IDDSI Level 7 Diet: Regular and Easy to Chew Explained
IDDSI Level 7 has two sub-levels — Regular (RG7) and Easy to Chew (EC7). What each means, the fork pressure test, food lists, and when EC7 is right.
Level 7 is where the dysphagia journey often ends — or where it never quite began.
For people recovering from stroke, surgery, or illness and progressing back toward normal eating, Level 7 is the final step before a full unrestricted diet. For older adults whose chewing has weakened with age, dental changes, or fatigue — but who don't have a formal dysphagia diagnosis — Level 7 Easy to Chew may be the only texture modification they need. And for families who have been managing Levels 3, 4, 5, or 6 for months, the transition to Level 7 is one of the most meaningful moments in a recovery journey.
Level 7 is also the most misunderstood level in the framework — partly because it has two sub-levels with different purposes, and partly because most people assume it means no restrictions at all. It doesn't. Understanding what Level 7 actually requires, and who it's appropriate for, matters whether you're just arriving at this level or trying to decide whether it's the right next step.
Level 7 Has Two Sub-Levels — And They're Different
This is the part most caregivers don't know — and the part that causes the most confusion.
In October 2018, IDDSI officially announced the expansion of Level 7 Regular to include a sub-level called Easy to Chew, in response to requests from clinicians and those working in aged care facilities.
The two sub-levels are:
Level 7 Regular (RG7): A completely unrestricted normal diet. No texture modifications. No size restrictions. All foods of all textures. Everyday foods of various textures that are developmentally and age-appropriate. Biting and chewing ability needed. This is the level most people eat at every day without thinking about it. When an SLP discharges someone from dysphagia management, a return to Level 7 Regular is the goal.
Level 7 Easy to Chew (EC7): A normal diet restricted to soft and tender textures only. No size restrictions — pieces can be any size, unlike Level 6's 1.5cm limit — but all foods must be soft enough to break apart with the side of a fork or spoon. Everyday foods of soft and tender textures only. Requires biting and chewing ability.
The critical distinction: Level 7 Easy to Chew is intended for those who do not require particle size restriction to reduce choking risk. The requirement for softer food choices at EC7 is related to reasons other than increased concern about choking.
In plain terms: Level 6 Soft and Bite-Sized restricts piece size because the person needs pieces small enough to manage safely if chewing is incomplete. Level 7 Easy to Chew removes that size restriction — because the person can chew adequately, they just need the food to be soft enough to chew without excessive effort or fatigue.
Who Is Level 7 Easy to Chew For?
EC7 was created for individuals who don't necessarily have dysphagia but benefit from softer foods. This is the broadest audience of any IDDSI level — and the one most under-recognised in caregiver settings.
Older adults with weakened chewing muscles: Requests for EC7 came particularly from those working in aged care facilities for older individuals who could manage eating softer foods but struggled with harder textures due to age, deconditioning, minor changes in dental status, fatigue, or personal preference. Someone who has eaten normally their whole life but finds steak, hard bread, or raw vegetables increasingly difficult is a natural EC7 candidate — even without a dysphagia diagnosis.
People recovering from head and neck surgery or dental treatment: Jaw pain, mouth soreness, or reduced mouth opening after surgery make hard textures temporarily unmanageable. EC7 provides the flexibility of a normal diet without requiring the effort of chewing hard or tough foods.
People in dysphagia recovery who have progressed from Level 6: When someone has been on a Soft and Bite-Sized diet and has improved to the point where piece size is no longer a clinical concern — but some texture restriction is still appropriate — EC7 is the natural progression before full Level 7 Regular.
People with dentures or dental problems: Poorly fitting dentures, missing teeth, or significant dental pain make hard foods genuinely difficult without representing a swallowing safety issue.
Easy-to-chew food may be used if you have strong enough chewing ability to break down soft and tender foods into pieces without help. It is not suitable if you are at increased risk of choking. This texture may be right if you usually choose to eat soft food, have weaker chewing muscles for hard or firm textures, but can chew soft and tender food without becoming tired.
The One Test That Confirms Level 7 Easy to Chew
Unlike Levels 3–6, Level 7 Easy to Chew has no syringe test, no spoon tilt test, and no size restriction. There is one test only:
The Fork Pressure Test — Same as Level 6
Press the side of a fork onto the food with your thumb until your thumbnail blanches white. The food should break apart completely and not regain its shape.
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.
This is the same fork pressure test used at Level 6 — but without the 1.5cm size limit. A piece of soft, slow-cooked beef the size of a golf ball passes the EC7 fork test if it squashes completely under gentle pressure. The same piece at Level 6 would need to be cut to thumbnail size first.
Level 7 Regular (RG7): No testing. No restrictions. If the person can manage all food textures safely, they are at Level 7 Regular and no modification is needed.
What Level 7 Easy to Chew Looks Like Compared to Level 6
This is where caregivers progressing from Level 6 to Level 7 EC need the clearest guidance:
| Level 6 Soft and Bite-Sized | Level 7 Easy to Chew | |
|---|---|---|
| Piece size | Maximum 1.5cm × 1.5cm | No restriction — any size |
| Texture requirement | Soft enough to mash with fork | Soft enough to break with fork |
| Cutting required? | Yes — everything to 1.5cm | No — if it passes fork test |
| Chewing required? | Yes — moderate | Yes — adequate chewing needed |
| For choking risk? | Yes — size restriction reduces risk | No — not designed to reduce choking risk |
| Fork pressure test? | Yes | Yes |
| Who decides? | SLP prescription | SLP prescription |
The practical implication: at Level 7 Easy to Chew, a caregiver no longer needs to cut everything to thumbnail size before it goes on the plate. A soft-cooked piece of fish, a tender chicken thigh, a ripe banana — all can be served in normal-looking portions. The focus shifts entirely from size to texture.
The Level 7 Easy-to-Chew Food List
✅ Foods That Work Well at Level 7: Easy to Chew
The principle: if it passes the fork pressure test at any size, it is EC7 appropriate. Soft and tender is the defining characteristic. Every entry below should be fork-tested before serving — the same food prepared differently on different days may produce different results.
Proteins:
Tender slow-cooked meat — all cuts that have been braised, slow-cooked, or poached until genuinely tender. A slow-cooked chicken thigh, a braised piece of beef, a poached fish fillet. These pass the fork test even at large portion sizes.
Most fish — the majority of fish cooked gently are naturally EC7. Steamed, poached, or baked white fish, salmon, or trout. Remove all bones and skin. Avoid deep-fried fish in thick batter — the batter may be crunchier than the flesh.
Eggs in all forms — scrambled, poached, soft omelette, soft boiled. Hard-boiled egg white can occasionally be firm enough to fail the fork test — check before serving.
Minced meat dishes — bolognese, shepherd's pie, chilli, meatballs in sauce. All naturally EC7 when properly cooked — no special preparation needed.
Legumes — well-cooked lentils, butter beans, chickpeas, cannellini beans. Served whole (no need to mash at Level 7). May be served in soups, stews, or as side dishes.
Soft sausages — well-cooked until completely soft, skin removed. Fork-test before serving, as texture varies by brand.
Tofu — soft and firm tofu depending on preparation. Silken tofu is naturally EC7. Firm tofu passes the fork test when cooked in a sauce until tender.
Carbohydrates:
Bread — soft white or wholegrain bread is EC7. The significant change from Level 6: crusts are allowed at EC7 if they pass the fork test. A soft, fresh bread crust that compresses easily under fork pressure is appropriate. A very hard or stale crust is not.
Pasta — cooked until tender — not al dente. Any shape and size. No cutting required at EC7, unlike Level 6. Serve with a sauce to maintain moisture.
Rice — well-cooked rice in any serving style. Unlike Level 6, no requirement for a thick sauce to hold the rice together — though moisture is still preferable.
Potatoes — boiled, mashed, baked (flesh only). At EC7, potatoes can be served in larger pieces than at Level 6 — a quartered boiled potato passes the fork test easily.
Soft pancakes, crumpets, scones — soft throughout. No hard crusts or dried-out edges.
Most cereals — porridge, Ready Brek, Weetabix soaked in milk, soft muesli soaked in milk. Drain excess milk before serving. Avoid granola and very crunchy cereals.
Vegetables:
Aim to include at least one portion of vegetables at each meal. Cook vegetables until they are soft and tender.
Most cooked vegetables are naturally EC7 — the fork pressure test is the check. Boiled, steamed, or roasted until tender.
Naturally suitable: Carrot (well cooked), courgette, butternut squash, sweet potato, potato, peas (tender), green beans (well cooked), spinach, broccoli (tender florets), cauliflower (tender florets), canned tomatoes, avocado.
Requires cooking first: All raw hard vegetables — raw carrot, raw cucumber, raw celery — fail the fork test and are not EC7.
Always avoid: Stir-fried vegetables that retain firmness. Corn on the cob requires hard biting action. Celery strings even when cooked.
Fruit:
Most ripe soft fruit is naturally EC7. Skin, pips, and pith should be removed from fresh fruits.
Suitable: Banana, ripe mango, peeled ripe peach or nectarine, soft melon, tinned fruit in juice or syrup (drained), ripe kiwi (peeled), soft berries, ripe pear (peeled).
Requires checking: Apples — raw apples are generally not EC7 as it requires significant biting force. A very ripe or stewed apple may pass the fork test. Always check.
Avoid: Dried fruit — very chewy. Pineapple — fibrous core and tough texture even when ripe. Fruit with hard pips or seeds — remove all of these before serving.
Dairy and desserts:
All dairy and soft desserts are naturally EC7 or below — yogurt, custard, ice cream, smooth cheese, soft cheese, cream cheese. Desserts with hard bases (cheesecake biscuit base, pie pastry, crumble topping) need the hard component removed. The soft filling or topping is fine; the crunchy base is not.
Suitable desserts: Soft sponge cake (no hard edges), steamed pudding, bread and butter pudding (fully soft), mousse, panna cotta, trifle without hard biscuit layer, cheesecake filling without biscuit base, tiramisu (ensure sponge layers are fully softened).
❌ Foods Not Appropriate for Level 7 Easy to Chew
These are the foods that fail the fork pressure test — either because they are too hard, too tough, too crunchy, or too chewy:
Hard foods:
- Boiled sweets and hard candy
- Nuts and seeds of all kinds
- Raw hard vegetables — raw carrot, celery, radish, raw broccoli, raw cauliflower
- Hard bread crusts — very crispy baguette crust, stale bread
- Crackers and crispbreads
- Granola and crunchy muesli
Tough and chewy foods:
- Steak — regardless of how it is cooked, steak almost always fails the fork test
- Bacon — too chewy and fibrous regardless of cooking method
- Gristle and cartilage — remove all from any meat
- Dried or jerky-style meats
- Chewy caramel, toffee, nougat
Crunchy and crispy foods:
- Crisps, flaky pastry
- Fried foods with a hard batter or coating
- Pork crackling
- Croutons and breadcrumbs in hard form
Stringy and fibrous foods:
- Raw pineapple — fibrous core
- Celery strings even when cooked
- Very stringy runner beans
- Tough asparagus ends
Mixed texture risks (if choking is a concern):
IDDSI advises that Level 7 Easy to Chew is intended for those who do not require particle size restriction to reduce choking risk. If an individual has an increased risk of choking on foods, this level would not reduce that risk in itself.
If there is any concern about choking risk — whether from a swallowing profile, cognitive impairment, or mealtime behaviour — confirm with the SLP before moving to EC7. Level 6, with its size restriction, provides more choking protection.
What Changes at Level 7 — And What Doesn't
What changes from Level 6 to Level 7 Easy to Chew:
No more cutting everything to thumbnail size. This is the most practically significant change for caregivers — meals can be served in normal-looking portions. A fish fillet on a plate. A chicken thigh. A whole scone. The visual dignity of a normal meal returns.
No more size-checking every piece before it goes on the plate. The fork pressure test is still required for anything that might be tough — but the measurement step is gone.
A much wider variety of bread and bakery products becomes available. At Level 6, bread required crusts removed and pieces cut to 1.5cm. At EC7, a soft roll can be served whole.
What doesn't change:
The fork pressure test still applies to all proteins and many vegetables. Hard, tough, and crunchy foods are still not appropriate. The SLP must prescribe or approve the transition — it is not a decision to make independently.
Liquids are not affected by the IDDSI food level. If the person has been on thickened liquids at Level 2 or Level 3, the liquid prescription remains separate from the food level. Progressing to EC7 food does not automatically mean thin liquids are appropriate. Always confirm the liquid level with the SLP independently of the food level.
| Meal | Level 6 version | Level 7 EC version |
|---|---|---|
| Breakfast | Scrambled eggs, soft bread crusts removed, cut to 1.5cm | Scrambled eggs, soft bread roll served whole |
| Lunch | Minced chicken in sauce, vegetables cut to 1.5cm | Tender chicken thigh served whole, soft-cooked vegetables in normal portions |
| Dinner | Bolognese with pasta cut to 1.5cm pieces | Bolognese with normal-sized pasta |
| Snack | Soft banana pieces | Whole banana |
The Transition From Level 6 to Level 7 — What to Expect
For someone who has been on Level 6 Soft and Bite-Sized and is progressing to Level 7 Easy to Chew, the transition is usually gradual and guided by the SLP.
What to introduce first: Foods that are clearly soft and tender — soft fish, well-cooked chicken in sauce, soft bread, ripe fruit. These pass the fork test comfortably and give both the person and the caregiver confidence before introducing more challenging textures.
What to introduce carefully: Bread with any crust, meat in larger pieces, and raw soft fruit. These may pass the fork test on a good day and fail on a day when the person is tired or the food is slightly less cooked than usual. Introduce them when the person is well-rested and eating conditions are optimal.
What to avoid initially: Any food close to the border between EC7 and not-EC7 — foods that might pass the fork test when very fresh but fail when slightly dried out. Better to wait until EC7 is well-established before testing borderline foods.
Monitoring during transition: Watch for any return of coughing, throat clearing, or increased mealtime effort that might suggest the food texture is more demanding than the person can manage. If these signs appear, report to the SLP before continuing at EC7.
Level 7 Regular — When No Restriction Is Needed
For completeness: Level 7 Regular is a completely unrestricted normal diet. You may be prescribed a Level 7 regular easy-to-chew diet if you need softer foods because of a recent illness, mouth or jaw pain, or personal preference — but Level 7 Regular has no food restrictions at all.
When an SLP discharges someone from dysphagia management and recommends a return to normal eating, they are recommending Level 7 Regular. There is nothing to manage, no food list to follow, and no fork test to perform. The person can eat whatever they choose.
If someone has been on Level 7 Regular and has developed new swallowing difficulties — perhaps due to a new diagnosis or a medication change — the starting point for reassessment is a return to the SLP rather than self-downgrading to a lower level.
Frequently Asked Questions
What is the difference between IDDSI Level 7 Regular and Level 7 Easy to Chew?
Level 7 Regular (RG7) is a completely unrestricted normal diet requiring biting and chewing ability across all textures. Level 7 Easy to Chew (EC7) is a normal diet of soft and tender textures only — same level, different texture restriction. RG7 has no food restrictions. EC7 restricts food to soft and tender textures that pass the fork pressure test, with no particle size limit.
Is Level 7 Easy to Chew the same as a soft diet?
Similar in principle but more precisely defined. The old term "soft diet" varied between hospitals and countries. EC7 was created to eliminate the ambiguous language, like "soft," that varied between every facility. EC7 has a specific test — the fork pressure test — that makes the requirement objective and consistent regardless of who is preparing the food.
Does someone at Level 7 Easy to Chew need thickened drinks?
Not necessarily — liquid level is prescribed separately from food texture level. A person may have dysphagia affecting their ability to drink thin liquids, but would not need particle size restriction for food. Someone at EC7 food may be on thin liquids (Level 0), slightly thick (Level 1), or any liquid level. Confirm with the SLP.
Can someone with dysphagia eat at Level 7 Easy to Chew?
Yes — EC7 is compatible with some dysphagia profiles. A person who can eat foods within EC7 can have dysphagia — in particular, it is possible that someone may have dysphagia affecting their ability to drink thin liquids but would not require particle size restriction. Whether EC7 is appropriate depends on the specific swallowing profile and must be determined by an SLP.
Can I decide to move someone from Level 6 to Level 7 Easy to Chew without SLP review?
No — IDDSI level changes require SLP assessment. Even if the person seems to be managing Level 6 well and you believe they are ready for EC7, the transition must be confirmed by the SLP, who can formally reassess swallowing safety. Making this change independently is a clinical risk.
What is the fork pressure test, and how do I do it?
Press down on a piece of food with the side of a fork until your thumbnail goes white. Lift the fork to see that the food is completely squashed and does not regain its shape. If it squashes completely — the food passes the EC7 test. If it resists, springs back, or requires significant force — it does not pass and is not appropriate for Level 7 Easy to Chew.
Does Level 7 Easy to Chew apply to children?
The IDDSI framework covers both adults and children, but with different size specifications at lower levels. At Level 7 Easy to Chew, there is no size restriction for either group — the fork pressure test applies the same way. However, the appropriateness of EC7 for a child should always be determined by a paediatric SLP.
References
IDDSI Framework. (2019, updated 2024). Level 7 — Regular and Easy to Chew: Descriptors and testing. https://www.iddsi.org/framework
IDDSI Board. (2019). A bit of background on Regular 7 Easy to Chew (EC7). RCSLT e-bite May 2019. https://www.rcslt.org/wp-content/uploads/media/docs/clinical-guidance/iddsi-ebite-may-2019-L7EC.pdf
Royal College of Speech and Language Therapists. (2020). The IDDSI framework. https://www.rcslt.org/members/clinical-guidance/the-iddsi-framework/
Cambridge University Hospitals NHS Foundation Trust. (n.d.). Easy to chew IDDSI Level 7. https://www.cuh.nhs.uk/patient-information/easy-to-chew-iddsi-level-7/
East Kent Hospitals University NHS Foundation Trust. (n.d.). Advice when you need to follow an IDDSI Level 7 Easy to Chew diet. https://leaflets.ekhuft.nhs.uk/advice-when-you-need-to-follow-an-iddsi-international-dysphagia-diet-standardisation-initiative-level-7-easy-to-chew-diet/html/
Cichero, J. A. Y., et al. (2017). Development of international terminology and definitions for texture-modified foods and thickened fluids used in dysphagia management. Dysphagia, 32(2), 293–314. https://doi.org/10.1007/s00455-016-9758-y
American Speech-Language-Hearing Association. (n.d.). Adult dysphagia (Practice Portal). https://www.asha.org/practice-portal/clinical-topics/adult-dysphagia/
