ALS Manual - Diet and Drink

As chewing and swallowing problems develop, it will be necessary to make dietary changes to cope with these reduced eating abilities.

Consult with your dietitian or doctor regarding changes to your diet. With a weakened tongue and lips, it is not only difficult to chew, it is difficult to position food in your mouth so it won't either fall out between your lips, or fall down your throat before you have finished chewing.

When eating or drinking consider the following:

Smaller and softer
Food should be softer and cut into smaller pieces that can slide down the throat with minimum chewing.

Not too runny
If food or drinks are too runny, some of the liquid can run into the airway to the lungs and cause coughing.

Not too dry
If food is too dry, such as dry toast, it tends to irritate the throat and causes coughing. This problem can often be solved by adding butter, jam etc.

Not too sticky
Foods that are too sticky, such as a thick sticky sauce, will be a problem if they don't flow in the mouth and throat. Thinning the sauce can help.

Foods that may be easier to manage

Custards, applesauce, sherbets, puddings, plain yogurt
Crustless toast with butter, crustless French toast
Dark chicken meat with gravy
Canned fruit, soft fruit (for example, bananas)
Eggs (scrambled, poached, omelettes)
Cooked cereals (with milk)
Casseroles (macaroni and cheese)
Milkshakes, frozen ice cream bars
Mashed potatoes with gravy
Gelatin with yogurt/cottage cheese
Salmon/tuna/egg salad
Thick soups
Juice nectars, tomato juice, vegetable juice
Pasta with sauce

Specific foods that may cause problems

Extra-spicy, “hot” or acidic foods
Soft fresh bread
Cookies, crackers, dry cereal, graham crackers
Dry muffins, cake
Dry, fibrous, or bony meats and fish
Coconut, pineapple
Sticky foods (for example, peanut butter)
Stringy vegetables (for example, lettuce, celery)
Fried noodles, rice
Popcorn, potato chips, nuts
Fruits and vegetables with skin or seeds (for example, peas, corn, apples, berries)

A dietitian can make helpful suggestions about the following:

Suitable methods of cooking;
Substitutions for suitable foods;
Ways to thicken thin liquids (for example, use commercial thickeners, mashed potato, arrowroot, gelatin, sour cream, egg, cornstarch, flour, infant cereals);
Types of semi-solid foods (pudding, custard, cottage cheese, pureed fruit).

It is difficult to maintain a fully balanced diet if you have chewing and swallowing difficulties. There are many ways to add nutrients to food - this is not the time to worry about fat and cholesterol! Special high-nutrient powders, drinks and puddings are available commercially in some drug and health food stores. Check out how you like the taste before spending too much money on these products. When you are unable to continue eating normal meals, you should consult a dietitian for recommendations regarding nutritional supplements. Also, if you haven't already done so, now is the time to consider having a feeding tube.