Eating is a process of chewing and swallowing. Chewing is done primarily with jaw muscles that, in people with ALS, do not always weaken when other mouth and swallowing muscles are weakening. Weakened jaw muscles are more likely to occur in the latter stages of ALS.

Swallowing is a three-phase process:
First, the tongue moves the food back against the soft palate. If these muscles are weakened, food may get stuck in the mouth, or fall back to the throat before it has been fully chewed.

Second, the upper and lower throat muscles move the food down the passage to the stomach (oesophagus), as well as close off passages to the nose (nasal cavity) and the air passage to the lungs (trachea). If throat muscles are weakened three types of problems can occur. Food can:

• get into the nose cavity, especially if the patient is lying down;
• get stuck in the throat;
• cause choking by blocking off the airway to the lungs (trachea).

In the third phase of swallowing, the top of the muscle system that moves food down to the stomach (the upper oesophageal sphincter muscle) is usually closed. It normally relaxes and opens to receive food and pass it down to the stomach. People with ALS can find that this muscle doesn't relax, in which case food gets stuck, feeling as if it is stuck in the back of throat.

Because of the variety of muscles used to speak and swallow, the problems that occur as a result of degeneration depend on which muscles have been affected. Also, as ALS progresses, conditions change and eating and drinking procedures usually have to change as well. As these problems occur it is important that you consult a doctor, a speech-language pathologist, and/or other professionals who have had training and experience in this area.

If you have your swallowing assessed by videofluoroscopy or other procedures, it is worth asking that you and your caregiver also have a look. That will give you a better understanding of what happens inside your throat when you swallow.

Different people can have different problems and remedies, depending on their physical, mental and emotional conditions.

Eating can be a dangerous activity for people with ALS with weakened throat muscles. Don't take risks. Learn as much as you can about your own swallowing limitations from a speech-language pathologist, a dietitian and other healthcare professionals. Become aware of swallowing changes as they occur in your throat muscles, and ensure that your diet is adapted to your changing abilities.

Take more time
Eating and drinking may be a very slow and labour intensive process. Allow more time to eat meals and never hurry.

Be relaxed when eating
A person experiencing difficulty with eating and drinking may feel acute embarrassment. Anxiety and distress may accompany embarrassment, and anxiety itself impairs the ability to relax. Being relaxed and feeling confident is of tremendous assistance.

Some people find it easier to relax if there are no distractions. For example, they may turn off the TV or radio, and discourage visitors from calling at meal times. Others find distractions helpful in allowing them to relax and feel less anxious.

Concentrate on eating
Eating in a group may result in not being able to concentrate on swallowing or feeling that you cannot take your own time, resulting in an adequate meal not being eaten or being rushed, causing coughing and distress. Eating alone may make it easier, though it may also be important to have at least one other person nearby should you encounter problems.

Focus on eating position
With chewing and swallowing problems you should try eating in an upright position, with the chin tucked towards the chest to close off the airway to the lungs when swallowing and to prevent coughing. Drinking may be easier with the use of a cut out Styrofoam cup. Tilt the chair back as far as is comfortable. Again use a chin tuck.

Take small bites
With weakened tongue and lip muscles, smaller bites are easier to handle in your mouth and will reduce the chances of choking if the food falls into the throat before being fully chewed.

Be prepared
Learn what to do before an emergency happens. When the throat gets irritated or blocked, it can close around the irritant making it difficult to breathe. Even your saliva can cause coughing and choking. This may also happen when a few small particles from a previous meal are still stuck in the throat. Practice the following so that you will be prepared when this happens:

Try to relax
Lean forward, the further the better, depending on the seriousness of the problem. If possible, stand up and bend over as if to touch your toes

Try to take small breaths through the nose
Expel the food by breathing in slowly, and exhaling or coughing quickly. For more force “splint” you're abdomen by crossing your arms over your lower abdomen and pressing firmly in and down as you cough out. A caregiver can also do this by standing behind you and pressing their hands into your abdomen as you cough. Ask a nurse or other professional to show you this technique, known as the Heimlich maneuver, and practice it with your caregivers as soon as possible so that you will know what to do should choking occur.

Never hit a choking person on the back
When a person is choking from food, hitting on the back can cause the food to jam tighter in the throat.

Ask a member of your ALS team about this or contact your regional ALS Unit, local Red Cross Society or St. John's Ambulance branch for CPR and First Aid courses in your area which some of your caregivers can take.

Take food and liquid separately
It may be difficult for the throat muscles to switch between eating and drinking, which require slightly different muscle activity. It may help to eat food separately from drinking, rather than switching back and forth.

When food sits in your throat
If you feel food sitting in your throat, try swallowing two or three times to clear it, before taking more food. It may be that the upper oesophageal sphincter muscles at the bottom of your throat, which are normally closed, are not relaxing and opening as actively as they should to allow swallowing.

Never use liquid to wash down food
If food is stuck in the throat and liquid is added, the liquid can very easily be channelled into the airway leading to your chest, and cause choking.