The Role of Thick Water in Swallowing Disorders

Thickened water, while unfamiliar to many, plays a crucial role in the lives of individuals with certain health conditions. Let's delve deeper into the world of thick water and explore its characteristics, uses, and importance.

What Is Thick Water? Understanding the Basics

Thick water, also referred to as thickened water, is a specially modified form of water designed to have a higher viscosity than regular water. It's created by adding specific thickening agents to plain water, transforming its consistency from liquid to a more gel-like substance. The thickness can be adjusted to various levels, ranging from slightly thicker than normal water to a pudding-like consistency. It is commonly used as part of dysphagia management for individuals with swallowing difficulties (dysphagia) which is used to reduce the risk of aspiration.

People with dysphagia might have trouble swallowing thin liquids because they can flow quickly, increasing the risk of liquids entering the airway and causing aspiration. Thickening liquids can help slow down the flow, making them safer to swallow.

The Science Behind Thickened Water

The thickening process involves using specific commercial thickening agent or powders that change the molecular structure of the water. The level of thickening can vary based on individual needs, as determined by healthcare professionals such as speech-language pathologists.

Thickened Water Purpose: A Lifeline for Many

The primary purpose of thickened water is to assist individuals with dysphagia, or difficulty swallowing. This condition can affect people of all ages but is more common in older adults and those with certain medical conditions. Some causes of dysphagia include:

1. Neurological disorders: Parkinson's disease, multiple sclerosis, cerebral palsy
2. Stroke or traumatic brain injury
3. Muscular disorders: Muscular dystrophy
4. Developmental disabilities
5. Dementia and Alzheimer's disease
6. Certain types of cancer, especially those affecting the head and neck

For these individuals, thin liquids like regular water can pose a serious risk. When swallowing is impaired, thin liquids can easily enter the airway instead of the esophagus, leading to choking or aspiration pneumonia - a potentially life-threatening condition where liquid enters the lungs.

Thickened water moves more slowly through the throat, allowing more time for the swallowing muscles to coordinate and direct the liquid properly. This slower movement significantly reduces the risk of aspiration and makes hydration safer for those with swallowing difficulties.

How Does Thick Water Taste? The Sensory Experience

One of the most common questions about thick water is how it tastes. Surprisingly, the taste of thickened water is not too different from regular water, however, it can depend on the type of thickener you are using. Generally, thickening agents are designed to be as neutral as possible, altering the consistency without impacting the flavor, however, as stated above some do change the taste despite their intention.

Moreover, the texture and mouthfeel of thick water are noticeably different:

• Mildly thick (nectar thick): Similar to a thin syrup, fruit nectar or smoothie
• Moderately thick (honey thick): Comparable to room-temperature honey
• Extremely thick (pudding thick): Resembles the consistency of a pudding or yogurt

While the taste supposedly remains largely neutral, some users and even our in our own experience there is a slightly different aftertaste or a subtle change in flavor, especially with higher thickness levels. It's important to note that the sensory experience can vary among individuals, and some may find it takes time to adjust to the new texture or thickness.

Types of Thickened Water Applications

Thickened water comes in various consistencies, each serving a specific purpose:

1. Mildly thick (nectar-like): Often used for individuals with mild dysphagia or as a stepping stone to thinner liquids
2. Moderately thick (honey-like): Suitable for those with moderate swallowing difficulties
3. Extremely thick (pudding-like): Used for severe dysphagia cases where maximum control over liquid flow is necessary

The appropriate thickness is determined by healthcare professionals, typically through a swallowing assessment conducted by a speech-language pathologist.

Preparing and Using Thickened Water

Thickened water can be purchased pre-made or prepared at home using thickening powders or gels. When preparing at home below is a basic outline of how to combine a thickener with water, however, we always recommend following the instructions on the package. 

1. Start with 4oz of cold water 
2. Add the recommended amount of thickener based on desired consistency
3. Mix thoroughly and allow to stand for a few minutes to reach full thickness
4. Always follow the guidance provided by the healthcare professional

It's crucial to maintain the correct consistency, as liquids that are too thin can be dangerous, and some overly thick liquids may be unpalatable.

The concept of thickening isn't limited to water. Almost all other beverages can be thickened to accommodate dysphagia, i.e. coffee, juice, milk, soda, etc. However, it might depending on what thickener you're using in order to achieve the most pleasant final product.

The Importance of Proper Hydration

It might be obvious, but it's super important to note that for individuals using thickened water, maintaining proper hydration is crucial. Dehydration can exacerbate swallowing difficulties and lead to other health complications. Caregivers and/or healthcare providers must emphasize that those relying on thickened liquids consume adequate amounts throughout the day.

Challenges and Considerations

While thickened water provides a safer alternative for those with dysphagia, it's not without challenges. Below are some that we've noticed that can cause issues:

1. Acceptance: Some individuals may find it difficult to adjust to the different texture and/or amounts most thickeners require to be added to 4oz of liquid.
2. Proper preparation: Incorrect mixing can lead to inconsistent thickness
3. Temperature sensitivity: Some thickeners may behave differently with hot or cold liquids

Thickened water allows for safe hydration and helps prevent serious complications associated with dysphagia. If you or someone you know is experiencing swallowing difficulties, it's crucial to consult with a healthcare professional. They can provide proper guidance on the use of thickened water and other strategies to manage dysphagia safely and effectively.