Dysphagia, or difficulty swallowing, is a condition that can affect people of all ages but is particularly prevalent in older adults and those with neurological conditions or injuries. When a person's mouth or throat muscles are uncoordinated or weak, thin liquids can flow too quickly, potentially entering the airway. This is known as aspiration and can lead to serious respiratory complications, such as pneumonia. To mitigate this risk, specialized diets featuring modified food textures and thickened liquids are often prescribed by a speech-language pathologist (SLP).
What Defines Thickened Drinks Level 2 (Mildly Thick)?
According to the International Dysphagia Diet Standardisation Initiative (IDDSI), a global framework for classifying diet textures, Level 2 is officially known as 'Mildly Thick'. This level corresponds to what was previously often referred to as 'nectar thick'.
Characteristics of Level 2 Mildly Thick Liquids
- Pourable, but slower: A Level 2 liquid pours easily but is noticeably slower than unthickened liquids like water.
- Sippable: It can be sipped from a cup. Drinking it through a standard-bore straw is possible, but requires some effort.
- Uniform Consistency: The liquid should be smooth, without any lumps or fibers that could interfere with swallowing.
- Testing Method: The IDDSI framework provides a simple, low-tech way to verify the thickness using a standard 10 mL syringe. When 10 mL of the liquid is allowed to flow for 10 seconds, a mildly thick liquid will leave between 4 mL and 8 mL remaining in the syringe.
Who Needs Mildly Thickened Liquids?
A speech-language pathologist is responsible for assessing swallowing function and determining the appropriate diet level. A Level 2 mildly thick liquid diet is typically recommended for individuals who struggle with the speed of thin liquids but do not require the slower movement of a more viscous liquid. This might include patients recovering from a mild stroke, those with a short-term infection causing swallowing issues, or others with specific neurological conditions.
How to Prepare Level 2 Thickened Drinks at Home
Preparing Level 2 thickened drinks requires precision and attention to consistency to ensure safety. Different commercial thickeners, whether powder or gel-based, will have their own specific mixing instructions. Most thickeners are tasteless and can be added to a variety of beverages, from water and milk to juice and coffee.
General Preparation Tips
- Read the Label: Always follow the manufacturer's directions for the specific thickener product you are using. The amount needed can vary significantly by brand.
- Measure Accurately: Use the provided scoop to ensure the correct proportion of thickener to liquid. A typical guideline might be two scoops per 200ml of liquid for Level 2, but this varies.
- Mix Thoroughly: Stir the thickener briskly, ideally with a whisk or fork, to prevent lumps. For beverages like milk, using a shaker bottle can help achieve a smoother texture.
- Allow to Stand: Give the mixture a few minutes to reach its full thickness. Some drinks, particularly cold ones, may take longer to thicken completely.
- Test the Consistency: After waiting, perform the IDDSI syringe flow test to confirm the liquid is at the correct Level 2 consistency.
Benefits and Considerations of a Level 2 Thickened Drink Diet
Like any medical intervention, Level 2 thickened liquids have both advantages and potential disadvantages that must be considered.
Benefits
- Increased Safety: The slower flow of the liquid allows individuals with delayed or uncoordinated swallowing reflexes more time to manage the fluid, reducing the risk of aspiration.
- Improved Hydration: By making it safer to drink, patients may be more likely to consume adequate fluids, helping to prevent dehydration.
- Increased Nutritional Intake: If other aspects of the diet are restricted, thickened drinks can help ensure necessary fluids and, when used with nutritional supplements, essential nutrients are consumed.
Considerations
- Reduced Palatability: Some patients report that thickened liquids have an altered taste and texture, which can affect their willingness to drink and lead to poor adherence.
- Potential for Dehydration: Despite improved safety, some individuals may still decrease their overall fluid intake due to taste or feeling full faster, increasing dehydration risk.
- Altered Medication Absorption: Thickened liquids can sometimes impair the absorption or bioavailability of medications. It is essential to discuss all liquid medications with a pharmacist or physician.
- Gastrointestinal Effects: Some thickeners may cause minor side effects, such as gas, bloating, or constipation in certain individuals.
Foods Compatible with a Level 2 Thickened Drink Diet
For individuals on a dysphagia diet, it's important to remember that any fluid-like foods, including sauces, gravies, and soups, may also need to be thickened to the prescribed level.
Suitable Foods to Thicken
- Beverages: Water, juices without pulp, milk, coffee, tea, and nutritional supplements.
- Soups and Sauces: Smooth cream-based soups and gravies can be thickened using a commercial thickener or a household agent like cornflour.
Foods and Drinks to Avoid
- Thinning Foods: Items that melt into a thin liquid in the mouth, such as ice cream, sorbet, and gelatin, are a hazard and should be avoided.
- Soups with Chunks: Any soups containing large pieces of meat or vegetables should be avoided unless pureed and thickened.
Comparison of IDDSI Drink Levels
To illustrate the differences, here is a comparison of Level 2 with the surrounding IDDSI levels for drinks. All are verified using the 10 mL syringe flow test.
| Feature | IDDSI Level 1: Slightly Thick | IDDSI Level 2: Mildly Thick | IDDSI Level 3: Moderately Thick |
|---|---|---|---|
| Flow Rate | Flows slightly slower than water; leaves a little residue on a spoon | Flows slower than Level 1; pours quickly from a spoon | Flows much more slowly; requires a spoon to consume effectively |
| Consistency | Similar to single cream or some anti-regurgitation formulas | Thicker than Level 1; similar to a thick milkshake or syrup | Thick, like honey or custard |
| Consumption | Easily drunk from a cup or through a straw | Drunk from a cup; can use a straw with some effort | Drunk from a cup, but very difficult to drink through a straw |
| Syringe Test (10s) | 1-4 mL remains in the syringe | 4-8 mL remains in the syringe | >8 mL remains in the syringe |
Conclusion
For individuals with dysphagia, Level 2 thickened drinks represent a critical and effective strategy for ensuring safe hydration and managing swallowing difficulties. By slowing the flow of liquids, they provide increased control during swallowing and significantly reduce the risk of aspiration. It is important that the recommendation for this specific level comes from a qualified healthcare professional, such as an SLP, who can provide personalized guidance. Proper preparation according to the IDDSI framework is vital for both safety and nutritional adequacy. As with any diet modification, close monitoring and communication with healthcare providers are key to a successful management plan. For further reference on the framework and testing methods, consult the official IDDSI website.
