Can you add thickener to Ensure for safe swallowing?

October 22, 2025 •

4 min read

According to the International Dysphagia Diet Standardisation Initiative (IDDSI), millions of people worldwide require thickened liquids for safe swallowing, which raises the common question: can you add thickener to Ensure? The answer is yes, but the method depends on the thickener, and careful preparation is essential to prevent lumps and maintain a safe consistency.

Quick Summary

It is possible to thicken Ensure to aid with swallowing difficulties, though its high protein and fat content can present challenges. Using gel-based thickeners is often easier to achieve a smooth, lump-free consistency than with powders. Proper mixing technique and following professional guidance are crucial.

Key Points

Thickening is possible: You can add commercial thickeners, especially gum-based ones, to Ensure to treat dysphagia.
Gel thickeners mix best: Gel-based thickeners (like SimplyThick) are easier to blend into protein-rich drinks like Ensure without forming lumps.
Avoid thickener buildup: To prevent lumps, add the thickener to a dry cup first, then pour in the liquid and stir vigorously.
Allow time to set: After mixing, let the Ensure sit for several minutes to allow the thickener to activate and reach its final consistency.
Consult a professional: A speech-language pathologist (SLP) must determine the appropriate thickener amount and consistency level for safe consumption.
Use thickened ice: Never add regular ice cubes to thickened liquids; instead, freeze liquid thickened with a gum-based thickener to avoid altering the consistency.
Avoid Ensure Clear: Ensure Clear is often reported to be difficult to thicken effectively, especially with powders, and may be best avoided for this purpose.

Why is thickening Ensure necessary?

For individuals with dysphagia, a condition that impairs swallowing, thin liquids can pose a significant risk of aspiration—entering the lungs instead of the stomach. Speech-language pathologists (SLPs) often recommend thickening liquids like Ensure to slow their movement, allowing for safer consumption. While Ensure is a vital source of nutrition, its standard consistency is too thin for some dysphagia patients, necessitating the addition of a thickener.

Challenges with thickening nutritional supplements

Thickening supplements like Ensure can be more challenging than thickening water or juice due to their high content of protein and fat. These components can interact with starch-based thickeners and cause lumping or a gradual thickening over time. For this reason, gum-based thickeners, available in both gel and powder forms, are often recommended because they tend to produce a clearer, more stable consistency.

How to add thickener to Ensure

Proper mixing is key to achieving a safe and consistent texture. Always follow the manufacturer's instructions for the specific thickener brand you are using, as ratios and mixing times can vary. The International Dysphagia Diet Standardisation Initiative (IDDSI) provides a framework for assessing liquid consistency, which your healthcare team will refer to.

Step-by-step guide for mixing

Start with the right tools: You will need your Ensure, the thickener, a measuring scoop (often included with the thickener), a dry mixing cup, and a spoon or whisk.
Prepare the thickener: Measure the recommended amount of thickening powder or gel into a clean, dry cup. It's crucial to add the thickener to the container before the liquid to help prevent lumps.
Pour and stir immediately: Pour the Ensure into the cup with the thickener and begin stirring vigorously right away. Some thickeners, particularly gum-based ones, begin to work instantly. For high-protein liquids like Ensure, a hand whisk or an electric mixer on a slow speed can aid in achieving a smooth consistency.
Allow time to thicken: Depending on the thickener type, the mixture may need to stand for 1 to 10 minutes to reach its final consistency. Ensure contains milk products, so it might require a slightly longer thickening time.
Check consistency: Before serving, perform a consistency check using the IDDSI framework (e.g., using a syringe or a fork drip test). Your speech-language pathologist will teach you the correct method for the prescribed consistency level.
Refrigerate and store: If preparing in bulk, store the thickened Ensure in a sealed, covered container in the refrigerator and use within 24 hours. Always re-whisk before serving, as separation can occur over time.

Comparison of thickener types


Feature	Starch-Based Powder Thickeners	Gum-Based (Xanthan/Gel) Thickeners
Ingredients	Modified food starch (e.g., cornstarch)	Xanthan gum or cellulose gum
Consistency	Can have a slightly grainy, cloudy appearance and may continue to thicken over time.	Generally clear, smooth, and more stable over time, maintaining a consistent viscosity.
Mixing	Requires vigorous mixing; can be prone to clumping, especially with high-protein liquids.	Mixes more easily, particularly gel versions, with less chance of clumping.
Flavor	Can impart a starchy, slightly chalky taste.	Typically flavorless and does not alter the taste of the beverage significantly.
Temperature	Can be less stable when mixed with hot liquids.	Can maintain viscosity even with temperature changes, including freezing (great for thickened ice pops!).
Cost	Often less expensive than other options.	Can be more expensive due to ease of use and stability.

Important considerations and safety tips

Consult a professional: Always consult with a speech-language pathologist (SLP) and a doctor before thickening any liquids. They will determine the appropriate consistency (IDDSI level) for the patient.
Read labels carefully: The amount of thickener needed can vary greatly between brands and depending on the liquid's temperature. Read the instructions provided by the thickener manufacturer and ensure it is gluten-free, lactose-free, or kosher if necessary.
Thicken before serving: For safety, thicken liquids prior to serving. Do not add more thickener to a pre-thickened liquid that is too thin, as this can cause uneven consistency and lumps. It is safer to start over.
Thickened ice cubes: Never use regular ice cubes in thickened beverages, as they will melt and change the consistency, creating a swallowing hazard. Instead, use gum-based thickeners to create thickened ice cubes.
Avoid certain Ensure products: Some specific Ensure products, like Ensure Clear, are noted as being more difficult to thicken, especially with powdered thickeners. Gel-based thickeners or alternative Ensure products may be better choices.

Conclusion

While adding thickener to Ensure is a common practice for managing dysphagia, it is not a simple pour-and-mix process. Success hinges on selecting the right type of thickener—typically gum-based for better stability and palatability—and using a careful mixing technique to avoid lumps and inconsistent viscosity. For the safest and most effective results, always seek guidance from a speech-language pathologist and healthcare team to determine the correct consistency level for the individual. With proper preparation, thickened Ensure can provide a safe and nutritious option for those with swallowing difficulties. For more information on the official guidelines for thickened liquids, refer to the IDDSI website.

Source for official swallowing guidelines: IDDSI: Home

Frequently Asked Questions

Lumps in thickened Ensure are often caused by adding the thickener powder directly into the liquid instead of adding the liquid to the powder. The high protein and fat content in Ensure can also make it more challenging to mix smoothly, especially with starch-based powders.

It is not recommended to use household ingredients like cornstarch to thicken Ensure for a person with dysphagia. Commercial thickeners are specifically designed to achieve a consistent, stable, and predictable viscosity required for safe swallowing. Homemade thickeners can break down over time, creating a swallowing hazard.

Yes, you can thicken Ensure for use in both hot and cold preparations. However, the temperature of the liquid can affect the final consistency, so it's important to be consistent with your mixing and follow the manufacturer's instructions. Gum-based thickeners are generally more stable across a wider temperature range.

Liquid or gel-based thickeners are generally easier and more effective for thickening high-protein supplements like Ensure. They blend more readily, are less prone to clumping, and typically result in a more stable, lump-free consistency than powdered thickeners.

The stability of thickened Ensure depends on the type of thickener used. Gum-based thickeners can maintain a stable consistency for several hours (often up to 4 hours). Starch-based thickeners, however, may continue to thicken over time, requiring immediate consumption after mixing.

Yes, thickened Ensure can often be prepared in a bulk batch, covered tightly, and refrigerated. It is best to check the manufacturer's specific guidelines, but the mixture is usually stable for up to 24 hours. Always re-whisk and re-check the consistency before serving from a refrigerated batch.

The International Dysphagia Diet Standardisation Initiative (IDDSI) is a global framework that standardizes food texture and drink thickness levels for people with dysphagia. It is important because it provides a clear, measurable, and consistent system for healthcare professionals to prescribe the safest consistency, reducing risks associated with swallowing disorders.