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Easy Solids Before Difficult Solids

Michelle's story:

“Having all my kids and grandkids together for lunch on Easter is a joy to my soul. It’’s more than worth all the cooking beforehand, and all the dishes that will follow. We clink our glasses and toast each other before taking our first sips of wine/juice/water. And then we dig in, starting, of course, with a slice from the huge ham. But with my first bite, I feel the color drain from my face. I lean away from the table as the terrifying pain hits me. It’’s right in the middle of my chest, but I tell myself it happens right after I swallow a big bite, so it can’’t be a heart attack. I’’m breathing fine, so, I’’m not choking. My thoughts are racing: what is going on?”!

Michelle was still a little shaken just thinking about it, as she told me her story. Her experience with an esophagus attack is familiar. I have talked to many patients who tell me a version of this story. For most people, a holiday meal focuses around a show-stopping deluxe protein. It'’s the same every time: ham at Easter, turkey on Thanksgiving, or prime rib at Christmas.

This tendency is so clear, it occasioned my second rule as outlined in Esophagus Attack: easy solids before difficult solids. Eat easy solids to warm up your esophagus and get it better prepared for more difficult solids.


An easy solid is any solid food you know won'’t get stuck after you swallow it.

Easy solids are different for each person. Your esophagus may be wider or narrower than the next person. Corn, peas, sliced mushrooms, chopped salad, edamame, steamed green beans, and sliced cucumber are examples of foods that pass easily for most people.


A difficult solid is any solid food that has gotten stuck before, or that you worry will get stuck after you swallow it.

Here'’s a typical Sunday meal in my home. Mashed sweet potatoes, macaroni and cheese, sliced pears, and a grilled steak. A carbonated water and a glass of red wine are my liquids. I grill the steak, and I love steak, so that'’s what I want to eat first. It'’s juicy and warm. Steak is my favorite thing on the plate.

But I do not eat the warm, juicy steak first. Steak represents a difficult solid for me, as it is for many people. I sip and then gulp the water. I eat the mashed potatoes, macaroni, or a few slices of pear first. I take a sip or drink of water or wine after each solid bite.

So, I'’ll eat mashed potatoes, then macaroni and cheese, then pears. I chew and swallow at least twenty bites and evaluate. Anything stuck? After swallowing twenty easy solid bites and no issues, I cut into my steak. I take a small bite. Chew well. Swallow. Drink a big sip or small gulp of carbonated water. Reassess after swallowing liquid and make sure everything is clear. If in doubt, I take another drink of water.

I quietly celebrate success. When I follow my own three rules, I can enjoy the meal without an attack. Anyone who follows the system should be able to do the same.


Photo by Jakob Owens on Unsplash

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