Difficulty swallowing liquids

It is characterised by coughing or the feeling of needing to clear your throat and the sensation of choking after drinking water or other liquids. It is not common in lung cancer but may occur. Occasionally, voice changes also occur after swallowing. It is recommended to modify and adapt the viscosity/texture of liquids, including water, to prevent these liquids from going to the lung and causing potentially dangerous lung infections.


There are currently three types of viscosities according to the degree of dysphagia to liquids: nectar, honey, or pudding. The referring oncologist will indicate the specific viscosity to which food should be adapted to each case.

Viscosity classification for liquid dysphagia
viscosity Examples of drinks and food
nectar Texture similar to peach juice.
It can be drunk with a straw or a glass.
When decanted, it forms a fine filament.
Tomato juice, peach juice, commercial vegetable creams, gazpacho, liquid yogurts to drink.
honey Honey-like texture.
You can’t drink it with a cane, but you can drink it with a glass.
When decanted, it forms large shapeless drops.
Whipped yogurt, custard.
pudding Custard or pudding texture.
It is eaten only with a spoon.
When decanted, it falls as a shaped mass.
Flam, curd, curd.

There are different types of commercial thickeners, and it is essential to always follow the instructions for each one:

Things to consider when thickening beverages with commercial thickeners
  • The dosage indicated on the package corresponds to the quantity needed to obtain the required viscosity in water. If we thicken a different type of beverage, the dosage to obtain the same viscosity may vary.
  • It is important to respect the time the thickener needs to perform its function. The time may vary depending on the type of liquid and its temperature, so it is recommended to thicken the beverage at the same temperature as it will be consumed, respect the indicated time, and always drink it within the indicated time. This will avoid changes in viscosity due to a temperature change.
  • If adding an ingredient to the beverage or mixing different beverages, it is necessary to do so before adding the thickener. Never thicken a drink and then add another ingredient.
  • The original viscosity of a juice is not always fully liquid, so we may need to add less thickener dosage as indicated on the packaging to achieve the required viscosity.
  • Depending on the fruit or fruits used to make the juice, it may be necessary to strain the juice before thickening it.
Milk and milk drinks
  • Getting the thickener to fully dissolve can be difficult. Generally, milk and milk-based drinks will need a longer action time to thicken.
  • The thickener usually dissolves better if the drink is hot.
Plant-based beverages
  • The dissolution of the thickener in plant-based or vegetable drinks is usually easier than in dairy drinks, although a longer action time may also be necessary.
Carbonated beverages
  • Removing the gas from any beverage containing it will help to include the thickener better.
Other beverages
  • In the case of beverages such as tea, black coffee or other infusions, more thickener than indicated may be required to achieve the desired viscosity.
  • If you have a nutritional supplement prescribed by your centre of reference, you might need to adapt its viscosity considering these recommendations.

Take medication with food, beverages, or gelled water with the indicated viscosity.

Sitting down or as sat up and incorporated as possible, always avoiding hyperextension of the head.

Eat slowly, leaving sufficient time in between each spoonful.

Double textures are those composed of both liquid and solid parts: soup with pasta, rice with milk, yoghurt with muesli, milk with muffins, and foods such as mandarin, oranges, or very juicy fruits. Having both textures in the mouth can make it difficult to control the swallowing of liquids.

Such as pineapple, artichokes, asparagus and fibrous meats, or those that crumble easily when eaten, such as crackers, chips, breadsticks or nuts. Also, avoid pulses where the skin flakes off easily.

When these foods come into contact with the heat of the mouth and saliva, they turn liquid. Agar or special gelled waters, available in pharmacies, can be used for this type of preparation.

You can choose to thicken common beverages following the guidelines from above and, on occasion, prepare beverages with different or uncommon flavours. To do so, prepare the beverage following the standard way, then strain to remove fibres or seeds, and then add thickener to obtain the required viscosity.

Homemade pink lemonade
Ingredients (serves two)

  • 100 g strawberries
  • 50 g blueberries
  • 70 g chilled lemon juice (about two lemons)
  • A few leaves of fresh mint
  • 200 ml very cold water
  • 1 tsp sweetener (sugar, honey, syrup…), optional and according to preference


  • Add the strawberries and blueberries (they should be well chilled and therefore have been in the fridge for a couple of hours before use), cleaned and without leaves, the lemon juice, the mint leaves, water, and sugar or sweetener of your choice to a blender or container suitable for blending.
  • Blend.
  • Strain the lemonade through a very fine sieve to remove any particles.
  • Pour the drink into two glasses.
  • Add the commercial thickener to each glass (containing about 200 ml of lemonade each) and follow the indications of the product and the dosage to obtain the required* viscosity.
  • Check viscosity before serving. Serve cold.

*When making beverages that include non-liquid ingredients, the resulting viscosity may correspond to a nectar or honey viscosity, and therefore it is important to keep in mind that the dosage indicated on the product might have to be adapted.

Avoid eating alone.