What’s Changing With Bread in IDDSI
The International Dysphagia Diet Standardization Initiative (IDDSI) has announced that there are incoming updates to its documents, expected throughout 2026. These updates are based on feedback from the global IDDSI community on user experiences, as well as clinician insights. With the goal of keeping guidance clear and evidence-based, IDDSI has announced a change to the use of bread in modified texture diets.
Historically, bread products have been treated with caution in dysphagia diets because they can
- dry out quickly
- form a sticky ball of food ( or “bolus”)
- crumble apart and fall down before you’re ready
These characteristics increase choking risk. Earlier IDDSI materials included pregelled or soaked breads as a strategy to help keep these common foods on the menu. However, recent research has raised concerns about how the guidance is being interpreted for your kitchen.
Key Findings Behind the Update
In a March 2026 feature article in the IDDSI newsletter, Dr. Julie Cichero highlighted findings from an Australian coroners’ investigation about bread as a choking risk. The investigation found:
- The term “gelled” was not clearly defined, leading to inconsistent interpretation
- Staff had varying understanding of what qualifies as gelled bread
- Preparation methods were not standardized or consistently applied
For these reasons, the coroner questioned whether gelled bread should remain a permissible food when prescribed a minced and moist diet.
What IDDSI Has Decided
After reviewing the article and the coronial report, the IDDSI Board of Directors decided the terms “pregelled” or “soaked breads” will be removed from IDDSI documents and resource materials. This doesn’t create a new texture level or formal rule change, but it does remove wording that may have led to confusion.
What This Means in Practice
For caregivers and clinicians, this update reinforces an important point: Bread should not be assumed safe simply because it is labeled “soaked” or “gelled”. Any food served must still meet IDDSI testing standards.
Looking Ahead
IDDSI has indicated that updates will continue to roll out over 2026. These changes are part of a broader effort to improve clarity in how texture-modified diets are applied across care settings. They shift us toward more precise, observable guidance, rather than relying on looser, term based preparation. I will be making adjustments to published recipes to reflect the changes.
Bottom Line
Bread has been a challenging food in dysphagia diets, but it still can appear on the menu. This update does not redefine the framework, but it does highlight the risks of unclear terms and inconsistent preparation. The safest approach continues to be following IDDSI testing methods at time of service.
