For patients who cannot safely swallow thin liquids, thickening agents are the single most essential piece of dysphagia equipment. A properly thickened drink can be the difference between a patient who stays hydrated and one who develops repeated aspiration pneumonia. But not all commercial thickeners are created equal — in fact, the differences between products are large enough that switching from one brand to another can materially change clinical outcomes, patient compliance, and quality of life.
This guide provides a detailed, brand-by-brand comparison of the most commonly used commercial thickening agents in Hong Kong, Singapore, Australia, the UK, and North America. It covers the two main chemical categories (modified starch and xanthan gum), the practical differences in how they thicken, how they taste, how they interact with different beverages, how they hold up over time, and their relative costs. Written for speech-language pathologists selecting products for their facilities, for families choosing products for home use, and for institutional purchasers making formulary decisions.
Commercial thickeners fall into two broad chemical categories, each with distinct properties:
How they work: Starch granules (typically from corn, potato, or waxy maize) that have been chemically or physically modified to thicken cold liquids more readily than unmodified starch. When added to a liquid, the starch absorbs water and swells, increasing viscosity.
Examples: Thick & Easy (Hormel), ThickenUp (Nestlé — original version), Nutilis Powder (Nutricia), Resource ThickenUp (Nestlé).
Pros:
Cons:
How they work: Xanthan gum is a polysaccharide produced by bacterial fermentation (Xanthomonas campestris). It forms a structured gel network that thickens liquids without heating, and is amylase-resistant (meaning saliva does not break it down significantly).
Examples: SimplyThick (SimplyThick LLC), ThickenUp Clear (Nestlé), Nutilis Clear (Nutricia), Resource ThickenUp Gel Express (Nestlé).
Pros:
Cons:
Category: Xanthan gum Markets: Hong Kong, Singapore, Australia, Europe, USA Pack sizes: 125g tins, 1.4g individual sachets, 24x1.4g box Cost (Hong Kong): HKD 180-220 per 125g tin; HKD 3-5 per sachet
Mixing instructions:
Performance:
Taste: Minimal flavor impact. Slightly slippery mouthfeel.
Professional verdict: Currently the market leader in Asia-Pacific commercial dysphagia care. Used in most Hong Kong Hospital Authority dysphagia programs. Most consistent clinical performance but higher cost.
Category: Xanthan gum (similar to ThickenUp Clear) Markets: Europe (especially UK, Germany), Australia, some Asian markets Pack sizes: 175g tins, 1.2g sachets Cost (Hong Kong): HKD 200-250 per 175g tin
Mixing instructions:
Performance:
Taste: Very neutral. Almost indistinguishable from unthickened drink in subtle flavors.
Professional verdict: Competes directly with ThickenUp Clear. Preferred in UK NHS and European markets. Both are excellent xanthan-based products with minor performance differences.
Category: Modified starch (original); also has a xanthan gum version (Thick & Easy Clear) Markets: USA (dominant), Canada, some international Pack sizes: 225g canister, individual sachets, pre-thickened beverages Cost (Hong Kong): HKD 160-200 per canister
Mixing instructions:
Performance:
Taste: Slight chalky mouthfeel; neutral flavor.
Professional verdict: The most widely used thickener in North American hospitals. Inexpensive, familiar, and effective for patients who are not particularly prolonged drinkers. For patients who drink slowly (>15 minutes per cup), switch to the Clear (xanthan) version.
Category: Xanthan gum (gel form, pre-hydrated) Markets: USA, Canada, Japan, limited Asia Pack sizes: Individual gel packets, bulk gel pumps Cost (Hong Kong): Not widely available; US retail ~USD 40-60 per box
Key feature: SimplyThick is sold as a pre-hydrated gel, not a powder. Caregivers squeeze a premeasured amount into the drink and stir briefly. This eliminates the “will it dissolve?” variability of powder thickeners.
Performance:
CRITICAL SAFETY WARNING: SimplyThick was linked to a cluster of necrotizing enterocolitis (NEC) cases in premature infants in 2011. FDA issued warnings. Do not use SimplyThick or any xanthan-based thickener in infants under 1 year of age. For adult use, SimplyThick is safe.
Professional verdict: Convenient, fast, transparent, amylase-resistant. Popular with home caregivers due to ease of use. Higher cost per drink than powder thickeners. Absolutely contraindicated for infants.
Category: Modified starch (with some gum additives) Markets: UK, Europe, Australia Pack sizes: 300g and 670g tins Cost: Moderate
Performance:
Professional verdict: Older product, being phased out in favor of Nutilis Clear (xanthan version). Still used in some institutions due to cost.
Category: Modified starch Markets: Global Pack sizes: Various
Performance: Traditional starch thickener. Cloudy. Amylase-sensitive. Being replaced by ThickenUp Clear in most markets.
Professional verdict: Outdated. Should be replaced with ThickenUp Clear in any clinical setting unless budget constraints dictate otherwise.
Several brands now offer pre-thickened drinks (water, juice, coffee, milk) in single-serve containers:
Pros:
Cons:
Professional verdict: Valuable for specific settings (travel, short-term stays, or when caregivers cannot reliably measure thickener). Too expensive for daily home use. Most commonly ordered for hospital meal trays.
When evaluating a thickener for your patient or facility, consider:
This is the single most important factor for patients who drink slowly, have significant drooling, or who keep drinks in the mouth for a long time.
Clarity matters for patient acceptance. Many patients refuse “cloudy water” but happily drink “clear thickened water.”
Xanthan thickeners generally have less flavor impact than starch thickeners. However, both can cause a subtle “slippery” or “slimy” mouthfeel that some patients find unpleasant.
Xanthan-thickened drinks hold their viscosity for 4-8 hours. Starch-thickened drinks can thicken over the first 5-10 minutes (as starch absorbs water) and then thin over the next 30 minutes (as amylase begins to work if any saliva has contacted the drink).
| Drink Type | Xanthan Works? | Starch Works? | Notes |
|---|---|---|---|
| Water | Yes | Yes | Both work; xanthan clearer |
| Juice (clear) | Yes | Yes | Xanthan maintains color |
| Juice (pulpy) | Yes | Yes | Both work |
| Milk | Yes | Yes | Both work |
| Tea (hot) | Yes | Yes | Both work |
| Coffee (hot) | Yes | Yes | Both work |
| Carbonated drinks | Partial | Partial | Bubbles lost during mixing |
| Alcohol | Yes | Yes | Less studied |
| Oral Nutritional Supplements (Ensure, Fortisip) | Yes | Yes | Check manufacturer for pre-thickened versions |
| Soup | Usually not needed | Usually not needed | Soups often already at Level 1-2 |
Rough calculations for a 200 mL drink at IDDSI Level 3 (moderately thick):
For a patient drinking 8 cups per day, the daily cost ranges from HKD 12 (starch) to HKD 120 (pre-thickened) — a 10x difference.
Best choice: Xanthan gum powder (ThickenUp Clear or Nutilis Clear) Why: Amylase resistance matters (patients may drink slowly); clarity matters (patient acceptance); cost is manageable for home use; versatile across drinks.
Best choice: Xanthan gum powder in bulk; pre-thickened beverages on meal trays Why: Consistency across staff; reliable IDDSI compliance; can have bulk powder for staff-prepared drinks.
Best choice: Xanthan gum powder in bulk; cost-effective brand (multiple options) Why: Residents often drink slowly; amylase resistance critical; cost control matters.
Best choice: Xanthan gum (ThickenUp Clear), NOT SimplyThick Why: Pediatric safety; xanthan acceptable >12 months; avoid pre-hydrated gels due to NEC history.
NEITHER category recommended without physician direction Why: NEC risk with xanthan; variable effectiveness with starch. In hospitals, rice cereal-thickened feeds are sometimes used but this is a physician decision, not a caregiver choice.
Best choice: Modified starch (Thick & Easy, original ThickenUp) with careful preparation Why: Cost-effective; accept limitations on amylase and clarity; prepare drinks immediately before consumption.
Corn starch, potato starch, or tapioca flour from the grocery store are NOT equivalent to commercial dysphagia thickeners. They have different gelatinization properties, require heating, and do not achieve reliable IDDSI levels. Do not substitute.
Pouring powder “until it looks thick enough” is the most common caregiver error. Without measurement, you cannot achieve consistent IDDSI levels, and the drink may be unsafe (too thin) or unpalatable (too thick). Always measure.
If a starch-thickened drink has thinned due to amylase, adding more powder does NOT restore it. Discard and prepare fresh.
IDDSI compliance should be verified with a flow test (10 mL syringe, 10 seconds) after mixing. Do not assume the recipe produces the right level — always verify.
Switching from ThickenUp Clear to Nutilis Clear mid-week without adjusting measurements can produce different viscosities. If switching brands, re-verify IDDSI levels.
Where to buy thickeners in Hong Kong:
Expected prices:
Commercial thickeners are one of the most important tools in dysphagia management, and the choice between brands and categories materially affects patient safety and quality of life. For most patients in most settings, a xanthan gum-based thickener (ThickenUp Clear, Nutilis Clear, or similar) is the best choice due to its amylase resistance, clarity, and consistent IDDSI compliance. Modified starch thickeners remain useful in budget-constrained settings or for patients who drink quickly and do not experience amylase breakdown problems.
The most important principle, regardless of which thickener you choose, is consistency and measurement. The most expensive thickener in the world will fail a patient if the caregiver adds “a little extra” or “just a pinch less.” Train everyone who prepares drinks, provide accurate measuring tools, verify IDDSI compliance, and adjust as needed based on the patient’s clinical response.
Dysphagia care is ultimately about trust — the patient trusts the caregiver to prepare something safe to drink; the caregiver trusts the product to do what it claims. Choosing a quality thickener, preparing it correctly, and monitoring outcomes is how that trust is built and maintained.