How is Swallowing Affected by ALS?

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease that has a lot of different symptoms associated with it. These symptoms can present numerous challenges for the individual who has been diagnosed and include issues such as struggling with slurred speech and muscle weakness.

One common ALS symptom is related to swallowing. As the nerves begin to deteriorate, individuals may have trouble chewing food and might need to swallow several times to get that food down the throat. Other issues such as aspiration, where food or drink gets into the windpipe, can also cause problems for the individual.

Here we take a closer look at the impact ALS has on swallowing and how this problem can be managed as the disease progresses.

How is Swallowing Affected by ALS?

Difficulty swallowing is also called dysphagia and is a common symptom of ALS, and which sometimes occurs in the early stages of the disease. The swallowing reflex is served by a complex series of actions involving muscles in the tongue, mouth and throat. The tongue, for example, performs the important task of moving the food to the back of the mouth (try swallowing without moving it at all).

Once the nerves sending signals to swallow have deteriorated, these muscles become severely weakened. That means an individual may have difficulty eating certain kinds of food or may require more liquid to ease movement down the throat.

• Trouble swallowing also has a knock-on effect for the windpipe called aspiration. There is a risk of food or drink going down the windpipe and causing an infection or choking.
• Individuals will also tend to have more saliva in their mouth which can cause drooling.
• Towards the later stages of the disease, swallowing may become impossible, which means that a feeding tube will need to be used.

Signs Associated with Swallowing Difficulty

ALS dysphagia can start as something mild and be a minor inconvenience. It can, however, quickly progress and it’s essential to keep an eye out for more severe symptoms.

These include:

• Coughing or choking when drinking or eating food.
• Making gurgling noises when swallowing.
• Taking more time over meals and having to take smaller bites.
• Food spilling out of the mouth or coming out of the nose.
• Excess saliva which may exhibit as drooling.
• Getting breathless while eating.

Understanding what is happening with regards to swallowing is critical and there are a number of different options that can be used at each stage as the disease progresses.

Management of Dysphagia

There are several approaches that can be used to manage ALS dysphagia. The first of these is making choices about what is eaten. Some foods can be difficult to swallow, so adding a sauce or gravy makes it easier for the individual to consume. Thickening drinks is also an option, mainly to ensure that liquids don’t go down too quickly and cause aspiration.

Developing certain strategies also helps, especially in the early stages. One is to double up on swallowing to ensure that food goes down and doesn’t stick in the throat. Another is taking a sip of water with each bite.

As swallowing becomes more difficult, blending food may be the most sensible option. As the disease progresses and the swallowing reflex disappears altogether, the normal approach is to use a feeding tube. This can be used orally or the tube can be inserted directly into the stomach. 

Excess Saliva

Once dysphagia starts to become an issue, it can seem as though the individual salivates more. This is actually because they are not swallowing properly rather than more saliva being created.

Again, in the early stages, this is easy to handle with something like a napkin or making a conscious effort to swallow. Not eating foods that are either too sweet or too sour can also keep salivation under control.

As the disease progresses this issue becomes a little more troublesome. One solution is to have a portable suction device that can be used to quickly get rid of excess saliva.

There are some medications such as glycopyrrolate and propantheline that help reduce salivation. Some of these do come with side-effects such as drowsiness and difficulty urinating so it’s essential to weigh the pros and cons before choosing a particular drug and to always speak to a medical professional to get their advice.

For a more natural solution, a couple of glasses of fresh tomato juice a day can help reduce saliva output. Tomatoes contain lycopene and the drink can be sweetened, if necessary, by adding sugar.