Foods and Drinks to Avoid if You Have Myasthenia Gravis

A healthy diet is important for a healthy life, but it can be difficult to manage for people with a chronic disease like myasthenia gravis (MG). The neuromuscular disorder causes severe fatigue and muscle weakness, including in the muscles involved in breathing, chewing, and swallowing.

But even for well-controlled myasthenia gravis, it’s important to carefully consider what you consume, because certain types of foods are more likely than others to cause choking, jaw fatigue, or post-meal fatigue, while others can interfere with MG medications. Make sure to consult a registered dietitian for diet advice and a speech-language pathologist if you’re having swallowing difficulties.

Here are some foods and meal types they may recommend you avoid.

Dry, Crumbly Foods

The process of eating requires a chorus of muscles all working together to manipulate food in the mouth, chew, push it into the back of the throat, and swallow.

Dry, crumbly foods like crackers, toast, and flaky pastries are common “aspiration triggers” for people with myasthenia gravis, because small, loose particles can scatter while chewing, entering the airway before the epiglottis closes or slipping into a poorly closed epiglottis.

“Softer, moist foods are generally easier and safer,” Dr. Gonzalez says.

If you do choose to eat dry, crumbly foods, “keep a glass of water at hand and take small sips while eating,” says Benjamin Becker, MD, a neuromuscular neurologist at University of Michigan Health in Ann Arbor. This will moisten the food and form it into a cohesive bolus (ball of food).

Tough Meats

Because MG affects muscle strength and energy levels, jaw fatigue can easily set in before you finish your meal if you’re eating tough meats like steak or pork chops.

Sticky, Thick Textures

“The texture of the food needs to be considered,” Du says, “because MG can affect the swallowing muscles when we eat.” But this doesn’t mean you have to completely write off sticky foods like peanut butter. “If you put a thin layer on bread, that's perfect,” she says.

Mixed Consistencies

Eating food with both liquid and solid components, such as chunky soup and cereal with milk, can be a dangerous aspiration risk.

If you choose to eat mixed-consistency food, Du recommends alternating between the liquid and solid portions.

Large, Heavy Meals

If you have MG, however, this intensive digestive process must tap into an already small energy budget, potentially worsening the systemic weakness you feel. Experts recommend eating small, more frequent meals rather than large, heavy meals. Gonzalez further suggests avoiding eating when fatigued or reclined.

“Eating should be done sitting fully upright, with slow, small bites and adequate chewing,” she says.

Greasy or Spicy Foods

Refined Sugars

Quinine Water

While some people promote quinine — a malaria drug that is also found in tonic water in very low concentrations — to treat leg cramps, a common issue in people with MG, it’s not generally recommended because it can increase weakness.

Alcohol

Methylcellulose

Methylcellulose is also a food additive found in much lower concentrations in processed products like plant-based meats, ice cream, and gluten-free baked goods. Though this usage has a smaller impact on pyridostigmine absorption, Du advises separating ingesting pyridostigmine and methylcellulose-containing products by 30 minutes to an hour.

The Takeaway

• Certain foods — including dry or crumbly foods, tough meats, sticky textures, and food with liquid and solid components — pose aspiration and jaw fatigue risks because myasthenia gravis weakens the muscles involved in chewing and swallowing.
• Large, heavy meals can worsen systemic MG fatigue, so opt for small, frequent meals eaten sitting fully upright and timed to when your medication is at peak effect.
• Some substances like quinine (tonic water), alcohol, and methylcellulose should generally be avoided because they can worsen MG symptoms or interfere with medication absorption.
• Always consult a registered dietitian and a speech-language pathologist for personalized guidance, as dietary needs vary based on disease severity and medication regimen.