What to Eat and Avoid with MG Dysphagia

While I was in the hospital being tested for myasthenia gravis (MG), I developed a symptom no one wants - the inability to swallow, or dysphagia. It came out of the blue. I had no warning. I was served a hamburger for dinner. I took a few bites and swallowed them with no problem ... the next bite got stuck in my throat. I was unable to swallow or bring it up at first. It was absolutely terrifying!

The severity of that symptom only lasted a short time. Though I was still having difficulty swallowing, it was never that bad again. However, I did learn to take precautions with what I ate and still do. I’ve seen many people struggle with what to eat when MG has affected those muscles, so I thought I’d share some of the things I did that helped me get through those times.

Tips for eating

I would make sure I was sitting upright at the table and didn’t slouch. Concentrate on swallowing, so remove all distractions from your area. Talking is a distraction, so if you are having a great deal of difficulty swallowing, you may need to either dine alone or ask for quiet, calm conversation at the table.

That’s a tough one, because it’s also important to interact with your loved ones and mealtime is the obvious time in which to do that. This is one I would recommend only as a last resort. However, you need to gauge your dining conditions to your swallowing abilities.

Remember to adjust the thickness of the food to accommodate your abilities. I could tolerate regular mashed potatoes with gravy, but maybe you need the potatoes thinner. Same with other mashed or pureed foods.

Food considerations and dysphagia

Below I have listed some foods to consider if you are experiencing dysphagia, but the list is far from complete and may need to be adjusted to each person's abilities. Foods I could tolerate, you may not be able to - but many foods can be modified. Fortunately, I can eat most any food I want now, but I’m always careful and I always try to keep a drink close.

Fruit

I could eat soft fruit if cut in small pieces or pureed. Some fruit that may be tolerated are melons with all seeds removed, pealed pears, peeled peaches, strawberries, mashed bananas, applesauce, fruit packed in juice and cut or mashed. You can also try these in smoothies with milk or yogurt.

Fruit I avoided:

• Apples
• Berries
• Fibrous or stringy textured fruit
• Fruits with thick skins, e.g. unpeeled pears, peaches, etc.
• Grapes

Vegetables

I ate a lot of soft foods that were easily mashed or pureed, such as mashed potatoes, carrots, and beets. If the food is too thick, I add a little broth, gravy, milk, or other appropriate liquid to the food. I also used gravy to help moisten them.

Vegetables I avoided:

• Celery
• Corn
• Hominy
• Peas, due to the translucent, slightly tough skin
• Fresh tomatoes
• Salads

Meat

I cooked meat for my family and I had the same cuts myself. The difference was, I chopped my meat to very small particles with my meat grinder, almost like ground beef. I also added gravy to the meat to help it slide down easier.

Meat I avoided:

• Uncut or unground meat
• Bacon (Even if crisp, it isn’t easy for me to swallow)

Breads, cereals, and pasta

For me, breads, cereals, and pastries are permitted as tolerated if they get soft with milk or other liquid. Cereals that soften easily in milk were ok for me. Oatmeal may be okay if it wasn’t lumpy and I could get it to the right texture. I can eat pasta if mashed or cut very small, but I avoid non-pureed pasta, rice, etc.

I avoided:

• Sandwiches
• Chewy bread, such as ciabatta or bagels (unless well soaked)
• Crunchy and crumbly foods, such as toast, biscuits, crackers, crisps, etc.
• Shredded wheat (my favorite) - too much of the wheat that doesn’t soften enough
• Grape Nuts with raisins
• Pie crusts or other crunch pastries

Dairy and dessert

As long as cheese was melted, in small pieces, or spreadable, I could eat it. If it will melt and not become stringy, it was usually okay.

Desserts were easy for me to work out. Anything that I could puree without compromising the intended flavor, I did. This included puddings, souffles, and more. I could also add moisture to brownies, cakes, soft muffins and donuts as needed.

I was able to eat ice cream, but if you require thickened fluids in order to swallow more safely, ice cream may melt too much to provide you with the thickness you need. Jello-o is another food that may or may not work. Like ice cream, it tends to melt in your mouth and turn into a thin liquid.

Dairy and dessert I avoided:

• Desserts that are too dry or chewy, such as cookies
• Chewy candies and gum
• Stringy-type cheese

Soups and liquids

I had no problems swallowing any liquids, but some people may have problems with thin and/or thick liquids. If you need to thicken the liquid, there are thickeners and pre-thickened liquids at your local pharmacy. If unsure, check with the pharmacist or a dietician.

If I had soup, I’d get broth or chicken noodle soup. I’d have any soup I liked that I didn’t have to work much at swallowing. Sometimes, I’d use the chicken noodle soup on my mashed potatoes when I didn’t have gravy.

Check in with your healthcare provider

Be sure you always check with your healthcare provider prior changing your diet, even if your swallowing improves. NEVER try new foods when you’re alone. Add dysphagia to your list of illnesses. Healthcare providers need to be aware of any issues you may have.

I keep a list of medications, physicians and their contact information, surgeries, vaccines, tests needed, etc. on a spreadsheet that I take with me any time I seek medical attention. If you have dysphagia, include a list of foods/liquids you can and cannot tolerate and why.