ALS diet: Foods to eat and avoid
Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease that damages motor neurons, eventually leading to disability and an inability to perform everyday tasks, including difficulty with eating and drinking.
As ALS progresses, the weakened muscles involved in chewing and swallowing, as well as digestive issues, may lead to malnutrition and weight loss, which can further complicate ALS symptoms. Further fatigue and weakness can follow when someone with ALS is not able to take in all of the nutrients they need.
A variety of strategies can assist with nutritional issues in people with ALS, including knowing which foods to eat and avoid, different diets that may help lessen symptoms, additional supplements that may boost nutrition, and the use of adaptive aids for holding cutlery and cups.
While the underlying cause of ALS still is not clear, contributing factors such as genetics, environmental exposure, and lifestyle habits that include nutrition choices have been associated with an increased risk of ALS.
It’s important to note that while some studies point to an association between ALS and nutrition, there still is no solid proof that diet affects ALS, and more study is needed in this area.
A higher risk of ALS has been linked to an increased intake of glutamate, which is a naturally occurring amino acid produced by the body. It’s found in some types of food, such as certain cheeses, Asian sauces, and processed meat, along with the well-known additive monosodium glutamate or MSG. An excessive amount of glutamate, which also is a neurotransmitter in the brain, has been linked to Alzheimer’s disease, Parkinson’s disease, and ALS.
In contrast, foods containing antioxidant and anti-inflammatory compounds, such as vitamin E, polyunsaturated fatty acids, and carotenoids — foods that are yellow or orange in color, such as carrots, corn, and pumpkins — are associated with a lower risk of developing ALS.
Once someone has been diagnosed with ALS, improving dietary quality by limiting pro-inflammatory foods, controlling glucose and lipid levels, and boosting certain nutrients may help to slow the breakdown of muscles, improve energy levels, and keep the immune system strong.
Evidence also indicates that many people with ALS experience hypermetabolism — or elevated resting energy expenditure — which might contribute to more rapid ALS progression. This results in high energy depletion, even while resting, making it harder for a person to get enough nutrition to fuel their body and maintain a healthy weight.
While there is no single guideline for the best ALS diet, an emphasis is placed on weight maintenance or gain, as well as on taking in the proper amount of nutrients, especially if the person with ALS is malnourished.
Different diets — such as the ketogenic diet and the Paleolithic diet — may be useful in alleviating ALS symptoms and slowing the decline of functional abilities.
Following a high-calorie diet has been found to be safe and tolerable for people with ALS, but there is conflicting evidence as to its benefits in terms of improving weight gain and body mass index, prolonging survival, and preventing muscle wasting.
Investigations into dietary protocols are ongoing, with a focus on care and clinical research to ensure adequate nutrition, along with the psychological reasons that might lead a person with ALS to avoid eating, or to feel a loss of control over their nutrition and lose all enjoyment of eating.
Mental health issues such as anxiety and depression also may contribute to a diminished appetite and weight loss in ALS patients. As such, these concerns should be taken seriously and addressed to maintain the best overall health possible.
In general, people with ALS should eat a well-balanced diet that includes foods high in protein, fiber, healthy fats, and vitamins and minerals. Drinking plenty of fluids and staying hydrated also is important in maintaining good health.
An ALS-friendly diet should include foods considered to be antioxidants and anti-inflammatory, containing vitamin E, omega-3, and other polyunsaturated fatty acids, along with vegetables and fruits in a variety of colors, particularly yellow and orange.
People with ALS should take in enough calories each day to maintain a healthy body weight. Because eating more often is not possible, adding foods high in fats or carbohydrates can help with maintaining or gaining weight. A dietitian can help if weight loss is a concern.
People with ALS may experience fatigue while chewing or have difficulty moving food with their tongue. They may also choke on food, or experience other difficulties in swallowing, a condition known as dysphagia that occurs when the muscles of the lips, tongue, and throat start to weaken.
Some signs of dysphagia are:
- frequent coughing or choking on food while swallowing
- food or liquid spilling through the mouth or nose
- food sticking in the throat after swallowing
- pooling of saliva in the mouth that may look like drooling
- unintentional weight loss due to a lack of proper nutrition.
Strategies to reduce the risk of dysphagia may start with speech therapy, which focuses on strengthening the muscles involved in speaking and swallowing. A speech therapist can provide instructions on techniques for swallowing, and guidance as to the safest foods and liquids to consume.
It’s also advisable for a person with ALS to avoid eating alone, as the risk of choking or of food or liquid entering the airways (aspiration) make it crucial to have someone nearby who is ready to assist if needed. If possible, the caregiver should be familiar with how to perform the Heimlich maneuver.
An increase in both the volume and thickness of saliva also can complicate the process of swallowing for someone with ALS. Medications are available to help reduce excessive saliva production (also known as sialorrhea) and improve swallowing comfort. In some cases, portable suction devices can be used to remove excess saliva.
Seek guidance from a healthcare professional for a comprehensive evaluation of sialorrhea and a plan tailored for the individual with ALS.
Here are some additional tips to avoid complications from dysphagia:
- take the time to eat slowly
- eat in a quiet location without distractions
- swallow all food in the mouth before talking
- sit upright while eating, and for half an hour after the meal is finished.
To support a healthy diet, here are suggestions for foods that are nutritious and easy to swallow:
- Opt for foods that are naturally soft and require minimal chewing, such as soft-boiled eggs, apple sauce, ripe bananas, and pudding.
- Use sauces, gravy, broth, or dressing on dry foods to make them easier to swallow.
- Adjust the texture of foods by running them through a blender or food processor.
- Add liquids such as water, milk, or soup to pureed food to make a thicker liquid that is comfortable to swallow.
Certain foods should be avoided, as they have a tendency to get stuck in the throat. These can include foods that are hard, sticky, fibrous, or have skins or seeds.
Foods to steer clear of include:
- raw fruits and vegetables, such as corn, strawberries, and coconuts
- nuts, such as whole walnuts or almonds, or nut butters
- sticky foods like soft bread or rice
- tough or stringy meats
- popcorn and other crunchy snacks
- thin, runny foods and liquids.
According to the ALS Association, people with the disease should not exclude any of the five main food groups — protein, vegetables, fruit, dairy, and fats/oils — and should keep general U.S. dietary guidelines in mind.
Foods rich in polyunsaturated fatty acids and fiber are recommended, as are those high in calories if you struggle to maintain or increase your weight.
Foods with polyunsaturated fatty acids include:
- extra virgin olive oil
- soybean, corn, and canola oils
Foods high in fiber include:
- vegetables: broccoli, green peas, cauliflower, carrots (select a variety of colors, especially dark green and orange)
- fruits: raspberries, blackberries, pears, apples (choose a variety of colors)
- whole grains: barley, bulgar, oats, buckwheat
- legumes: lentils, split peas, beans, chickpeas, edamame
- nuts and seeds: almonds, chia, flaxseed, hazelnuts, hemp, peanuts, pistachios (recommended unless chewing/swallowing problems exist).
Foods high in calories include:
- nuts and nut butter
- brown rice
- potatoes, sweet potatoes
- beans and legumes
- salmon and oily fish
- whole grain bread
- whole milk, Greek yogurt.
While there is no official list of foods to avoid with ALS and research is ongoing, there is some evidence that foods high in glutamate may negatively affect ALS. In addition, beef, pork, and luncheon meats have been associated with poorer ALS function.
Some foods to potentially avoid with ALS include:
- soy sauce, fish sauce, oyster sauce
- sweets, candy
- soda or other sugary drinks
- aged cheeses, particularly parmesan and Roquefort
- mushrooms, such as shiitake and button
- processed meat
- seafood, including anchovies.
Dietary supplements, including vitamins, minerals, and natural foods, are still under investigation for their potential benefits in ALS patients and, although they are usually available over the counter, their ingredients are not well regulated. In addition, some supplements may interfere with medications or negatively affect ALS symptoms. For these reasons, ALS patients should consult their doctors before adding any supplements to their diets.
There is no robust evidence that supplements are able to reverse ALS or its progression. However, while more research is needed, some studies indicate that certain vitamins and minerals may have protective properties, including the following:
- Vitamin E may reduce free radical production and prevent oxidative damage (the increased production of free radicals that can cause damage to DNA and other cellular structures).
- Vitamin D also can serve as an antioxidant.
- Vitamin B12 is essential for the proper development and function of the brain and spinal cord.
- Coenzyme Q10 is an enzyme with antioxidant properties that may provide neuroprotection.
- Omega-3 fatty acids are polyunsaturated fatty acids required for proper brain functioning and are known to reduce neuroinflammation.
People with ALS should eat a balanced diet that ensures proper nutrition. Some research teams have looked at particular diets that could potentially benefit ALS patients, but no definite conclusions can be drawn at this point as more studies are needed in this field.
The ketogenic or keto diet is high in fat and low in carbohydrates. This diet focuses on using a different type of fuel source called ketone bodies that are produced by the liver using fats. When the body is deprived of energy, ketone bodies are used as energy stores. This puts your body into a metabolic state called ketosis, where it is burning fat for energy rather than glucose (blood sugar).
This makes ketones an important energy source for the brain. The brain normally depends on glucose, so switching it to ketones changes the brain’s metabolism, something that may help ease the energy crisis in neurodegenerative diseases such as ALS.
Because people living with ALS may experience energy deprivation due to malnutrition, a keto diet may be helpful. Further studies are warranted to evaluate the potential benefit of the keto diet for ALS.
A Paleolithic or paleo diet consists of vegetables, fruits, nuts, roots, and meat, similar to what a person living in the Stone Age might have eaten. It avoids more modern foods like dairy, grains, legumes, processed oils, sugar, salt, alcohol, and coffee.
However, the diet omits important sources of protein, fiber, calcium, and other vitamins and nutrients that are beneficial for people with ALS.
While the paleo diet may be helpful in maintaining weight, people with ALS should consult a nutritionist or dietitian prior to starting this or any diet.
Intermittent fasting involves limiting food intake for a certain period of time, cycling between periods of fasting and eating. There are several approaches for intermittent fasting, some of which include limiting eating times to certain hours of the day, or fasting on alternate days.
In the general population, potential benefits of intermittent fasting may include weight management, more energy and less fatigue, and sharper thinking and memory. Studies also have shown that it could help with heart health and diabetes.
For people with ALS, however, caution is strongly advised when it comes to intermittent fasting, as dietary restriction may be detrimental, and there has been very little study in humans to suggest significant benefits. Preclinical data points to the possibility that intermittent fasting may accelerate neuronal death in ALS.
As ALS News Today columnist Kristin Neva writes, navigating meal preferences for her husband Todd, who is paralyzed with ALS, can be challenging.
“While he’s still able to eat, food contributes significantly to his quality of life,” Neva says, adding, “If Todd were healthy, he could cook food for himself. He used to be an excellent cook. But now his desire for variety falls on me.”
If loss of appetite is a problem, a number of strategies may be of help:
- Eat smaller meals more frequently, and eat food before drinking, so the stomach doesn’t fill up on liquids.
- Drink a nutrition supplement.
- Use thickeners to make liquids easier to swallow.
- Cut food into small pieces to help weakened chewing and swallowing muscles.
- Consult a dietitian to expand menu and cooking planning, with a focus on appetizing foods that are rich in nutrients.
- Use assistive technology, such as adaptive utensils, cups, plates, and bowls, to make eating easier.
Tube feeding involves implanting a device that can be used to deliver essential nutrients and liquids directly into a person’s stomach. Along with delivering nutrition, the tube can be used for certain oral medications.
Enteral tube feeding is offered to people with ALS who have dysphagia (trouble swallowing) to prevent weight loss and aspiration. Percutaneous endoscopic gastrostomy (PEG) is the most common form of tube feeding; in it, a PEG tube is inserted into your stomach through an opening made on the abdomen.
What is being fed through the tube varies according to the needs of the person, including food run through a blender to high-calorie nutrition aimed at improving nutritional status and potentially prolonging life.
ALS News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.
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