What is Thick Water?

Thick water is water mixed with a food-grade thickening agent to make it safe and easier to swallow. It is used by people with dysphagia — difficulty swallowing — who cannot safely drink regular thin liquids. Thickening slows the flow of the liquid, giving the person more control and reducing the risk of liquid entering the airway.

When I started SimplyThick back in 2001, it was hard to imagine that someday our work to make water thick would become a brief viral challenge. In 2021, there was a TikTok thickened water challenge. It was a strange way for acquaintances to figure out what we do at SimplyThick. And since 2021, the trend comes and goes with some regularity.

The problem with the TikTok challenge is that the best-performing videos showcase the strongest negative reactions to a product that makes someone's life meaningfully better every day. I want to give you the full picture — who needs thick water, why it works, what to expect, and how to get it.

What is dysphagia?

Dysphagia is the medical term for difficulty swallowing. For people with dysphagia, this is not a once-in-a-while issue. Problems occur with most or all of their swallows every single day. Dysphagia can happen at any age and for many reasons. Almost half of all swallowing problems stem from neurological conditions — Parkinson's Disease, stroke, and ALS (Lou Gehrig's disease) among them. Other causes include brain tumors, head and neck cancers, and procedures such as prolonged intubation of the trachea.

People with dysphagia experience problems when they swallow food or drink and often experience a choking sensation. Eating and drinking become a chore. They need to make sure they consume enough to avoid dehydration and malnutrition — not easy when every swallow is a challenge.

Dysphagia is a serious medical condition with a variety of causes and treatments. Do not self-diagnose or self-treat. If you think you or a loved one has dysphagia, seek medical attention.

Which conditions most often lead to a diet order for thick water?

Not everyone with dysphagia needs thick water — a speech-language pathologist (SLP) will evaluate each person and determine the appropriate IDDSI level, if any. That said, certain conditions more commonly lead to a diet order for thickened liquids:

Parkinson's Disease — A progressive neurological condition that gradually affects muscle control throughout the body, including the muscles that coordinate swallowing. As Parkinson's progresses, the swallowing reflex may slow or weaken, increasing aspiration risk.

Stroke — A stroke can damage the parts of the brain that control swallowing. Dysphagia affects approximately 50% of stroke patients in the acute phase, and many continue to need thickened liquids during recovery or long-term.

ALS (Amyotrophic Lateral Sclerosis) — A progressive neuromuscular disease in which swallowing difficulties are common, often becoming more significant as the condition advances.

Dementia — In later stages of Alzheimer's and other dementias, neurological changes can impair the coordination of swallowing. Thickened liquids are commonly used in memory care settings.

Head and neck cancer — Surgery and radiation treatment can damage the structures involved in swallowing, sometimes permanently. Many survivors require thickened liquids as part of long-term dietary management.

Other causes — Traumatic brain injury, multiple sclerosis, cerebral palsy, and prolonged intubation can all affect swallowing function at various stages.

In all of these cases, thick water isn't a treatment for the underlying condition — it's an accommodation that makes safe hydration possible while the condition is managed.

What is thick water, and how does it help?

Thick water is simply plain, ordinary water that is thickened to allow a person with dysphagia to swallow safely. Thickening slows the liquid in the mouth, giving the person more control and reducing the risk of aspiration — liquid entering the airway instead of the esophagus. Aspiration can cause aspiration pneumonia, which is a serious and sometimes life-threatening complication.

The reason we prefer to thicken water and other liquids is that the alternatives are less desirable — feeding tubes, for example. With thick water, the person is still drinking with their mouth, still experiencing the functional and social act of drinking. The least invasive option — thick water — is generally preferred.

How thick is thick water?

Thick water comes in several levels of thickness, according to the International Dysphagia Diet Standardisation Initiative (IDDSI). A speech-language pathologist will determine the specific level appropriate for the individual.

• Level 0 — Thin: Normal, everyday liquids — water, coffee, tea, soda. No modification needed.

• Level 1 — Slightly Thick: Just a little thicker than water. Flows easily from a cup, similar to a light syrup.

• Level 2 — Mildly Thick: Flows off a spoon more slowly than water. Can be sipped from a cup with a little more effort.

• Level 3 — Moderately Thick: Pours slowly and dollops off a spoon. Still drinkable from a cup but requires effort. Often compared to honey.

• Level 4 — Extremely Thick: Cannot be poured from a cup. More likely to be eaten with a spoon than sipped — similar to a yogurt consistency.

IDDSI has a few simple, inexpensive tests to verify the thickness is precise. Watch how simple it is to conduct the IDDSI flow test designed to measure the thickness of the water.

For facility staff and healthcare professionals: IDDSI is now the recognized standard of care in the U.S., with enforcement beginning in California in 2025. Learn what the regulatory landscape looks like and what your facility needs to know.

Pre-thickened water vs. thickening at home

There are two practical ways to get thick water: buy it pre-thickened, or thicken it yourself.

Pre-thickened water comes ready to drink, bottled at a specific IDDSI level. Thick-It Clear Advantage and Hormel Thick & Easy are the most widely available brands, each offered in multiple sizes and IDDSI levels. This is a convenient option — no mixing, consistent results, ready immediately. It works well for facility use or situations where simplicity is the priority. The tradeoffs are cost (roughly $0.20–$0.27 per fluid ounce depending on brand and size) and bulk. If you are heading out for the day and need six to eight servings of fluid, pre-thickened water bottles add up in weight and volume fast.

Thickening at home means adding a measured amount of thickening agent to any beverage on demand. There are three main categories:

Gel thickeners (xanthan gum gel): SimplyThick EasyMix is the option I know best. It mixes fast, produces no lumps, and is ready to drink almost immediately — which is why I can mix, thicken, test, and drink on video within a three-minute window. It does not mix completely clear, but it works with virtually any aqueous beverage and holds its consistency well over time. Available in individual EasyMix packets (small, lightweight, and accurate — ideal for travel or on-the-go use), bottles (the most popular format by far, and more economical than packets for everyday home use), and large pouches for higher-volume users.

Xanthan gum powder thickeners (clear result): Products like Thick-It Clear and Resource Thicken Up Clear use powdered xanthan gum and produce a clear solution — which some people prefer aesthetically. The tradeoff is that powdered xanthan can be tricky to mix. Lumps are a real concern, and most products require you to hold the thickened beverage for five minutes or more before drinking to allow the powder to fully hydrate. If you are mixing in a hurry, this category is less forgiving.

Starch-based powder thickeners: Thick-It Original and similar starch-based products are widely available at pharmacies and tend to be the lowest-cost option. They cloud beverages and continue to thicken over time if the drink sits — something to be aware of in facility settings or when preparing drinks in advance.

Home thickening is more economical at scale and gives you real flexibility: you can thicken coffee, juice, tea, milk, or anything else the person actually enjoys drinking. For on-the-go use, SimplyThick EasyMix individual packets are a much lighter and less bulky option than carrying pre-thickened water bottles — especially if you will be out all day.

Where to buy thick water

Pre-thickened water is available at major pharmacies (CVS, Walgreens, Rite Aid), medical supply stores, and online through Amazon. Search for "thickener" along with your prescribed IDDSI level to find the right option.

SimplyThick EasyMix is available at simplythick.com, Amazon, and through healthcare supply distributors. Individual packets, bottles, and pouches are all available depending on your usage needs.

Xanthan and starch powder thickeners — Thick-It Clear, Resource Thicken Up Clear, Thick-It Original, and similar products — are stocked at most pharmacies and available online.

If you are in a skilled nursing facility or assisted living community, the dietary team should already have a thickened liquid protocol in place. The SLP who issued the diet order can also guide you toward preferred products.

What does thick water actually taste like?

This is the question the TikTok challenge tried to answer — dramatically, and not always helpfully.

The honest answer: it depends on the thickener. Starch-based thickeners can impart a slightly starchy quality and a bit of texture that some people notice, especially in water. Gel-based and xanthan powder thickeners are generally considered more neutral — the water stays clearer and the taste change is minimal.

Texture is a bigger adjustment than taste for most people. At Level 2 or Level 3, the liquid moves differently in the mouth. At Level 4, it is closer to eating than drinking. For someone newly on thick water, there is a period of adjustment.

But here is the part that gets lost in the viral clips: the people reacting most dramatically are healthy adults with no swallowing problems who have never experienced dysphagia. For the people who actually need thick water — whose alternative is aspiration, pneumonia, a feeding tube, or chronic dehydration — the texture is a reasonable trade. And for many of them, the ability to keep drinking their morning coffee or their evening glass of juice, thickened to a safe level, is genuinely meaningful. You don't have to give it up.

Cost and insurance basics

Pre-thickened water runs roughly $0.25 per fluid ounce in single-serve sizes — a 46-ounce bottle is typically around $11–12. For someone drinking the recommended daily fluid intake, that cost adds up quickly. Thickening at home with a gel or powder thickener is considerably more economical on a per-ounce basis.

Coverage is the harder question. The U.S. Food and Drug Administration classifies thickeners as ordinary foods, not medical supplies. Because health insurance generally does not cover everyday food items, standard plans typically do not cover thickeners — even when there is a documented clinical need. Some Medicaid waiver programs and veterans' benefits may provide coverage, particularly for specific patient populations with a demonstrated financial need.

I am not a coverage expert — verify with your specific plan, and do not assume it won't be covered without asking.

Would you choose thick water for a loved one?

Thick water serves a crucial role in the lives of people with dysphagia. Swallowing problems can make drinking water difficult — even dangerous. In many cases, thick water makes it possible to continue drinking and staying hydrated without more invasive interventions.

If you are a caregiver or healthcare professional looking to go deeper, my YouTube channel covers the IDDSI flow test, how to thicken liquids correctly, and much more. If you are just getting started with IDDSI, IDDSI.org has free training resources and testing materials available to anyone.

Frequently Asked Questions

What is thick water used for?Thick water is used by people with dysphagia who cannot safely swallow regular thin liquids. Thickening slows the flow of the liquid, giving the person more control and reducing the risk of aspiration — liquid entering the airway.

Why does thick water exist?Because aspiration is a serious and sometimes life-threatening risk for people with certain neurological and medical conditions. Thick water is the least invasive way to allow safe hydration when thin liquids are no longer safe to swallow.

What is the difference between thick water and thickened water?The terms are used interchangeably. Both refer to water modified with a thickening agent to a specific IDDSI level. "Thickened liquids" is the standard clinical term.

Is thick water safe to drink?Yes — the thickening agents used (xanthan gum, modified starch) are food-grade ingredients that are safe for consumption. If you have a diet order for a specific IDDSI level, you need to make sure the thickness is correct for your prescribed level, which is where the IDDSI flow test comes in.

Can you make thick water at home?Yes. Add a measured amount of a food-grade thickener — gel-based or powder-based — to plain water and mix according to package directions or your SLP's instructions. You can verify the consistency using the IDDSI flow test.

What is the purpose of thick water?To make safe oral hydration possible for people with swallowing problems. Without thickened liquids, many dysphagia patients face dehydration, malnutrition, or the need for a feeding tube. Thick water keeps drinking possible.

Does thick water have to be water?No — any aqueous beverage can be thickened: coffee, tea, juice, milk, nutritional supplements. "Thick water" specifically refers to thickened water, but the same thickening agents and IDDSI levels apply to all liquids. As I say: if it's aqueous, I'll thicken it.