As the implementation of the International Dysphagia Diet Standardisation Initiative (IDDSI) rolls out across North America and the world, we keep learning new bits of helpful and valuable information. I love sharing these with everyone!
Here is my latest list of tips and tricks:
Applesauce needs to be thickened.
Pasta sauce needs to be processed and thickened.
You can make a bread product that complies with IDDSI standards.
The appearance of what you serve matters.
Extremely Thick, Level 4 Liquids will make your journey better. They are the best tool for thickening loose wathe liquids AND safely adding moistness to food.
A simple flow test can provide an excellent correlation to a high-end rheometer.
A fork is amazingly standardized around the world.
IDDSI Funnels are so easy to use.
Supplements are the most difficult liquids to thicken
Slightly Thick is a thickness for adults.
A very common snack and food in long-term care facilities, applesauce, has often been served as part of a pureed menu. However, if you stop and think about it, we all know that applesauce releases water-thin liquids from the bulk, posing a risk for those with dysphagia. It is probably best categorized as a mixed consistency food as generally sold. If you don’t believe me, look at this picture:
Add some thickener to the apple sauce, and you can stop the separation. We have found that 4-6g of SimplyThick® EasyMix™ in a single serving will stop the separation.
2. Pasta Sauce
In my experience, most commercial red pasta sauces have two issues with them. First, they tend to have some larger pieces– tomato chunks, for example. So, I usually put any sauce in the blender for 10 – 20 seconds to ensure that any larger bits get processed. Second, red pasta sauces are often best characterized as a mixed consistency. They will give off water-thin liquids – which are a risk for those with dysphagia.
We have found that adding 6 -12g of SimplyThick EasyMix to a 24 oz jar of sauce will stop the separation.
IDDSI discovered that regular bread is a significant choking hazard as they developed their diet standards. As a result, regular bread is not allowed on most IDDSI diet levels. My team spent a lot of time in the summer of 2020 creating a pureed bread recipe that tastes great. They came up with a great recipe that you can see here.
4. The Appearance of Food Matters.
We all have heard that we eat with our eyes. Often modified foods are scooped and plopped on plates. It’s not very visually appealing. It doesn’t look tasty. Take some time to shape the food. Make it visually appealing, and people will eat more. And it doesn’t have to be fancy. You can simply form the food with geometric shapes. A poster presentation by Melanie Betz and Rush University Medical Center found their patients consumed 500 more calories per day by merely forming the food into simple shapes. If you’d like a pdf of the poster, let me know in the comments.
5. Extremely Thick Liquids Will Make Your Journey Better.
They are the best tool for both thickening loose liquids AND safely adding moistness to food.
I’ve written about this before. We have found Extremely Thick, Level 4 liquids to be the most versatile tool for making texture-modified foods. The Extremely Thick liquid will lubricate and moisten. It is not water-thin. But it will mix with water-thin liquids in the food and thicken them.
6. A Simple Flow Test Can Remarkably Correlate To A High-End Rheometer.
According to a journal article that looked into it, there is a 0.9 correlation between the results of the IDDSI Flow Test and a rheometer. Rheometers cost tens of thousands of dollars. And a syringe can be found for 10 cents. An IDDSI Funnel costs $2.50.
$2.50 / $10,000 = 1/4,000.
So for 1/4,000th of the cost of a rheometer, you can have 90% of the accuracy. Pretty cool!
7. A Fork Is Amazingly Standardized Around The World.
Did you know that the space between the tines of a fork are remarkably consistent? Around the globe? As the IDDSI diet standards were being developed, the team assembled a vast array of forks worldwide and found many of them have the same space between the tines -4mm. And with that discovery, they had a tool in many kitchens around the world that would allow people to measure the size of minced food!
8. IDDSI Funnels Are So Easy To Use.
The IDDSI Funnel has a unique design. The concept was to put a funnel on top of a syringe. Why? So you can pour the sample into the IDDSI Funnel without a second syringe. The design is elegant and straightforward and very easy to use. They are available for purchase here.
9. Supplements Are The Most Difficult Liquids To Thicken.
Supplements are a cornerstone of nutrition therapy. But their composition is quite varied. As a result, we have found that each supplement needs to be tested with whatever thickener you are using to ensure they are producing the correct thickness at the time of service. We have even found different results with different flavors within the same product line. Other factors that can affect the outcome are the temperature, the time before serving, and the amount of mixing. It’s a significant amount of work upfront, but it will be worth it once your formulations are figured out for your workflow.
10. Slightly Thick, Level 1, Is A Thickness For Adults!
Slightly Thick, Level 1 is a “new” thickness with origins in the pediatric world. It was in use before IDDSI, but it had interesting names like “half nectar.” IDDSI adopted it into their framework.
There has been some misunderstanding that it is a thickness for pediatrics because it came from the pediatric world. That is not true. It is an IDDSI level and can be used by anyone. One SLP told me that Slightly Thick was her most commonly assigned thickness level. I expect the use of Slightly Thick to increase as people adopt IDDSI.
Hopefully, these ten tips and tricks are helpful for you in your IDDSI journey. If you have any thoughts on other information I should include next time, let me know in the comments!