IDDSI Level 5 Minced & Moist (Orange)
Nutrition Therapy
A level 5 minced & moist diet is prescribed to patients who are unable to bite foods, have pain or difficulty chewing foods, or easily tire when chewing foods. Foods in this diet are served minced, soft, and moist with food pieces no larger than 4 mm wide x 15 mm long.
Your registered dietitian nutritionist (RDN) can help you figure out how to include your favorite foods while following this diet.
How to Test Your Food
Use a fork or spoon to test if your foods are safe to eat while on this diet. Cooking method and serving temperature can affect texture, so be sure to test your foods just before you begin to eat.
IDDSI Fork Test: Pieces should be no wider than the slot between fork tines (4 mm) and no longer than the base of the fork (15 mm). Minced food pieces should fit between the prongs of a fork.
IDDSI Fork Pressure Test: Using your thumb, press down on a small piece of the food gently and before your nail turns white. The food passes the test if it is completely squashed and does not go back to its original shape.
IDDSI Spoon Tilt Test: Food should hold its shape on the spoon, slide off spoon easily with almost no food left on the spoon. You may need to gently flick the spoon to get food to fall off and there may be a small thin film left on the spoon. The food sample may spread slightly on the plate.
All foods you eat must meet food test requirements.
Tips
Prepare foods to make them soft, tender and moist.
Some foods may be difficult to mince to the appropriate size. If they cannot be finely minced, it is best to puree these foods.
Add gravy, sauce, vegetable juice, cooking water, fruit juice, milk, or half-and-half while cooking to make foods moist.
Serve foods in thick enough liquids that help hold the food together, coat the food and so the liquid does not run off the food. Thicken liquids to the consistency recommended by your clinician.
Strain the liquid or blend it in so the food is one consistency. Some strategies:
Drain milk from cereal
Drain juice or syrup from canned fruit
Create a roux from water and flour to thicken the broth, gravy, or sauce from soups, stews, and casserole.
Monitor leftover foods while reheating to make sure they don’t form a tough outer crust that could make the food harder to eat.
Foods Recommended and Not Recommended
Food lists are based on the International Dysphagia Diet Standardization Initiative (IDDSI) Framework. Use IDDSI testing methods to confirm your foods and drinks are safe.
The following table is not a complete list of foods recommended. Other foods may be OK to eat as long as they meet IDDSI testing requirements. Ask your RDN if you want to know the safety of other foods not included on this list.
Food Group Foods Recommended (Foods should be finely minced or mashed, no larger than 4 mm wide x 15 mm long, and pass the IDDSI test for Level 5)
Foods Not Recommended (Foods larger than 4 mm wide x 15 mm long)
Grains – Foods Recommended
All well-moistened, soft cooked hot cereals that meet the size requirements. Serve without excess liquid.
Cold cereal (if approved by your clinician) that meets the size requirements, drained and served without excess liquid.
Pregelled, soaked breads that are consistently moist throughout with no hardened sections.
Muffins, pancakes, waffles, biscuits and bread dressing served moist and that meet the size requirements. These foods may be served puree.
Soft cooked pasta and potato dishes that meet the size requirements. Serve in a thick and smooth sauce that does not separate from pasta.
Rice, couscous, quinoa that is not sticky or glutinous and does not separate into individual grains when cooked. Served with a thick and smooth sauce that does not separate away from food.
Grains – Foods Not Recommended
Any cereal that doesn’t meet size requirements and is served with excess liquid.
Regular – consistency, dry bread or toast.
Sandwiches with regular-consistency bread.
Pasta and potato dishes with pieces that don’t meet size requirements and are served in thin sauces.
Grainy, sticky, or glutinous rice. Rice that separates into individual grains when cooked or served and is served dry without sauce.
Protein Foods – Foods Recommended
Note; if protein foods cannot be processed soft and at the appropriate size, puree the foods instead.
Cooked, moist, soft and tender meats minced or finely mashed to meet the size requirements.
Red meat, including beef, pork, sausage or lamb.
Poultry, including skinless chicken or turkey.
Seafood, including fish (salmon, herring, and sardines), shrimp, lobster, clams, and scallops.
Eggs and egg substitutes finely mashed to meet the size requirements.
Casseroles with small chunks of meat, ground meats, or tender meats finely mashed to meet size requirements. Serve in a thick and smooth sauce or gravy, draining excess.
Prepared, moistened soy foods, such as tofu or tempeh finely mashed to meet the size requirements.
Prepared, moistened meat alternatives, such as plant protein veggie burgers and sausages finely mashed to meet the size requirements. Serve in a thick and smooth sauce or gravy, draining excess, if necessary.
Cooked, moistened legumes, such as dried beans, lentils, or peas without shells mashed to meet the size requirements. Serve in a thick and smooth sauce or gravy, draining excess.
Protein Foods – Foods Not Recommended
Protein foods that don’t meet size requirements.
Protein foods served with un-drained thin liquids.
Chicken, turkey and fish with skin on or with bones.
Fish with skin on with bones; or that is not soft enough to be broken into size requirements.
Chunky and smooth nuts seed butters, unless recipe meets requirements.
Whole nuts and seeds, such as peanuts and almonds; pistachios and sunflower seeds.
Dairy and Dairy Alternatives – Foods Recommended
Yogurt (without nuts or coconut), cottage cheese finely mashed to meet the size requirements.
Cream cheese, sour cream, pudding, custard and whipped topping, with thickness adjusted as needed to meet the size requirement.
Frozen desserts such as ice cream, sherbet, malts, and frozen yogurt if recommended by your clinician.
Milk, fortified soy milk, fortified nut milk in the liquid consistency recommended by your clinician.
Dairy and Dairy Alternatives – Foods Not Recommended
Yogurt with nuts or coconut.
Hard, dry, chewy or sticky cheese.
Cheese chunks that do not meet size requirements.
Frozen desserts such as ice cream, sherbet, malts, and frozen yogurt, unless approved by a clinician.
Vegetables – Foods Recommended
Cooked, tender vegetables and potatoes finely mashed to meet requirements and with liquid drained. If indicated, serve in a thick and smooth sauce or gravy, draining excess. There should not be thin liquid separating from food.
Peas, creamed peas and creamed corn with soft skins and free of husks; may be blended or incorporated into IDDSI safe stews and soups. If incorporated into a recipe, must pass IDDSI testing methods.
Vegetable juices in the liquid consistency recommended by your clinician.
Vegetables – Foods Not Recommended
All raw vegetables including lettuce.
Cooked vegetables larger than diet requirements
Cooked vegetables that are fibrous, tough, firm, or stringy such as green beans and peapods.
Peas with tough skins or shells.
Sticky or crunchy potatoes such as potato/mashed potato casseroles with hard tops.
Stir-fried, undercooked or fried vegetables.
Fruit – Foods Recommended
Canned and cooked fruits, drained of excess juices, served finely minced or mashed to meet the size requirements. If indicated, serve in a thick and smooth sauce or liquid, draining excess. There should not be thin liquid separating from food.
Soft, peeled fresh fruits such as peaches, nectarines, kiwi, cantaloupe, and honeydew, soft berries with small seeds (i.e. strawberries).
If indicated, serve in a thick and smooth liquid, draining excess. There should not be thin liquid separating from food.
100% fruit juice in the liquid consistency recommended by your clinician.
Fruit – Foods Not Recommended
Soft fruit pieces larger than required of diet, or fruit served with excess juice.
Most fresh fruits with difficult-to-chew peels or pits/seeds such as grapes and apples; and difficult-to-chew or hard/crunchy fresh fruits such as apples or pears.
Stringy, high-pulp fibrous fruits such as papaya, pineapple, rhubarb or mango unless prepared to meet diet requirements.
Fruits with high water content, that juice separates from solid in the mouth such as watermelon unless approved by clinician.
Dried fruit such as raisins, prunes, or apricots.
Fruit leather, fruit roll-ups, fruit snacks, dried fruits.
Beverages – Foods Recommended
Coffee, tea, water, 100% fruit juice, and nutritional supplements in the liquid consistency recommended by your clinician.
Beverages – Foods Not Recommended
Liquids not approved by your clinicians.
Other – Foods Recommended
Prepared foods, including casseroles, cooked salads, baked goods, and snacks that meet the size requirements.
If indicated, serve in a thick and smooth sauce, gravy or liquid, draining excess. There should not be thin liquid separating from food. Pureed soups with small chunks that meet size requirements.
All seasonings and sweeteners, including honey.
Other – Food Not Recommended
Jelly
Level 5 Minced & Moist (Orange) Sample 1-Day Menu
Meal
Breakfast
1 scrambled egg cut into 4 mm x 15 mm long pieces
1 cup oatmeal, moist, excess liquid drained, with lumps no larger than 4 mm x 15 mm long
1 slice pregelled, soaked bread or level 4 puree bread
2 teaspoons butter
½ cup orange juice (in the liquid consistency recommended by your clinician)
1 cup 1% milk (in the liquid consistency recommended by your clinician)
Lunch
1 cup moist pureed beef stew, excess liquid drained, prepared with pieces no larger than 4 mm x 15 mm long and served in a thick and smooth sauce
½ cup cottage cheese, excess liquid drained and pieces no larger than 4 mm x 15 mm long
1 slice pregelled, soaked bread, moistened and gelled throughout product
1 teaspoon butter
½ cup canned fruit cocktail, drained, with pieces no larger than 4 mm x 15 mm long or served mashed
½ cup cinnamon custard
1 cup 1% milk (in the liquid consistency recommended by your clinician)
Dinner
3 ounces moist, tender chicken with pieces no larger than 4 mm x 15 mm long pieces
2 tablespoons of gravy
½ cup soft cooked potatoes, cut into pieces no larger than 4 mm x 15 mm long
½ cup cooked soft carrots cut into pieces no larger than 4 mm x 15 mm long
1 slice pregelled bread, soaked bread, moistened and gelled throughout product
1 teaspoon butter
½ cup canned peaches, drained, cut into pieces no larger than 4 mm x 15 mm long or served mashed
1 cup 1% milk (in the liquid consistency recommended by your clinician)
Snacks
½ cup vanilla yogurt
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