While it seems counterintuitive to thicken food for dysphagia patients, food thickeners can be effective in preventing aspiration – a condition where patients may accidentally breathe food into their windpipe due to reduced tongue control or poor swallowing reflexes. People with swallowing impairment often suffer from aspiration, which may result in aspiration pneumonia.

Thickeners are usually added to a food or liquid to increase the viscosity of a diet or beverage. They tend to be odourless and tasteless and are usually gum or starch-based. Generally, food thickeners minimise risks of aspiration by reducing the speed of which the food travels down the throat, and allows more time for the muscles to close the windpipe.

In general, there are two ways for patients to consume fluids – pre-thickened drinks[LSYS2]  that are commercially sold or by adding thickening agents to a beverage at home. The latter is more widely used in Singapore but it comes with challenges and health risks if the meal is not prepared correctly. Based on observations of caregivers and speech therapists, the following are challenges encountered in thickening foods.

Runny Mixture

Adding too little thickener may result in a runny mixture. Since certain dysphagia patients may not be able to consume watery substances, this increases the risks of aspiration and in worse cases, aspiration pneumonia when water gets into their lungs.

Lumpy Mixture

On the other hand, adding too much thickener or not stirring a mixture properly may result in lumps. This can increase risks of choking and may potentially block proper airflow.

Changes to Texture

There are situations where the correct amount of thickener was added, but enzymes from contact with saliva, or changes in surrounding temperature may alter the consistency of the mixture. This may lead to a runny mixture over time. 

Hard-to-thicken Nutritional Supplements

Some food and beverages may take a long time to thicken. For example, milk-based nutritional supplements may take up to 20 minutes of constant stirring for the thickener to properly set after mixing into the beverage. Some nutritional supplements may even be incompatible with all brands of food thickeners, and thus cannot be thickened.

Food Wastage

Improper thickening leads to food waste as the mixture is not suitable to be consumed by the dysphagia patient. This is also an unnecessary cost incurred as both the beverage and the thickener must be disposed.

The greatest challenge of improper food thickening is the risk of aspiration and pneumonia aspiration in dysphagia patients. Depending on the dysphagia diet recommended by a certified healthcare professional, caregivers and patients need to pay attention to the consistency of the food. When it comes to using thickeners, it is recommended for less experienced caregivers to consider pre-thickened drinks [LSYS3] to avoid unnecessary risks. Pre-thickened nutritional supplements are also cost-saving in the long run.

Tip: Always consult a certified speech therapist for further evaluation and advice if you or your loved ones experience dysphagia.