Carbonated Beverages


Not Nectar Thick

When patients have dysphagia, often sensory techniques, including carbonation can help increase aspects of the swallow.  For some reason, at one point in time, the research was translated to substitution of carbonated beverages, including soda to replace nectar thick liquids.



Carbonated Beverages

Carbonated beverages have hit the dysphagia world by storm.  Much of the recent dysphagia research has focused on the sensory portion of the swallow and how sensory drives the swallowing process.  Part of the sensory process is carbonated beverages.  One of the common misconceptions at this time is that carbonated beverages act as a nectar thick liquid.

The Sensory System

Carbonation is a sensory option for dysphagia rehabilitation.   It’s effective through a process called chemesthesis, where the “bubbly” or “fizzy” of the carbonated beverage acts as a Trigeminal irritant.  The Trigeminal Nerve or Cranial Nerve V is one of the major swallowing nerves.  The Trigeminal Nerve has bare nerve endings making it more susceptible to sensory or afferent input.

Rather than acting as a nectar thick liquid, the carbonated beverage actually increases the sensory stimulation for the swallow.  Sensory input (afferent drive) drives the motoric output (efferent drive).

Research of Carbonated Beverages Shows:

No significant effect on oral transit time, pharyngeal transit time, initiation of pharyngeal swallow or pharyngeal retention.  Carbonated beverages sis however decrease penetration/aspiration with 5 & 10 ml swallows.  (Saravou & Walshe).

Carbonated thin liquid significantly decreased the incidence of spillover, delayed pharyngeal response and laryngeal penetration compared to non-carbonated thin liquids.  (Newman et al).

Drinks containing chemical ingredients that activate sour and heat receptors alter swallowing physiology greater than water.  (Krival & Bates).

It is likely that sour and carbonated beverages reflect a more organized activation of the submental muscles because of more effective afferent input to the Nucleus Tractus Solitarius.  (Miura, et al).

One of the important issues to consider when looking at research involving carbonated beverages is that the researchers in these studies do not use Coke, Pepsi or Sprite.  They use Ginger Brew, Club Soda or carbonated citrus.

One Size Does Not Fit All

It is vital, as with any other compensation or technique to view the effects of carbonated beverages.  As with other strategies, you may not see the same effect in every patient and sometimes, the strategy you choose may make the swallow worse.


Krival K, Bates C. Effects of Club Soda and Ginger Brew on Linguapalatal Pressures in Healthy Swallowing. Dysphagia (2012). 27: 228-239.

Newman, et al. Carbonated Thin Liquid Significantly Decreases the Incidence of Spillover, Delayed Pharyngeal Response and Laryngeal Penetration Compared to Non-Carbonated Thin Liquids. Dysphagia 2001: 16: 146-150.

Saravou K, Walshe M. Effects of Carbonated Liquids on Oropharyngeal Swallowing Measures in People with Neurogenic Dysphagia. Dysphagia(2012) 27: 240-250.

Miura, Yutaka, et al. “Effects of taste solutions, carbonation, and cold stimulus on the power frequency content of swallowing submental surface electromyography.” Chemical senses 34.4 (2009): 325-331.

Morishita, M., Mori, S., Yamagami, S., & Mizutani, M. (2014). Effect of carbonated beverages on pharyngeal swallowing in young individuals and elderly inpatients. Dysphagia29(2), 213-222.

Rofes, L., Cola, P. C., & Clavé, P. (2014). The effects of sensory stimulation on neurogenic oropharyngeal dysphagia. Journal of Gastroenterology and Hepatology Research3(5).

Regan, J. (2020). Impact of sensory stimulation on pharyngo-esophageal swallowing biomechanics in adults with dysphagia: a high-resolution manometry study. Dysphagia35(5), 825-833.

Turkington, L., Ward, E. C., Farrell, A., Porter, L., & Wall, L. R. (2019). Impact of carbonation on neurogenic dysphagia and an exploration of the clinical predictors of a response to carbonation. International journal of language & communication disorders54(3), 499-513.

Turkington, L. G., Ward, E. C., & Farrell, A. M. (2017). Carbonation as a sensory enhancement strategy: a narrative synthesis of existing evidence. Disability and rehabilitation39(19), 1958-1967.

Lundine, J. P., Bates, D. G., & Yin, H. (2015). Analysis of carbonated thin liquids in pediatric neurogenic dysphagia. Pediatric radiology45(9), 1323-1332.

17 thoughts on “Carbonated Beverages

  1. Do we know whether carbonated water can be used in the same way as free water or does the altered Ph have a negative impact on the lungs and increase the pneumonia risk when aspirated?

  2. Hi there,
    It is worth considering that carbonated beverages are thought to have multimodal sensory properties (Not just Trigeminal stimulation via chemethesis). Eg. Chandrashekar et al. 2009 and a recent review (Turkington et al. 2016).
    Best wishes,


  3. Well I find coke to be effective. I’m curious , an ER doc told me to take a big gulp….this can work but sometimes it spills over into the airway….is there a recommended protocol? Smaller dips?
    Need help

  4. My wife was told that her epiglottis doesn’t work right and she’s at risk for aspiration unless she drinks thicken liquids. Because of this, she has stopped drinking Squirt and also champagne. This article has given me second thoughts about these drinks. I’ve successfully used ThickenUp Clear in her Chardonnay, but flat champagne and Squirt seems ridiculous. Is there any research about champagne?

  5. I dont usually have carbonated drink, but today i had 2 cans separately cause i was thirsty and was out eating with friends…i noticed that i was able to gulp most of the drink, which would usually be a problem for me with any other fluid. When i got home, i was surprisingly able to gulp down a cup of water, which was something i had difficulties with. And so i searched google to see if there has been any research on this.

  6. I understand that VF/FEES would be good to ensure carbonated drinks are safe and effective as a strategy. but just in case there were still small amounts being aspirated , would there not be concerns about what the acidity levels would do to the lungs? (The same query about acidic drinks goes for uncarbonated drinks such as orange juice). Thanks!

    1. Many people can aspirate a variety of items with no issues. The patient is more than likely aspirating a variety of items prior to VFSS/FEES so testing carbonated beverages can tell you a lot about that patient, whether it is an effective strategy or not. You can’t be completely afraid of aspiration because everyone is going to aspirate at some point.

  7. Thanks so much for summarizing this information so well. I have heard some chatter related to carbonated drinks and now I have a clearebu defat and and great jump off point to continue learning about this.

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