When It’s Too Much To Swallow

Swallowing is something we take for granted, at least many of us. That is until you can’t swallow or at least swallow easily and comfortably. Swallowing is defined as the ability to move around food in the mouth and then down to the stomach for further digestion. The process of swallowing involves more than just the tongue and throat. It involves every cell, nerve, gland, tissue, and muscle starting at the lips, through the mouth, and down the 10 to 13 inches of the esophagus which is less than 1 inch in diameter. Since April is National Oral, Head, and Neck Cancer Awareness Month, let’s delve further into the difficulty swallowing cancer patients can experience.

Certain types of cancers including mouth, tongue, jaw, throat, pharynx (the tube behind the nose leading to the esophagus), and esophagus can trigger major changes in the ability to swallow. For example, a tumor may be blocking the passage of food or cancer treatment may alter the healthy production of vital saliva, enzymes, and tissues. Treatments may cause inflammation and irritation of oral and digestive tissues, causing painful chewing and swallowing. If you aren’t about to move food through the mouth and esophagus to the stomach, you are at higher risk serious issues such as dehydration, aspiration, choking, infection, pain, weight loss, and malnutrition. These issues can lead decreased quality of life, breaks in treatment, and reduced response to treatments.

Many cancer survivors that I talk to downplay problems swallowing, but this can be detrimental. Problems swallowing are important to address quickly because it’s often a sign of treatable issues. Get a handle on side effects early in your treatment journey. Let’s talk about some strategies to work through those difficult swallowing issues.

Properly prepare for treatment.

Before you begin treatment, there a few things you should do to prepare.

• Visit your dentist to create a good dental care plan.
• Give up tobacco use chewing, dipping, and smoking.
• Speak with a dietitian to do a nutritional screening and created a healthy eating strategy.

Choose soft foods.

The texture of the foods you eat can either help heal your damaged mouth or throat or it can further injure your swallowing system so pick soft foods.

• Add gravy and sauces to foods to change their texture. Dip food into other liquids like milk, syrup, custard, or yogurt.
• Prepare your foods to retain moisture by stewing, boiling, or slow cooking meat and veggies instead of frying.
• Trim dry edges from food before serving.
• Avoid acidic fruits and chooses; opt for cherry, apple, grape, or peaches instead of oranges, grapefruits, or lemons.
• Say no to alcohol even in mouthwash!
• Avoid hot and spicy foods.
• Sip liquids after each bite to moisten food in the mouth.
• Don’t eat crusty breads, pretzels, chips, raw fruits, or raw vegetables.

Address changes in taste.

Cancer treatments can cause changes in taste and smell. There are steps you can take to manage your taste challenges.

• Start with your dental and gum health. Ask if a special rinse or toothpaste is right for you. Remember to floss often and use a soft toothbrush or sponge to brush your teeth.
• Work with all of the 4 tastes sweet, sour, bitter and salty. If food tastes sweet, add a sour flavor or sauce or even a squeeze of lemon. If meats are bitter in flavor, marinade meat for a few hours before cooking or serve with a sweet sauce. Select unsalted food or reduced-sodium choices if salty tastes are a turn-off.
• Metallic taste in the mouth is often a side effect so use plastic flatware, cups, and storage containers instead of metal.

Speak with an expert about nutrition.

Consulting with a RDN as part of your healthcare team is an important part of your treatment plan. Individualized nutrition counseling for patients with head and neck cancers (HNC) has shown to improve nutritional status and quality of life for patients compared to patients who receive no counseling or only general nutrition advice.[1] This is especially true if you have nutrition related side effects like involuntary weight loss, dehydration, or malnutrition. HNC patients exhibit one of the highest rates of malnutrition among all cancer diagnoses with 25-50% of these patient at risk for malnutrition prior to starting treatment.[2] Up to 78.9% of people with esophageal cancer are diagnosed with malnutrition during treatment.[3] Ask your healthcare team for a referral to a RDN who specializes in caring for people with your type of cancer. Or, use the Academy of Nutrition and Dietetics’ RDN locator to find a RDN in your area.

Expect nutritional support.

At some cancer centers nutritional support is used before treatment starts, especially if the patient is already experiencing signs of malnutrition. What is nutritional support? Nutritional support is a way to boost your nutrition when you aren’t getting what your body needs from your regular eating habits. The most frequent recommendation for nutritional support is to include a concentrated source of nutrition in your diet. Usually these “sources” are liquid nutrition drinks or similar fortifying products. However, nutritional support can also include tube feeding.

Again, ask to speak with a registered dietitian nutritionist (RDN) as a part of your multidisciplinary treatment team. Your RDN may suggest you use oral or liquid nutritional drinks or a tube feeding before treatments begin so you will be in the best nutritional status at the beginning of your treatments. While in treatment, if you lose 5% of your body weight in one month or 10% in two to three months, you are unable to eat enough to sustain good nutrition, or you are severely dehydrated, your RDN may recommend a feeding tube or enteral nutrition. Feeding tubes options are often temporary until your body can consume and digest healthy amounts of food and fluids alone. Even with a feeding tube, you can be mobile and independent. A feeding tube can help you increase your strength and immunity during treatment and keep you from becoming severely malnourished.