Many people living with ALS/MND find eating and drinking more difficult over time. About 80% of people with ALS/MND develop difficulty swallowing at some point. For most people, these changes happen gradually.
This page explains how swallowing and saliva can change, how to stay well-nourished, and when a feeding tube may help.
On this page
Swallowing │ Nutrition │ Saliva │ Feeding tubes │ Who can help │ Resources
How swallowing changes
In about 30% of people, ALS/MND first affects the muscles used for speaking and swallowing. This is called bulbar-onset ALS/MND. In others, swallowing changes appear later in the disease.
Difficulty swallowing is called dysphagia. It happens when the nerves and muscles of the mouth and throat stop working properly. Food, drink, or saliva can then enter the airway instead of the stomach. This is called aspiration. It can cause coughing and choking, and it can lead to a chest infection.
Common signs of swallowing changes include:
- Coughing or choking during or after meals
- Difficulty chewing, or meals taking much longer than before
- Weight loss or a poor appetite
- Not drinking enough, which can lead to dehydration and constipation
- Repeated chest infections
Tell your care team about swallowing changes early. A swallowing assessment can identify risks and help you make changes before problems develop.
Staying well-nourished
Maintaining weight is an important goal for people living with ALS/MND. The body may need more energy than before, while eating becomes harder. Weight loss can reduce strength and energy.
The care team can recommend practical changes, such as:
- Changing the texture of food, for example, soft, minced, or puréed meals
- Thickening drinks so they are easier to swallow safely
- Using positions and techniques that make swallowing safer
- Eating smaller meals more often, and choosing foods high in calories and protein
- Using adapted cutlery, cups, and plates
The right approach is different for each person and changes over time. Talk to a speech-language pathologist or dietitian before making major changes to diet.
Saliva
ALS/MND can also affect saliva. Some people have saliva that pools in the mouth and causes drooling. This is called sialorrhea and affects about 30% of people with ALS/MND. Others have thick saliva that is difficult to clear from the mouth and throat.
Both problems can be treated. The care team can recommend changes to posture, equipment, medication, and other treatments. Good oral care also helps keep the mouth comfortable and reduces the risk of infection.
Feeding tubes
A feeding tube provides nutrition, fluids, and medication directly to the stomach. It can help when eating and drinking by mouth is no longer enough or no longer safe. A feeding tube can help a person maintain weight, strength, and energy.
Many people continue to eat and drink some food by mouth for enjoyment after a tube is fitted, if it is safe to do so.
Talk to the care team about feeding tubes early. This gives time to understand the options and make a decision before the need is urgent.
Who can help
A multidisciplinary care team supports eating, drinking, and swallowing. The team can include:
- Speech-language pathologist (also called a speech and language therapist): assesses swallowing and recommends safe swallowing strategies and food textures
- Dietitian or nutritionist: helps maintain weight and plans meals that meet nutritional needs
- Occupational therapist: recommends equipment that makes eating and drinking easier
- Gastroenterologist: places feeding tubes and manages digestive problems
- Respiratory therapist: helps with clearing the airway and preventing chest infections
- Dentist or oral health professional: supports mouth care and oral health
For support with breathing and chest infections, see Respiratory Care.
Videos about nutrition and swallowing
Watch videos about nutrition, swallowing, and eating and drinking with ALS/MND.
Sources: Statistics on swallowing difficulty, bulbar onset, and sialorrhea are from a 2024 review of dysphagia and sialorrhea in ALS, published in the Journal of Neurology.
Resources from our members
Explore additional resources about nutrition, swallowing, saliva, and feeding tubes developed by Alliance member associations.
Nutrition and eating
What Can a Dietitian Do for You?
ALS Centrum Nederland · Dutch
An overview of the role of a dietitian as part of the multidisciplinary care team for people living with ALS/MND.
Eating and Drinking with MND
MND Association · English
A detailed guide to changes in eating and drinking, who can help, and practical ways to make meals easier and safer. It also includes easy-to-swallow recipes.
Culinary Care for ALS: A Nutritional Toolkit
ALS Society of Quebec · English and French
A toolkit to help families adapt meals as nutritional needs change, written for people living with ALS/MND, caregivers, and health professionals.
High-Calorie and Easy-to-Chew Recipes
The ALS Association · English
Recipes for breakfast, lunch, dinner, and snacks, along with lists of foods that may be easier or harder to manage.
ALS and Nutrition
Les Turner ALS Foundation · English
A guide explaining why people living with ALS/MND may need more calories, with practical strategies for maintaining weight and hydration.
Swallowing and saliva
Swallowing Difficulties
MND Association · English and other languages
Information about managing swallowing difficulties, saliva problems, coughing, and choking.
Dysphagia
ALS Schweiz · German, French, and English
Information about the stages of dysphagia, from recognizing early signs to strategies for eating, speaking, and swallowing, with links to further resources.
What to Do When Choking
ALS Centrum Nederland · Dutch and English
Information and short videos showing what to do when a person with ALS/MND has trouble swallowing or is choking. A useful refresher for caregivers and health professionals.
Feeding tubes
Tube Feeding
MND Association · English and other languages
Information about what a feeding tube is, how it works, when to consider one, and what changes to expect after it is fitted. The resource is designed to support decision-making.
MyTube
Sheffield Institute for Translational Neuroscience · English
Short videos explaining how feeding tubes are fitted and what life with a tube is like, including experiences shared by people living with ALS/MND and caregivers.