A Nutrition Guide: How do you prepare thickened liquids?

According to the International Dysphagia Diet Standardisation Initiative (IDDSI), thickened liquids are crucial for managing dysphagia by slowing the liquid's flow, making it easier and safer to swallow. Learning how do you prepare thickened liquids correctly is essential for preventing aspiration and ensuring proper hydration.

Quick Summary

Preparing thickened liquids is a necessary dietary modification for individuals with swallowing difficulties. This comprehensive guide provides step-by-step instructions for mixing different types of thickeners to achieve a safe and correct consistency, based on the IDDSI framework.

Key Points

• Consult a Professional: Always follow the specific recommendations of a speech-language pathologist or doctor regarding the appropriate thickness level for dysphagia.

• Add Powder to Dry Container First: For powdered thickeners, measure the powder into a dry cup or container before adding the liquid to prevent clumping.

• Stir Briskly and Wait: Stir vigorously for at least 20-30 seconds, then allow the liquid to stand for the recommended time to fully thicken.

• Use the IDDSI Framework: Employ tests like the syringe or fork drip test to verify that the liquid has reached the correct and safe consistency level.

• Choose the Right Thickener: Select a commercial thickener (gum-based for stability, starch-based for cost) or a natural option based on the liquid type and desired outcome.

• Be Aware of Temperature and Time: Some thickeners continue to thicken over time or change consistency with temperature. Gum-based thickeners offer greater stability.

Understanding the Need for Thickened Liquids

Dysphagia, or difficulty swallowing, is a common condition that affects many people, including the elderly, individuals recovering from a stroke, or those with neurological disorders. For these individuals, thin liquids like water or juice can move too quickly, entering the airway instead of the esophagus, a dangerous event called aspiration. Aspiration can lead to choking or serious respiratory infections like pneumonia. Thickened liquids, prepared with specific agents, move more slowly and cohesively, giving the individual more time and control to complete a safe swallow.

Choosing the Right Thickening Agent

The type of thickener you use can affect the liquid’s texture, taste, and stability over time. Always follow the specific recommendations of a speech-language pathologist or other healthcare professional for the appropriate thickness level.

Commercial Thickeners

Available in powder, gel, or pre-thickened forms, commercial thickeners are a reliable and common choice for their consistency and convenience.

• Powdered Thickeners (Starch-based): Made from modified cornstarch, these are widely available and cost-effective. They are often flavorless but can become cloudy and continue to thicken over time, especially with hot liquids.
• Powdered Thickeners (Gum-based): Composed of xanthan gum, these are newer and more palatable. They create a clear, smooth, and consistent texture that is stable over time and with varying temperatures. This consistency is less likely to change as the liquid stands.
• Gel Thickeners: Typically xanthan gum-based, these come in convenient single-serving packets or bottles, requiring no measuring. They blend instantly and smoothly without altering the taste or appearance of the liquid, even in carbonated drinks.

Natural Thickeners

For some applications, particularly in recipes or for those who prefer natural ingredients, kitchen staples can be used.

• Pureed Fruits or Vegetables: Blending a portion of fruit like banana or canned peaches can thicken juices or smoothies. Pureed vegetables or instant potato flakes can be used for soups.
• Infant Rice Cereal: This can be a useful thickener for milk-based drinks and can be added directly to the liquid.
• Cornstarch or Flour: Often used for hot items, these starches need to be cooked to fully activate their thickening properties. A slurry must be made with cold liquid first to prevent lumps.

Step-by-Step Guide: How to Prepare Thickened Liquids

For best results, follow these general steps, always referring to the specific product instructions for exact measurements.

Using Commercial Powdered Thickeners

1. Measure Accurately: Use the scoop provided with the thickener. Measure the prescribed number of scoops based on your desired consistency level (e.g., nectar-thick, honey-thick).
2. Add to Dry Container: Pour the measured powder into a clean, dry glass or cup. Adding liquid directly to powder can cause clumping.
3. Add Liquid and Stir: Pour the prescribed amount of liquid into the cup with the powder. Stir briskly with a whisk or fork for 20-30 seconds until the powder is fully dissolved.
4. Allow to Set: Let the mixture stand for the recommended time (e.g., 1-5 minutes). This allows the thickener to activate fully. Some liquids, like milk or nutritional supplements, may take longer to reach their final consistency.
5. Test and Serve: Check the consistency against the IDDSI framework before serving. If it's too thick, add more liquid. If too thin, increase the powder in the next batch. Do not add more powder to a liquid that has already started thickening, as it can cause lumps.

Using Gel Thickeners

Gel thickeners are often simpler to use, as they blend without clumping.

1. Measure Liquid: Pour your desired liquid into a glass.
2. Add Gel: Squeeze or pump the recommended amount of gel thickener into the liquid.
3. Stir Briefly: Stir for 20 seconds. The gel will blend in almost instantly.
4. Serve: The liquid is ready to serve immediately, with no waiting time required for setting.

Using Natural Thickeners

1. Puree Method: Blend a portion of fruit, beans, or cooked vegetables with a small amount of liquid until smooth. Stir the puree back into the main liquid or soup and heat if needed.
2. Slurry Method (for heated liquids): For cornstarch, whisk equal parts cold water and cornstarch in a separate bowl to create a smooth slurry. Bring the soup or sauce to a simmer, then slowly whisk in the slurry until it thickens.

Ensuring Consistency with the IDDSI Framework

The International Dysphagia Diet Standardisation Initiative (IDDSI) provides a framework with specific tests to ensure liquids are the correct thickness. Your speech-language pathologist will advise on the correct level for you or your loved one.

• IDDSI Flow Test: This test uses a specific syringe to measure how much liquid flows out in a given time. This is the most accurate method for determining consistency.
• Fork Drip Test: For moderately thick liquids (Level 3), a fork should hold some liquid, which should slowly drip between the tines. For extremely thick (Level 4), the liquid should not drip through the tines.

Comparison of Thickening Agents

Feature	Starch-Based Thickeners	Gum-Based Thickeners	Natural Thickeners (e.g., Purees)
Preparation	Requires precise measurement and mixing time.	Blends quickly and easily, often instantly.	Varies by ingredient; may require heating or blending.
Clarity	Can become cloudy, especially with water.	Remains clear and transparent.	Depends on ingredients; fruit purees can alter color.
Taste	Can leave a starchy or gritty aftertaste.	Neutral taste, does not alter original flavor.	Adds the flavor of the natural ingredient used.
Consistency	May continue to thicken over time; less stable.	Highly stable; maintains consistency over time and temperature.	Less stable; can thin out over time or with heat changes.
Cost	Generally more affordable.	Can be more expensive than starch-based products.	Varies; often less expensive if using common kitchen items.
Use Case	Most effective in standard, single-serve applications.	Excellent for carbonated drinks, freezing, and bulk prep.	Good for adding flavor and for use in recipes like soups.

Best Practices for Successful Thickening

To ensure consistency and prevent common issues, follow these simple tips:

• Use Dry Equipment: Ensure your mixing cup, scoop, and whisk are completely dry before you begin. Moisture can cause powdered thickeners to clump.
• Mix Thoroughly: Stir briskly for the entire recommended duration to fully dissolve the powder and prevent a lumpy or uneven texture.
• Be Aware of Temperature: Some thickeners perform differently based on temperature. Starch-based thickeners are less stable with temperature changes, while xanthan gum is more consistent.
• Avoid Melting Ingredients: Never use ice cream, gelatin, or sorbet, as these will melt into thin liquids and become an aspiration risk. Thicken a gum-based liquid and freeze it to make safe ice cubes or popsicles instead.
• Consult a Professional: A speech-language pathologist can provide an individual assessment and the specific thickener level needed for safety. The International Dysphagia Diet Standardisation Initiative (IDDSI) provides valuable resources and testing methods at www.iddsi.org.

Conclusion

Preparing thickened liquids correctly is a critical aspect of managing dysphagia, directly impacting an individual's safety and quality of life. By understanding the different types of thickeners available and mastering the proper preparation techniques, caregivers and patients can ensure that all beverages meet the required consistency for safer swallowing. While commercial thickeners offer reliability and ease of use, natural alternatives can provide variety and flavor. Always follow the guidance of a healthcare professional and adhere to safety protocols to prevent aspiration and promote proper hydration. Regular testing using methods like the IDDSI framework ensures the right consistency is maintained every time.

Frequently Asked Questions

What is the difference between starch-based and gum-based thickeners?

Starch-based thickeners (e.g., modified cornstarch) are widely available and affordable but can become cloudy, gritty, and continue to thicken over time. Gum-based thickeners (e.g., xanthan gum) are newer, remain clear, and provide a stable, consistent thickness that doesn't change over time or temperature.

How do I prevent lumps when preparing thickened liquids?

To prevent lumps, always add the powdered thickener to a clean, dry cup before pouring in the liquid. Stir briskly with a whisk or fork as you add the liquid and continue to stir until it is fully dissolved.

Can I use cornstarch to thicken cold drinks?

No, cornstarch requires heat to activate its thickening properties. It will not thicken cold liquids effectively. For cold drinks, use a commercial powder or gel thickener, especially a gum-based one, which thickens instantly regardless of temperature.

Why did my thickened liquid become too thick or thin after sitting?

The most common reasons are using a thickener that continues to thicken over time (like starch-based powders) or using the wrong ratio of thickener to liquid. Always allow the liquid to stand for the recommended time before serving and test the consistency.

Is it safe to freeze thickened liquids?

Only gum-based thickeners (like xanthan gum) maintain their viscosity when frozen and thawed. Starch-based thickeners will lose their thickened consistency upon melting. It is never safe to use items like ice cream or gelatin, as they will melt into a thin liquid and pose an aspiration risk.

What happens if I add more thickener to a liquid that is already mixed?

Adding more powder to a liquid that has already started thickening can cause it to become lumpy. If the liquid isn't thick enough, it's best to discard the batch and start over with a fresh, correctly portioned mixture.

How do I thicken soups for a person with dysphagia?

For pureed soups, you can blend some of the vegetables or beans back into the soup. For broths, make a slurry with a starch like cornstarch and cold liquid, then whisk it into the hot soup. Instant potato flakes can also be used effectively.