High-Protein Fortified Shake (Thickened) | IDDSI Level 1-2 Recipe

IDDSI Level 1-2 (Mildly to Moderately Thick) | 15 minutes | Easy

Protein-energy malnutrition is a serious and common complication of dysphagia. Reduced oral intake, fatigue at mealtimes, and the unpalatability of commercial nutritional supplements all contribute to inadequate protein consumption in elderly patients with swallowing difficulties. This fortified shake uses whole milk, full-fat milk powder, smooth peanut butter and ripe banana to deliver approximately 18–22g of protein and 350 kcal per serving — without requiring any commercial supplement. The consistency can be adjusted to IDDSI Level 1 or Level 2 depending on the individual’s prescription.

Ingredients (1 serving)

• 200ml full-fat dairy milk (or 4 tablespoons full-fat milk powder reconstituted in 200ml cooled boiled water)
• 2 tablespoons full-fat milk powder (added additionally to boost protein content)
• 1.5 tablespoons smooth peanut butter (choose a natural variety with no added sugar or hydrogenated oils)
• Half a ripe banana (the riper the better — black-speckled skin indicates peak ripeness and softest texture)
• 1 tsp honey (optional, to increase sweetness and caloric density)
• 2–5g commercial thickener powder (adjusted per product instructions to achieve IDDSI Level 1 or Level 2)
• 30ml cooled boiled water (to adjust consistency if needed)

Method

1. Peel the banana and break into small pieces. Combine with milk, milk powder, peanut butter and honey (if using) in a blender.
2. Blend on high speed for 60 seconds until completely smooth with no visible particles. The peanut butter must be fully incorporated — no peanut fragments should remain.
3. Pass through a fine-mesh sieve to confirm particle-free consistency. If any banana fibres are detected, sieve again.
4. Measure 200ml of the strained shake into a large cup.
5. Following the manufacturer’s instructions for your thickener, add the appropriate quantity; whisk vigorously with a fork or electric milk frother for 20–30 seconds.
6. Stand for 2 minutes to allow full hydration of the thickener, then stir once more.
7. Perform an IDDSI syringe test (see below) to confirm the target level before serving.

Texture Test

IDDSI Level 1 (Mildly Thick) confirmation: 8–10ml flows from an inverted syringe in 10 seconds. The shake flows freely with only a faint coating resistance.

IDDSI Level 2 (Moderately Thick) confirmation: 4–8ml flows from an inverted syringe in 10 seconds. The shake moves like thin syrup, pausing briefly on a tilted spoon before flowing off.

Particle-free confirmation: The shake must be completely free of particles. Peanut fragments or banana fibre strands are non-compliant. If detected, re-blend and re-sieve.

Safety Notes

⚠️ Use smooth peanut butter only — crunchy or chunky peanut butter contains solid nut fragments that persist through blending and do not meet IDDSI Level 1-2 requirements. Only smooth peanut butter is appropriate; confirm particle-free status visually after sieving.

⚠️ Banana ripeness matters — underripe bananas contain more fibre and starch, producing coarser fibres that are harder to fully blend. Use over-ripe bananas (skin heavily spotted with black) for the smoothest result.

⚠️ Confirm peanut allergy status — always verify that the individual has no peanut allergy before preparing this recipe. If peanut allergy is present, macadamia nut butter or sunflower seed butter are suitable alternatives that provide similar fat and caloric content.

⚠️ Milk powder must dissolve completely — undissolved milk powder clumps constitute solid particles. If in doubt, dissolve the milk powder in a small amount of warm water before adding to the blender.

Sourcing in Hong Kong

• Full-fat milk powder: Available at PARKnSHOP and Wellcome in multiple brands; choose full-fat (not skimmed) for maximum caloric and protein density
• Smooth peanut butter: Supermarket spreads aisle; choose natural varieties labelled “peanuts only” or “peanuts and salt”; avoid products containing hydrogenated vegetable oils
• Ripe bananas: Wet markets and supermarkets; heavily spotted bananas are sweeter, softer, and easier to blend to a particle-free consistency; often available at a discount at wet market stalls near closing time

Nutrition

Approximately 350–380 kcal per serving (250ml), 18–22g protein, 14g fat, 38g carbohydrate, 380mg calcium. Milk powder provides high-quality whey and casein protein plus calcium; peanut butter contributes plant protein, monounsaturated fats and vitamin E; banana provides potassium and rapidly available carbohydrate. Compared with commercial nutritional supplements, this shake uses recognisable whole-food ingredients, which often results in higher palatability and better intake compliance in elderly patients — a critical consideration given that uneaten supplements provide zero nutrition.

Cultural Note

While milkshakes are not traditional Cantonese fare, banana milk and peanut drinks are familiar flavours in Hong Kong cha chaan teng culture — banana milk is a standard cha chaan teng beverage, and peanut paste (花生糊) is a beloved Cantonese dessert. This shake bridges familiar Hong Kong flavour profiles with modern nutritional fortification, offering elderly residents a protein-rich drink that feels like a treat rather than a supplement, which meaningfully supports adherence.