Understanding the Need to Thicken Oral Nutritional Supplements
Individuals with dysphagia often need thickened fluids to facilitate a safer swallow. Thin liquids move quickly, which can increase the risk of aspiration (when fluid enters the lungs), leading to complications like aspiration pneumonia. Oral nutritional supplements (ONS), such as Ensure or Fortisip, are crucial for managing malnutrition, but in their standard, thin liquid form, they can pose a risk for individuals with swallowing difficulties. Therefore, thickening these supplements becomes a necessary part of their nutritional management plan.
The Importance of Professional Guidance
Before attempting to thicken any supplement, it is paramount to consult a healthcare professional, such as a Speech-Language Pathologist (SLP) or dietitian. These specialists can determine the appropriate liquid thickness level based on a thorough swallowing assessment. They are also knowledgeable about the specific interactions between thickening agents and various types of ONS, which can be critical for maintaining the supplement's effectiveness and taste.
Commercial Thickening Agents: Starch vs. Gum
When it comes to thickening oral nutritional supplements, the primary options are commercial powder or gel thickeners, which are typically either starch-based or gum-based. Both types have distinct properties that affect the final product.
Starch-Based Thickeners
Starch-based powders have been used for decades and are generally accessible and affordable. They work by absorbing liquid, and as they sit, they continue to absorb, which can lead to the drink becoming progressively thicker over time. This makes consistency management challenging and is a major drawback, as the thickness level can change between preparation and consumption. Starch thickeners may also give a slightly grainy texture and a starchy flavor, which can negatively affect palatability.
Gum-Based Thickeners
Gum-based thickeners, often made from xanthan gum, are a more modern alternative. They are generally preferred for their ability to create a smooth, consistent texture that is stable over time and temperature. They do not continue to thicken after setting and typically do not alter the flavor of the supplement. However, some studies have noted potential interactions between xanthan gum and the nutrients in certain supplements, which can affect bioavailability. Gel-based versions of gum thickeners are also available and are very effective at preventing lumps.
Comparison of Thickener Types
To illustrate the differences, here is a comparison table of starch-based and gum-based thickeners:
| Feature | Starch-Based Thickeners | Gum-Based Thickeners |
|---|---|---|
| Mechanism | Absorbs liquid and swells, continually thickening over time. | Creates a stable network that maintains its viscosity. |
| Consistency | Can become progressively thicker; may result in lumps or gritty texture. | Stable and consistent viscosity; results in a smooth, clear texture. |
| Taste/Appearance | Can add a starchy flavor and cloudiness. | Generally tasteless and allows clear fluids to remain clear. |
| Cost | Typically more affordable. | Can be more expensive due to advanced formulation. |
| Interaction with Nutrients | Less studied interaction with nutrients compared to gums. | Can bind with positively charged minerals (e.g., iron, zinc), potentially reducing their bioavailability. |
| Temperature Stability | Can be less stable and more difficult to mix correctly with hot liquids. | Viscosity is stable across a wide range of temperatures, including freezing. |
Practical Steps for Thickening ONS
For those authorized by a healthcare provider to thicken ONS, following manufacturer instructions meticulously is key to achieving a safe and effective result. The specific method can vary depending on the thickener and the supplement.
Here is a general guide for using powdered thickeners with ONS:
- Start with a clean, dry cup. Always measure the dry thickener first.
- Measure accurately. Use the scoop provided with the thickener. The dosage needed will depend on the desired International Dysphagia Diet Standardisation Initiative (IDDSI) level, such as mildly thick (nectar) or moderately thick (honey).
- Prepare the supplement. Shake the ONS container well to ensure it is thoroughly mixed.
- Combine and mix. Add the measured thickener to the dry cup first, then pour in the ONS. Stir vigorously with a whisk or fork for the recommended time, usually about 30 seconds. Some supplements, particularly milk-based ones, may require extra whisking.
- Allow it to stand. Let the mixture rest for the specified time, typically 1 to 5 minutes, to allow the thickener to reach its final consistency.
- Check the consistency. Before serving, perform an IDDSI flow test using a 10mL syringe to confirm the correct thickness level. A consistently correct thickness is critical for safety.
- Store and monitor. If preparing a batch, store it tightly covered in the refrigerator and use it within 24 hours. Always re-whisk before serving, as some products can separate upon standing.
Alternative and Advanced Options
Beyond standard powders, other options exist. Pre-thickened oral nutritional supplements are ready-to-drink, offering the highest convenience and most reliable consistency. These are often recommended by healthcare professionals for optimal safety. Some specialized products are formulated with amylase-resistant properties to ensure the supplement doesn't thin out in the mouth due to saliva, a critical feature for dysphagia management.
It is important to remember that successful thickening involves precision. Even small variations in measurement or mixing technique can lead to an inconsistent and potentially unsafe product. For those needing thickened fluids, exploring pre-thickened options or working closely with an SLP to refine thickening methods is essential for both safety and quality of life.
Conclusion
Yes, it is possible and often necessary to thicken oral nutritional supplements for individuals with dysphagia. The process, however, is not as simple as adding a generic thickener. It requires the right choice of commercial thickening agent, often a gum-based one for best consistency, and strict adherence to specific preparation guidelines. Most importantly, it necessitates close collaboration with healthcare professionals, particularly a Speech-Language Pathologist, who can provide expert assessment and recommendations. This ensures that the thickened supplement is not only safe to swallow but also retains its nutritional value, effectively managing both the swallowing difficulty and the risk of malnutrition.
This article is for informational purposes only and should not replace advice from a qualified healthcare professional. For specific guidance on thickening supplements, consult a doctor or speech-language pathologist. For more on the IDDSI standards, visit the official IDDSI website.
