What should I use when thickening food for IDDSI?

We have had quite a few requests for answers to this question recently. In part, this is as a result of organisations adopting our ORAL training and dysphagia foodservice production system principles, which ensure that all the key aspects of producing food for dysphagia diets are considered, and in place, for consistent, assured results. In taking this approach it is inevitable that the question of thickening food for IDDSI is raised.

The IDDSI Framework defines food and drink textures, as levels, using objective, critical, testing methods, set out on the IDDSI Audit Sheets. The suitable textures must be stable over time periods of up to half an hour (giving time for consumption) without significant textural changes that would cause the failure of IDDSI tests and introduce risk.

Cooking for the IDDSI Framework

For the cook trying to ensure that the food they produce can pass the IDDSI Testing Methods, and that it remains suitable over the mealtime can bring great challenges. Time plays a huge part in this puzzle, as over time there are some critical changes that can occur:

Temperature change: Hot food and drinks will cool and cold food and drinks may warm up, affected by the temperature of the things around them. Generally speaking, as things cool down they become thicker and firmer; and as they warm up they become thinner and more tender.

Separation: The physics at play that allows a substance of mixed components to keep its structure is complex, and without everything being ‘just right’ the structure will start to break down. Forces holding things together will be acted on, resulting in changes to appearance, and importantly for maintaining IDDSI requirements, liquid can seep out, separating, and causing mixed textures to become apparent.

Chemical reactions: The complex nature of the composition of food, and some drinks, can mean that reactions between components after the item is made can result in unwanted texture changes. An obvious example of this can be seen with starchy foods that can thicken, become firm or form skins, due to starch molecules binding together.

Why does this matter when thickening food for IDDSI?

Let’s first look at why we might need to thicken food: There are 2 main requirements as to why we might be thickening food for IDDSI.

The first is the most obvious, and relates to LQ3 and PU4, when the food is too thin to pass the IDDSI Testing Method for thickness. For LQ3, the critical test is the Gravity Flow Test, now using the new IDDSI Funnel! If too much of the food passes through the funnel in the 10 second testing time than it will need to be thickened. For PU4, the critical test is the Fork Drip Test. The food will weed to be thickened if, when it is tested, it drips through the prongs of a metal dinner fork.

The second reason for thickening food for IDDSI relates to the separation of thin liquids over time. This can happen at all IDDSI Levels where the occurrences of mixed consistencies must be avoided, LQ3 to EC7. The influence of time here cannot be overstated, as you may find that at first appearance the food produced passes all the defining critical IDDSI Testing Methods, only for separation to occur and creating separate textures.

What methods can be used when thickening food for the IDDSI Framework?

We like to keep things simple at Oak House Kitchen, so that methods can be easily adopted, and lasting improvements can be made.

On the topic of thickening food for IDDSI we must explore what is meant by simplicity. Our experience has shown that the usual solution wanted involves trying to use ingredients and methods that are already available. This sounds simple: the simplicity being the accessibility.

Kitchen staples

This is a very valid option, for many reasons, and provided the approach is taken as a positive decision, and not just to sweep the complexity of this requirement (illustrated above) under the carpet, it can work. Flour and cornflour do indeed thicken, however they are unstable and sticky and require cooking (heating) to work. Accurate recipe testing and controlled cooking, storage and service conditions will need to be tight.

There are many other things available in a kitchen that will add body to something that is too thin, but in almost all cases flavour, colour and nutrition are affected (reflected in the ORAL Quality Audit); complex methods and controls are needed; and what works in one recipe won’t necessarily work in another.

Real simplicity

Working with chefs, organisations and manufacturers, committed to trying to improve their production standards and efficiency, we educate that the simple solution to be identified should be the simplicity of application that can affect the most items being made. To this end let’s look at the practical requirements of a dysphagia foodservice production system:

  1. Have a regular menu that can easily be reformed to any IDDSI Level
  2. Carry out reform processes so that IDDSI Testing Methods can be applied
  3. Find that the food produced is too thin or separates
  4. Mix in something that will correct this instantly so that it is suitable to serve

That’s simplicity, and that’s achievable. The ORAL: Dysphagia Foodservice Production System ensures the menu is available and managed for consistent results. Safety is improved and time and money is saved. This is clear now with the evidence we are seeing.

Point 4 on the list is also achievable with the various starch and gum based food grade thickeners on the market. The all have slightly different specifications and ingredients, but they all allow easy dosing and mixing when thickening food for IDDSI.

What’s next…

Many of the points raised here will be discussed in an upcoming IDDSI Myth Busting session with Peter Lam, Co-Chair of IDDSI, Dr Ben Hanson, expert in the science behind IDDSI and swallowing, and us, giving a culinary perspective. If you are interested in joining in with questions or just listening – SIGN UP HERE – it’s not to be missed!

For the IDDSI Audit sheets, mentioned in the article, visit the IDDSI resources page HERE and download for use.

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