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Tips for Dealing with Swallowing Problems in People with Multiple Sclerosis

These Might Help with Dysphagia


Updated June 25, 2008

It is estimated that 30 to 40 percent of people with multiple sclerosis (MS) have difficulties swallowing. Also known as dysphagia, problems with swallowing can pose choking dangers or lead to aspiration pneumonia (where food or liquid goes into the lungs and causes infection). On the other hand, these problems can be so subtle that many people don’t even notice them, except when they occasionally gag on a bite of food or have a coughing fit when trying to swallow a pill. Regardless of how severe your dysphagia might be, it is important that those of us with MS who may have swallowing problems review our habits around eating and see if we can create new (and safer) habits.

You may notice that many of the tips below are not only “common sense,” they are also the things that our mothers tried to drill into our heads throughout childhood as basic table manners.

Sit Up Straight: It is important to sit up ramrod-straight, not only while eating, but also for at least 30 minutes following a meal. This applies to all situations, not just mealtimes – this means no lounging on the floor while shoving in nachos during the Superbowl and no slumping down in your chair shoving popcorn in at the movie theater.

Mindful Eating Challenge: We could probably all slow down when we eat. Try this technique: Place food on your fork and put it in your mouth. Put your fork down. Chew your food very thoroughly, then swallow. Do not pick up your fork again until your mouth is empty. This will allow you to work through each swallow before starting to negotiate the next bite.

Sounds easy? Ha! Try it during your next meal. I challenge you to put a five-dollar bill next to your plate. If you can get through the entire meal using this technique, it is yours to spend on a little treat. If not, into the “piggy bank” it goes. Keep doing this at each meal. By the time you can successfully make it through a meal using this technique with no slips, I will wager that you will be able to afford a pretty nice present for yourself. You will have also developed a habit that will really benefit you in the future.

Don’t Talk With Food in Your Mouth: Again, how many times did you hear this while you were growing up? If only we had all listened, there wouldn’t be so many bad habits to work on breaking.

Thicken Your Liquids: For some people, thin liquids tend to go down the “wrong way,” causing sputtering and coughing. There are specific thickeners that can be added to liquids to help them go down more smoothly. These are usually corn starch-based.

Eat the Right Kinds of Foods: Hard, crumbly, dry and crunchy foods may create particles that aggravate your dysphagia. Adding gravy or avoiding these kinds of foods altogether may really help you. You may need to eat very soft or pureed foods.

Eat Smaller Meals: Just like with any other sustained activity, we can get “swallowing fatigue,” where our muscles get tired and our attention starts wandering towards the end of a big meal. Instead of just trying to “get done” by shoveling food in faster and taking bigger bites, try breaking meals into smaller portions. It will be easier to eat slowly and concentrate on each bite.

Take a Symptom Inventory: Think about how you feel before sitting down to eat. If your other symptoms seem worse at a particular time of day or under certain circumstances, there is a good chance that your dysphagia will be acting up, too. Remember, fatigue will contribute to swallowing problems. Also, it probably isn’t a good idea to eat outside in hot weather, as heat intolerance can aggravate all MS symptoms. If you happen to be at a picnic in the summer, skip the fried chicken in favor of some ice cream.

Alternate Liquids and Solids: For some people, swallowing difficulties show up as problems getting the food to go all the way down the esophagus. It may be helpful to take a small sip or two of a liquid between bites. This will keep the food moist and moving. End your meal with some liquid, as well.

Perfect Your Technique: Try tucking your chin in toward your chest slightly while swallowing. Moving your chin in one-half inch closes off the airways, preventing food and liquid from going into your respiratory passages.


Courtney, Susan Wells. Symptom Awareness: Difficulties with Swallowing. The Motivator. (Published by the Multiple Sclerosis Association of America) Fall 2007; 38-39.

Randall T. Shapiro. Managing the Symptoms of Multiple Sclerosis (5th ed.). New York: Demos Medical Publishing, 2007.

The Multiple Sclerosis Resource Centre. Swallowing Difficulties.

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