Nutrition for dyspagia: honey thick fluids

							                                        “Honey Thick”
                                           Fluids



Dietitian:
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Speech Pathologist:
                                                                                    SMICS
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                                                                        SOUTHERN MELBOURNE
                                                                     INTEGRATED CANCER SERVICE


                                                         This material has been produced as part of a SMICS project by members of the
                                         Speech Pathology and Nutrition Departments at The Alfred, Monash Medical Centre and Peter Mac Cancer Centre

                      #3179 VCS 01/08
Warning Sings                                                            What are “Honey Thick” fluids?
Warning signs to report to your Speech Pathologist:
 7 Coughing/choking when drinking or eating                              These are fluids that have been specially thickened so that they are easier
 7 Recurrent chest infections                                            to control in the mouth and safer to swallow. These fluids are not easily
Warning signs to report to your dietician:                               pourable or drunk from a cup or by straw. It is easiest to take honey thick
 7 Unintentional loss of weight                                          fluids with a spoon. They should leave a thick coating in the cup after
 7 Feelings of thirst or hunger                                          being poured.
 7 If you have a medical condition that requires a therapeutic diet      Why do I need “Honey Thick” fluids?
   Eg. Diabetes, Renal disease
                                                                         Your speech pathologist has identified that you have a swallowing
Remember: All fluids must be thickened including water, tea, juices in   problem. Swallowing problems can occur as a result of head and neck
tin fruit, drinks to wash down tablets.                                  cancer, and / or as a possible side effect of your treatment. Because thin
                                                                         fluids flow quickly they are more likely to enter your airway when you
                                                                         have a swallowing problem. This may cause coughing, chest infections
Additional Comments                                                      and sometimes pneumonia.

                                                                         What fluids are classified as “Honey Thick” fluids?
                                                                         There are 2 main types of honey thick fluids:
                                                                         1. Some pre-prepared foods that are naturally a thick consistency eg.
                                                                            yoghurt, (without fruit pieces), fruche, thick pureed soups, thick
                                                                            custard, gravy and thick sauces.
                                                                         2. Honey thickened fluids which are made using a bamix/blender and a
                                                                            powder thickening agent. Suitable fluids which can be thickened in
                                                                            this way include cordial, fruit juice, milk (plain/flavoured), soup and
                                                                            nutritional supplements (eg. Fortisip, Nutridrink).




                                                                         Adequate Hydration
                                                                         It is important to ensure you still drink enough fluid each day to remain
                                                                         hydrated. Aim for at least 6-8* glasses per day (approximately 1 .5 litres /
                                                                         day), increasing this on hot days. For this reason it is a good idea to make
                                                                         up 1 or 2 litres at a time and keep them refrigerated.
                                                                         (Note: Some people may require a fluid restriction for medical purposes)
Recipes for “Honey Thick” fluids using Supercol or Procol®                  Radiotherapy:
Guarcol, Resource ThickenUp
                                                                            During and after radiotherapy to the head and neck area, swallowing
                                                                            acidic drinks like orange juice and alcohol may become painful. It is
                                           per 1 litre                      recommended that you temporarily avoid these.

     Apple, Or,         1L Juice                                            Thickening Hot Fluids
 Apple/Blackcurrant     3 ½ teaspoons Supercol, Procol® or Guarcol®
       Juice            8 level tablespoons Resource ThickenUp®             Because it can be difficult to thicken hot drinks using Supercol, Procol®
                                                                            or Guarcol, we recommend that hot drinks, such as coffee, tea or hot
    Orange Juice        1L Orange Juice                                     chocolate are thickened individually using Resource ThickenUp®. To
                        3 ½ teaspoons Supercol, Procol® or Guarcol®         prepare, add 4 ½ teaspoons to 200mls of fluid.
                        8 level tablespoons Resource ThickenUp®
                                                                            Alternatively, you can thicken COLD drinks and then heat (microwave,
   Full cream milk      1L Milk                                             stove).
                        3 ½ teaspoons Supercol, Procol® or Guarcol®
                        8 level tablespoons Resource ThickenUp®             Hints for Preparation
      Sustagen          12 scoops Sustagen (240g) + 1L Milk                  7   Use a measuring spoon/jug to ensure exact measurements
                        3 ½ teaspoons Supercol, Procol® or Guarcol®          7   Use a blender or bamix to ensure the drinks are smooth, with no
                        8 level tablespoons Resource ThickenUp®
                                                                                 lumps
       Cordial          1L Water                                             7   Refrigeration may increase thickness of drinks a little. Stir fluid, if it
                        3 ½ teaspoons Supercol, Procol® or Guarcol®              remains too thick, add a small amount of liquid and return to
                        8 level tablespoons Resource ThickenUp®                  blender/ bamix.

                                                                            Commercially Available Thickening Agents and Pre-Made
Thickening Agents:                                                          “Honey Thick” Drinks

NOTE: There are other thickening agents on the market. If you wish to use
                                                                             7   The thickening agents we recommend are Supercol®, Procol® ,
                                                                                 Guarcol and Resource ThickenUp®. Contact your Nutrition
an alternative to Supercol®, Procol®, Guarcol or Resource ThickenUp,
                                                                                 Department for supplies.
speak to your Speech Pathologist and please see below for further
information.
                                                                             7   You can purchase ready-to-serve thickened drinks and thickening
                                                                                 powder from some chemists. Resource® offers a range of thickened
                                                                                 juice and milk drinks available in 1890mL bottles, Tetra packs and
WARNING: Because Supercol® ,          Procol®®, Guarcoland Resource              114mL cups. These pre-thickened drinks come in “Nectar” and
ThickenUp are powerful thickening agents, they should only be used               “Honey” thick. Your Speech Pathologist recommends “Honey
according to the recommended recipes list above. They should never be            Thick”.
inhaled and should be kept out of reach of children.                         7   To locate your nearest Chemist that supplies Resource®, please
                                                                                 contact Novartis on 1800 069 643, or via the internet on
                                                                                 www.novartisnutrition.com