Swallowing 101: How it works, risk factors & 5 tips for a healthy esophagus

Mid adult woman drinking water

How often do you swallow? For most people, the answer is several hundred times a day — which is pretty high for a bodily function most of us take for granted.

“Most people swallow involuntarily about 600 times per day,” says Dr. Gordon Peters, medical director at BlueCross BlueShield of Tennessee. “That’s roughly once per minute while awake and even more during meals. Unfortunately, swallowing disorders are fairly common as we age. About 1 in 25 of us will deal with difficulty swallowing at some point in our lives.”

How does swallowing work?

Dr. Peters: Swallowing is a vital function for the oral intake of nutrition and hydration. It works in conjunction with saliva production and has a great impact on quality of life. This is especially true when it comes to protecting our airways.

In our bodies, two different organ systems — respiration and digestion — share the same track. If these functions cross and we take fluids or solids into our lungs, it can cause serious damage, as well as conditions such as aspiration pneumonia. To protect our airway, the epiglottis must close properly while we swallow food. This ensures fluid goes to the stomach, not the lungs.

Humans are lucky to have such a complex system. Birds, for example, rely strictly on gravity, throwing their heads back so food will fall into their stomach. Fish use water to propel food into the stomach through gills. It’s because our system is so sophisticated that we can make so many sounds and form words while animals can’t.

How common are swallowing disorders (dysphagia)?

Dr. Peters: Unfortunately, swallowing disorders are very common, especially as people get older. Strokes and neurological diseases (Parkinson’s, multiple sclerosis, dementia) often lead people to experience difficulty swallowing.

Known as dysphagia, this problem leaves people unable to reliably protect their airway. People with dysphagia have trouble moving food from the mouth to the stomach. This can cause symptoms such as:

  • Choking
  • Drooling
  • Coughing
  • Pain, and
  • Difficulty breathing.

How do you treat swallowing disorders?

Dr. Peters: It depends how severe the disorder is, but often:

  • Speech therapists can help by teaching people how to relearn swallowing.
  • If that’s not physically possible, choosing a diet with foods of a certain consistency (soft or liquid) can help protect people with dysphagia.
  • E-stim therapy uses an electrical current to stimulate the muscles responsible for swallowing.
  • In severe cases, a feeding or gastrostomy tube may need to be inserted into the stomach.

What are the risk factors for dysphagia?

Dr. Peters: There aren’t many risk factors for dysphagia.

  • Smoking is the biggest one, as are oral cancers that require surgery on the oral track.
  • Age is indirectly related. Comorbidities such as stroke or cerebrovascular disease can cause weakness in the muscles that control swallowing.
  • In other parts of the world, parasites can actually paralyze the esophagus so you can’t swallow, but that’s not something we see often in the U.S.
  • Finally, you may experience dysphagia if you have a hiatal hernia or gastroesophageal reflux disease (GERD).

What are the signs you may have a problem swallowing?

Dr. Peters: If you find yourself choking, gagging, or gasping when you’re eating, chewing, or laying down, that may indicate a swallowing problem.

Any tips for healthy swallowing?

Dr. Peters: Most of swallowing is reflexive, meaning we don’t have control over it.

However, we can always work to improve our safety by doing a few things:

  1. Don’t smoke!
    If you’ve tried to quit and it didn’t work, keep trying.
  2. Control your blood pressure.
    Strokes are a leading cause of dysphagia, and high blood pressure leads to stroke.
  3. Get GERD under control.
    Making sure all esophageal issues are treated and controlled will help keep your swallowing ability in place.
  4. Take smaller bites.
  5. Chew your food well before attempting to swallow. 

Dr. Peters: Taking small bites and chewing food completely is also a part of mindful eating, so it’s good for you on several levels.

            7 ways to eat more mindfully

Ashley Brantley

Ashley Brantley has been writing about food, culture and health for more than a decade, and has lived in three of Tennessee’s four major cities (Memphis, Nashville and Knoxville).

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Get more information about specific health terms, topics and conditions to better manage your health on bcbst.com. BlueCross BlueShield of Tennessee members can access wellness-related discounts on fitness products, gym memberships, healthy eating and more through Blue365®. BCBST members can also find tools and resources to help improve health and well-being by logging into BlueAccess and going to the Managing Your Health tab.

Filed under: Mind & Body


Ashley Brantley has been writing about food, culture and health for more than a decade, and has lived in three of Tennessee’s four major cities (Memphis, Nashville and Knoxville).