Swallowing and Nutrition

Appetite decline: Appetite decline is a common symptom in people with advanced MS and can lead to depleted protein stores that impact skin health and overall well-being.

Poor fluid intake: Water is a major component of blood and dehydration reduces the body’s blood volume. This reduces oxygen and nutrient delivery to the skin. Baseline fluid requirements for an adult are a minimum of 1.5 litres per day. With swallowing problems, and sometimes concerns about incontinence, many people with MS do not take adequate fluids.

Swallowing problems: Coughing after drinking liquids, or choking while eating certain foods, particularly those with crumbly textures, are signs of swallowing difficulties, or dysphagia.

When this kind of coughing or choking occurs, the food or liquids are inhaled into the trachea (windpipe) instead of going down the oesophagus (gullet) and into the stomach. Once in the lungs, the inhaled food or liquids can cause pneumonia or abscesses.

Swallowing problems are initially diagnosed by a careful history and neurologic examination of the tongue and swallowing muscles. A special imaging procedure called a modified barium swallow (videofluoroscopy) is used to evaluate a person’s ability to chew and swallow solids and liquids.

In this test, the person drinks a small quantity of barium, which makes the structures of the mouth, throat, and oesophagus visible on x-ray. The movement of these structures is recorded on videotape by a videofluoroscope as the person eats or drinks foods of varying consistencies—thin liquid, thick liquid, and solid. The precise location and manner of a swallowing defect can then be identified, and treatment prescribed. It is important to remember that the testing might not replicate your experience at home.

Swallowing, like many other MS symptoms, can change from day to day and hour to hour. Therefore, the timing of the test, whether it is in the morning or afternoon for example, could make a difference in the results. A speech & language therapist is the professional who diagnoses and treats swallowing difficulties.

Many people who have difficulty swallowing also have speech disorders. Speech & language therapist also evaluate, diagnose, and treat these problems.

You can self refer to your local speech  and language therapist or GP, Public Health Nurse or your local MS Regional Office can make a referral on your behalf.

The following are food safety tips that might be helpful to address swallowing problems and avoid dehydration, poor nutrition, or the risk of aspiration pneumonia. The goal is to help your loved one get the most nutrition and pleasure from food and drink while keeping discomfort to a minimum.

• The best position for eating is sitting.
• Avoid having the head tilted backwards.
• For those using wheeled mobility, consider a water bottle called a drink-aide that allows wheelchair users to drink independently, even if they have limited or no upper body movement.
• Consider beginning a meal with something icy and thick—a sherbet shake, or a fruit or vegetable smoothie. The cool temperature will improve crucial nerve conduction.
• Take one small bite or sip at a time. Never try consecutive swallowing. 
• Never wash food down with a liquid. Instead, add moisture to the solid food. Use sauces, broth, soup, water, or milk.
• Think about spoon size and what works best.
• Choose soft, moist foods first, as they are easier to swallow. Dry solids and thin liquids are more difficult, and require closer attention for safe swallowing.
• Avoid thin liquids altogether when fatigued. Consider consuming thin liquids in the morning and thicker liquids in the late afternoon or evening.
• Identify and then avoid foods that cause choking or coughing, such as potato chips.
• Experiment with a kitchen blender. Some favourite dishes can be pureed without losing their familiar flavour.
• Check with a speech and language therapist if your loved one starts to slow down during a meal, pause and switch to something icy.
• Make mealtimes a calm and social part of the day and save discussion of “hot” topics for times when no one is trying to eat.
• Offer mouth care frequently.
• If you have concerns about diet in general you can seek advice from the Irish Dietetic Institute