Finding Pasta for IDDSI Diets: Why We Had to Do It Ourselves
- John Holahan
- Sep 11
- 5 min read
When we wrote a cookbook for dysphagia diets and texture-modified foods, how could we leave pasta out? We knew we couldn’t – pasta had to be in the cookbook!!
Pasta has always been a big part of my life. Especially with three kids around the house. From Sunday meal prepping farfalle for a week of school lunches, to endless boxes of Kraft Mac & Cheese when the kids were little, to homemade lasagnas that we froze leftovers for a week of future dinners — pasta just felt normal. It felt like home.
So, when we were working on a dysphagia cookbook, I couldn’t imagine leaving pasta out. But there was a problem: pasta and dysphagia diets don’t easily mix.
Why Pasta Doesn’t Play Nice with Dysphagia Diets
Most pasta is simply wheat flour mixed with water or eggs, which is formed and cut into shapes and dried. As we cook pasta and rehydrate the pasta, starch molecules swell and are released from the wheat and into the cooking water. Starch is a natural thickener, and its presence is the cause of the stickiness with pasta.
Thickener molecules, whether loose in a solution or bound in a pasta noodle, behave differently based on how much water is present. In a really dilute situation, you may not even notice that the thickener is present. But as the concentration of the thickener increases, thickener molecules pack together and get really thick. And eventually, when most of the water is gone (like after cooking noodles and putting them in a strainer), they become sticky.
When you cut or puree pasta shapes, a lot of starch is also released from the noodles, leading to a bigger, stickier mess. It seems that stickiness is a natural and normal part of pasta.
When we serve whole noodles, we coat them in oil or sauce to prevent the noodles from getting sticky. But we can’t do that as well in a dysphagia diet. We tend to cut or process the pasta so much that a huge amount of starch is released and the processed pasta is very sticky.
Our First Failures and a Breakthrough for Level 4 (Pureed)
When we first tried to make pastas that fit into a texture-modified diet incorporating IDDSI in our SimplyThick lab, we failed. And we were frustrated.
Eventually, we found a method for IDDSI Level 4 (pureed) pasta that works. It is practical for a home user, but its usability is limited in an institutional setting. Although it isn’t perfect, we were happy and relieved to have an answer – even if it is not perfect for all situations. We published our method in our cookbook, Modern Dysphagia Cookbook. I’ll go over the method in the next section.
Our Tested Method for Smooth, Pureed Pasta
Remember, pasta is made almost entirely of starch, and starch is tricky.
When you boil pasta, those starch molecules swell up and get ready to release. If you try to cut, chop or puree hot pasta, all that starch comes rushing out — turning your dish into an unworkable, sticky, gummy mess. And it really will stick to the spoon when you try to use the IDDSI Spoon Tilt Test.
To solve this for pureed (Level 4) pasta recipes, we developed a method in our lab:
● Cook pasta 2–3x longer than normal, in a large excess of water, to pull out loose starch. You want to be sure there is plenty of water for the pasta to absorb.
● Chill the pasta immediately to stop starch release, especially when you are going to puree it.
● Puree it cold with milk and butter for a smoother, less sticky consistency.
● Heat only when ready to serve, because reheating pureed pasta for long periods just makes it sticky again.
This gave us a reliable method for pureed pasta. But honestly, it felt frustrating that people who needed Minced & Moist or Soft & Bite-Sized diets still had no easy pasta options.
We Couldn’t Stop at Pureed
We kept trying other options in the lab, but we didn’t find a good answer for other dysphagia diet levels like IDDSI Level 5 (Minced & Moist) or Level 6 (Soft & Bite-Sized).
I heard from people out in the world that there were shapes that could work naturally. So, I started on a quest to find and catalog the pasta shapes that would work without any processing. However, I could find little good information out there on the sizes of COOKED pasta shapes. I even contacted one of the largest pasta manufacturers, asking if they could tell me the size of their pasta after cooking - and still couldn’t get an answer, even after explaining it was for people with swallowing disorders.
The Pasta Project: Testing 55 Pastas Ourselves
So, like any stubborn team, we decided to do the work ourselves: we bought and tested about 55 different pastas ourselves.
As we shared our pureed pasta method with people, two possible techniques for achieving the other levels came to light:
Chop up dry pasta shapes in a food processor before cooking
Find pasta shapes that naturally fit the IDDSI size and softness guidelines
I actually never tried the idea chopping up dry pasta simply because the other idea of simply cooking a shape that would be the correct size naturally is so simple.
So, we went shopping and eventually bought and cooked more than 55 different pasta brands and shapes.
After weeks of cooking, measuring, tasting, and testing, we found:
● 11 pasta shapes that work for Minced & Moist (≤4mm pieces)
● 8 pasta shapes that work for Soft & Bite-Sized (≤15mm pieces)
Cooking Tips to Make Any Pasta More Dysphagia-Friendly
Here is a roundup of key tips to making any of these pasta shapes to meet the softness required for a dysphagia diet:
Cook your pasta longer than the package says. Pasta labels usually aim for "al dente" - which is way too firm for a dysphagia diet. Add at least 5 extra minutes of cooking time.
Use plenty of water to ensure the pasta becomes fully tender and soft all the way through. 2-3 times the typical amount of water is my recommendation.
Always add a little oil to the cooked pasta. It adds some calories and it coats the pasta to prevent it from drying out quickly.
Always test the finished pasta with all the appropriate testing methods for the IDDSI diet level you are trying to make.
Why Pasta Still Matters
Pasta is affordable. It’s comforting. It’s part of everyday life. And with the right shapes and a few simple cooking tweaks, it can absolutely be part of a dysphagia-friendly diet too.
I'm proud we put in the work - and I’m excited to finally make pasta an easy, approachable option again for people with dysphagia.
Wondering What We’ll Tackle Next?
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About the author
John Holahan is the President and Founder of SimplyThick, LLC and an inaugural member of the IDDSI Hall of Appreciation. He is also a member of the Canadian IDDSI Reference Group (CIRG) and a founder of the United States IDDSI Reference Group (USIRG). He is the
inventor of the patented thickener - SimplyThick. Mr. Holahan has worked with thickeners since 2001.
Resources
Modern Dysphagia Cooking. (n.d.). Home. https://www.moderndysphagiacooking.com
Merino, G., Marín-Arroyo, M. R., Beriain, M. J., & Ibañez, F. C. (2021). Dishes adapted to dysphagia: Sensory characteristics and their relationship to hedonic acceptance. Foods, 10(2), 480. https://doi.org/10.3390/foods10020480
Knorr. (n.d.). Stop pasta sticking. https://www.knorr.com/uk/tips-and-tricks/stop-pasta-sticking.html
International Dysphagia Diet Standardisation Initiative. (n.d.). Home. https://www.iddsi.org/
International Dysphagia Diet Standardisation Initiative. (n.d.). Framework. https://www.iddsi.org/standards/framework
International Dysphagia Diet Standardisation Initiative. (n.d.). Patient handouts. https://www.iddsi.org/resources/patient-handouts