What adjustments need to be made to food selection in the event of a swallowing disorder in ALS?

The choice of food can already make swallowing easier. Particular difficulties (even in the early stages of dysphagia) can arise when swallowing drinks and liquid foods (e.g. water, juice, soup). Foods that are particularly dry (e.g. bread) or crumbly (cookies, nuts, crispbread, etc.) can also be problematic. There are no general “regularities” for the foods mentioned.

It is advisable for every patient (if necessary, together with a speech therapist) to try out the suitability of individual aids and to determine individual tolerance. The following recommendations are to be understood as general experiences that have been described by a large number of patients. Overall, the following recommendations have proven to be effective in the selection of foods: Fibrous foods (e.g. rhubarb and asparagus), acidic drinks (e.g. red fruit juices) and foods (e.g. pickles), carbonated drinks (fizzy drinks and carbonated mineral water), strongly spiced and hot foods should be avoided, as the spices stimulate saliva production and can exacerbate any existing sialorrhea.

Replacing meat with fish is recommended, as fish has a suitable consistency for a swallowing disorder. Hard cheese should be substituted for cream cheese, as cream cheese has a suitable consistency. Rice or pasta should be replaced by potatoes or mashed potatoes due to their favorable consistency. Herbs and spice dust should be avoided as they in themselves can cause upper respiratory tract irritation and choking. Sticky food (e.g. white bread) should be avoided.

The individual tolerance of certain food components (and the associated avoidance recommendation) depends on the specific situation. For example, the tolerance of dry and crumbly foods or the development of stickiness of food components can be largely determined by whether there is a deficiency or (frequent) excess of saliva.