A Slõ Story
Slõ Drinks started because of a chance conversation our Founder, Mathew had with a Speech and Language Therapist on a Monday afternoon in a Manchester hospital.
Walking out of a puree tasting he asked her, “Is there anything else your dysphagia patients would like?” She replied, “A pleasant thickened drink.”
Mathew spent the majority of his working life in the food and drink industry, promoting brands and creating new products for them. Specializing in the Catering Sector for beer and restaurant brands, he started to work in the Healthcare sector. Focusing on special diets for the UK’s National Health Service (NHS) Hospitals.
During this time, he began to understand how important nutrition is for a patient’s recovery and wellbeing, which ultimately introduced him to people with swallowing difficulties – dysphagia and the meeting with the Speech Therapist that inspired the launch of Slõ Drinks.
Swallowing difficulties can range from slight to severe and once diagnosed, its medical term is Dysphagia. It affects the epiglottis, the flap of skin at the top of lungs/stomach. This doesn’t close quickly enough, and so ordinary foods go into the lungs instead of the stomach and induce choking. Clinicians call this aspiration. It can lead to aspiration pneumonia, malnutrition and worse.
To prevent these complications, meals need to be pureed, mashed or just soft. It was after presenting these meals that Mathew had his conversation.
After leaving the hospital he Googled thickened drinks and discovered tins of thickener were the product of choice. These contain a modified maize starch which you spooned into a drink to thicken it up.
This format had been used for over decade with no developments and several brands providing the same product offering.
When thickener from tins is added to a drink, it doesn’t work straight away and so carers tend to add more. They then pass to the drinker a drink that looks like grey wallpaper paste. It can also turn the taste of a drink sour. The thickener may not have dissolved and will need sieving through teeth and leave a gritty sticky residue on their teeth.
He couldn’t believe in the 21st century those with dysphagia have to put up with drinks like this. They should still be able to have something enjoyable to drink – despite their condition.
That started a research project.
Initial research reviewed current preparation practice, what drinks were being served and how they could be improved.
Patients were given drinks too thick or too thin for their swallowing ability. Some drinks separated within minutes. Some got thicker. Drinks stirred with the end of a pen and passed to patients with iceberg-sized un-dissolved pieces of thickener floating on the top of them.
One person was recorded making a thickened drink and spilling more thickener around the cup than it.
Over several months he met with clinicians, therapists and carers around the UK using tins of thickeners presenting his solution.
It was a cup containing a powdered drink flavouring and a specific volume of thickener. To make, water was added. It would always match the flow rate the patient needed and therefore be safer to swallow.
Some said, “You’re wasting your time.” Others said, “We’ve been using tins of thickener for years and it does the job. Why change now?” Despite that, he continued taking on useful opinions and suggestions, until thousands of miles, plenty of late nights, early mornings and weekends – Mid 2006 – success.
Slõ Drinks in cups were presented to Manchester Royal Infirmary and no changes requested. The following day presented them to the Royal Liverpool and the same positive response.
Shortly after he received an order and both Hospitals started to use them. That led to the next development – putting Slõ Drinks on prescription.
The UK’s NHS provides a service called Continuity of Care. If a patient is provided a product in the hospital it should be available to them after discharge on prescription.
As result a prescription application had to be made to the ACBS (The Advisory Committee for Borderline Substances). After months of collecting the data required to prove their suitability and submit an application.
The Slõ Cold Juice drinks were approved. Unfortunately, the hot drinks were not and required further evidence to prove their case.
Slõ Hot Chocolate, Slõ White Coffee and Slõ White Tea were finally approved and available in 2009.
Product development was put on hold on focus switched to selling Slõ Drinks to hospitals.
Sale continue to grow but slowly. Most hospitals have contracts with international Pharma companies.
An application was therefore made to the National Health Service’ own supplier – NHS Supplies to be listed on the Enteral Feeds contract. Listed in the contract every NHS hospital ward can order Slõ Drinks direct.
Slõ Hot Drinks are approved by the ACBS.
A very significant meeting happened this year.
For the first time a Dietitian attended a meeting organized by the Speech and Language Therapy team. She asked if we could provide savoury oral nutritional thickened drinks.
This led to research into the viability of producing a thickened high protein, high calorie soup.
By mid-2010 one had been created. Using only natural ingredients, it was presented ready to use and only needed reheating.
To make Slõ Soup available to patient after leaving hospital, it was trialed with patients. testing for safety, taste, ease of use and palatability. All the data required was collected over the next 10 months with positive results.
Unfortunately, by the end of 2010 additional research showed that whilst savoury nutritional supplements have a use, it would be limited. As a direct result, it was decided to terminate the project.
Slõ Cold Hot and Cold Drinks are now being used across the Country.
At a meeting with a diverse group of healthcare professionals, the benefits of using Slõ Drinks to hydrate patients was discussed. One clinician started to laugh and suggested we should produce Sloe Gin – a British liquor.
She revealed that people with swallowing difficulties do want alcohol. As a company that focused on providing ways for this patient group to drink safely and maintain their hydration levels – it was dismissed as a joke.
Mathew believes every passing comment should be taken seriously and is always worth reviewing. Subsequent research highlighted there was a need to make alcohol safer to swallow. Those with swallowing difficulties don’t want to drink to get drunk. They want to just enjoy the taste and the social side of drinking.
The possibilities of producing ways to make Slõ alcoholic drinks were discussed but no action was taken.
A Dietitian made contact to ask if we had an alcoholic range. Her elderly patient wanted to take Communion and couldn’t because she was diagnosed with dysphagia.
After extensive research a tasteless, quick dissolving thickener that would thicken wine was found. A sample containing enough for one glass was packaged and sent – with great success.
Subsequently, the sachet and packaging was refined to contain enough of our thickener to change one UK standard pub measure (175ml) of red, white or rose wine into a Slõ Wine
suitable for any swallowing difficulty.
This led to a fundamental change in how Slõ Drinks were made.
We would test our thickeners in a drink to decide which was most effective. Recording how the fats, sugars and pH levels of each drink affected the performance of the thickener. The volume required to make a drink to a specific consistency was calculated and then put into a single serve sachet. To make a safe drink, the sachet contents simply needed to be mixed with the volume of liquid we specified.
A Pediatric Dietitian heard about Slõ Wine and wanted to know if we could make fizzy drinks safer to swallow. One of her clients wanted cola but could not thicken it.
Slõ Fizzy was shortly available. It changes any carbonated drink into Slõ Cola, Slõ 7UP, Slõ Sprite including Slõ Carbonated water. It also trapped the bubbles in the drink which produced a pleasant popping sensation on the tongue.
Based on this success, attempts were made to thicken carbonated alcoholic drinks. Sachets were then made available to create Slõ Beer and Slõ Cider.
This year saw the start of the biggest research project undertaken. We were asked if we could create a milk based oral nutritional supplement (ONS) that is thickened
It would be another 3 years before it would finally make it to market.
Slõ Drinks in cups and Slõ Drinks sachets continue to sell.
Research continues to find ways to provide a palatable powdered pre-thickened oral nutritional supplement.
It highlights that current practice is to attempt to thicken supplements with starch and gum thickeners which do not work, (the high fat content of these supplements prevents these thickeners bonding to it) or use expensive ready to drink alternatives.
The first prototypes are produced ready for testing in 2015 and are called Slõ Milkshakes+.
The Slõ Drinkers Club is launched on the website entitling buyers to discounts.
Slõ Milkshakes+ testing begins with patients and proves successful. The data is collected, and an application made to the ACBS to make it available for Healthcare Professionals to prescribe. It is rejected. A revised application is submitted.
The first enquiry is received about how to use Slõ Drinks with medicinal pills.
Taking solid dose medication is difficult to impossible for those with swallowing difficulties. There are many legal issues surrounding the crushing of pills and adding them to texture modified food and drinks. For many the only alternative is use liquid formulations which are expensive and don’t match the flow rate that people need – ultimately making them unsafe.
A development plan is launched to source a solution.
The first order from America is received.
Slõ Milkshakes+ are approved and go on sale in March. They are the 1st and only powdered pre-thickened oral nutritional supplement in the world.
The first production run arrives unbranded to test the packaging design. All 40,000 sachets are labelled by hand, front and back. After making them ready just 7 sachets are sold. In April sales double to 14 sachets.
Research continues into how to make solid dose medication safer to swallow.
Meetings with clinicians in an Acute and Community settings to introduce Slõ Milkshakes+ take place throughout the year.
At one of these meeting a Dietitian highlights those with swallowing difficulties are deficient in vitamins and minerals. This is a direct result of not being able to consume large meals or eat in the quantities required to maintain a balanced diet. Vitamin and mineral pills are available but cannot be swallowed safely.
Our solution was to create oral nutritional sprays: Slõ Vitamin Sprays.
These deposit the Recommended Daily Allowance of 12 essential vitamins on the inside of the cheek. There they are absorbed quickly through the buccal mucosa – inside of the cheek wall.
Whilst this worked well, it wasn’t popular and was removed from sale at the end of 2018.
However, it may just be ahead of its time. It provides a safe method of providing essential nutrients and may therefore re-appear in the future.
A new way of describing flow rates was launched in the UK called the International Dysphagia Diet Standardization Initiative (IDDSI).
All packaging is revised, and we become the first company to print these terms on our packaging.
Reducing cross contamination in hospitals and care facilities becomes a priority for the NHS. Working with our sachet supplier, we become the first company to apply an antibacterial varnish to all our sachets. This prevents pathogens sticking to the packaging to reduce the risks of contamination.
Working with a specialist manufacture, we create our latest Slo Drink – a liquid that makes pills easy to swallow.
Pill-Eze is a pre-thickened liquid which wraps around a tablet and holds it allowing it to be safely swallowed. It has a sweet cherry flavour to hide the taste of the pill or capsule in it.
On arrival at the stomach it quickly dissipates leaving the pill to provide its intended relief.
Importantly, it is virtually chemically inert and compares to the Ph level of the stomach (4.2pH).
Subjected to over 100 scientific compatibility studies and as a result with the exceptions of: effervescent and crushed tablets; rapid dissolving, sustained release medication or those containing Iodine – Pill-Eze is compatible with pills, tablets and (liquid containing) capsules, vitamin preparations, food supplements and other solid dosage forms meant to be swallowed
Pill-Eze will dramatically reduce the need to use expensive liquid medicine preparations, however it will take time to be accepted. Liquid preparations have been used for a long time.
But the UK’s NHS and other Health Authorities around the world are under huge financial pressure to reduce spend on medication. As Pill-Eze can be used with off-licence generic medications it will be reviewed as an affordable and viable alternative.
There trend towards milk alternatives that are suitable for a Vegan diet, kick starts research into producing a water based oral nutritional supplements.
Slõ Juice+ is created. The first pre-thickened and powdered oral nutritional supplement which is suitable for Vegans. A program of patient testing is started.
Slõ Milkshake+ Banana flavour is created and a program of patient testing starts.
When the IDDSI flow rates were introduced they included a new category IDDSI 1- Slightly Thick. Never used before it was slow to be adopted by prescribing clinicians, but demand for it is growing.
All Slõ Drinks can therefore now be made at this level and an application to the ACBS has been made to approve Slõ Milkshakes+ at this level.