Thickened liquids are a medical dietary adjustment that thickens the consistency of fluids in order to prevent choking. Thickened liquids are recommended for individuals who have difficulty swallowing (dysphagia) and keeping food or liquid from entering their airway. Dysphagia is usually caused by a neurological condition such as a stroke, a weakening of the muscles or nerves of the esophagus or from an obstruction (blockage) in the throat.
Types of Thickened LiquidsThin or low viscosity liquids such as regular water pose the greatest risk for choking and aspiration to individuals with dysphagia. In order to prevent aspiration in at-risk people, additives can increase the viscosity (thickness) of a fluid. In addition to water, examples of thin liquids include soda, coffee, juice and soup broth. An example of a naturally thicker liquid (higher viscosity) would be buttermilk. The amount a fluid that should be thickened is usually determined by the severity of dysphagia.
Nectar-like or mildly thickened liquids have a consistency that will still run off a spoon. However, the fluid has enough consistency that a light film will remain on the spoon’s surface.
Honey-like or moderately thickened liquid will no longer flow freely off the spoon. Instead honey-like liquids will drip off the tip of the spoon.
Spoon-thick or extremely thickened liquid will no longer drip off the spoon. Spoon thick liquids are more solid and will remain on the spoon when the spoon is tipped. This is more like the consistency of pudding.
What Types of Thickeners Are Available?
There are now a variety of thickening products available commercially. You can buy pre-thickened drinks or thickening products that you mix yourself. Thickeners come in starch-based and gum-based varieties; each with its own set of advantages and disadvantages. Despite some controversy over whether or not hydration is affected by using thickeners, studies in both rats and humans have shown that there is a 95% absorption of the liquid with the use of commercial thickeners. Seeking help from a speech language pathologist or a nutritionist on how to properly thicken fluids can be helpful.
Starch-based thickeners are easier to mix; however, they are best consumed immediately after mixing. The longer a starch-based thickener sits, the thicker the consistency will become. If the liquid is then refrigerated, the liquid may become too thick. Commercial products include:
- Thicken Up
Gum-based thickeners require more care to mix as they tend to clump more and must be mixed well to avoid inconsistent fluid thickness. If the liquid is not mixed properly, you could accidentally increase the risk of choking rather than decrease it. One advantage of gum-based thickeners is that once mixed, the consistency remains stable and can be refrigerated. Commercial products include:
- Thik & Clear
How Do I Know If I Need Thickened Liquids?If your physician has concerns that you have dysphagia, he or she will likely recommend that you be evaluated by a speech language pathologist. He or she will be able to perform the necessary testing to determine whether you are at risk for aspiration and choking. Speech language pathologists often perform an evaluation in which they will ask you questions, look at your facial and oral structure and watch you eat. If further testing is necessary, a modified barium swallow (MBS) study or fiberoptic endoscopic evaluation of swallowing (FEES) may be ordered. Based on the results of these tests your doctor may recommend thickened liquids.
Speech Pathology Australia. Australian Standards for Texture Modified Foods and Fluids. Accessed: September 28, 2011 from http://www.speechpathologyaustralia.org.au/library/Poster.pdf
Intermountain Healthcare. (2009). Difficulty Swallowing (Dysphagia). Accessed: September 28, 2011 from http://intermountainhealthcare.org/HEALTH-RESOURCES/HEALTH-TOPICS/HEALTHWISE/content/tp23477spec/difficulty-swallowing-%28dysphagia%29.aspx
Mills, R. H. (2008, October 14). Dysphagia Management: Using Thickened Liquids.////The ASHA Leader. Access: September 28, 2011 from http://www.asha.org/Publications/leader/2008/081014/f081014a4/
Garcia, J.M. & Chamber, E. IV. (2010). Managing Dysphagia Through Diet Modifications. American Journal of Nursing. 110:11; pp. 26-23. Accessed: September 28, 2011 from http://journals.lww.com/ajnonline/Fulltext/2010/11000/Managing_Dysphagia_Through_Diet_Modifications.23.aspx#P112