Dysphagia Facts

1. WHAT IS DYSPHAGIA?

Dysphagia (pronounced dis - fay - ja) is the medical term that means swallowing difficulty. Someone with Dysphagia has a hard time swallowing foods and/or liquids without having them “go down the wrong pipe”. Dysphagia is not a disease; it is a condition that results because of a disease. Some of the common reasons why someone might develop Dysphagia include; having a stroke, mouth or throat cancer, nerve disorders (like Parkinson’s, multiple sclerosis, ALS, etc.) or dementia / Alzheimer’s (forgetting how to swallow). Dysphagia could be short term or it might be a life-long problem.

2. WHAT DOES NECTAR–LIKE CONSISTENCY MEAN?

Nectar–like is a term to describe a liquid that is slightly thicker than water. Nectar–like is not a flavor and it has nothing to do with any particular fruit nectar. You can buy beverages called nectars like pear nectar but this does not mean that the item is nectar–like. A nectar–like beverage will be the consistency of an unset gelatin.

3. WHAT DOES HONEY–LIKE CONSISTENCY MEAN?

Honey–like is a term to describe a liquid that is as thick as honey but it is not honey, beverages are not honey flavored and do not contain any honey.

4. WHAT DOES SPOON-THICK OR PUDDING CONSISTENCY MEAN?

Spoon-thick or “pudding” consistency are terms used to describe a liquid that is as thick as a pudding.

5. CAN I THICKEN SUPPLEMENTS (LIKE BOOST® OR ENSURE®) WITH THICKENERS?

Yes, you can thicken any liquid; however, thickening supplements is not always easy. Supplements are harder to thicken because they are higher in protein and fat than water, fruit juices, and other typical beverages. Liquid thickeners will work best when thickening supplements because they are already a liquid and will mix in easier. Powder thickeners can be used to thicken supplements but because they are powder they have more of a tendency to make lumps. You will need to stir the thickener into the supplement well. And, follow the manufacturer’s instructions for the amount of thickener to add to reach the consistency you need.

6. I HAVE DIABETES. WILL DRINKING THICKENED LIQUIDS MAKE MY BLOOD SUGAR LEVELS GO UP?

All thickeners are safe for diabetics to use. Different brands of thickeners will have slightly different amounts of carbohydrate and calories per serving so be sure to check the label of the thickener you are using. Thickeners add very few carbohydrates or calories to beverages. Generally it is the beverage itself that will have more of an impact on blood sugar levels. If you are counting carbohydrates, you will want to include the amount of carbohydrate that the thickener adds to the meal occasion and treat it like you would any other carbohydrate.

7. IF I CAN ONLY DRINK THICKENED LIQUIDS WON’T I STILL BE THIRSTY?

Thirst is a mechanism that your body uses to let you know it needs water. Keeping in mind that thickened liquids are providing fluid feeling thirsty may mean you simply need to drink more – even if more means drinking another thickened beverage.
Some people will say they do not feel as satisfied or quenched with only thickened liquids. We suggest including ‘lighter’ beverages – like water, lemonade, or tart fruit drinks - that might be more refreshing.

8. IF I CAN ONLY DRINK THICKENED LIQUIDS WON’T I GET DEHYDRATED?

Thickened liquids provide the same hydration that you would get from the unthickened liquid. The thickeners, whether powder or liquid, do not bind fluids. Powder thickeners are generally made from a modified cornstarch which begins to breakdown right away in the mouth. The process of starch digestion actually provides water into the system. The liquid thickeners do not begin to digest until they are in the colon but they still free up water for reabsorption by the body.

9. DO I NEED A PRESCRIPTION FOR THICKENERS OR THICKENED LIQUIDS?

No, you do not need a prescription. However, your speech therapist or other health care professional should give you a diet level and/or liquid consistency to follow and instructions for use of the product.

10. WHERE CAN I BUY THICKENERS AND THICKENED LIQUIDS?

Many products are available through this web site www.Dysphagia-Diet.com. Other drug store web sites and manufacturer web sites may also sell the product(s) you are seeking.

11. WILL MY INSURANCE PAY FOR THICKENERS OR PRE-THICKENED LIQUIDS?

Maybe. Insurance coverage will vary from state to state and plan to plan. Ask your insurance provider if thickened beverages are covered or what information you need to provide to request coverage consideration. Sometimes your physician or other healthcare provider can be of assistance.

12. HOW CAN A PERSON GET USED TO DRINKING LIQUIDS THICKENED?

Thickened liquids are not normal but they can become an acquired taste. It is best to start out with a beverage that will not seem so unusual if it is a little thicker. Something like apple juice when thickened will taste like applesauce. Other fruit juices when thickened will taste like fruit purée. Once ‘eating your liquids’ is a not so odd, additional beverage can start to be included like water, milk, coffee, tea and so on.

13. WHAT IS THE DIFFERENCE BETWEEN POWDER THICKENERS AND LIQUID THICKENERS

The main difference between powder thickeners and liquid thickeners will be ease of use and cost. Liquid thickeners will be easier to mix into liquids. Use whichever product you like that works well for your situation and is easily available.

14. IS ONE TYPE OF THICKENER BETTER THAN THE OTHERS?

No, there are a variety of thickeners in the marketplace and they all do the job. Use whichever product you like that works well for your situation and is easily available.

15. CAN YOU THICKEN BEER, WINE OR OTHER ALCOHOLIC BEVERAGES?

Yes, but carbonation will be lost with starch-based thickeners. Gum-based thickeners can retain carbonation. Also, depending on the thickener you use the beverage may “foam up” so start with a larger glass to allow for expansion and easy stirring.

16. CAN YOU THICKEN SODA POP?

Yes, but carbonation will be lost. Gum-based thickeners can retain carbonation. Also, depending on the thickener you use the beverage may “foam up” so start with a larger glass to allow for expansion and easy stirring.

17. HOW DO I THICKEN BREAST MILK?

Your speech language pathologist will give you instructions for thickening and a consistency target. Enzymes in breast milk may break down some commercial thickening agents so it is important to discuss brands and product options with your healthcare provider.

18. CAN I USE THICKENERS TO THICKEN SOLID FOODS?

Yes, check with the manufacturer’s web site for recipes or call them via their 800 toll-free number on the product label for recipes. As a rule of thumb the amount of thickener per serving of a pureed solid food will be similar to what is needed for a serving of a thickened liquid.

19. WHAT IS IDDSI?

IDDSI is the International Dysphagia Diet Standardization Initiative. A global initiative to improve the lives of over 590 million people worldwide living with dysphagia.
In 2017, ASHA, the American Speech and Hearing Association and FNCE, The Academy of Nutrition and Dietetic have both endorsed the new framework that is culturally sensitive, measurable and applicable to individuals of all age groups in all care settings.
For more information go to https://iddsi.org

20. CAN BEVERAGES BE THICKENED IN BULK IN ADVANCE?

IDDSI recommends using a Flow Test to determine Viscosity at the time of serving the beverage.

21. DO THICKENERS CAUSE CONSTIPATION?

Thickeners would not be expected to cause or contribute to constipation. Generally, inadequate fluid or fiber intake and the overall diet composition contribute to constipation. Medications and lack of physical activity may also play a role in constipation.

22. DO THICKENERS CAUSE DIARRHEA?

Thickeners would not be expected to cause or contribute to diarrhea.

23. HOW DO I SELECT THE BEST THICKENER?

The following chart is intended to help you understand the pros and cons of the different thickening agents you can buy. Information is included for pre-thickened products to help you decide if that is a good choice for you. Before you change any current product you are using be sure to discuss options with your speech language pathologist, doctor, dietitian or other health care provider that is assisting you with your dysphagia management.

	Powder Thickeners (Starch & Gum Based)	Liquid Thickeners (Gum-Based)	Pre-Thickened Products
Considerations
Variety	Virtually limitless. Powder thickeners can be mixed with any beverage to the desired consistency. Powder thickeners will be slightly more difficult to use in carbonated, alcoholic and high protein shake / supplement beverages.	Virtually limitless. Liquid thickeners can be mixed with any beverage to the desired consistency. Easier to use in carbonated, alcoholic and high protein shake / supplement beverages	Variety of pre-thickened beverages is limited to 'popular' items such as water, milk, and several juices or juice drink beverages.
Can I thicken hot and cold beverages?	Yes, although thickening hot drinks is not always easy.	Yes, liquids work well in hot drinks.	It is not recommended to heat pre-thickened drinks as heating may interfere with the consistency.
Appearance	Clear beverages will appear cloudy with starch-based and have a slightly grainy texture.	Clear beverages remain clear and smooth.	Clear beverages are slightly cloudy and smooth in texture.
Easy to Use	Powder thickeners require measuring and immediate vigorous mixing to get them into solution. Powders can lump if not thoroughly mixed in.	Liquid thickeners require measuring and vigorous mixing to get them into solution. Liquid thickeners will not lump.	No mixing required. Just open and drink.
Time to thicken	Starch-based powder thickeners require from 1 to 3 minutes to reach consistency depending on brand used. Gum-based require 5 minutes.	Liquid thickeners require virtually no time to reach consistency.	No time, pre-thickened drinks are at the labeled consistency right out of the package whether chilled or at room temperature. However, the beverage may appear to be slightly thicker when chilled.
Thickening over time	Starch-based powder thickeners may thicken over time, especially if too much powder is added initially. After 5 minutes, gum-based do not thicken over time.	Liquid thickeners do not thicken over time.	Pre-thickened drinks will not change consistency but they will be slightly thicker when chilled vs. at room temperature. Pre-thickened beverages are designed to be the consistency as labeled regardless of serving temperature.
Cost	Starch-based powder thickeners will tend to be the least expensive because they are the most basic form of thickening agent. Powdered gums may be a bit more expensive.	Liquid thickeners are a step on in convenience so they will be more expensive then powders but less then pre-thickened.	Pre-thickened beverages will be the most expensive because they offer total convenience.
Can I thicken foods?	Yes. Most manufacturers will have recipes for using the powder thickeners in a variety of foods.	Yes. Most manufacturers will have recipes for using the liquid thickeners in a variety of foods.	For maximum convenience there are some canned pureed foods available that are heat and serve.
Ingredients	Modified (corn) food starch or carboxy methyl cellulose gum.	Xanthan gum	Check product label for thickening agent used.
Packaging Options	Resealable Can, Individual serving packets	Recloseable bottle, Individual serving pouch	Recloseable multi-serving container, 8 fl oz., 4 fl oz.
Shelf Life	24 - 36 months unopened	12-24 months unopened	9-12 months unopened
Are these okay for people with diabetes?	Yes, most starch-based powder thickeners will add approximately 1 carbohydrate exchange to the food/drink. Gum-based will not contribute any meaningful amount of carbohydrates to the food/drink.	Yes, liquid thickeners will not contribute any meaningful amount of carbohydrates to the food/drink.	Yes, check the nutrition facts panel for the amount of carbohydrate in the product.
Are these products gluten-free?	Usually they are, but check the label to be certain.	Usually they are, but check the label to be certain.	Usually they are, but check the label to be certain.
Are these products lactose-free?	Usually they are, but check the label to be certain.	Usually they are, but check the label to be certain.	Unless it is thickened milk, usually they are, but check the label to be certain.
Are these products kosher?	Usually they are, but check the label to be certain.	Usually they are, but check the label to be certain.	Usually they are, but check the label to be certain.

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