Changing how you eat may reduce the impact of myasthenia gravis (MG), a condition that can affect your ability to swallow.

MG is an autoimmune, neuromuscular disease affecting your voluntary muscles.

An autoimmune disease is a condition in which your immune system mistakenly attacks your healthy cells. In MG, the cells your immune system targets are the ones that allow nerves to connect to muscles. As these cells become suppressed, your muscles weaken.

MG commonly affects the throat, which can sometimes make it difficult to swallow.

Chewing and swallowing food is a complex process involving the cooperation of many nerves and about 50 pairs of muscles. MG can affect this vital functionality and make it a challenge to eat and drink.

There are four phases in swallowing:

  • oral preparatory, when food or liquid enters your mouth
  • oral voluntary, when you chew or manipulate food in your mouth
  • pharyngeal, when your swallowing muscles contract to move food into your esophagus
  • esophageal, when food travels through your esophagus to your stomach

Trouble swallowing, also called dysphagia, can occur if any of these phases are disrupted.

What does trouble swallowing due to myasthenia gravis feel like?

If you experience MG dysphagia, it might feel like:

  • your food is stuck at the back of your throat
  • you can’t get your throat to move properly
  • your food went down the wrong way, causing you to cough
  • your food entered your nasal cavities

It can be frustrating and frightening, too.

How does it show up on tests?

Doctors can conduct several types of tests to diagnose MG:

  • Physical exam: This will include questions about your medical history.
  • Neurological exam: The doctor checks your muscle tone and strength, along with your sense of touch, coordination, and eye movements.
  • Electrodiagnostics: Doctors use this type of testing to assess muscle response to stimulus and nerve-to-muscle transmission.
  • Blood test: Doctors use bloodwork to look for high levels of certain antibodies associated with MG.

What are the symptoms of myasthenia gravis, and how do they affect daily life?

MG symptoms can vary from one person to the next. Sometimes, they’re mild and improve with rest and tend to be less pronounced earlier in the day.

Symptoms can include:

  • eye muscle weakness
  • eyelid drooping
  • vision blurring or doubling
  • facial expression changes
  • swallowing difficulties
  • speech impairments
  • shortness of breath
  • weakness in your neck, legs, arms, hands, and fingers

Sometimes, symptoms can worsen with triggers to the point of becoming a myasthenic crisis.

A myasthenic crisis is an urgent medical event that occurs when your breathing is impacted enough for you to need the help of a ventilator.

Common triggers include:

  • stress
  • infection
  • surgery
  • adverse medication reaction

Myasthenic crises affect about 15–20% of people living with MG, about half of whom can’t identify what triggered their event.

When MG makes swallowing difficult, there are ways to make eating and drinking a little easier.

Aside from trying the strategies below, it is also a good idea to talk with your doctor and see a speech therapist for individualized recommendations since each person with MG has different needs.

Managing eating fatigue

Eating can cause MG muscle fatigue, but there are a few strategies to manage this.

You may benefit from adjusting your meal schedule to suit your energy levels.

This might mean eating your largest meal early in the day since MG weakness tends to be more noticeable in the afternoon. Or you can try eating several smaller meals throughout the day.

You can also make your food easier to eat by cutting or chopping it into smaller pieces.

Eating slowly can help, as can avoiding conversation while you eat.

If you take anticholinesterase medication, your doctor might have some suggestions about how to effectively time your doses before meals.

Clearing your throat more easily

MG can make it challenging to clear all the food from your throat, but there are solutions that may help:

  • adding ingredients or toppings that moisten food, like butter, gravy, yogurt, mayonnaise, or sour cream
  • choosing softer meats like fish or chicken
  • adjusting your head positioning slightly to see if this can make swallowing easier

Certain foods may get stuck in your throat more easily, so choosing alternatives can help.

Examples of foods to avoid include:

  • tough meat
  • muffins
  • sandwiches
  • bagels
  • popcorn
  • crackers
  • chips
  • nuts
  • cookies

Keeping your chin down while swallowing food may also make it easier to clear your throat.

A 2021 study found that a chin-down position made swallowing food easier for participants with MG. The study compared chin-down and neutral chin positions and found that the former was helpful for improving pharyngeal clearance, possibly due to changes in swallowing pressure.

For some people, tilting their head forward can cause food to enter their nasal cavities. So, if you want to try a chin-down position, it might be helpful to eat smaller mouthfuls of food and keep your head as upright as possible.

Reducing the chance of aspiration

Aspiration occurs when you accidentally inhale food or liquid that you meant to swallow. If this inhalation occurs without any noticeable signs, it’s referred to as silent aspiration.

Aspiration can lead to issues like lung scarring and pneumonia.

To reduce the chance of aspiration, avoid or take caution with foods that contain thin liquids.

Examples include:

  • melting popsicles
  • fruit that contains juice when you bite into it
  • mixed consistency foods like cereal with milk or soup with clear broth

It can also help to thicken the fluids you consume. Your doctor or speech pathologist can suggest a safe consistency to aim for.

An MG crisis can occur with a flare (an exacerbation of symptoms). So, if you think your symptoms might be worsening, it’s a good time to meet with your doctor to see if you should adjust your treatment.

Signs to watch for include:

  • trouble swallowing
  • difficulty chewing
  • needing to catch your breath more often than usual, such as during conversations
  • challenges with walking

If you experience shortness of breath, it’s important to call 911 for immediate medical care.

While you wait, you can rest and stay calm. If you’re alone, unlocking the front door and waiting nearby can make it easier for first responders to locate you.

Myasthenia gravis can cause muscle weakness that makes swallowing difficult.

Things to try to make eating easier include eating small meals, dicing or softening your food, and eating slowly.

If you’re experiencing trouble chewing, swallowing, or walking, your doctor may be able to adjust your treatment to help.

If you experience shortness of breath, seek immediate medical care.