Thick Water and Other Thickened Liquids

Thick water and other thickened liquids allow those with swallowing disorders such as dysphagia to control the fluid in their mouth better. These beverages help slow down the rate these liquids flow down the throat, which lessens the chance of fluid going into your airway. Liquids that go into your airway end up in your lungs and can cause pneumonia or a lung infection.

The thicker consistency of thick water and other thickened liquids makes them less likely to cause a person to accidentally breathe fluid into the lungs (aspirate) while they are drinking. Individuals with difficulty swallowing may find that thickened liquids enable them to swallow safely.

What is thick water?

thick-it clear advantage thick waterThickened liquids are a medical dietary adjustment that increases fluids’ consistency to prevent choking. Thickened liquids are recommended for individuals who have difficulty swallowing (dysphagia) and keeping food or liquid from entering the airway. You may need to have thickened liquids for dysphagia if you have a neurological condition such as a stroke, a weakening of the esophagus’ muscles or nerves, or from a blockage in the throat.

Viscosity is the measurement of how thin or thick a liquid is. The lower the viscosity, the thinner the liquid. Thus, the higher the viscosity, the thicker the liquid. When a thin liquid such as water is mixed with Xanthan Gum or modified starch, the liquid starts to thicken, forming into thick water. The more Xanthum Gum or modified starch added, the thicker the liquid consistency becomes.


Starch-based thickeners are easier to mix, but they are best consumed immediately after mixing. The longer a starch-based thickener sits, the thicker the consistency will become. If the liquid is then refrigerated, the fluid may become too thick.

Xanthan gum-based thickeners are more versatile and have a more stable viscosity than starch. Once this type of thickener achieves its optimal viscosity, your food or beverage will be ready for consumption at the consistency that you want it. Xanthan gum-based thickeners can be frozen, thawed, and refrigerated while retaining the desired consistency.

Commercial Xanthan gum-based thickened products include:

Why would thick water be recommended?

Dysphagia – If you suffer from dysphagia, you may need help moving liquids more slowly down your throat. Thick water and other thickened liquids give extra time to control the liquid while swallowing. Thickened liquids may also help to protect the airway.

Trach Tube Removal – Patients may be advised to consume thickened liquids after the trachea tube that helped them breathe is removed. Thickened liquids may help effectively and safely transfer fluids from the mouth to the stomach after this breathing tube is removed.

Speech or Oral Issue – If you are seeing a Speech-Language Pathologist, they may recommend thickened liquids to make swallowing liquids safer for a couple of reasons.

  • If you have a delayed swallow, thick water or thickened liquids can slow down the liquid flow. Thin liquids move fast and can spill out of the mouth and into the throat before you are ready to swallow.
  • Not only do thin liquids move fast, but they are also difficult to control and unpredictable. Thickened liquids can keep the sip of liquid together in one ball (also known as a bolus). If you have decreased airway closure, thin liquids can splash into the airway before, during, or after swallowing.

The goal is to prevent liquids from entering your airway and getting into your lungs. If fluids enter the airway, it could lead to discomforts such as coughing, congestion, shortness of breath, and aspiration pneumonia.

What are the levels of thickness of thickened liquids?

Liquid consistencies greatly vary across different products. The International Dysphagia Diet Standardisation Initiative ( created a standardization for thickened liquids that includes five levels starting with zero:

0. Thin liquids: (unthickened liquids such as water, coffee, tea, broth, skim milk)

1. Slightly Thick: (similar to V8 juice consistency)

2. Mildly Thick: (nectar consistency)

3. Moderately Thick: (honey consistency)

4. Extremely Thick: (pudding consistency)

The IDDSI created the Flow Test so you can check the thickness accuracy of liquids in your own home. For example, you may think that your Ensure is a thickened liquid, but with the IDDSI Flow Test, it tests as only a thin liquid (level 0). You will need a 10ml Slip Tip Syringe to perform the flow test and can view the steps below.

What are the benefits of thick water and other thickened liquids?

  • Thick water or thickened liquids allow better control of the fluids in the mouth as the swallowing process takes place.
  • Studies have shown there is less of a chance of aspiration with thickened fluids for various reasons specific to the individual swallow.
  • Thickened liquids may allow the throat more time to initiate the beginning phase of swallowing, protecting the airway.
  • There are options for pre-thickened liquids that can be purchased to lessen the potential drawbacks that come with manual thickening of liquids.

Precautions of thickened liquids

  • Those who use thickened liquids are at a higher risk of dehydration, increasing the risk of other complications such as urinary tract infections.
  • Thick water and thickened liquids do not entirely eliminate the risk of aspiration.
  • For some, thick water or other thickened liquids are less favorable to the taste than thin liquids.
  • There are special considerations to consider when thickening liquids, such as clumping, thickening over time if left out, and the effects on blood sugar levels.
  • Thickening liquids requires effort and time if you are manually thickening liquids. Alternately, purchasing pre-thickened liquids can be expensive.

What can you do to improve the taste?

  • 12 pack of Boost Plus nutritional drinkThe more products you try, the more you will discover what you prefer. Many of the products on the market today use Xanthan gum, which helps prevent dry mouth and doesn’t change the taste of the liquid it is added to.
  • When adding a thickener to milk, it may be helpful to add a few drops of vanilla extract to bring back the flavor.
  • The best way to make tasty and naturally thick smoothies is to use a blender. Yogurt, a banana, or avocado can be used as thickening agents. You can add all sorts of fruits, protein powders, or supplements like Ensure or Boost in the nutritional value and taste.

Check out this recipe idea to make: Nutritious Smoothie.

Where to buy thick water and other thickeners?

At Personally Delivered, we carry a wide assortment of thickened liquids and pureed foods. Shop our online store, choose a few different types of thickened products, and start discovering what you like. If you need assistance with your selections, we have helpful Product Experts that can help guide you through the purchasing process.

Always consult with your doctor or nutritionist before taking on a new dietary plan. They will help you estimate the number of calories and protein you need and any dietary restrictions you should follow. If you have diabetes, it is also helpful to check with your doctor about your sugar/carbohydrate intake. Many natural fruits are loaded with sugar. They will also advise you on how thick your liquids and foods should be for safe swallowing.

Popular Thickened Liquids and Other Nutritional Products

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