*This post is sponsored by SimplyThick. Although SimplyThick has paid for this post, I am a huge fan of SimplyThick when liquids need to be thickened! You can visit the SimplyThick Dysphagia Ramblings page here to request free samples.*
SimplyThick (you know, the gel thickener) was founded back in 2001 by John Holahan. SimplyThick was founded when a prototype was created using a liquid xanthan gum thickener. This was a ground-breaking alternative to the starch thickeners that were widely used at the time. You can read more about SimplyThick in John’s own words!
If you have attended the ASHA convention, you might remember their table (the one with the wine fountain!)
Steele, CM, Molfenter, SM, Peladeau-Pigeon, M, Polacco, RC, Yee, C. Variations in Tongue-Palate Swallowing Pressures When Swallowing Xanthan 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 xanthan thickener was supplied by Flavour Creations, Inc.
Results: Healthy adults do recruit higher tongue-palate pressure amplitudes with nectar and honey thick liquids using xanthan 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:
That the sweetness of the flavoring may have contributed to the observed pressure differences compared to the water.
Sip volume was not controlled and the influence of the sip size on tongue pressures is unknown.
Participants with dentures had to remove their top plates to avoid damage from glue from the sensors.
Different thickening agents may encourage different results.
I think this area will take an interesting turn with the amount of people getting their tongues pierced. What are your thoughts?