Diseases and Medical Conditions

Amyotrophic Lateral Sclerosis (ALS) and Nutrition

November 4, 2016   /

Amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease, is a progressive neurological disease that destroys nerve cells throughout the body, including those of the spinal cord and muscles.

Impact on nutrition
ALS has an impact on nutrition:

  • Between 16% and 50% of people with ALS are malnourished, and these people fare significantly worse over time.
  • Swallowing dysfunction from involvement of the lower sets of cranial nerves occurs.
  • Hypermetabolism is common among people with ALS.

However, people with ALS can improve their nutritional status. Some suggestions follow.

Percutaneous endoscopic gastrostomy (PEG) placement
Many people with ALS benefit from PEG placement in the later stages of the disease. Enteral nutrition support can improve the respiratory status of ALS patients, but an improved effect on survival is not yet conclusively proven. Having a PEG tube does not mean that you cannot take any food or liquid by mouth. Tube feeding is used to supplement your usual diet if you are not able to consume enough.

Magnesium and lycopene
Some people find magnesium and lycopene useful.

Lycopene is naturally found in:

  • Cooked tomato products
  • Red grapefruit
  • Guava
  • Dried apricots
  • Watermelon

Magnesium is naturally found in:

  • Green vegetables
  • Legumes
  • Nuts
  • Seeds
  • Whole grains

Swallowing difficulties
If you are having trouble swallowing, have a soft diet and thickened liquids, as necessary. Examples of soft foods include:

  • Moist meat loaf
  • Poached fish fillets
  • Omelets
  • Soufflés
  • Chicken or tuna salad with extra mayonnaise
  • Canned fruits
  • Ripe bananas
  • Mashed potatoes
  • Bread stuffing with gravy
  • Macaroni and cheese
  • Baked pasta with extra sauce
  • Pudding
  • Custard

If you are having trouble swallowing, avoid the following foods:

  • Raw produce
  • Peanut butter
  • Nuts
  • Corn
  • Crackers
  • Tough meats

Thick saliva
If your saliva is really thick, try increasing your fluid intake. Consider eliminating cow’s milk and chocolate from your diet, if they seem to increase saliva production.

Provide adequate fiber in the diet. Fiber is found in:

  • Fruits
  • Vegetables
  • Whole-wheat breads
  • Whole-wheat pastas
  • Oatmeal
  • Bran
  • Grains, such as quinoa and barley

Additional meals
Eat five or six meals each day. Consume high-calorie foods.

Add the following to your food:

  • Butter
  • Sour cream
  • Peanut butter
  • Jam
  • Dry milk powder
  • Mayonnaise
  • Jelly
  • Honey
  • Vegetable oil
  • Heavy cream

Try eating or drinking:

  • Ice cream
  • Milk shakes
  • Eggnog
  • Fruit juices
  • Instant breakfast beverages
  • Protein bars
  • Nutritional supplements recommended by a dietitian

Multivitamins and mineral supplements
Many experts recommend a daily multivitamin and mineral supplement.

Use lightweight utensils or special dishes, as recommended by an occupational therapist.

Vitamins, minerals, antioxidants, and herbs
Although many vitamins, minerals, antioxidants, and herbs are recommended by various people for ALS, they are not proven as clinically relevant in studies to date.

References and recommended readings

ALS Association. Maintaining good nutrition with ALS: a guide for patients, families and friends. Available at: http://www.alsa.org/files/cms/Resources/Nutrition(1).pdf. Accessed June 20, 2010.

Commare C. Caring for patients with ALS: implications for dietitians. Today’s Dietitian [serial online]. 2007;8:84. Available at: http://www.todaysdietitian.com/newarchives/tdoct2007pg84.shtml. Accessed June 20, 2010.

Life Extension®. Amyotrophic lateral sclerosis: Lou Gehrig’s disease. Available at: http://www.lef.org/protocols/neurological/als_01.htm. Accessed June 20, 2010.        

MDA®, ALS Division. Chapter five—nutrition issues. Available at: http://www.als-mda.org/publications/alscare/ch5/. Accessed June 20, 2010.