Difficulty swallowing can cause choking and make it hard to eat or take pills. Fluids you’re trying to swallow may even come out of your nose. Trouble swallowing (which doctors refer to as dysphagia) is a symptom that between 30 percent and 60 percent of people with myasthenia gravis (MG) experience. For some, it’s the first symptom of MG. For others, it may be the only symptom. But there are things you can do to make it easier to take in the food and nutrition you need.

What Causes Swallowing Problems With Myasthenia Gravis?

Swallowing is a complex process. Many nerves work in a fine balance to control the ways that the muscles of the mouth, throat, and esophagus (the pipe that carries food to the stomach) work together. In people with myasthenia gravis, the immune system attacks certain proteins in muscles that receive signals from the nerves. As a result, this fine balance is thrown out of whack. Nerves can’t communicate as well with muscles, and this causes muscle weakness. In people whose throat muscles are affected by MG, dysphagia can make it difficult to swallow solid foods, liquids, or even saliva.

Complications From Difficulty Swallowing

When you have trouble swallowing, you run the risk of several complications.

Poor Nutrition and Unintended Weight Loss

Difficulty swallowing can make it hard to take in all of the fluids and nutrients that you need. As a result, you run the risk of malnutrition, dehydration, and weight loss. Be sure to watch out for warning signs that you’re not eating enough. Tell your doctor if your weight drops by 5 pounds or more.

One member of MGteam underscored these difficulties by noting: “I wait to eat when I absolutely need to because eating is such a chore, as is swallowing food.”

Aspiration Pneumonia

Difficulty swallowing presents another complication. Food may accidentally go into your airway (down the trachea and in the lungs). When food particles (or liquid) go into your lungs, they can bring bacteria with them and cause aspiration pneumonia. This is a serious condition, especially for people who are older.

Choking

Choking is another complication for people who have difficulty swallowing. One MGteam member recently had this experience at breakfast: “I swallowed a sip of coffee the wrong way and coughed much longer than usual. I felt like I was having an asthma attack.”

People are usually able to clear the food or fluid that has gotten into their airway. However, sometimes food can completely block the airway, and a person is unable to breathe. When this happens, lifesaving efforts are necessary.

The Heimlich maneuver is a first-aid method that involves applying upward thrusts under the rib cage to dislodge the food that has gotten stuck. It should be performed when a person can’t breathe, speak, or cough because they are choking. Everyone should know how to perform this lifesaving maneuver — especially the friends and family of a person with dysphagia. You can find instructions and videos online that will show you how to do it safely and effectively.

Tips for Eating Safely

Swallowing can be a daily challenge for people with myasthenia gravis. As one MGteam member put it, “A good day means that swallowing is happening without incident.” Here are some tips that may help you eat safely despite trouble swallowing.

1. Eat Smaller, More Frequent Meals

Consider eating six small meals a day if eating three full meals makes you tired. This may help you get enough calories. If liquids are easier to swallow, you can drink soups and shakes for some of your small meals. Consider making smoothies with yogurt, milk, and peanut butter to increase your protein intake.

2. Make Foods Easier To Swallow

Some foods are more difficult to eat. If, say, meat gives you more trouble, you could chop it into fine pieces or use a blender to make it into a paste. That way, you won’t need to chew as much. Add sauce, sour cream, or yogurt to give your solid foods extra flavor and moisture.

Some foods have a combination of two or more textures — for instance, soups with chunky ingredients, cereal with milk, or pasta with sauce — that can make them harder to swallow. Consider eating the two items separately. For instance, drain the milk or broth with a sieve and eat the chunky ingredients separately from the liquids. If soup is challenging because it contains pieces of meat and vegetables, consider pureeing it.

Thicker liquids can be safer to swallow than thinner liquids. Consider blending liquids with an avocado to thicken the fluid without changing the flavor, plus add healthy fats to your diet. Commercial products, such as Thick-It, are available to thicken foods. Mashed potatoes are another possible solution.

One MGteam member advised others to “just eat slower and find foods that are easy to swallow.”

3. Choose Foods Wisely

Make the most of nutritious foods that are soft and don’t require a lot of chewing. Eggs are soft and easy to chew and swallow. They’re also full of protein and other nutrients. Eggs contain many essential vitamins, and just two eggs give you up to 30 percent of your daily vitamin needs.

4. Use the Chin-Tuck Maneuver

Put a bite of food in your mouth and lower your chin toward your chest before you swallow. This blocks your airway while you swallow so the food goes down your esophagus and into your stomach, instead of into your lungs.

5. Time Your Meals for When MG Treatment Works Best

Time your meals around the peak of your medication. If you use a medication such as pyridostigmine (Mestinon) to improve muscle function, eat your meal about an hour after you’ve taken it.

Also, if you have difficulty swallowing pills, consider placing them in pudding so that they are easier to take. You might also be able to crush your pill and mix it in with food, but some pills have to be swallowed whole, so check with your pharmacist first. If crushing pills isn’t an option, ask your health care provider whether your medication is available in a liquid form.

6. Rest Up!

Rest before meals. Also, avoid talking when you’re eating. This can help to cut down on fatigue. It’s also a good idea to avoid gum, which can tire out the muscles you use for chewing and swallowing.

As one MGteam member noted, “Take time to rest. Always listen to your body.”

7. Ask Your Doctor About Other Medications

Some medications can be problematic for people with myasthenia gravis. For instance, certain classes of antibiotics can worsen myasthenia gravis symptoms. Ciprofloxacin (Cipro) is an example of a fluoroquinolone antibiotic that can cause difficulty swallowing and that people with myasthenia gravis should often avoid.

Identifying medications that will work best for you (while minimizing risks) requires teamwork between you, your pharmacist, your primary care provider, and any specialists that you see.

Be Open With Your Doctor About Swallowing Problems

Let your doctor know how often you notice problems with swallowing and how it’s affecting your life. If swallowing is becoming more and more difficult, ask your physician whether you could benefit from seeing a speech-language pathologist (SLP) who can perform a swallowing assessment. An SLP may be able to collaborate with you to help you swallow better.

Since this symptom can lead to dangerous complications, it’s important to work with your medical team to get it under control. If swallowing problems or other MG symptoms are getting worse, it may be time to have a discussion about your MG treatment options.

Talk With Others Who Understand

MGteam is the social network for people with myasthenia gravis and their loved ones. On MGteam, more than 2,200 members come together to ask questions, give advice, and share their stories with others who understand life with myasthenia gravis.

Are you living with myasthenia gravis? Do you have difficulty swallowing? Have you found ways to make swallowing easier? What are your “go-to” foods that are especially easy to eat? Share your experience in the comments below, or start a conversation by posting on your Activities page.