Variations in Tongue-Palate Pressures with Xantham Gum Thickened Liquids-Research Overview

Steele, CM, Molfenter, SM, Peladeau-Pigeon, M, Polacco, RC, Yee, C.  Variations in Tongue-Palate Swallowing Pressures When Swallowing Xantham Gum-Thickened Liquids.  Dysphagia (2014) 29:678-684.

“Thickened liquids are frequently recommended to reduce the risk of aspiration in patients with oropharyngeal dysphagia.”  We know that tongue-palate pressures increase with thicker liquids, however little is known about the differences in swallowing pressures with nectar and honey thick liquids.

“Liquid boluses are initially held in a chamber along the midline groove of the tongue.  The tongue moves upwards and forwards, compressing a bolus against the palate and squeezing it backwards in a conveyer-belt like fashion.  As the bolus reaches the pharynx, the tongue withdraws from the palate, and sweeps downwards and backwards.” 

Participants:  78 healthy adults.  40 (19 men and 21 women) with a mean age of 27 and 38 (22 women and 16 men) with a mean age of 70.  No participants had a history of swallow, motor speech, gastro-esophageal or neurological difficulties.  

Equipment:  Lingual pressures were measured using the lingual manometry module of the KayPentax Swallowing Signals Lab.  Using a soft silicone strip with three pressure bulbs were placed in the palate and measurements were registered at the anterior, mid and posterior hard palate.  Participants took blocks of 4 repeated sips using flavored (lime, raspberry, diet raspberry or cranberry) water, nectar thick and honey thick liquids.  Sip size was not controlled and cups contained 60 ml of liquid.  The cup was instructed to be removed from the lips following each sip.  The xantham thickener was supplied by Flavour Creations, Inc.  

Results:  Healthy adults do recruit higher tongue-palate pressure amplitudes with nectar and honey thick liquids using xantham gum as compared to water.  The authors warn that “although thicker liquids elicit higher amplitudes of tongue-palate pressure compared to water, the observed values should still be easily achieved by most adults, falling below 40% of maximum isometric pressure values.”  It is also important to remember that although thickened liquids require higher tongue pressures to propel, caution is needed when selecting thickened liquids for patients with reduced tongue strength and that viscosity may become too thick to be effective for oral processing.

The authors also warn that there are limitations to the findings including:

  1. That the sweetness of the flavoring may have contributed to the observed pressure differences compared to the water.
  2. Sip volume was not controlled and the influence of the sip size on tongue pressures is unknown.
  3. Participants with dentures had to remove their top plates to avoid damage from glue from the sensors.
  4. Different thickening agents may encourage different results.

Tongue

I think this area will take an interesting turn with the amount of people getting their tongues pierced.  What are your thoughts?

Failure or Success

drinking-glass

I failed the #thickenedliquidchallenge.  When I say failed, I mean 3 drinks in and I was done.  By drinks I don’t mean cups, I mean 3 swallows.  

The message from this:  Please, do not put me on honey thickliquids as I will only take 3 drinks.

In this failure, I did as I pledged.  I donated to the National Foundation of Swallowing Disorders (NFOSD).  I donated to fund a new future webinar because learning and education is so important!

So was my failure really a success?  It depends on your point of view.

Did you take the #thickenedliquidchallenge?  Were you able to drink honey thick liquids for 12 hours?  Did you donate to the NFOSD?

Gelmix Thickener

I was really excited to see Gelmix at the ASHA Convention this year.  I’ve heard a lot about Gelmix, but have never had the opportunity to try it until now!What is Gelmix?

Gelmix is a “healthy thickener” as it is USDA Organic.  Gelmix was formulated to thick breast milk, formula and other liquids.  Gelmix is also free from common allergens including:  gluten, corn, lactose, casein and soy.

Gelmix is made from Carob Bean Gum.  Carob Bean Gum is widely used for its gelling and thickening properties.  The other two ingredients in Gelmix are Organic Tapioca Maltodextrin and Calcium Carbonate.

Gelmix is activated in warm liquids, so you must warm the liquid prior to thickening it with Gelmix.

Gelmix can be used for term infants and children under 3 to thicken to a “light honey-thick consistency.”  For children over 3 and adults, Gelmix can be used to thicken liquids to a “spoon-thick consistency.”

Gelmix is contraindicated for infants under a gestational age of 42 weeks or under 6 pounds.  It also cannot be used with infants with suspected allergy to galactomannans.

Gelmix is available in an 8.8 oz jar (250 grams) which will thicken up to 624 fluid ounces for $29.99 or you can buy the “stick pack” which contain 5 stick, individual serving packets for $5.99.  Each stick will thicken 4 oz of liquid to nectar consistency.

The instructions for thickening with Gelmix:

  • Warm desired amount of liquid (between 100-120 degrees F for best results).
  • Sprinkle in Gelmix per usage instructions.
  • Mix well until Gelmix is completely dissolved.
  • Wait 5 minutes for the mixture to thicken and cool to a safe feeding temperature, mix again before serving.

Usage Instructions:

Infants and Children under 3:

  • Half Nectar:  Add 1 scoop for every 3-4 ounces of liquid.
  • Nectar-Thick:  Add 1 scoop for every 2 ounces of liquid.

(For infants and children under 3 years old, do not use more than one scoop Gelmix per 2 ounces of liquid.  To avoid gassiness, start with lowest concentration, particularly for infants 6-12 pounds.)

Adults and Children over 3:

  • Nectar-Thick:  Add 2 scoops per 4 ounces of liquid.
  • Honey-Thick:  Add 3-4 scoops per 4 ounces of liquid.
  • Spoon-Thick:  Add 4-5 scoops per 4 ounces of liquid.

Gelmix may gradually thicken over time.

Time for a Trial



Last night, I thought what a great time to try Gelmix and combine it with the #thickenedliquidchallenge.   I heated up my water and some milk.  I mixed the Gelmix in, per recommendations for honey thickened liquid.

 

I used a whisk to mix the thickener because when using a spoon, the water was extremely clumpy.  The milk actually became more of a pudding thick liquid.

The water was a little discolored, as with almost all thickened water.  The Gelmix really didn’t add a flavor to the water.

 

The milk was not discolored at all and had no added flavor.

The texture was another thing.  I am just not a honey-thickened liquid person.

I miserably failed the #thickenedliquidchallenge and will be donating to the National Foundation of Swallowing Disorders (NFOSD).

The Gelmix seems to be a good option for a more organic thickener, if you have access to heating your liquids.  It seems to be a great option for babies and would love to hear your thoughts on using Gelmix with babies!