Managing swallowing symptoms with myasthenia gravis

Swallowing problems are common in myasthenia gravis (MG) because this neuromuscular condition can weaken the muscles needed for eating and drinking.

When these muscles are affected, swallowing difficulties can increase the risk of complications such as choking and aspiration, which in turn can lead to pneumonia.

Fortunately, practical safe eating tips — including making thoughtful food choices, adjusting your eating routine, and working with your healthcare team — can help you stay safer during meals and continue enjoying eating despite MG and swallowing difficulties.

Of course, if you notice sudden changes in swallowing or develop new breathing problems, seek immediate medical care, as these could signal a flare-up of your MG symptoms.

Why MG makes swallowing difficult

MG disrupts the signals between nerve endings and muscles, so your muscles can’t contract as strongly or reliably as they should.

When MG affects the muscles needed for chewing and swallowing, it can cause dysphagia, which is the medical term for difficulty swallowing. These swallowing challenges and other MG eating difficulties can vary day to day or even meal to meal, often worsening with fatigue and affecting your ability to eat safely.

Common symptoms of dysphagia in MG include:

• food feeling stuck in your throat
• choking or coughing when eating or drinking
• needing more time to swallow each bite or sip
• changes in your speech or voice after eating

The potential risks of untreated swallowing symptoms include:

• increased risk of aspiration (food or liquid entering your airway)
• repeated choking episodes, which can be frightening
• malnutrition or dehydration due to eating less
• respiratory infections (such as pneumonia) from aspiration

How doctors and therapists can help

It’s important to reach out to your MG care team for guidance and support in managing swallowing difficulties as they can come up. Your team will help develop a plan for MG dysphagia treatment that hopefully works for you.

Your neurologist can help by adjusting medications to strengthen your muscles and prevent symptom flares, which can make eating and swallowing easier.

A speech-language pathologist (SLP) familiar with MG can offer speech therapy for swallowing difficulties, which includes assessing your swallowing abilities and recommending exercises and techniques to keep eating safely.

Meanwhile, a registered dietitian can suggest meal plans and food preparation strategies, such as an MG-friendly soft food diet that consists of thickened liquids or pureed meals to maintain nutrition without adding extra effort or risk.

In some cases, your care team may recommend temporary feeding support, such as a feeding tube, until it’s safe to resume normal eating.

Tips for safer and easier eating

You can make everyday eating more manageable by adjusting your food choices and habits:

• Choose softer foods or pureed meals as needed.
• Drink thicker liquids, which are often safer than thin drinks.
• Alternate small bites of food with sips of liquid.
• Eat your largest meal earlier in the day, when you have more energy.
• Rest before meals or snacks to preserve muscle strength.
• Avoid hot foods and liquids, which may relax throat muscles.
• Try small, frequent meals instead of three large ones.

Early support and using mealtime strategies for neuromuscular disorders can reduce risks while helping you maintain your nutrition and comfort during meals, which can help with managing symptoms of MG.