It's a real question we face every day. Can this person eat that food? And the International Dysphagia Diet Standardisation Initiative (IDDSI) Framework gives us the tools to answer these questions ourselves.
IDDSI describes itself as a descriptive diet. And IDDSI says it is not a prescriptive diet. The National Dysphagia Diet (NDD) is a prescriptive diet.
I recently talked about this concept - prescriptive vs. descriptive with a friend. It took a bit of effort to make the distinction clear. But it was worth it because she lit up with excitement when I finally got it right. She immediately understood that there is a lot of freedom and power to meet individual desires.
It is a simple and powerful concept that I’m not sure is broadly understood.
What is the difference between a prescriptive diet and a descriptive diet?
The IDDSI Framework and diet levels describe the foods and the food functionality that meets the standards of each diet level. And the IDDSI Framework also provides the test methods to be sure the food has the proper functionality when served TODAY. IDDSI fully recognizes that the behavior of food may vary (considerably) depending on when, who, and how a particular food is prepared and served.
IDDSI does not prescribe foods to diet levels. The are no lists of acceptable or not acceptable foods within the IDDSI Framework*.
What is an example of descriptive vs. prescriptive in practice?
My favorite example is a banana. Everyone knows bananas come in many shapes, sizes, and softness. Everyone has seen bananas that are green and hard. Or too ripe and too soft.
A prescriptive diet would tell us that bananas are either "acceptable" or not. And if you love bananas, but they aren't on the acceptable list, too bad.
A descriptive diet tells us how foods should behave and gives us the test methods to see if the food meets the requirements. So if you love bananas, you need to test the ones you have today and see if they meet the standards.
An IDDSI Soft & Bite-Sized, Level 6 banana must be soft enough to squish with a fork with just enough force to blanch the fingernail.
So, here’s the question: “are bananas on the menu today?”
And the answer is, “let's test the bananas and decide.” A banana today may or may not pass the test method. But when it does, it is on the menu.
The power of a descriptive diet
This is one of the many beautiful concepts in the IDDSI Framework. We have the tools to test and decide if a food fits the framework precisely as it was prepared and as we are serving it right now, today. The choice to be a descriptive diet instead of a prescriptive diet unlocks so much flexibility within a dysphagia diet! This flexibility allows everyone to make the meals, snacks, and treats that will encourage greater consumption.
* Within the IDDSI Framework, there are no lists of acceptable and not acceptable foods. However, there are some handouts on the IDDSI website that include categories of food that may or may not be acceptable within a particular diet level. Or there are handouts with examples of acceptable foods. These are offered to expand and clarify the wording within the Framework.