Skip to main content

Advertisement

Log in

Effects of Saliva on Starch-thickened Drinks with Acidic and Neutral pH

  • Original Article
  • Published:
Dysphagia Aims and scope Submit manuscript

Abstract

Powdered maize starch thickeners are used to modify drink consistency in the clinical management of dysphagia. Amylase is a digestive enzyme found in saliva which breaks down starch. This action is dependent on pH, which varies in practice depending on the particular drink. This study measured the effects of human saliva on the viscosity of drinks thickened with a widely used starch-based thickener. Experiments simulated a possible clinical scenario whereby saliva enters a cup and contaminates a drink. Citric acid (E330) was added to water to produce a controlled range of pH from 3.0 to 7.0, and several commercially available drinks with naturally low pH were investigated. When saliva was added to thickened water, viscosity was reduced to less than 1% of its original value after 10–15 min. However, lowering pH systematically slowed the reduction in viscosity attributable to saliva. At pH 3.5 and below, saliva was found to have no significant effect on viscosity. The pH of drinks in this study ranged from 2.6 for Coca Cola to 6.2 for black coffee. Again, low pH slowed the effect of saliva. For many popular drinks, having pH of 3.6 or less, viscosity was not significantly affected by the addition of saliva.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Notes

  1. In contrast, untreated corn starch (known as cornflour in the UK) is used in home baking and as an ingredient in pre-prepared meals but is not used as an instant thickening powder for dysphagia management.

References

  1. Whelan K. Inadequate fluid intakes in dysphagic acute stroke. Clin Nutr. 2001;20(5):423–8.

    Article  PubMed  CAS  Google Scholar 

  2. Layne KA, Losinski DS, Zenner PM, Ament JA. Using the Fleming Index of dysphagia to establish prevalence. Dysphagia. 1989;4(1):39–42.

    Article  PubMed  CAS  Google Scholar 

  3. Goulding R, Bakheit AMO. Evaluation of the benefits of monitoring fluid thickness in the dietary management of dysphagic stroke patients. Clin Rehabil. 2000;14:119–24.

    Article  PubMed  CAS  Google Scholar 

  4. Finestone HM, Foley NC, Woodbury MG, Greene-Finestone L. Quantifying fluid intake in dysphagic stroke patients: a preliminary comparison of oral and nonoral strategies. Arch Phys Med Rehabil. 2001;82:1744–6.

    Article  PubMed  CAS  Google Scholar 

  5. Kayser-Jones J, Schell ES, Porter C, Barbaccia JC, Shaw H. Factors contributing to dehydration in nursing homes: inadequate staffing and lack of professional supervision. J Am Geriatr Soc. 1999;47(10):1187–94.

    PubMed  CAS  Google Scholar 

  6. Davis LA. Quality of life issues related to dysphagia. Top Geriatr Rehabil. 2007;23:352–65.

    Google Scholar 

  7. Ekberg O, Hamdy S, Woisard V, Wuttge-Hannig A, Ortega P. Social and psychological burden of dysphagia: its impact on diagnosis and treatment. Dysphagia. 2002;17:139–46.

    Article  PubMed  Google Scholar 

  8. Dantas RO, Kern MK, Massey BT, Dodds WJ, Kahrilas PJ, Brasseur JG, Cook IJ, Lang IM. Effect of swallowed bolus variables on oral and pharyngeal phases of swallowing. Am J Physiol. 1990;258:G675–81.

    PubMed  CAS  Google Scholar 

  9. Cichero JAY, Jackson O, Halley PJ, Murdoch BE. Which one of these is not like the others? An inter-hospital study of the viscosity of thickened fluids. J Speech Lang Hear Res. 2000;43:537–47.

    PubMed  CAS  Google Scholar 

  10. Miller JL, Watkin KL. The influence of bolus volume and viscosity on anterior lingual force during the oral stage of swallowing. Dysphagia. 1996;11:117–24.

    Article  PubMed  CAS  Google Scholar 

  11. Logemann JA, Gensler G, Robbins J, Lindblad AS, Brandt D, Hind JA, Kosek S, Dikeman K, Kazandjian M, Gramigna GD, Lundy D, McGarvey-Toler S, Miller Gardner PJ. A randomized study of three interventions for aspiration of thin liquids in patients with dementia or Parkinson’s disease. J Speech Lang Hear Res. 2008;51:173–83.

    Article  PubMed  Google Scholar 

  12. Cichero JAY, Murdoch BE. Dysphagia: foundation, theory and practice. Chichester: Wiley; 2006.

    Google Scholar 

  13. Vaclavik VA, Christian EW. Essentials of food science. New York: Springer; 2008.

    Google Scholar 

  14. Dewar RJ, Joyce MJ. The thixotropic and rheopectic behaviour of maize starch and maltodextrin thickeners used in dysphagia therapy. Carbohydr Polym. 2006;65:296–305.

    Article  CAS  Google Scholar 

  15. Dokic L, Jakovljevic J, Dokic P. Relation between viscous characteristics and dextrose equivalent of maltodextrins. Starch. 2004;56(11):520–5.

    Article  CAS  Google Scholar 

  16. Hall JE. Guyton and hall textbook of medical physiology. 12th ed. Philadelphia: Saunders; 2010.

    Google Scholar 

  17. Harris M, Edgar M, Meghji S. Saliva: Its secretion, composition and functions. In: Clinical oral science. London: Butterworth-Heinemann, 1997

  18. Heinzerling CI, Smit G, Dransfield E. Modelling oral conditions and thickness perception of a starch product. Int Dairy J. 2008;18:867–73.

    Article  CAS  Google Scholar 

  19. Janssen AM, Terpstra ME, De Wijk RA, Prinz JF. Relations between rheological properties, saliva-induced structure breakdown and sensory texture attributes of custards. J Texture Stud. 2007;38:42–69.

    Article  Google Scholar 

  20. Ferry AL, Hort J, Mitchell JR, Lagarrigue S, Pamies BV. Effect of amylase activity on starch paste viscosity and its implications for flavor perception. J Texture Stud. 2004;35:511–24.

    Article  Google Scholar 

  21. Hanson B, O’Leary MT, Smith CH. The effect of saliva on the viscosity of thickened drinks, Dysphagia. doi:10.1007/s00455-011-9330-8.

  22. Lavelle CLB, editor. Applied physiology of the mouth. Bristol: John Wright and Sons Ltd; 1975.

    Google Scholar 

  23. British Dietetic Association. National Descriptors for Texture Modification in Adults. Birmingham: BDA, 2009.

  24. O’Leary M, Hanson B, Smith CH. Variation of the apparent viscosity of thickened drinks. Int J Lang Commun Disord. 2011;46(1):17–29.

    PubMed  Google Scholar 

  25. Salimetrics LLC, Saliva Collection and Handling Advice. Available oat www.salimetrics.com. Accessed 1 May 2011.

  26. Malkin AY. Rheology Fundamentals. Toronto: ChemTec Publishing, 1994 (www.chemtec.org).

  27. Sharma F, Sherman P. Identification of stimuli controlling the sensory evaluation of viscosity. J Texture Stud. 1973;4:111–8.

    Article  Google Scholar 

  28. Sopade PA, Halley PJ, Cichero JAY, Ward LC. Rheological characterisation of food thickeners marketed in Australia in various media for the management of dysphagia. I: water and cordial. J Food Eng. 2007;79:69–82.

    Article  Google Scholar 

  29. O’Leary M, Hanson B, Smith CH. Viscosity and non-Newtonian features of thickened fluids used for dysphagia therapy. J Food Sci. 2010;75:E330–8.

    Article  PubMed  Google Scholar 

  30. Pelletier CA, Lawless HT. Effect of citric acid and citric acid–sucrose mixtures on swallowing in neurogenic oropharyngeal dysphagia. Dysphagia. 2003;18:231–41.

    Article  PubMed  Google Scholar 

  31. Desse M, Mitchell J, Wolf B, Budtova T. Droplet deformation and break-up under shear: hydrocolloid solution vs. suspension of starch granules. Food Hydrocolloids. 2011;25:495–502.

    Article  CAS  Google Scholar 

  32. Sevón L, Laine MA, Karjalainen S, Doroguinskaia A, Helenius H, Kiss E, Lehtonen-Veromaa M. Effect of age on flow-rate, protein and electrolyte composition of stimulated whole saliva in healthy, non-smoking women. Open Dent J. 2008;2:89–92.

    Article  PubMed  Google Scholar 

  33. Tylenda CA, Ship JA, Fox PC, Baum BJ. Evaluation of submandibular salivary flow rate in different age groups. J Dent Res. 1988;67(9):1225–8.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgment

This study was partly supported by an educational grant (Ref: Dept: 440000 Proj: 301253) by Fresenius-Kabi Ltd. to the first author.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Ben Hanson.

Appendix

Appendix

See Tables 2 and 3.

Table 2 Constituent ingredients of some commercially available thickeners
Table 3 pH measurements for popular drinks

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hanson, B., Cox, B., Kaliviotis, E. et al. Effects of Saliva on Starch-thickened Drinks with Acidic and Neutral pH. Dysphagia 27, 427–435 (2012). https://doi.org/10.1007/s00455-011-9386-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00455-011-9386-5

Keywords

Navigation