PO Retraining: One-Stop Reconditioning Plan
Stepwise GI + oropharyngeal + nervous-system reconditioning
Purpose

Regain oral intake after underuse

This plan is designed for people who believe their difficulty eating is physiologic (dysmotility, neurologic coordination, reflux, post-illness deconditioning, prolonged tube feeding, etc.). It keeps the framing physiologic while still addressing the very real “threat system” and sensory amplification that can block eating.

Core idea: underuse leads to deconditioning across multiple layers (mouth/sensory → swallow coordination → stomach accommodation → gut-brain signaling). Progress is built by graded exposure to safe inputs, with repetition, pacing, and objective progression criteria.
Saved level: None
Target: Level 6

How to use this page

  • Pick your current Level (0–6) and follow that level’s daily structure.
  • Use the progression criteria to decide when to move up (not willpower).
  • Add the Mouth/Texture Training track from day 1 (even before “real meals”).
  • Use the Common Sensations section to normalize sensations without dismissing them.

What success looks like

  • Eating becomes less “foregrounded” and less symptom-scanned.
  • Sensations still occur but feel less alarming and less intense.
  • Volume and variety increase because the system adapts.
  • Setbacks happen; you return to structure and keep trend-lines moving.
Conceptual Framework

What’s happening

1) Deconditioning is real

  • Mouth/oral phase: texture tolerance and swallow timing degrade with underuse.
  • Esophagus: normal peristalsis can feel “weird” when you’re scanning for it.
  • Stomach accommodation: capacity and comfort with volume can shrink with low intake.
  • Gut signaling: nausea, fullness, reflux, and globus can amplify after long avoidance.
The nervous system learns “food = threat” via repeated bad experiences (pain, choking fear, reflux), then increases monitoring and sensitivity. That’s not a moral failure and not “imaginary.”

2) A “threat-state” blocks eating

  • Threat-state increases muscle tension (throat, jaw), slows coordination, and raises symptom salience.
  • It can trigger protective reflexes: gagging, early fullness, nausea, and air swallowing.
  • It drives avoidance, which reinforces the threat prediction.
We do not need to label this as “psych.” We treat it like any other physiologic conditioning loop: inputs → predictions → body response → learning.
Just Remember
  • We’re rebuilding tolerance and coordination after underuse.
  • Your system has learned to overreact to normal sensations. We can retrain that.
  • We’re changing the prediction your body makes when food arrives.
  • This is the same principle as physical therapy: graded, repeatable exposure with criteria.
Ethics + transparency
  • This site emphasizes physiology, conditioning, and nervous-system retraining; it does not claim symptoms are fake.
  • It includes attention, expectation, and fear-conditioning tools because those mechanisms are part of human physiology.
  • Red flags and medical evaluation guidance are included to avoid unsafe reassurance.
Stepwise PO progression

Levels 0–6: What you are doing at each stage

Each level is defined by type of input, volume goal, and repetition. You progress when your body shows adaptation, not when you “feel ready.”

Rule: Pick a level you can complete consistently. If you repeatedly fail the level, drop one level and rebuild momentum.
Level Focus Inputs Progression criteria
Level 0
Stabilize
 Reduce threat-state; practice mouth exposure without “meals.” Water/ice chips, warm tea, tiny sips, “hold in mouth” drills. Complete 3–6 exposure sessions/day for 2 days with manageable symptoms.
Level 1
Thin liquids
 Consistent swallow timing + low-volume tolerance. Broth, oral rehydration, thin shakes, juice diluted. Hit planned volume for 2–3 days without escalating panic/avoidance.
Level 2
Thick liquids
 Texture tolerance; slower flow; reduce aspiration fear. Smoothies, yogurt drinks, pudding-thick supplements. Finish 3 planned intakes/day; symptoms trend down or stable.
Level 3
Purees
 Chew-free “food” with defined bites. Applesauce, mashed potatoes, soups with puree texture. Two “mini-meals”/day + snacks; mouth drills continue.
Level 4
Soft solids
 Chewing + swallow sequencing; stomach volume rebuilding. Eggs, oatmeal, soft pasta, flaky fish, tender meats in small bites. One full meal/day (small) + 2 mini-meals; minimal avoidance behavior.
Level 5
Mixed textures
 Real-world eating; mixed consistencies. Sandwiches, rice bowls, salads (as tolerated), normal portions. 2+ meals/day; variety expanding; setbacks recover within 24–48h.
Level 6
Maintenance
 Normalize; reduce tracking; “life eating.” Normal diet with flexible choices. Stable intake 2–4 weeks; tracking optional; confidence restored.
Picking your level (fast method)
  • Choose the highest level you can complete for 48 hours without repeated “bail-outs.”
  • If symptoms spike and you stop sessions early: drop one level for 24–48h, then retry.
  • If you complete sessions but feel uncomfortable: stay put; adaptation often shows on day 2–4.
Daily dosing: how many sessions?
  • Minimum: 3 sessions/day (morning, mid-day, evening).
  • Better: 4–6 short sessions/day (reduces fear load per session).
  • Each session: warm-up 2–5 min → exposure 5–15 min → neutral finish.

Your level-specific plan

Select a level above to highlight the matching plan below.

Level 0 plan

Stabilize + mouth exposure

  • 3–6 sessions/day: ice chip or water + “hold in mouth” (10–20 seconds) before swallow.
  • Goal: complete the session even if sensations appear; stop at the planned endpoint.
  • Add texture desensitization (see Mouth/Texture section) from day 1.
You are training two things: (1) “food input is safe,” (2) coordination can be calm and automatic again.
Level 1 plan

Thin liquids (structured sips)

  • 3–5 sessions/day: 1–3 oz per session (start low), sips every 30–60 seconds.
  • Optional: warm liquids can reduce spasm-like sensations for some people.
  • Keep mouth drills: hold 5–10 seconds before swallowing on 3–5 sips per session.
Level 2 plan

Thick liquids (slow flow)

  • 3–4 sessions/day: 2–4 oz per session of smoothie/yogurt/pudding-thick supplement.
  • Use smaller spoonfuls; “pause, hold, swallow” sequencing.
  • Add gentle chewing motions (even without solids) to re-engage patterns.
Level 3 plan

Purees (defined bites)

  • 2 mini-meals/day + 1–2 snack sessions; start with 6–10 bites per mini-meal.
  • Each bite: place → hold 3–5 sec → swallow → breath.
  • Stay upright 30–60 min if reflux-prone; avoid “checking” after each bite.
Level 4 plan

Soft solids (chew + swallow)

  • 1 small meal/day + 2 mini-meals; bite size = “pea-to-dime.”
  • Chew count is optional; priority is slow, calm sequencing.
  • Increase volume by tiny increments every 1–2 days.
Level 5 plan

Mixed textures (real-world)

  • 2 meals/day + snack; introduce 1 “challenge food” 3x/week in small doses.
  • Use neutral finish; avoid immediate post-meal symptom rumination loops.
  • Keep a “fallback” safe food to prevent spirals.
Level 6 plan

Maintenance (reduce tracking)

  • Eat with flexibility; keep 1–2 structured habits if helpful.
  • Stop measuring symptoms so often; measure function instead.
  • If setback: drop 1 level for 24–48h, then return.
The goal is “automatic eating again,” not perfect absence of sensation.
Mouth / texture / sensory training

Rebuild oral tolerance and make swallowing automatic again

Even when the main complaint feels “in the chest” or “in the stomach,” the mouth/throat can become a sensory trigger. These drills build familiarity with textures and reduce the “alarm” response to normal sensations.

Track A: “Hold, explore, then swallow”

  • Start with water, then move to thicker liquids and purees as tolerated.
  • Place a small amount in mouth, hold 10–20 sec, notice texture/temperature, then swallow.
  • Goal is not comfort; goal is familiarity and a calm finish.
This is controlled exposure: your system learns the sensation is safe and stops overreacting.

Track B: Texture ladder (graded)

Pick 1–2 items and repeat daily for a few days before moving on.

  • Easy warm water, ice chip, thin broth
  • Easy smoothie / yogurt drink
  • Medium applesauce, pudding, mashed potato
  • Medium oatmeal, soft scrambled egg
  • Advanced soft pasta, flaky fish, tender chicken in tiny bites
  • Advanced mixed textures (soup with pieces, sandwich)
Drill set (5–8 minutes total)
  • Jaw release: gentle open/close x 8; tongue rests on roof of mouth.
  • Saliva swallows: 5 slow swallows; exhale after each.
  • “Hold then swallow”: 5 reps with tiny sips/spoonfuls.
  • One “weird” rep: deliberately notice the sensation, label it “normal,” then swallow anyway.
Make it physiologic (not “therapy”)
  • Call it “oropharyngeal reconditioning” or “sensory recalibration.”
  • Explain: repeated exposure reduces sensory gain via habituation and prediction updating.
  • Explain: threat-state increases muscle tension and symptom intensity; downshifting is a motor optimization tool.
Common sensations (normalize without dismissing)

What you might feel, what it often means, and what to do

Globus (lump/throat fullness)
  • Often linked to reflux, throat muscle tension, dryness, post-nasal drip, or heightened sensation.
  • Can be triggered by scanning, repeated swallowing attempts, and “checking” sensations.
What to do
  • Do one planned swallow sequence, then stop “testing” it.
  • Warm water sip; gentle jaw release; long exhale.
  • Continue the plan at smaller dose rather than stopping entirely.
Feeling peristalsis / “spasm-like” chest sensations
  • Esophageal movement can become noticeable when attention is high and intake is irregular.
  • Cold liquids, large gulps, and rapid intake can worsen sensations in some people.
  • Plan: smaller sips, warm liquids, slower pacing, upright posture; consider Level 1–2 structure.
Early fullness / pressure / nausea when increasing volume
  • Common during stomach accommodation retraining after low intake.
  • Plan: increase volume in tiny increments; distribute across more sessions; finish neutral.
  • Do not “prove” capacity in one sitting; that teaches threat-state and reinforces avoidance.
Reflux or burning
  • Upright posture, smaller dose, and avoiding immediate lying down can help.
  • Use a consistent schedule instead of large episodic intakes.
  • If symptoms are severe, progressive, or associated with red flags, escalate evaluation (see Safety).
Gagging / coughing / fear of choking
  • Fear tightens coordination; start with controlled textures and planned bites.
  • Use “hold then swallow” with tiny amounts; focus on exhale after swallow.
  • If true aspiration concerns exist, involve speech/swallow evaluation.
Tracker (local only)

Save your current level + log sessions

This tracker stores data in your browser (localStorage). Nothing is uploaded.

Current level

Quick session log

Export/Import uses a JSON file you save locally.

Recent logs

No logs yet.
Safety

When to stop self-guided retraining and seek medical evaluation

Urgent evaluation if any of the following:
  • Chest pain/pressure concerning for cardiac cause, severe shortness of breath, syncope.
  • Inability to handle secretions, repeated choking/aspiration events, cyanosis.
  • GI bleeding (hematemesis, melena), severe dehydration, or rapidly worsening weakness.
Prompt evaluation if:
  • Progressive dysphagia, odynophagia, persistent vomiting, or unintentional weight loss.
  • New focal neurologic deficits, new voice changes, or aspiration pneumonia concerns.
  • Symptoms are worsening despite consistent low-level structure for 7–14 days.
Clinical note

This site is educational and is not medical advice. If you have a feeding tube or complex comorbidities, coordinate changes with your clinical team. Progression should be individualized to safety and nutrition needs.

FAQ

Common sticking points

I’m not eating normal food, and I still have sensations--how can this be about stomach retraining?
  • Even small, non-meal intake still produces sensations (reflux, peristalsis, fullness) that your system can learn to fear.
  • Stomach accommodation and gut signaling adapt to regular, graded inputs—starting wherever you are.
  • The plan builds predictable exposures so sensations become less alarming and less dominant.
What if I relapse for a day?
  • Drop one level for 24–48h to regain control and complete sessions.
  • Then return to the prior level when stable.
  • This isn't relapsing, this isn't a moral failue. It's a normal, expected part of training.
How long does this take?
  • Many people see measurable change within days, but stable reconditioning often takes weeks.
  • Trends matter more than any single day.
References / concepts

Concepts used here include graded exposure, habituation, interoception and sensory gain, motor reconditioning, swallow sequencing, and gastric accommodation. This page intentionally uses physiologic language to preserve buy-in while still addressing mechanisms that influence symptoms.

Printed from robbie-med.github.io (PO retraining plan).