A Guide on How to Make Moderately Thick Liquids for Nutritional Needs

According to the International Dysphagia Diet Standardisation Initiative (IDDSI), moderately thick liquids (Level 3) are essential for people with swallowing difficulties (dysphagia) to help prevent liquids from entering the airway. Here is a comprehensive guide on how to make moderately thick liquids safely and effectively using various methods.

Quick Summary

Creating thickened beverages is a vital aspect of a nutrition diet for those with swallowing challenges. This guide explains how to achieve the correct consistency using commercial and household thickeners, emphasizing safety and consistency checks.

Key Points

• Understanding IDDSI: Moderately thick liquids correspond to IDDSI Level 3, characterized by a honey-like consistency that drips slowly from a fork.

• Commercial Thickeners: Powdered and gel-based commercial thickeners provide reliable and consistent results; always follow the manufacturer's instructions carefully.

• Household Options: Ingredients like cornstarch, instant potato flakes, and baby cereal can be used to thicken liquids, particularly for hot preparations like soups and sauces.

• Check Consistency: After mixing, allow the liquid to set for a few minutes and perform a fork drip or flow test to ensure the correct thickness before serving.

• Prioritize Safety: Avoid products that melt (like ice cream) and use thickened ice cubes with gum-based thickeners to prevent changes in consistency.

• Enhance Flavor: To encourage adequate fluid intake, use naturally thick or flavorful bases like pureed fruits, milk, or fortified nutritional supplements.

• Monitor Hydration: Watch for signs of dehydration, as individuals on thickened liquids may drink less. Consult a professional for a personalized hydration plan.

Understanding Moderately Thick (IDDSI Level 3) Consistency

Moderately thick liquids are designed for individuals who struggle to control thinner liquids in their mouth and throat. Achieving the correct consistency is crucial for safety, as liquids that are too thin pose a choking risk. The International Dysphagia Diet Standardisation Initiative (IDDSI) provides a global framework for classifying thickened liquids and food textures. IDDSI Level 3 is described as honey-like in thickness, where the liquid pours slowly in dollops. It is smooth and lacks any lumps, fibers, or seeds.

To ensure the correct consistency, IDDSI recommends two practical tests:

• The Fork Drip Test: A moderately thick liquid should slowly drip in dollops or strands through the prongs of a fork rather than flowing freely.
• The IDDSI Flow Test: Using a 10 mL syringe, after 10 seconds of flow, no less than 8 mL of a Level 3 liquid should remain in the syringe.

Using Commercial Thickeners to Achieve the Right Consistency

Commercial thickeners are a reliable and consistent option for preparing thickened liquids. They are available in both powdered and gel forms and are specifically formulated to produce predictable results.

Powdered Thickeners

These are the most common type and come with detailed instructions based on the desired thickness level. They are available in two main varieties:

1. Starch-based: Often derived from modified cornstarch, these thickeners have been available for many years.
2. Gum-based: Typically made with xanthan gum, these are a newer option known for not altering the taste, appearance, or smell of the liquid. They also offer better temperature and time stability.

Steps for using powdered thickeners:

1. Measure the liquid into a cup. Ensure it is not excessively hot, as this can affect the thickener's performance.
2. Using the provided scoop, add the recommended amount of powder for a moderately thick consistency.
3. Stir briskly with a whisk or fork for 20–30 seconds to fully dissolve the powder and prevent lumps.
4. Let the mixture stand for 1–5 minutes to reach its final consistency. Note that some thickeners may continue to thicken over time.
5. Test the consistency using the IDDSI methods before serving.

Gel-Based Thickeners

Gel-based products, like SimplyThick®, come in a convenient gel form that can be mixed into liquids without needing extensive stirring. They also provide consistent thickness over time and are less likely to produce lumps than powdered versions.

Thickening Liquids Using Household Ingredients

For those who prefer or need to use readily available kitchen staples, several household ingredients can be used to thicken liquids. These often work best for hot liquids, gravies, and soups.

Common household thickeners:

• Cornstarch: Create a 'slurry' by mixing equal parts cornstarch and cold water until smooth before stirring it into a simmering liquid. Bring to a boil and cook until thickened.
• Instant Potato Flakes: Add to boiling pureed soups, gravies, or sauces to thicken.
• Infant Cereal: A great option for thickening milk, smoothies, or nutritional supplements.
• Pureed Fruits/Vegetables: Blending items like banana, applesauce, or pumpkin puree can naturally thicken juices or shakes.
• Flour: Combine with a small amount of cold liquid or use it to make a roux for gravies and sauces.

Comparison of Thickening Agents

Feature	Commercial (Starch-Based)	Commercial (Gum-Based)	Household (e.g., Cornstarch)
Taste/Texture	May have a slightly chalky or gritty texture and starchy aftertaste.	Tasteless and odorless; provides a smooth, consistent texture.	Can impart a starchy or floury flavor if not cooked properly.
Stability	May continue to thicken over time; less stable with temperature changes.	Highly stable over time and with both hot and cold liquids.	Less predictable and can become lumpy if not mixed correctly.
Convenience	Easy to find at pharmacies or online. Pre-measured packets available.	Available online and sometimes at pharmacies; slightly less common.	Readily available in most kitchens; requires more preparation and attention.
Versatility	Works with most liquids, hot and cold. Can become cloudy.	Works well with a wide range of liquids, maintaining clarity.	Best for hot liquids, soups, and sauces. Can be challenging with cold beverages.

Essential Tips for Success and Safety

Creating safe and palatable thickened liquids requires attention to detail. Follow these guidelines to ensure the best results:

• Always read and follow the manufacturer's instructions for commercial products, as ratios and setting times vary.
• Measure accurately: Use the correct scoop or measuring spoons for consistency. It is safer for the liquid to be slightly too thick than too thin.
• Wait and Test: Allow the liquid to stand for the recommended time before serving. Always perform the appropriate IDDSI test to verify the consistency.
• Stir vigorously: This helps prevent clumps and ensures even distribution of the thickener.
• Consider the temperature: Certain thickeners react differently to hot and cold liquids. Gum-based thickeners offer greater temperature stability.
• Avoid certain foods: Items that melt, like ice cream, sherbet, and gelatin desserts, should be avoided as they revert to a thin liquid state. Avoid using regular ice cubes, as their melting can alter the consistency. For thickened ice cubes, use a gum-based thickener.
• Flavor Matters: To improve palatability and encourage intake, experiment with different flavorings, like flavored syrups or fruit purees, or offer a variety of naturally thick drinks.

Maintaining Proper Nutrition and Hydration

Individuals on a thickened liquid diet are at a higher risk of dehydration due to reduced fluid intake, as thickened drinks can be less appealing. To combat this:

• Increase intake opportunities: Encourage drinking throughout the day, not just at meals. Set reminders or a schedule to prompt fluid consumption.
• Offer nutritious choices: Use nutritious bases like milk, juice, or nutritional supplement drinks (e.g., Boost, Ensure) to add calories and protein. For example, you can thicken fortified milk or fruit nectars.
• Monitor hydration levels: Watch for signs of dehydration, such as dry mouth, dark urine, or weakness.
• Talk to a professional: A dietitian or Speech-Language Pathologist can help create a customized nutritional plan to ensure adequate intake.

Conclusion

Knowing how to make moderately thick liquids is a critical skill for caregivers and individuals managing dysphagia. By understanding the IDDSI guidelines and learning the proper techniques for using commercial or household thickeners, you can ensure safer swallowing and help maintain proper hydration and nutrition. Always prioritize safety by following instructions, testing consistency, and consulting with healthcare professionals for personalized advice. Consistency and creativity can make a significant difference in improving the mealtime experience.

For more detailed information on the IDDSI framework and testing methods, visit the official website: https://www.iddsi.org/

Frequently Asked Questions

What is the difference between nectar-thick and moderately thick liquids?

Nectar-thick (IDDSI Level 2) is a mildly thick consistency that pours quickly from a spoon, like some fruit nectars. Moderately thick (IDDSI Level 3) is a honey-like consistency that pours more slowly and drips in dollops from a fork.

Can I use cornstarch to thicken cold drinks?

Cornstarch is most effective for thickening hot liquids, as the heat helps the starch molecules bind and thicken. For cold beverages, commercial thickeners or pureed fruits are more reliable.

How do I know if my thickened liquid is the right consistency?

The most reliable methods are the IDDSI Fork Drip Test (liquid drips slowly in dollops through the fork prongs) and the IDDSI Flow Test (more than 8 mL remains in a 10 mL syringe after 10 seconds).

What if my liquid is too thick?

If your liquid becomes too thick, you can add more of the un-thickened liquid to thin it out. Stir thoroughly and re-test the consistency before serving.

Can I use a blender to mix the thickener?

Yes, a blender can be used, especially for larger batches or thicker household ingredients. However, be careful not to over-blend commercial thickeners, as this can affect the final consistency.

Do all liquids need to be thickened?

Yes, if a moderately thick consistency is recommended, all liquids, including water, coffee, juice, and soup broth, must be thickened to the prescribed level to ensure safety.

What should I do if the liquid becomes lumpy?

Lumps can be caused by not stirring fast enough or by adding the thickener too quickly. Try whisking the mixture vigorously. If a lump remains, strain the liquid through a sieve for a smoother texture.