What are the risks of thickeners and how to use them safely?

December 3, 2025 •

3 min read

According to a 2023 briefing from the Gloucestershire Speech and Language Therapy department, thickener use can cause serious complications such as reduced fluid intake, dehydration, chest infections, and constipation. Understanding these potential dangers is crucial for anyone using these agents.

Quick Summary

Thickeners carry risks including gastrointestinal upset, dehydration, and potential choking hazards if improperly prepared. Specific agents pose particular dangers for infants, while prolonged or incorrect use can impact long-term health and quality of life.

Key Points

Dehydration and Malnutrition: Medically prescribed thickeners can lead to reduced fluid intake and malnutrition, as patients may find the altered taste and texture unpleasant.
Risks for Infants: The use of certain thickeners, especially xanthan gum, has been linked to necrotizing enterocolitis (NEC), a serious intestinal condition, particularly in premature infants.
Aspiration and Choking: Improperly prepared thickeners, such as those with lumps or incorrect viscosity, can increase the risk of choking and aspiration in individuals with swallowing difficulties.
Gut Health Concerns: Food thickeners like carrageenan and common emulsifiers have been linked to gut inflammation and alterations in the microbiome in some animal and lab studies.
Altered Medication Absorption: Thickening agents can sometimes interfere with the absorption of prescribed medications, which requires consideration by a healthcare provider.
Quality of Life Impact: The unpleasant taste and texture of thickened fluids can negatively affect a patient's quality of life and create persistent feelings of thirst.
Handling and Preparation Issues: Consistency can change over time or be inconsistent if not mixed properly, impacting its effectiveness and safety.

Understanding the Purpose and Potential Drawbacks of Thickeners

Thickeners are substances added to liquids or foods to increase their viscosity. In a medical context, they are commonly used for individuals with dysphagia (swallowing difficulties) to make drinks safer and easier to swallow, reducing the risk of aspiration pneumonia. However, their use is not without risks, which vary depending on the patient's age, medical condition, and the type of thickener used. Beyond medical applications, thickeners are ubiquitous in processed foods and have generated controversy regarding their potential effects on gut health.

Medical Thickener Risks for Dysphagia Patients

While thickeners are a critical tool for dysphagia management, they introduce several challenges and potential complications for patients. Healthcare professionals must weigh the benefits against these risks on an individual basis. These risks include nutritional and hydration issues like dehydration and malnutrition due to reduced fluid intake from unpleasant taste or texture. There are also physiological risks such as increased pharyngeal residue and difficulty clearing aspirated material, which can lead to infection. Furthermore, altered taste and social stigma can impact a patient's quality of life.

Specific Dangers for Vulnerable Populations

Certain groups, particularly premature infants and individuals with specific medical histories, are at a higher risk of serious complications from thickener use. In 2011, the FDA issued a warning regarding a xanthan gum-based thickener and its association with necrotizing enterocolitis (NEC), a severe inflammatory intestinal condition, in premature infants. This underscores the need for extreme caution when using thickeners with infants. For more details on the risks of fluid thickeners in dysphagia, you can refer to {Link: DrOracle.ai https://www.droracle.ai/articles/324583/contraindications-or-risks-of-fluid-thickener}.

Patients with impaired sensation or a history of aspiration pneumonia also require close monitoring.

Thickener Use in Processed Foods: The Carrageenan and Emulsifier Controversy

Beyond medical use, thickeners and emulsifiers in processed foods have raised concerns.

Carrageenan's Potential Effects

Carrageenan, derived from red seaweed, has been linked to intestinal inflammation and increased gut permeability in some studies. Some individuals also report digestive issues.

Emulsifiers and the Gut Microbiome

Food emulsifiers like CMC and P80 have been shown in animal studies to alter the gut microbiome, potentially leading to inflammation and metabolic disorders. Minimizing exposure, especially for infants, is recommended.

Risks from Improper Mixing and Preparation

Incorrect preparation can increase the risk of harm.

Incorrect Consistency: Too little thickener doesn't reduce aspiration risk, while too much creates a choking hazard.
Lumps: Poorly mixed powder can create lumps, a choking hazard.
Delayed Thickening: Some thickeners' consistency changes over time, requiring careful timing for safe consumption.

Comparison of Common Thickener Types

Understanding the different properties of medical thickeners is important.


Feature	Starch-Based Thickeners	Gum-Based Thickeners	Key Risk
Mechanism	Swells and binds with liquid.	Forms a gel-like matrix.	Risk of altering taste/texture and inconsistency over time.
Effectiveness	Can effectively thicken liquids.	Often more effective at reducing penetration/aspiration.	Potentially less effective for some patients compared to gum-based.
Patient Acceptance	Sometimes less palatable; may be gritty.	Often better accepted by patients due to smoother texture and less impact on taste.	Dependent on patient preference and specific thickener.
GI Side Effects	Associated with constipation with prolonged use.	Can cause gas and bloating in high amounts.	Risk of constipation with prolonged use.
Example	Modified cornstarch.	Xanthan gum, guar gum.	Xanthan gum has a historical link to NEC in premature infants.

Conclusion

Thickeners have risks in both food and healthcare. Medical use can lead to dehydration, malnutrition, and patient compliance issues, while improper preparation creates choking and aspiration hazards. Some thickeners pose severe risks like NEC in premature infants. Processed food thickeners like carrageenan and emulsifiers are being studied for effects on gut health. Safe and effective use requires understanding the risks and seeking professional guidance. For dysphagia, work with healthcare professionals to choose appropriate thickeners and monitor for complications. Be aware of thickeners in processed foods to make informed dietary choices. {Link: GHC NHS https://www.ghc.nhs.uk/our-teams-and-services/adultslt/slt-resources-for-professionals/}.

Frequently Asked Questions

Yes, medically prescribed food thickeners can cause dehydration. Many patients with dysphagia may drink less fluids than they need because they dislike the taste and texture of thickened liquids, leading to insufficient fluid intake.

While thickeners are sometimes used for infant reflux, certain types like xanthan gum have been linked to necrotizing enterocolitis (NEC) in premature infants. Professional medical advice is crucial, and parents should never use thickeners on infants without a specific recommendation from a pediatrician.

For individuals with dysphagia, risks of thickeners include dehydration, reduced quality of life due to altered taste, increased pharyngeal residue after swallowing, and difficulty clearing aspirated material from the airway.

Some animal and lab studies suggest that carrageenan can cause gut inflammation and increase intestinal permeability. However, human research is limited and mixed, and more evidence is needed to determine the effects on human health.

High doses of xanthan gum can cause digestive issues like gas, bloating, and diarrhea due to its high fiber content. It can also potentially trigger allergic reactions in sensitive individuals, especially if derived from allergenic sources like corn or wheat.

Some emulsifiers, a category of thickeners used in processed foods, have been linked to changes in the gut microbiome and potential inflammatory issues in animal studies. While generally recognized as safe, experts advise minimizing intake of these additives, particularly for infants.

Improper mixing can lead to lumps or an incorrect thickness, which can increase the risk of choking or aspiration. Using the wrong viscosity can also negate the safety benefits intended for dysphagia patients.

Yes, thickeners can affect the absorption and effectiveness of some prescribed medications. It is important to consider this interaction and discuss it with a healthcare professional.