Understanding the IDDSI Framework and Level 3 Consistency
For individuals with dysphagia, a condition that makes swallowing difficult, altering the thickness of liquids is a common safety precaution. The International Dysphagia Diet Standardisation Initiative (IDDSI) provides a globally recognized framework with standardized levels for liquid thickness and food texture. Level 3, known as 'Moderately Thick' or 'Honey Thick', describes a liquid that is thick enough to drip slowly off a spoon in dollops or strands, yet can still be taken from a cup. This consistency requires some effort to drink, even with a wide-bore straw. The specific viscosity for Level 3 is defined by the IDDSI Flow Test, where 8-10 mL of liquid remains in a 10 mL syringe after 10 seconds.
Why Thickener Amount Recommendations Vary by Brand
There is no single correct answer to how many scoops of thickener for level 3? because the formula and potency of thickening agents differ between manufacturers. Thickeners are typically made from either starch or a gum base (like xanthan gum), each with a different mechanism for creating viscosity. Gum-based thickeners, for example, often require less powder to achieve the same result as starch-based ones. This variance is why it is critical to always use the scoop provided with the thickener container and to follow the mixing chart printed on the packaging.
Factors Influencing Liquid Thickness
Beyond the brand and type of thickener, several other factors can affect the final liquid consistency:
- Type of Liquid: The composition of the liquid being thickened is a significant variable. Liquids with different pH levels, such as fruit juices, or those containing fats, like milk, can react differently with thickeners than plain water. For example, thickening tea or coffee requires adding milk and sugar before the thickener.
- Temperature: The temperature of the liquid can impact how quickly and how much it thickens. Some thickeners are designed to work well in both hot and cold liquids, while others may perform differently. Some products may require a short standing time after mixing to reach their final consistency.
- Mixing Technique: Over-mixing can incorporate too much air, creating bubbles and potentially altering the thickness. Conversely, not stirring quickly and thoroughly enough can result in clumps.
Comparison of Thickeners for IDDSI Level 3
The following table provides examples of the amount of thickener required for IDDSI Level 3 based on specific brand instructions. This should be used as a guide only, and the specific instructions on your product's label must be followed.
| Thickener Brand (Examples from Search) | Amount-to-Liquid Ratio for Level 3 | Notes on Use |
|---|---|---|
| Resource ThickenUp Clear | Follow product instructions for the amount needed per 200ml (6.7 fl oz) | Add powder to empty glass, then add liquid and stir briskly. |
| Thick & Easy® Clear | Follow product instructions for the amount needed per 200ml (6.7 fl oz) | Mix with 200ml of liquid. Leave to stand for 2-3 minutes to reach final thickness. |
| Thick & Easy Instant Food Thickener (Honey-Thick) | Follow product instructions for the amount needed per 4 fl oz | Some products are pre-portioned in packets for convenience. Always check the packet size and instructions. |
The Correct Method for Thickening Liquids
To ensure the final consistency is correct and safe, a standardized mixing procedure is essential. While specific steps can vary, a general process based on thickener guidelines includes:
- Use the Provided Scoop: If your thickener comes with a scoop, use it to measure the powder. Do not substitute it with a standard kitchen measuring spoon, as scoop sizes vary significantly. If not provided, follow weight or volume measurements as instructed.
- Add Powder First: Add the required amount of thickener into a clean, dry glass or cup as per the instructions.
- Measure Liquid: Measure the specific volume of liquid (e.g., 200ml) that corresponds to the amount of thickener being used according to the product's directions.
- Mix Vigorously: Pour the liquid into the glass with the powder. Stir briskly and immediately with a fork or whisk for approximately 20-30 seconds, until the powder is completely dissolved.
- Allow to Stand: Let the thickened liquid stand for the recommended time (usually 1 to 5 minutes) to reach its full, stable consistency.
- Test Consistency: Before serving, always check the thickness. You can use the IDDSI Fork Drip Test, where Level 3 liquid should slowly drip through the prongs in dollops.
Professional Guidance and Safety
Individuals requiring thickened liquids should always be under the care of a healthcare professional, such as a Speech-Language Pathologist (SLP) or dietitian. An SLP will determine the appropriate IDDSI level based on a swallowing assessment. They can provide personalized advice on the correct thickener type, amount, and consistency testing methods. It is crucial to remember that thickening liquids is a medical intervention, not a dietary choice, and requires strict adherence to professional recommendations to prevent aspiration and other complications. For more detailed information on consistency testing, the official IDDSI website offers comprehensive resources, including patient handouts and videos.
Conclusion
Ultimately, the amount of thickener required for IDDSI Level 3 is not a fixed measurement. It is determined by the specific brand of thickener, the volume and type of liquid, and the instructions provided by the manufacturer. Safe consumption depends on precise measurement and proper mixing techniques. Adhering to the guidance of a Speech-Language Pathologist and checking the consistency before each serving are the most important steps to ensure a safe and effective dysphagia diet.
