels, you can effectively plan meals that meet the specific needs of individuals with dysphagia. Remember to consult with healthcare professionals and follow their recommendations to ensure the best possible outcomes.

With the IDDSI framework, you can navigate dysphagia diets with confidence, promoting safe and enjoyable eating experiences for everyone involved.

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