Pros and Cons of Thickened Liquids from a Registered Dietitian

Thickened liquids play a critical role in the healthcare, offering a solution to people who have trouble swallowing. Thickened fluids are perfect in their ability to aid individuals with swallowing difficulties, commonly known as dysphagia, and have become a staple in the nutrition care and management of such conditions. 

While the advantages of thickened liquids are undeniable, they also bring with them a set of drawbacks that warrant careful consideration. In this article, we will delve into the pros and cons of thickened liquids, exploring the ways in which they enhance the quality of life for some and pose challenges for others. 

Whether you are a healthcare professional seeking to better understand their implications or an individual affected by dysphagia seeking information on this dietary modification, this comprehensive exploration will provide valuable insights into the multifaceted world of thickened liquids.

three drinks in clear glasses lined up with straws, they appear to be smoothies which are thick liquids.

What are Thickened Liquids?

Thickened liquids are regular drinks that are made using a commercial thickening agent so that drinks can be safely consumed by someone who has swallowing difficulty. Thickened liquids have a slower transit time down the throat and esophagus allowing the throat muscles time to move it down the right pipe.

The thickening agents are usually made from a type of starch (think along the lines of corn starch) in order to thicken the drink. Thickened liquids do not affect the bioavailability of water in drinks, which helps to prevent dehydration if had in adequate amounts.

There are pre-thickened liquids available to buy, but there are also thickening powders which can be added to just about any liquid.

Pros of Thickened Liquids

Thickened liquids can be beneficial for the individual that needs to have them, here are some of the key benefits of them.

  • Reduced risk of aspiration pneumonia
  • Improved swallowing safety
  • Enhanced nutritional intake
  • Customization according to taste
  • Improving quality of life
  • Reduced hospitalization risk

Cons of Thickened Liquids

Thickened fluids are typically given as a matter of health and safe swallowing not by choice, here is a list of cons of thickened fluids that need to be seriously considered.

  • Altered taste and texture is unappealing
  • Difficulty in hydration
  • Limited beverage choices
  • Compliance challenges
  • Preparation storage and hassle
  • Nutritional concerns
  • Cost of purchase

Thickened Liquid Levels

Thickened liquids in the older adult population are offered as either mildly thick or moderately thick. These were previously called honey thick and nectar thick respectively. The thicker the liquid, the slower it moves down the throat, allowing for a safer swallow.

The names prior to being changed to mildly and moderately thick give you a good idea about the type of thickness each should have. A mildly thick fluid should flow easily like nectar, but slow enough that it is not the viscosity of a thin liquid.

Moderately thick fluids, previously called honey thick, are for individuals with serious swallowing difficulties.

Why Would Someone Need Thickened Liquids?

older man grasping his throat appearing to have difficulty swallowing.

Thickened liquids are made for individuals with swallowing difficulty, also known as Dysphagia. Dysphagia is a health condition where the throat muscles have weakened and food and fluids no longer go to the esophagus.

Dysphagia affects people differently, cases range from mild to severe and are typically diagnosed by a Speech Language-Pathologist (SLP). Dysphagia also affects different parts of the throat which leads to a different diagnosis based on where the issue is. These are:

  1. Oropharyngeal Dysphagia
  2. Esophageal Dysphagia
  3. Esophogastric Dysphagia
  4. Paraesophageal Dysphagia

If you want to go more in-depth with your Dysphagia knowledge, here is a good explanation.

Frequently Asked Questions

What if someone refuses thickened fluids?

Quality of life needs to be heavily weighed when someone requires thickened fluids. There are circumstances where someone will refuse thickened fluids, they need to be educated on the risks of not having them. If they have Dysphagia, it’s important that they’re aware they are at high risk of aspiration pneumonia which can lead to premature death.

I’d recommend having a Speech-Language Pathologist involved in the discussion to see if there is a way to compromise. They can manage a balance between quality of life and safety.

Do thickened fluids cause dehydration?

Thickened fluids do not in themselves cause dehydration. But some people that take thickened fluids do not find they quench their thirst, do not enjoy the taste or texture, which results in them not drinking as much fluids.

When they don’t drink enough fluids, typically recommended to have at least 8 cups of fluids per day. They are at higher risk of dehydration, increased risk of urinary tract infections and serious health issues. It’s best to find thickened fluids that they enjoy.

What fluids can’t be thickened?

There are some oral nutritional supplements that are difficult to thicken with a thickening agent. Jell-O is another liquid that does not hold thickening agent so it should not be served to people who need thickened liquids.

All fluids should be given the flow test to ensure that it is thickened to the proper level, you can find the test for liquids here with a video!

Dietitian Takeaway Points

  • Someone with Dysphagia should not automatically be given thickened fluids. Discussions should be held about goals of care, quality of life, and their wishes should be respected.
  • The Registered Dietitian should always be honest about the pros and cons of thickened liquids when discussing the options.
  • A Registered Dietitian, Speech Language-Pathologist and Doctor should always be involved in discussions where someone chooses to not have thickened fluids.
  • Thickened fluids can be a great, safe alternative to keep someone swallowing safely and reduce serious health risks.
  • Ensure someone on thickened fluids is getting a minimum 8 cups of thickened fluids per day.

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Michelle Saari is a Registered Dietitian based in Canada. She has a Master's Degree in Human Nutritional Sciences and is a passionate advocate for spreading easy to understand, reliable, and trustworthy nutrition information. She is currently a full time online entrepreneur with two nutrition focused websites.

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