….But I Don’t Like Thickened Liquids!

From the desk of Carol G Winchester, MS SLP CCC

I understand that for some reason you have been recommended to drink thickened liquids and you are not a fan of this recommendation at the present time. First let me explain why the thickened liquids have been suggested and then we can discuss options to make it more palatable.

When you swallow, the liquids enter your mouth via glass or cup sip, a straw, or a sip cup such as a Tervis Tumbler with a lid on it. The liquid then goes over the tongue and theoretically gathers in the middle of the tongue until you voluntarily swallow. At that point, the tongue throws the liquid back into the throat, or pharynx, and at the same time your vocal cords close to protect your airway as you hold your breath during the swallow. Try that now yourself: Swallow a sip of a drink or the saliva in your mouth. You had to hold your breath to make that happen!  When you have dysphagia, the coordination of these movements is interrupted at some point, and that puts the liquid at risk of entering the airway with open vocal folds, at which point you either cough it out or the liquid heads to the lungs. The theory of thickened liquids is that the thicker a liquid is, the slower it travels through the mouth and throat, and the more time your brain has to perform the coordinated movements to protect your airway and your lungs. It is not unlike that ketchup commercial we are all familiar with – Heinz Ketchup being thicker than Catsup– remember that? The Heinz Ketchup is thicker and when they turn the bottles upside down, the Heinz takes a lot longer to come out of the bottle. That’s what thickened liquids do to protect you!

So what can you do to keep yourself safe while at the same time enjoy the liquids you love? Let’s take a look at the different consistencies and see what options I can present:

Thin Liquids are a problem with meals but seem ok other times: This is likely caused by the food residue you have in your mouth or throat during the meal process. The thin liquids literally bounce off the residue and enter the airway before you have time to gather and swallow safely. Your speech therapist may have recommended using a lid on a cup, like the Tervis Tumbler, without a straw, so that the liquid enters into the front of the mouth and gives you a little more control. They may also have tried various techniques with a swallowing instrumentation, such as FEES (Fiberoptic Endoscopic Evaluation of Swallowing), to verify exactly what is going on and give you alternatives. Taking small sips, one at a time, is very important while eating.

Nectar Thick Liquids: This consistency is likely recommended because the control on the thin liquids was just too risky. Nectar thick liquids can be achieved by utilizing a thickener with the liquid, or you can buy naturally nectar thick liquids so that no thickener is necessary. For example, there are nectar juices (in the juice aisle of the grocery store), nutritional drinks such as Ensure, or even some soda pop with bubbles that make it act like a nectar thick liquid. Some almond milks (or any alternative milk) and chocolate milks may be thick enough to function as a nectar thick liquid. Tomato juice is always a good alternative if GERD is not a problem for you, as is prune juice. In lieu of thickening your water, try some of the bubbly waters with flavors that are on the market. There are so many alternatives that you can work with your Speech Pathologist to fine-tune to your needs! If you are going to use a thickener, there are some that are on the market that don’t change the taste of your drinks. Look for our links to the products we like!

Honey Thick Liquid: Honey thick liquids are a little more difficult to buy off the shelf in the grocery store, but you can make them palatable. The obvious choice is a milkshake. We often suggest trying a McDonald’s milkshake with that fat straw that they provide, and see if that gives you the control you need to swallow safely. In addition to a milkshake, a frosty or Icee with a flavor may give you a bit of a treat in a safe way. Do not drink the melted ice, as that would be a thin liquid, but work with your Speech Pathologist on these techniques. Finally, we suggest to our clients that you secure a good thickener for the type of drink you wish to consume. For example, I once had a client that wanted to play poker with the guys, and he was embarrassed that he had to use a thick liquid and couldn’t enjoy a beer. We showed him how he could try two or three different thickeners that were perfectly compatible with beer, and lo and behold he rejoined his poker group and enjoyed his beer…..and did so safely! Water thickened to a honey thick consistency is not great, no matter how you do it, so I always suggest making a tea or lemonade or some flavor you enjoy to mix with your water.  Be careful not to add ice and let it melt, as that will make your liquid thinner and defeat the purpose. I’ve yet to find a patient that could not find something they love, but hadn’t thought of, to safely enjoy the honey thick liquid!

One more thought. Please remember that your dysphagia may be temporary, or you may be in the rehabilitation process. The thickened liquids are akin to putting a bandaid on a cut. You are giving your muscles, nerves, and lungs a chance to heal and to function to their full potential. If you do not give them time to heal, you only diminish your full potential for recovery. Figuring out your preferences and techniques to accommodate yourself during this time is worth a conversation with your Speech Pathology Dysphagia Specialist. The options are endless!


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