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"I jumped on board with IDDSI because I’ve always believed it would reduce errors in the food served to people."

John Holahan

Image by João Silas
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Descriptive, not prescriptive

The International Dysphagia Diet Standardisation Initiative (IDDSI) has been promoting the idea that it is a descriptive diet. And that it is not a prescriptive diet. I was recently talking about this concept with a friend. It was fun to see her light up with excitement when the concept got through to her.

It really is a simple and powerful concept that I’m not sure is broadly understood. I’ll admit that when I was first introduced to the concept in a presentation slide from IDDSI, I didn’t grasp the concept immediately, and probably did a very bad job teaching that point.

John Holahan discusses the difference between descriptive and prescriptive diets for those with swallowing disorders.
International Dysphagia Diet Standardisation Initiative (IDDSI) - Descriptive vs Prescriptive Diets

So, what does it mean to be descriptive but not prescriptive? It means that at its core, IDDSI diets describe the foods and the food functionality that meets the standards of each diet level. And IDDSI defaults to their test methods to be sure the food has the proper functionality when served TODAY. IDDSI fully recognizes that the behavior of food may vary (greatly) depending on who and how a food is prepared or served.

IDDSI does not prescribe foods to diet levels.

My favorite example is a banana. We’ve all seen bananas that are green and hard. And we’ve seen bananas that are firm and ripe. Or soft and ripe. And probably even too ripe and too soft. A Level 6 – Soft & Bite-Sized 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, “It depends on what was delivered to us today”. A banana today may or may not pass the test method. But when it does, it is on the menu.

Another example is pasta. When we’ve taken a frozen lasagna and processed it to a Level 5 – Minced & Moist, it will pass the IDDSI test methods right away. And even 15 minutes later it will pass. But at 30 minutes, it may have cooled, evaporated some moisture, and become a bit sticky. Now it fails the Spoon Tilt Test because it won’t fall off the spoon easily.

What does this tell us? A couple of things really:

  1. If you are in a large-scale food service operation, this may not be a food that will make it into your menus without a serious re-work.

  2. But if you are at home or at a smaller scale operation, you can serve this lasagna, with the awareness of everyone that it will become sticky. As it is being eaten, you have to do a Spoon Tilt Test every couple of minutes and when it gets sticky, refresh it. Perhaps, you simply add a little warm marinara to refresh the lasagna.

This is part of the beauty of IDDSI’s choice to be a descriptive diet instead of a prescriptive diet – the test methods guide us on what can be served and what shouldn’t be served at each meal. Yet, it also gives us the flexibility to customize the menu to the exact situation in which the food is being prepared and served and to the exact tastes of the person who is being served.



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