8 Ways to Ease MS-Related Swallowing Problems

If you have dysphagia, chew on these tips for easier swallowing

Good posture while eating is important.
Good posture while eating is important. Kathrin Ziegler/Getty Images

The barrage of symptoms that come with multiple sclerosis (MS) can leave you feeling like no function of your body is unaffected. Pain, vision problems, dizziness—and now trouble swallowing? Between 30- and 40-percent of people with MS are estimated to experience difficulties swallowing, known as dysphagia, at one time or another.

Fortunately, many symptoms of MS come and go over the years, and when it comes to eating and drinking, there's a lot you can do to minimize your chances of choking or developing aspiration pneumonia (when food or liquids are inhaled into the trachea and lungs, causing infection).

Dysphagia in People with MS

Regardless of how severe your dysphagia might be, it is important that those of us with MS who may have swallowing difficulties review our habits around eating and see if we can create new (and safer) habits. Some swallowing problems can be so subtle that you may not even notice them, except when you occasionally gag on a bite of food or have a coughing fit when trying to swallow a pill.

Tips for Dealing with MS-Related Swallowing Problems

Here are eight ways to ease MS-related swallowing problems. 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 while munching on popcorn at the movies.

Do a body check before eating. Check in with your body before a meal. If your other symptoms are acting up, there is a good chance that your dysphagia will kick in, too—so be extra mindful of chewing slowly and of your food choices (more on that in the next point). Remember, fatigue will also contribute to swallowing problems.

And it probably isn’t a good idea to eat outside in hot weather, as heat intolerance can aggravate all MS symptoms.

Avoid hard, dry, and crumbly foods. Hard, crumbly, dry and crunchy foods, such as granola, may leave particles in your throat and windpipe that aggravate your dysphagia. Softening these foods (say, soaking the granola in milk and then heating it up) or avoiding these kinds of foods altogether may help you. You may need to eat very soft or pureed foods (instead of granola, perhaps try instant oatmeal).

Don’t talk with food in your mouth. Again, how many times did you hear this while you were growing up? Instead of speaking with a mouthful of food, try to eat calmly, fully chewing your food, in a quiet environment. If you're having lunch with friends or colleagues, be sure to chew thoroughly before chiming in.

Eat more mindfully. In our hectic culture, it's more common to eat on the run or inhale food while doing something else than it is to carve out 20 minutes to focus on your meal.

But with MS swallowing difficulties, you have all the more reason to make eating an event without interruptions so that you can (carefully) savor every bite—and you'll probably find that this is a more enjoyable way to eat anyway! 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.

Tuck your chin. 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.

Eat smaller meals more frequently rather than three square meals a day. 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.

Alternate between 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.

Talk to your doctor about liquid thickening agents. 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. Pre-thickened drinks and commercial thickeners may be purchased at drugstores and pharmacies. But because some of them are made with sugary ingredients, and they may lead to dehydration if they are relied on too heavily, it's a good idea to talk to your doctor first.


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.

Walker, Katherine and Selinger, Marilyn. Swallowing Problems (Dysphagia) in Multiple Sclerosis: A Provider’s Approach. U.S. Department of Veteran's Affairs, September 2009.

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